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Pyramid of Family Care Revisited: Family Needs & Our Resources
Yasaman Mottaghipour, Ph.D
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Overview Introduction Pyramid of Family Care Pyramid Journey
Capacity Building Training Supervision
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Literature Family intervention efficacy in:
reducing relapse rate decreasing stress and burden Family intervention/diagnosis Service delivery level/effectiveness Collaborate with families (not pathologise)
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Barriers to Family Work
Skills and training Confidentiality Resources Attitudes - family work “highly specialized”
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Family Needs Information/education Coping skills Crisis support
Communication Rarely family therapy
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Pyramid of Family Care: A framework for family involvement with adult mental health services*
*Mottaghipour Y. & Bickerton A.
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The Pyramid of Family Care: Concept
Food Pyramid Maslow’s Pyramid
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Maslow’s Pyramid Self- Actualisation Esteem Needs Belonging Needs
Safety Needs Physiological Needs
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Pyramid of Family Care Minimum standard of care
Minimum standard of care based on service resources and availability
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Pyramid of Family Care: Overview
User friendly template for everyday practice Basic to specialised Clinical and training tool Minimal standard of care Collaboration
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Pyramid of Family Care: Confidentiality dilemma
Consent important Confidential and non-confidential information
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Pyramid of Family Care Minimum standard of care
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Pyramid of Family Care I.Connection & Assessment Minimum
standard of care I.Connection & Assessment
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Pyramid of Family Care: I. Connection and Assessment
Introductions and explanation of the family service partnerships Documentation of the contact details of key family members Assessment of the urgent and basic needs of family Establishment of a system of safety Orientation to the Mental Health service Development of a plan and involvement of other agencies (as needed)
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Pyramid of Family Care II General Education I. Connection & Assessment
Minimum standard of care II General Education I. Connection & Assessment
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Pyramid of Family Care: II. General Education
Assessment of needs Education: Mental health services Illness/treatment Mental Health Act Community resources & NGO Referral and liaison (as needed) At each level , reassess the individual and family needs and connect with other services as needed
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Pyramid of Family Care III. Psycho-education II. General Education
Minimum standard of care II. General Education I. Connection & Assessment
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Pyramid of Family Care: III. Psycho-education
Assessment of needs Psycho-education: Single family education session Family education group Referral and liaison (as needed) Coping strategies, support and education
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Pyramid of Family Care IV. Consultation III. Psycho-education
Minimum standard of care II. General Education I. Connection & Assessment
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Pyramid of Family Care: IV. Consultation
Assessment of needs Continue contact and support Consultation (as needed) Referral and liaison (as needed) Opening up new therapeutic possibilities
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Pyramid of Family Care IV. Consultation III. Psycho-education
V. Family Therapy IV. Consultation III. Psycho-education Minimum standard of care II. General Education I. Connection & Assessment
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Pyramid of Family Care: V. Family therapy
Assessment of needs Family therapy Ongoing liaison between professionals
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Pyramid of Family Care: Moving up the Pyramid
Family related factors: High distress Problems in other family members Pre-existing risk factors - eg. family violence Illness related factors: Type Chronicity Disability
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Uses of the Pyramid of Family Care
Clinical tool Quality assurance Standardization Training tool Service development Research
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Pyramid of Family Care: Conclusion
Framework for involving families in everyday practice Higher level interventions are built upon family- service partnerships Empowering clinicians to work with families
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Pyramid of Family Care Premises
If all family members have their basic needs met, then only a small proportion will need specialized services It is within the scope and competence of generalist mental health service providers to engage, assess and address the basic needs of most family caregivers As clinicians , professionals we have difficult time with basics/common sense. We tend to complicate the issues, think about rare complicated problems/challenges. It is good and bad !!
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Pyramid of Family Care IV. Consultation III. Psycho-education
V. Family Therapy IV. Consultation III. Psycho-education Minimum level of care II. General Education I. Connection & Assessment
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Pyramid of Family Care Journey
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Connecting with Carers Is Everybody’s Business
Training resource Handbook and DVD Capacity building Pyramid of Family Care Bickerton A. et al. Working with Families Program, Sutherland Division of Mental Health, South Eastern Sydney Illawarra Area Health Service, NSW Health 2007. Example with working based on each step of pyramid. exercises
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Questions to Consider Rate your service. What parts get higher or lower rating? How families/carers will rate your service? Children Sibling System of safety
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Pyramid of Family Care/ Educational Package
Education package based on level two and three of the Pyramid 14 modules to use for family education Clinical guide Presentation Fact sheet Video clip Hassack K. Connecting with Carers through Education: a guide for mental health service providers. South Eastern Sydney Illawara, NSW 2010. Hossack k. et al. Connecting with Carers through Education: a guide for mental health service providers, South Eastern Sydney Illawarra Health Service, NSW Health 2010.
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Pyramid of Family Care/ Cultural
Connecting with Culturally and Linguistically Diverse (CALD) carers Linguistic Cultural Acculturation Stigma Woodland Lisa, et al. Connecting with Carers from Culturally and Linguistically Diverse Backgrounds, Multicultural Health and Mental Health Services, South Eastern Sydney Local Health District, NSW Health 2012. Cultural, myths, values in terms of family structure, significant people, health professionals from the same culture Literacy ? For written information
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Pyramid of Family Care/ Cultural
e.g.. for level one: bilingual mental health practitioner/service
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Level One: Connection and Assessment
Interpreter / Confidentiality Bilingual Cultural background Level of acculturation Intergeneration conflict
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Level Two: General Education
Myths about mental illness Stigma : experience and judgment of community Experience of mental health services in country of origin Preferred language and English Multicultural community supports Education to significant people in the community
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Questions to Consider What techniques and resources do you have in your service for connecting with CALD carers? What barriers do you encounter in your service? A play was developed . Language, stigman
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Working with “CALD” Carers
Language Cultural Higher level of stigma? Immigration issues Lower level of mental health literacy Resources More similarities
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Project Air Strategy for Personality Disorders*
Project for personality disorder Improve capacity of mainstream health services Referral pathways between generic and specialist treatment Use of Pyramid of care Training Grenyer BFS & Fanaian M (2015) Final report on the treatment of personality disorders research project ( ) Wollongong: University of Wollongong, Illawarra Health and Medical Research Institute * Grenyer BFS & Fanaian M (2015). Final report on the treatment of personality disorders research project ( ) Wollongong: University of Wollongong, Illawarra Health and Medical Research Institute.
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Pyramid of Family Care: Similar Settings
Responding to the need of children and parents in families experiencing drug and alcohol problems The Supervisor’s guide: Integrating Family Inclusive Practice into Clinical Supervision for the Addiction Workforce National Guidelines for a Comprehensive System to Support Family Caregivers of Adult with Mental Health Problems and Illnesses Grunert S. & Tsantefski M. Prevention Research Quarterly , Australian Drug Foundation Publication, Drug Info 17, Victoria 2012. Kina Families Addiction Trust (2010), The Supervisors Guide: Integrating Family Inclusive Practice into Clinical Supervision for Addiction Workforce. Wellington: Matua Raki. MacCourt P., Family Caregivers Advisory Committee, Mental Health Commission of Canada (2013). National Guidelines for a Comprehensive System to Support Family Caregivers of Adult with Mental Health Problems and Illnesses. Calgary AB: Mental Health Canada
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Pyramid of Family Care Guidelines
70% women 60% employed 20% care for another person as well 47% over 5 years of caregiving Take care of their grandchildren 10% of clients refused consent, but half of family caregivers were contacted. Statistics from research cited on Canadian guideline Clinicians did not believe that such contact would benefit the client.
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Summary: Pyramid of Family Care Journey
Educational / Training Linguistic and Cultural considerations Manual for families Guidelines Applying to Other diagnostic categories
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Developing Family Friendly Services
Pyramid of family care Cost effective Sustainable family friendly services Capacity building How family friendly your service is? Commitment of all staffs How family friendly your service is?
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Capacity Building Leadership Organizational structures
Workforce development Strategic resource allocation Partnerships
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Capacity Building Leadership : Support for family friendly initiatives at all levels Organizational structures/organizational support Committees Policy and procedures Core clinical group Two sided. What we can do for staff, what for families. Two side of a coin. Activities. Interrelated. One builds on another and hence increase the capacity of service
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Capacity Building Workforce development Strategic resource development
Training for staff Supervision and consultation Strategic resource development Factsheets and packages Family room Partnerships: Working with Non Government Organizations Examples from working with families project
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Capacity Building Initial linking and engagement of families
Knowledge and skills Support for families Need more work on initial linking and engagement. On both sides Newsletters, flyers and information sheets (written material), 2 hour session at ward
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Training and Supervision
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Carers’ Experience Burdensome responsibility
Roller coaster and unpredictable experience Feeling responsible for their illness Coming to terms with the change Becoming closer Maintaining hope McCann TV, et al. First-Time Primary Caregivers’ Experience of Caring for Adult with Frist-Episode Psychosis. Schizophrenia Bulletin , 37(2): , 2011.
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Experience of Family Psychoeducation
Alliance Support Anxiety and tension Knowledge and learning Time Structure Nilsen L. et all. Patient and members experiences of a psychoeducational family intervention after a first episode psychosis: a qualitative study. Issues Mental Health Nursing 35(1):58-68, 2014. Oslo study When we plan for training we have to take these into consideration.
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Pyramid of Family Care: Baseline Clinician Skills
Counselling Empathic listening Skills in developing a working alliance Knowledge of mental illness
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Training: Connection and Assessment
“CAP” – Connect , Assess and Plan* Change of attitude Shared language Words to use when working with carers and patients/clients *Mottaghipour Y. & Bickerton A.
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Outline of the “CAP” : Family Assessment Proforma
Reason for referral Genogram Family and the illness: Knowledge Impact Past treatment experiences
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Outline of the “CAP” : Family Assessment Proforma
General Family Assessment: History History of family violence/child at risk Structure Communication patterns Life cycle changes Family - community relationship Family’s strengths Stress level
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Process of Family Recovery
Denial Recognition Coping Advocacy
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Denial Skills Information Experience Survival skills Etiology
Treatment Prognosis Devastation Guilt Shame Blame Anxiety Depression
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Recognition Skills Information Experience Crisis response skills
Negotiating skills Meaning of symptoms Resources Medications Hopelessness Limitation of services Disillusionment Worry Burn-out Mourning anger
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Coping Skills Information Experience Personal stress management skills
Symptom/problem behavior management skills Collaboration skills Personal stress Managing symptoms Self-help groups Accepting chronicity Letting go of dreams Acknowledging personal limits Trying new behavior Focus on management
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Advocacy Skills Information Experience
Advocacy and organizational skills Educational skills Public relations Political process Advocacy Confrontation Initiation Assertiveness Transformation New awareness of personal power Renewed capacity to feel alive and excited
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Training: General Education
Workshop Genogram Family of origin Family questions/ group exercise Resources Role playing
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Training: Psychoeducation
Workshop Referral Contact Preparation Observers Content Role playing
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Training: Consultation
Direct service for families Training for staff Family consultation session: Clinician referral Consultation team One way mirror Family viewing consultation team as well Therapeutic summary letter Or it could be like supervision for staff. The direct service is more like consultation with other specialties in medical setting
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Family therapy
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Supervision Parallel process/ booster session for us?
Adherence to protocol Shared/common language Taping /recording the sessions Group supervision
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Supervision, Supervision, Supervision !!
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What We Gain? A team member Ally Better outcome Satisfaction
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