Covid-19 and Families With Parental Mental Illness: Crisis and Opportunity

Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness: a randomised controlled trial and cost analysis

Background

Parental mental illness (PMI) is common and places children at high risk of developing psychological disorders. Family Talk (FT) is a well-known, whole-family, 7-session intervention designed to reduce the risk of transgenerational psychopathology. However, very few larger-scale evaluations of FT (across only a limited number of settings) have been conducted to date while there have been no cost analyses. This study aimed to assess the effectiveness and costs of delivering FT in improving child and family psychosocial functioning in families with PMI within routine mental health settings.

Methods

A total of 83 families with PMI, with children aged 5-18 years, were randomly assigned on a 2:1 ratio to receive either the FT intervention (n=55 families) or usual services (n=28 families) across 10 adult, child and primary care mental health sites in Ireland. Parental disorders included anxiety/depression (57%), Bipolar Disorder (20%), Borderline Personality Disorder (12%), Post-Traumatic Stress Disorder (8%) and psychosis (2%). Detailed assessments with parents were conducted at baseline and 6-month follow up.

Results

FT led to significant improvements in family functioning and child behaviour at 6-month follow up when compared to usual services, with medium effect sizes indicated. Parent participants with lower mental health literacy at baseline also showed significant post-intervention improvements. Those parents with less severe mental illness at baseline, and families with more partner and economic supports, reported additional significant post-intervention improvements in child depression/anxiety and parental mental health symptoms. The cost of FT amounted to €761.50 per family, although this decreased to €415.31 when recurring costs only were included.

Conclusion

The findings from this study, which was conducted within the context of a national programme to introduce family-focused practice in Ireland, demonstrate that FT is a low-cost intervention that improved child and family psychosocial functioning across different mental health disorders within routine adult, child and primary care mental health services. The findings contribute to the growing evidence base for FT, and provide a robust basis to inform practice and policy development for families with parental mental illness both in Ireland and elsewhere.

Clinical trial registration

https://www.isrctn.com/ISRCTN13365858, identifier ISRCTN13365858.

The global impact of COVID-19 on child protection professionals: A scoping review and thematic analysis

BACKGROUND

The COVID-19 pandemic triggered new risks for child maltreatment (CM) and exacerbated existing challenges for families and children, elevating the importance of child protection professionals (CPPs) while also adding barriers to their work. During the pandemic, many CPPs experienced increased workloads, a disrupted work environment, and personal pandemic-related hardships. However, the scope of how COVID-19 impacted CPPs globally, as well as their adopted coping strategies, have not been well explored.

OBJECTIVE

This study addresses these gaps in the research by conducting an international scoping review to explore and analyze these topics.

METHOD

The scoping review was performed in six languages: English, Hebrew, Arabic, French, Spanish, and Portuguese, across 16 databases. Sixteen manuscripts were included in the final thematic analysis of this review.

RESULTS

Two main themes were identified: 1) the impact of COVID-19 on CPPs, and 2) the coping and adaptation strategies employed by CPPs during COVID-19. This review revealed and emphasized the importance of CPPs' resilience during COVID-19, underpinned by the theoretical framework of the social ecology of resilience.

CONCLUSIONS

This study highlights the responsibility of social ecologies and organizational structures to create readiness for a rapid response in times of crisis as well as valuable evidence to inform how CPPs, children, and families may be better supported in the event of a future crisis.

Child Tax Credit, Spending Patterns, and Mental Health: Mediation Analyses of Data from the U.S. Census Bureau's Household Pulse Survey during COVID-19

This study examined the relationship between the receipt of COVID-19 child tax credit and adult mental health problems in the United States, and we explored whether and the extent to which a wide range of spending patterns of the credit-15 patterns regarding basic necessities, child education, and household expenditure-mediated the relationship. We used COVID-19-specialized data from the U.S. Census Bureau's Household Pulse Survey, a representative population sample (N = 98,026) of adult respondents (18 and older) who participated between 21 July 2021 and 11 July 2022. By conducting mediation analyses with logistic regression, we found relationships between the credit and lower levels of anxiety (odds ratio [OR] = 0.914; 95% confidence interval [CI] = 0.879, 0.952). The OR was substantially mediated by spending on basic necessities such as food and housing costs (proportion mediated = 46% and 44%, respectively). The mediating role was relatively moderate in the case of spending on child education and household expenditure. We also found that spending the credit on savings or investments reduces the effect of the child tax credit on anxiety (-40%) while donations or giving to family were not a significant mediator. Findings on depression were consistent with anxiety. The child tax credit-depression relationships were substantially mediated by spending on food and housing (proportion mediated = 53% and 70%). These mediation analyses suggested that different patterns of credit spending are important mediators of the relationship between the receipt of the child tax credit and mental illnesses. Public health approaches to improve adult mental health during and after the COVID-19 pandemic need to consider the notable mediating role of spending patterns.

DAILY LIFE OF FAMILIES AND COVID-19: IN THE LIGHT OF THE COMPREHENSIVE SOCIOLOGY OF MICHEL MAFFESOLI

ABSTRACT Objective to understand the changes that occurred in family daily life faced with illness and/or death of a family member by Covid-19. Method exploratory, analytical, qualitative study, rooted in The Comprehensive Sociology and Daily Life of Michel Maffesoli. Data were collected between September and October 2021 in the municipalities of Maringá, Colorado, Mandaguaçu and Floriano district. Participants were 19 families with at least one family member who became ill and/or died by Covid-19. The sampling was by the non-probabilistic Snowball technique. The in-depth technique was used to explore the daily lives of families. The content of the speeches was organized through thematic analysis. The interpretative synthesis was constructed and discussed from the theoretical framework. Results a category called "Familial daily life after illness and/or loss by Covid-19", emerged from the convergence between the reference which was divided into two subcategories: "Changes in daily life and family functioning" and "Changes after the loss of a loved one". Thus, in the analysis, it was found that the changes in family daily life were permeated by obstacles that were caused by financial and physical limitations or the absence of the element (key person) that once gave solidity to the family unit. Conclusion the daily life of families was profoundly modified, changes negatively affected socio-family relationships, from the most banal aspects of daily life to the more complex ones. This study contributes to the nursing practice and its understanding of an effective practice and supports the development of programs for the surviving families of Covid-19.

QUOTIDIANO FAMILIAL DIANTE DO ADOECIMENTO POR COVID-19: À LUZ DA SOCIOLOGIA COMPREENSIVA DE MICHEL MAFFESOLI

RESUMO Objetivo apreender as mudanças ocorridas no quotidiano familial diante do adoecimento e/ou morte de um membro familiar por Covid-19. Método estudo exploratório, analítico, qualitativo, ancorado na Sociologia Compreensiva e do Quotidiano de Michel Maffesoli. A coleta de dados ocorreu entre setembro e outubro de 2021, nos municípios de Maringá, Colorado, Mandaguaçu e no Distrito de Floriano. Participaram 19 famílias que tiveram ao menos um familiar que adoeceu e/ou faleceu por Covid-19. A amostragem foi por meio da técnica não probabilística Snowball. Utilizou-se a técnica em profundidade para explorar o quotidiano das famílias. Organizou-se o conteúdo das falas por meio da análise temática. As sínteses interpretativas foram construídas e discutidas a partir do referencial teórico. Resultados da convergência entre o referencial e os depoimentos emergiu uma categoria denominada “Quotidiano familial após o adoecimento e/ou perda por Covid-19,” dividida em duas subcategorias: “Mudanças no quotidiano e funcionamento familiar” e “Mudanças após a perda de um ente querido”. Assim, na análise, constatou-se que as mudanças no quotidiano familial foram permeadas por obstáculos que se configuraram por limitações financeiras, físicas ou a ausência do elemento (pessoa-chave) que, outrora, conferia solidez à unidade familiar. Conclusão o quotidiano familial foi profundamente modificado, as transformações incidiram negativamente sobre as relações sociofamiliares, desde os aspectos mais banais do cotidiano até os mais complexos. Este estudo contribui para o saber-fazer do enfermeiro na compreensão de uma prática efetiva, apoiando o desenvolvimento de programas de apoio às famílias sobreviventes da Covid-19.

An Evaluation of the Acceptability, Appropriateness, and Utility of a Bibliotherapy for Children of Parents With a Mental Illness

BACKGROUND

Children of parents with a mental illness are at higher risk for various psychiatric problems and adaptive difficulties compared to those of parents without mental health problems. Certain preventive psychoeducational interventions target these children to promote their well-being and resilience and prevent the emergence of adaptive difficulties. However, few such interventions have been developed and evaluated specifically for elementary school-aged children of parents with a mental illness.

OBJECTIVES

This study aims to evaluate an interpersonal psychotherapy-based book targeting children living with a parent with a mental illness.

METHODS

The study examines children, parents and psychosocial workers' perception of the acceptability, appropriateness and utility of the book. In total, 22 participants answered online open-ended questions after reading the book.

RESULTS

The book was highly appreciated and positively perceived by the families and psychosocial workers. Results suggest that children, parents and psychosocial workers viewed it as an appropriate and useful tool for supporting children with a parent with a mental illness. The present study reveals that the bibliotherapy appears well adapted to the developmental level of school-age children.

DISCUSSION

This study presents a book that shows promise for supporting the resilience of elementary school-aged children having a parent with a mental illness. Results highlight the importance of tailoring the content and modalities of interventions to the developmental level, needs and preferences of elementary school-aged children. The relevance of a collaborative method is also discussed, thus providing knowledge regarding this type of approach for the development of interventions targeting children.

Perspective: Implications of the COVID-19 Pandemic for Family-Focused Practice With Parents With Mental Illness and Their Families

The goal of this perspective piece is to suggest challenges to family-focused practice with parents with mental illness and their children that have emerged during the COVID-19 pandemic. We discuss implications for practice, policy, and research that will benefit from rigorous study in the future, as we sift through lessons learned. The impact of the pandemic on the mental health and well-being of people around the world has been documented. Common adaptations in service delivery have included a shift to telehealth and digital tools. The pandemic has posed challenges to practice across the EASE Framework components for family-focused practice (i.e., Engage, Assess, Support, and Educate) for both parents/families and practitioners. Governmental policy and funding responses will be critical to addressing the impact of stresses, disruptions and losses endured during the past months. Pandemic experiences and consequences have implications for research measures, methods, and outcomes, given the dramatic changes in people's lives and the contexts in which they live. The shift to research implementation in virtual environments has resulted in challenges in maintaining confidentiality, and the privacy and security of data. As we move forward, it will be important to acknowledge the remaining uncertainty about the future and accommodate the profound changes in family life, professional practice, and research implementation related to the pandemic in our efforts to demonstrate the effectiveness of positive lessons learned while developing new approaches for dealing with the negative consequences of the pandemic.

A Family-Focused Intervention for Parental Mental Illness: A Practitioner Perspective

Background: Parental mental illness (PMI) is common and can lead to children developing mental disorders. Family Talk (FT) is a well-known and widely implemented intervention designed to reduce the risk of transgenerational psychopathology. However, given the research to practise "gap," very little qualitative research, to date, has investigated practitioner experiences in implementing FT. This study aimed to explore the practitioner-perceived barriers and facilitators to the implementation and sustainability of FT within mainstream mental health settings. Methods: This qualitative study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] within 15 adult (AMHS), child (CAMHS), primary care mental health, and child protection sites in Ireland. Semi-structured interviews and focus groups were undertaken with a purposive sample of clinicians (n = 31) and managers (n = 10), based on their experiences of implementing FT. Interview data were transcribed verbatim, analysed using constructivist grounded theory, and informed by Fixsen's implementation science framework. Results: Service providers highlighted a number of benefits for approximately two thirds of families across different diagnoses and mental health settings (AMHS/CAMHS/primary care). Sites varied in their capacity to embed FT, with key enablers identified as acquiring managerial and organisational support, building clinician skill, and establishing interagency collaboration. Implementation challenges included: recruitment difficulties, stresses in working with multiply-disadvantaged families, disruption in delivery due to the COVID-19 global pandemic, and sustainability concerns (e.g., perceived fit of FT with organisational remit/capacity, systemic and cultural barriers to change). Conclusion: This study is only the second qualitative study ever conducted to explore practitioner experiences in implementing FT, and the first conducted within the context of an RCT and national research programme to introduce family-focused practise (FFP) for families living with PMI. The findings illuminate the successes and complexities of implementing FFP in a country without a "think family" infrastructure, whilst highlighting a number of important generalisable lessons for the implementation of FT, and other similar interventions, elsewhere.

The Family Talk Programme in Ireland: A Qualitative Analysis of the Experiences of Families With Parental Mental Illness

Background: Parental mental illness is common, costly, can lead to children developing mental disorders and impaired lifetime outcomes, and places a substantial burden on caregiving partners. Family Talk (FT) is a widely implemented, 7-session, whole-family programme, with promising evidence of effectiveness in targeting the intergenerational transmission of mental illness. However, to date, very little qualitative research of family experiences of FT has been undertaken. The objectives of this study were to: (1) investigate the experiences of families attending FT; and (2) explore the key facilitators and barriers to engagement in mainstream mental health settings. Methods: This study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] implemented in 15 adult, child and primary care mental health sites in Ireland. Semi-structured interviews were conducted with a purposive sample of 45 participants, including 23 parents with mental illness (PMI), 7 partners and 15 children/young people aged 9 to 18 years. Interview data were transcribed verbatim and analysed using constructivist grounded theory. Results: Over two thirds of families across sites reported substantial benefits from participation in FT, including reduced stigma, giving children and partners a voice, increased service-user confidence, and improved family communication/relationships. Key facilitators identified by families included: programme delivery by a competent, non-judgmental clinician; the whole-family approach; and family readiness to engage. Barriers to engagement included stigma, family crises/relapse, service constraints, impact of COVID-19, and a need for further child, family and follow-up sessions/supports. Conclusion: This study is the first qualitative analysis of family experiences of FT to be conducted within the context of an RCT and national programme to introduce family-focused practise for families with PMI. The findings illustrate that FT is beneficial across cultural/policy contexts, different mental disorders and can be implemented across adult and child mental health settings, including children with existing mental health challenges. Key barriers and facilitators to implementation were identified by families, all of which should help to inform the future implementation of FT, and other similar interventions, both in Ireland and elsewhere.