Families Matter: A CCFC approach to helping ACT recipients achieve

their recovery-oriented goals

Thomas Jewell, PhDPascale Jean-Noel, LMSW

October 23, 2012

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Consumer Centered Family Consultation

Consumer Centered Family Consultation (CCFC)

• Brief, education-based engagement and consultation service completed in 1-3 sessions

• Consumers are at the center of all decisions– Who to invite; which topics to discuss and not to discuss

• There are several distinct phases/components

• It is characterized by collaboration that promotes anequal partnership between consumers, families and providers (all are present for CCFC meetings)

- It’s for consumers and/or families at all stages of illness- It’s for professionals with varying degrees of experience

Engagement and Planning

Engagement conversation(s) with consumer

Pre-planning Meeting(s) with consumer

Outreach conversation(s) with family/supports

CCFC Approach (Face-to-Face Mtgs)

Define & Prioritize Wants & NeedsUnderstandingAcknowledgingPrioritizing with All StakeholdersSetting/Refining GoalsManaging the Agenda

Plan and/or Provide Next Steps EducationSupportPractical GuidanceProblem-SolvingConnecting with ResourcesReferring (e.g, NAMI)

ConnectReceive InformationSupportingOffering HopeEmpathizing

Similar to other types of consultations…

• Information and goals of the consultation are solicited from the customer

• Education is provided

• Information & choices are given

• Follow through is up to the customer

Guiding Principles

Natural SupportsCollaborationShared Decision MakingSelf-Directed Recovery

Flattened Triangle Approach• All parts of the

treatment triangle (consumer, family & provider) collaborate

• Not hierarchical

• Level playing field

• Each person has expertise

Pre-Planning Meeting• 1-2 conversations between consumer and

practitioner• Emphasis: Consumer is in the “driver’s seat” and

has choices• Plan: the goals/issues to discuss during CCFC

(and what not to discuss)• Plan: outreach method to family/supports• Prep: the family often wants to share some

perspectives and experiences• Discuss: how to handle “curveballs”

Decision guide for involving family or friends to support treatment and recovery

What is this guide about?

This guide helps adults with mental health concerns and their clinicians. It’s a tool for making decisions about whether and/or how to involve family members or friends in support of recovery goals and treatment.

Consumer Centered Family Consultation Decision Guide

• The guide integrates the principles of shared decision making

• The guide provides the consumer and clinician with an easy to understand, practical step by step approach to decision making

• The guide offers a framework to begin a conversation with consumers about including others in their recovery process

• The transparency of a written guide helps to build safety and trust in the therapeutic relationship

Review Decision Guide

Copies of the Decision Guide are available on theFamily Institute website (see “Resources”):

www.nysfamilyinstitute.org

How many conversations did it take to engage a consumer before s/he said “yes” to CCFC?

• 2.43 conversations (on average)– 19% indicated an average of 1 time– 9% indicated an average of 1.5 times– 34% indicated an average of 2 times– 8% indicated an average of 2.5 times– 17% indicated an average of 3 times– 10% indicated an average greater than 3 times

• Any effort made by the clinicians to engage with consumers about expanding their circle of support adds value to the service provided

Less than one-quarter of consumers said “yes” after initial engagement attempt

Tips for Outreach with Family/Supports

• Set aside enough time to discuss CCFC

• Introduce yourself with a focus on your role in helping consumer

• Share some personal aspect(s) of yourself to foster genuine relationship building

• Explain that this is a proactive phone call and not crisis oriented

• Make sure to tell them that this is not family therapy

• Explain the CCFC model (e.g., may help to use the brochure)

Tips for Outreach with Family/Supports (Con’t)

• Explain: this is consumer driven and their loved one has given permission for everyone to talk with one another

• Ask if they are interested in participating in the recovery of their loved one in a specific way. Let them know it’s time-limited.

• If interested, set up a time and work out logistics (date, time and location)

• If not interested, ask if you can call them again in the future and give them your phone number for them to call if they change their mind

• Thank them for their time and consideration and end with comments that instill hope

CCFC Brochure• A brief service for

consumers of mental health services, their chosen support system, and their clinician – all working together to support the consumers’ recovery process. CCFC brochure is available on the Family

Institute website (see “Resources”): www.nysfamilyinstitute.org

Phone contacts with families…

• What proportion of clinicians indicated there were usually phone contacts with families during the CCFC process?– 85% said “YES” (there were phone contacts)

• Of those, how many phone calls typically took place per family?– 2.36 phone calls, on average

Note: 87% indicated there were typically 3 phone calls or less

Phone contacts with families (cont)…

• When phone contacts occurred, how long did each call typically last (in minutes)?– Mean Score = 13.38 min. (SD = 7.21)

• Approximately one-half (49%) of respondents indicated 10 minutes or less

• 38% indicated more than 10 minutes but less than or equal to 20 minutes

• 12% indicated between 21-30 minutes

Sample Progress NoteConsumer Name: _______________________ Date of consultation: _________________________ID number: ____________________________ Session duration: ____________________________ Consumer present? (circle) Yes No Family Member(s):__________________________ Location: __________________________ Family Consultation: (circle session number)Relationship(s) to Consumer: _____________ (1) (2) (3) Other____________________

Consumer Engagement: Date in which the consumer signed the release of information: _________ Consumer’s expectation/wants regarding the consultation with family: _______________________ ________________________________________________________________________________Service plan goal to be supported by the consultation? ____________________________________

Presenting goals/needs/wants: Please check all that apply and provide a brief summary.___ Information about the consumer’s mental health issues (e.g., diagnosis, causes, treatments)___ Problem solving (specific issue)___ Family relationships (e.g., communication, coping strategies)___ Support (e.g., options for linkage to professional and community sources of support)___ Practical assistance and advocacy (e.g., navigating the mental health system)___ Other problems/ needs/wants __________________________________________________

Consultation services provided: Please check all that apply and provide a brief summary.

Family Work as Best Practice

People with mental health concerns who have on-going contact with their families (or wish to) should be offered a family based intervention which provides a combination of: education about the illness family support crisis intervention problem solving skills training practical guidance

Schizophrenia PORT Treatment Recommendations

Why do it? Preliminary evidence for the impact of CCFC

Feedback from 51 clinicians described improvements in the following:

• Family understanding of mental illness and substance use• Family involvement in supporting treatment and recovery• Family perception that they are better supported• Family communication and comfort with treatment staff

• Consumer communication with family (quality and quantity)• Consumer comfort with and value of family involvement• Consumer perception of support/understanding by others• Consumer communication and comfort with treatment staff• Consumer treatment engagement/involvement• Consumer recovery-oriented outcomes

In addition to CCFC, what othersupports are available?

• The Spectrum of Family Services – Community Led Services

• NAMI - many services (www.naminys.org) – Family to Family Education Program– Monthly support groups – Information nights

– Agency Led Services• Integrate family into the intake, assessment and ongoing care as

agreed upon by consumer• CCFC (additional meetings)• Family Support Groups• Resource Library• Family Information Nights• Family Education Curriculum• Family Therapy/Behavioral Family Therapy

Hope is embedded in the CCFC model…

• Hope is critical to recovery• Hope offers a sense of

connection, support & relief• Hope gives you company…

you have one another to help combat the illness

• Consumers AND families need to hear the message of hope… and that they all can have an important role in recovery

Contact Information for Presenters

Thomas Jewell, PhDjewellt@nyspi.columbia.edu

585-474-8684

Pascale Jean-Noel, LMSWjeannoe@nyspis.columbia.edi

212-543-5464