Family-focused Practice Research Articles

A multi-perspective exploration of health visitors’ family focused practice with mothers who have mental illness and their families: a mixed methods study protocol

ABSTRACT Background: Maternal mental illness is a major public health issue and can adversely affect the whole family. Worldwide, about 10% of pregnant women and 13% of women who have just given birth experience a mental illness, primarily depression and anxiety. Increasingly, research and policy are recognising the benefits of a family focused approach to practice. This approach emphasises the family as the unit of attention. Currently, little research is available which has explored Family Focused Practice (FFP) in health visiting. Objective: This study aims to explore health visitors’ FFP with mothers who have mental illness and their partners. Methods: A mixed-methods sequential explanatory design consisting of two phases; quantitative followed by qualitative, will be utilised in this study. In the first phase, the Family Focused Mental Health Practice Questionnaire will be used to measure the extent of health visitors’ FFP, and factors that enable and hinder it. The questionnaire will be distributed to practicing health visitors (n = 410). In the second phase, semi-structured interviews will be conducted with health visitors, mothers who have mental illnesses and their partners, to further explore and explain the findings from phase one. Discussion: While the evidence base for the adoption of a family focused approach is growing, there is little understanding of health visitors’ FFP with mothers who have mental illness and their partners. This study will develop understanding of health visitors’ FFP, from multiple perspectives, that can be used to inform practice, education, research and policy.

The Impact of the "Semente" Program on the Family-Focused Practice of Mental Health Professionals in Portugal.

Background: Children of parents with mental illness (COPMI) are a high-risk group. There is a strong association between parents’ psychiatric disorders and the incidence of psychopathology in their children. These children need to be identified and supported by mental health workers early, and hence, clinical practice in adult mental health services needs to change from a focus on individual patients to a more systemic family focus. “Semente,” a mental health promotion program developed by the Psychiatry Service of Fernando Fonseca hospital (Lisbon, Portugal), had been established to identify these children and families and promote their mental health, by decreasing the impact of risk factors and promoting protective factors. The program included preventive COPMI interventions and implementation of activities offered to families with children in the mental health care. The aim of the present study was to evaluate changes in mental health care after the training in “Child Talks” intervention (two to three psycho-educational meetings with parents and children) and implementation of the “Semente” program. Methods: Participants (N = 51) were all professionals from Psychiatric Service of Fernando Fonseca Hospital who received Child Talks training. The Family-Focused Mental Health Practice Questionnaire (FFMPQ) was used to measure change in professionals’ attitudes, knowledge, confidence, and organizational structure in working with these families. All participants filled in the questionnaire before training and 10 months later. Results: The results showed that, from pre- to post-measurement, the professionals changed clinical practice significantly. The largest changes were visible in the improved provision of support at the workplace for family-focused practice and the clarity and availability of the policies and procedures. Furthermore, the skill and knowledge of the mental health workers showed significant improvement at posttest. Conclusion: The positive results of this study were not unexpected; the training, implementation of routines, and procedures as well as workplace support were aims of the “Semente” program. Interpretation of the results should be taken with caution because of the small sample and the lower reliability of some of scales of the FFMPQ. The results indicate that professionals moved from patient focus to family focus during the implementation of the “Semente” program.

Mental Health Professionals’ Perspectives of Family-focused Practice across Child and Adult Mental Health Settings: A Qualitative Synthesis

The shift towards a family-focused approach to practice has been highly endorsed across child and adult mental health services, with increasing policy development and a growing evidence base. The aim of this review was to synthesize the qualitative evidence of professionals’ perspectives and experiences of implementing family-focused practice across these settings. Electronic databases were searched up to March 2018, with nine articles included. The synthesis produced two overarching challenges relating to the organizational and system issues of family-focused practice and clinicians’ attitudes, knowledge, and practice towards addressing the complexity of families’ needs. The findings point to a limited evidence of professionals viewing the benefits of family-focused practice and a lack of coherence relating to professionals’ investment in family-focused practice. These are discussed within policy and implementation factors.

Predictors and enablers of mental health nurses' family-focused practice.

Family-focused practice improves outcomes for families where parents have a mental illness. However, there is limited understanding regarding the factors that predict and enable these practices. This study aimed to identify factors that predict and enable mental health nurses' family-focused practice. A sequential mixed methods design was used. A total of 343 mental health nurses, practicing in 12 mental health services (in acute inpatient and community settings), throughout Ireland completed the Family Focused Mental Health Practice Questionnaire, measuring family-focused behaviours and other factors that impact family-focused activities. Hierarchical multiple regression identified 14 predictors of family-focused practice. The most important predictors noted were nurses' skill and knowledge, own parenting experience, and work setting (i.e. community). Fourteen nurses, who achieved high scores on the questionnaire, subsequently participated in semistructured interviews to elaborate on enablers of family-focused practice. Participants described drawing on their parenting experiences to normalize parenting challenges, encouraging service users to disclose parenting concerns, and promoting trust. The opportunity to visit a service user's home allowed them to observe how the parent was coping and forge a close relationship with them. Nurses' personal characteristics and work setting are key factors in determining family-focused practice. This study extends current research by clearly highlighting predictors of family-focused practice and reporting how various enablers promoted family-focused practice. The capacity of nurses to support families has training, organizational and policy implications within adult mental health services in Ireland and elsewhere.

Family-Focused Practice for Families Affected by Maternal Mental Illness and Substance Misuse in Home Visiting: A Qualitative Systematic Review.

Maternal mental illness is a major public health issue and can adversely affect the whole family. Increasingly, research and policy are recognizing the benefits of a family-focused approach to practice, an approach that emphasizes the family as the unit of care. This review was conducted with the aim of systematically analyzing the qualitative literature surrounding health visitors' family-focused practice with mothers who have mental illness and/or substance misuse. Through the synthesis, we developed three main findings: (a) parents' needs regarding health visitors' family-focused practice, (b) the ambiguity of mental illness in health visiting, and (c) the challenges of family-focused practice in health visiting. Above all, health visitors, families, and mothers with mental illness experience many challenges in family-focused practice, even though it is both desirable and beneficial. This calls for a deeper understanding of how family-focused practice can be effectively practiced in health visiting.

Parental Mental Illness: Cross-Sectional Analysis Of Family Focused Practice within the Early Childhood Sector

During the preschool years (3–5 years), children living with parental mental illness are more at risk of various adverse developmental outcomes, compared to other children. Early childhood services are opportune settings for prevention and early intervention strategies that may support preschool children living with parental mental illness. However, there is limited research examining how the early childhood sector supports the child, parent and family. The aim of the study was to explore family focused practices within the early childhood sector in terms of the level of self-perceived knowledge, skill and confidence; and compare the self-perceived knowledge, skill and confidence between preschool teachers and childcare workers. A sample of 40 preschool teachers and 39 childcare providers rated themselves across eight domains that describe their knowledge, confidence and skill using the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Overall, the sample rated themselves positively across all domains. In a cross-sectional analysis, a t-statistic comparison of preschool teachers and childcare providers showed that childcare providers scored significantly higher than preschool teachers in parenting support, referrals and assessing the impact of parental illness on the child. Future studies might identify the barriers and enablers for Family Focus Practice (FFP) across different groups of workers in the early childhood sector.

Mental health professionals\u2019 family-focused practice with families with dependent children: a survey study

BackgroundMany people with a mental illness are parents caring for dependent children. These children are at greater risk of developing their own mental health concerns compared to other children. Mental health services are opportune places for healthcare professionals to identify clients’ parenting status and address the needs of their children. There is a knowledge gap regarding Thai mental health professionals’ family-focused knowledge and practices when working with parents with mental illness and their children and families.MethodsThis cross –sectional survey study examined the attitudes, knowledge and practices of a sample (n = 349) of the Thai mental health professional workforce (nurses, social workers, psychologists, psychiatrists) using a translated version of the Family-Focused Mental Health Practice Questionnaire (FFMHPQ).ResultsThe majority of clinicians reported no training in family (76.8%) or child-focused practice (79.7%). Compared to other professional groups, psychiatric nurses reported lower scores on almost all aspects of family-focused practice except supporting clients in their parenting role within the context of their mental illness. Social workers scored highest overall including having more workplace support for family-focused practice as well as a higher awareness of family-focused policy and procedures than psychiatrists; social workers also scored higher than psychologists on providing support to families and parents. All mental health care professional groups reported a need for training and inter-professional practice when working with families.ConclusionsThe findings indicate an important opportunity for the prevention of intergenerational mental illness in whose parents have mental illness by strengthening the professional development of nurses and other health professionals in child and family-focused knowledge and practice.

Family-focused practice within a recovery framework: practitioners\u2019 qualitative perspectives

BackgroundFamily-focused practice (FFP) is an effective approach to supporting individuals with mental illness. ‘Recovery’ is also central to contemporary mental health care. However, there is a dearth of evidence about how the two concepts are related and subsequently implemented in practice. The aim of this study was to explore practitioners’ understandings and practices of FFP within a recovery framework.MethodsPurposive/snowball sampling was used to recruit and conduct qualitative interviews with 11 mental health practitioners in rural Australia. Concurrent sampling and data collection were informed by thematic analysis and continued until data saturation was reached.ResultsParticipants found it difficult to articulate their understandings of FFP within a recovery framework. Nonetheless they were able to describe practices that embodied family-focused recovery. Barriers to such practices included medical models of care, where there are often a shortage of skilled staff and high demands for care. Stigma (self and from others) and confidentiality were also identified as barriers to involving family members in recovery focused care.ConclusionsFamily-focused recovery care is a priority in many high-income countries. A family-focused recovery framework is needed to assist service planners, practitioners, family members and those with mental health needs and ensure such care is embedded within practice guidelines.

"Nicht von schlechten Eltern - NischE": A Family Orientated Collaborative Care Approach to Support Children in Families with Mentally Ill Parents

"Nicht von schlechten Eltern - NischE": A Family Orientated Collaborative Care Approach to Support Children in Families with Mentally Ill Parents The present work describes the setting- and multi-professional offer "NischE" in Gütersloh, a systemic approach for the care of children and their mentally ill parents. Children of mentally ill parents are a special risk group for developing their own mental illness. The aim of the collaborative care model between child and adolescent psychiatry, youth services and adult psychiatry is to enable affected families in terms of family-focused practice a low threshold access to different services. For this purpose, two positions have been created to advise the affected families and support access to the help system in the sense of a systemic case management in a project. The article describes the background and the need for the development of the offer, the current scientific knowledge base on the subject and illustrates the procedure using a case study from practice.

‘They are the children of our clients, they are our responsibility’: a phenomenological evaluation of a school holiday program for children of adult clients of a mental health service

ABSTRACTObjective: A range of protective factors have been identified for children who have a parent with a mental illness including social connectedness and proactive intervention by the mental health workforce. However, adult mental health (AMH) services are often limited in their capacity to provide preventative and early intervention-based family inclusive care. This study aimed to explore the meaning and experience of participation in a biannual child focused program delivered by AMH services to the children of clients of the service; from the perspectives of children, parents and mental health clinicians.Method: The study was guided by an interpretative hermeneutic phenomenological approach, using semi-structured interviews and focus groups and thematic analysis.Results: Analysis of interviews with children and young people identified three themes related to their described experiences of the group: escapism, the unexpected comfort of connection and fun in safe relationships. Analysis of interviews with the mental health clinicians who staff the program identified five overlapping professional and personal themes: journeys; working differently; behind closed doors, a wider lens and difficult good times. Interviews with parents described their perceived benefits of the program including respite, access to information about mental illness and their children’s enjoyment.Discussion: This program creates a non-intrusive mechanism within which AMH services can engage notoriously difficult to access families and deliver early intervention and prevention services while demonstrating a commitment to family-focused practice.

The Impact of Organizational Factors and Government Policy on Psychiatric Nurses' Family-Focused Practice With Parents Who Have Mental Illness, Their Dependent Children, and Families in Ireland.

Government policy and organizational factors influence family-focused practice (FFP) in adult mental health services. However, how these aspects shape psychiatric nurses' practice with parents who have mental illness, their dependent children, and families is less well understood. Drawing on the findings of a qualitative study, this article explores the way in which Irish policy and organizational factors might influence psychiatric nurses' FFP, and whether (and how) FFP might be further promoted. A purposive sample of 14 psychiatric nurses from eight mental health services completed semi-structured interviews. The analysis was inductive and presented as thematic networks. Both groups described how policies and organizational culture enabled and/or hindered FFP, with differences between community and acute participants seen. This study indicates a need for policies and organizational supports, including child and family skills training, to promote a whole family approach in adult mental health services.

Worker, workplace or families: What influences family focused practices in adult mental health?

Introduction Family focused practice is thought to lead to positive outcomes for all family members. However, there are multiple barriers and enablers in adult mental health services to practitioners undertaking these actions. Aim The aim of this study was to examine the relative importance of worker, workforce and family factors to predict family focused practices (FFPs) in adult mental health services. Method Three hundred and seven adult mental health workers completed a 45 items family focused practice measure of 16 family focused practices. Thesis It was found that worker skill and knowledge about family work and an ability to assess the degree of parental insight into the child's connections to other family members and the community were important predictors of FFP, along with the closely related-worker confidence. While aspects of the worker, workplace and family each contribute to FFPs, this study highlighted the importance of worker skill, knowledge and confidence as central issues for adult mental health workers. Implications for practice Study implications include the need for training in specific FFPs, the provision of time to engage with clients on parenting issues and the need 5 to ensure that there are adequate services for workers to refer family members to.

Family-focused practice in mental health care: An integrative review

ABSTRACTWhile mental health services are increasingly encouraged to engage in family-focused practice, it is a poorly understood term. The aim of review was to synthesize evidence on the concept and scope of family-focused practice in adult and child and youth mental health care settings. An integrative literature review method was used. Electronic databases were systematically searched between 1994–2014. In 40 included articles, family-focused practice was conceptualized variously depending on who comprised the "family," the family type, and context of practice. Six core and inter-related family-focused practices were identified: assessment; psychoeducation; instrumental, emotional, and social support; family care planning and goal-setting; liaison between families and services; and a coordinated system of care between families and services. "Family" as defined by its members forms a basis for practice that is oriented to providing a "whole of family" approach to care. Key principles and family-focused practices are recommended across mental health settings.

Family-focused practice

Working with ‘troubled’ families can be challenging, but Beverley Bailey believes adopting a therapeutic approach can help to make every contact count.

The family-focused practice of primary care clinicians: a case of missed opportunities

Background: Many patients who present to primary care settings with mental health concerns are parents with dependent children. However, little is known about the family-focused practices of these clinicians.Aim: To identify the family-focused practices of a group of primary care clinicians.Methods: A sequential mixed methodology was employed; 21 primary care clinicians completed the Family Focused Mental Health Practice Questionnaire and then participated in one of three focus groups.Results: Primary care clinicians do not commonly engage with patients about family issues though many acknowledged that family-focused practice was important. Some questioned whether being family focused was part of their role with other barriers related to funding. Most expressed a need for training, though some indicated that they would not engage in a family-focused manner nor be trained in this approach, unless it was compulsory. The study highlights the missed opportunity for family-focused practices in primary care settings.Conclusions: This study demonstrates the need for an “authorising” environment in which family-focused practices are not only supported but expected.

Differences Between Irish and Australian Psychiatric Nurses' Family-Focused Practice in Adult Mental Health Services

Psychiatric nurses' practice with parents who have mental illness, their children and families is an important issue internationally. This study provides a comparison of Irish and Australian psychiatric nurses' family-focused practices in adult mental health services. Three hundred and forty three nurses across Ireland and 155 from Australia completed the Family Focused Mental Health Practice Questionnaire. Cross-country comparisons revealed significant differences, in terms of family-focused skill, knowledge, confidence and practice. Australian psychiatric nurses engaged in higher family-focused practice compared to Irish nurses. The comparative differences between countries may be attributable to differences in training, workplace support and policy.

Pathways of Care: targeting the early childhood sector for early intervention

While many people with a mental illness care for young children, there is a paucity of resources for these families and the professionals working with them. The purpose of this paper is to describe a new online resource, Pathways of Care, specifically designed for parents with a mental illness, early childhood educators, and mental health workers, and report on a pilot evaluation of the resource. Using a mixed method design, the effectiveness of the online resource in effecting worker confidence, knowledge and family-focused practice change will be examined. Pathways of Care aims to promote collaborative practice between agencies, identify relevant agencies and support workers in talking to parents about mental illness in families. Fifteen workers completed the Family Focus Mental Health Practice Questionnaire pre- and post-viewing the resource, to measure confidence and practice change; semi-structured interviews were then conducted with eight of these same workers to further explore the utility of the resource. Findings tentatively indicate that the resource was effective in increasing worker knowledge and confidence. This study highlights the importance of the development and provision of resources, such as the Pathways of Care, to promote collaboration between service providers in the early childhood and mental health sectors working with families with young children.

Bringing the Family Back in: On Role Assignment and Clientification in the Swedish Social Services

In Sweden, municipal social services provide help and support for vulnerable people with a variety of needs. Although the family has long been understood to be a focus of social work interventions, it is unclear how it is brought into the casework process in the highly individualised and specialised municipal social services. Therefore, in this study we investigated processes of client-making and role assignment in five service sectors: social assistance, child welfare, substance abuse, disability, and elderly care. We carried out focus group interviews with social workers in each of these sectors in a mid-sized community in central Sweden. Findings showed that clienthood and the family are interpreted in different ways. The family is brought into or kept out of service provisions in ways that are connected to social workers’ construction of the family either as expert, client or non-client. However, the role of the family may also change during the casework process. Findings are examined in relation to theories of the welfare state and implications for family-focused practice are discussed.

The Family-Focused Mental Health Practice Questionnaire

It is estimated that 1 in 5 children have a parent with a mental illness, and studies have shown that such children are more likely to develop mental health problems when compared with their peers. Research has demonstrated the benefits of mental health clinician family-sensitive practice to both parents and their children; however, a measure of clinician practice is not available. The psychometric properties of a questionnaire measuring family-focused practice in the psychiatric setting are reported here. There were 307 public adult mental health worker participants, predominantly from the nursing profession and working full time. Principal component analysis highlighted 14 subscales that summarize 49 items reflecting organizational and worker factors, such as skill/knowledge about the impact of parental mental illness on children and worker confidence. Subscales are discussed in relation to the literature and psychiatric policy. The measure appears a useful tool for evaluation, benchmarking for training and organizational improvement, and ultimately, for increasing quality services to parents, families, and particularly children associated with psychiatric services.

Barriers and facilitators to the achievement of community-focused public health nursing practice: a UK perspective

To explore the extent to which Community Health Nurses (CHN) engage in community-focused public health practice and the facilitators and barriers to such practice. The government promotes the role of nurses in public health. However, there is confusion as to what constitutes public health; a lack of support to move from individual and family-focused practice to community-focused practice; and, inconsistency of the use of titles. A 15% quota sample (n = 409), drawn from a population of 2668 CHNs, participated in a quantitative survey. Response rate was 67% (n = 275). Over half of CHN time was spent with individuals and families, community level activity accounting for only 18%. Only 9% of respondents had completed a community needs assessment. Education was key to the promotion of community-focused practice with collection of individual activity data a major barrier. There is a gap between the rhetoric and reality of community public health nursing. Development of a shared vision of public health nursing and commissioning of education to meet public health priorities is essential. Furthermore, strengthening public health nurse leadership to foster innovative practice and methods of measuring public health nursing outcomes is required.