Implementing MF-PEP Groups in an Urban Public Mental Health System: Results from a 3 Year Study

Background and Purpose: The Multiple Family Psychoeducation Program (MF-PEP) is a promising group intervention program for youth living with bipolar disorders and/or depression and their primary caregivers. This 8 week group intervention developed by Fristad et al. (2011) provides the youth and parents with tools to cope with the illness.  One large urban mental health system selected this intervention to implement in 6 different sites over 3 years serving primarily African American and Latino families.  The goal of implementing this intervention was to enhance services to this population and to change the delivery of services to include a group model. The core questions in this study focused on organizational change issues, as well as, behavioral health outcomes for the youth involved in the groups.  The organizational change issues questions included determining what types of training and ongoing supports were needed to implement the intervention, how best to recruit and maintain families in the groups and what issues were involved in sustaining this intervention over time. The behavioral health outcomes for the youth focused on overall functioning in major life domains and for the youth and parents the coping skills learned during the group intervention. One adaptation to the MF-PEP leadership model was the addition of a parent advocate to the group facilitation team.  Methods:  The study included pre and post measures of the youth and primary caregivers who and periodic surveys of group leaders and administrators to address training and organizational change issues.  The youth and primary caregivers completed at the start of the group and the post group, the Columbia Impairment Scale that examines youth functioning with peers, siblings, school, parents, and persons in authority. Evaluations of the group experience were also completed in the final group session.  Administrators and group leaders were interviewed before and after each group cycle to address the organizational change issues.  Descriptive data analyses and t-tests were used to examine the change issues in the groups.  Qualitative methods were used to explore themes from the different sites related to organizational change issues. Results:  Over 70 youth and families participated in the MF-PEP groups over time with a majority (over 80%) of the youth identifying as African American.  Pre and post group measures demonstrated significant improvement in youth functioning and youth and primary caregiver coping skills.  Administrators and group leaders (including the parent advocates) noted several challenges in delivering this MF-PEP group at their sites including recruitment was time consuming, finding time to prepare for the group sessions each week was difficult due to workload expectations for leaders and the reimbursement for the groups was low for this amount of effort involved in delivering the group intervention (e.g. providing transportation, reminder calls, food, child care). Conclusions and Implications: The MF-PEP group demonstrated positive outcomes for the youth and primary caregivers who completed the program.  Time for leaders to be trained and prepare for weekly groups, recruitment of families, and resources needed to sustain these groups are major organizational challenges.