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Chronic Illness: Empowering Families in the Journey Part 1

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The MFLN's Family Development, Family Transitions, Military Caregiving, and Nutrition & Wellness offer this collaborative two-part webinar for military family service professionals on chronic illness. During Part 1 participants will discuss the stressors associated with chronic illness and its impact on health and wellness of individuals and families; explore the ways families influence the health and wellbeing of each other (i.e. family routines, nutrition, dynamics, interpersonal communication, support, etc.); and learn effective strategies for interdisciplinary collaboration among service providers (mental health clinicians, early interventionists, dietitians, family advocates, medical doctors, etc.) when working with families struggling with chronic illness.  Participants will engage in case study discussions to identify and assess the family development, transitions, caregiving, and nutrition/wellness perspectives of chronic illness issues within military families. Strategies, tools, and resources will be shared.

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Chronic Illness: Empowering Families in the Journey Part 1

  1. 1. https://learn.extension.org/events/2899 Chronic Illness: Empowering Families in the Journey - Part 1 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.
  2. 2. Connecting military family service providers and Cooperative Extension professionals to research and to each other through engaging online learning opportunities www.extension.org/militaryfamilies MFLN Intro 2 Sign up for webinar email notifications at www.extension.org/62831
  3. 3. 3 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
  4. 4. Learning Objectives In this session we will: 1. Discuss the stressors associated with chronic illness and its impact on health and wellness of individuals and families 2. Explore the ways families influence the health and well- being of each other 3. Learn effective strategies for interdisciplinary collaboration among service providers when working with families struggling with chronic illness 4
  5. 5. Research has long shown a powerful and reciprocal link between the health of couples’ relationships and the physical health of those who inhabit the couple(s). 5
  6. 6. Let’s Discuss… What are some examples of the link between the health of a couple’s relationship and their individual physical health? 6
  7. 7. Relationship Health ↔ Physical Health • Relationship quality affects partners’ health – Immune functioning – Endocrine stress hormones – Development and course of chronic illnesses • Physical health affects relationship quality – Partner match vs. mismatch in health status – Illness “in the way” of the couple – Caregiver stress and burden For example… 7
  8. 8. Chronic Pain in Relational Context(s) • Chronic pain is significantly associated with – Poor relationship satisfaction – Poor dyadic adjustment – Both partners’ development of: o depressive symptoms o anxiety symptoms 8
  9. 9. Chronic Pain, cont. • Spousal involvement through facilitative communication, responsiveness, and support is strongly associated with – Decreased intensity of pain – Less depressive symptoms – Increased relationship satisfaction 9
  10. 10. 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 10
  11. 11. Connecting the Dots, cont. • Individual Health (1) • Couple / Dyadic Health (1+1=2) • Family Health (1+1+1….) • Community / Public Health (1+1+1+10000s) 11
  12. 12. 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… 12
  13. 13. Health (and Healthcare) is a Systemic Phenomenon Biological- e.g., muscular, neurological, cardiovascular Psychological- e.g., emotions, mood, personality Behavioral- e.g., personal conduct, reactivity Dyadic/Family- e.g., interactional, comm patterns, boundaries Social- e.g., friends, faith communities, school, work Ethnic/Cultural- e.g., heritage, socioeconomic status Ecological- e.g., government, healthcare system, environmental 13
  14. 14. Psychological Social Ethnic/Cultural Biological Behavioral Dyadic / Family Ecological 14
  15. 15. Psychological Perceptual Cognitive Mood Emotions Mastery 15
  16. 16. Health and Resiliency in Individuals • Perceptions – Stress Theory / Perceptions > Stressors or Resources • Cognitions – Attribution Styles / Automatic personal “tapes” – Narrative Styles / Use of History  Present/Future • Mood – Depression / Anxiety / Anger • Behaviors – Physical, Medication, Do’s and Don’ts 16
  17. 17. Individuals, cont. • Mastery vs. Fatalism – Mastery can be empowering or destabilizing – Fatalism can facilitate appropriate acceptance or circumvent personal efficacy 17
  18. 18. Individuals, cont. • The person we are with 24 hours per day is the person primarily responsible for our health • The way(s) that we perceive something defines how it affects us • Personal (cognitive) “tapes” and attribution styles define our context(s) • Moods and Emotions can empower or immobilize us • High mastery-orientation can be a blessing or a curse, depending on its focus and relative flexibility 18
  19. 19. But most of us reside in couple- or family- relationships… 19
  20. 20. Dyadic / Family Communication Patterns Interaction Patterns Power Structure Subsystems Interpersonal Boundaries 20
  21. 21. The Couple/Family System is in the middle of the Biopsychsocial Continuum (It connects Individuals to larger Social Systems) 21
  22. 22. Health and Resiliency in Couple/Family Systems • Communication Patterns • Interaction Patterns • Power Structure • Subsystems • Interpersonal Boundaries 22
  23. 23. Communication • Communicating all the time vs. only when there is a problem • Communicating regarding what is GOOD vs. what is bad • Healthy communication makes us vulnerable, but all growth involves risk • “This is what I need” vs. “This is what you should do” • “This is how I feel” vs. “This is how you feel” or “This is what you are doing wrong” 23
  24. 24. Communication, cont. • Listening vs. waiting for the other to stop talking • Reflecting vs. “Yeah, but…” or minimizing • Focusing on behavior vs. character • Win/Win vs. Compromise vs. Win/Lose • Being Assertive vs. Being Aggressive • Honesty vs. Niceties (e.g., “nothing,” “fine”) • Dyadic communication vs. triangulation • Time outs and cool-offs vs. marathon finishes 24
  25. 25. Couple/Families • Interaction Patterns – Relationship “dances” – Balancing Unconditional vs. Conditional Love • Power Structure – Rigid vs. Chaotic • Interpersonal Boundaries – Disengaged vs. Enmeshed – Changes over time as developmentally appropriate 25
  26. 26. Couples/Families, cont. • Most people reside in families, and members’ lives are interwoven • The family’s main function is to protect the safety of its members • Health-related behaviors are learned in the family • Families carry on cultural rituals • Much of life’s stress is family-related • Better outcomes occur when family members co- own issues of illness and health 26
  27. 27. Let’s Discuss… Share your experiences and insights 27
  28. 28. Social Friends Community Groups Healthcare Teams Faith Communities School / Work 28
  29. 29. Social Systems • Friends – Peer support is invaluable and cannot be replaced by family support • Support Groups – Esoteric empathy and empowerment • Community Groups – Support groups + outward mission • Faith Communities / School / Work – Can offer sense of purpose and meaning 29
  30. 30. Social Friends Community Groups Healthcare Teams Faith Communities School / Work 30
  31. 31. Healthcare Teams Coordinated 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 31
  32. 32. 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) 32
  33. 33. Healthcare Teams, cont. • Team Membership (or accessible collaborators) – Primary care physicians (and physician extenders) – Nurses, Nurse Practitioners – Educator (diabetes, dietitian, etc.) – Pharmacist – Behavioral Health (LMFT, LP, LICSW, LADC, etc.) – Psychiatrist – Patient Advocate – Care Coordinator – Others (by clinic, population, specialty) 33
  34. 34. Healthcare Teams, cont. • Work to understand patients’/families’ worlds • Find out about personhoods first, “issues” later • Listen (vs only talking, problem-solving, or directing); maintain an empathic presence • Endeavor to see the world through your patients’/families’ eyes • Embrace your patients’/families’ lived-experience and wisdom… 34
  35. 35. Embracing Patients’ & Families’ Wisdom • Where’s “the line” between being supportive and being a nag? • How can partners not burn-out from supporting a spouse whose pain is chronic and whose complaints are never-ending? • How can someone with a terminal illness share his/her feelings about dying without alarming or upsetting his/her partner? 35
  36. 36. Embracing Wisdom, cont. • How can someone share their feelings about his/her partners’ dying without alarming or upsetting the partner? • How do we help couples handle the sometimes intrusive role of health professionals in their lives? • How can a couple get support for their relationship when family and friends do not know what to say or do to be helpful? 36
  37. 37. Healthcare Teams, cont. • Don’t be afraid to be emotionally honest and vivid • Include patients/families as members of your team 37
  38. 38. Let’s Discuss… What are other strategies for working with families struggling with chronic illness? 38
  39. 39. Case Study 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. 39
  40. 40. 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.
  41. 41. 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.
  42. 42. Questions to Consider o What are the strengths of this family? o What seems to be the common stressors experienced by this family? o How can we as service professionals empower this family? In what ways? o What tools/resources would be beneficial to share with this family? 42
  43. 43. Connect With Us Online! 43
  44. 44. Connect with MFLN Family Development Online! MFLN Family Development MFLN Family Development @MFLNFD MFLN Family Development To subscribe to our MFLN Family Development newsletter send an email to: MFLNfamilydevelopment@gmail.com with the Subject: Subscribe FD SMS icons 44
  45. 45. Connect with MFLN Family Transitions Online! MFLN Family Transitions MFLN Family Transitions @MFLNFT MFLN Family Transitions FT SMS Icons 45
  46. 46. Connect with MFLN Military Caregiving Online! MFLN Military Caregiving MFLN Military Caregiving @MFLNMC MFLN Military Caregiving @mfln_mc 46
  47. 47. Connect with MFLN Nutrition & Wellness Online! MFLN Nutrition @MFLNNW Military Families Learning Network MFLN Nutrition and Wellness MFLN Nutrition and Wellness NW SMS icons 47
  48. 48. https://www.linkedin.com/groups/8409844 MFLN Intro We invite MFLN Service Provider Partners to our private LinkedIn Group! DoD Branch Services Reserve Guard Cooperative Extension 48
  49. 49. • One survey, three different ways to receive a certificate – MFLN Military Caregiving and Family Development concentration areas are offering 1.5 CEU credits from the UT School of Social Work and the Georgia Marriage and Family Therapy (GMFT) to credentialed participants. – MFLN Nutrition and Wellness is offering a CPEU Certificate for the Commission of Dietetics Registration (CDR)/Certificate of Completion. – MFLN Certificate of Completion for providers interested in receiving general training. • To receive a CEU credit OR certificate of completion, please complete the evaluation survey found at: https://vte.co1.qualtrics.com/SE/?SID=SV_2lfvK2p2CXh0vwp CEU Credit Certificate of Completion 49
  50. 50. Upcoming Events Chronic Illness: Empowering Families in the Journey- Part II • Date: Thursday, January 26 • Time: 11:00 am – 12:00 pm Eastern • Location: https://learn.extension.org/events/2900 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 The Scoop on Gluten Free: Research and Practice Tips • Date: Tuesday, February 14 • Time: 11:00 am – 12:00 pm Eastern • Location: https://learn.extension.org/events/2832 50
  51. 51. Upcoming Events, cont. Engaging Across Generations Part I: Unique Mindsets • Date: Tuesday, May 2 • Time: 11:00 am – 12:30 pm Eastern • Location: https://learn.extension.org/events/2911 Engaging Across Generations Part II: Tools Techniques • Date: Tuesday, May 9 • Time: 11:00 am – 12:30 pm Eastern • Location: https://learn.extension.org/events/2912 51
  52. 52. www.extension.org/62581 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.
  53. 53. Image Citations • Slide 3, Image: Tai J. Mendenhall, Ph.D. Photo Credit: Tai J. Mendenhall • Images from slides (5, 6, 8, 17, 22, 27, 31, 38 and 41) licensed from iStockphoto.com by Texas AM AgriLife Extension Service and the Military Families Learning Network (MFLN), under Member ID: 8085767 53