Where do you work as a Family Therapist?
I often get asked this question socially and by other healthcare professionals. I think it may be because it is still relatively unusual for people to think of a Family Therapist working with health issues. The domain of health is often more easily associated with the work of doctors and nurses and, perhaps more recently, psychologists.
I have been working with the Children & Young People’s Health Partnership (CYPHP) since January 2017. CYPHP is an integrated clinical service looking at the mental health needs of children with a range of health conditions (asthma, epilepsy, constipation, and eczema) in Lambeth and Southwark.
You go into a family’s home?
As I explain my role, I tell my listener that I often travel across Lambeth and Southwark to go to a family’s home to meet everyone in their household. Generally, the child is referred to me by one of the specialist children nurses in our team, who noted that their chronic condition has brought up social and emotional issues alongside the physical concerns. And this combination is having an impact on the quality of life for the child (and family), their view of self, and others.
So yes, I see families in their home, or wherever they feel safe. Other safe spaces often include their GP surgery, school, or a local Children’s Centre. This is news to whomever I speak to, including families, other health care professionals, and my own friends. I could only assume that many people still see the ‘business’ of health as being carried out in hospitals and other specialist health care settings. In such a way, ‘health’ can inadvertently still be thought of as removed from the challenges of daily life that families can face while also concerned about their child’s health.
So, what is the difference between a family home visit compared to a clinical setting?
My experience is that often I get to know the family more quickly in their own environment. Perhaps they are more themselves, as they are at home and I am the visitor. I am also more mindful of seeking permission from the family, entering their space, seeking to understand their worries, perhaps more than I would in my own clinical space.
For example:
I knock at the front door and a busy mother on a council estate opens the door having just got home from school with two children under 10 years old, and a toddler in tow. The mother has forgotten I was coming.
I ask: Is it still alright to meet now?
She is laden with shopping bags and looks flustered.
I ask: Is okay to meet now, or shall I come back another time?
The mother invites me in, and apologises for the chaos. I wonder, shall I take my shoes off? I stand in the doorway. Where shall I go now?
She tells me to go straight ahead to the lounge where the two older children run ahead to welcome me in, laughing and playing, vying for my attention.
I ask the mother: Where I shall sit down.
The mother tells me which chair to sit on, and I sit. This visit starts well.
But, aren’t their challenges with home visits?
Authority
I am aware that seeing families in ‘their’ space can also somewhat diminish the sense of authority we, as health and mental health professionals, inherently carry with ourselves compared to when we invite families to our hospitals, our clinics, our space and, effectively, our rules.
Negotiating authority and professional expertise is a very different task when you are sitting in somebody’s living room. While working at CYPHP, ideas on how to best manage this tension are often shared in our weekly multidisciplinary meetings. It provides an invaluable opportunity for the whole CYPHP Health Team (nurses, mental health professionals, doctors) to discuss these and other live clinical issues.
Not engaging
For example:
I can think of other days when a visit does not even start… I have knocked on the door and there has been no answer.
The child has an ongoing health condition and the family has been finding it difficult to manage this, as well as additional concerns about the child’s low mood. These concerns have only emerged in a recent discussion at the Child in Need meeting attended by one of the CYPHP nurses.
I am reminded that not all parents or young people want to meet professionals.
Or know what professionals might be able to help them with.
Or have the energy to find out.
This meeting is not going to happen in the family’s home, and I need to think about what else I might do to reach out to this family. So it’s back to our clinical team discussion, to plan together how to best engage the family in a conversation about the child’s low mood, and its impact on the ongoing management of the health condition.
Finding the right environment
Homes are busy places. At times it can be difficult to find a space to meet a young person on their own as part of an assessment of their mental health needs. I share my dilemma with the family and offer alternatives; what about opportunities to meet at school or their GP surgery?
In saying this, I can also think of a young person who did not mind going to the hospital for his chronic health condition, but did not want to talk about his difficulties with feelings, anxiety, relationships in the hospital. He wanted to talk to his family at home.
It is not just children who prefer this, some parents do too. I have noticed that this has been particularly helpful for some parents with mental and physical illness who find it easier to access services in more familiar surroundings e.g. at home, or at their child’s school.
Some additional thoughts
As I reflect on the families I have worked with in CYPHP, it is clear that many of them had previously found it difficult to engage with health and mental health services based in hospitals and clinics. In some cases this has contributed to a detrimental effect on the health of children and young people.
The families I have worked with face multiple challenges, the physical and mental health needs of children and young people, often intertwined with the physical and mental health needs of their primary care givers, within the context of different levels of social adversity.
Seeing families in the familiar space of their homes and communities is not just about a ‘change of scenery’ from hospitals and clinics, it’s about:
- a change in thinking
- a way of reaching out by being willing to listen
- signposting and addressing issues beyond the traditional barriers between services
Specifically, thinking about physical health services in relation to mental health services, adult services in relation to children services, and health services in relation to social care.
CYPHP’s aim of promoting with families an understanding of health in its broadest definition (physical, mental, and social) is one of its strengths, contributing to keeping children happy, healthy, safe, and well. This is one of the reasons I like my job as a Family Therapist in CYPHP.
Louise Rocks
CYPHP Family Therapist
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