Melinda Goodyear - Academia.edu (original) (raw)

Papers by Melinda Goodyear

Frontiers in Psychiatry, 2022

BackgroundTranslating evidence-based practice to routine care is known to take significant time a... more BackgroundTranslating evidence-based practice to routine care is known to take significant time and effort. While many evidenced-based family-focused practices have been developed and piloted in the last 30 years, there is little evidence of sustained practice in Adult Mental Health Services. Moreover, many barriers have been identified at both the practitioner and organizational level, however sustainability of practice change is little understood. What is clear, is that sustained use of a new practice is dependent on more than individual practitioners' practice.Design and MethodDrawing on research on sustaining Let's Talk about Children in adult mental health services and in the field of implementation science, this article proposes a model for sustaining family focused practice in adult mental health services.Sustainability Model for Family-Focused PracticeAn operational model developed from key elements for sustaining Let's Talk about Children identifies six action p...

Community Mental Health Journal, 2020

Intergenerational trauma is a discrete form of trauma which occurs when traumatic effects are pas... more Intergenerational trauma is a discrete form of trauma which occurs when traumatic effects are passed across generations without exposure to the original event. This qualitative study aimed to explore how psychiatrists understand intergenerational trauma in respect to their practice, for the purposes of identifying interventions for addressing intergenerational trauma in public mental health services. Findings revealed that psychiatrists observe intergenerational trauma frequently in their roles and try to opportunistically promote awareness of trauma with adults, and refer families to external services for supportive interventions. They feel powerless when faced with directly intervening with intergenerational trauma and required restructuring of their roles to adequately address it in public settings. Findings have implications for training, advocacy and research on the relationship between trauma and mental illness. Alongside this, there is an indicated need for examination of how systems can ensure access to appropriate services once organisations become trauma-informed.

International Journal of Mental Health Nursing, 2020

Sustainability is a desired outcome of implementation. Understanding how organizations support ne... more Sustainability is a desired outcome of implementation. Understanding how organizations support new practices after implementation is important for sustainability. Let's Talk about Children (hereby referred to as 'Let's Talk'), a family-focused intervention with parents with a mental illness, improves family, parent, and child outcomes. Little is understood about how organizations support sustained practice. The study aimed to (i) understand the implementation process that occurred in eight adult mental health services during a previous randomized controlled trial; (ii) establish their continued capacity to embed Let's Talk; and (iii) explore links between organizational capacity and sustained delivery by practitioners. This mixed method study used a questionnaire and individual interviews to collect data on the implementation process and current organizational capacity to support Let's Talk 12months after the randomized controlled trial. Links between organizational capacity and the adult mental health services with practitioners' continuing to use Let's Talk in the past 12 months were explored. Services with higher current organizational capacity scores had practitioners currently delivering Let's Talk. These services had all made changes to their organizational structures to support Let's Talk practice. All services experienced significant changes during and after implementation, influencing sustainability of Let's Talk. Addressing organizational capacity appears to be important to enable sustainability of Let's Talk implementation endeavours. Real-world settings are constantly changing systems requiring ongoing tracking and adjustments to understand and support sustainability. Internal service development staff appear to support the shaping of organizational capacity to support Let's Talk; however, broader organizational support is needed for change within a complex system.

Archives of Psychiatric Nursing, 2020

Background: The Family Model is increasingly used as a framework to promote a whole family approa... more Background: The Family Model is increasingly used as a framework to promote a whole family approaches in mental health services. The purpose of this qualitative study was to (i) explore whether nurses practice in accordance with the Model when providing services for parents who have mental illness, (ii) determine whether components of the model are employed more in some workplaces (i.e. acute in-patient units versus community settings) and iii) ascertain reasons as to why this may be the case. Method: A purposive sample of 14 nurses from eight mental health services in Ireland, completed semi-structured interviews. Results: Findings indicated that nurses' practice incorporated most key components of The Family Model, including supporting service users' dependent children. However, some practices were not explicit in the Model, such as supporting other adult family members (i.e. grandparents). While nurses' practice in community settings was more aligned with The Family Model than in acute in-patient units, there was a notable absence of reference to domain six (cultural considerations) in both settings. A holistic and family-centered philosophy, coupled with collegial and managerial support and a focus on prevention were the main features that enabled family focused practice in community settings. Conclusion: As only a subgroup of nurses practice in accordance with The Family Model, efforts are required by nurses, their organisations and the broader system to promote family focused practice. The Family Model may be a useful framework, with further refinement, for guiding nurses' practice.

Advances in Mental Health, 2020

Developing research and evaluation skills in a family, parent or child health workforce The healt... more Developing research and evaluation skills in a family, parent or child health workforce The health sector is a dynamic and constantly evolving environment. Health workers face a myriad of challenges including providing quality clinical care whilst balancing elevated client and organisational expectations, budgetary constraints and adapting to technological advancements. Training health workers in research skills equips them to be instrumental in the development and implementation of evidence-based practices that reflect contemporary health service delivery. Research training seeks to develop health worker knowledge, skills and behaviour in practice research and evidence and where possible to develop an evidence focused organisational culture. This special issue reports on a four-year collaboration between Children'

Clinical Nursing Studies, 2018

Objective: Recent research has found over 70% of children attending a mental health service also ... more Objective: Recent research has found over 70% of children attending a mental health service also have a parent with a mental illness. Research on the impact of mental illness in families focuses primarily on how parental mental illness impacts on children. What is not understood is the experience of parents and children where both have a mental illness. The aim of this study was to investigate the experiences of parents where both a child and a parent have a mental illness.Methods: Thirty-seven parents were interviewed using a narrative design to determine their personal and family experiences. Interviews were analyzed using interpretative phenomenological analysis with a number of themes highlighted.Results: Themes particular to this family type were: impact of parental mental illness; specific strategies; bidirectional impacts of mental illness; and intergenerational factors. Also raised were supports parents would have liked. From the narrative of these parents the challenges of ...

Journal of Mental Health, 2020

Abstract Background Trauma is a factor impacting the lives of many people experiencing psychiatri... more Abstract Background Trauma is a factor impacting the lives of many people experiencing psychiatric disorders. Trauma affects people’s responses to illness as well as their interactions with services. Aim This study aimed to explore the understandings and experiences of psychiatrists of working with trauma and emerging models of Trauma-Informed Care. Methods An interpretive qualitative inquiry was undertaken using semi-structured in-depth interviews with psychiatrists. Results Four themes were identified: Making sense of trauma; A contentious relationship between trauma and mental illness; Treatment made more challenging by trauma; Trauma-Informed Care highlights tensions. Psychiatrists are familiar with the concept of trauma but there are differences in beliefs about its relationship to mental illness that are consequential for practice. Trauma-Informed Care is seen as an effort to humanise mental health services, but with perceived limited impact on psychiatrists’ roles. Conclusion Findings indicate need for further consultation and collaboration with psychiatrists around trauma-informed care implementation; as well as consideration of what is required to develop professional consensus on trauma and its relationship to illness.

Journal of Psychiatric and Mental Health Nursing, 2020

Weimand BM. Leadership perspectives on key elements influencing implementing a family-focused int... more Weimand BM. Leadership perspectives on key elements influencing implementing a family-focused intervention in mental health services.

Background: A research project aimed to improve the situation of children of parents with a menta... more Background: A research project aimed to improve the situation of children of parents with a mental illness (COPMI) has recently begun in the Austrian region of Tyrol. The project aims to strengthen formal and informal support structures around the child through enhancing their village of collaborative support. Understanding the current situation in the region is vital for implementing practice change. This paper aims to gain knowledge on the Tyrolean societal and service provision context. Methods: We collected qualitative and quantitative data on overall societal characteristics, epidemiology of mental illness in Tyrol, services that currently exist within adult mental health care and for supporting children, parents and families, uptake of services, and current practices and challenges of identifying and supporting COPMIs. We analysed data along several external context dimensions: 1) professional influences, 2) political support, 3) social climate, 4) local infrastructure, 5) pol...

International Journal of Mental Health Nursing, 2019

Use of routine outcome measures are frequently used to ascertain improvement in children's sympto... more Use of routine outcome measures are frequently used to ascertain improvement in children's symptomology, this study examined whether living with a parent with a mental illness impacted outcome measures. The study examined 134 children attending a Child and Adolescent Mental Health Service (CAMHS). The majority lived with a parent reporting mental illness. Routine HoNOSCA and CGAS outcome measures were collected over a 6-month period. Children of parents with a mental illness scored higher on most outcome measures. All children improved on most variables over the 6 months of CAMHS intervention with children of parents with mental illness showing greater improvement compared to other children on behaviour but less improvement on all other variables. They did not, however, improve as much on education-related factors and showed lower improvement in overall functioning. Younger children with a parent with a mental illness improved least in the area of behaviour. This study highlighted the need for greater use and integration of measures where children live with a parent who has a mental illness. Findings suggest parental mental illness impacted on overall child outcomes, and this influence remained irrespective of clinical intervention. The common occurrence of parental mental illness, where children also have a mental illness, indicates focusing on a wider set of outcome measures for more effective intervention. Analysis of a larger cohort sample is warranted.

Frontiers in Psychiatry, 2019

Frontiers in Psychiatry, 2019

1. scoping, 4) co-development, 5) implementation, 6) evaluating the practice approaches, and 7) k... more 3) scoping, 4) co-development, 5) implementation, 6) evaluating the practice approaches, and 7) knowledge dissemination. "Scoping" will involve exploring the existing evidence, practice, and current state of identification and collaborative care in Tyrol, Austria. "Co-development" involves the co-design of practice approaches to identify and support children in partnership with key stakeholders and service providers working in Tyrol. The "implementation" of practice approaches will be based on the results of the co-development phase and will involve working with organizations to develop support strategies that draw on known organizational drivers from the field of implementation science to support the rollout of the practice approaches. In "Evaluation" we will follow principles of a realist approach; this includes developing program theories and logic models for the practice approaches. Those will set out the outcomes hypothesized to achieve and the processes that are expected to lead to those changes. This will refer to changes in children, parents, and practitioners. We expect that the main focus will be on measuring child quality of life and mental health outcomes, and outcomes that are on the path to those (such as social support needs, resilience, mental health literacy, stigma, and help-seeking behavior) as well as costs. The "child voice" WP focuses on children's perceptions and needs as the importance of "assent" and support of children to develop their own "voice" in health care is increasingly recognized within child health research. The "dissemination" step focuses on reaching a broad public audience of different stakeholders, researchers, and families involved. Discussion: The research project aims to directly improve identification and support of vulnerable children across selected regions in Tyrol, Austria, and by doing so, improve the health and well-being of future generations, through breaking the cycle of intergenerational transfer of adverse childhood experiences.

International Journal of Mental Health Nursing, 2018

This paper provides a framework for essential family-focused practices (EASE: Engage, Assess, Sup... more This paper provides a framework for essential family-focused practices (EASE: Engage, Assess, Support, Educate) for clinicians to support parents with mental illness in the context of their family. The framework is underpinned by relational recovery as the parent/ consumer's recovery is considered within the context of their relationships, including the relationship between clinician and parent/consumer. The central aim is to strengthen nurses' and other clinicians' capacity to address key psychosocial needs of parents and to strengthen relational recovery in families where parents have mental illness. The EASE framework is a theory and evidence-informed family practice approach to relational recovery within healthcare provision. The EASE practice components are defined and illustrated with practice exemplars that operationalize the framework within adult service settings. Potential applications and outcomes of using EASE are also described. The framework is intended as a practical guide for working with parents and families in inpatient and community mental health settings and may also be relevant for clinicians in a range of contexts including child welfare and primary health care.

International journal of mental health nursing, Jan 27, 2018

Family-focused practice improves outcomes for families where parents have a mental illness. Howev... more Family-focused practice improves outcomes for families where parents have a mental illness. However, there is limited understanding regarding the factors that predict and enable these practices. This study aimed to identify factors that predict and enable mental health nurses' family-focused practice. A sequential mixed methods design was used. A total of 343 mental health nurses, practicing in 12 mental health services (in acute inpatient and community settings), throughout Ireland completed the Family Focused Mental Health Practice Questionnaire, measuring family-focused behaviours and other factors that impact family-focused activities. Hierarchical multiple regression identified 14 predictors of family-focused practice. The most important predictors noted were nurses' skill and knowledge, own parenting experience, and work setting (i.e. community). Fourteen nurses, who achieved high scores on the questionnaire, subsequently participated in semistructured interviews to el...

International Journal of Mental Health Nursing, 2017

Social connection is a fundamental human need, but challenging for individuals with characteristi... more Social connection is a fundamental human need, but challenging for individuals with characteristics that are socially stigmatized. Parenting with mental illness presents obstacles, as well as opportunities, for connection. In the present study, we examined connectedness within a personal recovery paradigm for rural mothers with a mental illness. In-depth interviews with 17 mothers with a mental illness, utilizing constructivist grounded theory, resulted in six categories of meaning, including 'yearning for connection', 'connecting intensely', 'encountering rejection and exclusion', 'choosing isolation', 'being known', and 'finding peers/helping others'. Women expressed a strong desire for connection, but for many, prior experiences of trauma and rejection created barriers to the development of trust, preventing some women from seeking opportunities for connection. Connectedness to self and significant others, and a broader life meaning and purpose can support and expedite personal recovery from mental illness for rural women. However the factors that contribute to the mental illness might also inhibit the development of trust needed to attain social connection. Increasing connectedness in mothers with mental illness is a complex endeavour requiring concerted focus as distinct from other service-delivery goals. The perinatal period could be a key time for intervention.

BMC Psychiatry, 2017

Background: A considerable number of people with a mental illness are parents caring for dependen... more Background: A considerable number of people with a mental illness are parents caring for dependent children. For those with a mental illness, parenting can provide a sense of competence, belonging, identity and hope and hence is well aligned to the concept of personal recovery. However, little research has focused on the recovery journey of those who are parents and have a mental illness. This randomised controlled trial aims to (i) evaluate the effectiveness of an intervention model of recovery for parents (Let's Talk about Children) in three different mental health service sectors and (ii) examine the economic value of a larger roll out (longer term) of the parent recovery model. Methods: A two arm parallel randomised controlled trial will be used with participants, who are being treated for their mental illness in adult mental health, non-government community mental health or family welfare services. The study will involve 192 parents, who are considered by their treating practitioner to be sufficiently well to provide informed consent and participate in an intervention (Let's Talk about Children) or control group (treatment as usual). Participant randomisation will occur at the level of the treating practitioner and will be based on whether the randomised practitioner is trained in the intervention. Outcomes are compared at pre, post intervention and six-month follow-up. Recovery, parenting and family functioning, and quality of life questionnaires will be used to measure parent wellbeing and the economic benefits of the intervention. Discussion: This is the first randomised controlled trial to investigate the efficacy of a parenting intervention on recovery outcomes and the first to provide an economic evaluation of an intervention for parents with a mental illness. An implementation model is required to embed the intervention in different sectors. Trial registration: The trial was retrospectively registered: ACTRN12616000460404 on the 8/4/2016.

International Journal of Mental Health Nursing, 2017

Nearly 50% of all mental illnesses begin in childhood before the age of 14 years, and over 20% of... more 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.

Child & Youth Services, 2016

ABSTRACT This paper acknowledges progress over the last 20 years in addressing intergenerational ... more ABSTRACT This paper acknowledges progress over the last 20 years in addressing intergenerational risks to the mental health of children whose parents experience mental illness (COPMI-Children of Parents with a Mental Illness and FaPMI-Families Where a Parent Has a Mental Illness) and emphasises ongoing challenges to implement evidence informed family focused interventions. Challenges include variability in practice at individual, regional, and cross-national service system levels and the gap between implementation science and practice. This article begins to address this gap with descriptions of key systems approaches and implementation strategies from around the world to illustrate variability and common themes. A multifaceted, integrated systems approach is proposed as a way forward. Learnings and experience from initiatives, expertise and evidence targeting other vulnerable groups and successful change implementation will enhance existing (COPMI/FaPMI) efforts to facilitate systems change and improve the lives and futures of these children and families around the world.

Archives of Psychiatric Nursing, 2016

Psychiatric nurses' practice with parents who have mental illness, their children and families is... more Psychiatric nurses' practice with parents who have mental illness, their children and families is an important issue internationally. This study provides a comparison of Irish and Australian psychiatric nurses' family focused practices in adult mental health services. Three hundred and forty three nurses across Ireland and 155 from Australia completed the Family Focused Mental Health Practice Questionnaire. Crosscountry comparisons revealed significant differences, in terms of family focused skill, knowledge, confidence and practice. Australian psychiatric nurses engaged in higher family focused practice compared to Irish nurses. The comparative differences between countries may be attributable to differences in training, workplace support and policy.

Frontiers in Psychiatry, 2022

BackgroundTranslating evidence-based practice to routine care is known to take significant time a... more BackgroundTranslating evidence-based practice to routine care is known to take significant time and effort. While many evidenced-based family-focused practices have been developed and piloted in the last 30 years, there is little evidence of sustained practice in Adult Mental Health Services. Moreover, many barriers have been identified at both the practitioner and organizational level, however sustainability of practice change is little understood. What is clear, is that sustained use of a new practice is dependent on more than individual practitioners' practice.Design and MethodDrawing on research on sustaining Let's Talk about Children in adult mental health services and in the field of implementation science, this article proposes a model for sustaining family focused practice in adult mental health services.Sustainability Model for Family-Focused PracticeAn operational model developed from key elements for sustaining Let's Talk about Children identifies six action p...

Community Mental Health Journal, 2020

Intergenerational trauma is a discrete form of trauma which occurs when traumatic effects are pas... more Intergenerational trauma is a discrete form of trauma which occurs when traumatic effects are passed across generations without exposure to the original event. This qualitative study aimed to explore how psychiatrists understand intergenerational trauma in respect to their practice, for the purposes of identifying interventions for addressing intergenerational trauma in public mental health services. Findings revealed that psychiatrists observe intergenerational trauma frequently in their roles and try to opportunistically promote awareness of trauma with adults, and refer families to external services for supportive interventions. They feel powerless when faced with directly intervening with intergenerational trauma and required restructuring of their roles to adequately address it in public settings. Findings have implications for training, advocacy and research on the relationship between trauma and mental illness. Alongside this, there is an indicated need for examination of how systems can ensure access to appropriate services once organisations become trauma-informed.

International Journal of Mental Health Nursing, 2020

Sustainability is a desired outcome of implementation. Understanding how organizations support ne... more Sustainability is a desired outcome of implementation. Understanding how organizations support new practices after implementation is important for sustainability. Let's Talk about Children (hereby referred to as 'Let's Talk'), a family-focused intervention with parents with a mental illness, improves family, parent, and child outcomes. Little is understood about how organizations support sustained practice. The study aimed to (i) understand the implementation process that occurred in eight adult mental health services during a previous randomized controlled trial; (ii) establish their continued capacity to embed Let's Talk; and (iii) explore links between organizational capacity and sustained delivery by practitioners. This mixed method study used a questionnaire and individual interviews to collect data on the implementation process and current organizational capacity to support Let's Talk 12months after the randomized controlled trial. Links between organizational capacity and the adult mental health services with practitioners' continuing to use Let's Talk in the past 12 months were explored. Services with higher current organizational capacity scores had practitioners currently delivering Let's Talk. These services had all made changes to their organizational structures to support Let's Talk practice. All services experienced significant changes during and after implementation, influencing sustainability of Let's Talk. Addressing organizational capacity appears to be important to enable sustainability of Let's Talk implementation endeavours. Real-world settings are constantly changing systems requiring ongoing tracking and adjustments to understand and support sustainability. Internal service development staff appear to support the shaping of organizational capacity to support Let's Talk; however, broader organizational support is needed for change within a complex system.

Archives of Psychiatric Nursing, 2020

Background: The Family Model is increasingly used as a framework to promote a whole family approa... more Background: The Family Model is increasingly used as a framework to promote a whole family approaches in mental health services. The purpose of this qualitative study was to (i) explore whether nurses practice in accordance with the Model when providing services for parents who have mental illness, (ii) determine whether components of the model are employed more in some workplaces (i.e. acute in-patient units versus community settings) and iii) ascertain reasons as to why this may be the case. Method: A purposive sample of 14 nurses from eight mental health services in Ireland, completed semi-structured interviews. Results: Findings indicated that nurses' practice incorporated most key components of The Family Model, including supporting service users' dependent children. However, some practices were not explicit in the Model, such as supporting other adult family members (i.e. grandparents). While nurses' practice in community settings was more aligned with The Family Model than in acute in-patient units, there was a notable absence of reference to domain six (cultural considerations) in both settings. A holistic and family-centered philosophy, coupled with collegial and managerial support and a focus on prevention were the main features that enabled family focused practice in community settings. Conclusion: As only a subgroup of nurses practice in accordance with The Family Model, efforts are required by nurses, their organisations and the broader system to promote family focused practice. The Family Model may be a useful framework, with further refinement, for guiding nurses' practice.

Advances in Mental Health, 2020

Developing research and evaluation skills in a family, parent or child health workforce The healt... more Developing research and evaluation skills in a family, parent or child health workforce The health sector is a dynamic and constantly evolving environment. Health workers face a myriad of challenges including providing quality clinical care whilst balancing elevated client and organisational expectations, budgetary constraints and adapting to technological advancements. Training health workers in research skills equips them to be instrumental in the development and implementation of evidence-based practices that reflect contemporary health service delivery. Research training seeks to develop health worker knowledge, skills and behaviour in practice research and evidence and where possible to develop an evidence focused organisational culture. This special issue reports on a four-year collaboration between Children'

Clinical Nursing Studies, 2018

Objective: Recent research has found over 70% of children attending a mental health service also ... more Objective: Recent research has found over 70% of children attending a mental health service also have a parent with a mental illness. Research on the impact of mental illness in families focuses primarily on how parental mental illness impacts on children. What is not understood is the experience of parents and children where both have a mental illness. The aim of this study was to investigate the experiences of parents where both a child and a parent have a mental illness.Methods: Thirty-seven parents were interviewed using a narrative design to determine their personal and family experiences. Interviews were analyzed using interpretative phenomenological analysis with a number of themes highlighted.Results: Themes particular to this family type were: impact of parental mental illness; specific strategies; bidirectional impacts of mental illness; and intergenerational factors. Also raised were supports parents would have liked. From the narrative of these parents the challenges of ...

Journal of Mental Health, 2020

Abstract Background Trauma is a factor impacting the lives of many people experiencing psychiatri... more Abstract Background Trauma is a factor impacting the lives of many people experiencing psychiatric disorders. Trauma affects people’s responses to illness as well as their interactions with services. Aim This study aimed to explore the understandings and experiences of psychiatrists of working with trauma and emerging models of Trauma-Informed Care. Methods An interpretive qualitative inquiry was undertaken using semi-structured in-depth interviews with psychiatrists. Results Four themes were identified: Making sense of trauma; A contentious relationship between trauma and mental illness; Treatment made more challenging by trauma; Trauma-Informed Care highlights tensions. Psychiatrists are familiar with the concept of trauma but there are differences in beliefs about its relationship to mental illness that are consequential for practice. Trauma-Informed Care is seen as an effort to humanise mental health services, but with perceived limited impact on psychiatrists’ roles. Conclusion Findings indicate need for further consultation and collaboration with psychiatrists around trauma-informed care implementation; as well as consideration of what is required to develop professional consensus on trauma and its relationship to illness.

Journal of Psychiatric and Mental Health Nursing, 2020

Weimand BM. Leadership perspectives on key elements influencing implementing a family-focused int... more Weimand BM. Leadership perspectives on key elements influencing implementing a family-focused intervention in mental health services.

Background: A research project aimed to improve the situation of children of parents with a menta... more Background: A research project aimed to improve the situation of children of parents with a mental illness (COPMI) has recently begun in the Austrian region of Tyrol. The project aims to strengthen formal and informal support structures around the child through enhancing their village of collaborative support. Understanding the current situation in the region is vital for implementing practice change. This paper aims to gain knowledge on the Tyrolean societal and service provision context. Methods: We collected qualitative and quantitative data on overall societal characteristics, epidemiology of mental illness in Tyrol, services that currently exist within adult mental health care and for supporting children, parents and families, uptake of services, and current practices and challenges of identifying and supporting COPMIs. We analysed data along several external context dimensions: 1) professional influences, 2) political support, 3) social climate, 4) local infrastructure, 5) pol...

International Journal of Mental Health Nursing, 2019

Use of routine outcome measures are frequently used to ascertain improvement in children's sympto... more Use of routine outcome measures are frequently used to ascertain improvement in children's symptomology, this study examined whether living with a parent with a mental illness impacted outcome measures. The study examined 134 children attending a Child and Adolescent Mental Health Service (CAMHS). The majority lived with a parent reporting mental illness. Routine HoNOSCA and CGAS outcome measures were collected over a 6-month period. Children of parents with a mental illness scored higher on most outcome measures. All children improved on most variables over the 6 months of CAMHS intervention with children of parents with mental illness showing greater improvement compared to other children on behaviour but less improvement on all other variables. They did not, however, improve as much on education-related factors and showed lower improvement in overall functioning. Younger children with a parent with a mental illness improved least in the area of behaviour. This study highlighted the need for greater use and integration of measures where children live with a parent who has a mental illness. Findings suggest parental mental illness impacted on overall child outcomes, and this influence remained irrespective of clinical intervention. The common occurrence of parental mental illness, where children also have a mental illness, indicates focusing on a wider set of outcome measures for more effective intervention. Analysis of a larger cohort sample is warranted.

Frontiers in Psychiatry, 2019

Frontiers in Psychiatry, 2019

1. scoping, 4) co-development, 5) implementation, 6) evaluating the practice approaches, and 7) k... more 3) scoping, 4) co-development, 5) implementation, 6) evaluating the practice approaches, and 7) knowledge dissemination. "Scoping" will involve exploring the existing evidence, practice, and current state of identification and collaborative care in Tyrol, Austria. "Co-development" involves the co-design of practice approaches to identify and support children in partnership with key stakeholders and service providers working in Tyrol. The "implementation" of practice approaches will be based on the results of the co-development phase and will involve working with organizations to develop support strategies that draw on known organizational drivers from the field of implementation science to support the rollout of the practice approaches. In "Evaluation" we will follow principles of a realist approach; this includes developing program theories and logic models for the practice approaches. Those will set out the outcomes hypothesized to achieve and the processes that are expected to lead to those changes. This will refer to changes in children, parents, and practitioners. We expect that the main focus will be on measuring child quality of life and mental health outcomes, and outcomes that are on the path to those (such as social support needs, resilience, mental health literacy, stigma, and help-seeking behavior) as well as costs. The "child voice" WP focuses on children's perceptions and needs as the importance of "assent" and support of children to develop their own "voice" in health care is increasingly recognized within child health research. The "dissemination" step focuses on reaching a broad public audience of different stakeholders, researchers, and families involved. Discussion: The research project aims to directly improve identification and support of vulnerable children across selected regions in Tyrol, Austria, and by doing so, improve the health and well-being of future generations, through breaking the cycle of intergenerational transfer of adverse childhood experiences.

International Journal of Mental Health Nursing, 2018

This paper provides a framework for essential family-focused practices (EASE: Engage, Assess, Sup... more This paper provides a framework for essential family-focused practices (EASE: Engage, Assess, Support, Educate) for clinicians to support parents with mental illness in the context of their family. The framework is underpinned by relational recovery as the parent/ consumer's recovery is considered within the context of their relationships, including the relationship between clinician and parent/consumer. The central aim is to strengthen nurses' and other clinicians' capacity to address key psychosocial needs of parents and to strengthen relational recovery in families where parents have mental illness. The EASE framework is a theory and evidence-informed family practice approach to relational recovery within healthcare provision. The EASE practice components are defined and illustrated with practice exemplars that operationalize the framework within adult service settings. Potential applications and outcomes of using EASE are also described. The framework is intended as a practical guide for working with parents and families in inpatient and community mental health settings and may also be relevant for clinicians in a range of contexts including child welfare and primary health care.

International journal of mental health nursing, Jan 27, 2018

Family-focused practice improves outcomes for families where parents have a mental illness. Howev... more Family-focused practice improves outcomes for families where parents have a mental illness. However, there is limited understanding regarding the factors that predict and enable these practices. This study aimed to identify factors that predict and enable mental health nurses' family-focused practice. A sequential mixed methods design was used. A total of 343 mental health nurses, practicing in 12 mental health services (in acute inpatient and community settings), throughout Ireland completed the Family Focused Mental Health Practice Questionnaire, measuring family-focused behaviours and other factors that impact family-focused activities. Hierarchical multiple regression identified 14 predictors of family-focused practice. The most important predictors noted were nurses' skill and knowledge, own parenting experience, and work setting (i.e. community). Fourteen nurses, who achieved high scores on the questionnaire, subsequently participated in semistructured interviews to el...

International Journal of Mental Health Nursing, 2017

Social connection is a fundamental human need, but challenging for individuals with characteristi... more Social connection is a fundamental human need, but challenging for individuals with characteristics that are socially stigmatized. Parenting with mental illness presents obstacles, as well as opportunities, for connection. In the present study, we examined connectedness within a personal recovery paradigm for rural mothers with a mental illness. In-depth interviews with 17 mothers with a mental illness, utilizing constructivist grounded theory, resulted in six categories of meaning, including 'yearning for connection', 'connecting intensely', 'encountering rejection and exclusion', 'choosing isolation', 'being known', and 'finding peers/helping others'. Women expressed a strong desire for connection, but for many, prior experiences of trauma and rejection created barriers to the development of trust, preventing some women from seeking opportunities for connection. Connectedness to self and significant others, and a broader life meaning and purpose can support and expedite personal recovery from mental illness for rural women. However the factors that contribute to the mental illness might also inhibit the development of trust needed to attain social connection. Increasing connectedness in mothers with mental illness is a complex endeavour requiring concerted focus as distinct from other service-delivery goals. The perinatal period could be a key time for intervention.

BMC Psychiatry, 2017

Background: A considerable number of people with a mental illness are parents caring for dependen... more Background: A considerable number of people with a mental illness are parents caring for dependent children. For those with a mental illness, parenting can provide a sense of competence, belonging, identity and hope and hence is well aligned to the concept of personal recovery. However, little research has focused on the recovery journey of those who are parents and have a mental illness. This randomised controlled trial aims to (i) evaluate the effectiveness of an intervention model of recovery for parents (Let's Talk about Children) in three different mental health service sectors and (ii) examine the economic value of a larger roll out (longer term) of the parent recovery model. Methods: A two arm parallel randomised controlled trial will be used with participants, who are being treated for their mental illness in adult mental health, non-government community mental health or family welfare services. The study will involve 192 parents, who are considered by their treating practitioner to be sufficiently well to provide informed consent and participate in an intervention (Let's Talk about Children) or control group (treatment as usual). Participant randomisation will occur at the level of the treating practitioner and will be based on whether the randomised practitioner is trained in the intervention. Outcomes are compared at pre, post intervention and six-month follow-up. Recovery, parenting and family functioning, and quality of life questionnaires will be used to measure parent wellbeing and the economic benefits of the intervention. Discussion: This is the first randomised controlled trial to investigate the efficacy of a parenting intervention on recovery outcomes and the first to provide an economic evaluation of an intervention for parents with a mental illness. An implementation model is required to embed the intervention in different sectors. Trial registration: The trial was retrospectively registered: ACTRN12616000460404 on the 8/4/2016.

International Journal of Mental Health Nursing, 2017

Nearly 50% of all mental illnesses begin in childhood before the age of 14 years, and over 20% of... more 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.

Child & Youth Services, 2016

ABSTRACT This paper acknowledges progress over the last 20 years in addressing intergenerational ... more ABSTRACT This paper acknowledges progress over the last 20 years in addressing intergenerational risks to the mental health of children whose parents experience mental illness (COPMI-Children of Parents with a Mental Illness and FaPMI-Families Where a Parent Has a Mental Illness) and emphasises ongoing challenges to implement evidence informed family focused interventions. Challenges include variability in practice at individual, regional, and cross-national service system levels and the gap between implementation science and practice. This article begins to address this gap with descriptions of key systems approaches and implementation strategies from around the world to illustrate variability and common themes. A multifaceted, integrated systems approach is proposed as a way forward. Learnings and experience from initiatives, expertise and evidence targeting other vulnerable groups and successful change implementation will enhance existing (COPMI/FaPMI) efforts to facilitate systems change and improve the lives and futures of these children and families around the world.

Archives of Psychiatric Nursing, 2016

Psychiatric nurses' practice with parents who have mental illness, their children and families is... more Psychiatric nurses' practice with parents who have mental illness, their children and families is an important issue internationally. This study provides a comparison of Irish and Australian psychiatric nurses' family focused practices in adult mental health services. Three hundred and forty three nurses across Ireland and 155 from Australia completed the Family Focused Mental Health Practice Questionnaire. Crosscountry comparisons revealed significant differences, in terms of family focused skill, knowledge, confidence and practice. Australian psychiatric nurses engaged in higher family focused practice compared to Irish nurses. The comparative differences between countries may be attributable to differences in training, workplace support and policy.