Family involvement practices for persons with psychotic disorders in community mental health centres - a cross-sectional fidelity-based study

Lars Hestmark, Kristin Sverdvik Heiervang, Reidar Pedersen, Kristiane Myckland Hansson, Torleif Ruud, Maria Romøren, Lars Hestmark, Kristin Sverdvik Heiervang, Reidar Pedersen, Kristiane Myckland Hansson, Torleif Ruud, Maria Romøren

Abstract

Background: Family involvement for persons with psychotic disorders is supported by scientific evidence, as well as legal and ethical considerations, and recommended in clinical practice guidelines. This article reports a cross-sectional measurement of the level of implementation of such guidelines in fifteen community mental health centre units in Norway, and presents a novel fidelity scale to measure basic family involvement and support. The aim was to investigate current family involvement practices comprehensively, as a basis for targeted quality improvement.

Methods: We employed three fidelity scales, with 12-14 items, to measure family involvement practices. Items were scored from 1 to 5, where 1 equals no implementation and 5 equals full implementation. Data was analysed using descriptive statistics, a non-parametric test, and calculation of interrater reliability for the scales.

Results: The mean score was 2.33 on the fidelity scale measuring basic family involvement and support. Among patients with psychotic disorders, only 4% had received family psychoeducation. On the family psychoeducation fidelity assessment scale, measuring practice and content, the mean score was 2.78. Among the eight units who offered family psychoeducation, it was 4.34. On the general organizational index scale, measuring the organisation and implementation of family psychoeducation, the mean score was 1.78. Among the units who offered family psychoeducation, it was 2.46. As a measure of interrater reliability, the intra-class correlation coefficient was 0.99 for the basic family involvement and support scale, 0.93 for the family psychoeducation fidelity assessment scale and 0.96 for the general organizational index scale.

Conclusions: The implementation level of the national guidelines on family involvement for persons with psychotic disorders was generally poor. The quality of family psychoeducation was high, but few patients had received this evidence-based treatment. Our novel fidelity scale shows promising psychometric properties and may prove a useful tool to improve the quality of health services. There is a need to increase the implementation of family involvement practices in Norway, to reach a larger percentage of patients and relatives.

Trial registration: ClinicalTrials.gov Identifier NCT03869177 . Registered 11.03.19.

Keywords: Family involvement; Family psychoeducation; Fidelity scale; Implementation science; Mental health services research; Psychotic disorders; Schizophrenia.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. International Statistical Classification of Diseases and Related Health Problems - ICD-10. Schizophrenia, schizotypal and delusional disorders (F20-F29): World Health Organization 2016 [Available from: ]. Accessed Feb 2021.
    1. Weimand BM, Hedelin B, Hall-Lord ML, Sällström C. “Left alone with straining but inescapable responsibilities:” relatives’ experiences with mental health services. Issues Ment Health Nurs. 2011;32(11):703–710. doi: 10.3109/01612840.2011.598606.
    1. Vermeulen B, Lauwers H, Spruytte N, Van Audenhove C, Magro C, Saunders J, Jones K. Experiences of family caregivers for persons with severe mental illness: an international exploration. Leuven: LUCAS KU Leuven/EUFAMI; 2015.
    1. Bucci S, Berry K, Barrowclough C, Haddock G. Family interventions in psychosis: a review of the evidence and barriers to implementation. Aust Psychol. 2016;51(1):62–68. doi: 10.1111/ap.12172.
    1. Rummel-Kluge C, Pitschel-Walz G, Bauml J, Kissling W. Psychoeducation in schizophrenia--results of a survey of all psychiatric institutions in Germany, Austria, and Switzerland. Schizophr Bull. 2006;32(4):765–775. doi: 10.1093/schbul/sbl006.
    1. Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database Syst Rev. 2010;12:CD000088. doi: 10.1002/14651858.CD000088.pub2.
    1. Baandrup L, Ostrup Rasmussen J, Klokker L, Austin S, Bjornshave T, Fuglsang Bliksted V, et al. Treatment of adult patients with schizophrenia and complex mental health needs - a national clinical guideline. Nord J Psychiatry. 2016;70(3):231–240. doi: 10.3109/08039488.2015.1074285.
    1. Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E. Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry. 2010;197(5):350–356. doi: 10.1192/bjp.bp.109.074526.
    1. Claxton M, Onwumere J, Fornells-Ambrojo M. Do family interventions improve outcomes in early psychosis? A systematic review and meta-analysis. Front Psychol. 2017;8:371. doi: 10.3389/fpsyg.2017.00371.
    1. Pilling S, Bebbington P, Kuipers E, Garety P, Geddes J, Orbach G, et al. Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med. 2002;32(5):763–782. doi: 10.1017/s0033291702005895.
    1. Yesufu-Udechuku A, Harrison B, Mayo-Wilson E, Young N, Woodhams P, Shiers D, Kuipers E, Kendall T. Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry. 2015;206(4):268–274. doi: 10.1192/bjp.bp.114.147561.
    1. Sin J, Gillard S, Spain D, Cornelius V, Chen T, Henderson C. Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis. Clin Psychol Rev. 2017;56:13–24. doi: 10.1016/j.cpr.2017.05.002.
    1. Lobban F, Postlethwaite A, Glentworth D, Pinfold V, Wainwright L, Dunn G, Clancy A, Haddock G. A systematic review of randomised controlled trials of interventions reporting outcomes for relatives of people with psychosis. Clin Psychol Rev. 2013;33(3):372–382. doi: 10.1016/j.cpr.2012.12.004.
    1. Ma CF, Chien WT, Bressington DT. Family intervention for caregivers of people with recent-onset psychosis: a systematic review and meta-analysis. Early Interv Psychiatry. 2018;12(4):535–560. doi: 10.1111/eip.12494.
    1. Hasan AA, Jaber AA. The effect of a family intervention on primary caregivers psychological outcomes: findings from the integrative literature review. Perspect Psychiatr Care. 2019;55(2):277–290. doi: 10.1111/ppc.12339.
    1. Lucksted A, McFarlane W, Downing D, Dixon L. Recent developments in family psychoeducation as an evidence-based practice. J Marital Fam Ther. 2012;38(1):101–121. doi: 10.1111/j.1752-0606.2011.00256.x.
    1. Landeweer E, Molewijk B, Hem MH, Pedersen R. Worlds apart? A scoping review addressing different stakeholder perspectives on barriers to family involvement in the care for persons with severe mental illness. BMC Health Serv Res. 2017;17(1):349. doi: 10.1186/s12913-017-2213-4.
    1. Eassom E, Giacco D, Dirik A, Priebe S. Implementing family involvement in the treatment of patients with psychosis: a systematic review of facilitating and hindering factors. BMJ Open. 2014;4(10):e006108. doi: 10.1136/bmjopen-2014-006108.
    1. Mottaghipour Y, Bickerton A. The pyramid of family care: a framework of family involvement with adult mental health services. Aust J Adv Ment Health. 2005;4(3):210. doi: 10.5172/jamh.4.3.210.
    1. Veileder om pårørende i helse- og omsorgstjenesten. Oslo: Helsedirektoratet; 2017. [Available from: ]. Accessed Feb 2021.
    1. Nasjonal faglig retningslinje for utredning, behandling og oppfølging av personer med psykoselidelser. Oslo: Helsedirektoratet; 2013. [Available from: ]. Accessed Feb 2021.
    1. Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, Kulkarni J, McGorry P, Nielssen O, Tran N. Royal Australian and new Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry. 2016;50(5):410–472. doi: 10.1177/0004867416641195.
    1. Dixon LB, Dickerson F, Bellack AS, Bennett M, Dickinson D, Goldberg RW, Lehman A, Tenhula WN, Calmes C, Pasillas RM, Peer J, Kreyenbuhl J, Schizophrenia Patient Outcomes Research Team (PORT) The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull. 2010;36(1):48–70. doi: 10.1093/schbul/sbp115.
    1. Gühne U, Weinmann S, Arnold K, Becker T, Riedel-Heller S. S3 guideline on psychosocial therapies in severe mental illness: evidence and recommendations. Eur Arch Psychiatry Clin Neurosci. 2015;265(3):173–188. doi: 10.1007/s00406-014-0558-9.
    1. Kuipers E, Yesufu-Udechuku A, Taylor C, Kendall T. Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ. 2014;348(feb12 1):g1173. doi: 10.1136/bmj.g1173.
    1. Hestmark L, Romøren M, Heiervang KS, Weimand B, Ruud T, Norvoll R, Hansson KM, Norheim I, Aas E, Landeweer EGM, Pedersen R. Implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres (IFIP): protocol for a cluster randomised controlled trial. BMC Health Serv Res. 2020;20(1):934. doi: 10.1186/s12913-020-05792-4.
    1. Bond GR, Drake RE. Assessing the Fidelity of evidence-based practices: history and current status of a standardized measurement methodology. Admin Pol Ment Health. 2020;47(6):874–884. doi: 10.1007/s10488-019-00991-6.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–808. doi: 10.1136/.
    1. Bond GR, Drake RE, McHugo GJ, Rapp CA, Whitley R. Strategies for improving Fidelity in the National Evidence-Based Practices Project. Research on social work practice. Res Soc Work Pract. 2009;19(5):569–581. doi: 10.1177/1049731509335531.
    1. Adair CE, McDougall GM, Mitton CR, Joyce AS, Wild TC, Gordon A, et al. Continuity of care and health outcomes among persons with severe mental illness. Psychiatr Serv. 2005;56(9):1061–1069. doi: 10.1176/appi.ps.56.9.1061.
    1. Macdonald A, Adamis D, Craig T, Murray R. Continuity of care and clinical outcomes in the community for people with severe mental illness. Br J Psychiatry. 2019;214(5):273–278. doi: 10.1192/bjp.2018.261.
    1. Henderson C, Flood C, Leese M, Thornicroft G, Sutherby K, Szmukler G. Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial. BMJ. 2004;329(7458):136. doi: 10.1136/bmj.38155.585046.63.
    1. Thornicroft G, Farrelly S, Szmukler G, Birchwood M, Waheed W, Flach C, Barrett B, Byford S, Henderson C, Sutherby K, Lester H, Rose D, Dunn G, Leese M, Marshall M. Clinical outcomes of joint crisis plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial. Lancet. 2013;381(9878):1634–1641. doi: 10.1016/S0140-6736(13)60105-1.
    1. Ruchlewska A, Wierdsma AI, Kamperman AM, van der Gaag M, Smulders R, Roosenschoon BJ, Mulder CL. Effect of crisis plans on admissions and emergency visits: a randomized controlled trial. PLoS One. 2014;9(3):e91882. doi: 10.1371/journal.pone.0091882.
    1. Bond GR, Williams J, Evans L, Salyers M, Kim HW, Sharpe H, Leff HS. Psychiatric rehabilitation fidelity toolkit. Cambridge: Human Services Research Institute; 2000.
    1. Joa I, Johannessen JO, Heiervang KS, Sviland AA, Nordin HA, Landers M, Ruud T, Drake RE, Bond GR. The family Psychoeducation Fidelity scale: psychometric properties. Admin Pol Ment Health. 2020;47(6):894–900. doi: 10.1007/s10488-020-01040-3.
    1. Kealey EM, Leckman-Westin E, Jewell TC, Finnerty MT. Multifamily group Psychoeducation in New York state: implementation and Fidelity outcomes. Psychiatr Serv. 2015;66(11):1194–1199. doi: 10.1176/appi.ps.201400403.
    1. Heiervang KS, Egeland KM, Landers M, Ruud T, Joa I, Drake RE, Bond GR. Psychometric properties of the general organizational index (GOI): a measure of individualization and quality improvement to complement program Fidelity. Admin Pol Ment Health. 2020;47(6):920–926. doi: 10.1007/s10488-020-01025-2.
    1. Aaltonen J, Seikkula J, Lehtinen K. The comprehensive open-dialogue approach in Western Lapland: I. the incidence of non-affective psychosis and prodromal states. Psychosis. 2011;3(3):179–191. doi: 10.1080/17522439.2011.601750.

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