Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011...

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Session #ML-1October 29, 2011

2011 Collaborative Family Healthcare Association Annual Meeting

MAINSTREAMING MEDICAL FAMILY THERAPY:The Importance of a Systemic Approach to Integrated Healthcare

 Susan H McDaniel PhD, University of Rochester William J Doherty PhD, University of MinnesotaJeri Hepworth PhD, University of Connecticut

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Faculty Disclosure

Please add the commercial interest disclosures that you reported on your signed Disclosure form:

I/We have not had any relevant financial relationships during the past 12 months.

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Need/Practice Gap & Supporting Resources

• Need for a biopsychosocial approach to psychotherapy and behavioral health

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

*Participants can identify the original vision and concepts of Medical Family Therapy, including its use as a metaframework for other approaches such as CBT, DBT, and psychoeducation.*Participants can describe this family systems-based approach to behavioral health in primary care as well as specialty settings.*Participants can discuss the compelling need for Medical Family Therapy as it relates to ethical, interpersonal, and socioeconomic issues in healthcare.*Participants can discuss future opportunities and challenges for family- oriented behavioral health in the emerging healthcare system. *Participants will identify how medical family therapy principles can be helpful in team development and role clarification in the Patient-centered Medical Home.

Objectives

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Expected Outcome

What do you plan for this talk to change in the participant’s practice?

• Incorporate an overall systematic framework for behavioral health in healthcare.

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

MEDICAL FAMILY THERAPYHistory and New Contexts

William J. Doherty, PhDProfessor of Family Social Science & Family and Community Medicine

University of Minnesota

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

• The Origin Story• The biopsychosocial systems approach• Family focus• Medical Family Therapy as metaframework

*Can be used by many disciplines*Can be used with many problems and populations

• Agency and communion still overarching goals • Member of collaborative team: from triangle to team• Health care reform as larger context

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Roles and Strategies for Medical Family Therapists

Jeri Hepworth, PhDProfessor and Vice-Chair of Family Medicine

University of Connecticut

President, Society of Teachers of Family Medicine

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Roles and Strategies for Medical Family Therapists

1) Behavioral Health Consultant

2) Clinical Team Member and Consultant

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Medical Family Therapist as Systemic Behavioral Health Consultant

•  Tracking medical and mental health outcomes• Tracking medication and treatment adherence• Supporting the patient’s relationship with the referring provider • Providing psychoeducation about the diagnoses and treatment• Encouraging patient and family activation • Clarifying motivation for change and treatment• Negotiating a mutually-agreeable treatment plan• Facilitating family support• Encouraging psychiatric consultation when needed • Engaging in targeted brief therapy

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Clinical Strategies

• Recognize the Biological Dimension

Patients have bodies and disease• Elicit the family illness history and meaning

Health Beliefs and History• Respect defenses, remove blame, and accept

unacceptable feelings

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Clinical Strategies (continued)

• Provide Psychoeducation and Support Describe Common Patterns of Interaction

• Reinforce the family’s non-illness identity Put the Illness in It’s Place

• Facilitate Communication Within the Family and the Clinical Team

• Attend To Developmental issues

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

• Increase the Family’s Sense of Agency

Patient Activation and Empowerment• Enhance the Family’s Sense of Communion

Allow Others to Help • Maintain an Empathic Presence with the Family

Mindfulness of the Therapist

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Enhancing Team Functioning

• Multi-Level Participation• Respect defenses, remove blame, and accept

unacceptable feelings• Facilitate Communication• Attend to Developmental Issues• Increase Agency and Communion of Team• Mindful Team Practice

Susan H. McDaniel, Ph.D.Dr. Laurie Sands Distinguished Professor of Families and Health

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Session #October __, 20110:00 AM

Director, Institute for the FamilyAssociate Chair, Department of Family Medicine

University of Rochester Medical Center

MEDICAL FAMILY THERAPY IN ACTION:GENETIC CONDITIONS

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Most patients, across conditions, are not significantly distressed after testing positive

for a genetic illness

(Lerman, Vroyle, Tercyak & Hemann, 2002, JCCP Review)

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Dealing with familial illness risk is not a rational process

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Coping with Health Information

Monitoring Behavior

-Scan and amplify threatening cues

-Seek Information Blunting Behavior

-Distract from or avoid threatening cues

-Minimize Information

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Medical Family Therapy

Monitoring Behavior

-Benefit from targeted information -Family members provide support & record information

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Medical Family Therapy

Blunting Behavior

-Emphasize future outcome of current behavior

-Family members increase concerns, confront denial, and provide support

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

The Psychology of Genetic Testing

• Huntington Disease

10-20% Sought Testing

• Breast Cancer

35-43% Sought Testing

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

The Psychology of Genetic Conditions

Perceived rather than scientific risk influences: • Behavior• Decision-Making• Emotional Outcome

4042

1613

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Wanting to know for one’s children is the single biggest reason

that adults choose to get tested for genetic conditions

The Need to Know

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Clinical Strategies for Medical Family Therapy

1 - Recognize the Biological Dimension 2 - Elicit the family illness history and meaning 3 - Respect defenses, remove blame, and accept unacceptable feelings. 4 - Facilitate communication. 5 - Attend to developmental issues 6 - Reinforce the family’s non-illness identity 7 - Provide psychoeducation and support. 8 - Increase the family's sense of agency 9 - Enhance the family’s sense of communion10 - Maintain an empathic presence with the family

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Behind every health and mental health professional is a person and a family with a history of medical and mental

health issues

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Medical Family Therapy in the 21st Century

Must be

• Conceptually creative• Clinically innovative• Seek truth through research

It’s a Bird…Steven T. Seagle and Teddy Kristiansen, DC Comics, 2004

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!