A Delphi survey to explore best practice for practitioners offering family intervention for psychosis to families with children

Abstract

Parents experiencing psychosis can face challenges in addition to those usually associated with being a parent, with their children at increased risk of negative outcomes. Although a strong evidence base has shown that family interventions for psychosis (FIp) can mitigate distress for adult relatives, techniques described in the systemic and parenting literature to facilitate the inclusion of children in family therapy are largely absent from the FIp literature and training. This study used a three-round Delphi survey to investigate what experienced FIp clinicians consider to be best practice regarding the inclusion of children in parental FIp. Findings demonstrated support for including children, with high levels of consensus regarding methods of facilitating their involvement, as well as organisational factors that would support this. The results have important clinical implications given that many FIp practitioners work with families, following brief psychosis specific training, without exposure to the broader literature.

Facilitating children’s in-session involvement in child and family therapies: A dynamic framework of clinical practices.

“…In other words, the type of management and workplace culture (cf. Diaz et al, 2019; Stige et al, 2021; Thompson et al, 2020) may provide practitioners with the skills and conditions necessary both to individualize treatments and to maintain fidelity to their key components—or not. Hence, practitioners’ possibilities to facilitate children’s involvement are not necessarily determined by factors they can easily control (cf.…”

“…Research indicating what practitioners can do to facilitate (or hinder) children's in-session involvement in child and family therapies are scattered, though less contradicting. Among the identified facilitators are the following: attending to children's experiences and exploring their motivation (Jungbluth & Shirk, 2009), properly explaining the treatment rationale (Ovenstad et al, 2023), using personal examples (B-C. Chu & Kendall, 2009), tailoring treatments (Stige et al, 2021), encouraging children to express themselves freely (Núñez et al, 2021), aligning with children and validating their challenges (O'Reilly & Kiyimba, 2013), integrating ones' approach with colleagues in child services (Thompson et al, 2020), using feedback systems (Lambert & Ogles, 2014), addressing children at their level, and using play to access their realities (Villeneuve & LaRoche, 1993).…”

“…While Ovenstad et al (2023) recently proposed that children who report a strong alliance are more involved in their therapies, Morris et al (2016) concluded that an affective bond between children and practitioners is not required for involvement to exist. Furthermore, the extent of organizational support, such as training and supervision, may provide practitioners with the conditions they need to facilitate involvement, or not (Thompson et al, 2020). Similarly, Stige et al (2021) found that managing the pull between system requirements and clinical judgements is the main gateway to adolescent involvement in psychotherapy initiated by adults.…”

Reconnecting systemic family therapy: How family therapy training can attend to the ecosystem and climate emergency, recommendations from a Delphi survey

“…There are a wide variety of approaches to implementing Delphi surveys and little consensus as to the most appropriate approach (Keeney et al, 2011). This study follows a commonly described format used by Thompson et al (2019). Round two survey (S2)…”

“…There is a range of definitions of consensus in Delphi studies (Von Der Gracht, 2012). Following Thompson et al (2019), in this study the Likert scale was collapsed into three categories of agreement, disagreement or neither, as shown in Figure 1.…”