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Maine's recent success was initiated by a state trade association of mental health centers and services, with support from but little involvement by the state mental health authority, which recently began exploring a formal partnership to continue and deepen this largely successful effort.

A simultaneous effort in Illinois, initiated by the state authority but distinctly lacking consensus among center directors or the state NAMI chapter, has been less successful One state that has had some success is New Jersey, which was able to disseminate family psychoeducation by setting expectations and requirements at the state level. With the exception of the New Jersey effort, experience suggests that the most promising strategy is one in which provider organizations take the initiative with support from consumer and family organizations, the state mental health authority, and the key insurance payers.

Appropriate reimbursement for family psychoeducation will follow. Experience also suggests that several years of consistent effort and ongoing monitoring are required for success. Fortunately, this process is not necessarily an expensive one: Maine implemented its family psychoeducation program in more than 90 percent of agencies for about 25 cents per capita over four years, including evaluation costs.

The principal costs are in human effort, especially the effort required to overcome resistance to change. Delivery of services to families must be subject to accountability and tracking. Although many states encourage the delivery of services to families, few monitor such services or make funding contingent on the services being delivered One system-level option is for mental health centers to create a position for an adult family intervention coordinator, who would serve as the contact person for interventions, facilitate communication between staff and families, supervise clinicians, and monitor fidelity FFEP is currently available in 41 states, many of which have waiting lists.

FFEP and other mutual-assistance family programs are organized and led by trained volunteers from families of persons who have mental illness. These community programs are offered regardless of the mentally ill person's treatment status. They tend to be brief—for example, 12 weeks for FFEP—and mix families of persons with various diagnoses, although they focus on persons with schizophrenia or bipolar disorder. On the basis of a trauma-and-recovery model of a family's experience in coping with mental illness, FFEP merges education with specific support mechanisms to help families through the various stages of comprehending and coping with a family member's mental illness The program focuses first on outcomes of family members and their well-being, although benefits to the patient are also considered to be important Uncontrolled research on FFEP and its predecessor, Journey of Hope, suggests that the program increases the participants' knowledge about the causes and treatment of mental illness, their understanding of the mental health system, and their well-being In a prospective, naturalistic study, FFEP participants reported that they had significantly less displeasure and concern about members of their family who had mental illness and significantly more empowerment at the family, community, and service-system levels after they had completed the program Benefits observed at the end of the program had been sustained six months after the intervention.

Preliminary results from a second ongoing study with a waiting-list control design have revealed similar findings. Although FFEP currently lacks rigorous scientific evidence of efficacy in improving clinical or functional outcomes of persons who have mental illness, it shows considerable promise for improving the well-being of family members.

In recent research and practice, attempts have been made to optimize the clinical opportunities provided by family psychoeducation and peer-based programs such as FFEP by developing partnerships between the two strategies. For example, family psychoeducation programs have used FFEP teachers as leaders, and participation in FFEP has facilitated eventual participation in family psychoeducation. The efficacy and effectiveness of family psychoeducation as an evidence-based practice have been established.

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To date, the use of family psychoeducation in routine clinical practice is alarmingly limited. Research has recently begun to develop dissemination interventions targeted at the programmatic and organizational levels, with some success. Ongoing research must continue to develop practical and low-cost strategies to introduce and sustain family psychoeducation in typical practice settings. Basic research that identifies the barriers to implementing family psychoeducation in various clinical settings is also needed—for example, the impact of clinicians' attitudes, geographic factors, funding, disconnection of patients from family members, and stigma—as well as the extent to which variations in these factors mediate the outcomes of educational interventions.

Dissemination could also be facilitated by further exploring the integration of family psychoeducation with psychosocial interventions—such as assertive community treatment, supported employment, and social skills training—and other evidence-based cognitive-behavioral strategies for improving the treatment outcomes of persons with mental illness. Promising efforts have combined the energy, enthusiasm, and expertise of grassroots family organizations such as NAMI with professional and clinical programs. Dixon and Dr.

Lefley is with the University of Miami School of Medicine. Miklowitz is with the University of Colorado. Leff J: Working with the families of schizophrenic patients. New York, Wiley, Google Scholar. New York, Praeger, Google Scholar. New York, Guilford, Google Scholar. Burland JF: Family-to-Family: a trauma and recovery model of family education.

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Family Psychoeducation for Serious Mental Illness by Harriet P. Lefley

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Family psychoeducation for the treatment of psychosis

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Solomon P, Draine J, Mannion E: The impact of individualized consultation and group workshop family education interventions in ill relative outcomes. Solomon P: Interventions for families of individuals with schizophrenia: maximizing outcomes for their relatives. Forgot Username? Forgot password? Keep me signed in. New User. Sign in via OpenAthens. Change Password. Old Password. New Password. Password Changed Successfully Your password has been changed. Returning user. Forget yout Password? If the address matches an existing account you will receive an email with instructions to reset your password Close.

Evidence-Based Practices for Services to Families of People With Psychiatric Disabilities

Forgot your Username? Enter your email address below and we will send you your username. Back to table of contents. Previous article. Evidence-Based Practices Full Access. Lisa Dixon Search for more papers by this author. William R. McFarlane Search for more papers by this author. Harriet Lefley Search for more papers by this author.

Alicia Lucksted Search for more papers by this author. Michael Cohen Search for more papers by this author. Ian Falloon Search for more papers by this author. Kim Mueser Search for more papers by this author. David Miklowitz Search for more papers by this author. Phyllis Solomon Search for more papers by this author. Diane Sondheimer Search for more papers by this author. Add to favorites Download Citations Track Citations. Abstract Family psychoeducation is an evidence-based practice that has been shown to reduce relapse rates and facilitate recovery of persons who have mental illness.

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Psychiatric rehabilitation interventions are currently a mixture of evidence-based practices, promising practices and emerging methods that can be effectively tied together, providing a broad strategy to achieve personal functional recovery. AV and SB participated in the writing process of the first draft of the manuscript, revised and approved the final version of the manuscript.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Andreou C, Moritz S. Non-pharmacological interventions for schizophrenia: how much can be achieved and how?

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J Adv Nurs. Keywords: severe mental illness, psychosocial rehabilitation, evidence-based practice, recovery, person-centered treatment.