Pre-Post Outcome Evaluations of Family Psychoeducation for Consumers and Family Members: A Pilot Study to Overcome the Annotated Barriers

Background: Family members play key roles for consumers with severe mental illness in their recovery (e.g., facilitating the engagement process of consumers to other effective treatments). Family psychoeduation (FPE) is designed to provide information, skills, and support helping families and adult consumers better understand mental illnesses and work collaboratively. While outcomes of FPE are positive in general (e.g., reduced burnout, increased knowledge), high rates of non-dissemination/non-accessibility of FPE are identified (Cohen et al, 2008). FPE is often led by mental health professionals (e.g., psychiatrists) and offered as part of a clinical treatment plan. Potential barriers in implementation include: 1) not affordable for professional staff time at the agency level; 2) not compatible with many clinicians’ theoretical training (more complex than standard individual training); 3) past negative experiences of family members with mental health providers; and 4) consumer reluctance to place further burden on family members (Lucksted et al, 2012). Kansas has provided FPE since 2008 using case managers and peer support specialists to overcome these barriers.

Methods: We modified the SAMHSA FPE training manuals and provided training and consultation to case managers in 6 community mental health centers. Four of the sites participated in this study where 24 consumers and their family members agreed to complete questionnaires at baseline (prior to the intervention) and 6 months. Recovery Assessment Scale (five domains and total RAS), knowledge, problem-solving, and communication skills scales were filled by consumers. Family members completed burden, knowledge, problem-solving, and communication skills scales. Mixed effects regression analyses were used to examine the pre-post mean score differences accounting for missing data.

Results: Mean age of the consumers was 37.2±12.2, above half (59%) were male, 58% were white, 80% had a schizophrenia diagnosis, 12% had less than high school education, 84% were not employed, and 50% lived with family members. Mean age of the family members was 53.1±13.5, 89% were female, 13% had less than high school education, 52% were not employed, and majority (61%) were parents. Descriptive statistics of outcomes for baseline and 6 months follow: hope (2.8±0.6 to 3.1±0.6), ask for help (3.1±0.6 to 3.3±0.6), goal orientation (3.2±0.6 to 3.4±0.6), reliance on others (3.2±0.6 to 3.5±0.4), no domination by symptom (2.4±0.6 to 2.7±0.7) in RAS, Total RAS (2.9±0.5 to 3.2±0.5), knowledge (2.8±0.6 to 3.0±0.6), problem-solving (2.4±0.7 to 2.9±0.7), communication (2.9±0.5 to 3.2±0.3) for consumers; and burden (2.3±0.6 to 2.1±0.4), knowledge (2.8±0.6 to 2.9±0.7), problem-solving (2.6±0.6 to 2.8±0.4), and communication (3.1±0.5 to 3.1±0.4) for family members. Pre-post evaluations indicated that consumers significantly improved hope (p=.05), no domination by symptom (p=.06), RAS total (p=.03), problem solving (p=.01), communication (p=.06), and family members reduced burden (p=.04) between baseline and 6 months.  

Conclusions and implications: Our pilot study showed some promising results on consumer and family member outcomes for FPE led by case managers. The findings are informative for the states where FPE is not reimbursable for case managers as providers. We will discuss the training methods, modified fidelity, and potential roles of social workers supporting successful FPE and the future directions.