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Welcome to the Consumer Centered Family Consultation “Family Guidelines” Webinar Hosted by: The Family Institute for Education, Practice & Research The webinar will begin shortly. Thank you for your patience. For audio access, please call 1-800-244-9194, then enter code: 990024# For any technical difficulties, please call 585-279-7902

Agenda for Today • Hello and introductions • Family Guidelines – Background and introducing them to families/consumers • Detailed discussion of each guideline • Wrap-up and discussion

Overview and Background • Carol Anderson (1986) & William McFarlane (2004) • Roots: Biology of schizophrenia • Integrated into formal family psychoeducation since mid- to late-1980s • Evidence based: Combine Family Guidelines with a problem-solving process • Most helpful: Introduce Guidelines to family/consumer, then help family implement them (ideal) Family Guidelines – Sources: Carol Anderson, Schizophrenia and the Family (Guilford Press, 1986); Dr. William McFarlane, Multi-Family Groups in the Treatment of Severe Psychiatric Disorders (Guilford Press, September 2004).

Family Guidelines • Go slow—things will get better in their own time. • Keep it cool—tone down disagreements and enthusiasm. • Keep it warm—stay connected, supportive and respectful. • Give each other space—time out is important for everyone. • Set limits—a few good rules keep things clear. • Ignore what you cannot change—let some things slide, but DON’T ignore violence. • Keep it simple—say what you have to say in clear, calm, positive terms.

Family Guidelines (continued) • Follow the treatment plan (Consider using medications)—take only medications that are prescribed and take them only as prescribed. • Carry on business as usual—re-establish family routines as quickly as possible and reconnect with family and friends. • Take care of yourself—it’s important to keep your own batteries “charged”. • Avoid street drugs or alcohol—they make symptoms worse. • Pick up on early warning signs—observe changes then consult with your clinician. • Solve problems step by step—make changes gradually…work on one thing at a time. • Lower expectations temporarily—don’t make unrealistic comparisons, e.g., compare this month to last month rather than this year to last year.

Introducing the Guidelines to Families/Supports and Consumers • Tell everyone about the Guidelines • Most people want to know “how can I help” – here’s a way to help that’s proven to work • Evidence based – lots of research • Many of the most challenging problems can be helped by using the Guidelines • Suggest that using the guidelines can help everyone in the family/system

Introducing the Guidelines to Families/Supports and Consumers (con’t) • Let people know that the Guidelines address, in part, the psychobiology of illness • Designed to help deal with stress/stressors • Designed to reduce tension and stimulation • Designed to increase predictability and calm in the environment • Guidelines are like behavioral strategies for other illnesses (give example, such as diabetes) • Guidelines should be discussed with consumers in advance of sharing them with family/supports (e.g., during the pre-planning meeting)

Introducing the Guidelines to Families/Supports and Consumers (con’t) • Sharing the Family Guidelines with supports should be considered a strategy for helping consumer achieve his/her specific goal(s) • Offer to provide education and information about the Guidelines

A DETAILED LOOK AT EACH GUIDELINE

“Go Slow” • There is a psychobiological recovery process that cannot be accelerated without risking another relapse or stalling functional progress. • Stresses and demands are taken seriously and steps toward recovery are paced to keep stress at a reasonable level.

“Go Slow” • Slow, careful, steady progress can achieve remarkable degrees of functional improvement without a set back.

“Keep it Cool” • To compensate for difficulty in regulating arousal, the people closest to the susceptible person can help create a relatively quiet and calm environment. • Attempt to protect against sudden intrusions, confrontational conversations, arousing entertainment, and simultaneous or multiple kinds of sensory input.

“Keep it Cool” • Sensory overload can be avoided by these same means, and also by, for example, reducing background noise, keeping light levels moderate, and having only one conversation going at a time. • The optimal emotional tone is in the middle range, not intense and especially not negative (e.g., airplane pilot).

“Keep it Warm” • The people closest to the individual can strive for a fairly neutral, yet still emotionally warm environment. • The optimal emotional tone is in the middle range, not overly distant, cold or rigid—think “Muzak”.

“Give `em Space” • Decrease the likelihood of over-stimulation by allowing “time-outs” and a time and place to withdraw, without rejecting. • Try not to nag • Keep vigilance to a minimum • Remember that time-out is important for everyone

“Give `em Space” • Benign indifference is still caring and care-taking. To avoid complete withdrawal of a family member, it’s helpful to offer opportunities to engage in activities, but accept refusals if s/he is unable to participate or needs to be alone at that time.

“Set Limits” • A few good rules keep things clear. Everyone needs to know what is expected of them. • Clear expectations can help lower stress.

“Ignore What You Can’t Change” • Let some things slide. • Don’t ignore violence. • Don’t ignore hints or threats of suicide.

“Ignore What You Can’t Change” • With psychosis, to compensate for delusions or people responding to hallucinations, family and friends can be encouraged to change the subject and not dwell on delusional ideas, but rather focus on less stressful topics.

“Keep it Simple” • To help with any information processing difficulties, conversations can be shorter, less complex and focused on everyday topics—less is best.

“Keep it Simple” • Complexity in the environment and stressful life events can overwhelm cognitive and coping capacities. Protect and buffer as much as possible.

“Keep it Simple” • Avoid mind-reading and allow everyone to speak for themselves, as positively as possible—to assume is not to know.

“Follow the Treatment Plan (Consider Using Medication)” • Medication can improve symptoms and protect your future. • A little goes a long way. Don’t stop medication when you begin to feel better. Work with your doctor to find the right medication and the right dose. • Take medications that are only prescribed

“Carry On Business As Usual” • Continue or reestablish family routines. • Stay in touch with family and friends. • We all need a support system – and having a good support system helps us be better supporters of others.

“Take Care of Yourself” • Schedule pleasant events (e.g., things you enjoy or used to enjoy) and do other things to take care of yourself. • Try hard not to feel guilty when taking a break. • It’s important to “re-charge” one’s own battery.

Consider Not Using Street Drugs or Alcohol • Watch out for the effects of street drugs and alcohol; they can make symptoms worse and may cause relapse. • Never use cocaine, amphetamines (“speed”) or hallucinogens at all for any reason.

Consider Not Using Street Drugs or Alcohol • Avoid over-the-counter stimulants like pseudoephedrine, diet pills, No-Doze and inhalants. • Stay away from nicotine and caffeine, as hard as that might be. • Keep alcohol to a bare minimum, or don’t use at all if possible.

“Pick Up On Early Signs” • Use the symptoms as indicators and note changes; if they re-appear, slow down, simplify and look for support and help, quickly. • Learn to identify early warning signs and changes in symptoms. Consult with your therapist, family clinician or psychiatrist / nurse practitioner.

“Solve Problems Step By Step” • Make changes gradually. Work on one thing at a time. • Define a problem as simply as possible, then brainstorm to figure out 1 or 2 “new things” to try over a 1-2 week period of time. • Look for coping methods that work for you, and work with your clinicians and your team to find other methods when yours don’t work.

“Lower Expectations, Temporarily” • Be cautious about comparing things on a day-to-day basis. • Slow, careful and steady rehabilitation can achieve remarkable degrees of functional improvement without relapse. • Use a “personal yardstick” to compare this month to last month, for the individual.

Questions to Consider… • What are your thoughts and/or reactions to the Guidelines? • How does this fit in (or not fit in) with the work you’re doing with consumers?

Think About Next Steps… • How might you try using these with consumers and their support people? • What might keep you from introducing these Guidelines with consumers? • How might you and the colleagues in your program support one another in using the Guidelines?

Thank you for being with us today The slides in this webinar will be made available on our website at www.nysfamilyinstitute.org If you have additional questions, please contact: Sherri Ladd at 585-279-7902 or Sherri_Ladd@urmc.rochester.edu

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