Challenges and support for children of parents with mental health and substance use disorders: a scoping review

Introduction

Children whose parents experience mental health disorders and substance use challenges represent a highly vulnerable population, as they often contend with unstable home environments, inconsistent caregiving, and an elevated risk of exposure to traumatic events such as neglect or abuse (1). Stigma and secrecy surrounding parental mental illness can further isolate these children, limiting their access to supportive social networks (2). Compounding these risks, the prevalence of mental health disorders among youth has been on the rise globally. In Norway, for instance, diagnoses in boys climbed from 7.6% to 10.9% and in girls from 7.3% to 12.5% between 2010 and 2022, underscoring the urgency of addressing the needs of children impacted by parental mental illness and substance use (3).

Despite clear evidence of the challenges these children face, specialized interventions remain scarce (2). Existing services often focus on treating the parent or the family unit as a whole, overlooking children’s individual experiences and developmental stages (4). To address these gaps, resilience has emerged as a core concept, highlighting protective factors like emotional regulation, coping strategies, and social skills that can mitigate adverse circumstances (5-7). However, many resilience-building programs are too generalized, insufficiently tailored to the unique experiences of these children, or fail to consider gender differences that significantly influence how boys and girls respond to parental mental illness and substance use (4).

Further complicating the situation is the critical developmental window of ages 10–18 years, during which children experience pronounced physical, emotional, and cognitive changes (8,9). Early adolescence is both a period of heightened vulnerability and an opportune time to introduce targeted, evidence-based interventions that can establish healthier coping mechanisms. Research consistently shows that proactive support can prevent the progression of mental health disorders and alleviate long-term burdens on healthcare systems (10-12). However, a lack of straightforward, widely accessible programs, alongside limited qualitative research on children’s lived experiences, continues to impede the development of effective, culturally sensitive interventions. This study therefore aims to fill these gaps by identifying current best practices and proposing a streamlined, practical intervention to bolster emotional regulation, coping strategies, and social skills in children affected by parental mental health and substance use disorders. To ensure real-world applicability, we will spotlight tangible, existing programs (including parent-focused, child-focused, and school or community-based interventions) and detail them in a user-friendly format. We will also outline a policy framework that goes beyond calls for increased funding, advocating instead for multifaceted approaches such as stigma reduction campaigns, workforce training, and interdisciplinary collaboration that can more holistically support this at-risk youth population.

By systematically examining evidence from these diverse viewpoints in a comprehensive manner, we aim to provide valuable insights for policymakers, mental health practitioners, and researchers. We present this article in accordance with the PRISMA-ScR reporting checklist (available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-24-131/rc).

Methods

The methodology employed in this study is a scoping review, designed to thoroughly explore existing literature on the perspectives of children, parents, and healthcare professionals regarding family participation in mental health care. These insights will aid in developing family-centered care models that are evidence-based and deeply respectful of family autonomy and empowerment.

Our scoping review adheres to principles akin to those of systematic reviews, emphasizing rigorous and transparent methods at every stage. By meticulously documenting our processes, we enable replication by other researchers, thereby enhancing the reliability of our findings and addressing concerns about methodological rigor (13). The scoping review method seeks to achieve both depth and breadth, aiming to thoroughly understand how the subject is addressed in the current literature. As we become more familiar with the literature, we may refine our search terms and conduct more sensitive searches to ensure comprehensive coverage. This flexible approach allows for an iterative and reflective process throughout the study. In light of these distinctions, we will now detail the six stages of the framework we employed for our scoping study (13).

Stage 1: identifying the working questions

Regarding the aim of the scoping review, two working questions were developed to guide the following inquiry

The question in step one aims to clarify the overarching focus of the review and establish a clear boundary for what will be examined. By defining the core issue early on, it ensures all subsequent steps are aligned with the central objective, guiding both the inclusion criteria and analytical direction of the study.

• What characterizes the range and nature of the existing scientific literature on the challenges faced by children of parents with mental health and substance use disorders, and the support available to them?
• What are the key themes and findings regarding the challenges these children face and the support mechanisms that effectively assist them, as reported in the literature?

Stage 2: identifying relevant studies

From May 2024 to November 2024, we conducted systematic online searches across four databases relevant to mental health nursing and qualitative, peer-reviewed literature: CINAHL, PubMed, Scopus, and Web of Science. Our initial systematic search was structured into four distinct blocks, each focusing on:

• Block A: children of parents with mental health disorders;
• Block B: children of parents with substance use disorders;
• Block C: challenges and risks encountered by these children;
• Block D: support interventions and resilience-building programs.

For each block, we used a combination of controlled vocabulary from database thesauri and free-text terms to capture relevant literature comprehensively. A comprehensive search strategy, including MeSH terms, Boolean operators, search limits, and databases used, is detailed in the sought strategy to ensure transparency and reproducibility.

During the search process, adjustments were made as follows:

• Block A was broadened to include a wider range of parental mental health disorders, such as depression, anxiety, bipolar disorder, and schizophrenia, as well as substance-related issues like alcohol and drug misuse and co-occurring disorders.
• Block B was refined to encompass perspectives from children aged 10–18 years, their parents, and healthcare professionals, with a focus on emotional and psychological impacts, developmental challenges, social isolation, trauma exposure, and gender-specific responses experienced by these children.
• Block C was extended to include a comprehensive array of challenges and risks specific to these children, emphasizing the effects of family dynamics, social and environmental factors, and systemic barriers to support.
• Block D was refined to cover a diverse range of support interventions, including structured resilience-building programs, therapeutic approaches like counseling and cognitive-behavioral therapy, informal support mechanisms such as peer groups and community initiatives, and programs aimed at enhancing coping skills and emotional regulation among affected children.

The search was carried out in collaboration with a research librarian and was completed in November 2024. All identified references were imported and managed using Covidence software.

To ensure a thorough approach, we adopted broad definitions for key concepts related to the challenges faced by these children and the available support. Keywords such as ‘resilience’, ‘coping strategies’, ‘emotional regulation’, ‘social skills’, ‘interventions’, ‘support programs’, ‘psychosocial support’, ‘preventive measures’, ‘children of parents with mental illness’, ‘parental substance use’, ‘adolescent mental health’, and ‘family interventions’ were included to maximize retrieval of all pertinent literature on the topic. We anticipated that broad definitions could result in an extensive number of references. To manage this, we maintained a wide scope initially, allowing us to refine and effectively address the literature’s volume and scope as the project evolved. To ensure accessibility and facilitate the comparability of findings within the global research community, we limited the search to articles published in English. This decision ensures that the included studies can be widely understood and incorporated into international discussions, which is crucial for developing universally applicable recommendations.

To ensure the relevance of our findings to current practices and policy discussions, we limited our review to articles published in the last ten years [2014–2024]. This time frame reflects the most recent advances in research and practice, capturing evolving understandings of the challenges and support mechanisms for children of parents with mental health and substance use disorders. By focusing on recent literature, we ensure that the findings and recommendations are aligned with contemporary frameworks, interventions, and socio-political contexts (12).

Stage 3: study selection

To ensure consistent decision-making, we established inclusion and exclusion criteria similar to those used in systematic reviews (14). Our inclusion criteria focused on peer-reviewed, full-text journal articles published from 2014 to 2024. We specifically sought studies that explored the experiences of children aged 10–18 years, their parents, and healthcare professionals within the contexts of mental health and substance use disorders. We included both qualitative and quantitative research that addressed the challenges faced by these children and the interventions designed to support them. Additionally, our criteria were refined to include studies that examined resilience, coping strategies, emotional regulation, social skills, and responses specific to gender. These additions provided insights into effective support mechanisms. We excluded conference abstracts, book chapters, dissertations, or any non-peer-reviewed materials. Studies were also excluded if they did not focus on mental health and substance use challenges affecting if the target age range was not clearly analyzable, or if they did not examine relevant outcomes. From an initial 4,233 references, we removed 114 duplicates, leaving 4,119 for review. After title and abstract screening, 3,892 references were excluded, followed by 208 more based on specific criteria (Figure 1). This process led to a final selection of 19 studies that met our criteria and contributed to the review’s objectives.

Figure 1 PRISMA—challenges and support for children of parents.

Stage 4: charting the data

Data charting involved extracting information to describe the range and nature of the included studies (Table 1). Additionally, the charting process entailed a structured approach to data analysis, starting with a broad comprehension of the data, followed by identifying relevant statements, finding commonalities, and ultimately discerning central themes related to the challenges faced by these children and the support mechanisms that assist them (15,16). This process was facilitated by team discussions and the use of Covidence software.

• Overall understanding: reviewing the studies to develop a comprehensive understanding of the data.
• Meaning unit identification: identifying and extracting “meaning units” statements relevant to the research aim.
• Commonality identification: analyzing the meaning units to identify common meanings, which were then grouped into descriptive categories.
• Theme identification: conducting an analysis to identify patterns of regularities and variations, leading to the identification of central themes emerging from the data. Steps three and four were conducted through discussions within the research team (15).

Stage 5: collating and summarizing results

The process of collating and summarizing results focused on formulating answers to our research questions. This led to the material presented below in the “Results” section.

Stage 6: consultation exercise (optional stage)

Alongside the five stages of our review, we initiated a consultative process with a diverse group of stakeholders’ child mental health nurses, representatives from support organizations, and professionals who have direct experience with mental health and substance use disorders using a combination of face-to-face sessions, virtual meetings, and email exchanges. This inclusive approach was vital in identifying ongoing challenges and gathering comprehensive insights into children’s experiences, alongside the perspectives of their parents and the professionals who support them. Our collaboration illuminated areas in need of further exploration and ensured that the review addressed the broad spectrum of needs and realities faced by everyone involved.

Following Arksey and O’Malley’s framework (13), this consultative phase served as the final step in our comprehensive review process. Through monthly in-person meetings and supplemental email exchanges, we refined our research questions, aligned the findings with real-world challenges, and ensured that the proposed interventions would be culturally relevant and practically feasible. Building on these varied insights, we then proceeded to sequentially present and discuss the compiled material in the subsequent sections.

Results

The results of this review highlight the multifaceted challenges faced by children of parents with mental health and substance use disorders, emphasizing their increased vulnerability to emotional, social, and developmental risks. Drawing from the literature, the findings underscore the importance of targeted interventions, family engagement, integrated support systems, and continuous monitoring to address these challenges effectively. Each theme is supported by evidence from the reviewed studies, providing a comprehensive understanding of the strategies needed to improve outcomes for these children and their families.

This review highlights significant challenges and risk factors faced by children of parents with mental health and substance use disorders, emphasizing the need for targeted interventions and integrated support systems. We ensured that all statements in the “Results” section are directly supported by cited sources, providing clear evidence for each conclusion drawn.

Impact and risk factors

The impacts of parental substance use and mental health disorders on children include a range of emotional, social, and developmental challenges. Research consistently shows that children exposed to these conditions are at increased risk of maltreatment and behavioral issues that can persist into adulthood, highlighting the profound influence parental health has on child development. A lack of stability and predictability in these environments undermines healthy emotional growth. Parental disorders often hinder the ability to provide consistent, nurturing care, which is vital for secure attachment and emotional regulation (17,18).

Developmentally, children in such environments frequently show delayed milestones in cognitive and emotional growth. Chaotic household conditions linked to substance misuse can impair cognitive abilities and lead to emotional dysregulation (19-21). Additionally, attachment disorders are common, hindering these children from forming secure relationships later in life. Behaviorally, children of parents with mental health and substance use disorders often exhibit externalizing problems, like aggression, and internalizing issues, such as anxiety. Matsuda et al. [2019] describe these behaviors as coping mechanisms developed in the absence of adequate parental guidance, which can have long-term negative effects on social interactions and academic performance (17). Stigma around these disorders often results in social isolation, adding to children’s emotional struggles. Without supportive social networks, they lack the community connections needed for healthy development and resilience.

A major consequence of these environments is the heightened risk of maltreatment, including neglect and abuse (21). A reviewed study emphasizes the importance of family therapy in involving parents to improve family dynamics and reduce risks. Evidence suggests that family therapy can educate parents about the impact of their behavior on their children and provide strategies to manage these challenges effectively. Community-based programs play a critical role in offering support, reducing stigma, and fostering understanding of mental health and substance use disorders. They provide essential social networks and opportunities for positive interactions, crucial for child development and well-being. In summary, children of parents with mental health and substance use disorders face significant challenges, including developmental delays, behavioral issues, and maltreatment (19,22). Targeted interventions and community support can mitigate risks and improve developmental outcomes, allowing these vulnerable children to achieve better health and lead more fulfilling lives (23).

Parent and family engagement

The participation of parents in therapy can foster a healing environment, not just for the individual but for the entire family unit. This approach allows parents to develop better coping strategies, improve parenting skills, and strengthen family dynamics, which are essential for creating a supportive home environment (18,24,25).

Strategies that enhance parental skills often focus on improving communication, conflict resolution, and emotional management. For instance, Mechling et al. [2024] discuss how interventions that include parents, particularly those with substance use disorders, can benefit the entire family system, especially when grandparents are actively involved in raising grandchildren. This involvement can provide additional stability and support, helping to buffer the adverse effects often experienced by children in these households (26).

Furthermore, Matsuda et al. [2019] emphasize the importance of increasing ‘parenting self-agency’, or parents’ belief in their ability to perform parenting roles effectively as a critical factor in improving child outcomes. Training programs that empower parents with skills and knowledge about child development and effective parenting strategies can lead to more competent parenting, which in turn supports children’s emotional and psychological well-being (17).

Extended family members, such as grandparents, often play a pivotal role in providing care and stability. Research by Mechling et al. [2024] highlights how grandparents often step into primary caregiving roles when parents struggle with addiction or mental health issues. This shift not only affects the grandparents’ lives but also has significant implications for the emotional and developmental trajectory of children. These dynamics underscore the importance of including extended family members in therapeutic interventions, which can enhance the resilience of the entire family network (26).

Moreover, involving parents in therapeutic processes also means addressing their mental health needs, which can significantly affect their parenting. For example, Guastaferro et al. [2021] found that treating parental mental health issues could lead to improved parenting practices and better child outcomes (27). Similarly, interventions like those discussed by Champion et al. [2023] which aim to educate parents about health behaviors and provide strategies for managing their health, can have a profound impact on the overall health and well-being of the family (18). Additionally, educational programs that involve parents, as reported by Guastaferro et al. [2021] can align parent and child perceptions on parenting practices, which is crucial for effective communication and relationship building (27). Understanding and managing parental expectations and behaviors can help mitigate potential conflicts and misunderstandings within the family, leading to a more harmonious home environment and better mental health outcomes for children.

Community and school-based programs also play a crucial role in supporting families dealing with parental substance use and mental health disorders. As noted by Guastaferro et al. [2021] integrating school-based support with family therapy can provide children with a consistent support network that extends beyond the home, promoting resilience and stability (27). In summary, involving parents and extended family members in therapeutic interventions not only addresses the immediate challenges associated with parental mental health and substance use disorders but also enhances the long-term resilience and well-being of children. By fostering an environment of understanding, support, and continuous learning, these interventions can significantly improve the life trajectories of all family members involved.

Integrated support systems

Children of parents with mental health and substance use disorders face an elevated risk of emotional and behavioral challenges, often due to the instability these conditions bring to the home. Studies highlight increased risks of child maltreatment associated with parental mental health issues (21), and untreated parental disorders frequently result in child protective services’ involvement (6). Interventions like psychotherapy can mitigate these risks by improving parenting practices and stabilizing home environments (21,28).

Based on the review of the included articles, proactive and comprehensive intervention strategies are consistently highlighted as essential for addressing root causes rather than simply reacting to crises. Effective support systems that integrate mental health care, substance abuse treatment, primary healthcare, and social services are widely recommended in the literature for providing holistic support to both parents and children (21,28). Such coordinated approaches not only aid in treating immediate conditions but are also noted to prevent the recurrence of issues related to mental health and substance use (6).

The reviewed studies emphasize the importance of strong policy frameworks to support these integrated care models by ensuring adequate funding, resources, and training for service delivery. Additionally, several articles suggest that policies aimed at reducing stigma surrounding mental health and substance use disorders play a critical role in encouraging families to seek timely help (7,29). Early intervention and preventive measures are frequently identified as key components of effective systems, enabling the identification of at-risk families before problems escalate. Research points to the value of equipping parents with skills and support to foster healthy family dynamics, which directly benefits their children’s emotional and psychological well-being (6,7,30).

Findings indicate that options such as family therapy, individual counseling, and specialized child support are effective in helping children manage the challenges associated with their parents’ mental health and substance use disorders (21,28). Research underscores the necessity of continuous monitoring and evaluation within integrated systems to ensure interventions remain responsive to families’ evolving needs (6). Evidence also suggests that regular feedback from healthcare providers, social workers, and families contributes to refining practices and improving outcomes (25). Research from Lopes et al. [2021] and Mark et al. [2024] offers valuable insights, guiding the way to more effective, innovative support models for vulnerable children and their families. Implementing these systems through robust policy frameworks can make essential services more accessible, reducing the enduring impacts on children’s wellbeing (6,21).

Continuous monitoring and adaptive support

Children of parents with mental health and substance use disorders face considerable emotional, social, and developmental challenges due to instability at home. Educational and community programs offer critical support, helping children build resilience and stability in otherwise unpredictable environments. Schools provide structure, emotional support, and coping strategies through counseling and support programs, often becoming a crucial resource for children who may not have access to mental health services. Educators and school staff, who frequently notice behavioral shifts early, play a key role in initiating timely interventions, addressing issues before they escalate (31,32). Community programs further bolster this support, offering safe spaces for children to develop social skills, resilience, and self-esteem. Through mentorship, support groups, and recreational activities, community centers foster a sense of belonging and provide mental health resources, crucial in areas with high substance use rates (24,25).

Integrating healthcare services within these frameworks ensures that children’s physical and emotional needs are consistently met, creating a foundation for healthy development. For instance, regular health screenings help in early identification of issues, especially for children at risk of neglect, allowing timely intervention and continuous support. Programs that support positive parent-child interactions in therapeutic settings strengthen family relationships, reducing neglect and improving family cohesion (25,27). Research underscores the long-term impact of stable support systems, linking them to better educational and health outcomes for children. By addressing immediate needs, these programs can disrupt cycles of neglect and abuse, improving social and economic outcomes in adulthood (31,32). Thus, investing in integrated support systems is essential for creating resilience and stability for these vulnerable children (25,27,33). Continuous monitoring and adaptive support are also essential to meet the evolving needs of children as they progress through developmental stages. Early in life, children may require counseling for emotional distress, while later, they might benefit more from academic mentoring or peer support groups to address broader social challenges (34). Pediatric clinics in underserved communities often serve as key touchpoints for ongoing assessment, allowing providers to observe shifts in emotional and social needs and respond with appropriate interventions (35).

This adaptive support requires collaboration among educators, healthcare providers, and social workers to ensure that all aspects of a child’s well-being are addressed. Regular, culturally sensitive assessments enable personalized support that aligns with each child’s situation. However, implementing continuous monitoring systems faces challenges, including limited resources and institutional resistance. Overcoming these barriers requires leadership committed to child-centered approaches. Evidence from studies, like Palumbo et al. [2022], supports the impact of such systems, showing that tailored interventions can significantly enhance resilience and emotional regulation in children of parents with substance use disorders (34). In summary, adaptive support systems, combined with educational and community resources, are vital to supporting children of parents with mental health and substance use challenges. Investing in responsive, comprehensive frameworks helps nurture resilience and improve long-term well-being, offering these children a pathway to a healthier, more stable future (22).

Discussion

The discussion integrates the four primary themes identified through the review: impact and risk factors, parent and family engagement, integrated support systems, and continuous monitoring and adaptive support. Each theme offers insight into the complex challenges faced by children of parents with mental health and substance use disorders and highlights opportunities for effective interventions. By exploring these themes in an integrated manner, we can better understand how interventions can be optimized to support these vulnerable children.

Impact and risk factors

Children in environments affected by parental mental health and substance use disorders face significant instability that can lead to emotional, social, and developmental setbacks. The literature consistently shows a direct correlation between parental health issues and increased risk for child maltreatment, neglect, and behavioral problems (30,36). These children often experience an unstable home environment marked by inconsistent caregiving (17). For instance, studies have highlighted how children in these settings may develop internalizing behaviors such as anxiety and depression or externalizing behaviors such as aggression and conduct problems (30,36,37). This dual spectrum of behavioral issues underscores the need for interventions that address both the emotional and behavioral health of the child. Furthermore, the unpredictability and inconsistency of the home environment can hinder secure attachment, which is critical for healthy emotional development. Secure attachment is fundamental for children’s ability to regulate emotions and develop resilience in the face of adversity (23).

Effective interventions must thus focus on stabilizing these environments and providing consistent, trauma-informed support to mitigate these risks (21). Trauma-informed care, which emphasizes understanding, recognizing, and responding to the effects of trauma, can help create a safe and supportive environment that is conducive to positive developmental outcomes (38). Additionally, programs aimed at supporting parents in managing their mental health and substance use are crucial, as improving parental well-being directly impacts the child’s environment (6).

Parent and family engagement

Engaging parents in therapeutic processes and enhancing their parenting skills are crucial for the emotional and psychological well-being of the child (27,39). Interventions need to be tailored to improve family dynamics and support structures within the home, with special consideration for the roles extended family members, such as grandparents, play in providing stability (15). For instance, when grandparents step in as primary caregivers, they can provide a sense of stability and continuity that is often missing in homes affected by mental health and substance use issues (36). Parental engagement in therapy helps improve communication within the family, enhances emotional availability, and ultimately fosters a more supportive home environment (17,27). Strategies that enhance parental skills often focus on improving communication, conflict resolution, and emotional regulation, which are critical for maintaining a nurturing environment. Research indicates that involving parents in interventions, even those struggling with their own health challenges, can create a more positive family atmosphere that benefits children significantly (30). The inclusion of extended family in support systems is particularly valuable. Grandparents and other relatives often take on caregiving roles, and their involvement can help buffer the adverse effects experienced by children in these settings (15). Involving the wider family network in therapeutic interventions not only provides additional support for the child but also alleviates some of the caregiving burden on parents, thus reducing stress within the family unit.

Integrated support systems

Addressing the comprehensive needs of these families requires integrated systems that coordinate healthcare, education, and community services. Such systems should aim to provide seamless support, addressing both medical and psychosocial needs to prevent the worsening of issues and improve overall family functioning (6,21). Integrated support systems that bring together healthcare providers, social services, and educational institutions can effectively address the multifaceted needs of these children and their families (38). For example, healthcare professionals can work with schools to ensure that children receive the necessary emotional and academic support. School-based programs that focus on social-emotional learning have been shown to improve resilience and coping skills in children facing adverse home environments (32). By integrating healthcare and educational resources, children can receive holistic support that addresses both their mental health needs and their academic challenges.

Moreover, the integration of healthcare and social services is crucial for ensuring that families receive comprehensive care without falling through the cracks of fragmented service delivery (31). Families dealing with mental health and substance use issues often require a range of services, from mental health counseling to financial assistance, and integrated support systems can help streamline access to these resources. Such systems not only reduce the burden on families but also enhance the effectiveness of interventions by ensuring that all aspects of a family’s needs are addressed in a coordinated manner.

Continuous monitoring and adaptive support

Children of parents with mental health and substance use disorders benefit from ongoing support that adapts to their evolving needs (34). Educational and community programs play a vital role in providing stability and resources necessary for building resilience and coping skills. Schools provide a stable environment where children can access counseling services, support groups, and other resources that help them manage the challenges they face at home (31). Continuous monitoring is essential for adapting interventions to meet the changing needs of children as they grow. The developmental stage of each child must be considered, as the needs of a 10-year-old differ significantly from those of an adolescent nearing adulthood (32). Adaptive support requires collaboration among educators, healthcare providers, and social workers to ensure that all aspects of a child’s well-being are addressed. For instance, regular assessments of a child’s emotional and social needs can help identify emerging issues early, allowing for timely intervention (34). Community programs also provide crucial support by offering safe spaces where children can engage in positive social interactions and develop important life skills. Programs such as mentorship, recreational activities, and support groups can foster a sense of belonging and community, which is often lacking for children in these situations (31). Such community-based initiatives can be particularly effective in areas with limited access to formal mental health services, as they provide a more accessible form of support for children and their families.

Cross-theme discussion

These themes are not isolated; rather, they intersect to highlight the complexity of supporting children in these circumstances. For instance, integrated support systems facilitate continuous monitoring and adaptive support, which in turn can enhance parent and family engagement. Addressing the immediate impact and risk factors can lay the groundwork for long-term stability through integrated and continuous support mechanisms. The dynamic interplay between these themes highlights the need for a multi-level approach that addresses both the immediate and long-term needs of these children (39). The integration of support systems, as seen in successful interventions, demonstrates the value of a holistic approach that brings together different sectors to support both the child and the family. For example, programs that combine family therapy with school-based support have shown improved outcomes in both academic performance and emotional well-being (21). This cross-sector collaboration ensures that children receive consistent support across different areas of their lives, reducing the likelihood of issues being overlooked or inadequately addressed.

The discussion integrates findings from the literature, illustrating how interventions have succeeded or failed in various contexts. For instance, resilience-building programs that include parental involvement have shown promise in mitigating the negative impacts of parental substance use (39). Programs that focus on building emotional regulation skills in children, while simultaneously addressing the mental health needs of the parent, have been particularly effective in reducing behavioral problems and improving overall family functioning (30). Gender-sensitive approaches are also critical, as boys and girls often experience and respond to parental mental health and substance use issues differently (30). Boys may exhibit more externalizing behaviors, such as aggression, while girls are more likely to internalize their distress, leading to anxiety and depression. Tailoring interventions to address these gender-specific needs can enhance their effectiveness, as it ensures that the unique experiences of each child are considered (36).

Contribution to research science

This review contributes to the research science by clarifying the complex interplay of factors affecting children of parents with mental health and substance use disorders. It identifies gaps in current research, particularly the lack of targeted, child-specific interventions and the need for integrated approaches that consider the child’s perspective within family and community contexts. The review also underscores the importance of resilience-building as a critical component of interventions and highlights the need for more gender-sensitive approaches that recognize the distinct needs of boys and girls.

By synthesizing existing literature, this review provides a foundation for future research and intervention development. It emphasizes the need for comprehensive, multi-level approaches that integrate healthcare, education, and community resources to support these children effectively. Furthermore, it calls for more longitudinal studies that can provide insights into the long-term effectiveness of different interventions and help identify the most promising strategies for supporting these vulnerable populations.

Limitations

This scoping review has several limitations that should be acknowledged. First, the search was limited to peer-reviewed academic journals, potentially excluding relevant grey literature, such as reports from non-governmental organizations or policy documents, which could provide additional insights into support mechanisms and intervention strategies for children of parents with mental health and substance use disorders. Second, the review only included studies published in English, which may have excluded important findings from non-English literature, potentially introducing a language bias. Third, the scope was broad, which while providing a comprehensive overview, might have limited the depth of analysis in specific areas, such as cultural influences on resilience or gender-specific challenges. Furthermore, the review primarily focused on children aged 10–18 years, potentially overlooking the unique needs of younger children who might require different types of support. Lastly, as a scoping review, this study did not evaluate the quality of included studies, limiting the ability to draw conclusions regarding the efficacy of the interventions discussed. Future research would benefit from systematic reviews or meta-analyses to assess the effectiveness of specific interventions for this vulnerable population.

Conclusions

This scoping review emphasizes the critical need for comprehensive, tailored interventions to address the diverse and complex challenges faced by children of parents with mental health and substance use disorders. These children encounter substantial risks, including emotional, psychological, and developmental hurdles, often exacerbated by unstable home environments and inadequate support systems. Effective interventions must adopt a multi-level approach that integrates healthcare, education, and community services to ensure cohesive, targeted support.

Structured programs focused on resilience and emotional regulation are essential. Such interventions could provide children with coping mechanisms to manage stress and trauma, enhancing their capacity to navigate challenging home situations. Involving parents and extended family members in therapeutic processes can significantly improve family dynamics. Programs that support parental skill development in communication, conflict resolution, and emotional regulation foster a more supportive environment. This is especially beneficial when extended family members, like grandparents, play a caregiving role.

Developing integrated support systems that bridge healthcare, mental health, and social services is crucial. These systems should address both the medical and psychosocial needs of children and parents to prevent fragmented care and improve access to resources. Policymakers must prioritize funding and resources to support such integrative models. Schools and community programs should offer ongoing support that adapts to children’s evolving needs, providing a stable foundation for their development. Continuous assessment of children’s emotional and social needs, facilitated by collaboration among educators, healthcare providers, and social workers, ensures timely interventions that can adjust to developmental stages.

Future research should aim to evaluate the effectiveness of these interventions, explore gender-sensitive approaches, and develop culturally relevant strategies. Investing in integrated, adaptive support systems can significantly improve the long-term well-being and life outcomes of these vulnerable children, offering them a pathway toward a more stable and healthy future.

We have proposed recommendations to practitioners and policymakers for implementing solutions tailored to the target groups (Table 2).

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the PRISMA-ScR reporting checklist. Available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-24-131/rc

Peer Review File: Available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-24-131/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-24-131/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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