It has been known for many years that the children of parents with mental illness run a high risk of developing psychiatric and other problems both during their childhood and later in adulthood. Meeting and providing support for the patients’ children has, however, been a neglected area in adult psychiatry until today. Recent supplementary legislation in the Nordic countries obligates the professionals in health services to take account of the needs for information and support of the children and their families when a parent suffers from a serious illness. Beardslee’s preventive family intervention (FI) is the first family-based and structured method used in psychiatric services in Sweden. The method has some evidence of positive long-term effects for the children and families with parental depression. The purpose of this thesis was to investigate the FIs safety and feasibility in Sweden (paper I), its’ perceived impact for the families (papers I, III and IV) and also to examine the process of the FI from the perspective of the ill parent, the other parent and the children (papers II, III and IV). The studies were conducted in naturalistic settings. The data in paper I was collected by using a questionnaire to parents and children (117 parents and 89 children responded) one month after an FI. Paper II comprises interviews with ten parents, suffering from depression, about their decision process for participation in an FI. In papers III and IV the data from 25 interviews with parents and 14 interviews with children about the experiences of the FI is presented. Seventy five professionals from 29 psychiatric units had conducted the FIs for the families that participated in the studies. The data was analyzed by descriptive statistics and chi2 (I), Grounded theory (II and III) and Qualitative content analysis (IV). The results in paper I showed that the overall satisfaction with the FI was high for both parents and children. Ninety three percent of the answers from parents to questions concerning the satisfaction with the FI were positive, and 71 % of the answers from the children. The reported perceived impact of the FI was also predominantly positive. Feelings of guilt decreased for 89 % of the children who had had feelings of guilt towards the parent prior to the FI. Knowledge about the parent’s illness was perceived to increase for 74 % of the children. There were a few negative answers about the impact of FI from the children; five children experienced increased concerns about the parent and three children reported a lower level of well-being after the FI. In paper II the interviews with the depressed parents revealed ambivalence in the decision to participate in an FI. The parents longed for knowing how their children were feeling, how they thought about the illness and if it had harmed them. On the other hand, the parents were anxious about hearing the answers to their questions, as feelings of shame and guilt were associated with these. Exposure to outside opinion was also both relieving and scaring. The examination of the parents’ experiences continued in paper III. The process of opening up the dialogue about the illness with the children was demanding. To listen to the children’s experiences, to find the words to speak about the illness to the children and finally to be able to start to talk about it in the family session required a solid base of confidence and security in the professionals and in the method. The FI as a method seemed to provide favorable conditions for an establishment of an alliance with the parents. The children’s experiences of the FI are presented in paper IV. Most of the children described a sense of relief because of better knowledge about the parent’s illness and increased communication in the family and thus they also felt released from some worry for the parent. They could spend more time with their friends and did not need to take so much responsibility at home. Parents and children in the same families described the changes in similar ways, indicating mutual understanding in the families. The parents experienced themselves as stronger in their roles as parents and less ashamed. In summary, the families are satisfied with their participation in FI, they report a positive impact and the number of perceived negative effects is low. The children describe a sense of relief from concerns about the parent’s illness.

Den här kvalitativa studien belyser hur socialarbetare beskriver barn till föräldrar med missbruksproblematik, hinder och utmaningar i arbetet med dessa barn och samverkan mellan de olika yrkesgrupperna i arbetet med barn till föräldrar med missbruksproblematik. Ytterligare belyser studien de stöd och insatser som de olika verksamheterna erbjuder för dessa barn. Undersökningen utfördes i två olika kommuner i södra Sverige. Utifrån den valda kvalitativa metoden nåddes ett resultat från informanternas berättelser. Resultatet påvisar att det finns en mängd olika orsaker till varför det finns svårigheter i att upptäcka barn till föräldrar med missbruksproblematik. En återkommande orsak i resultatet är föräldrarnas förnekelse om sitt missbruksproblematik. I resultatet framkommer det att alla barn påverkas av föräldrarnas missbruksproblematik, dock är påverkas barnen individuellt. Det påvisas att ett samarbete sker mellan de olika yrkesgrupper dock kan samverkan förbättras. Slutsatsen är att samhället behöver mer kunskap om barn i missbruksfamiljer och att fler skall våga anmäla.

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Titel: ''Alkoholmissbruk synliggörs inte alltid för socialtjänsten'' – Socialsekreterares arbete med barn som växer upp i familjer med alkoholmissbrukande föräldrar Författare: Mimmi Bäcke and Luul Issa  Studien syftade till att undersöka socialsekreterares arbete med barn som växer upp i familjer med alkoholmissbrukande föräldrar. Utifrån en kvalitativ ansats hölls semistrukturerade intervjuer med fyra socialsekreterare. Resultatet visar att socialsekreterarna beskriver det sociala arbetet kring barn som lever i familjer med alkoholmissbruk som komplext. Vidare uppgav socialsekreterarna att insatser är behovsinriktat och utformas utifrån varje enskild situation. Resultatet visar att de vanligaste stödinsatser är stödsamtal och stödgruppsverksamhet. Däremot saknas tillförlitligt underlag för insatsernas effektivitet. Slutligen visar resultatet att samverkan mellan socialsekreterare och andra aktörer upplevs som bristfällig. / Title: ''Alcohol abuse is not always visible to the social services'' – Social workers' work with children who grow up in families with alcohol-abusing parents Authors: Mimmi Bäcke and Luul Issa  This study aims to investigate how social workers work with children growing up in families with alcohol-abusing parents. Based on a qualitative approach, semi-structured interviews were held with four social workers. The results show that the social workers describe the social work with children living in families with alcohol abuse as complex. Furthermore, the social workers stated that interventions are needs-oriented and designed for each specific situation. Here, the results show that the most common support measures are support talks and support group activities. However, there is insufficient research for efficiency of measures taken. Lastly, the results show that collaboration between social worker and other professionals is perceived insufficient.

This is a scoping review about adult children of parents with alcohol abuse based on ten articles published by researchers. The aim of this study was to examine the impact of parental alcohol addiction on adult children's psychological well-being and health, and to identify what support and interventions society can offer to improve the situation of adult children in families where at least one parent has alcohol addiction. To identify and analyse patterns and themes, I conducted a thematic analysis. In the thematic analysis, I found themes that touched on attachment and role reversal, the role of communication and its effects on children, and help and social interventions. The result showed that alcohol abuse doesn’t only affect the individual with the illness but also the people around them; such as their kids. Relatives of people with alcohol abuse have the right to get help from society. Many adults who have had difficulties with attachment need motivation to break the pattern so as not to pass on their patterns and behaviours to the next generation. The adult children have experienced parents' denial of their addiction, dysfunctional communication and insecure attachment, which has led to negative and faulty self-perception and self-esteem. Other emotions such as worry, sadness and anger also appear in the results. The result of the scoping review showed that parents' support and openness about their addiction to the adult children is important. The support is needed to help the children develop resilience and to promote well-being, development and self-esteem. That interventions and support from society can help individuals develop strategies to focus on their own well-being and avoid passing on negative behaviour patterns to their children.

Barn till föräldrar med substansmissbruk är en utsatt grupp då denna målgrupp lätt glöms bort eller inte ses av samhället. Att växa upp i en miljö med missbruk ökar risken för eget substansmissbruk eller psykisk ohälsa. Syftet med studien är att analysera webbaserade organisationers stöd och hjälp till barn och unga som lever i en missbruksmiljö. Metoden som används är en databassökning och textanalys. I resultatet framkommer det att frivilligorganisationernas hemsidor är mer användarvänliga för barn och unga då deras huvudsyfte är att vända sig direkt till den målgruppen jämfört med Statliga, Kommunala, Regionala, Länsstyrelsens hemsidor som är riktade att nå ut med sin information till allmänheten. / Children of parents with substance abuse are a vulnerable group and is easily forgotten by the society. Growing up in an environment with addiction increases the risk of own abuse or mental illness. The aim of the study is to analyze webbased support from different organizations, aimed to address children and young people living in an abusive environment. The method used, is a database-search and text-analysis approach. The result shows that NGO’s websites are more userfriendly for children and young people, probably because their main purpose is to address directly to this target group, compared to local-governmental, municipal, regional and county-governmental websites

Trust amongst key stakeholders in schools is a vital aspect for a healthy school culture and climate. This study aims to investigate faculty trust perceptions within an international school context in West Africa. Grounded within a theoretical framework of “Schools as Open-Social Systems”, faculty trust perceptions in colleagues, principals and parents & children were investigated via a quantitative analysis process. Whilst overall results reflect positive faculty trust perceptions in colleagues, principals and clients (parents and children) at the various schools in question, there exists a significant difference for faculty trust in clients and faculty trust in principals across secondary and elementary schools. Results therefore point to a difference in culture and climate that exists across secondary and elementary sections of these schools. An implication of this study would be for school leaders to make tangible efforts towards harmonising the overall culture and climate of these various school sections in order to work towards a common mission and vision. / Tillit bland olika aktörer i skolan är viktig för ett positiv skolkultur och klimat. Denna studie syftar till att undersöka lärarnas tillitsuppfattning i ett internationellt sammanhang i Väst Afrika. Teoretiska utgångspunkter för studien utgår från skolorna som öppna sociala system och kvantitativ analys används för att undersöka lärarnas tillitsuppfattning hos rektorer, kollegor samt föräldrar och barn. Trots att resultaten visar ett positiv tillitsuppfattning hos kollegor, finns det skillnader i lärarnas förtroende i rektorer samt lärarnas förtroende i föräldrar och barn i olika skolnivåer det vill säga mellan grundskolorna och gymnasieskolor. Det påpekar dels skillnader i skolkultur och klimat som existerar mellan grundskolorna och gymnasieskolorna i denna studie. Studien påvisar att skolledare borde agera för att bibehålla ett gemensamt skolklimat och kultur inom alla avdelningar. På så sätt stärks skolans vision och uppdrag.

Bakgrund: Psykisk ohälsa kan vara allt från tillfälliga psykiska besvär till livslånga funktionsnedsättningar. En åttondel av världens befolkning lever med psykiatriska tillstånd. Sjuksköterskan upplever svårigheter i vårdandet av patienter med psykisk ohälsa. Bristande anknytning mellan barnet och föräldern kan påverka barnets utveckling negativt. Syfte: Syftet var att sammanställa och beskriva upplevelser av att vara barn till en eller flera föräldrar med psykisk ohälsa. Metod: Litteraturstudie med deskriptiv design och tematisk dataanalys. Genom sökning i databaserna Pubmed och Cinahl sammanställdes 11 artiklar som redovisas i resultatdelen. Huvudresultat: Identifierade teman var psykiska sjukdomen och den sjuka föräldern, inverkan på känslor och beteende, och barnens upplevelser av stöd. Barnen upplevde att den psykiskt sjuka föräldern var olik andra föräldrar och att hemsituationen var oförutsägbar. Barnen beskrev att den sjuka föräldern var mindre involverad i deras liv. Det beskrevs även positiva aspekter hos föräldern. Barnen upplevde negativa känslor relaterade till förälderns sjukdomssymtom och barnen kunde olika mycket om sjukdomen. Barnen ville gömma förälderns ohälsa och ha tid och rum för sig själva bortom sjukdomen. Barnen upplevde ett utökat ansvar men att de fick stöd både inom och utanför familjen. Slutsats: Barn till föräldrar med psykisk ohälsa känner negativa känslor och kan bli dåligt behandlade av sina sjuka föräldrar. Kunskapen om barns upplevelser ger sjuksköterskan bättre förutsättningar att stötta dessa barn inom olika vårdsammanhang. Sjuksköterskan bör se till att barnet eller den psykiska ohälsan inte hamnar i skymundan utan bör ha ett helhetsperspektiv på situationen. / Background: Mental illness can be anything from temporary psychological problems to lifelong mental disabilities. One eighth of the world's population lives with psychiatric conditions. The nurse experiences difficulties in the care of patients with mental illness. Lack of connection between the child and the parent can adversely affect the child's development. Aim: The aim was to compile and describe experiences of being a child of one or more parents with mental illness. Method: Literature study with descriptive design and thematic data analysis. By searching the databases Pubmed and Cinahl, 11 articles were compiled which are reported in the results section. Main results: Identified themes were the mental illness and the ill parent, the impact on emotions and behaviour, and the children's experiences of support. The children felt that the mentally ill parent was different from other parents and that the home situation was unpredictable. The children described that the sick parent was less involved in their lives. Positive aspects of the parent were also described. The children experienced negative emotions related to the parent's disease symptoms and the knowledge about the disease differed among the children. The children wanted to hide the parent's mental illness and have time and space for themselves beyond the illness. The children experienced an extended responsibility but they also received support both inside and outside the family. Conclusion: Children of parents with mental illness feel negative emotions and may be treated badly by their ill parents. The knowledge of children's experiences gives the nurse better conditions to support these children in different care contexts. The nurse should ensure that neither the child nor the mental illness is overlooked, and should have a holistic perspective on the situation.

The purpose of this thesis was to examine children’s right to self-determination within healthcare and to which extent guardians should receive information. The Swedish Children and Parents Code Chapter 6 Section 11, the Public Access and Security Act Chapter 12 Section 3 and the Patient Act Chapter 3 Section 3 constitutes the core of the thesis. The primary question is how they relate to each other. The thesis shows that guardians according to The Swedish Children and Parents Code Chapter 6 Section 11 has a right and an obligation to decide on issues related to a child’s personal affairs. The Patient Act Chapter 3 Section 3 states that guardians should receive the same information as a child, when the child is a patient. It can be concluded that information in regards to a child’s guardians is considered confidential as long as the situation is not covered by the Swedish Children and Parents Code Chapter 6 Section 11 or if it can be assumed that the child will suffer significant harm, according to the Public Access and Security Act Chapter 12 Section 3. If the child however has right to self-determination in the question at hand, it therefore disposes the confidentiality and information cannot be given to the guardians without consent from the child. It can also be concluded that even though a child has the right to self-determination in regards to a health care action, there might be situations where the risks of future injuries are so significant that the child cannot have the autonomy required in which case parental involvement is necessary. In those cases, the guardians should be informed about the situation. In reality guardians receive written information about a child’s healthcare through a journal online called Journalen via nätet and through copies of the journal on paper. The two methods hold age limits, which cannot be found in the legislation. The thesis shows that confidential information runs the risk of being disclosed without necessary consent due to these methods. Another risk is that guardians are prevented from receiving the information that the law ascribes to them.

<p>Barn påverkas av föräldrars psykiska sjukdom i form av oro, rädsla och skuld samt har en förhöjd risk att själva drabbas av psykisk sjukdom. En utmaning för den psykiatriska vården är det ökande antalet av vuxna med psykiatrisk sjukdom som även är föräldrar till minderåriga barn. Sjuksköterskor inom psykiatrin har en viktig roll när det gäller att uppmärksamma dessa barn samt se till att de får adekvat hjälp och stöd. Syftet med studien var att beskriva hur barn till föräldrar med psykisk sjukdom upplever det stöd de får ifrån den psykiatriska vården samt beskriva vårdpersonals upplevelser av stöd till dessa barn. Metoden som användes var kvalitativa forskningsintervjuer som<em> </em>genomfördes med sex barn som har föräldrar med psykisk sjukdom och fjorton vårdpersonal som arbetar inom den psykiatriska vården. Intervjuerna analyserades med kvalitativ innehållsanalys och resultatet utmynnade i fyra kategorier. 1. Barn till föräldrar med psykisk sjukdom upplever sig bli hjälpta av stödet från den psykiatriska vården även om det bör förbättras. 2. Vårdpersonal upplever att den psykiatriska vården erbjuder olika verksamheter som ger ett gott stöd till barn även om det bör förbättras. 3. Vårdpersonal upplever att barn behöver uppmärksammas, informeras och stödjas i kontakten med sina föräldrar. 4. Vårdpersonal upplever svårigheter i form av osäkerhet kring sin egen kunskap samt föräldrars ovilja att blanda in barn i den psykiatriska vården. En slutsats av studien är att barn till föräldrar med psykisk sjukdom får ett relativt gott stöd även om det behöver förbättras. För att göra detta krävs utbildning av vårdpersonal och att verksamheten har framtagna rutiner och användbara metoder för att kunna stödja barn.</p> / <p>Children get affected by parents mentally illness in form of anxiety, fear and guilt and also have an enhanced risk to suffer from mentally illness themselves. A challenge to the psychiatric care is the increasing number of adults with a mental illness who also are parents to under aged children. Nurses in the psychiatric care have an important role when it comes to notice these children and make sure that they receive adequate help and support. The purpose of the study was to describe how children of mentally ill parents experience the support they receive from the psychiatric care and describe psychiatric healthcare workers experiences of these children’s support. The method that was used in this study was qualitative interviews with six children of mentally ill parents and fourteen psychiatric healthcare workers. The interviews were analysed based on qualitative content analysis and gave four categories as result. 1. Children of mentally ill parents experience help due to the support from the psychiatric care even though it should be improved. 2. Psychiatric healthcare workers experience that the psychiatric care offers a variable of activities that give a good support to children even though it should be improved. 3. Psychiatric healthcare workers experience that children need attention, be informed and supported in their relationship to their parents. 4. Psychiatric healthcare workers experience difficulties like insecurity about their own knowledge and parents’ unwillingness to involve the children in the psychiatric care. A conclusion from this study is that children of mentally ill parents receive a relatively good support even though it needs to be improved. To do that it takes education of the psychiatric healthcare workers and that the psychiatric care is given routines and useful methods to support children.</p>