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—by Paul M. Kubek and Matthew K. Weiland

Akron, OH—At the Northeast IDDT Regional Stakeholders meeting in May, participants shared challenges and emerging solutions to implementing and sustaining family psychoeducational programs and enhancing the recruitment and retention of service team members. Family psychoeducation is a core component of the Integrated Dual Disorder Treatment (IDDT) model. The Ohio SAMI CCOE has observed that achieving and sustaining fidelity to this item on the IDDT fidelity scale has been particularly challenging throughout the country, even in the northeast region of Ohio where several long-standing IDDT programs have consistently achieved moderate to high overall fidelity to the model.

The CCOE has observed that staff turnover continues to be a trend not only in Ohio but also throughout the nation. There are a variety of contributing factors, which sometimes include ineffective recruiting strategies and insufficient clinical supervision and professional development practices.

Re-building Bridges Among Consumers, Families, & Service Providers

According to Ohio SAMI CCOE Consultant and Trainer Jeremy S. Evenden, MSSA, LISW, who co-chairs the northeast regional stakeholders meeting, some of the primary goals of family psychoeducational programs are to improve the relationship between consumers and their family members and to educate all about severe mental illness and addiction. The programs also provide strategies for consumers and family members to be partners in managing symptoms and advancing rehabilitation and recovery.

Barriers identified

Northeast regional stakeholders have acknowledged that engaging family members is challenging for several reasons:

• Family members may feel stigmatized by severe mental illness and are reluctant to participate in activities sponsored by service organizations.
• Family members and consumers often have strained relationships and have difficulty communicating and collaborating effectively in the process of recovery.
• Family members themselves may also be struggling with symptoms of mental illness and addiction.
• Identifying meeting days and times that accommodate a majority of those interested in the programs is difficult because family members have different schedules.
• Clinicians often struggle with how to discuss family involvement with consumers in a motivational way (i.e., using motivational-interviewing techniques).

Effective strategies

Stakeholders in the northeast region also discussed several strategies that have worked for them. They emphasize that events which provide free food to participants often draw interest. Two examples of successful programs include the following:

• Informal "family night" social events for consumers and their family members, which are designed simply to introduce and acquaint people to each other, to create peer-support networks and the feeling that they are not alone.
• Formal multiple family psychoeducational programs, which are designed to teach consumers and family members about severe mental illness and addiction as well as strategies for working together to manage symptoms and to advance recovery.
• Co-sponsor and/or co-host family events with local chapters of the National Alliance on Mental Illness (NAMI) or other consumer-advocate groups.

Sustaining the momentum

Evenden explains that several organizations have found that attendance at family programs often reaches a "ceiling", with the same families attending. In addition, interest and attendance eventually diminishes and dissipates over time. The stakeholders are committed to experimenting with new strategies to increase interest in and the influence of family programs. Evenden adds that it will take patience, persistence, and creativity.

"A big focus of family programs is to help mend relationships and rebuild trust between consumers and family members," he says. "Sometimes families are not particularly knowledgeable about mental illness. Many times they may feel guilty, as though they caused the condition or that it resulted from something they may have done. So we're working through a lot of guilt feelings, a lot of anger. These are difficult feelings to work with."

Staff Retention

One of the challenges of sustaining IDDT services as a whole over time, Evenden says, is providing a continuity of care from a consistent team of service providers. He adds that many Ohio organizations continue to struggle with staff turnover. For instance, organizations in the northeast region are finding themselves in a one- to two-year cycle of hiring and training new team members, some of whom are recent graduates of schools of social work, counseling, and psychology that do not necessarily teach principles and practices of IDDT. (An exception is the Mandel School of Applied Social Sciences.)

"The young graduates join the team, then in a couple of years they are moving on to other types of jobs," he says.

Possible solutions

Stakeholders in the northeast have shared potential solutions for improving recruitment and retention of dedicated service team members, including the following:

• Look for candidates who can not only articulate but who can also demonstrate a heartfelt desire to help people with co-occurring disorders through recovery.
• Utilize effective interview questions that help identify the most committed and qualified candidates (e.g., stakeholders are working to identify, acquire, and share effective interview instruments).
• Conduct group interviews that include the entire service team or the most experienced team members to see if the candidate "fits" - if he or she will contribute to cohesion, collaboration, and creative problem-solving.
• Have top candidates shadow a team member during his or her work with consumers in the community.
• Other possible solutions recommended by the Ohio SAMI CCOE include the following:
• Provide weekly clinical supervision to all team members, including new hires.
• Provide other staff-development opportunities that encourage new team members to grow into different roles in the organization over time.
• Consider cross-team mentoring opportunities with other Northeast Ohio IDDT teams. 

Professional Peer Support

The Ohio SAMI CCOE sponsors quarterly IDDT regional stakeholders meetings in Ohio. The purpose of these meetings is to create a network of professional peer-support that encourages honesty about challenges and barriers to implementation and creativity to explore and test possible solutions. The networks disseminate lessons-learned through practice.

Stakeholders typically include the following from inpatient and community-based organizations that provide services and from county boards that provide support for IDDT in their communities:

• Team leaders
• Program managers
• Quality assurance professionals
• Administrators
• Policymakers
• Direct-service staff
• Consumers and family advocates

Academic-Community Partnership

The Ohio SAMI CCOE is a program of the Center for Evidence-Based Practices at ÐÇ¿Õ´«Ã½, which is a partnership between the Mandel School of Applied Social Sciences and the Department of Psychiatry at the Case School of Medicine. The Ohio SAMI CCOE works in collaboration with and is supported by the following:

• Ohio Department of Mental Health
• Ohio Department of Alcohol and Drug Addiction Services

Paul M. Kubek, MA, is director of communications at the Center for Evidence-Based Practices at ÐÇ¿Õ´«Ã½. Matthew K. Weiland, MA, is senior writer, producer, and new-media specialist.