The invisible work keeping families together – by AA Lee

“Despite our strong outcomes, Families First remains relatively unknown outside Tusla. We’ve been so busy working on the ground that we haven’t told our story.” – Alice Ann Lee

For almost two decades, I’ve worked with families who are hanging on by a thread. Parents who feel they’ve failed. Teenagers who have lost hope. Families who love each other deeply but can no longer find a way to live together safely.

This is the world in which the Families First team operates — quietly, intensively, and often unseen. We’re part of Archways, and for 19 years we’ve been providing an evidence-based, trauma-informed systemic* therapy service to families referred by Tusla. Our work focuses on children on the edge of care or already in alternative placements — those facing the most complex emotional, behavioural, and relational challenges.

While much of Ireland’s focus rightly falls on foster care and residential services, what we do sits one step before that: we help families heal and stabilise so that children can remain safely at home.

What makes our approach different

In Families First, we don’t work with just one person. We work with the whole system: the child, the parents, and sometimes the extended family and foster carers. Every piece of the system influences the others.

Our model combines systemic family therapy and individual psychotherapy with trauma-informed practice. We meet families where they are — literally. Most of our therapy takes place in their homes, because for many of our families, getting to a clinic isn’t realistic. We also offer out-of-hours sessions to match the rhythm of real family life.

Over time, we’ve learned that if you focus only on the young person’s difficulties without addressing the parent’s trauma or the family’s relationships, the change won’t last. Parents often carry their own histories of abuse, neglect, or loss. Unless those stories are part of the work, healing cannot take root.

Two Irish research studies — one retrospective and one randomised controlled trial — have shown significant improvements in adolescent behaviour, emotional wellbeing, and family adjustment for families who complete our programme. The evidence supports what we see every day: this approach works.

Lisa’s story: rebuilding trust through understanding

Lisa was sixteen when she was referred to us. She had autism and severe anxiety, had stopped attending school, and spent most of her time in her room. Her mother, Karen, was exhausted. Every attempt to help seemed to end in an argument.
Over 10 months of therapy, we focused first on rebuilding the relationship between them. We explored how autism and anxiety interacted with family stress and we helped Karen find new ways to communicate with her daughter. Lisa began to express her needs more clearly, and her mother learned how to respond without escalating conflict.

Together, we found an alternative education placement that suited Lisa’s needs. She started attending full-time and began to rediscover her confidence. The change was slow but steady. By the end, Lisa’s family felt calmer and more connected, and Lisa was thriving.

“Lisa became more confident, more open,” her mother told me recently. “Our home is a different place now. I’ll always be grateful for the support we received.”

Harold’s story: healing through connection

Harold entered foster care at age four with his two younger siblings. By sixteen, he was struggling with identity and loss — why he was in care, why his father had denied him, and why his mother seemed distant.

We began by helping Harold tell his story. Using art and narrative therapy, he explored questions about his past that he had never been able to ask. We also supported his mother, who began grief counselling for the first time, and brought both of them together for joint sessions.

Gradually, Harold’s understanding of his life became clearer. His relationship with his mother strengthened. His foster placement stabilised. He began an apprenticeship and started to picture a future for himself.

“For the first time, I felt heard,” he told us. “I understood my story instead of feeling lost in it.”

Why this work matters

This kind of therapy takes time. It takes flexibility, consistency, and a willingness to walk alongside families through chaos, ambivalence, and pain. But when it works, it changes lives — not just for the young person, but for the entire family system.
Our approach also saves public resources. Families First has helped avert out-of-home placements, sustain foster placements, and support safe family reunifications. By addressing trauma, relationships, and practical needs together, we reduce the number of separate services families must engage with — and the risk of them dropping out altogether.

A social worker recently told me, “This service has been life-changing for many families. We’ve seen real reductions in risk and huge improvements in relationships.”

After nineteen years

Despite our strong outcomes, Families First remains relatively unknown outside Tusla. We’ve been so busy working on the ground that we haven’t told our story. But our work deserves to be seen — because it shows what’s possible when families are met with compassion, skill, and understanding.

As Ireland faces growing pressure on the care system, we need to invest more in prevention and early therapeutic intervention. Families First has shown that when families are supported holistically — not judged, not fragmented across services — children can stay at home, and families can heal.

Nineteen years in, I still believe in the same simple truth that brought me into this work: real change happens in relationships. And every time a parent and teenager start talking again, or a child finds safety in their own home, we’re reminded that this quiet, invisible work matters more than ever.

* “Systemic” work means looking at a person’s family, community and other support networks, rather than solely viewing them as an individual facing a challenge. To find out more, visit: https://archways.ie/. Of note, Queen’s University Belfast teaches a Masters in Systemic Practice and Family Therapy, part-time over three years.