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Family Education Family Psychoeducation Family Consultation. PSRT 4271: The Family Role in Rehabilitation Week 7; T.H. Pyle, Instructor. Live case update…. Today’s Learning Objectives. Disability Theory Intervention Mechanics 3 Critical Family Interventions IFSS Intro. Modalities.

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family education family psychoeducation family consultation

Family EducationFamily Psychoeducation Family Consultation

PSRT 4271: The Family Role in Rehabilitation

Week 7; T.H. Pyle, Instructor

today s learning objectives
Today’s Learning Objectives
  • Disability Theory
  • Intervention Mechanics
  • 3 Critical Family Interventions
  • IFSS Intro
modalities
Modalities
  • Family education (FE)
  • Family psychoeducation (FPE)
  • Family consultation (FC)
modalities1
Modalities
  • Family education (FE) ____
  • Family psychoeducation (FPE) IFSS
  • Family consultation (FC) IFSS
the tragedy model swain french 2000
The Tragedy Model (Swain & French, 2000)
  • What causes disability?
      • Impairment? Or reaction to it?
  • What basis?
      • Disabled want to be other than disabled?
      • Disabling expectations?
          • “Independent”, “normal”, “adjust”, “accept”
      • Ingrained identities of non-disabled?
      • Invalidation by non-disabled?
          • Experts, family, media
disability philosophy power dell orto 2004
Disability Philosophy (Power & Dell Orto, 2004)
  • Traditional view: Tragedy
      • Debilitation
      • Chronicity
      • Families at fault
  • Modern view: Opportunity
      • Enjoy life
      • Affirm values
      • Determine lifestyle
positive personal identity
Positive Personal Identity
  • Disability enhances life
      • Special benefits
      • “Liberation of disfigurement”
      • Heightened understanding of others’ trials
positive collective identity
Positive Collective Identity
  • Redefining disability
      • Barriers constructed in a disabling society…
  • Organized movement: A social network!
  • Collective expression
the affirmation model swain french 2000
“The Affirmation Model” (Swain & French, 2000)
  • “A valuing approach…”
  • Not through…
      • … assumptions on non-disabled.
      • … the medical model
  • By disabled, about disabled
intervention assumptions power dell orto 2004 p 124
Intervention: Assumptions (Power & Dell Orto, 2004, p. 124)
  • Interventions = joint ventures.
  • Families have needs..
  • Family needs change.
  • Responses come from more than illness.
  • Families face multiple “risks”.
  • Families may oppose interventions.
  • Family participation is beneficial to all.
  • Different families respond differently.
intervention assumptions power dell orto 2004 p 1241
Intervention: Assumptions (Power & Dell Orto, 2004, p. 124)
  • Interventions = joint ventures.
  • Families have needs..
  • Family needs change.
  • Responses come from more than illness.
  • Families face multiple “risks”.
  • Families may oppose interventions.
  • Family participation is beneficial to all.
  • Different families respond differently.
intervention assumptions power dell orto 2004 p 1242
Intervention: Assumptions (Power & Dell Orto, 2004, p. 124)
  • Interventions = joint ventures.
  • Families have needs.
  • Family needs change.
  • Responses come from more than illness.
  • Families face multiple “risks”.
  • Families may oppose interventions.
  • Family participation is beneficial to all.
  • Different families respond differently.
intervention goals power dell orto 2004 p 126
Intervention: Goals (Power & Dell Orto, 2004, p. 126)
  • Help families adapt.
      • Especially at the 3 “trigger points”…
  • Help families assist.
intervention 5 connection skills power dell orto 2004 p 126
Intervention: 5 Connection Skills (Power & Dell Orto, 2004, p. 126)
  • Make families feel welcome.
  • Listen, open, accept, empathize.
  • Solicit family expectations.
  • Understand differences; respect diversity.
  • “Verbally reinforce” in family meetings.
intervention 6 roles power dell orto 2004 p 127
Intervention: 6 Roles (Power & Dell Orto, 2004, p. 127)
  • Assessor
  • Informant
  • Teacher
  • Builder (of support systems)
  • Challenger
  • Advocate
  • Guardian (preventer)
intervention trigger points power dell otto 2004
Intervention: Trigger Points (Power & Dell Otto, 2004)
  • Diagnosis
  • Hospital treatment
  • Outpatient and rehabilitation treatment
trigger no 1 diagnosis power dell otto 2004
Trigger No. 1: Diagnosis (Power & Dell Otto, 2004)
  • Identify needs.
      • A very vulnerable time
  • Provide crisis intervention.
    • Three phases: Beginning, Middle, Termination
  • Inform.
      • Understanding of medical information
  • Refer.
trigger no 2 hospital power dell otto 2004
Trigger No. 2: Hospital(Power & Dell Otto, 2004)
  • Respond to family needs.
      • Reframe situation, marshal resources, understand treatment and prognosis, feel competent, establish collaboration
  • Inform.
  • Identify strengths and limitations
  • Suggest solutions.
  • Support.
trigger no 3 outpatient power dell otto 2004
Trigger No. 3: Outpatient((Power & Dell Otto, 2004)
  • Respond to family needs.
  • Support.
  • Redefine expectations.
      • Loved one in the “sick” role…
  • Balance living and caring.
  • And …
slide24
…, 2
  • Assist family to assist the loved one.
      • Understand the loved one…
      • Involve the loved one…
      • Help the loved one…
      • Understand the family members…
slide25
So…
  • Disability: whose definition?
  • Tragedy  Opportunity
  • Adapt & Assist
for example
For example…

http://www.ted.com/talks/elyn_saks_seeing_mental_illness.html

benefits of groups power dell orto 2004 p 154
Benefits of Groups (Power & Dell Orto, 2004, p. 154)
  • Model roles
  • Support LT needs
  • Create support structure
  • Refer to other supports
  • Teach coping
  • Channel information
benefits of groups power dell orto 2004 p 1541
Benefits of Groups (Power & Dell Orto, 2004, p. 154)
  • Promote dialogue
  • Create accountability
  • Diffuse problems
  • Share burdens
  • Develop networks
  • Adapt expectations
  • Advocate
  • Model roles
  • Support LT needs
  • Create support structure
  • Refer to other supports
  • Teach coping
  • Channel information
critical issues power del orto 2004 p 157
Critical Issues (Power & Del Orto, 2004, p. 157)
  • Marital matters
  • Sibling reactions
  • Substance abuse
  • Work deterioration
  • Financial pressures
  • Diminishing social support
  • Changed lifestyle prospects
  • LT endurance
group leader tasks power del orto 2004 p 157
Group Leader Tasks (Power & Del Orto, 2004, p. 157)
  • Structure groups
  • Model behaviors
  • Listening sensitively
  • Create good climate
  • Set limits
  • Promote benefit
group leader attributes power del orto 2004 p 157
Group Leader Attributes (Power & Del Orto, 2004, p. 157)
  • Skills
      • Intervention
      • Medical knowledge
      • Articulation
      • Discernment
      • Orchestration
      • Anticipation
      • Judiciousness
  • Characteristics
      • Kindness
      • Compassion
      • Resilience
  • Perspectives
      • Experience
      • Awareness
      • Understanding
      • Learning
fe content lefley 2009 p 41
FE: Content (Lefley, 2009, p. 41)
  • Premise: diathesis-stress model
  • Medications
  • Compliance
  • Expectancy of change
  • Stress identification and control
  • Family issues
  • Loved one issues
  • Joint planning
family psychoeducation
Family Psychoeducation

Multifamily Groups

fpe theoretical premise lefley 2009 p 28 40
FPE: Theoretical Premise (Lefley, 2009, p. 28, 40)
  • Diathesis-Stress
      • Biological deficits cause overreaction to environmental stimuli
      • Techniques can reduce environmental stimulation and complexity
      • Caregivers can learn these techniques
fpe a behavior management model
FPE: A Behavior Management Model
  • Education
  • Communication training
  • Problem-solving training
  • Coping techniques training
fpe common characteristics lucksted et al 2012 p 102
FPE: Common Characteristics (Lucksted et al., 2012, p. 102)
  • Families: Need info, assistance, support
  • Assumes: Behavior has effects
  • Elements: Info, cognitive, behavioral, problem-solving, emotional, coping, consultation
  • Led by: Trained pros
  • Part of: Clinical treatment plan
  • Focus: Consumer
  • Content: Comprehensive
  • Dx specific
dx specific
Dx Specific…
  • Schizophrenia
  • Bipolar
  • Eating disorders
  • OCD
  • Dual diagnoses
  • PTSD
  • TBI
fpe program types lucksted et al 2012
FPE: Program Types (Lucksted et al., 2012)
  • Individual family
  • Multifamily
  • Include consumer
  • Don’t include consumer
  • Length
  • Emphasis
fpe goals lucksted 2012 p 111
FPE Goals (Lucksted, 2012, p. 111)
  • Information
  • Skills
  • Problem-solving
  • Support
international research lucksted 2012
International Research (Lucksted, 2012)
  • China
    • Six studies show:
      • Reduced relapse
      • Reduced burden
      • Improved functioning
      • Self-efficacy
  • Hong Kong
  • Australia
  • Italy
  • Pakistan
  • Japan
  • Thailand
barriers lucksted 2012 p 113
Barriers (Lucksted, 2012, p. 113)
  • Stigma
  • Lack of confidence in system
  • Consumer reluctance to involve families
  • Consumer discomfort or desire for privacy
  • Skepticism
  • Competing family responsibilities
fpe a model for asian americans bae kung 2000
FPE: A Model for Asian Americans (Bae & Kung, 2000)
  • Issues
    • For stable loved ones in the community
    • Asians: not a single ethnic group
    • Targets 1st and 2nd generation
    • Different classes, different values
    • Validation needed
fpe a model for asian americans bae kung 20001
FPE: A Model for Asian Americans (Bae & Kung, 2000)

Five generalized stages:

  • Preparation
  • Engagement
  • Psychoeducation Workshop
  • Therapeutic Stage
  • Ending Stage
fpe dissemination issues lucksted et al 2012 p 112
FPE: Dissemination Issues (Lucksted et al., 2012, p. 112)
  • Not compatible with clinicians’ training.
  • More complex than standard treatments.
  • Not readily “trialable”.
  • Outcomes (LT) not readily observable.
family consultation schmidt monaghan 2012
Family Consultation(Schmidt & Monaghan, 2012)
  • Collaborative process
  • Agenda set by family’s concerns
  • Acknowledge the family’s competence
  • Consultation and support for coping
  • Individual
  • Group
  • Support Group
family consultation schmidt monaghan 20121
Family Consultation (Schmidt & Monaghan, 2012)

New Jersey:

1st state to offer family consultation

ifss origins
IFSS: Origins…
  • 1988: Policy paper
  • 1995: Family Support for Persons with Serious Mental Illness Act
  • 1997: Regulations
  • 1999: Pilot study
ifss rationale
IFSS: Rationale
  • Hospital admits: 32% lived with families prior
  • Discharges: 60% go back to families
  • Community program enrollment: 54% live with family
ifss pilot studies
IFSS: Pilot Studies
  • N = 191
  • Caregiver burden: down 23% at 6 months
  • Hospitalizations reduced: 75%
  • Crisis service use: down 90%
ifss service elements
IFSS: Service Elements
  • Adults
  • Info, education, support in…
    • Symptoms and treatments
    • Crisis management
    • Local systems
    • Wellness and recovery
  • Not therapy, but collaboration
ifss results schmidt monaghan 2012
IFSS: Results (Schmidt & Monaghan, 2012)

Average Reduction of Family Concerns: 10.4%