2. Welcome to the Consumer Centered Family Consultation “Family Education about Psychosis” Webinar Hosted by: The Family Institute for Education, Practice & Research The webinar will begin shortly. Thank you for your patience. For audio access, please call 1-800-244-9194, then enter code: 990024# For any technical difficulties, please call 585-732-4040

3. 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

4. What types of family education work (on a 1:1 family/consumer basis) have people already done?

5. 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)

6. 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)

7. These family factors are teachable skills

8. Education about psychosis is often a first step in families learning these skills

9. 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?

10. 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)

11. Be Clear About Structure and Format of 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

12. 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

13. 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

14. 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

15. *Sample Agenda from CCFC* Education Meeting

17. Materials that may be helpful to share with families/supports

18. Psychosis – The Basics [slides developed for and used with families]

19. 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 Practices Copyright  West Institute William R. McFarlane, MD

22. Functions of the Prefrontal Cortex Problem-solving Planning Attention Initiative Motivation Integration of thought and affect Mental liveliness Evidence-Based Practices Copyright  West Institute William R. McFarlane, MD

28. Psychosis represents an unusual sensitivity to: l Sensory stimulation l Prolonged stress, strenuous demands l Rapid change l Complexity l Social disruption l Illicit drugs and alcohol l Negative emotional experience Copyright  West Institute William R. McFarlane, MD Evidence-Based Practices

29. 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

34. EXPERIENCE OF PSYCHOSIS

35. 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.”

36. 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.”

37. Schizophrenia Overview Packet (Document adapted from the Training & Education Center, Philadelphia, PA)

43. The Complete Family Guide to Schizophrenia Mueser & Gingerich (2006).

47. When someone you love has a mental illness Woolis, R. (2003).

53. 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).

54. 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.

55. 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.

57. 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)

58. 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?

59. Discussion and Q & A

60. 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.orgwww.nysfamilyinstitute.org Next event for PRACTITIONERS will be held on July9 th & 10 th from 3:00pm-4:00pm Next webinar series for QITs will be held on July2 nd & 3 rd from 3:00pm-4:00pm