A 3-way family meeting involving the young person, the primary caregiver, and the practitioner or key worker is a useful therapeutic vehicle for teaching practical skills such as communication and problem solving. Meeting face-to-face allows the practitioner to observe the young person and family member/s interacting, help them to set goals for behaviour change, model behaviours that can facilitate positive change, and provide timely reinforcement.

At a more subtle level, the family meeting is an ideal vehicle for modeling a range of attitudes for parents/caregivers including:

• Optimism that change is possible;
• Commitment to provide support, and
• Willingness to hear all sides of the story.

In many cases a single session is the only opportunity that will be available to work face-to-face 3-ways with the young person and their primary caregiver. To be maximally beneficial it is best if the meeting is highly structured.

Think carefully about where the meeting should be held. The family home may be most convenient for the parent/caregiver, but in some families it may be difficult to secure privacy if you meet in the family home. Meeting in an office will provide the advantages of quiet, freedom from interruptions, and a neutral space. If you meet at the family home make every effort to secure a room where the three of you can talk in privacy. If other people are present, explain that it is necessary to keep the work focused on the dynamics between the young person and the primary caregiver.

Three key principles of family meetings for all participants to bear in mind include:

1. The aim is to find ways to move forward, not to talk about the past
2. The role of the practitioner is to provide tools, not to give answers
3. The session needs to be structured and business-like, hence the practitioner will keep proceedings focused on the agenda.

It is vital to brief all participants on these principles prior to the meeting. The first family meeting involving the young person, caregiver, and practitioner should be held only after you have met one-on-one with the parent or caregiver. Prior to the family meeting, the caregiver should also have received orientation, basic information about the service and the role of the practitioner should have been provided and ground rules should have been discussed and negotiated.

The caregiver may or may not be fully engaged at the time the first family meeting is conducted. If a caregiver is not fully committed, it is still appropriate to invite them to participate in a meeting as part of their decision-making process.

The following 3 points of action are recommended as agenda items to be covered in the first family meeting:

1. Set positive expectations - A good way to start the meeting is to thank the caregiver for attending and review progress that has been achieved so far in the one-on-one work with the young person and with the caregiver. Highlight the ways in which each individual is demonstrating readiness and willingness to improve their relationship.

2. Set clear goals for the work to be completed together.  A useful exercise to initiate collaborative goal setting is the Relationship Happiness Scale  developed for A-CRA. There is an Adolescent Version and a Caregiver Version of the scale. Steps for using this scale are as follows:

• Provide rationale for the exercise;
• Give the young person and the caregiver 2-3 minutes to complete the scales;
• Collect the two forms and review several ratings for each person. Start with the highest rating items in order to start off with a positive note. Ask why the particular rating was given and then what it would take to shift it to a higher rating;
• Help the caregiver and the adolescent to select a category in which they want to make a request for a change in the other person. They can choose different categories. Suggest they choose categories rated in the middle of the scale so that difficulties in these areas are not too severe and feasible goals can be created.
• Identifying an area of the relationship in which each person would like to see changes provides a strong basis for setting goals. If the types of changes wanted are relatively clear it will be relatively straightforward for each person to begin to formulate requests for change, in which case it is sensible to proceed to teaching Family Communication Skills. If the types of changes wanted by one or both individuals are not clear and there is confusion or disagreement about the ways forward it may be more productive to proceed to Family Problem Solving Skills.

3. Family Communication Skills or Family Problem Solving Skills – On the basis of the review of the Relationship Happiness Scale, work with the young person and caregiver to decide if it would be most helpful to learn Family Communication Skills or Family Problem Solving Skills. It is important that at least some new skills are learned in the first family meeting. Learning Communication Skills is generally quicker than Problem Solving Skills, so the former may be the best choice if time is limited.