Walk-In Together: Fostering Accessible & Inclusive Mental Health Care for Families in Distress

In 2020, The Bouverie Centre developed a new approach to its family work in response to the overwhelming need for timely mental health services due to the COVID-19 pandemic and lockdowns. Integrating walk-in mental health service models, with origins from USA Medical Emergency Rooms and Free Clinics in the 1960s, and our own Single Session Thinking applications, Walk-In Together was piloted for families.

Integrating Single Session Thinking and Walk-In Services for Families

For more than 20 years, The Bouverie Centre has developed, researched, implemented and offered training on Single Session Thinking (SST). SST was designed to maximise the effectiveness of brief client interactions in family therapy settings where the mental health of a member is of concern. SST is a framework that guides practitioners to make the most of each client contact, particularly the first session, by treating it as if it may be the only one. With this, our evidence also shows the efficacy of telehealth provision for families (Mclean et al, 2021).

Walk-In Together takes this practice-research a step further. A 75-minute telehealth session to families presenting with a challenge associated with mental ill-health, substance misuse or trauma, is scheduled within days of first contact with the Centre. Noting during the COVID-19 era, sessions were offered on the same day of contact. Since returning to post pandemic “real life”, families more often request a pre-arranged booking for an appointment, to allow all family members to participate. This extra booking time also allows space as needed to arrange interpreters and allow for a First Nations therapist to be present for First Nations families.

The first iteration of the program in 2020 involved three therapists in every session – two on-camera and the third off-camera taking notes and joining on-camera for the final reflection. In 2023, we tested whether the same quality service could be delivered by two therapists. In short, results showed it can.

Our current Walk-In Together process

1. Pre-session reflection questionnaire is emailed to each family member for completion before the family therapy session.
2. Online Session, co-facilitated by two therapists, focussed on helping the family set their own goals for the conversation, via relational questioning specific to the family’s main challenge.
3. Therapy team offers a reflection, providing an open and transparent view of the family’s challenges and their opportunities from here.
4. Family responds to reflection, sharing their collective insights on what caught their attention in the therapists’ reflection, and how it relates to their original hopes and purpose.
5. Session summary notes are read aloud by the relevant therapist (on-camera). The family is then invited to make changes to ensure the summary is accurate.
6. At the end of session, each family member is invited to share what they will take away (learnings, insights or actions) from the session.
7. The family is offered a follow-up phone-call two weeks later and is welcomed to “walk back again” into the service after a six-week interval, if needed.
8. Session summary notes are sent to the family within 48 hours to reinforce the family’s learnings and next steps.

Research findings on efficacy (Hartley et al, 2023)

• Acceptability & Short-term effectiveness
  Of 22 families, almost all reported immediate increase in optimism about their future as a family when asked six weeks later.
  • 85% reported Walk-In Together had provided effective support for their presenting challenge.
  • 88% continued to feel confident about what to do next.
  • Only nine families (40%) required a continuing multi-session family therapy service.

• Two vs Three family therapists
  None of the 24 families commented they required more therapists in their session. When asked, it was the therapists’ skills and attributes, plus the service’s accessibility, that was most important for families.

• Walk-In Together vs Multi-session Family Therapy
  Families who attended Walk-In Together were compared against those who had attended Multi-session Family Therapy on the effectiveness of the service. Asked 6-12 months after service completion, 82% of Walk-In Together families reported high satisfaction, relative to 77% of families in the Multi-session Family Therapy condition.

Walk-In Together – A new way forward for family inclusion in mental health care?

While further research is underway with larger samples, early indications suggest Walk-In Therapy helps reduce the number of families waiting for therapy and may substantially reduce burden on the mental health system, whilst at the same time improving client care.

With over 200 families using our Walk-In Together Therapy service, we’ve seen how it has increased accessibility and inclusivity for families in providing a safe, contained, and flexible service. It enables support with complex presentations at the point of need and at a time chosen by the family.

On the basis of these findings, we are currently incorporating Walk-in Together into a new, permanent service pathway as the standard first encounter for all families who are eligible for family therapy at The Bouverie Centre. With this, we are optimistic in expanding our capacity to help more families and at the time they choose to seek help, within the same funding envelope.

The Walk-In Together pilot represents an important advancement in the availability of accessible, brief mental health care for families in distress. We believe it offers a quality mental health intervention at the time of greatest need. Further developments are underway via a Medibank funded PhD program of research and Victorian Department of Health funded training initiatives to disseminate and support implementation with clinical partnerships.

The Bouverie Centre is an integrated Practice-Research-Translation Centre of La Trobe University based in Melbourne. We are also the funded state-wide provider of specialist family therapy services to families and of specialist systemic training across mental health and allied fields. Established in 1956, Bouverie is the largest family therapy organisation globally. Our four pillars include family therapy practice, teaching and research teams, with each involving our First Nations staff.

For further information.

Professor Jennifer McIntosh, Director, The Bouverie Centre jenn.mcintosh@latrobe.edu.au

Martin Pradel, Clinical Team Leader m.pradel@latrobe.edu.au

https://www.latrobe.edu.au/research/centres/health/bouverie