A Home-Based Family Intervention for Ethnic Minorities with a Mentally Ill Member

Abstract

This article presents the background, development, and content of a manualized home-based family intervention for ethnic minority families with a seriously mentally ill member. The development of this homelessness prevention intervention is based on the premise that the client's home can be one of the most effective venues for achieving long-term positive outcomes from mental health services. By observing the patient within the context of the home environment, staff can more accurately assess the family dynamics and encourage family members to fulfill more effective roles as caregivers. The agency within which this manualized intervention is implemented is an Integrated Services Agency (ISA) which serves the highest utilizers of the most costly mental health services in the public sector. Through effective case management and other interventions, the agency has been able to change the service utilization pattern from in-patient care, homelessness, and incarceration to community treatment within the framework of integrated comprehensive services. Ten salient points which have been significant to this agency's positive outcomes are discussed. We also provide a model for conceptualizing the strengths and burdens of the study population of low-SES African Americans and Latinos. We identified the strengths as the extended family, the kinship network, the church and spirituality, and strong education and work ethics. The burdens for this population include racism, discrimination, and poverty which co-occur in a poor inner-city community. The main element of the family intervention is the home visit. Case managers make home visits on a semi-weekly basis. While the components of the home visit are not all innovative, the delivery of the services is designed to take into consideration the cultural values, beliefs, and behaviors of the minority groups that receive the services. The services provided are engagement, assessment, and development of the service plan, monitoring, strategies for coping with mental illness, the extended provider role, and family skill development. Other family support services are family groups and family respite.