psychoeducation workshop for families
TRANSCRIPT
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PSYCHOEDUCATIONPSYCHOEDUCATIONWORKSHOPWORKSHOP
FOR FAMILIESFOR FAMILIES
Raising the Bar Project – Raising the Bar Project – Valley Nonprofit ResourcesValley Nonprofit Resources
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Stages of a Psychoeducational
Multifamily Group
JoiningFamily and patient
separately3-6 weeks
Educa-tional
workshopFamilies only
1 day
Ongoing MFG
Families & patients
bi-weekly for 1 year
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SCHIZOPHRENIA SCHIZOPHRENIA • Is a no-fault biological illness• Causes immense suffering for the person
and family• Is a handicap but does not need to be a
disability• Recovery is possible• New treatments increase recovery• Families can help in many ways
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SCHIZOPHRENIAS ARE NOTSCHIZOPHRENIAS ARE NOT
• All psychoses • Split personality• Contagious• Anyone’s fault• Hopeless
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DIAGNOSIS OF DIAGNOSIS OF SCHIZOPHRENIASCHIZOPHRENIA
SymptomsSymptoms: two or more of the following:: two or more of the following:DelusionsDelusionsHallucinationsHallucinationsDisorganized speechDisorganized speechGrossly, disorganized behaviorGrossly, disorganized behaviorLack of feelings of driveLack of feelings of drive
That produce marked impairment,That produce marked impairment, Last more than 6 months, andLast more than 6 months, and Are not due to drugs or medical conditionAre not due to drugs or medical condition
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SYMPTOM CLUSTERSSYMPTOM CLUSTERSPOSITIVEPOSITIVE NEGATIVENEGATIVEHallucinationsHallucinations Few feelingsFew feelingsDelusionsDelusions Lack of driveLack of drive
IMPAIRMENTS IMPAIRMENTS WorkWork RelationshipsRelationships Self-careSelf-careCOGNITIVECOGNITIVE MOODMOODMemoryMemory DepressionDepressionProblem solvingProblem solving HopelessnessHopelessness
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SCHIZOPHRENIA IS THE SAME IN SCHIZOPHRENIA IS THE SAME IN ALL COUNTRIESALL COUNTRIES
• Occurs in 1% of all types of people• First occurs between age 15 and 30• Has the same core symptoms• Has the same pattern of relapse and
remission• Is a lifelong illness
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FIRST EXPRESSION OFFIRST EXPRESSION OFSCHIZOPHRENIASCHIZOPHRENIA
Usually seen between age 15 and 30Usually seen between age 15 and 30 Occurs during cortical pruning processOccurs during cortical pruning process Causes progressive damage during the first few Causes progressive damage during the first few
years (autotoxicity)years (autotoxicity) Severity of damage can be lessenedSeverity of damage can be lessened May sometimes be preventableMay sometimes be preventable
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BETTER PROGNOSIS:BETTER PROGNOSIS:TREATMENT VARIABLESTREATMENT VARIABLES
Treatment begins soon after onsetTreatment begins soon after onset Good response to medicationGood response to medication New medications are availableNew medications are available Psychosocial rehabilitation is availablePsychosocial rehabilitation is available Person participates in best treatmentsPerson participates in best treatments
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BETTER PROGNOSIS: BETTER PROGNOSIS: FAMILY VARIABLESFAMILY VARIABLES
Family understands the illnessFamily understands the illness Family helps the person get treatmentFamily helps the person get treatment Family assists in recoveryFamily assists in recovery Family provides opportunities for successFamily provides opportunities for success
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SCHIZOPHRENIASCHIZOPHRENIA A no-fault illness…A no-fault illness… With genetic and biological causes…With genetic and biological causes… Supersensitive to stress, drugs and family Supersensitive to stress, drugs and family
atmosphere…atmosphere… With initial deterioration that is lessenedWith initial deterioration that is lessened Can have good long-term prognosisCan have good long-term prognosis
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POSSIBLE CAUSESPOSSIBLE CAUSESFOR SCHIZOPHRENIAFOR SCHIZOPHRENIA
PURELY GENETICPURELY GENETICBIOLOGICAL NOT GENETICBIOLOGICAL NOT GENETICIntrauterine TraumaIntrauterine TraumaBrain VirusBrain Virus GENETIC VULNERABILITY PLUSGENETIC VULNERABILITY PLUSBiological StressBiological Stress + +Psychosocial StressPsychosocial Stress
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GENETIC RISK OF GENETIC RISK OF SCHIZOPHRENIASCHIZOPHRENIA
RISKSRISKS
Identical TwinIdentical Twin 46% 46% Both ParentsBoth Parents 48%48%Sibling or ParentSibling or Parent 12%12%Aunt, Nephew, GrandparentAunt, Nephew, Grandparent 5% 5%First cousin, great AuntFirst cousin, great Aunt 2% 2%No relativeNo relative 1% 1%
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BIOLOGICAL RISK FACTORS BIOLOGICAL RISK FACTORS (NOT GENETIC)(NOT GENETIC)
Winter birthWinter birth Viral infection in the 20Viral infection in the 20 thth-30-30thth week of week of
pregnancypregnancy Rh incompatibilityRh incompatibility Starvation during pregnancyStarvation during pregnancy Anoxia at birthAnoxia at birth
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Factors that affect Mental Capacity
Socio-Environmental Stressors Psychological Vulnerability
Preventative Factors•Social Support•Developmental Skills•Rehabilitation Program•Antipsychotic Medication
Results from Rehabilitation
ImpairmentHandicaps
Disabilities
Good Bad
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STRESS DOES NOT DIRECTLY STRESS DOES NOT DIRECTLY CAUSE SCHIZOPHRENIACAUSE SCHIZOPHRENIA
Strong Genetic Strong Genetic PredispositionPredisposition
Weak Genetic Weak Genetic PredispositionPredisposition
No Genetic No Genetic PredispositionPredisposition
+
+
HighStress
HighStress
Schizophrenia
Schizophrenia
Other Disorders No Schizophrenia
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SCHIZOPHRENIA ALTERSSCHIZOPHRENIA ALTERSBRAIN FUNCTIONINGBRAIN FUNCTIONING
Normal Schizophrenic
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FRONTAL LOBES GOVERNFRONTAL LOBES GOVERN
• Drive and Ambition• Problem solving• Cognitive flexibility• Capacity to plan• Time sequential thinking• Social awareness
• Empathy• Mood• Insight• Impulsivity• Judgment• Abstraction• Working memory
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TEMPORAL LOBE FUNCTIONSTEMPORAL LOBE FUNCTIONS
PerceptionPerception
Reality OrientationReality Orientation
MemoryMemory
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REDUCED TEMPORALREDUCED TEMPORALLOBE STRUCTURESLOBE STRUCTURES
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BASAL GANGLIA FUNCTIONSBASAL GANGLIA FUNCTIONS
• Inhibit unwanted sensory input
• Filter out irrelevant sensory input
• Regulate arousal
• Govern concentration
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LIMBIC SYSTEM FUNCTIONSLIMBIC SYSTEM FUNCTIONS
• Understanding emotional events
• Linking current perception to
past memories
• Learning from experience
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REDUCED LIMBICREDUCED LIMBICSYSTEM STRUCTURESSYSTEM STRUCTURES
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TANGLED CELLS INTANGLED CELLS INLIMBIC SYSTEMLIMBIC SYSTEM
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DOPAMINE BINDING TODOPAMINE BINDING TOA DOPAMINE RECEPTORA DOPAMINE RECEPTOR
Dopamine
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DOPAMINE HYPOTHESISDOPAMINE HYPOTHESIS
NormalUntreated
SchizophrenicMedicated
Schizophrenic
Signal Nerves
Synapse
Receptor Nerves
D D D
D
D D D D D D
D D DM M
D
D DM
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TREATMENT OF TREATMENT OF SCHIZOPHRENIASCHIZOPHRENIA
Medication controls symptoms and relapseMedication controls symptoms and relapse Psychosocial rehabilitation teaches (Vocational)Psychosocial rehabilitation teaches (Vocational) Family skills and atmosphere supportFamily skills and atmosphere support Early intervention prevents deteriorationEarly intervention prevents deterioration Lifetime treatment is requiredLifetime treatment is required
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TREATMENT OF TREATMENT OF SCHIZOPHRENIASCHIZOPHRENIA
Relapse Rate Per Year
Meds + Family Skills Training
Meds + Rehabilitation Program
Meds + Specialized Therapy
Meds + Traditional Psychotherapy
Antipsychotic Medication
Any Treatment w/o Medication
No Treatment
8%
8%
20%
30%
30%70%
70%
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SCHIZOPHRENIA WITH THE SCHIZOPHRENIA WITH THE BEST TREATMENTBEST TREATMENT
Good
Function
Poor
PremorbidProdromalDeterioration Stable Relapsing Stable
AGE0 10 20 30 40 50 60 70
BeginMedication,Rehabilitation,Family skillsTraining
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ANTIPSYCHOTIC ANTIPSYCHOTIC MEDICATIONMEDICATION
Reduces relapseReduces relapse Reduces brain dysfunctionReduces brain dysfunction Improved medications availableImproved medications available Unique individual responseUnique individual response First step to recoveryFirst step to recovery
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ANTIPSYCHOTIC ANTIPSYCHOTIC MEDICATIONS REDUCE:MEDICATIONS REDUCE:
Hallucinations and delusionsHallucinations and delusions Bizarre behaviorBizarre behavior Agitation and pacingAgitation and pacing Hostility and aggressionHostility and aggression Disordered thinkingDisordered thinking InsomniaInsomnia
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DOPAMINE HYPOTHESISDOPAMINE HYPOTHESIS
NormalUntreated
SchizophrenicMedicated
Schizophrenic
Signal Nerves
Synapse
Receptor Nerves
D D D
D
D D D D D D
D D DM M
D
D DM
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LONG-ACTING INJECTIONLONG-ACTING INJECTION
AdvantagesAdvantages DisadvantagesDisadvantages-More easily absorbed-More easily absorbed -Blood level declines-Blood level declines
-More convenient -More convenient -Less convenient-Less convenient
-Compliance assured-Compliance assured -Choices limited-Choices limited
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NEW ANTIPSYCHOTICSNEW ANTIPSYCHOTICS
Improve negative symptomsImprove negative symptoms Probably reduce cognitive deficitsProbably reduce cognitive deficits Cause no or few movement side effectsCause no or few movement side effects Result in less use of side effect medicationResult in less use of side effect medication Produce better complianceProduce better compliance
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DOSE AND RELAPSEDOSE AND RELAPSE
1/10Dose
100%
80%
60%
40%
20%
0%
70%
56%
24%14%
Placebo 1/4 Dose StandardDose
% R
elap
se/Y
ear
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PROBLEMATIC PROBLEMATIC SIDE EFFECTSSIDE EFFECTS
Dysphoric response (feel less alive)Dysphoric response (feel less alive) Extrapyramidal Side Effects (EPS)Extrapyramidal Side Effects (EPS)
Akathisia (restlessness)Akathisia (restlessness)
Parkinsonian (tremors, drooling)Parkinsonian (tremors, drooling)
Acute dystonia (rigidity, spasms)Acute dystonia (rigidity, spasms)
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METHODS FOR MANAGING METHODS FOR MANAGING SIDE EFFECTSSIDE EFFECTS
Waiting until the body adjustsWaiting until the body adjusts Taking medication at nightTaking medication at night Medication with different side effects Medication with different side effects Antiparkinsonian medicationAntiparkinsonian medication Reducing dosage of antipsychoticReducing dosage of antipsychotic Using techniques to treat side effectsUsing techniques to treat side effects
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SELECTING MEDICATION SELECTING MEDICATION DOSAGEDOSAGE
Optimum Dose
Dose
Side Effects
Symptoms
Less More
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INEFFECTIVE TREATMENTSINEFFECTIVE TREATMENTS
Megavitamins or dietMegavitamins or diet DialysisDialysis Insight-oriented psychotherapy:Insight-oriented psychotherapy:
individual or familiar individual or familiar Folk and religion healingFolk and religion healing HypnosisHypnosis
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TREATMENT OFTREATMENT OFSCHIZOPHRENIASCHIZOPHRENIA
Doctor or program that specializesDoctor or program that specializes Medication controls symptoms and relapseMedication controls symptoms and relapse Psychosocial rehabilitation teachesPsychosocial rehabilitation teaches Family skills and atmosphere supportFamily skills and atmosphere support Early intervention prevents deteriorationEarly intervention prevents deterioration Lifetime treatment is requiredLifetime treatment is required
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FAMILIES CAN HELP:FAMILIES CAN HELP:
Learn about schizophreniaLearn about schizophrenia Find good treatmentFind good treatment Provide a healing environmentProvide a healing environment Have realistic hopeHave realistic hope Keep the whole family strongKeep the whole family strong
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HELPFUL FAMILIESHELPFUL FAMILIES Accept the person as illAccept the person as ill Attribute symptoms to the illnessAttribute symptoms to the illness Set realistic, attainable goalsSet realistic, attainable goals Include the ill person in the familyInclude the ill person in the family Keep a loving distanceKeep a loving distance Have a calm atmosphereHave a calm atmosphere Give frequent praiseGive frequent praise Give specific criticismGive specific criticism
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FAMILIES INFLUENCE FAMILIES INFLUENCE OUTCOMEOUTCOME
Natural skillsNatural skillsfit schizophreniafit schizophrenia
No familyNo family
Poor fit of skills
21%
48%
RELAPSE RATE
30%
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CONSEQUENCES OF CONSEQUENCES OF EXPECTATIONSEXPECTATIONS
Too HighToo High Repeated failureRepeated failure RelapseRelapse
RealisticRealistic Best FunctioningBest FunctioningSuccess, JoySuccess, Joy
Too LowToo Low InstitutionalizationInstitutionalizationDespair, Giving upDespair, Giving up
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FAMILYFAMILYEVENTSEVENTS
AND THEAND THECOMPARISONCOMPARISONWITH OTHERSWITH OTHERS
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LOVE THE PERSON LOVE THE PERSON HATE THE ILLNESS HATE THE ILLNESS
Understand which behaviors are symptomsUnderstand which behaviors are symptoms No one is to blame for symptomsNo one is to blame for symptoms Never take symptoms personallyNever take symptoms personally Reach out to the person, not the symptoms.Reach out to the person, not the symptoms.
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THE EASIEST TASKS BECOME THE EASIEST TASKS BECOME EXTREMELY DIFFICULTEXTREMELY DIFFICULT
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HELP FOR FAMILIESHELP FOR FAMILIES
Friends and extended familyFriends and extended family Books and classesBooks and classes National Alliance on Mental Illness National Alliance on Mental Illness
(NAMI)(NAMI) Knowledgeable professionalsKnowledgeable professionals
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
1. MOVE FORWARD ONE STEP AT A TIME
•Recovery is a slow process
•Staying calm and relaxed is important
•Maintain optimism
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MAINTAIN HOPEMAINTAIN HOPE
FunctionalLevel
Time
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
2. MAINTAIN A RELAXED ENVIRONMENT
•Being enthusiastic is normal do not get excited
•Disagreement and getting mad is normal do not get excited
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
3. PROVIDE ENOUGH PERSONAL SPACE
•Privacy is important
•It is okay to offer it
•It is okay to reject it
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
4. SETTING LIMITS AND NORMS
-Everyone should be aware of norms
-With a few norms, everything is clearer
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
5. ACCEPTING WHAT WE CANNOT CHANGE
•Understanding what you can give up
•Do not ignore violent behavior
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
6. EXPRESS YOURSELF CLEARLY, CALMLY AND CONSTRUCTIVELY
•Simplifying things lead to better understanding
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
7. TEMPORARILY REDUCE EXPECTATCTION
•Use personal experience
•Compare this month with previous good months, rather than last year or next.
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
8. FOLLOW DOCTOR’S SUGGESTIONS
•TAKE MEDICATION AS PRESCRIBED
•Do not take medication that is not prescribed to you
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
9. REESTABLISH FAMILY RELATIONSHIPS AND DAILY ROUTINES ASAP
•Return to a good routine ASAP
•Maintain strong ties with family and friends
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
10. ABSTAIN FROM DRUGS AND ALCOHOL
-Voids effects of medication
-Worsens treatment
-Worsens side effects
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
11. DETECTING RELAPSE WARNING SIGNS
•Observe relevant changes
•Immediately consult with case manager or psychiatrist
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PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT
12. SOLVE PROBLEMS STEP-BY-STEP
-Gradually introduce changes
-Work on one thing at a time
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Intervention Techniques I:Intervention Techniques I:The Problem Solving MethodThe Problem Solving Method
Stop and ThinkStop and Think Define the ProblemDefine the Problem Possible SolutionsPossible Solutions Evaluate each SolutionEvaluate each Solution Choose and Plan to Implement your SolutionChoose and Plan to Implement your Solution Resource ManagementResource Management Pick a Time and Do It!Pick a Time and Do It!