Appendix 2: The Partnering With Families Affected by Concurrent Disorders Project

Partnering with Families Affected by Concurrent Disorders - Facilitators' Guide

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Phase 1
Phase 2
Phase 3
Development of the Facilitator’s Guide and Family Resource

Partnering with Families Affected by Concurrent Disorders compared two family interventions, a concurrent disorders family education and support group and an educational manual/workbook for family members of individuals with concurrent mental illness and substance use.

Although most sources recommend that in order to achieve improvements in the ill person’s status, (such as increased functionality, decreased hospitalization, better substance use outcomes and fewer relapses), family group interventions should run for no less than nine months, we had as our overarching goal the improved well-being of the family members and caregivers. Family members did provide us with anecdotal evidence in favour of improved consumer outcomes associated with family interventions, but our study revealed positive and significantly improved outcomes for family members themselves after a period of only three months. Results revealed significant positive changes, particularly in terms of mastery and self-efficacy, satisfaction with life, coping, and reduced caregiver burden.

Phase 1

During Phase 1 of the project, we conducted a focus group to find out what families needed. Needs that emerged included:

information about various psychiatric diagnoses and associated treatments, especially psychotropic medication
information about alcohol/drug use and dependence and how problematic substance use interacts with mental illness and with prescribed medication
information about community resources for consumers and families
effective family communication techniques
self-care and coping with stress
crisis management.

Results also suggested that family members preferred a structure that included both peer support and facilitator-led educational components.

Phase 2

Using the results from the Phase 1 focus group, we began Phase 2: to design and pilot a support group intervention. The purpose of this phase was to evaluate the group content and format.

Ten family members participated in a 90-minute weekly support group for six weeks. The group provided educational material about concurrent disorders and allowed participants to share their personal stories, challenges and coping strategies.

At the end of the pilot phase, we completed open-ended qualitative interviews with family member participants, evaluating overall satisfaction with the group content and format. The principal investigator administered a series of quantitative instrument tools to participating family members during a one-to-one meeting before beginning the group intervention; these tools were administered again at the completion of the pilot study. These tools were designed to measure changes in:

perceptions of social support
feelings of personal mastery and empowerment
sense of caregiver burden
level of hopefulness
degree of stigma.

Phase 3

Phase 3 employed a randomized controlled trial to determine the effectiveness of a 12-week group intervention. This intervention consists of a one-hour peer support open discussion, followed by a 30-minute educational session led by the group co-facilitators. The educational content is based on primary areas of interest identified by family participants from Phases 1 and 2 of the study.

Family members at both the CAMH site and a community-based agency in Brockville, Ontario were randomly assigned to either an experimental intervention group or the control condition. Each of the two sites recruited up to 10 participants for each of the experimental and the control conditions, for a total sample size of 20 study participants per site. The control condition participants did not take part in a support group; they received a comprehensive educational manual designed for family members, which they worked on their own.

Quantitative data analysis demonstrated significant improvements from baseline assessment to completion of the Family CD Education and Support intervention. Results from analysis of the manual-only intervention did not show as much improvement across the variables studied, although when the two interventions were compared, there were no significant differences between them. Although the support group intervention showed significant positive changes across a greater number of variables than the manual-only intervention, the extent of the changes between the two interventions was not statistically significant. In other words, the results showed that both interventions—manual only and group support—produced positive effects for participants. We were not able to conclude that one was better than the other, in spite of the trend data in favour of the support group.

Limitations in the study include a short follow-up period and a small number of study subjects. The findings do justify, we believe, further work in this area, with a larger study cohort and a more extended follow-up period. Nonetheless, we can say that both these interventions did produce positive effects in a number of life areas: empowerment, social support, coping, hopefulness, perceived stigma, satisfaction with life and reduced caregiver burden

Feedback from consumers participating in pilot support groups, from the group facilitators and data, both qualitative and quantitative, all endorse the merit and value of offering this service to family members affected by concurrent disorders.

I was really amazed because I’ve never heard of any group like this, where both the mental health and substance use problems are dealt with. I didn’t think anything like this was available at all. I didn’t realize there was nothing for families of someone with concurrent disorders until I started reading more about it and before we started the group.

—Family CD group participant

Thank you for the opportunity to review this information. I found it very informative. . . . I have had some personal experience attempting to navigate the treatment system (my husband was diagnosed with mental illness about 11 years ago) and this information would have been very useful to me at that time. I am certain it will reduce anxiety/fear around mental illness and addiction by giving families the information they need and steps to follow if they have no previous experience with this devastating disease. This resource gave me a sense of hope that individuals with concurrent disorders can recover and lead productive lives.

– Clinician / Case Worker

Development of the Facilitator’s Guide and Family Resource

Development of the facilitators’ guide and family resource was an integral part of the study. The first set of participant materials was developed based on information from the Phase 1 focus group. This material was used in the pilot group. We used this material and the feedback from the pilot group participants to create Version 1 of the family resource.

Version 1 of the family resource was used as the psychoeducation component of the intervention group and was the manual given to the control group. We then revised Version 1 based on the input from the participants. The revised manual—called Concurrent Disorders: A Resource for Families—was reviewed by family members and service providers across Ontario. Their comments and suggestions informed the final revision. The result is A Family Guide to Concurrent Disorders .

The facilitators’ guide is based on the facilitators’ notes from the pilot and the trial and an analysis of the qualitative interviews with family member participants.

We hope that this process will be one of continuing iteration, so that suggestions and recommendations from facilitators and participants will allow us to update and improve this resource.

Partnering With Families Affected by Concurrent Disorders

Appendix 2: The Partnering With Families Affected by Concurrent Disorders Project

Phase 1

Phase 2

Phase 3

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