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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

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National Meeting 2008

3043 — Implementation of Family Services in Outpatient Mental Health

Cohen AN (VA Desert Pacific MIRECC), Glynn SM (Greater Los Angeles VA Healthcare Center and University of California, Los Angeles), Hamilton A (VA Desert Pacific MIRECC), Young AS (VA Desert Pacific MIRECC amd University of California Los Angeles), Dixon L (VA Capitol Network MIRECC and University of Maryland School of Medicine)

Objectives:
Family Psychoeducation decreases relapse in individuals with schizophrenia. Effect sizes are comparable to psychopharmacologic trials. Few families are getting services. We surveyed key stakeholders to understand the implementation barriers and create a plan for expanding the treated population.

Methods:
Veterans with schizophrenia in 3 VA mental health clinics (n=398) and their providers (n=66) were interviewed at baseline and 15 months about veteran-family contact, family-provider contact, and veteran interest in having families involved. Providers completed a survey on their training and knowledge around family services (Competency Assessment Instrument) and their workload (Maslach Burnout Inventory). Qualitative interviews were conducted for a process evaluation of family services implementation.

Results:
The majority (n=274; 69%) of veterans have supportive family member. Of those, 117 (43%) reported their family had never had contact with the treatment team; an additional 52 (19%) reported no contact in the past 12 months. Of those available at follow-up, 259 said they did not want their families involved in their care. Concerns included privacy (n=56; 22%), overburdened family (n=52; 20%), and no local family (n=43; 22%). Of the 33 veterans who wanted involvement, 23 (70%) wanted more family-psychiatrist contact. There was no effect of age or ethnicity on interest in family involvement. Provider competency in family involvement was .49 (SD=.22), a moderate level. In terms of job burnout, 21% reported high levels of burnout, defined as high levels of emotional exhaustion and depersonalization and low sense of personal accomplishment. Providers assumed veteran-family contact was low and families were “dysfunctional”, “inconsistent”, and “usually the problem”.

Implications:
Patient and clinician barriers must be addressed to implement this evidence-based practice. Veteran-family contact is high; family-provider contact is low. Many veterans do not want their families more involved, and many providers have a skewed vision of families. Organizational barriers include no evening hours, limited staff, and no community outreach. Based on this data, we developed a treatment heuristic that provides family interventions at varying intensity levels, titrated to family and consumer needs and circumstances. An engagement strategy to be utilized with veterans has been developed, piloted, and will be presented.

Impacts:
Data is being utilized in novel quality improvement strategies.


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