successful single family engagement
Post on 30-Dec-2015
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Successful Single Family Engagement
Be friendly
Listen
Be curious about families’ actual experience
Don’t censor empathic responses to tragic
events
Use the “Sorry” strategy
Come to terms with not being the only one with
knowledge and skills
Be responsive to requests and give practical
help as asked
Successful Multi-Family Engagement
Tell them it works
Model non- pathologising and non-judging
Reassurance about being better or worse than
others
Stigma busting
Reassurance about confidentiality
Help in managing symptoms
“What do I have to offer”
“What can other families offer me”
Psychoeducation Workshop What we are aiming for?
• Families feel well informed about current
biological, psychological and social information
and options for individual and family well being
• Families have felt able to share their experiences
with others
• Both ill and non-ill family members are viewed as
skilled and knowledgable
• Families engage well with each other
Psychoeducational Workshop
You are the dinner event host.......for a group of
people who are anxious, have special needs and
who don’t know each other
Psychoeducation Workshop Process
• Keep it interactive and explorative
• Encourage everyone to be involved
• Use inclusive language (Take a “we” and “us”
stance not a “they” stance)
• Accommodate many knowledges rather than
trying to impose one framework or a “right way”
• Float hypotheses and dilemmas to generate
discussion
• Promote “bilingualism” (psychiatric lingo as well
as the lived experience)
Psychiatric BilingualismPrivate Experience
Sensitive to stimulus: “I can taste and hear everything” “I’m super-sensitive”
Confusion: “scrambled newspaper”
Feeling overwhelmed: “There’s too much going on”
Distracted: “I can’t read or concentrate” “my head is racing all the time”
Special experiences “stuck on something” “It feels like the world is depending on me” “I thought I was God”
Feeling unsafe & suspicious
Finding it hard to sleep/ “I can’t sit still”
Psychiatric Terms
Disturbed Arousal and
Attention
Thought Disorder
Disorganisation
Delusions
Hallucinations
Withdrawal
Paranoia
Loss of motivation
Bilingualism
Working in families’ own language
Favourite metaphors of mental illness from
clients, families .. or yourself
Thoughts on Engagement“Everyone was treated equally. Coming to group made ill people feel not
ill” (M- non-ill partner)
“It was helpful that other people were being so open and nobody was treating you like an idiot. It gave me confidence to open up” There was that safety from disapproval and criticism and just not being understood” (B-non-ill mother)
“The skills of the workers in helping people feel confident to speak is very important” (Pa-ill family member)
“The group was a healthy shift in focus because it wasn’t too serious. There’d be food on the table, tea and coffee. It wasn’t a lot of long faces around the table. So there was a sort of lightness about it instead of a dead seriousness that sometimes happens” (B-carer mother)
Psychoeducation Workshop Content
Causes of mental illness
Common illness experiences
The role of medication and non-medical treatments
Family impact/ trauma
Families' sharing their lived experience
The service system
Coping skills that families find useful
It comes down to Arousal Attention and Integration
The relationship between arousal and attention is sensitive..
We need to be aroused on a sensory level to pay attention to the world around us
In a psychotic state, people are over-aroused. This means they find it hard to pay attention and to process information properly.
Low attention and arousal can result in negative symptoms
Brain Changes
• Prefrontal cortex (underactive)
Problem-solving, planning, attention, initiative, motivation
• Limbic system (overactive)
Heightened arousal
Cingulate cortex (underactive)
Emotional lability and disconnection of thoughts/feelings
Causes: The Likely Culprits
Some genetic predisposition –activation of underlying codes
–may be more so for illness consisting of negative symptoms
Some trauma impact (Brian Koehler, John Read (9.3X Psychosis)
–sensitisation to stress (cortisol pathways)
– purposeful adaptations
–may be more prevalent for illness consisting of positive symptoms
Some interactional stress (Helm Stierlin) –strategy for resolution of intractable conflict (intra personal, family and /or social)
–purposeful positioning
Stress Vulnerability Model
Variable individual stress thresholds
Biological and psychological vulnerability
Multiple stressors or triggers (primary & seocondary)
Family Communication Stress (EE)
High Expressed Emotion = Intensity, negativity and complexity (Leff & Vaughan)
e.g.• Critical comments• Over-involvement• Lack of warmth• Crowding• Excessive pressure to perform• Interactions with conflict• Multiple sources of input
or... Changes to family perceptions of ill person that lead to changed communication (Barrowclough)
Content: Available Treatment
Physical issues (Sleep, drugs, vitamins, natural remedies)
Medical treatment/ CTOs
Non-medical ways of dealing with primary impact (thinking skills, managing symptoms, managing arousal/ triggers)
Dealing with secondary impact (social skills, personal development, employment)
Content: Family Impact
Discarded ideas of families as causing mental illness (be up front about this)
How families deal with trauma impact
Changes to life cycles/family roles
Challenges to communication and conflict resolution
Coping skills
Options: Single Family work, Debriefing and Multi-family group work
Inner West MFG Evidence
Ill family members in the MFG had significantly less relapse than those who were in case management only
12% of MFG group vs 36% of CM group immediately after the group
25% of MFG vs 63% of CM group after 18 months
Significant reduction in psychiatric symptoms for families in MFG
Ill family members in the MFG were more involved in employment-related activities
Content: The service system
Outline the roles of the various teams including emergency options, case management and ISPs
Identify non-government psychiatric support services, centrelink and CRS services
Describe individual and family therapy services
Describe client and carer advocacy services mental illness fellowship, SANE, ARAFEMI
Content: Coping Skills• Revise expectations, temporarily
– be realistic– determine your own yardstick
• Keep the emotional environment low key– enthusiasm is normal; tone it down– disagreement is normal; tone it down
• Give people space– Time out is important for everyone– It is okay to offer. Its okay to refuse.
• Be clear about limits– Create reasonable rules for living together.– Rules and limits can help create a low key predictable home environment
Content: Coping Skills• Ignore the unimportant stuff
– No one can change everything at once.
• Keep communication simple– Discuss what you have to say to each other calmly, clearly and positively
• Be clear about the best use of medication– Let the doctor know about side effects or concerns– Keep track of medication usage
• Develop a normal family routine– Keep many family routines independent of the person with the illness
• Pick up early warning signs– take time to study and identify particular warning signs– discuss them at times of low tension– initiate contact with mental health workers
Ongoing Group: Format• socialising 10• go round (past two weeks) 20• defining a focus for work 10
• simple problem• narrative problem• solution focussed exceptions
• generate ideas (no holds barred) 10• toss around up and down side 20 • locate workable solutions 5• generate a plan with the family 5• socialising 10
Picking the problem
• Don’t ignore medication, safety or drug issues!
• Simplify• Narrow• Concentrate on behavior• Focus on relapse risk• Avoid crisis issues too complex or risky for
the group setting
Brainstorming
• All members can contribute
• All suggestions are welcome
• No suggestion is analyzed or critiqued during
brainstorming
• Suggestions are limited to 10 - 12 ideas
• The person with the identified problem chooses 1 -
2 suggestions to try
Taking Action
• An action plan is developed for the chosen suggestion(s)
• Tasks are identified and assigned• Consensus is achieved prior to leaving the
meeting• The plan is reviewed at the next meeting to
determine success or the need for further problem-solving
Working on ProblemsIt was great to have that creativity from the group by exploring it on
the whiteboard and then getting a photocopy on different issues and different suggestions (E- ill family member)
“It was a space where we could actually have mental health issues talked about. My dad and I had never spoken about it (E- ill family member)
“Being with people in the same boat means you are compelled to find solutions” (A-ill family member)
One older member talked about the importance of forgiving each other so their change in behaviour was not always as great as
their way of thinking” (A-facilitator)
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