To promote coping and to prevent inappropriate or extensive caring activities among children with ill parents, there is a need for increased access to flexible home-based services adapted to the type of parental illness.

BackgroundNorway is one of the first countries to require all health professionals to play a part in prevention for children of parents with all kinds of illnesses (mental illness, drug addiction, or severe physical illness or injury) in order to mitigate their increased risk of psychosocial problems. Hospitals are required to have child responsible personnel (CRP) to promote and coordinate support given by health professionals to patients who are parents and to their children.MethodsThis study examined the extent to which the new law had been implemented as intended in Norwegian hospitals, using Fixsen’s Active Implementation Framework. A stratified random sample of managers and child responsible personnel (n = 167) from five Hospitals filled in an adapted version of the Implementation Components Questionnaire (ICQ) about the implementation of policy changes. Additional information was collected from 21 hospital coordinators (H-CRP) from 16 other hospitals.ResultsSignificant differences were found between the five hospitals, with lowest score from the smallest hopitals. Additional analysis, comparing the 21 hospitals, as reported by the H-CRP, suggests a clear pattern of smaller hospitals having less innovative resources to implement the policy changes. Leadership, resources and system intervention (strategies to work with other systems) were key predictors of a more successful implementation process.ConclusionsLegal changes are helpful, but quality improvements are needed to secure equal chances of protection and support for children of ill parents.Trial registrationThe study is approved by the Regional Committee on Medical and Health Research Etics South-East (reg.no. 2012/1176) and by the Privacy Ombudsmann.

BackgroundChanges in Norwegian law and health policy require all health professionals to help safeguard the provision of information and follow-up for the children of parents with mental or physical illness, or substance abuse problems, to decrease their risk of psychosocial problems. There is a lack of knowledge on how the national changes have been received by hospital-based health professionals, and if they have led to an increase in family focused practice.MethodsThis cross-sectional study examined the adherence of health professionals’ (N = 280) in five hospitals to new guidelines for family focused practice, using a translated and generic version of Family Focused Mental Health Practice Questionnaire.ResultsOverall, health professionals scored high on knowledge and skills, and were confident in working with families and children, but reported moderate levels of family support and referrals. Comparison of the five hospitals showed significant differences in terms of workplace support, knowledge and skills and family support. The smallest hospital had less workplace support and less knowledge and skills but scored medium on family support. The two largest hospitals scored highest on family support, but with significant differences on parents refusing to have conversations with children.ConclusionsDifferences in implementation of family focused practice highlight the need to tailor improvement strategies to specific barriers at the different hospitals. The use of implementation theories and improvement strategies could promote full implementation, where all families and children in need were identified and had access to family support.Trial registration The study is approved by the Regional Committee on Medical and Health Research Ethics South-East Q5 37 (reg. no. 2012/1176) and by the Privacy Ombudsman.

Background A considerable body of research has explored implications of severe parental illness on children. However, less is known about what children and adolescents with a severely ill parent experience as the most challenging. Aims To describe what children with a severely ill parent experience as their most difficult challenge. Methods A qualitative descriptive design with a manifest content analysis was used on data from a cross‐sectional, multicenter study on children of patients in five Norwegian Health trusts. Data consisted of written textual responds from 238 children (age 8–18) to one open‐ended question in a self‐report questionnaire. Results The overall theme concerning the children’s most difficult challenge was named ‘the drama of life unfoldment’, reflecting the parental illness’ impact on themselves, their relationships with others, and their life circumstances. The subthemes consisted of: Children’s experiences of difficult thoughts and feelings; negatively impaired relationship with parents, friends and others; and challenging life events and obstacles in welfare. Conclusions The most difficult challenge experienced by the children with a severely ill parent implies life unfoldment challenges and include negative personal and relational impact, challenging life events and obstacles in welfare.

Purpose: Severe parental somatic illnesses can influence the entire family, including adolescents' everyday life, psychosocial functioning and health. Within salutogenesis, it is highlighted that stressor life events, such as parental somatic illness, might lead to a chain of events that can produce tension. There is a lack of in-depth understanding regarding how adolescents living in a situation with a severely somatically ill parent (SIP) perceive their own mental health. The aim of this study was therefore to explore the lived experience of Norwegian adolescents living with an SIP, and their perception of the parental illness' influence on their mental health. Methods: Interpretative phenomenological analysis was used. In-depth interviews were conducted with 11 adolescents (aged 13-18 years) who had an SIP. Two adolescents with an SIP participated in study preparation and data analysis. Results: Adolescents perceived parental somatic illness as a multifaceted influence on their mental health as it represented both personal and relational strain and growth. Their perceptions can be conceptualized by the super-ordinate theme "living in an earthquake zone", and by two themes, "inner shakes-but not falling apart" and "relational aftershocksgains and losses". Conclusion: For adolescents, parental somatic illness means personal and relational strain and growth.