Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness (PRIMERA—Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children): study protocol for a randomised controlled trial

Abstract

Background Parental mental illness is common and can lead to dependent children incurring a high risk of developing mental disorders, physical illness, and impaired educational and occupational outcomes. Family Talk is one of the better known interventions designed to prevent the intergenerational transmission of mental illness. However, its evidence base is small, with few robust independent randomised controlled trials, and no associated process or cost evaluations. The PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children) research programme involves a mixed method evaluation of Family Talk which is being delivered in mental health settings in Ireland to improve child and family psychosocial functioning in families with parental mental illness. Methods The study comprises a multi-centre, randomised controlled trial (RCT), with nested economic and process evaluations, to assess the clinical and cost-effectiveness and implementation mechanisms of Family Talk compared to usual services. The study is being conducted in 15 adult and child mental health settings in Ireland. Families with a parent with mental illness, and children aged 5–18 years (n = 144 families) will be randomised to either the 7-session Family Talk programme (n = 96) or to standard care (n = 48) using a 2:1 allocation ratio. The primary outcomes are child psychosocial functioning and family functioning. Secondary outcomes are as follows: understanding and experience of parental mental illness, parental mental health, child and parental resilience, partner wellbeing and service utilisation. Blind assessments will take place at pre-intervention and at 6- and 12-month follow-up. Discussion Given the prevalence and burden of intergenerational mental illness, it is imperative that prevention through evidence-based interventions becomes a public health priority. The current study will provide an important contribution to the international evidence base for Family Talk whilst also helping to identify key implementation lessons in the scaling up of Family Talk, and other similar interventions, within routine mental health settings. Trial registration ISRCTN Registry, ISRCTN13365858. Registered 5th February 2019.

The Family Talk Programme in Ireland: A Qualitative Analysis of the Experiences of Families With Parental Mental Illness

“…In addition, a small number of families were discharged from AMHS/CAMHS before they could start FT, while several other families disengaged due to their unhappiness with long waiting lists, and delays/disruptions due to the COVID-19 lockdown restrictions. These difficulties reflect general underfunding of mental health services in the RoI, alongside a lack of policy/practise priority given to supporting this population in an Irish context (26,45,55). Some challenges were also noted during the intervention phase.…”

“…For instance, FT is not always delivered in countries with specific policy/practise guidance for this population. This qualitative study was nested within an RCT of the Family Talk intervention in Ireland for families with parental mental illness and children aged 5-18 years; the aim of the RCT was to assess the nature and extent of any pre-post intervention changes in child and family psychosocial functioning (26) and data analysis is currently underway. The objectives of the current study were to: (1) investigate the experiences of families attending FT; and (2) explore the processes of change, contextual factors or intervention characteristics that may influence trial outcomes in mainstream mental health settings (26).…”

“…Consequently, the national Health Service Executive (HSE) provided funding for the current research programme—called “PRIMERA” ( P romoting R esearch and I nnovation in M ental h E alth se R vices for f A milies and children), the primary aims of which were to: (1) identify/develop, implement, and evaluate family-focused interventions for families with PMI; and (2) inform a “think family” care delivery agenda within mental health services in Ireland. Following an initial scoping study that demonstrated a lack of structured support for this population in the RoI, it was agreed with stakeholders that clinicians across 15 AMHS, CAMHS and child protection/welfare service sites would deliver Family Talk as part of a randomised controlled trial (RCT), with embedded qualitative and economic analyses ( 6 , 26 ). FT was chosen for implementation as it: incorporates a structured “whole family” evidence-based approach; can be used with a range of mental disorders; provided freely available and high quality online training/resources 2 ; and was replicable and capable of being implemented across sites in Ireland ( 6 ).…”

Covid-19 and Families With Parental Mental Illness: Crisis and Opportunity

“…In 2017, the Health Services Executive in the RoI funded the "PRIMERA" 2 (23,24). Eighty percent of the PRIMERA parent sample attend AMHS for various mental health disorders; 20% receive antidepressant medication or primary care psychological support (24). This research provided the impetus for this paper.…”

“…In 2017, the Health Services Executive in the RoI funded the “PRIMERA” 2 research programme (2017–2021) to help implement and evaluate family-focused practise for families with PMI (randomised controlled trial (RCT) involving 92 families [152 parents, 249 children]) in 15 sites across the RoI and involving adult, child, and primary care mental health services ( 23 , 24 ). Eighty percent of the PRIMERA parent sample attend AMHS for various mental health disorders; 20% receive antidepressant medication or primary care psychological support ( 24 ). This research provided the impetus for this paper.…”