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

1. Session #E2 October 28, 20111:30 PM 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 Medicine Zephon Lister, PhD, Director of Collaborative Care Program, Family Medicine Residency, Division of Family & Preventive Medicine, University of California, San Diego Mary 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 Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

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

3. 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.

4. 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

5. Expected Outcome At 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

6. Learning Assessment A 10 minute Question & Answer period will be provided at the conclusion of the presentation

7. 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)

8. 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

9. 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.

10. CCFH Model with Diabetes Care • Bio-psycho-social Influences • Collaborative Approach Patient – Family - Healthcare Team • Family Resilience Framework Shift from Deficit, Problem Focus to Strengths & Resources for Positive Patient / Family Adaptation • Developmental, life-span View: Illness – Individual - Family • Attuned to socio-economic, cultural, spiritual diversity & varied family forms

11. 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

12. Need for Family Psychosocial Map • Assess, strengthen family functioning: Beliefs, Organization, Communication • Psychosocial understanding of diabetes • Understanding developmental issues

15. 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

16. 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

17. 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

18. 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

19. New KDC PT Initial Appt. 1st F/U Appt. 4-12 wks. Existing KDC Complex Case Psychosocial Instruments 1/2 sent in advance 1/2 completed @ KDC before/after appt. Diabetes Educ. Regular KDC Appt. M.D. Diabetes Educ. Diabetes Educ. Family Assess. M.D. M.D. 1-Day Family Skills Workshop When Appropriate, Short-term Indiv./Couple/Fam. Intervention @ KDC Psychosocial Orientation & Assess. Psychosocial Eval. @ KDC Hi-Risk 1-4 wks. Intensive Eval. When Appropriate, Complex Cases Intensive Tx by CCFH

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

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

22. 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).

23. 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

24. 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).

25. 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

26. 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

27. 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

28. Professional Collaboration, Education, & Development • Psychosocial Rounds with collaborative presentation and discussion of complex cases

29. Component 3: Community Education and Outreach • Free educational events offered to the consumer community

30. 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.

31. Data: Relationship Family Functioning to Diabetes Disease Management Data Analysis is being completed for presentation

32. Key References Chicago 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

33. Key References Armour, 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.

34. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!