Family Care of Schizophrenia: A Problem-solving Approach to the Treatment of Mental Illness
| Manual Title |
Family Care of Schizophrenia: A Problem-solving Approach to the Treatment of Mental Illness |
| Creators |
Ian R.G. Falloon, M.D. et al |
| Reference |
Falloon, IRG, Boyd, JL, & McGill, CW (1984). Family care of schizophrenia: A problem-solving approach to the treatment of mental illness. New York: Guilford
Falloon, IRH, Laporta, M, Fadden, G., & Graham-Hole, V. (1993). Managing stress in families: Cognitive and behavioral strategies for enhancing coping skills. New York:
Routledge. [Out of print] |
| Price |
unknown |
| Contact Information: |
Ian R. Falloon, M.D.
Professor Emeritus of University of Auckland
Auckland, New Zealand
|
Program Overview:
Theoretical Approach:
Behavioral / Cognitive-behavioral. The patient is viewed as the expert on their disorder. Families are encouraged to lower expectations and face daily problems with a "1 day at a time" approach. Program assumes that improving the family's coping, communication and problem solving will help them to cope after treatment has ended. Families are urged to be an active part of the treatment team.
Setting:
Initial writing (1984 book) focused on working work with individual family in the home (patient is included); however, subsequent research (see below) has included clinic sessions.
Format:
Treatment program has three phases:
- Two 3-hour assessment sessions (including the patient) are scheduled as soon as patient is discharged from hospital and has been stabilized on medications.
- Two specific education sessions are provided, namely "what is schizophrenia" and "medication management" [text contains outlines of these sessions, including
specific handouts for the family]
- Family sessions then focus on communication skills & problem-solving techniques [Text describes the general goals and procedures of these sessions]
Frequency / Duration:
Family sessions are weekly for 3 months, biweekly for 6 months, then monthly thereafter.
The entire program typically lasts 9 months to 1 year.
Typically ~21 family sessions total.
Research:
Note: Falloon's work has been researched extensively. Therefore, only three of his key studies will be described.
Falloon, Boyd, et al (1985)
- Methods: Random assignment of 39 patients in public hospitals after an episode of schizophrenia to either of the following for 9 months:
- 25 hour-long sessions of individual therapy in the clinic (focusing on problem-solving) [n = 20]
- 25 hour-long sessions of single-family therapy (BFT) in patient's home [n = 19]
After first 9 months, each got once/month follow up sessions (family OR individual)
- Results:
After 2 yrs - relapse:
- 17% of BFT treatment relapsed vs
- 83% of individual treatment relapsed
Over the 2 years - total number of hospital days:
- BFT group had total of 66 days
- Individual treatment group had total of 408 days
Also, affective disturbance was less in the BFT cases
Randolph et al (1994) - application of Falloon's BFT (1984) in a VA mental health clinic
Methods: Randomly assigned to BFT or standard care
BFT protocol included 25 sessions over 12 months on declining contact basis (n = 41) (Ended up mean of 21 sessions: 2 sessions to assess; 6 sessions of education; 6 to communication; 7 to problem-solving)
Results:
In first year of treatment - relapse
- 14% of BFT had symptomatic exacerbations vs.
- 55% of standard care
In first year of treatment - long-term exacerbations
- 5% of BFT had exacerbations lasting at least 2 weeks vs.
- 30% with standard care
At 2-year follow-up (Randolph et al, 1995 cited in Mueser & Glynn 1998) - relapse
- 10% of family group had relapsed vs.
- 40% of routine treatment group had relapsed
Schooler et al (1997): Treatment Strategies for Schizophrenia (TSS) Study (a combination of single-family treatment with multiple-family groups)
- Methods: All families attend a 3-6 hour psychoeducation workshop (patients NOT included) presented by members of patient's treatment teams (modeled on Anderson's survival skills workshop).
Families then randomly assigned to 2 conditions:
- Applied Family management (AFM): 1 year of Falloon's BFT in the home (32 sessions focusing on education, communication, problem-solving) AND 2 years
monthly support group for family & patient
- Supportive Family management: (SFM): 2 years of 90 minute monthly support group for families & patients (8-20 participants)
Note: The monthly support groups included a focus on the biological nature of schizophrenia & the fact that families are not to blame
- Results:
No difference in relapse rates between AFM & SFM (32% of patients readmitted overall)
No difference in social functioning (both groups showed improvement) (Mueser et al (1991)
Neither group showed improvement in family burden (no difference)
AFM group's patients experienced significantly less family friction & the relatives demonstrated significantly lower levels of rejecting attitudes toward patients (than SFM)
Other relevant research findings:
- Falloon et al (1987): BFT (in the home) resulted in significant improvements in social relationships, household tasks, work activity & leisure activities over 2 years in comparison to standard treatment
- Cardin et al (1986): Found that the combination of family treatment & standard care gave cost savings of 19%
- Falloon & Pederson (1985): Long-term family treatment has decreased caregiver's burden, decreased caregiver distress, & increased coping skills
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