Research and organizational issues for the implementation of family work in community psychiatric services

Standards of practice for the adult mental health workforce: meeting the needs of families where a parent has a mental illness

This article outlines the development of practice standards for the adult mental health workforce for addressing the needs of families where a parent has a mental illness (FaPMI). The practice standards recommended here were formulated using a modified cooperative inquiry process with a group of senior clinical leaders in adult mental health services in Australia, following consultation with the available literature and policy documents. The aim of the project was to generate, align, and operationalize family-inclusive practice standards within the core activities of the adult mental health workforce and integrate into the continuum of care and recovery for service users who are parents of dependent children. As part of a modified Delphi method, the standards were also ranked by the senior clinical leaders to determine what they believe to be essential and recommended practices for the adult mental health workforce they manage. We argue that developing practice standards that provide practical and realistic expectations of the adult mental health service workforce enable services and workers to better adapt practice to respond to FaPMI.

Factors that may Facilitate or Hinder a Family-Focus in the Treatment of Parents with a Mental Illness

Children with mentally ill parents are at risk of developing mental health problems themselves. To enhance early support for these children may prevent mental health problems from being transmitted from one generation to the next. The sample (N = 219) included health professionals in a large university hospital, who responded to a web-based survey on the routines of the mental health services, attitudes within the workforce capacity, worker's knowledge on the impact of parental mental illness on children, knowledge on legislation concerning children of patients, experience, expectations for possible outcomes of change in current clinical practice and demographic variables. A total of 56 % reported that they did not identify whether or not patients had children. There were no significant differences between the groups (identifiers and non-identifiers) except for the two scales measuring aspects of knowledge, i.e., Knowledge Children and Knowledge Legislation where workers who identified children had higher scores. The results also showed that younger workers with a medium level of education scored higher on Positive Attitudes. Furthermore, workers who reported to have more knowledge about children and the impact of mental illness on the parenting role were less concerned about a child-focussed approach interfering with the patient-therapist relation.

Contextual barriers to the successful implementation of family-centered practice in mental health care: a Hong Kong study

This article presents findings from an exploratory study to identify nurses' perspectives on factors that hinder the implementation of family-centered practice in mental health settings in Hong Kong. Thirty-four nurses participated in the study by completing the pre- and post-questionnaires. Ten nurses were invited to participate in focus group and case interviews. The analysis identified knowledge-practice gap, role of psychiatric nurses, professional identity of psychiatric nurses, and management support as negatively affecting the nurses in implementing a family-centered approach to mental health care. Suggestions about facilitating the implementation of the family-centered approach into clinical practice are offered.

Prevention of involuntary admission through Family Group Conferencing: a qualitative case study in community mental health nursing

AIM

To understand whether and how Family Group Conferencing might contribute to the social embedding of clients with mental illness.

BACKGROUND

Ensuring the social integration of psychiatric clients is a key aspect of community mental health nursing. Family Group Conferencing has potency to create conditions for clients' social embedding and subsequently can prevent coercive measures.

DESIGN

A naturalistic qualitative case study on the process of one conference that was part of 41 conferences that had been organized and studied from January 2011-September 2013 in a public mental health care setting in the north of the Netherlands.

METHODS

Semi-structured interviews (N = 20) were conducted with four stakeholder groups (N = 13) involved in a conference on liveability problems in a local neighbourhood wherein a man with schizophrenia resides.

FINDINGS

To prevent an involuntary admission to a psychiatric ward of a man with schizophrenia, neighbourhood residents requested a family group conference between themselves, the sister of the man and the mental health organization. As a possible conference aggravated psychotic problems, it was decided to organize it without the client. Nine months after the conference, liveability problems in the neighbourhood had been reduced and coercive measures adverted. The conference strengthened the community and resulted in a plan countering liveability problems.

CONCLUSION

The case indicates that social embedding of clients with severe psychiatric problems can be strengthened by Family Group Conferencing and that hence coercive measures can be prevented. A shift is required from working with the individual client to a community driven approach.

Do nurses support the patient in his or her role as a parent in adult psychiatry? A survey of mental health nurses in Finland

This study describes the extent to which registered and practical mental health nurses support, and consider the support in the units on parental responsibility in adult psychiatry, with regard to clients who are parents of dependent children and the predictors for this. A questionnaire survey was carried out in 2005 with Finnish practical and registered mental health nurses. Most nurses claimed that they support the well-being of parent clients and discuss with them about their children. At the units there is offered a support for parents in the therapeutic milieu and with managing at home with their parental duties. Nurses' ability to support their clients as parents and to recognize the support at the units increases through personal experiences such as being parent, professional experience, and further professional education.

Collecting subjective and rating scale data within a single case study design: cognitive behavioural therapy for a person experiencing psychosis

This paper reports on a case study for a person with a diagnosis of schizophrenia using cognitive behavioural therapy. A range of scales was used to detect treatment effect and outcome. No significant clinical changes were detected using the scales, which are routinely used with such interventions. Subjective data were also collected in the form of a narrative, with the recipient of therapy identifying outcomes, which are not reflected within the rating scale data. Implications for practice include valuing the subjective experience reported by service users. The paper concludes that rating scale data and subjective accounts should be seen on an equal footing when evaluating specific therapeutic interventions.

Parental mental illness: a review of barriers and issues for working with families and children

Many consumers of psychiatric services are parents, making these services the opportunistic point for supporting consumers' children. While evidence suggests that assisting such children improves their mental health, there is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This paper summarizes the constraining barriers and issues for the psychiatric workforce according to: (1) policy and management; (2) interagency collaboration; (3) worker attitude,skill and knowledge; (4) the parent-consumer; and (5) the consumer's family, including children. Potential solutions are presented, with a particular focus on the hierarchical nature of these barriers. Recommendations are made, including organizational audits to identify the most pressing barriers that impede family sensitive practice.

Do nurses working in adult psychiatry take into consideration the support network of families affected by parental mental disorder?

The aim of this study was to gain information about registered and practical mental health nurses' activities concerning support network of families affected by parental mental illness. Data were collected using a structured questionnaire distributed to all 608 practical and registered mental health nurses working in adult psychiatric units in five Finnish university hospitals. A total of 311 nurses returned completed questionnaires (response rate 51%). Sixty per cent (n = 222) of registered nurses and 36% (n = 88) of practical mental health nurses responded. Information about family relationships and socio-economic situation was gathered regularly by all nurses. The nurses' individual characteristics, such as being a parent, further family education and use of family-centred care, were significantly related to their activeness in discussing the family's support network with the parents. Discussing family relationships and families support networks forms part of patient care in adult psychiatric nursing with families with dependent children (under 18 years of age). Nurses can work directly with the parents to aid them to strengthen their support network for themselves and their children.

Excellence in nursing: a model for implementing Family Systems Nursing in nursing practice at an institutional level in Iceland

An innovative opportunity is being created by nursing leaders from practice and education in Iceland to implement Family Systems Nursing at an institutional level on all units and divisions with the Landspitali University Hospital. This article describes the phases of the implementation model for knowledge translation that will be operationalized over four years. The goals of implementing Family Systems Nursing at the Landspitali University Hospital are to (a) educate all practicing nurses in Family Systems Nursing and, in particular, the Calgary family assessment and intervention models; (b) strengthen practicing nurses' clinical skills for intervening with families by offering specific clinical training courses to all nurses using family skills labs; and (c) explore and assess the difference that the theoretical and clinical programs make for the nurses, the patients and their families, and the nurses' practice (the family-nurse relationship).

Including children in family-focused acquired brain injury rehabilitation: a national survey of rehabilitation staff practice

Objective: To establish whether rehabilitation staff work regularly with child relatives of adults with acquired brain injury to involve them in their family member's rehabilitation. To explore factors influencing rehabilitation staff's decisions about involving child relatives.

Design: A cross-sectional postal survey design was used for the main study. Questionnaire packs were sent to rehabilitation staff, followed by a reminder letter one week later. Non-responders received a follow-up pack after three weeks.

A prospective design was used with a subsample of participants who re-completed the questionnaire one month later.

Subjects: Participants were 393 multidisciplinary staff working in rehabilitation services for adults with acquired brain injury throughout the UK.

Main measures: A questionnaire based on the theory of planned behaviour was designed specially for the purposes of the study.

Results: A response rate of 67% (n = 263) was obtained. Few respondents (19%, n = 50) reported carrying out work with child relatives. Perceived behavioural control (e.g. access to training, resources and support) significantly predicted staff's intention to work with child relatives, and whether they carried this out. Staff's attitudes towards work with child relatives also significantly predicted intentions. Other influential factors were anxiety, training, work setting and perceptions of colleagues' attitudes.

Conclusions: Little work is carried out with child relatives by acquired brain injury rehabilitation staff, influenced by several factors. A priority in addressing this is to provide staff training.

The Thorn Course: rhetoric and reality

The Thorn Course that provides psychosocial interventions and family work training for UK mental health professionals was founded in 1992. Since this time policy, service provision and needs have changed. The aim of this study was to examine the Thorn Course through relevant literature, in order to establish whether research and policy have been integrated into practice within training and services. A search of professional journal databases was conducted. Keywords used were 'Thorn Course' and 'psychosocial intervention training'. The resulting body of literature was reviewed. Five main themes emerged which were examined: needs identified, delivering the Thorn Course, training outcomes, implementing interventions and user and carer involvement. There is a distinct lack of research studies evaluating any aspect of the Thorn Course. There is little evidence that user and carer involvement has moved beyond rhetoric and community mental health nurses continue to lack opportunities and support to implement psychosocial skills acquired in training.

Implementing family intervention following training: what can the matter be?

Family interventions (FI) have been established as an effective treatment for psychosis. Training in this intervention is now widely available in the UK. This paper reports a review of published literature that investigates whether, following this training, graduates provide this evidence-based treatment for individuals with psychosis and their caregivers. It further seeks to identify the barriers to implementation in cases where the treatment is not provided and assess benefits for service users and carers when it is. The review was conducted using the MEDline, PsycINFO, CINAHL and Embase databases. Studies that have attempted to evaluate the rates of implementation of FI by graduates of FI training programmes were identified, retrieved and reviewed. Six studies investigating the rates of implementation upon graduation were identified. The findings of these six studies were generally consistent. Rates of implementation by graduates of training programmes are usually low and a small number of graduates work with most of the families who are seen. The studies reviewed failed to assess service user and carer outcomes or consider the full range of likely impediments to the implementation of this evidence-based intervention. A key barrier to the implementation of FI is the reliance upon professionally developed and facilitated approaches. Alternative models that are service user and carer-led may provide a potential solution to the problem of implementation. Implications for future research and practice are considered.