Family Psychoeducation:

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Why Focus on Family Psychoeducation (FPE)?. People want information to help them better understand psychiatric illnessConsumers generally want and need the support of their familiesFamilies usually want to be a part of the consumer's recoveryPeople want to develop skills to get back into the mainstream of lifeFamilies need help reducing caregiver burden.

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Family Psychoeducation:

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1. Family Psychoeducation:

2. Why Focus on Family Psychoeducation (FPE)? People want information to help them better understand psychiatric illness Consumers generally want and need the support of their families Families usually want to be a part of the consumer’s recovery People want to develop skills to get back into the mainstream of life Families need help reducing caregiver burden

3. Common Effects of Caregiving Anxiety Depression Increased susceptibility to illness Potential exposure to violence Marital discord Economic & time investment Gratifications; close, rewarding, meaningful relationships

4. Positive Outcomes from FPE The consumer and family work together towards recovery Can be beneficial in recovery from schizophrenia and severe mood disorders

5. Research on FPE Standardized family programs developed by Anderson, Falloon, Leff, McFarlane, Barrowclough, and others Outcome studies report a reduction in annual relapse rates for medicated, community-based people of as much as 50% by using a variety of educational, supportive, and behavioral techniques

6. Combined Results of FPE Programs on 2-year Cumulative Relapse Rates in Schizophrenia (11 Studies)

7. More Research on FPE Functioning in the community improves steadily Family members have less stress, improved coping skills, greater satisfaction with caretaking, and fewer physical illnesses over time

8. 1. Families do not cause mental illness! 2. The consumer defines who is family. 3. Collaboration between family and professionals optimizes the outcome of mental illness. 4. Family education helps relatives support their loved ones in pursuing their recovery goals. 5. Reducing family stress and improving coping can improve the quality of all member’s lives. 6. Family support can validate the experiences of all members and facilitate shared problem solving. 7. Family collaboration is long-term, not short-term.

9. Who Can Benefit from FPE? Consumers living with or in regular contact with family members Wide range of family relationships (e.g., parents, siblings, spouses, children) Families where there is significant tension at home Families who want to help consumer pursue recovery goals Other people with caring relationships with consumer

10. Two Evidence-based FPE Models Multifamily groups (McFarlane) Behavioral family therapy (Falloon/Miklowitz/Mueser)

11. Multifamily Groups vs. Behavioral Family Therapy MFGs usually time-unlimited, provide opportunities for social support & validation BFT usually time limited, easier to tailor to individual family, including outreach & involvement of more family members BFT may be easier earlier on in illness, before families have fully accepted disorder Consumers and families may need the practitioner’s guidance to decide; some families may benefit from both

12. The History of Multifamily Groups Originated 30+ years ago in a NY hospital Families were offered education in a group format without consumers Consumers wanted to join Hospital staff noticed significant improvements (e.g., increased social skills and interest in treatment) in consumers, improved family involvement, and communication

13. Core Elements of Psychoeducation Joining Education Problem-solving Interactional change Structural change Multi-family contact


15. What Happens During Joining? Discuss personal interests = it’s a good way to facilitate getting to know one another Identify early warning signs of illness Explore reactions to illness Identify coping strategies Review family social networks

16. What Happens During Joining? (Cont.) Identify characteristic precipitants for relapse (“triggers”) Investigate ways to reduce burden Offer opportunities to explore feelings of loss and “what might have been” Share “Family Guidelines’ with consumers and family members

17. The Psychoeducation Workshop An educational opportunity for families held after the joining sessions and prior to multifamily groups

18. The Psychoeducational Workshop 6 hours of illness education Relaxed, friendly atmosphere Co-leaders act as hosts Questions and interactions encouraged

19. The Workshop is Held in a Classroom Format Promotes comfort Families can interact without pressure Encourages learning Co-leaders act as educators

20. Educational Workshop Agenda History and epidemiology Biology of illness Treatment: effects and side effects Family emotional reactions Family behavioral reactions Guidelines for coping Socializing

21. Structure of Biweekly MFG Sessions Informal socializing Check-in, “caring and sharing” Group problem-solving Make an action plan

22. Characteristics of Problem-solving

23. Take Action! An action plan is developed for the chosen suggestion(s) Tasks are identified and assigned Consensus is achieved prior to leaving the meeting The plan is reviewed at the next meeting to determine success or the need for further problem-solving

24. Where can FPE Groups be Held? Inpatient units Partial hospital programs Outpatient settings ACT programs Group homes Nursing homes With NAMI chapter

25. Starting a FPE Group Find a compatible co-facilitator Attend a training and follow the manual Explore your own motivation and enthusiasm since barriers will appear Promote this model to your supervisor because you will need his/her support Adhere to the problem-solving format since this is not group process

26. Format of BFT Individual family sessions Relatives and clients included “Open door” policy for reluctant participants One hour sessions Sessions conducted on a “declining contact basis” Treatment is long-term, not short-term Focus is on learning new information and skills, not fostering insight

27. Components of BFT Engagement Assessment Psychoeducation (using handouts) Communication skills training Problem-solving training Additional problems and strategies

28. Engaging The Family Be respectful, non-judgmental, empathic Explain you want to help family members become “members of the treatment team” Describe goals of family program as education, reducing hospitalizations, and helping client independence Allow relatives to vent and “tell their story”

29. Assessment For Each Family Member What do they understand about the disorders? What are their short-term goals? What are their long-term goals? What interferes with obtaining their goals? For the Family as a Unit What are their strengths? What problems do they have in communication? How do they solve problems together?

30. Internal Structure of BFT Treatment Sessions Initial greetings, review of the week, identify pressing problems needing immediate attention Review of family members’ goals (after educational sessions) Review homework and family meeting Continue work on previous topic or begin new topic Assign homework Address pressing problems (if any)

31. Principles of Psychoeducation Education is interactive Use multiple teaching aids Connote consumer as the “expert” Elicit relatives’ experience and understanding Avoid conflict and confrontation Education is a long-term process Evaluate understanding Review materials as often as possible

33. Communication Problems that Warrant Skills Training Frequent fights Pejorative put-downs Snide, sarcastic, caustic comments Lack of verbal reinforcement between members Difficulty being specific when talking about feelings and behavior

34. Communication Skills Taught Using Social Skills Training Active listening Expressing positive feelings Making positive requests Expressing negative feelings Compromise and negotiation Requesting a time-out

35. Example of a Communication Skill Expressing Positive Feelings Look at the person Say exactly what the person did that pleased you; be specific Tell the person the feeling it gave you--be precise

36. Problem Solving 1. Define the problem 2. Brainstorm solutions 3. Evaluate solutions 4. Choose best solution(s) 5. Plan on how to implement solution 6. Follow up plan

37. Format of Problem Solving “Chairman” leads family through steps of problem solving “Secretary” records problems solving efforts Focus is on getting all members’ input AND sticking to steps of problem solving If at first you don’t succeed, problem solve again Always schedule a follow-up meeting

38. Examples of Topics for Family Problem-solving Identifying new social outlets Responding to offers to use substances Determining strategies for dealing with persistent symptoms Exploring recreational activities Finding work or other meaningful activities

39. Termination of BFT: Timing Usually meet with families for 1 to 2 years, on a declining contact basis, such as: Weekly sessions for 3 months Biweekly sessions for 6 months Every three weeks for 2 months Monthly for 3 months

40. Practical Issues of Starting a BFT Program Identify consumers currently receiving services who have at least weekly contact with family Approach the consumer first, asking permission to meet with family Convey interest in the well-being of both the consumer and the family

41. Practical Issues in Starting a BFT Program (Cont.) Be willing to help with practical problems, such as putting people in touch with appropriate services (i.e., housing, income) Set up appointments with family members at times convenient to them If possible, offer sessions at home or other locations Make sure that sessions are reimbursable Be willing to help with overcoming transportation and other problems Routinely offer BFT to new consumers

42. Practical Issues in Maintaining a BFT Program Provide weekly group supervision to all clinicians providing BFT Set up an advisory board including family members Educate all staff members about the program; enlist their support and share “success stories” with them Make referral to BFT a routine part of admissions

43. Resources Multifamily Groups McFarlane, W. R. (2002). Multifamily Groups in the Treatment of Severe Psychiatric Disorders. New York: Guilford Press. SAMHSA Implementation Kit: Behavioral Family Therapy Falloon, I. R. H., Boyd, J. L., & McGill, C. W. (1984). Family Care of Schizophrenia: A Problem-Solving Approach to the Treatment of Mental Illness. New York: Guilford Press. Miklowitz, D. J., & Goldstein, M. J. (1997). Bipolar Disorder: A Family-Focused Treatment Approach. New York: Guilford. Mueser, K. T., & Glynn, S. M. (1999). Behavioral Family Therapy for Psychiatric Disorders. (Second ed.). Oakland, CA: New Harbinger. (Contains educational curriculum) Mueser, K. T., Noordsy, D. L., Drake, R. E., & Fox, L. (2003). Integrated Treatment for Dual Disorders: A Guide to Effective Practice. New York: Guilford Press. (Contains educational curriculum)

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