Employment Multifamily Group Project Alex Kopelowicz, MD Roberto Zarate, PhD Human Interaction Research Institute New Haven, CT – March 15-16, 2012

MFG Staff Training: Day 1 8:00-8:30 amBreakfast 8:30-9:15 amBrief Introductions by Agencies 9:15-9:45 amWelcome/Overview of the MFG Training Program 9:45-10:30- amWhat is MFG and Why Should We Do It? 10:30-10:45 am Break 10:45-12:30 pmMFG Components (Joining Sessions, Educational Workshop & Problem Solving Groups) 12:30-1:30 pmLunch 1:30 – 4:00 pmJoining Sessions (Demonstration & Role Plays)

MFG Staff Training: Day 2 MFG Staff Training: Day 2 8:00-8:30 amBreakfast 8:30–9:00 amReview/Overview of Problem Solving in MFGs 9:00-10:30 amMFG Sessions (Demonstration and Role Plays) 10:30-10:45 amBreak 10:45-12:00 noonMFG Sessions (Role Plays Continued) 12:00–1:00 pmLunch 1:00–3:00 pmMFG Sessions (Role Plays Continued) 3:00 -3:30 pmQuestions and Wrap-Up

Standard Approaches to Family Work Psychoeducation Psychoeducation Communication skills training Communication skills training Problem solving techniques Problem solving techniques Social network development (MFG) Social network development (MFG)

Better Outcomes in Family Psychoeducation Better Outcomes in Family Psychoeducation Over 20 controlled clinical trials, comparing to standard outpatient treatment (Dixon, 2003), have shown: Over 20 controlled clinical trials, comparing to standard outpatient treatment (Dixon, 2003), have shown: –Increased employment At least twice the number of consumers employed, and up to four times greater--over 50% employed after two years--when combined with supported employment At least twice the number of consumers employed, and up to four times greater--over 50% employed after two years--when combined with supported employment –Improved family relationships and well-being –Reduced friction and family burden –Reduced medical illness in family members Doctor visits for family members decreased by over 50% in one year Doctor visits for family members decreased by over 50% in one year

FFT, N=31 CM, N=70 Wilcoxon Test, c 2 (1)=3.99, P =.046 PretreatmentFollow-upTreatment Miklowitz DJ, et al. Biol Psychiatry, 2000;48(6): Year Survival Rates Among Bipolar Patients in Family-Focused Treatment Versus Case Management

Stages of a Psychoeducational Multifamily Group Joining Family and clients separately 3-6weeks Educa- tional workshop Families only 1 day Ongoing MFG Families & clients bi-weekly 6 months

Joining with Families and Clients JOINING means to CONNECT, BUILD RAPPORT, CONVEY EMPATHY, ESTABLISH AN ALLIANCE, ENGAGE JOINING means to CONNECT, BUILD RAPPORT, CONVEY EMPATHY, ESTABLISH AN ALLIANCE, ENGAGE It is the first stage of intervention It is the first stage of intervention Designed to create a bond between Client/Family Members and Family Counselors Designed to create a bond between Client/Family Members and Family Counselors COUNSELOR as ADVOCATE COUNSELOR as ADVOCATE

Joining Proecedures THREE Joining Meetings THREE Joining Meetings  SEPARATELY with Relatives and Clients  WEEKLY – 1 HOUR with Relatives, ½ HOUR with Clients Start sessions A.S.A.P. after client/family enrolls Start sessions A.S.A.P. after client/family enrolls Gain an understanding of family’s stresses, problems, reactions to client’s unemployment/underemployment, etc. Gain an understanding of family’s stresses, problems, reactions to client’s unemployment/underemployment, etc.

JOINING – I 15 Minutes of SOCIAL TALK 15 Minutes of SOCIAL TALK Discuss the experience of looking for, getting and losing jobs Discuss the experience of looking for, getting and losing jobs Review any recent stressful event: Who and what helped or didn’t Review any recent stressful event: Who and what helped or didn’t IDENTIFY WARNING SIGNS OF STRESS – PRECIPITANTS IDENTIFY WARNING SIGNS OF STRESS – PRECIPITANTS Distribute to families & keep for future reference Distribute to families & keep for future reference Describe the plan for ongoing MFG sessions Describe the plan for ongoing MFG sessions 5 Minutes SOCIALIZING 5 Minutes SOCIALIZING

JOINING – II 15 Minutes of SOCIAL TALK 15 Minutes of SOCIAL TALK Review past experiences with co-workers, supervisors, supervisees, etc. Review past experiences with co-workers, supervisors, supervisees, etc. FAMILY’S EXPERIENCE DURING STRESSFUL EVENTS FAMILY’S EXPERIENCE DURING STRESSFUL EVENTS  The sharing of painful events: A crucial aspect of “Joining”  The client/family’s understanding of causes Family’s social network & resources (material & emotional) Family’s social network & resources (material & emotional) 5 Minutes SOCIALIZING 5 Minutes SOCIALIZING

JOINING – III 15 Minutes of SOCIAL TALK 15 Minutes of SOCIAL TALK Family’s social network & resources Family’s social network & resources Developing and maintaining a support network Developing and maintaining a support network SHORT & LONG-TERM GOALS (e.g., Employment) SHORT & LONG-TERM GOALS (e.g., Employment) Preparation for Workshop & MFGs Preparation for Workshop & MFGs

MULTIFAMILY GROUPS Five to eight families Five to eight families Two family counselors/facilitators Two family counselors/facilitators 1 ½-hour sessions – biweekly over six months or more 1 ½-hour sessions – biweekly over six months or more Refreshments/snacks are provided Refreshments/snacks are provided Initial sessions avoid emphasis on conflict Initial sessions avoid emphasis on conflict Initial sessions emphasize establishing a working alliance by building group identity and developing a sense of mutual interest and concern - drop outs are failures Initial sessions emphasize establishing a working alliance by building group identity and developing a sense of mutual interest and concern - drop outs are failures

FIRST MFG SESSION “GETTING TO KNOW EACH OTHER”  Go Around the Room  Background  Hobbies  Occupation  Interests  Counselor Goes First (Discloses/Shares with the Group) SETTING BASIC RULES  Regular ATTENDANCE (for Relatives)  CONFIDENTIALITY (No Pressure to Disclose)  INTERACTION AMONG MEMBERS  PHYSICAL/EMOTIONAL CONTROL  PHYSICAL/EMOTIONAL CONTROL

SECOND MFG SESSION “HOW UNEMPLOYMENT/UNDEREMPLOYMENT HAS CHANGED OUR LIVES” “HOW UNEMPLOYMENT/UNDEREMPLOYMENT HAS CHANGED OUR LIVES”  Building a SENSE OF TRUST & COMMITMENT  Sense of COMMON EXPERIENCE (Listen to each other)  Strengthening GROUP IDENTITY & SENSE OF RELIEF  The CLIENT’S INNER EXPERIENCES  Counselors emphasize the vital role of SHARING GRIEF, CONFUSION, GUILT, FEAR with those “on the same boat”. CONFUSION, GUILT, FEAR with those “on the same boat”. AND HOPE AND HOPE Remind participants about Problem Solving (next session) Remind participants about Problem Solving (next session)

GENERAL POINTS New Members New Members Late-Arriving Members Late-Arriving Members Reminders about Attending Reminders about Attending Crises & Emergencies Crises & Emergencies COMMUNICATION & INTERACTIONS COMMUNICATION & INTERACTIONS  Counselors DON’T speak for clients or relatives  Interaction among members is essential  Clients are ENCOURAGED (not pressured) to participate participate  Respect other’s turn and avoid criticism  Respect other’s turn and avoid criticism

PROBLEM SOLVING IN MFGs The CORE of MFG Sessions The CORE of MFG Sessions Designed to compensate for limited education Designed to compensate for limited education FORMAT: FORMAT: Checking in15 Minutes Go-round20 Minutes Selecting a Problem to Solve5 Minutes Solving the Problem45 Minutes Wrap-up Socializing5 Minutes Counselors should GET READY and HAVE A PLAN – IN ADVANCE Counselors should GET READY and HAVE A PLAN – IN ADVANCE

Selecting an Employment-Related Problem to Solve TOPICS: (Identified prior to MFG or during group) TOPICS: (Identified prior to MFG or during group)Transportation Child Care Drugs and Alcohol Life Events/Domestic Problems Housing Disagreements among Family Members “REJECTED” PROBLEMS: “REJECTED” PROBLEMS: Make a Direct Suggestion and Review Outcome Meet Outside the Group (e.g., Crises) Refer to Past Solutions that Apply Refer to Solution/Family with Successful Outcome

THE PROBLEM-SOLVING METHOD 1. Define the Problem or Goal 2. List Possible Solutions 3. Evaluate Advantages and Disadvantages of Each Solution 4. Choose “the Best” Solution 5. Implement Plan to Carry Out Solution 6. Review Implementation and Outcome