College of Human and Health Sciences, Swansea University, Swansea, Wales, UK.
College Of Medicine, Swansea University, Swansea, Wales, UK.
BMC Health Serv Res. 2020 Mar 12;20(1):195. doi: 10.1186/s12913-020-5015-z.
Unrecognised and untreated parental mental illness is a major adverse childhood experience with potentially life-long consequences for health and wellbeing. In the United Kingdom (UK) health visitors provide a universal health promotion service to children aged 0-5 years, which includes safeguarding. This preventive work is highly relevant to policy aims of improving outcomes for children living with adverse childhood experiences, but is currently under researched. The aim of this study was to explore how health visitors promote young children's wellbeing when a parent has a mental health problem, and to co-produce strategies to improve child health outcomes.
A mixed methods study was conducted, consisting of a cross-sectional survey and consensus workshops in Wales, UK. In phase 1 health visitors (n = 174) responded to an online questionnaire designed to explore the nature and scope of their preventive work with families experiencing mental ill health. For phase 2 providers of health and other support services (n = 38) took part in Nominal Group Technique workshops to co-produce strategies for better joint working to protect the wellbeing of children living with parental ill health.
We identified that health visitors routinely provide support to families where parents have a range of mental health problems, including severe mental illness. Most practice is focused on mothers with depression, and fewer respondents were confident about working with fathers. Unmet training needs were identified in relation to adult mental illness, particularly the impact upon children. Solutions to working more effectively with professional and voluntary agencies included raising awareness of professional roles and responsibilities, timely two-way communication, taking a strengths-based approach and maintaining a focus on the child.
This study provided evidence on the range of parental mental ill health encountered by health visitors and the strategies they use to protect children's wellbeing. Increasing the effectiveness of joint working is key to improving outcomes for babies and young children, including greater use of voluntary sector services. This study has implications for those who commission and provide health and welfare services for children, and adult mental health services.
未被识别和未经治疗的父母精神疾病是一种主要的不良儿童经历，对健康和幸福感可能会产生终身影响。在英国，健康访视员为 0-5 岁儿童提供普遍的健康促进服务，其中包括保障服务。这项预防工作与改善有不良儿童经历的儿童的结果的政策目标高度相关，但目前研究不足。本研究的目的是探讨健康访视员如何在父母有心理健康问题时促进幼儿的幸福感，并共同制定改善儿童健康结果的策略。
本研究采用混合方法，包括在威尔士进行的横断面调查和共识研讨会。在第一阶段，健康访视员（n=174）回答了一份在线问卷，旨在探讨他们在为有心理健康问题的家庭提供预防工作时的性质和范围。在第二阶段，卫生和其他支持服务的提供者（n=38）参加了名义团体技术研讨会，共同制定更好的联合工作策略，以保护有父母健康问题的儿童的幸福感。
我们发现，健康访视员通常为有一系列心理健康问题的家庭提供支持，包括严重的精神疾病。大多数做法都集中在患有抑郁症的母亲身上，而较少的受访者对与父亲合作有信心。在成人精神疾病方面，存在未满足的培训需求，特别是对儿童的影响。解决与专业和志愿机构更有效地合作的方案包括提高对专业角色和责任的认识、及时双向沟通、采取基于优势的方法以及关注儿童。
本研究提供了健康访视员遇到的父母精神健康问题的范围以及他们用来保护儿童幸福感的策略的证据。提高联合工作的有效性是改善婴儿和幼儿结果的关键，包括更多地利用志愿部门服务。本研究对为儿童提供健康和福利服务以及成人心理健康服务的人具有影响。
