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Family-centred care

Why family-centred care?

Family members are often the primary support for people who have substance use or mental health issues. They play a critical role in promoting health and wellness. Involving families is a key strategy for meeting the needs of both clients and families. Family-centred care identifies and builds on the strengths and interconnectedness of families.

Adopting a family-centred care approach requires a shift in organizational practices and in the attitudes and behaviours of individual providers. Although there are a growing number of interventions that support family members, many agencies do not see helping families as their mandate. If they do, it is often secondary to the job of working with the client.

In this video from the Family Council, the Southam family talks about the role of family-centred care.

Definition

Family-centred care considers the family as a primary unit of care, which can help to determine treatment and recovery goals.

Family-centred care is often misinterpreted as family-sensitive care. Family-sensitive care recognizes the critical role families have in supporting family members throughout treatment and recovery. It encourages family members to participate in the client's care according to the client's desire and consent.

Although both approaches value the involvement of family and aim to maintain a respectful relationship with the client's family, the family's role in setting treatment goals differs. Family-centred care involves the participation of the family in the goal-setting and treatment processes.

In family-sensitive care, treatment and recovery goals are set with the health care team and do not necessarily include the family. However, lack of consent does not preclude education and support to family members. Evidence strongly suggests that education and support have a positive impact on client well-being and treatment outcomes.

Balancing risk

Family-centred care requires a shift in organizational culture. Clinical decision-making power needs to be transferred to front-line staff to enable them to be flexible in supporting family-centred practices. It entails developing and maintaining mechanisms to monitor and encourage family input.

Family-centred care has risks of reducing client determination in the decision-making process of treatment and recovery goals. However, research demonstrates that this collaborative approach to care improves health care quality and cost-effectiveness.

About 72% of people with a mental illness are discharged to the care of their families. This makes family-centred care particularly important because the approach:

  • reduces the rate of rehospitalization and relapse
  • enhances medication compliance
  • improves interpersonal functioning and family relationships.

Principles of family-centred care

Follow these practices that are key to a family-centred care approach:

  • Provide support and respect for families.
  • Listen to families' concerns and involve them as equal partners in planning and treatment delivery whenever possible.
  • Acknowledge, value and respect family members' expertise.
  • Offer a variety of evidence-based interventions for families.
  • Acknowledge that family members also move through their own journey of recovery parallel to that of the client.
  • Explore family members' expectations of the treatment program and expectations for the client.
  • Assess the family's ability (strengths and limitations) to support the client.
  • Provide ways for the family to build resilience in the presence of emotional pain, conflicts, difficult emotions, extreme stress and caregiver compassion fatigue.
  • Help the family develop problem-solving skills.
  • Facilitate access to other professionals in the event that contact with the family or client ends.

Collaboration

Collaboration between families, clients and care providers is essential in supporting clients and families throughout treatment and recovery. Collaboration facilitates reintegration into the community. Too often family members are not welcomed or included in this process due to challenges around privacy legislation. Health care providers who want to involve families must know about privacy and signed consent initiatives.

In Canada, progress over the last decade in involving families has resulted from growing awareness that social support is crucial to producing effective long-term outcomes. Family involvement has also grown because of increasing family mobilization and advocacy around the need and right of families to understand, participate in and contribute to their loved ones' treatment.

Related approaches

Evidence summary

Centre for Addiction and Mental  Health. (2004). Putting Family-Centered Care Philosophy into Practice. Toronto, ON: Author.

Centre of Addiction and Mental Health. (2011). Practice Model: Partners in Care. Toronto, ON: Author.

Colleges of Nurses of Ontario. (2006). Practice Standards: Therapeutic Nurse-Client Relationship. Toronto, ON: Author.

O'Grady, C. (2005). The impact of concurrent disorders on the family. In W.J.W. Skinner (Ed.), Treating Concurrent Disorders: A Guide for Counsellors. Toronto, ON: Centre for Addiction and Mental Health.

O'Grady, C.P. & Skinner, W.J.W. (2007). Partnering with Families Affected by Concurrent Disorders: Facilitators' Guide. Toronto, ON: Centre for Addiction and Mental Health.

For your clients and their families

  • The Family Toolkit, developed by B.C. Partners for Mental Health and Addictions Information, consists of five learning modules that cover mental health and substance use problems:

Module 1: Understanding Mental and Substance Use Disorders

Module 2: Supporting Recovery from a Mental or Substance Use Disorder

Module 3: Communication and Problem-Solving Skills

Module 4: Caring for Yourself and Other Family Members

Module 5: Children and Youth in the School System

  • The Life Recovery Program provides a trauma-informed psychoeducation program for addiction and mental health recovery. It provides tools for both clients and families and other supports.

Training

  • Collaborating with Families Affected by Concurrent Disorders is a six-week online course for health care providers that explores the needs of families affected by concurrent disorders. It also suggests strategies that health care providers can use to empower families and make their experiences more positive.

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