When a child is struggling with their mental health, a psychologist's instinct is often to focus only on the child.
At the 91ɫ Psychology Clinic, however, researchers and graduate students are working from a different premise: that understanding a child means understanding the family around them.
Heather Prime, a clinical psychologist and associate professor in the , is leading that effort with a team of graduate students.
At the clinic – a mental health care facility for families in the community and training centre for 91ɫ’s emerging clinical psychologists – graduate students study family mental health while also engaging directly with clients. As part of their clinical training, the students deliver services and conduct supervised assessments with families.
PhD candidate Gillian Shoychet’s doctoral dissertation sits at the centre of this work: she is studying how to implement family assessments in a university clinic, using feedback from families to refine the model.
Their work, alongside researcher Maya Koven, is outlined in an published in JAMA Pediatrics which argues that family systems assessments remain underused in the care of older children and youth.
"The family system – all family members and the interactions between them – influences a child's development and mental health," says Shoychet. "Children's mental health does not exist in isolation."
The approach centres on the Lausanne Trilogue Play Paradigm, a structured assessment that originated in Lausanne, Switzerland. During the assessment, families complete tasks while clinicians film the sessions. In a follow-up meeting, clips are played back to the family and observations are discussed collaboratively.
"We don't say ‘here's what we learned, and here's what you need to do,’" says Prime. "We say, ‘here's what we saw – how does that make sense to you?’"
A key focus of this approach is the co-parenting relationship: the parenting team and how both caregivers work together to support their child. The team’s research states that this dimension is rarely examined in standard child mental health care, where assessments typically involve only one caregiver.
"We're interested in all those relationships that are co-occurring," says Shoychet. "Without observing all those different pieces, it's hard to get a full sense of the child in a holistic manner."
The assessment spans four sessions and concludes with a tip sheet compiled by the clinical team and a follow-up check-in. For some families, that is enough. For others, it becomes a roadmap – pointing toward individual therapy for the child, parental support or longer-term family therapy.
"It's really a broader systemic map of what services families might be able to access," says Prime.
Building that map required significant groundwork by Shoychet. With support from Koven and the graduate student team, Shoychet worked to merge two existing clinical manuals into a single program guide designed for the 91ɫ Psychology Clinic and its clinical, research and training teams.
"It takes a lot of time, a lot of attention to detail, a lot of patience,” says Shoychet of that project. “As a graduate student, I'm not just getting training to do this program – I'm supporting the implementation of it in my clinic, which is a very unique experience."
Graduate students are trained through a deliberate scaffolding approach. They begin by observing how Prime leads a case, then they work alongside her as co-therapists. Eventually, they take the lead themselves. Between sessions, the team gathers for group consultations – typically joined by collaborator Diane Philipp, a child psychiatrist at The Garry Hurvitz Centre for Community Mental Health at SickKids who was instrumental in bringing this training model to Canada.
"Even if the student isn't the primary clinician, students on the team can come watch, provide feedback and learn," says Shoychet. "It's a really beautiful learning opportunity."
Families are also active participants in shaping the program. Surveys provide meaningful feedback on time commitment, session satisfaction and whether families felt their clinician was supportive.
"We're not just evaluating outcomes," says Shoychet. "We're really trying to understand how the program works in this specific setting and what we need to change to meet the needs of the communities we serve."
"I actually get to see the value that this has for families and be part of changing it to make it more valuable," she adds. "That was one of my aspirations for coming into grad school."
Both Prime and Shoychet share the same vision for the program: to serve those in need while creating meaningful learning experiences for grad students.
Success would mean sustainable program, says Prime, characterized by ongoing training opportunities for graduate students to serve a continuous intake of families.
"We put so much heart and soul into this project," adds Shoychet. "I'm hopeful that people will know more about it."
With files from Mzwandile Poncana