Development of an Evidence-Informed and Codesigned Model of Support for Children of Parents With a Mental Illness— “It Takes a Village” Approach

Abstract

Providing support to parents and their children to help address the cycle of intergenerational impacts of mental illness and reduce the negative consequences for children is a key focus of selective prevention approaches in public mental health. However, a key issue for children of parents with a mental illness is the lack of access to early intervention and prevention support when needed. They are not easily identifiable (until presenting with significant mental health issues of their own) and not easily accessing the necessary support that address the complex interplay of parental mental illness within families. There are significant barriers to the early identification of these children, particularly for mental health care. Furthermore, there is a lack of collaborative care that might enhance identification as well as offer services and support for these families. The “It takes a Village” project seeks to improve mental health outcomes for children through the co-development, implementation and evaluation of an approach to collaborative practice concerned with the identification of families where a parent has a mental illness, and establishing a service model to promote child-focused support networks in Austria. Here we describe the development of service delivery approach for the “It takes a Village” project that aims to improve identification and support of these children within enhancements of the existing service systems and informal supports. 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. Results highlight the steps involved in translating evidence-based components, local practice wisdom and lived experience into the “It takes a Village” practice model for Tyrol, Austria. We highlight through this paper how regional context-specific solutions are essential in the redesign of care models that meet the complex needs of children of parents with a mental illness. Service system and policy formation with local and experienced stakeholders are also vital to ensure the solutions are implementation-ready, particularly when introducing new practice models that rely on organizational change and new ways of practice with vulnerable families. This also creates a solid foundation for the evaluation of the “It take a Village” approach for children of parents with a mental illness in Austria.

Parenting and Serious Mental Illness (SMI): A Systematic Review and Metasynthesis

“…Echoing Bronfenbrenner’s Ecological Systems Theory (Bronfenbrenner, 1992 ) that views psychosocial processes to be influenced by multiple levels of the surrounding environment, our study findings highlight that change is needed at multiple systemic levels to promote better relationships between parents and their children, families, HCPs, and wider cultural and political networks. In line with recent calls for a ‘village’ approach of social connectedness for families who experience multiple adversities (Goodyear et al, 2022 ; Reupert et al, 2022 ), a shift in practice approach is indicated, particularly given that Family Focused Practice (FFP) is not widely implemented even within countries that mandate it (Falkov et al, 2016 ; Furlong et al, 2021 ). A strengths-based approach could shift system-wide perceptions of threat, promoting parents’ sense of safety and connection with their children, their parenting roles, and the communities they live within, supporting better access to, and use of, support.…”

“…In particular, parents’ experiences of navigating relationships with their children and wider systems, and their ideas about parenting support, are not yet fully understood. Consequently, parental needs are often disregarded by services, leaving parents feeling unheard and unsupported (David et al, 2011 ; Goodyear et al, 2022 ).…”

It Takes a Village to Raise a Child: Understanding and Expanding the Concept of the “Village”

“…The Austrian project mentioned at the start of this perspective, titled How to raise a village to raise a child , has a program theory model that the authors argued promotes the capacity of the village to care for children and families; this model outlines resource inputs, systems and individual context considerations and triggers for behavior changes ( 48 ), with a particular focus on translation and implementation ( 49 ). A subsequent article further emphasized the importance of regional context specific solutions and engagement with local and experienced stakeholders to ensure service models are implementation ready ( 50 ). As the authors themselves conceded, their work to date has not yet demonstrated the effectiveness of this approach, especially in terms of child outcomes ( 50 ).…”

“…A subsequent article further emphasized the importance of regional context specific solutions and engagement with local and experienced stakeholders to ensure service models are implementation ready ( 50 ). As the authors themselves conceded, their work to date has not yet demonstrated the effectiveness of this approach, especially in terms of child outcomes ( 50 ). A major issue in the field appears to be that many of these broad community projects have not been rigorously evaluated, especially in regard to how children may benefit.…”

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

“…The co‐design process and its results are described elsewhere (Goodyear et al . 2022). In summary, six co‐design workshops took place over 6 months using the knowledge from the scoping phase (Fig.…”