Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria.
School of Rural Health, Monash University Melbourne, Wellington Rd, Clayton, Victoria, 3800, Australia.
BMC Health Serv Res. 2020 Apr 19;20(1):326. doi: 10.1186/s12913-020-05184-8.
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.
We collected qualitative (17 interviews among stakeholder and people with lived experience) and quantitative data (e.g. health insurance data) regarding overall societal characteristics, epidemiology of mental illness, currently existing services, uptake of services, and current practices and challenges of identifying and supporting COPMIs. We analysed data along eight external context dimensions: 1) professional influences, 2) political support, 3) social climate, 4) local infrastructure, 5) policy and legal climate, 6) relational climate, 7) target population, and 8) funding and economic climate.
We identified that there is awareness of potential challenges related to COPMIs at both a professional and planning level. Additionally, there is a lack of installed support processes and standards to meet these children's needs across Tyrol. A variety of services are available both for unwell parents, as well as for families and individual family members. Yet, only one small service addresses COPMIs directly. Services fall into different sectors (education, health, social affairs) and are funded from different sources, making coordination difficult. Access varies from universal to rather restricted (i.e. through referral). The potential number of parents which could be reached in order to identify their children via adult mental health, differs considerably by setting. Societal structures indicate that the informal and voluntary sector may be a realistic source for supporting COPMIs.
The societal structures and the current services provide a rich resource for improving identification and support of COPMIs, however considerable coordination and behaviour change efforts will be required due to the fragmentation of the system and professional cultures. The insights into the context of supporting COPMIs have been of high value for developing and implementing practice changes in the local organizations.
目前，在奥地利蒂罗尔地区正在进行一项旨在改善父母患有精神疾病的儿童（COPMI）处境的研究项目。该项目旨在通过加强儿童所在社区的协作支持，来加强针对儿童的正式和非正式支持结构。了解该地区的现状对于实施实践变革至关重要。本文旨在了解蒂罗尔地区的社会和服务提供情况。
我们收集了定性数据（在利益相关者和有生活经验的人中进行了 17 次访谈）和定量数据（例如，健康保险数据），涉及整体社会特征、精神疾病的流行病学、现有服务、服务利用率、以及识别和支持 COPMI 的当前做法和挑战。我们根据以下八个外部环境维度对数据进行了分析：1）专业影响，2）政治支持，3）社会氛围，4）当地基础设施，5）政策和法律环境，6）关系氛围，7）目标人群，8）资金和经济环境。
我们发现，在专业和规划层面上，人们都意识到了与 COPMI 相关的潜在挑战。此外，蒂罗尔还缺乏满足这些儿童需求的既定支持流程和标准。有各种各样的服务可供患病父母以及家庭和个别家庭成员使用。然而，只有一个小型服务直接针对 COPMI。服务分为不同的部门（教育、卫生、社会事务），并由不同的来源提供资金，这使得协调变得困难。服务的获取范围从普及到相当受限（即通过转介）。通过成人心理健康识别其子女的父母数量因环境而异，差异很大。社会结构表明，非正规和志愿部门可能是支持 COPMI 的现实来源。
社会结构和现有服务为改善 COPMI 的识别和支持提供了丰富的资源，但是由于系统和专业文化的碎片化，需要进行大量的协调和行为改变努力。这些有关支持 COPMI 的背景信息为当地组织制定和实施实践变革提供了很高的价值。
