Building family skills together: implementing a family intervention in an adult mental health team

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the The Bouverie Centre, Faculty of Health Science, La Trobe University, Bundoora.

The research described in this thesis was conducted as part of an implementation and outcome research project called Building Family Skills Together. My research used an Ethnographic Action Research methodology to determine how to best implement Behavioural Family Therapy (BFT), a psychoeducational family intervention, in the routine practice of a continuing care team in an adult mental health service. Implementation science informed an approach where I was located part-time in the continuing care team as a family practice specialist for two years. All practitioners were trained and the team was provided with intensive implementation support to enable practitioners to provide BFT within their case management role. Practitioners generally found it difficult to engage families in BFT and the extent of their pre-existing contact with families appeared important in this process. BFT offered practitioners a positive and contrasting experience of practice, although they found BFT challenging to integrate with case management. Co-working was critical to practitioners overcoming their anxiety about conducting BFT. Families were initially uncomfortable in participating in BFT, yet found it helpful especially in promoting open discussion of the impact of mental illness. Although a hierarchical and defensive team culture constrained adoption of BFT, organisational changes were made to integrate and accommodate the intervention within clinical care. Staff turnover negatively impacted on implementation. My multi-faceted implementation role sought to achieve a balance between problem-solving, acknowledging success, driving change, and promoting on-going shared ownership. Coworking, monitoring uptake, the use of informal feedback and capitalising on the role of emerging champions were important in implementation. Whilst intensive implementation support did not appear to increase individual practitioner uptake compared to levels reported in previous research, an organisational structure was established to co-ordinate BFT and support practitioners through the appointment of practice champions. Recommendations for implementing family interventions in mental health and for further research are provided.