How to use the Families CARE manual

From the Introduction to Families CARE: Helping Families Cope and Relate Effectively Facilitator’s Manual

The Families CARE program comprises 18 modules, including sample introductory and closing sessions. Different treatment settings and different populations have distinct resources, needs and structures, so the manual and materials are designed to be tailored your program—you do not need to offer all 18 modules. For example, some facilities or programs may offer full day or weekend workshops, others might offer a time-limited series of individual or group sessions, and yet others might offer ongoing long-term groups.

In describing the program, we will assume that you are offering time-limited outpatient group sessions, which is probably the most common and beneficial way in which family treatment is offered. Weekly sessions offer family members ongoing support and guidance for an extended period, without saturating them with too much information at once, while providing opportunities to practise what they are learning at home between sessions.

Choosing modules

We recommend that the group program run for at least 10 sessions, to enable the participants to develop supportive relationships and to change the ways they cope and deal with their situation. At CAMH, as noted earlier, we start with a two-hour educational evening (the equivalent of two sessions), open to all, in which we present information on substance use problems and recovery, and their effects on families. This is followed by eight closed group sessions for attendees of the educational evening who would like additional support and education. We then offer optional workshops on specific topics that may not be relevant to all the group members.

There is enough material in the manual for at least 18 sessions. However, many modules could be extended over multiple sessions, so if you are able to offer a longer-term or ongoing group you will have plenty of material to do so. Feedback from the pilot stage suggests that some family members appreciate receiving treatment beyond 10 weeks so, if you offer a time-limited group, you may choose to provide one or more booster or reunion sessions at a later date. It is becoming increasingly evident that booster sessions can help clients sustain gains in the longer term (Connors & Walitzer, 2001; Eyberg et al., 1998).

If you provide only short-term treatment it will not be possible to cover all 18 modules, so the facilitators will need to determine which modules are the most relevant (a pre-treatment survey, through which you can obtain clients’ input on the topics they would like to be addressed, is included as Appendix 1 of this introduction). We recommend that you devote at least one session to each module (excluding the final session), because covering more than one module in a single session would be difficult and may overwhelm participants. However, as noted above, you may wish to dedicate more than one session to a particular topic if it is particularly salient or problematic for the participants.

There is no set order in which to provide the sessions. However, we recommend that, after introducing the program in Module 1: Starting Out, you present Module 2: Understanding Substance Use Problems and Their Effect on Families, which is the most informational session and the least demanding for group members. We cover this session in our educational evening.

We suggest that you then choose at least two modules that are designed to improve family members’ well-being and to prepare them for later topics that may be more emotionally demanding. These modules are:

• Module 3: Taking Care of Yourself
• Module 4: Finding Support
• Module 5: Managing Stress
• Module 6: Using Religious and Spiritual Resources.

We strongly advise you to then deal with crisis management and safety (Module 7: Staying Safe and Managing Crises). Participants must be able to maintain their safety if they are going to deal with their emotions, make changes in their relationships and be successful in treatment.

You can then move on to one or both of two modules that involve deeper emotional processing and the learning of emotion management skills:

• Module 8: Grieving and Coping
• Module 9: Managing Emotions.

We suggest that only after providing information, helping to bolster family members’ well-being, ensuring safety, and dealing with emotions do you begin tackling the change-oriented modules and those specifically related to the person with a substance use problem. We recommend that you begin with one of the modules that cover communication, because these modules offer family members tools to help them make changes in their relationship with the person who has a substance use problem. The relevant modules are:

• Module 10: Communicating Effectively with a Person Who Has a Substance Use Problem
• Module 11: Problem Solving
• Module 12: Setting Goals and Making Change Happen
• Module 13: Responding to a Person Who Has a Substance Use Problem
• Module 14: Supporting the Recovery of a Person with a Substance Use Problem
• Module 15: Setting Limits with a Person Who Has a Substance Use Problem.

Module 16: Helping Children Affected by Substance Use in the Family may go anywhere in the cycle or can be offered as a standalone workshop. At CAMH, we have provided it as a workshop that family members who have attended our groups can attend if it is relevant to them.

Finally, we recommend that if you have a time-limited group, you end with Module 17: Finding Hope, and Module 18: Next Steps. Even if your program is ongoing, you may wish to periodically incorporate some of the components of Module 18 to help family members evaluate what they have done and to determine next steps.

This information is summarized in the table below.

Order of modules^*

A. Providing basic information

Module 1: Starting Out

Module 2: Understanding Substance Use Problems and Their Effect on Families

B. Improving family members’ well-being

Module 3: Taking Care of Yourself

Module 4: Finding Support

Module 5: Managing Stress

Module 6: Using Religious and Spiritual Resources

C. Ensuring safety

Module 7: Staying Safe and Managing Crises

D. Dealing with emotions

Module 8: Grieving and Coping

Module 9: Managing Emotions

E. Communicating and making change

Module 10: Communicating Effectively with a Person Who Has a Substance Use Problem

Module 11: Problem Solving

Module 12: Setting Goals and Making Change Happen

Module 13: Responding to a Person Who Has a Substance Use Problem

Module 14: Supporting the Recovery of a Person with a Substance Use Problem

Module 15: Setting Limits with a Person Who Has a Substance Use Problem

Module 16: Helping Children Affected by Substance Use in the Family^†

F. Ending

Module 17: Finding Hope

Module 18: Next Steps

* It is recommended that at least one module from each lettered section be completed before moving on to those in the next section. Within most sections, the modules may be completed in any order. Certain modules may be omitted, depending on time available (see page 15 for details).

† May be offered anywhere in the cycle, or as an optional standalone workshop.

Components of the manual

For each module, we provide objectives and a session outline, teaching points and a discussion of key topics, and handouts.

Objectives and session outline

The module objectives help facilitators to quickly see what each module covers. They will also help you to stay focused during the sessions on what you hope clients will learn. The session outline provides an at-a-glance guide to the format of each module.

Teaching points and discussion

This part of each module will help you prepare for the session and guide you in conducting the sessions. The material was developed by therapists who have facilitated the program and contributed to this project. It includes suggestions for how to cover topics, such as:

• ways to explain or define concepts
• questions to ask to promote discussion
• exercises to help clients reflect on a topic.

These session protocols also provide advice and background information to help you handle topics knowledgeably and effectively. Ideally you will have the opportunity to become comfortable with this material prior to each session, and will need to refer to it only occasionally during sessions.

Handouts

Each module includes handouts that provide information, clinical exercises and home practice for clients to use during the sessions and at home. The teaching points sections provide instructions for when and how to use the handouts. The home practice assignments are important, so you should emphasize the need for family members to complete the assignments.

We have found it helpful to give the group members binders in which to keep their handouts. Once you have decided what modules you will cover, you can fill the binders with all the material you will use. Alternatively, you can distribute hole-punched handouts each week. If you fill the binders at the beginning of the group, it avoids the need to distribute handouts during each session, which can be distracting, and it enables participants who miss a session to look over the material at home and do the home practice.

Note: This manual is intended only as a guide, and should not supersede the perceptions and judgment of the facilitators. We expect that you will adapt the procedures, exercises, information and handouts to make them relevant and helpful to the family members you work with.

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

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