Enhancing family focused practice in the voluntary and community sector in Northern Ireland using The Family Model

Why use The Family Model within the voluntary and community sector? Parental mental illness (PMI) is a global public health issue as it may negatively impact all aspects of children’s development (Beardslee et al., 2012; Mennen et al., 2015; Reupert & Maybery, 2016; Ruud et al., 2019). Conversely, children’s experiences and difficulties may impact parents’ mental health (Reupert & Maybery, 2016). Across the United Kingdom (UK), it is estimated that 10% of mothers and 6% of fathers have mental health problems at any given time (Mental Health Foundation, [MHF] 2016). Northern Ireland (NI) has currently got the highest levels of maternal mental illness within the UK (Abel et al., 2019); with one in four children, aged 0–16 years, exposed to maternal mental illness and 53% of children over 16 having a mother who has been diagnosed with a common (i.e. depression and anxiety) or severe mental illness (i.e. psychosis). To provide optimal support for both parents and their children it is recommended that services adopt a whole of family approach (Grant et al., 2018; Rudd et al., 2019). Family focused practice (FFP) is a method of care delivery that emphasises the family as the unit of attention. Increasing evidence suggests that FFP can “improve outcomes for the parent with mental illness, reduce the subjective and objective burden of care for families, and provide a preventative and supportive function for children” (Foster et al., 2012, p.7). There are also economic benefits in providing good quality parenting support and preventative interventions for the whole family (Moore et al., 2012). However, whilst many service providers wish to engage in FFP, they report barriers which include: knowledge and skills deficits in working with children, focussing on parenting and, and involving the whole family (Grant, Reupert, Maybery & Goodyear, 2018; Grant, Goodyear, Maybery & Reupert, 2016; Landeweer, Molewijk, Hem & Pedersen, 2017; Maybery et al., 2017 Reupert, Williamson & Maybery, 2017). Organizational or systemic factors may also significantly impede FFP. For instance, a lack of liaison between different services and sectors (e.g. child protection and adult mental health) is a significant barrier to working with families (Bellin, Osteen, Heffernan, Levy, & Snyder-Vogel, 2011) as is having inadequate resources, including training (Grant et al., 2018; Lauritzen, 2014). Several studies have found that service providers’ knowledge and skill (Grant et al., 2018; Grant 2014; Maybery et al., 2016), together with previous child and family focused training (Grant 2014; Goodyear et al., 2017) are the most significant predictors of FFP. When service providers report adequate knowledge and skills, they perceive fewer barriers to FFP and are more likely to engage in it (Grant et al., 2018; Grant et al., 2016; Korhonen et al., 2010; Maybery et al., 2016). Since 2009, the Think Family Northern Ireland (TFNI) Initiative has been introduced within statutory adult mental health (AMH) and children’s services to promote Health and Social Care Professionals’ (H&SCP) capacity to support families when parents have mental illness. This investment in FFP by the Health and Social Care Board (HSCB) (Donaghy 2014) has included The Family Model (TFM), which has been used at a broader policy/organisational systems level and to support H&SCP in their FFP, predominantly in statutory adult mental health (AMH) and children’s services. The Family Model provides a visual map of the six key areas (domains) relevant to an affected person’s experience of mental illness and her/his immediate relatives (Falkov 2012). This visual map/tool can be used by service providers, in collaboration with parents and their families to facilitate a family focused approach to service delivery (Falkov 2012; Weimand et al., 2017). The Family Model has also provided a theoretical basis for the TFNI initiative and it has supported early and ongoing planning, regional and local initiatives to improve family focused assessment, planning, treatment and communication (Donaghy 2014). Family focused practice is relevant to all mental health and children’s service sectors, including the Community and Voluntary Service (VCS). The VCS represents an important resource for both AMH and Children’s services and is recognised in the literature as such (Butler, Mc Laughlin, Hayes & Percy, 2018; Grant et al., 2018). As many of the services provided by the VCS are commissioned by the HSCB, they are required to adhere to legislation, Department of Health (DOH) strategies and good practice guidelines as it applies to families. There is therefore an increasing impetus to promote FFP amongst service providers within the VCS, who represent an important workforce component with significant potential to contribute to the necessary paradigm shift for FFP across all services. What did we do? The Health and Social Care Board’s ongoing commitment to the TFNI Initiative has supported further work, with specific focus on introducing TFM within the VCS to promote FFP. In July 2018, the HSCB allocated eight months funding to Children in Northern Ireland (CiNI) for adaptation of TFM, specifically for the VCS and delivery of a one-day training programme on the Model. This one-day programme was delivered, to 256 participants from 80 organisations, by trainers who had undertaken a two-day Train the Trainer programme on TFM. The two-day Train the Trainer programme, the first of it’s kind, was also funded as part of the initiative. The one-day training programme was evaluated by Queen’s University Belfast (QUB). The aim of the evaluation was threefold: 1) To examine participants’ perceptions of existing organisational support for FFP, 2) To explore their satisfaction with the one-day training programme on TFM and 3) To make recommendations for future training and organisational support for FFP. Leadership and high-level support was provided throughout by CiNI Executive and service user involvement occurred throughout the duration of the project. Key findings and recommendations Our recommendations are based on the following key findings and conclusions: • While service providers within the VCS appear to be well placed to support families, when parents experience mental illness, immediately prior to undertaking the one-day training programme on TFM, they were unsure about their capacity to engage in FFP. • There was a successful bespoke adaptation of TFM for use by Trainers with service providers in the VCS. • The vast majority of participants were very satisfied with TFM one-day training program (content and delivery), suggesting appropriateness for this service sector, including that it is feasible, appealing, usable and fits with existing approaches. • There was a significant participant wish for further training to consolidate learning and implementation of knowledge to practice. • Participants emphasized their support for scaling up TFM training and recommended training for all service providers within the VCS and for cross agency / discipline training. • Overall, findings highlight the opportunity for further consolidation of the TFNI Initiative, by broadening FFP reach into the VCS. This in turn will help to address the recommendations from the recent HSCB commissioned study on FFP for increased uptake and utilisation of TFM. Based on the findings of this current initiative, specific recommendations include the need to develop an implementation strategy/plan for targeting the VCS and other sectors of the workforce to: 1. Address ongoing barriers to FFP in all services, including the VCS. 2. Provide refresher training to consolidate and sustain skills for those who have undertaken the one-day training on TFM. 3. Provide training to all VCS staff, who have not undertaken the one-day training to promote uptake and utilisation of TFM and A5 version, including integrated cross sector/agency training. 4. Develop leadership and organisational support to embed TFM within the VCS; strategic (e.g. CiNI). 5. Operational (e.g. supervision; network support; use of TFM eLearning website www.thefamilymodel.com); 6. Ensure partnership and collaboration with service users at all stages 7. Facilitate access to and use of the eLearning foundation programme on TFM via the leadership centre. 8. Facilitate research to examine outcomes of using TFM for families and services.