Utilizing Family Strengths and Family Resources at Multi-Levels: A Journey of Developing Contextually Relevant Knowledge

1. Utilizing Family Strengths and Family Resources at Multi-Levels: A Journey of Developing Contextually Relevant Knowledge for Family Centered Social Work in Hong Kong Joyce L. C. Ma Professor & Chairperson Department of Social Work The Chinese University of Hong Kong

3. Shift of views toward families of people with mental illnesses Families as a pathology in 1960s and parent blaming to Families as resources and full partners in psychosocial management from 1980s onwards Reasons of working with families of people with mental illnesses

4. Relationship between family expressed emotion and relapse confirmed at two year follow-up in an English study (Brown, Birley & Wing, 1972) High emotional expressed families (HEE) Low emotional expressed families (LEE) Relationship between family atmosphere and relapse of schizophrenia

5. HEE families 58% relapse rate LEE families 16% relapse rate Emotional climate of the family Criticism Hostility Emotional involvement Warmth Positive remarks Contact hours less than 35 hours per week (Vaugh & Leff, 1976) Relationship between family atmosphere and relapse of schizophrenia

6. Mexican-American families Chandigarh, Northern India 90% LEE Respond to the breakdown of family members Tolerance Sadness Not anger Not hostility as in the West Cross-cultural applicability

7. Importance of socio-cultural context Socially relevant and culturally-specific knowledge for Chinese families in Hong Kong Insights of the study

8. Spillover effects of childhood disorders (e.g., autism, ADHD) on parents and families Divorce rate is in the 80% range in families with children with autism spectrum disorder Maternal depression common for mothers with ADHD Mother with a child suffering from ADHD in a problem-solving context more controlling and hostile than mother with a normal child Burden of Chinese families in caring people diagnosed with schizophrenia (Chan, 1993; Sun, 1994; Wong, 1991 & 2000) Objective burden and subjective burden equally heavy High psychosocial distress of caregivers Family functioning less healthier (Sun, 1994) Problems and difficulties experienced by families of the mentally ill

9. Burden of caregiving equally heavy for parents with young people suffering from eating disorders United Kingdom (Treasure, Murphy, Szmukler, Todd, Gavan & Joyce, 2001) Germany (Graap et al., 2008) Hong Kong (Ma, 2008) Family work done in the past Mutual help groups for psychotic patients and their families (Ma, 1986) Self-help groups across several social service agencies providing psychiatric rehabilitation (Ma, 1992) Problems and difficulties experienced by families of the mentally ill

10. Insufficient studies on practice knowledge in utilizing family strengths and family resources Heightened awareness on importance of involving father in mental health services but professional engagement of the father was limited Knowledge gap

11. Family-centered service delivery, across disciplines and settings, recognizes the centrality of he family in the lives of individuals. It is guided by fully informed choices made by the family and focuses upon the strengths and capabilities of these families (Allen & Petr, 1996; p. 68) Definition of Family Centered Service Delivery

12. ? A pig under the roof Concept of Family in Traditional Chinese culture

13. ?? Looting of women in the evening Meaning of Marriage in Ancient China

14. ? A person kneeling down Woman be submissive, subordinate and subjugate to men Imbalance of power between men and women in Chinese families Meaning of Woman in Ancient China

15. My journey began when I was a social worker in mental health services in a general hospital Continue developing the knowledge as a social work academics in the university

16. Adaptation of the Micucci�s Model (1998) to the Chinese Context Integrated four theoretical perspectives Psychodynamic Feminist psychodynamic Socio-cultural Family systems Applicability of structural family therapy for Chinese young people suffering from anorexia nervosa in Hong Kong and Shenzhen

17. Isolation and conditional acceptance Control versus genuine connection Symptomatic cycle Three processes interwoven with each other (Micucci, 1998) Essential Family Processes in Families with ED

18. Focus on identifying constricting family process that has maintained the symptoms of ED Ultimate goal Assist the emaciated young person and the parents to interrupt the symptomatic cycle of interactions Cultivate a holding environment for recovery Treatment Principles

19. Redefining the problem and negotiating the contract Encouraging parental collaboration Addressing unresolved conflicts Handling relapses Supporting individual development and Supporting the transformation (Micucci, 1998) Treatment Steps

20. Enrichment of the cultural perspective Definition of family, jia (?) for family assessment Mainzi (??), face to identify hidden messages of the emaciated young person and to allow gracious exit of individual family member/s in refusing to deal with the family conflicts Motivating and engaging the ambivalent young person in treatment Working on other family problems (Ma, 2008) Modification of the Model in a Chinese Context

21. Chinese emaciated children and adolescents benefited from family treatment and routine psychiatric treatment Treatment effect changes on patients� Excessive concern over body shape Personality characteristic of perfectionism Change in the six dimensions of the level of psychological distress is statistically insignificant but clinically significant Symptomatic to functional range (Ma & Lai, 2009) Results of our study

22. Mean scores of our sample lower than the norms gathered by Shek (1995) Marital quality poorer in terms of marital satisfaction than adjusted Chinese couple (Ma & Lai, 2009) Change in parents� marital quality

23. Family therapy beneficial Create a social context for them to iron out their difficulties in coping with AN Resolve disparity in refeeding the emaciated daughter Provide strong emotional support Instill hope (Ma & Lai, 2006) Subjective experiences of the parents

24. Learn the pains and suffering of their parents as great as her own suffering Emotional support Parents Siblings Therapist (Ma & Lai, 2006) Patient�s perspective

25. Mother-daughter conflicts Coming back of the disengaged father and active involvement in the care of the emaciated young person Triangulation of the young person into the couple�s conflict Therapist�s intervention to assist the family to interrupt the symptomatic cycle Change in parenting methods Parents assisted patient to expand the scope of life Patient�s recovery (Ma, in press) Path of changes in the eyes of a young person with AN and parents in Shenzhen

26. Family therapy applicable for young people with an ED Outcome research Hearing the voices of the young person and her families Succeeded to develop ways to engage the previously uninvolved father in parenting and care of the young person with an eating disorder Contributions of our studies

27. Identify the symptomatic cycles and shift the family attention from the symptom to the symptomatic cycles that have impeded the parents� collaboration and the patient�s recovery Foster the positive forces for change (e.g., active involvement of the father in parenting and care of the patient) Help family to interrupt the symptomatic cycles Support Advice Creation of the holding context to resolve the conflicts Help parents to assist the patient to expand her scope of life Contributions of our studies

28. Track the process of change to fill the knowledge gap Shed light on the critical roles played by the therapist in treatment Contributions of our studies

29. All in the same boat: A preliminary study of the program outcome of social network project in a deprived community in Hong Kong Tin Shui Wai, A City of Sorrow and Sadness

30. geographically isolated area majority residents are new arrivals, low income, low educational level, underemployment and unemployment weak social network residents are not familiar with community resources Tin Shui Wai

31. Collaboration between our centre ELCHK, Tin Shui Wai Integrated Youth Service Center Financially supported by a private fund FAMILY AMBASSADOR PROJECT

32. To mobilize residents in the community, develop their potentials and capability as peer helpers and foster mutual help and support in the community to minimize social isolation and social exclusion FAMILY AMBASSADOR PROJECTObjective

33. Training of the Family Ambassador

34. Promote the concept of family mental health and develop strength perspective of family Share own family story and ways to face life adversities Introduce the community resources to the residents Mobilize the residents to utilize the community resources Roles of the family ambassador

35. Closing Ceremony

36. 64 FAs registered and 61 (95%) FAs complete the project FAs outreach 381 (average 6.24) friends, relatives and neighbors to promote the message of family mental health, FAs outreach 270 (average 4.4) friends, relatives and neighbors to introduce and mobilize them to use community resources Project efficacy

37. 58 FAs give written feedback after the completion of the project: 49 FAs(85%) like to be family ambassador 51 FAs(88%) more involve in community and concern the needs of others 54 FAs (93%) are willing to continue the service Service efficacy

38. Focus group was held in January 2008. 9 FAs participated the meeting The results showed that the project has positive impacts to individual, family and community. Service efficacy

39. Individual Level Positive thinking Optimistic Feel blessed Positive self-image Improve self-confidence (Ma, Wong & Cheng, 2009) Participants� feedback

40. Applicability of Multi-Family Groups in Hong Kong The practice team of our center

41. Implemented since March 2008 to presence Qualitative Research Pre and post in-depth interview to gather the experiences of the participant families Review of the group process Documentation of family responses toward different types of activities and skills Total 23 families attended the multiple family group, 5 groups were conducted (1 for adolescents with school problem, 2 for children with learning problems, 2 for children with ADHD) Model development

42. Content of the group ? Frequency ? Composition Clientele specific Problem specific Types of group activities Process versus content Intervention efficacy Issues addressed in model development

43. Commonality across the three projects Family-centered practice recognizes the centrality of he family in the lives of individuals Guided by the fully informed choices made by the family and Focuses upon the strengths and capabilities of these families (Allen & Petr, 1996; p. 68) Positive feedback and appreciation from the families Discussion

44. Flexible use of research methods Hearing voices of the service users Pre- and post-treatment individual and conjoint interviews Review of the treatment videotapes with consent Focus group interviews Reflective thinking and synthesis of practice knowledge Peer discussion Conference presentation Academic writing Discussion

45. Navigating upstream to face the barriers of family work A lack of physical space in which to meet the families No mandate to provide family care (i.e., lack of reward or recognition for family work) Long working hours of Hong Kong low-income families Dominant discourse of parent-blaming in general and mother-blaming in particular Lack of professional competence and confidence Discussion

46. Venues for continued professional sharing and discussion on family work Supportive agency policy Family centered service model Physical space Incentives and reward for good family practice Staff training, professional development and supervision Flexible office hours Recommendations

47. END OF PRESENTATION THANK YOU VERY MUCH