Family Psychoeducation for Serious Mental Illness

Transcription

1 University Press Scholarship Online You are looking at 1-7 of 7 items for: keywords : family psychoeducation Family Psychoeducation for Serious Mental Illness Item type: book acprof:oso/ This book gives an overview of family psychoeducation as an evidencebased psychosocial treatment for schizophrenia and other major psychiatric disorders. Family psychoeducation has produced a robust body of research indicating significant, sustained reductions in patients' relapse and rehospitalization rates and improvements in families' wellbeing. Converging with historical changes in mental health systems, the empirical findings and new theoretical approaches that produced this treatment modality are described. Responsive to research data and expressed informational needs of families of persons with severe mental illness, psychoeducational models were developed by major research centers in the U.S., the U.K., and other European countries, and in China. The book presents theoretical premises and a research overview, together with descriptions of model programs and long-range outcomes. Psychoeducation for prodromal, first-episode, and child and adolescents interventions are discussed as well as for diverse diagnoses and special populations. Cross-cultural and international studies are presented, with a focus on uniformities and cultural variations. Briefer versions of family education, now widely utilized, are then discussed, including research findings of efficacy. Generic components are presented together with a discussion of variations. Training models and issues, and required competencies, are presented. Contemporary applications of family psychoeducation in American and European mental health systems are described, with research on barriers to implementation and suggested solutions. A critical assessment of unresolved issues is followed by a discussion of future trends in families' involvement in the treatment process. An Appendix provides information on family organizations and other selected resources for families in various countries throughout the world, as well as useful materials for service providers. Page 1 of 5

2 Model Research Programs: family psychoeducation Page 2 of 5 acprof:oso/ This chapter describes in detail the format, structure, and content areas of some of the major family psychoeducation (FPE) studies. Single and multi-family models and other adaptations are discussed. Initial research in the UK focused on reducing high expressed emotion (EE), but subsequently FPE was extended to low EE families as well based on families' self-assessed needs and problems. Seminal programs in the US evolved in Pittsburgh, California, and New York State. In Europe, the Optimal Treatment Project of Ian Falloon and associates continues as an international collaborative group to promote the routine use of evidencebased practices (EBPs) for schizophrenia in clinical facilities, including FPE. Large sample studies indicate the efficacy of these bundled optimal treatments. Miklowitz and Goldstein's Family Focused Treatment for bipolar disorder is described. A final section on long-term effects ranging from seven-year to eleven-year follow-ups, in Germany, the UK, and Italy, showed positive effects. International And Cross-Cultural Studies: uniformities and variations acprof:oso/ This chapter states that family psychoeducation (FPE) is increasingly being applied in multiple cultural contexts, rural and urban. Most FPE offer the basic content of education about mental illness and problemsolving techniques. Almost all have yielded findings of symptom reduction and fewer hospitalizations. Special programs developed for ethnic communities in the UK the US, and Australia are described, with materials reflecting cultural values or norms added to basic FPE content. Suggestions for adapting FPE content and examples of illness management training for Latino patients with schizophrenia are presented, with research results. Examples of FPE and data from a large number of countries, primarily from Europe and Asia, and one from Latin

3 America, are presented. The European Commission Study explored both the impact of training for staff professionals and the results of their FPE interventions in six countries in Europe. Exceptionally rigorous FPE studies in China, and others in Thailand and Japan, have also produced positive findings. Family Interventions In Major Mental Illness: models and commonalities acprof:oso/ This chapter compares different models of family interventions in serious mental illness. Family therapy has been based on a premise of systemic dysfunction, although some newer models question preexisting pathology and focus on strengthening coping skills; family consultation is limited to helping families address specific concerns. Family psychoeducation (FPE) and family education (FE) have similar core content. However, FPE focuses on client outcome, while briefer FE, taught by trained family members, is designed to help key relatives understand and cope with the illness. Two other multi-family models include psychoeducational support groups, offered by some agencies as an ongoing supportive resource for clients' families or for the general public. Family support groups, which are also open ended and continuous, are usually extensions of advocacy groups such as NAMI or MHA. Some research data show positive effects of FE for participants. However, only FPE fully satisfies the EBP criteria established in the introduction for treatment of clients. Early Interventions: prodromal, children, and adolescents acprof:oso/ This chapter focuses on family psychoeducation (FPE) for prodromal interventions and for children and adolescents with a diagnosis of severe emotional disturbance (SED). In the Portland Identification and Early Page 3 of 5

4 Referral (PIER) program in Maine, teachers and health care workers in seventeen school districts collaborate to identify prodromal signs of potential schizophrenia with referral for treatment. The integration of McFarlane's multi-family FPE with other treatments were used in PIER and for first-episode psychosis in various sites, including the Treatment and Intervention in Psychosis (TIPS) project in Norway and Denmark, and other European projects. First episode-psychosis interventions include the Prevention and Recovery of First Episode Psychosis (PREP) program in Illinois, and HOMES (Home-Oriented Management of Early Psychosis) in Australia. Family interventions for bipolar disorder of children and adolescents include RAINBOW, Ohio State University's Program for Childhood Mood Disorders, a Canadian program, and others. Positive findings include symptom alleviation and improved relationships with peers and families. Theoretical Premises and research overviews: the evidence for family psychoeducation acprof:oso/ This chapter provides a distillation of the theoretical premises underlying family psychoeducation (FPE) and the large research overviews that support its efficacy. FPE is based on the basic premise that underlying biological deficits make certain individuals overreact to environmental stimuli that are experienced as stressful. With appropriate education, FPE not only reduces demands of high EE but under any conditions makes for more competent caregiving and improved relationships. The chapter then presents a large number of comprehensive overviews of randomized controlled studies of FPE, with descriptions of the methodology of several major meta-analyses. Overall, these studies demonstrate significant reduction of relapse and rehospitalizations, reduction of days in hospital, and improvement of family knowledge and wellbeing in patients whose relatives received FPE in contrast to other or no family interventions. Page 4 of 5

5 Introduction acprof:oso/ This chapter defines the basic concepts used in this book. Evidencebased practice (EBP) refers to the application of empirically-supported treatments in work with clients. As an EBP, family psychoeducation (FPE) is a time-limited structured intervention that reduces relapse and rehospitalization of clients with serious mental illness by enhancing their families' knowledge and coping skills. Serious mental illness is defined in terms of diagnosis, severity, and persistence, along with prevalence data from national population-based studies. The chapter presents data on the scope of families' involvement with persons with serious mental illness, in residential caregiving and/or ongoing social support. With few service providers offering education on illness management, education programs were largely developed outside of mental health systems, by organizations such as NAMI and MHA. Within systems, FPE emerged with research support of treatment efficacy by focusing on illness education and training in communication and problem-solving techniques. Page 5 of 5