Development of family interventions: a 9-month pilot study

Abstract

This article outlines the introduction and development of a team of like-minded people utilizing family interventions (FIs) in a NHS Trust. FIs can be described as therapy sessions for families of people experiencing psychosis, which involve the family, client and therapist. The sessions focus on key elements, such as engagement and assessment, psycho-education, communication skills, problem-solving and relapse prevention. Through this focus, problems are analysed and ultimately the interventions are decided and agreed upon. The analysis of the team utilizing FIs in a NHS Trust raises many questions, identifies problems encountered in its conception and highlights managerial difficulties that occurred when trying to balance caseload demands and something envisaged as resource- and time-hungry. The Trust, however, views FIs as one of the ways of addressing part of the National Institute for Health and Clinical Excellence (2002) guidelines, Schizophrenia: Core Interventions in the Treatment of Schizophrenia in Primary and Secondary Care, and lately, Organising and Delivering Psychological Therapies (Department of Health, 2004), and are keen to improve the quality of the service user and carer experience.

Implementing family involvement in the treatment of patients with psychosis: a systematic review of facilitating and hindering factors

“…Overwhelmingly, staff reported on the practical burdens of family work: that it requires time, resources and funding and is difficult to integrate with other clinical casework, 62 64–70 73 75–87 particularly in areas with high demands and clinical crises. 73 82 83 Specific needs reported for family work included flexible hours 64 65 67 70 80 82–84 87–90 and the accommodation of family requirements such as childcare facilities 80 or home visits. 82 89 91 A lack of systems and structure for carrying out and recording family work was also reported as a barrier to implementation and problem during delivery.…”

“… 82 89 91 A lack of systems and structure for carrying out and recording family work was also reported as a barrier to implementation and problem during delivery. 63 87 92 This included a lack of coordination between inpatient and outpatient care. 62 These issues were compounded by reports of services and managers not making time allowances for family work, for example, not providing time in lieu for out of hours work, 64 65 77 83 84 or obstructing time use, for example, by refusing the release of staff for training.…”

“…Commonly, staff reported on the unsupportive attitudes of managers and colleagues as limiting the implementation of family involvement. 63 64 66 77–79 87 92 93 This ranged from a ‘management culture of benign neglect rather than of active opposition’ 93 to overt challenges such as not respecting ring-fenced time for family work. 87 The strongest facilitator seemed to be that of strong leadership through senior management support and developing strategic solutions.…”

“…63 64 66 77–79 87 92 93 This ranged from a ‘management culture of benign neglect rather than of active opposition’ 93 to overt challenges such as not respecting ring-fenced time for family work. 87 The strongest facilitator seemed to be that of strong leadership through senior management support and developing strategic solutions. This ‘sanctioned’ family work, giving it core priority status within the service, 64 and could facilitate specific powerful initiatives such as writing family work into business plans, policies and job descriptions of all staff.…”

The implementation of the NICE guidelines for schizophrenia: Barriers to the implementation of psychological interventions and recommendations for the future

“…There is increasing focus on the role of service recipients in facilitating the implementation of evidence‐based guidance. This often involves increasing public awareness of guidelines, presumably in the hope of encouraging people to asserting their own rights to treatment (Michie & Lester, 2005; Paton & Esop, 2005). Fadden (2006) also discusses the importance of empowering service users and families to assert their rights to access psychological interventions via advocacy groups and recognizes the role of these groups in contributing to the successful implementation of interventions.…”