Adult mental health clinicians' perspectives of parents with a mental illness and their children: single and dual focus approaches.

BACKGROUND: When clinicians in the adult mental health sector work with clients who are parents with dependent children, it is critical they are able to acknowledge and respond to the needs of the parents and their children. However, little is known about clinicians' personal perspectives and reactions towards these parents and children or if/how they balance the needs of both. METHODS: Semi structured interviews were conducted with eleven clinicians from adult mental health services in Australia. Interviews focused on clinicians' experiences when working with parents who have mental illness. Transcripts were analysed within an Interpretative Phenomenological Analysis framework to examine participants' perspectives and personal reactions to parents and children. RESULTS: There was considerable divergence in participants' reactions towards parents and children and the focus of their perspectives when working with parental mental illness. Feelings of sympathy and responsibility made it difficult for some participants to maintain a dual focus on parents and children and contributed to some adopting practices that focused on the needs of parents (n = 3) or children (n = 1) exclusively. Other participants (n = 7) described strategies and supports that allowed them to manage these feelings and sustain a dual focus that incorporated the experiences and needs of both parents and children. CONCLUSIONS: It is difficult for some mental health clinicians to maintain a dual focus that incorporates the needs and experiences of parents and their children. However, findings suggest that the challenges of a dual focus may be mitigated through adequate workplace support and a strengths-based practice framework that emphasises parental empowerment.

Web-Based Health Intervention for Young People Who Have a Parent with a Mental Illness: Delphi Study Among Potential Future Users.

BACKGROUND: Young people who have a parent with a mental illness face elevated risks to their mental health and well-being. However, they may not have access to appropriate interventions. Web-based interventions may reach and meet the needs of this at-risk group, yet their preferences regarding the features of this medium are unknown. OBJECTIVE: This study sought to determine the utility of a Web-based intervention to meet the needs of young people who have a parent with a mental illness and their perspectives regarding the types of features of such a website. METHODS: A systematic, 2-round Delphi study was employed to solicit the views of 282 young people aged 16 to 21 years (Round 1, n=14; Round 2, n=268) from urban and regional settings in Australia who self-reported that their parent has a mental illness. "Regional" was used to refer to nonurban participants in the study. After ascertaining whether a Web-based intervention was warranted, Web-based intervention features were identified, including how the site might be facilitated, topics, duration and frequency, and the nature of the professional contact. The extent to which young people agreed on the importance of these factors was assessed. Differences and similarities across gender and location were investigated. A mixed method analytic framework was employed using thematic analysis as well as 2-way between-groups analysis of covariance (ANCOVA) controlling for age and chi-square test of independence analysis. RESULTS: Both rounds highlighted a strong preference for a Web-based intervention. Consensus was reached for a professionally monitored site, young people and professionals having equal input into the weekly facilitated sessions (eg, sharing the lead role in discussions or deciding on relevant session content), unlimited time access, 1-hour, open discussion, weekly sessions over 6 weeks, psychoeducation about mental illness, and considerations for the management of safety violations. There were significant main effects of location type and several of the preferred features for a Web-based intervention for young people who have a parent with a mental illness. However, effect sizes were small to moderate, limiting practical application. CONCLUSIONS: Young people aged 16 to 21 years indicated a need for a professionally monitored, psychoeducational, Web-based intervention, with input from professional facilitators and other young people who have a parent with a mental illness, in addition to recommendations to external resources. These findings may inform the development of future Web-based interventions for this highly vulnerable group.

The Parental Cancer Questionnaire: scale structure, reliability, and validity.

PURPOSE: This study aims to determine the principal component structure of the Parental Cancer Questionnaire (PCQ) in a sample of adult children whose parents had cancer and to illustrate the validity and reliability of subscales. METHOD: The PCQ was administered to 311 adult children of parents with cancer along with the Posttraumatic Growth Inventory, Carer's Assessment of Difficulties Scale, Carer's Assessment of Satisfactions Scale, Reaction to Diagnosis of Cancer Questionnaire, and the Grief Diagnostic Instrument. RESULTS: Exploratory Principal Components Analysis identified three dimensions of the parental cancer experience (explaining 51 % of the variance amongst scale items). The components were parental cancer benefits (e.g. 'I became closer to my sick parent during his/her cancer.'), emotional experiences (e.g. 'I was devastated by my parent's cancer.'), and caregiver strain (e.g. 'I feel/felt there was nobody to assist or support me in caring for my parent.'). Convergent and discriminant validity were demonstrated by meaningful correlations with other related measures (ranging from 0.14 to 0.68), and strong internal reliability was shown with Cronbach α between 0.87 and 0.91. CONCLUSIONS: The PCQ has a clear three-component structure and demonstrates good reliability. The measure has excellent face, content, convergent, and discriminant validity, indicating a structure suitable for use in future research. The measure appears to be a useful measure of the experience of parental cancer for adult children.

Predictors of benefit finding in the adult children of patients with cancer.

This study aimed to investigate the predictors of benefit finding in 311 adult children of patients with cancer. Participants completed a comprehensive online/pen-and-paper survey measuring benefit finding, gender of parent, outcome and duration of illness, caregiving experience, and emotional experiences including reaction to diagnosis and grief and loss. Greater benefit finding was positively associated with stronger emotional experiences, satisfaction with the caregiving role, and outcome of parental cancer, explaining 15.3% of the variance in benefit finding. Higher emotional reactions and outcome of parental cancer as significant predictors of parental cancer provide some support for the applicability of theories of post-traumatic growth to this cohort.

Goal setting within family care planning: families with complex needs.

OBJECTIVE: To identify the key goals that are established by children and parents from families in which parents have substance use and/or mental health problems, and the level of progress achieved towards goals over 1 year of case management. DESIGN, SETTING AND PARTICIPANTS: Participants from three rural sites of a New South Wales non-government agency completed family care plans between 2008 and 2010. They included 44 parents and 41 children from 37 families where at least one parent had a dual diagnosis or mental illness. Family care plans were analysed to identify the frequency and progress of child and parent goals across 11 domains. MAIN OUTCOME MEASURES: Goals identified by parents and children, and change scores over a 12-month period. RESULTS: Children most frequently set goals to enhance their knowledge of mental illness, schooling, family connectedness and interpersonal skills. Parents most frequently set goals to improve their knowledge of mental health. Children recorded greatest goal achievement: in enhancing their mental health knowledge, community/social connectedness and accommodation needs. Parents recorded most goal progress in understanding developmental milestones of their children. CONCLUSIONS: Goal setting appears to be an important mechanism for assisting families with complex needs. Clinicians need to address the mental health literacy of families where a parent has a substance use problem and/or mental illness.

A "snapshot" of Australian programs to support children and adolescents whose parents have a mental illness.

OBJECTIVE: The aim of this study was to provide a "snapshot" of Australian programs targeting children and adolescents whose parents have a mental illness (COPMI). Specifically we aimed to (i) identify the aims and strategies of COPMI programs, (ii) ascertain the theoretical basis of these programs, (iii) determine the level and quality of evaluation protocols implemented, and (iv) draw on the practice wisdom of program facilitators for future program development. METHODS: Eighteen program facilitators responsible for 26 programs were identified through COPMI websites, e-discussion lists and snowball recruiting and invited to participate in a one hour interview based on the above four aims. Transcripts were qualitatively analyzed. RESULTS: Many COPMI programs target children aged between 8-13 who exhibit no psychological problems and live in urban areas. Overall, program facilitators aim to create opportunities for peer interaction, enhance coping, self-esteem, understanding of mental illness and offer respite from caring. Interventions are primarily supportive and preventative. While most programs are evaluated, measures on the whole are not standardized and/or gauge children's satisfaction of the program. CONCLUSION: Program facilitators require greater support, resources and training when evaluating COPMI programs. Program goals provide an indication of the evaluation measures required.

An Online Intervention to Promote Mental Health and Wellbeing for Young Adults Whose Parents Have Mental Illness and/or Substance Use Problems: Theoretical Basis and Intervention Description.

The transition to adulthood can be a vulnerable period for certain population groups. In particular, young adults aged 18-25 years who have a parent with mental illness and/or substance use problems face increased risks to their mental health compared to same aged peers. Yet these young adults may not have access to age-appropriate, targeted interventions, nor engage with traditional face-to-face health services. To support this vulnerable group, services need to engage with them in environments where they are likely to seek help, such as the Internet. This paper describes the risk mechanisms for this group of young adults, and the theoretical and empirical basis, aims, features and content of a tailored online group intervention; mi.spot (mental illness: supportive, preventative, online, targeted). The participatory approach employed to design the intervention is described. This involved working collaboratively with stakeholders (i.e., young adults, clinicians, researchers and website developers). Implementation considerations and future research priorities for an online approach targeting this group of young adults conclude the paper.

Prevalence of mental illness within families in a regional child-focussed mental health service.

Nearly 50% of all mental illnesses begin in childhood before the age of 14 years, and over 20% of parents have a mental illness. Few studies have examined the co-occurrence of mental illnesses in parents and children. In the present study, we examined the extent of mental illness within families of 152 clients attending an Australian regional child and adolescent mental health service (CAMHS). A cross-sectional study design was employed involving a case record review and clinician-completed questionnaire of the children and youth attending a CAMHS. It was found that 79% of these children were living with a parent with mental illness. The predominant diagnosis of both child and parent was an anxiety or mood disorder, and many families had co-occurring risk factors of domestic violence and limited social supports. The findings in this Australian cohort are similar to those of other international research. While novel in nature, the present study has highlighted the extent of both mental illness and scarce supports for both children and parents in the same family. The findings indicate the need for a coordinated multiservice delivery of appropriate and consistent family-focussed interventions, responding to both mental illness and social supports for children and parents. Further research should examine specific components of family need and support, as seen through the eyes of the child and their parent.