A Model Program for Integrated Family-Centered Collaborative Healthcare: Chicago Center for Family

Health & University of Chicago Kovler Diabetes Center

John S. Rolland, MD, MS, Professor of Psychiatry, & Executive Director, Chicago Center for

Family Health, University of Chicago Pritzker School of MedicineZephon Lister, PhD, Director of Collaborative Care Program, Family Medicine Residency, Division of Family & Preventive Medicine, University of California, San DiegoMary Kelleher, MS, LMFT, Faculty, Chicago Center for Family Health (affiliated University

of Chicago)Isha Williams, MS, LMFT, Past-Doctoral Fellow, Families, Illness & Collaborative Healthcare, Chicago Center for Family Health (affiliated University of Chicago)

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Session #E2October 28, 20111:30 PM

Faculty Disclosure

We have not had any relevant financial relationships during the past 12 months.

Need/Practice Gap & Supporting Resources

Diabetes is an epidemic in the United States, affecting over 25 million people. This presentation describes an innovative full collaboration between the Chicago Center for Family Health (CCFH) and the University of Chicago Kovler Diabetes Center (KDC). This new comprehensive Center provides care across the lifespan for over 6000 patients with diabetes. CCFH is partnered to develop and implement the psychosocial component of care. CCFH faculty and Families, Illness, and Collaborative Healthcare doctoral fellows utilize a fully integrated collaborative care model for their on-site work at KDC. The clinical care approach is resilience-oriented and family-centered, drawing on Rolland’s Family Systems Illness and Walsh’s Family Resilience Models.

Objectives

This presentation describes:• The development and implementation of a resilience-

oriented, family-centered collaborative model of care, fully-integrated in a major university-based comprehensive diabetes center.

• Components of routine behavioral healthcare• Evolution, successes, & challenges of collaboration• Healthcare professional education and development • Presentation of data• Potential generalizability as a model of collaborative care in

specialty medicine

Expected OutcomeAt the Conclusion of this presentation, participants will be able to:

• Describe the key conceptual underpinnings of a fully integrated resilience-oriented and family-centered model of behavioral healthcare in a large specialty medical service or center

• Have a template for implementation of this model in a range of specialty medicine clinical services or centers (e.g. diabetes, cancer)

• List and design implementation the various clinical and educational components of this comprehensive collaborative model

• Describe challenges and methods of collaboration in diabetes and other similar specialty services

Learning Assessment

A 10 minute Question & Answer period will be provided at the conclusion of the presentation

Chicago Center for Family Health

• Internationally recognized as one of the foremost family-systems oriented training institutes in the world

• Provides specialized training & services to promote healthy family functioning and adaptation to stressful life challenges

• Innovative community-based, collaborative, resilience-oriented practice model to strengthen families at risk, in crisis, or facing persistent challenges

• Promotes family-centered collaborative healthcare - a systems-based model that views the family as the primary unit of care

• CCFH is an independent affiliate of the University of Chicago. CCFH is a non-profit, 501 (c)(3)

Kovler Diabetes Center University of Chicago Pritzker School of Medicine

• Fully integrated pediatric and adult diabetes program

• “One-stop shopping” for all individuals managing diabetes complications• Internationally recognized research leader: Diabetes Research and

Training Center, Health Studies

• Standardized, ADA recognized adult and pediatric diabetes teaching

programs

• Aggressive use of cutting-edge technology: pumps, sensors, software

• Accessibility: email / website interactions for pump / meter patients

• Adolescent and Teen Transitions Program, including satellite locations

• In-house podiatry and hypertension care• Close interaction with Juvenile Diabetes Research Foundation and the

American Diabetes Association

Basic Premises:• The psychosocial aspects of diabetes are crucial when developing

a chronic disease management plan

• Optimal psychosocial approach considers the family, broadly defined, as the psychological and care giving focal point

• Built into a comprehensive biopsychosocial model for diabetes management from the very beginning at the time of diagnosis

• The psychosocial component addresses both patients’ and family members’ needs using a developmental, life-span model that is culturally sensitive

• Fuller integration of the biomedical and psychosocial aspects of care directly in healthcare settings.

CCFH Model with Diabetes Care• Bio-psycho-social Influences

• Collaborative ApproachPatient – Family - Healthcare Team

• Family Resilience FrameworkShift from Deficit, Problem Focus toStrengths & Resources for PositivePatient / Family Adaptation

• Developmental, life-span View: Illness – Individual - Family

• Attuned to socio-economic, cultural, spiritual diversity & varied family forms

Diabetes & the Family• Family as a key resource & partner in care

• Diabetes and related stresses affect family life, all members and relationships

• Family organization and process can influence treatment adherence & disease course; Respectful involvement: risks, stress, conflict functioning & wellbeing of patient and family

Need for Family Psychosocial Map

• Assess, strengthen family functioning: Beliefs, Organization, Communication

• Psychosocial understanding of diabetes

• Understanding developmental issues

Multigenerational Developmental Perspective with Diabetes

• Individual and family development • Prior experience with illness & loss,

including stories of resilience

• Current timing

• Impact on future individual and family life planning

Overall Design: Four Components

1) Family centered clinical & psychoeducational services

2) Professional education and development for service providers

3) Community education and outreach

4) Family resources

Component 1: Family-Centered Clinical and Psychoeducational Services

Routine family-oriented psychosocial consultation/screening concurrent with the medical providers’ and diabetes educators’ intakes at the time of entry into KDC. This includes providing pertinent family psychoeducational information.

• Engages patients and their families

• Provides an orientation to treatment plans and their role

• Uses family strengths as a resource for optimal diabetes care management and identifies patient/family vulnerabilities that need to be addressed for successful diabetes treatment

• Facilitates early identification of a subset of patients/families that are multi-stressed and dysfunctional, who often become high users of medical and psychiatric resources coupled with low adherence with diabetes management

Family-Centered Clinical & Psychoeducational Services

• Routine screening family consultation combined with a brief psychological screening of the patient at time of diagnosis or entry into the Kovler Diabetes Center.

• Identify & Refer complex or “high risk” cases for counseling

• Periodic family psychosocial “check-ups” and consultations-- at key diabetes-related transitions or -- disruptive individual and family transitions

New KDC PTInitial Appt.

M.D.

Diabetes Educ.

PsychosocialOrientation & Assess.

1-Day Family Skills Workshop

1st F/U Appt.4-12 wks.

Family Assess.

When Appropriate,Short-term

Indiv./Couple/Fam.Intervention

@ KDC@ KDCHi-Risk1-4 wks.

Intensive Eval.

When Appropriate,Complex Cases

Intensive Tx by CCFH

Existing KDCComplex Case

Regular KDC Appt.

Diabetes Educ.

M.D.

Diabetes Educ.

M.D.

Psychosocial Eval.

Psychosocial Instruments1/2 sent in advance

1/2 completed @ KDC before/after appt.

Behavioral Healthcare Components

• Family-oriented assessment and screening tools, completed by patients/key family members at KDC intake or complex case consultation

Behavioral Healthcare Components

• “Complex” case consultation (e.g. adherence issues). High risk cases receive brief or more intensive therapy.

Referral of complex or “high risk” cases

• In-depth individual, couple, and family consultation and counseling

• Referrals to CCFH faculty clinicians and doctoral fellows with expertise in Families, Illness and Collaborative healthcare

• Cases that would benefit from more intensive individual and/or family intervention to avert poor disease management and psychiatric morbidity (e.g. depression, eating disorders, substance abuse, marital conflict).

Behavioral Healthcare Components

• Periodic psychosocial “check-ups” and consultations are available at key diabetes-related or disruptive individual/family transitions.

• Address illness and management complications that frequently arise at stressful transitions such as starting a family, transitioning to adulthood, job loss, loss of a loved one, divorce and remarriage

Behavioral Healthcare Components

Psychoeducational workshop days for patients and their families to provide information, skills-building, and family-networking. Includes:

• Initial workshop for newly diagnosed patients and their families

• Topical workshops for major life transitions (transition to adulthood, early marriage) and family challenges (communication/problem-solving, caregiving).

Psychoeducational multi-family discussion workshop modules for diabetes patients

and their families

• Large group presentations providing information, discussion, and break-out sessions for groups of families

• Co-led by CCFH faculty in tandem with Kovler Diabetes Center team staff

• Fosters support networks among families in the community coping with diabetes

• Identifies individuals, couples, and families at high risk for maladaptation

Multiple Family Discussion Groups & Educational Days

• Address Key psychosocial challenges

isolation and support & networking of families dealing with similar issues.

• Provide information, guidelines to reduce stress, avert medical crises

• Draw out strengths, resources to live and love well with diabetes

Component 2:Professional Education and Development

• Continuing Medical Education programs (CME) for all direct diabetes providers

• Continuing Education programs for nurses, social workers, dietitians and other allied health professionals

• Intensive training for core Kovler Diabetes Center team members

Professional Collaboration, Education, & Development

• Psychosocial Rounds with collaborative presentation and discussion of complex cases

Component 3:

Community Education and Outreach

• Free educational events offered to the consumer community

Component 4:

Family Resources

• Database to link families in the program

• Resource to families:• with a newly diagnosed member • those going through a difficult transition such as starting a family or launching to adulthood, independent living.

Data: Relationship Family Functioning to Diabetes Disease Management

Data Analysis is being completed for presentation

Key ReferencesChicago Center for Family Health

jrolland@uchicago.edu, www.ccfhchicago.org

Rolland, J. (1994). Families, Illness, & Disability: An Integrative Treatment Model. New York: Basic Books.

Rolland, J.S. (2011). Mastering family challenges in serious illness and disability: A normative systemic health paradigm. In F. Walsh (Ed.), Normal family processes. 4th Edition. New York: Guilford.

Rolland, J.S. & Walsh, F.W. (2005). Systemic training for healthcare professionals: The Chicago Center for Family Health Approach. Family Process, 44, no 3, 283-301.

Rolland, J.S., & Walsh, F. W. (2006). Facilitating family resilience with childhood illness and disability. Current Opinion in Pediatrics, 18: 527-538.

Walsh, F. (2006, 2nd edition). Strengthening Family Resilience. New York: Guilford.

Walsh, F. (2010). Resilience in Families Facing Serious Health Challenges, In M. Craft-Rosenberg , & S.R. Pehler (Ed.) Sage Encyclopedia of Families & Health

Key ReferencesArmour, T.A., Norris, S.L., Jack, L., Zhang, X. & Fisher, L. (2005). The effectiveness of family

interventions in people with diabetes mellitus: a systematic review. Diabetic Medicine, 22:10, 1295-1305.

Campbell, T.L. (2003). The effectiveness of family interventions for physical disorders. Journal of Marital and Family Therapy, 29 (2): 263-281.

Carr, D. & Springer, K.W. (2010). Advances in families and health research in the 21st century. Journal of Marriage and the Family, 72(3), 743-761.

Gonzalez, S., & Steinglass, P. (2002). Application of multifamily groups in chronic medical disorders. In W. F. McFarlane (Ed.) Multifamily groups in the treatment of severe psychiatric disorders. (pp. 315-341). New York: Guilford Press.

McBroom, L., & Enriquez, M. (2009). Review of family-centered interventions to enhance the health outcomes of children with type 1 diabetes. Diabetes Educator, 35(3), 428-438.

Phelps, K., Howell, C., Hill, S., Seeman, T., Lamson, J., Hodgson, J., & Smith, D. (2009). A collaborative care model for patients with Type-2 Diabetes. Families, Systems, & Health, 27:2, 131-140.

Weihs, K., Fisher, L., Baird, M (2002). Families, Health, and Behavior: Committee on Health & Behavior: Research, Practice & Policy, Division of Neuroscience &Behavioral Health and Division of Health Promotion & Disease Prevention, Institute of Medicine, National Academy of Sciences. Families, Systems, & Health, 20:1, 7-47.

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

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