https://learn.extension.org/events/2900

Chronic Illness: Empowering Families in the Journey - Part 2

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Readiness Policy, U.S. Department of Defense under Award Number 2015-48770-24368.

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MFLN Intro

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Tai J. Mendenhall, Ph.D., LMFT

Today’s Presenter• Medical Family Therapist • Associate Professor in the Couple

and Family Therapy Program, UMN’s Dept. of Family Social Science

• Adjunct professor, UMN’s Dept. of Family Medicine & Community Health

• Associate Director of UMN’s Citizen Professional Center

• Director of the UMN’s Medical Reserve Corps’ Mental Health Disaster-Response Teams

Learning Objectives

Participants will promote effective management of chronic illness with military families by:

1) Understanding ways to harness resources2) Discussing techniques to provide support3) Identifying strategies to utilize resilience

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Case Study, revisited

Family Structure:

Eve is a 40 year old mother of two (Thomas-5 y/o; Jenna-7 y/o) who has served 3 tours of duty oversees. She has a husband who is retired Air Force and served in combat.

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Chronic Illness Struggles:

Eve has been diagnosed with Systemic Lupus Erythematosus, an auto-immune disease causing severe inflammation due to the body’s immune system attacking healthy tissues instead of only bacteria and viruses. Symptoms that she experiences include: severe fatigue, gastrointestinal (GI) issues, skin rash, hair loss, joint pain, swelling and inflammation. Eve is on a medication regimen that assists in alleviating some of the pain and discomfort but struggles with not knowing how bad she will feel each day. Eve has started a gluten free diet as her doctor relayed she has a gluten intolerance and also that gluten can worsen inflammation experienced.

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Impact on Family:

Eve loves her family and wants to be very involved in her children’s lives. She often feels guilty for not feeling well and being able to keep up with 2 small children. She feels as though she is not participating as fully in her marriage and family’s day to day routines.

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Let’s Discuss…

For those who were on the first webinar, what additional thoughts did you have on our case study?

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Connecting the Dots

• Biopsychosocial lens(es)• Biopsychosocial/spiritual lens(es)• Medicine Wheel lens(es)• Collaborative Family Health Care• Integrated Family Health Care• Patient-centered Medical Home model(s)• Family-centered Medical Home model(s)• Community-oriented Primary Care• Community-based Participatory Research

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Connecting the Dots, cont.

• Collaborative / Integrated Health Care–Primary Care–Mental Health Care–Co-located Care–Coordinated Care–Shared Care–Integrated Behavioral Health–Patient/Family-centered…

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Psychological

Social

Ethnic/Cultural

Biological

Behavioral

Dyadic / Family

Ecological

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Healthcare TeamsCoordinated treatment by medical and behavioral health providers in the care of individual patients/clients and their families

Effective multidisciplinary collaboration encompasses non-hierarchical working relationships between providers

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Healthcare Teams, cont.

• A practice team tailored to the needs of each patient/family– with a shared population and mission– using a systemic clinical approach(es)– supported by a community that expects behavioral and

primary care integration as “standard” care– supported by office practices, leadership, and business

models– with continuous quality improvement efforts (and

responsive practice refinements)

Source: CJ Peek (2013) 13

Healthcare Teams, cont.

• Work to understand patients’/families’ worlds• Find out about personhoods first, “issues” later• Listen (versus only talking, problem-solving, or

directing); maintain an empathic presence• Endeavor to see the world through your

patients’/families’ eyes• Don’t be afraid to be emotionally honest and vivid• Include patients/families as members of your team

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Let’s Discuss…

What are your best practices when working with healthcare teams?

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Strategies for Engagement• Advancing Agency• Enhancing Communion• (Always) Connecting the Mind and the Body• Eliciting Illness Histories and Meanings• Respecting Defenses, Removing Blame, and

Accepting Unacceptable Feelings• Facilitating Communication• Attending to Developmental Issues• Reinforcing non-Illness Identity• Providing Psychoeducation and Support• Maintaining an Empathic Presence

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Advancing Agency

• Facilitating conversations to co-construct active and engaged participation in care–Small ways (e.g., water or coffee?)–Large ways (e.g., negotiating and constructing

treatment plans)

• Maintaining a “problem-solving” culture over the course of care

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Enhancing Communication

• Combating Illness’s commonplace isolation• Enhancing social connectedness and support• Working through barriers (real and imagined) in

accessing others’ attention, time, and regard

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(Always) Connecting the Mind and the Body

• Recognizing the biopsychosocial/spiritual complexities of illness

• Situate care discussions in cross-disciplinary contexts

• Team meetings (without patients/families)• Team meetings and care (with patients/families)

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Eliciting Illness Histories and Meanings

• Do patients/families see the illness as caused by personal decisions / failures?

• Do patients/families see the illness as caused by things that are not connected to personal decisions or fault(s)?

• Is the illness all curse? Some blessings in a curse?

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Respecting Defenses, Removing Blame, and

Accepting Unacceptable Feelings

• Denial• Anger• Sadness• Attributions of Blame• “Acceptable” versus “Unacceptable” Feelings• Mixed / Contradictory Emotions

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Facilitating Communication

• Expressive Skills• Receptive Skills• Meta-communication Skills• Co-constructing Solutions• Translating the Languages of Medicine

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Attending to Developmental Issues

• Developmentally Normative and Expected Illnesses• Developmental Abnormal and Unexpected Illnesses• Centripetal forces (inward) versus Centrifugal forces

(outward); match or mismatch?

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Reinforcing non-Illness Identity

• Be careful about identity changing to one that is defined by illness

• Externalizing Illness– How stand up to… ?– How still have… ?– How do [fill-in-the-blank] differently… ?

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Providing Psychoeducation and Support

• Translating, Educating, Processing• Knowledge is Power• Connecting patients/families with other

systems of support

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Maintaining an Empathic Presence

• Listening• Compassionate Presence / Silence• Journeying together

– sometimes just crying together

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Let’s Discuss…

What additional strategies have you found successful?

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Case StudyFamily Structure:

Leonard (age 35) is a divorced father of two (Naya-15; Nick-10). His job duties require frequent travel across the country and overseas. His ex-wife has primary custody of the children. Although he has job constraints, Leonard strives to be very involved in their lives both emotionally and financially. Three months ago, Leonard’s mother was diagnosed with terminal cancer and is currently in hospice. Leonard does not have any other family members to help assist with her care.

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Chronic Illness Struggles:

Leonard has been diagnosed with Type I diabetes. His constant traveling and stress-filled life style (lack of sleep, exercise and healthy food options) have negative impacts on his health. Recently his health insurance has changed, creating barriers to affordable health care options inclusive of medication supplies. He has been feeling more and more fatigued, has reduced his exercising significantly, and is starting to see more signs that his diabetes is not being managed properly. This continues to impact his emotional health as he feels hopeless that his responsibilities and illness stressors will not subside so that he can find a work/life balance.

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Impact on Family:

Leonard wants to be able to be physically there for his mother as she is nearing end of life. He also would like to be more involved with his children. He often finds himself feeling guilty and ashamed, especially when his mother and children express how much they miss him when he’s gone. When he is around, he has very little energy and finds himself disengaged with family members.

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Questions to Consider:

oWhat are the strengths of this family?

oWhat seems to be the common stressors experienced by this family?

oHow can we as service professionals empower the family? In what ways?

oWhat tools/resources would be beneficial to share with this family?

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Case StudyFamily Structure:

Bella (age 4) is the daughter of Nick (30) and Laurie (29). Bella has a younger brother Luke (10 months). The family has recently moved to Atlanta from a small town in South Georgia due to Bella’s medical needs and the fact that all of her specialists are in Atlanta.

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Chronic Illness Struggles:

Bella has been diagnosed with a rare heart condition called Hypoplastic Left Heart Syndrome (HLHS). She has had several surgeries since birth and has recently been put on the heart transplant list due to her declining health and most recent lab work. Bella gets fatigued quite easily and has to have a nurse in her home around the clock to monitor her vitals. She is on supplemental oxygen.

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Impact on Family:

Bella’s mother had to quit her job in order to take care of Bella the way that both she and Nick would like for her to be cared for. This caused a significant decrease in their income and has recently made Laurie feel guilty. When they learned that they were pregnant with Luke, it came as a surprise to them both. Although they love Luke very much, both Nick and Laurie feel a tremendous amount of guilt that they are unable to attend to him as much as they do Bella. They have recently moved to Atlanta to be closer to Bella’s team of doctors and to have access to more healthcare options for her. However, both Nick and Laurie’s entire support system was left behind in South Georgia.

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Questions to Consider:

oWhat are the strengths of this family?

oWhat seems to be the common stressors experienced by this family?

oHow can we as service professionals empower the family? In what ways?

oWhat tools/resources would be beneficial to share with this family?

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References & Additional Resources• Doherty, W., & Mendenhall, T. (in press). Medical family therapy. In American Psychological

Association’s (APA) APA Handbook of Contemporary Family Psychology. Washington, DC: APA.

• Hodgson, J., Lamson, A., Mendenhall, T., & Crane, R. (Eds.) (2014). Medical Family Therapy: Advanced Applications. New York: Springer.

• Mendenhall, T. (2016). MFT, trauma, and the military. Journal of Marital and Family Therapy. Retrieved from http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1752-0606/homepage/virtual_issue__mft__trauma__and_the_military.htm

• Mendenhall, T. (2016). Integrated care: A team-based approach to reduce healthcare costs and improve outcomes. Retrieved from http://cehdvision2020.umn.edu/cehd-blog/integrated-care/ . CEHD Vision 2020.

• Peek, C. (2013). Integrated behavioral health and primary care: A common language. In M. Talen & A. Valeras (Eds.), Integrated Behavioral Health in Primary Care (pp. 9-32). New York: Springer.

• Talen, M., & Valeras, A. (2013) (Eds.). Integrated Behavioral Health in Primary care. New York: Springer.

• Trump, L., & Mendenhall, T. (in press). Couples coping with Cardiovascular Disease: A systematic review. Families, Systems, & Health.

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Contact Information

Tai J. Mendenhall, Ph.D., LMFTUniversity of Minnesota, Twin CitiesDepartment of Family Social ScienceCouple and Family Therapy Program275 McNeal Hall; 1985 Buford Ave.Saint Paul, MN 55108

email: mend0009@umn.eduoffice: 612-624-3138fax: 612-625-4227

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Medicare 2017 - What it Means for You• Date: Wednesday, February 22• Time: 11:00 am – 12:00 pm Eastern• Location: https://learn.extension.org/events/2921

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46This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family

Readiness Policy, U.S. Department of Defense under Award Number 2015-48770-24368.

Image Citations

• Slide 3 and 31, Image: Tai J. Mendenhall, Ph.D. Photo Credit: Tai J. Mendenhall

• Images from slides (6, 13, 16, 20, 23-25, and 32) licensed from iStockphoto.com by Texas A&M AgriLife Extension Service and the Military Families Learning Network (MFLN), under Member ID: 8085767