Latino Multifamily Group
Staff Orientation
Alex Kopelowicz, MD
Thomas E. Backer, PhD
Valley Nonprofit Resources / Human Interaction Research Institute
Presentation Outline
A. What is MFG and why should we do it?
B. Components of MFG
C. Adapting MFG for Latinos
D. Preliminary findings of RCT focused on
MFG for Mexican-Americans
E. Disseminating the MFG
Components of the Latino MFG

Family psychoeducation

Communication skills training

Problem solving techniques

Social network development
PORT (2004) Treatment
Recommendations

Patients who have on-going contact with their
families should be offered a family psychosocial
intervention which spans at least nine months and
which provides a combination of education about the
illness, family support, crisis intervention, and
problem solving skills training. Such interventions
should also be offered to non-family caregivers.
Better outcomes in family
psychoeducation

Over 20 controlled clinical trials, comparing to standard
outpatient treatment, have shown:
– Much lower relapse rates and rehospitalization

Up to 75% reductions of rates; minimally 50%
– 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
– 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
McFarlane et al 2003
MFG Reduces
Re-hospitalization Rates
1
0.95
0.9
MFG
SC
0.85
0.8
0.75
Months
(Dyck et al, 2001)
11
9
7
5
3
1
0.7
1-Year Survival Rates Among Bipolar
Patients in Family-Focused Treatment
versus Case Management
Cumulative Survival Rate
1
FFT, N=31
0.8
0.6
0.4
CM, N=70
0.2
0
0
5
10
Pretreatment
15
20
25
30
35
Treatment
40
45
50
55
Follow-up
Wilcoxon Test, c2 (1)=3.99, P =.046
Miklowitz DJ, et al. Biol Psychiatry, 2000;48(6):582-592
Remission to 2 years
MFG
SFT
% in remission
100
90
80
70
60
50
0
100
200
300
400
500
600
700
Days at risk
N: PEMFG=83; PESFT=92
Main effect: p=.05
McFarlane et al, 2003
800
Dosages in MFG and SFT
Chlorpromazine equivalents in mgs.
1000
900
875
850
800
751
700
656
600
500
400
-5
McFarlane et al, 2003
0
5
10
15
Months
MFG
SFT
20
25
30
Stages of a Psychoeducational
Multifamily Group
Joining
Family and
client
separately
3-6 weeks
Educational
workshop
Families only
1 day
Ongoing
MFG
Families &
clients
bi-weekly 6-9 months
MULTIFAMILY GROUPS






Five to Eight Families
Two Facilitators
1 ½-Hour Sessions – Biweekly – 6-9 months
Refreshments/snacks provided
Initial sessions avoid emphasis on clinical
issues
Initial sessions emphasize establishing a
working alliance by building group identity
and developing a sense of mutual interest
and concern. Drop outs are failures
JOINING with FAMILIES & CLIENTS
JOINING
means to CONNECT, BUILD
RAPPORT, CONVEY EMPATHY, ESTABLISH AN
ALLIANCE, ENGAGE
It is the first stage of treatment
Designed to create a bond between
client/family members and facilitators
FACILITATOR as ADVOCATE
PROBLEM SOLVING IN MFGs




The CORE of MFG sessions
Designed to compensate information-processing
deficits in mental disorders
FORMAT:
Checking in
15 Minutes
Go-round
20 Minutes
Selecting a Problem to Solve
5 Minutes
Solving the Problem
45 Minutes
Wrap-up Socializing
5 Minutes
Facilitators should GET READY and HAVE A PLAN –
IN ADVANCE
THE PROBLEM-SOLVING
METHOD
1.
2.
3.
4.
5.
6.
Define the Problem or Goal
List Possible Solutions
Evaluate Advantages and
Disadvantages of each Solution
Choose “The Best” Solution
Implement Plan to Carry Out Solution
Review Implementation and Outcome
The Assessment of Culture


Best undertaken by paying attention to
people’s daily routines and how such
activities are tied to families, social
networks and communities
The key to a cultural assessment is asking
what matters most to people or what is
most at stake for people
The cultural question is:

What are the factors in a particular
culture that need to be considered prior
to implementing multifamily group
psychoeducation developed with a
Euro-American population of people
with mental disorders?
Cultural Modifications for
Latinos







Encourage participation of fathers
Acknowledge folk conceptions of illness
Reframe to fit family beliefs and attitudes
Focus on education rather than strictly on
communication/problem solving skills
Acknowledge each family member’s role
Goal: Interdependence vs independence
Utilize prosocial factors (e.g., warmth)
Efficacy of MFG – RCT
Study Results
T ime T o H o s p italiz atio n
100%





174 MexicanAmerican subjects
1 year of treatment
1 year of follow-up
Overall log-rank
Χ2=13.3, df=2,
p=.001.
Kopelowicz et al, under
review
% Not Rehospitalized
90%
80%
70%
60%
50%
40%
30%
A
20%
S
10%
C
0%
0
1-4
5-8
9-12
13-18
Mo n th s A fte r B a se lin e
19-24
Disseminating the MFG
Approach

Raising the Bar project
– Training program and technical assistance to implement
MFG for adults with mental illness
– Resulted in a number of program adoptions in the San
Fernando Valley region of Los Angeles

Latino MFG project
– Training program and technical assistance to implement
Spanish-language MFG for families of adolescents
– Resulted in six pilot adoptions so far, four of them
evaluated with positive results (national dissemination
now underway)
For more information, go to www.valleynonprofitresources.org, Resources section