Worker, workplace or families: What influences family focused practices in adult mental health?

WHAT IS KNOWN ON THE SUBJECT?: Family focused practice leads to positive outcomes for parents and children. There are barriers and enablers for practitioners being family focused. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Worker skill, knowledge and confidence about family work are the most important factors associated with family focused practices. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses require specific skill training in family focused practices, time to engage with clients on parenting issues and that there are adequate services to refer family members to. ABSTRACT: Introduction Family focused practice is thought to lead to positive outcomes for all family members. However, there are multiple barriers and enablers in adult mental health services to practitioners undertaking these actions. Aim The aim of this study was to examine the relative importance of worker, workforce and family factors to predict family focused practices (FFPs) in adult mental health services. Method Three hundred and seven adult mental health workers completed a 45 items family focused practice measure of 16 family focused practices. Thesis It was found that worker skill and knowledge about family work and an ability to assess the degree of parental insight into the child's connections to other family members and the community were important predictors of FFP, along with the closely related-worker confidence. While aspects of the worker, workplace and family each contribute to FFPs, this study highlighted the importance of worker skill, knowledge and confidence as central issues for adult mental health workers. Implications for practice Study implications include the need for training in specific FFPs, the provision of time to engage with clients on parenting issues and the need 5 to ensure that there are adequate services for workers to refer family members to.

Practitioners' experiences of working with families with complex needs.

Even though employing a family-sensitive approach has been shown to be beneficial for parents and children, there is sporadic uptake of this approach. This paper focuses on practitioners' perspectives when working with families where a parent, with dependent children, has a mental illness and/or substance abuse disorder. The aim of this research is twofold: (1) identify the issues practitioners face when working with families with complex needs; and (2) present the strategies they find to be effective in addressing family needs. Within the context of an organization that supported a family-sensitive approach, this study reports on 21 semi-structured interviews conducted over 15 months with 10 practitioners, as well as three focus group interviews with the same staff. Employing a qualitative framework, data highlighted the multifaceted nature of family problems, issues working with multiple agencies and problems associated with staff turnover. Successful strategies included working with the family on clearly defined and negotiated goals, focusing on family strengths and employing specific skills such as managing the sometimes competing needs of children and parents.

Training mental health promotion workers in programme evaluation.

In this paper, a programme to train mental health promotion workers in programme evaluation is described and evaluated. The programme is based on adult learning values, guidelines for programme evaluation training and the general principles of mental health promotion. Facilitated over 2 days, the programme also provided individual mentoring. Training was evaluated via a questionnaire immediately before and post training, and 6 months post training (n = 28, n = 18, n = 18). Additionally, individual interviews were used with seven participants and qualitatively analysed. Results indicate significant and sustained positive changes in knowledge, confidence and behaviour and while satisfaction reduced significantly at the six month follow-up, participants' level of satisfaction towards mentoring was consistent. Post training, participants reported a greater appreciation of the importance of evaluation planning and working collaboratively.

Programmes for parents with a mental illness.

Parents with a mental illness experience the same parenting stressors that other parents do, and at the same time need to manage their mental illness. However, few programmes are designed for parents who have a mental illness, with older children (as opposed to interventions for mothers with infants). This study identified the common components across six programmes developed for parents with a mental illness who have older children. Australian clinicians, responsible for six parenting programmes for those with a mental illness, participated in individual, semi-structured interviews, during 2008. Programme manuals and evaluation reports were also sourced. Analyses involved thematic analysis, inter-rater reliability and respondent validation. Data were organized in three main areas: (1) programme description (format, goals, length and participants' inclusion criteria); (2) theoretical framework (including clinicians' beliefs and evidence underpinning programmes); and (3) evaluation designs and methodologies. It was found that clinicians facilitated education and support via a peer intervention model for parents with various mental illness diagnoses, responsive to the needs of parents and in a time flexible manner. At the same time, clinicians found it difficult to articulate the theoretical framework of their programmes and employed mostly simplistic evaluation strategies.

Rural mental health workforce difficulties: a management perspective.

INTRODUCTION: The recruitment, retention and training of mental health workers is of major concern in rural Australia, and the Gippsland region of Victoria is no exception. Previous studies have identified a number of common factors in these workforce difficulties, including rurality, difficulties of access to professional development and training, and professional and personal isolation. However, those previous studies have often focused on medicine and been based on the perspectives of practitioners, and have almost ignored the perspectives of managers of rural mental health services. The study reported in this article sought to contribute to the development of a more sustainable and effective regional mental health workforce by complementing earlier insights with those of leading administrators, managers and senior clinicians in the field. METHODS: The study took a qualitative approach. It conducted semi-structured in-person interviews with 24 managers of health/mental-health services and senior administrators and clinicians working in organisations of varying sizes in the public and private sectors. Thematic content analysis of the transcribed interviews identified core difficulties these managers experienced in the recruitment, retention and training of employees. RESULTS: The study found that some of the issues commonly resulting in difficulties in recruiting, retaining and developing a trained workforce in rural areas, such as rurality (implying personal and professional isolation, distances to deliver service and small organisations) and a general shortage of trained personnel, are significant in Gippsland. Through its focus on the perspectives of leaders in the management of rural mental health services, however, the study found other key issues that contribute to workforce difficulties. Many, including the unattractive nature of mental health work, the fragmented administration of the mental health system, short-term and tied funding, and shortcomings in training are external to organisations. Interviewees indicated that these issues make it difficult for organisations to support personnel in ways that enhance personal and professional satisfaction and so retention and, in turn, the capacity to recruit new employees. Participants also highlighted issues internal to the organisation. The tensions that flow from the systemic forces require highly creative leadership to negotiate the numerous policy changes, diverse sources of funding, training regimens, worker cohorts and models of care. Managers must nurture the capacity of their own organisation to respond flexibly to the demands, by establishing a responsive culture and structure. They must also encourage the collaboration of their other organisations in their sub-regional grouping and the development of a regional sensibility. CONCLUSION: The approach taken by the study, particularly its focus on a management perspective, revealed that the difficulties experienced are the product of a core tension between a growing demand for mental health care, emerging specialities and technological advances in the field, and a diminished systemic capacity to support organisations in meeting the demand. Resolving this core tension is a key to the maintenance of a sustainable and effective workforce in Gippsland, and the role of management is crucial to that resolution.

Parental mental illness: a review of barriers and issues for working with families and children.

Many consumers of psychiatric services are parents, making these services the opportunistic point for supporting consumers' children. While evidence suggests that assisting such children improves their mental health, there is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This paper summarizes the constraining barriers and issues for the psychiatric workforce according to: (1) policy and management; (2) interagency collaboration; (3) worker attitude,skill and knowledge; (4) the parent-consumer; and (5) the consumer's family, including children. Potential solutions are presented, with a particular focus on the hierarchical nature of these barriers. Recommendations are made, including organizational audits to identify the most pressing barriers that impede family sensitive practice.

The negative event scale: measuring frequency and intensity of adult hassles.

This study examined the structure, concurrent validity, and reliability of a hassle measure for middle-aged adults in both event frequency and intensity recordings. The measure included a range of interpersonal day-to-day events and re-examined aspects of the primary appraisal confounding debate between Lazarus and colleagues (Lazarus, Delongis, Folkman, & Gruen, 1985) and Dohrenwend and Shrout (1985). Of the 373 participants, 73% were female, 72% were in paid work, 69% were in permanent relationships and 62% had children. Principal component analyses of separate hassle frequency and intensity scores highlighted components consistent with previous research. There were seven interpersonal and four non-interpersonal subscales associated with negative events with family and friends, work, health, money, and household. The subscales had very good reliability and concurrent validity and there were generally strong correlations (i.e. up .84) between frequency and intensity scores for each subscale. Given some important sampling limitations (e.g. female overrepresentation) the findings show a psychometrically sound hassle scale for adults.