The clinical effectiveness, cost-effectiveness and acceptability of community-based interventions aimed at improving or maintaining quality of life in children of parents with serious mental illness: a systematic review

Bee, Penny; Bower, Peter; Byford, Sarah; Churchill, Rachel; Calam, Rachel; Stallard, Paul; Pryjmachuk, Steven; Berzins, Kathryn; Cary, Maria; Wan, Ming Wai; Abel, Kathryn M.

doi:10.3310/hta18080

Cited by 104 publications

(152 citation statements)

References 259 publications

(254 reference statements)

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“…The disseminated information is generic without any consideration of individual barriers or the generation of an individualised action plan. Although behaviour change may be encouraged, its actual implementation will be at the discretion of the individual concerned Reproduced from Bee et al, 87 box 3, under the Non-Commercial Government Licence v1.0 (www.nationalarchives.gov.uk/doc/non-commercial-government-licence/non-commercialgovernment-licence.htm)…”

Section: ) Psychoeducationmentioning

confidence: 99%

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

et al. 2016

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BackgroundExposure to domestic violence and abuse (DVA) during childhood and adolescence increases the risk of negative outcomes across the lifespan.ObjectivesTo synthesise evidence on the clinical effectiveness, cost-effectiveness and acceptability of interventions for children exposed to DVA, with the aim of making recommendations for further research.Design(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and professional experience of interventions; (3) a network meta-analysis (NMA) of controlled trials and cost-effectiveness analysis; (4) an overview of current UK provision of interventions; and (5) consultations with young people, parents, service providers and commissioners.SettingsNorth America (11), the Netherlands (1) and Israel (1) for the systematic review of controlled trials of interventions; the USA (4) and the UK (1) for the systematic review of qualitative studies of participant and professional experience of interventions; and the UK for the overview of current UK provision of interventions and consultations with young people, parents, service providers and commissioners.ParticipantsA total of 1345 children for the systematic review of controlled trials of interventions; 100 children, 202 parents and 39 professionals for the systematic review of qualitative studies of participant and professional experience of interventions; and 16 young people, six parents and 20 service providers and commissioners for the consultation with young people, parents, service providers and commissioners.InterventionsPsychotherapeutic, advocacy, parenting skills and advocacy, psychoeducation, psychoeducation and advocacy, guided self-help.Main outcome measuresInternalising symptoms and externalising behaviour, mood, depression symptoms and diagnosis, post-traumatic stress disorder symptoms and self-esteem for the systematic review of controlled trials of interventions and NMA; views about and experience of interventions for the systematic review of qualitative studies of participant and professional experience of interventions and consultations.Data sourcesMEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, Social Care Online, Sociological Abstracts, Social Science Citation Index, World Health Organization trials portal and clinicaltrials.gov.Review methodsA narrative review; a NMA and incremental cost-effectiveness analysis; and a qualitative synthesis.ResultsThe evidence base on targeted interventions was small, with limited settings and types of interventions; children were mostly < 14 years of age, and there was an absence of comparative studies. The interventions evaluated in trials were mostly psychotherapeutic and psychoeducational interventions delivered to the non-abusive parent and child, usually based on the child’s exposure to DVA (not specific clinical or broader social needs). Qualitative studies largely focused on psychoeducational interventions, some of which included the abusive parent. The evidence for clinical effectiveness was as follows: 11 trials reported improvements in behavioural or mental health outcomes, with modest effect sizes but significant heterogeneity and high or unclear risk of bias. Psychoeducational group-based interventions delivered to the child were found to be more effective for improving mental health outcomes than other types of intervention. Interventions delivered to (non-abusive) parents and to children were most likely to be effective for improving behavioural outcomes. However, there is a large degree of uncertainty around comparisons, particularly with regard to mental health outcomes. In terms of evidence of cost-effectiveness, there were no economic studies of interventions. Cost-effectiveness was modelled on the basis of the NMA, estimating differences between types of interventions. The outcomes measured in trials were largely confined to children’s mental health and behavioural symptoms and disorders, although stakeholders’ concepts of success were broader, suggesting that a broader range of outcomes should be measured in trials. Group-based psychoeducational interventions delivered to children and non-abusive parents in parallel were largely acceptable to all stakeholders. There is limited evidence for the acceptability of other types of intervention. In terms of the UK evidence base and service delivery landscape, there were no UK-based trials, few qualitative studies and little widespread service evaluation. Most programmes are group-based psychoeducational interventions. However, the funding crisis in the DVA sector is significantly undermining programme delivery.ConclusionsThe evidence base regarding the acceptability, clinical effectiveness and cost-effectiveness of interventions to improve outcomes for children exposed to DVA is underdeveloped. There is an urgent need for more high-quality studies, particularly trials, that are designed to produce actionable, generalisable findings that can be implemented in real-world settings and that can inform decisions about which interventions to commission and scale. We suggest that there is a need to pause the development of new interventions and to focus on the systematic evaluation of existing programmes. With regard to the UK, we have identified three types of programme that could be justifiably prioritised for further study: psycho-education delivered to mothers and children, or children alone; parent skills training in combination with advocacy: and interventions involving the abusive parent/caregiver. We also suggest that there is need for key stakeholders to come together to explicitly identify and address the structural, practical and cultural barriers that may have hampered the development of the UK evidence base to date.Future work recommendationsThere is a need for well-designed, well-conducted and well-reported UK-based randomised controlled trials with cost-effectiveness analyses and nested qualitative studies. Development of consensus in the field about core outcome data sets is required. There is a need for further exploration of the acceptability and effectiveness of interventions for specific groups of children and young people (i.e. based on ethnicity, age, trauma exposure and clinical profile). There is also a need for an investigation of the context in which interventions are delivered, including organisational setting and the broader community context, and the evaluation of qualities, qualifications and disciplines of personnel delivering interventions. We recommend prioritisation of psychoeducational interventions and parent skills training delivered in combination with advocacy in the next phase of trials, and exploratory trials of interventions that engage both the abusive and the non-abusive parent.Study registrationThis study is registered as PROSPERO CRD42013004348 and PROSPERO CRD420130043489.FundingThe National Institute for Health Research Public Health Research programme.

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Section: ) Psychoeducationmentioning

confidence: 99%

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

et al. 2016

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“…However, many peer support interventions lack a strong theoretical framework [12] and the evaluation undertaken is generally of relatively poor quality [13]. Many child-focused interventions have age limits for participation (e.g.…”

Section: Introductionmentioning

confidence: 99%

Web-Based Health Intervention for Young People Who Have a Parent with a Mental Illness: Delphi Study Among Potential Future Users (Preprint)

Matar¹,

Maybery²,

McLean³

2018

Preprint

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Background: Young people who have a parent with a mental illness face elevated risks to their wellbeing. However, they may not have access to appropriate interventions. Online interventions may reach and meet the needs of this at-risk group, yet their preferences regarding the features of this medium are unknown. Objective: This study sought to determine the utility of an online intervention to meet the needs of young people who have a parent with a mental illness, and their perspectives regarding the types of features of such a website. Methods: A systematic, two-round Delphi study was employed to solicit the views of 282 young people aged 16 to 21 years (Round 1 n = 14, Round 2 n = 268), from urban and regional settings in Australia. 'Regional' was used to refer to non-urban participants in the study. After first ascertaining whether an online intervention was warranted, an extensive list of online intervention features was identified, including how the site might be facilitated, topics, duration and frequency, and the nature of professional contact. The extent to which young people agreed on the importance of these factors was assessed. Differences and similarities across gender and location were investigated. A mixed method analytic framework was employed using thematic analysis as well as two-way betweengroups analysis of covariance controlling for age (ANCOVA) and chi-square test of independence analysis. Results: Both rounds highlighted a strong preference for an online intervention. Consensus was reached for 1) a professionally monitored site; 2) young people and professionals having equal input into the weekly facilitated sessions (e.g., sharing lead role in discussions or deciding on relevant session content); 3) unlimited time access; 4) one-hour, open discussion, weekly sessions over 6 weeks; 5) preferred features for an online intervention; 6) psychoeducation about mental illness; and, 7) considerations for the management of safety violations. There were significant main effects of location type and several of the preferred features for an online intervention for young people who have a parent with a mental illness; however, effect sizes were small to moderate, limiting practical application. Conclusions: Young people aged 16 to 21 years indicated a need for a professionally monitored, psychoeducational, online intervention, with input from professional facilitators and other similar young people, in addition to recommendations to external resources. The findings can be used to inform the development of future online interventions for this highly vulnerable group.

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“…İngilte-re'de yapılan bir çalışmada, anne-babalarında ruhsal bozukluk saptanan çocukların çoğu, yaşam kalitelerinin artmasına en çok anne-babalarındaki hastalık belirtilerinin azaltılmasının katkısının olacağını belirtmişlerdir. 12 Şizofreni için genetik yüksek risk grubunda yer alan çocuk ve ergenlerin anne-babaları tarafın-dan daha sık ihmale uğrayabileceği ve duygusal sorunlar yaşayabileceği, yaşam kalitelerinin olumsuz şekilde etkilenebileceği varsayımından yola çıkılarak planlanan bu çalışmada; annebabasından biri şizofreni hastası olan çocuk ve ergenlerde ruhsal sorun varlığı, yaşam kalitesi düzeyleri, algıladıkları anne-baba tutumlarının incelenmesi ve anne-babalarında ruhsal bozukluk olmayan kontrol grubu ile karşılaştırılması amaçlanmıştır. Aynı zamanda hasta anne-babanın hastalığı ile ilgili değişkenlerin yaşam kalitesi ve algılanan anne-baba tutumları ile ilişkisinin incelenmesi planlanmıştır.…”

Section: Introductionunclassified

Perceived parental attitudes and the levels quality of life in children and adolescents at high risk for schizophrenia

Gümüştaş¹,

Fiş²,

Kütük³

et al. 2017

Anadolu Psikiyatri Derg

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The clinical effectiveness, cost-effectiveness and acceptability of community-based interventions aimed at improving or maintaining quality of life in children of parents with serious mental illness: a systematic review

Cited by 104 publications

References 259 publications

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

Web-Based Health Intervention for Young People Who Have a Parent with a Mental Illness: Delphi Study Among Potential Future Users (Preprint)

Perceived parental attitudes and the levels quality of life in children and adolescents at high risk for schizophrenia

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