Employment Multifamily Employment Multifamily Group ProjectGroup Project

Alex Kopelowicz, MDAlex Kopelowicz, MD

Roberto Zarate, PhDRoberto Zarate, PhD

Human Interaction Research InstituteHuman Interaction Research Institute

New Haven, CT – March 15-16, 2012New Haven, CT – March 15-16, 2012

MFG Staff Training: Day 1MFG Staff Training: Day 1

8:00-8:30 am Breakfast

8:30-9:15 am Brief Introductions by Agencies

9:15-9:45 am Welcome/Overview of the MFG Training Program

9:45-10:30- am What is MFG and Why Should We Do It?

10:30-10:45 am Break

10:45-12:30 pm MFG Components (Joining Sessions, Educational Workshop & Problem Solving Groups)

12:30-1:30 pm Lunch

1:30 – 4:00 pm Joining Sessions (Demonstration & Role Plays)

MFG Staff Training: Day 2MFG Staff Training: Day 2

8:00-8:30 am Breakfast

8:30–9:00 am Review/Overview of Problem Solving in MFGs

9:00-10:30 am MFG Sessions (Demonstration and Role Plays)

10:30-10:45 am Break

10:45-12:00 noon MFG Sessions (Role Plays Continued)

12:00–1:00 pm Lunch

1:00–3:00 pm MFG Sessions (Role Plays Continued)

3:00 -3:30 pm Questions and Wrap-Up

Standard ApproachesStandard Approachesto Family Workto Family Work

PsychoeducationPsychoeducation

Communication skills trainingCommunication skills training

Problem solving techniquesProblem solving techniques

Social network development (MFG)Social network development (MFG)

Better Outcomes in Better Outcomes in Family Family Psychoeducation Psychoeducation

Over 20 controlled clinical trials, comparing to Over 20 controlled clinical trials, comparing to standard outpatient treatment (Dixon, 2003), standard outpatient treatment (Dixon, 2003), have shown:have shown:– Increased employmentIncreased employment

At least twice the number of consumers employed, and up At least twice the number of consumers employed, and up to four times greater--over 50% employed after two years--to four times greater--over 50% employed after two years--when combined with supported employmentwhen combined with supported employment

– Improved family relationships and well-beingImproved family relationships and well-being– Reduced friction and family burdenReduced friction and family burden– Reduced medical illness in family membersReduced medical illness in family members

Doctor visits for family members decreased by over 50% in Doctor visits for family members decreased by over 50% in one yearone year

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Pretreatment Follow-upTreatment

Miklowitz DJ, et al. Biol Psychiatry, 2000;48(6):582-592

1-Year Survival Rates Among Bipolar Patients in Family-Focused Treatment Versus Case Management

Stages of a Psychoeducational Multifamily Group

Joining Family and clients separately 3-6weeks

Educa-tional workshopFamilies only1 day

Ongoing MFGFamilies & clientsbi-weekly 6 months

Joining with Families and ClientsJoining with Families and Clients

JOINING means to CONNECT, BUILD JOINING means to CONNECT, BUILD RAPPORT, CONVEY EMPATHY, ESTABLISH RAPPORT, CONVEY EMPATHY, ESTABLISH AN ALLIANCE, ENGAGEAN ALLIANCE, ENGAGEIt is the first stage of interventionIt is the first stage of interventionDesigned to create a bond between Designed to create a bond between Client/Family Members and Family Client/Family Members and Family CounselorsCounselorsCOUNSELOR as ADVOCATECOUNSELOR as ADVOCATE

Joining Proecedures Joining Proecedures

THREE Joining MeetingsTHREE Joining Meetings

SEPARATELY with Relatives and ClientsSEPARATELY with Relatives and Clients

WEEKLY – 1 HOUR with Relatives, ½ WEEKLY – 1 HOUR with Relatives, ½ HOURHOUR

with Clientswith Clients Start sessions A.S.A.P. after client/family Start sessions A.S.A.P. after client/family

enrollsenrolls Gain an understanding of familyGain an understanding of family’’s stresses, s stresses,

problems, reactions to clientproblems, reactions to client’’s s unemployment/underemployment, etc.unemployment/underemployment, etc.

JOINING – IJOINING – I

15 Minutes of SOCIAL TALK15 Minutes of SOCIAL TALK Discuss the experience of looking for, getting Discuss the experience of looking for, getting

and losing jobsand losing jobs Review any recent stressful event: Who and Review any recent stressful event: Who and

what helped or didnwhat helped or didn’’tt IDENTIFY WARNING SIGNS OF STRESS – IDENTIFY WARNING SIGNS OF STRESS –

PRECIPITANTSPRECIPITANTS Distribute to families & keep for future Distribute to families & keep for future

referencereference Describe the plan for ongoing MFG sessionsDescribe the plan for ongoing MFG sessions 5 Minutes SOCIALIZING5 Minutes SOCIALIZING

JOINING – II JOINING – II

15 Minutes of SOCIAL TALK15 Minutes of SOCIAL TALK Review past experiences with co-workers, Review past experiences with co-workers,

supervisors, supervisees, etc.supervisors, supervisees, etc. FAMILYFAMILY’’S EXPERIENCE DURING S EXPERIENCE DURING

STRESSFUL EVENTS STRESSFUL EVENTS The sharing of painful events: A crucial The sharing of painful events: A crucial

aspect of aspect of ““JoiningJoining”” The client/familyThe client/family’’s understanding of s understanding of causescauses

FamilyFamily’’s social network & resources s social network & resources (material & emotional)(material & emotional)

5 Minutes SOCIALIZING5 Minutes SOCIALIZING

JOINING – IIIJOINING – III

15 Minutes of SOCIAL TALK15 Minutes of SOCIAL TALK FamilyFamily’’s social network & s social network &

resourcesresources Developing and maintaining a Developing and maintaining a

support networksupport network SHORT & LONG-TERM GOALS (e.g., SHORT & LONG-TERM GOALS (e.g.,

Employment)Employment) Preparation for Workshop & MFGsPreparation for Workshop & MFGs

MULTIFAMILY GROUPS MULTIFAMILY GROUPS

Five to eight familiesFive to eight families Two family counselors/facilitatorsTwo family counselors/facilitators 1 ½-hour sessions – biweekly over six 1 ½-hour sessions – biweekly over six

months or moremonths or more Refreshments/snacks are providedRefreshments/snacks are provided Initial sessions avoid emphasis on conflictInitial sessions avoid emphasis on conflict Initial sessions emphasize establishing a Initial sessions emphasize establishing a

working alliance by building group identity working alliance by building group identity and developing a sense of mutual interest and developing a sense of mutual interest and concern - drop outs are failuresand concern - drop outs are failures

FIRST MFG SESSION FIRST MFG SESSION

““GETTING TO KNOW EACH OTHERGETTING TO KNOW EACH OTHER”” Go Around the RoomGo Around the Room

BackgroundBackground HobbiesHobbies OccupationOccupation InterestsInterests Counselor Goes First (Discloses/Shares with the Counselor Goes First (Discloses/Shares with the

Group)Group)

SETTING BASIC RULESSETTING BASIC RULES Regular ATTENDANCE (for Relatives)Regular ATTENDANCE (for Relatives) CONFIDENTIALITY (No Pressure to Disclose)CONFIDENTIALITY (No Pressure to Disclose) INTERACTION AMONG MEMBERSINTERACTION AMONG MEMBERS

PHYSICAL/EMOTIONAL CONTROLPHYSICAL/EMOTIONAL CONTROL

SECOND MFG SESSION SECOND MFG SESSION

““HOW UNEMPLOYMENT/UNDEREMPLOYMENT HOW UNEMPLOYMENT/UNDEREMPLOYMENT HAS CHANGED OUR LIVESHAS CHANGED OUR LIVES””

Building a SENSE OF TRUST & COMMITMENTBuilding a SENSE OF TRUST & COMMITMENT Sense of COMMON EXPERIENCE (Listen to each other)Sense of COMMON EXPERIENCE (Listen to each other) Strengthening GROUP IDENTITY & SENSE OF RELIEFStrengthening GROUP IDENTITY & SENSE OF RELIEF The CLIENTThe CLIENT’’S INNER EXPERIENCESS INNER EXPERIENCES Counselors emphasize the vital role of SHARING Counselors emphasize the vital role of SHARING GRIEF,GRIEF, CONFUSION, GUILT, FEAR with those CONFUSION, GUILT, FEAR with those ““on the same on the same boatboat””.. AND HOPEAND HOPE

Remind participants about Problem Solving (next Remind participants about Problem Solving (next session)session)

GENERAL POINTS GENERAL POINTS

New MembersNew Members Late-Arriving MembersLate-Arriving Members Reminders about AttendingReminders about Attending Crises & EmergenciesCrises & Emergencies

COMMUNICATION & INTERACTIONSCOMMUNICATION & INTERACTIONS Counselors DONCounselors DON’’T speak for clients or T speak for clients or relativesrelatives Interaction among members is essentialInteraction among members is essential Clients are ENCOURAGED (not pressured) toClients are ENCOURAGED (not pressured) to participateparticipate

Respect otherRespect other’’s turn and avoid criticisms turn and avoid criticism

PROBLEM SOLVING IN MFGsPROBLEM SOLVING IN MFGs

The CORE of MFG SessionsThe CORE of MFG Sessions Designed to compensate for limited education Designed to compensate for limited education FORMAT:FORMAT:

Checking inChecking in 15 Minutes15 MinutesGo-roundGo-round 20 Minutes20 MinutesSelecting a Problem to SolveSelecting a Problem to Solve 5 Minutes5 MinutesSolving the ProblemSolving the Problem 45 45

MinutesMinutesWrap-up SocializingWrap-up Socializing 5 5

MinutesMinutes Counselors should GET READY and HAVE A Counselors should GET READY and HAVE A

PLAN – IN ADVANCEPLAN – IN ADVANCE

Selecting an Employment-Selecting an Employment-Related Problem to Solve Related Problem to Solve

TOPICS: (Identified prior to MFG or during group)TOPICS: (Identified prior to MFG or during group)TransportationTransportationChild CareChild CareDrugs and AlcoholDrugs and AlcoholLife Events/Domestic ProblemsLife Events/Domestic ProblemsHousingHousingDisagreements among Family MembersDisagreements among Family Members

““REJECTEDREJECTED”” PROBLEMS: PROBLEMS:Make a Direct Suggestion and Review OutcomeMake a Direct Suggestion and Review OutcomeMeet Outside the Group (e.g., Crises)Meet Outside the Group (e.g., Crises)Refer to Past Solutions that ApplyRefer to Past Solutions that ApplyRefer to Solution/Family with Successful Refer to Solution/Family with Successful

OutcomeOutcome

THE PROBLEM-SOLVING THE PROBLEM-SOLVING METHODMETHOD

1.1. Define the Problem or GoalDefine the Problem or Goal

2.2. List Possible SolutionsList Possible Solutions

3.3. Evaluate Advantages and Evaluate Advantages and Disadvantages of Each SolutionDisadvantages of Each Solution

4.4. Choose Choose ““the Bestthe Best”” Solution Solution

5.5. Implement Plan to Carry Out SolutionImplement Plan to Carry Out Solution

6.6. Review Implementation and Review Implementation and OutcomeOutcome