Introduction to special issue: parenting interventions and the mental health of children and parents

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This special issue addresses how interventions focused on supporting adults in their parenting role are influenced by, and can influence child and parent mental health. The papers collected for this special issue explore aspects of the mechanisms via which mental health influences relationships and actions within the family, and how interventions focused on parenting support or skill building can influence the functioning of family members across the spectrum of severity and types of mental health difficulties in parents and children. The aim of this special issue was to stimulate discussion about how to best support good mental health in children and adults, and we believe the resulting collection presented herein successfully meets this aim.

In Australia, recent government investments in child and youth mental health initiatives demonstrate a policy-level commitment to addressing the challenges associated with poor mental health in our communities. Investment in professional development and workforce support initiatives, such as Emerging Minds (https://emergingminds.com.au/), has helped to raise public and cross-sectoral awareness about infant and child mental health as an issue.

Arguably, the same attention to addressing mental health concerns among the other key members of families – parents and those in a parenting role – is needed. Recently released research findings from a representative survey of parents living in one state of Australia suggest that while most parents of 0–18-year-old children report good mental health, two in every five had experienced symptoms of depression, anxiety or substance addiction since having children. The Parenting Today in Victoria Study of 2600 parents, including 1044 fathers, found that mental health issues among parents were common, with more than a quarter reporting current psychological distress in the moderate to serious range (Millward, Matthews, Wade, Forbes, & Seward, 2018; https://www.parentingrc.org.au/publications/parenting-today-in-victoria/).

Notwithstanding the depth of research and public health campaigns aimed at reducing the societal impact of adult mental illness through agencies like Beyond Blue (https://www.beyondblue.org.au/), there is a need for greater understanding about mental health challenges in parents, and how we can reduce the impact of this on children and families. National and international research provides evidence that parent mental health has a strong and enduring impact on children and parenting. A parent's ability to provide basic care for children and their provision of enriched and nurturing interactions with their children can be compromised by parents’ mental health difficulties (Reupert, Maybery, & Kowalenko, 2013). Parent mental health has been shown to have an impact on children's own mental health (McLaughlin et al., 2012; Weissman et al., 2006), and there is also evidence of impact on children's academic and social functioning (Mensah & Kiernan, 2010).

Despite these population-level risks, family context and the support available to the family can influence the level of children's risk exposure (Reupert et al., 2013). While parents with mental ill health may face more challenges in their parenting, this does not always have to be a trigger for concern by professionals. Parents with mental illness can sail the smooth and rough seas of parenting while effectively managing their own mental health needs. Some of the research presented in this special issue attests to that. A number of the included papers discuss how parents with a range of mental health concerns – including serious and diagnosed mental illness – can be supported to improve parenting. Improvement in parenting skills related to the provision of warm and positive interactions, reductions in over-protective behaviours and in parent stress are noted benefits of the receipt of professional support from among these special issue papers.

Wills and Petrakis (2018) explore the concept of ‘relational self-construal’ for parents. Relational self-construal is an aspect of self-concept that reflects how the individual sees themselves with respect to their relationships with others. The authors describe the relationship between relational self-construal and parent mental health, and its implications for intervention based on systematic review of the literature. They note that social expectations on parents have increased in recent decades, with competing demands for their time (i.e. paid employment, caring for aging parents, etc.) in addition to increasing expectations for time spent interacting with their child having a negative impact on parent mental health. They argue that mothers’ construal of themselves as mothers can influence their parenting, their responsiveness to interventions and ultimately their mental health.

Cairns, Potter, Nicholas, and Buhagiar (2018) discuss results from a mixed-method exploratory study aimed at deepening our understanding of the role parents can play in supporting adolescents’ mental health. The research explores the challenges experienced by parents and young people during this under-researched period of a young person's development, as well as their support needs and preferences. Using a large-scale survey of parents and in-depth consultation with adolescents, the authors offer valuable insights into the fears and worries of parents in relation to their teenage child's mental health. Parents found the process of gaining appropriate professional help for concerns about their child's mental health to be ‘fraught’ with difficulties. Findings from this study can help us better understand how to target and deliver interventions aimed at supporting parents at this pivotal time in their children's development. There are also significant implications from this research for the gaps in knowledge about parenting children during the adolescent years. Our own research, through the Parenting Today in Victoria study (Wade et al., 2018), suggested that compared to parents of younger children, parents of adolescents feel less effective as parents, are less confident in their own parenting skills and are less likely to report having someone they trust and could turn to for advice (Parenting Research Centre, 2017). There is a relative dearth of evidence-based parenting programs for parents of adolescents compared to parents of young children, making this an area in desperate need for continued research and development.

Four papers in this special issue report on community-based or ‘real-world’ evaluations of parent-directed interventions for parents with mental health concerns. Jarosz and Bayer (2017) describe an evaluation of the ‘Cool Little Kids’ parenting program. This study builds on previous evaluations of the program (Kennedy, Rapee, & Edwards, 2009; Rapee, Kennedy, Ingram, Edwards, & Sweeney, 2005; Rapee, Kennedy, Ingram, Edwards, & Sweeney, 2010) by describing results from a ‘real-world’ implementation of the program in an Australian community setting. The findings suggest positive outcomes for child mental health (internalising problems and anxiety) and for parent mental health (stress), as well as improvements in parenting practices when comparing pre and post-intervention scores on standardised measures. Feedback from parent participants about the usefulness of the program was also positive. More studies like this are required to assess the effectiveness of parenting support interventions following translation from research to community-based service settings.

McFarland and Fenton (2018) describe the implementation of a recovery-focused program with a small number of parents with mental illness. Their study adopted an interpretivist case study design, and while the sample was small, results from this community-based intervention case study trial are promising. McFarland and Fenton (2018) reflect on how views about mental illness may have impacted on recruitment. This highlights how far we still need to go to reduce stigma about mental illness and also how far we still are from normalising help-seeking for parenting.

In the paper by Gray, Townsend, Bourke, and Grenyer (2018), the acceptability and feasibility of a brief parenting intervention for parents with borderline personality disorder is described. Clinician's reports about the intervention revealed a number of important insights relevant for clinicians working in adult treatment settings. Of note, clinicians saw benefits to the adoption of a manualised approach to parenting support. There were apparent benefits noted by clinicians when they had greater guidance on how to have conversations with their clients about being a parent. This addresses a widely shared concern among adult-focused service providers that for many, clients may not even be asked about their parenting status.

The final evaluation-focused paper in this special issue addresses the acceptability of a single session model for use in therapeutic settings that supports clinicians to facilitate a semi-structured conversation between parents and children about mental health (Hoadley, Falkov, & Agalawatta, 2018). Clinicians’ and family members’ views about the approach suggested improved family communications and greater shared understanding of mental health issues within families with two generations of mental ill-health.

The final paper in this special issue describes the approach adopted by the developers of the SMS4Parents text-based parenting support initiative in designing the intervention (Fletcher et al., 2018). To create an acceptable version of the intervention suitable for mothers with severe perinatal mental illness and their partners, an expert advisory group rated suggested text message content on dimensions of importance, clarity, acceptability and consistency with evidence. Digital modalities of intervention for parenting skill building show great promise for future parenting support provision, and this study demonstrates how rigorous methods can be used to design interventions that have efficacy and relevance. As a group, the papers by McFarland and Fenton, Gray and colleagues, Hoadley and colleagues and Fletcher and colleagues provide a starting point from which to further explore the effectiveness and efficacy of the respective interventions.

Multiple aspects of the relationship between mental health and parenting are explored in this collection of papers. Themes addressed include the effects of parenting intervention for child and parent mental health, as well as consideration of parent mental health as a moderator or mediator of a range of other outcomes from parenting interventions. The included papers incorporate a range of research methodologies to explore the topic, illustrating how different theoretical frameworks and research paradigms are being employed by Australian researchers and professionals to explore the complexities of adult and child mental health and the ways we can influence outcomes for families in our communities. Greater knowledge of the effects of parenting interventions for child and parent mental health is still needed, especially for diverse populations and across the spectrum of symptom severity and child age. But we hope that this special issue serves to renew the conversation about how to best ensure parents and children with poor mental health can best benefit from therapeutic and non-therapeutic support offerings.

ORCID

Catherine Wade http://orcid.org/0000-0001-9417-5298