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.     

A Survey of Specialist Youth Gender Diversity Services in Australia: A Whole‐of‐Family Approach

The number of referrals for children and young people seeking to affirm their gender has risen exponentially in Australia and elsewhere. Whilst the individual mental health needs and treatment outcomes for this group have been the subject of recent research, considerably less emphasis has been placed on exploring and amalgamating individual family member experiences, particularly siblings, using circular questioning. Yet, gender diversity is known to affect everyone in the family, and research clearly demonstrates that youth who feel validated and supported by individual family members in their gender identities benefit from improved mental health and global outcomes. This study aims to explore current clinical practices, professional viewpoints, use of circular questioning, and whole‐of‐family involvement in specialist youth gender diversity services in Australia. Clinical leads and coordinators of publicly funded youth gender diversity services and individual specialists across Australia were invited to complete an online survey, exploring individual protocols and practices in relation to involving the family, and the rationale underpinning this. All six respondents agreed that adopting a systemic understanding, considering general family functioning, and seeking individual family member opinions, was critical. Nevertheless, all family members were infrequently seen, with resourcing issues and time constraints being cited as the main reasons. The value of adopting a systemic and whole‐of‐family line of enquiry was supported by all respondents. Whilst sibling viewpoints were considered valuable by most professionals, siblings were infrequently seen for a variety of reasons. Further attention could therefore be given to involving siblings during specialist assessments. The findings consistently highlighted the value of a systemic line of enquiry and whole‐of‐family approach for gender diversity services and specialists. However, no current assessment guidelines incorporate this as a recommendation. Therefore, future Australian guidelines could formalise a systemic approach.     

An Exploratory Investigation of Gay Stepfathers' Perceptions of Their Role

Abstract

This phenomenological study explored the gay stepfather role in its definitions, evolution, and factors that influenced how it was assumed and performed. Five gay men, living in a gay stepfamily that included the full or joint custody of the biological children of their partner, were asked to describe their perceptions of their family role in an open-ended, semi-structured interview. Data from all interviews were analyzed using the Atlas ti computer program (Muhr, 1997) that allowed identification of themes held commonly among the participants. Overall, the participants described stepfather roles and stepfamilies in terms that do not appear to be significantly different from heterosexual counterparts. The participants consistently mentioned the need for flexibility and patience in developing various aspects of their stepfather role such as co-parent/caretaker and friend/confidant. All participants discussed commitment to their families and the benefits gained in their stepfather role. Most had an effective, working relationship with the children's mothers. Interestingly, disclosure was not an issue in these families, and they reported feeling supported by extended family members.     

A Comparative Analysis of Adoptive Family Functioning with Gay,Lesbian, and Heterosexual Parents and Their Children

Abstract

The objectives of this comparative study were to examine adoptive family functioning with a sample of gay, lesbian, and heterosexual adoptive parents and their children. The results suggested that parent sexual orientation is not a significant predictor of adoptive family functioning, adopted child's behavior, and parent's perceptions of helpfulness from family support networks. Furthermore, a regression analysis suggested the following variables were associated with higher levels of family functioning: adoptive parents who were previously foster parents and children who had more previous placements prior to adoption. Lower family functioning was associated with children adopted through CPS; with children who had mental health diagnoses, learning disorders, or other handicapping conditions; and with children who were in a higher grade in school. The results of this comparative study of adoptive families support the need for more methodologically rigorous research that includes gay and lesbian adoptive parents along with heterosexual parents.     

Children Living With Uninsured Family Members: Differences by Family Structure

Despite increased access to insurance through the Patient Protection and Affordable Care Act of 2010, uninsurance rates are expected to remain relatively high. Having uninsured family members may expose children to financial hardships. Eligibility rules governing both private and public health insurance are based on outdated expectations about family structure. Using 2009–2011 data from the National Health Interview Survey (N = 65,038), the authors investigated family structure differences in family‐level insurance coverage of households with children. Children living with married biological parents were the least likely to have uninsured family members and most likely to have all family members covered by private insurance. Controlling for demographic characteristics and income, children in single‐mother families had the same risk of having an uninsured family member as children in married‐parent families. Children with cohabiting biological parents had higher rates of family uninsurance than children with married biological parents, even accounting for other characteristics.     

Integrating a Family-Centered Approach into Social Work Practice with Families of Children and Adolescents with Disabilities

Abstract

This article identifies a family-centered practice construct for working with children and adolescents with disabilities and their families. The experiences of these families have shifted considerably over the past 30 years. A legislative and historical context provides the basis for an understanding of present policies and practices that influence current approaches to service delivery. Though family-centered practice is emphasized in various practice settings, there is still a need to integrate this philosophy into social work practice with children and adolescents with disabilities and their families. In order to enhance the ability of the social worker to integrate this construct into practice, a framework for exploring the experiences of children, adolescents and families is provided. This framework provides an overview of factors related to the individual child, the family and siblings for the social worker to consider when working with these families. The social worker's role as collaborator, advocate, team member and family resource is highlighted.     

Mental Health Consumer and Carer Participation in Professional Education: ‘Getting There Together’ for Children of Parents with Mental Illness and Their Families

Abstract

‘Getting There Together’ is a professional education seminar developed as a collaborative project by professionals, mental health consumers and carers aimed at service providers who work with children of parents with mental illness and their families. The need for such professional education concerning this group is well recognised and the project reported herein was initiated by a reference group of professionals, consumers and carers focusing on children of parents with mental illness in the Eastern region of Melbourne (Victoria, Australia). The project began and continued as a collaborative effort during development and implementation, which ensured the experience, point of view and voice of consumers and carers was central to the material prepared, and at the time of seminar presentations. Seminar participants were from the family welfare, child care and supported housing sectors. Seminar participants found the first person accounts of consumers and carers the most helpful aspects of the seminars because they gave new insights into the experiences of carers and of mental health consumers as parents, as well as an understanding of ‘… the whole family, and how the child fits into the picture’.     

Motherhood and Family Health Advocacy in Nutrition and Exercise: “Doing the Tradition”

Studies tend to subsume women’s routine family healthcare responsibilities under the larger heading of “household labor.” This study argues that, women’s—and particularly mothers’—family healthcare work in the area of diet and physical activity represents a distinctive area for critical family communication research with potentially serious psychological, emotional, and physical consequences for women and their families. Interviews (N = 30) with young adult-family member dyads supported this assertion. Interview data illustrated that mothers struggled to fulfill incongruous health goals for themselves and their family members, and did so at the expense of their familial relationships (particularly with children) and their own health. Moreover, dyadic data analysis highlighted how young adults ascertained and carried on the “tradition” of the established mother-as-healthcare-provider role. Implications for theory and future research directions conclude this study.     

Critical phases among adoptees and their families: Implications for therapy

A growing body of literature indicates that families with adopted children seek mental health care for the adoptive and other family members more frequently and for different reasons than biologically-bound families. This paper addresses the struggles and corrective strategies for adoptive families at various levels of their development.     

Religiousness and Adolescent Behaviors

Abstract

This study examined the relative influence of religiousness on a sub-sample of adolescents (N = 1911) from a nationally representative sample of youth. Outcome measures included delinquency, substance abuse, physical health, mental health, and education. The study controlled for family processes and peer influences, as well as a variety of sociodemographic factors.

Parent religiosity and family processes, especially parental styles, are found to influence girls more so than boys, while exposure to peer influences affects both boys and girls on all outcome measures except delinquency. Findings highlight gender related similarities and differences that should be taken into account when providing interventions to adolescents and their families.     

Family Experiences of Caring for Relatives Who Have Received Electroconvulsive Therapy (ECT)

The research literature on family members’ experiences of the use of electroconvulsive therapy (ECT) is limited. This article explores the perspectives of family members whose relatives had received ECT. Drawing on a social constructionist perspective, this qualitative study collected data using in-depth interviews with nine families in South Australia, to examine how family members constructed the supports and challenges they experienced. The research found that families experienced a range of social and service system barriers, including social stigma and isolation, and limited support from health professionals. They had to negotiate caring expectations within a social context that stigmatised both mental illness and ECT. A need for ECT-specific mental health support groups was identified.

IMPLICATIONS

• Social workers’ roles in Australian hospitals could be further expanded to accommodate supporting families whose relatives have received ECT, referring families to community support, and advocating for specialist support post-ECT treatment.

• Social workers can further articulate their unique contribution to community care post-ECT treatment and advocate for supporting families.

• Increased focus on ongoing and preventative care for supporting families is a potential growth area for social workers in mental health.

     

Children with emotional disabilities: Perceptions of siblings

This paper reports the process and findings of a study of siblings of children with emotional disabilities. The intent of the research was to engage in an exploratory study through the use of a focus group to gain a preliminary understanding of the perceptions siblings have of a brother or sister with an emotional disability and the service system. Recommendations are given to mental health professionals for working with families and siblings of children with emotional disabilities. Ideas for including siblings in working with family systems are presented.     

Linking Housing,Social Services and Family Well-Being

Abstract

Securing adequate housing is a key component in achieving family well-being and a decent quality of life. It is expected that as many as twenty percent of the families currently on welfare, many of whom are disproportionately female and African American, may not be employable by the end of their lifetime benefit. These families, classified as “hard-to-serve” or “hard-to-employ,” are headed by an adult who may be struggling with substance abuse, physical or mental health problems, as well as low literacy and social competency issues that inhibit achieving self-sufficiency. This author will examine existing literature on welfare-dependent households coping with substance abuse and mental health problems, and how the lack of affordable housing impacts their ability to achieve self-sufficiency. This article presents a case study     

Wraparound Services: An Effective Intervention for Families Impacted by Severe Mental Illness

ABSTRACT

Children and families impacted by severe mental illness (SMI) have multiple strains that effect family functioning, child safety, and parental rights. Traditional services for children and families struggling with severe mental illness have not achieved success in improving family functioning and keeping families intact. Wraparound is a philosophy and a system of care with a promising evidence base that could enhance collaboration of child welfare, mental health, and community services to work more effectively with families impacted by SMI.     

Military Caregivers

Military caregivers provide essential services for their veteran or military service members who have serious injuries or illness. Of the estimated 39.8 million Americans who provide care for an adult, 1.1 million care for a post 9/11 veteran or service member. Caregivers may experience greater physical or mental health concerns including stress, depression and/or chronic illness, and have greater financial burden than their non-caregiving counterparts. Policy shifts such as the Caregivers and Veterans Omnibus Health Services Act of 2010 (2018) have created and expanded programs to support caregivers. Practitioners working with injured or ill military service members or veterans and their families should include a comprehensive biopsychosocial assessment of the whole family, utilizing several interventions, such as support groups, peer support, psychoeducational programs, training, individual and family counseling, and/or respite care services, to improve family function and reduce caregiver burden.     

Walk-in Together: A pilot study of a walk-in online family therapy intervention

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk-in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof-of-concept study investigating the acceptability and short-term effectiveness of an online walk-in family therapy service, Walk-in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk-in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre-session, post-session, and at 6 weeks follow-up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi-structured interview data. Post-session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post-session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well-received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk-in delivery model. This proof-of-concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk-in, telehealth model to meet the rising demand for therapeutic support for families in distress.     

Willingness and availability: Explaining new attitudes toward institutional elder care among Chinese elderly parents and their adult children

This paper studies the attitudes of Chinese elderly parents and their family members toward institutional elder care. Based on a sample survey of 265 elderly residents in 67 elder home institutions and 114 family members, this study finds that elders and family members generally had high evaluations of institutions' quality in terms of facility, medical, and direct care conditions. Elders who reported improved health and emotional well-being after entering institutions gave higher ratings to those institutions' quality. Among adult children, those who had more siblings tended to rate institutions higher than those who had fewer siblings. Factors that influenced elders' willingness to stay in an institution included marital status and financial ability. Widowed elders were more willing to stay in institutions compared with married counterparts. Elders who rated service charge very high preferred to stay at home due to the high cost of institutional care. In the family relatives' sample, gender was found to be related to willingness to place elderly parents in an institution; female children were less willing to place elderly parents in the institution.     

Descriptive Analysis of Foster Care Adoptions in New South Wales,Australia

This paper describes the population of children in care in New South Wales, Australia, who were adopted by their foster families (N?=?372) from 2003 to 2014. Data pertaining to 370 of these adoptees were available and obtained from administrative records accompanying adoption applications. Most of these children had been placed with their subsequent adoptive family during infancy. However, adoption orders occurred much later in their lives. According to the available information at the time of adoption, these children did not suffer the high levels of mental health problems typically identified in populations of children in foster care. Though the data do not include follow-up to determine if the contact agreed upon at the time of adoption orders translated into practice, the most frequently postadoption arrangement recorded was face-to-face contact, four times a year with mother and siblings. The high levels of openness and face-to-face contact in Australian adoptions from care are a significant point of difference with other adoption models, and presents a need for research in the area.

IMPLICATIONS

• Following the change of legislation in New South Wales, Australia, that prioritises open adoption over foster care, social workers in the field of child protection are well placed to assist in this process.

• Social workers can assess children entering care to identify those who will benefit from adoption in a timely manner; undertake casework and administrative aspects of the adoption process; work closely with the child, and birth and adoptive families by delivering pre- and post-adoption supports; and conduct longitudinal research on the outcomes for children adopted from care.