Developing a Partnership Between Mental Health Providers and Families of Adults with Severe Mental Illness: A Pilot Evaluation of NAMI Provider Education Program

Purpose: Involvement of families in the treatment process has been shown to enhance the recovery process for people with severe mental illness (SMI), yet mental health providers often do not actively reach out to families. In our recent needs assessment of family involvement, most mental health providers had not involved families in consumers' treatments and had not received any training on how to work with families. One promising approach to training providers is the National Alliance on Mental Illness (NAMI) Provider Education Program. This 10-week course was taught by a team of consumers, family members, and providers to help providers gain a better understanding of mental illnesses and their management from consumer and family perspectives. The goal of this pilot study was to evaluate the feasibility and preliminary effects of the training.

Methods: The NAMI Provider Education Program was provided to 24 clinical staff working with people with SMI in a community mental health center. Consumers-family dyads (N=23) were randomly selected from the providers' treatment teams. Mixed methods were used to evaluate the impact of the training at baseline, post-training, and 6-month follow up: self-administered survey, brief feedback form for each week's training topic, weekly team meeting observation (Providers), telephone survey (Consumers and Families). The survey questionnaire included information on the amount of family services providers provided to the families and perceived barriers to developing family-provider collaboration.

Results: Overall, providers reported lower level of service needs (F=4.21, p=.047) and greater perceived barriers to services (F=11.85, p=.002) than families reported over time. Both providers and families identified work related factors (e.g., work schedule, too many other work demands) as major barriers to working with families. But providers viewed consumer/family factors (e.g., consumer's refusal, family's lack of interest) as another key barrier, while families did not agree. They also provided significantly fewer services to the families at post-training and 6-month follow up (F=3.74, p=.036). The observation data revealed that at 6 month follow up, providers began to view family as a resource to support consumers and attempted to make more family contact ,but many continued to display negative attitudes (e.g., family involvement will cause stress for consumers and family). Providers tended to support positive family relationships but avoided direct family involvement if they perceived consumer/family relationship as negative. Despite various discussions on family issues, providers often failed to develop specific follow up plans to work with and meet the needs of families. Providers also struggled how to engage ‘difficult/uninterested' families and reported their need for more information and skills to work with such families.

Implications: To enhance partnership between provider, consumers, and families, the provider training should be closely adapting to the current level of knowledge and needs among providers in order to help them build more positive perceptions about family involvement and clinical skills to work with families.