Introduction to
Multifamily Groups
Alex Kopelowicz, MD
Thomas E. Backer, PhD
Human Interaction Research Institute
New Haven, CT October 28, 2011
Agenda
9:00 - 9:15 am
Welcome and introductions
9:15 - 10:00 am
Definition of MFG and evidence for its effectiveness
10:00 – 10:30 am
Steps for implementing MFG in New Haven
10:30 – 10:45 am
Break
10:45 – 12:00 pm
Overview of MFG components
12:00 – 1:00 pm
Lunch
1:00 -1:30 pm
Tailoring MFG for New Haven
1:30 – 2:00 pm
Workplace Fundamentals to augment MFG
2:15 – 2:30 pm
Challenges of implementing MFG
2:30 – 2:45 pm
Evaluating process and outcomes of MFG
2:45 – 3:00 pm
Next steps
Why Focus on the
MFG Approach with Families?
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Clients and relatives need information to help them better
understand mental disorders or other problems
Clients want and need the support of their families
Relatives often provide assistance, and want to be a part of
the client’s recovery and success
Clients want to develop skills and benefit from the help of
their relatives
Relatives need help reducing caregiver burden
Families need help reducing stress at home
PORT Treatment
Recommendations
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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.
Approaches to
Working with Families
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Psychoeducation
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Communication skills training
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Problem solving techniques
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Social network development
Principles of Multifamily Groups
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Engage Families on their Own Terms
Psychoeducation is Ongoing and Interactive
Keep Tension and Conflict in Family Meetings
to a Minimum
Family Work is Oriented Toward the Future
The Needs of the Whole Family are Addressed,
Not Just the Client
Avoid Blaming the Family
Critical Ingredients of
an Effective MFG
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Longer-term (6-9 months or longer)
Delivered by trained facilitators
Broad view of who is “family”
Inclusion of individual in family sessions
Education of families
Concern and empathy demonstrated for individual
and relatives
Avoidance of blaming or pathologizing family
Fostering development of all family members
7
Better Outcomes in
Family Psychoeducation
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Over 20 controlled clinical trials, comparing to standard
outpatient treatment, have shown:
– Much lower relapse rates and rehospitalization
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Up to 75% reductions of rates; minimally 50%
– Increased employment
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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
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Doctor visits for family members decreased by over 50% in one
year
Dixon et al 2003
Efficacy of MFG –
RCT Study Results
T ime T o H o s p italiz atio n
100%
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174 MexicanAmerican subjects
1 year of treatment
1 year of follow-up
Overall log-rank
Χ2=13.3, df=2,
p=.001.
% 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
Implementing MFG
in New Haven
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Step 1 - Initial analysis of site population and environment
Step 2 - Site orientation and learning (October 28)
Step 3 - Creation of adapted MFG for employment
Step 4 - Site staff training (date TBA)
Step 5 - Family psychoeducation session (date TBA)
Step 6 - Implementation and operation of MFG (6-9 months)
(including two troubleshooting visits by Dr. Kopelowicz)
Step 7 - Evaluation of MFG process and outcomes
Step 8 - Analysis of MFG and report to Casey Foundation
Stages of a
Multifamily Group
Joining
Family and
Client
separately
3-6 weeks
Psychoeducational
workshop
Families only
1 day
Ongoing
MFG
Families &
Clients
6-9 months
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
 Facilitators as advocates
Joining Procedures
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THREE Joining Meetings
 SEPARATELY with Relatives and Clients
 WEEKLY – 1 HOUR with Relatives, ½ HOUR
with Clients
Start sessions ASAP after crisis such as hospitalization
Gain an understanding of family’s stresses, problems,
reactions to client’s problems, etc.
Joining – I
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15 Minutes of SOCIAL TALK
Review any recent CRISIS: Who and What Helped or
Didn’t
IDENTIFY WARNING SIGNS – PRODROMAL SIGNS –
PRECIPITANTS
Distribute to Families & Keep for Future Reference
Describe the Plan for Ongoing MFG sessions
5 Minutes SOCIALIZING
Joining – II
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15 Minutes of SOCIAL TALK
FAMILY’S EXPERIENCE DURING EPISODES
 The Sharing of Painful Events: A Crucial Aspect
of “Joining”
 The Client/Family’s Understanding of
the
Client’s Problems
Family’s Social Network & Resources (Material &
Emotional)
5 Minutes SOCIALIZING
Joining – III
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15 Minutes of SOCIAL TALK
FAMILY’S SOCIAL NETWORK & RESOURCES
SHORT & LONG-TERM GOALS (e.g., Prevent
Relapse)
Preparation for Workshop & MFGs
Family Psychoeducation Workshop
(sample for families of adults with serious mental illnesses)
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9:00-10:00am
What is Mental Illness?
-Causes - Symptoms
-Duration - Hope
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10:00-10:15am
Break
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10:15-12:00pm
Treatment of Serious Mental Illness
-Medication
-Hospitalization
-Family Psychoeducation
-Social Skills Training
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12:00-1:00pm
Lunch
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1:00-4:00pm
The Family and Serious Mental Illness
-Familial Reaction
-Family Problems
-Family Support
Elements of MFG Sessions
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Five to eight families
Two facilitators
1 ½-Hour sessions – biweekly 6-9 months
Refreshments/snacks are 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
First MFG Session
“GETTING TO KNOW EACH OTHER”
 Go Around the Room
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Background
Hobbies
Occupation
Interests
Facilitator Goes First (Discloses/Shares with Group)
SETTING BASIC RULES
 Regular ATTENDANCE (for Relatives)
 CONFIDENTIALITY (No Pressure to Disclose)
 INTERACTION AMONG MEMBERS
 PHYSICAL/EMOTIONAL CONTROL
Second MFG Session
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Group process
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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
Facilitators emphasize the vital role of SHARING GRIEF,
CONFUSION, GUILT, FEAR with those “on the same boat”
AND HOPE
Remind participants about Problem Solving (next
session)
General Points on MFG
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New Members
Late-Arriving Members
Reminders about Attending
Crises & Emergencies
COMMUNICATION & INTERACTIONS
 Facilitators DON’T speak for clients or relatives
 Interaction among members is essential
 Clients are ENCOURAGED (not pressured) to
participate
 Respect other’s turn and avoid criticism
Problem Solving in MFGs
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The CORE of MFG Sessions
Designed to compensate for Information-Processing
Deficits
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
Selecting a Problem
to Solve
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TOPICS:
Safety in The Home
Medication Compliance
Drugs and Alcohol
Life Events
Outside Agency Events
Disagreements among Family Members
Conflict with a Family Guideline
“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
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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
MFG is Flexible
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MFG programs have been created for adults and
adolescents
Clinical populations have included clients with
schizophrenia, depression, ADHD and many other
problems
This MFG will focus on employment problems
The key question is:
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What are the factors that need to be considered prior
to implementing the employment-focused MFG
intervention with the target population in New Haven?
Target Population for
Employment-Focused MFG
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Adults who are hard to serve/hard to employ/hard
to house
Many have concurrent mental health, addiction and
trauma problems
Employment options include supported
employment, subsidized employment, day labor,
part time (typically not benefitted jobs)
Tailoring MFG to the Needs
of Clients in New Haven
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Attitudes
– Clients’ assumptions about employment and the benefits
of services are targeted
Subjective Norms
– Emphasis on encouraging family members to actively
support the client’s employment efforts
Perceived Behavioral Control
– Utilization of problem solving techniques to overcome
financial, insurance and transportation obstacles to
employment
Workplace Fundamental Skills
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How work changes your life
Learn about your workplace
Identify your own stressors
Manage symptoms and meds
Interactions to improve job
Appropriate socialization
Supports and motivation
Challenges of
Implementing MFG
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Is the MFG relevant for families of clients in my
agency?
Are potential MFG trainers (or family facilitators)
available at my agency?
Are resources available to support implementing
the MFG at my agency?
Are there two or more staff who can commit to the
two-day MFG training sessions?
Evaluating MFG
Process and Outcomes
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Staff Training Pre- and Post-Surveys
Family Member Pre-Interviews
Family Member Post-Interviews
Client Pre-Data
Client Post-Data
Facilitator and Administrative Interviews
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Evaluation forms are available online
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Contact Information
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Dr. Alex Kopelowicz, akopel@ucla.edu
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Dr. Tom Backer, tomhiri@aol.com
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We look forward to working with you!