The initial interview

From Implementing the program in Families CARE: Helping Families Cope and Relate Effectively Facilitator’s Manual

We recommend that prior to providing the program, you interview each interested family member (if two or more members of the same family are seeking treatment, you can interview them together). The interview gives potential participants an opportunity to tell you about themselves and their situation, and allows you to discuss confidentiality, determine family members’ eligibility, orient them to the program and discover their treatment needs.

Confidentiality

At the start of the interview you should outline the limits of confidentiality and how confidentiality is ensured. In most jurisdictions, the client’s confidentiality is protected unless there is a risk of harm (including harm caused by drinking and driving) to the client or others known to the client; a child is being abused or neglected; a client discloses having been sexually abused by a registered health care provider; or a client’s file has been subpoenaed. In most agencies, client information is maintained securely, either electronically or in a locked filing cabinet.

Hearing their story

Many family members have had few, if any, opportunities to share their story with others, and have a need to do so with a non-judgmental person. It is important to allow them time to talk about their experiences and their situation, and to provide supportive, validating responses. Allowing time for this during the interview allows potential participants to become more comfortable talking about their situation, which helps to prepare them for the group treatment. It also helps them to develop a connection and sense of trust with you, which will encourage their attendance at group sessions.

This portion of the interview should not be highly structured, but we encourage you to provide direction and containment if a person is becoming too emotionally vulnerable. We also recommend that you help family members focus on their strengths and coping resources, so they do not become overwhelmed with hopelessness at their situation. Praise them for their efforts at handling the situation and at coping, even if their methods have not proven successful.

Questions you might want to ask during this section include:

• What has brought you to seek treatment?
• How is your relationship with ___________ [the person with a substance use problem]?
• How has ___________ ’s substance use affected you, your relationship and others around you?
• What treatment have you or ___________ received and what has been the outcome?
• What have you done to try to improve your situation?
• How have you coped with your situation?

Determining eligibility

Families CARE can be helpful to many family members of people who have substance use problems, but some people may not be ready for it or able to benefit from it, and for others the program might interfere with existing treatment. The following are exclusion criteria:

• substance use problems
• severe mental health problems
• risk of harm
• severe crisis.

Substance use problems

Some family members may themselves use substances to a greater or lesser extent. We recommend excluding family members who themselves have substance use problems, because they may feel uncomfortable when other group members express their negative feelings about a relative’s substance use, and may not share the common desire of other group members for their relative to reduce his or her substance use. You will therefore need to ask family members about their own use, and determine if it is problematic. You may recommend that people not eligible for the program for this reason receive substance use treatment prior to participating in Families CARE.

Severe mental health problems

Some potential participants may be experiencing mental health problems, due perhaps in part to the stress of dealing with their relative who has a substance use problem. They may nonetheless be able to participate in Families CARE if the problem is mild to moderate and the person is relatively stable, or even if the problem is more severe but is being successfully treated elsewhere and is relatively stable. But for some family members with more severe mental problems that are not being treated and are not stabilized, the program may not be suitable. You will therefore need to determine the mental health and stability of family members, and may recommend that those with severe depression or anxiety, mania, psychosis or personality disorder receive mental health treatment before participating in Families CARE.

Risk of harm

Some family members may be at risk of harm, either from another person or from themselves. You should assess the risk to potential participants of abuse, violence, self-harm and suicide. If there is a risk of harm, you will need to ensure the person’s safety by developing a safety plan (see Module 7: Staying Safe and Managing Crises) and, if necessary, contacting and involving the relevant authorities. If a person is experiencing or at risk of severe abuse, we advise referring him or her for appropriate treatment, such as services for people experiencing domestic violence. While people in these situations will not be able to participate in the program, they should be encouraged to join when their situation has stabilized.

Severe crisis

Many people affected by familial substance use experience regular crises, which may sometimes have the paradoxical benefit of prompting them to seek treatment. Further, it is a goal of Families CARE that participation will help family members to prevent and deal with crises better. Nonetheless, family members may at times be so distraught and preoccupied by a severe crisis that they would not be able to benefit from the program at the current time. We suggest that in such cases you provide them with support and assistance (or refer them if necessary) and reconsider them for the program when they or their situation is more stable.

Orientation to the program

Family members should be given a description of the treatment to enable them to make an informed decision about their participation, and to develop realistic expectations about treatment. We recommend that you provide the following information:

• program details: the time, location, length and number of sessions; the facilitators; the approximate number of participants; whether groups are observed or videotaped, etc.
• program components: the general format of sessions, the inclusion of home practice assignments, the policy about attendance, etc.
• program goals (explain to potential participants that the focus of the treatment is on them and their needs, rather than the functioning of the person who has a substance use problem):
  • to increase family members’ knowledge about substance use and concurrent disorders, recovery and treatment
  • to improve family members’ well-being through better coping, self-care, support, spirituality, grieving, management of emotions and stress, and finding hope
  • to improve family members’ situations through enhancing safety, managing crises, problem solving, and attaining goals
  • to improve family members’ relationships through more effective communication, limit setting, response and support
• program content: topics that may be addressed
• alternative treatment options: other relevant programs offered at your facility or agency, or in the community.

Determining treatment needs

The pre-treatment survey (see Appendix 1 PDF) allows family members to note their goals and expectations, and to identify what topics they hope to address during the program and what questions they want answered.

You should also determine if potential participants have special needs for which accommodations might be needed (e.g., physical disabilities, hearing or visual impairments, food allergies [if food is being provided], or issues with reading proficiency or fluency in English), or cultural or religious beliefs that may be pertinent to the treatment process.

Ensure that family members understand the process going forward (e.g., who to contact for support, the date and time of the next appointment). Reinforce them for having taken this first step in seeking treatment and support.

Families CARE: Helping Families Cope and Relate Effectively Facilitator’s Manual

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