Developing a Support Program for Adult Children of Parents with Mental Illness: A Delphi Study.

Parental mental illness can have long-lasting impacts on a child's life. Although programs exist in supporting the needs of young children, there remains a paucity in programs that address the needs of adult children. A two-round Delphi study with adult children, academics and clinicians who have experience with parental mental illness was employed. A total of 45 and 24 participants participated in rounds one and two respectively. Open-ended questions in round one around program design and content were thematically analysed, and subsequently rated in round two. Adult children specifically identified four topics of need: (i) managing multiple roles, (ii) emotional regulation, (iii) setting relational boundaries and (iv) transition to parenthood. Current results provide the foundation for the development of modular programs that could be pilot tested with adult children who grew up with parents with mental illness.

Methods used by psychologists for identifying dyslexia: A systematic review.

Inconsistencies in the operationalisation of dyslexia in assessment practices are concerning. Variations in different countries' education contexts and education-related legislation could contribute to continuing discrepancies between psychologists' assessment practices. However, an international "snapshot" of these practices is unavailable. An international comparison of psychologists' dyslexia assessment practices could help ascertain whether there are contextual factors that can foster converging practices. Accordingly, this study systematically reviewed the literature to capture how psychologists identify and/or diagnose dyslexia across English-speaking countries. Quantitative and/or qualitative studies, published between 2013 and 2021, that investigated psychologists' self-reported methods for assessing, identifying, and/or diagnosing individuals with dyslexia were included. Eleven studies (published across fourteen papers) met the inclusion criteria. Most included studies sampled school psychologists who work in the USA. Psychologists' dyslexia assessment practices were diverse (including the use of cognitive discrepancy and response-to-intervention methods). The results highlight an international need to develop a consensus operational definition of dyslexia and universal assessment guidelines. Future research might investigate the practices and beliefs of psychologists who work outside of the USA, and to be inclusive of adult populations. Implications for research and training are explored.

Diagnosing adults with dyslexia: Psychologists' experiences and practices.

Previous research has investigated how psychologists identify dyslexia in school-aged children. However, it is presently unclear how psychologists diagnose dyslexia in adults. This study aimed to explore psychologists' understandings and experiences in how they assess adults for dyslexia. Nine psychologists in Australia were recruited from professional associations and interviewed using a semi-structured schedule. After member checks, transcripts were analysed using reflexive thematic analysis. The results suggested that participants' assessment practices with adults were similar to those used with children. However, participants were not confident in assessing adults due to a lack of an empirical base and training, and appropriately normed tools. Moreover, participants relied on their clinical judgment to help overcome barriers unique to the assessment of adults including obtaining an accurate developmental history and determining the relevancy of academic intervention for a formal diagnosis. Participants recommended (better) training and accessible research about how to efficaciously diagnose adults with dyslexia. The robustness of current diagnostic tools for equitably identifying adults with dyslexia was questioned by some participants. There is a need for national guidelines in Australia to support psychologists in identifying adults with dyslexia. International research and guidelines have an important role to play in informing this process.

Experiences and perspectives of self-compassion from young adult children of parents with mental illness.

INTRODUCTION: In adolescents and young adults, self-compassion has been positively associated with wellbeing and negatively associated with psychological distress. One population of youth who may draw particular benefit from self-compassion are those who have parents with mental illness. This qualitative study explored the perspectives and experiences of self-compassion among a group of young adult children of parents with mental illness. METHODS: A purposive sample of ten Australian emerging adults aged 18-25 years (3 men, 6 women and 1 non-binary person) participated in individual semi-structured telephone interviews. Interpretative Phenomenological Analysis was used to examine and interpret participants' experiences and perspectives of self-compassion. RESULTS: Participants described self-compassion as personally relevant and beneficial, although difficult to engage in. Some participants had learnt about, and actively practiced self-compassion, and offered advice for others. Conversely, others described self-compassion as difficult to practice and outlined barriers to self-compassion, from society and family life. Although participants identified common negative social conceptions of self-compassion, they articulated how self-compassion could be valuable for those who have parents with mental illness. CONCLUSIONS: Results indicate the perceived importance of self-compassion along with barriers and facilitators of self-compassion for young adults who have parents with a mental illness. Implications for clinical practice and suggestions for future research are presented.

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.

Children whose parents have a mental illness: prevalence, need and treatment.

Up to one in five young people live in families with a parent who has a mental illness. There are various genetic, individual, family and environmental risk factors for children living in these families. Outcomes for children vary according to factors related to a parent's mental illness as well as certain environmental protective and risk factors, related to the family, social support and community. Health care workers need to acknowledge their patients' parenting roles and responsibilities and the needs of other family members, especially children.

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.

Intervention programs for children whose parents have a mental illness: a review.

OBJECTIVE: To identify and describe intervention programs to improve outcomes for children whose parents have a mental illness. DATA SOURCES: Grey and black literature was sourced from (i) three previous reviews/scoping studies, (ii) PsycINFO and MEDLINE searches of English, German and Dutch papers, and (iii) in consultation with researchers, clinicians, consumers and carers in the field. STUDY SELECTION: Only programs specifically targeting children whose parent/s have a mental illness. No restrictions were placed on study quality. DATA EXTRACTION: Program description, target group and evidence base. DATA SYNTHESIS: Programs from Australia, Europe and North America were found and collated into (i) family interventions, (ii) peer-support programs, (iii) online interventions and (iv) bibliotherapy. Some programs had been evaluated, with promising results. Others had minimal or no evaluation. CONCLUSIONS: The core component across programs is the provision of psychosocial education to children about mental illness. More rigorous research is required to establish the conditions through which children's outcomes are enhanced.

'It's like they're learning what it is for the very first time': Clinician's accounts of self-compassion in clients whose parents experience mental illness.

OBJECTIVES: Individuals who have a parent with mental illness are more likely to experience mental illness than their contemporaries. As such, it is valuable to examine potential psychological resources, which might assist these individuals to experience good mental health throughout their lifespan. We aimed to learn how clinicians perceive self-compassion, and how it can be incorporated into therapy with clients who have parents with mental illness. DESIGN: A qualitative interview design was employed to explore clinicians' perspectives and experiences. METHODS: Eight mental health clinicians experienced in working with clients who have parents with mental illness were interviewed. Interpretative phenomenological analysis was used to establish themes representing the clinicians' perspectives and experiences of incorporating self-compassion into their work. RESULTS: This study found that clinicians were generally positive about incorporating self-compassion into interventions with clients who are children of parents with mental illness. The participants noted barriers to self-compassion for these clients, namely a poor sense of self and divided loyalty between self and family. Participants recommended taking time and care, building rapport and involving others when cultivating self-compassion with those who have parents with mental illness. CONCLUSIONS: This group of clinicians viewed self-compassion as relevant to clients whose parents have mental illness and believe it can be introduced therapeutically in various ways. Suggestions are made for tailoring self-compassion training to the needs and experiences of this group.

"Knowledge is power": educating children about their parent's mental illness.

Given the prevalence and associated vulnerabilities of children of parents with a mental illness (COPMI) it is essential to develop appropriate interventions. While education is an important component in many interventions, little is known about what topics are covered, delivery mode, and the efficacy in meeting the needs of this target group. Eighteen facilitators responsible for delivering COPMI programs across Australia were interviewed, fifteen of whom include education about mental illness in their treatment programs. According to program facilitators, education about mental health was important because they believed that knowledge equates to power, and can be cathartic. Education chiefly consisted of signs, symptoms, and treatments of various mental illnesses. The dominant mode of delivery was small and large group discussion. When delivering education, there was some consideration for children's ages. However, there was less differentiation in programs according to the diagnosis of parents' mental illness. Clinical and research implications conclude the article.

Relational trajectories in families with parental mental illness: a grounded theory approach.

BACKGROUND: Adult children of parents with mental illness experience a myriad of complex emotions as they attempt to make meaning of the lived experiences of their parents. A crucial time for adult children is emerging adulthood, a time when they move away from their family of origin and establish their own identity and independence. Despite existing research that provides a static description of adult children's lived experiences, the literature lacks an explanatory theory about the dynamic, relational processes that occur as adult children progress from one life stage to the next. METHODS: The current study aimed to develop an explanatory theory of the relational trajectory that adult children might experience as they course through adulthood and parenthood over time. Semistructured interviews using grounded theory analysis were conducted with 10 adult children aged between 27 and 51 years old. RESULTS: Three key phases within the Relational Trajectory Model (RTM) were identified: (i) confusion, (ii) contemplation, and (iii) reconciliation. By reflecting on their own parenting role, adult children were able to reach an evolved parental identity, with the majority of participants also making relationship reparations with their parents with mental illness. Parallels are drawn to theories of identity and intergenerational family systems to further explain and substantiate the processes encompassed within the RTM. CONCLUSION: Generating an explanatory theory serves as a potential guide for mental health professionals working with families with parental mental illness, by drawing attention to the intricacies of familial relationships and interpersonal ties.

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.

"We Are More than Our Parents' Mental Illness": Narratives from Adult Children.

Although research on children of parents with mental illness is growing, few researchers have examined the long-term impact of parental mental illness on adult children. This study explored the potential impact of growing up with a parent with a mental illness on the parenting role assumed by adult children. The qualitative study included ten participants, who were individually interviewed using a semi-structured interview schedule. Interpretative phenomenological analysis (IPA) along with member checks were utilised to derive themes from participants' narratives. Three main themes were identified, including: 'this is me', 'a whole new world', and 'because of you'. 'This is me' consisted of narratives highlighting how adult children intentionally went about parenting in ways different from their parents, and 'a whole new world' captured the salient identity that parenthood served for adult children. The third theme, 'because of you' highlighted the challenges adult children faced in their parenting roles as a result of their childhood experience living with a parent with mental illness. Participants highlighted the main challenges to be an absence of a reference point and lack of informal social supports. Recommendations for mental health practitioners and future research are presented in order to develop better ways to support adult children and their families.

The number of parents who are patients attending adult psychiatric services.

PURPOSE OF REVIEW: Having a parent with a mental illness is a major risk to children's wellbeing. The first step in developing policies and procedures that could assist these children is to determine the numbers of parents attending adult psychiatric services. This is the first systematic examination of the literature regarding the prevalence and family circumstances of parents attending adult psychiatric services. RECENT FINDINGS: Nine peer reviewed publications showed parent prevalence in adult services ranging from 12.2 to 45.0%. Prevalence variability is associated with the type of adult service (e.g. inpatient and outpatient), sampling (e.g. single service versus whole of state) and parent characteristics (e.g. sex, diagnosis, relationship status, family information). SUMMARY: A large minority of adult psychiatric service patients are parents. Given the prevention and early intervention benefits for parents and their families, adult psychiatric services need to be responsive to their needs. Future research should distinguish the type of service being audited, parent sex and diagnosis and the family circumstances that imbue greater risks to families, as well as opportunities to support children.