Hello and welcome. I'm Tristan Grindow, Deputy Medical Director and Director of Education for the American Psychiatric Association. I'm pleased that you are joining us for today's SMI Advisor webinar, Engaging the Individual and the Family in Treatment Planning. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary team has been designed to help you get the answers you need for your patients. Now I'd like to introduce you to the faculty for today's webinar. Dr. Terry Brister and Dr. Ken Duckworth. Dr. Duckworth serves as the Medical Director for the National Alliance on Mental Illness, NAMI. In addition to his work with NAMI, Dr. Duckworth is currently an Assistant Clinical Professor at Harvard Medical School and Associate Medical Director for Behavioral Health at Blue Cross and Blue Shield of Massachusetts. He is double board certified in Adult and Child and Adolescent Psychiatry. Dr. Brister is the Director of Information and Support at NAMI, where she is responsible for development of new programs and ensuring the overall quality of content of NAMI's existing programs. She is the author of NAMI Basics, the Signature Education Program for Parents and Other Caregivers of Children and Adolescents with Mental Illness, and co-author of NAMI Homefront, an educational program for families of service members and veterans who are experiencing mental health challenges. Dr. Brister is a core member of the SMI Advisor Clinical Expert Team and a licensed professional counselor. Terry and Ken, thank you so much for leading today's webinar. Thank you, Tristan. It's a pleasure to be here and to discuss our work together. I'm going to be starting on slide six with our disclosure. Both Dr. Brister and I are employees of NAMI, and we've been involved in the development of the content for the free NAMI education and support programs mentioned in this presentation. We won't be discussing other ideas, but we just wanted to make it clear that we're part of the NAMI family, and when we're discussing NAMI programs, you should know that about us. So, we'll stick to the literature around it, but that's a disclosure that we think is important for you to know. The learning objectives, we want you to understand the importance of involving people who live with these illnesses and their family of choice in treatment decisions at all levels, understand the value of providing the person and the family with comprehensive information about their condition and the treatment options available, and to learn the best practices for engaging people and their family through the treatment process, including the option of peer support. The current situation in engagement for people with serious mental illness shows that there is an opportunity to improve our overall engagement, and I say this as a person who has run a community mental health center, the Massachusetts Mental Health Center, who's been a state medical director for the Massachusetts Department of Mental Health and who volunteers at an early psychosis program, I see this challenge. So the two key bullets are less than 50% of people with a mental health diagnosis receive treatment, and about one-third of individuals with a serious mental illness who do seek mental health services drop out of treatment. So there's a particular challenge that we're trying to address in the lack of our ability to create the conditions that help to engage people who live with serious mental illness. I'm going to turn this over to my colleague, Terry Brister, in a moment, but I wanted to discuss models of care that can make a difference. So these models are on slide nine. Coordinated specialty care, as many of you know, the National Institute of Mental Health, SAMHSA, with support from NAMI's advocacy, has helped to grow over 250 first-episode of psychosis programs across the country, and coordinated specialty care emphasizes many of these recovery-oriented principles, including helping people learn to manage their own vulnerabilities, engaging the family very early on in services, thinking about recovery-oriented interventions, such as family psychoeducation, and also with supported employment and supported education. So that is coordinated specialty care. This came out of the RAISE, Recovery After Initial Schizophrenia, episode work that has been done. And so across the country, there are resources for people with early psychosis in every state except one, and these are a remarkable development that has occurred over the past five years. Another model that can make a difference with engagement is assertive community treatment. And those of you in community mental health know well that assertive community treatment was developed in Wisconsin with the closure of Mendota State Hospital's inpatient unit, and this was originally constructed as the hospital without walls. And the conceptualization was that the same treatment team that cared for people inside of the hospital would do so on an outpatient basis. There's a psychiatrist, a nurse, staff members, and each patient is discussed every single day just as they would be in the hospital. Assertive community treatment has been shown quite clearly to reduce re-hospitalization and to improve clinical outcomes, although it has been clear that if these programs are defunded, people go back to their prior level of functioning. So assertive community treatment has also evolved to involve peers in more recent iterations. The first version of assertive community treatment did not involve peer mentors or coaches or navigators. All of these are terms of art for people who live with serious mental illness and serve as resources and guides for people who are contending with their vulnerability. Internationally, Finland has created a remarkable program called Open Dialogues. This program is a 24-7 wraparound team, which resembles assertive community treatment in some ways, but there's a very intensive focus on listening to the person. The idea in Finland, actually this is developed in Lapland, the idea in this program is that not being heard is a tremendous vulnerability-generating problem and actually an insult for people. The idea that you have to be heard in the area of Finland that Open Dialogues has been developed is a core concept. The idea is the treatment team comes and listens to the person who's experiencing an early episode of psychosis, and the same team is available over time for weeks to months. There's a very light use of antipsychotic medications, there's a very intensive use of listening to the person and engaging the person, listening to the family and engaging the family. In Open Dialogues, they have some remarkable data. They even claim in some studies to have reduced the incidence of the onset of schizophrenia. This has not been shown to be the case in other countries. In Finland, they have a fairly homogeneous population, a homogeneous insurance system, and one language. I think this represents a brilliant, but perhaps difficult to apply model here in the United States. But I think the principles of listening to the person and actively engaging the family and doing that with a goal to listen instead of hospitalization, collaborate instead of diagnose, integrate their narrative into a care plan, it has some beautiful lessons for those of us who are interested in engagement. Headspace, another international program, is all across Australia. Dr. Patrick McGrory developed Headspace, which is a model not designed for people with psychosis, but is rather a drop-in, a friendly area for people with any mental health vulnerabilities or not. These are conceptualized as non-stigmatized or shame-inducing programs where people can just hang out and be themselves. And what Dr. McGrory has found in his work, that many of these individuals go on to develop anxiety disorders, depressive disorders, and it is not predictive of early psychosis, but it is quite predictive of engaging people in care. And the idea that there's a place to go that does not identify you as having a diagnosis or a label is appealing to people. And this is something that you have to convey clinically when you're working in early psychosis, but in early psychosis programs, the 250-plus coordinated specialty programs that I mentioned above. But in Headspace, the idea really is that mental health exists on a spectrum. Mental health vulnerabilities are welcome there, but you don't have to have a mental health vulnerability to be there. So those are good examples, too, in America. Coordinated specialty care that came out of RAISE, a sort of community treatment that came out of Wisconsin in the late 70s with the closure of hospitals and has very strong evidence to support it. Open Dialogues, which is a brilliant model out of Finland, may have challenges applying it to a more multicultural, complicated insurance space such as the United States. There is some effort in Framingham, Massachusetts, to do a replication led by Dr. Chris Gordon. And in Headspace in Australia, there's a national movement to promote acceptance and welcoming to people who are young adults and teens who may be struggling with things. I'm now going to hand it to my colleague, Dr. Terri Brister, to talk about NAMI peer-led education and support programs. Thank you, Terri. Thank you, Dr. Duckworth. You've just heard an excellent overview of some of the top programs that are kind of out-of-the-box programs for people with serious mental illness to meet them where they are. And I want to now dive a little deeper, or not a little deeper, a lot deeper into what's at the core of each of those models, as well as some of the peer-led programs that Dr. Duckworth will be talking about later on. And at the core is person-centered care, which really gets to the point he was making about the program in Finland. It's all about being heard. And this diagram that you see on the screen really does paint the picture of what we're talking about. The person is at the center, the services, the treatment system, the treatment team revolve around the person. Everything is directed by and to and for the person. And I want to point out that this model isn't exclusive to mental health care, but what we do know is that this model is very effective with mental illness, with mental health challenges, and all the symptoms that are involved with behavioral health conditions. And you can see the key components around the person. It promotes well-being, it honors choice. We're going to be talking about that more in detail. But with person-centered care, the person actively participates in every phase of their own treatment. People using the services are viewed as equal partners in the planning, the developing, and the monitoring of care. And this can be a unique concept in some organizations and some facilities, particularly ones that have been historically medical model, where it was all top-down. In-person-centered care, the person and the family, and the family is whoever the individual identifies. It might be a parent, it might be a partner or a spouse, it might be an adult sibling. It could be the person who lives next door to them. It's whoever they define as their family, whoever the important person is to them in their recovery journey. But the person and the family, as identified by the person, are at the center of the decisions and they're viewed as the experts by everybody on the treatment team. It's important to point out that this isn't just about giving people what they want. It's not just about letting the person receiving services have their way. It's about viewing them as a person and not just as a patient or as a client. But looking at them as a person with values, with desires, and with thoughts and valuable input about their own life. It's frankly as much about the way we think about how we provide care as it is about the actual services that we provide. So I wanna dig a little bit deeper now at what some of the specific aspects are of person-centered care. It's respecting the values of the person and putting them at the center, which I've mentioned many times already. But taking into account their personal preferences and express needs. It may be that they would choose one type of psychotherapy over another type of psychotherapy. It may be that they would prefer seeing someone who was more similar to them in an ethnic background if that's an option. But it's having some choices. It's also about coordinating and integrating the care. Looking at what services are needed by the individual rather than just throwing a cookie-cutter approach at the individual. If you have X diagnosis and you're having Y and Z symptoms, then our treatment plan for you is A and B. This is more personal than that. This is actually looking at what's going on with the person and listening to them, being heard. I'm probably gonna keep coming back to those words, Ken. It's working together to make sure that there's good communication, information, and education. This is in all directions. It's that the individual and the family are listening to the people on the treatment team and are understanding what they're actually saying. Not just hearing the words, but listening to them and understanding what they mean. Also that the communication goes the other way. That the treatment team members are listening to the individual and also listening to the family members that are involved. It's making sure that people feel safe, that they're physically comfortable in the treatment setting or a treatment team meeting. It's just always making sure that they are feeling okay about where they are and what's going on. It's providing emotional support. We've already mentioned the involving family and friends, whoever it is that's important to that individual. And making sure that there's continuity between and within these services. Having worked in a community mental health center for years, and many, many things have changed, thankfully. But if we're honest, we can each look in our own organizations and see where silos exist and see where they may be barriers between services, even in our own organizations. For example, between the behavioral health services and the psychiatric services and the substance use treatment component. These are things we have to be aware of. Making it easy, simple, clean for people to go back and forth between the components of services that they need, especially when they're within our own organization. And making sure that people have access to appropriate care when they need it. One of the key components at the core of person-centered care and all the things that the aspects that I've just talked about is supportive psychotherapy, which is really an underpinning of general mental health care that frequently we don't think about in terms of people with serious mental illness. We frequently think about treatment with medication and some of the more intensive or crisis-related services, but not so much the ongoing support that's needed for people as they walk their journey through recovery. And what we're really talking about is providing practical help and advice from clinicians that's geared to help the person with the mental illness manage and live with their illness. It's all about living with it. Not just managing the symptoms, but how do they navigate their life now that this illness is present? It includes components of comforting, advising, encouraging, and reassuring. And most importantly, again, listening empathetically and attentively to the individual and to the people who love them. Why is it important? It can go without saying, but I won't miss the opportunity to say it. It can ultimately improve the quality of the services available. It can help people get the care that they need when they need it. And it's empowering. It's empowering for people to be more active in advocating for themselves and the services that they need. I said initially that this isn't specific only to mental health services or services for people with mental illness. This is true with any health care relationships, but it's especially true in the illnesses that we're providing services for. What we know is that offering care in a more person-centered way can improve outcomes for all conditions, but again, especially true for mental illnesses. Some of the components that can specifically have an impact on outcomes include getting to know the person as a person and recognizing their individuality and strength. So many of the time, again, thinking back to mental health center days, you may have only 15 or 20 minutes with an individual, sometimes even less than that, if they're there just for a med check appointment or for an injection or whatever they happen to be there for. So it's critical to let the person know that you see them as being there. You do see them as an individual. Viewing them as an expert in their own health care, that they know what's best for them, and giving them options wherever that's possible. Sharing the power and responsibility. Again, joining with the individual and the family or the person that they've designated as being helpful and supportive of them to form a partnership and all being partners on the treatment team. Having a holistic approach to the person's need and providing care. Looking at the person, at their overall wellness, not just their symptoms that are associated with their mental illness. Are they smoking? Is that causing difficulty? Are they exercising? What kind of physical health are they in? But looking at the person, again, overall, including families. We've already mentioned that multiple times. And making sure, again, that the services are accessible, flexible, and easy to navigate. It needs to be said, should be said here, that HIPAA is involved. And I've mentioned family an awful lot of times. And we do have to think about confidentiality. And that's a very important issue, legally, ethically, morally. But it's also important to not give up asking the individual about signing a release of information. When they first come into services, frequently they can be guarded, maybe a little resistant. They may even be upset with the family member or the person that they care the most about because of whatever's led them into treatment. And they may not want to sign a release or involve anybody in treatment at that point. But as providers, we have to continue to ask and not give up trying to help them build a community of support to help them in their recovery. So it's incumbent on us not to just ask once and then assume that that's gonna always, no is always gonna be the answer. Some additional components that can impact outcomes are considering the person's whole experience, ensuring that their physical, cultural, and psychosocial environment of services support person-centered care. And this is huge for us in this country. As Ken mentioned, the program in Finland is super successful over there, but it is their environment and their culture is a little more homogeneous than this in the United States. So these are things we constantly have to be aware of, and it's even more incumbent in urban settings where there are more diverse populations and cultures. And then finally, ensuring that staff are supportive, well-trained in communication, and in striving to put people at the center of their own care. We know that organizations and facilities, healthcare organizations specifically, create cultures. They create climates of care that can be created top-down, they can be bottom-up, ideally, they're horizontal, and it's people just know that this is our culture. There's a saying within the peer movement, nothing about us without us. And that's a good mantra to keep in the back of your mind when you're trying to think about incorporating person-centered care. And I have a slide up here about a systems of care framework, and most of you on the phone are probably familiar with the systems of care concept. And this model is really built around the components of person-centered care. It's really about creating a system, creating a network of services that fit the person, and the person having access to the services that they need for best recovery, but not just being pigeonholed into a prefabricated treatment plan or treatment setting. So I thought it was worth, again, pointing out for those of you on the phone that the models that Ken mentioned are specific ways, innovative ways that can be more engaging for the person with mental illness. Person-centered care is at the crux of it, and person-centered care is also at the crux of developing a systems of care framework. And Ken, if you will pick up from here. Sure. So, you know, just to give you an example of the principles applied, you know, we're encouraging clinicians and people who lead services to think about the experience of the person and the family when there's an onset of psychosis. And in the chart you see on slide 16, there's an interaction which impacts multiple aspects of a person's life. The emerging symptoms change performance and behavior, may lead to more isolation, more irritability, more cognitive vulnerability, and feedback loops in school and in family systems in relationships may impact the individual, which increases stress and isolation. And having worked in an early psychosis clinic for five years, you have a pretty good sense of how much the individual and the family are going through when they have arrived. And sometimes it's a triumph for them to simply have arrived to an early psychosis program. Common experiences that people have entering treatment by being blamed when struggling to do your best. And this doesn't mean the clinicians are blaming them. They may be blaming themselves as family members. What did I do wrong? How did I contribute to my loved one's vulnerability? The individual, maybe when I smoked marijuana when I was in my early teen, that led to this. Is it my choices? How have I contributed to this? Which is a blaming phenomena, which you really wanna work against. People report that they try things that have worked but don't work now. So, a classic example of that would be to have a family meeting to talk things through. There's disagreements in the family that always worked for us, but now the individual is having psychotic experiences. Conflict and support systems are common and different interpretations of the vulnerability by different parents or by extended family or siblings can be important. The entire experience can be overlaid with grief, the process of loss, the awareness of the vulnerability can be slow to sink in for some people, but some people who appreciate what is transpiring do have a grief response and fear, anxiety, not knowing what's coming. And of course, finding our mental health quote system and quote, confusing and contradictory. These individuals with the Affordable Care Act are frequently in private insurance and the systems were often set up for people with serious and persistent mental illness to receive clinic care funded by Medicaid. And so, this is one example that I've observed that individuals before the age of 26 may be on their parents' insurance and they may not know how to navigate it. The parents, of course, are not allowed, per Terry's points about HIPAA information, unless the individual consents. So, you're now on your parents' insurance, you're living with psychosis, and you may not want the parents to be involved in things because of the conflict in the support models, in the family dynamics or in the understanding of the condition. So, this raises the level of clinical gain that you have to bring to quite a high level. Suicidality, of course, is a problem that people do experience with the onset of serious mental illness and this can also make people quite afraid. Shared decision-making is a really powerful tool and a good example of shared decision-making is to let people know that if you were going to do a medication trial, that you could anticipate that there would be side effects and really walking through the side effects, how you might prevent them collaboratively. So, even a low dose of a second-generation antipsychotic could easily generate weight gain and a lack of satiety, the feeling of fullness may just disappear for a person. And I have seen patients who claim to have never been told this. In shared decision-making, you would say, here's a medicine that may help you sleep, if that's a problem. It may help you with the anxiety you're feeling and it may help with the disorganized thinking or voices that you're hearing. But you need to know, we're gonna have to think about activity and nutrition collaboratively and thoughtfully. And so, that's a good example, is this treatment you want to try? So, that's shared decision-making. I also have a medicine that doesn't have those side effects that I could give you in low dose, but you might feel stiffness in your muscles, you might have movement disorders over time and you might find that to be a different challenge for you. Which of these treatments would you like to consider? And I think that this is an important, it's not tokenism, it's genuine. You're engaging with the person in a collaborative discussion about their treatment and their lives. When you engage family, as Terry mentioned, family should be identified by the person. Not everybody has a happy nuclear family. And I think that the support networks that people create over time are important to respect. As a clinical team, given the amount of individual time pressure and our historical focus on individual symptoms and diagnosis, there is a tendency to exclude families. I mean, the person is an adult and certainly in medical training, you don't really think of working with the family in many situations, unless it's end of life care or the person is a teenager in that transition age. The families also can have conflict and it can be, quote, easier, end quote, for the clinicians to say, you know, I'm gonna save the family for later. And that can be an error, working with the individual to say, we'd like to involve the people who love you, the people who are supporting you. And what we have found is that the practitioners often are open to the family's experience of what's happening. The family may, with the advantage of not living with the symptoms, have a similar narrative that the clinicians might have. And of course, the more you can empower and strengthen families, the better off your individual patient will be, because it is families that will be engaged long after you've left your job or the person has started a new treatment. The family will be there for most people for a very long time. Engagement, reaching out, listening, meeting people where they are, intentionally addressing power imbalances, you know, just making that as transparent as possible, offering to get somebody a cup of coffee, can be a nice way to acknowledge that you're providing a service, and while we may have a lot more training and education, they are there in a vulnerable state. Trying to create a narrative that connects the dots between what the person wants and what the opportunities are. Finding the purple in the Venn diagram, that they may not agree that they have a serious mental illness, and that can be fine, but they do wanna sleep better, and they wanna have friendships and a girlfriend. So let's focus on those goals. Those are areas that we can agree upon, and let's pursue them. The importance of the individual, and ask for feedback. How's this work going? How's our relationship going? How do you find the clinic? You know, it's not as clean as it should be. Thank you for telling me that. I'm gonna talk to people in housekeeping. You know, we're going through some budget cuts here at the clinic. Just acknowledge your environment may be suboptimal if you're in the public sector. I spent many years in the public sector, and just being honest and transparent about some of the challenges that you face can be humanizing. Potential barriers to engagement. Unwillingness to use creative and innovation approaches, deficits-based rather than strengths-based orientation. Most people don't like to be seen through their deficits and I understand that's our diagnostic framework with the medical tradition, but I think the strengths of a person, their capacities, what they can do is really crucial. The inability to work effectively across and within diverse cultures. So, you know, as soon as you have a sibling translating, you know, a language, you have identified a tremendous problem that you should work to identify. You also get to the idea of staffing your clinic with a diverse workforce. Admittedly, that can be a challenge in terms of finding people who have language and cultural capacity, but when you can do it, it's really valuable to people. Thinking about rules and regulations as kind of the primary. I have seen this on occasion, not a lot, and I have seen lack of respect for families on occasion, but not a lot. I think you have to think about engagement as these stages that are mentioned here from prior to entering treatment, the person had to get themselves to the clinic. That is something to be celebrated and thinking about engaging people through the initial evaluation and also the ongoing treatment planning, which again, using shared decision-making is a collaborative game plan that is put together. I wanna tell you a little bit about an engagement project that Terri was part of at NAMI and she will describe. And this resource, the engagement manual that we put together at NAMI is available for download. Terri, take it away. Terri? Terri? There we go. I was muted by the organizer. Sorry about that. It's okay, it's all good. Love technology. Thank you, Ken. The engagement report that Ken was talking about that you're looking at on the screen, you can download this at nami.org backslash engagement. And in 2016, NAMI launched an initiative highlighting the need for healthcare providers to practice engagement. And for all the reasons Ken and I have mentioned, feeling it was very important. We held a two-day listening session with stakeholders and created the report that you see in front of you. And the people who attended that event agreed, and I'm quoting, if we want to improve the lives of people with mental illness and their families, we have to shift to a culture that embraces engagement as a new standard of care. And that really was what the crux of this initiative was and what the crux of this guide is, that engagement is a strengths-based process through which people with mental health conditions form a healing connection with the people who support their recovery and wellness within the context of their family, the culture, the community, and the treatment providers. And the first moments of interaction between a service provider and a person seeking services can set the tone for the entire course of treatment. The first interaction can start a journey to recovery and a satisfying life, or it can leave a person unsure or even hopeless about their future and unwilling to go back a second time. There's research that shows that many people who seek mental health services drop out, as Ken mentioned earlier, but there's a study that showed that 70% that drop out do so after the first or second visit. And I wanna read a quote to you from Pete Early, who is one of the leading mental health advocates in the country and also a family member of a son with a mental illness. My son's first break was when he was most open to the idea of engagement. He was scared and he didn't know what was going on. He voluntarily went to see a psychiatrist, but the manner in which he was treated really closed the door at that opportune moment. The psychiatrist was proud of being the kind of doctor who tells it like it is. He told my son, you have a mental illness and you're gonna be on medications for the rest of your life. They'll probably cause you to gain a significant amount of weight. You probably won't be able to work in a regular job. If you don't take the medications, you're gonna end up homeless and jail or dead. My son's reaction was to reject that and to close the door on treatment. And unfortunately, this is not the, first of all, let me say, we know this is not the case all the time. We are not saying that at all, but these situations do happen. And as Ken was mentioning, having the conversation about what the options were, meeting the person where they were and seizing that opportunity while the person is ready to begin care or to make a change in their treatment plan. So we wanna talk about, or I wanna share the 12 principles that this group of stakeholders came up with, basic core principles of engagement. And it's making it a priority at all levels, all levels of the treatment system, training of providers and clinician, the payment system, what are our outcomes measurements? Communicating hope is essential at all levels from the people at the front desk who were scheduling the appointments to the nurses or the case managers who are providing the intermediate care to the therapist and the psychiatrist. Sharing information and decision-making. We talked about that earlier, the need for the communication to go all ways. Treating people with respect and dignity, using a strengths-based approach. Again, these are very much and very similar to those of just general person-centered care. Shaping services and supports around the life goals and interests. Taking risks and being adaptable to meet the individuals where they are. Maybe what the person is comfortable with is not something that you've tried before as a provider, but being willing to try and meet them where they are, to negotiate what can and can't be done as part of the treatment plan. Just think about considering their options. Providing opportunities for individuals to include family and other close supporters. We've talked repeatedly about how important that is. Recognizing the role of the community. What else is out there for the person in the hours that they're not in your treatment center or in your treatment facility? What else are they doing? What else are they involved in? What support systems are in place for them? Providing robust, meaningful peer and family involvement in the way the system is designed, the way that care is provided. Ken's gonna be talking with you shortly about some of NAMI's programs, but whether they're NAMI programs or programs that are provided by other mental health organizations that provide peer support, peer information and education. Again, helping the individual build as large and as broad of a community of support for their recovery as possible. And promoting collaboration among the service system and providers. And then last but not least, adding peer support services for the person in the family. When Ken was getting the call started or getting the webinar started about the involvement of peer specialists, that's something that's relatively new in the field, even though it's been around for several years. And I know in the mental health system here in Mississippi, where I live and where I've worked, we've struggled with how to engage them, how to best use them and keep them involved as active members of the treatment team. So what does NAMI do? And where does NAMI fit into this principles of engagement, engaging the family, engaging the individual? We provide education, support and awareness programs that are all peer led. Many of them are evidence-based. And we convene thought leaders around topics such as the engagement report, around advancing discovery, to help promote more research so that we get on the brain so we can have better treatments. And convening judicial experts to talk about what can we do to divert people from the criminal justice system, to get people the services that they need when they see them. The place where we are most helpful in providing support for the individual and the family is through the education and support programs. These programs have been shown, and we're talking about programs like NAMI Family to Family, NAMI Peer to Peer, NAMI Basics. Ken will give you some details about some of them in a minute. But the research that's been done on these programs, and they're basically psychosocial education programs, but peer led by people with the lived experience. So the family programs are led by family members of people with mental illness. The programs for the individuals with mental illness are led by peers. They're led by other individuals who are in recovery with mental illness. But the research that's been done, our programs have shown that people who take them or who attend the support groups show the outcomes that you see on the screen. Better problem solving skills, they feel more empowered to be involved in their own care, less family stress and improved coping skills. NAMI Provider is a unique program compared to the other programs that NAMI offers. And this is a program that was specifically developed to promote person centered care and the collaborative approach to treatment and shared decision making. It's a five session, 15 hour program for healthcare staff who work with individuals and families affected by mental illness. The sessions, which are two and a half hours each are organized into lectures, discussions, and group exercises. It's presented by a trained three person team. There's a family member of someone with mental illness, a person in recovery who's living well in their recovery. And the healthcare professional who's also either a family member or a person in recovery. This program has been around for a while and again was designed to be taught in community mental health centers, hospital settings, pretty much anywhere where there are professionals providing services for individuals with mental illness. Something really exciting that's happened in the last year that I think is part of the continued attention that we're seeing to person centered care and engagement is the Des Moines University School of Osteopathic Medicine in June of this year began offering this NAMI provider all 15 hours to all third year medical students at their medical school. 225 students in the class, they're the largest producer of primary care physicians. And they saw this as a critical piece of preparing these student physicians, students who were in medical school to be ready to interact with individuals with mental illnesses, whether they go into psychiatry or not, just the fact that they're gonna be interacting with these individuals. The goals of the program again are to introduce healthcare staff to what people with mental illnesses experience. What's it like to live their life the rest of the day when they're not in your office? Helping the staff gain an understanding of and empathy for their patients lived experience, especially when they're in treatment. And again, last but not least, promoting collaboration between the individual, the family and the providers, because we know that's what's necessary for the best levels of care. And this is the model that we promote in the provider program and in many of our NAMI programs that we're all in it together, the person in recovery, the family, their support system, and then the providers, the direct clinical care, where we get our information and our referral sources. And the center in the middle, we all have to partner. We're all teachers and mentors to each other and should all be advocating for the best possible care. And Ken is going to now tell you about some of the other NAMI programs. I'll be mentioning the NAMI Family-to-Family Program, but also making sure that you have a good handle on what else is out there that's outside of NAMI. The NAMI Family-to-Family Program is our best NAMI's best studied program. This is a 12 week based peer education for families taught by families who have loved ones with serious mental illness. This has been given to over 300,000 people across the nation. There's over 3000 trainers. This is available in multiple languages and is available in most everywhere across the country for free. It's a course that has been studied by Lisa Dixon and her colleagues. They looked at five counties around Baltimore and they compared people in Family-to-Family to people on a wait list. And there was a substantial improvement in coping and empowerment. And in a follow-up paper by Luxted, that paper showed nine months later, the results still held. It's a tremendous resource for family members of people who are living with serious mental illness is the better the family does, the better the individual will do. The program, Multifamily Groups for Families is a program developed by William McFarland, the Maine Medical Center. And this is a different variation on this theme. This is multifamily groups with the individual present who's living with a serious mental illness best studied in schizophrenia. These are led by a therapist and they're collaborative problem-solving groups where people puts their heads together and work on issues from sharing disclosure information when dating to problem-solving, getting a job. Multiple empirical studies have shown clear positive results for the individual and the family, including improving coping, improved employment outcomes and reduced hospitalizations. The challenge some people have found, we've had multifamily groups at the Massachusetts Mental Health Center, it can at times be difficult to organize people's time in modern schedules, which seem quite pressed for many people. A model that is devoted to the individual, not to the family, is the work, the Wellness Recovery Action Plan. And WRAP, as it is called, is a self-management course designed to improve self-care and promote recovery. So this is an educational peer support model. This is not a NAMI program. This exists in many clubhouses, recovery learning centers, and in peer-led programming across the nation. This was developed by Mary Ellen Copeland and a randomized controlled trial showed positive impact on several aspects of the person's perception of recovery and on scores of depression. Additional resources. These are resources that can be found on www.nami.org. College and Your Mental Health is starting the conversation, Navigating a Mental Health Crisis, how to help families and individuals think about crisis planning to avoid some of the problems we see with first responder complexity, planning ahead, anticipating symptom recurrence, figuring out where to go for resources. And then the Circle of Care is a guidebook for mental health caregivers, which will give you more of the information that we have discussed in this conversation. That concludes our pieces of the presentation. Thank you for your attention on an August day. And we're happy to take your questions.

webinar

serious mental illness

engagement

models of care

person-centered care

NAMI

peer-led programs

shared decision-making

supportive community