Heather Prime, PhD, explains why family systems assessments matter for child mental health

In a recent interview with Contemporary Pediatrics, Heather Prime, PhD, associate professor at York University, emphasized that children’s mental health cannot be fully understood in isolation from their family environment, making family systems assessments a critical component of pediatric mental health care.

Rather than viewing mental health concerns as inherent to the child, Prime explained that they emerge from dynamic interactions between the child and their broader context, particularly family processes. Parenting styles, co-parenting coordination and conflict, and the quality of family relationships all shape how a child’s distress develops, persists, and ultimately resolves.

Without assessing these factors, clinicians are left with an incomplete understanding of a child’s experience. Family systems assessments allow clinicians to identify patterns or negative cycles that may be maintaining symptoms and to work collaboratively with families to interrupt those patterns. Prime stressed that this approach is not about assigning blame, but about recognizing family strengths and using them to create a clear, supportive roadmap for change.

Despite their value, several barriers limit the routine use of family systems assessments. These assessments can be time-intensive and costly, requiring significant commitment from clinicians, health systems, and families alike. Many care settings are already overstretched, making it difficult to add resource-heavy assessments. Families may also face challenges such as language differences, cultural considerations, or logistical constraints that make close involvement in mental health care difficult or less appropriate.

To address these barriers, Prime highlighted practical solutions, including leveraging interdisciplinary teams, incorporating standardized and validated tools, and using virtual assessments to reduce burden. Even small additions, such as a single structured family measure, can provide valuable insights. Central to overcoming these challenges is strong clinician training in family-centered and culturally competent care.

Implementing family systems assessments in practice begins with treating the family as a core part of any child mental health evaluation. Prime encouraged clinicians to apply a bioecological understanding of development and to seek evidence-based training and resources for family assessment.

While many clinicians already consider the family informally, Prime urged them to reflect on how information is gathered. This includes ensuring input from all key caregivers, balancing informal interviews with standardized measures, and complementing caregiver reports with direct observation of family interactions using a strengths-based lens. Although this approach requires commitment from both clinicians and health systems, a wide range of resources is available to support integration into practice.

Follow-up care after family systems assessments can take multiple forms. In some cases, the assessment itself functions as a therapeutic intervention, serving as a starting point for collaborative conversations, psychoeducation, and the development of specific, measurable goals families can implement immediately. For others, it marks the beginning of a longer care pathway, helping guide service navigation and connections to appropriate supports, such as family therapy, parent mental health services, or individual child therapy. Even when limited to a single encounter, structured feedback and goal setting can provide meaningful guidance and momentum for families moving forward.

No relevant disclosures.