BackgroundChanges in Norwegian law and health policy require all health professionals to help safeguard the provision of information and follow-up for the children of parents with mental or physical illness, or substance abuse problems, to decrease their risk of psychosocial problems. There is a lack of knowledge on how the national changes have been received by hospital-based health professionals, and if they have led to an increase in family focused practice.MethodsThis cross-sectional study examined the adherence of health professionals’ (N = 280) in five hospitals to new guidelines for family focused practice, using a translated and generic version of Family Focused Mental Health Practice Questionnaire.ResultsOverall, health professionals scored high on knowledge and skills, and were confident in working with families and children, but reported moderate levels of family support and referrals. Comparison of the five hospitals showed significant differences in terms of workplace support, knowledge and skills and family support. The smallest hospital had less workplace support and less knowledge and skills but scored medium on family support. The two largest hospitals scored highest on family support, but with significant differences on parents refusing to have conversations with children.ConclusionsDifferences in implementation of family focused practice highlight the need to tailor improvement strategies to specific barriers at the different hospitals. The use of implementation theories and improvement strategies could promote full implementation, where all families and children in need were identified and had access to family support.Trial registration The study is approved by the Regional Committee on Medical and Health Research Ethics South-East Q5 37 (reg. no. 2012/1176) and by the Privacy Ombudsman.

Counter-acting forces to increase rural production and/or its efficiency, and to sustain an ecosystem now recognised to be under increasing and destructive pressures have created exigencies in achieving balanced natural resource management (NRM). Nowhere is this more apparent than in the management of the Murray Darling System in south-eastern Australia. All actions affecting natural resources impinge on the ecosystems that support those resources, the economy based on them, and the human society and culture connected to them. Change is best managed with the cooperation of those most affected. If NRM is to be achieved through informed community decisions, there is a need for a multidisciplinary process, drawing on specialist (intra-disciplinary) expertise, and a requirement to pull the resultant knowledge into an integrated form which supports decision-making at the management and community level. We propose a framework that identifies tasks necessary to support community decision-making and inject specialist technical knowledge into the process. For complex NRM issues, it is likely that there is insufficient information in one or more disciplines to support a strong decision. Where possible, this should lead to the interposition of targeted pilot trials, based on principles of adaptive management, prior to the final assessment and (presumedly) management plans. These 'management experiments' follow a similar path to specialist hypotheses and measurements (based on the same management intervention) followed by an integrated assessment. It appears that identification of, and engagement with, components of the community, and analytical techniques to support integrated assessment are two major areas in which new knowledge is urgently needed.

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