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      Overcoming Clinician and Parent Ambivalence: General Practitioners' Support of Children of Parents With Physical or Mental Illness and/or Substance Abuse

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          Abstract

          Children who are next of kin to parents with physical or mental illness and/or substance abuse need access to mental health support and several cost-effective interventions are available. Because most parents in the target group often consult general practitioners (GPs), GPs may have a crucial role in identifying burdened children and ensuring their follow-up. However, this important topic has received little attention in clinical discussions and research. In response to the knowledge gap, we conducted the research project Burdened Children as Next of Kin and the General Practitioner. Four sub-studies have been completed and published: a sub-study with qualitative analysis of focus group interviews with GPs (paper 1), a qualitative analysis of focus group interviews with adolescents as next of kin (paper 2), and a qualitative analysis of individual interviews with parents with illness and/or substance abuse (paper 3). The results from these sub-studies were incorporated in a survey sent to members of a nationwide GP organization (paper 4). The aim of the present sub-study was to gain further knowledge about conditions for the encounters between GPs and parents with impairments to be supportive for the children as next of kin. The material of the present sub-study derived from the project's four previous sub-studies and comprised a secondary analysis of the four prior sub-studies. We conducted an overarching thematic analysis of these sub-studies' results sections. We searched for statements from the GPs, the adolescents, and the parents on their experiences and evaluations of the needs of the children and their families, and the possible ways of accommodating these needs in general practice. The analysis shows that both GPs and parents were ambivalent about addressing the topic of the patients' children during consultations. This was the case although the GPs were in a good position to identify these vulnerable children, and the parents were worried about their children's situations. Possible strategies for GPs to overcome this ambivalence can be to (1) strengthen their competence in the topic, (2) gradually build trusting relationships with parents, and (3) gradually gain contextual knowledge about the families' situations. GPs can do this by performing ordinary GP tasks and acknowledging the parents' efforts to give their children good daily lives.

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          Most cited references36

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          The patient-centred clinical method. 1. A model for the doctor-patient interaction in family medicine.

          This article describes a patient-centred clinical method appropriate for family medicine. The method is designed to attain an understanding of the patient as well as his disease. This two-fold task is described in terms of two agendas: the physician's and the patient's. The key to an understanding of the patient's agenda is the physician's receptivity to cues offered by the patient, and behaviour which encourages him to express his expectations, feelings and fears. The physician's agenda is the explanation of the patient's illness in terms of a taxonomy of disease. In the patient-centred clinical method, both agendas are addressed by the physician and any conflict between them dealt with by negotiation. This is contrasted with the disease-centred method in which only the doctor's agenda is addressed. Further articles will describe the patient-centred method in operational terms.
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            Using thematic analysis in psychology

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              Do preventive interventions for children of mentally ill parents work? Results of a systematic review and meta-analysis.

              The transgenerational transmission of mental disorders is one of the most significant causes of psychiatric morbidity. Several risk factors for children of parents with mental illness (COPMI) have been identified in numerous studies and meta-analyses.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                08 January 2019
                2018
                : 9
                : 724
                Affiliations
                [1] 1Regional Center for Child and Youth Mental Health and Child Welfare, Uni Research Health , Bergen, Norway
                [2] 2Research Unit for General Practice, Uni Research Health , Bergen, Norway
                [3] 3Department of Psychosocial Science, University of Bergen , Bergen, Norway
                [4] 4Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen , Bergen, Norway
                [5] 5Clinical Psychology, Radboud University Nijmegen , Nijmegen, Netherlands
                [6] 6Impluz, Prevention Team Mental Health , Deventer, Netherlands
                [7] 7Regional Center of Child and Youth Mental Health and Child Welfare, Artic University of Tromsø , Tromsø, Norway
                Author notes

                Edited by: Joanne Nicholson, Brandeis University, United States

                Reviewed by: Kim Foster, Australian Catholic University, Australia; John W. Yuen, Hong Kong Polytechnic University, Hong Kong

                *Correspondence: Marit Hafting marit.hafting@ 123456uni.no

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2018.00724
                6331400
                a9f70c95-e425-425e-829e-384aa963b2aa
                Copyright © 2019 Hafting, Gullbrå, Anderssen, Rørtveit, Smith-Sivertsen and van Doesum.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 29 August 2018
                : 07 December 2018
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 46, Pages: 11, Words: 8865
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                children as next of kin,parents with impairments,general practitioners,health prevention,health promotion,qualitative research

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