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DR JUDITH LANDAU - HELPING FAMILIES AND COMMUNITIES ACCESS RESILIENCE TO PREVENT MENTAL ILLNESS AND ADDICTION FOLLOWING MASS DISASTER

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We may not be able to stop natural or human made mass disasters, losses from major epidemics, or acts of random violence from happening in our world - from the international opiate epidemic, to the mass shooting in Las Vegas, to the Grenfell Tower disater in London, but we can take steps to prevent the mental and physical damage this trauma can do to individuals, families and communities. By working through natural change agents as Family and Community Links, we empower those communities and families to build resilience and lead healthier lives in the present and for future generations. This presentation will review several studies and clinical vignettes that illustrate the benefit of mobilising individuals, families, and communities to build positive attachment and to draw on their intergenerational strengths and resilience. Practical methods of assessment, mapping, and intervention that consider all levels of individual, family and community involvement and collaboration will be presented.

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DR JUDITH LANDAU - HELPING FAMILIES AND COMMUNITIES ACCESS RESILIENCE TO PREVENT MENTAL ILLNESS AND ADDICTION FOLLOWING MASS DISASTER

  1. 1. Judith Landau, MD, DPM, LMFT, CFLE, CIP, CAI ARISE® Network www.ARISE-Network.com 303-44-3755 HELPING FAMILIES AND COMMUNITIES ACCESS RESILIENCE TO PREVENT MENTAL ILLNESS AND ADDICTION FOLLOWING MASS DISASTER
  2. 2. WE FACE GROWING GLOBAL CONCERNS…
  3. 3. OPIOID EPIDEMIC
  4. 4. Number of drug-related deaths increase again to highest level recorded: • 3,674 drug poisoning deaths (involving both legal and illegal drugs) registered in 2015 • Mortality rate increased 2014 to2015 from 59.6 to 65.1 deaths per million people – the highest rate since comparable records began in 1993 • This increase is mainly heroin/morphine related death Vanessa Fearn, mortality@ons.gsi.gov.uk ENGLAND & WALES © 1999-2018 Linking Human Systems, LLC
  5. 5. NATIONAL OVERDOSE DEATHS IN THE U S A © 1999 - 2016 Linking Human Systems, LLC A • Drug abuse costs the US 484 billion dollars per year: More than diabetes and cancer combined. • 2.5 million people die annually from alcohol and millions more suffer from illness and injury • 320,000 young people aged 15-29 years die annually: 9% of all deaths in that age group © 1999-2018 Linking Human Systems, LLC
  6. 6. Bloomberg reports that 2017 will surpass last year’s profits for the American heroin business. RISING DEATH TOLL: • Fentanyl (a synthetic opioid) being introduced into the heroin supply • Doses are cheaper and more deadly • Carfentanil and other synthetic opioids do not respond to treatments like naloxone https://inrecovery.com/how-did-cincinnati-become-heroins-ground-zero/
  7. 7. MASS TRAUMA
  8. 8. CHANGING TECHNOLOGY
  9. 9. Using social media Web sites is among the most common activity of children and adolescents: • By age 2, more than 90% of all American children have an online history • By 5 years old, nearly 50% interact with a computer or tablet • By 7-8 years old, many kids regularly play video games • 9 of 10 teens text and use social media O’Keeffe et al., 2011 Digital technology and social media dominate personal relationships, family and social interaction, daily habits and even primary thinking processes:
  10. 10. • A 15-year-long study by University of Michigan researchers found that the link between childhood TV-violence viewing and aggressive behavior persists into adulthood.
  11. 11. • Children who spent excessive amounts of time playing violent video games showed a greater propensity towards aggressive behavior, poorer grades in school and difficult relationships with their parents. (American Academy of Pediatrics)
  12. 12. CLIMATE CHANGE
  13. 13. • Earth’s climate is changing at an unprecedented rate • The United Nations estimates that there will be 200 million people displaced by climate change by the year 2050 • Climate change could create the world biggest refugee crisis CLIMATE REFUGEES
  14. 14. • A l l o f t h e s e f a c t o r s t h r e a t e n t h e f a b r i c o f f a m i l i e s . • F a m i l i e s a r e a k e y u n i t o f a l l c o m m u n i t i e s . • I f f a m i l i e s a r e a t r i s k , c o m m u n i t i e s a r e a t r i s k . THE PERFECT STORM
  15. 15. ORIGIN OF ADDICTION & ONSET OF MENTAL ILLNESS: TRAUMA & LOSS
  16. 16. Regardless of genetic factors, the onset of addiction is almost always connected to: • Significant death (especially if untimely) • Abuse (Physical, sexual or emotional) • Natural or human-made disaster
  17. 17. CONSEQUENCES OF TRAUMA Far far away, behind the word mountains, far from the countries Vokalia and Consonantia, there live the blind texts. Separated they live in Bookmarksgrove right at the coast of the Semantics, a large language ocean. • Attachment disorder • Depression and suicide • PTSD • Substance abuse • Process addictions • Mental illness • Cardiac stress & other pulmonary illness • Physical illnesses
  18. 18. FAMILY LIFE SPIRAL 1985
  19. 19. FAMILY LIFE SPIRAL 2015: THE ODYSSEY GENERATIO N
  20. 20. 1985
  21. 21. Depression & Suicide Relapse Stress TRAUMATIC TRANSITIONS RESULT IN INCREASED RATES OF…
  22. 22. DURING STRESS FAMILY ROLES BECOME CONFUSED
  23. 23. Transitional Checkerboard PGF PGM MGF MGM Husband Wife Mother Sibling 1 Sibling 2 Sibling 3 Father
  24. 24. Transitional Checkerboard PGF PGM MGF MGM Husband Wife Mother Sibling 1 Sibling 2 Sibling 3 Father
  25. 25. Transitional Checkerboard Husband Wife Mother Sibling 1 Sibling 2 Sibling 3 Father PGF PGM MGF MGM
  26. 26. Transitional Checkerboard Husband Wife Mother Sibling 1 Sibling 2 Sibling 3 Father PGF PGM MGF MGM
  27. 27. FAMILIES INFLUENCE OUTCOMES FOR INDIVIDUALS & COMMUNITIES
  28. 28. FAMILES ARE THE BASE UNIT OF THE COMMUNITY • The consequences of trauma, mental illness and addiction extend well beyond the individual directly impacted • Healing of trauma and its consequences require more than one individual • Without involving families we lose our most important resource • Working without individuals, families and communities the risk of long-term consequences of the trauma is increased
  29. 29. IMPORTANCE OF FAMILIES • Families are the primary source of many health-related beliefs and behaviors • Families provide a more accurate picture of the individual’s symptoms and compliance than the individual alone • Relapses and continued use/illness may be associated with depression or chronic physical illness in another family member • Frequent and unexplained relapses in a chronic illness may be associated with living with a family member with addiction or mental illness McDaniel, Campbell & Seaburn (1990)
  30. 30. THE KEY BELIEFS OF THE COLLABORATIVE TEAM FOR LONG-TERM HEALING • The family (and family history over generations) will help the collaborative team discover why there are problems here and now • The risk of addiction in future generations is great if past trauma, stress and grief are unresolved • Families are more motivated and more impactful than their professional allies • When recovery work is focused on an addicted individual in isolation, the family almost always unwittingly and unconsciously sabotages the effort • Recovery only happens when individual and family realize both the magnitude of the problem and that there is hope • The collaborative team also needs to believe in hope
  31. 31. INTERGENERATIONAL STUDY
  32. 32. INTERGENERATIONAL STUDY • This intergenerational adaptation gets perpetuated down the generations as “a way of being,” • If someone tries to go into recovery before the grieving is done, the the addicted individual relapses …subconsciously triggering reconnection • Between 3rd and 5th generations, the trauma is forgotten and the grief has been naturally resolved through the passage of time and people move into recovery.
  33. 33. ADDICTION IS RESILIENCE IN ACTION This pattern holds across time, countries and cultures.
  34. 34. CONNECTEDNESS TO FAMILY & CULTURE-OF-ORIGIN
  35. 35. CONNECTEDNESS STUDY 1 Measures 1. Sexual risk-taking 2. Frequency of contact with extended family 3. Knowledge of family stories across time Subjects Women in a Sexually Transmitted Disease Clinic compared with women in Social Community Center Results Measures of frequency of contact and knowledge of family stories held up together and separately and both correlated with reduced sexual risk-taking Landau, et al, 2000
  36. 36. CONNECTEDNESS STUDY 2 Measures Same as study 1 Subjects Troubled adolescent girls. Quantitative results were similar. Then analyzed stories for themes of resilience vs. vulnerability Results 1. Least risk-taking correlated to themes of resilience 2. Next lowest correlated with themes of vulnerability 3. Most risk-taking correlated with knowing no stories Interesting Finding: Content in stories of “resilience” and “vulnerability” were often identical – what varied was how the family perceived challenges they faced Tuttle et al, 2004
  37. 37. Draw on the family’s inherent resilience rather than labeling behavior and communication patterns as dysfunctional Labeling leads to continued vulnerability and risk-taking, rather than increased self- esteem, competence and self- efficacy Landau, et al., 2000 ENHANCING POSITIVE CONNECTEDNESS
  38. 38. SO…WE NEED TO RECONNECT FAMILIES IN ORDER TO BUILD OUR COMMUNITIES
  39. 39. THE ROLE OF THE FAMILY IN RECOVERY & HEALING
  40. 40. FAMILY MOTIVATION TO CHANGE Definition: The adaptive force operating within a family experiencing major loss or stress, which guides it first toward maintaining survival, and then toward healing when the threat is removed. Garrett & Landau, 2007 .
  41. 41. THE TRANSITIONAL PATHWAY Past Present Future Hope Relief Despair Transitional Pathway
  42. 42. HOW CAN FAMILIES FOSTER RESILIENCE Increase quality time with extended family Talk about inter-generational family strengths, values and themes Stay in regular contact with one another Family activities Worship together © 1999-2018 Linking Human Systems, LLC
  43. 43. WHAT ELSE CAN FAMILIES DO? • Share family meals • Take care of one another during times of stress • Meditate together • Get to know one another’s friends • Celebrate together • Grieve together
  44. 44. WHAT CAN PROFESSIONALS DO?
  45. 45. WHAT CAN EDUCATORS & CONSULTANTS DO? • Understand adolescent and young adult development • Understand the family life cycle • Recognize learning styles and challenges • Avoid judgmental language • Create and cultivate tolerance • Develop a robust referral network • Be able to do focus on goals not problems • Meet with people in their home setting • Collaborate with families • Know when to refer and when to delegate
  46. 46. WHAT CAN TREATMENT PROFESSIONALS & PROGRAMS DO? • Communicate with referring professionals • A continuum of collaborative care • Provide family psycho-education • Multifamily group and activities therapy • Family and group therapy • Regular communication with family
  47. 47. WHAT CAN LAW ENFORCEMENT AND OTHER FIRST RESPONDERS DO? • Debrief with a colleague or therapist on a regular basis • Always work with a team and know when to be a hero • Observe safety precautions at all times, for yourself and others • Know when to call for help • Be CPR certified • Learn when and how to administer naloxone
  48. 48. WHAT CAN COMMUNITIES DO? Hold Community Meetings Create Social Groups Expand Community Services Reach Out to Neighbors Hold Community Wide Events – Sing, Dance, Play Together
  49. 49. HOW DO WE MOBILIZE INDIVIDUALS, FAMILIES & COMMUNITIES?
  50. 50. LINC® COMMUNITY RESILIENCE Community & Family Level
  51. 51. LINC® COMMUNITY RESILIENCE LINC Community Resilience uses a 3-stage process to empower the community and to reduce long-term professional involvement: 1. The community comes together to share their history, traditions, and current situation (typically traumatic event, increase in problems, or mass disaster, etc.) 2. The community selects Community Links who lead them to establish clear goals and turn these into small workable tasks with committed work groups 3. The community takes over the process when the outside professionals withdraw Landau, 2004, 2007, 2011
  52. 52. • Elicit the invitation, authority, permission and commitment of the community • Provide the process – let the community generate content and goals that relate directly to their future directions and best interests • Turn goals into realistic tasks and practical projects, building on existing resources • The more peripheral the Interventionist(s), the more successful the program and community • We tread lightly leaving no footprints while the community takes credit for change LINC® COMMUNITY RESILIENCE (CONT.)
  53. 53. PYRAMID OF PREVENTION & INTERVENTION PLANNING Landau, 1990 Knowledge Authority Mission Change Makers Special Skills Leadership Context Neighborhood Motivation Support Invitation Permission© 1999-2018 Linking Human Systems, LLC
  54. 54. BUILDING RESILIENCE THAT CAN BE SUSTAINED OVER TIME WITH MINIMAL PROFESSIONAL INVOLVEMENT 3-stage process: 1. The community comes together to share their transitional pathway 2. The community selects community links who lead them to establish clear goals, and turn them into small workable tasks with committed work groups 3. The community takes over the process when the interventionists withdraw © 1999-2018 Linking Human Systems, LLC
  55. 55. SCRIPTS, THEMES, STRENGTHS, RESOURCES • With song we heal our wounds • Singing music and dancing • Strong family values • Connectedness • Preservation of culture and language • Protection and safety in the family • Adaptability • Closeness to the family • Sense of unity rather than division • Capacity to organize • Religion and religious tolerance • Education • Flexibility and survival skills • General enthusiasm and optimism • Open dreams • Honoring true worth • Loyalty to family and community © 1999-2018 Linking Human Systems, LLC
  56. 56. PRIORITIZING GOALS AND SETTING TASKS 1. Use singing, music and dance, help children to learn about the homeland and identity and cultures. Using preservation of culture and language to help children learn about homeland and identity --Raise children's’ sense of pride - take them to cultural events, bringing other children along, and then expanding into community 2. Be a role model for or children, raise children to be role models for other children using adaptability and finding education by using education and strong family values --be an advocate for other families, with parent teacher association 3. Contribute to immediate then to larger family then community by using all resources --teaching sense of unity and tolerance© 1999-2018 Linking Human Systems, LLC
  57. 57. PRIORITIZING GOALS AND SETTING TASKS CONT. 4. Use all resources particularly family connectedness and strong family values sense of unity rather than division to talk about grief rather than storing it for generations to come --Encourage members of own family and extended family to talk about loss and grief and any stress. Then spread to other families and join together to talk on a community scale. 5. Help from international community for Kosovar Albanians everywhere, using capacity to org and unity rather than division --Join community by making a party, and write an article about the community to invite leader from other communities, and tell to media. To do this we need to have a team or a group© 1999-2018 Linking Human Systems, LLC
  58. 58. PRIORITIZING GOALS AND SETTING TASKS CONT. 6. Develop and find facilities to work with children and families affected by trauma using family and community links --Identify family link to act as mentor --Find community link who will find professional help for kids in society because family doesn’t know where to look 7. Raise children to serve as role model for other children using education, and adaptability --Set boundaries and clear guidelines differently for discipline. Child has to learn about education and take full advantage. Find good school & extracurricular activities © 1999-2018 Linking Human Systems, LLC
  59. 59. LINC® EXAMPLE 1: COMMUNITY & FAMILY Community Resilience: 10,000 Lideres para el cambio (Buenos Aires Province, Argentina - pop. 12 million) • Focus: Violence, HIV/AIDS and substance abuse prevention for the entire community • Family/Community Link: Concerned community members working in collaboration across all levels of the community • Result: 400% increase in young substance abusers being brought into treatment by their families within 2 years • Follow up 15 years later, in one city of two million people, 37 of 43 projects were still functioning Landau, 2004, 2007, 2011; Yaria, 2002
  60. 60. LINC® EXAMPLE 2: COMMUNITY & FAMILY Community Resilience: Post-war Kosovo • Focus: improving services and treatment compliance of chronic mentally ill; reducing rates of addiction; developing health and mental health services • Family/Community Links: Professional and lay members of community • Results: • Established regional decentralized home health houses and treatment clinics • Mobilized Family and Community Links to reach out to families in each region • Ensured collaboration between health, mental health and new addiction services • Compliance rate of schizophrenics and families: 98% Agani, Landau, & Agani, 2010; Weine, et al., 2005
  61. 61. LINC® EXAMPLE 3: COMMUNITY & FAMILY Community Resilience: Aurora, CO 2015-2017 • Focus: Enhancing positive connectedness across community • Family/Community Links: Professional and lay members of community • Results: • Community is working together across racial and ethnic lines • Involving all sections of the community including police, journalists, first responders, refugees, immigrants, business owners • Currently building a coordinated community story about their history and their future hopes and dreams
  62. 62. LIFE® (LINC® FAMILY EMPOWERMENT) Group & Family Level
  63. 63. LIFE® (LINC® FAMILY EMPOWERMENT) Group and Family Intervention • Pilot studies: Taiwan and Rochester, NY, STD/HIV/AIDS prevention; The Bronx, reducing abuse in women and preventing STD/HIV/AIDS in women and families • Focus: 1) HIV+ person and family, 2) parents and family involved in domestic violence, and 3) domestically abused minority women • Links: Troubled person serving as a Link to family and community • enhance positive connectedness by changing perception of vulnerability to one of resilience • provide psycho-education Landau, Mittal & Wieling, 2008
  64. 64. LIFE® NIMH STUDY Project SUPPORT: Reaching Healing and Recovery Through Love, Hope and Respect • Focus: Abused inner city minority women • Aim: Reducing risk for HIV/AIDS infection and Reducing frequency and intensity of intimate partner violence (IPV) • Links: Abused women serving as Links to their families Data showed: • Increase in positive conversations with family members and interpretation of family stories • Increased sense of self worth and self advocacy • Increase in condom use • Increase in conversations related to the practice of safer sex with sexual partners • Women experienced reductions in physical, emotional and sexual violence Mittal, et al. (2016) NIMH KO1. PI: Mona Mittal, PhD. University of Maryland, College Park
  65. 65. ARISE® COMPREHENSIVE CARE WITH INTERVENTION
  66. 66. THE ARISE® MODEL: BASED ON TRANSITIONAL FAMILY THERAPY Transitional Family Therapy is an integrative approach that considers: • Here-and-now and “why now?” • Intergenerational family and contextual history, themes, scripts, stories, strengths • History of the family and their context. (Ecosystem) Landau, 1982; Landau-Stanton, 1986; Seaburn, Landau-Stanton, & Horwitz, 1995
  67. 67. ARISE® PHILOSOPHY We believe that individuals, families and communities are: • Intrinsically healthy and competent • In constant transition • Typically cope well with transition unless there are 3 or more transitions in a short space of time (or transitions are traumatic) • Able to access and utilize their strength and resilience unless they are cut off from their natural support systems
  68. 68. ARISE® PRINCIPLES Recovery and healing are based on: • Empowering family, community, and natural support system • Mobilizing and reconnecting the extended natural support system • Reinforcing connection to family- and culture-of-origin • Focusing on individual and family healing and recovery • Removing the “we/they” dichotomy
  69. 69. ARISE® COMPREHENSIVE CARE WITH INTERVENTION: • Focus: Individuals and families suffering from any progressive, relapsing, chronic and/or life-threatening illness • First Caller/Contact: Concerned family member, other support system member, or concerned professional • ARISE Support Network: Members of nuclear family, extended family, friends, community members, and relevant professionals • ARISE Comprehensive Care: • Begins right from the First Call or contact with the First Caller • Continues for a minimum of 6-12 months • May continue for several years in the case of serious mental illness and/or dual diagnosis © 1999-2018 Linking Human Systems, LLC
  70. 70. NIDA RESEARCH OUTCOME DATA Results of original ARISE NIDA study for substance abuse, replicated in the real world for substance and process addictions: • Treatment entry: • 50% entered treatment within 1 week (First Call or First Meeting) • 76% within 2 weeks • 83% within 3 weeks • Informal follow up at 6 months: 96% entered treatment • Most significant predictor: the more members of the support system involved, the better the outcome • Real world replication: 61% sober at 1 year with additional 10% improved Landau, et al., 2004
  71. 71. Preliminary Data: Brandeis Independent Evaluation of ARISE® Service at SSTAR and Gosnold • 2.5 years • 419 families • Over 60% successfully engaged through ARISE Intervention and retained in treatment for ARISE Continuing Care • Cost effective and efficient • Family members and addicted individuals spoke highly about ARISE Emsellem & Paull, March 2014 © 1999-2018 Linking Human Systems, LLC
  72. 72. FERNANDEZ, BEGLEY & MARLATT (2006), IDENTIFIED KEY ARISE SUCCESS FACTORS • The Intervention Network remains involved in collaboration throughout intervention, treatment & early recovery • The process relies on the inherent strength, motivation, and resilience of the family • The focus is on individual AND family recovery and healing • Individuals are invited and motivated to enter and participate actively in treatment © 1999-2018 Linking Human Systems, LLC
  73. 73. Judith Landau, MD, DPM, LMFT, CFLE, CIP, CAI ARISE® Network www.ARISE-Network.com 303-44-3755 HELPING FAMILIES AND COMMUNITIES ACCESS RESILIENCE TO PREVENT MENTAL ILLNESS AND ADDICTION FOLLOWING MASS DISASTER

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