Welcome to the Consumer Centered Family Consultation

“Family Education about Psychosis” Webinar

Hosted by: The Family Institute for

Education, Practice & ResearchThe webinar will begin shortly. Thank you for your

patience.

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Agenda for Today

• Hello and introductions

• Family Education - Background and introducing it to families/consumers

• Structure and Process Considerations

• Materials / Tools that may be helpful to share

• Wrap-up and discussion

What types of family education work (on a 1:1 family/consumer basis) have

people already done?

Background: Factors that led to experts viewing families as allies/partners

• Schizophrenia is a neurobiological disorder

• Biology, not families, causes schizophrenia

• Family factors influence psychosis outcomes

• Families are often default caregivers or case managers

• New treatments and approaches (e.g., person centeredness) bring new roles for people

• Traditional family therapy is not effective for psychosis

• Specific family interventions are among the most effective treatments for psychosis

Source: Amenson, C. S. Schizophrenia – Family Education Methods (copyright Pacific Clinics Institute)

Background: Family attitudes/skills that are associated with positive psychosis outcomes

• Accepting the person as having psychosis

• Attribute symptoms to the condition

• Set realistic, attainable goals

• Include the person in the family

• Provide support from a loving distance

• Maintain a calm family atmosphere

• Give frequent praise and encouragement

• Give specific constructive criticism and/or suggestions to promote growth

Source: Amenson, C. S. Schizophrenia – Family Education Methods (copyright Pacific Clinics Institute)

These family factors are teachable skills

Education about psychosisis often a first step in families

learning these skills

Goals of Family Education in Psychosis

• Provide information about the illness

• Provide a rationale for treatment

• Reduce guilt and blame of all involved

• Foster realistic expectations and hope

• Discuss role(s) that families/supports can have in promoting recovery

• Improve access to services

• Other?

Introducing “Education” to Families/Supports and Consumers

• Share the idea of providing education to everyone

• Suggest that education can help everyone in the family/system

• Transparency: talk openly about the goals for education [prior slide]

• Psychosis education with supports should be considered a strategy for helping consumer achieve his/her specific goal(s)

• Offer to provide education (within CCFC)

Be Clear About Structure and Formatof Education

• This is not a “process” and/or support session

• This is not a session with an open-ended agenda

• There is not an unlimited number of sessions

• This is not skills training/coaching

• This is not a session to solve problems• This is not meant to clarify problems, generate solutions,

and help people select best course of action

Be Clear About Structure and Format of Education (cont)

• This is designed to provide knowledge and resources

• This has a concrete agenda that (mostly) should be clarified “up front” and adhered to

• This is time-limited and curriculum/resource based

• This may or may not introduce skills

Tips• Set agenda in advance of meeting

• Bring enough copies of materials

• Over-estimate the time it will take to go through materials

• Keep one eye on the clock

• Go slower than you’d think

Tips• Take time to orient people to each handout – take

several breaths – then move forward

• Don’t go into all of the details, and tell people why you’re doing this (may need to assess reading levels/interest)

• Don’t let yourself become overwhelmed by multiple problems, new issues, or questions that slow the pace

• Repeat, repeat, repeat

*Sample Agenda from CCFC*

Education Meeting

Materials that may be helpful to share with

families/supports

Psychosis – The Basics

[slides developed for and used with families]

Symptoms Indicating Psychosis

· Hallucinations Hearing voices or seeing visions

· Delusions False beliefs or marked suspicions of others

· Disorganized thinking Jumbled thoughts, difficulty concentrating

Evidence-Based PracticesCopyright West Institute

William R. McFarlane, MD

Functions of the Prefrontal Cortex

• Problem-solving

• Planning

• Attention

• Initiative

• Motivation

• Integration of thought and affect

• Mental liveliness

Evidence-Based PracticesCopyright West Institute

William R. McFarlane, MD

Psychosis represents an unusual sensitivity to:

Sensory stimulation Prolonged stress, strenuous demands Rapid change Complexity Social disruption Illicit drugs and alcohol Negative emotional experience

Copyright West Institute

William R. McFarlane, MDEvidence-Based Practices

Psychological Functioning:Attention & Sensory Overload

• In order to pay attention, the human brain needs to filter and integrate incoming information

• In a psychotic state, people are over-loaded, which makes it hard to pay attention…information is missed

• With negative symptoms, a person is slow to register information and/or has poor attention

EXPERIENCE OF PSYCHOSIS

Actual Experiences

“Sometimes when people speak to me my head is overloaded. It’s too much to hold at once. It goes out as quick as it goes in. It makes you forget what you just heard because you can’t get hearing long enough. It’s just words in the air unless you can figure it out from their faces.”

Actual Experiences

“People took on a devilish look with a black outline and white shining eyes: all sorts of objects—chairs, buildings, obstacles—took on a life of their own; they seemed to make threatening gestures, to have an animistic outlook.”

Schizophrenia Overview Packet

(Document adapted from the Training & Education Center, Philadelphia, PA)

The Complete Family Guide to Schizophrenia

Mueser & Gingerich (2006).

When someone you love has a mental illness

Woolis, R. (2003).

The Family Guidelines

Family Guidelines – Sources: Carol Anderson, Schizophrenia and the Family (Guilford Press, 1986); Dr. William McFarlane, Multi-Family Groups in the Treatment of Severe Psychiatric Disorders (Guilford Press, September 2004).

Family Guidelines

1. Go slow—things will get better in their own time.

2. Keep it cool—tone down disagreements and enthusiasm.

3. Keep it warm—stay connected, supportive and respectful.

4. Give each other space—time out is important for everyone.

5. Set limits—a few good rules keep things clear.

6. Ignore what you cannot change—let some things slide, but DON’T ignore violence.

7. Keep it simple—say what you have to say in clear, calm, positive terms.

Family Guidelines (continued)

8. Follow the treatment plan (Consider using medications)—take only medications that are prescribed and take them only as prescribed.

9. Carry on business as usual—re-establish family routines as quickly as possible and reconnect with family and friends.

10. Take care of yourself—it’s important to keep your own batteries “charged”.

11. Avoid street drugs or alcohol—they make symptoms worse.

12. Pick up on early warning signs—observe changes then consult with your clinician.

13. Solve problems step by step—make changes gradually…work on one thing at a time.

14. Lower expectations temporarily—don’t make unrealistic comparisons, e.g., compare this month to last month rather than this year to last year.

Sample “Future” Education Topics to Cover with Families/Supports and Consumers…

• Information in the CCFC training guide

• Skills for Relapse Prevention

• Future Planning

• Communication Skills

• Other books

• APA and other trade association materials

• On-line / web-based information (e.g., SAMHSA, NIMH, NAMI)

• Partnering with local NAMI affiliate (Family to Family Education program)

Questions to Consider…

• What are your thoughts and/or reactions to providing education to families/supports?

• How does this fit in (or not fit in) with the work you’re doing with consumers?

Discussion and Q & A

Thank you for being with us today• Please complete the 3 survey questions before you

log off.

• The slides in this webinar will be made available on our website at www.nysfamilyinstitute.org

• Next event for PRACTITIONERS will be held on July9th & 10th from 3:00pm-4:00pm

• Next webinar series for QITs will be held on July2nd & 3rd from 3:00pm-4:00pm