Mental health promotion in young children : parents as a key to the identification and reduction of risk for development of disruptive behavior problems.

The papers of this thesis are not available in Munin: 1. Reedtz, C., Bertelsen, B., Lurie, J. I. M., Handegård, B. H., Clifford, G., & Mørch, W. T.: 'Eyberg Child Behavior Inventory (ECBI): Norwegian norms to identify conduct problems in children', Scandinavian Journal of Psychology (2008), vol. 49:31-38. Available at http://dx.doi.org/10.1111/j.1467-9450.2007.00621.x 2. Reedtz, C., Handegård, B. H., & Mørch, W-T.: 'Promoting positive parenting practices in primary care: Outcomes in a randomized controlled risk reduction trial', Scandinavian Journal of Psychology (2010), vol. 52(2):131–137. Available at http://dx.doi.org/10.1111/j.1467-9450.2010.00854.x 3. Reedtz, C., Martinussen, M., Jørgensen, F. W., Handegård, B. H., & Mørch, W. T.: 'Parents Seeking Help in Child Rearing: Who are they and how do their children behave?', Journal of Children's Services (2011), vol. 6(4):264 - 274. Available at http://dx.doi.org/10.1108/17466661111190956The main aim of this dissertation was threefold. First, to establish norms for a psychometric inventory used to assess behavior problems. The project presents the first Norwegian standardization of an assessment tool specifically designed to measure childhood conduct problems. Norwegian norms for the Eyberg Child Behavior Inventory (ECBI; Robinson, Eyberg, & Ross, 1980) based on data obtained from a random population sample (N = 4063) of children in the age range of four to twelve years are presented. The sample was drawn from rural and urban areas within three Norwegian town districts. Clinical and research advantages of having a properly standardized assessment tool for this specific subclass of childhood psychiatric problems in Norway are discussed. The second aim of this dissertation was to evaluate the effects of a short PT intervention to test whether a lower “dosage” of PT can be used to reduce risk factors related to development of childhood behavior problems. Data were obtained from parents in a RCT on PT for children aged 2 to 8 years (N = 186) at pre, post and one year follow up. The results showed significant differences in changes in the two groups, regarding reductions in harsh parenting and child behavior problems, strengthening positive parenting and parent’s sense of competence. The effects regarding parenting and parents’ perception of their satisfaction and efficacy all lasted through one-year follow up. These findings suggests that a shortened version of a well-structured parenting intervention, the Incredible Years program, implemented in primary care at community level, seems to be a sound way to reduce harsh parenting, and to strengthen positive parenting and parents’ sense of competence, in an effort to reduce important risk factors related to the development of early childhood behavior problems. The third aim of this dissertation was to explore characteristics of parents who signed up for parenting classes as well as their own reasons for participation. A substantial amount of research has revealed clear socio-economic differences in parental help-seeking behavior in a way where parents with higher socio-economic status more often seek help. However, researchers have also suggested that giving parent training to all parents in a nonstigmatizing fashion would enhance the effectiveness of such programs. Data were obtained from parents in a study on parent training for children aged 2 to 8 years (N = 189), and a follow up survey on these parents (N = 118). Results showed that parents in our study had high education, were married, and employed in full time jobs. The mean age of the children was under 4 years, and their Intensity and Problem scores on ECBI were higher than the Norwegian mean scores for their age group. Aspects of parent stress, parental concern, and parenting practices predicted the ECBI Intensity scores to a rather large extent. It seems to be the case, that parents with high SES risk factors may not come forward to participate in face-to-face self-recruitment mental health promotion interventions, even if the parenting intervention is offered at a time suitable for parents, is free of charge, and is offered in a nonstigmatizing way

Improved parenting maintained four years following a brief parent training intervention in a non-clinical sample

Published version. Source at http://dx.doi.org/10.1186/s40359-016-0150-3 Background: The aim of the present study is to evaluate whether the effects of a short, six session version of an evidence-based parent training programme (The Incredible Years), delivered in a non-clinical community sample in the northern Norway, are maintained 4 years following the initial intervention. Method: Data were collected primarily from mothers in a randomized controlled trial (N = 117). Children’s mean age at 4 year follow-up was 7.5 years. Results: A mixed model analyses of linear change with a time by condition interaction revealed that statistically significant differences were maintained between the parent training and control groups for several outcomes. The parent training group showed a reduction in harsh disciple and an increase of both self-reported positive parenting and parental efficacy when compared to the control group who received services as usual. No significant differences between the two groups were found for child behaviour problems as measured by the ECBI Intensity scale. In addition, mixed model analyses of quadratic change were conducted to test the differences in the trajectory of change over four time points. There were significant differences in the trajectory of change for (1) the ECBI with the parent training group showing an immediate drop in the intensity of problem behaviour and (2) the positive parenting scale showing an immediate steep increase; no other significant differences in trajectory were detected. Conclusions: Families from a non-clinical sample who participated in a brief version of the Incredible Years Basic parent training programme maintained changes in positive parenting, harsh discipline, and parental efficacy 4 years after completion of the intervention

Knowledge transfer in the field of parental mental illness: objectives, effective strategies, indicators of success, and sustainability

Background: Mental health problems are often transmitted from one generation to the next. However, transferring knowledge about interventions that reduce intergenerational transmission of disease to the field of parental mental illness has been very difficult. One of the most critical issues in mental health services research is the gap between what is generally known about effective treatment and what is provided to consumers in routine care. Discussion: In this article we discuss several aspects of knowledge transfer in the field of parental mental illness. Effective strategies and implementation prerequisites are explored, and we also discuss indicators of success and sustainability. Summary: Altogether, this article presents a rationale for the importance of preventive strategies for children of mentally ill parents. Furthermore, the discussion shows how complex it is to change clinical practice

Parenting sense of competence and associated factors among parents facing adversity in Norway: a cross-sectional study

Objective: Parenting sense of competence plays a central role in understanding the dynamics within a family and is central to positive parenting. Nevertheless, few studies have investigated parenting sense of competence among parents facing adversity. The study aimed to investigate self-reported parenting sense of competence (PSOC) and associated factors at individual, family, social and service levels among parents using a low threshold family service in Norway. Method: The study was based on a cross-sectional survey conducted in 2020. The sample consisted of 275 parents (83.3 % females, mean age 38 years). Linear regression analysis, adjusting for potential confounding factors, was conducted. Results: There were no statistically significant differences in the mean values for mothers and fathers on the Efficacy and Satisfaction subscales of the Parenting Sense of Competence Scale. Self-reported economic situation, symptoms of anxiety/depression, general health status, family functioning, social cohesion and support, and relationships with staff at the low-threshold service were all significantly associated with PSOC. However, no significant associations were found between PSOC and education level, cohabitation status, number of children, child age, substance abuse, or time spent at the low-threshold service. Conclusion: These findings highlight the complexity of factors influencing parental competence in populations facing adversities, underscoring the need for comprehensive approaches in parenting support programs. Tailored interventions targeting these determinants could significantly enhance the well-being of families facing adversities.publishedVersio

Child-focused practice in social services for adults in Norway

Summary - Children of social service users are at risk for developing mental health problems as well as social and behavioral problems. Social service counselors should therefore be aware of service users’ children and provide support for them. In fact, they are obligated by law to consider children's views and their best interests in cases affecting them. Despite this, little is known about social service counselors’ child focus in their practice. In this study, self-reported survey data from 93 counselors working for the Norwegian Labor and Welfare Administration (NAV) were analyzed to explore their child focus. Findings - Findings suggest that a particular focus on children is no part of common practice among NAV counselors; nor is use or knowledge of The United Nations Convention on the Rights of the Child (CRC). Knowledge and use of the CRC may be a predictor of child-focused practice. The results showed a significant difference of medium effect size between NAV counselors who ask about children and NAV counselors who do not when it comes to knowledge and use of the CRC. Applications - Policy makers and practitioners should utilize NAV's potential as a preventive arena. For NAV counselors to be aware of and support children of social service users they need a stronger focus on children and hence know and use the laws concerning children's rights. Incorporating children's rights into social workers’ education and internal training may strengthen the focus on children in NAV counselors’ practice

Evaluating workforce developments to support children of mentally ill parents: implementing new interventions in the adult mental healthcare in Northern Norway

Contains fulltext : 102515.pdf (publisher's version ) (Open Access)Background According to new Norwegian laws, mental healthcare for adults are obligated to assess all patients who are parents and to act on their children's needs. This article describes the study protocol of implementing the interventions Family Assessment and Child Talks for children of patients in the adult psychiatry of the University Hospital of Northern Norway. The project is designed to evaluate the process of changes in clinical practice due to the implementation of two interventions. The interventions to be implemented are a standardised Family Assessment Form and the intervention called Child Talks. The family assessment form is an intervention to identify children of mentally ill parents and their needs. The intervention Child Talks is a health-promoting and preventive intervention where the mental health workers talk with the family about the situation of the children and their needs. Methods/design There are two groups of participants in this study: (1) mental health workers in the clinic (N=220) and (2) patients who are parents (N=200) receiving treatment in the clinic. (1) In the evaluation of clinical practice, the authors use a pre-test, post-test and 1-year follow-up design. At pre-test, the authors evaluate status quo among mental health workers in the clinic regarding knowledge, attitudes, collaborative routines and clinical practice related to families with parental mental illness. After the pre-test is finished, the project move on to implement the interventions Family Assessment Form and Child Talks in the clinic. At post-test and 1-year follow-up, the authors evaluate the impact of implementing the Family Assessment Form in terms of how many children were identified and offered Child Talks in the clinic or referred to other services for additional support. (2) In the evaluation of parents/patients experience with the interventions, the authors use a pre-test post-test design. To identify children of mentally ill patients, the authors collect data on demographical variables for the patient and the child at pre-measures, as well as data on parental competence (PSOC) and parental concerns (PEDS) about their children. At post-measures, the authors evaluate the impact of the intervention in terms of user satisfaction, as well as changes between pre- and post-measures on parental competence (PSOC) and parental concerns (PEDS) about their children. Discussion The implication of implementing new interventions to safeguard children of mentally ill patients and the limitation of not measuring child development directly are discussed.6 p

Måleegenskaper ved den norske versjonen av Youth Self Report (YSR)

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Identification of Children of Mentally Ill Patients and Provision of Support According to the Norwegian Health Legislation: A 11-Year Review

Background: According to amended legislation implemented in Norway in 2010, personnel in healthcare services for adults are obligated to identify patients’ minor children and to assess the family situation. Health personnel is also obligated to contribute to adequate support to families affected by parental mental illness or substance use disorders. The intention behind the amendment was to support and protect children of mentally ill parents, as they are at risk of developing problems of their own. The aim of the present study was to evaluate health personnel’s practice during the years 2010-2020, more specifically; (a) to what extent children of patients with mental illness and substance use disorders are registered in patient records, and (b) to what extent activities relating to the assessment and support of patients’ minor children are documented in patient records. Method: The participants in the study are patients admitted to Division for Mental Health and Substance Use at the University Hospital of North Norway in the years 2010–2020. The data was drawn from patient records during October 2021. Results: The registration of patients’ minor children is considerably strengthened since the introduction of the new Norwegian Health Personnel Act in 2010, and estimates show that 56% of patients’ minor children are identified. However, only 31% of cases where patients have identified minor children this result in health personnel performing activities to support the children. Discussion: Based on the rising proportion of identified minor children throughout the 10-year period, it seems evident that the dissemination efforts have contributed to the development of some new skills among health personnel. However, compared with the national estimation that 35% of mentally ill and substance abusing patients have minor children, a large proportion of children remains unidentified. After identification, there seem to still be a long way to go before minor children are systematically offered support. Different solutions to strengthen the implementation of new skills in clinical practice, to ensure the identification of minor children and provision of necessary support for them is discussed

Parents with a mental illness and their sense of parenting competence

Objective - Research provides evidence that parental mental illness affects child development through parenting behaviour. This study investigates how parents with a mental illness report on their parenting sense of competence. Method - A sample of 141 parents receiving treatment at a clinic for mental health and substance use disorders participated. The Parenting Sense of Competence scale (PSOC) was used to assess participants’ parenting sense of competence. Information about diagnoses, child age and participation in a preventive family intervention called Child Talks was also collected. PSOC scores from our sample was compared to normative samples. Results - Parents with a mental illness reported having equal or higher PSOC scores compared to the normative samples. Neither children’s age, comorbidity nor parents’ diagnosis affected PSOC scores. PSOC satisfaction score was a significant predictor for participation in Child Talks, where lower scores were related to a small increase in participation rate. Discussion - The results indicate that parents with a mental illness do not view or report feeling less competent in the parenting role than the general population. We discuss the validity of the results and if there are factors that may influence parents’ reports such as stigma, fear of losing custody and impaired self-awareness

Implementing new routines in adult mental health care to identify and support children of mentally ill parents

BACKGROUND: Mental health problems are often transmitted from one generation to the next. This knowledge has led to changes in Norwegian legislation, making it mandatory to assess whether or not patients have children, and to provide necessary support for the children of mentally ill patients. The main purpose of this study was to evaluate the process of implementing new routines in adult mental health services to identify and support children of mentally ill parents. METHODS: The design was a pre-test post-test study. The sample (N = 219 at pre-test and N = 185 at post-test) included mental health professionals in the largest hospital in the region, who responded to a web-based survey on the routines of the services, attitudes within the workforce capacity, worker’s knowledge on the impact of parental mental illness on children, knowledge on legislation concerning children of patients, and demographic variables. RESULTS: The results of this study indicated that some changes are taking place in clinical practice in terms of increased identification of children. Adult mental health services providing support for the children was however not fully implemented as a new practice. CONCLUSION: The main finding in this study is that the identification frequency had increased significantly according to self-reported data since the Family Assessment Form was implemented. The increase in self-reported identification behavior is however taking place very slowly. Three years after the legislation was changed to making it mandatory to assess whether or not patients have children, it was still not fully incorporated in the routines of the entire workforce. In terms of support for the families affected by parental mental illness, the changes are not yet significant