Latino Multifamily Group Staff Orientation

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

Presentation Outline • What is MFG and why should we do it? • Components of MFG • Adapting MFG for Latinos • Preliminary findings of RCT focused on MFG for Mexican-Americans • Disseminating the MFG

Components of the Latino MFG Family psychoeducation Communication skills training Problem solving techniques Social network development

PORT (2004) 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.

Better outcomes in family psychoeducation Over 20 controlled clinical trials, comparing to standard outpatient treatment, have shown: Much lower relapse rates and rehospitalization 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 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 McFarlane et al 2003

MFG Reduces Re-hospitalization Rates (Dyck et al, 2001)

Pretreatment Treatment Follow-up 1-Year Survival Rates Among Bipolar Patients in Family-Focused Treatment versus Case Management FFT, N=31 CM, N=70 Wilcoxon Test, c2 (1)=3.99, P =.046 Miklowitz DJ, et al. Biol Psychiatry, 2000;48(6):582-592

Remission to 2 years N: PEMFG=83; PESFT=92Main effect: p=.05 McFarlane et al, 2003

Dosages in MFG and SFT McFarlane et al, 2003

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

MULTIFAMILY GROUPS • Five to Eight Families • Two Facilitators • 1 ½-Hour Sessions – Biweekly – 6-9 months • Refreshments/snacks provided • 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

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

PROBLEM SOLVING IN MFGs • The CORE of MFG sessions • Designed to compensate information-processing deficits in mental disorders • FORMAT: Checking in 15 Minutes Go-round 20 Minutes Selecting a Problem to Solve 5 Minutes Solving the Problem 45 Minutes Wrap-up Socializing 5 Minutes • Facilitators should GET READY and HAVE A PLAN – IN ADVANCE

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

The Assessment of Culture • Best undertaken by paying attention to people’s daily routines and how such activities are tied to families, social networks and communities • The key to a cultural assessment is asking what matters most to people or what is most at stake for people

The cultural question is: • What are the factors in a particular culture that need to be considered prior to implementing multifamily group psychoeducation developed with a Euro-American population of people with mental disorders?

Cultural Modifications for Latinos • Encourage participation of fathers • Acknowledge folk conceptions of illness • Reframe to fit family beliefs and attitudes • Focus on education rather than strictly on communication/problem solving skills • Acknowledge each family member’s role • Goal: Interdependence vs independence • Utilize prosocial factors (e.g., warmth)

Efficacy of MFG – RCT Study Results • 174 Mexican-American subjects • 1 year of treatment • 1 year of follow-up • Overall log-rank Χ2=13.3, df=2, p=.001. • Kopelowicz et al, under review

Disseminating the MFG Approach • Raising the Bar project • Training program and technical assistance to implement MFG for adults with mental illness • Resulted in a number of program adoptions in the San Fernando Valley region of Los Angeles • Latino MFG project • Training program and technical assistance to implement Spanish-language MFG for families of adolescents • Resulted in six pilot adoptions so far, four of them evaluated with positive results (national dissemination now underway) For more information, go to www.valleynonprofitresources.org, Resources section

Latino Multifamily Group Staff Orientation