Tool 12: Five Principles of Family Work

Five Principles of Family Work

     1. Partnering with families

    • Working together with families in partnership - collaboration

    2. Being “whole of family” minded

    • Viewing the family as a whole system. Understanding that any change for one family member will affect every other family member in some way

    3. Understanding family reactions

    • Being able to put oneself in the shoes of the family members and make sense off their reactions, such as confusion and fear, distress and anger

    4. Treating families with respect

    • Recognising different beliefs family members may hold because of culture, religion or social background, and meeting their various needs without judgement

     5. Empowering families using a strengths-based approach

    • Focusing on the strengths and abilities of family members, rather than their problems and weaknesses



Principle 1: Partnering with Families

Partnering with families recognises the vital role they play in providing support to the person with traumatic injury.

With the agreement of the person with the injury family members can provide crucial information regarding assessment, goal setting, therapy, evaluation and discharge planning.

Family members knowledge of their relative’s situation and expertise in knowing how to provide specific support is invaluable to the multidisciplinary team. Yet, the expertise of family members is often not recognised, and many decisions are made without family member input.

By partnering and consulting with family members, staff encourage active participation and assist family members to be better prepared to manage the challenges they may face in the future.

It is important to recognise that the family will be facing and dealing with the long term consequences of the injury.

To work together as a team with family members, communication channels must be clear and open. Both staff members and family members need to be able to exchange important information with one another. Families need to be both included and informed.

   Including families and sharing information

Including families and sharing information

Some ways to include and share information with the family are:

  • Check family involvement with the person who has the injury
  • Ask family members about how involved they want to be
  • View the family as part of the team and involve them in discussions, planning and goal setting. If they are unable to attend give them notes from meetings so they are kept up to date about the process
  • Acknowledge the level of involvement may change over time due to other responsibilities or commitments they may have
  • Although the person with the injury may be an adult, it is helpful to include the family in the decision making process so they understand what is being suggested and why
  • You can encourage families to be present sometimes at therapy so they can learn some of the skills required to care for the injured person. 

    This can include:

    o watching and learning about bowel care, hoisting, and skin care. 
    o When teaching family members, make sure you use language that can be understood
    and if required, repeat instructions or write things down
  • Encourage other team members to discuss care and treatment with the family and make sure the team are all providing consistent messages to the family
  • If family are unable to be present during working hours, keep them informed by telephone or e-mail so they can continue to feel they are part of the process
  • Most importantly remember that family members are a great resource to better understand the person with the injury.  They can give insight about a person’s coping, strengths, likes and dislikes which make it possible to work more effectively with them

It is important to remember that the person with the injury may not want to involve family members or for you to provide them with information.  If this is the case, and the person has the capacity to make their own decisions, you must respect their privacy and confidentiality.  You may need to ask for permission from the person to give family members feedback or information.

Principle 2: Being “whole of family” minded 

A traumatic injury doesn’t just happen to an individual, but to a family system.

Being ‘whole of family minded’ is another way of saying that we treat traumatic injury as happening to the whole family system. 

Everyone within this system is affected in some way by the injury. Different family members will have different needs in their ability to understand what has happened, depending on their age and how close they were to their injured relative. Traumatic injury can affect the roles family members carry out, the interactions that they have with each other, and the expectations and beliefs they hold. Each member of the family system may cope differently with the distress and adjust/adapt to the changes at a different pace and in different ways.

Being ‘whole of family minded means . . .

Being ‘whole of family minded means appreciating that the whole family is affected when a relative sustains a traumatic injury:

(i) different members of the family will have a different understanding and different information needs about the traumatic injury based on their age and their relationship to the relative who was injured;

(ii) each member of the family has a different set of roles and relationships with the other family members which are changed by the impact of the injury; and that

(iii) each member of the family will have a different way of coping and different support needs based on their age and their relationship to the relative who was injured.

So when thinking about families it is useful to think about:

(i) The information needs of siblings who are still children, siblings who are adolescents, of frail-aged grandparents, of adult children, of parents, of spouses, and of friends. How will they learn about the injury? How much do they need to know? What is the best way to communicate this information? Who is best situated to do this? What support might family members need to be able to communicate effectively about the injury and its’ consequences to other members of the family? How can we support this process over time as things change and evolve?

(ii) The different roles/relationships among family members.

(iii) The different coping responses and support needs for family members of different ages and relationships to the relative who has been injured.


Principle 3: Understanding family reactions

Families can experience many different types of reactions when their relative has sustained an injury, and when they openly display these reactions it can be difficult for staff.

Three common types of reactions are:

(i) Confused and fearful:

Earlier we viewed the DVD of Angela, and considered some of the key adjustment challenges she faced. Like many family members she was confused and fearful in the early stages of Steven’s time of rehabilitation, and wondered what the future held.

(ii) Distressed and/or crying:

Some family members will go through periods in which they will experience distress – distress may also be expressed through tears.

(iii) Anger:

Understanding some of the fears family members may be experiencing will mean we are less likely to personalise aggressive or angry responses.  

   Managing Family Reactions General Principles

Managing Family Reactions General Principles

Be open and non–defensive

Sometimes working with people in distress can come at the worst possible time. You are in the middle of a therapy session, you need to collect some information or you are simply asking someone how they are going. Because of this, it is often hard to manage people in distress.

  • Take a deep breath and put your own needs aside
  • Be mindful of your body language and frame of mind
  • Use S.O.L.E.R.
Listen and be empathic
  • Be genuine and listen to the feelings being expressed
  • Concentrate and focus attention
  • Don’t interrupt
  • Don’t assume or jump to conclusions
  • Put your own feelings, worries and emotions aside 
  • Put other needs aside for 10 minutes and allow the person to talk. Through telling their story, feelings will dissipate and become less intense
  • When they have calmed down, acknowledge their feelings
  • Discuss what sort of support they are getting or would like to have
Assess the situation
  • Assessing the situation when you encounter someone who is extremely distressed is the first step to managing and containing the situation

Principle 4: Treating families with respect

As we have mentioned, every family is unique, and may have different responses and needs.

Different cultural backgrounds, languages, beliefs, coping styles and social background, will influence how a family responds to staff, treatment, and the various challenges they face.

These aspects may be very different to our own experience of family and our own expectations about what a ‘good family’ will believe and do.

A starting point in demonstrating respect is being mindful of the labels that we use to describe families. Although there are many positive words and phrases that staff use, we need to be on our guard that we don’t fall into the trap of using negative labels, particularly for families who are challenging because of their differences compared to our ideas and expectations of families.

   Demonstrating respect in our work with families

Demonstrating respect in our work with families

  • Avoid labelling families. Rather than labelling family members, try to understand why they are responding or acting as they are.  If families are acting in ways that are aggressive, controlling or assertive, it is most likely because they are confused or frightened and trying to regain some control in their lives
  • Be clear about the staff member role and communicate what staff can and cannot do to help family members understand
  • Use consistent ways of communicating and follow through on agreed tasks.
  • Don’t ignore what family members have to say
  • Try to fit in with the families cultural practices if possible (e.g., leave shoes at door)

Make sure there are clear ways that families can raise their concerns or complaints without feeling they are risking the care or treatment of their relative. It is easy to forget that there is a power difference between families and the broader service systems within which staff work

Principle 5: Empowering families

An important way that staff can empower families is by identifying and focusing upon their strengths.

When working with family members of people with traumatic injuries it is often easy to identify those family members who are struggling, or “not coping”.

The strengths perspective is a framework which moves away from focusing on problems and instead focuses on strengths and possibilities within individuals and families.  Although this might seem like an easy task, it does take some practice!

It requires staff to take on an attitude which considers possibilities and opportunities, rather than barriers and challenges.

Family resources, talents, knowledge, and motivation are brought to the fore, and families are viewed through a “resilience-lens”, rather than a lens which focuses on labels and problems.

This does not mean that pain is not acknowledged or seen as real, but that in the midst of difficulty and challenge, strengths and a family’s capacity are noticed and drawn out.

   Some important factors for using a strengths-based approach with families are . . .

Some important factors for using a strengths-based approach with families are to:

  • Recognise that all families have strengths, capacities and resources
  • Listen to a family’s story carefully and acknowledge pain and sadness
  • Look for strengths and point them out
  • Ask questions which explore strengths, for eg. 
    • How have you managed to get to this point? 
    • What are your sources of support?
    • What has helped you in challenging times before?
    • What skills and strengths do different members of your family hold?
    •  How have you worked together as a family? 
  • Acknowledge that families are experts on their own situation
Brainstorming question: What are some strengths you have seen in the families you have worked with?
  • Examples: caring, loyal, hardworking, committed, resilient, hopeful, grateful...