Ellen T. Welsh

Access to family and systemic therapies remains limited. Digital mental health interventions offer potential to extend access; however, most are designed for individual users, presenting challenges when engaging multiple members of a family. This study used a participatory co‐design approach to inform the development of the Family e‐Hub, a systemic, self‐guided digital resource grounded in family‐specific design principles. Drawing on the perspectives of consumers with lived experience of family therapy and family therapists, the study aimed to co‐design recommendations for Family e‐Hub content and strategies for design and implementation that may enable engagement by families. Findings identified systemic techniques that may be translated to a self‐paced environment, recommendations for maintaining individual and relational safety, and strategies to support accessibility for diverse families. The paper summarizes these recommendations and discusses future directions for the Family e‐Hub and the broader development of systemic digital mental health interventions.

Purpose: Digital mental health interventions designed for individuals are rapidly expanding and demonstrate increasing evidence of effectiveness. Despite the central role families play in supporting individuals experiencing mental health challenges, there is a notable lack of digital interventions designed for use by family groups, alongside limited examination of the theoretical foundations informing their design. This paper aims to address this gap by exploring how systemic psychotherapy principles can inform the development of family-oriented digital mental health interventions. Design/methodology/approach: The paper undertakes a conceptual analysis comparing the theories of change underpinning individual psychotherapies with those central to systemic psychotherapies. It examines the implications of these theoretical differences for the design of digital mental health interventions supporting family engagement. Findings: The analysis demonstrates that systemic psychotherapies, focusing on relationships and interactional processes rather than individual symptom reduction, cannot be meaningfully translated into digital formats by simply adapting individually oriented interventions. Instead, family-centred digital interventions require bespoke design characteristics. The paper identifies key conceptual considerations and offers design-informed recommendations to guide the development of systemically informed digital platforms. Originality/value: This paper contributes novel theoretical insights by explicitly linking systemic psychotherapy models with digital intervention design. It advances understanding of how relational theories of change can inform the creation of digital mental health resources for families, an area that remains underexplored in both digital mental health and systemic psychotherapy literature.

Family roles in trauma recovery are increasingly recognised, yet systemic approaches remain underdeveloped because of limited models and engagement barriers. Single Session Thinking (SST) offers potential for trauma-related family work. This study identified how specialist family therapists were applying the SST approach when working with families affected by a traumatic event/s, and suggests corresponding adaptations to the existing SST session map. Sixteen specialist family therapists experienced in SST and trauma treatment completed a three-round Delphi study, producing practice guidelines and an adapted SST session map tailored to these families. Consensus was established on the foundation of family trauma treatment utilising an SST approach. Practice guidelines and adaptations to the SST session map emphasised containment, collaboration, and trauma-sensitive systemic practice. The adapted SST framework supports attuned, collaborative family engagement in high-demand, brief-intervention settings. Future research should incorporate family perspectives to further validate and refine the model alongside other trauma recovery approaches.

Background: Early relational health is critical for childhood development, and disruptions in infant-caregiver trust can heighten risk. MERTIL for Parents is a brief, universal, online program designed to build parental understanding of relational trust and its role in infant development. This pilot study is the first evaluation of the program. Objectives: To evaluate the acceptability and short-term outcomes of MERTIL for Parents. Methods: Seventy-three parents (n = 69 mothers) of children aged 0–5 years, referred by practitioners, completed the program and online questionnaires at baseline (N = 73), post-intervention (n = 50), and three-month follow-up (n = 25). Results: The program demonstrated high acceptability: 98% of parents who engaged with the program found the content useful, 92% felt the length was appropriate, and all would recommend it to others. Program completion and satisfaction did not vary by sociodemographic or psychosocial characteristics. At three-month follow-up, parents reported significant improvements in their enjoyment of the parent–child relationship (p < 0.001), attunement to their child (p < 0.001), parenting confidence/competence (p = 0.004 and p = 0.003), help-seeking amenability (p < 0.001), and a reduction in irritability toward the child (p < 0.001), with medium to large effect sizes. No significant changes were observed for items assessing reflective functioning or perceived rejection. Conclusions: MERTIL for Parents shows strong acceptability and promising preliminary outcomes as a scalable, attachment and trauma-informed intervention supporting early relational health. Future research should examine long-term impacts and evaluate broader implementation across diverse families and service contexts.

For women in prison, having safe and supportive relationships is the greatest predictor of staying safely out of custodial systems, post-release. We describe the development and delivery of ‘ Strengthening Connections ’: an in-prison family therapy service in Victoria, Australia that supported women to strengthen their relationships with family and allies to reduce recidivism risk. We piloted a stepped-care model comprising three levels of service delivery to support women’s relational health: 1) group-level sessions, 2) single-session family therapy, and 3) systemic family therapy approaches involving women along with their family or allies. We developed a trauma-informed, culturally safe approach to practice, and evidence-enriched resources for use in service delivery. During the three-year service pilot, we continuously improved on the service based on clinical consultations and process evaluation findings. This article describes the development, refinement and delivery of the service with reflections on potential for broader application.

Systemic family therapy aims to improve mental health and well‐being in the face of challenge by optimizing relational health between family members or people in close relationships. The potential of digital interventions for family mental health is underexplored. This study aimed to understand core principles that facilitate end‐user acceptability and engagement with such a resource. A modified Delphi study was conducted to identify key factors, barriers, and risks influencing family engagement with a digital mental health intervention (DMHI). The 18 participants comprised consumers ( n = 5), family therapists ( n = 8), and digital mental health professionals ( n = 5). Participants completed online questionnaires over two rounds. An agreement was reached on 23 essential factors, within four design principles: informed choice, anonymity and privacy, accessibility, and support and connection. Implications for the design of family DMHIs are considered alongside existing knowledge about individually focused DMHIs.

Background: The COVID-19 pandemic placed an additional mental health burden on individuals and families, resulting in widespread service access problems. Digital mental health interventions suggest promise for improved accessibility. Recent reviews have shown emerging evidence for individual use and early evidence for multiusers. However, attrition rates remain high for digital mental health interventions, and additional complexities exist when engaging multiple family members together. Objective: As such, this scoping review aims to detail the reported evidence for digital mental health interventions designed for family use with a focus on the build and design characteristics that promote accessibility and engagement and enable cocompletion by families. Methods: A systematic literature search of MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL databases was conducted for articles published in the English language from January 2002 to March 2024. Eligible records included empirical studies of digital platforms containing some elements designed for cocompletion by related people as well as some components intended to be completed without therapist engagement. Platforms were included in cases in which clinical evidence had been documented. Results: Of the 9527 papers reviewed, 85 (0.89%) met the eligibility criteria. A total of 24 unique platforms designed for co-use by related parties were identified. Relationships between participants included couples, parent-child dyads, family caregiver–care recipient dyads, and families. Common platform features included the delivery of content via structured interventions with no to minimal tailoring or personalization offered. Some interventions provided live contact with therapists. User engagement indicators and findings varied and included user experience, satisfaction, completion rates, and feasibility. Our findings are more remarkable for what was absent in the literature than what was present. Contrary to expectations, few studies reported any design and build characteristics that enabled coparticipation. No studies reported on platform features for enabling cocompletion or considerations for ensuring individual privacy and safety. None examined platform build or design characteristics as moderators of intervention effect, and none offered a formative evaluation of the platform itself. Conclusions: In this early era of digital mental health platform design, this novel review demonstrates a striking absence of information about design elements associated with the successful engagement of multiple related users in any aspect of a therapeutic process. There remains a large gap in the literature detailing and evaluating platform design, highlighting a significant opportunity for future cross-disciplinary research. This review details the incentive for undertaking such research; suggests design considerations when building digital mental health platforms for use by families; and offers recommendations for future development, including platform co-design and formative evaluation.

Although many young people demonstrate resilience and strength, research and clinical evidence highlight an upward trend in mental health concerns among those aged 12 to 25 years. Youth-specific digital mental health interventions (DMHIs) aim to address this trend by providing timely access to mental health support for young people (12–25 years). However, there is a considerable gap in understanding young people user experiences with digital interventions. This review, co-designed with Australia’s leading mental health organization Beyond Blue, utilizes a systematic methodology to synthesize evidence on user experience in youth-oriented digital mental health interventions that are fully or partially guided. Five relevant online databases were searched for articles published from 2018 to 2023, yielding 22,482 articles for screening and 22 studies were included in the present analysis. User experience outcomes relating to satisfaction and engagement were assessed for each included intervention, with experience indicators relating to usefulness, usability, value, credibility, and desirability being examined. Elements associated with positive/negative outcomes were extracted. Elements shown to positively influence user experience included peer engagement, modern app-based delivery, asynchronous support, and personalized content. In contrast, users disliked static content, homework/log-keeping, the requirement for multiple devices, and social media integration. Asynchronous interventions showed high satisfaction but faced engagement issues, with combined asynchronous/synchronous interventions reporting better completion rates. DMHIs offer a promising platform for youth mental health support and has the potential to dramatically increase the reach of interventions through the adoption of technological and user experience best practices. While young people respond positively to many aspects of intervention modernization, such as interactive, app-based design, other concepts, such as social media integration, they need to be adopted by the field more cautiously to ensure trust and engagement.Trial Registration CRD42023405812

Youth-specific digital mental health interventions (DMHI) represent an emerging field of study, and aim to increase access, improve socioemotional outcomes, and, where required, support triage to targeted interventions. However, prior reviews have reported inconsistent findings on the clinical effectiveness of such interventions in young adults (12–25 years). Further, shortfalls remain for the impact of guided interventions based on the mode of delivery and the type of human support personnel (e.g., professional or peer) guiding the intervention. In response, this systematic review, co-designed with Australia’s leading mental health organization, aims to assess the effectiveness of guided digital programs in improving youth socioemotional outcomes. Included studies involve young people experiencing mental ill-health, receiving brief (i.e., 1–12 sessions), digitally delivered (at least partially) psychological interventions that were guided or partially guided, tested in a type of experimental study, with a socioemotional outcome. Specific socioemotional outcomes examined were depression, anxiety, stress, wellbeing, mindfulness, and quality of life. A systematic search of the contemporary published and grey literature identified 22,482 records with 32 relevant records published between 2018 and 2023. A narrative synthesis guided integration of findings. Results demonstrated strong evidence for the effectiveness of guided interventions on socioemotional outcomes (i.e., depression, anxiety, stress) yet these effects were short-lived. When factoring in the use of different control groups (i.e., active vs. inactive), inconsistent effects were observed for the socioemotional outcomes of depression, anxiety, and stress. The mode of delivery (i.e., asynchronous, synchronous, combined) and the type of human support personnel did not appear to impact socioemotional outcomes. Results indicate efficacious brief digital interventions for depression and anxiety include refresher/follow-up content, goal setting content, and relapse prevention content. In contrast, poor efficacy is associated with interventions that include homework tasks, self-monitoring, and log-keeping content.PROSPERO, ID CRD42023405812.

BACKGROUND The COVID-19 pandemic placed an additional mental health burden on individuals and families, resulting in widespread service access problems. Digital mental health interventions suggest promise for improved accessibility. Recent reviews have shown emerging evidence for individual use and early evidence for multiusers. However, attrition rates remain high for digital mental health interventions, and additional complexities exist when engaging multiple family members together. OBJECTIVE As such, this scoping review aims to detail the reported evidence for digital mental health interventions designed for family use with a focus on the build and design characteristics that promote accessibility and engagement and enable cocompletion by families. METHODS A systematic literature search of MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL databases was conducted for articles published in the English language from January 2002 to March 2024. Eligible records included empirical studies of digital platforms containing some elements designed for cocompletion by related people as well as some components intended to be completed without therapist engagement. Platforms were included in cases in which clinical evidence had been documented. RESULTS Of the 9527 papers reviewed, 85 (0.89%) met the eligibility criteria. A total of 24 unique platforms designed for co-use by related parties were identified. Relationships between participants included couples, parent-child dyads, family caregiver–care recipient dyads, and families. Common platform features included the delivery of content via structured interventions with no to minimal tailoring or personalization offered. Some interventions provided live contact with therapists. User engagement indicators and findings varied and included user experience, satisfaction, completion rates, and feasibility. Our findings are more remarkable for what was absent in the literature than what was present. Contrary to expectations, few studies reported any design and build characteristics that enabled coparticipation. No studies reported on platform features for enabling cocompletion or considerations for ensuring individual privacy and safety. None examined platform build or design characteristics as moderators of intervention effect, and none offered a formative evaluation of the platform itself. CONCLUSIONS In this early era of digital mental health platform design, this novel review demonstrates a striking absence of information about design elements associated with the successful engagement of multiple related users in any aspect of a therapeutic process. There remains a large gap in the literature detailing and evaluating platform design, highlighting a significant opportunity for future cross-disciplinary research. This review details the incentive for undertaking such research; suggests design considerations when building digital mental health platforms for use by families; and offers recommendations for future development, including platform co-design and formative evaluation.