Latino Multifamily Group Program – Staff Training

Alex Kopelowicz, MDAlex Kopelowicz, MD

Thomas E. Backer, PhDThomas E. Backer, PhD

Valley Nonprofit ResourcesValley Nonprofit ResourcesHuman Interaction Research InstituteHuman Interaction Research Institute

LATINO MFG TRAINING LATINO MFG TRAINING PROGRAMPROGRAM

9:00- 9:30am Welcome/Overview of Latino MFG Training

What is MFG and Why Should We Do It?

Cultural Adaptation

LMFG Manual/PowerPoints/Resource Materials

9:30 -11:30 am Joining Sessions

11:30-12:00 pm Lunch

12:00 – 2:00 pm Problem Solving/Ongoing Sessions

2:00 – 2:45 pm Psychoeducational Workshop

2:45 – 3:00 pm Wrap-Up

PORT Treatment PORT Treatment RecommendationsRecommendations

Patients who have on-going contact with their Patients who have on-going contact with their families should be offered a family families should be offered a family psychosocial intervention which spans at least psychosocial intervention which spans at least nine months and which provides a nine months and which provides a combination of education about the illness, combination of education about the illness, family support, crisis intervention, and family support, crisis intervention, and problem solving skills training. Such problem solving skills training. Such interventions should also be offered to non-interventions should also be offered to non-family caregivers.family caregivers.

Better outcomes in Better outcomes in family family psychoeducationpsychoeducation Over 20 controlled clinical trials, comparing to standard Over 20 controlled clinical trials, comparing to standard

outpatient treatment, have shown:outpatient treatment, have shown:– Much lower relapse rates and re-hospitalizationMuch lower relapse rates and re-hospitalization

Up to 75% reductions of rates; minimally 50%Up to 75% reductions of rates; minimally 50%– Increased employmentIncreased employment

At least twice the number of consumers employed, and At least twice the number of consumers employed, and up to four times greater--over 50% employed after two up to four times greater--over 50% employed after two years--when combined with supported employmentyears--when 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 Doctor visits for family members decreased by over 50% in one year50% in one year

McFarlane et al 2003

Stages of a Psychoeducational Multifamily Group

JoiningFamily and client separately3-6 weeks

Educa-tional workshopFamilies only1 day

Ongoing MFGFamilies & clientsbi-weekly 6-9 months

MULTIFAMILY GROUPS MULTIFAMILY GROUPS

Five to eight familiesFive to eight families Two facilitatorsTwo facilitators 1 ½-hour sessions – biweekly – 6-9 months1 ½-hour sessions – biweekly – 6-9 months Refreshments/snacks are providedRefreshments/snacks are provided Initial sessions avoid emphasis on clinical Initial sessions avoid emphasis on clinical

issuesissues 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

JOINING with FAMILIES & JOINING with FAMILIES & CLIENTSCLIENTS

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 treatmentIt is the first stage of treatmentDesigned to create a bond between Designed to create a bond between client/family members and facilitatorsclient/family members and facilitatorsFACILITATORS as ADVOCATEFACILITATORS as ADVOCATE

JOINING PROCEDURES JOINING PROCEDURES

THREE Joining MeetingsTHREE Joining Meetings

SEPARATELY with Relatives and ClientsSEPARATELY with Relatives and Clients

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

with Clientswith Clients Start sessions A.S.A.P. after crisis or Start sessions A.S.A.P. after crisis or

hospitalizationhospitalization Gain an understanding of family’s stresses, Gain an understanding of family’s stresses,

problems, reactions to illness, etc.problems, reactions to illness, etc.

JOINING – IJOINING – I

15 Minutes of SOCIAL TALK15 Minutes of SOCIAL TALK Review any recent CRISIS: Who and Review any recent CRISIS: Who and

What Helped or Didn’tWhat Helped or Didn’t IDENTIFY WARNING SIGNS – PRODROMAL IDENTIFY WARNING SIGNS – PRODROMAL

SIGNS – PRECIPITANTSSIGNS – PRECIPITANTS Distribute to Families & Keep for Future Distribute to Families & Keep for Future

ReferenceReference Describe the Plan for On-going MFG Describe the Plan for On-going MFG

sessionssessions 5 Minutes SOCIALIZING5 Minutes SOCIALIZING

JOINING – II JOINING – II

15 Minutes of SOCIAL TALK15 Minutes of SOCIAL TALK FAMILY’S EXPERIENCE DURING FAMILY’S EXPERIENCE DURING

EPISODES EPISODES The Sharing of Painful Events: A The Sharing of Painful Events: A Crucial Crucial Aspect of “Joining”Aspect of “Joining” The Client/Family’s Understanding The Client/Family’s Understanding of of EtiologyEtiology

Family’s Social Network & Resources Family’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 FAMILY’S SOCIAL NETWORK & FAMILY’S SOCIAL NETWORK &

RESOURCESRESOURCES SHORT & LONG-TERM GOALS SHORT & LONG-TERM GOALS

(e.g., Prevent Relapse)(e.g., Prevent Relapse) Preparation for Workshop & MFGsPreparation for Workshop & MFGs

FIRST MFG SESSION FIRST MFG SESSION

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

BackgroundBackground HobbiesHobbies OccupationOccupation InterestsInterests Clinician Goes First (Discloses/Shares with the Clinician 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 MENTAL DISORDERS HAVE CHANGED HOW MENTAL DISORDERS HAVE CHANGED

OUR LIVES”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 PATIENT’S INNER EXPERIENCESThe PATIENT’S INNER EXPERIENCES Clinicians emphasize the vital role of SHARING GRIEF,Clinicians emphasize the vital role of SHARING GRIEF, CONFUSION, GUILT, FEAR with those “on the same CONFUSION, GUILT, FEAR with those “on the same boat”.boat”. 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 Clinicians DON’T speak for clients or Clinicians DON’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 others’ turn and avoid criticismRespect others’ turn and avoid criticism

PROBLEM SOLVING IN PROBLEM SOLVING IN MFGsMFGs

The CORE of MFG sessionsThe CORE of MFG sessions Designed to compensate for information-Designed to compensate for information-

processing deficits in mental disordersprocessing deficits in mental disorders 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 Minutes45 MinutesWrap-up SocializingWrap-up Socializing 5 Minutes5 Minutes

Facilitators should GET READY and HAVE A PLAN Facilitators should GET READY and HAVE A PLAN – IN ADVANCE– IN ADVANCE

SELECTING A PROBLEM SELECTING A PROBLEM TO SOLVE TO SOLVE

TOPICS:TOPICS:Safety in The HomeSafety in The HomeMedication ComplianceMedication ComplianceDrugs and AlcoholDrugs and AlcoholLife EventsLife EventsOutside Agency EventsOutside Agency EventsDisagreements among Family MembersDisagreements among Family MembersConflict with a Family GuidelineConflict with a Family Guideline

“ “REJECTED” PROBLEMS:REJECTED” 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-THE PROBLEM-SOLVING METHODSOLVING METHOD

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 “The Best” SolutionChoose “The Best” Solution

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

6.6. Review Implementation and Review Implementation and OutcomeOutcome

For More InformationFor More Information

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Resources section – Latino Multifamily Resources section – Latino Multifamily Group pageGroup page