Latino Multifamily Group Program – Staff Training

Latino Multifamily Group Program – Staff Training Alex Kopelowicz, MD Thomas E. Backer, PhD Valley Nonprofit ResourcesHuman Interaction Research Institute

LATINO MFG TRAINING PROGRAM 9:00- 9:30am Welcome/Overview of Latino MFG Training What is MFG and Why Should We Do It? Cultural Adaptation LMFG Manual/PowerPoints/Resource Materials 9:30 -11:30 am Joining Sessions 11:30-12:00 pm Lunch 12:00 – 2:00 pm Problem Solving/Ongoing Sessions 2:00 – 2:45 pm Psychoeducational Workshop 2:45 – 3:00 pm Wrap-Up

PORT 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 re-hospitalization • 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

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 are 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 FACILITATORS as ADVOCATE

JOINING PROCEDURES • THREE Joining Meetings  SEPARATELY with Relatives and Clients  WEEKLY – 1 HOUR with Relatives, ½ HOUR with Clients • Start sessions A.S.A.P. after crisis or hospitalization • Gain an understanding of family’s stresses, problems, reactions to illness, etc.

JOINING – I • 15 Minutes of SOCIAL TALK • Review any recent CRISIS: Who and What Helped or Didn’t • IDENTIFY WARNING SIGNS – PRODROMAL SIGNS – PRECIPITANTS • Distribute to Families & Keep for Future Reference • Describe the Plan for On-going MFG sessions • 5 Minutes SOCIALIZING

JOINING – II • 15 Minutes of SOCIAL TALK • FAMILY’S EXPERIENCE DURING EPISODES  The Sharing of Painful Events: A Crucial Aspect of “Joining”  The Client/Family’s Understanding of Etiology • Family’s Social Network & Resources (Material & Emotional) • 5 Minutes SOCIALIZING

JOINING – III • 15 Minutes of SOCIAL TALK • FAMILY’S SOCIAL NETWORK & RESOURCES • SHORT & LONG-TERM GOALS (e.g., Prevent Relapse) • Preparation for Workshop & MFGs

FIRST MFG SESSION “GETTING TO KNOW EACH OTHER” Go Around the Room  Background  Hobbies  Occupation  Interests  Clinician Goes First (Discloses/Shares with the Group) SETTING BASIC RULES  Regular ATTENDANCE (for Relatives)  CONFIDENTIALITY (No Pressure to Disclose)  INTERACTION AMONG MEMBERS  PHYSICAL/EMOTIONAL CONTROL

SECOND MFG SESSION • “HOW MENTAL DISORDERS HAVE CHANGED OUR LIVES”  Building a SENSE OF TRUST & COMMITMENT  Sense of COMMON EXPERIENCE (Listen to each other)  Strengthening GROUP IDENTITY & SENSE OF RELIEF  The PATIENT’S INNER EXPERIENCES  Clinicians emphasize the vital role of SHARING GRIEF, CONFUSION, GUILT, FEAR with those “on the same boat”. AND HOPE • Remind participants about Problem Solving (next session)

GENERAL POINTS • New Members • Late-Arriving Members • Reminders about Attending • Crises & Emergencies • COMMUNICATION & INTERACTIONS  Clinicians DON’T speak for clients or relatives  Interaction among members is essential  Clients are ENCOURAGED (not pressured) to participate  Respect others’ turn and avoid criticism

PROBLEM SOLVING IN MFGs • The CORE of MFG sessions • Designed to compensate for 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

SELECTING A PROBLEM TO SOLVE • TOPICS: Safety in The Home Medication Compliance Drugs and Alcohol Life Events Outside Agency Events Disagreements among Family Members Conflict with a Family Guideline • “REJECTED” PROBLEMS: Make a Direct Suggestion and Review Outcome Meet Outside the Group (e.g., Crises) Refer to Past Solutions that Apply Refer to Solution/Family with Successful Outcome

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

For More Information • Contact Valley Nonprofit Resources, 818/990-0176 • Go to www.valleynonprofitresources.org, Resources section – Latino Multifamily Group page

Latino Multifamily Group Program – Staff Training