Transcript “I do not know what the future will hold, but I know there is hope.” ENGAGING FAMILIES Tommie Ann Bower Chief Clinical Officer Gosnold,

“I do not know what the future will hold, but I know there is hope.”
ENGAGING FAMILIES
Tommie Ann Bower
Chief Clinical Officer
Gosnold, Inc.
www.gosnold.org
Family engagement has been stated as
a fundamental element of treatment
(Etheridge and Hubbard, 2000),
noted to predict improved retention in
treatment (Liddell, 2004)
and can lead to better outcomes
(Coppello et al., 2005).
A three-fold look at issues of
family engagement
FAMILY
Addicted
Individual
Treatment
Systems
Clinical
Interventions
Goals: Thanks to Dave
• What is it like to be a family member
coming into treatment systems?
• What are the problems families bring to
to us (if we ask?)
• What ways can we meet the needs of
families?
When family is marginal:
talk through, walk-through
First Contact: no families allowed to call
Pre admission: N/A.
First meeting, intake assessment: psychosocial
assessments embedded bias (family as perps!)
Orientation: “Our rules, our way.” Embedded bias:
Family as rule-breaking enablers.
The treatment episode: continuum of non-contact.
Family as disruptors of healing. Problem people who
are NEEDY!
Discharge, continuing care: and now, back to the family
First contact/admission stories
from walk-through
• The prospective client is the only one who
can call.
• Agencies gathered little information from the
family members about the client. Information
for family members was usually not provided.
• Family members were often treated with
suspicion, discouraged from engagement, or
dismissed from consideration.
• The role-playing family member was
frequently ignored or asked to wait.
The things we do and don’t do
• Other than children who were enrolled in the
programs, family members were unwelcome.
• Visitation was allowed, but was usually scheduled on
weekends when core staff members were not
available.
• Family members of men more were likely to access
services than women. Stigma
• Unmarried partners less likely to be welcome.
• Many staff changes make it difficult to implement
hand offs of new clients, and to inform family
members who the woman’s counselor will be.
And what is family
anyway?
“For practical purposes, family can be
defined according to the individual’s
closest emotional connections.”
(SAMHSA,TIP 39, P.3).
Looking at the discrepancies between
what we say and what we do: 3C’s
• Cause: Many assessments look for genetic
and environmental contributions to the
individual’s addictions
• Control “family prevented person from
getting help” (purposefully because they were
TOOO CO-DEPENDENT & they didn’t go to
Alanon.
• Cure—if family had not enabled—the person
would have been cured by our treatment
• Family might have contributed to abuse,
neglect, violence—our population more likely
to have add-ons.
When family is engaged: a
NIATx view of engagement
Lessons from CSAT’s PPW
programs—another NIATx project
1. Pre-admission and first night:
Walden House, California asks woman
to identify family to attend a first dinner.
The Village South Miami offers family a
tour of the program.
Others offer FAQ sheets and even phone
numbers and names to contact
counselors!
Orientation for family
Consider adding in time for questions from
families. Develop Frequently Asked
Questions materials from family member
questions.
Consider opportunity for confidential information
sharing.
Consider understanding what family needs from
us as well as what we need from family!
Learn from families
• SSTARBIRTH used informal focus
groups at dinner to solicit input from
family members on how to increase
family participation. They changed
visiting times in order to increase
engagement.
• Consider adding a family alumni group
Visitation may be good for
treatment
• PROTOTYPES holds potluck dinners that
helped increase contacts from 81 to 115
• WEKU quadrupled the participation in family
night and has added a mother/daughter tea
• Family Works of Omaha offers a barbeque
family picnic.
• Waldenhouse has a family outreach event
approximately once per month, such as an
outing at a park.
Arkansas goes karaoke
(percent families attending)
September
August
July
June
May
'island'
theme karaoke
March
February
December
November
Baseline
mending
fances
theme
April
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
school
supplies external
children
Karaoke &
crafts
Prototypes California
• COMMUNITY IMPACT:
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Reduced costs of foster care
Reduced recidivism in treatment
Reduced costs of welfare through vocational linkages
Increased family support through community based linkages
• PROGRAM IMPACT:
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Increased retention
Help broader program to become more family focused
Use “changes” as pilot studies for program enhancement
Increased family bonding
What’s it like to be a family
member?
Worry, sleepless nights. Your disease controls my life
and affects everyone in my life.
Mistrust, hurt, anger, love, hate, hope, discourage, guilt,
understanding, disbelief.
Listening to stories and
concerns: Toast at 3:00 a.m.
• Afraid he is going to die. Afraid he will kill
someone. Not knowing what he is going to
do.
• The lying hurt.
• I feel like I am watching you die a very slow
death.
• It was heartbreaking to watch you deteriorate
physically, mentally, spiritually right in front of
my eyes.
LANGUAGE: 4 C’S
Reducing shame and stigma for families:
1. Cause – yes, families think they
caused it.
2. Control – families think they can
control it, by vigilance
3. Cure – families want to cure it by
doing the right thing.
4. Collaboration a skill
• With the disease
• With the recovery
• To change the oil or
not to change the
oil.
• To delete the phone
numbers on cell or
not.
• Decisions,
Learning from and with families
4-session exercise
• A time line: what the family has witnessed.
(clinical tool and an empathy)
Process: how many years does this time line
cover, and how long have you known it’s a
problem
Questions to process time line
with families
• How long ago did the problems start?
• When did you know there was a
problem?
• Experience: most families have a great
store of data regarding the progression
and path of the addiction.
ROLES QUIZ: no more language of
blame:
the end of enablers in our life time
“It” peace keeper detective
counselor
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Moving company
Tow truck
Answering machine
Doormat
Baby sitter
Laundromat
Banker
Judge, probation officer
Personal shopper
Personal credit company
Night watchman
Stages of change for families
• Parallel process demonstration try to
change something.
• Renaming for access
Contemplation Stage
the YEAH BUT STAGE
Communication: See Think Feel
(and yes and no exercises)
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What do you observe? I see you go
to meetings every night
What does it make you think? It
makes me think that you are taking
your recovery seriously and that
you are really making an effort
How does it make you feel? And it
makes me feel proud and hopeful.
Skills development and
processing with families
1. Parallel Process Demonstration:
working with signs and symptoms
Ask: When the addict is doing that, what
are you doing? What are your signs
and symptoms
Recovery work sheets and
recovery agreement
AI:
1. Triggers are:
2. Situations that are
unsafe for me in early
recovery.
3. If I behave this way =
relapse help me by
4. If I relapse do this
5. My aftercare plan and
responsibilities are:
Family:
1. What triggers your fear
of a relapse?
2. What situations would
be safer for you to
avoid?
3. Seeing AI’s behaviors
4. If a relapse, then I will:
5. My responsibilities for
my health.
The down side of families
When they get the idea that there is help
they want MORE: They don’t leave the
basement.
Families don’t have crises on your
schedule.
They always want to jam an intervention
into 3 hours yesterday.
Gosnold’s Spectrum of Services
Open Availability:
GRO phone
Sunday Education
Interventions
Recovery Coaching
Drop-in Support
Community Forums, including intervention
demo for community and hospitals.
Gosnold at Cataumet:
Weekly education; multi family group
17 Months Gosnold Reaching Out:
number of individuals
and families served
Service
Sunday Ed.
4 session Ed Group
Support Sessions
Interventions
10 Community
Forums
Recovery Coaching
Total
Families
547
48
40
41
143
Individuals
752
88
81
261
342
31
850
79
1603
Potential for collaboration
• Advocacy
• Broadening our definition on who is
affected and making family a customer.
• Compassion for the impact of addiction
on lives of the affected.
Resources
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SAMHSA: “Family-Centered Treatment for Women with Substance Use
Disorders—History, Key Elements, and Challenges”, 2007
Invitational Intervention, Judith Landau and James Garrett, 2006: Linking
Human Resources
ARISE training and consultation: www.linkinghumansystems.com
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Monica McGoldrick et al. Genograms: Assessment and Intervention,
W.W. Norton, 2007
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Monica McGoldrick, You Can Go Home Again: Reconnecting with Your Family,
W.W. Norton, New York, 1995
CSAT, Substance Abuse Treatment and Family Therapy, TIP 39
And of course: www.NACOA.org; Timmen Cermark, Salvatore Minuchin,
Virginia Satir, Claudia Black, Sharon Wegscheider-Cruse, and a host of others
who have informed treatment approaches and understanding the complexities of
families affected by substance use disorders.
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drops out
school
11th
out late
fights
stays at
friends
at bar, late/
sleeping all day
wrecks dirt bike
1st arrest
possession
minor
misses
grandmotherÕs
80th birthday
friend
andy
wants
money