1. Assertive Case Management & Feedback as a Clinical Intervention Linda May, PhD, MFT – Case Manager Rachel Loewy, PhD – Clinical Director

2. Family-aided Assertive Community Treatment A clinical and employment intervention  Rapid, crisis-oriented initiation of treatment  Case management using key Assertive Community Treatment methods Integrated, multidisciplinary team Outreach PRN; rapid response Continuous case review References (see details of reference on handouts): FACT: Integrating Family Psychoeducation and Assertive Community Treatment by William R. McFarlane, MD A Comparison of Two Levels of Family-Aided Assertive Community Treatment by William R. McFarlane, MD, etal. Moving Assertive Community Treatment into Standard Practice by Susan D. Phillips, MSW, etal. http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/family/ http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/family/ - Assertive Community Treatment: Information for Practitioners, Implementation Tips NAMI SF website print out

3. FACT  Psychoeducational multifamily groups  Supported employment and education  Collaboration with schools, colleges and employers  Cognitive assessments used in school or job  Low-dose atypical antipsychotic medication  Mood stabilizers, as indicated by symptoms

4. Practitioners have found...  Renewed interest in work  Increased job satisfaction  Improved ability to help families and consumers deal with issues in early stages  Families and consumers take more control of recovery and feel more empowered

5. Family practitioners Pediatricians School guidance counselors, nurses, social workers Employers General Public Mental health clinicians Military bases and recruiters Clergy Emergency and crisis services College health services Case Mgt

6. Case Example  Prodrome to Psychosis History: substance abuse, attention and motivational problems Parent with SMI, caretaking parent evolved to critical, overprotective Client isolated, decreased function, increasing symptoms Client ambivalence re diagnosis, meds Crisis intervention, team interventions – minimize trauma of treatment

7. Providing Feedback to Clients and Their Families Rachel Loewy, PhD

8. Talking about symptoms  Use client’s words  Identify “thinking problems”  Identify other areas of concern (anxiety, depression, substance use, etc.)  Confirm with client/family- ask for feedback  Identify areas of functioning impacted by symptoms

9. Explaining risk for psychosis  Define “psychosis” in lay language (e.g. can’t tell the difference between what’s real and what’s not real)  Identify thinking problems as “high-risk” symptoms or “psychosis”  Explain that majority of people with UHR syndrome do not develop a psychotic disorder, but 20-40% do so within 1 year  Advantages of early intervention and hope for recovery: describe high level of functioning now associated with psychosis

10. Explaining risk for psychosis  Identify client/family’s strengths that serve as protective factors  Identify specific risk factors for client (substance use, refuses treatment, social isolation, etc)  Invite reactions/questions from client & family; provide empathic support  Discuss feedback again with additional family members present or after further assessments as part of an “ongoing dialogue.”

11. Treatment recommendations  Commend for seeking help “early”  Medical assessment to rule out other causes (blood work, EEG, CT scan)  Individual/group therapy for specific symptom clusters (e.g. CBT for depression/anxiety/thinking problems substance abuse treatment  Psychiatrist evaluation

12. Treatment recommendations  Family support through MFGs (provide guidelines handout). As appropriate, recommend single family therapy.  Decide on action plan (will provide specific referrals, etc.)  Encourage client/family to call with any questions.  Repeat feedback at second meeting with more family members, or after further assessment

13. Differential diagnosis & treatment  Bipolar Disorder NOS Describe depression & treatment recommendations Describe hypomania and risk for mania Describe social impairment Describe cognitive impairment  Describe difference between Bipolar, schizophrenia and schizoaffective,  Emphasize diagnostic uncertainty in the face of pressure regarding diagnosis  Discuss risk for full psychosis in context of family history  Medications for bipolar and prodrome  Identify signs to watch out for and a plan for possible increase in symptoms (communicate with family member), despite current refusal of treatment

14. Thanks for joining us, Next week – Cognitive Behavioral Therapy for Early Psychosis