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Latino Multifamily Group Staff Orientation. Alex Kopelowicz , MD Thomas E. Backer, PhD Valley Nonprofit Resources / Human Interaction Research Institute . Presentation Outline. What is MFG and why should we do it? Components of MFG Adapting MFG for Latinos

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Latino multifamily group staff orientation
Latino Multifamily Group Staff Orientation

Alex Kopelowicz, MD

Thomas E. Backer, PhD

Valley Nonprofit Resources / Human Interaction Research Institute


Presentation outline
Presentation Outline

  • What is MFG and why should we do it?

  • Components of MFG

  • Adapting MFG for Latinos

  • Preliminary findings of RCT focused on MFG for Mexican-Americans

  • Disseminating the MFG


Components of the latino mfg
Components of the Latino MFG

Family psychoeducation

Communication skills training

Problem solving techniques

Social network development


Port 2004 treatment recommendations
PORT (2004) Treatment Recommendations

  • Patients who have on-going contact with their families should be offered a family psychosocial intervention which spans at least nine months and which provides a combination of education about the illness, family support, crisis intervention, and problem solving skills training. Such interventions should also be offered to non-family caregivers.


Better outcomes in family psychoeducation
Better outcomes in family psychoeducation

Over 20 controlled clinical trials, comparing to standard outpatient treatment, have shown:

Much lower relapse rates and rehospitalization

Up to 75% reductions of rates; minimally 50%

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

McFarlane et al 2003


Mfg reduces re hospitalization rates
MFG Reduces Re-hospitalization Rates

(Dyck et al, 2001)


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


Remission to 2 years
Remission to 2 years

N: PEMFG=83; PESFT=92Main effect: p=.05

McFarlane et al, 2003


Dosages in mfg and sft
Dosages in MFG and SFT

McFarlane et al, 2003


Stages of a Psychoeducational Multifamily Group

Educa-

tional

workshop

Ongoing

MFG

Families &

clients

bi-weekly - 6-9 months

Joining

Family and client

separately

3-6 weeks

Families only

1 day


Multifamily groups
MULTIFAMILY GROUPS

  • Five to Eight Families

  • Two Facilitators

  • 1 ½-Hour Sessions – Biweekly – 6-9 months

  • Refreshments/snacks provided

  • Initial sessions avoid emphasis on clinical issues

  • Initial sessions emphasize establishing a working alliance by building group identity and developing a sense of mutual interest and concern. Drop outs are failures


Joining with families clients

JOINING with FAMILIES & CLIENTS

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

It is the first stage of treatment

Designed to create a bond between client/family members and facilitators

FACILITATOR as ADVOCATE


Problem solving in mfgs
PROBLEM SOLVING IN MFGs

  • The CORE of MFG sessions

  • Designed to compensate information-processing deficits in mental disorders

  • 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

  • Facilitators should GET READY and HAVE A PLAN – IN ADVANCE


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


The assessment of culture
The Assessment of Culture

  • Best undertaken by paying attention to people’s daily routines and how such activities are tied to families, social networks and communities

  • The key to a cultural assessment is asking what matters most to people or what is most at stake for people


The cultural question is
The cultural question is:

  • What are the factors in a particular culture that need to be considered prior to implementing multifamily group psychoeducation developed with a Euro-American population of people with mental disorders?


Cultural modifications for latinos
Cultural Modifications for Latinos

  • Encourage participation of fathers

  • Acknowledge folk conceptions of illness

  • Reframe to fit family beliefs and attitudes

  • Focus on education rather than strictly on communication/problem solving skills

  • Acknowledge each family member’s role

  • Goal: Interdependence vs independence

  • Utilize prosocial factors (e.g., warmth)


Efficacy of mfg rct study results
Efficacy of MFG – RCT Study Results

  • 174 Mexican-American subjects

  • 1 year of treatment

  • 1 year of follow-up

  • Overall log-rank Χ2=13.3, df=2, p=.001.

  • Kopelowicz et al, under review


Disseminating the mfg approach
Disseminating the MFG Approach

  • Raising the Bar project

    • Training program and technical assistance to implement MFG for adults with mental illness

    • Resulted in a number of program adoptions in the San Fernando Valley region of Los Angeles

  • Latino MFG project

    • Training program and technical assistance to implement Spanish-language MFG for families of adolescents

    • Resulted in six pilot adoptions so far, four of them evaluated with positive results (national dissemination now underway)

      For more information, go to www.valleynonprofitresources.org, Resources section


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