Family Matters: Using a Person Centered Consultation Strategy to Involve Families in Treatment and Recovery. Speaker Name Title Organization

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1 Anthony Salerno Ph.D. New York University Anne Smith LMSW University of Rochester Medical Center (URMC) Thomas Jewell Ph.D. URMC & Coordinated Care Services Inc. Family Matters: Using a Person Centered Consultation Strategy to Involve Families in Treatment and Recovery Speaker Name Title Organization

2 Anthony Salerno, Ph.D. In New York State, Dr. Salerno has developed system-wide strategies to promote evidence-based practices, with a particular emphasis on health selfmanagement and family psycho-education. Dr. Salerno was the lead author of the Wellness Self-Management Plus workbook that integrates mental health, substance use and physical health topics. As a senior consultant with the National Council, Dr. Salerno provides consultation and technical assistance to numerous organizations implementing integrated care models for individuals with serious mental health problems. As a faculty member with the McSilver Institute for Poverty Policy and Research affiliated with the Silver School of Social Work, New York University, Dr. Salerno assists organizations serving impoverished communities to systematically adopt and sustain practice innovations.

3 Anne Smith, LMSW Anne Smith is the Executive Director at The University of Rochester s Family Institute for Education, Practice & Research. She has overseen numerous statewide implementations on evidenced-based practices in family psychoeducation and is a trainer for mental health professionals across New York State on how to implement family services, more specifically, the Consumer Centered Family Consultation Model. She also facilitates a variety of training and informational seminars on the importance of involving a support system for people that have severe and persistent mental illness. Anne received her master s degree in social work from the University at Buffalo where her concentration was in mental health, substance abuse and family work. Anne has experience serving children and adults with limited capacities and/or mental illnesses as well as assisting their families.

4 Thomas Jewell, Ph.D. In New York State, Dr. Jewell is Director of Research and Evaluation at URMC s Family Institute, where he also has an appointment as an Adjunct Assistant Professor of Psychiatry. He plays an active role with the Family Institute on family services research and as a training consultant working with community mental health teams striving to implement family services. He is a Senior Consultant at Coordinated Care Services, Inc. (CCSI) in Rochester, NY. As a Project Manager with The New York State Psychiatric Institute s (NYSPI) Center for Practice Innovations (CPI) at Columbia Psychiatry, Columbia University, Dr. Jewell specializes in developing user-friendly technical assistance resources and guiding agencies through practice changes related to the implementation of services for adults with severe mental illness. In his role with CPI he is also a trainer for the NYS implementation of a first episode psychosis program called OnTrackNY.

5 Agenda Understand the value of working with families and others in the person s social network to support and promote the accomplishment of a consumer s personally meaningful whole health goals. Recognize the benefits of a consumer centered consultation model for the consumer, family and friends and the practitioner. Engage a consumer in identifying his/her natural supports that comprise his/her Circle of Support. Apply a consumer centered approach to inform and engage consumers in deciding who to involve and in what way they would like a member of their social network involved. Describe strategies on: a) how to connect with families, b) when to engage and define areas of focus, and c) planning interventions with family.

6 Why is one s social network important? An individual s social network is one of the most significant factors in building personal resilience, managing stress and chronic health conditions, and promoting health and wellness Individuals who have experienced significant BH difficulties are at greater risk for a limited social support. BH and PC organizations do not typically establish routine approaches to explore and engage the consumers circle of support as a resource to promote health and recovery. A recent special edition in APA s Health Psychology Journal (2014) emphasized this point through a comprehensive review of the research literature demonstrating the important role of social networks in adult health. ( In fact, one recent review concluded that the influence of social relationships on risk for mortality is comparable to that of smoking and alcohol consumption (Holt-Lunstad et al., 2010).

7 Benefits of Evidence Based Family Involvement and Challenges Benefits Reduced relapse rates in schizophrenia by 20-50% Fewer/less severe symptoms and greater stability Improved compliance with medication Improved family knowledge, functioning and coping Reduced family member distress (e.g., anxiety, depression) Greater hope, empowerment and life satisfaction for family member Challenges High demands on service providers, consumers and family members Long duration of services Relatively extensive training required Reaches relatively small number of consumers

8 Why the Consumer Centered Consultation Model? The literature provides inadequate guidance on highly practical and feasible models to guide practitioners in exploring the client s circle of support. Involving others as part of the person s health plan needs to align with the principles and values of shared decision making, self-determination, client centeredness, recovery and whole health. Evidence based approaches such as Multiple Family Groups have been challenging to implement and sustain There is a place for a brief, practical and consumer directed approach that engages one or more members of the consumer s Circle of Support in supporting the consumer s goals.

9 Let s Define Family Many different ways to define family. Family can be blood relatives, non-blood relatives, immediate, extended, blended, significant others, close friends, clergy, etc. Most important is that consumer defines who s in his or her family and support network Worth noting: 1 in 4 people in U.S. diagnosed with a major mental illness = lots of family members

10 % of Study Participants (N=230) Consumer Preference for Family Involvement in Care Agree Disagree/Mixed/Refused Written Information Attend Support Group Treatment Sessions Call Team Cohen, Drapalski, Glynn, Medoff, Fang, Dixon. Preferences for Family Involvement in Care Among Consumers With Serious Mental Illness. (Psychiatric Services in Advance, December 15, 2012; doi: /appi.ps )

11 What does engaging the persons Circle of Support for Whole Health mean? Having a conversation with the client about. The important people in his/her life including family, friends, spouse, romantic partner Exploring who the client may want to play a role in promoting their health Identifying the kind of support the client would find helpful Discussing client concerns about involving others in promoting health goals Deciding who and how to engage a person in the client s circle of support Inviting the family member to a face to face meeting including the practitioner, the client and the family member

12 The Consumer Centered Family Consultation Approach Consumer Centered Family Consultation (CCFC) is a brief, educationbased engagement and consultation service that is typically completed in one to five meetings It promotes collaboration among adult consumers of mental health services, members of their family or social network, and service providers to support each consumer s recovery The focus of CCFC is the person/consumer with a behavioral health issue (the focus is not the family or traditional family therapy) There are specific shared decision-making tools embedded in the process of engaging people and their natural supports CCFC provides an opportunity to help by involving people s natural supports in meaningful ways, as well as helping people (consumers and family members) connect to the things that they want/need

13 Consumer Centered Family Consultation 12

14 Tools to help with conversations with consumers

15 Decision guide for involving family or friends to support treatment and recovery What is this guide about? This guide helps adults with whole health concerns and their clinicians. It s a tool for making decisions about whether and/or how to involve family members or friends in support of whole health goals and treatment.

16 Let s take a closer look at the Decision Guide? Copies of the Decision Guide are available on the Family Institute website (see Resources ):

17 Planning Meeting(s) (Prior to family outreach; if client has already consented to family involvement) 1-2 conversations between consumer and practitioner Emphasis: Consumer is in the driver s seat and has choices Plan: the goals/issues to discuss during CCFC (and what not to discuss) Plan: outreach method to family/supports Prep: the family will share some of their perspectives and experiences Discuss: how to handle curveballs

18 Let s take a closer look at the Pre-Planning Tool? Copies of the Pre- Planning Tool are available on the Family Institute website (see Resources ):

19 What happens after the decision guide and pre-planning meeting(s)?

20 CCFC: Face-to-Face Meetings Connect Receive Information Supporting Offering Hope Empathizing Define & Prioritize Wants & Needs Understanding and Acknowledging Prioritizing with All Stakeholders Setting/Refining Goals Managing the Agenda Plan and/or Provide Next Steps Education Support Practical Guidance Problem-Solving Connecting with Resources Referring (e.g, NAMI)

21 ABC s of Consumer Centered Family Consultation Connecting Defining & prioritizing wants/needs Planning action steps

22 CONNECTING Initial stage of a Consumer Centered Family Consultation: Casual conversation Review and describe the purpose and limits of a consultation meeting Support the family in telling their story Demonstrate understanding via empathic responding Commend family members for taking steps to work together and point out other strengths of the family

23 DEFINING & PRIORITIZING WANTS/NEEDS Consultant shares his/her perspective Elicits reactions of family members to consultant s perspective Merges perspectives on shared values and goals Creates a list of consumer and family wants & needs Engages consumer and family members in deciding on high priority issues Identifies high priority issues and discusses next steps

24 PLANNING ACTION STEPS Address high priority wants and needs Imparting information about their loved one s whole health needs, treatment and other services Exploring the degree to which the family member is willing and able to provide support in the manner preferred by the consumer Offer guidelines for families related to supporting their loved one s treatment and recovery Provide emotional support Provide information about resources in the community Direct assistance and advocacy to help family navigate the health system

25 Play video here TESTIMONIALS Mario (consumer) and his mother, June In response to the question: What would you tell a family member who is considering participating in CCFC? Clip: Mario #2 (from beginning)

26 CLINICIAN: I think it leveled the playing field in that I think that everybody left the consultation - all families involved - feeling that it was more of a collaborative approach. That it wasn t the client and us or the client and them but that we were all working on this together.

27 FAMILY MEMBER: Well I have to say that knowing that I have this team behind me, has taken a lot of the pressure off of me and I don t feel so, so all of it depends on me. My husband was not up to dealing with it. So he pretty much left it to me. But it just is good to know that I can turn to this team if I really need to. It makes a big difference having that.

28 CONSUMER: By listening to her [mom s] concerns I gained a better understanding of who my mother is and how she relates to me and how I should relate to her. So, overall it was helpful. And it made it, I think, it gave us a level of comfort that we didn t have before.

29 Play video here Tarell (consumer) In response to question: How did CCFC help your family understand what you were experiencing? Clip: Tarell (from beginning)

30 QUESTIONS

31 CONTACT INFORMATION Anthony Salerno Anne Smith Thomas Jewell