Family Intervention, Crisis Response Plan for Patients With Schizophrenia

(Part 3 of 3)

In the final part of this video series, Meagan Thistle, assistant digital editor, Psych Congress Network finishes her interview with Amber Hoberg, NP, Centric Physicians Group, San Antonio, Texas, on-site at Psych Congress​​​​​​, discussing family intervention and crisis response plans for treating patients with schizophrenia.

In Part 1 of this series, Hoberg discussed meeting her patients where they are to increase treatment compliance, and in Part 2 she addressed medication adherence and collaborative care.

Read the transcript:

Meagan Thistle:  In addition to that collaboration with your team and the patient, how do you bring the family in? How do we bring the family into part of the treatment process in helping them get involved?

Amber Hoberg:  That's a really important question, because like I said, some patients, I do have family involvement, and the others, I don't.

The ones where the family are involved, I do encourage them to come to the appointments with the patients. I want the patients and their family members to both feel heard. A lot of times, a majority of my patients do live with their family members. Having that collaboration for them is super important.

One, I need to educate them on the disease state. Some of the questions I'll get from family members are like, "When are they going to go back to normal?" or, "Why do they keep doing this?" It's a series of education where they're at in their disease state, "Why compliance with medications is so important," "Why we want to keep them adherent."

Also, sometimes, if I have patients that are refusing medications or not wanting to take a certain medication, involving the family and educating the patient as well as the family on why I'm offering this alternative, why this might be a good approach, and what it does for the patient in the long run.

For instance, I had a patient the other day, that first new-onset schizophrenia, and who was not being compliant with his PO medication. We talked about long-acting injectables with him. At first, he was like, "I'll just take the pills."

We talked about it, and I showed him the scale. "Look, if you continue to quit taking your medications, you're going to keep declining, and you're going to have more episodes, and they're going to be harder to treat. Long-acting injectables are the way we need to go."

It wasn't until I involved the mom in the communication of, "This is why I'm asking for this to happen, and this is why I'm trying to work with him on accepting this as a treatment option. One, it's going to make him more successful in life. Two, we're going to prevent further episodes from him declining."

She was one of the ones that asked me, "When is he going to go back to normal?" "This is what creates that normalcy for him." When I involved the mom into the equation, she was able to talk to him in a manner that she talks to him, and talked with me in collaboration, and asked me questions. We were able to get him successfully on the long-acting injectables.

Again, the family collaboration is very important. It's important because they live with them every day. They also want to be able to provide that care to the patient, and we want to prevent caregiver burden or stress for them as well so that we make sure that we're addressing all the needs of everybody in the household.

Meagan:  Great. If you could elaborate a bit on any crisis response that you might have to discuss with the family if an episode does occur, how do you approach that conversation? Any resources?

Amber:  Again, here in San Antonio where I live, we do talk about crisis intervention. Where do you go if somebody is having these issues?

We're trying to stabilize them, but we need to get them into an intervention. Here in San Antonio, we actually have a mental health crisis team that does come out to patients. They can assess the patient, they can see where they are, decide whether or not we can manage this in the home.

If it's something that they need to go to the hospital to manage, they have mental health officers that come to the home as well that work with these patients, get them to accept treatment if it's something that they need. Then, they take them in a nonthreatening way to wherever it is that they need to go, which I think is a great approach.

One of the things we want to prevent is more trauma or more stress for the patient because that's going to worsen their overall illness. We do have a pretty good team here that does work with them in helping them get that crisis stabilization that they need.

I use those support systems that I have, and I talk to the parents about it. I give them the phone numbers of who they need to contact and what that needs to look like, and then I help walk them through the process. I pretty much am involved throughout the process until they get to where they need to go.

Meagan:  Thank you so much for joining us. Do you have any final thoughts? Anything else about meeting patients where they are? Anything in general that you'd like to share with the audience?

Amber:  I do want to thank you guys so much for allowing me to do this with you guys today. Some of my final thoughts is please, make sure, no matter what, that you're maintaining that consistency with your patients, that you're asking patients questions about their medication regimen, that you're talking to the families.

Making sure that you're addressing their needs as well, but also making sure that you're listening to the patient's individualized goals as well. Where do they want to be? Where does their success lie? Again, when we partner with everybody and we work in collaboration, we're that more successful to make a difference for our patients.