Family-inclusive approaches when working with young people accessing mental health support
Legislation dictates how families should be included when young people legally regarded as a minor (under 18 years) access mental health supports. Common law and some state laws provide for children under 18 years to be able to consent to treatment if they have sufficient ‘maturity and understanding’.32 Legislation should be considered alongside the evidence and practice guidance outlined in this short article.
Understanding family context and appropriately including family members when providing mental health support to young people can improve engagement with services and increase overall wellbeing.1,2,3,4,5,6 Although practitioners often understand the benefits of family inclusion when working with young people, it can be challenging to balance a young person’s right to privacy with family-inclusion guidance.1,2,7,8,9 This short article describes family-inclusive approaches and outlines the evidence that supports practitioners to include families when working with young people accessing mental health support.
What are family-inclusive approaches?
Family-inclusive approaches support young people to include their family context and members in care assessments, planning and treatment when accessing mental health support.2,10,11 In mental health services, it’s recognised that the inclusion of family members is helpful for young people aged 12-25, particularly if they live with family.7 Evidence supports adopting a broad definition of family and listening to young people’s definition of who they consider ‘family’ and their key support network.3,7
Many terms are used interchangeably to talk about family-inclusive approaches (e.g., family-focused practice,3,12 family-centred practice and approaches13) with a lack of clarity on the level of family inclusion being described.4 Despite inconsistent terminology, all terms adhere to some common principles:3
- Whole-of-family context: Understanding family context and relationships is essential to supporting a young person’s mental health needs.
- Strengths-based perspective: Practitioners recognise that young people and their families have, and can develop, skills to support their mental health needs and recovery.
- Families can provide support: Family members are often a young persons’ closest social relationship. Young people can receive effective support through their family members.
- Communication and collaboration: Regardless of the level of direct family involvement with the approach, communication between practitioners, clients and their families should be collaborative and respectful.
- All families are unique: The culture and language traditions of each family should be respected and diversity across and within families should be appreciated.3,13,14
Family-inclusive approaches exist along a continuum, from acknowledging that young people’s lives occur in a broader social context to specific practices that include families in decision making or provide family members with direct support.3,5,12,13,15 Including family will look different for each young person and there may be instances when it is not appropriate to directly include family members due to safety concerns or unreasonable behaviour.33 Family-inclusive principles and approaches can support practitioners to consider a young person’s care within the broader family context without direct contact with family.24
Family-inclusive approaches for young people accessing mental health support
When accessing mental health support, young people’s right to privacy and participation in decision making can lead to practitioner concerns around confidentiality,1,2,7,16,17 and young people can feel worried about family reactions and stigma.1,7,16,17 However, Australian and international systematic reviews present strong evidence that understanding family contexts and including family with a client’s consent leads to positive outcomes in a range of health and welfare settings.4,6,18,19,20,21
In the context of young people accessing mental health support, small-scale Australian and international studies find that family-inclusive approaches can improve a young person’s quality of life,1 reduce levels of anxiety,22 reduce relapse rates,3,15 and increase carer capacity and understanding.15,16 However, a recent UK and Australian systematic review highlights that consistent quality assessment is needed across adolescent mental health services generally to better evaluate the effectiveness of approaches.17 Better evaluation can support practitioners to understand which family-inclusive approaches are most effective when working with young people.
Australian and international evidence supports the following family-inclusive approaches when working with young people accessing mental health support. These approaches are not mutually exclusive and can overlap but are all underpinned by family-inclusive principles.3
|Family-inclusive approach||Details||Supporting evidence|
|Psychoeducation for family members||Psychoeducation provides mental health information to family members to support their understanding of the young person’s mental health challenges, including building support skills and learning how to manage their own stress and mental health.3,6,12,13 This can be general information or specific to a young person’s diagnosis or treatment.3 While there is strong evidence for using psychoeducation as part of a family-inclusive approach,6,16,23,24 some practitioners report that it can be time consuming to implement.5||3,4,6,10,12,22,23,24,25,28|
|Instrumental, emotional and social support for family members||Foster et al. (2016) identified that families can benefit from instrumental (practical support; e.g., help with referrals), social (support to expand social networks), and emotional support (being empathetic towards family members) when a service user is experiencing mental health challenges. These types of support can encompass a range of practices where help is provided directly to family members, not via the service user.3||3,4,6,16,25|
|Coordinated care between families and mental health support||Coordinated care, sometimes referred to as integrated care, is inherently collaborative between services, young people and their families. This means that services see young people and their families as important members of the ‘team’. Specific examples include ‘Wraparound’ services or a ‘warm handoff’ between services.3,6||3,4,6,15|
|Information sharing between family and services||Information sharing is a two-way process where practitioners provide information about a young person’s diagnosis and treatment to families, and families provide information about their family context to practitioners. This has been identified as an important practice for assessing suicide risks in clinical settings.18||4,8,18|
|Family care planning, including goal setting||Family care planning considers family members in the development of a young person’s care plan, helps family members understand how to contribute to a young person’s care plan and how to respond in a crisis. Families also set their own goals to support a young person’s recovery and consider their own mental health.3||3,4|
|Single Session Family Consulting||Single Session Family Consulting (SSFC), developed by The Bouverie Centre, is a brief intervention where practitioners meet clients and family members together for 1–3 sessions to collaborate on how they can be included in a young person’s treatment, assess needs, answer questions and provide information.1,5,26,27 Brief interventions such as SSFC may not be suitable for managing more complex mental health presentations; for example, young people with psychosis, disruptive behaviour problems or acute crisis.27,28||1,5,10,26,27,30|
|The Family Model||The Family Model (TFM) is a framework that supports practitioners to implement family-inclusive practice.29 TFM helps to understand the connections and relationships within families and between families and services using diagrams.29 An Australian study recently explored TFM with child mental health service practitioners and found that practitioners reported better understandings of family relationships and challenges when using TFM.29,30||2,29,30|
|Family assessment||Family assessment supports practitioners to understand a young person’s family context. It can include mapping a young person’s relationships or genograms.7 The assessment can be carried out with the young person over multiple sessions by asking questions about their family context and relationships. Assessments can also be carried out with family members to support understanding of parenting skills, mental health literacy and the effect of mental illness on the family.3,7||3,7|
What are the evidence-based implications for practice?
The following considerations have been shown to support the implementation of family-inclusive approaches:
It is not necessary to include families in every aspect of a young person’s treatment.3,9 Practitioners can provide general information to families on how to support people’s mental health without providing personal information.3,10 Discussing partial consent and regularly reviewing agreements with young people can support family inclusion and build trust, while acknowledging potential privacy concerns.3,7
A person-centred approach places the young person, their choices and strengths at the centre of the approach.4,16 Person-centred approaches can support family-inclusive approaches,16 empowering young people to communicate their desired outcomes and make decisions about their treatment, including levels of family inclusion.1,4,6,16
Workforce education and training
Training courses for practitioners can increase staff confidence and competence in selecting and delivering family-inclusive approaches.3,4,15 Sawrikar and colleagues (2021) found that providing training on family engagement led to an increase in practitioner confidence and ability to include fathers who are often excluded from family-inclusive approaches and treatment interventions.31
Organisational culture and policies
To effectively implement family-inclusive approaches, practitioners need support from an organisation’s culture and processes.8,15,29 Updating organisational policies to encourage and reflect family-inclusive principles can help implement consistent practice; for example, including policies around flexible appointment times after school and work hours.3,6 Practitioners also need sufficient time and resources to be able to engage family members effectively.10
Online services and telehealth
Online or telehealth support can provide accessible opportunities to deliver family-inclusive approaches, such as instrumental support.6,24,28 Single session family consulting follow-up phone calls with families have also been shown to be beneficial.5
Australian and international evidence shows that when family is included meaningfully in a young person’s care planning and treatment, it can lead to positive outcomes for service users and their families.1,2,3,4,5,6 When young people are supported to include their family, it can lead to a higher likelihood of continued treatment, reduced rates of relapse, reduced anxiety, improved satisfaction with care and increased overall wellbeing.1,2,3,15,22
Further reading and related resources
Family and friends inclusive practice handbook
This handbook by headspace provides guidance on how to provide family-inclusive practice, including how to talk to young people and their family about family inclusion.
Family inclusion in mental health and related areas
The Bouverie Centre develops practice models, training, and resources to support services to understand and implement family-inclusive practices.
A practical guide for working with carers of people with a mental illness
This guide by Mind Australia provides practical guidance on how to work with families of people with a mental illness.
Fact sheet – Infant child and youth mental health and wellbeing services
The Royal Commission into Victoria’s Mental Health System provides a fact sheet on Infant, child and young mental health and wellbeing services including recommendations for best practice.
Single Session Family Consultation
This website by The Bouverie Centre provides information on ways to implement Single Session Family Consultation.
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