Latino Multifamily Group Program – Staff Training Alex Kopelowicz, MD Thomas E. Backer, PhD Valley Nonprofit Resources Human Interaction Research Institute

LATINO MFG TRAINING PROGRAM 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 pmLunch 12:00 – 2:00 pm Problem Solving/Ongoing Sessions 2:00 – 2:45 pmPsychoeducational Workshop 2:45 – 3:00 pm Wrap-Up

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

Better outcomes in family psychoeducation Over 20 controlled clinical trials, comparing to standard outpatient treatment, have shown: Over 20 controlled clinical trials, comparing to standard outpatient treatment, have shown: –Much lower relapse rates and re-hospitalization Up to 75% reductions of rates; minimally 50% Up to 75% reductions of rates; minimally 50% –Increased employment At least twice the number of consumers employed, and up to four times greater--over 50% employed after two years-- when combined with supported employment At least twice the number of consumers employed, and up to four times greater--over 50% employed after two years-- when combined with supported employment –Improved family relationships and well-being –Reduced friction and family burden –Reduced medical illness in family members Doctor visits for family members decreased by over 50% in one year Doctor visits for family members decreased by over 50% in one year McFarlane et al 2003

Stages of a Psychoeducational Multifamily Group Joining Family and client separately 3-6 weeks Educa- tional workshop Families only 1 day Ongoing MFG Families & clients bi-weekly 6-9 months

MULTIFAMILY GROUPS Five to eight families Five to eight families Two facilitators Two facilitators 1 ½-hour sessions – biweekly – 6-9 months 1 ½-hour sessions – biweekly – 6-9 months Refreshments/snacks are provided Refreshments/snacks are provided Initial sessions avoid emphasis on clinical issues Initial sessions avoid emphasis on clinical issues Initial sessions emphasize establishing a working alliance by building group identity and developing a sense of mutual interest and concern. Drop outs are failures Initial sessions emphasize establishing a working alliance by building group identity and developing a sense of mutual interest and concern. Drop outs are failures

JOINING with FAMILIES & CLIENTS JOINING means to CONNECT, BUILD RAPPORT, CONVEY EMPATHY, ESTABLISH AN ALLIANCE, ENGAGE JOINING means to CONNECT, BUILD RAPPORT, CONVEY EMPATHY, ESTABLISH AN ALLIANCE, ENGAGE It is the first stage of treatment It is the first stage of treatment Designed to create a bond between client/family members and facilitators Designed to create a bond between client/family members and facilitators FACILITATORS as ADVOCATE FACILITATORS as ADVOCATE

JOINING PROCEDURES THREE Joining Meetings THREE Joining Meetings  SEPARATELY with Relatives and Clients  WEEKLY – 1 HOUR with Relatives, ½ HOUR with Clients Start sessions A.S.A.P. after crisis or hospitalization Start sessions A.S.A.P. after crisis or hospitalization Gain an understanding of family’s stresses, problems, reactions to illness, etc. Gain an understanding of family’s stresses, problems, reactions to illness, etc.

JOINING – I 15 Minutes of SOCIAL TALK 15 Minutes of SOCIAL TALK Review any recent CRISIS: Who and What Helped or Didn’t Review any recent CRISIS: Who and What Helped or Didn’t IDENTIFY WARNING SIGNS – PRODROMAL SIGNS – PRECIPITANTS IDENTIFY WARNING SIGNS – PRODROMAL SIGNS – PRECIPITANTS Distribute to Families & Keep for Future Reference Distribute to Families & Keep for Future Reference Describe the Plan for On-going MFG sessions Describe the Plan for On-going MFG sessions 5 Minutes SOCIALIZING 5 Minutes SOCIALIZING

JOINING – II 15 Minutes of SOCIAL TALK 15 Minutes of SOCIAL TALK FAMILY’S EXPERIENCE DURING EPISODES FAMILY’S EXPERIENCE DURING EPISODES  The Sharing of Painful Events: A Crucial Aspect of “Joining”  The Client/Family’s Understanding of Etiology Family’s Social Network & Resources (Material & Emotional) Family’s Social Network & Resources (Material & Emotional) 5 Minutes SOCIALIZING 5 Minutes SOCIALIZING

JOINING – III 15 Minutes of SOCIAL TALK 15 Minutes of SOCIAL TALK FAMILY’S SOCIAL NETWORK & RESOURCES FAMILY’S SOCIAL NETWORK & RESOURCES SHORT & LONG-TERM GOALS (e.g., Prevent Relapse) SHORT & LONG-TERM GOALS (e.g., Prevent Relapse) Preparation for Workshop & MFGs Preparation for Workshop & MFGs

FIRST MFG SESSION “GETTING TO KNOW EACH OTHER”  Go Around the Room  Background  Hobbies  Occupation  Interests  Clinician Goes First (Discloses/Shares with the Group) SETTING BASIC RULES  Regular ATTENDANCE (for Relatives)  CONFIDENTIALITY (No Pressure to Disclose)  INTERACTION AMONG MEMBERS  PHYSICAL/EMOTIONAL CONTROL  PHYSICAL/EMOTIONAL CONTROL

SECOND MFG SESSION “HOW MENTAL DISORDERS HAVE CHANGED OUR LIVES” “HOW MENTAL DISORDERS HAVE CHANGED OUR LIVES”  Building a SENSE OF TRUST & COMMITMENT  Sense of COMMON EXPERIENCE (Listen to each other)  Strengthening GROUP IDENTITY & SENSE OF RELIEF  The PATIENT’S INNER EXPERIENCES  Clinicians emphasize the vital role of SHARING GRIEF, CONFUSION, GUILT, FEAR with those “on the same boat”. CONFUSION, GUILT, FEAR with those “on the same boat”. AND HOPE AND HOPE Remind participants about Problem Solving (next session) Remind participants about Problem Solving (next session)

GENERAL POINTS New Members New Members Late-Arriving Members Late-Arriving Members Reminders about Attending Reminders about Attending Crises & Emergencies Crises & Emergencies COMMUNICATION & INTERACTIONS COMMUNICATION & INTERACTIONS  Clinicians DON’T speak for clients or relatives  Interaction among members is essential  Clients are ENCOURAGED (not pressured) to participate participate  Respect others’ turn and avoid criticism  Respect others’ turn and avoid criticism

PROBLEM SOLVING IN MFGs The CORE of MFG sessions The CORE of MFG sessions Designed to compensate for information-processing deficits in mental disorders Designed to compensate for information-processing deficits in mental disorders FORMAT: FORMAT: Checking in15 Minutes Go-round20 Minutes Selecting a Problem to Solve5 Minutes Solving the Problem45 Minutes Wrap-up Socializing5 Minutes Facilitators should GET READY and HAVE A PLAN – IN ADVANCE Facilitators should GET READY and HAVE A PLAN – IN ADVANCE

SELECTING A PROBLEM TO SOLVE TOPICS: TOPICS: Safety in The Home Medication Compliance Drugs and Alcohol Life Events Outside Agency Events Disagreements among Family Members Conflict with a Family Guideline “REJECTED” PROBLEMS: “REJECTED” PROBLEMS: Make a Direct Suggestion and Review Outcome Meet Outside the Group (e.g., Crises) Refer to Past Solutions that Apply Refer to Solution/Family with Successful Outcome

THE PROBLEM-SOLVING METHOD 1. Define the Problem or Goal 2. List Possible Solutions 3. Evaluate Advantages and Disadvantages of each Solution 4. Choose “The Best” Solution 5. Implement Plan to Carry Out Solution 6. Review Implementation and Outcome

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