Parental mental illness is common and can lead to dependent children incurring a high risk of developing mental disorders, physical illness, and impaired educational and occupational outcomes. Family ...Talk is one of the better known interventions designed to prevent the intergenerational transmission of mental illness. However, its evidence base is small, with few robust independent randomised controlled trials, and no associated process or cost evaluations. The PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children) research programme involves a mixed method evaluation of Family Talk which is being delivered in mental health settings in Ireland to improve child and family psychosocial functioning in families with parental mental illness.
The study comprises a multi-centre, randomised controlled trial (RCT), with nested economic and process evaluations, to assess the clinical and cost-effectiveness and implementation mechanisms of Family Talk compared to usual services. The study is being conducted in 15 adult and child mental health settings in Ireland. Families with a parent with mental illness, and children aged 5-18 years (n = 144 families) will be randomised to either the 7-session Family Talk programme (n = 96) or to standard care (n = 48) using a 2:1 allocation ratio. The primary outcomes are child psychosocial functioning and family functioning. Secondary outcomes are as follows: understanding and experience of parental mental illness, parental mental health, child and parental resilience, partner wellbeing and service utilisation. Blind assessments will take place at pre-intervention and at 6- and 12-month follow-up.
Given the prevalence and burden of intergenerational mental illness, it is imperative that prevention through evidence-based interventions becomes a public health priority. The current study will provide an important contribution to the international evidence base for Family Talk whilst also helping to identify key implementation lessons in the scaling up of Family Talk, and other similar interventions, within routine mental health settings.
ISRCTN Registry, ISRCTN13365858 . Registered 5th February 2019.
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.
Parental mental illness (PMI) is common and places children at high risk of developing psychological disorders.
(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.
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.
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.
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.
https://www.isrctn.com/ISRCTN13365858, identifier ISRCTN13365858.
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.
Controlled trials demonstrate that parenting programs work, but less is known about the processes of change, contextual factors or intervention characteristics that influence trial outcomes. This ...qualitative study assessed the experiences of Irish parents involved in a randomized controlled trial of the Incredible Years BASIC parenting program, with a view to understanding how and why the program works, or does not work, within disadvantaged settings. Data from 33 parents of young children (aged 3–7 years) with conduct problems were collected by semi-structured interviews and analysed using constructivist grounded theory. Emerging themes indicated that parents perceived the program to have produced positive changes through learning key parenting skills (e.g. positive attention, empathy and problem-solving skills) and through enhanced parental mood/confidence, derived primarily from gaining non-judgmental support from the group. Parents also experienced cultural, personal and environmental challenges in learning the new skills, including discomfort with praise and positive attention, conflict with their partner and parenting within an antisocial environment. Parents dropped out of the course for largely circumstantial reasons. These findings should help to inform the future implementation of this well-known parenting program both in Ireland and elsewhere.
The COVID-19 emergency has affected us all, but not equally. Families where parents have mental illness (PMI) are potentially at increased risk, but little is known about how they or their support ...services managed under lockdown/restrictions. We harnessed our existing partnerships with adult and child mental health services in the Republic of Ireland (RoI) and Northern Ireland (NI) to investigate the qualitative experiences of service users and families in coping during the first COVID-19 lockdown (March–May 2020), and how services were supporting them. Semi-structured phone/online interviews were conducted with 22 clinicians/managers (12 from RoI; 10 from NI) who provided information from their caseloads (~155 families with PMI). Sixteen family members (10 from RoI, 6 from NI) were also interviewed. Data were analysed using standard thematic analysis. Sixty percent of families reported improved mental health, primarily due to respite from daily stresses and the “normalisation” of mental distress in the general population. Approximately 30%, typically with more severe/enduring mental illness, reported additional challenges, and mental distress including: unmanageable child behaviours; fear of relapse/hospitalisation; financial difficulties; absence of child care; and a lack of routines. Service provision varied considerably across regions. The experiences within this case study highlight unique opportunities to address the multiple stresses of pre-emergency daily living. We also highlight how mental health services and governments might become more “pandemic ready” to more effectively support vulnerable families, including addressing service overload issues, optimising the use of digital technologies, and providing in-person contact and social supports where required.
Evidence-based parenting programs (EBPPs) are recommended as a first-choice intervention in addressing child conduct problems, but positive outcomes achieved in controlled research environments are ...not always replicated within mainstream services, particularly when delivered in disadvantaged settings. This qualitative study, nested within a randomized controlled trial, investigated the barriers and facilitators associated with the implementation of the Incredible Years Parenting Program (IYPP) in five healthcare services based in disadvantaged areas in Ireland. We conducted semi-structured interviews with service managers (N = 5) and group facilitators (N = 11) who delivered the parenting groups. Interview data were analysed using grounded theory. The findings indicate that the key drivers of successful implementation include: (1) compatibility between intervention and agency goals; (2) intra- and inter-agency supports to enhance fidelity, retention of parents, and leverage of funding; and (3) careful attention paid to group composition and screening for parental readiness to attend the program. There was variability in the extent to which the IYPP was integrated into services and key challenges related to the retention of multiply-disadvantaged parents and sustainability issues. Reassuringly, the analysis also revealed measures by which such challenges may be addressed. This study is one of the first to investigate the agency processes and factors involved in implementing an EBPP with disadvantaged families in mainstream healthcare settings. In addition, there are a number of important generalizable lessons for the implementation and upscaling of EBPPs elsewhere.
Early-onset child conduct problems are common and costly. A large number of studies and some previous reviews have focused on behavioural and cognitive-behavioural group-based parenting ...interventions, but methodological limitations are commonplace and evidence for the effectiveness and cost-effectiveness of these programmes has been unclear.
To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills.
We searched the following databases between 23 and 31 January 2011: CENTRAL (2011, Issue 1), MEDLINE (1950 to current), EMBASE (1980 to current), CINAHL (1982 to current), PsycINFO (1872 to current), Social Science Citation Index (1956 to current), ASSIA (1987 to current), ERIC (1966 to current), Sociological Abstracts (1963 to current), Academic Search Premier (1970 to current), Econlit (1969 to current), PEDE (1980 to current), Dissertations and Theses Abstracts (1980 to present), NHS EED (searched 31 January 2011), HEED (searched 31 January 2011), DARE (searched 31 January 2011), HTA (searched 31 January 2011), mRCT (searched 29 January 2011). We searched the following parent training websites on 31 January 2011: Triple P Library, Incredible Years Library and Parent Management Training. We also searched the reference lists of studies and reviews.
We included studies if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. We only included studies that used at least one standardised instrument to measure child conduct problems.
Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information.
This review includes 13 trials (10 RCTs and three quasi-randomised trials), as well as two economic evaluations based on two of the trials. Overall, there were 1078 participants (646 in the intervention group; 432 in the control group). The results indicate that parent training produced a statistically significant reduction in child conduct problems, whether assessed by parents (standardised mean difference (SMD) -0.53; 95% confidence interval (CI) -0.72 to -0.34) or independently assessed (SMD -0.44; 95% CI -0.77 to -0.11). The intervention led to statistically significant improvements in parental mental health (SMD -0.36; 95% CI -0.52 to -0.20) and positive parenting skills, based on both parent reports (SMD -0.53; 95% CI -0.90 to -0.16) and independent reports (SMD -0.47; 95% CI -0.65 to -0.29). Parent training also produced a statistically significant reduction in negative or harsh parenting practices according to both parent reports (SMD -0.77; 95% CI -0.96 to -0.59) and independent assessments (SMD -0.42; 95% CI -0.67 to -0.16). Moreover, the intervention demonstrated evidence of cost-effectiveness. When compared to a waiting list control group, there was a cost of approximately $2500 (GBP 1712; EUR 2217) per family to bring the average child with clinical levels of conduct problems into the non-clinical range. These costs of programme delivery are modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems.
Behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills in the short term. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Further research is needed on the long-term assessment of outcomes.
•Incredible Years Parenting Program highly acceptable to foster and birth parents.•Significant improvements in foster child emotional and behavioral difficulties.•Enhanced child relationships with ...birth and foster parents.•Trauma-informed adaptations to program delivery advised.•Program may add value to standard training and supports for foster children.
Trauma-related social, emotional and behavioral difficulties (SEBD) are common among children in foster care and are the primary reason for placement breakdown. SEBD in foster children – and especially in the context of unstable and troubled relationships with both foster and biological parents - affects the child’s future functioning and has substantial cost implications in terms of public service utilization. The aim of this study was to assess the utility and perceived effectiveness of the 18-week Incredible Years parenting program (IYPP) which was delivered, on an exploratory basis, to both biological and foster parents (including kinship and non-relative care) of 23 foster children (aged 3–10 years). Biological and foster parent pairs (n = 46) were assessed at pre-intervention and at 6-month follow up, using measures of child SEBD, parenting stress, competencies, and quality of child-parent/carer relationships. One-to-one interviews and a focus group were also undertaken with a subset of biological parents (n = 12), foster carers (n = 11) and Social Work clinicians (n = 5) who delivered the program; the findings were analyzed using grounded theory. Both biological and foster parents reported statistically significant improvements in child SEBD, parent–child relationships, and in parenting stress and competencies. The qualitative findings highlighted further benefits for families, such as an increased number of access visits between biological parents and children and improved relationships with Social Work clinicians. Several factors were identified as important when implementing the IYPP with foster children, including: potential difficulties in engaging both foster and biological parents within the Social Work infrastructure; making appropriate adaptations to program principles, and integrating delivery with a trauma-informed approach. These findings contribute to the growing body of evidence that the IYPP could add value to the standard training and supports for foster parents, children and biological parents.
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