In a review of services for children with special health care needs, Bruder [1] traces the development of the concept of family-centred care from the 1960s when it was first described through to the integral involvement of families in early intervention by family empowerment [2] into a philosophy of care and a set of principles to guide service delivery. The rationale for family intervention is clear: experiences in the family context are critical to the child’s development [3]; the caregiving family is constant in the child’s life; the caregiver has the most time and greatest opportunity to influence the child’s development and competence, even where professional input is available [4]. Parental attitudes and beliefs have a powerful influence on the child [1], and if their resources are utilised to the full, costs to communities and schools are decreased because children arrive at school ready to learn [5].

Dunst [6] outlined the features of family-centred early intervention programmes as practices that: regard families with dignity and respect; share information so that families can make informed decisions and choices about intervention options; use practices that are individualised, flexible and responsive; encourage collaboration and partnerships between professionals and families; provide the support needed by families to help them to care for their children and result in the best outcomes for all. Ingber and Dromi have added the attitude of treating parents as experts regarding their family’s needs [7], and Brotherson et al. highlight the importance of home visiting in meeting emotional needs [8]. Where progammes adopt these features, for example with families of children with hearing loss, engagement and satisfaction with services are better [9]. A study by Moeller [10] highlights the benefits of family-based early intervention. High levels of family involvement correlated with positive language outcomes, and conversely, limited family involvement was associated with significant child language delays at 5 years, especially when enrollment in intervention was late. Significantly better language scores were associated with early enrollment in intervention. In spite of the obvious benefits of this type of approach, there are difficulties translating these principles into everyday practice worldwide [5, 9, 11].

Moving across the developmental lifespan, the value of involving the family in terms of preventative work in reducing health-risk behaviours and promoting social adaption in early adolescence has been examined. Family-centred intervention has been used to attempt to reduce antisocial behaviour and substance use with successful outcomes: young people in families who engaged in the intervention based on contact between professionals, school and families, and using principles of motivational interviewing exhibited lower rates of antisocial behaviour and substance misuse compared with matched controls [12].

In a review of family-based treatments for serious antisocial behaviour including conduct disorders, delinquency, substance abuse and criminal behaviour in adolescents, Henggeler and Sheidow [13] describe the benefits of a range of family models including multisystemic therapy, functional family therapy, multidimensional treatment, foster care and brief strategic family therapy. They note that these therapies are characterised by being flexible, strengths focussed, pragmatic and individualised. Particular issues they highlight include the need for more evaluation of these approaches with different cultural groups, and also issues linked with implementation, with many of these programmes being provided through purveyor organisations rather than through traditional mental health systems. This raises issues for those areas that cannot afford to import them, or have trained practitioners to deliver them. Other reviews in this area confirm that there is now clear evidence that family therapy is an efficacious treatment approach for adolescent substance misuse, although the authors once again highlight the need for further research in the area of ‘implementation science’, given the lack of widespread use of family-based approaches in routine clinical practice settings [14].

One of the areas where the role of the family seems to be central and the interplay between family involvement and early intervention is clear is in relation to the management of eating disorders, in particular, anorexia nervosa. A significant study carried out at the Maudsley Hospital in London comparing individual therapy with family therapy, and which followed people up for 5 years demonstrated that outcomes, in particular, weight gain, were better in those offered family therapy early in the course of the disorder [16]. Where there was a long duration of illness, both treatment modalities were associated with a poor outcome. Lock [17] highlighted the need for prevention and early intervention for those at risk of anorexia nervosa, given the evidence that symptoms develop long before the full syndrome becomes apparent. Highlighting further the benefits of family therapy, Lock noted that family therapy appeared to produce positive effects more quickly than individual therapy, prevent dropout and play a significant role in reducing the need for more expensive inpatient and residential treatments [18]. He also pointed out that treatments needed to be phase-specific. For example, for younger teenagers, the key issues may be early socialisation and identity, whereas for older adolescents issues related to dating, leaving home or making decisions about further education may be more pertinent. This is a theme that is referred to in much of the literature around the topics that are addressed in family work involving young people across a range of disorders.

A series of further studies continues to confirm the positive benefits of working with the family when a young person has an eating disorder. It is clear that this type of approach is both effective and acceptable to both the young person with the problem and the family and can be delivered in different formats such as manualised family-based treatment [19]. In this study, participants reported a range of positive outcomes including increased closeness, communication, openness, honesty, problem-solving skills, parental understanding, awareness of feelings, family support, patience, cooperation, appreciation and overall happiness, with decreases in arguing and criticism. The mechanism whereby positive results are achieved has been shown to be linked with the development of a strong therapeutic alliance with parents [20].