An explanatory model of factors enabling sustainability of let’s talk in an adult mental health service: a participatory case study

Allchin, Becca; O’Hanlon, Brendan; Weimand, Bente; Boyer, Fran; Cripps, G; Gill, Lisa; Paisley, Brooke; Pietsch, Sian; Wynne, B.P.; Goodyear, Melinda

doi:10.1186/s13033-020-00380-9

Cited by 10 publications

(17 citation statements)

References 74 publications

(135 reference statements)

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“…Secondly, even though AMHS may appear the most natural fit for FT/FFP and provide a common context for the implementation of FFPs (45,48,49), families in this study reported benefits across both AMHS and CAMHS settings. FT is typically delivered as a preventive intervention to families whose children do not attend mental health services (14,15) but in this study, most of the child participants, including those who attended CAMHS, reported that FT had improved their well-being and family relationships.…”

Section: Discussionmentioning

confidence: 75%

“…As noted in previous qualitative studies, they felt that this had enabled all perspectives to be surfaced and heard, and improved mutual understanding and family relationships ( 32 – 34 ). Nevertheless, whole-family programmes appear to be less commonly delivered than parent-only models ( 48 , 49 ), most probably due to the additional buy-in and logistics required in involving children. Our findings suggest that without the involvement of the child(ren), parents may not become aware of their worries and burdens as demonstrated here by the surprise and alarm that parents reported when their children opened up during the FT sessions.…”

Section: Resultsmentioning

confidence: 99%

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The Family Talk Programme in Ireland: A Qualitative Analysis of the Experiences of Families With Parental Mental Illness

et al. 2021

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Background: Parental mental illness is common, costly, can lead to children developing mental disorders and impaired lifetime outcomes, and places a substantial burden on caregiving partners. Family Talk (FT) is a widely implemented, 7-session, whole-family programme, with promising evidence of effectiveness in targeting the intergenerational transmission of mental illness. However, to date, very little qualitative research of family experiences of FT has been undertaken. The objectives of this study were to: (1) investigate the experiences of families attending FT; and (2) explore the key facilitators and barriers to engagement in mainstream mental health settings.Methods: This study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] implemented in 15 adult, child and primary care mental health sites in Ireland. Semi-structured interviews were conducted with a purposive sample of 45 participants, including 23 parents with mental illness (PMI), 7 partners and 15 children/young people aged 9 to 18 years. Interview data were transcribed verbatim and analysed using constructivist grounded theory.Results: Over two thirds of families across sites reported substantial benefits from participation in FT, including reduced stigma, giving children and partners a voice, increased service-user confidence, and improved family communication/relationships. Key facilitators identified by families included: programme delivery by a competent, non-judgmental clinician; the whole-family approach; and family readiness to engage. Barriers to engagement included stigma, family crises/relapse, service constraints, impact of COVID-19, and a need for further child, family and follow-up sessions/supports.Conclusion: This study is the first qualitative analysis of family experiences of FT to be conducted within the context of an RCT and national programme to introduce family-focused practise for families with PMI. The findings illustrate that FT is beneficial across cultural/policy contexts, different mental disorders and can be implemented across adult and child mental health settings, including children with existing mental health challenges. Key barriers and facilitators to implementation were identified by families, all of which should help to inform the future implementation of FT, and other similar interventions, both in Ireland and elsewhere.

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Section: Discussionmentioning

confidence: 75%

Section: Resultsmentioning

confidence: 99%

The Family Talk Programme in Ireland: A Qualitative Analysis of the Experiences of Families With Parental Mental Illness

et al. 2021

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“…The model is drawn from a series of five mixed method studies exploring the sustainability of the family-focused practice, Let's Talk about Children (LTC) in eight AMHS in Victoria, Australia, involved in a RCT of LTC ( 52 ). The series of studies documented practitioner use and organizational capacity in the eight AMHS and developed an explanatory model of factors enabling sustainability in one AMHS ( 45 , 66 – 69 ). The research series used a participatory research approach working in partnership with change agents within AMHS across Victoria.…”

Section: Design and Methodsmentioning

confidence: 99%

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

et al. 2022

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BackgroundTranslating evidence-based practice to routine care is known to take significant time and effort. While many evidenced-based family-focused practices have been developed and piloted in the last 30 years, there is little evidence of sustained practice in Adult Mental Health Services. Moreover, many barriers have been identified at both the practitioner and organizational level, however sustainability of practice change is little understood. What is clear, is that sustained use of a new practice is dependent on more than individual practitioners' practice.Design and MethodDrawing on research on sustaining Let's Talk about Children in adult mental health services and in the field of implementation science, this article proposes a model for sustaining family focused practice in adult mental health services.Sustainability Model for Family-Focused PracticeAn operational model developed from key elements for sustaining Let's Talk about Children identifies six action points for Adult Mental Health Services and their contexts to support the sustainability of family-focused practices. The model aims to support Services to take action in the complexity of real-world sustainability, providing action points for engaging with service users and practitioners, aligning intra-organizational activities, and the wider context.ConclusionThe model for sustaining family-focused practice draws attention to the importance of sustainability in this field. It provides a practical framework for program developers, implementers, adult mental health services and policy-makers to consider both the components that support the sustainability and their interconnection. The model could be built on to develop implementation guides and measures to support its application.

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“…However, this type of service delivery is not as common in services who might be coming into contact with these parents and their families (15). In adult mental health, for example, a change to this type of service delivery is slow, as it is in conflict with the predominant medicalised individual client care model, and enhanced by limiting supportive administrative structures to encourage family focused practice (16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Development of an Evidence-Informed and Codesigned Model of Support for Children of Parents With a Mental Illness— “It Takes a Village” Approach

et al. 2022

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Providing support to parents and their children to help address the cycle of intergenerational impacts of mental illness and reduce the negative consequences for children is a key focus of selective prevention approaches in public mental health. However, a key issue for children of parents with a mental illness is the lack of access to early intervention and prevention support when needed. They are not easily identifiable (until presenting with significant mental health issues of their own) and not easily accessing the necessary support that address the complex interplay of parental mental illness within families. There are significant barriers to the early identification of these children, particularly for mental health care. Furthermore, there is a lack of collaborative care that might enhance identification as well as offer services and support for these families. The “It takes a Village” project seeks to improve mental health outcomes for children through the co-development, implementation and evaluation of an approach to collaborative practice concerned with the identification of families where a parent has a mental illness, and establishing a service model to promote child-focused support networks in Austria. Here we describe the development of service delivery approach for the “It takes a Village” project that aims to improve identification and support of these children within enhancements of the existing service systems and informal supports. The paper describes the use of codesign and other implementation strategies, applied to a research setting, with the aim of impacting the sustainability of workforce reform to achieve lasting social impact. Results highlight the steps involved in translating evidence-based components, local practice wisdom and lived experience into the “It takes a Village” practice model for Tyrol, Austria. We highlight through this paper how regional context-specific solutions are essential in the redesign of care models that meet the complex needs of children of parents with a mental illness. Service system and policy formation with local and experienced stakeholders are also vital to ensure the solutions are implementation-ready, particularly when introducing new practice models that rely on organizational change and new ways of practice with vulnerable families. This also creates a solid foundation for the evaluation of the “It take a Village” approach for children of parents with a mental illness in Austria.

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An explanatory model of factors enabling sustainability of let’s talk in an adult mental health service: a participatory case study

Cited by 10 publications

References 74 publications

The Family Talk Programme in Ireland: A Qualitative Analysis of the Experiences of Families With Parental Mental Illness

The Family Talk Programme in Ireland: A Qualitative Analysis of the Experiences of Families With Parental Mental Illness

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

Development of an Evidence-Informed and Codesigned Model of Support for Children of Parents With a Mental Illness— “It Takes a Village” Approach

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