1. https://learn.extension.org/events/2900
Chronic Illness: Empowering Families
in the Journey - Part 2

2. Connecting military family service providers
and Cooperative Extension professionals to research
and to each other through engaging online learning opportunities
www.militaryfamilies.extension.org
MFLN Intro
2
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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. Learning Objectives
Participants will promote effective management of
chronic illness with military families by:
1)Understanding ways to harness resources
2)Discussing techniques to provide support
3)Identifying strategies to utilize resilience
4

5. 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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6. 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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7. 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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8. Let’s Discuss…
For those who were on the first
webinar, what additional thoughts
did you have on our case study?
8

9. 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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10. 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…
10

11. Psychological
Social
Ethnic/Cultural
Biological
Behavioral
Dyadic / Family
Ecological
11

12. 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
12

13. 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

14. 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
14

15. Let’s Discuss…
What are your best practices when
working with healthcare teams?
15

16. 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
16

17. 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
17

18. 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
18

19. (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)
19

20. 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?
20

21. Respecting Defenses,
Removing Blame, and
Accepting Unacceptable Feelings
• Denial
• Anger
• Sadness
• Attributions of Blame
• “Acceptable” versus “Unacceptable” Feelings
• Mixed / Contradictory Emotions
21

22. Facilitating Communication
• Expressive Skills
• Receptive Skills
• Meta-communication Skills
• Co-constructing Solutions
• Translating the Languages of Medicine
22

23. Attending to
Developmental Issues
• Developmentally Normative and Expected Illnesses
• Developmental Abnormal and Unexpected Illnesses
• Centripetal forces (inward) versus Centrifugal forces
(outward); match or mismatch?
23

24. 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… ?
24

25. Providing Psychoeducation
and Support
• Translating, Educating, Processing
• Knowledge is Power
• Connecting patients/families with other
systems of support
25

26. Maintaining an
Empathic Presence
• Listening
• Compassionate Presence / Silence
• Journeying together
– sometimes just crying together
26

27. Let’s Discuss…
What additional strategies have you
found successful?
27

28. Case Study
Family 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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29. 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.
29

30. 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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31. 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?
31

32. Case Study
Family 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.
32

33. 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.
33

34. 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.
34

35. 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?
35

36. 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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37. Contact Information
Tai J. Mendenhall, Ph.D., LMFT
University of Minnesota, Twin Cities
Department of Family Social Science
Couple and Family Therapy Program
275 McNeal Hall; 1985 Buford Ave.
Saint Paul, MN 55108
email: mend0009@umn.edu
office: 612-624-3138
fax: 612-625-4227
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43. https://www.linkedin.com/groups/8409844
MFLN Intro
We invite MFLN Service Provider Partners
to our private LinkedIn Group!
DoD
Branch Services
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Guard
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44. • 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_blojt7trvXXDYy1
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CEU Credit &
Certificate of Completion
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45. 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
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
Upcoming Events
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46. www.extension.org/62581
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47. 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