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Family Coaching Clinics: A New Model of Preventive Mental Health Care

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Diane Flannery
Co-Director
UCLA Semel Institute Global Center for Children and Families
(University-based social program)


Submitted by: DFlannery

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by noblesdg on May 9, 2008 - 12:32

Changemakers' homepage asserts. "Our evidence-based model provides targeted coaching modules based on cognitive-behavioral strategies that help families achieve well-being. " What empirical information have you collected that demonstrates the effectiveness of coaching to sustain or enhance well being? Would you share your source data?

I am a doctoral student in the midst of dissertation research of life coaching as an effective tool of promoting optimal wellness of professionals in high-stress environments. The specific focus of my study involves pastor and ministers. I continue to uncover substantial anecdotal evidence that suggests significant benefits. However, it is challenging to find empirical evidence. Any assistance that you could provide or suggested sources that might lead me to such information would be appreciated.

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Dan Nobles

by noblesdg on May 9, 2008 - 12:23

Changemakers' homepage asserts. "Our evidence-based model provides targeted coaching modules based on cognitive-behavioral strategies that help families achieve well-being. " What empirical information have you collected that demonstrates the effectiveness of coaching to sustain or enhance well being? Would you share your source data?

I am a doctoral student in the midst of dissertation research of life coaching as an effective tool of promoting optimal wellness of professionals in high-stress environments. The specific focus of my study involves pastor and ministers. I continue to uncover substantial anecdotal evidence that suggests significant benefits. However, it is challenging to find empirical evidence. Any assistance that you could provide or suggested sources that might lead me to such information would be very appreciated.

Dan Nobles
PhD Student
Trinity Theological Seminary

by ippisl on September 16, 2007 - 12:31

this seems like a great idea.since you've mentioned that coaches would have MA or PHD degree , what would be the cost of a coaching hour relative to that of a psychotherapist ?

And also ,since you deal with mid-level problems , with evidence based treatments (so i assume the treatments arre not to complex , without the need of extensive clinical knowldge and expertise to administer ) is it possible to work with BA level coaches ,that would be experts in your specific type of services ?

by DFlannery on September 29, 2007 - 01:36

These are great questions, thanks for raising them. You are absolutely right that we are aiming for simple, straightforward treatments that could be delivered by BA-level coaches. Coaches will work as part of a team of professionals with varying types of experience, including a PhD-level clinical supervisor who has 30 years experience. We are putting together our training program right now, and we plan to hire coaches of all ages, gender and ethnicities.

We are currently testing different pricing structures for family coaching. We can't tell you the specific price right now, but it will definitely be below the rates for psychotherapy. People often turn to psychotherapy when a problem is deeply entrenched and at a crisis point – which costs more to solve. Coaching costs less to administer, since it is designed to be preventive and address problems in 6-10 sessions.

by bunchoay on August 29, 2007 - 07:08

I think this is a wonderful program

by volunteerku on August 29, 2007 - 06:44

I agree, it is time to take our interventions to where the consumers are. For too long, evidence-based mental health programs have languished in academic and public health circles.
Families already have so much on their plates, juggling the stresses of working, raising children, and leading busy lives, and we want to make it easier for them to get the support they need when and where they need it.

by Karin Hillhouse on August 27, 2007 - 15:58

I like that you've chosen "clinic" in this context...the idea of a place where families can go for "coaching" on all the challenges they face in daily life--where they can go to learn and practice skills and join others in a group wanting the same skills, wanting to improve their results. When you're considering the term some more, also remember that kids and their parents go to soccer clinics, to basketball clinics, to running clinics, tennis clinics, etc., to practice (and have fun) with coaches who are trained to help. Family life, school live, daily life can be likened to the challenge/engagement of playing sports so perhaps the "sports clinic" analogy is spot on. In any event, the idea of "family coaching clinics" widely and easily accessible to all who would benefit from coaching on parenting, group dynamics, and socialization skills is innovative and compelling. Presumably, the coaches' training includes the ability to recognize when clients need to be referred for more specialized attention by other health professionals outside and beyond the Family Coaching Clinic.

by DFlannery on August 28, 2007 - 15:10

We appreciate your enthusiasm for our Family Coaching Clinic name. There is clearly a difference in opinion emerging about the merit of the name. We will be giving careful consideration to what our final word choice is. Thanks for your input!

by sarhoden on August 27, 2007 - 23:44

As someone who has taught in South LA for four years, I am curious to know how this program would be implemented in urban retail centers. Considering the occupancy rate of several malls in south LA, and in my opinion, the low occupancy rate in malls more generally across America in urban areas, I would think that it would be more economically beneficial to have a 2 step phase in plan that would include as many socio-economic areas as possible. Just a thought.

Great idea and good luck with the program!

by DFlannery on August 28, 2007 - 15:11

Thank you for thinking so carefully about the viability of retail spaces in urban areas. We will have to chose our shopping malls carefully so that we can be a part of retail locations that are used by the surrounding communities. We intend to start with one location and then branch out once we have worked out some of the initial kinks. So your idea of a 2 step process is exactly what we have in mind.

by Erin1074 on August 27, 2007 - 14:35

I think this is a great idea! Placing the clinic in retail settings makes it an accessible resource for families, which is greatly needed. I would also recommend taking the label of clinic off of the name, so that families see it more as a fun place to go, rather than a "clinical site," which can imply something is wrong.

by DFlannery on August 27, 2007 - 15:07

The word “Clinics” is clearly causing some concern. Since our aim is to normalize and de-stigmatize preventive mental health care for families, the label “clinic” may just have to go. We are taking this under strong and serious consideration.

by jasarnow on August 27, 2007 - 13:34

You say that the Family Coaching Clinics utilize an evidence-based coaching model. What kinds of research is the model based on? Do you have a standard technique you use to "translate" evidence-based interventions into coaching modules or methods?

by DFlannery on August 27, 2007 - 19:41

The UCLA Global Center for Children and Families staff have developed several effective behavioral interventions for families and adolescents dealing with issues like suicide, HIV, homelessness, substance abuse, etc. All of the interventions have been scientifically tested using randomized, controlled trials. They all share common core elements on which their effectiveness depends. These core elements (techniques like framing an issue or regulating emotions) form the foundation of the family coaching model.

Our translation technique involves reading all of the scientific literature available on a mid-level issue like bullying. We try to understand predictable patterns of behavior associated with the issue. Then we map the core elements to the behaviors associated with the coaching issue. Our goal is trying to teach new behaviors that can replace the old ones.

by Art on August 26, 2007 - 13:57

You mention that the Family Coaching Clinics may possibly respond to family mental health issues just as Minute Clinics address physical health conditions. Could you say a little bit more about how the Minute Clinics work and how your model is similar? I love the idea that helping a child deal with bullies or assisting a family to deal with divorce could be as easy as curing an ear infection or diagnosing strep throat. I would appreciate hearing more about your program would work.

by DFlannery on August 27, 2007 - 15:10

First, they both engage families in retail spaces where families can easily access them. In our case, we intend Family Coaching to be in shopping malls, as a stand alone space, next to the Gap or the Disney Store, not inside an existing CVS Drugstore.

Second, Family Coaching will contend with common mental health prevention topics, just as the Minute Clinic contends with common behavioral health issues. All families face issues like transitions into first grade or middle school, just as almost all families have to deal with strep throat at some point. Research shows that there are some relatively simple behavior changes families can make to help children make these transitions successfully, and that families can learn these things in a few sessions with a trained expert. It's not quite as easy as taking antibiotics for strep throat, but it's a lot easier than families sometimes think when they're in the midst of a problem!

Third, both clinics are ready to triage more difficult cases to traditional sources of care. Upon intake or during the course of care, if a family presents a more serious problem such as severe depression or ADHD, we will connect this family to the appropriate psychological, psychiatric, or educational specialists. We are committed to ensuring that families receive the appropriate level of care.

To get a more complete picture of the Minute Clinics, we suggest you explore their website at www.minuteclinic.com.

by JLespron on August 25, 2007 - 19:36

I think this is a wonderful program and a much-needed service! You indicate that you are designing these programs for middle-class families. Aren't the most at risk populations the disenfranchised and uninsured? Out of curiosity, why aren’t you designing these services for uninsured and minority families at the outset?

by DFlannery on August 27, 2007 - 12:16

You are quite right. Some of the most at-risk families are the disenfranchised and uninsured. As researchers, we have been working with these families for decades and have an unwavering commitment to their well being. It is very important to us to make coaching available to families of any income level. The Family Coaching model targets “mid-level” problems, such as bullying and key school transitions (e.g. first grade or middle school), which affect families of all income levels.

We firmly believe that to take behavioral interventions to the wider public, we must target middle and upper-income families for these services, not just low-income families and the uninsured. Unfortunately, programs that focus exclusively on the problems of the disadvantaged, can become stigmatized. No family wants to identify itself with issues of poverty, even those who struggle with poverty on a daily basis.

Our intention is to build a Family Coaching model that will be attractive to every family of any income level. Once Family Coaching is up and running, families from more affluent backgrounds will provide the self-sustaining financial backbone, while families in need of financial assistance will receive services on a sliding scale (or even with insurance co-payments).

by LManon on August 25, 2007 - 18:30

Family Coaching sounds like a great idea! You mention that the Family Coaching Clinics are integrated into more broadly focused Family Centers that will attract a broad cross-section of families. I'd love to hear more about these Family Centers. Will they be like community centers? Children's museums?

GOOD LUCK!

GO UCLA!

by DFlannery on August 27, 2007 - 18:38

The Family Centers are still in the development phase, but the idea is to create an exciting family destination. We want to combine the best concepts from children’s museums, community centers, and performance spaces all at the same time. What we imagine is a place that mirrors the work we will be doing. It will be open, with lots of light, and filled with natural materials. The architecture will create intimate corners that allow personal reflection and open spaces for gathering with others to share and learn.

by RonOrr on August 24, 2007 - 20:05

I think this is a great idea. However, why do you need to call it a Family Coaching "Clinic"? A "clinic" is for people with something wrong. Everyone knows what a coach is and having a coach is not stigmatizing. Why not call this Family Coaching? I think having the word "clinic" in the title is not necessary and does keep some stigma to receiving services.

by DFlannery on August 26, 2007 - 01:33

Thanks so much for bringing this up. You raise a good point. We will seriously consider whether calling these "clinics" gives the right impression of what family coaching is all about. It might well be less stigmatizing to use a different name. This is very helpful feedback.

by nhorton on August 22, 2007 - 18:13

As a licensed family therapist, I am thrilled with the benefits I believe this model will bring to the sustainability of health to families and in turn to the communities we share. Even more exciting is the vision you hold to replicate the service globally. Brava!

by DFlannery on August 23, 2007 - 14:46

Thanks so much for your enthusiasm for the Family Coaching Clinics! We are convinced that healthy families are essential to thriving communities, and vice versa. When the continuum of mental health services is expanded and made available to more people, everyone benefits.

by barb91302 on August 22, 2007 - 13:08

Barbara from Calabasas, California

I have a few questions about the coaching part of the project:

1. what kind of problems will be addressed?

2. what qualifications will the coaches have?

3. How will you decide if a problem is too "heavy" to be dealt with by a coaching program?

Thanks!

by DFlannery on August 22, 2007 - 18:05

Your trio of questions cut to the heart of some critical issues. We cannot thank you enough for giving such careful thought to our proposal. We’ll take each question one at a time, because they all deserve careful consideration.

by DFlannery on August 22, 2007 - 18:10

We are going to target what we call “mid-level” problems, such as dealing with bullying, moving through key school transitions (e.g. entering first grade or middle school), parenting well at different stages (e.g. toddlers, tweens), handling teens' (and tweens!) emerging sexuality, sibling rivalry, or maintaining healthy family schedules. These are all issues that most every family encounters at some time or another. We believe that all families could use a little help in coming up with better ways to help their families tackle these common issues. There are some relatively simple ways families can change their behavior to shift these kinds of things, but right now families don’t know where to turn for reliable assistance.

by DFlannery on August 22, 2007 - 18:08

Coaches will be mental health care professionals. We imagine a diversity of training backgrounds, including Masters level and Doctorate level clinicians. Our commitment is to take mental health care expertise out into the world, so that families can get effective, focused care in a comfortable setting without the fear of stigma, from trained professionals who have the expertise to coach families to health and well-being.

by DFlannery on August 22, 2007 - 18:09

Thank you for raising this issue! We think that being able to recognize when we can help and when we cannot is critical to the success of our program. Coaches will be trained mental health care professionals who will have the expertise and training to recognize when a problem is beyond the scope of coaching. We will do very careful intake, and coaches will have a set of assessment "rules" to help determine when a family should be triaged to more traditional mental health care, such as psychiatry, where they can receive the more intensive attention their problems require. When coaches encounter a family with such a problem, they will help the family identify a professional who has just the right qualifications to give them the treatment they need. And there may be some families who will benefit from both traditional mental health care and coaching at the same time!

by sule2004 on August 22, 2007 - 09:56

This is a very bold, innovative approach that makes so much sense: it goes where the clients are. Besides, it is time for mental health issues to "come out of the closet."

by DFlannery on August 22, 2007 - 18:03

Thanks for your encouragement. We couldn’t agree with you more. Preventive mental health has decades of research behind it, establishing the benefits it can provide to families from all walks of life. We need to mobilize our expertise and proactively engage the world.

by frhodes on August 20, 2007 - 12:12

Finally, a plan utilizing modern marketing strategies to focus, package, and deliver family mental health services in a familiar retail context to address real-world family issues. This represents a signifiant and optimistic departure from traditional paradigms that have sought to translate evidence-based behavior-change strategies into effective, sustainable programs for the general community.

Go Family Coaching!

by DFlannery on August 22, 2007 - 13:38

Thank you for your enthusiasm.

We think traditional strategies to mental health have been effective for those who can engage them, but engagement is the problem. The need for services is greater than the use. It is time for behavioral science to take itself outside of it’s comfort zone and get out into the places where families are spending their time already.

If we want to build a healthier world, we must engage the world. Everywhere in the world, the marketplace is a space where people go to acquire goods and services and make human connections, whether it is malls in the United States or a local market in Uganda. It is our duty to take our scientific knowledge about health and well-being to the people where they are.

by Anonymous on August 20, 2007 - 01:15

In any society and espacially the world today, interventions that restore family cohesion in all aspects must be supported. This is a good model that may save nations because if supported, its effectiveness will not just be applicable to the United States but to all countries that view the need for such an intervention. My opinion is mental assistnce should focus on the family and this i must affirm is a great initiative that i pray will reach Africa and specifically - Uganda for that matter. I therefore vote for this idea. Thanks - Esther Uganda

by DFlannery on August 22, 2007 - 13:15

Esther, thank you so much for your encouragement!

We would love for our programs to reach outside the United States. Because we are based in Los Angeles some of our first efforts will be here where we can most easily monitor their progress. That said, we have every intention of broadening our scope outside of Los Angles and the United States to the rest of the world. We are currently working on grant proposals for projects in China and South Africa that will engage people in local markets (just like we want to engage people in shopping malls in the United States). We also have a new program called Global Buddies, which is helping children and families in Los Angeles and South Africa make connections that will improve the lives of families in both countries. We want to make our interventions available to everyone and anyone who could benefit from them.

Thanks again for your vote!

by Anonymous on August 20, 2007 - 01:09

Voting for UCLA family Coaching Clinics

by LilaTBelanoff on August 19, 2007 - 18:59

Designing the clinics from the perspective of family wellness is critical and an innovative approach to gaining acceptance. Locating the clinics where pressured families are already spending time serves to make it easier for families to make use of services and followthrough with the consistency needed over time to achieve the benefits of coaching. MArketing to all families is so important from both the income generating aspect and the notion that all families have the need for parenting skills- not just low income families who are often targeted for special programs tending to stigmatize program users. This program has the potential of making a tremendous difference for large numbers of families.

by DFlannery on August 22, 2007 - 14:17

We absolutely agree with you. In order to reduce the stigma that is attached to preventive mental health, we think engaging families of all income levels, not just targeted low-income families, is crucial. Every family has times of stress when a little coaching today would go a long way toward well being in the future.

A fully functional Family Coaching Clinic would work on a sliding scale (or even with insurance co-payments), where those in financial need would be provided with the assistance they require to access services, while families from affluent backgrounds would provide the self-sustaining financial backbone.

Coaching will be available to everyone for the benefit of all!

by naihua on August 19, 2007 - 13:00

This project is an excellent way to take critically needed mental health services to where the consumers are. As banks are moving their service delivery into shopping malls and supermarkets, to where their consumers are, mental health service providers might also benefit from the same. This project has the potential to engage consumers in a way that is less stigmatized and user-friendly than the traditional mental health service delivery venues. I look forward to the arrival of the Family Coaching Clinic in my neighborhood soon!

by DFlannery on August 22, 2007 - 13:51

We agree, it is time to take our interventions to where the consumers are. For too long, evidence-based mental health programs have languished in academic and public health circles. This is our opportunity to engage consumers with the same vigor as Coca-Cola and McDonald's, but with health and well-being as the target of consumer’s dollars.

Families already have so much on their plates, juggling the stresses of working, raising children, and leading busy lives, and we want to make it easier for them to get the support they need when and where they need it.

by Vizals on August 19, 2007 - 00:22

We all need this--yes I'm sane. Marketing to remove the stigma will definitely help!

by DFlannery on August 22, 2007 - 22:39

This is the most concise summary of our proposal we could imagine. Kudos.

by DFlannery on August 22, 2007 - 13:40

This is the most concise summary of our proposal we could imagine. Kudos.

by DFlannery on August 17, 2007 - 01:36

Thank you so much for your interest in our Family Coaching Clinics. Please see below for our reply to your good questions about market demand and marketing strategies.

1) Has any market testing been conducted to see what the potential demand would be for such a service?

Our initial market testing has consisted of general market research into current trends centered on wellness, prevention, and parental spending. We see that a wellness boom is sweeping the United States. Prevention—best thought of as a holistic, integrated approach that encompasses mental, physical and spiritual well-being—is being integrated into many aspects of health care delivery and personal lifestyle choices. Americans spend over $200 billion a year on wellness and sustainable living, exemplified by a broad array of services, products, and centers spanning traditional and alternative medicine, spirituality, fitness and nutrition, as well as “green” living and sustainable lifestyles.

U.S. parents spend upward of $40 billion a year on their children between the ages of four and twelve, and parental spending has increased by 400 percent in the past 20 years. While the marketplace offers few choices for products and services genuinely designed to increase children’s well-being, there is some evidence that the wellness trend is beginning to expand to include children. In Los Angeles, for instance, a newly opened day spa called The Treehouse Social Club has hit a nerve in the family marketplace. Combining standard beauty and relaxation treatments for adults with mini-treatments for children, along with a child-friendly gourmet café and an array of imaginative and enriching children’s classes and play opportunities, the center is thriving and rapidly expanding. The success of this venture, along with family oriented “destination” malls, suggests that families are hungry for experiences that give them a feeling of well-being and connection.

The Family Coaching Clinics are designed to help families achieve a strong foundation for well-being by learning to identify their strengths and stressors and develop effective strategies to cope with developmental and cultural challenges. We believe that family wellness is a fundamental value that matters to all parents, and that there is a significant market for substantive tools, like family coaching, that helps parents and children solve problems and build the kind of lives they desire.

As we move from the pilot into the start-up stage, we will increase market testing of each of our specific services, coaching modules and delivery options, to ensure that we have assessed these markets correctly. We plan to launch a web-based “real time data collection system,” which will inform our development of evidence-based coaching interventions as well as serve as a method of continual quality improvement. We will continually refine our services to maintain alignment with what families need and want to address common childrearing problems.

2) Is there a tangible demand outside the middle income market?

Our experience is that parents everywhere want the best for their children. We know that there is a significant unmet need for mental health services among low-income families. An estimated 80% of children who need mental health care do not receive it, and a disproportionate number of those are poor or uninsured (e.g., approximately 31% of low income children do not receive needed care, versus 23% of middle class children). We also know that the kinds of childrearing problems family coaching will address – e.g. bullying in schools, key school transitions, healthy eating and exercise, and emerging sexuality – are issues that face families across the socio-economic spectrum.

In addition to keeping fees for family coaching as affordable as possible, we are establishing a sliding scale and scholarship structure to offer coaching to all families who need it, regardless of their ability to pay. As the Family Coaching Clinics make family coaching easily accessible in shopping malls and reduce the stigma often associated with mental health care (see answer to 3 below), we believe that families in the lower income market segments will be eager to participate in these relatively simple family coaching strategies that help them build a better future for their children.

3) Due to the stigma that mental health holds in so many communities throughout the country, how will these clinics be marketed?

The Family Coaching Clinics will be marketed within the context of holistic Family Centers designed from a perspective of family wellness rather than family dysfunction. These centers will appeal to a broad range of families, offering a multi-dimensional framework for preventive mental health care characterized by three features:

• Innovative and inspiring techniques for helping families adopt and sustain healthier life styles, incorporating action-oriented family coaching; exciting, interactive education; and accessible, engaging self-directed products;
• Consumer-oriented delivery model, with clearly defined services offered in accessible retail environments that make it easy for families to find and engage with the help they need; and
• Evidence-based programs for family well-being, derived from top quality scientific research within the UCLA community and around the world.

A fundamental goal of the UCLA Family Centers is to de-stigmatize mental health care for families, changing the way that preventive mental health and family wellness are perceived in society. In addition to family coaching, the Family Centers will offer a dynamic mix of interactive educational and cultural programming that attracts a variety of parents and children. We expect families to be eager to attend events at the Family Centers. Innovative classes and workshops designed to inspire and engage; bold and exciting cultural events tied to critical family issues; high quality, appealingly packaged products to support family well-being—all will create a powerful atmosphere of creative expression and community engagement that galvanizes parents and children to take responsibility for their family’s wellness.

By providing multiple avenues for families to engage with the same childrearing topics they might explore through coaching, we will help to normalize these issues and attract families who might be reluctant to seek out psychotherapy. In addition, the Family Coaching Clinics will offer a very clearly defined menu of services, organizing coaching modules around simple and straightforward childrearing problems that any family might struggle with. Our model is based on the view that all parents need help with childrearing at one time or another. Just as athletes need coaches to realize their full potential, so do families. The Family Centers will also include docents or concierges, who are parents trained to orient visitors to the Family Center, welcome them, and guide them to the resources and support available for specific issues they may be experiencing.

By developing a transparent, straightforward coaching model and by marketing the Family Coaching Clinics within the context of Family Centers with broad appeal and interest, we will help to de-stigmatize mental health care for families. This will make it much more likely that families will get the help they need early, while common problems are relatively easy to resolve, rather than waiting until problems are larger and their consequences more serious.

by tahn on August 15, 2007 - 13:02

Dear Dr. Flanery:

We see the potential of Family Coaching Clinics of becoming the Minute Clinic of mental health. Has any market testing been conducted to see what the potential demand would be for such a service? Is there a tangible demand outside the middle income market? The idea of turning mental health around to preventive care rather than treating crises is indeed transformative. Also, due to the stigma that mental health holds in so many communities throughout the country, how will these clinics be marketed?

Thank you in advance for your response!

Changemakers Team

GO BRUINS!