Session #E2
October 28, 2011
1:30 PM
A Model Program for Integrated Family-Centered
Collaborative Healthcare: Chicago Center for Family
Health & University of Chicago Kovler Diabetes Center
John S. Rolland, MD, MS, Professor of Psychiatry, & Executive Director, Chicago Center for
Family Health, University of Chicago Pritzker School of Medicine
Zephon Lister, PhD, Director of Collaborative Care Program, Family Medicine Residency,
Division of Family & Preventive Medicine, University of California, San Diego
Mary Kelleher, MS, LMFT, Faculty, Chicago Center for Family Health (affiliated University
of Chicago)
Isha Williams, MS, LMFT, Past-Doctoral Fellow, Families, Illness & Collaborative
Healthcare, Chicago Center for Family Health (affiliated University of Chicago)
Collaborative Family Healthcare Association 13th Annual Conference
October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.
Faculty Disclosure
We have not had any relevant financial relationships
during the past 12 months.
Need/Practice Gap & Supporting Resources
Diabetes is an epidemic in the United States, affecting over 25 million
people. This presentation describes an innovative full
collaboration between the Chicago Center for Family Health
(CCFH) and the University of Chicago Kovler Diabetes Center
(KDC). This new comprehensive Center provides care across the
lifespan for over 6000 patients with diabetes. CCFH is partnered
to develop and implement the psychosocial component of care.
CCFH faculty and Families, Illness, and Collaborative Healthcare
doctoral fellows utilize a fully integrated collaborative care model
for their on-site work at KDC. The clinical care approach is
resilience-oriented and family-centered, drawing on Rolland’s
Family Systems Illness and Walsh’s Family Resilience Models.
Objectives
This presentation describes:
• The development and implementation of a resilienceoriented, family-centered collaborative model of care, fullyintegrated in a major university-based comprehensive
diabetes center.
• Components of routine behavioral healthcare
• Evolution, successes, & challenges of collaboration
• Healthcare professional education and development
• Presentation of data
• Potential generalizability as a model of collaborative care in
specialty medicine
Expected Outcome
At the Conclusion of this presentation, participants will be able to:
• Describe the key conceptual underpinnings of a fully integrated
resilience-oriented and family-centered model of behavioral
healthcare in a large specialty medical service or center
• Have a template for implementation of this model in a range of
specialty medicine clinical services or centers (e.g. diabetes,
cancer)
• List and design implementation the various clinical and
educational components of this comprehensive collaborative
model
• Describe challenges and methods of collaboration in diabetes
and other similar specialty services
Learning Assessment
A 10 minute Question & Answer period will be
provided at the conclusion of the presentation
Chicago Center for Family Health
• Internationally recognized as one of the foremost family-systems oriented
training institutes in the world
• Provides specialized training & services to promote healthy family
functioning and adaptation to stressful life challenges
• Innovative community-based, collaborative, resilience-oriented practice
model to strengthen families at risk, in crisis, or facing persistent
challenges
• Promotes family-centered collaborative healthcare - a systems-based
model that views the family as the primary unit of care
• CCFH is an independent affiliate of the University of Chicago. CCFH is a
non-profit, 501 (c)(3)
Kovler Diabetes Center
University of Chicago Pritzker School of Medicine
• Fully integrated pediatric and adult diabetes program
• “One-stop shopping” for all individuals managing diabetes complications
• Internationally recognized research leader: Diabetes Research and Training
Center, Health Studies
• Standardized, ADA recognized adult and pediatric diabetes teaching
programs
• Aggressive use of cutting-edge technology: pumps, sensors, software
• Accessibility: email / website interactions for pump / meter patients
• Adolescent and Teen Transitions Program, including satellite locations
• In-house podiatry and hypertension care
• Close interaction with Juvenile Diabetes Research Foundation and the
American Diabetes Association
Basic Premises:
• The psychosocial aspects of diabetes are crucial when
developing a chronic disease management plan
• Optimal psychosocial approach considers the family, broadly
defined, as the psychological and care giving focal point
• Built into a comprehensive biopsychosocial model for
diabetes management from the very beginning at the time of
diagnosis
• The psychosocial component addresses both patients’ and
family members’ needs using a developmental, life-span
model that is culturally sensitive
• Fuller integration of the biomedical and psychosocial aspects
of care directly in healthcare settings.
CCFH Model with Diabetes Care
• Bio-psycho-social Influences
• Collaborative Approach
Patient – Family - Healthcare Team
• Family Resilience Framework
Shift from Deficit, Problem Focus to
Strengths & Resources for Positive
Patient / Family Adaptation
• Developmental, life-span View:
Illness – Individual - Family
• Attuned to socio-economic, cultural, spiritual diversity &
varied family forms
Diabetes & the Family
• Family as a key resource & partner in care
• Diabetes and related stresses affect family life, all
members and relationships
• Family organization and process can influence
treatment adherence & disease course; Respectful
involvement:
 risks, stress, conflict
 functioning & wellbeing of patient and family
Need for Family Psychosocial Map
• Assess, strengthen family functioning:
Beliefs, Organization, Communication
• Psychosocial understanding of diabetes
• Understanding developmental issues
Multigenerational Developmental
Perspective with Diabetes
• Individual and family development
• Prior experience with illness & loss,
including stories of resilience
• Current timing
• Impact on future individual and family life
planning
Overall Design: Four Components
1) Family centered clinical & psychoeducational
services
2) Professional education and development for service
providers
3) Community education and outreach
4) Family resources
Component 1:
Family-Centered Clinical and Psychoeducational
Services
Routine family-oriented psychosocial consultation/screening concurrent with
the medical providers’ and diabetes educators’ intakes at the time of entry
into KDC. This includes providing pertinent family psychoeducational
information.
• Engages patients and their families
• Provides an orientation to treatment plans and their role
• Uses family strengths as a resource for optimal diabetes care
management and identifies patient/family vulnerabilities that
need to be addressed for successful diabetes treatment
• Facilitates early identification of a subset of patients/families that
are multi-stressed and dysfunctional, who often become high
users of medical and psychiatric resources coupled with low
adherence with diabetes management
Family-Centered
Clinical & Psychoeducational Services
• Routine screening family consultation combined with
a brief psychological screening of the patient
at time of diagnosis or entry into the Kovler Diabetes Center.
• Identify & Refer complex or “high risk” cases for counseling
•
Periodic family psychosocial “check-ups” and consultations
-- at key diabetes-related transitions or
-- disruptive individual and family transitions
1st F/U Appt.
4-12 wks.
New KDC PT
Initial Appt.
Psychosocial Instruments
1/2 sent in advance
1/2 completed @ KDC
before/after appt.
Existing KDC
Complex Case
Diabetes Educ.
Regular KDC Appt.
M.D.
Diabetes Educ.
Diabetes Educ.
Family Assess.
M.D.
M.D.
1-Day Family
Skills Workshop
Psychosocial
Orientation & Assess.
@ KDC
Hi-Risk
1-4 wks.
Intensive Eval.
When Appropriate,
Short-term
Indiv./Couple/Fam.
Intervention
@ KDC
Psychosocial Eval.
When Appropriate,
Complex Cases
Intensive Tx by CCFH
Behavioral Healthcare Components
• Family-oriented assessment and screening
tools, completed by patients/key family
members at KDC intake or complex case
consultation
Behavioral Healthcare Components
• “Complex” case consultation (e.g. adherence
issues). High risk cases receive brief or more
intensive therapy.
Referral of complex or “high risk” cases
•
In-depth individual, couple, and family consultation and
counseling
•
Referrals to CCFH faculty clinicians and doctoral fellows with
expertise in Families, Illness and Collaborative healthcare
•
Cases that would benefit from more intensive individual
and/or family intervention to avert poor disease
management and psychiatric morbidity (e.g. depression,
eating disorders, substance abuse, marital conflict).
Behavioral Healthcare Components
• Periodic psychosocial “check-ups” and consultations
are available at key diabetes-related or disruptive
individual/family transitions.
• Address illness and management complications that
frequently arise at stressful transitions such as
starting a family, transitioning to adulthood, job loss,
loss of a loved one, divorce and remarriage
Behavioral Healthcare Components
Psychoeducational workshop days for patients
and their families to provide information,
skills-building, and family-networking.
Includes:
• Initial workshop for newly diagnosed patients
and their families
• Topical workshops for major life transitions
(transition to adulthood, early marriage) and
family challenges (communication/problemsolving, caregiving).
Psychoeducational multi-family discussion
workshop modules for diabetes patients
and their families
•
Large group presentations providing information, discussion, and breakout sessions for groups of families
•
Co-led by CCFH faculty in tandem with Kovler Diabetes Center team
staff
•
Fosters support networks among families in the community coping with
diabetes
•
Identifies individuals, couples, and families at high risk for maladaptation
Multiple Family Discussion Groups &
Educational Days
• Address Key psychosocial challenges
 isolation and  support & networking of
families dealing with similar issues.
• Provide information, guidelines to reduce
stress, avert medical crises
• Draw out strengths, resources to live and love
well with diabetes
Component 2:
Professional Education and Development
• Continuing Medical Education programs (CME) for all direct
diabetes providers
• Continuing Education programs for nurses, social workers,
dietitians and other allied health professionals
• Intensive training for core Kovler Diabetes Center team
members
Professional Collaboration, Education,
& Development
• Psychosocial Rounds with collaborative
presentation and discussion of complex cases
Component 3:
Community Education and Outreach
• Free educational events offered to the
consumer community
Component 4:
Family Resources
• Database to link families in the program
• Resource to families:
• with a newly diagnosed member
• those going through a difficult transition
such as starting a family or launching to
adulthood, independent living.
Data: Relationship Family Functioning
to Diabetes Disease Management
Data Analysis is being completed for
presentation
Key References
Chicago Center for Family Health
jrolland@uchicago.edu, www.ccfhchicago.org
Rolland, J. (1994). Families, Illness, & Disability: An Integrative Treatment Model. New York:
Basic Books.
Rolland, J.S. (2011). Mastering family challenges in serious illness and disability: A normative
systemic health paradigm. In F. Walsh (Ed.), Normal family processes. 4th Edition.
New York: Guilford.
Rolland, J.S. & Walsh, F.W. (2005). Systemic training for healthcare professionals: The
Chicago Center for Family Health Approach. Family Process, 44, no 3, 283-301.
Rolland, J.S., & Walsh, F. W. (2006). Facilitating family resilience with childhood illness and
disability. Current Opinion in Pediatrics, 18: 527-538.
Walsh, F. (2006, 2nd edition). Strengthening Family Resilience. New York: Guilford.
Walsh, F. (2010). Resilience in Families Facing Serious Health Challenges, In M. CraftRosenberg , & S.R. Pehler (Ed.) Sage Encyclopedia of Families & Health
Key References
Armour, T.A., Norris, S.L., Jack, L., Zhang, X. & Fisher, L. (2005). The effectiveness of
family interventions in people with diabetes mellitus: a systematic review. Diabetic
Medicine, 22:10, 1295-1305.
Campbell, T.L. (2003). The effectiveness of family interventions for physical disorders.
Journal of Marital and Family Therapy, 29 (2): 263-281.
Carr, D. & Springer, K.W. (2010). Advances in families and health research in the 21st
century. Journal of Marriage and the Family, 72(3), 743-761.
Gonzalez, S., & Steinglass, P. (2002). Application of multifamily groups in chronic
medical disorders. In W. F. McFarlane (Ed.) Multifamily groups in the treatment of
severe psychiatric disorders. (pp. 315-341). New York: Guilford Press.
McBroom, L., & Enriquez, M. (2009). Review of family-centered interventions to
enhance the health outcomes of children with type 1 diabetes. Diabetes Educator,
35(3), 428-438.
Phelps, K., Howell, C., Hill, S., Seeman, T., Lamson, J., Hodgson, J., & Smith, D. (2009). A
collaborative care model for patients with Type-2 Diabetes. Families, Systems, &
Health, 27:2, 131-140.
Weihs, K., Fisher, L., Baird, M (2002). Families, Health, and Behavior: Committee on
Health & Behavior: Research, Practice & Policy, Division of Neuroscience
&Behavioral Health and Division of Health Promotion & Disease Prevention,
Institute of Medicine, National Academy of Sciences. Families, Systems, &
Health, 20:1, 7-47.
Session Evaluation
Please complete and return the
evaluation form to the classroom monitor
before leaving this session.
Thank you!