Transcript Document

Multiple Family Groups for
Psychosis: A Brief Overview of
the Model and Tips for Getting
Started
June 2010
Susan Gingerich, MSW
[email protected]
Topics of workshop
• Brief review of the Multifamily Group (MFG)
model
• Locating additional resources and educational
materials
• Basic steps for getting an MFG Started
• Common Challenges
• Evaluating stage of readiness and taking the first
step
Multifamily Groups: Three Main
Tasks
• Teach families knowledge, strategies and skills
• Provide social support, opportunities to learn from others’
experience and hear other suggestions for solving
problems
• Develop a social network
Helpful Resources
• Multifamily Groups in the Treatment of Severe Psychiatric
Disorders. William McFarlane. 2002. Guilford Press.
• “Family Psychoeducation KIT. ” Substance Abuse and
Mental Health Services (SAMHSA). New edition (2009)
available free at
http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/too
lkits/family/
• Family Psychoeducation for Serious Mental Illness.
Harriet Lefley. 2009.
• “Psychoeducational Family Groups.” Book chapter in
press by Ellen Lukens and Helle Thorning. In A. Rubin
and D. Springer (editor). Psychosocial Treatment of
Schizophrenia.
Sources of Educational Handouts
• Mueser, K.T. & Gingerich, S. (2006). Complete Family Guide
to Schizophrenia. NY, NY: Guilford Press.
• Mueser, K.T. & Glynn, S. (1999). Behavioral Family Therapy
for Psychiatric Disorders. Oakland, CA: New Harbinger.
Appendix 3 (pages 276-328)
• Mueser, et al. (2003). Integrated Treatment for Dual
Disorders. NY, NY: Guilford Press. Appendix B (pages 357414)
• Illness Management and Recovery toolkit:
http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolk
its/illness/ These have been translated into Dutch by Bavo
Europort.
• SAFE Program: Support and Family Education.
http://www.ouhsc.edu/safeprogram/
Basic Facts about Multifamily
Psychoeducational Groups
• Time-unlimited (recommended at least 9 months)
• Include the client
• Conducted every two weeks (sometimes declining
to monthly sessions) for 90 minutes
• Single diagnosis, closed groups recommended
• If necessary, family members can attend without
the client and vice versa
• Co-leaders highly recommended
• 4-8 families in a group
Stages of Multifamily Groups
• Stage 1: Joining
• Stage 2: Psychoeducational Workshop
• Stage 3: Multifamily Group Sessions
Joining
• Individual meetings with individuals and
their families
• 2-3 recommended for each family
One Day Psychoeducational Workshop
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Brings families together for approx. 6 hours
Positive message about working together
Covers factual information
Multiple opportunities for asking questions,
sharing their own experiences, getting to
know each other as people
Multifamily
Group Sessions
Initial socializing
“Go-round,” where group members
review the week’s events, problems are
identified
Selection of a problem to work on
15 min
20 min
Problem-solving as a group
45 min
Final socializing
5 min
5 min
Steps of Problem-Solving
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1. Define the problem
2. Brainstorm possible solutions
3. Evaluate solutions (pro’s & con’s)
4. Choose the best solution or combination
5. Plan how to implement the solution (make an
action plan)
• 6. Follow up the implementation (follow up on
action plan)
Basic First Steps for Starting an
MFG
1. Work with your organization to develop an Advisory
Team or Steering Committee
2. Identify staff members
3. Introduce program, get word out
4. Identify individuals and families
5. Conduct joining sessions
6. Conduct Psychoeducation Workshop
7. Provide biweekly family groups
8. Meet regularly for supervision and support
9. Meet regularly with Advisory Team
1.
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Work with your organization to
develop an Advisory Committee
Make the case for implementing an MFG
Describe components
Cite research
Identify problems at organization that could be addressed
by having an MFG
Make connection between MFG and mission of the
organization
In the Advisory/Steering committee, include director of
organization, MFG leaders, other staff members,
individuals, and family members
2. Identify staff members to provide
services and make referrals
• Staff members who have expressed an interest in working
with families
• Staff members who have received training
• Staff members who have experience with mental illness
themselves or with a family member
• Identify who has “first contact” with people
• Plan for co-leaders, and a back-up
3. Introduce program, get the word
out
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In-service training, staff meetings
Community programs
National Family Organizations
Churches, synagogues, mosques, temples
Schools, libraries
Develop brochure for individuals, families, staff
members
Possible contents for a brochure
• What are Multiple Family Groups? An evidence-based
practice that gives individuals and their families information
about mental illnesses, helps them build social supports, and
enhances problem-solving, communication, and coping skills.
• Why participate? Individuals who participated in MFGs have
fewer relapses and less time in the hospital. Families who
participate report greater knowledge of mental illnesses and
less stress, confusion, and isolation
• How does it work? First, individuals and their family meet
with a staff member. Then they attend an all-day educational
workshop with other families. Next they attend a group with
the same families that meets for 90 minutes, twice a month.
There people will find information, support, and help with
solving common problems.
• Who can I contact?
4. Identify individuals with similar
diagnosis with family
involvement
• Individuals who experience psychosis, such as schizophrenia,
schizoaffective; Bipolar disorder;Depression
• Consider targeting groups who may share common challenges,
e.g., first episode, frequent hospitalizations, desire for
employment or going back to school, interest in independent
living, difficulties with taking medication
• Consider approaching individuals who have recently
experienced a problem (e.g., increase in symptoms,
rehospitalization)
• Expect to take time to engage some individuals
• Consider grouping people with similar language or cultural
needs
5. Conduct joining sessions with 4-8
families
• Allow some separate time with client and family
members (could be a divided session)
• 2-3 joining sessions per family
• Can “piggyback” the joining sessions (e.g., have
separate sessions all in one evening)
• Can schedule two or three appointments a week with
one family to speed up readiness for joining group
• Alternate which group leader does the joining
sessions; introduce other leader if possible
• May need to use motivational interviewing during
joining sessions in order to increase engagement,
confidence
6. Conduct Psychoeducation
Workshop
• Make it friendly, welcoming. Don’t separate self at
breaks.
• Provide food (including dishes from participant’s culture)
and consider providing music
• Cover main points, using jargon-free language and visual
illustrations when possible
• Divide presentation among co-leaders who have joined
with group members
• Offer other professionals for specific parts (doctor, nurse,
social worker) of the presentation
• Break information down into small chunks
• If possible, ask a family member to speak about the
benefits they have experienced from such a group
7. Provide biweekly family groups
• Make it friendly, welcoming. “Include yourself in.”
• Provide food (including dishes from participant’s culture) and consider
providing music before and after
• Use a flip chart or white board to write down main points and
problem-solving steps
• Divide roles among co-leaders and alternate who leads group, who
writes down problem-solving steps, who helps people take a break
• Occasionally invite guest speakers (doctor, nurse, social worker,
attorney) if group members request special information
• Be receptive to ideas of holiday parties, celebrations, “hobby night”
• Be sure to rotate whose problem is solved, and to involve all group
members in generating solutions
8. Meet regularly (e.g., weekly) for
supervision and support
• Weekly supervision helps family clinicians learn the model
more thoroughly and to develop strategies for challenges.
• Use the SAMHSA toolkit for possible breakdown of
learning the skills together of conducting MFGs
• Review both successes and challenges
• For challenges, use problem-solving method
• Monthly consultation with an experienced group leader can
clarify points of the model and provide additional
strategies for challenges
9. Meet regularly with
Advisory/Steering Committee
• Consider monthly meetings with steering committee
• Review both successes and challenges
• Give regular reports that summarize the MFG experience
(e.g., how many meetings held, attendance, subjects
covered, problems used in problem-solving, skills
displayed
• Get the assistance of organization director to help solve
challenges (e.g., meeting room unavailable, difficulty
getting referrals, evening reception staff unfriendly to
families who arrive for meetings)
• Get feedback from family representative
• Ask for what you need to make the MFG successful
Challenges are bound to come up
• We do NOT respond to challenges in the way
illustrated by the following slide:
Common Problems: Suggestions for
Each will be Provided in Workshop
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Getting referrals
Families reluctant to join
Individuals reluctant to join
People have had bad experience with mental health
services in the past
Group members may be disruptive or dominate
conversation
Group members may be reticent
Family members may “protect” others by saying they are
unable or unwilling to come
Cultural issues and beliefs may interfere with attendance
Problem-solving to Address Our Own
Challenges
• Take one of the challenges for MFGs brought up
in the workshop.
• Use the 6 step problem-solving as a small group to
come up with a possible solution/action plan.
• Report back to the larger group.
Evaluate Your Stage of Readiness
to Implement an MFG
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Pre-contemplation?
Contemplation?
Preparation?
Action?
Maintenance?
Relapse?
Another way to look at your stage
of readiness
• How interested are you? (scale of 1-10)
• How important is it to you? (scale of 1-10)
• How confident are you? (scale of 1-10)
Complete all or part of MFG
Planning Sheet
See next slide and planning sheet attached to the
handout.
Discussion or
Decision
1. Identifying clients
(age, dia gnosis, contact
with family, etc)
2. Approaching and
engagin g clients and
families
3. Location of groups
4. Day of week and time
5. Starting date
6. Transportation and
parking
7. Food
8. Notebook s or
folde rs for all group
membe rs, xeroxing of
mate rials
9. Comm unicating and
coordinat ing with othe r
treatment providers
10. Time to prepare for
sessions
Action Steps
Closing comment
“Without this group I would have been lost
and alone. I didn’t know other people were
going through the same thing. I didn’t
know that they could help me and I could
help them. This group is like a family to
me.”
Family member in Philadelphia.