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Employment Multifamily Group Project. Alex Kopelowicz, MD Roberto Zarate, PhD Human Interaction Research Institute New Haven, CT – March 15-16, 2012. MFG Staff Training: Day 1. 8:00-8:30 am Breakfast 8:30-9:15 am Brief Introductions by Agencies

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employment multifamily group project
Employment Multifamily Group Project

Alex Kopelowicz, MD

Roberto Zarate, PhD

Human Interaction Research Institute

New Haven, CT – March 15-16, 2012

mfg staff training day 1
MFG Staff Training: Day 1

8:00-8:30 am Breakfast

8:30-9:15 am Brief Introductions by Agencies

9:15-9:45 am Welcome/Overview of the MFG Training Program

9:45-10:30- am What is MFG and Why Should We Do It?

10:30-10:45 am Break

10:45-12:30 pm MFG Components (Joining Sessions, Educational Workshop & Problem Solving Groups)

12:30-1:30 pm Lunch

1:30 – 4:00 pm Joining Sessions (Demonstration & Role Plays)

mfg staff training day 2
MFG Staff Training: Day 2

8:00-8:30 am Breakfast

8:30–9:00 am Review/Overview of Problem Solving in MFGs

9:00-10:30 am MFG Sessions (Demonstration and Role Plays)

10:30-10:45 am Break

10:45-12:00 noon MFG Sessions (Role Plays Continued)

12:00–1:00 pm Lunch

1:00–3:00 pm MFG Sessions (Role Plays Continued)

3:00 -3:30 pm Questions and Wrap-Up

standard approaches to family work
Standard Approachesto Family Work
  • Psychoeducation
  • Communication skills training
  • Problem solving techniques
  • Social network development (MFG)
better outcomes in family psychoeducation
Better Outcomes in Family Psychoeducation
  • Over 20 controlled clinical trials, comparing to standard outpatient treatment (Dixon, 2003), have shown:
    • Increased employment
      • At least twice the number of consumers employed, and up to four times greater--over 50% employed after two years--when combined with supported employment
    • Improved family relationships and well-being
    • Reduced friction and family burden
    • Reduced medical illness in family members
      • Doctor visits for family members decreased by over 50% in one year
1 year survival rates among bipolar patients in family focused treatment versus case management

Pretreatment

Treatment

Follow-up

1-Year Survival Rates Among Bipolar Patients in Family-Focused Treatment Versus Case Management

FFT, N=31

CM, N=70

Wilcoxon Test, c2 (1)=3.99, P =.046

Miklowitz DJ, et al. Biol Psychiatry, 2000;48(6):582-592

slide7

Stages of a Psychoeducational Multifamily Group

Educa-

tional

workshop

Ongoing

MFG

Families &

clients

bi-weekly

6 months

Joining

Family and

clients

separately

3-6weeks

Families only

1 day

joining with families and clients

Joining with Families and Clients

JOINING means to CONNECT, BUILD RAPPORT, CONVEY EMPATHY, ESTABLISH AN ALLIANCE, ENGAGE

It is the first stage of intervention

Designed to create a bond between Client/Family Members and Family Counselors

COUNSELOR as ADVOCATE

joining proecedures
Joining Proecedures
  • THREE Joining Meetings

 SEPARATELY with Relatives and Clients

 WEEKLY – 1 HOUR with Relatives, ½ HOUR

with Clients

  • Start sessions A.S.A.P. after client/family enrolls
  • Gain an understanding of family’s stresses, problems, reactions to client’s unemployment/underemployment, etc.
joining i
JOINING – I
  • 15 Minutes of SOCIAL TALK
  • Discuss the experience of looking for, getting and losing jobs
  • Review any recent stressful event: Who and what helped or didn’t
  • IDENTIFY WARNING SIGNS OF STRESS – PRECIPITANTS
  • Distribute to families & keep for future reference
  • Describe the plan for ongoing MFG sessions
  • 5 Minutes SOCIALIZING
joining ii
JOINING – II
  • 15 Minutes of SOCIAL TALK
  • Review past experiences with co-workers, supervisors, supervisees, etc.
  • FAMILY’S EXPERIENCE DURING STRESSFUL EVENTS

 The sharing of painful events: A crucial aspect of “Joining”

 The client/family’s understanding of causes

  • Family’s social network & resources (material & emotional)
  • 5 Minutes SOCIALIZING
joining iii
JOINING – III
  • 15 Minutes of SOCIAL TALK
  • Family’s social network & resources
  • Developing and maintaining a support network
  • SHORT & LONG-TERM GOALS (e.g., Employment)
  • Preparation for Workshop & MFGs
multifamily groups
MULTIFAMILY GROUPS
  • Five to eight families
  • Two family counselors/facilitators
  • 1 ½-hour sessions – biweekly over six months or more
  • Refreshments/snacks are provided
  • Initial sessions avoid emphasis on conflict
  • Initial sessions emphasize establishing a working alliance by building group identity and developing a sense of mutual interest and concern - drop outs are failures
first mfg session
FIRST MFG SESSION

“GETTING TO KNOW EACH OTHER”

Go Around the Room

 Background

 Hobbies

 Occupation

 Interests

 Counselor Goes First (Discloses/Shares with the Group)

SETTING BASIC RULES

 Regular ATTENDANCE (for Relatives)

 CONFIDENTIALITY (No Pressure to Disclose)

 INTERACTION AMONG MEMBERS

 PHYSICAL/EMOTIONAL CONTROL

second mfg session
SECOND MFG SESSION
  • “HOW UNEMPLOYMENT/UNDEREMPLOYMENT HAS CHANGED OUR LIVES”

 Building a SENSE OF TRUST & COMMITMENT

 Sense of COMMON EXPERIENCE (Listen to each other)

 Strengthening GROUP IDENTITY & SENSE OF RELIEF

 The CLIENT’S INNER EXPERIENCES

 Counselors emphasize the vital role of SHARING GRIEF,

CONFUSION, GUILT, FEAR with those “on the same boat”.

AND HOPE

  • Remind participants about Problem Solving (next session)
general points
GENERAL POINTS
  • New Members
  • Late-Arriving Members
  • Reminders about Attending
  • Crises & Emergencies
  • COMMUNICATION & INTERACTIONS

 Counselors DON’T speak for clients or relatives

 Interaction among members is essential

 Clients are ENCOURAGED (not pressured) to

participate

 Respect other’s turn and avoid criticism

problem solving in mfgs
PROBLEM SOLVING IN MFGs
  • The CORE of MFG Sessions
  • Designed to compensate for limited education
  • FORMAT:

Checking in 15 Minutes

Go-round 20 Minutes

Selecting a Problem to Solve 5 Minutes

Solving the Problem 45 Minutes

Wrap-up Socializing 5 Minutes

  • Counselors should GET READY and HAVE A PLAN – IN ADVANCE
selecting an employment related problem to solve
Selecting an Employment-Related Problem to Solve
  • TOPICS: (Identified prior to MFG or during group)

Transportation

Child Care

Drugs and Alcohol

Life Events/Domestic Problems

Housing

Disagreements among Family Members

  • “REJECTED” PROBLEMS:

Make a Direct Suggestion and Review Outcome

Meet Outside the Group (e.g., Crises)

Refer to Past Solutions that Apply

Refer to Solution/Family with Successful Outcome

the problem solving method
THE PROBLEM-SOLVING METHOD
  • Define the Problem or Goal
  • List Possible Solutions
  • Evaluate Advantages and Disadvantages of Each Solution
  • Choose “the Best” Solution
  • Implement Plan to Carry Out Solution
  • Review Implementation and Outcome
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