The Power of Family Integration & Natural Supports: Creating & Educating Recovery Teams

The Power of Family Integration & Natural Supports: Creating & Educating Recovery Teams

North Carolina Recovery ConferenceNovember 14, 2014

Ellen Howe, Chris Mulchay, Hillary Jones & Sharon YoungCooperRiis Healing Community

Background & Rationale

• CooperRiis began with bi-annual family ed weekends & informal staff support

• Families loved it but asked for more

• One of our early social workers, Dorothy Haner, presented research which indicates that family ed improves the long term outcomes of treatment

Background & Rationale

• Topics came from family feedback & research

• A curriculum was developed that could be delivered over the phone with co-learner model

• This format was converted into current experiential curriculum

Research Supporting Family Education indicates:

• Markedly higher reduction in relapse and re-hospitalization rates for individuals whose families received psycho-education as opposed to those who did not (differences ranging from 15-20% over 2 years)

• Improved well being of family members• Increased participation in Voc Rehab• Decreased cost of care

Evidence Based Practices for Services of People with Psychiatric Disabilities, Dixon et al, PSYCHIATRIC SERVICES, July 2001 Vol. 52 No. 7

Schedule

• We begin each of the 2 days at 9:00 a.m. & finish at 5 p.m.the first day and 4 the second day.

• We have lunch from 12 to 1 every day.

• We have breaks both in the morning & the afternoon.

Format

• 8 Sessions

• Session length: 1 ½ hrs to 2 hrs

• Teaching modalities: powerpoint presentations, videos, small & large group discussions, & experiential activities

• All activities are voluntary

• Follow-up sheet provided

Topics Covered• Introduction & Orientation • Understanding Emotional Health

Conditions• Effective Communication• Common Reactions to Emotional Health

Conditions• Family Systems• Effective Family Problem Solving• Navigating Times of Crisis• Wrap Up

Session 1: Introduction & Orientation

• Ice Breaker• Background & Rationale for Program• Logistics• Creation of Ground Rules including

voluntary participation & the “T”• Video about recovery movement• Conspiracy of Hope Article• Family Experiential Activity

Mix and Mingle! • Where did you grow up?• What is your favorite desert?• What was your favorite childhood toy?• What superpower would you have if you could?• If you could be any animal, which would you be

& why?• What is a favorite place you have visited?• What place would you like to visit?• What was your first pet?• What would you do if you knew you could not

fail?

The Conspiracy of Hope by Pat Deegan

Session 2: Understanding Emotional Health Conditions

•Acknowledgement of the complexity & mystery of this issue•Advantages & disadvantages of

Diagnosis's

•Video: First person account

about Diagnoses

•Biopsychosocial Model with

scenario•Exploration of Stigma with Video

•Recovery Language w/ role play & exercise

•Small discussions & experiential activity Bricks and Rocks Activity are used to exemplify overcoming stigma

Recovery Language Role Play

Scene• You arrive early for a support group for loved ones with mental health

challenges. Before the meeting you run into a woman you have never met. She introduces herself as Frances and casual conversation ensues. During the conversation, Frances begins to describe her adult daughter:

• Role Play Scenario

Session 3: Strengthening Communication

• Importance of good communication• Assessing communication skills worksheet• Elements of good communication

• Clear vs ambiguous communication w/ practice

• Impact of emotional health conditions on communication

• Managing mis-understandings

Session 3: Strengthening Communication

• Blindfolded mine-field activitiy

• Non verbal communication

• Attentive listening (practice)

• Barriers to listening• Supportive listening

(practice)• I statements (practice)

Communication Scenarios Activity

Scenario:Henry has been feeling quite depressed lately. He works for the family business. Due to his depression, he has been having a harder time getting out of bed and has been missing more work. When he does make it to work he is often late. When his mom asks what is going on, Henry shrugs and just says, “I’ve been sick.” When she asks more about what kind of sickness, he is rather vague, “just sick with whatever had been going around.” She continues to try to gather information, but just gets one or two word answers.

What tips would you give to Henry’s mom about how to respond?

Session 4: Common Reactions to Emotional Health Conditions

• Review the stages of recovery

• Emotional State of Response Model for family recovery process

• 4 Stages of Care Giving Experience Model

• Video Glen Close: Bring Change to Mind

Stage 4 of Care Giving Model

• Acceptance:– I did not cause it.– I cannot control it.– I cannot cure it.– All I can do is cope

with it.

What is Ambiguous Loss?

• A loss of previously held beliefs and expectations about one’s life

• Is not defined by one particular event

• Is vague, unclear, and ongoing

• Is difficult to define and, therefore, recognized by others

How it often looks and feels• Immobilized• Feel helpless and hopeless• Blocked coping • Isolation• Symptoms of depression • Anxiety • Physical exhaustion • Emotional exhaustion • Denial or selective attention to one aspect of the

situation • Feelings of guilt and self blame• Relationships change• Societal beliefs about prognosis enhance

despair

How do I move forward ?– Establish and maintain

some consistency/routine

– Educate yourself

– Identify the loss and acknowledge ways that it has impacted you and your family

– Plenty of social and emotional support

– Identify, accept, and express your feelings and thoughts

– Remember the 4 C’s (cause, control, cure, cope)

– Both/And thinking, Not Either/Or

– Set healthy boundaries

– Acknowledge changes and believe in new possibilities

– Look for the meaning

– Spiritual connection

– Hope

Create a Self Care Plan

– Can be realistically incorporated into your life.

– Are a consistent and preventative practice, not a last resort.

Using the paper and markers provided, create a self-care plan with activities and intentions that:

Session 5: Family Systems

• Activity to elicit different definitions of family w/discussion

• Explanation of family as a system• Family Sculpting Exercise• Family Rules with Video• Explanation of family roles & role changes• Explain types of family boundaries with video• Explain blame trap• Honoring strengths with exercise

Family Sculpting Activity • Narrative Story Presented that most families can connect

with

Cassie is an introverted girl who is bright and gets straight A’s in high school. She has an amazing boyfriend and is close with her parents and brother, who is away at collage. She is sensitive to her father’s on going struggle with depression.

The summer before Cassie left for college, her boyfriend dies. When Cassie begins college, she starts to disconnect from her friends. She moves into her own place where she isolates and begins to make huge darkly themed murals with spray paint.

Cassie gets suspended from college when she gets her grades and discovers she has failed most of her classes.

• Explain and demonstrate how family sculpting works. Set up the first scene then give the audience other scenarios and have them help with the sculpting process.

Problem Solving: Strengthening Skills for

New Solutions

Session Six

New Solutions

• Common problems shared

• Styles of problem solving

• Tips for effective problem solving

• Teaching of a Structured Problem Solving Approach

• Experiential Problem Solving activities

• Quick Sand experiential exercise

Experiential Problem Solving: Group Line Up

Think of a number between 1 and 100.

• Without talking, arrange yourself in a line from lowest number to highest number. Once completed, signal to the facilitator by giving a thumbs up.

Experiential Problem Solving: Group Line Up

Think of an animal.

• Without using words, arrange yourself in order from smallest to largest animal. Once completed, signal to the facilitator by giving a thumbs up.

A Structured Approach to Effective Problem Solving

•Identify the Problem•Brainstorm Ideas•Evaluate Alternatives•Decide on Optimal Solution•Plan Steps to be Taken•Implement Solution•Review: Did the Solution Work?•If Unsuccessful Try Another Solution or Revise Plan and Try Again

Session 7: Navigating Crisis

• Centering activity (video)• Definition and normalization of crisis• Behavioral, emotional and cognitive aspect with

worksheet• Managing Stress• Triggers• Ways to support during crisis• WRAP

– (with Peer Support Specialist)

• Advance Care Directive activity

Aspects of Crisis Worksheet

Session 8: Wrap Up• Give a review of topics, allow for lingering questions to

be answered• De-briefing; structured questions provided to help guide

this process• Family Appreciation Activity with Sea Rose Cards

• Follow up calls

• Families ask to fill out post survey’s to help improve quality of program

DataSurveyed participants (59) indicated that they moderately to strongly agreed that:

- the topics were relevant.- helpful information was learned.- the family emerged as a stronger recovery team.

- they felt personally supported by the experience.

- the format for the training was effective.

Data

• Pre/Post Knowledge survey data indicated that participants on average, gained significant knowledge about the topics covered in the training

• On a 1-5 scale average rose from 2.7 to 3.9 (2 = a little knowledge, 3 = a lot of knowledge, 4 = fully knowledgeable)

Data

• Participants rated the following topics as most helpful:

The role of hope within recoveryLearning specific communication skills such as “I statements”Learning about the concept of

ambiguous lossLearning about WRAP

Learning about stigma

Data

• Quotations from participants:

It was helpful to learn how a change in language used has such an impact. . .

The section on ambiguous loss reminded me how important this is for my son and how maybe more attention should be place on this. .

I like the idea that when you help others you are giving yourself a message of worthiness.

Family sculpting is a powerful visual to clarify family roles.

Data• Quotations from Participants:

WRAP was so good. I like the thought of looking at ourselves as our own detectives

Forgiveness and acceptance of what is and what has already happened as a result of my illness feels more possible now.

I feel more validated in my struggles and feelings through the process and feel that my parents may feel more at ease with their role and reactions.

Data

• Quotations from Participants:

Learned active listening. Learned I don’t have to solve the problem or issue!

I think we’ll work together to better communicate and notice the signs sooner, and accept challenges when they arise.

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