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Biomedical subjects

W R McFarlane

Publications and source records attributed to W R McFarlane.

14 recordsLinked to original sources
PubMed2001

Evidence-based practices for services to families of people with psychiatric disabilities.

Family psychoeducation is an evidence-based practice that has been shown to reduce relapse rates and facilitate recovery of persons who have mental illness. A core set of characteristics of effective family psychoeducation programs has been developed, including the provision of emotional support, education, resources during periods of crisis, and problem-solving skills. Unfortunately, the use of family psychoeducation in routine practice has been limited. Barriers at the level of the consumer and his or her family members, the clinician and the administrator, and the mental health authority reflect the existence of attitudinal, knowledge-based, practical, and systemic obstacles to implementation. Family psychoeducation dissemination efforts that have been successful to date have built consensus at all levels, including among consumers and their family members; have provided ample training, technical assistance, and supervision to clinical staff; and have maintained a long-term perspective.

Evidence-Based Medicine↗
PubMed2001

Predictors of dissemination of family psychoeducation in community mental health centers in Maine and Illinois.

OBJECTIVE: The aim of this study was to determine whether it is possible at the time of staff training to predict whether a mental health center will succeed in implementing family psychoeducation services. METHODS: Fifteen mental health agencies in Maine and 51 in Illinois in which clinicians and administrators were trained in multifamily psychoeducation were studied. Participants were surveyed immediately after their initial training sessions and nine months later. Participants' demographic characteristics, agency characteristics, and principal components derived from the survey data were analyzed to identify factors associated with implementation of family psychoeducation services. RESULTS: The regression model successfully predicted which sites would succeed. Success was more likely at sites where the treatment model was viewed more positively at the outset, where real and perceived resource limitations were addressed, where inducements to implementation were seen as less important, and where attention was paid to the difference between new and existing treatment methods. Nearly all the Maine sites (14, or 93 percent) implemented multifamily psychoeducation services, whereas only five of the Illinois sites (10 percent) implemented this form of treatment. The Maine trainees were less skeptical about family psychoeducation and more interested in receiving supervision and consultation. In Maine there was wide-ranging and local consensus before and during implementation, and more federal funding was available than in Illinois. CONCLUSIONS: Surveys of clinicians allowed prediction of which sites would successfully implement family psychoeducation services. Consensus building and funding appeared to be critical to successful outcomes.

Adult↗
PubMed2000

Employment outcomes in family-aided assertive community treatment.

Family-aided assertive community treatment (FACT) was enhanced by adding vocational specialists to help persons with severe mental illness obtain competitive employment. Results were then tested against those of conventional vocational rehabilitation (CVR). The FACT cohort demonstrated significantly better employment rates than did the CVR, while negative symptoms declined in the former and increased in the latter. No evidence was found that competitive work presented a significant risk for relapse.

Adult↗
PubMed2000

Management of negative symptoms among patients with schizophrenia attending multiple-family groups.

OBJECTIVE: Outcomes for negative symptoms over a one-year period were examined in two groups of patients, one receiving psychoeducational multiple-family group treatment and one receiving standard care. METHODS: A total of 63 outpatients, ages 18 to 45 years, with DSM-IV diagnoses of schizophrenic disorders were randomly assigned to standard care or multiple-family group psychoeducation treatment at a large mental health center in Spokane, Washington. Treatment assignment was stratified by whether patients were taking typical or atypical antipsychotic medications. Negative symptom status was monitored monthly for one year by raters blind to group assignment and measured as a composite of five symptoms using the Modified Scale for the Assessment of Negative Symptoms. RESULTS: When the analysis controlled for baseline negative symptoms, participants in the multiple-family group experienced significantly reduced negative symptoms compared with those receiving standard care. Taking atypical antipsychotic medication or having a diagnosis of substance abuse was not associated with the severity of negative symptoms. An additional analysis of the five individual negative symptoms indicated small but consistent group differences on all dimensions except inattention. Negative symptoms were significantly correlated with relapse to acute illness but not with outpatient or inpatient service use. CONCLUSIONS: The study demonstrated that a psychoeducational multiple-family group intervention was more effective than standard care in managing negative symptoms over a 12-month period. The results are particularly relevant because negative symptoms are associated with relapse, poor social and occupational functioning, cognitive impairment, and lower subjective quality of life.

Adolescent↗
PubMed1997

Fact: integrating family psychoeducation and assertive community treatment.

Family Psychoeducation and Assertive Community Treatment are both state-of-the-art service systems with rich empirical foundations, demonstrating unusual effectiveness in randomized clinical trials. Recent research suggests a possible additive effect on selected outcomes when the two approaches are integrated. This paper reviews the role of family support and intervention in the care of persons with serious mental illnesses, presents the research literature on psychoeducation, and highlights benefits of merging the multiple-family version of this approach into the work of assertive community treatment programs.

Adaptation, Psychological↗
PubMed1996

A comparison of two levels of family-aided assertive community treatment.

OBJECTIVE: The study examined differences in outcomes for patients with schizophrenic disorders who were receiving assertive community treatment based on whether their families were involved in their treatment more intensively in psychoeducational multifamily groups or episodically in crisis family intervention. METHODS: Sixty-eight individuals who met DSM-III-R criteria for schizophrenic disorders and who had at least one other major complicating factor were randomly assigned to the two treatment conditions, and clinical and functional outcomes over a 24-month follow-up period were compared. RESULTS: Both groups had significant reductions in rehospitalization rates and symptom levels and increased participation in treatment. Patients in multifamily group treatment had higher employment rates during the study. Otherwise, few significant differences in the major outcome variables were found. In both treatment conditions family members reported significant improvements in their objective and subjective burden; in friction, dissatisfaction, and overinvolvement with the patient; and in the patient's functioning. CONCLUSIONS: The results suggest that systematic family involvement enhances the rehabilitation and family-related outcomes of assertive community treatment. Patients in multifamily group treatment had better employment outcomes.

Adolescent↗
PubMed1995

Multiple-family groups and psychoeducation in the treatment of schizophrenia.

OBJECTIVE: To compare outcomes in psychoeducational multiple-family group treatment vs psychoeducational single-family treatment. METHOD: A total of 172 acutely psychotic patients, aged 18 to 45 years, with DSM-III-R schizophrenic disorders were randomly assigned to single- or multiple-family psychoeducational treatment at six public hospitals in the state of New York. Psychotic relapse, symptom status, medication compliance, rehospitalization, and employment were assessed independently during 2 years of supervised treatment. RESULTS: The multiple-family groups yielded significantly lower 2-year cumulative relapse rates than did the single-family modality (16% vs 27%) and achieved markedly lower rates in patients whose conditions had not remitted at index hospital discharge (13% vs 33%). The relapse hazard ratio between treatments was 1:3. The relapse rate for both modalities was less than half the expected rate (65% to 80% for 2 years) for patients receiving individual treatment and medication. Rehospitalization rates and psychotic symptoms decreased significantly, and medication compliance was high, to an equal degree in both modalities. CONCLUSION: Psychoeducational multiple-family groups were more effective than single-family treatment in extending remission, especially in patients at higher risk for relapse, with a cost-benefit ratio of up to 1:34.

Adolescent↗
PubMed1995

Psychoeducational multiple family groups: four-year relapse outcome in schizophrenia.

Earlier studies of family psychoeducation and clinical reports on multiple family groups (MFGs) have reported substantial reductions in relapse rates for patients with schizophrenia. These groups offer an expanded social network and thereby may confer a margin of protection against relapse. However, to date, there has not been an empirical trial of this modality. The advent of family psychoeducational and behavioral management strategies provided the basis for an experimental, three-way comparison of psychoeducational MFGs to psychoeducation in a single-family format and to MFGs without psychoeducation, using symptomatic relapse as the outcome criterion. After 4 years, the psychoeducational MFGs were significantly more effective in extending remission than the single-family format, while the MFGs without psychoeducation approximated outcome in the psychoeducational MFGs. The respective relapse rates at 4 years were 50%, 78%, and 57%; MFGs averaged 12.5% and 14% per year. These results point toward an enhanced and independent, long-term therapeutic effect for multiple family groups, when combined with antipsychotic medication and psychoeducation, with especially promising cost-effectiveness.

Adult↗
PubMed1994

Multiple-family groups and psychoeducation in the treatment of schizophrenia.

Recent studies suggest that the multiple-family group is a preferable vehicle for assisting families and treating and rehabilitating persons with schizophrenia within a psychoeducational clinical framework. This approach is probably the most cost-effective treatment for schizophrenia developed since antipsychotic medication.

Caregivers↗
PubMed1993

From research to clinical practice: dissemination of New York State's family psychoeducation project.

The New York Family Support Demonstration Project was begun in 1984 to translate the results of research on family psychoeducation in the treatment of schizophrenia into general practice. Goals were to compare experimentally a single-family psychoeducation model with a multiple-family group format, to replicate successful outcomes in ordinary clinical settings, and to train agency clinicians in the model. A total of 172 schizophrenic patients and their families from six sites across the state were followed for two years. Relapse rates comparable to those in more narrowly focused research studies were obtained in ordinary clinical settings. Patients in the multiple-family format had substantially lower risk of relapse than patients in single-family treatment. Over the next three years, the multiple-family approach was successfully disseminated across the state using a strategy based on five central assumptions of the psychoeducational model.

Combined Modality Therapy↗
PubMed1991

Creating a supportive environment using staff psychoeducation in a supervised residence.

The prevailing approach to rehabilitation in residential care emphasizes goal attainment. This approach often produces considerable stress for residents, most of whom have schizophrenia. Based on the view that low-demand environments, incorporating graduated expectations, may be more appropriate for this patient population, a three-component model for creating and maintaining a calm, supportive environment in a supervised residence was developed. The model utilizes staff psychoeducation, which is based on the principles of family psychoeducation, a highly effective intervention for patients with schizophrenia. The three components of the model are training in supportive interaction, a medication-monitoring program, and a behavioral approach to problem solving. Resident groups promote each of these components. The groups' goals are encouragement of positive, low-key interactions, compliance with medications, and slow, steady rehabilitation.

Adult↗
PubMed1982

Family treatments of schizophrenia: background and state of the art.

Schizophrenia, as a failure to achieve maturity and independence, has always had distressing effects on a patient's family. Unfortunately, scientific theories that propose the family itself as a contributing factor have eroded the alliance between professionals and family members and added to the burden of family guilt. The initiative in designing family therapy for schizophrenia began among an early group of innovators who subscribed to strong family-theory ideologies. Today a more pragmatic group, trained in various research methodologies, has taken the lead. The authors discuss the historical development of family therapy for schizophrenia and review new programs including relatives' groups, psychoeducational family therapy, and strategic and systemic approaches.

Adaptation, Psychological↗