Family-focused practice within a recovery framework: practitioners' qualitative perspectives.

BACKGROUND: Family-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. METHODS: Purposive/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. RESULTS: Participants 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. CONCLUSIONS: Family-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.

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

WHAT IS KNOWN ON THE SUBJECT?: Family focused practice leads to positive outcomes for parents and children. There are barriers and enablers for practitioners being family focused. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Worker skill, knowledge and confidence about family work are the most important factors associated with family focused practices. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses require specific skill training in family focused practices, time to engage with clients on parenting issues and that there are adequate services to refer family members to. ABSTRACT: 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.

Practitioners' experiences of working with families with complex needs.

Even though employing a family-sensitive approach has been shown to be beneficial for parents and children, there is sporadic uptake of this approach. This paper focuses on practitioners' perspectives when working with families where a parent, with dependent children, has a mental illness and/or substance abuse disorder. The aim of this research is twofold: (1) identify the issues practitioners face when working with families with complex needs; and (2) present the strategies they find to be effective in addressing family needs. Within the context of an organization that supported a family-sensitive approach, this study reports on 21 semi-structured interviews conducted over 15 months with 10 practitioners, as well as three focus group interviews with the same staff. Employing a qualitative framework, data highlighted the multifaceted nature of family problems, issues working with multiple agencies and problems associated with staff turnover. Successful strategies included working with the family on clearly defined and negotiated goals, focusing on family strengths and employing specific skills such as managing the sometimes competing needs of children and parents.

Mothers with an eating disorder: 'food comes before anything'.

There is little research that has presented the voices of mothers with an eating disorder (ED). The aim of this study was to clinicians present the experiences of mothers, drawn from the community, who have an ED and their perceptions regarding how their ED impacts on their children and parenting. Semi-structured, individual interviews were conducted with nine mothers with various EDs. Interpretative Phenomenological Analysis, alongside member checks and inter-rater reliability, was employed to analyze data. Six themes were identified: (1) the impact of an ED on children; (2) modelling disturbed eating behaviours; (3) prioritizing food before children's needs, or as described by one participant, 'food comes before anything'; (4) children motivate recovery; (5) secrecy within families; and (6) treatment needs. Overall, mothers juggled to balance the competing demands of an ED and the needs of their children. The need for clinicians to acknowledge and support a mother's role when treating EDs is highlighted.

Training mental health promotion workers in programme evaluation.

In this paper, a programme to train mental health promotion workers in programme evaluation is described and evaluated. The programme is based on adult learning values, guidelines for programme evaluation training and the general principles of mental health promotion. Facilitated over 2 days, the programme also provided individual mentoring. Training was evaluated via a questionnaire immediately before and post training, and 6 months post training (n = 28, n = 18, n = 18). Additionally, individual interviews were used with seven participants and qualitatively analysed. Results indicate significant and sustained positive changes in knowledge, confidence and behaviour and while satisfaction reduced significantly at the six month follow-up, participants' level of satisfaction towards mentoring was consistent. Post training, participants reported a greater appreciation of the importance of evaluation planning and working collaboratively.

Programmes for parents with a mental illness.

Parents with a mental illness experience the same parenting stressors that other parents do, and at the same time need to manage their mental illness. However, few programmes are designed for parents who have a mental illness, with older children (as opposed to interventions for mothers with infants). This study identified the common components across six programmes developed for parents with a mental illness who have older children. Australian clinicians, responsible for six parenting programmes for those with a mental illness, participated in individual, semi-structured interviews, during 2008. Programme manuals and evaluation reports were also sourced. Analyses involved thematic analysis, inter-rater reliability and respondent validation. Data were organized in three main areas: (1) programme description (format, goals, length and participants' inclusion criteria); (2) theoretical framework (including clinicians' beliefs and evidence underpinning programmes); and (3) evaluation designs and methodologies. It was found that clinicians facilitated education and support via a peer intervention model for parents with various mental illness diagnoses, responsive to the needs of parents and in a time flexible manner. At the same time, clinicians found it difficult to articulate the theoretical framework of their programmes and employed mostly simplistic evaluation strategies.

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.