Parent advocates in children's mental health: program implementation processes and considerations

A Narrative Review of Factors Influencing Peer Support Role Implementation in Mental Health Systems: Implications for Research, Policy and Practice

With increasing calls to incorporate recovery principles into conventional mental health care, the importance of peer support worker (PSW) services has gained attention. However, studies consistently show that PSWs remain underutilized. Although research addresses several factors that influence formal implementation of their role, there is lack of a comprehensive framework that synthesizes the factors and addresses their interlevel interactions. This paper provides a narrative review and synthesis of literature on multilevel factors that influence formal PSW role implementation in mental health systems. We conducted a search of literature and reviewed 38 articles that met inclusion criteria. Our thematic analysis involved identifying first and second order categories that applied across studies, and developing third order interpretations through iterations. We synthesized the findings in a multilevel framework consisting of macro, meso and micro level influences. Influencing factors at the macro level include broader socio-cultural factors (medical model, recovery values, professional power dynamics, training and certification), regulatory and political factors (policy mandates, political commitment), and economic and financial factors (funding, affordability of services). Factors at the meso level include organizational culture, organizational leadership, change management, and human resource management policies. Micro level influences pertain to relationships between PSWs and team members, and PSW wellbeing. Interlevel interactions are also outlined. Limitations and implications for research, policy and practice are addressed.

Engaging and Supporting Young Children and their Families in Early Childhood Mental Health Services: The Role of the Family Partner

This study explores the role of family partners, peer professionals with lived experiences of raising a child with behavioral health needs, and their value in primary and community-care based mental health services for young children aged 0-8 years. Interviews and focus groups were conducted with staff, leadership, and caregiver participants (n = 38) from two early childhood mental health programs and analyzed using thematic analysis. Five interdependent themes emerged: (1) the centrality of lived experience to the family partner role; (2) the importance of the family partner in family engagement and relationship building; (3) the value added by the family partner in navigating systems; (4) the ability of the family partner to build skills and empower caregivers; (5) the role of the family partner in alleviating caregiver stress and other mental health concerns. Adapting and expanding the role of family partners will improve effective mental health care for children and their caregivers.

Parent Empowerment in Pediatric Healthcare Settings: A Systematic Review of Observational Studies

BACKGROUND

Parent empowerment is often an expressed goal in clinical pediatrics and in pediatric research, but the antecedents and consequences of parent empowerment are not well established.

OBJECTIVE

The objective of this systematic review was to synthesize potential antecedents and consequences of parent empowerment in healthcare settings.

ELIGIBILITY CRITERIA

The inclusion criteria were (1) studies with results about parent empowerment in the context of children's healthcare or healthcare providers; and (2) qualitative studies, observational studies, and systematic reviews of such studies.

INFORMATION SOURCES

We searched the databases of PubMed, Web of Science, and Google Scholar (2006-2017) and reference lists.

INCLUDED STUDIES

Forty-four articles met the inclusion criteria.

SYNTHESIS OF RESULTS

We identified six themes within consequences of empowerment: increased parent involvement in daily care, improved symptom management, enhanced informational needs and tools, increased involvement in care decisions, increased advocacy for child, and engagement in empowering others. Six themes summarizing antecedents of empowerment also emerged: parent-provider relationships, processes of care, experiences with medical care, experiences with community services, receiving informational/emotional support, and building personal capacity and narrative. We synthesized these findings into a conceptual model to guide future intervention development and evaluation.

STRENGTHS AND LIMITATIONS OF EVIDENCE

Non-English articles were excluded.

INTERPRETATION

Parent empowerment may enhance parent involvement in daily care and care decisions, improve child symptoms, enhance informational needs and skills, and increase advocacy and altruistic behaviors. Parent empowerment may be promoted by the parent-provider relationship and care processes, finding the right fit of medical and community services, and attention to the cognitive and emotional needs of parents.

CLINICAL REGISTRATION NO

PROSPERO 2017:CRD42017059478.

Learning by supporting others-experienced parents' development process when supporting other parents with a child with type 1 diabetes

AIMS AND OBJECTIVES

To describe and analyse coach-parents' development process when supporting parents of children recently diagnosed with type 1 diabetes mellitus (T1DM).

BACKGROUND

It has been found repeatedly that providing social support for families with a child diagnosed with T1DM promotes health and well-being for both the child and the parents. Less explored are the processes experienced by those who provide this support. However, research has found that acting as a provider of social support promotes personal development, strengthens communication skills and increases self-confidence.

METHODS

The study design was based on Constructivist Grounded Theory, and data were collected, through repeated focus-group discussions, from eight coach-parents at a Swedish hospital from 2012-2015.

RESULTS

The core category in the data was identified as a learning process where coach-parents emphasised their own learning in the dyad supporter-supported, and in the interaction with other parents in the repeated focus-group discussions. The coach-parents' motivation for participation was a wish to learn more and to help other parents in a life-changing situation. They also pointed out hindrances and their frustration when unable to provide support.

CONCLUSIONS

This study leads to the conclusion that people who provide support benefit from doing so. Encountering people with similar experiences in a supportive situation promotes a reciprocal learning process, based on the supporter's wish to help people in a situation they recognise. A further conclusion is that social support is not only essential initially, but is also important over a longer period and that it follows various life stages.

RELEVANCE TO CLINICAL PRACTICE

Setting up repeated focus-group discussions might be a relevant and effective tool for paediatric diabetes nurses to use in promoting health and well-being for both families with a newly diagnosed child and experienced families.

Parent Depression and Anger in Peer-Delivered Parent Support Services

Knowledge about parents who seek peer-delivered parent support services in children's mental health is limited. In this prospective study, characteristics of 124 parents who sought peer parent advocate services related to their children's behavioral difficulties are described. This urban sample consisted primarily of low-income mothers of color, 80% of whom were caring for children with clinically significant behavioral problems. Of these parents, 64% endorsed clinically significant levels of depressive symptoms at baseline. Linear mixed effects models were used to examine associations between parent depression and anger expression with working alliances with peer advocates. No independent or combined effects of parent depression or anger expression on working alliance were found. However, adjusting for family demographic factors, caregiver strain and child symptoms, parent depression interacted with anger expression to influence working alliances, primarily around agreement and mutual engagement on goals. Among parents who endorsed clinically significant depressive symptoms, anger expression did not influence working alliance but among non-depressed parents, anger expression was negatively associated with working alliance. Implications for training peer parent advocates to more effectively engage low income parents are discussed.

From parent to 'peer facilitator': a qualitative study of a peer-led parenting programme

BACKGROUND

Peer-led interventions are increasingly common in community health settings. Although peer-led approaches have proven benefits for service users, relatively little is known about the process and outcomes of participation for peer leaders. This study investigated experiences of parents who had participated as 'peer facilitators' in Empowering Parents, Empowering Communities (EPEC), a peer-led programme designed to improve access to evidence-based parenting support in socially disadvantaged communities.

METHOD

A qualitative cross-sectional design was used. Semi-structured interviews were conducted with 14 peer facilitators and scrutinized using thematic analysis.

RESULTS

Peer facilitators developed their knowledge and skills through personal experience of receiving parenting support, participation in formal training and supervised practice, access to an intervention manual, and peer modelling. Peer facilitators described positive changes in their own families, confidence and social status. Transformative personal gains reinforced peer facilitators' role commitment and contributed to a cohesive 'family' identity among EPEC staff and service users. Peer facilitators' enthusiasm, openness and mutual identification with families were seen as critical to EPEC's effectiveness and sustainability. Peer facilitators also found the training emotionally and intellectually demanding. There were particular difficulties around logistical issues (e.g. finding convenient supervision times), managing psychosocial complexity and child safeguarding.

CONCLUSIONS

The successful delivery and sustained implementation of peer-led interventions requires careful attention to the personal qualities and support of peer leaders. Based on the findings of this study, support should include training, access to intervention manuals, regular and responsive supervision, and logistical/administrative assistance. Further research is required to elaborate and extend these findings to other peer-led programmes.

Collaboratively reframing mental health for integration of HIV care in Ethiopia

BACKGROUND

Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes.

METHOD

We describe a model for integrating complex specialty care with generalist/primary care, using as an illustration the integration of mental health into hospital-based HIV treatment services in Ethiopia. Generalists and specialists collaboratively developed mental health treatments to fit the knowledge, skills and resources of the generalists. The model recognizes commonalities between mental health and general medical care, focusing on practical interventions acceptable to patients. It was developed through a process of literature review, interviews, observing clinical practice, pilot trainings and expert consultation. Preliminary evaluation results were obtained by debriefing generalist trainees after their return to their clinical sites.

RESULTS

In planning interviews, generalists reported discomfort making mental health diagnoses but recognition of symptom groups including low mood, anxiety, thought problems, poor child behaviour, seizures and substance use. Diagnostic and treatment algorithms were developed for these groups and tailored to the setting by including possible medical causes and burdens of living with HIV. First-line treatment included modalities familiar to generalists: empathetic patient-provider interactions, psychoeducation, cognitive reframing, referral to community supports and elements of symptom-specific evidence-informed counselling. Training introduced basic skills, with evolving expertise supported by job aides and ongoing support from mental health nurses cross-trained in HIV testing. Feedback from trainees suggested the programme fit well with generalists' settings and clinical goals.

CONCLUSIONS

An integration model based on collaboratively developing processes that fit the generalist setting shows promise as a method for incorporating complex, multi-faceted interventions into general medical settings. Formal evaluations will be needed to compare the quality of care provided with more traditional approaches and to determine the resources required to sustain quality over time.

Quality indicators for multidisciplinary team functioning in community-based children's mental health services

The current study examined the organizational social context in 21 community-based programs serving youth at-risk for out-of-home care due to emotional or behavioral disorders and their families and program performance on five quality indicators of team functioning in teams that included a family support specialist. Results indicate that programs with higher performance on structures to facilitate teamwork, informal communication mechanisms among team members, and the ability to integrate family support specialists as equal members of the team showed more positive organizational functioning. Implications for the role of quality indicators in health care reform efforts are discussed.

Family Peer Advocates: A Pilot Study of the Content and Process of Service Provision

Professional family peer advocates are increasingly employed by public mental health systems to deliver family-to-family support that reduces barriers families face in accessing children's mental health care. These services, however, are neither uniformly available nor standardized. This pilot study describes the process, content and context of family-to-family support services. Simulating a parent seeking services, a trained standardized parent participated as a client in meetings with advocates in four programs and collected data through structured observations, a structured survey, and session audiotapes. The "walk-through" process was determined to be feasible and acceptable to family peer advocates as a way of evaluating services. Four family peer advocates provided an average of 25 services during each 2-session simulation with the standardized parent, including the following: information and educational support, instruction and skills development, emotional and affirmational support, instrumental support, and advocacy. Findings also revealed variability in the range of services provided and identified challenges in aspects of service provision, such as boundaries of advocate roles, availability of confidential service environments, and addressing crises and parent concerns about child safety. This paper provides the first in-depth look at services provided by this emerging workforce.

Measuring Family Caregiver Perceptions of Support in Caring for Children and Youth With Mental Health Concerns

This correlational study assessed how families of children with mental illness perceived the levels of support they received from informal and formal resource providers and the associations between perceived support and child outcomes. Adult caregivers (N = 904) of youth receiving public mental health care services were administered the Family Caregiver Perceptions of Support Scale developed by the authors to assess family caregiver perceptions of support prior to and at termination of services. Factor analysis identified three types of caregiver anticipated supports: informal support resources, support for treatment plan influence, and health care resources. The domains were significantly and positively associated with one another but did not uniformly correlate with youth mental health outcomes. The study provides preliminary evidence that treatment gains in youth mental health outcomes are observed when caregivers perceive support in treatment processes. Suggestions for future research are made, stressing the importance of caregivers and providers working together and describing needs related to future scale improvements.