Discussion: Using the Walden Library
Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use research literature to explore ideas, guide your thinking, and gain new insights. As you search the research literature, it is important to use resources that are peer-reviewed and from scholarly journals. You may already have some favorite online resources and databases that you use or have found useful in the past.
For this Discussion, you explore databases available through the Walden Library.
Post the following:
Using proper APA formatting, cite the peer-reviewed article you selected that pertains to your practice area and is of particular interest to you and identify the database that you used to search for the article. Explain any difficulties you experienced while searching for this article. Would this database be useful to your colleagues? Explain why or why not. Would you recommend this database? Explain why or why not.
DATABASE BELOW USED TO OBTAIN MY ARTICLE
APA PsycInfo (formerly PsycInfo)
- The largest resource devoted to scholarly peer-reviewed literature in the behavioral sciences and mental health. Also includes book chapters, books, dissertations, and all content from APA PsycArticles
Discussion: Using the Walden Library Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use research literature to explore ideas, guide
Child & Youth Care Forum (2021) 50:1107–1130 https://doi.org/10.1007/s10566-021-09608-2 REVIEW Psychological Treatments with Children of Parents with Mental Illness: A Systematic Review Eva Tapias 1 · Marta Coromina 1 · Nuria Grases 1 · Susana Ochoa 1 Accepted: 12 February 2021 / Published online: 23 February 2021 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature 2021 Abstract Background Several studies have reported that children of parents with mental illness have 41–70% chance of developing mental health problems. This has encouraged an increase in preventive interventions directed at these children. Objectives This systematic review aimed to describe preventive psychological interven- tions addressed to children of parents who are suering a mental disorder. We identied the aims of these treatments, their approach and components. Sociodemographic character – istics of the subjects and outcomes were examined. Method Psycinfo and Pubmed were consulted using the PICO process. We included stud- ies in English or Spanish describing a preventive psychological intervention. Results 16 studies were included. Most studies were focused on promoting resilience and increasing children’s understanding of the parent’s disorder. Psychoeducation was included in 87,5% of treatments. Family, multifamily and children group interventions were equally used as approach. Conclusions Psychoeducation emerged as an indispensable component of the interven- tions. Other frequent components comprised skills training, emotional regulation training, and playful activities. Most therapies were carried out in a group setting. Specically, a multifamily approach is regarded as the most ecient. Most of the studies yielded signi- cant results. Keyword Parental mental illness · Mental health · Family · Child · Psychological intervention · Prevention * Eva Tapias [email protected] Marta Coromina [email protected] Nuria Grases [email protected] Susana Ochoa [email protected] 1 Parc Sanitari Sant Joan de Déu, Camí Vell de la Colònia, 25, Sant Boi de Llobregat, 08830 Barcelona, Spain Vol.:(0123456789) 1 3 1108 Child & Youth Care Forum (2021) 50:1107–1130 Background Between 21 and 23% of children live with a parent who has a mental disorder (Maybery et al. 2009). Previous literature has identied that between 16 and 79% of the parents of children that are treated in child and adolescent mental health services (CAMHS) have mental health problems (Campbell et al. 2020; Maybery and Reupert 2018; Ruud et al. 2019). It is estimated that the risk of mental illness in children is between 10 and 20% in the general population. However, several studies have reported that children of parents with mental illness (COPMI) have a 41–70% chance of developing mental health problems (Kato et al. 2015; Kieling et al. 2011). The risk of a severe mental illness in COPMI is 32%, (Siegenthaler et al. 2012), due to genetic and psychosocial factors (Cooklin 2010; Hosman et al. 2009). COPMI grow at risk of being exposed to multiple stressors (poor interaction with parents, family stress, severe or permissive parenting style, stigmatization or isolation) that could trigger internalizing and externalizing symptoms (Compas et al. 2010; England and Sim 2009; Goodman and Gotlib 1999; Hosman et al. 2009; Thomason et al. 2014). In the last 20 years, the literature has raised awareness on the personal experiences and the needs of COPMI (Campbell et al. 2020; Cooklin 2013; Goodyear et al. 2009). For instance, many COPMI experience role-reversal, what could cause that children provide their parents with primary care and assume adult responsibilities (Aldridge and Becker 2003). COPMI often become hyper-alert to their own behavior and symptoms due to their fear of developing their parents’ illness (Cooklin 2013). COPMI may also experience other fears, such as feelings of guilt for their parent’s illness, being stigmatized or singled-out, losing closeness with the aected parent or fear that the parent will die (Cooklin 2013). Furthermore, COPMI often lack information regarding their parent’s situation. A British survey detected than more than half of parents in general population do not talk to their children about mental disorders (Maybery and Reupert 2018), which could foster wrong beliefs and consequent fears. COPMI under the age of 5 receive even less information about their parents’ situation (Reedtz et al. 2019). Many authors have argued the impor – tance of providing a clear and understandable explanation about the parents’ illness as a method of reducing anxiety and fears. Being provided with information about the incom- prehensible behavior of their parents could diminish their emotional responses, and could help them relate those behaviors to the specic mental disorder (Beardslee and Podorefsky 1988; Cooklin 2013; Riebschleger et al. 2009). Bilsborough (2004) explored COPMI’s needs in the United Kingdom, Australia and Scandinavian countries. They concluded that these children demand (1) an explanation about their parents’ mental disorder, (2) support from an adult that does not belong to the family, especially in dicult moments such as crisis or exacerbation of symptoms, (3) interaction with other people in similar situations to share experiences and fears with, and (4) to compensate role reversal, for example, by having more time to spend with friends. Furthermore, children whose parents require hospitalization due to a psychiatric disorder were more likely to experience developmental vulnerability in all domains of school readi- ness, including the physical, social, emotional, communicational and cognitive spheres (Bell et al. 2019). There are multiple interventions directed to COPMI. Many of them have identied that psychoeducation, coping skills and social support are instrumental keys for reducing feelings of guilt and shame in children, for promoting resilience, and for strengthening knowledge about their parent’s diculties (Marston et al. 2016; Pitman and Matthey 2004; 1 3 1109 Child & Youth Care Forum (2021) 50:1107–1130 Reedtz et al. 2019; Reupert and Maybery 2010; Riebschleger et al. 2009). Interestingly, Mosek (2014) has emphasized that psychoeducation needs to be continuously administered to have a positive and signicant impact. Other common strategies in these treatments include skills training, parent support and peer support (Goodyear et al. 2009; Marston 2016). However, other studies have highlighted the benets of learning from sharing expe- riences and gaining alternative coping skills, suggesting that peer relationships may have a strong inuence on COPMI’s attitudes and behavior (Cu and Pietsch 1997; Turner 1999). Similarly, previous literature has suggested that a family approach could be espe- cially appropriate (Agha et al. 2013; Robson and Gingell 2012). These approaches promote parents’ capacities, build protective factors in children and reduce the burden of the par – ent’s illness on their ospring (Bell et al. 2019; Campbell 2020; Siegenthaler et al. 2012). Family approaches have shown a decrease of 40% in the risk of mental health problems in COPMI (Siegenthaler et al. 2012). Considering the elevated number of children in this situation and the consequent risk for mental health problems, our aim with this study was to review studies reporting preven- tive psychological interventions addressed to COPMI. Our specic aims are to (1) describe the aims of these interventions, (2) examine the modality of the programs (family therapy, multi-family group treatment, individual therapy, etc.), (3) identify their components (psy – choeducation, children groups…), (4) describe socio-demographic characteristics, and (5) examine the outcomes of these interventions. This review is distinguishable because only interventions which include children with- out mental disorders are examined. The content, the type of interventions and their out- comes are described so that mechanisms of change can be detected and then eective pre- ventive treatments can be implemented in diverse geographic and cultural contexts. Method Research Evidence Identication To facilitate the search through evidence-based practice, we used the PICO process. We have followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) (Fig. 1). Literature was retrieved from the PsycInfo and PubMed databases dur – ing May 2019. Review has been done between May 2019 and May 2020. To identify rel- evant papers to contextualize our work, we inspected the reference lists of the included articles. Literature Search Our search strategy was designed by an academic librarian at Parc Sanitari Sant Joan de Déu. The terms included on the broad search string strategy on Pubmed were: ((((((“Psy – chotherapy, Group”[MAJR] AND family))) AND ((mental illness) OR (mental health) OR (mental disorder))) AND parental AND (intervention* OR program* OR therap* OR treat- ment*)))) OR “Child of Impaired Parents/psychology”. The terms used in the PsychInfo search were: ((impaired + par – ents) + OR + (impaired + parenting)) + AND + ((intervention) + OR + (pro- gram*)) + AND + child*. Our search included papers published in the last 25 years (from 1994 to 2019). 1 3 1110 Child & Youth Care Forum (2021) 50:1107–1130 Inclusion Criteria We included papers with a description of a preventive psychological intervention addressed to children who have at least one parent with a mental disorder (aective, psychotic, post- traumatic, anxiety, eating or personality disorder). We only included children without clini- cal symptoms, between 0–18 years of age. Papers had to be written in English or Spanish language. Fig.1 Study PRISMA diagram 1 3 1111 Child & Youth Care Forum (2021) 50:1107–1130 Exclusion Criteria We excluded systematic reviews, case studies, studies not focusing on a psychological intervention, treatments in adults, intervention with parents with an organic disease or with only substance use disorder, and treatments with children who have a mental illness. Selection of Studies and Data The rst author (ET) conducted a systematic review to identify eligible studies. Once these were selected, multiple information (aims, type of program and intervention components, sample size, demographic characteristics of the sample, assessment instrument, results and conclusions) was extracted and summarized in Table 1. Quality Assessment We used the quality assessment tool for quantitative studies (QATQS; National Collaborat- ing Centre for Methods and Tools, 2008) to assess the quality of the quantitative studies reviewed (Table 2). QATQS assesses methodological rigor in six areas: (a) selection bias; (b) design; (c) confounders; (d) blinding; (e) data collection method; and (f) withdrawals and drop-outs. The QATQS scoring was conducted independently by both authors and dis- crepancies were discussed and resolved. Ethics Statement This review adheres to the legal requirements of the study country. Results As revealed in the PRISMA diagram (Fig. 1), we discarded 181 studies because they did not meet our inclusion criteria. We removed 1175 articles because they reported data on children of healthy parents, or children of parents with organic diseases. We excluded 156 papers because they reported data on parents with substance use disorders only. We discarded 99 studies that reported non-preventive interventions. We excluded 2 studies because they were addressed to siblings with mental health problems. We found 16 studies that met the inclusion criteria. Table 1 provides a summary of the details of each study. Study Quality (QATQS) Table 2 summarizes the QATQS details of each of the 16 studies included in the sample. A total of 7 studies were randomized controlled trials, 5 studies were quasi experimental (with pre-post interventions) and 4 studies were qualitative analysis. Most of the quantita- tive studies (n = 7, 58.33%) had a moderate risk of bias, while the rest (n = 5, 41.67%) were classied as strong studies. The main limitation to the studies was a lack of information on the numbers and reasons for drop-outs. Another limitation is that we consider that the evaluators of some studies were not blind to the participants’ condition. However, most of the studies used sound measures and had control groups. 1 3 1112 Child & Youth Care Forum (2021) 50:1107–1130 Table 1 Summary of studies included in this review Author and year Intervention aimsType of programIntervention com- ponents Sample Design and assess- ment instruments 1 Results and con- clusions Key words Beardslee et al. (1997) To increase fami- lies understand- ing of parental disorder, to pre- vent depression in children, to promote parent’s insight 6–10 sessions consisting in a combination of these interven- tions: Family, parental and Individual (with children) Psychoeducation 36 families with one parent diagnosed with an aective disorder (52 children without currently psychiatric symp- toms) Randomized con- trolled trial K-SADS-E-R, CDI, Children’s Global Assess- ment Scale, CBCL, YSR, Semi-estructured child and parents interview, FRI, SADS-L, Global Assessment Scale Children increased understanding of the disorder and adaptative func- tioning. Results were maintained for at least 1 year and a half. No dierence in adults’ child- related concerns Preventive interven- tion, depression, family, adoles- cence, change Nicholson et al. (2009) To improve parent recovery and child resilience, to partner with family to build essential skills, to provide access to supports, to attend family needs Family options is a family -centered intervention for 12–18 months conducted by a family coach Psychoeducation, emotional sup- port, solutions to problems, practicing skills, 24 h assistance 22 families with mothers who has a serious mental ill- ness (PTSD, BD or MDD) and their chil- dren (52, between 18 months-16 years) Observational/ descriptive lon- gitudinal study (pilot study). MINI, ASSIST, LSC-R, Gloval Severity Index of the Brief Symp- tom Inventory, Short Form 8, MOSSSS Mothers improved well-being, support and resources at 6 months post- enrollment in family options Parents with mental illnesses, children, families, recovery 1 3 1113 Child & Youth Care Forum (2021) 50:1107–1130 Table 1 (continued) Author and year Intervention aimsType of programIntervention com- ponents Sample Design and assess- ment instruments 1 Results and con- clusions Key words Breslend et al. (2019) To reduce chil- dren’s internal- izing problems to prevent social problems A multi-family cognitive-behav – ioral intervention with 12 sessions, where in the majority parent and youth groups met separately Psychoeducation, parenting skills, children’s skills for coping with their parents’ illness 180 families with a parent who has history of MDD and their children with internalizing prob- lems (9–15 aged) Randomized con- trolled trial Schedule for aec- tive disorders and schizophrenia for school-age chil- dren present and lifetime version, SCID, YSR, Internalizing problems scale Intervention decreased levels of youth internal- izing problems at the 6-month and 12-month follow up, and reduced socials problems at 6-month follow up. Reductions in social problems were not associ- ated with further reductions in internalizing problems. Conclusion was that lower levels of internaliz- ing problems predicted lower social problems No key words 1 3 1114 Child & Youth Care Forum (2021) 50:1107–1130 Table 1 (continued) Author and yearIntervention aimsType of programIntervention com- ponents Sample Design and assess- ment instruments 1 Results and con- clusions Key words Wolpert et al. (2015) To increase chil- dren’s disease understanding, to help adults to rely on their competence as a parents, to encourage chil- dren to engage pleasurable activities Kidstime is a multi-family intervention (1/ month during 2′5 h). In a part of each session children and parents are separated Psychoeducation, dramatizations, games, warm-up exercises, pizza moment 5 families with one parent who has a severe mental health problem and their children (the pro- gram is addressed to children 4–16 years) Qualitative analysis: interviews that were analyzed using thematic networks analysis The program was highly evaluated by parents and children, espe- cially to learn about disorders and their impact on family, to reduce isolation and to have fun Child, mental health, Kidstime, parental mental illness, parent Pitman and Mat- they (2004) To increase chil- dren’s disease understanding and resilience, to teach life skills, to improve self-expression and creativ – ity, to increase self-esteem, to reduce feelings of isolation A group inter – vention called SMILES with children during 3 consecutive days (6 h per day) Psychoeducation, communica- tion exercises, problem solving, artwork, musi- cal, interactive and relaxation exercises, peer support 25 children aged 8 to 16 who have parents suering a severe mental disorder. 17 children were attended 3 days and 8 of them only 2 days Quasi-experi- mental study. Before and after (without any comparative group). Ques- tionnaire about knowledge (con- structed for this program), life skills measure (for this program too), feedback each day about satisfaction and what they had learned and a parent’s feedback for m Children and par – ents felt children has learned about illness, spend a good time, and know that their case wasn’t the only one No key words 1 3 1115 Child & Youth Care Forum (2021) 50:1107–1130 Table 1 (continued) Author and year Intervention aimsType of programIntervention com- ponents Sample Design and assess- ment instruments 1 Results and con- clusions Key words Fraser and Paken- ham(2008) To improve chil- dren’s disorder understanding, to increase con- nectedness with peers and coping skills Grupal pyschoso- cial peer-support intervention for children (Kop – ing Adolescent Group Program). 3 sessions (6 h per day) Psychoeducation, coping skills training, peer support, group discussion, quizzes, other activities (videos, games, creative art…) 27 children aged 12–18 whose parents has a several mental illness Quasi-experimen- tal study. Before and after (with a waiting list com- parison group) Items of knowl- edge of satisfac- tion, mental illness and awareness of parents mental illness, Social Connectedness Scale, Stress Questionnaire- Family Stress Version, CDI, Life Scale, Strenghts and Diculties Questionnaire, YCOPI, Clinically signicant improvements in awareness of mental illness, prosocial behav – ior, life satisfac- tion. It reduced depression but no increased coping strategies Adolescents, children, parental mental illness, psychosocial inter – vention, young careers 1 3 1116 Child & Youth Care Forum (2021) 50:1107–1130 Table 1 (continued) Author and yearIntervention aimsType of programIntervention com- ponents Sample Design and assess- ment instruments 1 Results and con- clusions Key words Compas et al. (2015) To educate families about depres- sive disorders, to increase family’s recognition of stressors, to train in adaptive coping responses to stress and to improve parent- ing skills Family-group cognitive-behav – ioral intervention with 12 weekly sessions Psychoeduca- tion, parenting skills training, children’s skills training 180 families (160 mothers and 20 fathers with a diag- nosis of depression or dysthymia, and 242 children aged 9–15 years) Randomized con- trolled trial CES-D, CBCL, YSR, K-SADS- PL, Familiy SES indicators, BDI- II, SCID Intervention produced sustained eects in decreasing depressive symp- toms, internaliz- ing and external- izing symptoms in children, and better skills in families. CBCL only showed signicant eect at 2 months, being an excep- tion from the rest of the question- naires Parental depres- sion, prevention, moderation 1 3 1117 Child & Youth Care Forum (2021) 50:1107–1130 Table 1 (continued) Author and year Intervention aimsType of programIntervention com- ponents Sample Design and assess- ment instruments 1 Results and con- clusions Key words Finkelstein et al. (2005) To build resilience, to develop cop- ing skills related to improving self-protection and self-sooth- ing, to increase interpersonal relationships and self-identity Group intervention with children during 10 ses- sions (75 min per week) and 2 booster ses- sions. It is and adaptation of Peled and David Groupwork with children of battered women: a practitioner’s manual Psychoeducation, emotional regula- tion, children’s coping skills, assertiveness skills, relaxa- tion, service coordination and advocacy, snack time 115 children (5–10 aged) of women who had been aected by mental illness, substance abuse and violence Quasi-experimen- tal study. Before and after (with- out any compara- tive group) Semi-structured interviews (1 with child and 1 with mother), CBCL, BERS 70% of mothers reported noticing changes in chil- dren, especially in communica- tion, attitude, behavior, and skills (safety, coping, addiction and recovery). 6% had doubts about the worth of group No key words Hayman (2009) To increase resil- ience Program with a group of adolescents (peer support program and education) Social skills, peer support, education with modelling, music program, educa- tional and funny activities 34 adolescents aged between 12–18 years old who have a family member (a parent or a sibling) with mental illness (severe or not) Qualitative analysis: verbal feedback from participants and their families Participants and their families reported improvements in adolescent’s self- condence, self- esteem, trusting friendships and ability to cope with diculties Adolescence, family, mental health, mental illness, peer support 1 3 1118 Child & Youth Care Forum (2021) 50:1107–1130 Table 1 (continued) Author and yearIntervention aimsType of programIntervention com- ponents Sample Design and assess- ment instruments 1 Results and con- clusions Key words Rasing et al. (2013) To prevent depression in adolescents, to determine moderators of eectiveness Group intervention with adoles- cents (A jump forward), with 6 sessions of 90 min each of them Psychoeduca- tion, cognitive restructuration, exposure to fears Girls adolescents (11–15 aged) with non-clinical depres- sive and/or anxiety symptoms with parents who show indicators of psycho- pathology Randomized controlled trial. CDI 2, SCAS, SCAS-P, CRSQ, CNCEQ-R, RSI, BSI, OBVL No results because it’s only a study protocol for a randomized controlled trial Prevention, indi- cated, selective, depression, anxi- ety, adolescents, high risk Hinden et al. (2005) To promote stabili- zation of parent’s mental illness, to enhance social support networks, to increase parent- ing skills, to improve child functioning A family social support program Emotional sup- port, 24 h crisis services, family case manage- ment, material and economic support, advo- cacy services 8 families (14 chil- dren) who have a parent with a mental disorder (MDD, psychotic disorders or anxiety disorder) Qualitative analysis with a semi-structured interview for parents No results because it’s only a design No key words 1 3 1119 Child & Youth Care Forum (2021) 50:1107–1130 Table 1 (continued) Author and year Intervention aimsType of programIntervention com- ponents Sample Design and assess- ment instruments 1 Results and con- clusions Key words Riebschleger et al. (2009) To strengthen youth protective factors YES is a multi- family group with 6 sessions of 2 h each one Psychoeducation, craft activity, themed discus- sion, incentives, physical group activity, coping strategies 17 youth (10–16 aged) whose parents have a psychiatric illness (depression, anxiety, schizophrenia or a personality disorder) Quasi-experimen- tal study. Before and after (with- out any compara- tive group) KPIRT, A-COPE Results showed a signicant increase in knowledge of psychiatric disorders. Youth mentioned signicantly increased use of the coping skills. No signicant change in overall coping Mental health education, youth perspectives, resil- iency, and family issues 1 3 1120 Child & Youth Care Forum (2021) 50:1107–1130 Table 1 (continued) Author and yearIntervention aimsType of programIntervention com- ponents Sample Design and assess- ment instruments 1 Results and con- clusions Key words Rosenblum et al. (2017) To improve parents mental health, to strengthening family’s protec- tives factors, to enhance mothers wellbeing and positive parent- ing, to improve children’s outcomes Multifamily par – enting interven- tion with mums and children (Mom Power). 13 sessions weekly (10 group sessions and 3 individuals), with a part of each session in which children and parents are separated Psychoeducation, meal, role plays, group discus- sions, cognitive- behavioral therapy, mind– body exercises, emotional regula- tion, practice of supportive car – egiving, “Guest day”, concrete support in times of need 68 high-risk mothers (history of maltreat- ment, mental disor – der, limited access to resources) and their young children (age < 6 years) Randomized con- trolled trial Life stressor checklist, PPDS, National Wom- en’s Study PTSD Module PSI-SF, CHQ, Connec- tion to Services Tracking Sheet, self-report retrospective questionnaire of connection to community pro- fessionals, self- report evaluation of perceived helpfulness of the intervention Improvements in mental health symptoms and parenting stress, especially in mothers with trauma histories. There was found that intervention increased feel- ings of caregiver ecacy, which correlated positively to the number of sessions they assisted. For the overall group of women in the treatment condition, no signicant cor – relations between attendance and change scores in mental health or parenting vari- ables was found Community-based randomized controlled trial, parenting interven- tion, maternal mental health, parenting stress, interpersonal trauma history 1 3 1121 Child & Youth Care Forum (2021) 50:1107–1130 Table 1 (continued) Author and year Intervention aimsType of programIntervention com- ponents Sample Design and assess- ment instruments 1 Results and con- clusions Key words Sadeh-Sharvit et al. (2016) To change feed- ing practices of parents, to prevent risk of psychopathology in children 12 group sessions (90 min each one) with moth – ers and their partners and 12 family sessions (parents and children) Psychoeduca- tion, behavioral experiments related to child feeding 20 mothers diagnosed with an eating dis- order, their spouses and their children (between the aged of 4 and 48 months) Quasi-experimen- tal study. Before and after (with- out any compara- tive group) CFQ, CBCL, ICQ- 6, EDI-2, BSI, PSI/SF Intervention showed ecacy to improve child feeding practices and more posi- tive perceptions of children among their parents. No sig- nicant changes in maternal stress No key words Solantaus et al. (2010) To promote parenting and child develop- ment, to prevent children’s mental disorders, to help to understanding the disease, to support interper – sonal relation- ships A family interven- tion (Family Talk) with a minimum of 6 sessions (15–45 min) Psychoeducation, self-help guide for parents, skills training to talk about disorder 119 families with parental mood disorder. Children between 8–16 years old Randomized con- trolled trial BDI, STAI, SDQ, SCARED There was a signif- icant decrease on children’s emo- tional symptoms, anxiety and an improve on chil- dren’s prosocial behavior. Hyper – activity tended to decrease, but change did not reach statistical signicance Parental depres- sion, child mental health, preventive intervention, rand- omized trial 1 3 1122 Child & Youth Care Forum (2021) 50:1107–1130 Table 1 (continued) Author and yearIntervention aimsType of programIntervention com- ponents Sample Design and assess- ment instruments 1 Results and con- clusions Key words Van Santvoort et al. (2014) To reduce chil- dren’s negative cognitions, emotional and behavioral prob- lems, to improve social support, competence and interaction with parents Support group for children with 8 weekly sessions (90 min) and a booster session. Parents received information about the pos- sible impact of their illness Psychoeduca- tion, role plays, games, group discussions, training social skills, social network, emo- tional regulation, information for parents about mental disorders and addiction 254 families with parents mentally ill and/or substance addicted. Children had to be 8–12 years old Randomized con- trolled trial SPPC, Dutch Parent Child Interaction Ques- tionnaire, SDQ, BSI, LLM Children experienced a signicant decrease in nega- tive cognitions and increased social support, sustained during almost 3 months School-age children, mentally or addicted parents, prevention, support groups, eective- ness 1 3 1123 Child & Youth Care Forum (2021) 50:1107–1130 Aims of the Interventions It was found that 75% of the programs had the aim of increasing children’s resilience, improve their functioning, approaching coping skills, self-protection or self-esteem (Com- pas et al. 2015; Finkelstein et al. 2005; Fraser and Pakenham 2008; Hayman 2009; Hinden et al. 2005; Nicholson et al. 2009; Pitman and Matthey 2004; Riebschleger et al. 2009; Rosenblum et al. 2017; Solantaus et al. 2010; Van Santvoort et al. 2014; Wolpert et al. 2015). More over, 6 studies aimed to increase the families’ understanding of the paren- tal disorder. One of the approaches (Beardslee et al. 1997) specically targeted parents’ insight as well (Beardslee et al. 1997; Compas et al. 2015; Fraser and Pakenham 2008; Pitman and Matthey 2004; Solantaus et al. 2010; Wolpert et al. 2015). Another 6 stud- ies focused on preventing symptoms of mental disorder in children (Beardslee et al. 1997; Breslend et al. 2019; Rasing et al. 2013; Sadeh-Sharvit et al. 2016; Solantaus et al. 2010; Van Santvoort et al. 2014). Another 6 interventions had the objective of promoting parent- ing skills and help adults rely on their competence as parents (Compas et al. 2015; Hinden et al. 2005; Nicholson et al. 2009; Rosenblum et al. 2017; Van Santvoort et al. 2014; Wolp- ert et al. 2015). Further, 25% of the studies had other aims: improving parents’ recovery (Hinden et al. 2005; Nicholson et al. 2009; Rosenblum et al. 2017; Sadeh-Sharvit et al. Table 2 Quality assessment tool for quantitative studies scoring assessment of intervention studies Q Qualitative study Reference Selection biasDesignConfounders BlindingsData collec- tion Withdrawals and drop- outs Global Beardslee et al. (1997) 211 213 2 Nicholson et al. (2009) Q QQ QQQ Q Breslend et al. (2019) 111 211 1 Wolpert et al. (2015) QQQ QQQ Q Pitman and Matthey (2004) 2 22 231 2 Fraser and Pakenham (2008) 2 21 222 2 Compas et al. (2015) 211 111 1 Finkelstein et al. (2005) 2 21 213 2 Hayman (2009) QQQ QQQ Q Rasing et al. (2013) 111 213 2 Hinden et al. (2005) QQQ QQQ Q Riebschleger et al. (2009) 2 21 121 1 Rosenblum et al. (2017) 1 11 112 1 Sadeh-Sharvit et al. (2016) 2 21 212 2 Solantaus et al. (2010) 311 212 2 Van Santvoort et al. (2014) 2 11 112 1 1 3 1124 Child & Youth Care Forum (2021) 50:1107–1130 2016), increasing connectedness and promoting access to dierent sources of support (Hin- den et al. 2005; Nicholson et al. 2009; Solantaus et al. 2010; Van Santvoort et al. 2014). Type of Interventions More over, 37.5% of the interventions were carried out in a group setting with children or adolescents (Finkelstein et al. 2005; Fraser and Pakenham 2008; Hayman 2009; Pitman and Matthey 2004; Rasing et al. 2013; Solantaus et al. 2010). Multifamily groups were used by 31.25% of the studies (Breslend et al. 2019; Compas et al. 2015; Riebschleger et al. 2009; Rosenblum et al. 2017; Wolpert et al. 2015;). Finally, 31.5% used a family- centered approach (Beardslee et al. 1997; Hinden et al. 2005; Nicholson et al. 2009; Sadeh- Sharvit et al. 2016; Solantaus et al. 2010). Of note, a study combined family interventions with parental sessions (Sadeh-Sharvit et al. 2016) and another one (Beardslee et al. 1997) combined parental and children sessions. Intervention Components It was found that 87.5% of the studies use psychoeducation as one of the main compo- nents of the intervention. Only two studies (Hayman (2009) and Hinden et al (2005)) did not include psychoeducation as a main component in their interventions. Further, 68.75% of the sample contemplated skill training. These included: social skills, problem solving and coping with their parents’ illness (Breslend et al. 2019; Compas et al. 2015; Finkel- stein et al. 2005; Fraser and Pakenham 2008; Hayman 2009; Hinden et al. 2005; Nicholson et al. 2009; Rosenblum et al. 2017). Half of the interventions included playful activities (dramatizations, games, snack time, artwork, quizzes or roleplays) (Finkelstein et al. 2005; Fraser and Pakenham 2008; Hayman 2009; Pitman and Matthey 2004; Riebschleger et al. 2009; Van Santvoost et al. 2014; Wolpert et al. 2015). Emotional regulation components were included in 43.75% of the interventions (Beardslee et al. 1997; Finkelstein et al. 2005; Hayman 2009; Nicholson et al. 2009; Pitman and Matthey 2004; Rosenblum et al. 2017; Van Santvoort et al. 2014;). These included mind–body exercises or relaxation among oth- ers. Other components were parenting skills (37.5%) (Breslend et al. 2019; Compas et al. 2015; Nicholson et al. 2009; Rosenblum et al. 2017; Sadeh-Sharvit et al. 2016; Solantaus et al. 2010), peer support (31.25%) (Fraser and Pakenham 2008; Hayman 2009; Pitman and Matthey, 2004; Rosenblum et al. 2017; Van Santvoort et al. 2014), concrete support (25%, such as 24 assistance, advocacy or economic support) (Finkelstein et al. 2005; Hinden et al. 2005; Nicholson et al. 2009; Rosenblum et al. 2017) and group discussion (18.75%) (Fraser and Pakenham 2008; Riebschleger et al. 2009; Rosenblum et al. 2017). Characteristics of Samples The parents’ diagnosis varied among studies. It was found that 25% of the studies included parents with aective disorders (Beardslee et al. 1997; Breslend et al. 2019; Compas et al. 2015; Solantaus et al. 2010), 25% of the studies included serious mental illness in gen- eral (Fraser and Pakenham 2008; Nicholson et al. 2009; Pitman and Matthey 2004; Wolp- ert et al. 2015;) and 25% of the studies included any kind of mental disorder (Hayman 2009; Hinden et al. 2005; Rasing et al. 2013; Riebschleger et al. 2009). A smaller propor – tion of the studies (18.75%) included high-risk parents, dened as parents who suered 1 3 1125 Child & Youth Care Forum (2021) 50:1107–1130 mental illness, substance abuse and/or had a history of maltreatment (Finkelstein et al. 2005; Rosenblum et al. 2017; Van Santvoort et al. 2014). One intervention (Sadeh-Sharvit et al. 2016) was specically designed for families in which one of the parents suers from an eating disorder. Concerning parents’ gender, only two interventions (Nicholson et al. 2009; Rosenblum et al. 2017) were specically designed to mothers. Mothers and fathers with mental disor – ders were included in 75% of the studies. There are three categories according to the age of the children in treatment: babies (0–3 years), kids (3–12 years) and teenagers (12–18 years). Nicholson’s et al. (2009) inter – vention was aimed at children with ages in any of the three categories. Beardslee et al. (1997) and Hinden et al. (2005) did not specify age. Further, 37.5% of the interventions included kids and teenagers (Breslend et al. 2019; Compas et al. 2015; Pitman and Matthey 2004; Riebschleger et al. 2009; Solantaus et al. 2010; Wolpert et al. 2015). Three of them were addressed to kids only (Finkelstein et al. 2005; Rosenblum et al. 2017; Van Santvoort et al. 2014) and other three were addressed to teenagers only (Hayman 2009; Fraser and Pakenham 2008; Rasing et al. 2013). Lastly, Sadeh-Sharvit’s et al. (2016) intervention was focused on babies. Outcomes: Changes in Children Clinically signicant changes were observed in 56.25% of the children. Furthermore, 31.25% of the studies reported a decrease in non-clinical symptoms (internalizing or externalizing problems) (Breslend et al. 2019; Compas et al. 2015; Sadeh-Sharvit et al. 2016; Solantaus et al. 2010; Van Santvoort et al. 2014). A quarter of the studies reported improvements in adaptive functioning and found that participants used learned skills (Compas et al. 2015; Fraser and Pakenham 2008; Riebschleger et al. 2009; Solantaus et al. 2010). Also, 25% had a better understanding of their parents’ disorder (Beardslee et al. 1997; Fraser and Pakenham 2008; Sadeh-Sharvit et al. 2016; Riebschleger et al. 2009). Parent-reported qualitative changes in children were reported in 18.75% of the literature (Finkelstein et al. 2005; Pitman and Matthey 2004; Wolpert et al. 2015), and were con- sistent with the aforementioned outcomes. Noteworthy, 12.5% of the treatments did not specify changes in children (Nicholson et al. 2009; Rosenblum et al. 2017). Finally, the last 12.5% did not describe outcomes because the studies only detailed the program design (Hinden et al. 2005; Rasing et al. 2013). Discussion This study aimed to systematically review the literature in preventive psychological treat- ments aimed at COPMI (Cooklin 2010; Dean et al. 2010; Hayman 2009). Most of the quantitative studies reviewed had a moderate risk of bias, while the rest had low risk. COPMI have a risk of up to 70% of developing mental health problems (Siegenthaler et al. 2012). Therefore, it is not surprising that the goal of most of the treatments is to pro- mote resilience and, consequently, prevent prospective mental illness. Another relevant aim seems to increase the understanding of the parents’ disease. Commonly, COPMI do not have enough information about their parents’ situation, what triggers signicant feelings of fear and guilt (Cooklin 2013; Reedtz et al. 2019). Knowing about their parents’ mental dis- order is a need the children themselves claim (Bilsborough 2004). This claim is supported 1 3 1126 Child & Youth Care Forum (2021) 50:1107–1130 by evidence indicating that providing adequate knowledge may reduce children’s ailment and may improve their perception of the parent (Beardslee and Podorefsky 1988; Cooklin 2013). Frequently, COPMI live a role-reversal situation that could be improved by empowering parents (Aldridge and Becker 2003). Thus, a considerable proportion of the studies tackled parental skills. In addition, COPMI seem to have greater diculties in school performance (Bell et al. 2019). These diculties could stem in COPMI’s burden of tasks that should not belong to them, hampering their resources to focus on their academic tasks. Taking these results into account, future research should clarify the relationship between parenting skills and school performance. Previous reviews (Marston et al. 2016; Reedtz et al. 2019), have reported that most of the programs incorporate psychoeducation as a central component of the intervention. Psychoeducation can increase resilience in COPMI by providing a greater understanding of the parent’s illness, what could reduce guilt and fear and, give children tools to man- age role-reversal. These results allow us to conclude that psychoeducation is a tool that allows achieving the objectives of the interventions aimed at COPMI. Noteworthy, Mosek (2014) stressed that psychoeducation needs to be continuously oered for it to be eective. Improving children’s skills (social skills, problem-solving, adaptively coping with their parents’ illness) emerged as the next most frequent component of the interventions. This component was part of two thirds of the interventions, and it is regarded as necessary to promote resilience (Riebschleger et al. 2009). More than half of the studies include train- ing in emotional regulation strategies, specially improving children’s self expression and promoting exercises to help them relax during times of stress (such as relaxation, music or artwork). Improving the ability to modulate emotional states may be crucial in man- aging dicult situations and reduce ailment, ultimately improving resilience and prevent- ing internalizing and externalizing symptoms (Aldao et al. 2016). Surprisingly, previous reviews on this topic have not considered training in emotional regulation a main compo- nent of preventive interventions (Marston et al. 2016). Playful interventions seem to be a signicant yet not indispensable approach to the interventions. Playful interventions could encourage kids and teenagers to experience pleasant moments that could increase their sat- isfaction with the treatment and their adherence to it. In the context of multi-family inter – ventions, playful activities can create happy family moments, while games and dramatiza- tions can help express dicult experiences. Further, a signicant percentage of therapies (37.5%) included training in parenting skills to empower parents and reduce role reversal. This component could improve family dynamics and promote protective factors that could prevent relapses in parents. Previous research considered peer support as an important ther – apeutic component (Goodyear et al. 2009; Marston et al. 2016). We found that only a third of the interventions mentioned peer support as a specic component. However, 68.75% of the treatments we reviewed had a multi-family setting or included a group of children. Therefore, we can deduce that being in contact with peers is instrumental in treatments addressed to COPMI, because it allows children to share their fears and experiences (Bils- borough 2004), while providing a better learning of coping skills (Cu and Pietsch 1997; Turner 1999). Regarding the setting of the interventions, we found that the dierent therapeutic groups (multi-family group, children or adolescent groups or family therapies) were proportion- ally identical Evidence suggests that a family approach has several benets on COPMI and their parents, such as reducing children’s risk of mental disorders by 40%, promoting par – ents’ capacities and building resilience on the children (Bell et al. 2019; Campbell et al. 2020; Siegenthaler et al. 2012). Despite the many added benets of multi-family groups, 1 3 1127 Child & Youth Care Forum (2021) 50:1107–1130 information on them is lacking in the scientic literature. Multi-family groups may help parents and children understand the ailments of their counterparts. Further, multi-family groups foster the notion that other families experience the same issues as they do. Shared experiences could reduce feelings of shame or of being dierent. Ultimately, multi-family group interventions may provide a more ecient approach to provide psychoeducation, problem-solving, peer support and to work on family dynamics and parental skills. Inter – estingly, most of these programs are not aimed at specic mental disorders, parents’ gender or children’s age. However, kids and adolescents are equally included in the family groups, which facilitates working on diculties between parents and children that arise in dierent stages of development. Regarding the quality of the studies, several studies (Breslend et al. 2019; Compas et al. 2015; Riebschleger et al. 2009; Van Santvoort et al. 2014) emerged as “strong” and obtained good outcomes in children. Psychoeducation was a present component in all of them. Breslend et al. (2019) program was particularly remarkable as it reduced internal- izing subclinical symptoms and social problems using a multifamily approach and works on parental and children’s skills. Similarly, Compas et al. (2015) presents a similar inter – vention in results and components, but its single-family approach demands more resources (especially time). Riebschleger et al. (2009) developed a multi-family intervention with playful components that was eective in increasing children’s knowledge about mental health problems. Finally, Van Santvoort et al. (2014) described a program targeted to chil- dren that includes games and emotional regulation strategies, which is eective in reducing COPMI’s negative cognitions and increasing social support. Strenghts and Limitations This work presents an extensive review using two relevant databases in the eld of mental health. We reviewed interventions addressed to prevent mental health problems in COPMI. Preventive models can substantially alleviate suering, and help making a more ecient use of mental health resources. In this review, we have reported the objectives of the interventions, their modality, their components, their sociodemographic characteristics and their outcomes. We evaluated the quality of the articles, and we found that none of them had a high risk of bias. Therefore, we believe our work can be used as a guide for mental health professionals developing interventions aimed at COPMI. The results of this work must be interpreted in light of some limitations. Interdiscipli- nary databases have not been used. We have included qualitative studies, but their quality could not be evaluated. The high heterogeneity in the variables reported by each study may have hampered the comparability between studies. Some studies only presented a design for an intervention and therefore, no results were reported. Conclusions In conclusion, treatments addressed to COPMI have the objective of promoting resilience and increasing the understanding of the parents’ disorder. Psychoeducation is regarded as an instrumental content of these programs, usually combined with other techniques such as skills training, emotional regulation, playful components or peer support. Finally, a group 1 3 1128 Child & Youth Care Forum (2021) 50:1107–1130 setting is the most frequent approach. In this way, we believe multifamily therapies could provide a more complete and ecient approach. Compliance with Ethical Standards Conict of interest Authors declare that they have no relevant or material nancial interests to declare. References Agha, S. S., Zammit, S., Thapar, A., & Langley, K. (2013). Are parental ADHD problems associated with a more severe clinical presentation and greater family adversity in children with ADHD? 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