Measuring Recovery in Parents Experiencing Mental Health Problems

Abstract

Parenting is a fundamental life domain with increasing evidence suggesting the parenting role has the capacity to inform and promote mental health recovery. Two reviews examined the current tools available to assess parenting in the context of recovery. Review one identified 35 quantitative measures of parenting used in interventions for parents with mental health problems. None of these measures appeared to consider parenting from a recovery orientation. Review two identified 25 measures of personal recovery; however, none appeared to consider the parenting role. Despite the fundamental life role of parenting, our ability to measure these constructs appears limited. Further research is warranted into the development of a measure of recovery that considers the parenting role.

Keywords

recovery parenting mental health measures

In any 12-month period, one in five Australians aged 16 to 85 years will experience a mental health disorder (T. Slade, Johnston, Oakley Browne, Andrews, & Whiteford, 2009). Recent Australian estimates suggest up to one in five young people have a parent with a mental health problem (Reupert, Maybery, & Kowalenko, 2013). For parents with mental health problems, they must navigate managing the normal challenges of parenting as well as their mental health problem (Reupert & Maybery, 2016).

Introduction

Parenting is a critical life domain for many parents with mental health problems (Biebel, Nicholson, Woolsey, & Wolf, 2016; Dolman, Jones, & Howard, 2013; Goodyear et al., 2015; Hine, Maybery, & Goodyear, 2018; Nicholson, 2010; Reupert, Price-Robertson, & Maybery, 2017). Broadly, parenting refers to the activities of an adult that are aimed at meeting their child’s basic needs (e.g., basic care, safety, emotional warmth) and promoting their transition to adulthood (Brockington et al., 2011). The risks for reduced psychological, social, and physical health outcomes for the children of parents with mental health problems are well established (Maybery, Ling, Szakacs, & Reupert, 2005; Ranning, Laursen, Thorup, Hjorthoj, & Nordentoft, 2015; Siegenthaler, Munder, & Egger, 2012; van Santvoort et al., 2015). Increasing evidence, however, suggests that preventive interventions targeting parents with mental health problems can reduce the risk for their children developing mental health problems by 40% (Siegenthaler et al., 2012).

In recent years, a paradigm shift in the treatment model for mental health problems can be seen, moving from a focus on symptom reduction to personal recovery. Personal recovery refers to the notion that mental health services should encourage and support individuals with mental health problems to live meaningful lives whether or not their symptoms are present (Commonwealth of Australia, 2013). It thus emphasizes that recovery from mental health problems is unique to every individual and their context (Leamy, Bird, Le Boutillier, Williams, & Slade, 2011). For the purposes of the present review, the term personal recovery will be used to refer to the unique recovery process of an individual mental health consumer. Recovery and mental health recovery will be used as broader, conceptual terms.

A recent milestone for research in this area was a systematic review of the personal recovery literature that highlighted five key underlying domains of the personal recovery concept. In this systematic review of the literature Leamy and colleagues (2011) identified: Connectedness, Hope and optimism for the future, Identity, Meaning in life, and Empowerment, together known as CHIME, as core personal recovery processes. They also conceptualized these as dimensions of measurable change in terms of personal recovery, and suggest they provide a framework for which research and clinical practice can be oriented (Leamy et al., 2011). Recently, it has been suggested that personal recovery does not occur in isolation but rather within the social context of the individual (Goodyear et al., 2015; Wyder & Bland, 2014). An individual’s social context refers to the network of relationships and community in which they are embedded (Goodyear et al., 2015). This social context, as well as an individual’s roles within it, thus may underlie and promote recovery (Hunt & Stein, 2012; Tew et al., 2012). The parenting role may be considered a unique and important role for many parents.

In terms of the CHIME framework, the parenting role may: offer opportunities for connections with others and participation in meaningful activities (Connectedness; Nicholson, 2010), be a source of hope (Hope and optimism about the future; Reupert et al., 2017), promote self-agency and be a source of positive identity (Identity; Carpenter-Song, Holcombe, Torrey, Hipolito, & Peterson, 2014; Evenson, Rhodes, Feigenbaum, & Solly, 2008; Hine et al., 2018; Nicholson, 2010), provide a sense of purpose (Meaning; Carpenter-Song et al., 2014; Evenson et al., 2008; Reupert et al., 2017), and offer incentive to improve/recover (Empowerment; Reupert, Maybery, Cox, & Scott Stokes, 2015). Accordingly, it has been suggested that recovery-oriented practice may be enhanced by supporting parents in their parenting role as part of mental health services (Commonwealth of Australia, 2013; Hine et al., 2018; Maybery et al., 2015).

Numerous interventions for parents with mental health problems have been conducted. A recent systematic review by Reupert et al. (2017), however, found only three interventions incorporated parenting as a focus in recovery-oriented mental health practice (Family Options, Let’s Talk About Children, Parenting with Success and Satisfaction). Recovery-oriented mental health practice focuses on supporting individuals to take responsibility for their own recovery and well-being, regardless of whether their symptoms are present (Commonwealth of Australia, 2013). The three interventions identified by Reupert et al. (2017) all focused on the parenting role within a recovery and/or rehabilitation framework. For example, Family Options (Nicholson, Albert, Gershenson, Williams, & Biebel, 2009) is a rehabilitation-based intervention focused on resilience and recovery for parents with serious mental health issues and their children. This intervention involves the use of “Family Coaches” to build relationships with families, as well as provide support, education, and feedback (Nicholson et al., 2009). Reupert et al.’s (2017) systematic review identified, however, that the majority of interventions to date target all or at-risk parents, or focus on modifying parenting behavior to promote child well-being. Although the parenting role may have the capacity to inform and promote recovery, it appears that research is only just beginning to consider this in terms of recovery-oriented interventions (Reupert et al., 2017).

Research also suggests that in clinical practice parenting is not routinely considered (Reupert & Maybery, 2016). Specifically, that often mental health service providers and treatment protocols do not consider parent status and/or parenting-related issues (Reupert & Maybery, 2015, 2016). Despite estimates of parental mental health problems and its’ relationship with recovery, consideration of parenting status and issues in mental health practice and research is not commonplace. This represents a gap in the literature and deserves consideration.

As evidenced above, only recently has research considered parenting in relation to mental health recovery and notably the recovery literature rarely mentions parenting. Parenting measures typically assess concepts such as parenting functioning, skills, stress, and competence. Personal recovery measures aim to evaluate recovery-related dimensions, such as meaning and purpose, regardless of an individual’s levels of clinical symptomatology (Sklar, Groessl, O’Connell, Davidson, & Aarons, 2013). It is thus unlikely that existing measures of parenting or measures of recovery incorporate the alternate concept. A measure that assesses the parenting role within the context of recovery or from a recovery orientation would involve measurement of key aspects of recovery (i.e., CHIME elements) in relation to parenting (e.g., the extent a parent feels empowered by their children—Empowerment). The present paper aims to investigate the current tools available to enable assessment of parenting in the context of recovery. The two research questions for this article are the following:

Research Question 1: What measures of parenting are commonly used in therapeutic interventions for parents with mental health problems?

Research Question 2: What measures of personal recovery consider the parenting role?

Review 1: Measuring Parenting in Mental Health and Recovery Interventions

Numerous studies have developed interventions for parents with mental health problems and/or their children (see Siegenthaler et al., 2012 for a review). This is not unexpected given the prevalence of parent mental health problems, and the documented economic value of such preventive interventions (van Santvoort et al., 2015). Many of these studies include measures of parenting, such as of parenting competence or stress. This is consistent with the samples used (i.e., parents) and the impact of mental health problems on parenting (Ranning et al., 2015; van Santvoort et al., 2015). Recent research identified that at present few recovery-oriented parenting interventions exist (Reupert et al., 2017). To date it remains unclear whether existing parenting measures used in interventions for parents with mental health problems are recovery oriented.

Several reviews of these interventions have been undertaken. A systematic review of interventions for parents with mental disorders identified 13 trials (Siegenthaler et al., 2012). Similarly, a systematic review of interventions for children of parents with serious mental illness (e.g., schizophrenia) located 29 trials, of which 26 were only for parents with severe depression (Bee et al., 2014). Both these reviews found the majority of interventions target parents with affective disorders/depression (Bee et al., 2014; Siegenthaler et al., 2012). Interestingly, Siegenthaler et al. (2012) also identified that most interventions involve cognitive, behavioral, or psychoeducational therapeutic approaches aimed to improve parenting skills. This finding supports the notion that interventions for parents with mental health problems may routinely include parenting measures. Unfortunately, no studies to date could be identified that investigated the recovery orientation of these measures. Given the recent paradigm shift in mental health practice toward recovery orientation (Commonwealth of Australia, 2013), this is of importance. Furthermore, research findings suggest that clinical and recovery-oriented outcome measures do not assess the same constructs (Andresen, Caputi, & Oades, 2010). For these reasons, the first review involves a systematic search and qualitative synthesis of studies involving therapeutic interventions for parents with mental health problems to identify which measures of parenting were routinely used and whether they considered parenting from a recovery orientation.

Method

Search strategy

Three bibliographic databases were searched via EBSCOhost: MEDLINE, PsycINFO, and CINAHL, from inception to May 2017. The following search terms were used (parent OR mother OR father OR guardian) N5 (“mental health” OR “mental illness*” OR “mental disorder*” OR “mental disease*” OR “mental problem*” OR “psychiatr* health” OR “psychiatr* illness*” OR “psychiatr* disorder*” OR “psychol* health” OR “psychol* illness*” OR “psychol* disorder*” OR “psychol* problem*”) AND [(“intervention” OR therap* OR treatment) AND (parenting OR parenthood OR motherhood OR fatherhood OR famil*)]. Search limiters were English language, journal article, peer-reviewed, and adult sample. This search resulted in 961 articles (see Figure 1).

Figure 1.

PRISMA flow diagram (Liberati et al., 2009) for systematic search of interventions for parents with mental health problems that include quantitative measures of parenting.

Article screening

After removing duplicates, articles were then screened by title and abstract to determine whether they met inclusion criteria. Inclusion criteria were the following:

Sample consisted of parents with a mental illness or mental health problems.

Involved therapeutic intervention for parents.

Used quantitative measures of parenting to assess outcomes of intervention.

The remaining 75 articles identified via biblographic database search were screened for eligibility via full text. This resulted in 18 articles identified from the electronic database search that met inclusion criteria.

Supplementary article sources

A reference list search was conducted on the resulting articles included after screening. This located an additional 13 nonduplicate articles meeting inclusion criteria. An author search using Google Scholar was also conducted on six key authors in the parenting and mental illness literature: Beardslee, Biebel, Maybery, Nicholson, Reupert, and Solantaus. This identified an additional two articles. The final sample of articles included in the qualitative synthesis was 33 (see Figure 1).

Data extraction

Data were extracted from the full-text articles of the 33 included articles into Microsoft Excel. Data collected included author, publication date, sample size, gender [% male], sample composition, child age, study design (e.g., randomized controlled trial), intervention (e.g., interpersonal therapy), delivery method (e.g., individual, face-face), and parenting measures used (e.g., Parenting Stress Index; see Table 1).

Table 1.

Summary Table of Articles Included in Systematic Search of Interventions for Parents With Mental Health Problems.

Authors	Year	n	% males	Sample composition	Child age	Study design	Intervention	Delivery method	Parenting-related outcome measures
Beardslee, Wright, Gladstone, & Forbes	2007	97	NS	Parent with mood disorder	8-15 yrs	Randomized controlled trial	Standardized manual-based prevention strategies–informational lectures (2) and brief clinician-based approach (2-9 sessions)	Group, face-face and individual, face-face	Family Relationship Inventory
Bilszta, Buist, Wang, & Zulkefli	2012	74	0	Mothers with depression	Infants (newborn)	Randomized controlled trial	Video (1-7 sessions) or feedback (1-5 sessions)	Individual, face-face	Parenting Sense of Competence Scale
Brunette, Richardson, White, Bemis, & Eelkema	2004	8	0	Mothers with severe psychotic or mood disorder	NS	Cohort study, no control group	Integrated family treatment (41-78 visits/yr)	Individual, face-face	Parenting Stress Index (3rd ed.)
Bryant-Waugh, Turner, Jones, & Gamble	2007	11	0	Mothers with eating disorders	0-5 yrs	Cohort study, no control group	Parenting Skills and Support Intervention (8 × 90 mins)	Group, face-face	Parenting Concern Scale^a
Casselman & Pemberton	2015	5	100	OEF/OIF veterans with previous PTSD diagnosis	NS	Cohort study, no control group	ACT and parenting psychoeducation therapy group (8 × 1 hr)	Group, face-face	Kansas Parental Satisfaction Scale; Parental Acceptance-Rejection/Control Questionnaire–Short Form
Clark, Tluczek, & Brown	2008	32	0	Mothers with postpartum depression	0-2 yrs	Randomized controlled trial	Mother-infant therapy group (12 × 2 hrs)	Group, face-face	Parenting Stress Index (2nd ed.)
Clark, Tluczek, & Wenzel	2003	39	0	Mothers with postpartum depression	1-24 mo	Cohort study, with control group	Interpersonal psychotherapy (12 × 1 hr) or Mother-infant therapy group (12 × 1.5 hrs)	Group, face-face and individual, face-face	Parenting Stress Index (2nd ed.)
Cooper & Reupert	2017	19	11	Parents with mental illness or with a partner who had a mental illness	0-18 yrs	Cohort study, no control group	“Let’s Talk About Children” psychoeducational resource (30-page booklet)	Individual, booklet	“Parenting and Mental Illness” questionnaire^a; Parenting Self-Agency Measure
Davis, Myers, Logsdon, & Bauer	2016	2,063	6	Parents of children aged 4-35 mo with and without depressive symptoms	4-35 mo	Cohort study, with control group	Family centered care	Individual, face-face	“Parenting behaviors”^a
Fonagy, Sleed, & Baradon	2016	76	0	Mothers with probable psychiatric disorder	0-12 mo	Randomized controlled trial	Psychoanalytic Parent-infant Psychotherapy (1-49 sessions)	Individual, face-face	Mothers’ Object Relations Scales; Parenting Stress Index–Short Form
Forman et al.	2007	156	0	Mothers with depression	Infants (~6 mo)	Randomized controlled trial	Interpersonal psychotherapy (12 wks)	Individual, face-face	Parenting Stress Index (3rd ed.)
Gelfand, Teti, Seiner, & Jameson	1996	111	0	Mothers with and without depression	3-13 mo	Cohort study, with control group	Nurse home-visit intervention (29 visits)	Individual, face-face	Maternal Self-Efficacy Scale; Parenting Stress Index (2nd ed.)
Glavin, Smith, Sørum, & Ellefsen	2010	2,247	0	Mothers with and without postnatal depression	Infants (newborn)	Quasi-experimental design (nonequivalent groups)	Public health nurse delivered home visiting and supportive counseling	Individual, face-face	Parenting Stress Index(3rd ed.)
Goodman, Guarino, & Prager	2013	6	0	Mothers with depressive symptoms	5.7-8 wks	Cohort study, no control group	Perinatal Dyadic Psychotherapy (8 × ~1 hr)	Individual, face-face	Maternal Self-Report Inventory; Parenting Stress Index–Short Form
Isobel, Meehan, & Pretty	2016	5	9	Parents with a mental illness	3-12 yrs	Cohort study, no control group	Parenting program (‘Tuning into Kids’; 6 × 2 hrs)	Group, face-face	Parents’ Concerns Questionnaire; Parent Emotional Style Questionnaire
Jones et al.	2014	24	3	Parents with bipolar disorder	4-10 yrs	Randomized pilot study	Parenting intervention (10 wks)	Individual, online modules	Parenting Scale
Jones et al.	2015	N/A	N/A	Parents with a bipolar disorder diagnosis	3-10 yrs	Randomized controlled trial	Integrated bipolar parenting intervention (8 × 30 mins)	Individual, online modules	Confusion, Hubbub, and Order Scale; Parenting Scale; Parenting Sense of Competence Scale; Parenting Stress Index (3rd ed.)
Kaplan, Solomon, Salzer, & Brusilovskiy	2014	60	0	Mothers with schizophrenia spectrum or mood disorder	0-18 yrs	Randomized controlled trial	Parenting education (12 × 30 mins) and peer support	Individual, online and group, online	Family Coping Inventory; Healthy Families Parenting Inventory; Parenting Sense of Competence Scale
Marston, Maybery, & Reupert	2014	31	13	Parents with diagnosis of depression and/or anxiety	8-12 yrs	Cohort study, no control group	Family Focus DVD (60 mins)	Individual, DVD	“Parenting and Mental Illness” questionnaire^a
Maybery et al.	2017	N/A	N/A	Parents receiving mental health treatment	0-18 yrs	Randomized controlled trial	“Let’s Talk About Children” (2-3 sessions)	Individual, face-face	McMaster Family Assessment Device; Parenting Self-Agency Measure; Parental Stress Scale
Morrell et al.	2009	418	0	Mothers with PND symptoms	Infants (6-8 wks)	Cluster randomized trial	CBT or person centered health visitor delivered intervention (8 × 1 hr)	Individual, face-face	Parenting Stress Index–Short Form
Murray, Cooper, Wilson, & Romaniuk	2003	193	0	Mothers with postpartum depression	Infants (8 wks)	Randomized controlled trial	CBT, nondirective supportive counseling or brief psychodynamic psychotherapy (10 wks)	Individual, face-face	Checklist of “maternal management of infant behavior and problems in the mother infant relationship”^a
Phelan, Howe, Cashman, & Batchelor	2012	86	9	Parents with self-reported mental health problem	2-10 yrs	Cohort study, no control group	Mental Health Positive Parenting Program (adaptation of Triple P; 10 wks)	Group, face-face and individual, face-face	Parenting Scale
Rayner et al.	2016	N/A	N/A	Parents with elevated acute stress symptoms	0-18 yrs	Randomized controlled trial	“Take a Breath,” ACT-based (6 × 90 mins)	Group, online (facilitated)	Family Management Measure; Parent Experience of Child Illness
Riemersma, van Santvoort, Janssens, Hosman, & van Doesum	2015	N/A	N/A	Parents with mental illness who also had child with mild intellectual disability	10-20 yrs	Quasi-experimental design	“You are Okay”–support group for children (10 × 1.5 hrs) and online educational program for parents (5 modules)	Group, face-face and individual, online (modules)	Nijmeegse Ouderlijke Stress Index (in Dutch); Parenting Scale; Parenting Self-Agency Measure
Runfola et al.	2014	13	0	Mothers with history of eating disorders	0-3 yrs	Cohort study, no control group	“NURTURE” Parenting Intervention (16 × 1.5 hrs)	Group, online (web-conferencing)	Parenting Sense of Competence Scale; Child Interaction Survey
Sadeh-Sharvit, Zubery, Mankovski, Steiner, & Lock	2016	12	0	Mothers with eating disorders	0-5 yrs	Cohort study, no control group	Parent-based prevention group program (12 × 90 mins), individual family sessions (12 × 1 hr)	Group, face-face and individual, face-face	Parenting Stress Index–Short Form
Suchman, Ordway, de las Heras, & McMahon	2016	17	0	Mothers receiving outpatient mental health services for themselves or their child	0-7 yrs	Cohort study, no control group	Mothering from the Inside Out (mentalization-based parenting intervention; 12 × 1 hr)	Individual, face-face	Parenting Stress Index–Short Form
Valdez, Mills, Barrueco, Leis, & Riley	2011	10	0	Mothers in treatment for depression	9-16 yrs	Cohort study, no control group	“Keeping Families Strong” (10 sessions)	Group (family), face-face	Alabama Parenting Questionnaire; Child report of Parenting Behavior Inventory; Family Times and Routines Index; McMaster Family Assessment Device
Valdez, Padilla, Moore, & Magaña	2013	13	0	Mothers with depression	9-18 yrs	Cohort study, no control group	“Fortalezas Familiares” (Family Strengths; 12 sessions)	Group (family), face-face	Alabama Parenting Questionnaire; Conflict Behavior Questionnaire; Family Times and Routines Index; McMaster Family Assessment Device; Child report of Parenting Behavior Inventory (revised)
van der Ende, van Busschbach, Nicholson, Korevaar, & van Weeghel	2014	26	23	Parents with serious mental illness	0-21 yrs	Cohort study, with control group	Parenting with Success and Satisfaction (~1 yr)	Individual, face-face and workbooks	Tool to Measure Parenting Self-Efficacy
van der Zanden, Speetjens, Arntz, & Onrust	2010	28	12	Parents with a mental illness	1-21 yrs	Cohort study, no control group	“KopOpOuders”–Parenting Support Course (8 × 90 mins)	Group, online (facilitated)	Ouderlijke Opvattingen over Opvoeding questionnaire (in Dutch); Parenting Scale (Dutch version)
Wansink, Janssens, Hoencamp, Middelkoop, & Hosman	2015	99	12	Parent with a psychiatric disorder	3-10 yrs	Randomized controlled trial	Preventive Basic Care Management (~ 18 mo)	Individual, face to face and phone	Family Functioning Questionnaire; Parenting Daily Hassles

Note. ACT = Acceptance and Commitment Therapy; CBT = Cognitive Behavior Therapy; ed. = edition; hrs = hours; mins = minutes; mo = months; N/A = not applicable, e.g., for protocol paper; NS = not specified, that is, information could not be located in article; OEF = Operation Enduring Freedom; OIF = Operation Iraqi Freedom; PND = postnatal depression; PTSD = posttraumatic stress; wks = weeks; ; yr/yrs = year/years.

Measure developed by study.

Results

Study demographics

The final sample of articles consisted of a variety of interventions for parents with mental health problems. Interestingly, almost all studies were published in the last 10 years (n = 29). Most studies, however, had limited sample sizes, with only six studies having samples above 100 participants. These studies tended to be large-scale population-based designs involving broad interventions (e.g., parent report of family-centered care, nurse home visiting program). Furthermore, four studies identified were protocols, meaning the sample was not yet recruited. Given the logistical and financial challenges involved in conducting intervention studies, however, it is not unexpected that most studies reported modest numbers of participants.

Parenting measures

Across the 33 included studies, 35 quantitative measures of parenting were identified (see Table 2). In terms of the number of measures used in each study, the majority used one (n = 17) or two (n = 10) measures of parenting, with only six papers reporting three or more measures. Five of the measures used were developed by the study authors and thus not psychometrically established. Of the 57 articles excluded at full-text review, only eight did not include parenting measures and six only included observational or qualitative measures of parenting.

Table 2.

Summary of Parenting Measures Identified in Included Articles.

Measure	Brief description	Number of studies citing
Parenting Stress Index (PSI; Abidin, 1986, 1995a)	120-item self-report measure of stress in parent–child relationship. Covers three main domains of stress: parent characteristics, child characteristics and situational/demographic life stress, resulting in 17 subscale scores.	7
Parenting Scale (PS; Arnold, O’Leary, Wolff, & Acker, 1993)	30-item self-report measure of parent disciplinary practices. Consists of three factors: laxness, overactivity, and verbosity.	5
Parenting Stress Index–Short Form (PSI-SF; Abidin, 1995b)	36-item self-report measure of stress in the parent–child relationship. Consists of three subscales: parental distress, parent–child dysfunctional interaction, and difficult child.	5
Parenting Sense of Competence Scale (PSOC; Gibaud-Wallston & Wandersaman, 1978; Johnston & Mash, 1989)	17-item self-report measure of parenting self-esteem. It consists of two factors: satisfaction and efficacy.	4
Parenting Self-Agency Measure (PSAM; Dumka, Stoerzinger, Jackson, & Roosa, 1996)	5- or 10-item self-report measure of parent confidence in their parenting ability. Domains include confidence, helplessness in the face of child opposition and persistence.	3
McMaster Family Assessment Device (FAD; Epstein, Baldwin, & Bishop, 1983)	53/60-item self-report measure of family functioning. Consists of seven subscales, including communication, general functioning and affective responsiveness.	3
Alabama Parenting Questionnaire (APQ; Shelton, Frick, & Wooton, 1996)	42-item measure of parenting. Consists of five subscales, including involvement, positive parenting and poor monitoring/supervision.	2
Child Report of Parenting Behavior Inventory (CRPBI; Schaefer, 1965)	Child- and parent-report measure of parenting behavior in terms of domains such as acceptance, rejection, and consistent discipline.	2
Family Times and Routines Index (FTRI; McCubbin, McCubbin, & Thompson, 1987)	30-item self-report measure of the types of activities and routines families participate in and their value.	2
Child Interaction Survey (CIS; Bugental, Blue, & Cruzcoxa, 1989)	18-item self-report measure of parents’ perceived control or power in influencing outcomes of caregiving.	1
Conflict Behavior Questionnaire (CBQ; Robin & Foster, 1989)	75-item parent and 73-item adolescent-report measures of conflict and negative communication experienced by the family.	1
Confusion, Hubbub, and Order Scale (CHAOS; Matheny, Wachs, Ludwig, & Phillips, 1995)	Parent-report measure of family coherence and home environmental confusion.	1
Family Coping Inventory (FCI; McCubbin, Boss, Wilson, & Dahl, 1981)	Self-report measure of family coping. Domains include social support, family stress and psychological coping theories.	1
Family Functioning Questionnaire (FFQ; Ten Brink, Van der Steege, Van der Haar, Veerman, & Baartman, 2000)	Self-report measure of family functioning, including subscales on parenting skills.	1
Family Management Measure (FaMM; Knafl et al., 2011)	53-item self-report measure of how families cope with caring for child with chronic condition. Consists of six subscales including child’s daily life, family life difficulty, and condition management ability.	1
Family Relationship Inventory (FRI; Holahan & Moos, 1983)	27-item measure of family functioning. Consists of three subscales: cohesion, expressiveness, and conflict.	1
Healthy Families Parenting Inventory (HFPI; LeCroy, Krysik, & Milligan, 2005)	63-item self-report measure of the key domains of healthy parenting of young children. Consists of nine domains including: parenting efficacy, parenting skills, personal care, and role satisfaction.	1
Kansas Parental Satisfaction Scale (KPSS; James et al., 1985)	3-item measure of parent’s satisfaction with themselves as a parent, their child’s behavior and their relationship with their child.	1
Checklist of “maternal management of infant behavior and problems in mother-infant relationship”^a (Murray, Cooper, Wilson, & Romaniuk, 2003)	Self-report checklist measuring mother’s experience of infant behavior and mother–infant relationship difficulties.	1
Maternal Self-Efficacy Scale (MSES; Teti & Gelfand, 1991)	Self-report measure of maternal self-efficacy in mothering and domains of infant care.	1
Maternal Self-Report Inventory (MSRI; Shea & Tronick, 1988)	Self-report measure of maternal self-esteem. Consists of seven domains such as caretaking ability, general preparedness for mothering role, and acceptance of baby.	1
Mothers’ Object Relations Scales (MORS; Oates & Gervai, 2003)	Self-report measure of mothers’ working models of their infants. It consists of two subscales: warmth and invasion.	1
Nijmeegse Ouderlijke Stress Index [Nijmegen Parental Stress Index] (Langemeijer, Peijnenburg, & Veerman, 1997)	6-item measure of feelings of parenting incompetence (in Dutch).	1
Ouderlijke Opvattingen over Opvoeding [Parental Perceptions of Parenting Questionnaire] (van der Zanden, Speetjens, Arntz, & Onrust, 2010)	11-item self-report measure of parental competence (in Dutch). Consists of two subscales: feelings of competence (from Parenting Self-Agency Measure) and feelings of incompetence (from Nijmegen Parenting Stress Index, short version).	1
Parents’ Concerns Questionnaire (Matthey & White, 2002)	Brief self-report measure of parents’ concerns with their children’s behavior and parenting.	1
Parents Emotional Style Questionnaire (PESQ; Havighurst, Wilson, Harley, & Prior, 2009)	21-item self-report measure of parent emotion-socialization practices.	1
Parent Experience of Child Illness (PECI; Bonner et al., 2006)	25-item self-report measure of parent adjustment to their child’s chronic or acute serious illness.	1
Parental Stress Scale (Berry & Jones, 1995)	18-item self-report measure of parenting stress. Consists of four subscales: parental rewards, parental stressors, lack of control, and parental satisfaction.	1
Parental Acceptance-Rejection/Control Questionnaire-Short Form (PARQ/Control; Rohner & Khaleque, 2005)	29-item measure of positive parenting behavior. Five subscales: warmth-affection, hostility-aggression, indifference-neglect, undifferentiated rejection, and control.	1
“Parenting behaviors”^a (Davis, Myers, Logsdon, & Bauer, 2016)	Study developed measure of parenting routines, enrichment, punitive disciplinary behaviors, positive disciplinary strategies, and child-proofing.	1
Parenting Concern Scale^a (Bryant-Waugh, Turner, Jones, & Gamble, 2007)	Brief measure developed for the study to measure parenting concerns.	1
Parenting Daily Hassles (PDH; Crnic & Greenberg, 1990)	20-item self-report measure of the frequency and intensity of everyday parenting hassles.	1
“Parenting and Mental Illness” scale^a (Cooper & Reupert, 2017)	18-item self-report measure consisting of statements about parenting and mental illness developed by the research team.	1
“Parenting and Mental Illness” questionnaire^a (Marston, Maybery, & Reupert, 2014)	21-item self-report questionnaire consisting of statements about mental illness and parenting developed by the research team.	1
Tool to Measure Parenting Self-Efficacy (TOPSE; Kendall & Bloomfield, 2005)	82-item self-report measure of parenting self-efficacy. Consists of nine subscales, including emotion and affection, control, and self-acceptance.	1

Developed by study, not an established measure.

The most commonly reported measure used across the included studies was the Parenting Stress Index (PSI; Abidin, 1986, 1995a, 1995b). The PSI has both 120-item (Abidin, 1986, 1995a) and 36-item short-form versions (PSI-SF; Abidin, 1995b). It is a self-report measure of stress related to the parent-child relationship. Seven studies in the present review reported using the 2nd or 3rd edition of the 120-item PSI (Abidin, 1986, 1995a), and five the PSI-SF (Abidin, 1995b). The Parenting Scale (PS; Arnold, O’Leary, Wolff, & Acker, 1993) was the next most utilized measure of parenting in the present review (n = 5). The PS is a 30-item measure of parenting disciplinary practices. The Parenting Sense of Competence Scale (PSOC; Gibaud-Wallston & Wandersaman, 1978; Johnston & Mash, 1989) was used in four studies. The PSOC is a 17-item measure of parenting self-esteem. The Parenting Self-Agency Measure (PSAM; Dumka, Stoerzinger, Jackson, & Roosa, 1996) and McMaster Family Assessment Device (FAD; Epstein, Baldwin, & Bishop, 1983) were the next most reported parenting measures, both used in three studies. The remaining 29 measures of parenting were reported in two or fewer studies (see Table 2 for more detail on these measures).

The most frequently used measures in the present review assessed parenting stress (PSI, PSI-SF), parent disciplinary practices (PS), parenting self-esteem (PSOC, PSAM), and family functioning (FAD). Considering all 35 measures, broadly they measured a number of concepts, such as general parenting behavior, parenting self-efficacy/competence, and family functioning (see Figure 2).

Figure 2.

Concepts measured by identified parenting measures.

The two measures that considered parenting and mental illness were most closely aligned with recovery. These measures, however, focused on the parent’s perspectives on mental illness and parenting, rather than parenting in the context of recovery (Cooper & Reupert, 2017; Marston, Maybery, & Reupert, 2014). An example item is “I encourage the children in my family to seek help in coping with mental health problems in the family.” None of the identified parenting measures thus apppeared to consider parenting using a recovery-oriented framework.

Discussion

A systematic search of the literature identified 33 interventions for parents with mental health problems that included quantitative measures of parenting. Across these interventions, 35 unique measures of parenting were cited. The most frequently reported measures were the PSI (Abidin, 1986, 1995a), PS (Arnold et al., 1993), PSI-SF (Abidin, 1995b), and PSOC (Gibaud-Wallston & Wandersaman, 1978; Johnston & Mash, 1989). These measures assessed a range of parenting-related concepts such as parenting stress, discipline, and competence. No measures could be identified that assessed parenting from a recovery orientation.

Some concepts assessed in the identified parenting measures, such as parenting stress and competence, overlap to some extent with certain CHIME elements. For example, parenting stress could be related to Connectedness, and parenting competence to Identity. No measures, however, could be identified that were specifically recovery oriented or overtly connected to the CHIME framework. This represents a gap in the literature considering shifts toward recovery orientation. The present findings may reflect the notion that the majority of parenting measures assess generic parenting concepts. They are not required to be specific to parents with mental health concerns, and hence until recently there has been no requirement for them to be recovery oriented.

Review 2: Recovery Measures and the Parenting Role

A systematic search of interventions for parents with mental health problems identified that while many parenting measures exist, none appear to consider parenting from a perspective of recovery. Most assess concepts such as parenting stress, conflict, and competence. The next logical step was to investigate whether any established personal recovery measures consider the parenting role.

The current reviews emphasis on personal recovery reflects both Australian and international policy regarding mental health service delivery (Commonwealth of Australia, 2013; M. Slade, 2010). Personal recovery is a unique and individual process (Leamy et al., 2011), and although it may be associated with clinical improvements, such as greater functioning and a reduction in symptoms, it may also be independent of clinical recovery (Burgess, Pirkis, Coombs, & Rosen, 2011). It has thus been suggested that personal recovery outcomes should be measured alongside clinical outcomes to broaden the range of individual level outcomes assessed, and enable assessment of outcomes that are meaningful to consumers (Andresen et al., 2010; Burgess et al., 2011).

A number of measures have already been developed to assess personal recovery in mental health (Burgess et al., 2011; Sklar et al., 2013). Recovery measures by design are recovery oriented. Although some research has considered the alignment of these measures with the CHIME framework (Shanks et al., 2013), no studies could be identified that considered the parenting orientation of existing personal recovery measures. Two systematic reviews, however, have been conducted on measures of personal recovery in mental health (Shanks et al., 2013; Sklar et al., 2013). To determine whether any established personal recovery measures consider the parenting role, the results of these two systematic reviews will be combined and analyzed.

Method

Search strategy

Before undertaking a systematic search of the literature of mental health personal recovery measures, a preliminary search to identify any pre-existing systematic reviews was completed. This identified two recent systematic reviews completed on personal recovery measures in mental health: Shanks et al. (2013) and Sklar et al. (2013). These results of these two reviews were combined. Given these studies only searched articles until May 2012 and August 2012 respectively, an adjunct search was conducted to identify any measures developed after August 2012.

Systematic review 1: Sklar et al

Sklar and colleagues (2013) conducted a systematic search of two bibliographic databases (MEDLINE and PsycINFO) from inception to August 2012. No limits were applied to date or type of publication. Search terms were Recovery, Assessment, Mental Health, Mental Health Assessment, Mental Health Recovery, Recovery Oriented Assessment, Mental Illness, Mental Illness Assessment, Mental Illness Recovery, Severe Mental Illness, Psychological Assessment, and Scale. Literature searches on titles of identified instruments were also conducted. Measures were included if there were designed for adults, self- or clinician/provider-report, had established psychometric properties, were quantitative measures, and were designed to assess individual recovery outcomes. Sklar and colleagues search resulted in 13 measures of mental health recovery (see Table 3, column 2).

Table 3.

Combined Results of Personal Recovery Measures From Sklar, Groessl, O’Connell, Davidson, and Aarons (2013), Shanks et al. (2013), and the Adjunct Search.

Measure	Sklar et al. (2013)	Shanks et al. (2013)	Adjunct search	Subscales/dimensions
Bipolar Recovery Questionnaire (BRQ; Jones, Mulligan, Higginson, Dunn, & Morrison, 2013)			×	N/A^a
Consumer Recovery Measure (CRM; Lusczakoski, Olmos-Gallo, Milnor, & McKinney, 2016; Mental Health Center of Denver, 2005)			×	Active growth, Hope, Social network, Safety, Symptom management (item categories)
Consumer Recovery Outcomes System (CROS 3.0; Miller, 2005)	×	×		Hope for the Future, Daily Function, Coping with Clinical Symptoms, Quality of Life
Illness Management and Recovery Scale (IMR; Mueser et al., 2005)	×	×		Personal goals, knowledge of mental illness, involvement of significant others, impaired functioning, symptoms, stress, coping, relapse prevention, hospitalization, medication and use of drugs and alcohol
Maryland Assessment of Recovery in People with SMI (MARS; Drapalski et al., 2012)	×	×		Self-direction or empowerment, holistic, nonlinear, strengths based, responsibility, hope
Mental Health Recovery Measure (MHRM; Young & Bullock, 2003)	×	×		Overcoming Stuckness, Self-Empowerment, Learning and Self-Redefinition, Basic Functioning, Overall Well-being, New Potentials
Mental Health Recovery Star (MHRS; Dickens, Weleminsky, Onifade, & Sugarman, 2012)	×	×		Managing mental health, physical health and self-care, living skills, social networks, work, relationships, addictive behavior, responsibilities, identity and self-esteem, trust and hope
Milestones to Recovery Scale (MTR; Doyle, Logan, Ludlow, & Holloway, 2012)	×			Symptoms, behavior and functioning, interpersonal engagement, therapeutic engagement
My Voice, My Life (Gordon, Ellis, Siegert, & Walkey, 2013)			×	Relationships, Day-to-day life, Culture, Physical health, Quality of life, Mental health, Recovery, Hope and empowerment, Spirituality, Resources, Satisfaction with services
Ohio Outcomes System (OOS; The Ohio Department of Mental Health, 2009)	×			Symptom Distress, Quality of Life, Making Decisions Empowerment
Peer Outcomes Protocol (POP; Campbell, Cook, Jonikas, & Einspahr, 2004)	×			Personhood and Empowerment, Recovery
Psychosis Recovery Inventory (PRI; Chen, Tam, Wong, Law, & Chiu, 2005)		×		Attitude to illness, attitude to treatment, perception of recovery and relapse
Questionnaire About the Process of Recovery (QPR; Neil et al., 2009)		×		Intrapersonal, Interpersonal
Recovery Assessment Scale (RAS; Corrigan, Giffort, Rashid, Leary, & Okeke, 1999; Giffort, Schmook, Woody, Vollendorf, & Gervain, 1995)	×	×		Personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, not dominated by symptoms
Recovery Assessment Scale—Domains and Stages (RAS-DS; Hancock, Scanlan, Honey, Bundy, & O’Shea, 2015)			×	Doing things I value, Looking forward, Mastering my illness, Connecting and belonging
Recovery Markers Questionnaire (RMQ; Ridgway, Press, Ratzlaff, Davidson, & Rapp, 2003)		×		Process factors, goal-oriented thinking, self-agency, self-efficacy, symptoms, social support, basic resources
Recovery Process Inventory (RPI; Jerrell, Cousins, & Roberts, 2006)	×	×		Anguish, connected to others, others’ care or help, living situation, confidence and purpose, hopeful or cares for self
Self-Identified Stage of Recovery (SISR; Andresen, 2007)	×	×		Five stages of recovery (moratorium, awareness, preparation, rebuilding, growth) and four recovery processes (hope, responsibility, identity, meaning)
Service-user Recovery Evaluation (SeRvE) Scale (Barber, Parkes, Parsons, & Cook, 2012)			×	Existential well-being, religious well-being, emotional state, social well-being, social ill-being, connectedness, religious ill-being, existential ill-being, stigma and shame
Short Interview to Assess Stages of Recovery (SIST-R; Wolstencroft, Oades, Caputi, & Andresen, 2010)		×		Five stages of recovery (moratorium, awareness, preparation, rebuilding, growth)
Social Recovery Measure (SRM; Marino, 2015, 2016)			×	Self, community
Stages of Recovery Instrument (STORI; Andresen, Caputi, & Oades, 2006)	×	×		Five stages of recovery (moratorium, awareness, preparation, rebuilding, growth) and four recovery processes (hope, responsibility, identity, meaning)
Stages of Recovery Scale (Song & Hsu, 2011)	×			Five stages of recovery (moratorium, awareness, preparation, rebuilding, growth)
Utah Recovery Scale (URS; Katzenbach, 2013)			×	N/A^a
Westbridge Dual Recovery Inventory (Noel, Woods, Routhier, & Drake, 2016)			×	Housing, education, employment, friendship, family, mental health, substance use, spirituality, tobacco use, healthy eating, exercise, sleep hygiene, physical health, and personal hygiene

Note. SMI = serious mental illness.

No subscales or dimensions reported for this measure.

Systematic review 2: Shanks et al

Shanks et al. (2013) conducted a systematic search involving six data sources. This search included eight electronic databases (from inception to May 2012): MEDLINE, PsycINFO, EMBASE, CINAHL, CSA Illumina, TRIP, CDSR, and DARE. The five other data sources were 11 web-based repositories, a Google Scholar search, abstracts from three international conference series, hand-searching of three journals, and reference lists of included articles. Search terms were reported to fall under four domains: personal recovery, mental illness, measure or instrument, and psychometric properties. Articles were included if they involved the use or validation of a measure of personal recovery, were published in a peer or non-peer reviewed publication, were web-accessible, included a population of 16- to 65-year-old adults who had a mental illness (not substance use or eating disorders). Shanks and colleagues systematic review identified 13 measures of personal recovery in mental health (see Table 3, column 3).

Adjunct search

A search was conducted to identify measures developed following the searches conducted by Sklar et al. (2013) and Shanks et al. (2013). This search was modeled on that conducted by Sklar et al. (2013). The following search terms were used as subject terms: (recovery OR “mental health recovery” OR “mental illness recovery”) AND (assessment OR “mental health assessment” OR “recovery oriented assessment” OR “mental illness assessment” OR “psychological assessment” OR scale) AND (“mental health” OR “mental illness” OR “severe mental illness”). The PsycINFO and MEDLINE Complete (via EBSCO host) databases were searched from August 2012 until 8th August 2017. Articles were included if they involved the development or validation of a measure of personal recovery in mental health not previously identified by Shanks et al. (2013) or Sklar et al. (2013). This search resulted in 98 nonduplicate articles, of which nine met inclusion criteria, and consisted of eight unique measures of personal recovery in mental health not previously identified (see Table 3, column 4).

Results

To obtain a more comprehensive review, the measures identified from the two systematic reviews (Shanks et al., 2013; Sklar et al., 2013) and the adjunct search were combined (see Table 3). This resulted in 25 unique measures of personal recovery in mental health. Nine measures were identified by both systematic review studies, four only by Sklar et al. (2013) and four only by Shanks et al. (2013). The adjunct search identified an additional eight measures.

Of the 25 recovery measures four were focused on assessing stages of recovery process (i.e., moratorium, awareness, preparation, rebuilding, growth). The remaining 21 measures assessed personal recovery. Several of these measures assessed various components of social role functioning, such as connecting to others (Recovery Process Inventory [RPI]; Recovery Assessment Scale - Domains and Stages [RAS—DS]; Service-user Recovery Evaluation Scale [SeRvE Scale]), social support (Recovery Markers Questionnaire [RMQ]), interpersonal engagement (Questionnaire About the Process of Recovery [QPR]; Milestones to Recovery Scale [MTR]), relationships (Mental Health Recovery Star [MHRS]; My Voice, My Life), involvement of significant others (Illness Management and Recovery Scale [IMR]), social well-being/ill-being (SeRvE Scale), social networks (Consumer Recovery Measure [CRM]; Social Recovery Measure [SRM]), and family/friends (Westbridge Dual Recovery Inventory). No measures or subscale of measures were identified, however, which appeared to consider the parenting role specifically.

Discussion

The findings from the second review highlighted 25 unique measures of personal recovery in mental health. Of relevance to parenting, several measures considered roles associated with social functioning. This included concepts such as social support, interpersonal engagement, and relationships. No measures could be identified that appeared to consider the parenting role, for example, by including items on having children or parenting in relation to CHIME elements (e.g., the extent a parent feels empowered by their children -Empowerment).

Recent research suggests recovery occurs within the social environment of an individual (Hunt & Stein, 2012; Tew et al., 2012). Historically, however, the role of an individual’s family has been considered primarily as an environmental factor impacting upon the individual (Maybery et al., 2015; Wyder & Bland, 2014). Only recently has research has begun to consider the parenting role and one’s family as positively impacting recovery (Nicholson, 2010; Wyder & Bland, 2014), which may in part reflect the present findings.

Shanks et al. (2013) and Sklar et al. (2013) used similar search terms in their systematic reviews. Interestingly, a proportion of measures identified by each review were not found by the other. Shanks et al. (2013)’s search involved six separate data sources including eight, compared to two, electronic bibliographic databases. Furthermore, the inclusion and exclusion criteria for the two reviews differed. These findings highlight the heterogeneity of systematic reviews. Despite representing higher levels of evidence, they still involve a level of subjectivity. In addition, the reporting of search strategy and methodology was somewhat limited. It is known that there are word limits for publications, however, both reviews did not report their full search terms for the bibliographic database search, although Shanks et al. (2013) indicated these would be provided upon request. Nonetheless, this limits the ease of replicability of findings and indicates areas for future improvement. Given the present adjunct search was modeled off Sklar et al. (2013) this is also of importance. While this represents a limitation of the search, this method was explicitly chosen to match that of the previous review and identify any new measures developed in the past 5 years. It is not exhaustive and future research would benefit from the completion of a more extensive systematic review of personal recovery measures.

Despite the development of numerous mental health recovery measures (Burgess et al., 2011; Sklar et al., 2013), it appears none to date assess the parenting role in personal recovery. This is inconsistent with findings suggesting the parenting role may be closely aligned with and promote recovery (Biebel et al., 2016; Maybery et al., 2015; Nicholson, 2010). In light of findings regarding the alignment between parenting and recovery, and prevalence estimates for parental mental health problems, this represents a gap in current measures.

Discussion of the Findings

This review attempted to identify a measure that evaluated the parenting role from a recovery orientation. This sought to: identify measures of parenting used in interventions for parents with mental health problems that were recovery oriented (review 1) and identify whether any measures of personal recovery considered the parenting role (review 2). A systematic review of interventions for parents with mental health problems identified 35 measures used to assess parenting. The most commonly cited measures were the PSI (Abidin, 1986, 1995a), PSI-SF (Abidin, 1995b), PS (Arnold et al., 1993), and PSOC (Gibaud-Wallston & Wandersaman, 1978; Johnston & Mash, 1989). While these measures commonly assessed domains such as parenting stress, competence and skills, no measures were identified that appeared to assess parenting in terms of recovery. Consequently, established measures of personal recovery were investigated to determine if any considered parenting. The findings of two systematic reviews (Shanks et al., 2013; Sklar et al., 2013) and an adjunct search identified 25 unique measures of personal recovery. While some measures considered areas relevant to social functioning, such as interpersonal relationships and social support, no measures were identified that appeared to consider the parenting role in personal recovery. It thus appears that a measure of parenting in the context of mental health recovery does not yet exist.

The present findings indicate a clear gap in the literature. A large body of research and policy champions the notion of recovery-oriented mental health service delivery and treatment (Commonwealth of Australia, 2013; Leamy et al., 2011) and recognizes the potential utility of the parenting role in promoting recovery (Biebel et al., 2016; Maybery et al., 2015). It appears that measures to date do not provide a means of assessing an intervention targeting these two areas. One possible explanation for these findings could be that generic parenting measures are not designed to be used specifically with parents who have mental health problems. Similarly, it is probable that recovery measures assess broad domains relevant to recovery in all individuals, not only sub-groups such as parents. While these suggestions may explain the current findings, there are yet one in five parents with mental health problems for whom such measures would be relevant (Maybery, Reupert, Patrick, Goodyear, & Crase, 2009).

This is not to say clinical outcome measures, such as the parenting and family functioning tools reviewed, are not useful. Research suggests, however, that scores on these tools do not necessarily align with consumer defined recovery (Andresen et al., 2010; Burgess et al., 2011). Moving toward a recovery-oriented mental health system requires use of recovery-oriented measures (Sklar et al., 2013). In addition, these measures need to provide aggregable information that can inform evaluation of mental health services and interventions, while still being meaningful to the consumer (M. Slade, 2010).

Limitations

The present review is not without limitations. Specifically, the first systematic search does not represent an exhaustive search of the literature. It included three bibliographic databases, and was limited to studies published in peer-reviewed journals and in English. Nonetheless, it offers strength in that further hand-searching of reference lists of included articles and key authors in the literature was undertaken. Furthermore, it represents a preliminary step in considering parenting measures used in therapeutic interventions for parents with mental health problems.

The second search also is limited in that it relied largely on the results of two systematic reviews that were conducted approximately 4 years ago. The adjunct search modeled on Sklar et al. (2013)’s search was completed to address this limitation. Although not exhaustive, it is likely to identify the majority of new personal recovery measures published in the interim period.

Future Directions

The present review found despite increasing consideration of the parenting role in recovery, no measures to date appear to exist to assess this construct. While numerous measures assess parenting and personal recovery individually, the intersection between these measures, that is measures assessing the parenting role in recovery, has been ignored. With increasing focus on recovery-oriented mental health practice, development of such a measure would be of great benefit. This would enable evaluation of interventions and services ability to support and promote recovery in the parenting role. The development and use of such measures should not be limited to parents with mental health issues who have young children, but also to those with children that are adolescents and young adults, who face similar challenges.

The development and validation of a measure of parenting recovery is clearly warranted. The CHIME framework outlines the key processes revelant to recovery. It thus provides the ideal framework along which to develop a measure of parenting recovery. Specifically, items could be created to align with each of the dimensions of the CHIME framework. This is consistent with recent research which attempted to align various components of the parenting role with the CHIME framework (see Maybery et al., 2015). Given much research has found parenting is related to numerous components of the CHIME framework (Carpenter-Song et al., 2014; Evenson et al., 2008; Hine et al., 2018; Nicholson, 2010; Reupert et al., 2015; Reupert et al., 2017), this approach shows considerable promise. No research to date, however, appears to have translated these findings into a tool which can be used to assess such outcomes.

Conclusion

Adults with mental health problems are equally likely to be parents as those without mental health problems. Parents with mental health problems need to contend with the normal challenges of parenting, along with managing their mental health problems. Although parents with mental health problems report that their parenting role can be a source of additional stress, the majority identify that it is a source of identity, hope, and meaning, and hence is a key life domain for them. It has thus been suggested that the parenting role may help promote and encourage recovery for parents with mental health problems. Few interventions, however, that focus on parenting in a recovery-oriented framework exist. Furthermore, at present there does not appear to be a measure which assesses recovery in terms of the parenting role. The parenting role appears to be an important life domain for many parents with mental health problems, and hence targeted assessment of the impact of parenting focused interventions would inform improved evaluation. Given the shift toward recovery orientation in mental health service delivery, this represents a gap in the literature. Greater coordination in efforts, including improved evaluation and methodology would be of benefit not only for research, but for consumers and their families, as well as the services that support them.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Victorian Department of Health, 50 Lonsdale Street, Melbourne, Victoria, Australia.

Author Biographies

Emma Thompson, MPsych, recently completed a Master of Psychology (Clinical) degree at Deakin University in Burwood, Victoria, Australia. She has a particular interest in working with children, adolescents, and their families to promote improved trajectories and outcomes both clinically and through research. Recent publications include “Protocol for a Prospective, School-Based Standardisation Study of a Digital Social Skills Assessment Tool for Children: The Paediatric Evaluation of Emotions, Relationships, and Socialisation (PEERS) Study” in BMJ Open (2018, with E. J. Thompson et al.), and “Posttraumatic Stress Symptom Severity and Health Service Utilization in Trauma-Exposed Parents” in Health Psychology (2017, with E. J. Thompson et al.)

Jade Sheen, DPsych, is an associate professor of clinical psychology as well as Director of Simulation-based Education at Deakin University in Burwood, Victoria, Australia. She has a particular interest in working with children and families, as well as improving the training of postgraduate psychology trainees. Recent publications include “The Role of Television in Perceptions of Dangerousness” in The Journal of Mental Health Training, Education and Practice (2018, with L. Alexander, J. Sheen, N. Rinehart, M. Hay, & L. Boyd), “So Your Child Refuses to Go to School? Here’s How to Respond” in The Conversation (2018, with J. Sheen & A. Dudley), and “More Than Just a Tantrum: Here’s What to Do If Your Child Has Oppositional Defiant Disorder” in The Conversation (2018, with J. Sheen & J. McGillivray).

Darryl Maybery, PhD, is the director of the School of Rural Health and a professor of rural mental health research at Monash University in Moe, Victoria, Australia. His central research area focuses upon vulnerable families, particularly with regard to the impact of parental mental health problems on children aiming to reduce the “cycle of mental illness” in families. Recent publications include: “Prevalence of Mental Illness Within Families in a Regional Child-Focussed Mental Health Service” in International Journal of Mental Health Nursing (2018, with M. F. A. Naughton, D. J. Maybery, & M. Goodyear), and “Developing an Australian-First Recovery Model for Parents in Victorian Mental Health and Family Services: A Study Protocol for a Randomised Controlled Trial” in BMC Psychiatry Open (2017, with D. Maybery et al.)

References

Abidin

R. R.

(1986). Parenting Stress Index (2nd ed.). Charlottesville, VA: Pediatric Psychology Press.

Abidin

R. R.

(1995a). Parenting Stress Index (3rd ed.). Odessa, FL: Psychological Assessment Resources.

Abidin

R. R.

(1995b). Parenting Stress Index—Short Form: Professional manual. Odessa, FL: Psychological Assessment Resources.

Andresen

(2007). The experiences of recovery from schizophrenia: Development of a definition, model and measure of recovery (Unpublished doctoral thesis). University of Wollongong, New South Wales, Australia. Retrieved from https://ro.uow.edu.au/theses/814/

Andresen

Caputi

Oades

(2006). Stages Of Recovery Instrument: Development of a measure of recovery from serious mental illness. Australian and New Zealand Journal of Psychiatry, 40, 972-980. https://doi.org/10.1111/j.1440-1614.2006.01921.x

Andresen

Caputi

Oades

L. G.

(2010). Do clinical outcome measures assess consumer-defined recovery? Psychiatry Research, 177, 309-317. https://doi.org/10.1016/j.psychres.2010.02.013

Arnold

D. S.

O’Leary

S. G.

Wolff

L. S.

Acker

M. M.

(1993). The Parenting Scale: A measure of dysfunctional parenting in discipline situations. Psychological Assessment, 5, 137-144. https://doi.org/10.1037/1040-3590.5.2.137

Barber

J. M.

Parkes

Parsons

Cook

C. C. H.

(2012). Importance of spiritual well-being in assessment of recovery: The Service User Recovery Evaluation (SeRvE) scale. The Psychiatrist, 36, 444-450. https://doi.org/10.1192/pb.bp.111.037838

Beardslee

W. R.

Wright

E. J.

Gladstone

T. R. G.

Forbes

(2007). Long-term effects from a randomized trial of two public health preventive interventions for parental depression. Journal of Family Psychology, 21, 703-713. https://doi.org/10.1037/0893-3200.21.4.703

10.

Bee

Bower

Byford

Churchill

Calam

Stallard

. . . Abel

(2014). The clinical effectiveness, cost-effectiveness and acceptability of community-based interventions aimed at improving or maintaining quality of life in children of parents with serious mental illness: A systematic review. Health Technology Assessment, 18, 1-250. https://doi.org/10.3310/hta18080

11.

Berry

J. O.

Jones

W. H.

(1995). The Parental Stress Scale: Initial psychometric evidence. Journal of Social and Personal Relationships, 12, 463-472. https://doi.org/10.1177/0265407595123009

12.

Biebel

Nicholson

Woolsey

Wolf

(2016). Shifting an agency’s paradigm: Creating the capacity to intervene with parents with mental illness. American Journal of Psychiatric Rehabilitation, 19, 315-338. https://doi.org/10.1080/15487768.2016.1231641

13.

Bilszta

J. L. C.

Buist

A. E.

Wang

Zulkefli

N. R.

(2012). Use of video feedback intervention in an inpatient perinatal psychiatric setting to improve maternal parenting. Archives of Women’s Mental Health, 15, 249-257. https://doi.org/10.1007/s00737-012-0283-1

14.

Bonner

M. J.

Hardy

K. K.

Guill

A. B.

McLaughlin

Schweitzer

Carter

(2006). Development and validation of the Parent Experience of Child Illness. Journal of Pediatric Psychology, 31, 310-321. https://doi.org/10.1093/jpepsy/jsj034

15.

Brockington

Chandra

Dubowitz

Jones

Moussa

Nakku

Quadros Ferre

(2011). WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders. World Psychiatry, 10, 93-102. https://doi.org/10.1002/j.2051-5545.2011.tb00023.x

16.

Brunette

M. F.

Richardson

White

Bemis

Eelkema

R. E.

(2004). Integrated family treatment for parents with severe psychiatric disabilities. Psychiatric Rehabilitation Journal, 28, 177-180. https://doi.org/10.2975/28.2004.177.180

17.

Bryant-Waugh

Turner

Jones

Gamble

(2007). Developing a parenting skills-and-support intervention for mothers with eating disorders and pre-school children: Part 2. Piloting a group intervention. European Eating Disorders Review, 15, 439-448. https://doi.org/10.1002/erv.816

18.

Bugental

D. B.

Blue

J. B.

Cruzcoxa

(1989). Perceived control over caregiving outcomes: Implications for child abuse. Developmental Psychology, 25, 532-539. https://doi.org/10.1037/0012-1649.25.4.532

19.

Burgess

Pirkis

Coombs

Rosen

(2011). Assessing the value of existing recovery measures for routine use in Australian mental health services. Australian and New Zealand Journal of Psychiatry, 45, 267-280. https://doi.org/10.3109/00048674.2010.549996

20.

Campbell

Cook

Jonikas

Einspahr

(2004). Peer Outcomes Protocol Questionnaire. Chicago, IL: University of Illinois at Chicago.

21.

Carpenter-Song

E. A.

Holcombe

B. D.

Torrey

Hipolito

M. M. S.

Peterson

L. D.

(2014). Recovery in a family context: Experiences of mothers with serious mental illnesses. Psychiatric Rehabilitation Journal, 37, 162-169. https://doi.org/10.1037/prj0000041

22.

Casselman

R. B.

Pemberton

J. R.

(2015). ACT-based parenting group for veterans with PTSD: Development and preliminary outcomes. The American Journal of Family Therapy, 43, 57-66. https://doi.org/10.1080/01926187.2014.939003

23.

Chen

E. Y. H.

Tam

D. K. P.

Wong

J. W. S.

Law

C. W.

Chiu

C. P. Y.

(2005). Self-administered instrument to measure the patient’s experience of recovery after first-episode psychosis: Development and validation of the Psychosis Recovery Inventory. Australian and New Zealand Journal of Psychiatry, 39, 493-499. https://doi.org/10.1080/j.1440-1614.2005.01609.x

24.

Clark

Tluczek

Brown

(2008). A mother-infant therapy group model for postpartum depression. Infant Mental Health Journal, 29, 514-536. https://doi.org/10.1002/imhj.20189

25.

Clark

Tluczek

Wenzel

(2003). Psychotherapy for postpartum depression: A preliminary report. American Journal of Orthopsychiatry, 73, 441-454. https://doi.org/10.1037/0002-9432.73.4.441

26.

Commonwealth of Australia. (2013). A national framework for recovery-oriented mental health services: Guide for practitioners and providers. Canberra: Author. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/67d17065514cf8e8ca257c1d00017a90/$file/recovgde.pdf

27.

Cooper

Reupert

(2017). “Let’s talk about children” resource: A parallel mixed method evaluation. Social Work in Mental Health, 15, 47-65. https://doi.org/10.1080/15332985.2016.1170090

28.

Corrigan

P. W.

Giffort

Rashid

Leary

Okeke

(1999). Recovery as a psychological construct. Community Mental Health Journal, 35, 231-239. https://doi.org/10.1023/A:1018741302682

29.

Crnic

K. A.

Greenberg

M. T.

(1990). Minor parenting stresses with young children. Child Development, 61, 1628-1637. https://doi.org/10.1111/j.1467-8624.1990.tb02889.x

30.

Davis

D. W.

Myers

Logsdon

M. C.

Bauer

N. S.

(2016). The relationship among caregiver depressive symptoms, parenting behavior, and family-centered care. Journal of Pediatric Health Care, 30, 121-132. https://doi.org/10.1016/j.pedhc.2015.06.004

31.

Dickens

Weleminsky

Onifade

Sugarman

(2012). Recovery star: Validating user recovery. The Psychiatrist, 36, 45-50. https://doi.org/10.1192/pb.bp.111.034264

32.

Dolman

Jones

Howard

L. M.

(2013). Pre-conception to parenting: A systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Archives of Women’s Mental Health, 16, 173-196. https://doi.org/10.1007/s00737-013-0336-0

33.

Doyle

Logan

Ludlow

Holloway

(2012). Milestones To Recovery: Preliminary validation of a framework to promote recovery and map progress through the medium secure inpatient pathway. Criminal Behaviour and Mental Health, 22, 53-64. https://doi.org/10.1002/cbm.818

34.

Drapalski

A. L.

Medoff

Unick

G. J.

Velligan

D. I.

Dixon

L. B.

Bellack

A. S.

(2012). Assessing recovery of people with serious mental illness: Development of a new scale. Psychiatric Services, 63, 48-53. https://doi.org/10.1176/appi.ps.201100109

35.

Dumka

L. E.

Stoerzinger

H. D.

Jackson

K. M.

Roosa

M. W.

(1996). Examination of the cross-cultural and cross-language equivalence of the Parenting Self-Agency Measure. Family Relations, 45, 216-222. https://doi.org/10.2307/585293

36.

Epstein

N. B.

Baldwin

L. M.

Bishop

D. S.

(1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9, 171-180. https://doi.org/10.1111/j.1752-0606.1983.tb01497.x

37.

Evenson

Rhodes

Feigenbaum

Solly

(2008). The experiences of fathers with psychosis. Journal of Mental Health, 17, 629-642. https://doi.org/10.1080/09638230701506259

38.

Fonagy

Sleed

Baradon

(2016). Randomized controlled trial of parent-infant psychotherapy for parents with mental health problems and young infants. Infant Mental Health Journal, 37, 97-114. https://doi.org/10.1002/imhj.21553

39.

Forman

D. R.

O’Hara

M. W.

Stuart

Gorman

L. L.

Larsen

K. E.

Coy

K. C.

(2007). Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship. Development and Psychopathology, 19, 585-602. https://doi.org/10.1017/S0954579407070289

40.

Gelfand

D. M.

Teti

D. M.

Seiner

S. A.

Jameson

P. B.

(1996). Helping mothers fight depression: Evaluation of a home-based intervention program for depressed mothers and their infants. Journal of Clinical Child Psychology, 25, 406-422. https://doi.org/10.1207/s15374424jccp2504

41.

Gibaud-Wallston

Wandersaman

L. P.

(1978, August). Development and utility of the Parenting Sense of Competence Scale. Paper presented at the Meeting of the American Psychological Association, Toronto, Ontario, Canada.

42.

Giffort

Schmook

Woody

Vollendorf

Gervain

(1995). Construction of a scale to measure consumer recovery. Springfield, IL: Illinois Office of Mental Health.

43.

Glavin

Smith

Sørum

Ellefsen

(2010). Redesigned community postpartum care to prevent and treat postpartum depression in women—A one-year follow-up study. Journal of Clinical Nursing, 19, 3051-3062. https://doi.org/10.1111/j.1365-2702.2010.03332.x

44.

Goodman

J. H.

Guarino

A. J.

Prager

J. E.

(2013). Perinatal dyadic psychotherapy: Design, implementation, and acceptability. Journal of Family Nursing, 19, 295-323. https://doi.org/10.1177/1074840713484822

45.

Goodyear

Hill

Allchin

McCormick

Hine

Cuff

O’Hanlon

(2015). Standards of practice for the adult mental health workforce: Meeting the needs of families where a parent has a mental illness. International Journal of Mental Health Nursing, 24, 169-180. https://doi.org/10.1111/inm.12120

46.

Gordon

S. E.

Ellis

P. M.

Siegert

R. J.

Walkey

F. H.

(2013). Development of a self-assessed consumer recovery outcome measure: My Voice, My Life. Administration and Policy in Mental Health and Mental Health Services Research, 40, 199-210. https://doi.org/10.1007/s10488-012-0417-9

47.

Hancock

Scanlan

J. N.

Honey

Bundy

A. C.

O’Shea

(2015). Recovery Assessment Scale—Domains and Stages (RAS-DS): Its feasibility and outcome measurement capacity. Australian and New Zealand Journal of Psychiatry, 49, 624-633. https://doi.org/10.1177/0004867414564084

48.

Havighurst

S. S.

Wilson

K. R.

Harley

A. E.

Prior

M. R.

(2009). Tuning in to kids: An emotion-focused parenting program—Initial findings from a community trial. Journal of Community Psychology, 37, 1008-1023. https://doi.org/10.1002/jcop.20345

49.

Hine

R. H.

Maybery

D. J.

Goodyear

M. J.

(2018). Identity in recovery for mothers with a mental illness: A literature review. Psychiatric Rehabilitation Journal, 41, 16-28. https://doi.org/10.1037/prj0000215

50.

Holahan

C. J.

Moos

R. H.

(1983). The quality of social support: Measures of family and work relationships. British Journal of Clinical Psychology, 22, 157-162. https://doi.org/10.1111/j.2044-8260.1983.tb00596.x

51.

Hunt

M. G.

Stein

C. H.

(2012). Valued social roles and measuring mental health recovery: Examining the structure of the tapestry. Psychiatric Rehabilitation Journal, 35, 441-446. https://doi.org/10.1037/h0094577

52.

Isobel

Meehan

Pretty

(2016). An emotional awareness based parenting group for parents with mental illness: A mixed methods feasibility study of community mental health nurse facilitation. Archives of Psychiatric Nursing, 30, 35-40. https://doi.org/10.1016/j.apnu.2015.10.007

53.

James

D. E.

Schumm

W. R.

Kennedy

C. E.

Grigsby

C. C.

Shectman

K. L.

Nichols

C. W.

(1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169. https://doi.org/10.2466/pr0.1985.57.1.163

54.

Jerrell

J. M.

Cousins

V. C.

Roberts

K. M.

(2006). Psychometrics of the Recovery Process Inventory. The Journal of Behavioral Health Services & Research, 33, 464-473. https://doi.org/10.1007/s11414-006-9031-5

55.

Johnston

Mash

E. J.

(1989). A measure of parenting satisfaction and efficacy. Journal of Clinical Child Psychology, 18, 167-175. https://doi.org/10.1207/s15374424jccp1802_8

56.

Jones

Calam

Sanders

Diggle

P. J.

Dempsey

Sadhnani

(2014). A pilot web based positive parenting intervention to help bipolar parents to improve perceived parenting skills and child outcomes. Behavioural and Cognitive Psychotherapy, 42, 283-296. https://doi.org/10.1017/S135246581300009X

57.

Jones

Mulligan

L. D.

Higginson

Dunn

Morrison

A. P.

(2013). The Bipolar Recovery Questionnaire: Psychometric properties of a quantitative measure of recovery experiences in bipolar disorder. Journal of Affective Disorders, 147, 34-43. https://doi.org/10.1016/j.jad.2012.10.003

58.

Jones

Wainwright

L. D.

Jovanoska

Vincent

Diggle

P. J.

Calam

. . . Lobban

(2015). An exploratory randomised controlled trial of a web-based Integrated Bipolar Parenting Intervention (IBPI) for bipolar parents of young children (aged 3-10). BMC Psychiatry, 15, Article 122. https://doi.org/10.1186/s12888-015-0505-y

59.

Kaplan

Solomon

P. L.

Salzer

M. S.

Brusilovskiy

(2014). Assessing an internet-based parenting intervention for mothers with a serious mental illness: A randomized controlled trial. Psychiatric Rehabilitation Journal, 37, 222-231. https://doi.org/10.1037/prj0000080

60.

Katzenbach

R. J.

(2013). Measuring growth: The reliability and validity of the Utah Recovery Scale (Doctoral dissertation). Brigham Young University, Provo, UT.

61.

Kendall

Bloomfield

(2005). Developing and validating a tool to measure parenting self-efficacy. Journal of Advanced Nursing, 51, 174-181. https://doi.org/10.1111/j.1365-2648.2005.03479.x

62.

Knafl

Deatrick

J. A.

Gallo

Dixon

Grey

Knafl

O’Malley

(2011). Assessment of the psychometric properties of the Family Management Measure. Journal of Pediatric Psychology, 36, 494-505. https://doi.org/10.1093/jpepsy/jsp034

63.

Langemeijer

Peijnenburg

Veerman

J. W.

(1997). Het gebruik van vragenlijsten in de gezinsdiagnostiek: Begeleiding van het keuzeproces [The use of questionnaires in family diagnostics: Guidance of the selection process]. In Pijnenburg

H. M.

van Rijswijk

C. M.

Ruijssenaars

A. J. J. M.

Veerman

J. W.

(Eds.), Pedagogisch jaarboek [Pedagogical yearbook] (pp. 25-39). Delft, The Netherlands: Eburon.

64.

Leamy

Bird

Le Boutillier

Williams

Slade

(2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. The British Journal of Psychiatry, 199, 445-452. https://doi.org/10.1192/bjp.bp.110.083733

65.

LeCroy

C. W.

Krysik

Milligan

(2005). Healthy Family Parenting Inventory. Retrieved from http://www.lecroymilligan.com/pages/hfpi-download.php

66.

Liberati

Altman

D. G.

Tetzlaff

Mulrow

Gøtzsche

P. C.

Ioannidis

J. P.

. . . Moher

(2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6, e1000100. https://doi.org/10.1371/journal.pmed.1000100

67.

Lusczakoski

K. K.

Olmos-Gallo

P. A.

Milnor

McKinney

C. J.

(2016). Measuring mental health recovery: An application of Rasch modeling to the Consumer Recovery Measure. The Journal of Behavioral Health Services & Research, 43, 104-115. https://doi.org/10.1007/s11414-014-9411-1

68.

Marino

C. K.

(2015). To belong, contribute, and hope: First stage development of a measure of social recovery. Journal of Mental Health, 24, 68-72. https://doi.org/10.3109/09638237.2014.954696

69.

Marino

C. K.

(2016). The development and validation of the Social Recovery Measure (Doctoral dissertation). Portland State University, OR. https://doi.org/10.15760/etd.2921

70.

Marston

Maybery

Reupert

(2014). Empowering families where a parent has a mental illness: A preliminary evaluation of the “family focus” DVD. Advances in Mental Health, 12, 136-146. https://doi.org/10.1080/18374905.2014.11081891

71.

Matheny

A. P.

Wachs

T. D.

Ludwig

J. L.

Phillips

(1995). Bringing order out of chaos: Psychometric characteristics of the Confusion, Hubbub, And Order Scale. Journal of Applied Developmental Psychology, 16, 429-444. https://doi.org/10.1016/0193-3973(95)90028-4

72.

Matthey

White

(2002). The Parent Concerns Questionnaire-v9-brief. Sydney, New South Wales, Australia: Sydney South West Area Health Service.

73.

Maybery

Goodyear

Reupert

Sheen

Cann

Dalziel

. . . von Doussa

(2017). Developing an Australian-first recovery model for parents in Victorian mental health and family services: A study protocol for a randomised controlled trial. BMC Psychiatry Open, 17, Article 198. http://dx.doi.org/10.1186/s12888-017-1357-4

74.

Maybery

Ling

Szakacs

Reupert

(2005). Children of a parent with a mental illness: Perspectives on need. Australian e-Journal for the Advancement of Mental Health, 4, 78-88. https://doi.org/10.5172/jamh.4.2.78

75.

Maybery

Meadows

Clark

Sutton

Reupert

Nicholson

(2015). A personal recovery model for parents with mental health problems. In Reupert

Maybery

Nicholson

Göpfert

Seeman

M. V.

(Eds.), Parental psychiatric disorder: Distressed parents and their families (3rd ed., pp. 312-323). Cambridge, UK: Cambridge University Press.

76.

Maybery

Reupert

Patrick

Goodyear

Crase

(2009). Prevalence of parental mental illness in Australian families. Psychiatric Bulletin, 33, 22-26. https://doi.org/10.1192/pb.bp.107.018861

77.

McCubbin

H. I.

Boss

Wilson

Dahl

(1981). Family Coping Inventory (FCI). In McCubbin

H. I.

Thompson

A. I.

McCubbin

M. A.

(Eds.), Family assessment: Resiliency, coping and adaptation: Inventories for research and practice (pp. 625-637). Madison, WI: University of Wisconsin–Madison.

78.

McCubbin

H. I.

McCubbin

M. A.

Thompson

A. I.

(1987). Family Time And Routines Index. In McCubbin

H. I.

Thompson

A. I.

(Eds.), Family assessment inventories for research and practice (pp. 133-141). Madison, WI: University of Wisconsin–Madison.

79.

Mental Health Center of Denver. (2005). The recovery initiative at the Mental Health Center of Denver. Denver, CO: The Recovery Committee.

80.

Miller

(2005). Consumer Recovery Outcomes System (CROS 3.0). In Campbell-Orde

Chamberlin

Carpenter

Leff

(Eds.), Measuring the promise: A compendium of recovery measures (pp. 25-31). Cambridge, MA: Evaluation Center at Human Services Research Institute.

81.

Morrell

C. J.

Slade

Warner

Paley

Dixon

Walters

S. J.

. . . Nicholl

(2009). Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: Pragmatic cluster randomised trial in primary care. British Medical Journal, 338, Article a3045. https://doi.org/10.1136/bmj.a3045

82.

Mueser

K. T.

Gingerich

Salyers

M. P.

McGuire

A. B.

Reyes

R. U.

Cunningham

(2005). Illness Management and Recovery (IMR) Scales. In Campbell-Orde

Chamberlin

Leff

(Eds.), Measuring the promise: A compendium of recovery measures (pp. 124-132). Cambridge, MA: Evaluation Center at Human Services Research Institute.

83.

Murray

Cooper

P. J.

Wilson

Romaniuk

(2003). Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: 2. Impact on the mother-child relationship and child outcome. The British Journal of Psychology, 182, 420-427. https://doi.org/10.1192/bjp.02.178

84.

Neil

S. T.

Kilbride

Pitt

Nothard

Welford

Sellwood

Morrison

A. P.

(2009). The Questionnaire about the Process of Recovery (QPR): A measurement tool developed in collaboration with service users. Psychosis, 1, 145-155. https://doi.org/10.1080/17522430902913450

85.

Nicholson

(2010). Parenting and recovery for mothers with mental disorders. In Levin

B. L.

Becker

M. A.

(Eds.), A public health perspective of women’s mental health (pp. 359-372). New York, NY: Springer.

86.

Nicholson

Albert

Gershenson

Williams

Biebel

(2009). Family Options for parents with mental illnesses: A developmental, mixed methods pilot study. Psychiatric Rehabilitation Journal, 33, 106-114. https://doi.org/10.2975/33.2.2009.106.114

87.

Noel

Woods

Routhier

Drake

(2016). Planning treatment and assessing recovery in participants with dual diagnosis: Preliminary evaluation of a new clinical tool. Journal of Dual Diagnosis, 12, 55-62. https://doi.org/10.1080/15504263.2016.1146555

88.

Oates

J. M.

Gervai

(2003, August). Mothers’ Object Relations Scales. Paper presented at the 11th European Conference on Developmental Psychology, Milan, Italy.

89.

The Ohio Department of Mental Health. (2009). The Ohio Mental Health Consumer Outcome System: Procedural manual (11th ed.). Columbus, OH: Author.

90.

Phelan

R. F.

Howe

D. J.

Cashman

E. L.

Batchelor

S. H.

(2012). Enhancing parenting skills for parents with mental illness: The Mental Health Positive Parenting Program. MJA Open, 199(Suppl. 1), 30-33. https://doi.org/10.5694/mjao11.11181

91.

Ranning

Laursen

T. M.

Thorup

Hjorthoj

Nordentoft

(2015). Serious mental illness and disrupted caregiving for children: A nationwide, register-based cohort study. The Journal of Clinical Psychiatry, 76, e1006-e1014. https://doi.org/10.4088/JCP.13m08931

92.

Rayner

Muscara

Dimovski

McCarthy

M. C.

Yamada

Anderson

V. A.

. . . Nicholson

J. M.

(2016). Take A Breath: Study protocol for a randomized controlled trial of an online group intervention to reduce traumatic stress in parents of children with a life threatening illness or injury. BMC Psychiatry, 16, Article 169. https://doi.org/10.1186/s12888-016-0861-2

93.

Reupert

Maybery

(2015). Evidence relating to the effectiveness of community-based interventions to improve the quality of life for children of parents with serious mental illness is weak; better quality studies are required. Evidence Based Nursing, 18, 10-11. https://doi.org/10.1136/eb-2014-101822

94.

Reupert

Maybery

(2016). What do we know about families where parents have a mental illness? A systematic review. Child & Youth Services, 37, 98-111. https://doi.org/10.1080/0145935X.2016.1104037

95.

Reupert

Maybery

Cox

Scott Stokes

(2015). Place of family in recovery models for those with a mental illness. International Journal of Mental Health Nursing, 24, 495-506. https://doi.org/10.1111/inm.12146

96.

Reupert

Maybery

Kowalenko

(2013). Children whose parents have a mental illness: Prevalence, need and treatment. The Medical Journal of Australia, 199, 7-9. https://doi.org/10.5694/mja11.11200

97.

Reupert

Price-Robertson

Maybery

(2017). Parenting as a focus of recovery: A systematic review of current practice. Psychiatric Rehabilitation Journal, 40, 361-370. https://doi.org/10.1037/prj0000240

98.

Ridgway

P. A.

Press

Ratzlaff

Davidson

Rapp

C. A.

(2003). Report on field testing the Recovery Enhancing Environment Measure. Lawrence, KS: The University of Kansas.

99.

Riemersma

van Santvoort

Janssens

J. M. A. M.

Hosman

C. M. H.

van Doesum

K. T. M.

(2015). “You are Okay”: A support and educational program for children with mild intellectual disability and their parents with a mental illness: Study protocol of a quasi-experimental design. BMC Psychiatry, 15, Article 318. https://doi.org/10.1186/s12888-015-0698-0

100.

Robin

A. L.

Foster

S. L.

(1989). Questionnaire and observational assessment. In Robin

A. L.

Foster

S. L.

(Eds.), Negotiating parent-adolescent conflict: A behavioral-family systems approach (pp. 77-98). New York, NY: Guilford Press.

101.

Rohner

R. P.

Khaleque

(2005). Parental Acceptance-Rejection/Control Questionnaire (PARQ/control): Test manual. In Rohner

R. P.

Khaleque

(Eds.), Handbook for the study of parental acceptance and rejection (4th ed., pp. 137-186). Storrs, CT: Rohner Research.

102.

Runfola

Zucker

N. L.

Von Holle

Mazzeo

Hodges

E. A.

Perrin

E. M.

. . . Bulik

C. M.

(2014). NURTURE: Development and pilot testing of a novel parenting intervention for mothers with histories of an eating disorder. International Journal of Eating Disorders, 47, 1-12. https://doi.org/10.1002/eat.22178

103.

Sadeh-Sharvit

Zubery

Mankovski

Steiner

Lock

J. D.

(2016). Parent-based prevention program for the children of mothers with eating disorders: Feasibility and preliminary outcomes. Eating Disorders, 24, 312-325. https://doi.org/10.1080/10640266.2016.1153400

104.

Schaefer

E. S.

(1965). Children’s reports of parental behavior: An inventory. Child Development, 36, 413-424. https://doi.org/10.2307/1126465

105.

Shanks

Williams

Leamy

Bird

V. J.

Le Boutillier

Slade

(2013). Measures of personal recovery: A systematic review. Psychiatric Services, 64, 974-980. https://doi.org/10.1176/appi.ps.005012012

106.

Shea

Tronick

(1988). The Maternal Self-Report Inventory: A research and clinical instrument for assessing maternal self-esteem. Theory and Research in Behavioral Pediatrics, 4, 104-141.

107.

Shelton

K. K.

Frick

P. J.

Wooton

(1996). Assessment of parenting practices in families of elementary school-aged children. Journal of Clinical Child Psychology, 25, 317-329. https://doi.org/10.1207/s15374424jccp2503_8

108.

Siegenthaler

Munder

Egger

(2012). Effect of preventive interventions in mentally ill parents on the mental health of the offspring: Systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 8-17.e8. https://doi.org/10.1016/j.jaac.2011.10.018

109.

Sklar

Groessl

E. J.

O’Connell

Davidson

Aarons

G. A.

(2013). Instruments for measuring mental health recovery: A systematic review. Clinical Psychology Review, 33, 1082-1095. https://doi.org/10.1016/j.cpr.2013.08.002

110.

Slade

(2010). Measuring recovery in mental health services. Israel Journal of Psychiatry and Related Sciences, 47, 206-212.

111.

Slade

Johnston

Oakley Browne

M. A.

Andrews

Whiteford

(2009). 2007 National Survey of Mental Health and Wellbeing: Methods and key findings. Australian and New Zealand Journal of Psychiatry, 43, 594-605. https://doi.org/10.1080/00048670902970882

112.

Song

L.-Y.

Hsu

S.-T.

(2011). The development of the Stages of Recovery Scale for persons with persistent mental illness. Research on Social Work Practice, 21, 572-581. https://doi.org/10.1177/1049731511402218

113.

Suchman

N. E.

Ordway

M. R.

de las Heras

McMahon

T. J.

(2016). Mothering from the inside out: Results of a pilot study testing a mentalization-based therapy for mothers enrolled in mental health services. Attachment & Human Development, 18, 596-617. https://doi.org/10.1080/14616734.2016.1226371

114.

Ten Brink

L. T.

Van der Steege

Van der Haar

A. N.

Veerman

J. W.

Baartman

H. E. M

. (2000). De experimentele handleiding Vragenlijst Gezinsfunctioneren [Experimental manual of the Family Functioning Questionnaire]. Utrecht, The Netherlands: NIZW/PI research.

115.

Teti

D. M.

Gelfand

D. M.

(1991). Behavioral competence among mothers of infants in the first year: The mediational role of maternal self-efficacy. Child Development, 62, 918-929. https://doi.org/10.1111/j.1467-8624.1991.tb01580.x

116.

Tew

Ramon

Slade

Bird

Melton

Le Boutillier

(2012). Social factors and recovery from mental health difficulties: A review of the evidence. The British Journal of Social Work, 42, 443-460.

117.

Valdez

C. R.

Mills

C. L.

Barrueco

Leis

Riley

A. W.

(2011). A pilot study of a family-focused intervention for children and families affected by maternal depression. Journal of Family Therapy, 33, 3-19. https://doi.org/10.1111/j.1467-6427.2010.00529.x

118.

Valdez

C. R.

Padilla

Moore

Magaña

(2013). Feasibility, acceptability, and preliminary outcomes of the Fortalezas Familiares intervention for Latino families facing maternal depression. Family Process, 52, 394-410. https://doi.org/10.1111/famp.12033

119.

van der Ende

P. C.

van Busschbach

J. T.

Nicholson

Korevaar

E. L.

van Weeghel

. (2014). Parenting and psychiatric rehabilitation: Can parents with severe mental illness benefit from a new approach? Psychiatric Rehabilitation Journal, 37, 201-208. https://doi.org/10.1037/prj0000067

120.

van der Zanden

R. A. P.

Speetjens

P. A. M.

Arntz

K. S. E.

Onrust

S. A

. (2010). Online group course for parents with mental illness: Development and pilot study. Journal of Medical Internet Research, 12, e50. https://doi.org/10.2196/jmir.1394

121.

van Santvoort

Hosman

C. M. H.

Janssens

J. M. A. M.

van Doesum

K. T. M.

Reupert

van Loon

L. M. A

. (2015). The impact of various parental mental disorders on children’s diagnoses: A systematic review. Clinical Child and Family Psychology Review, 18, 281-299. https://doi.org/10.1007/s10567-015-0191-9

122.

Wansink

H. J.

Janssens

J. M. A.

Hoencamp

Middelkoop

B. J.

Hosman

C. M.

(2015). Effects of preventive family service coordination for parents with mental illnesses and their children, a RCT. Family, Systems, & Health, 33, 110-119. https://doi.org/10.1037/fsh0000105

123.

Wolstencroft

Oades

Caputi

Andresen

(2010). Development of a structured interview schedule to assess stage of psychological recovery from enduring mental illness. International Journal of Psychiatry in Clinical Practice, 14, 182-189. https://doi.org/10.3109/13651501003668552

124.

Wyder

Bland

(2014). The recovery framework as a way of understanding families’ responses to mental illness: Balancing different needs and recovery journeys. Australian Social Work, 67, 179-196. https://doi.org/10.1080/0312407X.2013.875580

125.

Young

S. L.

Bullock

W. A.

(2003). The Mental Health Recovery Measure. Toledo, OH: University of Toledo.