CASE MANAGEMENT

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CASE MANAGEMENT FAMILY INCLUSIONMAKING IT
WORK!

• Pat Taff, RN,BSHA
• Education Program Director
• NAMI SC
• Left click to Advance to Next Slide

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SCDMH Mission Statement

• To Support the recovery of people with mental
  illness.
• Included in SCDMH Values Family Inclusion and
  the benefits of strong family support

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Family Inclusion RatedBEST PRACTICE STATUS

• The acronym STRIDE, provides a map for
  implementing Family Inclusion

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STRIDE asks the professional to..

• Include the Client and the family in creating a
  treatment plan for the Clients recovery.

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STRIDE Asks you to

• See the Treatment Team as a
• Three Legged Stool

Case Manager
Client/Consumer
Family Member/s
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STRIDE In a Nut Shell

• Support no fault disease
• Teamwork 3 legged stool
• Respect - lived experience, courage
• Information - about all aspects of illness
• Development coping skills, adaptation
  
• Empowerment information a plan for
• personal recovery process advocacy.

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STRIDE helps to achieveThe Desired Goal
Recovery For the ClientBut we realize there are
roadblocks in implementing STRIDE

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Case Managers may feel they are

• Burdened with heavy case loads!
• Bogged down with paper work!
• Work under System constraints
• Too busy to add families to the agenda.

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Case Managers may feel that

• Families can be difficult
• Often, family contact makes my client worse!
• families often disengage from their ill family
  member
• The client has alienated self from family

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Clients may feel Family Inclusion wont work
because

• Family doesnt understand me or my illness!
• Family doesnt want to see me any more.
• Family is too anxious about me and my illness.

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Families may feel they are

• Blamed for the illness
• Stigmatized
• Isolated
• Misunderstood
• Frustrated by The System.
• Left in the dark about the Illness.

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How does the Case Manager pull this team together?

• It Can be a Challenge..
• But when we know the facts
• It is Possible!

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Paradigm shift in our thinking

• Before the decade of the Brain
• MHP did the treatment plans
• Client/Patient was sick and not able to
  participate in planning.

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Family members were not included as they were
thought to

• Cause mental illness
• Schizophrenogenic Mothers
• Family Dysfunction
• Enmeshed and overly involved

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The Real Facts

• Mental Illness is not caused by Family
• Mental Illness has a Biological Basis.
• Schizophrenia, Bipolar Disorder, OCD, Major
  Depression, Anxiety Disorder, Panic Disorder
  are now known to be Brain Disorders that respond
  to new specific medications.

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Fact People can Recover from Mental Illness
with

• A treatment team that formulates a comprehensive
  Treatment Plan.
• Early Diagnosis, Medication, Therapy
• Educated Family members who can provide emotional
  support.
• Peer Support.
• Community Support.

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Fact Often Family Members dont act in ways
that are helpful to their loved one.

• Their behavior often perpetuates the myth that
  families cause mental illness.

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Why do Families behave in ways that look
dysfunctional?

• We need to look at the
• ILLNESS

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Traditional Approach in TreatingMental Illness

• Focus on Family
• Dysfunction

The Family
The Client
The Health Care Team
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New Treatment Strategyhas come to the fore

• Medical Family Therapy
• Puts the focus on
• the Impact of the
• Illness
• on the Family

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The Therapeutic QuadrangleIn Medical Family
Therapy

The Client
Clinical Goals
The Family
The Illness

• To increase agency
• Active involvement of the family unit

• To promote communion
• Strengthen emotional bonds

The Health Care Team
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The Illness alters the clients behavior

• The Clients behavior effects the familys
  behavior.
• The cause is the
• Illness.

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The Experience of Mental Illness is known as a
Catastrophic Event

• Mental Illness does not occur
• in a vacuum.
• It impacts the whole family.

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A Catastrophic Event

• Is an event that is
• Unexpected
• Unprepared for
• We have little or no control over.

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We have all experienced a Catastrophic Event

• 9/11
• Was an event that
• Was unexpected.
• We were not prepared for.
• We had no control over it.
• The Result was

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It had profound effect on those who lived
through it

• Their emotions
• The way they related to others
• Their ability to carry out normal activities

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Post 9/11

• Behavior radically changed
• It was the
• Catastrophic Event
• That impacted their lives and behavior.
• The had NORMAL REACTIONS
• to
• ABNORMAL CIRCUMSTANCES.

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The diagnosis of a major illness The sudden
loss of a loved one

• Are
• Catastrophic Events

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The diagnosis of a severe illness

• Puts a family under tremendous emotional stress
• We understand this and give them what they need.

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We provide

• Support
• Understanding for emotions
• Practical Resources
• Education
• Time to process and heal for those who suffer loss

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People in NYC post 9/11 received

• Understanding for their Emotions/no judgment
• Emotional support/counseling
• Practical Resources
• Financial aid
• No one labeled them Dysfunctional

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Diagnosis of CancerPatient and Family receive

• Education as a family unit
• No blame for the illness
• Understanding for emotional distress
• A prognosis
• Treatment options

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The Diagnosis of Mental Illness

• Can occur suddenly and unexpectedly.
• Creates confusion, anxiety, fear
• Can leave a family stranded-no knowledge of how
  to navigate the system.
• Is often delayed because of stigma
• May bring financial stress no insurance or
  inadequate insurance.

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The Family may feel

• Judged
• Blamed
• Misunderstood
• Isolated
• Alienated
• In the dark
• Desperate for answers/help

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The Family experiences a range of emotions

• Guilt
• Anger
• Frustration
• Fear
• Denial
• Grief

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The emotions are the result a Catastrophic Event
The Illness

• It is important to understand that their behavior
  is not Abnormal
• The Behavior is a
• Normal Reaction
• to an
• Abnormal Circumstance

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These are predictable responses Stages of
Emotional Response

• There are 3 Stages
• Each Stage is identified by specific emotions.
• Each Stage has Specific Needs that once filled
  help the whole family to begin to recover.

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Stages of Emotional Response

• STAGE I. Dealing with Catastrophic Events
  Crisis, Chaos, Shock, Denial Needs Support,
  comfort, empathy, resources
• STAGE II. Learning to Cope Anger, Guilt,
  Resentment, Recognition, Grief.Needs vent
  feeling, education, self-care, skill training, ,
  Letting go.
• STAGE III. Moving Into Advocacy Under- Standing,
  Acceptance, advocacy/Action. Needs Activism,
  restoring balance in life NAMI.

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Recognizing The Emotional Stage a Family member
is in enables you to supply the need with
information and resources

• When a families needs are met
• They can be brought on board the Treatment
  Planning Team
• This is Family Inclusion

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Family Members go through their own recovery
process.

• As they begin to heal and care for themselves-
• they are better able to support their loved one
  in their recover process.

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Family Inclusion has been awarded Best Practice
status because it works!

• It is not something to placate an anxious family-
  
• It sets a stage on which recovery becomes very
  real possibility.

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Family Inclusion

• Removes blame from the family
• Normalizes feelings.
• Builds an alliance where everyone is valued
• Provides an atmosphere where a realistic
  Treatment plan can be formulated.

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Family Inclusion makes your job easier!

• The small amount of effort it takes to get a
  family involved
• Can reap huge benefits for you and your ability
  to make recovery a
• reality for your client

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In Family Inclusion we understand that the
family observes first hand

• Medication Adherence Issues
• Side Effects that influence the above.
• Increase or decrease in Symptoms
• Sleep disturbances

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Family Members can observe

• Violent or suicidal behavior
• Alcohol or drug use.
• Early signs of Relapse.
• Adverse reaction to medications
• With this knowledge you can
• Possibly head off relapse or hospitalization

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Making Family Inclusion Work!

• Get your Client on board
• Stress-Confidentiality will be Maintained
• Ask to meet with the family as soon as possible.
• Encourage them to get the family members involved
  in NAMI.

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Get the Client on board

• Stress that an educated family will reduce
  tension and stress at home.
• Stress that the more supportive the family is-
  the better their chances for recovery.
• Strive for reconciliation between family members.

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Get the Family on Board by

• Stressing your role in maintaining client
  confidentiality.
• Explaining that you can share medical aspects of
  the disease such as
• Diagnosis
• Symptoms
• Medications
• Side Effects

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Get the Family on Board

• Encouraging them to join local NAMI Affiliate.
• For Education Free 12 week Peer taught
  -Family-to-Family course
• Affiliate/Education Meetings
• Support Groups

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The Family-To-Family Program provides

• Solid, scientific information about Brain
  Disorders.
• Empathy for their loved one
• Insight into what it is like to experience the
  challenges that come when living with mental
  illness.
• Information about the Major Mental illnesses.
• Better coping and communication skills.

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Getting the Family on board

• Remove blame and shame by explaining they will
  have
• Predictable Emotional Stages
• Encourage them to find NAMI support groups where
  they can share with others who understand.

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Getting the Family on board

• If the Family does not respond in a positive way
  at first
• Understand that The Family may in be anger,
  denial, shock.
• Understand that they may not have had a good
  experience with professionals in the past.
• Try again later after they have had time to
  absorb the impact of the Stressor.

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Resource Information

• NAMI SC Brochures
• Family-To-Family Brochures.
• NAMI State Office number 803-733-9592.
• NAMI National website - www_at_nami.org

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Resources for Case Managers

• Sign up for the NAMI Provider Education Program!
• This is a free-10 week 30 hour program based on
  the acclaimed NAMI Family-To-Family Course. 30
  Continuing Education Units are offered.

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Resources for Case Managers

• The Provider Education Program is offered at the
  following agencies
• Columbia Area Mental Health Center
• Bryan Hospital
• Patrick B. Harris Psychiatric Hospital
• Charleston/Dorchester Mental Health Center.

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Provider EducationComing soon to an agency near
you!

• Palmetto Richland Springs
• Greenville Mental Health Center
• Coastal Empire Mental Health Center

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Thank you for all the hard work you do!

• NAMI Families Salute you!
• Please consider becoming a memberwe need caring
  professionals!
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