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Family EducationFamily Psychoeducation

Family ConsultationPSRT 4271: The Family Role in Rehabilitation

Week 7; T.H. Pyle, Instructor

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Live case update…

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Disability Theory

Intervention Mechanics

3 Critical Family Interventions

IFSS Intro

Today’s Learning Objectives

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Family education (FE)

Family psychoeducation (FPE)

Family consultation (FC)

Modalities

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Family education (FE) ____

Family psychoeducation (FPE) IFSS

Family consultation (FC) IFSS

Modalities

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What Causes Disability?

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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

The Tragedy Model (Swain & French, 2000)

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Traditional view: Tragedy Debilitation Chronicity Families at fault

Modern view: Opportunity Enjoy life Affirm values Determine lifestyle

Disability Philosophy (Power & Dell Orto, 2004)

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Disability enhances life

Special benefits

“Liberation of disfigurement”

Heightened understanding of others’ trials

Positive Personal Identity

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Redefining disability Barriers constructed in a disabling

society…

Organized movement: A social network!

Collective expression

Positive Collective Identity

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“A valuing approach…”

Not through… … assumptions on

non-disabled. … the medical

model

By disabled, about disabled

“The Affirmation Model” (Swain & French, 2000)

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1. Interventions = joint ventures.2. Families have needs..3. Family needs change.4. Responses come from more than illness.5. Families face multiple “risks”.6. Families may oppose interventions.7. Family participation is beneficial to all.8. Different families respond differently.

Intervention: Assumptions (Power & Dell Orto, 2004, p. 124)

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1. Interventions = joint ventures.2. Families have needs..3. Family needs change.4. Responses come from more than illness.5. Families face multiple “risks”.6. Families may oppose interventions.7. Family participation is beneficial to all.8. Different families respond differently.

Intervention: Assumptions (Power & Dell Orto, 2004, p. 124)

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1. Interventions = joint ventures.

2. Families have needs.

3. Family needs change.

4. Responses come from more than illness.

5. Families face multiple “risks”.

6. Families may oppose interventions.

7. Family participation is beneficial to all.

8. Different families respond differently.

Intervention: Assumptions (Power & Dell Orto, 2004, p. 124)

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1. Help families adapt. Especially at the 3 “trigger points”…

2. Help families assist.

Intervention: Goals (Power & Dell Orto, 2004, p. 126)

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1. Make families feel welcome.

2. Listen, open, accept, empathize.

3. Solicit family expectations.

4. Understand differences; respect diversity.

5. “Verbally reinforce” in family meetings.

Intervention: 5 Connection Skills (Power & Dell Orto, 2004, p. 126)

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Assessor Informant Teacher Builder (of support systems) Challenger Advocate Guardian (preventer)

Intervention: 6 Roles (Power & Dell Orto, 2004, p. 127)

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1. Diagnosis

2. Hospital treatment

3. Outpatient and rehabilitation treatment

Intervention: Trigger Points (Power & Dell Otto, 2004)

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Identify needs. A very vulnerable time

Provide crisis intervention. ◦ Three phases: Beginning, Middle, Termination

Inform. Understanding of medical information

Refer.

Trigger No. 1: Diagnosis (Power & Dell Otto, 2004)

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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. 2: Hospital(Power & Dell Otto, 2004)

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Respond to family needs.

Support.

Redefine expectations. Loved one in the “sick” role…

Balance living and caring.

And …

Trigger No. 3: Outpatient((Power & Dell Otto, 2004)

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Assist family to assist the loved one. Understand the loved one… Involve the loved one… Help the loved one… Understand the family members…

…, 2

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Disability: whose definition?

Tragedy Opportunity

Adapt & Assist

So…

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For example…

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

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Group Counseling

Model roles Support LT needs Create support structure Refer to other supports Teach coping Channel information

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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

Promote dialogue Create accountability Diffuse problems Share burdens Develop networks Adapt expectations Advocate

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Benefits of Groups (Power & Dell Orto, 2004, p. 154)

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Marital matters Sibling reactions Substance abuse Work deterioration Financial pressures Diminishing social support Changed lifestyle prospects LT endurance

Critical Issues (Power & Del Orto, 2004, p. 157)

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Structure groups Model behaviors Listening sensitively

Create good climate Set limits Promote benefit

Group Leader Tasks (Power & Del Orto, 2004, p. 157)

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Characteristics Kindness Compassion Resilience

Perspectives Experience Awareness Understanding Learning

Skills Intervention Medical knowledge Articulation Discernment Orchestration Anticipation Judiciousness

Group Leader Attributes (Power & Del Orto, 2004, p. 157)

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Family Education

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Premise: diathesis-stress model Medications Compliance Expectancy of change Stress identification and control Family issues Loved one issues Joint planning

FE: Content (Lefley, 2009, p. 41)

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Family Psychoeducation

Multifamily Groups

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Diathesis-Stress

Biological deficits cause overreaction to environmental stimuli

Techniques can reduce environmental stimulation and complexity

Caregivers can learn these techniques

FPE: Theoretical Premise (Lefley, 2009, p. 28, 40)

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Education

Communication training

Problem-solving training

Coping techniques training

FPE: A Behavior Management Model

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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

FPE: Common Characteristics (Lucksted et al., 2012, p. 102)

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Schizophrenia Bipolar Eating disorders OCD Dual diagnoses PTSD TBI

Dx Specific…

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Individual family Multifamily

Include consumer Don’t include consumer

Length Emphasis

FPE: Program Types (Lucksted et al., 2012)

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Information

Skills

Problem-solving

Support

FPE Goals (Lucksted, 2012, p. 111)

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Hong Kong Australia Italy Pakistan Japan Thailand

China◦ Six studies show:

Reduced relapse Reduced burden Improved functioning Self-efficacy

International Research (Lucksted, 2012)

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Stigma

Lack of confidence in system

Consumer reluctance to involve families

Consumer discomfort or desire for privacy

Skepticism

Competing family responsibilities

Barriers (Lucksted, 2012, p. 113)

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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, 2000)

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Five generalized stages:

1. Preparation2. Engagement3. Psychoeducation Workshop4. Therapeutic Stage5. Ending Stage

FPE: A Model for Asian Americans (Bae & Kung, 2000)

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Not compatible with clinicians’ training.

More complex than standard treatments.

Not readily “trialable”.

Outcomes (LT) not readily observable.

FPE: Dissemination Issues (Lucksted et al., 2012, p. 112)

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Family Consultation

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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, 2012)

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New Jersey:1st state to offer family consultation

Family Consultation (Schmidt & Monaghan, 2012)

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: “IFSS NJ”

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1988: Policy paper

1995: Family Support for Persons with Serious Mental Illness Act

1997: Regulations

1999: Pilot study

IFSS: Origins…

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Hospital admits: 32% lived with families prior

Discharges: 60% go back to families

Community program enrollment: 54% live with family

IFSS: Rationale

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N = 191

Caregiver burden: down 23% at 6 months

Hospitalizations reduced: 75%

Crisis service use: down 90%

IFSS: Pilot Studies

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Adults

Info, education, support in…

◦Symptoms and treatments◦Crisis management◦Local systems◦Wellness and recovery

Not therapy, but collaboration

IFSS: Service Elements

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Average Reduction of Family Concerns: 10.4%

IFSS: Results (Schmidt & Monaghan, 2012)