In this section, you will find the foundational information of this toolkit.
Why a Toolkit is Needed
The Value of Resilience
How to Use This Toolkit
A Note to the Recovery Team
Increasing Family Engagement
How to Apply the Brief Resilience Scale
This toolkit is based on a systematic review of relevant literature that found families affected by OUD benefit from education, skill-building, and individual or group therapeutic services.
It is the product of research and review during my enrollment in the George Mason University Doctor of Nursing Practice Program.
The purpose of this toolkit is to help members of the treatment recovery team engage and support families affected by opioid use disorder.
It is filled with resources that can be administered to family members to assist in their own learning, healing, and recovery process.
This toolkit makes the recommendation that recovery team members assess family resilience using the BRS.
This may help to identify which family members are most in need of services and the extent of the intervention they may require.
The BRS scale was created by Smith et al. (2008).
If you are interested in a PDF version of this Toolkit:
It is attached below!
In the United States, three million people have an opioid use disorder (OUD) or have had one in the past (Azadfard, 2020).
Millions of individuals suffer from the consequences of opioid addiction, but even more are affected indirectly. Especially, their families.
Addiction, by definition, is negative, damaging, and stressful to the family (Orford et al., 2010).
Families affected by OUD are at risk for mental, emotional, and physical ailments because of the strain that is associated with substance abuse. OUD can also impact families negatively through parenting, child development, psychosocial, and household safety (Smith & Wilson, 2016).
Families can also be the cause or victims of intergenerational trauma, due to 80% of people with OUD having experienced traumatic childhood events (Winstanley, 2019).
Drug overdose is now the leading cause of accidental death in the United States (Ryznar, 2018). Children may experience neglect, environmental instability, or secondary trauma from witnessing a parental overdose (Winstanley, 2019).
Family members are powerful tools in one’s recovery. Their interactions with the client can either impede or support one’s recovery (Englandkennedy & Horton, 2011).
Family or social support capital helped individuals maintain sustained long-term recovery (Heckman et al., 2018).
Family members have been found to derive the greatest support from increased education, group support, therapy, and skill-building (Kelly et al., 2017; Shumway et al. 2017; Faberman et al., 2018). In doing so, they may become more resilient.
This collection of information is intended to help the recovery team find ideas, resources, and information quickly which may be disbursed to family members based on their needs.
Resilience is often referred to as one’s ability to “bounce back” from difficult situations. Being resilient has been associated with increased longevity, reduced depression, and improved life satisfaction (Harvard Health, 2017). It is important to note that resilience has been found able to be improved (Connor & Davidson, 2003). Individuals who achieve improved resilience go on to exhibit global improvement (Connor & Davidson, 2003).
Stress is an established component of families experiencing opioid use disorder. Given the vulnerabilities of this population, increasing resilience can be a way to increase their overall protective factors (Smith et al., 2017).
Quantifying resilience is beneficial because it can serve as a “measure of stress coping ability” (Connor & Davidson, 2003).
According to the DSM-5, to be diagnosed with an opioid use disorder one must exhibit two out of eleven symptoms over the course of one year. These symptoms include: Requiring larger doses; Inability to “cut back”; Additional time spent trying to obtain the medication; Cravings; Opioids disrupting functioning; Continued use despite life disruption; Opioid use in physically hazardous situations; Continued use despite physical and psychological consequences; Tolerance; Withdrawal
Resilience is the ability to bounce back or recover from stress.
(Smith et al., 2008)
The term “family” is used here to encompass those who serve as the individual’s “closest emotional connections”.
This toolkit was created for the “recovery team”. This team varies based on the setting but is generally composed of a DEA Waivered MAT prescribing clinician, peer supporter, counselor or therapist, psychiatry/psychology support, or sponsor.
Use the engagement tips and conversation starters below to help you connect with family members.
Have the family member take the Brief Resilience Scale (BRS)
Correlate the BRS score with low, medium, or high resilience
Offer Resources based on resilience stratification and need.
Dear Recovery Team Members,
This toolkit was created in hopes of simplifying the process of engaging and assisting family members affected by opioid use disorder during their loved one’s recovery process. Depending on your current work environment, you may already feel stretched thin in time, resources, or manpower. Your emotional reserves may already be near depletion. It is my hope that the likely extra step of engaging families does not feel burdensome. Rather, I hope the task of collecting this information into one lengthy document may ease your already heavy burdens. As well as result in improved outcomes for your clients and communities.
This could also be an opportunity to designate the role of family outreach to a specific team member. Ideally, there could be peer support in every setting to help facilitate these connections and strengthen the hope and engagement of families. This may be something for us all to work toward.
Thank you for all that you do!
Why should families be involved?
•Improved recovery outcomes for the client
•Risk reduction and addressing vulnerabilities
•Feelings or support and reduce isolation
Where to start?
•Ask the client if you can reach out to their family to offer supportive services.
•Obtain contact information.
•If they are not interested, respect their decision
Reasons for Client Hesitation
•Feel they have already “burdened” their families
•Concern for their privacy
•Feel stigmatized by family
•Family member is busy or uninterested
“Evidence has found involving families in the recovery process has mutual benefits for you and your family. Is there someone in your life you may want me to reach out to?”
“Sometimes people do better when their families are on board with the treatment plan. Would you like me to reach out to them and offer some resources?”
“This has been a difficult road for you and your family. I would be happy to reach out to them and offer some resources if that would be ok with you?
“Do you have any family members who may want to be connected with education resources, skill-building exercises, or support groups?”
“Hello (Family member name), My name is -----, and I am a (job title) working with your (son, daughter, husband, wife, etc.) through their recovery.
Involving families in the recovery process has mutual benefits for you and your family.
I’m reaching out to see if you would like some education materials related to recovery, skill-building, or resources in the area to support families going through similar situations.
Would you be interested in that?”
A study conducted by Ingoldsby et al. titled “Review of interventions to improve family engagement and retention in parent and child mental health programs” (2010) found several strategies for family engagement:
•Asking families directly about barriers to participation and addressing them.
•Managing expectations about treatment, financial concerns, scheduling, and transportation. •Facilitating trust, acting as a leader, negotiating, and instilling hope.
•Ethnographic interviewing to elicit their “story”, exploring values, and cultural perspectives on treatment
•Telephone reminders about meetings.
•Monetary incentives (increased enrollment but not engagement or retention).
Have the families complete the Brief Resilience Scale (BRS).
From there, you will have a better understanding of their current state of resilience. This will assist you in determining the extent of resources and the amount of support to offer.
( Smith et al., 2008 )
If you would like to explore resources without using the resilience score, please continue exploring the other tabs above.
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