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This paper delves into the creative methodology adopted whilst engaging in a research study with five families whose young children (aged between 8 and 10 years old) were excluded from school due to social, emotional and mental health difficulties. The complex needs surrounding these families often lead to them being labelled as hard-to-reach and therefore challenging to engage in research. This paper will explore these challenges, the ethical dilemmas that emerged, the constant observation throughout, the reflexivity and flexibility required by the researchers and the relationships forged. Using various creative methods as part of the Mosaic approach both the children and their parents were able to play a part in the meaning-making process throughout the research journey. The culmination of the research study took place in the format of a multi-family group session which provided a safe space for an intergenerational encounter allowing for the children's and parent's authentic voices to continue to be heard. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Open Dialogue was developed in Finland in the 1980s by clinical psychologist, Jaakko Seikkula. It is a development of family therapy, recognises previous trauma and has proven to be very effective in situations of acute mental illness, and in particular psychosis.Trauma Informed Care is a practice based on the understanding of and responsiveness to the impact of trauma. When people have experienced trauma, they may have difficulties in their everyday life and experience negative physical health outcomes as well as the risk of developing mental ill health.Open Dialogue is aligned to mental health care which aims to be trauma‐informed, person‐centred and rights‐based. Examples exist of the use of both approaches for service delivery with limited evaluation. What the paper adds to existing knowledge?: To our knowledge, no formal evaluation has been made of the use of open dialogue as a Trauma Informed therapy approach to support individuals and their family networks.Although both approaches recognise the impact of trauma on individuals, no study has explored the effectiveness of this treatment combination for use by mental health nurses.This review is timely as it provides insights into contemporary services that are trauma informed and have used Open Dialogue to extend therapy work with individuals and their family/networks.This scoping review was able to determine whether recommendations for clinical practice and training in Open Dialogue with Trauma Informed Care approaches could be identified. What are the implications for practice?: This review provided a broad overview on the current types of trauma‐informed care services incorporating Open Dialogue approaches into their practice.The literature, though sparce, identifies that Trauma Informed Care recognises multiple origins for mental ill health. Open dialogue has an affinity with the common values of mental health nurses. As combined therapies, they are demonstrating usefulness in engaging families and people in their journey towards recovery.Rigid adherence to Open Dialogue focus and delivery as well as training practices could be revised to make them more open to what people and their families wish to discuss. The person with mental ill health and previous trauma should be able to direct the narrative. Trauma Informed Practice principles could be adapted to improve consumer satisfaction with Open Dialogue approaches. Introduction: A large proportion of people who access mental health services have a lived experienced of trauma and are more likely to have a history of complex trauma. Open Dialogue and Trauma Informed Care practices identify previous trauma as a factor related to later psychosis. This scoping review has identified similarities and contrasts in how an Open Dialogue and Trauma Informed Care approach have been combined to complement one another for clinical work with people presenting with psychosis and previous trauma. Aim: We aimed to answer the following research question in this scoping review: What is known of the combined use of Open Dialogue and Trauma Informed Care practice when working with consumers and their family networks? As such, the purpose of this paper was to explore the application to practice and identify if any training existed and been evaluated. Method: This scoping review was based on the Arksey and O'Malley's framework. A comprehensive search was performed across five electronic databases. Grey literature was also searched through Psyche Info and Google Scholar for books, Dissertation and Theses, alongside hand searching of the reference of the studies. Articles searched was from January 2013 to January 2023. Results: Five distinct themes were identified from the literature: (1) Linking open dialogue with trauma, (2) Response to treatment, (3) Empowerment and information sharing, (4) Interpretation by clinical services, (5) Staff training outcomes. Discussion: Some tentative recommendations for practice recognised the individuals' unique story and perspective, suggested that trauma is an important concept to assess. Services practising as Trauma Informed Services that have incorporated an Open Dialogue approach have mixed experiences. The use of Open Dialogue may have some benefits for family work and exploring consumer narratives while building a network of support. However, consumers identified similar frustrations with service delivery as with the family therapy literature. For example, it was difficult to bring family members together and difficult to discuss previous traumatic events in front of family. People experiencing training in Open Dialogue reported it taking a slow pace and not what they were familiar with. Implications for Practice: Open Dialogue can facilitate engagement of consumers and their family networks and greater recognition of the peer workforce to promote collaboration in therapy is needed. Future research should also focus on evaluating the effectiveness of such services and comparing their outcomes across regions. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic impacted children, adolescents, and their families, with significant psychosocial consequences. The prevalence of anxiety, depression, and self-injurious behaviors increased in our youth, as well as the number of suicide attempts and hospitalizations related to suicidal ideation. Additionally, parents' mental health saw increasing rates of depression, irritability, and alcohol use combined with worsening family function, child-parent connectedness, positive family expressiveness, and increases in family conflict. In light of these statistics, we created CHATogether (Compassionate Home, Action Together), a pilot family-centered intervention using multi-faceted psychotherapeutic approaches to improve familial communication and relational health between adolescents and their parents. This paper discusses the implementation of the CHATogether intervention at the Adolescent Intensive Outpatient Program (IOP), providing an example of the intervention through an in-depth pilot case, and evaluation of the program's acceptability and feasibility. Methods: This paper describes a case in detail and evaluation from a total of 30 families that completed CHATogether in the initial pilot. Each family had 4–6 one-hour CHATogether sessions during their 6-week treatment course at the IOP. Before and after CHATogether, adolescents and their parents separately completed a questionnaire designed to explore their perceived family conflicts. After completion of the program, participants completed a brief quality improvement survey to assess their overall experience with CHATogether. In the reported case, the family completed Patient-Reported Outcomes Measurement Information System (PROMIS) depressive and anxiety symptoms scales, Conflict Behavior Questionnaires (CBQ), 9-item Concise Health Risk Tracking Self-Report (CHRT-SR9), and help-seeking attitude from adults during distress and suicide concerns. Results: The pilot case showed a trend of improvement in reported depressive and anxiety symptoms, child-parent conflicts, subfactors of suicide risk including pessimism, helplessness, and despair, help-seeking acceptability from parents for suicide concerns, and the establishment of individualized family relationship goals. Preliminary feedback from participating families demonstrated positive effects on intra-family communication and improvement in the overall family dynamic. Adolescents (n = 30/30) and their parents (n = 30/30) rated "strongly agree" or "agree" that their families had benefited from CHATogether and welcomed participation in future program development. Conclusion: This study presents CHATogether as a novel family-centered intervention to address post-pandemic family mental health stress, especially when a family system was disrupted and negatively affected the mental health of children and adolescents. The intervention facilitated positive child-parent communication on a variety of topics, through tools such as emotional expression and help-seeking behavior. The reported pilot case and evaluation suggested CHATogether's acceptability and feasibility in a clinical context. We also provided quality improvement feedback to guide future studies in establishing the efficacy of CHATogether and other similar models of clinical family interventions. [ABSTRACT FROM AUTHOR]

Introduction: Although there have been qualitative meta-syntheses on experiences of eating disorders treatments, there is a paucity of syntheses specifically examining the perspectives and experiences of eating disorders treatments (ED) in East Asia (EA). Such synthesis could facilitate a better understanding of culture-specific perspectives and experiences. This review complements a quantitative scoping review published on ED treatments in EA (Yim & Schmidt, 2023), where most interventions reviewed focused on cognitive behavioural therapy (CBT) and internet interventions. The present meta-synthesis summarises stakeholders' views on treatments and to synthesise clinical and research recommendations. Method: A systematic search of five databases and a citation search were conducted to identify relevant studies and data were analysed using thematic synthesis. Out of the 301 studies found, a total of 12 papers were included in the analysis. Results: A diverse range of treatments, such as family therapy, paediatric/psychiatric inpatient care, CBT, and counselling, were discussed. Three overarching themes were identified: Delineating Physical and Psychological Recovery; 'I am not alone in this battle'; and Barriers to Change. The themes further delve into the various obstacles to recovery, including financial concerns and limited access to professionals and services. Culture-specific factors include family obligations and promoting family harmony. Balancing interdependence and independence from one's family, as well as understanding family body ideals versus broader societal body ideals, are important considerations in ED interventions. Discussion: Some themes paralleled other qualitative syntheses, highlighting improved family relationships, perceived authoritarianism in treatments, and financial barriers. The review extends beyond the previous findings, revealing nuanced factors like family roles, cultural values, and norms. Clinical recommendations include incorporating family context in treatment and considering cultural influences on body image ideals. Capacity building through telemedicine and increased training is essential for advancing ED treatment in East Asia. Continued research is needed to better understand and treat people affected by ED in EA. Plain English Summary: Research on eating disorders (EDs) treatment mainly focuses on Western countries, with little exploration of experiences in East Asia. To fill this gap, we reviewed 12 studies on the perspectives of individuals, families and clinicians regarding EDs treatments in East Asia. Our synthesis identified three main themes: Physical and Psychological Recovery: Effective treatment needs to address both physical and mental aspects of recovery. Finding Support – 'I am not alone in this battle': Many individuals find strength in knowing they are not alone. Barriers to Change: Obstacles like financial difficulties, limited EDs knowledge from professionals, and cultural factors can hinder recovery. Cultural-specific factors such as family obligations and maintaining family harmony can impact on treatment motivation and effectiveness. Balancing family's wishes/ interdependence and personal aspirations/ independence can also be a challenge. Our findings highlight the need for culturally sensitive treatments. Expanding telemedicine and increasing provider training can also help overcome treatment barriers. In conclusion, understanding cultural and contextual factors is essential for developing effective support systems and improving ED treatment outcomes in East Asia. [ABSTRACT FROM AUTHOR]

This document is a position paper published by the Canadian Journal of Psychiatry, providing updated curriculum guidelines for training in substance use disorders (SUDs) in psychiatry. The paper highlights the limited training in SUDs compared to other psychiatric disorders, despite the increasing prevalence of SUDs in psychiatric care settings. It emphasizes the importance of psychiatry residents developing the necessary knowledge, skills, and attitudes for managing patients with SUDs. The paper also discusses the challenges in training, such as a shortage of experienced faculty and negative attitudes towards patients with SUDs. It provides recommendations for clinical content, seminar content, and clinical rotations and entrustable professional activities (EPAs) related to SUDs. The goal is to promote uniform knowledge, skill, and attitude development for residents nationally. [Extracted from the article]

Family violence is becoming increasingly visible in Australia, with many state and federal governments taking on more responsibility to address family violence and its impacts on those affected. Current efforts are focused on practice frameworks, identifying and responding to risk factors, and social justice frameworks including legislating against family violence in a range of jurisdictions and addressing more broadly the structural and cultural forces that perpetuate violence and further oppress those victimised. Family violence is not unique to Australia, with prevalence rates internationally suggesting family violence occurs irrespective of country, race, age, culture, effectiveness of social policies or socioeconomic status. This paper explores relevant foundational concepts of Bowen family systems theory (BFST) as it relates to family violence and explores opportunities to evolve practice in this area. BFST offers a unique contribution towards addressing family violence, particularly in relation to the public health challenge of addressing family polyvictimisation. The paper also explores how BFST conceptualises family violence and the role of the professional in working with the family as a single emotional unit. The unique focus of BFST on observing and defining self within the emotional family unit through observation of the underlying multigenerational emotional patterns of functioning provides unique opportunities to evolve and develop both the capacity of clinicians and responses to families who are navigating the serious and challenging impacts of family violence. [ABSTRACT FROM AUTHOR]

This paper overviews Bowen family systems theory and its approach to family therapy. It aims to introduce this influential approach and a sample of developments in theory and practice since Bowen's first publications of his research and theory. This paper is the second edition of a 1999 article with the same title (Brown, Australian and New Zealand Journal of Family Therapy, 20, 94 and 1999) and, 25 years later, offers new insights from the original author's ongoing research into the theory. This new edition is in collaboration with a second author and Bowen theory scholar, bringing fresh perspectives on the theory's applicability to family therapy practice. The core concepts are presented briefly, and a case example with a parent and symptomatic adolescent demonstrates how theory informs the role of the therapist and the therapeutic work. Examples of criticisms of Bowen theory are also discussed, including the misinterpretation around the idea of emotion in Bowen theory that is communicated in Gottman's training. Differentiation of self is clarified as the integration of emotion and intellect rather than privileging one over another, which affords the opportunity for individuals to avoid being governed by the invisible strings of sensitivities in relationships and instead be themselves in good emotional contact with the other person. [ABSTRACT FROM AUTHOR]

Adopted children are often at a risk of experiencing several neurobiological and psychosocial difficulties. Adoptive parents must support these difficulties whilst managing their own idiosyncratic challenges. Family-based psychotherapeutic interventions which promote adoptive family functioning, environments and relationships can mediate these difficulties for adopted families. This review synthesises evidence exploring family-based psychological interventions for adoptive families, appraises the literature's strengths and weaknesses, and reports characteristics of promising interventions. Included studies recruited domestically adoptive families receiving psychotherapeutic interventions delivered to at least one adoptive parent and child. The authors searched seven electronic information databases, four grey literature databases, two journals and five relevant websites up to 12.12.2022. The quantitative Risk of Bias in Non-Randomised Studies of Interventions tool and the qualitative Critical Skills Appraisal Programme checklist assessed risk of bias. The narrative synthesis presents 20 papers detailing 18 studies involving at least 729 adopted children and 829 adoptive parents. Findings provide preliminary support for integrative interventions which include aspects of sensory activities, attachment-based play, Dyadic Developmental Psychotherapy and Eye Movement Desensitisation and Reprocessing with Therapeutic Input provided to adopted children and adoptive parents separately, alongside the adoptive family. However, risk of bias was high, limiting the conclusions. Future research should examine the feasibility, acceptability and efficacy of integrative therapeutic approaches for adoptive families to further direct clinical practice. [ABSTRACT FROM AUTHOR]

We write this paper as DClinPsy staff who have implemented Association of Family Therapy and Systemic Practice (AFT) Foundation and Intermediate level accreditation embedded within DClinPsy training. We describe the context and landscape in which this has happened, the positives we believe it brings and the challenges we have faced along the way. We offer suggestions for courses on this journey of approaches, methods and techniques that we have found helpful, and reflect on our next steps. Within the paper we include the voice of a trainee who is completing this training currently and consider what clinical psychologists in the NHS can do to support trainees and courses in achieving systemic secondary accreditation. [ABSTRACT FROM AUTHOR]

The writer shares the course of treatment with a gender nonbinary teenager and their parents that utilized techniques from drama therapy, relational self psychology, sculpting, and family therapy. Following the rupture and attempted repair with the patient's parents, work with the patient and their family finally led to a joint decision to terminate treatment. This case study discusses the clinical challenges and implications of working within a family system in which parents' values misalign with the psychotherapist's treatment goals. This paper contains misgendering that can emotionally trigger some individuals. [ABSTRACT FROM AUTHOR]

This paper presents an analysis of how three interlocutors sequentially organize and accomplish mutual understanding in naturally occurring audiovisual recordings of therapy sessions. The analysis is in keeping with microanalysis of face-to-face dialog (MFD) and follows operational definitions of three-step micro-processes that interlocutors use when they calibrate new information; that is, how they agree that they have understood each other's words and actions well enough for current practical purposes. Pointing to some of the complexities that characterize triadic interactions, the analysis contributes with new documentations of 'suspended', 'nested', 'branched', 'multi-paced', and 'mixed interpretations' calibrations. The analysis also demonstrates how interlocutors may calibrate the 'tone' of an utterance before the topical content is mutually understood. The results and their implications may be relevant to practitioners of institutional talks at large, where the quality and outcome of, for instance, assessments and interventions largely rely on accomplishing mutual understanding. [ABSTRACT FROM AUTHOR]

The Ackerman Institute for the Family, established in 1960 by Dr Nathan Ackerman, stands as one of the oldest and most respected family therapy institutes in the United States. Ackerman pioneered the integration of systemic insights into group settings, emphasised the crucial role of family in therapy, and advocated for the advancement and acceptance of family therapy. 'The Ackerman' played a pivotal role in launching Family Process, the first journal dedicated to academic activities in family therapy. Diversity and inclusion have been central tenets of Ackerman philosophy, evident in its programs, training courses, and staff composition. This commitment has produced a veritable cadre of family therapy leaders who have contributed significantly to both the Ackerman Institute and the profession, influencing policy decisions and clinical practices. One of the most esteemed and respected thought leaders and innovators of our field, who played a vital role in the legacy of several institutions, including the Ackerman, is Dr. Evan Imber‐Black. She served as a long‐time faculty member and director of the Ackerman Center for Families and Health. Her expertise encompasses the exploration of family rituals and family secrets, with a focus on the importance of rituals in providing meaning, identity, and connection across diverse cultures and family life cycles. As editor of Family Process for 8 years, she highlights the importance of examining scholarly work in the context of cultures as a requirement – we do not stand outside the culture – we are active participants. This paper is based on a conversation with Dr Evan Imber‐Black, held in June 2023, delving into her personal and professional experiences, her connection to the Ackerman Institute, and her influential work on family rituals and secrets. Through this exploration, the paper sheds light on her commitment to diversity and the lasting impact of Dr Imber‐Black's contributions to family therapy. [ABSTRACT FROM AUTHOR]

As the bilingual Spanish-speaking population in the United States (U.S.) steadily rises (U.S. Census Bureau in Language spoken at home, https://data.census.gov/cedsci/profile?q=United%20States&g=0100000US, 2020), the need for systemic therapists who are competent in working with Spanish-speaking clients also increases. While it is unrealistic to require all mental health practitioners to be bilingual English and Spanish speakers, systemic therapists can improve their understanding of the impact that clients' native language can have on the therapeutic process. In this paper, we synthesize concepts from narrative therapy and linguistic relativity to provide non-Spanish-speaking clinicians with a unique perspective of case conceptualizations and therapeutic interventions for clients who natively speak Spanish. A clinical vignette is presented to illustrate the practical application of linguistic relativity informed systemic therapy. Potential theoretical and clinical implications of this treatment suggestion are explored. [ABSTRACT FROM AUTHOR]

Theological/spiritual reflection in psychotherapeutic practice has increased in recent years. Approaches for reflection and integration vary depending on the practitioner's spiritual and theoretical beliefs. The integrative approach utilized in this paper is derived from a phenomenological perspective of the author, who was schooled in pastoral theology and later family therapy. Considering the pastoral theologian Seward Hiltner's perspectival approach, this integrative approach creates a conversational method, integrating the client's concerns with specific narrative therapy interventions or practices and the theological/spiritual concepts of immanence–transcendence. Finally, this case study's methodology offers constructive questions that clinical practitioners can apply to specific psychotherapy approaches as well as theological concepts. [ABSTRACT FROM AUTHOR]

Various forms of eating disorder focused family therapy (FT‐ED) have been developed and evaluated for adolescents. FT‐ED for adolescent anorexia nervosa (AN) focuses on empowering parents/carers with the knowledge and skills required to facilitate recovery for their child. The recent trend and increased awareness of the period between adolescence and adulthood during ages 18–25, known as ‘emerging adulthood’, has brought into question whether the traditional treatment approach for adults with AN, that is, individual therapies, is the most appropriate approach for this age group. This paper briefly outlines the current forms FT‐ED for emerging adults with AN and examines the evidence for each. We then present considerations for tailoring FT‐ED for emerging adults with AN across three broad domains: structure and set‐up, process, and content. Finally, we present suggestions on how to troubleshoot common pitfalls that may be encountered, such as reluctance to include parents in treatment. Future research should examine which forms of FT‐ED are best for which emerging adults and families and under what contexts. There is also a need to explore the incorporation of technology into sessions with families who live apart. [ABSTRACT FROM AUTHOR]

In this paper, we report on findings from a three‐part enquiry into the essence of working with families of origin where all members are adult. Findings, in conversational form, describe the nature of adult family ruptures encountered, pathways to repair and unique factors associated with the therapeutic encounter with adult families relative to those with still dependent children. In exploring emergent themes, we hoped to come to some understandings of the models and unique skill sets that characterise and enhance family therapy with adult families. We found that, unlike families with younger children, adult children are often the more motivated sub‐system and indeed the drivers of a referral for therapy. The therapeutic focus centred around legacy work from prior unresolved family traumas or disrupted developmental processes. Features of the therapeutic process included supporting new and more proportional narratives about ingrained wounds, together with redefinition of caregiving relationships and a future gaze towards becoming an independent yet connected family structure. We consider the therapist's posture in validating the adult child's experience, contextualising parent histories and clearing emotional barriers that block healthy giving and receiving of care. Key decision points in the therapist's work included how to balance the past context of the rupture with its current legacy, and the place of exoneration versus forgiveness in the progression towards secure individuation. Findings may help refine therapeutic methods in the application of systemic therapies with adult family forms, particularly on the intersection with the adult mental health system. [ABSTRACT FROM AUTHOR]

The context of this paper is family situations where young people are experiencing significant behavioural and emotional problems. Based on a qualitative study, it offers an empirical and theoretical contribution to the understanding of family‐related factors that promote or hinder behaviour change. Data were collected through face‐to‐face, semi‐structured group interviews with nine families (28 participants), all of them mandatory recipients of child welfare services in Croatia. Thematic analysis comprised primary coding designed to elicit information about individual family members' capacity for change and secondary coding of family‐level phenomena. The results indicated 10 phenomena that were judged to represent factors that helped or hindered change. The discussion section suggests three broad categories of capacity to change at family level (Goals and Priorities; Problem solving dynamics; and Development of role relationship). This analysis is offered as the basis for an examination of the concept of family capacity for change. [ABSTRACT FROM AUTHOR]

Astrophysicists and cosmologists seriously propose that our universe, with its three dimensions and local physical bylaws, is one of an infinite number of parallel universes. This paper discusses the relevance of these ideas for contemporary systemic family therapy, such as thinking about the therapist's positioning in relation to the family. Ideas such as the anthropic principle suggest each meeting of a therapist and family forms a unique systemic entity or singularity with its own universe of by‐laws peculiar to a location in time and space. We are like travellers between parallel family therapy universes where the therapist's epistemology, theory or model is less important than how therapists and clients position themselves towards each other. This ecological positioning encompasses contextual, emotional, cultural, ethical and spiritual belief systems. [ABSTRACT FROM AUTHOR]

The aim of this paper is to examine the experiences and views of parents whose child lived with type 1 diabetes (T1DM) and eating disorder (ED), specifically 'diabulimia' and the professional support offered to them. Interpretative phenomenological analysis (IPA) was employed as a methodology to explore the experience of three parents (mothers) living in the United Kingdom, regarding their chronically ill children. Four themes emerged from the analysis: battling, blaming, surviving and loss. These were interpreted through the lens of systemic theory. Within the framework of the results and the discussion, further research and the provision of systemic family therapy for children, parents and families in both paediatric and adolescent‐to‐adult transition diabetes clinics is recommended. [ABSTRACT FROM AUTHOR]

This paper serves as a preliminary presentation of an existential family therapy approach. It is based on presentation delivered at the Fifth European Conference for Existential Therapy, held in Istanbul on May 2024. Existential family therapy is a therapeutic approach that aims to integrate existential psychotherapy with foundational principles of family therapy. It is a work in progress with important implications for clinical practice and future research. [ABSTRACT FROM AUTHOR]

This study explores the experience of promoting inclusion and anti‐racism work as either performance or deep work in the couple and family therapy (CFT) field through narrative qualitative analysis. While performance‐based approaches focus on meeting external expectations and diversity quotas, deep work involves critical self‐reflection, ongoing learning, and a commitment to addressing systemic inequalities. The paper prioritizes how deep inclusion assists with developing new approaches to creating meaningful and lasting change in teaching, research, and clinical work in the CFT field. Some professionals in the field include educators, researchers, and therapists who are engaged in anti‐racism work, a recognition of the impact of systemic racism on family dynamics and therapeutic interventions, and a commitment to centering the voices and experiences of marginalized individuals and communities. Implications present a need for ongoing education, training, and support for professionals in the CFT field and other family science and family mental health‐related professions. This study also identifies limitations and future directions for research in promoting inclusion and anti‐racism work in family science and family mental health‐related fields. It is essential to promote inclusion and anti‐racism as deep work to create more inclusive and equitable teaching, research, and therapeutic environments that value the experiences of all individuals and communities. Challenges include resistance from shaking systems and making ourselves and others vulnerable with uncomfortable and continuous conversations. Our primary goal is to contribute to and inspire dialogue about the perspectives CFTs and other mental health‐related professionals are taking in the relationship to inclusion and anti‐racism work. [ABSTRACT FROM AUTHOR]

TIAP is an observational procedure to assess family functioning detecting simultaneously the role of each participant and the interdependence of relational behaviors. In particular, the procedure requires family members to play according to different interactive configurations (parent1-children; parent2-children, all together, children and parents as separate units) and therefore different microtransitions from one configuration to another. As such, the procedure allows to study how family members coordinate to maintain stability, promote change, and encourage members to explore different interactive configurations within the family system. TIAP has been validated through several studies conducted with different non-clinical groups of families that have highlighted the salient aspects of family functioning, and significant correlations with variables external to the family system, such as children's social-emotional competence in the educational context. This paper focuses on the use of TIAP in the contexts of assessing parental competence. Specifically, the article aims to describe, through the reference to a clinical case, the results emerged from a study conducted with 33 families involved in a parenting assessment process. The study is part of a broader collaborative project between the Child and Adolescent Neuropsychiatry Clinic of the Italian National Health Service in Parma, the University of Parma, and the Bologna Family Therapy Center. TIAP was administered to all the families involved as a complement to other tools routinely used for all cases handled by the professionals of the clinic. The coding system includes different indices. Some analyze the interactive family modes: family coordination (mutual attention and responsiveness), the responses to potentials for change (disregard, absorption, amplification), and intra-familiar exploration. Other indices concern the quality of the interactions: the relational triadic dynamic of microtransition (detaching-entrusting-welcoming-joining) and the consistency/inconsistency of the communication channels. The results highlighted how TIAP makes it possible to identify the specific interactive modalities of the different members and their interdependence and reciprocity, favoring the identification of both family weaknesses and family resources, including the children's contribution. Furthermore, the general data trend showed that TIAP indices detect some important prognostic elements capable of guiding the court's decisions. [ABSTRACT FROM AUTHOR]

The transition to parenthood, or the addition of another child to the family system is a life altering event for both mothers and fathers that can affect both parents individually and their relationship. For some parents, this includes perinatal suicidal ideation. Despite the prevalence of perinatal mood disorders, there are no systemic models designed specifically for couples who are at risk for suicide. This paper reviews the literature on the prevalence of perinatal suicidal ideation and proposes an integrative treatment model using aspects of Collaborative Assessment of Suicidality (CAMS), Attachment based family therapy (ABFT), and Emotionally Focused Therapy (EFT). [ABSTRACT FROM AUTHOR]

This article presents research that explored the ways that systemic and family therapists might approach the support of families living with dementia. A constructivist grounded theory methodology was used to interpret interviews with four systemic family therapists working in the United Kingdom. All participants had professional and/or lived experience of dementia. Transcript analysis and theoretical sampling led to the development of five categories, each related to different aspects of considering systemic therapy in a dementia context. These categories were further developed into a 'systemically informed dementia orienteering' conceptual framework, which is presented in this paper as a learning resource. Findings are related to existing literature, and recommendations for future research are made. [ABSTRACT FROM AUTHOR]

This paper reports on the results of a study exploring sibling stories of parental mental distress and the societal discourses that may have contributed to the adult siblings' sense‐making. Four sibling pairs were purposively recruited and interviewed, using a narrative inquiry approach. Two main plots were constructed through analysis of the participants' narratives: 'The story of us' and 'We are who we are because of what happened'. Results highlighted that the identity construction of each sibling and the collective identities of the sibling pairs are influenced by the parental mental health context. The findings also suggest a change in the siblings' meaning‐making from childhood to adulthood. These findings are considered along with the implications for systemic practice and research. [ABSTRACT FROM AUTHOR]

This conceptual paper explores the surprising impact exerted by third elements on the escalation and de‐escalation of conflicts in business families. To this end, we draw on core concepts of Batesonian cybernetic theory to perform a reconceptualisation of pertinent literature on changing conflict dynamics gathered in family business research and consultancy. Based on this reconceptualisation, we identify explanations and key mechanisms for the impact of third elements on conflict dynamics. Our study thus contributes to research at the interface of family business research, conflict research and cybernetic theory development. [ABSTRACT FROM AUTHOR]

Preparing the future mental health workforce requires clinicians to be able to adapt their clinical work to different mental and medical healthcare settings to meet the growing need for mental health services. Medical Family Therapists (MedFTs) are specifically trained to provide care for patients from a biopsychosocial-spiritual perspective in diverse clinical settings. Having a theoretical foundation is a necessity for MedFTs to be able to adapt their clinical work to different contexts. Solution-focused therapy provides such a foundation. This paper provides examples of how MedFTs can use solution-focused therapy in traditional psychotherapy, integrated primary care, and integrated psychiatric care. [ABSTRACT FROM AUTHOR]

Umberta Telfener is a highly respected figure known for her diverse contributions to various facets of family and systemic therapy. Her leadership style has earned her a reputation as somewhat of a 'cultural anthropologist,' reflecting her aptitude for creating connections, establishing relationships, and developing partnerships. Her unique 'Umberta style' is known for boundless energy, active leadership, and fierce commitment to challenging the status quo. Despite being in office for just a year at the European Family Therapy Association (EFTA), Umberta has conceived and developed numerous projects, establishing networks with practitioners, and systemic thinkers across the world. Rooted in classical philosophical training, her pursuit aligns with the systematic study of fundamental questions about existence, reason, knowledge, value, mind, and language. Umberta's role reminds one of a 'Chasqui,' a Quechua term for a 'messenger,' which aptly describes her agile networking skills. She actively communicates and shares vital messages, supporting the international community of systemic practitioners. This paper is based on an in‐person conversation held in July 2023 at Umberta's country home in Tuscany. Our discussion delves into her extensive professional experience, from training at the Philadelphia Child Guidance Clinic, being mentored by Boscolo and Cecchin in Milan, to her leadership role as the current EFTA president. Umberta reflects on early pioneers who influenced her thinking and her impactful work with systems. [ABSTRACT FROM AUTHOR]

Systematic uptake of family-centered care (FCC) interventions remains challenging and frequently suboptimal in many neonatal intensive care units (NICUs). Across NICUs in the United States, integrating family members as partners in infant caregiving and decision-making has not been well supported and routine screening and provision of psychological support for parents remains inadequate. Trauma-informed care (TIC) may offer a more comprehensive approach to NICU care which can encompass FCC principles and promote family recovery and resilience by recognizing and responding to the traumas experienced by NICU infants and families. The current paper aimed to understand needs identified by mothers of NICU-hospitalized children and reports a focused analysis of one-on-one interview data (n = 13 mothers) collected during a larger mixed methods study. Reflexive thematic analysis was used to understand needs identified by mothers and to explore how these needs aligned with TIC principles. Six themes were identified and subsequently examined in the context of the principles of TIC: I Just Had No Control, That Really Caught Us Off Guard, So Much Was Already Taken Away, We're People and There Needs To Be More Support and Practices Which Helped. Mothers' care needs were found to align with TIC principles. Findings suggest that implementation of TIC principles in NICU settings can support parental presence, participation in infant care, and mental health and support the potential of TIC as a more comprehensive approach to meeting the needs of NICU parents. [ABSTRACT FROM AUTHOR]

This paper describes a multi‐family therapy (MFT) group for adult outpatients with obsessive‐compulsive disorder and their family members. Since family accommodation (FA) is known to maintain OCD symptoms by preventing exposure and response prevention (ERP), reduction of FA is a major focus of the treatment. Furthermore, psychoeducation, conjoint ERP and (re)discovering resources and strengths of families are also important therapeutic foci of the family group. The organisation of MFT is explained and involvement of family is illustrated with clinical vignettes. Finally, some reflections about MFT are provided. On the basis of initial clinical impressions, MFT seems a promising approach. A clinical trial is currently underway. [ABSTRACT FROM AUTHOR]

Several psychotherapeutic interventions are recommended for Eating Disorders (EDs), chiefly individual cognitive-behavioral therapy and family-based treatments. Manualized individual psychodynamic treatments are recommended for adults with Anorexia Nervosa (AN). Evaluation of psychodynamic group treatments in treating EDs requires further assessment, and recent reviews focused only marginally on this topic. To fill this gap, a narrative review through APA PsychInfo, PubMed and Scopus was carried out. Psychodynamic group treatments appear to improve some ED symptoms at the end of the treatment; however, most of the studies cited were not manualized and lacked control groups and follow-ups. The differences in therapeutic methods and the criteria used to measure remission across the studies included, as well as the incorporation of diverse interventions (including psychodynamic group therapy and elements of BT/CBT or psychoeducation), create difficulties when it comes to forming conclusive judgments about the effectiveness of psychodynamic group therapies for Eating Disorders. The need for more rigorous research and Randomized Controlled Trials (RCTs) is evident. [ABSTRACT FROM AUTHOR]

Childhood obesity is a major public health burden. The prevalence of weight excess for children and the adolescent population (8 to 16 years) is 34.9%. During childhood, lifestyles are acquired, which are developed in adulthood. In this context, the role of parents is crucial, since they are the model to imitate. We aimed to evaluate the current evidence on the effects of family-based interventions as a tool in the treatment of childhood obesity. We reviewed studies indexed in several databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Original articles published from 1 January 2014 to 30 May 2024 with a controlled trial design were considered, in which family-based interventions were carried out compared to a control group or to data before the intervention. Although 148 records were identified in the search, 6 studies met inclusion criteria. Overall, studies reported beneficial effects of family-based interventions on improving anthropometric parameters: BMI z-score, BMI, waist circumference, and body fat percentage. Regarding nutritional and physical activity guidelines, general recommendations must consider increased consumption of fruits and vegetables, reducing sugary drinks, controlled screen time, and 30–60 min of physical activity/day. Thus, family-based interventions could be an effective non-pharmacological strategy for modulating childhood obesity, allowing families to modify their lifestyles. [ABSTRACT FROM AUTHOR]

Growing evidence indicates that family-based mind-body therapy programs (FMBTs) act as an important alternative for attention-deficit/hyperactivity disorder (ADHD) treatment in the youth with minimal side-effects. Moreover, FMBTs contribute to improving the family functioning of those affected by ADHD. To summarize and analyze the benefits and mechanisms, an extensive literature search of the EBSCOhost, PubMed, Web of Science, and Scopus databases was conducted to identify eligible studies. Fifteen studies published between 2010–2023 were reviewed. The included FMBTs were implemented with 850 children/adolescents and 996 parents/caregivers, of whom 201 parent couples attended the programs together with their children. All included FMBTs adopted mindfulness/meditation as the core practice to enhance the participants' mental focus and attention, and were designed for long-term engagement, with six including parent–child joint session(s). Positive changes were observed in both children and adolescents, including improvements in ADHD symptoms, behavioral problems, executive function, and school performance. Additionally, parents experienced positive changes in ADHD traits/symptoms, mental health, and parenting behaviors. Furthermore, FMBTs were found to enhance family functioning by delivering mindful strategies to family, restoring psychological capacity and interpersonal skills in family members, and improving parent–child relationships. The reviewed FMBTs demonstrated high levels of feasibility and participant satisfaction. The factors and issues potentially influencing the effectiveness and feasibility of FMBTs are also discussed. The findings indicate that FMBT holds promise as an ADHD treatment option in home settings. Future efforts may focus on optimizing the design of FMBTs to better address the diverse needs of families in varying circumstances. [ABSTRACT FROM AUTHOR]

Objective: To synthesise young person and family member perspectives on processes of change in family therapy for anorexia nervosa (AN), including systemic family therapy and manualised family-based treatments, to obtain an understanding of what helps and hinders positive change. Method: A systematic search of the literature was conducted to identify qualitative studies focussing on experiences of therapeutic change within family therapies for AN from the perspectives of young people and their families. Fifteen studies met inclusion criteria and underwent quality appraisal following which they were synthesised using a meta-synthesis approach. Results: Six overarching themes were generated: "A holistic focus on the young person's overall development"; "The therapeutic relationship as a vehicle for change"; "The therapist's confinement to a script and its impact on emotional attunement"; "A disempowering therapeutic context"; "Externalisation of the eating disorder (ED)"; and "The importance of family involvement". Positive change was helped by understanding and support given to the young person's overall development including their psychological, emotional, social and physical wellbeing, positive therapeutic relationships, relational containment within the family system and externalising conversations in which young people felt seen and heard. Positive change was hindered by inflexibility in the treatment approach, counter-effects of externalisation, negative experiences of the therapist, a narrow focus on food-intake and weight, as well as the neglect of family difficulties, emotional experiences, and psychological factors. Conclusions: Positive change regarding the young person's eating-related difficulties ensued in the context of positive relational changes between the young person, their family members, the therapist and treatment team, highlighting the significance of secure and trusting relationships. The findings of this review can be utilised by ED services to consider how they may adapt to the needs of young people and their families in order to improve treatment satisfaction, treatment outcomes, and in turn reduce risk for chronicity in AN. Plain English summary: This review synthesises the views of young people and their family members regarding their perspectives of therapeutic change within family therapies for Anorexia Nervosa (AN), including both manualised eating disorder-focussed family therapy models (family-based treatment; FBT and AN-focussed family therapy; FT-AN), as well as systemic family therapy (SyFT), to understand which aspects of these treatment approaches are helpful versus hindering to recovery from an eating disorder (ED). Parental involvement was crucial in facilitating the restoration of physical health through the process of parents taking temporary responsibility for the young person's eating behaviours until they can feed themselves again. However, treatment often failed to acknowledge and address the psychological and emotional difficulties that made the young person vulnerable to developing AN, as well as the psychological distress caused by increasing food-intake and weight. A positive therapeutic relationship in which families felt well supported by their therapist was important in providing containment during a time of familial strain and instability, yet there was a need for greater flexibility and individualisation within manualised ED-focussed family therapy approaches, particularly FBT. The findings highlight the importance of eliciting the young person's voice to enhance their personal agency in treatment and the value of therapeutic space to improve family functioning and enhance family unity. Lastly, they illuminate the need for manualised ED-focussed family therapy models to allow space for the therapist to emotionally attune to young people and families in order to contain their experience of distress. [ABSTRACT FROM AUTHOR]

Background: This systematic review investigated the impact of familial factors on individuals aged 10–17 who have clinical signs or symptoms of eating disorders. Simultaneously, it scrutinized the involvement of the family in therapy, as well as other forms of intervention. Methods: The PsycINFO, PubMed, and Scopus databases were used to search for research material comprehensively. After applying specific criteria, 46 articles were deemed suitable and included in the systematic review. The study comprised a cohort of 4794 adolescents who received a diagnosis of either Anorexia Nervosa (AN), Bulimia Nervosa (BN), or Binge-Eating Disorder (BED). In addition, controls were utilized for 1187 adolescents, 1563 parents, 1809 siblings, and 11 other relatives. Results: The connection between family factors and eating disorders is primarily determined by the families' level of functioning, satisfaction with the family dynamic, parents' attitudes toward their children, and the role of food within the family system. Family Therapy was the most used psychotherapeutic approach in the treatment of AN. The incidence of reports in BN closely paralleled that of Cognitive–Behavioral Therapy (CBT) models. Articles about (Enhanced) CBT were exclusively associated with BED. Conclusions: Family-based approaches are crucial in comprehending, preventing, and addressing eating disorders in adolescents. Incorporating the study of family dynamics and actively engaging families in the treatment process can significantly enhance recovery rates and decrease the occurrence of relapses. [ABSTRACT FROM AUTHOR]

Background: Psychoactive substance abuse can affect biological, psychological, social, and spiritual aspects, as well as the users' quality of life, and obliged to carry out medical and social rehabilitation. Purpose: The purpose of the study was to identify the effect of holistic rehabilitation programs on quality of life among drug abusers. Methods: Quasi-experimental with time series design. The sample of this study amounted to 54 people, taken by G-power, all participants who will take part in the rehabilitation program at the National Narcotics Board rehabilitation clinic. Rehabilitation interventions include health assessment, psychological assessments, health counseling, human immunodeficiency virus-related voluntary counseling and testing, addiction counseling, group therapy, family therapy, client and family monitoring, relapse prevention therapy, and postrehabilitation services. Interventions are provided for 10 weeks, and delivered by health professionals. Measurement of quality of life using World Health Organization Quality of Life—Brief Version (WHOQOL-BREF) MEAT 26 statements consisting of physical, psychological, environmental, and social relationship dimensions, with an alpha value of 0.8756. The data was analyzed with the Friedman test. Results: Holistic rehabilitation influences all dimensions quality of life of drug abusers with a P -value of <0.001. Conclusions: A holistic rehabilitation program improves the quality of life of drug abusers. [ABSTRACT FROM AUTHOR]

Objectives: The high prevalence of borderline personality disorder, along with comorbid psychiatric disorders and impulsive reactions (suicide attempts, self-mutilation, substance use, and impulsive behaviors) increase the need for effective psychological interventions. In this study, the effectiveness of dialectical behavior skills training based on the Soler method and family education with individual therapies are compared in this group of patients. Methods: In this single-blind case study, eight cases were selected through a targeted sampling method based on the inclusion and exclusion criteria. The participants were divided into two groups: Intervention individually and individual intervention with family education. Both group members and the family members of the second group received dialectical behavior skills training based on the Soler model. The participants completed the borderline personality inventory, self-harm inventory, and Barratt impulsivity scale in four stages: At the beginning of the sessions, in the middle of the treatment, at the end of the treatment, and three months after treatment. Results: The data were analyzed using the Wilcoxon test, Friedman test, and Mann-Whitney U test. The results indicate the effectiveness of the dialectical behavior skills training method based on the Soler model in reducing symptoms of borderline personality disorder and selfmutilation, as well as emotion regulation improvement at the significant level of P=0.05. Discussion: This treatment is recommended as an effective and short-term method for controlling symptoms of borderline personality disorder. Family education, in addition to dialectical behavior therapy, has been shown to have a positive effect on reducing symptoms in patients. [ABSTRACT FROM AUTHOR]

This is the protocol for a Campbell systematic review. The objectives are as follows. The aim of the present review is to synthesize evidence on the effectiveness of interventions for at‐risk families aimed at preventing the out‐of‐home placement of children or increasing the likelihood that children are reunited with their birth families following temporary care arrangements. The review has two objectives: (1) To assess the effectiveness of interventions for at‐risk families with children aged between 0 and 17 years old on measures of out‐of‐home placement and on secondary outcomes. (2) To identify factors that modify intervention effectiveness (e.g., prior placements, parental risk factors such as substance abuse, mental health issues, age, minority status, child risk factors such as disabilities, age, and gender). [ABSTRACT FROM AUTHOR]

Background: The joint evidence of the cost and the effectiveness of family-based therapies is modest. Objective: To study the cost-effectiveness of family therapy (FT) versus treatment-as-usual (TAU) for young people seen after self-harm combining data from an 18-month trial and hospital records up to 60-month from randomisation. Methods: We estimate the cost-effectiveness of FT compared to TAU over 5 years using a quasi-Markov state model based on self-harm hospitalisations where probabilities of belonging in a state are directly estimated from hospital data. The primary outcome is quality-adjusted life years (QALY). Cost perspective is NHS and PSS and includes treatment costs, health care use, and hospital attendances whether it is for self-harm or not. Incremental cost-effectiveness ratios are calculated and deterministic and probabilistic sensitivity analyses are conducted. Results: Both trial arms show a significant decrease in hospitalisations over the 60-month follow-up. In the base case scenario, FT participants incur higher costs (mean +£1,693) and negative incremental QALYs (-0.01) than TAU patients. The associated ICER at 5 years is dominated and the incremental health benefit at the £30,000 per QALY threshold is -0.067. Probabilistic Sensitivity Analysis finds the probability that FT is cost-effective is around 3 − 2% up to a maximum willingness to pay of £50,000 per QALY. This suggest that the extension of the data to 60 months show no difference in effectiveness between treatments. Conclusion: Whilst extended trial follow-up from routinely collected statistics is useful to improve the modelling of longer-term cost-effectiveness, FT is not cost-effective relative to TAU and dominated in a cost-utility analysis. Key points: • Extension of evidence base of hospitalisations from 18 months to 5 years show all hospitalisations and self-harm hospitalisations continue to decline with no incremental difference in performance between family therapy and treatment as usual. • The conditional cost of a self-harm hospitalisation falls in line with the probability of an hospitalisation. This suggests the constant conditional cost assumed by NICE may be unrealistic. It does not influence the health economic argument in this case but may well do where there is a difference in the rate of hospitalisations across treatments. • Out of hospital costs represent the main cost-driver and we are unable to estimate the longer-term relationship. Although this is unlikely to have any impact in this evaluation it remains an important research question. Similarly, the relationship between health-related quality of life and self-harm remains uncertain with smaller than anticipated differences measured when using self-harm hospitalisations. [ABSTRACT FROM AUTHOR]

Introduction: Immigrant youth face heightened risks of substance use due to the stress associated with immigration and acculturation. While parental intervention can have a preventative impact on substance use, parents need to be well-informed about substance use and effective interventions that can prevent substance use among immigrant youth. Such interventions ought to be culturally sensitive, family-based, and targeted at the specific substances that are prevalent in a given context. Identifying and curating interventions that can empower parents in addressing substance use can help mitigate the risks that immigrant youth may face. Methods: This scoping review aimed to identify the types, characteristics, and effectiveness of family-based substance use intervention programs. Based on Arksay and O'Malley's guidelines, interventions included in the review must have met the following criteria: (a) was a family-based intervention aiming to prevent substance use; (b) targeted immigrant teens aged 12 to 17 years old; (c) was published in English; (d) originated from Australia, Canada, New Zealand, or the United States. The pinch table was used to synthesize included articles, after which studies were compared and categorized, and cross-cutting categories were identified. Results: After screening 4551 searched literature, 13 studies that utilized family-based interventions were included in the review. All interventions were face-to-face programs, and most interventions involved parents and youth as participants. Eco-developmental theory and active learning strategies were used by multiple interventions. Given immigrant families were target stakeholders, both deep structure and surface structure cultural adaptations were utilized. Interventions increased parents' knowledge and skills regarding substance use prevention and delayed substance use initiation among youth. Conclusion: From the review, it was evident that parents are an essential element in any program aiming to prevent or reduce children's substance use. Besides information about substance use prevention, the curriculum also involves parenting and communication skills for parents to understand the protective effects of family. Effective family-based interventions for immigrant youth require attention to parenting and immigration stress, while also considering cultural adaptation. Future directions and limitations are also discussed. [ABSTRACT FROM AUTHOR]

Many autistic children access some form of early intervention, but little is known about the value for money of different programs. We completed a scoping review of full economic evaluations of early interventions for autistic children and/or their families. We identified nine studies and reviewed their methods and quality. Most studies involved behavioral interventions. Two were trial-based, and the others used various modelling methods. Clinical measures were often used to infer dependency levels and quality-adjusted life-years. No family-based or negative outcomes were included. Authors acknowledged uncertain treatment effects. We conclude that economic evaluations in this field are sparse, methods vary, and quality is sometimes poor. Economic research is needed alongside longer-term clinical trials, and outcome measurement in this population requires further exploration. [ABSTRACT FROM AUTHOR]

Background: Glycated hemoglobin (HbA1c) control is a crucial goal in the management of type 2 diabetes mellitus (T2DM), requiring lifelong commitment and family support. This study aimed to assess the effectiveness of family-based diabetes management intervention on HbA1c among adults with T2DM. Methods: From inception up to 2022, a comprehensive literature search was conducted across PubMed, ProQuest, Scopus, CORE, and the Cochrane Library. The quality of studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Effect sizes were calculated using standard deviations (SD), while the degree of heterogeneity was evaluated using the Higgins I2 test. Subgroup analyses were performed to explore factors contributing to sources of heterogeneity among trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed, and the protocol was registered with PROSPERO CRD42022384034. Results: A total of 18 randomized controlled trials (RCTs) involving 2815 participants indicated that family-based diabetes management intervention had a statistically significant impact on improving HbA1c (Mean Difference [MD] = −.47; 95% Confidence Interval [CI]: −.64 to −.30, p <.001) with a moderate level of heterogeneity (I2 = 59%). Subgroup analysis indicated that family-based diabetes management intervention among adults with T2DM in developing regions was more effective in improving HbA1c levels compared to developed countries. Conclusion: Family-based diabetes management interventions improved HbA1c. Further research is required to develop diabetes management strategies with a family focus that clearly defines the family's involvement. [ABSTRACT FROM AUTHOR]

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The purpose of this study was to document factors associated with a couple's decision to manage finances entirely jointly (i.e., pooled), somewhat jointly, or separately. Based on survey data from 636 married or cohabitating respondents, test results showed that married and less well-educated individuals are more likely to pool finances with their partners. Additionally, it was determined that the odds of partners pooling finances increase as the size of a household increases and when the household exhibits a positive net worth. In this study, households with two income earners were approximately 50% less likely to pool their finances compared to households with one income earner. It was further determined that those who reported agreeing on issues related to spending were more than twice as likely to pool their finances as compared to those who did not agree with their partner on issues related to spending. The findings from this study advance the marriage and family therapy literature by showing that financial integration style and financial decision-making responsibilities are separate constructs and should not be used as proxies for one another. [ABSTRACT FROM AUTHOR]

Background: Experiencing the illness and death of a child is a traumatic experience for the parents and the child's siblings. However, knowledge regarding effective grief interventions targeting the whole family is limited, including how to integrate age-appropriate support for siblings. Aim: We aimed to synthesize the empirical literature regarding grief interventions that target the whole family before and/or after the death of a child. Design: A scoping review following the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Data sources: We searched PubMed, PsycINFO, Embase, CINAHL, and Scopus covering January 1998–May 2022. We included studies describing any type of structured intervention targeting the whole family (i.e. parents and siblings) before or/and after the death of a child (below 18 years), with pre-post assessments of grief-related symptoms in the family as an outcome. Results: After removal of duplicates, we screened the titles and abstracts of 4078 publications and identified 30 publications for full-text screening. None of the studies met the inclusion criteria. Most of the studies were excluded because they either did not target the whole family or did not target families who had lost a child below 18 years. Bereavement camps were a popular form of family intervention, but none were evaluated in a pre-post design. No grief interventions offering support pre-death were found. Conclusions: There is great need for research to improve bereavement outcomes for the entire family and to potentially integrate this in pediatric palliative care. [ABSTRACT FROM AUTHOR]

At the core of collusions are unconscious unresolved issues shared by two or more participants, interlocked in a defensive maneuver. The issue at stake is avoided at an intrapsychic level and externalized in the interpersonal space. Unresolved issues may pertain to control, intimacy, loss, dependency, domination, boundaries and so on. This critical narrative review is based on a comprehensive consultation of the psychoanalytic, general system theory, family therapy and social psychology literature and is informed by our experience as psychotherapists, supervisors, and researchers. When working with the concept of collusion, be it as a clinician, supervisor or researcher, collusions must be delineated from other group dynamics. This might not always be easy. Moreover, reports on polyadic collusions and their contextual determinants are scattered in the literature of different psychotherapeutic approaches and lack precision at times. We therefore engage in a critical dialog with the literature and define different types of polyadic collusions, helping the reader gain a quick overview of this somehow neglected concept. Collusions occur in the psychiatric, psychotherapeutic, and medical setting, but especially in settings which ignore the unconscious and the impact of the wider social determinants on collusions. Collusion is a very useful concept since it brings together different therapeutic orientations but also patients and clinicians, the personal and professional of the caregiver, as well as psychotherapy, psychiatry, medicine, and the social sciences. [ABSTRACT FROM AUTHOR]

Background: Early intervention in psychosis (EIP) supports people who are experiencing their first episode of psychosis (FEP). A new Model of Care (MoC) for EIP services was launched in Ireland in 2019. Three EIP demonstration sites were chosen to test this MoC through a 'hub and spoke' approach. These services were a new way of organising care for people experiencing FEP, based upon a recovery model of care, and which sought to standardise care, improve access by clinically led multidisciplinary teams. This included newly created EIP keyworker roles whereby keyworkers assumed responsibilities regarding assessment, comprehensive individual care planning and coordination of care. Methods: A mixed methods design utilising the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were utilised. Descriptive analyses and logistic regression were performed to examine how increased keyworker engagement influenced the use of other psychosocial interventions within the EIP demonstration sites. Thematic analyses was used for qualitative data. Results: There was a strong positive relationship between keyworker contacts and psychosocial interventions offered. Specifically, the odds of achieving at least monthly engagement with cognitive behavioural therapy for psychosis (CBTp; (5.76 (2.43–13.64), p < 0.001), and behavioural family therapy (BFT; (5.52(1.63–18.69, p < 0.006)) increased by fivefold with each additional monthly keyworker contact. For individual placement support (IPS) each additional monthly keyworker contact was associated with a three-fold increase in the odds of achieving monthly attendance with IPS (3.73 (1.64–8.48), p < 0.002). Qualitative results found that the EIP keyworker role as viewed by both service users and staff as a valuable nodal point, with a particular emphasis on care coordination and effective communication. Conclusions: This study advances the understanding of keyworker effects through qualitative evidence of keyworkers functioning as a "linchpin" to the service, while the positive response association between keyworker contacts and engagement with other services provides quantitative support for keyworkers reducing the organisational or structural barriers to service access. Given the importance of these positions, health systems should ensure that EIP programmes identify qualified and experienced staff to fill these roles, as well as allocate the appropriate funding and protected time to support keyworker engagement and impact. [ABSTRACT FROM AUTHOR]