Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

The Mental Health Advantage of Immigrant‐Background Youth: The Role of Family Factors

Children of immigrant background, despite problems with acculturation, poverty, and discrimination, have better mental health than children of native parents. We asked whether this is a result of immigrant families' characteristics such as family structure and relations. Using a new comparative study on the integration of immigrant‐background youth conducted in England, Germany, the Netherlands, and Sweden (N = 18,716), particularly strong associations with mental health (internalizing and externalizing problems) were found for family structure, family cohesion, and parental warmth. Overall, half of the advantage in internalizing and externalizing problems among immigrant‐background youth could be accounted for by our measures of family structure and family relations, with family cohesion being particularly important.     

Work,Family, and Mental Health: Testing Different Models of Work‐Family Fit

Using family resilience theory, this study examined the effects of work‐family conflict and work‐family facilitation on mental health among working adults to gain a better understanding of work‐family fit. Data from the National Survey of Midlife Development in the United States (MIDUS) were used to compare different combinations of work‐family conflict and work‐family facilitation. Results suggest that family to work facilitation is a family protective factor that offsets and buffers the deleterious effects of work‐family conflict on mental health. The results across these outcomes suggest that work‐family conflict and facilitation must be considered separately, and that adult mental health is optimized when family to work facilitation is high and family to work and work to family conflict is low.     

Caregivers' Endorsement of Barriers to Mental Health Services for Children and Youth in Child Welfare

The purpose of this study was to examine the three most common types of caregivers in the child welfare system (birth parents, relative caregivers, and foster parents), an active child welfare case, caregivers' endorsement of barriers to mental health services and mental health service use by caregivers for the children under their care. The sample consisted of 430 dyads (caregivers and their children). Results indicate that an active child welfare case, provider characteristics, and accessibility of services predicted mental health service use for children. Implications for the child welfare and mental health systems are discussed.     

A Child‐inclusive Family Intervention in a Community Adult Mental Health Service

In this paper we describe an intervention that focuses on the needs of children in families where a parent has a mental illness and attends a community adult mental health setting. After a brief outline of the literature, we present a family approach that includes children and young people, their parents and grandparents. Case studies then illustrate the work as a ‘best practice’ for parents who are clients in community adult mental health services.     

Dialogical Research in Supervision: Practical Guidelines from Experienced Supervisors in Family Therapy,Child Protection,and Specialty Mental Health Services

This two‐year qualitative participatory research project examines practical guidelines for supervision. Sixteen experienced supervisors across professional settings of family therapy, child protection, and specialty mental health services in the geographical regions of Northern Norway and Northern Sweden outline four main practical guidelines in supervision based on their supervisory practices: (1) elaborating an agreed‐upon contract; (2) exploring potential formats; (3) exploring contents; (4) acknowledging responsibility for process and dilemmas. Participants summarised how they generated mutual growth in supervisory relationships, while being respectful of the first‐person perspective of supervisees. The study challenges pre‐dominating guidelines about deficit‐ or developmental stage‐oriented supervision. It illustrates reflecting processes and a polyphonic orientation in supervision by welcoming diversity, wondering, and tolerance for the not‐yet‐decided among involved persons in a mutual exploration and calibration of relevant knowledge. It outlines a dialogical research for sharing, exploring, and questioning knowledge as beneficial for whom, told by whom, and evaluated by whom.     

Engaging with Parents in Child and Adolescent Mental Health Services

This paper asks the question: How can child and adolescent mental health clinicians constructively engage parents as a resource in the young person's treatment? It draws from qualitative research data that explore parents' experience of their involvement in their adolescent's mental health treatment program. The paper especially focuses on challenges for clinicians in engaging with parents as part of the treatment program for young people. Clinicians' input about their perceptions of interacting with parents is utilised alongside parents' experiences of their involvement in clinical processes. The clinician data revealed key challenges were managing their reactions to parent defensiveness; broadening the focus from just alleviating symptoms in the young person; not taking sides with the young person; and resisting becoming an expert instructor. The paper discusses Murray Bowen's original family research about engaging parents in treatment with the symptom bearer and addresses how clinicians can build a positive alliance with parents that avoids blame while constructively opening exploration of the family relationship process as part of a collaborative approach.     

A Mixed Methods Exploration of Single Session Family Therapy in a Child and Adolescent Mental Health Service in Tasmania,Australia

Single session therapy (SST) is grounded in the belief that clients and families can effect change after one therapeutic encounter, using their own resources, with brief support and assistance from therapists. SST has been found to be an effective intervention for children, young people, and their families presenting with a wide range of difficulties. Research in child and adolescent mental health has shown that over 50% of families find one SST encounter is enough with no need for further specialist input. This study aims to explore family member experiences of SST (undertaken as single session family therapy and termed hereafter SSFT) as an initial intervention in a regional child and adolescent mental health service (CAMHS), specifically in terms of worry, confidence, and satisfaction outcomes. An exploratory, mixed methods convergent design was utilised using a combination of open questions and Thurstone scales. All eligible family members were invited to complete questionnaires before and after the SSFT, asking about level of worry, confidence, and overall satisfaction with SSFT. Quantitative and qualitative findings indicated most family members had a positive experience of SSFT, although differences were found between young people, parents, and siblings. Overall, family members’ level of worry decreased, while only parental confidence in managing the presenting issue(s) increased. Over half of the families did not require further contact with CAMHS following the SSFT. Our findings support previous research that SSFT is an effective, family-inclusive, and well received intervention for a variety of mental health issues facing children and young people. SSFT could be considered a beneficial and well received first response for the majority of CAMHS clients, which prioritises a family-inclusive approach. Future research could focus on attaining a more in-depth understanding of individual family member experiences with a view to improving SST delivery.     

Youth with Serious Mental Health Disorders: Wraparound as a Promising Intervention in New Zealand

Youth with serious mental health disorders present with a complexity of challenges for the mental health system, schools, youth justice, care and protection, and their communities. Research shows their needs are best achieved by providing coordinated intensive, multidisciplinary, and individualised services. This article outlines the prevalence and characteristics of youth with serious mental health disorders. It also discusses community‐based interventions used in New Zealand and their limitations. It introduces Wraparound, an intensive individualised coordination and care planning process as a promising practice for youth with serious mental health disorders and their families. Key principles and phases underpinning the Wraparound process are presented along with a case vignette to exemplify the process. Its theory of change, the challenges experienced in practice, and a brief overview of the evidence‐base are also discussed.     

Case‐Based Research in Family Therapy

Traditionally, case‐based research has not been considered as scientific by many in the field due to the lack of controlled conditions and objectivity. However, case‐study material may be more effective than once believed in educating family therapists. Future implications of the role of case studies in family therapy research are considered, including the manner in which case studies might be designed to be more rigorous so that they can serve as the basis for drawing causal inferences in clinical cases, and at the same time, provide family therapists with useful information to improve their skills. A discussion section highlights the future direction of case‐based research in the family therapy literature and how it may be used as an effective learning tool.     

Social Support and the Mental Health of Family Caregivers: Sons and Daughters Caring for Aging Parents in Japan

The prevalence of depressive symptoms among family caregivers has been documented as a serious social problem that could threaten the lives of the elderly and their family caregivers. Social support is considered to be a promising remedy for this problem, although a comprehensive examination of the availability and effectiveness of social support that includes both formal and informal support across multiple dimensions remains limited. In addition, little research has been conducted in Japan on gender differences in stress processes. This study tried to fill those gaps by analyzing recent survey data on sons and daughters who are caring for their elderly parents. The results indicate that sons and daughters have similar levels of formal and informal support for daily care and advice, while there are some gender differences in regard to the availability of other types of social support. It was also found that many types of informal support were significantly associated with a lower caregiver burden for daughters, although this was not necessarily the case for formal support. General instrumental support from formal sources was even associated with higher levels of distress. For sons acting as caregivers, daily caregiving support was the only formal support that was significantly associated with their lower level of distress. Issues of formal support are discussed, in order to reduce the psychological burdens borne by sons and daughters who care for their parents at home.     

Divorce and Family Structure in Norway: Associations With Adolescent Mental Health

The aim of this study was to examine the association between family structure and adolecent mental health, after the considerable increase in divorced parents choosing joint physical custody (JPC) in Norway. Data stem from the youth@hordaland study, a population-based survey conducted in Norway in 2012. A total of 7,707 adolescents (47% male) 16 to 19 years old were included in this study. The adolescents were classified into 6 family structures. Mental health was measured using the Strengths and Difficulties Questionnaire (SDQ). No significant differences between nondivorced families (reference) and JPC were observed. Adolescents from single-parent and stepfather families scored significantly higher on all 3 SDQ scales, and adolescents from stepmother families scored significantly higher on the SDQ total and SDQ externalizing scales. In conclusion, the results of this study indicated that adolescents living in JPC did not have more adjustment problems compared to their peers living in nondivorced families.     

Mindful of the Intersession Break in Family Therapy: The Time to Think Experiment

The Time to Think Experiment researches the experience of clinicians, consumers, and families of an intersession break, which has been used historically in various models of family therapy training. This qualitative pilot study explores the experiences of 21 clinicians, 19 consumers, and six family members using this break for reflection, across the domains of family and couple therapy, individual therapy, group work, and supervision in a mental health service covering the whole age range. Using a phenomenological design, the analysis included narrative, thematic, content, and comparative techniques. The paper considers the impact of privileging reflection in the therapy process, in a climate where models, work cultures, and general lifestyles may not encourage it. Using the intersession break to create space to ‘be’ in the therapy process is one way to integrate mindful and family therapy practice. The emerging themes of an intersession break to promote a richer and deeper therapy experience, and the apparent shift of responsibility for change from clinicians to consumers is discussed.     

Supporting Vulnerable Families Through School-Based Mental Health Services: Results of Caregiver and Teacher Focus Groups

Family perspectives facilitate participation and positive outcomes in child mental health treatment. In schools, families and teachers must cooperate to best meet children's mental health needs, also making teacher perspectives important. In this study, caregivers and teachers participated in focus groups following the pilot year of a school-based mental health (SBMH) project. Participants noted successes and challenges of the project and suggested improvements. Although this study focuses on the SBMH project, many of the study implications are applicable to other school mental health programs and may be of value to school and community practitioners.     

Family Matters: Research on Family Ties and Health, 2010 to 2020

Family ties have wide-ranging consequences for health, for better and for worse. This decade review uses a life course perspective to frame significant advances in research on the effects of family structure and transitions (e.g., marital status) and family dynamics and quality (e.g., emotional support from family members) on health across the life course. Significant advances include the linking of childhood family experiences to health at older ages, identification of biosocial processes that explain how family ties influence health throughout life, research on social contagion showing how family members influence one another's health, and attention to diversity in family and health dynamics, including gender, sexuality, socioeconomic, and racial diversity. Significant innovations in methods include dyadic and family-level analysis and causal inference strategies. The review concludes by identifying directions for future research on families and health, advocating for a “family biography” framework to guide future research, and calling for more research specifically designed to assess policies that affect families and their health from childhood into later life.     

Access Barriers to Mental Health Services for Older Adults from Diverse Populations: Perspectives of Leaders in Mental Health and Aging

This project is based on the results of telephone surveys with 52 local, state, and national informed respondents including policymakers, county leaders, planners, and advocates in mental health and aging with a particular focus on the states of California and Florida. This article addresses challenges to access to mental health services for diverse older adults including barriers related to race and ethnicity, socioeconomic status, location, age, gender, immigrant status, language, sexual orientation, and diagnosis. The article also highlights broad themes that emerged including (1) the importance of outreach and transportation tailored to diverse elders, and (2) recruitment of diverse staff and training related to diversity. The article concludes with policy and practice recommendations to reduce these disparities in access to mental health services for diverse populations of older adults.     

Implementing Evidence‐Based Parenting Programmes in a Small Sample of English Urban Local Authorities: Eligibility,Fidelity and Intensity

This article focuses on the implementation of evidence‐based parenting programmes (EBPPs) in a small sample of urban local authorities in England. The first part discusses the development of government policy, guidance and implementation issues. The second part presents findings from an exploratory study, which focused on the implementation of EBPPs in terms of programme eligibility, fidelity and intensity in six urban local authorities. Implementation was not necessarily in line with policy or guidance. Issues associated with programme fidelity along with concerns about sustainability as a result of cuts in funding are discussed and implications for policy and future research considered.     

Applied Restorative Justice as a Complement to Systemic Family Therapy: Theory and Practice Implications for Families Experiencing Intra‐Familial Adolescent Sibling Incest

This article considers the impact on and therapeutic responses to families where there has been intra‐familial sexual assault (IFSA) by an adolescent member of the family against another younger member of the family. In doing so, the article will specifically highlight the nexus between systemic family therapy ideas and an applied restorative justice response in the form of Youth Justice Conferencing (YJC), as experienced through working as a family therapist in the area of adolescent sexual offending.     

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.     

A Pilot Study to Explore the Influence of the ‘Safety First Assessment Intervention’ on the Family Environment

The family environment is considered an important influence on a young person's well‐being. The ‘Safety First Assessment Intervention’ is a model of care that considers and incorporates the importance of family environment when assessing and managing distressed young people. This pilot study explores the influence of the ‘Safety First Assessment Intervention’ on the family environment of young people referred to Child and Adolescent Mental Health Services. A pre‐ and post‐design was used, with families completing the Family Survey before and after their assessment/intervention. The Family Survey was correlated with a validated measure of family function, the APGAR, and pre‐intervention. Significant changes in multiple dimensions of family environment, including reduced level of distress for the adult, increased level of distress for the young person, improved sense of how the family felt the adult was managing currently, and improved confidence in family communication were found. There was no significant change in how the adult understood their role in helping the young person manage their distress. A thematic analysis showed trends in the current concerns for young people and adults as well as the difficulty young people in distress have in identifying their strengths. This pilot study demonstrates that the ‘Safety First Assessment Intervention’ can influence the family environment in a positive way and highlights the importance of using a family‐based approach for distressed young people.