Abstract
Background: Parental mental illness (PMI) is common and can lead to children developing mental disorders. Family Talk (FT) is a well-known and widely implemented intervention designed to reduce the risk of transgenerational psychopathology. However, given the research to practise “gap,” very little qualitative research, to date, has investigated practitioner experiences in implementing FT. This study aimed to explore the practitioner-perceived barriers and facilitators to the implementation and sustainability of FT within mainstream mental health settings.Methods: This qualitative study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] within 15 adult (AMHS), child (CAMHS), primary care mental health, and child protection sites in Ireland. Semi-structured interviews and focus groups were undertaken with a purposive sample of clinicians (n = 31) and managers (n = 10), based on their experiences of implementing FT. Interview data were transcribed verbatim, analysed using constructivist grounded theory, and informed by Fixsen's implementation science framework.Results: Service providers highlighted a number of benefits for approximately two thirds of families across different diagnoses and mental health settings (AMHS/CAMHS/primary care). Sites varied in their capacity to embed FT, with key enablers identified as acquiring managerial and organisational support, building clinician skill, and establishing interagency collaboration. Implementation challenges included: recruitment difficulties, stresses in working with multiply-disadvantaged families, disruption in delivery due to the COVID-19 global pandemic, and sustainability concerns (e.g., perceived fit of FT with organisational remit/capacity, systemic and cultural barriers to change).Conclusion: This study is only the second qualitative study ever conducted to explore practitioner experiences in implementing FT, and the first conducted within the context of an RCT and national research programme to introduce family-focused practise (FFP) for families living with PMI. The findings illuminate the successes and complexities of implementing FFP in a country without a “think family” infrastructure, whilst highlighting a number of important generalisable lessons for the implementation of FT, and other similar interventions, elsewhere.
Highlights
Parental mental illness (PMI) is common, with 23% of all families having at least one parent who has, or had, a mental disorder [1], and a 41–77% lifetime risk for children of developing serious mental illness, physical illness, and impaired educational and occupational outcomes [2]
Data on parenting status within mental health services is scarce [5], but early studies estimate that 25– 68% of adult mental health service users are parents, and 35– 60% of children presenting at child and adolescent mental health services have a parent with mental illness [6, 7]
family-focused practise (FFP) champions promoted interagency liaison amongst adult mental health services (AMHS), child and adolescent mental health services (CAMHS), Tusla, and primary care services which, in turn, facilitated recruitment, shared delivery, and learning. They engaged in regular awareness-raising and buy-in efforts with management/colleagues to raise the profile of Family Talk (FT) within their organisation through, for instance, promoting FT successes during multi-disciplinary team (MDT) meetings
Summary
Parental mental illness (PMI) is common, with 23% of all families having at least one parent who has, or had, a mental disorder [1], and a 41–77% lifetime risk for children of developing serious mental illness, physical illness, and impaired educational and occupational outcomes [2]. Both in Ireland and in other jurisdictions, these families have remained “invisible” and unsupported due to the segregation of adult and child mental health services [3, 4]. This study aimed to explore the practitioner-perceived barriers and facilitators to the implementation and sustainability of FT within mainstream mental health settings
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