Family-focused Approach Research Articles

Parent and adolescent perspectives on a novel transdisciplinary model of healthcare delivery for type 1 diabetes.

We aimed to obtain pre-adolescent/adolescent and parent input on a proposed transdisciplinary model for routine type 1 diabetes (T1D) healthcare in which an advanced practice nurse, dietitian, and psychologist with expertise in T1D and extensive cross-discipline training co-deliver care during quarterly T1D care visits using a family-focused approach. Participants were 17 parent-youth dyads plus one additional adolescent who responded to open-ended questions about the structure and format of the proposed transdisciplinary care model via an online, private social network. A six-member coding team developed and revised a codebook, coded question responses through iterative cycles of inductive coding, and distilled major recurring themes to obtain perspectives on the transdisciplinary care model and feedback on improving the model. We identified nine themes regarding reactions to our proposed transdisciplinary care model, which fell into three broad categories: 1) General Perceptions of Transdisciplinary Care (e.g., Transdisciplinary Care may facilitate improved communication and collaboration among providers and result in more holistic care); 2) Perceptions about Transdisciplinary Care Providers (e.g., Perspectives on the inclusion of dietitians and psychologists as members of the transdisciplinary care team were mixed); and 3) Suggestions for Improving the Transdisciplinary Care Model (e.g., Ensure care is patient/family centered and holistic). The present findings provided important feedback to modify our transdisciplinary care model and on parent and youth preferences for T1D healthcare delivery.

Failed implementation of a nursing intervention to support family caregivers: An evaluation study using Normalization Process Theory.

To evaluate the failed implementation of the Carer Support Needs Assessment Tool Intervention for family caregivers in end-of-life care, within a trial context using Normalization Process Theory (NPT). An evaluation study was conducted to learn lessons from our trial, which was not successful due to the low number of participants. The evaluation study utilized various data sources, including published data from interviews and questionnaires, and unpublished data derived from emails and conversation notes. Data were retrospectively collected. Thematic analysis was conducted guided by the NPT framework. This framework emphasizes that successful implementation of an intervention relies on its 'normalization', consisting of four constructs: coherence, cognitive participation, collective action and reflexive monitoring. Coherence (sense making): Nurses felt the intervention could contribute to their competence in assessing family caregivers' needs, but some were unsure how it differed from usual practice. Cognitive participation (relational work): Nurse champions played a crucial role in building a community of practice. However, sustaining this community was challenging due to staff turnover and shortages. Collective action (work done to enable the intervention): Nurses felt the Carer Support Needs Assessment Tool training enabled them to improve their support of family caregivers. However, contextual factors complicated implementation, such as being used to a patient rather than a family-focused approach and a high workload. Reflexive monitoring (appraisal of the intervention): Positive experiences of the nurses with the intervention motivated them to implement it. However, the research context made nurses hesitant to recruit family caregivers because of the potential burden of participation. Although the intervention demonstrated potential to assist nurses in providing tailored support to family caregivers, its integration into daily practice was not optimal. Contextual factors, such as a patient-focused approach to care and the research context, hampered normalization of the intervention. Assessing and considering contextual factors that may influence implementation of a complex care intervention is needed. The NPT provided a valuable framework for evaluating the implementation process in our study. What problem did the study address? This evaluation study analysed the factors that promoted or hindered the implementation of a nursing intervention to support family caregivers in end-of-life care. What were the main findings? Both the intervention and the intervention training have potential and value for nurses in providing tailored support to family caregivers. However, the implementation faced challenges due to organizational factors and the research context, including recruitment. Where and on whom will the research have an impact? This insight is valuable for all stakeholders involved in implementing complex nursing interventions, including researchers, nurses and funders. This study has adhered to the relevant EQUATOR guidelines: Standards for Reporting Qualitative Research (SRQR). There was no patient or public involved. The trial was prospectively registered on the Dutch Trial Register (NL7702).

COVID-19 and Family Visits: A Systematic Jurisdiction Analysis of Family Visitation and Safety Policies in Juvenile Correctional Facilities in the United States

When COVID-19 first hit the United States, juvenile correctional facilities across the country discontinued all in-person activities including family visits. Correctional facilities across the country were among the last institutions to reopen their doors for in-person activities given the heightened risk of rapid spread. Drawing on data gathered in February and March 2022, this study examined the state of family visitation policies and COVID-19 safety responses adopted by juvenile correctional facilities, as reported on websites, including information on the different types of contact allowed; COVID-19 safety protocols and practices; availability of information on COVID-19 infection and vaccination rates; and the overall timeliness, consistency, and comprehensiveness of the information available to families with incarcerated minor children. Our findings highlight just how untimely, inconsistent, and incomprehensive information and policies were across jurisdictions, sometimes with little to no stated explanation for their decision-making. We argue that juvenile correctional facilities should take a family-focused approach when developing and disseminating policies that impact the lives of incarcerated youth and their families, especially in times of global uncertainty.

Engaging caregivers to prevent substance use by at-risk adolescents in pediatric primary care.

Improving adolescent substance use prevention and treatment is an urgent public health priority in the United States. Current intervention models do not address how adolescents with a history of caregiver substance use are at particular risk for problematic substance use. We, therefore, reviewed the evidence on adolescent substance use prevention programs integrating caregiver-focused components and propose opportunities to incorporate adaptations of existing programs into pediatric primary care to improve outcomes for at-risk adolescents exposed to caregiver substance use. There are multiple evidence-based universal prevention programs that target adolescent substance use and incorporate caregivers; however, these programs do not address the specific concerns of caregivers with substance use. Caregiver-focused programs efficaciously address family and child risk factors for adolescent substance use but are not accessible to many families and have not been longitudinally studied to assess impact on adolescent substance use. Adaptation of existing prevention programs to pediatric primary care settings may open opportunities to improve engagement of families with caregiver substance use in targeted prevention strategies. Family Screening, Brief Intervention, and Referral to Treatment (F-SBIRT) is one model that can be incorporated into pediatric primary care to contextualize evidence-based practices to address substance use in a family-focused approach. To develop F-SBIRT, further research is needed to validate caregiver-focused screening tools, determine brief intervention (BI) best practices, and adapt existing evidence-based and caregiver-focused adolescent prevention programs for use with caregivers with substance use in pediatric primary care settings.

Tailored Psychoeducational Home Interventions for Children with a Chronic Illness: Families' Experiences.

The quality of life for a child with a chronic illness depends on various factors, including the illness's severity, medical treatments, psychosocial and educational support, resource availability, and community involvement. These biopsychosocial factors become significant when the child receives care at home. This article presents and evaluates a highly personalized support project offered to 40 Sicilian families, consisting of educational, social, and psychological services delivered at the families homes and in their communities. Guided by the Psychosocial Assessment Tool (PAT) and the Functional Psychology framework, the project employed a family-focused approach to healthcare and was based on a continuous dialogue between all stakeholders. The project was evaluated through a qualitative interview with eight families in the Palermo area, which was analyzed using consensual qualitative research. Results revealed families' appreciation of the project and the importance of a professional who listened to their needs, provided a connection with the medical team, and tailored activities inside and outside the home. The ability of professionals to listen and adapt activities to different contexts and needs was crucial for the project's success. We conclude that creating tailored family-level interventions with an educator acting as a liaison with the medical team is a widely acceptable strategy that should be further developed and investigated.

Living, Caring, Learning - Building family relationships in haemophilia care

Abstract With over 35 years’ experience of paediatric nursing, almost half of which she has spent in haemophilia care, Robyn reflects on the importance of taking a family-focused approach and engaging with parents and caregivers. She describes her experience of providing care for a family with two boys with severe haemophilia A and inhibitors, and how listening to and working closely with the parents enabled good outcomes. Robyn points to the central role of nursepatient relationship in haemophilia care but highlights the importance of ensuring that this close therapeutic relationship remains professional.

Advance care planning to patients with chronic kidney disease and their families: An intervention development study.

To develop an advance care planning intervention based on the needs of patients with chronic kidney disease, families and healthcare professionals. Patients with chronic kidney disease and their families request early advance care planning that continues throughout their illness trajectory. Healthcare professionals experience barriers to initiating advance care planning. Involvement of stakeholders in development of health interventions is important, to identify priorities, understand the problem and find solutions. The development was inspired by the Medical Research Council's framework, and codesign was applied. One future workshop and one design workshop were conducted with the consumers. The process was iterative, and data were analysed using the action research spiral. The Guidance for reporting intervention development studies in healthcare (GUIDED) was used. Five areas were considered significant to an advance care planning intervention; a biopsychosocial approach, early palliative care, a family-focused approach, early and continuous advance care planning and a consumer-centred approach. Based on these, a conversation process with healthcare professionals was designed to give patients and families the opportunity to share values, preferences and wishes for treatment and their family and everyday life. Codesign facilitated a collaborative process that allowed the consumers to have a significant impact on the design of an advance care planning intervention. A conversation process concerning everyday life, illness and treatment was designed for patients and families. The intervention included an advance care planning tool to guide the healthcare professionals. The intervention has the intention to improve the communication between healthcare professionals, patients and families. The study provides important knowledge about the significance of giving the patients and their families support in sharing their values, preferences and wishes for treatment and everyday life, thus, to improve care and treatment in their illness trajectory. What problem did the study address Patients with chronic kidney disease and their families strongly request early initiation of advance care planning that continues throughout the illness trajectory. Healthcare professionals experience barriers to the initiation of the advance care planning and request a more systematic approach. What were the main findings Development of a conversation process about everyday life, illness and treatment for patients diagnosed with chronic kidney disease and families, including an advance care planning tool to guide the healthcare professionals. Where and on whom will the research have an impact The study contributes an advance care planning intervention to patients in the early stages of chronic kidney disease and their families. We believe that the intervention could be included during consultations with healthcare professionals in other stages of chronic kidney disease as well as other chronic disease. To strengthen the reporting of the development of the advance care planning intervention, we used the Guidance for reporting intervention development studies in healthcare (GUIDED). The development of the intervention in this study was a collaborative process between patients, families, healthcare professionals and representatives from the Danish Kidney Association, the department's user council and the research team.

P22.01.A PERSON-CENTRED PRACTICE: EXPLORING FAMILY STRENGTH BY USING GENOGRAMS AND ECOMAPS

Abstract BACKGROUND Illness of a family member impacts the entire family. Family relationships, roles and tasks often change, and neuro-oncological caregivers experience a high level of burden and distress when playing a vital role in the informal care of the patient. The theory of Family Systems Nursing advises to approach the family rather than merely the patient. Within Family System Nursing the Family Nursing Conversations is an important intervention that focus on the interactions within a family and between the nurse and the family. The Calgary Family Assessment and Intervention Model (CFAM/CFIM) guide clinical practice to be family focused. According to these models, the drawings of genograms and ecomaps are efficient tools to graphicly portray the specific family constellation and social relationships. This presentation shows how genograms and ecograms can be applied to strength the dialogue with a family when implementing family-focused conversations. MATERIAL AND Methods In the neuro-oncological outpatient clinic at the University Hospital of Copenhagen we offer family and/or caregiver conversations. At the initial conversation, a genogram and an ecogram are drawn. By visualizing the family structure and interrelationships, the family is illustrated as a unit and the family can see their constellation in relation to each other and to the outside world. RESULTS Based upon the genograms and ecograms, a dialogue takes place. They have shown to be important tools to visualize the structure, with strengths and challenges within a family system. Further, they provide a good starting point for a family-focused communication. However, to implement these tools, training is required. Therefore, we have prepared teaching material to healthcare professionals. This material has been tested in family-focused conversations. CONCLUSION The use of genograms and ecomaps have proven to be efficient for a family-focused approach in a neuro-oncological outpatient clinic. They facilitate a good starting point for a family to identify their relationships and resources. During the conversations the family/caregivers often gain new insights and management strategies for coping.

YOU ARE OKAY. EXPERIENCES OF PARTICIPANTS WITH THE ‘YOU ARE OKAY’ PROGRAM

Many children with mild intellectual disabilities who have parents with mental health concerns suffer from social-emotional problems. The ‘You are Okay’ program is the first to support these children and their parents. An effect study showed first promising results in decreasing children’s emotional and behavioural problems. The current study was conducted to evaluate the intervention qualitatively using experiences of the participants. A combination of questionnaires administered to 28 children and fourteen parents and in-depth interviews with three children, two parents and eight professionals were used to evaluate the experiences of the participants. Children, parents and professionals viewed ‘You are Okay,’ especially its psychoeducation, mutual recognition, and support, as valuable and useful. However, carefully matching children in support groups and screening for pre-conditions seems to be essential for successful participation. This study concluded that ‘You are Okay’ supports children with mild intellectual disabilities and their parents with mental health concerns. The findings are also in line with the results of the effect study of the program, which showed that ‘You are Okay’ supports children by decreasing their emotional and behavioural problems after participating in the program. Together these results strengthen the idea that this family-focused approach is helpful in children’s treatment.

Measuring nurses' attitudes to family care: a longitudinal mixed method study

In a scenario of demographic changes with an ageing population and an increase in people with chronic illnesses, the family assumes a central role in the care of their family member. Providing nurses with knowledge and strategies of family-centred care may change current standards of practice to a more family-focused approach. To explore nurses' perceptions on the importance of involving families in the project of care and their attitudes before, during and after an implementation of family-centred care. A longitudinal mixed method study was conducted during the implementation of family-centred care in a health district. A training package for the district nurses and individual coaching by an experienced nurse were offered. The Families' Importance in Nursing Care-Nurses Attitudes (FINC-NA) questionnaire was administered pre- and post training and one year later and two focus groups were conducted. All the 19 health district nurses participated in the study; average age 49.3 years, working experience 26.8 years. Statistically significant changes were observed in all four dimensions of the FINC-NA: family as a personal and professional resource, as a partner and a burden. The same results were confirmed by the focus groups. An educational intervention for home care nurses proved to be useful during the implementation of family-centred care. A key aspect was the support offered to nurses in transferring their knowledge and skills to their practice.

Paternal Perinatal Depression in Modern-Day Fatherhood.

Postpartum depression in new mothers has become a widely recognized public health concern. Paternal perinatal depression (PPND) and the mental health of fathers in the perinatal period continues to receive significantly less public attention. Overall prevalence rates of up to 25% have been documented in first-time fathers. The presence of maternal depression, unsatisfactory couple relationships, and certain psychosocial and biological risk factors are associated with poor paternal bonding and increased depression risk. Depressed fathers experience excessive self-criticism, restlessness, irritability, and aggression rather than low mood. Depression in new fathers can lead to drug and alcohol abuse, food behavior disorders, and lack of impulse control. PPND leads to developmental delay, mental health disorders, and emotional or behavioral problems in the offspring. PPND may also adversely affect a child's ability to learn new information, with lasting intellectual and scholastic consequences. There currently are no official criteria to diagnose PPND, and neither are there validated screening tools available to fathers. A family-focused approach should be considered in place of the historically gender-focused mood assessment. Nontraditional interventions such as Internet communities, e-therapy, or group workshops are shown to combat a father's contextual understanding of therapy. Group therapy with integrated cognitive behavioral therapy can address masculine norms surrounding the parenting roles of fathers and can help cultivate support networks that are otherwise absent among new dads. PPND is ideally addressed by the adoption of a father-inclusive model of care that shifts the parenting paradigm and provides emotional and parenting support to men as they experience their new role as dad.

Behavioral problems and its associated factors among siblings of children with developmental disabilities: analytical cross-sectional study

ABSTRACT The typically developing siblings of children with disabilities are vulnerable to behavioral problems as they grow up in an environment of considerable stress. Yet, the needs and behavior problems of these siblings are often neglected especially in Pakistan. In this cross-sectional study, we assessed the behavior problems among siblings of children with developmental disabilities. The strength and difficulties questionnaire (SDQ) was administered on 250 siblings (aged 6–17 years) of children with a developmental disability (Autism, Intellectual disability (ID), Down Syndrome (DS), and Attention Deficit Hyperactive Disorder (ADHD)) attending special education institutions in Karachi, Pakistan. Multiple linear regression was applied to assess the relationship between SDQ scores and other demographic, parental, and disability-related factors. Adjusted beta coefficients were reported along with a 95% confidence interval. The average SDQ score was found to be 14 ± 6 among the siblings of children with developmental disabilities. Multivariable analysis showed that the estimated mean SDQ score was almost twice among siblings of children with ADHD (95% CI: 0.73–3.48) and ID (95% CI: 0.64–3.16) than siblings of children with Down syndrome. Also, the mean SDQ score was 8 units higher among siblings of children with a severe developmental disability compared to mild disability (95% CI: 6.79–9.47). The findings of the current study emphasize the need for appropriate mental health services, using a family-focused approach from therapeutic and counseling platforms to the siblings, parents, and disabled brother/sister for early identification and management of behavior issues. Abbreviations: ADHD: Attention Deficit Hyperactive Disorder; AKU: Aga Khan University; β: Beta Coefficient (Slope); βo: Intercept; CHS: Community Health Sciences; DS: Down syndrom; ERC: Ethical Review Committee; ID: Intellectual Disability; MLR: Multiple Linear Regression; SDQ: Strengths and Difficulties Questionnaire; SES: Socioeconomic Status; TD: Typically Developing

Transition of Adolescents with Inflammatory Bowel Disease-Are the Pediatric Teams up to the Task?

Our aim was to describe the challenges of the transition process of adolescents with inflammatory bowel disease (IBD), as seen from a pediatric-care perspective, to clarify the key obstacles and propose how to move forward. Semi-structured individual interviews of pediatric gastroenterologists and nurses were analyzed and interpreted according to the principles of social science. It is a challenge for the pediatric team to continuously match, support, and gently guide the ever-changing adolescent patient. All adolescent patients should be offered guidance regardless of their starting point, and specific individual needs should be taken into consideration. Adolescents burdened by psychosocial challenges require extra support. Early and continued interdisciplinary effort is essential. Collaboration with the parents must be continuously adapted to prepare them for their new roles and responsibilities. The shift from the pediatric family-focused approach to the individualistic approach of the Adult Gastroenterology Department signifies a fundamental change. Equipping adolescents with disease-management skills remains a comprehensive task. The following crucial questions remain: Who is capable of performing the transition? Who can dedicate the necessary resources for performing the transition? A transition center led by both pediatricians and adult gastroenterologists in an interdisciplinary setting that includes transition-trained persons may be the solution.

Nurses' views and practices on parental mental illness: An integrative review.

When a parent has a mental health problem, family members can be affected by it. Nursing professionals can provide care for the whole family, including children. Nurses can support the parental role of parents with mental illness. This integrative review aimed at the following: To identify and to synthesize the views and practices of nurses on parental mental illness (PMI). An integrative review methodology was employed, following PRISMA guidelines. Theoretical and empirical literature was included. Twenty-three articles were obtained to be analysed, using the Whittemore and Knafl approach. A lack of knowledge about nurses' views and practices on PMI was found. Especially, in some demographic areas such as Mediterranean countries and Central and South America. Different issues which influence how nurses perceive PMI were identified: subjective meaning of family concept, personal experience of being parent, and perceptions of mental illness, among others. The main findings on nurses' practices were as follows: guidelines to implement family-focused practices, knowledge, and skills; therapeutic relationship; and teamwork and interagency communication; among others. These issues are intimately related. They could act as enablers or barriers to support parental role of parents with mental illness. Adequate guidelines and policies are necessary to support parents with mental illness and their families. There is a need to include knowledge about PMI and family-focused approach in nursing education curricula. Training could include reflection on nurses' experiences and personal values to become aware of how these can affect their interventions and practices.

Felt Needs of the Caregivers for the Home Based Care for their Family Members with Severe Mental Illnesses

Background: Home-based care for persons with severe mental illness is a family-focused approach and addresses the caregiver's responsibility. It is cost-effective compared to the inpatient hospital settings, and it also allows the patients to stay with families in their communities while treatment is going on. In this context, this study aimed to explore the barrier to access mental health services and the caregivers' felt needs for home-based care for their family members with severe mental illness. Methods: This study adopted a cross-sectional descriptive design with 60 caregivers of family members with severe mental illnesses. Quantitative data were collected through a semi-structured interview schedule prepared and validated for this study, and the severity of illness was measured using the Clinical Global Impression Scale. Results: Caregivers faced difficulty in traveling along with their family members to the hospital for treatment (76.7%), accessibility issues (65%), and problems in mobilizing the patient to the hospital (54%). The majority of the caregivers (75%) preferred home-based care to manage the illness of the patient, with a focus on pharmacotherapy (83.3%), and the patient considered there should be appropriate training at home (63.3%). Conclusion: The majority of the caregivers felt the need for home-based care with a preference for both pharmacotherapy and self-care for their family members with severe mental illnesses.

Neuropsychological and Psychosocial Functioning of Children with Perinatal HIV-Infection in The Netherlands.

Advances in antiretroviral treatment improved the life expectancy of perinatally HIV-infected children. However, growing up with HIV provides challenges in daily functioning. This cross-sectional cohort study investigated the neuropsychological and psychosocial functioning of a group of perinatally HIV-infected children in the Netherlands and compared their outcomes with Dutch normative data and outcomes of a control group of uninfected siblings. The children’s functioning was assessed with internationally well-known and standardized questionnaires, using a multi-informant approach, including the perspectives of caregivers, teachers, and school-aged children. In addition, we explored the associations of socio-demographic and medical characteristics of the HIV-infected children with their neuropsychological and psychosocial functioning. Caregivers reported compromised functioning when compared to Dutch normative data for HIV-infected children in the areas of attention, sensory processing, social-emotional functioning, and health-related quality of life. Teachers reported in addition compromised executive functioning for HIV-infected children. A comparison with siblings revealed differences in executive functioning, problems with peers, and general health. The concurrent resemblance between HIV-infected children and siblings regarding problems in other domains implies that social and contextual factors may be of influence. A family-focused approach with special attention to the child’s socio-environmental context and additional attention for siblings is recommended.

School functioning of children with perinatal HIV-infection in high-income countries: A systematic review.

IntroductionSince the introduction of combination antiretroviral therapy, human immunodeficiency virus (HIV) infection is a manageable chronic disease. However, school-age children (4–18 years) living with HIV could still experience problems with functioning at school, due to the impact of the virus itself, medication, comorbidities and social stigma. School functioning covers academic achievement, school attendance, and social relationships and is of utmost importance to optimize normal participation.MethodsTo gain insight in school functioning problems of perinatally HIV-infected children, we performed a systematic review of the literature in multiple databases from January 1997 up to February 2019. Studies were included if they described outcomes of school functioning of school-age children perinatally infected with HIV, in high-income countries. Meta-analyses were performed for sufficiently comparable studies.Results and discussionResults from 32 studies show that HIV-infected children experience more problems in various areas of school functioning in comparison with national norms, matched healthy controls, siblings and HIV-exposed uninfected (HEU) children. The most pronounced differences concerned the usage of special educational services, general learning problems, and mathematics and reading performance scores. Comparisons with both national norms and siblings/HEU children show that the differences between HIV-infected children and siblings/HEU children were less pronounced. Moreover, siblings/HEU children also reported significantly worse outcomes compared to national norms. This suggests that problems in school functioning cannot be solely attributed to the HIV-infection, but that multiple socio-economic and cultural factors may play a role herein.ConclusionPerinatally HIV-infected children seem vulnerable to problems in various areas of school functioning. Therefore, monitoring of school functioning should be an important aspect in the care for these children. A family-focused approach with special attention to a child’s socio-environmental context and additional attention for siblings and HEU children, is therefore recommended.

New public management and practitioner autonomy in Children's Services in Norway and Wales: views from the frontline

The article examines aspects of professional autonomy informed by cross sectional surveys of social workers in Wales (UK) and Norway. The data show that in Wales there is circumscribed autonomy whereby rule compliance is both expected and scrutinised, and practitioners are more likely to spend time as a ‘screen-worker’, fettered by austerity, risk-focused and safety-oriented towards children. The Norwegian sample appears to enjoy front-line freedoms to utilise discretion in delivering bespoke preventive services and are much more likely to spend time at ‘street-level’ working in a child welfare and family-focused approach. Despite these profound differences between the two samples, both sets of practitioners consider their administrative duties to be an important feature of practice rather than an unwarranted diversion from direct work; participants in both countries consider their work to be of quality and most look forward to going to work. These and other variations and similarities in the data are discussed in light of relevant system features and policy.

The ParentingWell Learning Collaborative Feasibility Study: Training Adult Mental Health Service Practitioners in a Family-Focused Practice Approach

This study investigates the feasibility and impact of the ParentingWell Learning Collaborative (PWLC) model in supporting mental health practitioners in implementing the family-focused ParentingWell practice approach with adults with mental illness. An exploratory design and qualitative methods were employed. Practitioners (n = 29) participated in in-person orientation, training and debriefing sessions; virtual coaching sessions; and via an interactive online hub. Researchers obtained data on participant engagement and satisfaction, and participants’ reports of use, helpfulness, intention to use and impact. Participants were engaged in and highly satisfied with the PWLC. They deployed PWLC skills, tools and resources with parents. Evidence of impact was provided at the personal, practice and organizational levels. This study provides preliminary support for the feasibility and impact of the PWLC. Clear specification of a theoretically-based training model for practitioners is an essential step in adapting, implementing and testing interventions in new contexts .

The implementation of family-focused practice in adult mental health services: A systematic review exploring the influence of practitioner and workplace factors.

There is increased recognition of the need for greater and more appropriate support to be offered to families in which a parent experiences mental illness and has dependent children. One way of meeting this need is for adult mental health services to take a more family-focused approach. However, there are recognized difficulties in facilitating family-focused practice (FFP). The current review systematically synthesized quantitative and qualitative literature of practitioner perspectives and experiences of FFP in adult mental health settings to identify modifiable factors associated with its successful implementation. Five databases were searched systematically leading to the inclusion and quality assessment of 19 papers, ten of which were quantitative and nine qualitative. Analysis was guided by a narrative synthesis approach. Factors shown to influence FFP functioned at both practitioner and workplace levels and included personal attitudes, beliefs about job role, and perceptions of workplace support. Practitioners who felt that a family-focussed approach was inappropriate or detrimental to service users or outside of their remit as mental health professionals were less likely to adopt this approach. For those who saw the potential benefits of FFP, lack of confidence in their ability to deliver such an approach and lack of training can be barriers, as can lack of support and resources within services. This review highlights the need for actions to boost the awareness of adult mental health practitioners working with parents and to increase their confidence. It also makes the case for broader organizational support if family-focussed practice is to be implemented successfully.