Family intervention

1. Family intervention Done by :- Mohamed Abu Shawish

2. بعض مبادئ العلاج الاسري • WE ARE A DANCING PART OF BIGGER DANCE OF INTERACTING PART. ( G.BATESON). • نحن جزء راقص من المجموعة الراقصة المتفاعلة الكبرى • (جيدو بيتسون)

3. Family Intervention (FI) • FI emerged when research began taking interest in the family and the effects of the home environment on mentally sufferers after discharge from the psychiatric institutions . • FI reflects a shift from viewing families as the cause of illness to a source of support for the ill relative.

4. Family intervention science • Well define area of research in changing behavior in family. Nursing curricula need to shift from traditional family approaches not supported by research to evidence based family intervention.

5. Family movement • Patients who still live with their families should be offered a family psychosocial intervention and provides a combination of education about the illness, family support, crisis intervention, and problem solving skills training. Such interventions should also be offered to family caregivers (Lehman et al, 2004). • For these reason many institutions work in this issue include the National Alliance on Mental Illness (NAMI), the Federation for Families for Children's Mental Health, and Mental Health America (MHA), which was formerly the National Mental Health Association to offer rich resources for nurses working with families.

6. Cultural competency Cultural competence is essential in family interventions. • Respecting the roles of family members and community structures hierarchies, values, and beliefs within the patient's culture is critical (APA, 2007). • Specific multicultural contexts include immigration status, economics, education, ethnicity, religion, gender, age, role, minority-majority status, and geography. • Nurses need to examine their own sociocultural contexts, recognize similarities and differences with those of patients and families.

7. Cultural competency Studies in different cultures found that the Western or standard model of family intervention was not suitable to their cultures and may be intrusive also, it failed to show positive treatment outcomes (Weisman 2006). Culturally sensitive FI studies reported significant reduction in relapse rates and increase in patients and carers’ satisfaction with the service (WHO, 1998).

8. Professional Training • Clinical training programs in family therapy are open to psychiatric nurses and other health care professionals across the United States. They vary in duration, theoretical framework, and the level of knowledge and credentials required for participation. Usually they are limited to clinicians with graduate degrees in mental health. • Although the nurse generalize needs knowledge of family systems in one's daily clinical work with patients, the nurse family therapist should have a master's degree and didactic content and clinical seminars focused on formal family work and individual or group counseling related to awareness of one's family of origin

9. Family theories and intervention approaches • Currently, there's no unified system of family functioning has been established much of the original family therapy work was defined by specific schools, approaches, or models of family therapy. • Recognized family theories, include developmental, gender, organizational, functional, conflict, symbolic interaction, systems, family life course development, ecology, and social exchange and choice do exist (white and Klein, 2002).

10. Theoretical approaches to intervention includes cognitive behavioral, experiential, integrative, brief, systemic narrative, psychodynamic, psychoanalytical, solution focused strategic, structural, Transgenerational, and risk and protective factors (Sadock and Sadock, 2007). • Family theories provide a way to examine family processes, such as hierarchy (who is in charge), boundaries (closeness without much closeness or enmeshment and distance or estrangement), organization (how tasks are structured). • It is important for family therapist and psychiatric nurse to differentiate between adaptive and maladaptive family functioning in order to appropriately identify target symptoms for interventions.

11. Dysfunctional family pattern include • The acting-out adolescent who is a symptom bearer whose symptoms bring the family to treatment • The overprotective mother and distant father (distant; Through work, alcohol, or physical absence). • The over functioning "super wife" or "super husband" and the under functioning passive, dependent, and compliant spouse. • The spouse who maintains peace at any price and denies difficulties in the marriage bur suddenly feels wronged and self-righteous when the mate is discovered to be in legal trouble or having an affair.

12. The child who exhibits evidence of poor peer relation ships at school while attempting to parent younger siblings to compensate for ineffective or emotionally overwhelmed parents. • The overly close three generations of grandparent, parent, and grandchild in which lines of authority and generational identity are poorly defined and the child acts out because of a lack of effective limit setting by an agreed-on parental figure, The family with a substance-abusing member

13. Risk and protective factor

14. Assessment and planning The goals of a family assessment and subsequent intervention are as follows (Sadock and Sadock, 2007): • Reduction of psychiatric symptoms • Increase in family resourcefulness or skills Improvement in individual psychological needs and family interactions • Enhanced family awareness of how family patterns affect the health and satisfaction of their members. • Selection, implementation, and evaluation of treatment. Many methods of family assessment have been identified, including measures of relationships, family history, family APGAR, family relational diagnoses, self-report inventories, and genograms.

15. Model of assessing family • A systems model for assessing families would examine five levels, including individuals, dyads, nuclear families, extended family, and community and cultural systems. • The gold standard in clinical assessment is the clinical interview, and in clinical research it is the analysis of video- or audio-taped interviews. • One nursing model is the Calgary Family Assessment Model (CFAM) and the companion Calgary Family Intervention Model (CFIM) (Wright and Leahey, 2005). • Families are examined from structural, developmental, and functional categories to identify strengths and problems in the assessment. Interventions target change in cognitive, affective, and behavioral domains of family functioning. This model is often used to help families cope with physical or psychiatric illness in a family member.

16. Relational problem • There is no formal family diagnostics system existing, nurse may useful to use family relational problem in term of categorize described in the DSMIV.TR

17. Intervention THE PURPOSE OF FAMILY INTERVENTION IS • To promote, improve, and/or sustain effective family functioning in three domains: • Affective • Behavioral • Cognitive • This aimed to engaging families and encouraging them to be active participants in treatment and recovery thereby increasing their knowledge and improving coping skill; both patients and their families (Nathan and German, 2007). • Family interventions are delivered in a variety of settings, schools, homes, outpatient programs, offices, inpatient unresidential treatment programs, hospitals, courts, child developmental centers, churches, and other community settings. Nurpsychiatrists, psychologists, and social workers can provide family interventions, as can licensed marriage and family counselors

18. Indication for family intervention • Illness of one family member causing detrimental effect on another • Behavior of family member contributes to problems of another • One family member’s improved situation results in symptoms on another • Development of emotional, behavioral, or physical problem within the context of an already existing illness. • Illness newly diagnosed. • Marked deterioration of a family member’s condition. • Chronically ill family member moves home • Individual or family milestone missed or delayed • Chronically ill family member dies.

19. Contraindication of FI. • All family members decline pursuing help as a family • Family desires assistance, but from another professional.

20. Psychotherapy Family psychotherapy has two essential principles that distinguish it from individual or group therapy and from other types of family interventions, such as skills building. • The family is conceptualized as a behavior system unique properties rather than as the sum of the characteristic of its individual members. • It is assumed that a close relationship exists between the way a family functions as a group and the emotional adaptation of its individual members. The purpose of family psychotherapy is to improve inter-personal skills, communication, behavior, and functioning. • Page 609 psychotherapy useful in:-

21. Out come Measures Outcomes of family interventions include:- • individual change (e.g., medication adherence, hospitalization, relapse intervals, utilization of skill training, employment, global state, independent living, social functioning, school attendance). • interactions relevant to problem behaviors or social systems (e.g., family experience, ability to cope, need for supervision, effective communication). • Instruments such as the Burden Scale for Family Caregivers, which focuses on perceived negative effects of the caregiver situation and the health of the caregiver, are used by clinicians and researchers to examine the impact of medical and psychiatric disorders on the family. • In selecting an instrument for family intervention, nurses should use the best-known, standardized, briefest, and most valid and reliable instruments. The instruments should be pilot tested.

22. Research in family intervention • Studies of family intervention effectiveness, also known as family intervention science, have mostly been conducted in the last two decades. Research on families can include basic family research, family intervention research, and family-related research. In each of these areas of research, the conceptualization, measurement, and analysis view the family as Systems are composed of units who have some relationship to each other and are organized around those relationships, a change in one part causes a change in another

23. Youth • Much family intervention research has focused on youth. In 1999 the Office of Juvenile Justice and Delinquency, in collaboration with the Center for Substance Abuse Prevention, searched for "best practice" family-strengthening programs, specifically family pro-grams that have proven to be effective in the prevention of youth substance abuse and other dysfunctional behavior. • A guideline. Preventing Substance Abuse Among Children and Adolescents: Family-Centered Approaches, was developed based on systematic review (USDHHS, 1999). This guideline is based on the belief that the family is the first line of defense and they need to know which family interventions are effective in preventing substance abuse.

24. Multisystemice family therapy • MST is the integration of empirically based approaches, such as structural family therapy, cognitive behavior therapy, and psychopharmacological treatment, to address a variety of risk factors across the family, peer, school, and community levels. Treatment principles are clearly identified, and the home-based therapists are actively supervised. MST has been the focus of federally funded projects with multiple replications, revisions, and adaptations, and it is included in policy recommendations for juvenile offenders.

25. Family skills building The purposes of family and parent skills building are as follows: • Provide parents with new skills that they can use to nurture and protect their children. • Train parents to -deal with challenging children. • Help children develop prosaically skills. The level of evidence for the effectiveness of these programs is strong example of these program are:- • The Kumpfer Strengthening Families Program (SFP). • the Effective Blade Parenting Program, a cognitive behavioral program designed to meet the specific needs of African-American families. • evidence-based family intervention for youth is in-home support. A U.S. Prevention Task Force evaluated the effectiveness of early childhood home visitation for preventing violence (CDC, 2003).

26. Family psychoeducation • Much overlap exists between psychoeducarion and family psychotherapy for families with members who have schizophrenia and mood disorders. Psychoeducarion is often combined with marital and family therapy. Both psychoeducarion and psychotherapy focus on problem-solving and communication therapy. Outcomes of these interventions have demonstrated decreases feelings of rejection by family members, decreases in patient relapse. • A well-recognized psychoeducarion intervention was developed by the National Alliance on Mental Illness (NAMI). In the Family-to-Family program, families teach other families about the illnesses experienced by adult family members, methods of coping, and support resources. Participants have underscored the significance of information coming from other families in the education and support component of the program (Hyde et al, 2003).

27. Couple therapy • Another area of research focuses on the relationships of couples. Relationships have implications for health. Persons in healthy marriages and satisfying relationships have better health, healthier lifestyles, greater work productivity, and better coping with stress as compared with those persons who are divorced or never married Marital psychotherapy: is the treatment of the distress in a committed relationship or the education of a couple in regard to what makes healthy relationships, such as good communication skills. This modality has been used in the treatment of depression, substance abuse, sexual dysfunction, divorce, stepfamily conflict, and trauma. Strong clinical evidence supports the effectiveness ofthis intervention.

28. The role of the nurse • Case study ?

29. Mr. Ahmed 25 year old, is admitted for the first time to a psychiatric unit and diagnosed with schizoaffective disorder. He has recently been attending a technical school to learn computer repair, he receive much help from his family member especially the eldest brother Mohamed who seems to be the closest one to him in this decision, His parents insisted he be admitted due to increased isolation, low energy, excessive sleep, and, more recently, evidence that he talks to himself. His family seems supportive and visits him on his first night in the hospital. Case study

30. Correct answer for case study • Individual answer will vary. Possible answer may include the following elements: • Obtain Mr. Ahmad consent to include his family in his treatment. • Observe the patient with his family during their visits. • Provide the family an opportunity to ask questions about the patient illness and course of treatment . • Provide education for the family. • Help to coordinate a family meeting with the patient nurse, social worker, and physician. • Be supportive. • Assess the families needs and resources