Appendix 1: An overview of research

Partnering With Families Affected by Concurrent Disorders - Facilitators' Guide

In Appendix 1:

Need for family services: Highlighting the evidence
Approaches for working with families
Family support and education programs
References

Family support and education programs

Family education and support programs were developed in part because of a shortage of family psychoeducation programming. Many of these programs originated as grassroots initiatives by family members to offer programs that focused on their own needs. Family support and education now includes family–led programs, service provider-led programs, and programs led by family-service partnerships (Dixon et al., 2003).

Description

Family support and education programming is based on research that shows helping family members develop coping skills is likely to increase their “confidence or self-efficacy in managing their relatives’ illness and in reducing their own stress and burden” (Solomon, 1996).

Family support and education differs from family psychoeducation in that:

It is shorter—usually a maximum of 12 sessions.
Sessions can be facilitated by a service provider or a family member.
It is open to all family members, regardless of consumer’s diagnosis.
It does not require that the consumer is in treatment.
Consumers do not attend sessions with the family members.

Research

In contrast to family psychoeducation, family support and education programming does not yet have a large enough body of research to be considered an evidence-based practice.

However, researchers have started to investigate the outcomes of both service provider–led and family-led programs. Early evidence suggests that “families who participated in the interventions gained knowledge and felt greater satisfaction with mental health treatment, experienced a reduction in burden, distress and anxiety, and improved self-efficacy, and coping behaviors” (Solomon, 1996).

The Support and Family Education (SAFE) Program

The SAFE program is 14-session service provider–led program developed at the Department of Veterans Affairs (VA) in the United States. The program is designed to:

teach caregivers about mental illness
provide an opportunity for families to ask questions about treatment options
reduce stigma by providing a forum for families to discuss concerns and get support from peers
publicize the availability of mental health services at the VA centre
help families understand the importance of early intervention and of open communication with treatment providers
link families with treatment resources and community resources, including support groups (Sherman, 2003).

Sessions are not diagnosis-specific and families can choose to attend some, or all of the sessions.

Preliminary five-year program evaluation data have shown high levels of participant satisfaction and that participation is associated with an increased understanding of mental illness, awareness of treatment resources, and ability to engage in self-care activities as well as decreased caregiver distress (Sherman, 2006).

Family-to-Family Education Program (FFEP)

The FFEP is a family-led 12-week program that provides families with:

information about mental illness, treatments and rehabilitation
help with developing self-care, mutual assistance, communication, problem-solving and advocacy strategies
help with developing insight into their responses to mental illness (Dixon et al., 2004).

A controlled evaluation of the FFEP concluded that the program:

reduced subjective burden
increased empowerment
increased knowledge of mental illness and the mental health system
increased self-care.

When the participants were reassessed six months after the end of the program, the results indicated that the gains had been sustained (Dixon et al., 2004). These results confirmed the finding of earlier studies of the FFEP and its predecessor the Journey of Hope program (Pickett-Schenk, 2006).

The CAMH Partnering with Families Affected by Concurrent Disorders project builds on these studies. We intend to add to the evidence base for family support and education programs and to extend its reach to include programs that address the concerns of families whose relatives have both mental health and substance use problems. We describe our work to date in Appendix 2.

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