Innovation summary

There is a robust evidence base for the effectiveness of family interventions in schizophrenia, but these interventions are not yet routinely available in the UK. The Meriden Family Program is a training and organisational development program launched in 1998 to train clinical staff, service users, and carers in the skills needed to work with people with mental health problems and their families.

Meriden currently conducts a range of activities which include:

  • Training clinical staff to deliver quality, evidence-based family interventions
  • Helping organisations to build a family-sensitive culture and embed family work within mental health services
  • Building awareness of carers’ needs
  • Training in the development and facilitation of carer psycho-education and support groups
  • Creating inter-organisational linkages to promote uptake of innovations in evidence-based family work

Impact summary

  • Over 4,750 people have been trained to deliver family work worldwide

"My son, myself and our family are proof that behavioral family therapy can and does work."

 

Parent of a service user 

Innovation details

The Meriden Family Program  as one of many launched in the West Midlands region in 1998 aimed at promoting evidence-based health care and getting research implemented in practice. However, it is the only one that has been sustained—a testament to its contributions to mental health care in the United Kingdom and internationally.

The Meriden Family Program began working in the area of family interventions for schizophrenia even prior to the publication of the UK’s NICE Schizophrenia Guidelines in 2002. These guidelines stipulate that family interventions should be offered to 100% of families in which a member experiences schizophrenia. Over the past 15 years, Meriden has built the capacity of services to deliver quality, evidence-based family interventions through training and organisational development.

Although it is based in Birmingham, UK, and is part of the Birmingham and Solihull Mental Health NHS Foundation Trust, Meriden also provides consultation and training throughout the United Kingdom and internationally. Recent commissions have included Capital District Health Authority and the Department of Health and Wellbeing, Nova Scotia, and the Health Service Executive, Ireland. Meriden has also developed links and provided training for clinical staff working in Canada, Australia, Uganda, Singapore, Portugal, Spain, Greece, Japan, and Jersey.

The main objectives for the Meriden Family Program are:

  • To train and supervise multi-disciplinary groups of clinicians, along with service users and carers, in evidence-based family interventions and to adapt this training to suit specialist areas within mental health services
  • To ensure that the structure of family interventions delivered is consistent with an evidence-based model of Behavioral Family Therapy (BFT) which includes all the components defined within the 2009 NICE Guidelines for Schizophrenia. The Meriden model also complies with the Family Intervention competences specified within the IAPT Program for Severe Mental Illness.
  • To maintain contact with managers and key individuals within services; to identify barriers to the implementation of family work and develop solutions for overcoming them; to bring about attitudinal and organisational change resulting in family work becoming embedded in services
  • To ensure that mental health service provision is ‘family sensitive’ and provides a range of services and supports consistent with the “Triangle of Care” best practice guidance

A recent focus of the Meriden Family Program is on addressing the needs of those caring for people with long-term mental health problems, which are often unmet and ignored by services. The program now offers a range of training sessions in addition to family intervention training— including sessions on carers and confidentiality and in facilitating carer psycho-education and support groups (the “Caring for Carers” program).

Further, Meriden is concerned with implementing government policy and guidelines relating to improving services for the carers and family members of those experiencing mental health problems. The aim has been to link developments for the delivery of evidence-based family work with the involvement of carers across organisations (locally and nationally) to ensure that work is not duplicated and collaboration is encouraged.

Key drivers

Engaging Users and Carers

A Carer who has received family work is now employed by Meriden as a Carer Consultant. Carers and service users are actively involved in the delivery of therapy and training, in special interest groups and in raising the profile of the needs of families.

Engaging Managers

Ensuring key managers review current practice and develop action plans has positively influenced the culture of services. A key feature in bringing about change has been the development of training for managers so that they are clear about their role in ensuring that services to families are developed.

Cascade Model of Training

Since its conception in 1998, Meriden has adopted a cascade model of training. This has involved training cohorts of workers, followed by training a core team of trainers who are then able to cascade train skills to the local workforce. This has maximised sustainability within organisations and ensured the training has been both affordable and cost effective.

National Policy

In terms of external drivers, the NICE guidelines for Schizophrenia and Bipolar Disorder have both advocated the use of family intervention. The current IAPT Severe Mental Illness program further reinforces Family Intervention as a core component of the care pathway for those experiencing Psychosis, Schizophrenia and Bipolar Disorder.

Challenges

Although the Meriden Program’s training is consistently evaluated positively, implementation issues are still reported by those trained by the program. Our research suggests common barriers are shared by many trainees:

  • Family intervention not seen as a service priority and is “off the agenda” in teams/organisations
  • Time and general caseload management issues (e.g. inflexible working practices, accessibility of families, out-of-hours working)
  • Lack of support from managers/the multidisciplinary team
  • Lack of confidence (e.g. following a gap in service/not having worked with a family for a while)

Continuation

The Meriden Family Programme began as a West Midlands initiative in 1998, focusing predominantly on evidence-based interventions in schizophrenia. Since that time, training courses have been delivered in locations throughout the UK and within a wide range settings/client groups. This demonstrates how generalizable the Family Intervention (BFT) model is within mental health settings, and also how the cascade model adopted by the Meriden Family Programme allows for ease of ‘scaling up’ to meet the needs of a wider population.

Similarly, initial cohorts of training were commissioned by the Capital District Health Authority in Nova Scotia and, due to their success, were extended province-wide. Health Trusts in Scotland have had a similar experience, and the Republic of Ireland (Health Service Executive) is currently involved in a commission that will ensure family interventions are available through all of their Early Intervention in Psychosis teams.

Partners

Key partners are generally statutory services and voluntary agencies, including carer and service user organisations such as:

Many National Health Service (NHS) Trusts and mental health service providers have commissioned training from Meriden Family Program, which has worked closely with organisations such as the Royal College of Psychiatrists (UK).

Funders

The Meriden Family Program is funded through:

Evaluation methods

Monitoring and evaluation

The program monitors and evaluates its work on an ongoing basis.

Data are collected pre- and post-training from all course participants, and each training course is evaluated. Data exists for all those who have been trained by the programme over the past 15 years, including data on clinical background, demographics and frequency of contact with family/carers.  

A method of process research is also used, whereby data collected are fed back to organisations quickly and regularly to inform services of progress, deficiencies, and changes needed. As a result of participation in routine data collection, service users and carers report feeling more involved in the care process, listened to by professionals, and in control.

Formal evaluation

The program has evaluated the perception of families who have received family work and has produced numerous evaluations and reports relative to specific pieces of work and intervention (i.e. the range of “Caring for Carers” programs, Recovery for Carers research). Much of the work is documented on an ongoing basis in peer-reviewed journals and book chapters. Qualitative reports are published quarterly in the program’s widely disseminated newsletter which goes out to over 3,000 people.

Cost of implementation

Costs are met by services/organisations purchasing training, supervision and consultation activities from the Meriden Family Program. Costs are dependent on the size of the training cohorts and the nature of any implementation plans/ongoing support required.

Impact details

Domestic 

  • Over 2,986 people have been trained to deliver family work in the West Midlands, UK
  • 143 have been trained in the additional skills required to deliver in-house training and supervision

International

  • Over 4,766 people have been trained to deliver family work worldwide.
  • 332 have been trained in additional skills required to deliver in-house training and supervision.

References

  1. Falloon IRH et al. (1984) Family care of schizophrenia: a problem-solving approach to the treatment of mental illness. New York: Guilford Press.
  2. Falloon IRH (1985) Family management of schizophrenia. Baltimore: Johns Hopkins University Press.
  3. Falloon IRH (2004) Family work manual. Birmingham: Meriden Family Program.
  4. NICE (2009) Schizophrenia: core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. NICE clinical guideline 82.
  5. Roth AD and Pilling S (2013) A competence framework for psychological interventions with people with psychosis and bipolar disorder. Research Department of Clinical, Educational and Health Psychology, UCL.
  6. Worthington A et al. (2013) The triangle of care. London: Carers Trust.
  7. NICE (2006) Bipolar disorder: the management of bipolar disorder in adults, children and adolescents, in primary and secondary care. NICE clinical guideline 38.
  8. Campbell, A (2004) How was it for you? Families’ experiences of receiving Behavioural Family Therapy. Journal of Psychiatric and Mental Health Nursing, 11:261-267.

Research

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