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Family intervention

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Title: Family intervention


1
Family intervention
  • Done by - Mohamed Abu Shawish

2
  • ??? ????? ?????? ??????
  • WE ARE A DANCING PART OF BIGGER DANCE OF
    INTERACTING PART. ( G.BATESON).
  • ??? ??? ???? ?? ???????? ??????? ?????????
    ??????
  • (???? ??????)

3
Family Intervention (FI)
  • FI emerged when research began taking interest in
    the family and the effects of the home
    environment on mentally sufferers after discharge
    from the psychiatric institutions .
  • FI reflects a shift from viewing families as the
    cause of illness to a source of support for the
    ill relative.

4
Family intervention science
  • Well define area of research in changing behavior
    in family. Nursing curricula need to shift from
    traditional family approaches not supported by
    research to evidence based family intervention.

5
Family movement
  • Patients who still live with their families
    should be offered a family psychosocial
    intervention and provides a combination of
    education about the illness, family support,
    crisis intervention, and problem solving skills
    training. Such interventions should also be
    offered to family caregivers (Lehman et al,
    2004).
  • For these reason many institutions work in this
    issue include the National Alliance on Mental
    Illness (NAMI), the Federation for Families for
    Children's Mental Health, and Mental Health
    America (MHA), which was formerly the National
    Mental Health Association to offer rich resources
    for nurses working with families.

6
Cultural competency
  • Cultural competence is essential in family
    interventions.
  • Respecting the roles of family members and
    community structures hierarchies, values, and
    beliefs within the patient's culture is critical
    (APA, 2007).
  • Specific multicultural contexts include
    immigration status, economics, education,
    ethnicity, religion, gender, age, role,
    minority-majority status, and geography.
  • Nurses need to examine their own sociocultural
    contexts, recognize similarities and differences
    with those of patients and families.

7
Cultural competency
  • Studies in different cultures found that the
    Western or standard model of family intervention
    was not suitable to their cultures and may be
    intrusive also, it failed to show positive
    treatment outcomes (Weisman 2006).
  • Culturally sensitive FI studies reported
    significant reduction in relapse rates and
    increase in patients and carers satisfaction
    with the service (WHO, 1998).

8
Professional Training
  • Clinical training programs in family therapy are
    open to psychiatric nurses and other health care
    professionals across the United States. They vary
    in duration, theoretical framework, and the level
    of knowledge and credentials required for
    participation. Usually they are limited to
    clinicians with graduate degrees in mental
    health.
  • Although the nurse generalize needs knowledge of
    family systems in one's daily clinical work with
    patients, the nurse family therapist should have
    a master's degree and didactic content and
    clinical seminars focused on formal family work
    and individual or group counseling related to
    awareness of one's family of origin

9
Family theories and intervention approaches
  • Currently, there's no unified system of family
    functioning has been established much of the
    original family therapy work was defined by
    specific schools, approaches, or models of family
    therapy.
  • Recognized family theories, include
    developmental, gender, organizational,
    functional, conflict, symbolic interaction,
    systems, family life course development, ecology,
    and social exchange and choice do exist (white
    and Klein, 2002).

10
  • Theoretical approaches to intervention includes
    cognitive behavioral, experiential, integrative,
    brief, systemic narrative, psychodynamic,
    psychoanalytical, solution focused strategic,
    structural, Transgenerational, and risk and
    protective factors (Sadock and Sadock, 2007).
  • Family theories provide a way to examine family
    processes, such as hierarchy (who is in charge),
    boundaries (closeness without much closeness or
    enmeshment and distance or estrangement),
    organization (how tasks are structured).
  • It is important for family therapist and
    psychiatric nurse to differentiate between
    adaptive and maladaptive family functioning in
    order to appropriately identify target symptoms
    for interventions.

11
Dysfunctional family pattern include
  • The acting-out adolescent who is a symptom bearer
    whose symptoms bring the family to treatment
  • The overprotective mother and distant father
    (distant Through work, alcohol, or physical
    absence).
  • The over functioning "super wife" or "super
    husband" and the under functioning passive,
    dependent, and compliant spouse.
  • The spouse who maintains peace at any price and
    denies difficulties in the marriage bur suddenly
    feels wronged and self-righteous when the mate is
    discovered to be in legal trouble or having an
    affair.

12
  • The child who exhibits evidence of poor peer
    relation ships at school while attempting to
    parent younger siblings to compensate for
    ineffective or emotionally overwhelmed parents.
  • The overly close three generations of
    grandparent, parent, and grandchild in which
    lines of authority and generational identity are
    poorly defined and the child acts out because of
    a lack of effective limit setting by an agreed-on
    parental figure, The family with a
    substance-abusing member

13
Risk and protective factor
14
Assessment and planning
  • The goals of a family assessment and subsequent
    intervention are as follows (Sadock and Sadock,
    2007)
  • Reduction of psychiatric symptoms
  • Increase in family resourcefulness or skills
    Improvement in individual psychological needs and
    family interactions
  • Enhanced family awareness of how family patterns
    affect the health and satisfaction of their
    members.
  • Selection, implementation, and evaluation of
    treatment.
  • Many methods of family assessment have been
    identified, including measures of relationships,
    family history, family APGAR, family relational
    diagnoses, self-report inventories, and genograms.

15
Model of assessing family
  • A systems model for assessing families would
    examine five levels, including individuals,
    dyads, nuclear families, extended family, and
    community and cultural systems.
  • The gold standard in clinical assessment is the
    clinical interview, and in clinical research it
    is the analysis of video- or audio-taped
    interviews.
  • One nursing model is the Calgary Family
    Assessment Model (CFAM) and the companion Calgary
    Family Intervention Model (CFIM) (Wright and
    Leahey, 2005).
  • Families are examined from structural,
    developmental, and functional categories to
    identify strengths and problems in the
    assessment. Interventions target change in
    cognitive, affective, and behavioral domains of
    family functioning. This model is often used to
    help families cope with physical or psychiatric
    illness in a family member.

16
Relational problem
  • There is no formal family diagnostics system
    existing, nurse may useful to use family
    relational problem in term of categorize
    described in the DSMIV.TR

17
Intervention
  • THE PURPOSE OF FAMILY INTERVENTION IS
  • To promote, improve, and/or sustain effective
    family functioning in three domains
  • Affective
  • Behavioral
  • Cognitive
  • This aimed to engaging families and encouraging
    them to be active participants in treatment and
    recovery thereby increasing their knowledge and
    improving coping skill both patients and their
    families (Nathan and German, 2007).
  • Family interventions are delivered in a variety
    of settings, schools, homes, outpatient programs,
    offices, inpatient unresidential treatment
    programs, hospitals, courts, child developmental
    centers, churches, and other community settings.
    Nurpsychiatrists, psychologists, and social
    workers can provide family interventions, as can
    licensed marriage and family counselors

18
Indication for family intervention
  • Illness of one family member causing detrimental
    effect on another
  • Behavior of family member contributes to problems
    of another
  • One family members improved situation results in
    symptoms on another
  • Development of emotional, behavioral, or physical
    problem within the context of an already existing
    illness.
  • Illness newly diagnosed.
  • Marked deterioration of a family members
    condition.
  • Chronically ill family member moves home
  • Individual or family milestone missed or delayed
  • Chronically ill family member dies.

19
Contraindication of FI.
  • All family members decline pursuing help as a
    family
  • Family desires assistance, but from another
    professional.

20
Psychotherapy
  • Family psychotherapy has two essential principles
    that distinguish it from individual or group
    therapy and from other types of family
    interventions, such as skills building.
  • The family is conceptualized as a behavior
    system unique properties rather than as the sum
    of the characteristic of its individual members.
  • It is assumed that a close relationship exists
    between the way a family functions as a group and
    the emotional adaptation of its individual
    members.
  • The purpose of family psychotherapy is to improve
    inter-personal skills, communication, behavior,
    and functioning.
  • Page 609 psychotherapy useful in-

21
Out come Measures
  • Outcomes of family interventions include-
  • individual change (e.g., medication adherence,
    hospitalization, relapse intervals, utilization
    of skill training, employment, global state,
    independent living, social functioning, school
    attendance).
  • interactions relevant to problem behaviors or
    social systems (e.g., family experience, ability
    to cope, need for supervision, effective
    communication).
  • Instruments such as the Burden Scale for Family
    Caregivers, which focuses on perceived negative
    effects of the caregiver situation and the health
    of the caregiver, are used by clinicians and
    researchers to examine the impact of medical and
    psychiatric disorders on the family.
  • In selecting an instrument for family
    intervention, nurses should use the best-known,
    standardized, briefest, and most valid and
    reliable instruments. The instruments should be
    pilot tested.

22
Research in family intervention
  • Studies of family intervention effectiveness,
    also known as family intervention science, have
    mostly been conducted in the last two decades.
    Research on families can include basic family
    research, family intervention research, and
    family-related research. In each of these areas
    of research, the conceptualization, measurement,
    and analysis view the family as Systems are
    composed of
  • units who have some relationship
  • to each other and are organized around
  • those relationships, a change in one part
  • causes a change in another

23
Youth
  • Much family intervention research has focused on
    youth. In 1999 the Office of Juvenile Justice and
    Delinquency, in collaboration with the Center for
    Substance Abuse Prevention, searched for "best
    practice" family-strengthening programs,
    specifically family pro-grams that have proven to
    be effective in the prevention of youth
    substance abuse and other dysfunctional behavior.
  • A guideline. Preventing Substance Abuse Among
    Children and Adolescents Family-Centered
    Approaches, was developed based on systematic
    review (USDHHS, 1999). This guideline is based on
    the belief that the family is the first line of
    defense and they need to know which family
    interventions are effective in preventing
    substance abuse.

24
Multisystemice family therapy
  • MST is the integration of empirically based
    approaches, such as structural family therapy,
    cognitive behavior therapy, and
    psychopharmacological treatment, to address a
    variety of risk factors across the family, peer,
    school, and community levels. Treatment
    principles are clearly identified, and the
    home-based therapists are actively supervised.
    MST has been the focus of federally funded
    projects with multiple replications, revisions,
    and adaptations, and it is included in policy
    recommendations for juvenile offenders.

25
Family skills building
  • The purposes of family and parent skills building
    are as follows
  • Provide parents with new skills that they can use
    to nurture and protect their children.
  • Train parents to -deal with challenging
    children.
  • Help children develop prosaically skills. The
    level of evidence for the effectiveness of these
    programs is strong example of these program
    are-
  • The Kumpfer Strengthening Families Program (SFP).
  • the Effective Blade Parenting Program, a
    cognitive behavioral program designed to meet the
    specific needs of African-American families.
  • evidence-based family intervention for youth is
    in-home support. A U.S. Prevention Task Force
    evaluated the effectiveness of early childhood
    home visitation for preventing violence (CDC,
    2003).

26
Family psychoeducation
  • Much overlap exists between psychoeducarion and
    family psychotherapy for families with members
    who have schizophrenia and mood disorders.
    Psychoeducarion is often combined with marital
    and family therapy. Both psychoeducarion and
    psychotherapy focus on problem-solving and
    communication therapy. Outcomes of these
    interventions have demonstrated decreases
    feelings of rejection by family members,
    decreases in patient relapse.
  • A well-recognized psychoeducarion intervention
    was developed by the National Alliance on Mental
    Illness (NAMI). In the Family-to-Family program,
    families teach other families about the illnesses
    experienced by adult family members, methods of
    coping, and support resources. Participants have
    underscored the significance of information
    coming from other families in the education and
    support component of the program (Hyde et al,
    2003).

27
Couple therapy
  • Another area of research focuses on the
    relationships of couples. Relationships have
    implications for health. Persons in healthy
    marriages and satisfying relationships have
    better health, healthier lifestyles, greater work
    productivity, and better coping with stress as
    compared with those persons who are divorced or
    never married
  • Marital psychotherapy
  • is the treatment of the distress in a committed
    relationship or the education of a couple in
    regard to what makes healthy relationships, such
    as good communication skills. This modality has
    been used in the treatment of depression,
    substance abuse, sexual dysfunction, divorce,
    stepfamily conflict, and trauma. Strong clinical
    evidence supports the effectiveness ofthis
    intervention.

28
The role of the nurse
  • Case study
  • ?

29
Mr. Ahmed 25 year old, is admitted for the first
time to a psychiatric unit and diagnosed with
schizoaffective disorder. He has recently been
attending a technical school to learn computer
repair, he receive much help from his family
member especially the eldest brother Mohamed who
seems to be the closest one to him in this
decision, His parents insisted he be admitted due
to increased isolation, low energy, excessive
sleep, and, more recently, evidence that he talks
to himself. His family seems supportive and
visits him on his first night in the hospital.
Case study
30
Correct answer for case study
  • Individual answer will vary. Possible answer may
    include the following elements
  • Obtain Mr. Ahmad consent to include his family in
    his treatment.
  • Observe the patient with his family during their
    visits.
  • Provide the family an opportunity to ask
    questions about the patient illness and course of
    treatment .
  • Provide education for the family.
  • Help to coordinate a family meeting with the
    patient nurse, social worker, and physician.
  • Be supportive.
  • Assess the families needs and resources
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