Towards a Program Theory for Family-Focused Practice in Adult Mental Health Care Settings

An International Interview Study With Program Leaders

Dados Bibliográficos

ID15520849
AutoresAnnette Bauer (0000-0001-5156-1631, London School of Economics and Political Science, autor correspondente), Stephanie Best (0000-0002-1107-8976, Macquarie University), Janet Malley (0000-0001-5759-1647, London School of Economics and Political Science), Hanna Christiansen (0000-0002-8104-0711, Philipps University of Marburg), Melinda Goodyear (0000-0002-5928-0161, Monash University), Ingrid Zechmeister‐Koss (0000-0003-3713-7580, Austrian Institute for Health Technology Assessment GmbH), Ingrid Zechmeister-Koss, Jean Paul (0000-0003-0891-7035, Innsbruck Medical University)
Ano2021
Volume12
Páginas741225-741225
Data de publicação2021-10-22
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoFrontiers in Psychiatry (JOURNAL)
Identificadores do periódicoISSN: 1664-0640 • E-ISSN: 1664-0640
EditoraFrontiers Media (PUBLISHER • CH)
DOI10.3389/fpsyt.2021.741225
PMID34744833
OpenAlexW3208382852
IdiomaEN
Citações recebidas6
Referências citadas47

Objectives: In several high-income countries, family-focused practice programs have been introduced in adult mental health care settings to identify and support children whose parents live with mental health problems. Whilst their common goal is to reduce the impact of parental mental illness on children, the mechanisms by which they improve outcomes in different systems and settings are less well known. This kind of knowledge can importantly contribute to ensuring that practice programs achieve pre-defined impacts. Methods: The aim of this study was to develop knowledge about relationships between contextual factors, mechanisms and impact that could inform a program theory for developing, implementing, and evaluating family-focused practice. Principles of a realist evaluation approach and complex system thinking were used to conceptualize the design of semi-structured in-depth interviews with individuals who led the implementation of programs. Seventeen individuals from eight countries participated in the study. Results: Interviewees provided rich accounts of the components that programs should include, contextual factors in which they operated, as well as the behavior changes in practitioners that programs needed to achieve. Together with information from the literature, we developed an initial program theory, which illustrates the interconnectedness between changes that need to co-occur in practitioners, parents, and children, many of which related to a more open communication about parental mental health problems. Stigma, risk-focused and fragmented health systems, and a lack of management commitment were the root causes explaining, for example, why conversations about parents' mental illness did not take place, or not in a way that they could help children. Enabling practitioners to focus on parents' strengths was assumed to trigger changes in knowledge, emotions and behaviors in parents that would subsequently benefit children, by reducing feelings of guilt and improving self-esteem. Conclusion: To our knowledge, this is the first research, which synthesizes knowledge about how family-focused practice programs works in a way that it can inform the design, implementation, and evaluation of programs. Stakeholder, who fund, design, implement or evaluate programs should start co-developing and using program theories like the one presented in this paper to strengthen the design and delivery of family-focused practice

Medical education · Mental health · Mental illness · Psychiatry · Stigma (botany · Applied Psychology · Child and Adolescent Psychosocial and Emotional Development · Family Caregiving in Mental Illness · Maternal Mental Health During Pregnancy and Postpartum · Medicine · Nursing · Psychology