The Safety First Assessment Intervention: A Whole Family Approach for Young People with High Risk Mental Health Presentations

The following article provides a comprehensive guide to the clinical implementation of the Safety First Assessment Intervention (SFAI). The SFAI is a systemised, whole family approach for young people with high‐risk issues presenting in a mental health crisis. It is underpinned by the Safety First Model (Bickerton et al., 2007 ) and promotes community‐based care. The SFAI operationalises the foundation levels of the Safety First Model (SFM) through a highly structured clinical process. It draws on family systems theory, predominantly the work of Bowen ( 1978 ), to conceptualise distress through a multi‐generational systems lens and to prioritise the young person's natural support system (their family, friends, school and community) as their key resource. The SFAI engages this natural support system and facilitates open communication about symptoms, distress, safety and risk. This promotes a shared understanding of the key issues in a relational context and forms the basis of collaborative risk management. Thus, a system of safety emerges prioritising the family's role in optimising the young person's community‐based recovery. The need for pharmacotherapy and hospitalisation is therefore minimised. The article includes background theory, an outline of the structured assessment intervention and clinical techniques, including strategies for complex family situations. Specific strategies are illustrated with fictional vignettes. The work is based on the authors' accumulated experiences of working with young people and their families and carers in an acute Child and Adolescent Mental Health Service (CAMHS) for over a decade.     

From ‘public health’ to ‘safeguarding children’: British health visiting in policy,practice and research

This study examines the location of British health visiting in contemporary policy discourses concerned with public health and safeguarding children. It argues that professional identity and orientation can be understood through health visiting’s long history of public health work with children and families, which has included an engagement with protecting children. The expansive safeguarding children agenda, which includes the requirement to undertake a progressive universal approach to service provision and which incorporates a broad concept of risk and requires early intervention, has created tensions, particularly given current workforce constraints. The location and visibility of British health visiting in the academic and practice worlds also shape how the profession is understood.     

Safety First: A Model of Care for Working Systemically With High Risk Young People and Their Families in an Acute CAMHS Service

The following article outlines the Safety First Model for working with high‐risk young people in crisis. This hierarchical model prioritises emotional and physical safety by using multi‐systemic and family‐based interventions. A typical case example is used to illustrate the model and the structures and strategies employed at each level. The intervention model empowers families, facilitates their connections with other providers, and minimises the need for hospital admissions. The model also promotes collaborative and systemic practice in a child and adolescent mental health service.     

‘Somebody Else's Roadmap’: Lived Experience of Maudsley and Family‐based Therapy for Adolescent Anorexia Nervosa

The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.     

Intimate Partner Violence and Social Relational Theory: Examining the Influence of Children and Important Others on Mothers' Transition Out of Violent Relationships

Interviews with survivors of intimate partner violence were conducted to gain information on the transition from violent relationships to new non‐violent relationships. A subset of this data was re‐analysed using Social Relational Theory to gain further insight into the roles of children and important others who were identified as impacting this transition for mothers who had exited violent relationships. This paper reviews two major themes discovered during the SRT analysis that were inherent in the women's experiences: (i) agency of children, family, peers and community and (ii) power. In addition, this paper suggests implications for research, intervention and psychotherapeutic practice.     

‘A Chance to Stand Back’: Parenting Programmes for Parents of Adolescents

Parenting interventions were an important feature of New Labour’s policies to combat social exclusion. This paper critically examines parenting programmes for families with adolescents, assessing national and local policy aims against the perspectives of women who took part in a parenting course, which was the subject of a local evaluation. The paper argues that, while there were important positive outcomes for the participants, the high levels of unmet need which women reported reflect important disparities between the aims of the intervention, the level of service provision, and the needs and concerns of mothers and grandmothers.     

‘..It takes a lot of brain space’: Understanding young carers’ lives in England and the implications for policy and practice to reduce inappropriate and excessive care work

This qualitative study, undertaken in England, explored young carers’ perspectives on the nature of their caring responsibilities. The findings are significant, particularly in the context of England's Care Act 2014, which seeks to prevent children engaging in ‘excessive’ or ‘inappropriate’ caring. Our research placed children at the heart of the debate on what constitutes appropriate care. The findings raise key questions regarding effective implementation of contemporary child policy, duties of care towards children in caring roles and priorities for child protection and family support policy and practices, with the potential to inform thinking around child's well-being in wider contexts.     

Self‐Soothing — A Recursive Intrapsychic and Relational Process: The Contribution of the Bowen Theory to the Process of Self‐Soothing

The concept of self‐soothing originating in the psychodynamic tradition has attracted interest from therapists as a key skill in the managing and regulating of strong affect and emotional discomfort. While a capacity for self‐soothing is implicit in, and a vital prerequisite to, the process of differentiation, Murray Bowen also predicted that the outcome of increased differentiation is improved emotional equilibrium and a capacity for self‐soothing, clearly a recursive process. The attention of Bowen family systems theory to both the relational and intrapsychic aspects of human functioning provides a useful framework through which to explore these aspects of the dynamics of self‐soothing. This article describes some of the key processes involved in developing a self‐soothing capacity within an effort to define a more autonomous self in significant relationships. The author contrasts Family Systems thinking with other theoretical perspectives that speak to the importance of self‐soothing. Finally, the role of the therapist as a facilitator of an environment in which the self‐soothing resources of clients can emerge is considered alongside suggestions and strategies for how a therapist may contribute to a client's own efforts.     

Adolescents’ Perspectives on Personal and Societal Responsibility for Childhood Obesity — The Study of Beliefs through ‘Serious’ Game (PlayDecide)

The dominant approaches to public health policy on childhood obesity are based on the neoliberal emphasis of personal choice and individual responsibility. We study adolescents’ (N = 81) beliefs about responsibility for childhood obesity as a public health issue, through an innovative participatory method, PlayDecide, organised in two countries: the UK and Spain. There is no evidence of a blanket rejection of individual responsibility, rather, a call for renegotiation of the values that inform adolescents’ food choices. The findings suggest the need to broaden the framing of obesity‐related policy to go beyond the nutritional paradigm and include other values that signal health.     

Like a Parent and a Friend,but Not the Father: A Qualitative Study of Stepfathers’ Experiences in the Stepfamily

Research about the experience and position of stepfathers in stepfamilies is scarce. Using data from semi‐structured interviews with eight stepfathers, we aim to explore how stepfathers experience family life and their relationships with their (step)children and extended family members (biological father and grandparents), as well as how they describe their position within the stepfamily. Interpretative phenomenological analysis revealed three main themes: most participants saw themselves ‘like a parent and a friend.’ While none of them considered themselves as ‘the father’ – this position being assigned to the biological father – they described acting like a parent or a father figure in their relationships with the children. Secondly, despite some difficulties in the initial stages of formation of their new families, most participants described a positive evolution over time and were satisfied with their current family situation. Thirdly, the stepfather's positioning towards non‐cohabiting family members such as the biological father and grandparents added complexity but was managed well. Research findings are discussed in light of the current family therapy literature on working with stepfamilies.     

‘Now,We Have the Same Rights as Men to Keep Our Jobs’: Gendered Perceptions of Opportunity and Obstacles in a Mexican Workplace

Drawing on extensive qualitative data at a Mexican‐owned multinational corporation, this case study investigates professional employees’ perceptions of changes to a prohibitive work policy requiring women to quit working upon marriage and having children. Employees believed the policy change meant working women were valued employees, but how this translated into opportunity highlighted distinct views of the types of positions professional women could occupy at the company, reinforcing sex‐segregated job allocation. Whereas women's narratives pointed to cultural resistance, men's narratives attributed the dearth of women in higher level positions to their lack of professionalism and commitment to work. The work policy change only guaranteed the right for women to work as the company modernized to fit the neoliberal demands of the global marketplace. Now women faced the challenge of turning that right into career advancement in a traditionally masculine‐defined company. I argue that even with the policy change, gendered discourses on women in professional occupations constructed and maintained gender inequities in the workplace. This study contributes to the scholarly discussion on gendered discourses within the context of global restructuring by showing how mechanisms at work maintain gender inequity in the workplace.     

‘A Pest to Society’: The Charity Organisation Society's Domiciliary Assessments into the Circumstances of Poor Families and Children

This article examines the work of the Charity Organisation Society (COS) in assessing applications for children's admission to care in the late nineteenth‐century. It is based on an archive study of records kept by the ‘Waifs and Strays’ Society in England and Wales between 1882 and 1899, in particular 270 family assessments conducted by the COS. The focus was on parental behaviour rather than children's needs, with a strong narrative of taking children away to relieve parents of a burden. The research illuminates contested assumptions about childhood in the period, with resonance for current issues in policy and practice.     

A Social Constructivist Perspective on the Potential Relevance of Selected DSM‐5 Disorders for South African Children and Youth

In South Africa, careless implementation of child psychiatry's biomedical model of ‘mental disorder’ could stigmatise children and youth who have been made vulnerable by the lingering effects of apartheid — poverty and malnutrition, violence and abuse, and the HIV/AIDS pandemic. A focus on DSM‐5 category changes — regarding post‐traumatic stress disorder and ADHD — demonstrates that these psychiatric labels are impracticable and irrelevant in a post‐colonial developing country, where mental health care is delivered in the context of scarce services and unequal access. A social constructivist perspective enables us to broaden policy decisions and suggest directions for research.     

‘Tell Me and I Forget,Teach Me and I May Remember,Involve Me and I Learn. And That's What It's About.’ How a Co‐design Methodology is Used in the Delivery of Parents Building Solutions: A Qualitative Study

There are many parenting programs delivered in Australia and Parents Building Solutions (PBS) is one of these. Collaboratively designed by Parentzone staff of Anglicare Victoria, it has a twenty year history of building the evidence base. PBS stands apart from other programs because parents actively co‐design the sessions and content with skilled facilitators. Understanding the drivers, processes and practices that make the co‐design methodology work, is fundamental to the implementation science that underpins the program.This study aimed to examine the way co‐design was used in the delivery of PBS, specifically looking at program implementation and outcomes. Focus groups and interviews were conducted with Parentzone staff (team leaders and facilitators) and parents who had recently completed a program. Ethics approval was provided and analysis was conducted using NVivo software with co‐design as the unit of analysis. Three major themes about co‐design were present across team leaders, facilitators and parents: 1) responsiveness and flexibility are central to the functionality of co‐design within PBS; 2) facilitators implement the co‐design methodology using a suite of knowledge and skills; and 3) parents report tangible results from participating in a co‐designed parenting program. There was an overwhelming appreciation from both facilitators and parents about the co‐designed implementation style. Facilitators and team leaders highly valued the flexibility of the program which enabled their ability to respond to parent's needs. Furthermore, parents believed they achieved tangible outcomes derived from strategies and support delivered in the program. The co‐design methodology used in PBS was evident for all stakeholders and was a driver of program implementation and its outcomes. The methodology described in this has practice implications for family therapists and others who work directly parents and families.