Knowledge transfer can be defined as: The process which one unit – for example; an individual, a group, a department or an organization – is affected by the experience of another [
1]. It is important to highlight that providing information, presenting facts, arranging informative courses or even giving lectures is not the same as knowledge transfer. This is because knowledge alone is not necessarily sufficient in order to create behavior change. In essence, knowledge transfer is about facilitating behavior change. One way of explaining knowledge transfer is to regard it as the process of organizations seeking to improve performance by implementing a new practice [
1,
2].
How is knowledge transferred from one unit or organization to another? There are several factors that can facilitate or impede knowledge transfer in organizations and it is definitely possible to design organizations and procedures to promote knowledge transfer [
1,
2]. This is however a very complex area, consisting of many important mechanisms. The literature is extensive on this field, and we will discuss the most important mechanisms of knowledge transfer later in this article, but for now let’s just agree that there are many issues to address if you want to understand the mechanisms of knowledge transfer.
The field of parental mental illness
Many studies have documented that mental illness is very common [
3]. Mental illness is defined as a psychological pattern, potentially reflected in behavior, that is generally associated with distress or disability and is not considered part of normal development [
4]. According to the DSM IV criteria, the term mental disorder refers to a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual, is associated with present distress or disability and represents a manifestation of a behavioral, psychological, or biological dysfunction in the individual. The most common mental health problems are anxiety, depression and substance abuse issues [
5].
In a 2009 report on mental illness in Norway, The Norwegian Institute of Public Health (2009) estimated that up to 50% of the population will suffer from mental health problems at some point during their lifetime [
5].
Adults with mental health problems are not less likely to be parents then the rest of the population [
6]. Several international studies the past two decades have indicated that children with mentally ill parents are at risk of developing mental health problems themselves [
7‐
9]. Parental mental illness is considered a powerful risk-factor, with a potential of serious impact for the children. For instance: parents with depression have more difficulties in interaction with their children, are more intrusive, less involved and less responsive [
10‐
12].
More than one third of these children develop serious and long-lasting problems. Early in life, these children run a higher risk of abuse and neglect, depression, eating disorders, conduct problems and academic failure. Later in life, they are at a higher risk of depression, anxiety disorders, substance abuse, eating problems and personality disorders [
13‐
15].
Maternal symptoms of anxiety and depression increased the risk of emotional and disruptive problem behaviors in children as early as 18 months of age, according to new research findings from the Norwegian Institute of Public Health. And these problems are often found to be long lasting [
16].
It is especially when Parental mental illness is present during the early years of life that it triggers dys-regulated emotion patterns, negative emotionality and insecure attachment. A lot of documentation exists on the serious effects parental mental illness may have on the early developmental stages of a child’s life [
17‐
22]. It is safe to say that early intervention is essential to counteract permanent damage to the child’s developmental path.
Parental mental illness may interrupt the neurological development in offspring [
23,
24]. Since the brain is not fully developed when we are born, the experiences a child has growing up will have direct effect on the development of the brain [
23,
24]. Children of mentally ill parents are in many cases exposed to traumatic childhood experiences, for example: they can be witnesses to violence, or they may have been subject to abuse or neglect. This is commonly referred to as developmental traumas. Developmental traumas result from growing up in a context of ongoing danger, maltreatment, unpredictability, and/or neglect. Developmental traumas tend to surface as several disorders, i.e., regulatory disorder during infancy, attachment disorders, hyperkinetic conduct disorder at school age, or combined conduct and emotional disorders during adolescence [
23,
24]. Children that live under stressful conditions over time, will produce a lot of stress hormones and the child is in a way becoming programmed into a state of constant emergency preparedness. The child’s cognitive resources are tied up in being in a state of emergency, and this delays and impairs the child’s development in other areas [
23,
24].
Regulatory competence is a key concept. Emotional regulation is developed early in life in interaction with caregivers. Emotional regulation is a complex process involving: the subjective experience (feelings), cognitive responses (thoughts), physiological responses (for example heart rate or hormonal activity), and behavior (such as bodily actions or expressions) [
25]. Children who have been neglected or abused have been found to have a dysfunctional self-regulatory competence [
23].
The impact parental mental illness may have on offspring is commonly ignored within the adult mental health services [
26], even though there is thorough documentation that Parental mental illness is a powerful risk factor for children. The objective of including a focus on the patient’s children is linked to prevention, because there are measures that can be taken to counteract the risk, for instance by implementing a prevention perspective in adult mental health services. There is a substantial amount of research documenting that teaching parents positive parenting strategies to promote children’s self-confidence, pro-social behaviors, problem-solving skills and academic success reduces the risk for those children [
27,
28]. There is also growing evidence to support the idea that strengthening protective factors for children of mentally ill parents may reduce the incidence or prevalence of some mental disorders [
4]. There are several well-known protective factors for children of mentally ill parents, and they are commonly divided in three categories: family related factors (such as parental participation in the child’s life, sensitive upbringing strategies and consistent child-rearing approaches), individual factors (gender, self-esteem, intellectual capacity, social skills), and structural factors (positive school environment, social network, socio-economic status) [
21].
The prevention objective is threefold. First of all it’s about preventing children from developing poor regulatory competence, insecure and disorganized attachment [
23].
It also involves preventing added burden to the parents disease, because research has documented that treatment alone is not as effective as when it is combined with family focused strategies [
29]. And thirdly, and hopefully as a result of this; preventing mental illness from being transmitted from one generation to the next [
10].