Establishing family inclusive acute inpatient mental health services: a staff training programme in Somerset

In spite of policies advocating the involvement of families in the care of mental health service users in the UK there are few examples of training initiatives to bring this about. This article describes the delivery of a whole-team training initiative to promote family inclusive working in all acute inpatient units in Somerset. The three-day staff-training programme is described and training outcomes are reported. Staff reported a significant increase in confidence in their skills for working with families, and a pre- and post-training case note audit showed an increased consideration of the needs of families. This was accompanied by a modest increase in the average number of family meetings. Obstacles to family inclusive ways of working on inpatient units are described, and strategies to overcome these are discussed.     

Increasing access to psychological therapies for people with psychosis: predictors of successful training

BackgroundCognitive behavioural therapy for psychosis (CBTp) is recommended for people with schizophrenia, but routine delivery remains limited. Obstacles to increasing access include inadequate training, organisational support and supervision, resulting in low levels of staff competence and confidence. This study is a preliminary evaluation of a CBTp training programme, designed to overcome these obstacles and to increase routine delivery of competent CBTp.MethodTraining outcomes for a pilot group and for the first three cohorts to complete training were analysed to identify predictors of successful completion and of therapy delivery after training.ResultsObjective competence was attained by 37 students (out of 58), who delivered therapy to over 160 service users. Successful completion was associated with previous CBT therapy experience. Delivery after one year was associated with working in a therapy rather than a care co-ordination role.ConclusionsThe programme succeeded in training therapists to deliver competent therapy. Our results suggest that preliminary training in CBT for other disorders may improve success rates in CBTp. Despite extensive service liaison, delivery remained problematic for care co-ordinators without role change and provision of dedicated time. The findings should inform future implementation strategies.     

Job Satisfaction of Child Welfare Workers in an Urban Setting: Status and Predictors

Large urban areas present many challenges to those children and adults who reside in those settings. The social service workers in urban areas have clients with complex, multiple needs. Reliable and consistent workers are essential to successfully working with these families. In the current study, the job satisfaction of 29 social service workers in an urban child welfare agency was assessed using the Job Satisfaction Scale (JSS). The JSS measures satisfaction in 7 areas of one's job (i.e., work, supervision, coworkers, pay and promotion, work environment, training, and position). Data indicated that the staff were relatively satisfied, that satisfaction did not vary by staff position (family worker vs. social worker/supervisor), and that neither demographic factors nor prior experiences were predictors of job satisfaction. Implications for agency management and the provision of social services to urban families are discussed.     

Exploring the Base for Family Therapy Edited by Nathan W. Ackerman,Frances L. Beatman,and Stanford N. Sherman

General systems theory and group psychoanalytic psychology are utilized to present a typology of consultation requests that face the liaison psychiatrist in a general medical ward. These theories are also used to suggest interventions that enable the liaison psychiatrist to accomplish the dual purpose of providing useful consultations to the medical staff and training them in the psychological care of their patients without becoming trapped in the contradictory demands of the pressured medical-ward setting. Examples of psychosocial-medical rounds are presented illustrating three different kinds of consultation requests and specific intervention strategies.     

The use of a consultation team to network families with other helping systems

Families, therapists, and other service providers often find themselves uncooperative and at cross purposes when working toward solutions to family problems. Sometimes each professional is involved in one small piece of the problem and may never have encountered other providers and all family members. This paper describes a family-agencies-team consultation model intended to address the above issues. The model uses a consultation team to facilitate better understanding of family needs, helping agency roles, and service provider constraints. The approach has been successful in creating dialogue, generating a wide range of goals, engendering cooperation, empowering families, and affirming agency participation.In addition to the authors, the consultation team included staff members at the Pitt County Mental Health Center working with client families and other agencies in Pitt County, North Carolina.     

Improvements to Suicide Prevention Training for Prison Staff in England and Wales

Suicide prevention training for the prison service in England and Wales has been criticized. STORM is a package emphasizing the practice and review of interactions with suicidal persons and was evaluated in a pilot study for use in prisons. Trainees completed questionnaires immediately before and after training and at 6 to 8 months follow‐up. Training significantly improved attitudes, knowledge, and confidence, and improvements were maintained at follow‐up. Satisfaction with training was very high. STORM was successfully adapted for prison settings, and showed good effects among staff trained. It should be provided to the wider prison estate, with regular refresher training.     

Exploration of counsellors' perceptions of the redesigned service pathways: a qualitative study of a UK university student counselling service

To address the mental health needs of students, UK universities offer bespoke student counselling services. Economic pressures have led services to find innovative ways of redesigning their service pathway. Few studies have investigated staff perceptions of these changes. The aim of this study was to investigate perceptions of staff employed as counsellors at a student counselling service at a UK university that underwent service delivery changes. Face-to-face interviews were conducted with counsellors (n = 5). Framework analysis was used to identify themes and meta-themes. Five meta-themes were identified: the overarching service ethos and service working style; change in the university context; impact of change on working practice; recording and perceived impact on confidentiality; acceptability and effectiveness. Changes to the service resulted in a more efficient service that is perceived to be more acceptable to students. Staff perceptions differed regarding how changes have affected their counselling practice. Despite these differences, the increase in workload was consistently expressed. Tensions remain as staff strive to maintain high standards of service in this changing context. Future research should investigate the process of developing and implementing change as student counselling services strive to evolve sustainable ways of working.     

The use of behavioral skills training to improve staff performance of discrete trial training

Well‐trained staff are a prerequisite for successful implementation of treatment plans when working in human service contexts. The high rate of turnover makes the use of efficient and effective staff training all the more important. Previous research has used behavioral skills training to train teachers in correct implementation of discrete trial training of children with autism. They showed that a brief 10‐min procedure could effectively train staff and result in improved performance. The current study elaborated on previous work by using participants without prior exposure to the method, including treatment integrity data and testing for maintenance 1 month after training ended. The mean percentage of correct teaching responses for the three participants increased from 70%, 58%, and 66% during baseline to 97%, 96%, and 99%, respectively, following training. Results indicated that the training package was effective and the results were maintained 30 days later.     

Examining the Long-Term Effects of a Domestic Violence Training for Educators

Domestic violence affects not only the victims and perpetrators, but also children living in these households. This study examined the long-term effects of a training presented to all employees working in 22 different rural school districts (N = 556). Quantitative and qualitative data were collected to determine the long-term impact of the training. After approximately 4 years, the staff who had received the training reported that they had significantly more confidence in handling families dealing with domestic violence; however, both groups reported similar levels of general knowledge of the topic. Recommendations for training school personnel are provided along with key elements for replicating the training.     

The COSD Center Model

SUMMARY

This article describes the Children of Separation and Divorce Center, Inc: and how it empowers children and their families to cope with a major family transition. The rationale for creating the private, non-profit center is discussed and examples of the components of the center are illustrated to explain how children are empowered. Clinical and educational programs are client-need driven. The peer counselor program describes the participation of children and adults who are trained by COSD staff to be helpful to others. How COSD staff advocate for children and families of divorce is detailed with examples of judicial training, participation on advocacy boards and working with courts.     

Developing family‐inclusive mainstream mental health services

This paper argues that the current national policy context offers an opportunity to develop more family‐inclusive mainstream mental health services. It outlines a strategy to enhance working partnerships with carers and families and discusses its training implications. The first phase of a trust‐wide training programme in Somerset is described and the potential role for family therapists in promoting the wider application of systemic ideas is considered.     

Therapist attentiveness and negative capability in dialogical family meetings for psychosis

Jaakko Seikkula (2008) has pointed towards the importance of practitioners working in the present moment in dialogical therapy. Extrapolating from Seikkula's work, this article considers the significance of the qualities of therapist attentiveness, generosity and negative capability in dialogical family meetings for psychosis. It is proposed that these qualities are of particular importance when family meetings occur in crisis situations, as when under pressure practitioners can easily be drawn into prematurely interventionist stances that may unintentionally promote chronicity for the person experiencing psychosis. The value of co‐working arrangements in enabling practitioners to maintain attentiveness and negative capability in this work is also considered.     

Family interventions in schizophrenia: evidence for efficacy and proposed mechanisms of change

Family intervention for psychosis developed from empirical work on the role of emotion in families of those caring for someone with schizophrenia. The level of expressed emotion (EE) has been shown to be a robust predictor of subsequent outcome for service users returning to live in family settings. There is also evidence that staff have similar attitudes. This has led to the development of specific family interventions for schizophrenia. NICE Guidelines for Schizophrenia (2003) confirm that family intervention is effective at reducing service user relapse rates and recommends it for those in contact with carers. Exactly how family intervention improves outcome is less clear. A recent model of psychosis proposes a primarily emotional rather than cognitive route for family factors, and some evidence is presented which supports this. Implications for family interventions are discussed.     

Perceptions Among Child Welfare Staff when Modifying A Child Mental Health Intervention to be Implemented in Child Welfare Services

In order to increase access to child mental health evidence‐based interventions (EBIs) for vulnerable and hard‐to‐engage families involved in the child welfare (CW) system, innovative approaches coupled with input from service providers are needed. One potential solution involves utilizing task‐shifting strategies and implementation science theoretical frameworks to implement such EBIs in CW settings. This study examined perceptions among CW staff who were members of a collaborative advisory board involved in the implementation of the 4Rs and 2Ss Strengthening Families Program (4R2S) in CW placement prevention settings, utilizing task‐shifting strategies and the Practical, Robust, Implementation, and Sustainability Model. Advisory board members reported difficulties in engaging families, heavy workloads, and conflicting implementation initiatives. While 4R2S was perceived as generally aligned with their organization's mission, modifications to the intervention and to agency procedures were recommended to promote implementation success. Suggested modifications to the existing 4R2S training and supervision are discussed. Findings underscore the importance of understanding the experiences of CW service providers, which can inform future efforts to implement child mental health EBIs in CW services.     

Family Communication Patterns and Relational Maintenance Behavior: Direct and Mediated Associations with Friendship Closeness

In this study, both face‐to‐face and online relational maintenance behaviors were tested as mediators of family communication patterns and closeness with a same‐sex friend. Participants included 417 young adults recruited from communication courses at a large university in the Midwestern United States. The obtained structural model demonstrated that family communication patterns are associated with friendship closeness though face‐to‐face and online maintenance behaviors fully mediate this association. Specifically, young adults from high–conversation‐orientation families engage in more face‐to‐face maintenance behaviors, which are positively associated with friendship closeness. These findings inform understanding of how family communication patterns influence extrafamilial relationships, suggesting that parents’ cognitions and communication behaviors are associated with children’s social well‐being.     

A family intervention in psychosis service integrating the systemic and family management approaches

A project to establish new family intervention services to support people with psychotic symptoms and their families is described. The new services are developed by training a whole team in each main population centre. The multidisciplinary training course and the family intervention service are described, and the way in which we integrate the 'family management' and 'family therapy' approaches is discussed.     

Training staff in multiple family therapy in a children's psychiatric hospital: from theory to practice

This article describes a systematized method for training clinical staff from a variety of mental health professions while implementing supportive, process‐oriented multiple family therapy (MFT) in a children's psychiatric hospital. The model uses a step‐by‐step approach based upon learning objectives specific to the theory and practice of MFT for each stage of the process. External consultants skilled and experienced in MFT supported tuition in the initial stages. The method employs seminars with theoretical and experiential components, highlighting the major conceptual features of group, family therapy and MFT. Advanced stages of the training model include experiential learning in small groups and ongoing peer group supervision with live families. The systematic procedure has relevance for ongoing supervision, research and best standards of clinical practice in the hospital.     

Effects of computer‐aided instruction on the implementation of the MSWO stimulus preference assessment

This study evaluated a self‐instructional online training package to teach students and staff to conduct a stimulus preference assessment using the multiple‐stimulus without replacement procedure. The training package included a self‐instructional manual and video modeling and was delivered online. Training was evaluated using a multiple‐probe design across a total of six university students and four staff members. Overall, students improved from a mean of 35% correct in baseline to a mean of 94% correct following training, and staff improved from a mean of 23% correct in baseline to a mean of 87% correct following training. During retention and generalization simulated assessments conducted from 7 to 17 days following training, all participants performed considerably above baseline. The online delivery of the self‐instructional manual plus video modeling has tremendous potential for providing an effective method for teaching individuals to conduct stimulus preference assessments without face‐to‐face instruction.     

Staff survey results and characteristics that predict assault and injury to personnel working in mental health facilities

The purpose of this study was to complete a mental health staff opinion survey to identify patient and staff characteristics associated with staff assault and injury in psychiatric treatment settings and to develop a model of prediction for staff assault and injury utilizing these survey variables. The data consisted of opinion surveys sent to staff of 15 child, adolescent, and adult psychiatry inpatient units in the United States. Multivariate logistic regression was used to determine the level of assault and staff‐reported injury prediction that could be obtained from the staff‐completed opinion survey. Responses indicated a high prevalence of reported aggression, with 62.3% of staff endorsing verbal and physical aggression, property destruction, and self‐injurious behavior as being prevalent at their site, whereas only 4.1% rated none of these as prevalent. Staff working with children and adolescents in settings with high rates of psychiatric diagnoses reported increased frequency of assault and injury compared with those working with adults. Younger, less experienced staff reported higher rates of assault and injury. Staff working with female patients reported similar rates of assault and injury to those working with males. A logistic regression analysis using staff‐reported survey results of both staff and patient characteristics predicted assault correctly 73.7% of the time and injury 66.1% of the time. Resources for violence prevention and staff training programs in violence prevention are needed in child and adolescent psychiatry wards. Results are consistent with theories emphasizing the importance of negative emotions and affects, impulsivity, and frustration in goal‐directed activities in human aggression. Aggr. Behav. 29:31–40, 2003. © 2003 Wiley‐Liss, Inc.     

Family Peer Advocates: A Pilot Study of the Content and Process of Service Provision

Professional family peer advocates are increasingly employed by public mental health systems to deliver family-to-family support that reduces barriers families face in accessing children’s mental health care. These services, however, are neither uniformly available nor standardized. This pilot study describes the process, content and context of family-to-family support services. Simulating a parent seeking services, a trained standardized parent participated as a client in meetings with advocates in four programs and collected data through structured observations, a structured survey, and session audiotapes. The “walk-through” process was determined to be feasible and acceptable to family peer advocates as a way of evaluating services. Four family peer advocates provided an average of 25 services during each 2-session simulation with the standardized parent, including the following: information and educational support, instruction and skills development, emotional and affirmational support, instrumental support, and advocacy. Findings also revealed variability in the range of services provided and identified challenges in aspects of service provision, such as boundaries of advocate roles, availability of confidential service environments, and addressing crises and parent concerns about child safety. This paper provides the first in-depth look at services provided by this emerging workforce.