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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

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Latino Multifamily Group Staff Orientation

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

  2. 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

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

  4. 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.

  5. 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

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

  7. 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

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

  9. Dosages in MFG and SFT McFarlane et al, 2003

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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?

  17. 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)

  18. 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

  19. 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

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