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Applying the Behavioural Family Therapy Model in Complex Family Situations

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Applying the Behavioural Family Therapy Model in Complex Family Situations Soc. Sci. 2015, 4, 459–468; doi:10.3390/socsci4020459 OPEN ACCESS social sciences ISSN 2076-0760 www.mdpi.com/journal/socsci Article Applying the Behavioural Family Therapy Model in Complex Family Situations Rubina Jhadray *, Gráinne Fadden, Martin Atchison, Paula Conneely, Julia Danks, Alison Lee and Chris Mansell The Meriden Family Programme, Birmingham and Solihull Mental Health Foundation Trust, Tall Trees, The Uffculme Centre, Birmingham B13 8QY, UK; E-Mails: [email protected] (G.F.); [email protected] (M.A.); [email protected] (P.C.); [email protected] (J.D.); [email protected] (A.L.); [email protected] (C.M.) * Author to whom correspondence should be addressed; E-Mail: [email protected]; Tel.: +44-0121-301-2890; Fax: +44-0121-301-2891. Academic Editors: Carolina Munoz-Guzman and Nathan Hughes Received: 27 November 2014 / Accepted: 16 June 2015 / Published: 23 June 2015 Abstract: Behavioural Family Therapy (BFT) is a skills based intervention that aims to support families where a member is experiencing a mental health problem. The Meriden Family Programme has extensive experience in supporting families who have complex needs. The programme delivers training in the approach and works with families with the aim of providing information, education and reducing stress within the family environment. Training has recently taken place within various mental health services to equip staff with the skills to work collaboratively with families and to understand and support their needs. Keywords: behavioural family therapy; family intervention; mental health; complex needs; family support 1. Introduction The Meriden Family Programme has been delivering training in Behavioural Family Therapy (BFT) and working with families since 1998. The programme has delivered training locally, nationally and internationally as there is a widespread need for training in the area of family interventions [1]. The aim of the programme is to ensure that families have access to family sensitive services and Soc. Sci. 2015, 4 460 evidence based interventions. The programme uses a cascade training system, in which individuals are trained in BFT and then go on to train as trainers and supervisors. This allows them to deliver BFT courses and supervise others within their own organisations and services. To date there are over 5000 people trained in BFT worldwide and just over 400 trainers and supervisors. The Meriden Programme offers ongoing supervision to organisations that are delivering family work to ensure that implementation within their services is supported. The programme offers an array of specialist training packages which are available to professionals, family members and service users. When someone has a mental health problem, it does not only affect them individually but has an effect on the whole family: their daily lives, physical health and relationships [2]. The family is there as a support network for the individual and can be an integral part of the care and recovery process. The family can be seen as experts on their family member’s disorder and the difficulties that they are facing, and so they can be a valuable source of support if services work collaboratively with them. Families may experience high levels of stress, burden and may be up against issues such as confidentiality when trying to be a part of the care that their loved one is receiving [3]. They may need information and skills to help them understand and cope better with the disorder and what their family is experiencing. BFT is an approach aimed at supporting the family and the individual. It is a practical, skills based intervention that typically involves sharing information with the service user and their family about the service user’s mental health issues, experience and treatment. The intervention consists of a number of components including engagement, assessment, formulation and early warning signs work in which the family develops a clear “staying well” plan. Each family member is also encouraged to set realistic and achievable personal goals for themselves. BFT promotes positive communication, problem solving skills and stress management within the family. When families are under pressure, whether it be because of a mental health issue, substance misuse or other reasons, communication can often deteriorate or become minimal. BFT aims to promote positive communication within families through skills training, and looks at skills such as “expressing pleasant feelings” and “active listening”; with the aim of creating a more supportive and stress-free environment for everyone involved. This type of evidence based family approach has been shown to reduce relapse rates, stress and hospitalisation, therefore improving the quality of life for individuals suffering from mental health difficulties and their families [4,5]. Family interventions have been shown to be effective where individuals are suffering from Schizophrenia and Psychosis [4,6,7] and Bipolar Disorder [8,9]. The Meriden Programme team has worked with families who are experiencing a range of difficulties and who may have complex needs. The implementation of family interventions in clinical practice has been recommended by health guidelines and policies in the UK [10] and in the PORT Guidelines in the United States [11] encouraging professionals to take into account the needs of the family and to offer education and support. There has also recently been evidence showing the cost-effectiveness of family interventions highlighting the benefits for services as well as for families [12]. There are needs of families that are similar despite which service or specialism their family member is receiving care from. However, there may be some variation in their need for support and information depending on the nature of the problem and on what they are offered by services. It is important for professionals working in different settings to be aware and equipped to help families and keep them involved. This requirement impacts on the training provided to different services and the need to tailor it to the requirements of the team. With this is mind, we have recently delivered training on an eating Soc. Sci. 2015, 4 461 disorders unit, a mother and baby unit, within early intervention services and conducted a family work pilot project on an acute inpatient unit. BFT has also been utilised with families whose relatives are in secure settings. The detail of some of these is outlined below and highlights how family work can be beneficial in understanding and supporting families with complex needs in mental health services. 2. Case Examples of Supporting Families with Complex Needs 2.1. BFT in a Mother and Baby Unit A pilot project looking at the implementation of a brief family intervention within a Mother and Baby unit was recently conducted. The unit was looking to involve families further within the care of service users. A brief intervention consisting of components of the BFT model including assessment, information sharing, recognising early warning signs and developing a staying well plan and problem solving was delivered to all staff on the unit. The training lasted a day and was repeated to ensure that all staff were able to attend. All sessions with the family were designed to last 20 minutes in order to increase the chance of ward staff being able to commit to this amount of time. The families were then interviewed using a short post intervention questionnaire looking at the impact of being involved in the service user’s care in this way. The training team included a carer who had received the full BFT intervention along with his family who shared with the staff very clearly, how each of the components had been helpful to them as a family unit. As part of the training, for each component, staff were given time to practice the skills that they were learning. They had guided practice on delivering the sessions to families and received feedback from their peers and trainers in what they each did well and how they might do some things differently. Supervision sessions have been set up to support the staff beyond the training. The staff on the mother and baby unit already have systems in place for working with partners, but working with the brief family intervention meant identifying a wider network of support. This initially created an increased workload as more people were offered individual meetings. What had been designed as 20 minute sessions were turning into 1.5–2 hour meetings as the staff familiarised themselves with the questions and also the process of engaging people using this particular method of assessment. It was identified through supervision that some staff, although highly motivated and enthusiastic to use the approach were anxious about delivering some of the components and have avoided doing so. The delivery of the components and the engagement of the mothers and their families can be seen as key for the intervention to have maximum benefit. There could be potential difficulties in the initial engagement of mothers both as parents and people recovering from mental health problems. The focus on including families can be seen as important in meeting the needs of a mother suffering from a mental disorder [13]. However staff members also need to appreciate that some aspects of family relationships may be challenging. Some family relationships can be seen as potential stressors and can have a negative effect on the esteem and confidence of mothers [14]. So in situations such as these, the discussion of how engaging in the intervention can improve relationships and what the benefits of the intervention could be for the mother and the relationships she has with family members may be helpful. Discussions around ways in which the mother and family members may be able to communicate their needs and views better may take place in an attempt to overcome hesitancy towards family work.
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