Family Talk
Note on provider involvement: This provider has agreed to EIF’s terms of reference, and the assessment has been conducted and published with the full cooperation of the programme provider.
Family Talk (FT) is a targeted indicated programme for children aged 5-18 years whose parent(s) has/have a mental health diagnosis (typically anxiety or depression) and/or are in contact with mental health services . FT is delivered mainly in the home or in outpatient health settings, and aims to support healthy parent-child relationships in the context of mental illness.
- Family Talk (FT) is a strengths-based, psycho-educational, whole-family approach designed to enhance family communication and understanding of parental mental illness, improve family interpersonal relationships, and promote child resilience and utilisation of social supports.
- It is intended for children with parents who have mental health diagnoses and/or are in contact with mental health services.
- FT adaptation involves group discussion, roleplay, homework assignments, and use of video vignettes.
EIF Programme Assessment
Family Talk has evidence of a short-term positive impact on child outcomes from at least one rigorous evaluation.
What does the evidence rating mean?
Level 3 indicates evidence of efficacy. This means the programme can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome.
This programme does not receive a rating of 4 as it has not yet replicated its results in another rigorously conducted study, where at least one study indicates long-term impacts, and at least one uses measures independent of study participants.
What does the plus mean?
The plus rating indicates that this programme has evidence from at least one level 3 study, along with evidence from other studies rated 2 or better.
A rating of 2 indicates that a programme has a medium-low cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of £100–£499.
Child outcomes
According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:
Supporting children's mental health and wellbeing
This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.
Family Talk
Key programme characteristics
Who is it for?
The best available evidence for this programme relates to the following age-groups:
- Primary school
- Preadolescents
- Adolescents
How is it delivered?
The best available evidence for this programme relates to implementation through these delivery models:
- Individual
- Group
Where is it delivered?
The best available evidence for this programme relates to its implementation in these settings:
- Children's centre or early-years setting
- Out-patient health setting
How is it targeted?
The best available evidence for this programme relates to its implementation as:
- Targeted indicated
Where has it been implemented?
Australia, Canada, Colombia, Costa Rica, Finland, Iceland, Ireland, Netherlands, Norway, Sweden, United States
UK provision
This programme has not been implemented in the UK.
UK evaluation
This programme’s best evidence does not include evaluation conducted in the UK.
Spotlight sets
EIF does not currently include this programme within any Spotlight set.
Family Talk
About the programme
What happens during delivery?
How is it delivered?
Family Talk is delivered by clinicians to individual families in approximately 7 sessions, each of which lasts approximately one hour (or 6-9 hours in total).
What happens during the intervention?
As a flexible programme, the learning methods and activities may change depending on the needs of each family. Basic learning methods include:
- goal setting for parents to encourage reflection on the purpose of attending Family Talk;
- psychoeducation to enable the parent to better understand their illness and its potential impact on their child(ren);
- exploration of ways to build child and family resilience;
- the sharing and discussion of information on appropriate local supports for the child(ren);
- the co-development of a Family Plan in the event of the parent becoming unwell and requiring crisis care;
- child- friendly activities may be added to assist children during sessions.
What are the implementation requirements?
Who can deliver it?
Practitioners who deliver this programme need at least 3 years’ experience in working with adult or child mental health and/or child welfare and protection services. They normally include appropriately trained Social Workers, Family Therapists, Psychologists, Mental Health Nurses, and Occupational Therapists.
What are the training requirements?
Practitioners need to complete an online training course that takes approximately 10 hours to completetakes about 7-13h to complete. Booster training of practitioners is recommended.
How are the practitioners supervised?
Practitioners are normally supervised by a colleague someone in a managerial position who has also completed the online Family Talk training. Supervision meetings should be held every 4-6 weeks and supervision time/input may vary from take 4-14hours in total during FT delivery.
What are the systems for maintaining fidelity?
Programme fidelity is maintained through the following processes:
- Training manual
- Other online material
- Fidelity monitoring
Is there a licensing requirement?
There is no licence required to run this programme.
How does it work? (Theory of Change)
How does it work?
- A strengths-based psychoeducation approach to parental mental illness, provided within a family context, can help to reduce the risk of negative outcomes (especially those related to mental health problems) among dependent children by: enhancing their knowledge and understanding of parental mental illness; improving family communication and problem-solving; and promoting more positive family interactions and better family functioning within the home.
- The programme enables children and parents to: talk about parental mental illness; develop a shared understanding of the impact of parental mental illness on parenting, children and the family as a whole; access supports for the child if required; and develop strategies to strengthen child and family resilience and wellbeing.
- In the short-term, the parent is educated about their illness and its impact on their dependent child(ren), while the child(ren) is/are provided with an opportunity to express their concerns (often unspoken) about their parent’s mental illness and to explore how problems related to their experience might be addressed (including signposting to other supports), thereby improving family communication/interactions and child mental health.
- In the longer-term, the risk of negative mental health outcomes for children is reduced through enhanced family communication and functioning, and increased resilience.
Intended outcomes
Supporting children's mental health and wellbeing
Contact details
Family Talk
About the evidence
Family Talk’s most rigorous evidence comes from two RCTs which were conducted in Ireland and in Finland.
This programme has evidence from at least one rigorously conducted RCT along with evidence from an additional comparison group study. Consequently, the programme receives a 3+ rating overall.
Study 1
| Citation: | McGilloway et al., (unpublished) |
|---|---|
| Design: | RCT |
| Country: | Ireland |
| Sample: | 83 families, with children between 5 and 18 years old, with at least one parent with a diagnosis of mental illness or receiving support from their GP for mental illness |
| Timing: | Baseline, 6-months follow-up |
| Child outcomes: | Improved child behaviour |
| Other outcomes: | Improved family functioning |
| Study rating: | 3 |
McGilloway, S., Furlong, M., Mulligan, C., McGarr, S., McGuinness, C., O'Connor, S. and Whelan, N. (2022) PRIMERA Research Briefing Report. Centre for Mental Health and Community Research, Maynooth University Department of Psychology and Social Sciences Institute, Maynooth, Ireland.
Furlong, M., McGilloway, S., Mulligan, C., McGuinness, C., & Whelan, N. (2021a). Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness (PRIMERA—Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children): study protocol for a randomised controlled trial. Trials, 22(1), 1-18.
RCT conducted in Ireland with the full publication of results pending. The EIF programme assessment team had access to the methods and result section to inform the strength of evidence rating.
Study design and sample
This study involved random assignment of 83 families to a FT treatment group and a business as usual control group. This study was conducted in Ireland, with a sample of children aged between 5 and 18.
Measures
- Family functioning was measured using the Systematic Clinical Outcome and Routine Evaluation (SCORE-15) (parent-report)
- Child psychosocial functioning was measured using the Strengths and Difficulties Questionnaire (SDQ) (parent-report)
- Child depression was measured using the ‘Major Depression’ subscale from the Revised Children’s Anxiety and Depression Scale (RCADS) (parent-report)
- Child anxiety was measured using the Screen for Child Anxiety Related Emotional Disorders (SCARED) (parent-report)
- Parental mental health was measured using the Behaviour and Symptom Identification Scale 24 (BASIS-24) (parent- report)
- Parental coping and resilience was measured using the Coping Self-Efficacy (CSE) questionnaire (parent-report)
- Parental understanding of mental illness was measured using the Parental Understanding of Mental Illness questionnaire (PUMI) (parent-report)
Findings
Study 1 identified statistically significant positive impact on two child and family outcomes. These include:
- Improved family functioning
- Improved child behaviour (SDQ subscale)
Conclusions that can be drawn from this study are limited by the following issues:
- High overall and differential attrition
Study 1
| Citation: | Solantaus et al., 2010; Punamaki et al., 2013 |
|---|---|
| Design: | RCT |
| Country: | Finland |
| Sample: | 119 families, with children between 8 and 16 years old, with at least one parent in treatment for affective disorder |
| Timing: | 10-,18-month follow-up |
| Child outcomes: | Improved child behaviour |
| Other outcomes: | None measured |
| Study rating: | 2+ |
Study 2a - Solantaus, T., Paavonen, E. J., Toikka, S., & Punamäki, R. L. (2010). Preventive interventions in families with parental depression: children’s psychosocial symptoms and prosocial behaviour. European Child & Adolescent Psychiatry, 19(12), 883-892.
Study 2b - Punamäki, R. L., Paavonen, J., Toikka, S., & Solantaus, T. (2013). Effectiveness of preventive family intervention in improving cognitive attributions among children of depressed parents: a randomized study. Journal of Family Psychology, 27(4), 683.
Study design and sample
This study involved random assignment of 119 families to a FT treatment group and a Let’s Talk About the Children (LTC) control group. This study was conducted in Finland, with a sample of children aged between 8 and 16.
Measures
- Child cognitive attributions were measured using the Children’s Attributional Style Questionnaire-Revised (child-report)
- Child depressive symptoms were measured using the Child Depression Inventory (self-report) and Beck Depression Inventory (child-report)
- Child emotional symptoms were measured using the Strengths and Difficulties Questionnaire (child-report & parent-report)
- Child anxiety was measured using the Screen for Child Anxiety Related Emotional Disorders (parent-report)
Findings
Study 2a found the active control improved children's cognitive appraisal.
Study 2b describes additional outcomes and identified statistically significant positive impact on a number of child outcomes. These include:
- Decreased total symptoms (4-month follow-up)
- Decreased emotional symptoms (4-month follow-up)
- Increased prosocial behaviour (4-month follow-up)
Conclusions that can be drawn from this study are limited by the following issues:
- Use of active control
- Lack of clarity on attrition and how missing data were handled
- Lack of clarity if whether intent to treat analyses were conducted
Other studies
The following studies were identified for this programme but did not count towards the programme's overall evidence rating. A programme receives the same rating as its most robust study or studies.
Giannakopoulos, G., Solantaus, T., Tzavara, C., & Kolaitis, G. (2021). Mental health promotion and prevention interventions in families with parental depression: A randomized controlled trial. Journal of Affective Disorders, 278, 114-121.
Giannakopoulos, G., Tzavara, C., & Kolaitis, G. (2015). Preventing psychosocial problems and promoting health-related quality of life in children and adolescents struggling with parental depression. Open Journal of Depression, 4(02), 24.
RCT conducted in Greece with methodological limitations that preclude this study from contributing to the programme's evidence rating.
Furlong, M., Mulligan, C., McGarr, S., O'Connor, S., & McGilloway, S. (2021b). A Family-Focused Intervention for Parental Mental Illness: A Practitioner Perspective. Frontiers in Psychiatry, 12, 783161.
Mulligan, C., Furlong, M., McGarr, S., O'Connor, S., & McGilloway, S. (2021c). The Family Talk Programme in Ireland: A Qualitative Analysis of the Experiences of Families With Parental Mental Illness. Frontiers in Psychiatry, 12.
Additional publications on Study 1
Eklund, R., Alvariza, A., Kreicbergs, U., Jalmsell, L., & Lövgren, M. (2020). The Family Talk intervention for families when a parent is cared for in palliative care – potential effects from minor children’s perspectives. BMC Palliative Care, 19, 1-10.
Pilot study assessing feasibility of using the Family Talk intervention for children with a parent in palliative care
Christiansen, H., Anding, J., Schrott, B., & Röhrle, B. (2015). Children of mentally ill parents—a pilot study of a group intervention program. Frontiers in Psychology, 6, 1494.
Quasi-experimental study conducted in Germany with methodological limitations that preclude this study from contributing to the programme's evidence rating.
Pihkala, H., Cederström, A., & Sandlund, M. (2010). Beardslee's preventive family intervention for children of mentally ill parents: a Swedish national survey. International Journal of Mental Health Promotion, 12(1), 29-38.
Study reporting on survey investigating implementation of Family Talk in Sweden
Beardslee, W. R., Ayoub, C., Avery, M. W., Watts, C. L., & O'Carroll, K. L. (2010). Family Connections: an approach for strengthening early care systems in facing depression and adversity. American Journal of Orthopsychiatry, 80(4), 482
Study reporting the feasibility of implementing a systems-wide preventive program
Solantaus, T., Toikka, S., Alasuutari, M., Beardslee, W. R., & Paavonen, E. J. (2009). Safety, feasibility and family experiences of preventive interventions for children and families with parental depression. International Journal of Mental Health Promotion, 11(4), 15-24.
Solantaus, T., & Toikka, S. (2006). The effective family programme: Preventative services for the children of mentally ill parents in Finland. International Journal of Mental Health Promotion, 8(3), 37-44.
Additional reporting on study 2
D'Angelo. E.J. Llerena-Quinn, R. Shapiro, R., Colon, F., Rodriguez, P., Gallagher, K., & Beardslee, W. R. (2009). Adaptation of the preventive intervention program for depression for use with predominantly low‐income Latino families. Family Process, 48(2), 269-291.
Study reporting on the adaptation of Family Talk for Latino families in the United States
Podorefsky, D. L., McDonald-Dowdell, M., & Beardslee, W. R. (2001). Adaptation of preventive interventions for a low-income, culturally diverse community. Journal of the American Academy of Child & Adolescent Psychiatry, 40(8), 879-886.
Study reporting on the adaptation of an early version of Family Talk in the United States
Beardslee, W. R., Gladstone, T. R., Wright, E. J., & Cooper, A. B. (2003). A family-based approach to the prevention of depressive symptoms in children at risk: evidence of parental and child change. Pediatrics, 112(2), e119-e131.
Beardslee, W. R., Wright, E. J., Gladstone, T. R., & Forbes, P. (2007). Long-term effects from a randomized trial of two public health preventive interventions for parental depression. Journal of Family Psychology, 21(4), 703.
Methodologically limited RCT conducted in the United States.
Beardslee, W. R., Versage, E. M., Wright, E. J., Salt, P., Rothberg, P. C., Drezner, K., & Gladstone, T. R. G. (1997c). Examination of preventive interventions for families with depression: Evidence of change. Development and Psychopathology, 9(1), 109-130
Beardslee, W. R., Swatling, S., Hoke, L., Rothberg, P. C., Velde, P. V. D., Focht, L., & Podorefsky, D. (1998). From cognitive information to shared meaning: Healing principles in prevention intervention. Psychiatry, 61(2), 112-129.
Beardslee WR, Wright E, Rothberg PC, Salt P, Versage E (1996) Response of families to two preventive intervention strategies: long-term differences in behavior and attitude change. J Am Acad Child Adolesc Psychiatry 35:774–782
Beardslee, W. R., Wright, E., Salt, P., Gladstone, T. R. G., Versage, E., & Rothberg, P. C. (1997a). Examination of children’s responses to two preventive intervention strategies over time. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 196–204
Beardslee, W., Salt, P., Versage, E., Gladstone, T., Wright, E. & Rothberg, P. (1997b) Sustained change in parents receiving preventive interventions for families with depression. American Journal of Psychiatry 154 510–515.
Beardslee, W., Salt, P., Porterfield, K., Rothberg, P.C., Van de Velde, P., Swatling, S., Hoke, L., Moilanen, D. & Wheelock, I. (1993) Comparison of preventive interventions for families with a parental affective disorder. Journal of the American Academy of Adolescent Psychiatry 32 254–63.
Beardslee, W. R., Hoke, L., Wheelock, I., Rothberg, P. C., Van de Velde, P., & Swatling, S. (1992). Initial findings on preventive intervention for families with parental affective disorders. The American Journal of Psychiatry, 149 (10), 1335.
Foundational work informing the development of Family Talk
Published May 2024