The BROSH Program – A Therapeutic Intervention Program for Families with Mentally Ill Parents: A Formative Evaluation Study

Study Background

BROSH – the Hebrew acronym for mental health, social services and rehabilitation – is a therapeutic intervention program developed in Israel for families in which one or both parents suffer from mental illness. The program grew out of a long-term partnership between the social services and health services in southern Jerusalem. The program aims to provide optimal solutions for families with children up to age 12 in which at least one of the parents has a severe mental-health disability that affects the function of the family as a whole and of each individual family member.

In 2013, the World Health Organization (WHO) emphasized the need to develop government policy to create cooperation among health and social services in order to develop holistic solutions for people with mental health disabilities. Plans to develop BROSH began the end of 2014; the program was launched about a year later and it consolidates the partnership between the mental health and social systems, as recommended by the WHO. The program initiators are seeking to disseminate it throughout Israel, and for that reason, in early 2019, commissioned the research staff at the Myers-JDC-Brookdale Institute (MJB) to help define work methods for the program and to examine its implementation and outcomes as perceived by the professionals and parties involved.

Study Goal

The goal of this formative evaluation was to study and describe the program’s unique work model and to examine the implementation and outcomes as perceived by the professionals and parties involved in the program.

Study Method

The study used qualitative methods and included 15 semi-structured in-depth interviews with most of the personnel and parties involved in implementing the program: managers and staff; employees of the Social Service Department at the Jerusalem Municipality; professionals at the mental health services for the child; and professionals at the mental health service for adults. Some of the interviews were conducted face-to-face and some by video conference (Zoom) from April to June 2020. They were transcribed, analyzed and processed by MJB’s study team using qualitative thematic analysis. study team using qualitative thematic analysis. The findings were compared with a literature review conducted by Sorek and Szabo-Lael in 2017[1] on services and interventions in programs to rehabilitate parental functioning.

Findings and Conclusions

The study describes the program’s work model: background to its development and goals, its processes of working with the families, and its organizational structure (roles and work methods);  unique aspects of the work model; and perceptions about the program outcomes and the need to expand it.

BROSH is unique in the intensive assistance it offers to families in which at least one of the parents has a severe mental health disability. It is innovative in that it is based on a structured, organized partnership between the mental health and social services. It is implemented according to the best practice principles of programs for rehabilitation of parental function. The respondents perceive it to be productive and helpful – to the children, in the exercising of their basic rights, and to the parents, in getting optimal care from the services in the community. Thus, they report, the program enables the parents to fulfill their parenting role. We recommend that the Ministry of Labor, Social Affairs and Social Services and the Ministry of Health consider developing the program and extending it to the national level.

[1] Sorek, Y. & Szabo-Lael, R. (2017). Services and interventions for the preservation of the family unit and the reunification of children from out-of-home placements with their families. RR-730-17. Jerusalem: Myers-JDC-Brookdale Institute (Hebrew).