Family Involvement: Supporting Young People’s Circle of Care
For many of us, our family is an important source of emotional support and feelings of belonging and safety. This can be especially true for young people as they manage the transition to adulthood, at times while coping with mental health or substance use (MHSU) challenges. There is strong evidence highlighting the value of positive relationships with family in supporting the well-being of young people. Families can recognize early on when a young person is struggling, and many young people seek help at the encouragement of their families and friends. Families provide important contextual information for service providers, including how issues present differently in various situations as well as supporting a young person to navigate complex service systems and advocating on their behalf. At the same time, there are challenges that prevent the involvement of family and friends in the care and support of young people.
Families are diverse and dynamic — a young person’s definition of, and relationship with, their family may vary greatly and change over time. At the individual level, some youth may not want their families or caregivers to know they are accessing services or may not want them aware or involved due to fears of stigma, shame, rejection or causing worry. This concern can be a significant driver for young people not accessing mental health services, as noted in the 2023 Adolescent Health Survey from the McCreary Centre Society. Both youth and family members may also have concerns about the young person’s right to privacy, confidentiality and ability to make decisions about their own treatment. A young person’s MHSU struggles can be difficult for family and impact other individuals (including siblings) and relationships in challenging ways. In many cases, family members also need support to help navigate the challenges they personally encounter while supporting a young person.
At the service level, clinicians and service providers may lack the practice or training to effectively include family members, leading to discomfort and potentially causing them to exclude family members. They may have had negative experiences in previous attempts at inclusion and may require additional supports. And, importantly, at the system level, there has been limited development of tools to advance family involvement in care, as well as limited resources for programs, services and support for caregivers and families, especially for those of older youth.
Whatever “family” means and looks like for a young person, we know that families can play an important role in the health and well-being of youth as a natural support network that complements and extends beyond support from service providers. It is therefore important for young people to have a circle of care to support them when they are struggling, who can provide them with feelings of belonging and connectedness that are vital for their long-term wellness.
Family Inclusive Services at Foundry
Foundry is working to broaden our offerings of services for families of youth, recognizing the high volume of interest and need in many communities, as well as the valuable role of families in the lives of many young people. Indeed, current internal dataa (see Figure A) indicates that approximately 1 in 5 young people (ages 12–24) accessing services indicated that they learned about Foundry from a family member. For younger youth, this family referral was even more important — 39% of youth ages 12–14 and 28% of youth ages 15–17 heard about Foundry from a family member.
Family-based interventions offered at Foundry centres may include family peer support (FPS), family therapy, family education and workshops, drop-in caregiver support, family navigation, family mediation, family outreach, trauma resiliency training, cultural wellness services and more. In many instances, these services are offered in partnership and with the support and expertise of key community organizations, such as FamilySmart and Moms Stop the Harm.
Currently, all centres have at least one family inclusive service available, with the most accessed family inclusive services being FPS, counselling and family education and workshops (see Figure B). FPS is a core service offered across Foundry centres, where family members with lived experience of supporting a young person provide practical, emotional and social support for other families whose young people may be going through similar difficulties. As a valued service at Foundry, FPS offers families a feeling of connection and hope through shared experiences. Foundry is also working to develop its family-based cultural services offerings, including Elder supports and through programs such as Gathering our Medicine (see page 4 for more information.)
Other family-based interventions, including Emotion-Focused Family Therapy, are offered by trained counsellors, often jointly with Family Peer Supporters. Many centres offer family education groups or workshops which provide guidance on topics such as communication skills, self-care and condition‑specific information. Such training can assist families and caregivers to help youth facing MHSU challenges manage their substance use or reduce symptoms such as depression or anxiety.
Family-based intervention has also been shown to benefit youth with eating disorders compared to individual therapy alone and help improve symptoms for youth at high risk of psychosis. However, we should note that research around family inclusive services and interventions is still limited and primarily qualitative, and studies and programs vary widely in design, making it difficult to draw broader comparisons. Regardless, we know that many families seek support, information and skill-building so that they can help a young person who may be struggling.
We also know that some families who face additional barriers due to poverty, food or housing insecurity, and other challenges that stem from systemic inequities may need support to be involved, and some caregivers may have their own personal struggles. Our hope is to build on existing knowledge and gain new learnings so that we may offer a consistent array of accessible family inclusive services and supports, ranging from family inclusion in care planning to family‑specific therapies (i.e., young person and family member), as well as caregiver‑specific services.
Our Learning and Perspectives
A Broader Definition of “Family” and “Care”
Existing care and service systems are not explicitly or consistently designed for family involvement, partly because the dominant Western colonial approach to care, especially the medical model, tends to focus on the individual in isolation. Current systems may also make assumptions about what constitutes “family” — that the nuclear family and biological kinship ties are the only relationships that constitute legitimate family. However, this assumption can undermine what family means to a young person. Youth may find greater support and safety in relationships with extended family members, Elders, partners or other caring adults who become their “chosen family” and offer them a sense of belonging and safety. In still other instances, young people may also be a parent or caregiver themselves to a family member and may benefit from caregiver support.
A one‑size‑fits‑all approach to interventions is unlikely to meet the needs of all youth and their families. Working with Indigenous youth and their families means honouring how youth are living within intergenerational systems and relations, so that supporting a young Indigenous person means also supporting the whole family. For newcomer youth, immigration, acculturation and language barriers can affect family dynamics, and these struggles are often inseparable from their MHSU concerns.For many 2SLGBTQIA+ youth, friends and significant partners can be their primary source of support and feeling of belonging if family support is lacking. For families facing structural inequities, such as poverty and racism, the daily challenges and stress resulting from these inequities may create barriers for accessing services. These examples show that it is important to honour each type of family, familial relationship, family context and circle of care.
There are also assumptions in colonial systems about what constitutes “care” in the family context. Research shows that child protection authorities, clinicians and schools tend to over-report Indigenous and racialized families for neglect or abuse, often due to assumptions about risk and misinterpretation of cultural practices, using tools and frameworks that are grounded in classist and white-centric notions of acceptable child rearing.Social norms around gender also affect understandings and realities of caregiving. For example, 4 out of 5 family members accessing Foundry family inclusive services identify as women, which reflects caregiving norms and highlights an opportunity to engage more fathers or male family members at Foundry.
Intentional outreach is important to support a wider range of families who may be unfamiliar with or fear accessing care, particularly mental health care. This includes learning from and working with Indigenous youth and families to decolonize the concept of family and integrating concepts around community oriented care, including kinship circles. It is also important to engage in cross-sector conversations about the different definitions of family and care and how that impacts the well-being of youth.