![| The CHIMPS-NET Implementation Model [based on (22) and first published (25)] for the health care for children and their mentally ill parents.](https://www.researchgate.net/publication/358912642/figure/fig1/AS:1135015647809538@1647620226929/The-CHIMPS-NET-Implementation-Model-based-on-22-and-first-published-25-for-the_Q320.jpg)
Available via license: CC BY 4.0
Content may be subject to copyright.
A preview of the PDF is not available
Clinical Implementation and Evaluation of Three Implementation Interventions for a Family-Oriented Care for Children of Mentally Ill Parents (ci-chimps): Study Protocol for a Randomized Controlled Multicenter Trial
Abstract and Figures
Background
In Germany, approximately three million children under the age of eighteen have a mentally ill parent. These children are at an increased risk of developing a mental illness themselves (1) as well as a physical illness (2). While research has identified numerous evidence-based family-oriented interventions, little is known about how to implement such interventions effectively and efficiently in clinical practice in Germany. This implementation study (ci-chimps) evaluates three clinical implementation projects with three different implementation interventions for the optimal implementation of the tailored family-oriented preventive and therapeutic interventions in the CHIMPS-NET (children of mentally ill parents—research network) with an implementation model for children of mentally ill parents.
Methods
A two-group randomized controlled multicenter trial will examine changes in family-oriented practice and aspects of implementation at baseline as well as at 12- and 24-months follow-up. The CHIMPS-Network consists of 20 clinical centers. The centers in the intervention group receive the support of all of the three implementation interventions: (1) optimal pathways to care, (2) education and a training program for professionals, and (3) systematic screening for children. The centers in the control group do not receive this specific implementation support.
Discussion
While we know that children of mentally ill parents are an important target group to be addressed by preventive and therapeutic interventions, there is often a lack of structured implementation of family-oriented interventions in clinical practice in Germany. Using a randomized controlled multicenter trial design with a large and wide-ranging sample (clinics for adult psychiatry and clinics for child and adolescent psychiatry, university clinics and clinics at the real health care) will provide a robust understanding of implementing family-oriented changes in German clinical practice.
Trial Registration
The CHIMPS-NET-study was registered with the German Clinical Trials Register on 2019-12-19 (DRKS00020380) and with Clinical Trials on 2020-4-30 (NCT04369625), the ci-chimps-study was registered with the German Clinical Trials Register (DRKS00026217) on 2021-08-27, the Clinical Trials registration is in review process.
Figures - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Zusammenfassung
Kinder psychisch kranker Eltern sind als Risikogruppe für die Entwicklung eigener Auffälligkeiten bekannt. Gleichwohl weisen viele Unterstützungsangebote einen befristeten Projektcharakter auf, und es ist noch keine familienorientierte Regelversorgung für Kinder und Jugendliche mit psychisch erkrankten Eltern in Deutschland etabliert. Am Beispiel des Verbunds „Children of mentally ill parents – network“ (CHIMPS-NET) wird dargestellt, wie sich neue Versorgungsformen mit den Möglichkeiten des Innovationsfonds des Gemeinsamen Bundesausschusses (GB-A) in die Versorgung implementieren lassen. Das systematische Implementierungsmodell des Verbunds, basierend auf Arbeiten aus Australien und Norwegen, wird vorgestellt. Nach der Implementierung und bei erfolgreicher Evaluation ist eine Übernahme der bedarfsorientierten, familienorientierten Versorgungsformen des Verbunds in die regelhafte Versorgung geplant.
Zusammenfassung
Hintergrund
Psychisch erkrankte Eltern stellen einen Risikofaktor für die transgenerationale Weitergabe psychischer Störungen dar. In der Psychiatrie mit ihrem Fokus auf das Individuum werden Patient*innen nicht immer als Eltern erkannt.
Ziel der Arbeit
Entwicklung und Evaluation eines Trainings für medizinische Fachkräfte zur Unterstützung einer Familienorientierung in der Psychiatrie unter der Maßgabe einer bifokalen Perspektive, die den Indexpatienten und die Familie mit Schwerpunkt auf die Kinder im Blick behält, werden vorgestellt.
Methoden
Zur Etablierung der bifokalen Perspektive in Einstellungen, Wissen und Fertigkeiten wurde ein halbtägiges Training, bestehend aus einer Vorlesung und einem Seminar, entwickelt. Dieses wurde im Rahmen des Konsortiums Children of Mentally Ill Parents – Research-Network (CHIMPS-NET) an 7 Standorten in Deutschland in den dortigen Erwachsenen- sowie Kinder- und Jugendpsychiatrien durchgeführt. Der Bedarf wurde vor dem Training per Online-Fragebogen erfasst. Die Implementation wurde durch die qualitative Auswertung von Gedächtnisprotokollen der Trainerinnen begleitet.
Ergebnisse und Diskussion
Das Training konnte erfolgreich mit 120 Teilnehmenden durchgeführt werden, wobei das Ziel einer berufsgruppenübergreifenden Schulung des gesamten Personals, auch pandemiebedingt, nicht realisiert und die übenden Elemente des Trainings nicht gut genutzt werden konnten. Die Auswertung der Fragebogen, die ca. 50 % der Teilnehmenden ausfüllten, ergab bei der Gruppe der teilnehmenden Psychologinnen und Ärztinnen bereits eine deutliche Familienorientierung. Die qualitative Protokollauswertung aller Standorte zeigte den hohen Bedarf nach institutionsübergreifender Vernetzung und klaren Standardprozeduren, z. B. im Umgang mit Kindeswohlgefährdung.
Zusammenfassung
Kinder psychisch kranker Eltern sind als Risikogruppe für die Entwicklung eigener Auffälligkeiten bekannt. Gleichwohl weisen viele Unterstützungsangebote einen befristeten Projektcharakter auf, und es ist noch keine familienorientierte Regelversorgung für Kinder und Jugendliche mit psychisch erkrankten Eltern in Deutschland etabliert. Am Beispiel des Verbunds „Children of mentally ill parents – network“ (CHIMPS-NET) wird dargestellt, wie sich neue Versorgungsformen mit den Möglichkeiten des Innovationsfonds des Gemeinsamen Bundesausschusses (GB-A) in die Versorgung implementieren lassen. Das systematische Implementierungsmodell des Verbunds, basierend auf Arbeiten aus Australien und Norwegen, wird vorgestellt. Nach der Implementierung und bei erfolgreicher Evaluation ist eine Übernahme der bedarfsorientierten, familienorientierten Versorgungsformen des Verbunds in die regelhafte Versorgung geplant.
Zusammenfassung
Hintergrund
Kinder psychisch erkrankter Eltern haben ein erhöhtes Risiko für eigene psychische Belastungen, das durch das Erleben von Misshandlung und Vernachlässigung nochmals erhöht wird.
Ziel der Arbeit
Ziel der vorliegenden Arbeit ist es, die Entwicklung und erste Pilotierung spezifischer Screenings vorzustellen, die es ermöglichen, einen evtl. Unterstützungsbedarf bei Kindern psychisch erkrankter Eltern frühzeitig zu identifizieren.
Material und Methoden
Es wurden 2 Screeningverfahren für Kinder psychisch erkrankter Eltern entwickelt. Im Elternfragebogen des „Kinderscreenings“ werden psychische Auffälligkeiten der Kinder und Jugendlichen (6 bis 18 Jahre) sowie Ressourcen in Kurzform erfasst (psychische Auffälligkeiten: 26 Items, bestehende Ressourcen: 4 Items). Im „Familienscreening“ werden ebenfalls im Selbstbericht der Eltern familiäre Risiko- und Belastungsfaktoren (8 Items) sowie Hinweise auf Misshandlung und Vernachlässigung in der Familie (9 Items) erfragt.
Ergebnisse
Beide Screenings sind mithilfe eines Ampelsystems leicht auszuwerten. Psychiatrisch Behandelnde erhalten eine erste Einschätzung und konkrete Hinweise zum aktuellen psychosozialen Behandlungs- und Unterstützungsbedarf der gesamten Familie und besonders der Kinder. Sie können in der Folge weitere Schritte zur integrierten Versorgung der Familie einleiten.
Schlussfolgerung
Das Kinder- und das Familienscreening sind zeitökonomische, gut verständliche Screenings zur Identifizierung des Behandlungs- und Unterstützungsbedarfs der Familie. Im weiteren Verlauf ist geplant, die Screenings nach abschließender Validierung systematisch in der psychiatrischen Versorgung erkrankter Erwachsener einzusetzen. Somit kann den weitreichenden negativen Folgen für diese Kinder vorgebeugt werden.
Zusammenfassung
Hintergrund
Psychisch erkrankte Eltern stellen einen Risikofaktor für die transgenerationale Weitergabe psychischer Störungen dar. In der Psychiatrie mit ihrem Fokus auf das Individuum werden Patient*innen nicht immer als Eltern erkannt.
Ziel der Arbeit
Entwicklung und Evaluation eines Trainings für medizinische Fachkräfte zur Unterstützung einer Familienorientierung in der Psychiatrie unter der Maßgabe einer bifokalen Perspektive, die den Indexpatienten und die Familie mit Schwerpunkt auf die Kinder im Blick behält, werden vorgestellt.
Methoden
Zur Etablierung der bifokalen Perspektive in Einstellungen, Wissen und Fertigkeiten wurde ein halbtägiges Training, bestehend aus einer Vorlesung und einem Seminar, entwickelt. Dieses wurde im Rahmen des Konsortiums Children of Mentally Ill Parents – Research-Network (CHIMPS-NET) an 7 Standorten in Deutschland in den dortigen Erwachsenen- sowie Kinder- und Jugendpsychiatrien durchgeführt. Der Bedarf wurde vor dem Training per Online-Fragebogen erfasst. Die Implementation wurde durch die qualitative Auswertung von Gedächtnisprotokollen der Trainerinnen begleitet.
Ergebnisse und Diskussion
Das Training konnte erfolgreich mit 120 Teilnehmenden durchgeführt werden, wobei das Ziel einer berufsgruppenübergreifenden Schulung des gesamten Personals, auch pandemiebedingt, nicht realisiert und die übenden Elemente des Trainings nicht gut genutzt werden konnten. Die Auswertung der Fragebogen, die ca. 50 % der Teilnehmenden ausfüllten, ergab bei der Gruppe der teilnehmenden Psychologinnen und Ärztinnen bereits eine deutliche Familienorientierung. Die qualitative Protokollauswertung aller Standorte zeigte den hohen Bedarf nach institutionsübergreifender Vernetzung und klaren Standardprozeduren, z. B. im Umgang mit Kindeswohlgefährdung.
There is increased recognition of the need for greater and more appropriate support to be offered to families in which a parent experiences mental illness and has dependent children. One way of meeting this need is for adult mental health services to take a more family‐focused approach. However, there are recognized difficulties in facilitating family‐focused practice (FFP). The current review systematically synthesized quantitative and qualitative literature of practitioner perspectives and experiences of FFP in adult mental health settings to identify modifiable factors associated with its successful implementation. Five databases were searched systematically leading to the inclusion and quality assessment of 19 papers, ten of which were quantitative and nine qualitative. Analysis was guided by a narrative synthesis approach. Factors shown to influence FFP functioned at both practitioner and workplace levels and included personal attitudes, beliefs about job role, and perceptions of workplace support. Practitioners who felt that a family‐focussed approach was inappropriate or detrimental to service users or outside of their remit as mental health professionals were less likely to adopt this approach. For those who saw the potential benefits of FFP, lack of confidence in their ability to deliver such an approach and lack of training can be barriers, as can lack of support and resources within services. This review highlights the need for actions to boost the awareness of adult mental health practitioners working with parents and to increase their confidence. It also makes the case for broader organizational support if family‐focussed practice is to be implemented successfully.
Background: Children of mentally ill parents have a three to seven times higher risk of developing mental disorders compared to the general population. For this high-risk group, specialized prevention and intervention programs have already been developed. However, there has been insufficient sytematic evaluation to date. Moreover, effectiveness and the cost-effectiveness data of the respective programs until today is very scarce and at the same time constitutes the pre-condition for the program's implementation into regular health care.
Methods: The study consists of a two-group randomized controlled multicenter trial conducted at seven study sites throughout Germany and Switzerland. Participants are families with mentally ill parents and their children aged from 3 to 19 years. The intervention comprises 6 to 8 semi-structured sessions over a period of about 6 months. Topics discussed in the intervention include parental mental illness, coping, family relations and social support. Families in the control condition will receive treatment as usual. The children's mental health, assessed using the K-SADS-PL by blinded external raters will constitute the primary efficacy outcome. Further outcomes will be assessed from the parents' as well as from the children's perspectives. Participants are investigated at baseline, 6, 12, and 18 months after baseline assessment. In addition to the assessment of various psychosocial outcomes, a comprehensive health-economic evaluation will be performed.
Discussion: This paper describes the evaluation of a family-based intervention program for children of mentally ill parents (CHIMPs) in the regular health care system in Germany and Switzerland. A methodically sophisticated study design has been developed to reflect the complexity of the actual health care situation. This trial will contribute to the regular health care for the high-risk group of children of mentally ill parents.
Clinical Trial Registration: www.ClinicalTrials.gov , identifier NCT02308462; German Clinical Trials Register: DRKS00006806.
Background:
Health professionals in Norway are required by law to help safeguard information and follow-up with children of parents with mental or physical illness, or who have substance abuse problems, to reduce their higher risk of psychosocial problems. Knowledge is lacking regarding whether organisation and/or worker-related factors can explain the differences in health professionals' ability to support the families when patients are parents.
Methods:
Employing a translated, generic version of the Family Focused Mental Health Practice Questionnaire (FFPQ), this cross-sectional study examines family focused practice (FFP) differences in relation to health professionals' background and role (N = 280) along with exploring predictors of parent, child, and family support.
Results:
While most health professions had begun to have conversations with parents on children's needs, under one-third have had conversations with children. There were significant differences between nurses, social workers, psychologists, physicians, and others on seven of the FFP subscales, with physicians scoring lowest on five subscales and psychologists providing the least family support. Controlling for confounders, there were significant differences between child responsible personnel (CRP) and other clinicians (C), with CRP scoring significantly higher on knowledge and skills, confidence, and referrals. Predictors of FFP varied between less complex practices (talking with parents) and more complex practices (family support and referrals).
Conclusion:
The type of profession was a key predictor of delivering family support, suggesting that social workers have more undergraduate training to support families, followed by nurses; alternately, the results could suggest that that social workers and nurses have been more willing or able than physicians and psychologists to follow the new legal requirements. The findings highlight the importance of multidisciplinary teams and of tailoring training strategies to health professionals' needs in order to strengthen their ability to better support children and families when a parent is ill.
Objectives: This paper outlines the findings from the first stage of a research programme called PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and Children). This programme aims to identify, help implement and evaluate family-focused interventions for families where a parent has a mental illness, and promote a ‘think family’ service delivery agenda in the Republic of Ireland (RoI).
Methods: An initial scoping study was undertaken to: (1) assess the nature and extent of family-focused practice (FFP) in adult (N = 114) and child (N = 69) mental health services in the RoI; (2) review the international literature; and (3) undertake site/service visits to assess readiness for, and inform the implementation of, FFP.
Results: A national Expression of Interest (EoI) call led to 37 written submissions (20% response rate) plus six further requests for involvement from interested community services. Fifteen sites/services (35%) were included in the research following critical appraisal and consultation. FFP across services/sites was small-scale or non-existent. Following a literature review and other strategic/resource considerations, all sites were invited to deliver the Family Talk (FT) intervention; 12 agreed to do so; three sites will deliver other programmes. A series of activities was undertaken by the research team to support early implementation.
Discussion: This first phase of the research provides a critical starting point for promoting, and assessing the development of, FFP in mental health services in the RoI. Some useful generalisable lessons are also identified in terms of building capacity and beginning to change practice in this field.
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.
Background
Children of parents with mental disorder face multiple challenges.
Aims
To summarise evidence about parental mental disorder and child physical health.
Method
We searched seven databases for cohort or case–control studies quantifying associations between parental mental disorders (substance use, psychotic, mood, anxiety, obsessive–compulsive, post-traumatic stress and eating) and offspring physical health. Studies were excluded if: they reported perinatal outcomes only (<28 days) or outcomes after age 18; they measured outcome prior to exposure; or the sample was drawn from diseased children. A meta-analysis was conducted. The protocol was registered on the PROSPERO database (CRD42017072620).
Results
Searches revealed 15 945 non-duplicated studies. Forty-one studies met our inclusion criteria: ten investigated accidents/injuries; eight asthma; three other atopic diseases; ten overweight/obesity; ten studied other illnesses (eight from low-and middle-income countries (LMICs)). Half of the studies investigated maternal perinatal mental health, 17% investigated paternal mental disorder and 87% examined maternal depression. Meta-analysis revealed significantly higher rates of injuries (OR = 1.15, 95% CI 1.04–1.26), asthma (OR = 1.26, 95% CI 1.12–1.41) and outcomes recorded in LMICs (malnutrition: OR = 2.55, 95% CI 1.74–3.73; diarrhoea: OR = 2.16, 95% CI 1.65–2.84). Evidence was inconclusive for obesity and other atopic disorders.
Conclusions
Children of parents with mental disorder have health disadvantages; however, the evidence base is limited to risks for offspring following postnatal depression in mothers and there is little focus on fathers in the literature. Understanding the physical health risks of these vulnerable children is vital to improving lives. Future work should focus on discovering mechanisms linking physical and mental health across generations.
Declaration of interest
None.
The shift towards a family-focused approach to practice has been highly endorsed across child and adult mental health services, with increasing policy development and a growing evidence base. The aim of this review was to synthesize the qualitative evidence of professionals’ perspectives and experiences of implementing family-focused practice across these settings. Electronic databases were searched up to March 2018, with nine articles included. The synthesis produced two overarching challenges relating to the organizational and system issues of family-focused practice and clinicians’ attitudes, knowledge, and practice towards addressing the complexity of families’ needs. The findings point to a limited evidence of professionals viewing the benefits of family-focused practice and a lack of coherence relating to professionals’ investment in family-focused practice. These are discussed within policy and implementation factors.