The implementation of family‐focused practice in adult mental health services: A systematic review exploring the influence of practitioner and workplace factors

Abstract

There is increased recognition of the need for greater and more appropriate support to be offered to families in which a parent experiences mental illness and has dependent children. One way of meeting this need is for adult mental health services to take a more familyfocused approach. However, there are recognized difficulties in facilitating family-focused practice (FFP). The current review systematically synthesized quantitative and qualitative literature of practitioner perspectives and experiences of FFP in adult mental health settings to identify modifiable factors associated with its successful implementation. Five databases were searched systematically leading to the inclusion and quality assessment of 19 papers, ten of which were quantitative and nine qualitative. Analysis was guided by a narrative synthesis approach. Factors shown to influence FFP functioned at both practitioner and workplace levels and included personal attitudes, beliefs about job role, and perceptions of workplace support. Practitioners who felt that a family-focussed approach was inappropriate or detrimental to service users or outside of their remit as mental health professionals were less likely to adopt this approach. For those who saw the potential benefits of FFP, lack of confidence in their ability to deliver such an approach and lack of training can be barriers, as can lack of support and resources within services. This review highlights the need for actions to boost the awareness of adult mental health practitioners working with parents and to increase their confidence. It also makes the case for broader organizational support if family-focussed practice is to be implemented successfully.

A Sustainability Model for Family-Focused Practice in Adult Mental Health Services

“…To understand the lack of use of evidence-based family-focused practice in AMHS, research efforts have explored barriers at the practitioner and organization level. Inadequate family-focused training has been identified at the practitioner level, as has a lack of the necessary knowledge, skills and confidence in family-focused practice, limiting their ability to identify and support the parenting role of their clients while also holding their clients' children in mind ( 31 – 39 ). These barriers are reinforced by organizational contexts that do not routinely identify their client's parental status ( 29 , 40 – 42 ) and are funded to work with individuals within a biomedical professional-centered approach that is focused on treatment in acute episodic care ( 10 , 11 , 20 , 43 ).…”

Clinical Implementation and Evaluation of Three Implementation Interventions for a Family-Oriented Care for Children of Mentally Ill Parents (ci-chimps): Study Protocol for a Randomized Controlled Multicenter Trial

“…Because of the knowledge and the increasing awareness that children of mentally ill parents are an important target group to be addressed by preventive interventions, there are numerous programs and tools (10,11). But there is often a lack of structured implementation of family-oriented interventions in clinical practice not only in Germany (10)(11)(12)(13). Implementation can be defined as a specified set of activities designed to put into practice an activity or program of known dimensions (14).…”

“…Personal attitudes like self-reported skills and knowledge, beliefs about job role, and perceptions of workplace support seem to have a notable impact in supporting a successful and sustainable implementation (11,(16)(17)(18)(19)(20). Furthermore, organizational factors, such as reporting systems, meeting structures, leadership and supervision, are closely associated with satisfaction with the implementation process (11,17,(19)(20)(21).…”

“…They subclassify practitioner factors in personal attitudes like beliefs about family-oriented practice and professional subfactors like training and education, job role, skills and knowledge. Workplace factors were subclassified in service-related subfactors e.g., available resources and work setting and support-related subfactors like workplace support and time and workload ( 11 ).…”

What about the children? Adult mental health practitioners' experiences and views of family‐focused practice in Early Intervention Services

“…Foster et al (2016) identified six core practices of FFP: (1) family care planning and goals setting, (2) family and service liaison, (3) individual and family‐focused support, (4) individual and family‐focused assessment, (5) psychoeducation and (6) a coordinated system of care between families and services. Reviews have noted a lack of consistency in how FFP is implemented (Acri & Hoagwood, 2015; Foster et al, 2016; Gregg et al, 2021; Marston et al, 2016; Reupert et al, 2018; Smith et al, 2020), and there are persistent barriers to FFP delivery (Lauritzen et al, 2018; Leenman & Arblaster, 2020; Maybery & Reupert, 2009; Radley, Barlow, & Johns, 2021; Radley, Johns, et al, 2021; Reedtz et al, 2019; Strand & Rudolfsson, 2018). These barriers include insufficient organisational policy, management and resources, deficits in practitioner knowledge and skills, and factors associated with individual families, such as socio‐economic status and ethnic‐cultural traditions (Eassom et al, 2014; Grant et al, 2019; Gregg et al, 2021; Hoff & Laursen, 2019; Maybery & Reupert, 2009; Sin et al, 2017).…”