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A Model Program for Integrated Family-Centered Collaborative Healthcare: Chicago Center for Family Health


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 ... – PowerPoint PPT presentation

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Title: A Model Program for Integrated Family-Centered Collaborative Healthcare: Chicago Center for Family Health

A Model Program for Integrated Family-Centered
Collaborative Healthcare Chicago Center for
Family Health University of Chicago Kovler
Diabetes Center
Session E2 October 28, 2011130 PM
  • 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
  • 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 Rollands Family Systems Illness and Walshs
    Family Resilience Models.

  • This presentation describes
  • The development and implementation of a
    resilience-oriented, family-centered
    collaborative model of care, fully-integrated in
    a major university-based comprehensive diabetes
  • Components of routine behavioral healthcare
  • Evolution, successes, challenges of
  • 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
  • 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

  • Kovler Diabetes Center
  • University of Chicago Pritzker School of
  • Fully integrated pediatric and adult diabetes
  • One-stop shopping for all individuals managing
    diabetes complications
  • Internationally recognized research leader
    Diabetes Research and Training Center, Health
  • 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
  • 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
  • ? 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

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Multigenerational Developmental Perspective with
  • Individual and family development
  • Prior experience with illness loss, including
    stories of resilience
  • Current timing
  • Impact on future individual and family life

Overall Design Four Components
  • 1) Family centered clinical psychoeducational
  • 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
  • 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
  • Periodic family psychosocial check-ups and
  • -- at key diabetes-related transitions or
  • -- disruptive individual and family

New KDC PT Initial Appt.
1st F/U Appt. 4-12 wks.
Existing KDC Complex Case
Psychosocial Instruments 1/2 sent in advance 1/2
completed _at_ KDC before/after appt.
Diabetes Educ.
Regular KDC Appt.
Diabetes Educ.
Diabetes Educ.
Family Assess.
1-Day Family Skills Workshop
When Appropriate, Short-term Indiv./Couple/Fam. I
ntervention _at_ KDC
Psychosocial Orientation Assess.
Psychosocial Eval.
_at_ KDC Hi-Risk 1-4 wks. Intensive Eval.
When Appropriate, Complex Cases Intensive Tx by
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
  • 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

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/problem-solving,

  • Psychoeducational multi-family discussion
    workshop modules for diabetes patients and their
  • Large group presentations providing information,
    discussion, and break-out sessions for groups of
  • 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
  • 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
  • Intensive training for core Kovler Diabetes
    Center team members

Professional Collaboration, Education,
  • Psychosocial Rounds with collaborative
    presentation and discussion of complex cases

  • Component 3
  • Community Education and Outreach
  • Free educational events offered to the consumer

  • Component 4
  • Family Resources

Data Relationship Family Functioning to Diabetes
Disease Management
  • Data Analysis is being completed for presentation

Key References Chicago Center for Family
Health jrolland_at_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.
Craft- Rosenberg , 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, 2210,
  • Campbell, T.L. (2003). The effectiveness of
    family interventions for physical disorders.
    Journal of Marital and Family Therapy, 29 (2)
  • Carr, D. Springer, K.W. (2010). Advances in
    families and health research in the 21st century.
    Journal of Marriage and the Family, 72(3),
  • 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, 272,
  • 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, 201,

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