The Village research project aims to create a better understanding how to support children of mentally ill parents. This project is co-developed with stakeholders and implements and evaluates two practice approaches, focused on the child and on principles of collaborative care. The project uses mixed-methodologies, involving numerous data collection methods. It aims to directly improve identification and support of vulnerable children in Tyrol, and by doing so, improve the health and wellbeing of future Austrian generations, while breaking the cycle of intergenerational transfer of adverse childhood experiences. There will be two components to the evaluation – a process evaluation examining the impact of the village project activities and an outcome evaluation examining the impact of the new practice approaches. The process evaluation is expected to involve qualitative interviews/focus groups and surveys with participants, as well as formal and informal meetings with stakeholders to understand how the project has been implemented along the way. The research findings will also be relevant for healthcare providers and policy makers in other countries, and the international research community.
Our interdisciplinary team is made up of internationally esteemed researchers including: family and child/adolescent psychology, health economics, social science, applied linguistics, implementation science, and rural health. As part of this project the research team is developing specific expertise on transdisciplinary co-design research methods, whereby community-research partnerships are developed to design and implement those research questions valuable to the local community here in Tyrol.
This WP will identify the ways in which children currently, and wish to, participate in discussions about their needs, from child, service providers, and parent perspectives. This WP will uphold the project’s underpinning philosophy to hold the child at the centre of their own care, and to listen and support them in identifying their own formal and informal support network.
The importance of ‘assent’ and supporting children to develop their own ‘voice’ in healthcare is increasingly acknowledged within child health research. This follows the United Nations Convention on the Rights of the Child, acknowledging the ethical imperative and rights for children to be provided with their own health information. Concepts of ‘child voice’ and child-centred communication will contribute to developing practice approaches to improve identification and strengthen child-focused support for children who have a parent with a mental illness.
We will undertake narrative literature reviews of both paediatric healthcare interactions, and studies examining the concept of ‘child voice’. This will inform subsequent development and analysis within the broader project. We will conduct a series of sociological and linguistic micro-analyses across collected project data in Austria, supplemented by additional observational data. This project has the support of Professor Lesley Stirling, School of Languages and Linguistics, The University of Melbourne, Australia.
Findings will provide opportunities to educate professionals in appropriate ways to engage and support COPMI to become more communicatively active in conversations with adults about their needs. This WP will importantly address knowledge gaps in this area and inform practice change.
Identify:
This Work Package will generate the knowledge and conceptual frameworks to inform and to be tested in co-development, implementation and evaluation. In this phase, literature reviews will be conducted, and knowledge via stakeholders will be gathered to understand and describe: a) current practice, recommended practice and gaps in relation to the identification of children with mentally ill parents (COPMI), and collaborative care that listens to the child’s voice 2) the (unmet) needs for COPMI; 3) what works for whom and when, is cost-effective and the mechanisms (active ingredients) and contextual factors that can inform the development of logic models and the development of approaches. Stakeholders in the community, from services and families will be consulted using interviews, focus groups, desktop research and document review, and scoping reviews of the literature. Logic models will be drafted with the help of literature reviews and stakeholder interviews, in line with a realistic approach; this work will inform WP4 where the logic model will be co-developed and agreed with stakeholders.
This work package has three aims. Firstly, we will develop practice approaches and tools to identify children with mentally ill parents (COPMI) and to support them in everyday life by building networks among formal and informal support systems in Tyrol. Secondly, training material for implementing the practice approaches will be developed and thirdly, key-indicators for evaluating the practice approaches will be defined. The development of the practice approaches and evaluation indicators will be done in a participatory manner (co-design) involving representatives of stakeholders and particularly including people with lived experience.
To this end we will facilitate a series of design workshops with stakeholders at the study site to develop the components of the practice approaches based on the results from the scoping (WP 3). Qualitative methods will be applied to analyse the data collected throughout this WP.
This work package aims to translate the co-design approach (from Work package 4) into practice. The package will work with service providers and interested stakeholders to train and support the delivery identification of COPMI approaches, as well as the village approach aiming to establish and enhance informal and formal support networks around the child. This work package draws on what is known from the field of implementation science, which aims to assist in the translation of new evidence based interventions into routine delivery by service providers. In Tyrol, a number of interested service providers will be trained and mentored in the identification approach, and interested village agents will be trained and mentored in the support network approach that focuses on the child’s voice. A significant part of this work package will be to support a staged development of training and coaching support. It will involve extensive exploration of the context and a review of best practice in the literature (Work package 3), as well a preparatory stage to co-develop an approach that considers the context and the potential barriers, and develops strategies with key stakeholders to assist with establishing training supports for service providers in Tyrol (Work package 4). An evaluation (Work package 6) will be undertaken during this phase. Both an understanding of the implementation process as well as the impact of the new approaches on practitioners and families will be explored. Qualitative and quantitative methods will be applied to analyse the data collected throughout this WP.
The main objective of this WP is to generate evidence as to whether the practice approaches we developed were successfully implemented (process evaluation) and whether they led to positive outcomes for children and their families (outcomes evaluation). In addition, we are also evaluating the costs of implementing those practice changes and changes in resource use (cost evaluation). The evaluation will be carried out using a realist approach. That means we will not only be able to understand whether positive outcomes were achieved but also for whom, under which conditions and how. This kind of knowledge can be particularly useful in order to derive recommendations for rolling out an intervention in other localities.
The programme theory and logic models (developed in WP3, WP4) will inform the framework of evaluation. In terms of the process evaluation, we will measure things like: professionals trained; parents and children identified; children referred; as well as awareness and behaviour change in professionals. Outcomes as well as costs will be measured in a comparative study design, which will compare two strategies: one will be about identifying parents and their children (and providing them with additional information), the other one will be about identifying them and offering additional support for the children (in addition to information). What will be measured will be agreed with stakeholders during the scoping and co-developing phase (WP3, 4).
The objectives of this work package are: (1) to gain ownership and buy-in for the research among stakeholders throughout the different research phases, and (2) to achieve impact at an individual, community, regional and (inter-) national level; this includes impact in regards to research, practice and policy. All communication and dissemination will be designed sensitively, with the aim to reduce stigma as a potential barrier to the realization of the project. To achieve at this, a range of open-day forums will be organized throughout the project to which a wide range of stakeholders will be invited; this will include: families, service managers, politicians, researchers, commissioners, practitioners (including clinicians, social workers, school teachers). Events will inform stakeholders about the research and include educational components; for example, keynote speakers might talk about latest evidence and good practice; policy makers and influencers (including patient and professional associations) will be engaged via Ludwig Boltzmann Gesellschaft; partnerships will be built and managed with organisations and projects that have similar aims and work with similar target groups such as “Frühe Hilfen” and “Communities that Care”; ongoing information will be made available via a project specific website; a range of innovative communication tools (e.g. video, infographics) will be developed, which will be disseminated together with research reports throughout the project to promote the research aims, methods and findings; peer reviewed papers will be produced and published in recognized journals and a joint researcher-stakeholder conference is planned at the end of the project to communicate major findings to the wider community.
In this literature review, we aim to understand the broad spectrum of adverse effects from parental mental health problems in children and the economic consequences on an individual and societal level to navigate the design of economic evaluations in this field.
Zechmeister-Koss et al. (2022): Economic Evaluation of Family-Focused Programs When Parents Have a Mental Health Problem: Methodological Considerations. Value in Health, https://doi.org/10.1016/j.jval.2022.11.016
In this paper, we analyze our co-design process in which 26 community and 13 research partners collaborated to develop an intervention program for children whose parents have a mental illness. What is special about this paper is that our partners not only participated in the co-design process but also in the scientific publication.
Zechmeister-Koss, I., Aufhammer, S., Bachler, H., Bauer, A., Bechter, P., Buchheim, A., Christiansen, H., Fischer, M., Franz, M., Fuchs, M., Goodyear, M., Gruber, N., Hofer, A., Hölzle, L., Juen, E., Papanthimou, F., Prokop, M. and Paul, J.L. (2022), Practices to support co-design processes: A case-study of co-designing a program for children with parents with a mental health problem in the Austrian region of Tyrol. Int J Mental Health Nurs. https://doi.org/10.1111/inm.13078
Stigma can have devastating health and wellbeing impacts, not just on people with mental health problems, but on people associated with the stigmatized person. This is called stigma-by-association. The current study is a systematic mixed studies review, synthesizing knowledge about how this group of children experience stigma-by-association.
Dobener L-M, Fahrer J, Purtscheller D, Bauer A, Paul JL and Christiansen H (2022) How Do Children of Parents With Mental Illness Experience Stigma? A Systematic Mixed Studies Review. Front. Psychiatry 13:813519. doi: 10.3389/fpsyt.2022.813519
The paper describes the use of codesign and other implementation strategies, applied to a research setting, with the aim of impacting the sustainability of workforce reform to achieve lasting social impact.
Goodyear M, Zechmeister-Koss I, Bauer A, Christiansen H, Glatz-Grugger M and Paul JL (2022) Development of an Evidence-Informed and Codesigned Model of Support for Children of Parents With a Mental Illness— “It Takes a Village” Approach. Front. Psychiatry 12:806884. doi:10.3389/fpsyt.2021.806884
The aim of this study was to develop knowledge about relationships between contextual factors, mechanisms and impact that could inform a program theory for developing, implementing, and evaluating family-focused practice.
Bauer A, Best S, Malley J, Christiansen H, Goodyear M, Zechmeister-Koss I and Paul J (2021) Towards a Program Theory for Family-Focused Practice in Adult Mental Health Care Settings: An International Interview Study With Program Leaders. Front. Psychiatry 12:741225. doi: 10.3389/fpsyt.2021.741225
This review synthesised knowledge about how social support can be mobilised through interventions that seek to improve children’s mental health outcomes.
Bauer A, Stevens M, Purtscheller D, Knapp M, Fonagy P, Evans-Lacko S, et al. (2021) Mobilising social support to improve mental health for children and adolescents: A systematic review using principles of realist synthesis. PLoS ONE 16(5): e0251750.
Bauer A, Stevens M, Purtscheller D, Knapp M, Fonagy P, Evans-Lacko S, et al. (2021) Mobilising social support to improve mental health for children and adolescents: A systematic review using principles of realist synthesis. PLoS ONE 16(5): https://doi.org/10.1371/journal.pone.0251750
The article presents two current research projects on children of parents with a mental illness (COPMI) focusing on preventive approaches.
Christiansen H, Paul L. Unterstützung von Kindern mit psychisch erkrankten Eltern: Stand der Forschung, Vorstellung von zwei Praxisprojekten und Forderungen an die Bundesregierung. Prax. Kinderpsychol. Kinderpsychiat. 69/2020, 443-462 (2020)
The aim of this paper is to summarise the results from a multi-dimensional situational analysis, in order to obtain an in-depth understanding of the local context and the existing needs for supporting the affected children and their families.
Zechmeister-Koss, I., Goodyear, M., Tüchler, H. et al. Supporting children who have a parent with a mental illness in Tyrol: a situational analysis for informing co-development and implementation of practice changes. BMC Health Serv Res 20, 326 (2020). https://doi.org/10.1186/s12913-020-05184-8
The aim of this paper is to describe the uptake of mental health care benefits in Tyrol based on administrative claims data.
Zechmeister-Koss, I., Tüchler, H., Goodyear, M. et al. Reaching families where a parent has a mental disorder: Using big data to plan early interventions. Neuropsychiatr 34, 39–47 (2020). https://doi.org/10.1007/s40211-019-00323-y
This paper describes the process of engaging the public in generating societal relevant research questions and establishing international and interdisciplinary “Research Groups” on mental health of children and adolescents.
Kaisler R, Paul J (2019). Evidence-based practice and policies for impact on mental health of children and adolescents. Fteval Journal for Research and Technology Policy Evaluation. Vol. 48, pp. 114-119, DOI: 10.22163/fteval.2019.377
Study protocol
Christiansen H, Bauer A, Fatima B, Goodyear M, Lund IO, Zechmeister-Koss I and Paul JL (2019) Improving Identification and Child-Focused Collaborative Care for Children of Parents With a Mental Illness in Tyrol, Austria. Front. Psychiatry 10:233. doi: 10.3389/fpsyt.2019.00233
Parental mental illness is a common and serious complication during pregnancy and the first year after birth: up to 20 % of women and 10 % of men suffer from mental health problems such as depression or anxiety disorders in the perinatal period. This report describes the epidemiological situation as well as existing services in the field of prevention and care of PMI for Austria as an overview and in detail for Tyrol.
Zechmeister-Koss, I. Perinatal and infant mental health care in Austria. A mapping report of existing prevention, screening and care structures, with a specific focus on Tyrol. AIHTA Project Report No. 151. 2023. Vienna: HTA Austria – Austrian Institute for Health Technology Assessment GmbH.
The scoping review provides a comprehensive overview of international good practice models for perinatal and infant mental health care models and pathways. The results from this report can be used for further discussion and serve as a basis for designing, further developing and implementing PIMH care in Austria.
Reinsperger, I. and Paul, J. (2022): Perinatal and infant mental health care models and pathways. HTA-Projektbericht 148.
The project summary describes our co-design process to improve the sitaution for families with mental health problems in Tyrol with the Village concept as well as results from the piloting.
The report is intended to inform about existing health economic evidence in this field and to serve as a source of information for (health economic) researchers to conduct sound evaluations and impact assessments of family-oriented intervention programmes in the context of chil- dren and adolescents from parent with a mental illness.
Strohmaier C, Hölzle L, The economic and societal dimension of parental mental illness –Systematic review and economic evaluation framework, AIHTA Project Report No.: 142; 2021. Vienna: HTA Austria – Austrian Institute for Health Technology Assessment GmbH.
The report aims at providing an overview of the Tyrolean socio-economic and demographic situation (context information) as well as a mapping on existing in-kind and cash benefits (financial support) that may play a role in identifying and supporting children of parents with a mental illness and their families.
Zechmeister-Koss, I., Goodyear, M. Supporting children who have mentally ill parents in Tyrol: A mapping of existing support structures and epidemiological dimensions. LBI-HTA Projektbericht Nr.: 113a; 2018. Wien: Ludwig Boltzmann Institut für Health Technology Assessment.
The report aims to provide evidence on the epidemiology of mental disorders as well as on the characteristics on the uptakes of mental health benefits that are provided within the health care sector in Tyrol.
Zechmeister-Koss, I, Tüchler, H. Prevalence of mental disorders and uptake of mental health services in Tyrol: An analysis of epidemiological literature and administrative data from the Tyrolean health insurance. LBI-HTA Projektbericht Nr.: 113b. 2018. Wien: Ludwig Boltzmann Institute for Health Technology Assessment.
This document describes the Village practice approach to support practitioners in their work with children of parents with a mental illness and with the parents themselves. This framework is targeted at adult mental health practitioners, primary health clinicians and village facilitators.
Goodyear, Melinda; Zechmeister-koss, Ingrid; Burn, Matthew; Glatz-Grugger, Martina; Pinggera, Anna-Elena; Seis, Elena; et al. (2023). The "It Takes a Village" Practice Manual. Monash University. Model. https://doi.org/10.26180/22564960.v3
This review has been conducted in cooperation with colleagues in Germany and Denmark. It summarizes the current research on the associations of parental mental health symptoms and child mental health outcomes during the COVID-19 pandemic.
Stracke, M.; Heinzl, M.; Müller, A.D.; Gilbert, K.; Thorup, A.A.E.; Paul, J.L.; Christiansen, H. Mental Health Is a Family Affair—Systematic Review and Meta-Analysis on the Associations between Mental Health Problems in Parents and Children during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2023, 20, 4485. https://doi.org/10.3390/ ijerph20054485
This Editorial on the Research Topic "Parents with mental and/or substance use disorders and their children, volume II". It introduces 24 reflecting progress in the field, in the development and application of theory, and intervention specification, sustainability, and impact.
Nicholson J, Paul JL, Riebschleger J and Wittkowski A (2022) Editorial: Parents with mental and/or substance use disorders and their children, volume II. Front. Psychiatry 13:1020660. doi: 10.3389/fpsyt.2022.1020660
This brochure offers information, but also tips and offers of help for children and adolescents as well as parents.
Children notice the mental crises of their caregivers. They sense when their parents are not doing well. It is helpful for children to talk about this. Children therefore need support just as much as their parents.
The goal of "SiBa - Sichere Bases" is to relieve the burden on families and to strengthen family resources.
This article is amongst others published by Melinda Goodyear, one of the Village Co-Investigators from Australia. In their work, they propose a model for sustaining family focused practice in adult mental health services in Australia.
Allchin B, Weimand BM, O'Hanlon B and Goodyear M (2022) A Sustainability Model for Family-Focused Practice in Adult Mental Health Services. Front. Psychiatry 12:761889. doi: 10.3389/fpsyt.2021.761889
One of our Co-Investigators from Australia, Melinda Goodyear, reports in this article about a similar intervention like the Village project in Australia, called 'Let's talk about children'.
Goodyear MJ, Allchin B, Burn M, et al. Promoting Self-Determination in Parents With Mental Illness in Adult Mental Health Settings. Journal of Family Nursing. January 2022. doi:10.1177/10748407211067308
This work has been led by one of our colleagues and Co-Investigators from the London School of Economics and Political Science, Annette Bauer. They are making an economic case around perinatal mental health treatment where they created an integrated model of care.
Bauer et al. (2022), The economic case for increasing access to treatment for women with common mental health problems during the perinatal period. Care Policy and Evaluation Centre LSE, 2022
Our German co-investigator (Hanna Christiansen) and PhD students (Julia Fahrer, Lisa-Marie Dobener) provide useful therapeutic help for psychotherapists, pediatricians and pedagogues working with children of parents with mental illnesses.
In this study, colleagues from Norway identify the overarching structure of research on parents with psychiatric disorders, and the structure of the different research areas, as defined by psychiatric disorder groups in ICD-10, and identify both topics that are commonly examined, and topics that received attention in only a few of the research areas.
Andersen, N., Lund, I.O. Mapping the literature on parents with mental illness, across psychiatric sub-disciplines: a bibliometric review. BMC Psychiatry 20, 468 (2020). https://doi.org/10.1186/s12888-020-02825-4
Our colleague and Co-Investigator from the School of Rural Health, Monash University and the Parenting Research Centre in Australia, Melinda Goodyear, describes the intergenerational needs of families where a parent has a mental illness.
Goodyear M, McDonald M, von Doussa H, Cuff R, Dunlop B. Meeting the Intergenerational Needs of Families Where a Parent Has a Mental Illness [English and Spanish versions]. Journal of Parent and Family Mental Health 2018;3(2):1011. https://doi.org/10.7191/parentandfamily.1011
This is a video from the Canadian research project: Co-producing help-seeking narratives with children of parents with mental illnesses, by sociologists Brenda Gladstone and Jennifer Bramwell. More information see: http://brendagladstone.ca
For use by families where a parent has a mental illness, their supporters, and services who work with them.
Building on an evidence-based approach from Finland called "Lets Talk about Children", this Australian project aims to develop a recovery-based model specifically designed for parents with mental health problems. Our co-investigator, Melinda Goodyear, is involved.
Emerging Minds as international stakeholders of the Village project has been dedicated to the mental health and emotional wellbeing of Australian infants, children and families for over 20 years. Whether you’re a practitioner, parent, family member or organisation, here you can find mental health information and approaches for infants, children and families.
This publication is intended for professionals training or practicing in mental health.
