family focused practice
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2021 ◽  
Vol 12 ◽  
Author(s):  
Annette Bauer ◽  
Stephanie Best ◽  
Juliette Malley ◽  
Hanna Christiansen ◽  
Melinda Goodyear ◽  
...  

Objectives: In several high-income countries, family-focused practice programs have been introduced in adult mental health care settings to identify and support children whose parents live with mental health problems. Whilst their common goal is to reduce the impact of parental mental illness on children, the mechanisms by which they improve outcomes in different systems and settings are less well known. This kind of knowledge can importantly contribute to ensuring that practice programs achieve pre-defined impacts.Methods: The aim of this study was to develop knowledge about relationships between contextual factors, mechanisms and impact that could inform a program theory for developing, implementing, and evaluating family-focused practice. Principles of a realist evaluation approach and complex system thinking were used to conceptualize the design of semi-structured in-depth interviews with individuals who led the implementation of programs. Seventeen individuals from eight countries participated in the study.Results: Interviewees provided rich accounts of the components that programs should include, contextual factors in which they operated, as well as the behavior changes in practitioners that programs needed to achieve. Together with information from the literature, we developed an initial program theory, which illustrates the interconnectedness between changes that need to co-occur in practitioners, parents, and children, many of which related to a more open communication about parental mental health problems. Stigma, risk-focused and fragmented health systems, and a lack of management commitment were the root causes explaining, for example, why conversations about parents' mental illness did not take place, or not in a way that they could help children. Enabling practitioners to focus on parents' strengths was assumed to trigger changes in knowledge, emotions and behaviors in parents that would subsequently benefit children, by reducing feelings of guilt and improving self-esteem.Conclusion: To our knowledge, this is the first research, which synthesizes knowledge about how family-focused practice programs works in a way that it can inform the design, implementation, and evaluation of programs. Stakeholder, who fund, design, implement or evaluate programs should start co-developing and using program theories like the one presented in this paper to strengthen the design and delivery of family-focused practice.


2021 ◽  
Author(s):  
Rachel Leonard ◽  
Mark Linden ◽  
Anne Grant

Abstract Background While it is recognised that health visitors play a key role in supporting families when mothers have mental illness, there is limited understanding of health visitor’s family focused practice (FFP) in this context and its relationships with factors, such as, workload, training, skill and knowledge, and personal and professional experience. This paper examined the effect of health visitors’ interaction with the family, and personal and professional experience on their family focused practice. Methods A cross sectional questionnaire (Family Focused Mental Health Practice Questionnaire) was distributed to 488 health visitors, with 230 choosing to take part. Independent t-tests and one-way analysis of variance were used to compare family focused practice scores. Results Results found that health visitors who had face to face contact with partners and children (t(221) = 2.61, p = .01), and those that directly supported the partner (t(221) = 2.61, p = 0.01) had a significantly higher mean score, than those that did not. However, frequency of visits (daily, weekly, monthly or yearly) had no effect on family focused practice scores. Training also had a significant effect on family focused practice scores (F(2,221) = 4.841, p = 0.029). Analysis of variance revealed that personal experience of mental illness had a significant effect on scores (M = 97.58, p = 0.009), however variables such as, age, parental status, time since registration, and being in a specialist position had no effect. Conclusions In order for family focused practice to be effective, the quality, and content of visits and contact with family should be addressed, as opposed to a focus on the quantity of visits. However, in order for this to occur health visitors need to have appropriate support in their own right, with manageable caseloads and resources.


2020 ◽  
Vol 76 (5) ◽  
pp. 1255-1265
Author(s):  
Rachel Leonard ◽  
Mark Linden ◽  
Anne Grant

Author(s):  
Genevieve Leenman ◽  
Karen Arblaster

Purpose Approximately 20 per cent of Australian children live with a parent who experiences mental illness. These children have poorer health and psychosocial outcomes than their peers. While family-focused practice (FFP) can improve these outcomes, family-focused service provision is inconsistent. The purpose of this paper is to understand clinicians’ experiences of FFP and associated workplace factors. Design/methodology/approach In-depth interviews were conducted with ten community mental health clinicians. Interviews were audio recorded and transcribed. Data were analysed using thematic analysis. Findings A global theme of “navigating rocky terrain” captured clinicians’ experiences of working with families. The rocky terrain encompassed both family complexity and workplace barriers to FFP. Clinicians navigated this terrain by using multiple strategies to support families, working in partnership with families and other clinicians and services, and drawing on personal resources. Interactive approaches to enhancing knowledge and skills were preferred over paper-based information. While an organisation-wide approach to support FFP was beneficial, clinicians continued to feel challenged in implementing FFP. Research limitations/implications Working with families in which parents experience mental illness is affected by systemic issues at the family and organisational levels. Systemic approaches to both delivering and supporting this work are required. Partnership working and organisation-wide capacity building strategies emphasising interactive approaches to learning appear to have positive effects. Originality/value This study explores the challenges of FFP in a real-world multidisciplinary context where there has been a systemic approach to enabling this work. It highlights the challenges clinicians face in family-focused practice in spite of substantial organisational supports and suggests some approaches that might be effective. This is a topic which has received minimal attention in the literature.


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