Transcript Pyramid of Family Care

Pyramid of Family Care Revisited:
Family Needs & Our Resources
Yasaman Mottaghipour, Ph.D
Overview
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Introduction
Pyramid of Family Care
Pyramid Journey
Capacity Building
Training
Supervision
Literature
• Family intervention efficacy in:
– reducing relapse rate
– decreasing stress and burden
• Family intervention/diagnosis
• Service delivery level/effectiveness
• Collaborate with families
(not pathologise)
Barriers to Family Work
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Skills and training
Confidentiality
Resources
Attitudes - family work “highly specialized”
Family Needs
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Information/education
Coping skills
Crisis support
Communication
Rarely family therapy
Pyramid of Family Care:
A framework for family involvement with
adult mental health services*
*Mottaghipour Y. & Bickerton A.
The Pyramid of Family Care:
Concept
• Food Pyramid
• Maslow’s Pyramid
Maslow’s Pyramid
SelfActualisation
Esteem Needs
Belonging Needs
Safety Needs
Physiological Needs
Pyramid of Family Care
Minimum standard
of care
Pyramid of Family Care:
Overview
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User friendly template for everyday practice
Basic to specialised
Clinical and training tool
Minimal standard of care
Collaboration
Pyramid of Family Care:
Confidentiality dilemma
• Consent important
• Confidential and non-confidential information
Pyramid of Family Care
Minimum standard
of care
Pyramid of Family Care
Minimum
standard of care
I.Connection & Assessment
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)
Pyramid of Family Care
Minimum
standard of care
II General Education
I. Connection & Assessment
Pyramid of Family Care:
II. General Education
• Assessment of needs
• Education:
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Mental health services
Illness/treatment
Mental Health Act
Community resources & NGO
• Referral and liaison (as needed)
Pyramid of Family Care
III. Psycho-education
Minimum
standard of care
II. General Education
I. Connection & Assessment
Pyramid of Family Care:
III. Psycho-education
• Assessment of needs
• Psycho-education:
– Single family education session
– Family education group
• Referral and liaison (as needed)
Pyramid of Family Care
IV. Consultation
III. Psycho-education
Minimum
standard of care
II. General Education
I. Connection & Assessment
Pyramid of Family Care:
IV. Consultation
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Assessment of needs
Continue contact and support
Consultation (as needed)
Referral and liaison (as needed)
Pyramid of Family Care
V. Family
Therapy
IV. Consultation
III. Psycho-education
Minimum
standard of care
II. General Education
I. Connection & Assessment
Pyramid of Family Care:
V. Family therapy
• Assessment of needs
• Family therapy
• Ongoing liaison between professionals
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
Uses of the Pyramid of Family Care
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Clinical tool
Quality assurance
Standardization
Training tool
Service development
Research
Pyramid of Family Care:
Conclusion
• Framework for involving families in everyday
practice
• Higher level interventions are built upon familyservice partnerships
• Empowering clinicians to work with families
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
Pyramid of Family Care
V. Family
Therapy
IV. Consultation
Minimum level of care
III. Psycho-education
II. General Education
I. Connection & Assessment
Pyramid of Family Care Journey
Connecting with Carers
Is Everybody’s Business
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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.
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
Pyramid of Family Care/
Educational Package
• Education package based on level two and three
of the Pyramid
• 14 modules to use for family education
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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.
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.
Pyramid of Family Care/
Cultural
Level One:
Connection and Assessment
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Interpreter / Confidentiality
Bilingual
Cultural background
Level of acculturation
Intergeneration conflict
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
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?
Working with “CALD” Carers
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Language
Cultural
Higher level of stigma?
Immigration issues
Lower level of mental health literacy
Resources
More similarities
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 (2010-2013) Wollongong: University of Wollongong, Illawarra Health and
Medical Research Institute
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
Pyramid of Family Care
Guidelines
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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.
Summary:
Pyramid of Family Care Journey
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Educational / Training
Linguistic and Cultural considerations
Manual for families
Guidelines
Applying to Other diagnostic categories
Developing Family Friendly Services
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Pyramid of family care
Cost effective
Sustainable family friendly services
Capacity building
• How family friendly your service is?
Capacity Building
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Leadership
Organizational structures
Workforce development
Strategic resource allocation
Partnerships
Capacity Building
• Leadership : Support for family friendly
initiatives at all levels
• Organizational structures/organizational support
– Committees
– Policy and procedures
– Core clinical group
Capacity Building
• Workforce development
– Training for staff
– Supervision and consultation
• Strategic resource development
– Factsheets and packages
– Family room
• Partnerships: Working with Non Government
Organizations
Capacity Building
• Initial linking and engagement of families
• Knowledge and skills
• Support for families
Training and Supervision
Carers’ Experience
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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 FristEpisode Psychosis. Schizophrenia Bulletin , 37(2):381-388, 2011.
Experience of Family Psychoeducation
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Alliance
Support
Anxiety and tension
Knowledge and learning
Time
Structure
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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.
Pyramid of Family Care:
Baseline Clinician Skills
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Counselling
Empathic listening
Skills in developing a working alliance
Knowledge of mental illness
Training:
Connection and Assessment
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“CAP” – Connect , Assess and Plan*
Change of attitude
Shared language
Words to use when working with carers and
patients/clients
*Mottaghipour Y. & Bickerton A.
Outline of the “CAP” :
Family Assessment Proforma
• Reason for referral
• Genogram
• Family and the illness:
– Knowledge
– Impact
– Past treatment experiences
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
Process of Family Recovery
• Denial
• Recognition
• Coping
• Advocacy
Denial
Experience
•Devastation
•Guilt
•Shame
•Blame
•Anxiety
•Depression
Information
•Etiology
•Treatment
•Prognosis
Skills
Survival skills
Recognition
Experience
Information
Skills
•Hopelessness
•Limitation of
services
•Disillusionment
•Worry
•Burn-out
•Mourning
•anger
•Meaning of
symptoms
•Resources
•Medications
•Crisis response
skills
•Negotiating skills
Coping
Experience
Information
Skills
•Accepting
chronicity
•Letting go of
dreams
•Acknowledging
personal limits
•Trying new
behavior
•Focus on
management
•Personal stress
•Managing
symptoms
•Self-help groups
•Personal stress
management skills
•Symptom/problem
behavior
management skills
•Collaboration skills
Advocacy
Experience
Information
Skills
•Confrontation
•Initiation
•Assertiveness
•Transformation
•New awareness of
personal power
•Renewed capacity
to feel alive and
excited
•Public relations
•Political process
•Advocacy
•Advocacy and
organizational skills
•Educational skills
Training:
General Education
• Workshop
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Genogram
Family of origin
Family questions/ group exercise
Resources
Role playing
Training:
Psychoeducation
• Workshop
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Referral
Contact
Preparation
Observers
Content
Role playing
Training:
Consultation
• Direct service for families
• Training for staff
• Family consultation session:
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Clinician referral
Consultation team
One way mirror
Family viewing consultation team as well
Therapeutic summary letter
Family therapy
Supervision
• Parallel process/ booster session for us?
• Adherence to protocol
• Shared/common language
Supervision
Supervision, Supervision,
Supervision !!
What We Gain?
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A team member
Ally
Better outcome
Satisfaction