Multiple Family Groups for Psychosis: A Brief Overview of the Model and Tips for Getting Started

1. Multiple Family Groups for Psychosis: A Brief Overview of the Model and Tips for Getting Started June 2010 Susan Gingerich, MSW gingsusan@yahoo.com

2. Topics of workshop • Brief review of the Multifamily Group (MFG) model • Locating additional resources and educational materials • Basic steps for getting an MFG Started • Common Challenges • Evaluating stage of readiness and taking the first step

3. Multifamily Groups: Three Main Tasks • Teach families knowledge, strategies and skills • Provide social support, opportunities to learn from others’ experience and hear other suggestions for solving problems • Develop a social network

4. Helpful Resources • Multifamily Groups in the Treatment of Severe Psychiatric Disorders. William McFarlane. 2002. Guilford Press. • “Family Psychoeducation KIT. ” Substance Abuse and Mental Health Services (SAMHSA). New edition (2009) available free at http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/family/ • Family Psychoeducation for Serious Mental Illness. Harriet Lefley. 2009. • “Psychoeducational Family Groups.” Book chapter in press by Ellen Lukens and Helle Thorning. In A. Rubin and D. Springer (editor). Psychosocial Treatment of Schizophrenia.

5. Sources of Educational Handouts • Mueser, K.T. & Gingerich, S. (2006). Complete Family Guide to Schizophrenia. NY, NY: Guilford Press. • Mueser, K.T. & Glynn, S. (1999). Behavioral Family Therapy for Psychiatric Disorders. Oakland, CA: New Harbinger. Appendix 3 (pages 276-328) • Mueser, et al. (2003). Integrated Treatment for Dual Disorders. NY, NY: Guilford Press. Appendix B (pages 357-414) • Illness Management and Recovery toolkit: http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/illness/ These have been translated into Dutch by Bavo Europort. • SAFE Program: Support and Family Education. http://www.ouhsc.edu/safeprogram/

6. Basic Facts about Multifamily Psychoeducational Groups • Time-unlimited (recommended at least 9 months) • Include the client • Conducted every two weeks (sometimes declining to monthly sessions) for 90 minutes • Single diagnosis, closed groups recommended • If necessary, family members can attend without the client and vice versa • Co-leaders highly recommended • 4-8 families in a group

7. Stages of Multifamily Groups • Stage 1: Joining • Stage 2: Psychoeducational Workshop • Stage 3: Multifamily Group Sessions

8. Joining Individual meetings with individuals and their families 2-3 recommended for each family

9. One Day Psychoeducational Workshop • Brings families together for approx. 6 hours • Positive message about working together • Covers factual information • Multiple opportunities for asking questions, sharing their own experiences, getting to know each other as people

10. MultifamilyGroup Sessions

11. Steps of Problem-Solving • 1. Define the problem • 2. Brainstorm possible solutions • 3. Evaluate solutions (pro’s & con’s) • 4. Choose the best solution or combination • 5. Plan how to implement the solution (make an action plan) • 6. Follow up the implementation (follow up on action plan)

12. Basic First Steps for Starting an MFG • Work with your organization to develop an Advisory Team or Steering Committee • Identify staff members • Introduce program, get word out • Identify individuals and families • Conduct joining sessions • Conduct Psychoeducation Workshop • Provide biweekly family groups • Meet regularly for supervision and support • Meet regularly with Advisory Team

13. Work with your organization to develop an Advisory Committee Make the case for implementing an MFG Describe components Cite research Identify problems at organization that could be addressed by having an MFG Make connection between MFG and mission of the organization In the Advisory/Steering committee, include director of organization, MFG leaders, other staff members, individuals, and family members

14. 2. Identify staff members to provide services and make referrals • Staff members who have expressed an interest in working with families • Staff members who have received training • Staff members who have experience with mental illness themselves or with a family member • Identify who has “first contact” with people • Plan for co-leaders, and a back-up

15. 3. Introduce program, get the word out • In-service training, staff meetings • Community programs • National Family Organizations • Churches, synagogues, mosques, temples • Schools, libraries • Develop brochure for individuals, families, staff members

16. Possible contents for a brochure What are Multiple Family Groups? An evidence-based practice that gives individuals and their families information about mental illnesses, helps them build social supports, and enhances problem-solving, communication, and coping skills. Why participate? Individuals who participated in MFGs have fewer relapses and less time in the hospital. Families who participate report greater knowledge of mental illnesses and less stress, confusion, and isolation How does it work? First, individuals and their family meet with a staff member. Then they attend an all-day educational workshop with other families. Next they attend a group with the same families that meets for 90 minutes, twice a month. There people will find information, support, and help with solving common problems. Who can I contact?

17. 4. Identify individuals with similar diagnosis with family involvement Individuals who experience psychosis, such as schizophrenia, schizoaffective; Bipolar disorder;Depression Consider targeting groups who may share common challenges, e.g., first episode, frequent hospitalizations, desire for employment or going back to school, interest in independent living, difficulties with taking medication Consider approaching individuals who have recently experienced a problem (e.g., increase in symptoms, rehospitalization) Expect to take time to engage some individuals Consider grouping people with similar language or cultural needs

18. 5. Conduct joining sessions with 4-8 families Allow some separate time with client and family members (could be a divided session) 2-3 joining sessions per family Can “piggyback” the joining sessions (e.g., have separate sessions all in one evening) Can schedule two or three appointments a week with one family to speed up readiness for joining group Alternate which group leader does the joining sessions; introduce other leader if possible May need to use motivational interviewing during joining sessions in order to increase engagement, confidence

19. 6. Conduct Psychoeducation Workshop Make it friendly, welcoming. Don’t separate self at breaks. Provide food (including dishes from participant’s culture) and consider providing music Cover main points, using jargon-free language and visual illustrations when possible Divide presentation among co-leaders who have joined with group members Offer other professionals for specific parts (doctor, nurse, social worker) of the presentation Break information down into small chunks If possible, ask a family member to speak about the benefits they have experienced from such a group

20. 7. Provide biweekly family groups Make it friendly, welcoming. “Include yourself in.” Provide food (including dishes from participant’s culture) and consider providing music before and after Use a flip chart or white board to write down main points and problem-solving steps Divide roles among co-leaders and alternate who leads group, who writes down problem-solving steps, who helps people take a break Occasionally invite guest speakers (doctor, nurse, social worker, attorney) if group members request special information Be receptive to ideas of holiday parties, celebrations, “hobby night” Be sure to rotate whose problem is solved, and to involve all group members in generating solutions

21. 8. Meet regularly (e.g., weekly) for supervision and support Weekly supervision helps family clinicians learn the model more thoroughly and to develop strategies for challenges. Use the SAMHSA toolkit for possible breakdown of learning the skills together of conducting MFGs Review both successes and challenges For challenges, use problem-solving method Monthly consultation with an experienced group leader can clarify points of the model and provide additional strategies for challenges

22. 9. Meet regularly with Advisory/Steering Committee Consider monthly meetings with steering committee Review both successes and challenges Give regular reports that summarize the MFG experience (e.g., how many meetings held, attendance, subjects covered, problems used in problem-solving, skills displayed Get the assistance of organization director to help solve challenges (e.g., meeting room unavailable, difficulty getting referrals, evening reception staff unfriendly to families who arrive for meetings) Get feedback from family representative Ask for what you need to make the MFG successful

23. Challenges are bound to come up We do NOT respond to challenges in the way illustrated by the following slide:

25. Common Problems: Suggestions for Each will be Provided in Workshop Getting referrals Families reluctant to join Individuals reluctant to join People have had bad experience with mental health services in the past Group members may be disruptive or dominate conversation Group members may be reticent Family members may “protect” others by saying they are unable or unwilling to come Cultural issues and beliefs may interfere with attendance

26. Problem-solving to Address Our Own Challenges Take one of the challenges for MFGs brought up in the workshop. Use the 6 step problem-solving as a small group to come up with a possible solution/action plan. Report back to the larger group.

27. Evaluate Your Stage of Readiness to Implement an MFG Pre-contemplation? Contemplation? Preparation? Action? Maintenance? Relapse?

28. Another way to look at your stage of readiness How interested are you? (scale of 1-10) How important is it to you? (scale of 1-10) How confident are you? (scale of 1-10)

29. Complete all or part of MFG Planning Sheet See next slide and planning sheet attached to the handout.

31. Closing comment “Without this group I would have been lost and alone. I didn’t know other people were going through the same thing. I didn’t know that they could help me and I could help them. This group is like a family to me.” Family member in Philadelphia.