Application of cognitive-behavioural family intervention for schizophrenia in multidisciplinary teams: What can the matter be?

Abstract

Cognitive‐behavioural family interventions for schizophrenia have demonstrated utility in reducing relapse rates and improving functional status, but there is little information on the routine application of this work. In the current study therapists in standard health care settings were trained in delivering a cognitive‐behavioural intervention to clients and families. Six months to 3 years after the family training, 45 therapists reported the number of families they had systematically treated, and the difficulties they had encountered. Sixty‐nine per cent reported giving three sessions or more of the intervention to at least one family, but only 18% had used it with three or more families. Therapists reported particular difficulty integrating the family work with their other responsibilities and interests: Allowance of time to undertake the intervention, afterhours scheduling, and illness or holidays presented particular difficulties. Only 4% reported that their knowledge of behavioural techniques was a significant problem, but in a written test most therapists did not display minimum recall of the material on cognitive therapy, social skills training, or behavioural strategies. Therapists also reported whether they had used segments of the intervention in their routine clinical contacts. Over 80% said they applied all segments of the intervention at least once a month, but the frequencies for cognitive and behavioural strategies fell below 40% when they were corrected for recall of the segments. This study demonstrated significant problems in disseminating cognitive‐behavioural approaches to multidisciplinary settings.

Implementing psychological treatment for symptoms of psychosis in an area mental health service: The response of patients, therapists and managers

“…In some respects this study mirrors the family training of Kavanagh et al (1993) and Fadden (1997), in which therapists incorporated only small amounts of the new therapy. Both studies suggest that the gap between the rhetoric and the reality of changing priorities needs to be addressed by mental health services.…”

“…Studies of the adoption of innovative therapeutic techniques by clinicians in the mental health field have sometimes been disappointing. For example, several family interventions have been consistently supported by research evidence, but have been difficult to implement widely (Fadden, 1997;Kavanagh et al, 1993). Kavanagh et al reported a very limited uptake of their CBT based intervention, despite intensive training.…”

Psychological Treatments for Psychosis: Evidence Based but Unavailable?

“…Further, Robertson and Hearnshaw (1998) point out that professionals are more likely to change their practice if not overloaded. In today's mental health services, staff are routinely expected to manage change with no additional time or resources allocated, so this may be another cause for delay (as shown by Kavanagh et al, 1993, andFadden et al, 1997). Both studies found that trained staff indicated that lack of time was a major reason for not implementing new interventions.…”

Family psycho-education for people with schizophrenia and other psychotic disorders and their families

“…International studies measuring rates of practitioner uptake of FPE (provided to individual families) indicate that the average number of families seen per practitioner is 0.9-3.5 in periods ranging from 1 to 3½ years post-training (Bailey et al, 2003;Brooker et al, 2003;Fadden, 1997;Kavanagh et al, 1993;Magliano et al, 2005Magliano et al, , 2006. Comparison of uptake between sites is difficult because of variation in service settings, target populations and the extent of implementation support, including engagement of management and training.…”