The increased recognition of the importance of early mental health intervention, as well as the finding that over 50% of young people with psychosis live with their families (White, 1998), highlights the need for the development of a specialised program for this population. Current family research in recent-onset psychosis is limited, with most interventions adapted from programs for long-term severe mental illness. To date, the efficacy and applicability, as well as the uptake and retention rates of such programs with this population, are mixed, (i.e., Linszen et al., 1996). Furthermore, these programs have ranged from 9 months to 2 years in duration, which has raised significant cost, participation and delivery issues. It has been these concerns that have been the impetus for the present research into the development of a time-limited intervention tailored to the unique needs of families of young people with recent-onset psychosis.
An initial study was conducted to explore the nature of referrals (N = 65) to a regional family psychoeducation program. The study found that referrals of families of young person with a recent-onset psychosis made up over half of the referrals, although only 1 in 6 families attended the program. A second study entailed an exploration of the issues and needs of families and their young relatives with recent-onset psychosis. Using a qualitative methodology, 32 family members, 35 young people and 41 mental health staff were interviewed. Several themes emerged including the need for timely, accurate, relevant and age appropriate education, information and support for both families and their young relative. Specifically, consideration of the developmental stage of the young person and the phase of their illness emerged as an important mediating factor in working with these families.
The findings from the retrospective family program study and the qualitative study, contributed to the development of a brief individualized intervention [The Strengthening Ties family program (STF)] for parents of young people with recent-onset psychosis. The final studies in this body of research involved a five-family pilot of the intervention to fine tune and standardize both the assessment and intervention, and a two-group controlled trial involving 60-families of young people with recent-onset psychosis. In the controlled trial, participants were randomly assigned to either a brief parent-based intervention delivered at the outset of the young people's inpatient admission (I-BFI), or to a wait list control group tiiat received the brief intervention in a 6-week delayed format (D-BFI). Utilizing a problem-solving model and strengths approach (Rapp & Winterseen, 1989), the intervention focused on enhancing illness knowledge and understanding, as well as positive adaptation and problem-solving, coping and relationship strategies within the family. Parents who participated in the program were assessed at baseline, 6 weeks, 3 months, 6 months, and with a phone follow-up at 12 months,. The participants' mentally ill son or daughter was assessed at baseline and 6 months.
The findings from the controlled trial were that the brief intervention, whether delivered in the immediate (I-BFI) or delayed condition (D-BFI), had a positive impact upon parental illness knowledge, their level of coping and concern, general health, and their relationship caring for their ill relative. However, participants who received the intervention immediately, benefited earlier than participants in the wait list control group (D-BFI). Furthermore, even though this was a brief intervention, the positive effects of the intervention were maintained at the 6 -month follow-up. In relation to relapse there was no difference between the groups. This was not surprising, as both groups had received the intervention by the 3-month follow-up. A further finding in relation to relapse was a negative correlation with the initial parental scores on the positive subscales of the Experience of Caregiving and the Relationship Inventory, but a positive correlation with the Family Attitudes Scale and the negative subscale of the Relationship Inventory. Further analyses, however, did not reveal a significant predictor variable from the carer measures administered at baseline.
The brief strengths-oriented and parent-based intervention trialled in this study shows promise as a first-line approach with families of young people with recent onset psychosis. However, further research involving more extensive and longitudinal follow-up is required in order to substantiate the present findings and extend out knowledge of how best to support and assist these families.