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Stolper H, van Doesum K, Steketee M. An integrated family approach in the practice of adult and child mental health care. Front Psychiatry 2024; 15:1298268. [PMID: 38686126 PMCID: PMC11056573 DOI: 10.3389/fpsyt.2024.1298268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
This paper describes the practice of an integrated family approach to treatment in mental health care in which the focus is on the whole family and treatment is carried out by professionals of adult and child mental health services together. It is presented as an example of a best practice in finding a way to overcome barriers in implementing an integrated family approach in treatment for the benefit of families with a variety of interrelated problems. Even though there is a lot of knowledge about the importance of a family approach in mental health care with specific attention to the patients' parental role, the children, family relationships, and the social economic context, this is worldwide rarely implemented in the practice of mental health care. Barriers to keep the whole family in mind are identified on different levels: organizational policy, interagency collaboration, professionals, and patients themselves. As a solution, a model of an integrated family approach in mental health care is presented: how it is defined; which domains in the family are targeted; which key elements it contains; what the treatment consists of; and which procedures are followed in practice. A case illustrates how this approach might work in practice.
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Affiliation(s)
- Hanna Stolper
- Departement of Psychology Education and Child Studies, Erasmus University Rotterdam (EUR), Rotterdam, Netherlands
- Jeugd ggz Dimence Groep, Zwolle, Netherlands
| | - Karin van Doesum
- Department of Clinical Psychology, Radboud University Nijmegen, Nijmegen, Netherlands
- Impluz Dimence Groep, Deventer, Netherlands
| | - Majone Steketee
- Departement of Psychology Education and Child Studies, Erasmus University Rotterdam (EUR), Rotterdam, Netherlands
- Verwey-Jonker Instituut, Utrecht, Netherlands
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Linderborg C, Grant A, Weimand BM, Falkov AF, Östman M. Experiences of clinicians and managers in the implementation of a family focused model in child and adult psychiatry. Front Psychiatry 2024; 15:1360375. [PMID: 38563021 PMCID: PMC10982353 DOI: 10.3389/fpsyt.2024.1360375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction This paper describes the process of implementing a family focused model, The Family Model, in child and adolescent and adult mental health services in Sweden. Additionally, it describes a service development project carried out in both services within a defined geographical area of Region Stockholm. The Family Model is a communication tool designed to assist clinicians in both services to have family focused conversations with their patients and relatives. Internationally, the needs of individuals experiencing mental health challenges (parents, children and young people) and their close relatives are now well recognized, but barriers to family focused practice nevertheless persist. The aim of this study was to better understand clinicians` experiences in implementing The Family Model in both services. Methods Three preplanned focus group interviews were carried out with 14 clinicians and managers across both services and the data were analyzed in accordance with methods of Naturalistic inquiry. Result Findings suggest that The Family Model has utility in both services. The Naturalistic inquiry analyses revealed three main themes: individual, relational and organizational aspects with a total of 10 sub-themes of how the models influence the participants. Furthermore, analyses on a meta understanding level explored that participants underwent a developmental journey in learning about and using The Family Model in practice which was expressed through three themes: "Useful for burdened families", "Influencing prevention", and "To integrate this would be fantastic". Conclusions The Family Model, when adapted for the Swedish context, is a useful tool for assisting experienced clinicians to engage in family focused practice in both child and adolescent and adult mental health services. The Family Model highlights different aspects in everyday clinical services that were of special interest for clinicians, families, and the system. Future research could explore families' perspectives of the utility of the model.
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Affiliation(s)
- Camilla Linderborg
- Faculty of Health, Social and Welfare Studies, USN- University of South Eastern Norway, Drammen, Norway
- Child and Adolescent Psychiatry, Stockholm Regional Council, Stockholm, Sweden
| | - Anne Grant
- School of Nursing and Midwifery, Queens University Belfast, Belfast, United Kingdom
| | - Bente Margrethe Weimand
- Faculty of Health, Social and Welfare Studies, USN- University of South Eastern Norway, Drammen, Norway
- Faculty of Health and Social Sciences Mental Health and Addiction Services, Department for Research and Development, Akershus University Hospital, Oslo, Norway
| | - Adrian Farrel Falkov
- Department of Child and Youth Mental Health, Royal North Shore Hospital, Northern Sydney Health District, Sydney, NSW, Australia
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Harries CI, Smith DM, Gregg L, Allott R, Wittkowski A. Parents who experience psychosis: A qualitative exploration. Psychol Psychother 2023; 96:590-607. [PMID: 36912129 DOI: 10.1111/papt.12458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Psychosis can present parents with complex parenting challenges and significant adverse outcomes for parents and their children have been reported. However, remarkably little is known about how parenting is experienced by these parents. Therefore, this qualitative study aimed to understand the lived experiences of parents with psychosis, including how parenting support was experienced. DESIGN AND METHODS Using interpretative phenomenological analysis (IPA), eight biological parents (five mothers and three fathers) with psychosis were recruited and interviewed from early intervention in psychosis services in the Northwest of England. RESULTS Three superordinate themes and seven subordinate themes were identified. Theme 1 'Living with the Struggle: Painfully Disconnected' captured a persistent parenting struggle that distanced parents from their children and support due to all-consuming experiences of psychosis, fear and risk-focused service support. Theme 2 'Desired and Vulnerable Position: Comfortably Connected' captured parental experiences of symptom relief through connection with their children, alongside parental need to be integrated with the systems around them. Theme 3 'Exposed: Parenting Under a Spotlight' represented parental experiences of inescapable observation and judgement from the systems around them. CONCLUSIONS Novel insights into the role of misaligned parent and service priorities in parental perceptions of powerlessness, shame and disconnection from their children, valued parenting identities, and system supports are presented. Systemic interventions that target stigma, provide system-wide psychoeducation and promote person-centred, compassionate and meaningful connections between parents and the systems they live within are needed to promote better parenting outcomes.
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Affiliation(s)
- Claire I Harries
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Debbie M Smith
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Lynsey Gregg
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Rory Allott
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
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Stolper H, van Doesum K, Henselmans P, Bijl AL, Steketee M. The Patient's Voice as a Parent in Mental Health Care: A Qualitative Study. Int J Environ Res Public Health 2022; 19:ijerph192013164. [PMID: 36293747 PMCID: PMC9603497 DOI: 10.3390/ijerph192013164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 05/17/2023]
Abstract
OBJECTIVE This study is an evaluation of patients in mental health care who have undertaken treatment with an integrated family approach. The treatment focuses on the mental disorders of patients, their role as parents, the development of their young children, and family relationships. The treatment was conducted by professionals from an adult and a child mental health service in the Netherlands. The aim of the study was to identify the key elements and processes of this approach in order to develop a theoretical model. BACKGROUND Parental mental disorders have an impact on parenting and child development. To stop detrimental cascade effects and prevent parents and children from being caught up in the intergenerational transmission of psychopathology, a family approach in mental health care is needed. METHODS A qualitative design was adopted using thematic analysis. Data were collected through 18 interviews with patients. The themes in the interviews were which outcomes the patients experienced and which key elements of the treatment contributed to these outcomes. RESULTS In general, patients were satisfied with the treatment offered. Improved outcomes were within the domain of the family, the parent-child relationship, individual symptoms, and the functioning of the parent and the child. Patients mentioned six key elements of success in treatment: focus on the whole family, flexible treatment tailored to the situation of the family, components of the whole treatment reinforcing each other, multi-disciplinary consultation among involved professionals, a liaison between adult and child mental health services, and attention to the social and economic environment. CONCLUSIONS According to the majority of patients, treatment with an integrated family approach in mental health care is of value for themselves, their children, and family relationships, especially the parent-child relationship.
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Affiliation(s)
- Hanna Stolper
- Erasmus School of Social and Behavioural Science, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
- Jeugd ggz Dimence Groep, 7416 SB Deventer, The Netherlands
- Correspondence: ; Tel.: +31-613780095
| | - Karin van Doesum
- Department of Clinical Psychology, Radboud University Nijmegen, 6525 XZ Nijmegen, The Netherlands
| | | | - Anne Lynn Bijl
- Jeugd ggz Dimence Groep, 7416 SB Deventer, The Netherlands
| | - Majone Steketee
- Erasmus School of Social and Behavioural Science, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
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Leonard R, Linden M, Grant A. Personal and professional influences on health visitors' family focused practice for maternal mental illness: a cross sectional study. BMC Health Serv Res 2022; 22:113. [PMID: 35081961 PMCID: PMC8790840 DOI: 10.1186/s12913-022-07499-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/14/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Family focused practice (FFP) is an approach that recognises the inter-related needs of family members and recommends a continuum of activities to support families. 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 within community practice in Northern Ireland, 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 of FFP, 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.
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Affiliation(s)
- Rachel Leonard
- Research Fellow, School of Nursing and Midwifery, Queen’s University, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
| | - Mark Linden
- Research Fellow, School of Nursing and Midwifery, Queen’s University, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
| | - Anne Grant
- Research Fellow, School of Nursing and Midwifery, Queen’s University, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
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Stolper H, van Doesum K, Steketee M. Integrated Family Approach in Mental Health Care by Professionals From Adult and Child Mental Health Services: A Qualitative Study. Front Psychiatry 2022; 13:781556. [PMID: 35573344 PMCID: PMC9096092 DOI: 10.3389/fpsyt.2022.781556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/28/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE A multiple case-study in which each case was evaluated by adult and child mental health professionals who used an integrated family approach in their treatments. In this approach, treatment focuses on the mental disorders of the parents as well as on the development of the young child and family relationships. This study evaluated the experiences of professionals from adult and child mental health services using this approach. The aim of the study is identifying key elements of this approach, processes involved in treatment, and barriers to its success, with the aim of contributing to the development of practice based integrated mental health care for the whole family. BACKGROUND Parental mental disorders have an impact on parenting and child development. To stop detrimental cascade effects and prevent parent and child from being caught up in the intergenerational transmission of psychopathology, an integrated family approach in mental health care is needed. Methods: A qualitative case study design using a grounded theory approach. Data were collected through 19 group interviews of professionals (N = 37) from adult and infant mental health teams who worked together in the treatment of a family. RESULTS Professionals from the two services were comfortable coping with complexity and felt supported to perform their treatments by staying in touch with each other in multi-disciplinary consultations. They indicated that by attuning the treatment components to each other and tailoring them to the capabilities of the family, their treatments had more impact. A flexible attitude of all involved professionals and commitment to the interest of all family members was essential. CONCLUSION According to professionals, treatment with an integrated family approach in mental health care is of value for families by addressing the distinct roles, positions and relationships, by implementing a flexible complementary treatment plan, and by empowering professionals by multi-disciplinary consultations.
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Affiliation(s)
- Hanna Stolper
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Karin van Doesum
- Department of Clinical Psychology, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Majone Steketee
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
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