British Journal of Social Work Advance Access published February 17, 2012

British Journal of Social Work (2012) 17

doi:10.1093/bjsw/bcs006

Researching the Applicability of Family

Group Conferencing in Public Mental
Health Care
Gideon de Jong* and Gert Schout

*Correspondence to Gideon de Jong, School of Nursing, Hanze University of Applied

Sciences, Eyssoniusplein 18, 9714 CE Groningen, The Netherlands. E-mail: gideon.de.jong@
gmail.com

Abstract
Since the introduction of Family Group Conferences (FGCs) in the Netherlands, there has
been a steady growth in conferences being organised each year. Government policy
emphasises the importance of empowering families to strengthen their ability to take
responsibility for their own well-being. A recently adopted amendment in the Dutch
Civil Code reflects this commitment and designates FGC as good practice. However,
there is little knowledge on the application of FGCs in mental health care, let alone in
a setting even more specific, such as public mental health care (PMHC). Clients in
PMHC often have a limited network. The starting point of this study is the assumption
that conferences promote involvement, expand and restore relationships and generate
support. Over the next two years, we will research the applicability of FGCs in PMHC by
evaluating forty case studies. The aim of our study is to provide an answer to the question of whether Family Group Conferencing is an effective tool to generate social
support, to prevent coercion and to promote social integration in PMHC. Although
making contact and gaining trust is a goal of PMHC, it is an aim to study whether
FGCs can elevate or replace the work of professionals.
Keywords: Family group conference, public mental health care, underserved groups,
case study, participatory research

Accepted: January 2012

# The Author 2012. Published by Oxford University Press on behalf of

The British Association of Social Workers. All rights reserved.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on February 27, 2012

Gideon de Jong is researcher at the School of Nursing, Hanze University of Applied Sciences.
Recently, he co-operated with Gert Schout into researching public mental health care issues.
Dr Gert Schout is professor of Public Mental Health Care at the School of Nursing, Hanze
University of Applied Sciences. He received his Ph.D. in 2007 on a study into care avoidance
and care paralysis in public mental health. In his recent research, he focuses on ways to reach
underserved groups.

Page 2 of 7 Gideon de Jong and Gert Schout

Introduction

FGCs in the Netherlands

Since 2001, there has been a rise in the Netherlands of FGCs (known as
Eigen Kracht-conferenties in the Netherlands; see www.eigen-kracht.nl)
from twenty-one executed FGCs in 2001 to 593 conferences in 2010
(Gramberg, 2011). Research findings provide evidence of the improvement
in the safety and well-being of children and their families (Van Beek, 2004,
2005; Wijnen-Lunenburg et al., 2008). For example, in 2010, 95 per cent of
the conferences yielded a plan on which everyoneincluding the professionalsagreed. According to both families and professionals, in 86 per
cent of the cases, the established plan is being implemented. Moreover,
the majority of the clients (67 per cent), families (69 per cent) and professionals (66 per cent) mention that the living circumstances of clients have
been improved after the conference (Gramberg, 2011). National and
local policy in the Netherlands is strongly encouraging empowerment and
active citizenship, and advocates the involvement of family members in
solving problems within communities and families. The assumption is that
the strengthening of civic engagement reduces professional deployment
(Van Schagen, 2010).

A new Dutch amendment

In February 2011, an amendment in the Dutch Civil Code on The Law for
Youth Care and the Law for Foster Children (in Dutch: Wet op de Jeugdzorg

Downloaded from http://bjsw.oxfordjournals.org/ by guest on February 27, 2012

Strengthening natural recourses of communities and families is a challenge

all over the world (Burford, 2005). More than two decades of research into
the concept of Family Group Conferencing produced evidence that families
are capable of taking responsibility for their own living conditions. In this
approach, the traditional method of decision making in which the professional is in charge is abandoned; it is the family who determines the
agenda. Families often find better solutions than care providers (Lupton,
1998; Merkel-Holguin, 2004). Family group conferences (FGCs) enable
families to cope with problems in a manner that is consistent with their
own culture, lifestyle and history (Jackson and Morris, 1999; OShaughnessy
et al., 2010; Schmid and Pollack, 2009). Unlike traditional approaches that
are often family-centred, a FGC is family-driven (Merkel-Holguin, 2004,
p. 164). In other words, the approach is not aimed at the family, but achieves
results through the family. Family Group Conferencing employs the
resources within societythe natural resources of the family, friends and
neighbours are mobilised.

Family Group Conferencing in Public Mental Health Care Page 3 of 7

FGCs in PMHC
In most Western societies, PMHC facilities serve as a safety net for clients
who otherwise are not helped. Amongst them are: people with severe and
ongoing mental health problems, mostly dual diagnoses; multi-problem
families; homeless people; elderly with dementia or depression; clients
with learning difficulties; people living in unhygienic conditions; people
who cause nuisance. The PMHC in the Netherlands reaches out to underserved groups in situations that are not guided by a voluntary, individual
demand for aid. It is a joint network of professionals from different organisations such as mental health and addiction care who offer the expertise for
outreach treatment and co-ordination at a municipality level (Schout et al.,
2010, 2011). Core of the PMHC is to help in spite of a lack of active cooperation of the person (or persons). FGCs in PMHC therefore do not
seek to decrease employment of professionals because clients indeed
need rather more than less professional support. However, research can
reveal whether relatives can replace professionals when this is not attainable. Clients in PMHC (De Jong and Schout, 2011, p. 64):
(1)

are not or not sufficiently able to provide in their own living conditions:
shelter, food, income, social contacts, personal care, etc.;

(2)

have several problems simultaneously, including lack of personal care,

social isolation, unhygienic living circumstances, lack of a permanent
stable home environment, debts, mental problems and addiction
problems;

Downloaded from http://bjsw.oxfordjournals.org/ by guest on February 27, 2012

en de Pleegkinderenwet) was adopted (Voordewind et al., 2011). This

amendment encourages families to establish a plan themselves in situations
in which a childs development is at risk. Especially when families are confronted with judicial measurements, such as outplacement of children, this
new amendment could be beneficiarynot only because a well-established
and implemented plan could prevent coercion; moreover, family members
are invoked to act as active citizens and take responsibility for their own
and their childrens well-being. Similar amendments were adopted in
New Zealand in 1989 (The Young Persons and Their Families Act) (see
Levine, 2000) and in the UK in 2008 (The Public Law Outline) (see
Evans, 2011). Like the Dutch amendment, both legal regulations are
meant to reduce the role of the state and to empower families to deal
with issues in the family.
Implementation of FGC is mostly confined to youth care and related
systems (Hayes and Houston, 2007), but is also increasingly executed in
several adult contexts worldwide (see Malmberg-Heimonen, 2011). Both
national and local Dutch policy supports the execution of FGCs in fields
other than youth care, such as in education, elderly care and PMHC.

Page 4 of 7 Gideon de Jong and Gert Schout

(3)

do notfrom the perspective of the care systemreceive the care they

need in order to remain independent in society;

(4)

do not have a demand for helpfamily, neighbours and bystanders often

ask for helpso there is unwanted interference or assistance.

The study
From January 2011 until December 2012, we will be carrying out forty case
studies of FGCs in PMHC in the province of Groningen, the Netherlands.
Considering the recent review of international research on Family Group
Conferencing by Morris and Connoly (2010), who emphasise that mainly
small-scale studies have been carried out, we have chosen an extensive
mixed-methods approach (Creswell, 2009; Tashakkori and Teddlie, 2010).
Therefore, each case study consists of (i) a qualitative approach with semistructured interviews and focus groups to validate intermediate findings
and (ii) a quantitative impact analysis focusing on the regained control
over the situation, the extent of the achieved goals of the plan and the
number of professionals and relatives involved before and after the conference. The aim of our research is to provide an answer to the question of
whether Family Group Conferencing is an effective tool to generate
social support, to prevent coercion, to elevate the work of professionals
and to promote social integration.
Besides FGCs, community conferences will also be studied. Community
Conferencing is an approach to resolve conflicts within neighbourhoods
and is normally executed in situations of nuisance or juvenile crime
(see Abramson and Moore, 2001; Donaldson and Moore, 2001). In the
Netherlands, community conferences could also be requested at the same
organisation that organises FGCs. However, the approach is slightly

Downloaded from http://bjsw.oxfordjournals.org/ by guest on February 27, 2012

As indicated by Heru (2006) and Sherman and Carothers (2005), families

have a powerful influence on improving the health conditions of their relatives who are suffering from psychiatric disorders and/or addiction and on
reducing the risk of relapse. However, clients in PMHC often lack the
support of a vital social network. In the exploratory study of our study,
we raised the question of how natural resources of clients can be discovered,
developed and restored (De Jong and Schout, 2011). The central question
of our study is whether Family Group Conferencing could be applied in
PMHC. Jackson and Morris (1999) and OShaughnessy et al. (2010) state
that a FGC will not succeed when there is a lack of resources to support
the client. Contrarily, the main finding from our exploratory research is
that a lack of resources is a reason for organising a FGC (De Jong and
Schout, 2011). Both interviewed care providers and FGC co-ordinators
stated that a FGC could promote the involvement of the natural network
around a client. It could expand and restore relationships and generate
support.

Family Group Conferencing in Public Mental Health Care Page 5 of 7

Raising awareness amongst professionals

In the preparation stage of this extensive research project, we trained professionals in (public) mental health care to raise awareness that, in addition
to disorders and deficits, strengths and resources can also be found in client
systems that apparently seem to have few resources. Because of a lack of
knowledge amongst clients, mostly professionals refer to and encourage
clients to participate in a FGC (however, an official referral by a professional is not necessary because clients and their families can also refer to a FGC
in the Netherlands themselves). Professionals in Dutch mental health care
have little faith in the applicability of FGCs (Van Rooijen, 2010). Van
Rooijen suggests that faith in the capabilities of mental health services
exceeds faith in the capabilities of clients. However, professionals who
attended our training sessions responded enthusiastically to the approach
and the benefits it might yield to clients and their families, resulting in
more than twenty referrals for FGCs so far. Clients did not act reluctantly
to a FGC because, for them, it meant prevention of coercion, prevention of
eviction or the elevation of social isolation. Cases being involved areas is
typical for PMHCdiverse: addicted clients living in isolated circumstances or being homeless; multi-problem families who are causing nuisance
in their neighbourhoods; clients suffering from psychiatric disorders and
who are refusing the care they actually need.
We will provide regular updates about our research and will publish findings of the first twenty organised conferences in early 2012. We welcome
responses to our research and suggestions for improvements.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on February 27, 2012

different from traditional Family Group Conferencing, such as the presence

of the co-ordinator during all stages of the conference and its emphasis on
repairing harm. Our assumption is that Community Conferencing could be
a useful tool to repair harm and improve living conditions within neighbourhoods where PMHC clients cause nuisance.
All participants of the conference will be interviewed, as well as the involved
co-ordinator and professionals. The open interviews will be structured by a
topic list, containing the main themes we formulated in a recent article on
the findings from the exploratory part of our research (see De Jong and
Schout, 2011). Interviews will be audio taped and transcribed verbatim.
Transcribed interviews will be analysed with ATLAS.ti, resulting in
trends, patterns and deviations of patterns on the impact of the conference,
based on Flicks (2009) analytical methods to derive theory from data
inductively.
In addition to the interviews, focus group meetings will be organised to
validate our intermediate findings. We will address ethical considerations
and ensure traceability of our data.

Page 6 of 7 Gideon de Jong and Gert Schout

Acknowledgements
(1)

The 40 conferences are funded by the province and municipality of

Groningen.

(2)

The research project is funded by The Dutch Ministry of Health, Welfare

and Sport (Ministerie van Volksgezondheid, Welzijn en Sport), Fonds
NutsOhra, and the Netherlands Foundation for Mental Health (Fonds
Psychische Gezondheid).

References
Downloaded from http://bjsw.oxfordjournals.org/ by guest on February 27, 2012

Abramson, L. and Moore, D. B. (2001) Transforming conflict in the inner city community: Community Conferencing in Baltimore, Contemporary Justice Review, 4(3/4),
pp. 321 40.
Burford, G. (2005) Families: Their role as architects of civil society and social inclusion,
Practice: Social Work Action Research, 17(2), pp. 79 88.
Creswell, J. W. (2009) Research Design: Qualitative, Quantitative, and Mixed Methods
Approaches, 3rd edn, Thousand Oaks, Sage Publications.
De Jong, G. and Schout, G. (2011) Family group conferences in public mental health
care: An exploration of opportunities, International Journal of Mental Health
Nursing, 20(1), pp. 6374.
Donaldson, J. M. and Moore, D. B. (2001) Community Conferencing as a special case of
conflict transformation, in H. Strang and J. Braithwaite (eds), Restorative Justice and
Civil Society, Cambridge, Cambridge University Press, pp. 121 39.
Evans, C. A. (2011) The Public Law Outline and Family Group Conferences in childcare
practice, Child Care in Practice, 17(1), pp. 315.
Flick, U. (2009) An Introduction to Qualitative Research, 4th edn, Thousand Oaks, Sage.
Gramberg, P. (2011) Eigen Kracht-Conferenties voor Families en Individuen: Jaarcijfers
2010 [Family Group Conferences for Families and Individuals: Year Figures 2010],
Voorhout, WESP.
Hayes, D. and Houston, S. (2007) Lifeworld, system and Family Group Conferences: Habermass contribution to discourse in child protection, British Journal of
Social Work, 37(6), pp. 9871006.
Heru, A. M. (2006) Family psychiatry: From research to practice, American Journal of
Psychiatry, 163(6), pp. 962 8.
Jackson, S. and Morris, K. (1999) Family Group Conferences: User empowerment or
family self-reliance? A development from Lupton, British Journal of Social Work,
29(4), pp. 621 30.
Levine, M. (2000) The Family Group Conference in the New Zealand Children, Young
Persons, and Their Families Act of 1989 (CYP&F): Review and evaluation, Behavioral Sciences and the Law, 18(4), pp. 517 56.
Lupton, C. (1998) User empowerment or family self-reliance? The Family Group Conference Model, British Journal of Social Work, 28(1), pp. 107 28.
Malmberg-Heimonen, I. (2011) The effects of Family Group Conferences on social
support and mental health for longer-term social assistance recipients in Norway,
British Journal of Social Work, 41(5), pp. 949 67.

Family Group Conferencing in Public Mental Health Care Page 7 of 7

Downloaded from http://bjsw.oxfordjournals.org/ by guest on February 27, 2012

Merkel-Holguin, L. (2004) Sharing power with the people: Family Group Conferencing
as a democratic experiment, Journal of Sociology and Social Welfare, 31(1),
pp. 155 73.
Morris, K. and Connoly, M. (2010) Family decision making in child welfare: Challenges
in developing a knowledge base for practice, Child Abuse Review Advance Access
published September 20, 2010, DOI: 10.1002/car.1143.
OShaughnessy, R., Collins, C. and Fatimilehin, I. (2010) Building bridges in Liverpool:
Exploring the use of Family Group Conferences for black and minority ethnic children and their families, British Journal of Social Work, 40(7), pp. 2034 49.
Schmid, J. E. and Pollack, S. (2009) Developing shared knowledge: Family Group Conferencing as a means of negotiating power in the child welfare system, Practice: Social
Work Action Research, 21(3), pp. 175 88.
Schout, G., De Jong, G. and Zeelen, J. (2010) Establishing contact and gaining trust: An
exploratory study of care avoidance, Journal of Advanced Nursing, 66(2), pp. 324 33.
Schout, G., De Jong, G. and Zeelen, J. (2011) Beyond care avoidance and care paralysis,
Sociology, 45(4), pp. 665 81.
Sherman, M. D. and Carothers, R. A. (2005) Applying the readiness to change model to
implementation of family intervention for serious mental illness, Community Mental
Health Journal, 41(2), pp. 115 27.
Tashakkori, A. and Teddlie, C. (eds) (2010) SAGE Handbook of Mixed Methods in
Social and Behavioral Research, Thousand Oaks, Sage Publications.
Van Beek, F. (2004) According to Plan?: Research into the Plans and Follow-Up of
Eigen-Kracht Conferences (Subreport 2), Voorhout, WESP.
Van Beek, F. (2005) This is About My Future, Right?: Research into the Opinion of Children and Adolescents Regarding Eigen-Kracht Conferences (Subreport 3), Voorhout,
WESP.
Van Rooijen, M. (2010) Eigen Kracht Conferenties niet geliefd in psychiatrie [Family
Group Conferences not popular in psychiatry], Psy, 15(4), pp. 21 3.
Van Schagen, M. (2010) Terug naar Eigen Kracht [Back to Societys Natural Resources],
Dronten, Prosu Uitgeverij.
Voordewind, J., Dijsselbloem, J. and Dibi, T. (2011) Wijziging van Boek 1 van het Burgerlijk Wetboek, het Wetboek van Burgerlijke Rechtsvordering, de Wet op de Jeugdzorg en de Pleegkinderenwet in verband met Herziening van de Maatregelen van
Kinderbescherming [Modification of Book 1 of the Civil Code, the Code Book of
Civil Legal Claim, the Law for Youth Care and the Law for Foster Children associated
with Revisions of Measurements Related to Child Protection], The Hague, Tweede
Kamer der Staten-Generaal [Parliament of the Netherlands].
Wijnen-Lunenburg, P., Van Beek, F., Bijl, B., Gramberg, P. and Slot, W. (2008) Its the
Familys Move: The Effects of Eigen Kracht Conferences within the Context of Youth
Protection and with Respect to Safety, Social Cohesion and Control, Amsterdam, Vrije
Universiteit/Voorhout, WESP.