About the research project

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. 

 

About the research team

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.

Work packages

  • WP 1: MANAGEMENT

    • project management & communication
    • set up project structure
    • monitor milestones
    • organize joint stakeholder & researcher conference
  • WP 2: THE CHILD‘S VOICE

    • i.e. linguistic microanalysis of communicative interactions involving children
    •  Co-participation with children – photo voice, roundtable discussions
    Details

    Work package 2: Child's voice

    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.

  • WP 3: SCOPING

    Identify:

    • Existing evidence & practice & current state of collaboration in Austria (eg, practice, recommended approaches, gaps, barriers….)
    • active ingredients (eg, focus on the patient, trust)
    Details

    Work package 3: Scoping

    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.

  • WP 4: CO-DEVELOPMENT

    • Co-development of screening & collaboration approaches
    • present scoping summary
    • draft practice approaches
    • develop training approach
    Details

    Work package 4: Co-development

    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.

  • WP 5: IMPLEMENTATION

    • Training and implementation approaches
    • NIRN approach (exploration, installation, pre-implementation)
    • target group: COPMI 4-18 years of age
    Details

    Work package 5: Implementation

    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.

  • WP 6: EVALUATION

    • Formative (feasible, appropriate, and acceptable)
    • Process (intended implementation)
    • Outcome (cost-) effectiveness
    • Impact (ultimate goals)

     

    • Realist Evaluation
    Details

    Work package 6: Evaluation

    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).

  • WP 7: DISSEMINATION OF RESULTS

    • conferences
    • public media
    • open access publications
    • website
    •  patient-stakeholder-researcher conference
    Details

    Work package 7: Communication and Dissemination

    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.

  • OBJECTIVES

    • Collaborative child focus practice;
    • improved child development & well-being;
    • enhance cost-effectiveness through collaborative practice

Timeline

Interviews and Focus groups with Stakeholder (April-June 2018)

  • Aim: Reflect current practices amoung child and adolescent services and support for children of parents with a mental illness
  • Establish collabration with stakeholders to: co-design interventions, train for screening of children at-risk, gauge interest to act as a "Village facilitator" coordinating support for children, take part in the evaluation of implemented interventions
  • Target group: Mental Health servicesfor adults, children and adolescents
  • Required time: 1x 1-2 hours interview or 2-3 hours focus group 

Co-Design of interventions (October-March 2019)

  • Aim: build on scoping of literature reviews, interviews and focus groups to co-develop interventions with stakeholders
  • Target group: experts and stakeholders identified in scoping review (parents, children, health care professionals, youth services, etc.)
  • Required time: ca. 6x 2-3 hours
  • Workshops (once a month) 

Implementation of interventions 
(September 2019-September 
2020 to June 2021)

  • Aim: To implement the new co-designed practice approaches in services, with training and mentoring support of interested professionals who may wish to enhance their practice to support COPMI in their work or in the community. Training and mentoring will be conducted by experts in implementation science, who will also work with services to help support the change process.
  • Target group: service professionals, community members and identified "Village facilitators".    
  • Training workshops: 3 x 2 hrs and monthly mentoring.

Evaluation (2021-2022)

  • Aim: measure impact of implemented interventions regarding their cost efficiency unsing interviews and surveys for evaluation
  • Target group: all stakeholders involved in the project

Our Scientific Publications

  • Njål Andersen &  Ingunn Olea Lund

     

    Research on parental mental illness is often carried out in disorder specific research silos. Drawing on the different research areas, it is possible to leverage and combine existing knowledge, and identify insights that can be transferred across research areas. In this study, we 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.

  • Praxis der Kinderpsychologie und Kinderpsychiatrie

    Children of parents with mental illness (COPMI) have an increased risk of developing mental disorders themselves. According to estimates, around 25% of all children in Germany live with a parent with a mental illness. This is therefore a large high-risk group. At the same time, there are hardly any preventive interventions for this target group and studies investigating the mechanisms of transgenerational transmission of mental disorders are scarce. This article presents two current research projects on the topic and focuses on preventive interventions. In the BMBF-funded project "Children of Parents with a Mental Illness At Risk Evaluation" (COMPARE), mentally ill parents of children aged 1.5 to 16 years are studied. Parents must meet a current DSM-5 diagnosis and receive 25-45 hours of gold-standard Cognitive Behavioral Therapy (CBT). Half of the participating parents will also be randomized to receive the Positive Parenting Program. This is to test the effects of parental psychotherapy on children and whether additional parent training leads to incremental effects. The project "The Village" is a model project in the region of Tyrol, Austria, and focuses on the identification and collaborative care of COPMI.

    Translated with www.DeepL.com/Translator (free version)

  • Final report: Supporting children who have parents with mental disorders in Tyrol

    A mapping of existing Tyrolean support and societal structures

    Background

    A 4-year research project aims at improving the situation of children who have mentally ill parents (COPMI) in Tyrol. For developing practice approaches to better identify and support these children and their parents, we need an in-depth understanding of the regional Tyrolean characteristics in terms of existing support structures and the societal context they are embedded in.

  • Final report: 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

    Background and aim

    Different approaches can be followed for early identifying and supporting children with mentally ill parents. One is to get into contact with the chil- dren via the parents in the adult mental health care settings. To explore this strategy further, information on the prevalence of mental disorders and the users of mental health benefits is required. The report aims to provide evi- dence on the epidemiology of mental disorders as well as on the characteris- tics on the uptakes of mental health benefits that are provided within the health care sector in Tyrol.

  • Background: A research project, which aims to improve the situation of children of parents with a mental illness (COPMI) is currently underway in the Austrian region of Tyrol. The project aims to strengthen formal and informal support structures around the child, through enhancing their village of collaborative support. Understanding the current situation in the region is vital for implementing practice change. This paper aims to gain knowledge regarding the Tyrolean societal and service provision context.

  • Background: Children who grow up with a mentally ill parent often remain invisible and do not receive adequate support. Their prevalence is high (1 out of 4) and they are at increased risk of experiencing long-term difficulties. A research project aims to co-develop (researchers and stakeholders together), implement and evaluate practices to improve identification of and social support for the children and their families in Tyrol. We present the results of the co-development process based on six stakeholder workshops.

  • Background: Children who grow up with a parent who has a mental health problem (25%) are at increased risk of developing (health) problems themselves. One approach to reach those children for early intervention supports is through their parents seeking treatment within the adult mental healthcare system. We aimed to gain information on the users of adult mental health services in Tyrol, Austria in order to understand more about the identification of these families to provide support.

  • Background: For the last decades, health technology assessment has been strongly promoted in order to provide evidence-based rather than eminence-based healthcare. However, when it comes to implementing interventions that are based on processes and behavior rather than products, importing evidence-based interventions is likely to fail because it ignores the strong influ- ence of contextual factors. In a recently started research project, an alternative approach is tested.

  • Out of focus: care for children of parents with mental illnesses.

    Viel zu viel und doch zu wenig. Über- und Unterversorgung in der Medizin

    Christiansen, H. & Paul, J. L. 

  • Influences on drinking choices among Indigenous and non-Indigenous pregnant women in Australia

    • Gibson, S., Nagle, C., Paul, J., McCarthy, L., & Muggli, E. (2020)

    Despite women’s awareness that drinking alcohol in pregnancy can lead to lifelong disabilities in a child, it appears that an awareness alone does not discourage some pregnant women from drinking. To explore influences on pregnant women’s choices around alcohol use, we conducted interviews and group discussions with 14 Indigenous Australian and 14 non-Indigenous pregnant women attending antenatal care in a range of socioeconomic settings. 

  • Christiansen, H., Röhrle, B., Fahrer, J., Stracke, M., Dobener, L.-M. (2020)

     

     

Our Reports

  • Children of parents with a mental illness (COPMI) are more likely to experience negative long-term adversities. However, interventions to support their needs early can significantly enhance adjustment and reduce negative outcomes. Approximately one in four children currently lives with a parent with mental illness worldwide. The lifelong impact for individuals, governments, and broader society is likely to be substantial. There are significant workforce barriers to the early identification of COPMI and addressing their needs, particularly within the adult mental health care system. The current study aims to reduce such barriers and to improve identification of COPMI in the current health care systems.

Our Resources

  • Children of parents with a mental illness (COPMI) are more likely to experience negative long-term adversities. However, interventions to support their needs early can significantly enhance adjustment and reduce negative outcomes. Approximately one in four children currently lives with a parent with mental illness worldwide. The lifelong impact for individuals, governments, and broader society is likely to be substantial. There are significant workforce barriers to the early identification of COPMI and addressing their needs, particularly within the adult mental health care system. The current study aims to reduce such barriers and to improve identification of COPMI in the current health care systems.

  • Meeting the Intergenerational Needs of Families Where a Parent Has a Mental Illness

    Melinda Goodyear - School of Rural Health, Monash University and the Parenting Research Centre

    Parental mental illness can have a significant psychological, social and economic impacts on families. Because of the potential impact of a parent’s mental illness on children, it can also have an ‘intergen- erational’ impact.For example, children may develop a heightened awareness of their parent’s symptoms, become burdened with caring responsibilities and may even develop their own mental health conditions though a mix of genetic and environmental influences.For this reason, it is important for services to address the intergenerational impacts of parental mental illness. 

  • Video from the research project: Co-producing help-seeking narratives with children of parents with mental illnesses, by sociologist Brenda Gladstone and Jennifer Bramwell. More information see: http://brendagladstone.ca

  • A video from Monash University (Australia) with CoI Dr Melinda Goodyear and Prof Darryl Maybery describe their recent mental health research projects.

  • Resources for Parents and Professionals

    Families where a Parent has a Mental Illness (FaPMI)

    Resources for parents and professionals from 'Eastern Health', Victoria, Australia, for families where a parent has  a mental illness

  • COPMI material

    Children of parents with a mental illness

    An organisation promoting better outcomes for children and families where a parent experiences mental illness.

  • COPMI international

    A global partnership for child, parent and family mental health

  • Homepage for 'Let's Talk about Children' research study at Monash University, Melbourne, Australia. "Developing an Australian-first recovery model for parents in Victorian mental health and family services."

  • Australian national workforce centre for child mental health

  • This publication is intended for professionals training or practicing in mental health and not for the general public. The opinions expressed are those of the authors and do not necessarily represent the views of the editors or IACAPAP. This publication seeks to describe the best treatments and practices based on the scientific evidence available at the time of writing as evaluated by the authors and may change as a result of new research. Readers need to apply this knowledge to patients in accordance with the guidelines and laws of their country of practice. Some medications may not be available in some countries and readers should consult the specific drug information since not all dosages and unwanted effects are mentioned. Organizations, publications and websites are cited or linked to illustrate issues or as a source of further information. This does not mean that authors, the editors or IACAPAP endorse their content or recommendations, which should be critically assessed by the reader. Websites may also change or cease to exist.

  • ​Psychische Erkrankungen sind häufig. Weltweit leben ca. 25 % aller Kinder mit einem psychisch erkrankten Elternteil zusammen. Diese Kinder haben ein erhöhtes Risiko, psychische Störungen zu entwickeln und stellen so eine besondere Risikogruppe dar. Gleichzeitig gibt es für diese Zielgruppe kaum präventive Interventionsangebote. Zudem sind Studien selten, die die Mechanismen und Interventionsmöglichkeiten im Zusammenhang mit der transgenerationalen Transmission psychischer Störungen untersuchen. Das Buch fasst den aktuellen Stand der Forschung zu dem Thema prägnant zusammen und stellt ausgewählte Forschungsprogramme zur verbesserten Versorgung betroffener Familien vor sowie aktuelle Präventionsansätze.

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