1. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Session #ML-1 October 29, 2011 2011 Collaborative Family Healthcare Association Annual Meeting MAINSTREAMING MEDICAL FAMILY THERAPY: The Importance of a Systemic Approach to Integrated Healthcare Susan H McDaniel PhD, University of Rochester William J Doherty PhD, University of Minnesota Jeri Hepworth PhD, University of Connecticut

2. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Faculty Disclosure Please add the commercial interest disclosures that you reported on your signed Disclosure form: I/We have not had any relevant financial relationships during the past 12 months.

3. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Need/Practice Gap & Supporting Resources Need for a biopsychosocial approach to psychotherapy and behavioral health

4. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. *Participants can identify the original vision and concepts of Medical Family Therapy, including its use as a metaframework for other approaches such as CBT, DBT, and psychoeducation. *Participants can describe this family systems-based approach to behavioral health in primary care as well as specialty settings. *Participants can discuss the compelling need for Medical Family Therapy as it relates to ethical, interpersonal, and socioeconomic issues in healthcare. *Participants can discuss future opportunities and challenges for family- oriented behavioral health in the emerging healthcare system. *Participants will identify how medical family therapy principles can be helpful in team development and role clarification in the Patient-centered Medical Home. Objectives

5. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Expected Outcome What do you plan for this talk to change in the participant’s practice? Incorporate an overall systematic framework for behavioral health in healthcare.

6. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. MEDICAL FAMILY THERAPY History and New Contexts William J. Doherty, PhD Professor of Family Social Science & Family and Community Medicine University of Minnesota

7. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. The Origin Story The biopsychosocial systems approach Family focus Medical Family Therapy as metaframework *Can be used by many disciplines *Can be used with many problems and populations Agency and communion still overarching goals Member of collaborative team: from triangle to team Health care reform as larger context

8. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Roles and Strategies for Medical Family Therapists Jeri Hepworth, PhD Professor and Vice-Chair of Family Medicine University of Connecticut President, Society of Teachers of Family Medicine

9. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Roles and Strategies for Medical Family Therapists 1) Behavioral Health Consultant 2) Clinical Team Member and Consultant

10. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Medical Family Therapist as Systemic Behavioral Health Consultant Tracking medical and mental health outcomes Tracking medication and treatment adherence Supporting the patient’s relationship with the referring provider Providing psychoeducation about the diagnoses and treatment Encouraging patient and family activation Clarifying motivation for change and treatment Negotiating a mutually-agreeable treatment plan Facilitating family support Encouraging psychiatric consultation when needed Engaging in targeted brief therapy

11. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Clinical Strategies Recognize the Biological Dimension Patients have bodies and disease Elicit the family illness history and meaning Health Beliefs and History Respect defenses, remove blame, and accept unacceptable feelings

12. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Clinical Strategies (continued) Provide Psychoeducation and Support Describe Common Patterns of Interaction Reinforce the family’s non-illness identity Put the Illness in It’s Place Facilitate Communication Within the Family and the Clinical Team Attend To Developmental issues

13. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Increase the Family’s Sense of Agency Patient Activation and Empowerment Enhance the Family’s Sense of Communion Allow Others to Help Maintain an Empathic Presence with the Family Mindfulness of the Therapist

14. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Enhancing Team Functioning Multi-Level Participation Respect defenses, remove blame, and accept unacceptable feelings Facilitate Communication Attend to Developmental Issues Increase Agency and Communion of Team Mindful Team Practice

15. Susan H. McDaniel, Ph.D. Dr. Laurie Sands Distinguished Professor of Families and Health Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Session # October __, 2011 0:00 AM Director, Institute for the Family Associate Chair, Department of Family Medicine University of Rochester Medical Center MEDICAL FAMILY THERAPY IN ACTION: GENETIC CONDITIONS

16. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Most patients, across conditions, are not significantly distressed after testing positive for a genetic illness (Lerman, Vroyle, Tercyak & Hemann, 2002, JCCP Review)

17. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Dealing with familial illness risk is not a rational process

19. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Coping with Health Information  Monitoring Behavior -Scan and amplify threatening cues -Seek Information  Blunting Behavior -Distract from or avoid threatening cues -Minimize Information

20. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Medical Family Therapy  Monitoring Behavior - Benefit from targeted information -Family members provide support & record information

21. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Medical Family Therapy  Blunting Behavior - Emphasize future outcome of current behavior -Family members increase concerns, confront denial, and provide support

23. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. The Psychology of Genetic Testing Huntington Disease 10-20% Sought Testing Breast Cancer 35-43% Sought Testing

24. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. The Psychology of Genetic Conditions Perceived rather than scientific risk influences: Behavior Decision-Making Emotional Outcome

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32. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Wanting to know for one’s children is the single biggest reason that adults choose to get tested for genetic conditions

33. The Need to Know

34. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Clinical Strategies for Medical Family Therapy 1 - Recognize the Biological Dimension 2 - Elicit the family illness history and meaning 3 - Respect defenses, remove blame, and accept unacceptable feelings. 4 - Facilitate communication. 5 - Attend to developmental issues 6 - Reinforce the family’s non-illness identity 7 - Provide psychoeducation and support. 8 - Increase the family's sense of agency 9 - Enhance the family’s sense of communion 10 - Maintain an empathic presence with the family

35. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Behind every health and mental health professional is a person and a family with a history of medical and mental health issues

36. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Medical Family Therapy in the 21 st Century Must be Conceptually creative Clinically innovative Seek truth through research

37. It’s a Bird… Steven T. Seagle and Teddy Kristiansen, DC Comics, 2004

38. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!