Involving Family and Family-like People in Treatment

This is an area of the fidelity model in which structure and education may be useful to administration, middle management, and direct service staff. Providing minimum standards is intended to help ensure that this area is explored thoroughly. Providing resources and education to direct service staff is intended to help the staff carry out those standards with increased confidence. The following is one way to conceptualize a plan to improve this service:

1. Assess staff needs. Present this as an area that the program is going to address directly, and explain the rationale. Use this opportunity to elicit from staff what knowledge and resources they might need in order to address this topic effectively. Keep in mind that the broad topic of “psychoeducation” includes not only information on specific diagnoses, substance use, and how they interact (e.g., the stress-vulnerability model). Staff can also help clients improve their relationships and problem-solving abilities with others, help clients and their family/family-like supports in setting appropriate boundaries, offer support, and encourage involvement in treatment planning.

2. Set Expectations. Provide minimum expectations regarding addressing this topic and how it is

to be approached (e.g., use open-ended questions, elicit specific ways that others can be involved, explain to clients that they can decide how involved they want a person to be, etc.) This may include an actual document that becomes a part of the medical record. A sample of useful questions has been included (last page). Also set expectations about how often this information will be updated so that it is not just addressed once and forgotten.

3. Monitor progress. Decide how the implementation of these expectations will be tracked. Plan

ongoing discussion with providers to get feedback on how clients are responding, whether level of family/family-like supports is increasing, and what changes might be appropriate.

The question invariably arises: “What if a person literally has no one in their life?” In this situation, it is an important treatment opportunity. If clients state that they don’t desire anyone in their lives, the clinician should use Motivational Interviewing techniques to explore how developing and involving supports might be helpful. If clients express a desire for supports but insist that there is no one in their lives, this becomes an opportunity to develop the skills needed to develop and maintain such support. This is an especially crucial area given that a sober support network and regular meaningful activity play such an important role in recovery from dual disorders.

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Initiating Discussion of Family/Family-like Supports

1. Who are they people involved in my life? This includes anyone I see or talk to on a fairly

regular basis or people that I would like to see/talk to more often. __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ 2. Of the above-listed people, who would be the best person/people to help me in my recovery? 3. For each person in #2, what would I like them to be involved in (and how often)?

Developing goals Remembering to take pill medication Doing fun things Updating my case manager, therapist or doctor on how

I’m doing Understanding my recovery Improve our relationship/get along better Crisis plan Making new friends Other: _____________________________________________

4. What can my Case Manager do to help me accomplish the things I’ve listed? 5. What limits do I want to specify on my Release of Information to the people I’ve

listed?

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