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Family Education Family Psychoeducation Family Consultation

Family Education Family Psychoeducation Family Consultation. PSRT 4271: The Family Role in Rehabilitation Week 7; T.H. Pyle, Instructor. Live case update…. Today’s Learning Objectives. Disability Theory Intervention Mechanics 3 Critical Family Interventions IFSS Intro. Modalities.

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Family Education Family Psychoeducation Family Consultation

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  1. Family EducationFamily Psychoeducation Family Consultation PSRT 4271: The Family Role in Rehabilitation Week 7; T.H. Pyle, Instructor

  2. Live case update…

  3. Today’s Learning Objectives • Disability Theory • Intervention Mechanics • 3 Critical Family Interventions • IFSS Intro

  4. Modalities • Family education (FE) • Family psychoeducation (FPE) • Family consultation (FC)

  5. Modalities • Family education (FE) ____ • Family psychoeducation (FPE) IFSS • Family consultation (FC) IFSS

  6. What Causes Disability?

  7. The Tragedy Model (Swain & French, 2000) • What causes disability? • Impairment? Or reaction to it? • What basis? • Disabled want to be other than disabled? • Disabling expectations? • “Independent”, “normal”, “adjust”, “accept” • Ingrained identities of non-disabled? • Invalidation by non-disabled? • Experts, family, media

  8. Disability Philosophy (Power & Dell Orto, 2004) • Traditional view: Tragedy • Debilitation • Chronicity • Families at fault • Modern view: Opportunity • Enjoy life • Affirm values • Determine lifestyle

  9. Positive Personal Identity • Disability enhances life • Special benefits • “Liberation of disfigurement” • Heightened understanding of others’ trials

  10. Positive Collective Identity • Redefining disability • Barriers constructed in a disabling society… • Organized movement: A social network! • Collective expression

  11. “The Affirmation Model” (Swain & French, 2000) • “A valuing approach…” • Not through… • … assumptions on non-disabled. • … the medical model • By disabled, about disabled

  12. Intervention: Assumptions (Power & Dell Orto, 2004, p. 124) • Interventions = joint ventures. • Families have needs.. • Family needs change. • Responses come from more than illness. • Families face multiple “risks”. • Families may oppose interventions. • Family participation is beneficial to all. • Different families respond differently.

  13. Intervention: Assumptions (Power & Dell Orto, 2004, p. 124) • Interventions = joint ventures. • Families have needs.. • Family needs change. • Responses come from more than illness. • Families face multiple “risks”. • Families may oppose interventions. • Family participation is beneficial to all. • Different families respond differently.

  14. Intervention: Assumptions (Power & Dell Orto, 2004, p. 124) • Interventions = joint ventures. • Families have needs. • Family needs change. • Responses come from more than illness. • Families face multiple “risks”. • Families may oppose interventions. • Family participation is beneficial to all. • Different families respond differently.

  15. Intervention: Goals (Power & Dell Orto, 2004, p. 126) • Help families adapt. • Especially at the 3 “trigger points”… • Help families assist.

  16. Intervention: 5 Connection Skills (Power & Dell Orto, 2004, p. 126) • Make families feel welcome. • Listen, open, accept, empathize. • Solicit family expectations. • Understand differences; respect diversity. • “Verbally reinforce” in family meetings.

  17. Intervention: 6 Roles (Power & Dell Orto, 2004, p. 127) • Assessor • Informant • Teacher • Builder (of support systems) • Challenger • Advocate • Guardian (preventer)

  18. Intervention: Trigger Points (Power & Dell Otto, 2004) • Diagnosis • Hospital treatment • Outpatient and rehabilitation treatment

  19. Trigger No. 1: Diagnosis (Power & Dell Otto, 2004) • Identify needs. • A very vulnerable time • Provide crisis intervention. • Three phases: Beginning, Middle, Termination • Inform. • Understanding of medical information • Refer.

  20. Trigger No. 2: Hospital(Power & Dell Otto, 2004) • Respond to family needs. • Reframe situation, marshal resources, understand treatment and prognosis, feel competent, establish collaboration • Inform. • Identify strengths and limitations • Suggest solutions. • Support.

  21. Trigger No. 3: Outpatient((Power & Dell Otto, 2004) • Respond to family needs. • Support. • Redefine expectations. • Loved one in the “sick” role… • Balance living and caring. • And …

  22. …, 2 • Assist family to assist the loved one. • Understand the loved one… • Involve the loved one… • Help the loved one… • Understand the family members…

  23. So… • Disability: whose definition? • Tragedy  Opportunity • Adapt & Assist

  24. For example… http://www.ted.com/talks/elyn_saks_seeing_mental_illness.html

  25. Group Counseling

  26. Benefits of Groups (Power & Dell Orto, 2004, p. 154) • Model roles • Support LT needs • Create support structure • Refer to other supports • Teach coping • Channel information

  27. Benefits of Groups (Power & Dell Orto, 2004, p. 154) • Promote dialogue • Create accountability • Diffuse problems • Share burdens • Develop networks • Adapt expectations • Advocate • Model roles • Support LT needs • Create support structure • Refer to other supports • Teach coping • Channel information

  28. Critical Issues (Power & Del Orto, 2004, p. 157) • Marital matters • Sibling reactions • Substance abuse • Work deterioration • Financial pressures • Diminishing social support • Changed lifestyle prospects • LT endurance

  29. Group Leader Tasks (Power & Del Orto, 2004, p. 157) • Structure groups • Model behaviors • Listening sensitively • Create good climate • Set limits • Promote benefit

  30. Group Leader Attributes (Power & Del Orto, 2004, p. 157) • Skills • Intervention • Medical knowledge • Articulation • Discernment • Orchestration • Anticipation • Judiciousness • Characteristics • Kindness • Compassion • Resilience • Perspectives • Experience • Awareness • Understanding • Learning

  31. Family Education

  32. FE: Content (Lefley, 2009, p. 41) • Premise: diathesis-stress model • Medications • Compliance • Expectancy of change • Stress identification and control • Family issues • Loved one issues • Joint planning

  33. Family Psychoeducation Multifamily Groups

  34. FPE: Theoretical Premise (Lefley, 2009, p. 28, 40) • Diathesis-Stress • Biological deficits cause overreaction to environmental stimuli • Techniques can reduce environmental stimulation and complexity • Caregivers can learn these techniques

  35. FPE: A Behavior Management Model • Education • Communication training • Problem-solving training • Coping techniques training

  36. FPE: Common Characteristics (Lucksted et al., 2012, p. 102) • Families: Need info, assistance, support • Assumes: Behavior has effects • Elements: Info, cognitive, behavioral, problem-solving, emotional, coping, consultation • Led by: Trained pros • Part of: Clinical treatment plan • Focus: Consumer • Content: Comprehensive • Dx specific

  37. Dx Specific… • Schizophrenia • Bipolar • Eating disorders • OCD • Dual diagnoses • PTSD • TBI

  38. FPE: Program Types (Lucksted et al., 2012) • Individual family • Multifamily • Include consumer • Don’t include consumer • Length • Emphasis

  39. FPE Goals (Lucksted, 2012, p. 111) • Information • Skills • Problem-solving • Support

  40. International Research (Lucksted, 2012) • China • Six studies show: • Reduced relapse • Reduced burden • Improved functioning • Self-efficacy • Hong Kong • Australia • Italy • Pakistan • Japan • Thailand

  41. Barriers (Lucksted, 2012, p. 113) • Stigma • Lack of confidence in system • Consumer reluctance to involve families • Consumer discomfort or desire for privacy • Skepticism • Competing family responsibilities

  42. FPE: A Model for Asian Americans (Bae & Kung, 2000) • Issues • For stable loved ones in the community • Asians: not a single ethnic group • Targets 1st and 2nd generation • Different classes, different values • Validation needed

  43. FPE: A Model for Asian Americans (Bae & Kung, 2000) Five generalized stages: • Preparation • Engagement • Psychoeducation Workshop • Therapeutic Stage • Ending Stage

  44. FPE: Dissemination Issues (Lucksted et al., 2012, p. 112) • Not compatible with clinicians’ training. • More complex than standard treatments. • Not readily “trialable”. • Outcomes (LT) not readily observable.

  45. Family Consultation

  46. Family Consultation(Schmidt & Monaghan, 2012) • Collaborative process • Agenda set by family’s concerns • Acknowledge the family’s competence • Consultation and support for coping • Individual • Group • Support Group

  47. Family Consultation (Schmidt & Monaghan, 2012) New Jersey: 1st state to offer family consultation

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