Family work, Communication and Early Warning Signs GRIP

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Family work, Communication and Early Warning Signs

• GRIP carers group week 4

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Family Involvement - Why

• Its a strange a bewildering time
• Young people are often still living with their
  family
• Parents will often initiate referral, and
  maintain contact with services
• Person is understood in their family and social
  context
• Helps the familys understanding, relationships,
  and adjustment to change
• Minimises risk of problems developing in
  individuals or in the family as a whole
• Distress is common in families of those with
  psychosis and is higher among newer caregivers

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Common themes

• High level of emotions anger, fear, guilt
• Grief, loss and rejection
• Diagnostic uncertainty
• Practical help
• Being listened to
• Some families do not see the need for ongoing
  help initially
• Navigating the complex NHS maze
• A point of contact
• The needs of young children/siblings

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Expressed Emotion

• Being emotional is a normal response to an
  abnormal situation
• Emotions change as time goes on
• Some people cope through denial
• Expressed Emotion (EE) is a term that has been
  used to describe environments where there is a
  high level of hostility, critical comments, and
  emotional over-involvement.
• These families are more distressed
• These factors often emerge in the later years of
  someone's illness and is (understandably) common
  in over 50 of families
• A sense of loss is linked with EE
• High EE has been linked to higher relapse rates.

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The way we look at things

• Symptom type and severity dont appear to affect
  factors such as EE or family appraisal
• The familys thoughts and judgements of the
  persons behaviour appear to be most important
  predictors of distress
• The way you process or think about things has
  an impact on how you feel about it ... (link with
  CBT session next week)

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Family interventions- early on.

• Usually at your own home with 2 staff
• Different types of family input at different
  points in time
• Semi-structured
• Assessments
• Agenda setting
• Early on
• Counselling about grief and loss, and adjustment
  to changed expectations
• Stress-management
• Information/education

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Family interventions later stages

• Later on
• Communication
• Problem solving about day to day issues
• Coping strategies
• Task setting
• Reviewing
• Relapse prevention strategies (early warning
  signs, WRAP)
• Non judgemental, positive, constructive,
  collaborative

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What do the Families bring with them?

• Reluctance to seek help early on
• The idea that the problem is temporary and
  unlikely to recur
• The effects of lack of information/limited
  information/inaccurate information
• The emergence of a range of conflicting strong
  emotions in family members
• Denial sometimes
• Fear and concern about stigma
• The special needs of siblings, and children of
  young people who are already parents
• Issues around substance misuse

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