Family 

Psychoeducation

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

Building

Your Program

Family 

Psychoeducation

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

Building

Your Program
Acknowledgments

This document was prepared for the Substance Abuse and Mental Health Services Administration 

(SAMHSA) by the New Hampshire-Dartmouth Psychiatric Research Center under contract number 

280-00-8049 and Westat under contract number 270-03-6005, with SAMHSA, U.S. Department 

of Health and Human Services (HHS). Neal Brown, M.P.A., and Crystal Blyler, Ph.D., served as 

the Government Project Officers.

Disclaimer

The views, opinions, and content of this publication are those of the authors and contributors and 

do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services 

(CMHS), SAMHSA, or HHS.

Public Domain Notice

All material appearing in this document is in the public domain and may be reproduced 

or copied without permission from SAMHSA. Citation of the source is appreciated. However, 

this publication may not be reproduced or distributed for a fee without the specific, written 

authorization from the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be downloaded or ordered at http://www.samhsa.gov/shin. Or, please 

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Recommended Citation

Substance Abuse and Mental Health Services Administration. Family Psychoeducation: Building 

Your Program. HHS Pub. No. SMA-09-4422, Rockville, MD: Center for Mental Health Services, 

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and 

Human Services, 2009.

Originating Office

Center for Mental Health Services

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road

Rockville, MD 20857

HHS Publication No. SMA-09-4422

Printed 2009
For references, see the booklet The Evidence.

Building Your Program

Building Your Program is intended to help mental health 

authorities, agency administrators, and family intervention 

coordinators think through and develop the structure of 

Family Psychoeducation programs. The first part of this 

booklet gives you background information about the 

evidence-based model. This section is followed by specific 

information about your role in implementing and sustaining 

your program. Although you will work closely together 

to build your program, for ease, we separated tips into 

two sections:

n Tips for Mental Health Authorities; and

n Tips for Agency Administrators and Family 

Intervention Coordinators.

In preparing this information, we could think of no one better 

to advise you than people who have worked successfully 

with Family Psychoeducation programs. Therefore, we based 

the information in this booklet on the experience of veteran 

family intervention coordinators and administrators.

Family 

Psychoeducation
This KIT is part of a series of Evidence-Based Practices KITs created 

by the Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration, U.S. Department of Health 

and Human Services.

This booklet is part of the Family Psychoeducation KIT that includes 

a DVD, CD-ROM, and seven booklets:

How to Use the Evidence-Based Practices KITs

Getting Started with Evidence-Based Practices

Building Your Program

Training Frontline Staff

Evaluating Your Program

The Evidence

Using Multimedia to Introduce Your EBP
What’s in Building Your Program

What Is Family Psychoeducation?. . . . . . . . . . . . . . . . . 1

Tips for Mental Health Authorities. . . . . . . . . . . . . . . . 9

Tips for Agency Administrators 

and Family Intervention Coordinators. . . . . . . . . . . . . . 19

Family 

Psychoeducation

Building Your Program 1 What Is Family Psychoeducation?

Family Psychoeducation (FPE) is an 

approach for partnering with consumers 

and families to treat serious mental 

illnesses. FPE practitioners develop 

a working alliance with consumers 

and families.

The term psychoeducation can be 

misleading. While FPE includes many 

working elements, it is not family therapy. 

Instead, it is nearly the opposite. In family 

therapy, the family itself is the object of 

treatment. But in the FPE approach, 

the illness is the object of treatment, not 

the family. The goal is that practitioners, 

consumers, and families work together 

to support recovery.

Serious mental illnesses such as 

schizophrenia, bipolar disorder, and 

major depression are widely accepted 

in the medical field as illnesses with wellestablished symptoms and treatment. 

As with other disorders such as diabetes 

or hypertension, it is both honest and 

useful to give people practical information 

about their mental illnesses, how common 

they are, and how they can manage them.

Building Your Program

What Is Family Psychoeducation?
What Is Family Psychoeducation? 2 Building Your Program

Many consumers and families report that this 

information is helpful because it lets them know 

that they are not alone and it empowers them to 

participate fully in the recovery process. Similarly, 

research shows that consumer outcomes improve 

if families receive information and support (Dixon 

et al., 2001). For this reason, a number of family 

psychoeducation programs have been developed 

over the past two decades.

Models differ in their format (whether they 

use a multifamily or single-family format); 

duration of treatment; consumer participation; 

and location. Research shows that the critical 

ingredients of effective FPE include the following 

(Dixon et al., 2001):

n Education about serious mental illnesses;

n Information resources, especially during periods 

of crises;

n Skills training and ongoing guidance about 

managing mental illnesses;

n Problem solving; and

n Social and emotional support.

The phases of Family 

Psychoeducation

FPE services are provided in three phases:

n Joining sessions;

n An educational workshop; and

n Ongoing FPE sessions.

Joining sessions

Initially, FPE practitioners meet with consumers 

and their respective family members in introductory 

meetings called joining sessions. The purpose of 

these sessions is to learn about their experiences 

with mental illnesses, their strengths and resources, 

and their goals for treatment.

FPE practitioners engage consumers and families 

in a working alliance by showing respect, building 

trust, and offering concrete help. This working 

alliance is the foundation of FPE services. Joining 

sessions are considered the first phase of the 

FPE program.
Building Your Program 3 What Is Family Psychoeducation?

Educational workshop

In the second phase of the FPE program, FPE 

practitioners offer a 1-day educational workshop. 

The workshop is based on a standardized 

educational curriculum to meet the distinct 

educational needs of family members.

FPE practitioners also respond to the individual 

needs of consumers and families throughout 

the FPE program by providing information and 

resources. To keep consumers and families engaged 

in the FPE program, it is important to tailor 

education to meet consumer and family needs, 

especially in times of crisis.

Ongoing Family Psychoeducation sessions

After completing the joining sessions and 1-day 

workshop, FPE practitioners ask consumers and 

families to attend ongoing FPE sessions. When 

possible, practitioners offer ongoing FPE sessions 

in a multifamily group format. Consumers and 

families who attend multifamily groups benefit 

by connecting with others who have similar 

experiences. The peer support and mutual aid 

provided in the group builds social support 

networks for consumers and families who are often 

socially isolated.

Ongoing FPE sessions focus on current issues that 

consumers and families face and address them 

through a structured problem-solving approach. 

This approach helps consumers and families make 

gains in working toward consumers’ personal 

recovery goals.

FPE is not a short-term intervention. Studies 

show that offering fewer than 10 sessions does not 

produce the same positive outcomes (Cuijpers, 

1999). We currently recommend providing FPE 

for 9 months or more.

In summary, FPE practitioners provide information 

about mental illnesses and help consumers 

and families enhance their problem-solving, 

communication, and coping skills. When provided 

in the multifamily group format, ongoing FPE 

sessions also help consumers and families develop 

social supports.

Practice principles 

FPE is based on a core set of practice principles. 

These principles form the foundation of the 

evidence-based practice and guide practitioners 

in delivering effective FPE services.
What Is Family Psychoeducation? 4 Building Your Program

Practice Principles

Principle 1:

Consumers define 

who family is.

In FPE, the term family includes anyone consumers identify as being 

supportive in the recovery process. For FPE to work, consumers must 

identify supportive people they would like to involve in the FPE program. 

Some consumers may choose a relative. Others may identify a friend, 

employer, colleague, counselor, or other supportive person.

Principle 2:

The practitioner-consumer-family 

alliance is essential.

Consumers and families have often responded to serious mental illnesses 

with great resolve and resilience. FPE recognizes consumer and family 

strengths, experience, and expertise in living with serious mental illnesses.

FPE is based on a consumer-family-practitioner alliance. When forming 

alliances with consumers and families, FPE practitioners emphasize that 

consumers and families are not to blame for serious mental illnesses. FPE 

practitioners partner with consumers and families to better understand 

consumers and support their personal recovery goals. 

Principle 3:

Education and resources help 

families support consumers’ 

personal recovery goals.

Consumers benefit when family members are educated about mental 

illnesses. Educated families are better able to identify symptoms, recognize 

warning signs of relapse, support treatment goals, and promote recovery. 

Provide information resources to consumers and families, especially during 

times of acute psychiatric episodes or crisis.

Principle 4:

Consumers and families who 

receive ongoing guidance and 

skills training are better able to 

manage mental illnesses.

Consumers and families experience stress in many forms in response to 

mental illnesses. Practical issues such as obtaining services and managing 

symptoms daily are stressors. Learning techniques to reduce stress 

and improve communication and coping skills can strengthen family 

relationships and promote recovery. Learning how to recognize precipitating 

factors and prodromal symptoms can help prevent relapses. For more 

information, see Training Frontline Staff in this KIT.

Principle 5:

Problem solving helps consumers 

and families define and address 

current issues.

Using a structured problem-solving approach helps consumers and families 

break complicated issues into small, manageable steps that they may more 

easily address. This approach helps consumers take steps toward achieving 

their personal recovery goals.

Principle 6:

Social and emotional support 

validates experiences and 

facilitates problem solving.

FPE allows consumers and families to share their experiences and feelings. 

Social and emotional support lets consumers and families know that they 

are not alone. Participants in FPE often find relief when they openly discuss 

and problem-solve the issues that they face.
Building Your Program 5 What Is Family Psychoeducation?

How we know that Family 

Psychoeducation is effective

FPE is based on research that shows that 

consumers and families who participated in the 

components of the evidence-based model had 20 

to 50 percent fewer relapses and rehospitalizations 

than those who received standard individual 

services over 2 years (Penn & Mueser, 1996; Dixon 

& Lehman, 1995; Lam, Knipers, & Leff, 1993; 

Falloon et al., 1999). Those at the higher end of this 

range participated for more than 3 months.

Studies also show that FPE improved family wellbeing (Dixon et al., 2001). Families reported a 

greater knowledge of serious mental illnesses; 

a decrease in feeling confused, stressed, and 

isolated; and reduced medical illnesses and use 

of medical care (Dyck, Hendryx, Short, Voss, & 

McFarlane, 2002).

FPE has been found to increase consumers’ 

participation in vocational rehabilitation programs 

(Falloon & Pederson, 1985). Studies have shown 

employment rate gains of two to four times baseline 

levels, when combined with evidence-based 

practice Supported Employment (McFarlane, 

Dushay, Stastny, Deakins, & Link, 1996; McFarlane 

et al., 1995; McFarlane et al., 2000).

Based on this significant evidence, treatment 

guidelines recommend involving families in 

the treatment process by offering the critical 

ingredients outlined in this evidence-based model 

(Lehman & Steinwachs, 1998; American Psychiatric 

Association, 1997; Weiden, Scheifler, McEvoy, 

Allen, & Ross., 1999).

Who benefits most from Family 

Psychoeducation?

The greatest amount of research has shown benefits 

for consumers with schizophrenic disorders and 

their families (Dixon et al., 2001). Studies also show 

promising results for the following illnesses:

n Bipolar disorder—(Clarkin, Carpenter, Hull, 

Wilner, & Glick, 1998; Miklowitz & Goldstein, 

1997; Moltz, 1993; Parikh et al., 1997; Miklowitz 

et al., 2000; Simoneau, Miklowitz, Richards, 

Saleem, & George, 1999);

n Major depression—(Simoneau et al., 1999; 

Emanuels-Zuurveen & Emmelkamp, 1997; Leff 

et al., 2000);

n Obsessive-compulsive disorder—(Van Noppen, 

1999); and

n Borderline personality disorder—(Gunderson, 

Berkowitz, & Ruizsancho,, 1997).

Studies show that the effectiveness of FPE does 

not differ depending on consumers’ age, gender, 

education-level, or severity of illness.

This model has also been adapted and used 

effectively with a number of ethnic groups in a 

variety of settings in the United States. Studies have 

also been conducted in the following countries:

n England—(Leff, Kuipers, Berkowitz, & Sturgeon, 

1985; Leff et al., 1990; Tarrier et al., 1989);

n Spain—(Muela Martinez & Godoy Garcia, 2001; 

Montero, Gomez-Beneyto, Ruiz, Puche, & 

Adam, 1992; Tomaras et al., 2000);

n Germany—(Wiedemann et al., 2001); and

n China—(Xiong et al., 1994; Zhang, Wan, Li, & 

Phillips, 1994).
What Is Family Psychoeducation? 6 Building Your Program

Although more replications are desirable, all the 

evidence to date suggests that the positive effects 

of FPE generalize to nearly all major cultural 

populations: British, American, Australian, African 

American, Spanish or Latino, Scandinavian 

or Northern European, Chinese, and Japanese. 

However, anecdotally we know that culture and 

language pose significant barriers to providing 

FPE in some populations and, in any case, require 

culturally sensitive adaptations that must be further 

explored empirically.

Is Family Psychoeducation for the family’s 

benefit or for the consumer’s?

FPE is for both consumers and families. The 

goal is to support recovery from serious mental 

illnesses. The evidence-based model asks family 

members to help in that effort. Though it is 

designed to achieve clinical outcomes and recovery 

goals for consumers, beneficial effects have been 

found for families as well.

What if consumers do not have family 

or do not want their families involved?

In FPE, the term family includes anyone 

consumers identify as being supportive in the 

recovery process. The broad definition emphasizes 

that consumers choose whether to involve family 

and whom to involve. FPE helps consumers 

develop or enhance their support networks.

The evidence-based model has been found to work 

well with consumers who are disengaged from 

their families and have difficult treatment histories. 

Joining sessions give practitioners the opportunity 

to help consumers engage family members again 

in a constructive and supportive manner.

Research shows that practitioners often ask 

consumers for permission to involve their family 

members during a crisis (Marshall & Solomon, 

2003). Asking for family involvement at this 

time may raise suspicions for some consumers. 

Consequently, they may be more reluctant 

to identify supportive people. For this reason, 

modify your intake and assessment procedures 

so that consumers are routinely told about the FPE 

program and are periodically asked if they would like 

to involve someone supportive in their treatment. 

For more detail, see Set up referral procedures

under Tips for Agency Administrators and Family 

Intervention Coordinators in this booklet.

If consumers do not wish to involve family 

members in their treatment, FPE practitioners 

should respect their decision. If consumers do not 

give permission to share confidential information 

with their families, FPE practitioners may still 

respond to families’ questions and concerns. 

Even the strictest interpretation of confidentiality 

policies does not prohibit receiving information 

from families or giving them general information 

about serious mental illnesses and agency services 

(Bogart & Solomon, 1999; Zipple, Langle, Spaniol, 

& Fisher, 1997).

If families want to learn more about serious mental 

illnesses, FPE practitioners should direct them 

to local family organizations such as the National 

Alliance on Mental Illness (NAMI). Consumers 

who are not interested in FPE may benefit from 

other education and skills training programs that 

are targeted specifically to consumers such as 

Illness Management and Recovery. For more 

information, see the Illness Management and 

Recovery KIT.
Building Your Program 7 What Is Family Psychoeducation?

Where should Family 

Psychoeducation be provided?

The FPE multifamily group model was first 

developed in a partial hospital setting. Nearly 

all of the controlled research on effectiveness 

has been conducted in outpatient clinics and 

community mental health centers. The extent to 

which FPE can be successfully adapted to other 

types of agencies is unknown.

FPE has been successfully implemented in both 

urban and rural settings, as well as in mid-sized 

cities and suburbs. For more information, see 

The Evidence in this KIT.

Is it cost effective?

Implementing an FPE program has initial costs 

related to training and program development. 

However, studies show a low cost-benefit ratio 

related to savings from reduced hospital admissions, 

hospital days, and crisis intervention contacts 

(McFarlane, Dixon, Lukens, & Lucksted, 2003).

Cost-benefit ratios vary by state. For example, in 

New York, for every $1 in costs for FPE provided 

in a multifamily group format, a $34 savings in 

hospital costs occurred during the second year of 

treatment (McFarlane, 2002). In a hospital setting 

in Maine, an average net savings occurred of $4,300 

per consumer each year over 2 years. Ratios of $1 

spent for this service to $10 in saved hospitalization 

costs were routinely achieved.

Non-fiscal savings are achieved as complaints from 

families about services decrease and family support 

for the agency and the mental health authority 

grows. In many communities, this has translated 

into political support for funding for expanded 

and improved services.

Building Your Program 9 Tips for Mental Health Authorities

The Family Psychoeducation (FPE) KIT 

gives public mental health authorities a 

unique opportunity to improve clinical 

services for adults with serious mental 

illnesses. Research has shown that FPE 

has a consistent, positive impact on the 

lives of consumers and their families. 

The FPE KIT gives you information and 

guidance for implementing this evidencebased practice in a comprehensive and 

easy-to-use format.

Building Your Program

Tips for Mental Health Authorities

Successfully implementing evidence-based practices requires the leadership 

and involvement of mental health authorities. This section discusses why 

mental health authorities should be involved in implementing Family 

Psychoeducation and the types of activities that mental health authorities 

typically undertake.

Why should you be interested in Family Psychoeducation?
Tips for Mental Health Authorities 10 Building Your Program

How can mental health 

authorities support Family 

Psychoeducation?

As you read about FPE, you may think that 

it sounds great but unaffordable. We want to 

challenge that notion because mental health 

systems with limited resources are in the process 

of implementing FPE programs system-wide. 

These systems have visionaries who recognized 

the benefits of providing this evidence-based 

practice and who persisted in overcoming 

challenges. We hope you are that visionary 

for your system.

Implementing this evidence-based model takes a 

consolidated effort by agency staff, mental health 

authorities, consumers, and families. However, 

for this initiative to be successful, mental health 

authorities must lead and be involved in developing 

FPE programs in local communities.

Be Involved in Family Psychoeducation

Step 1 Create a vision by clearly articulating 

evidence-based practice principles 

and goals. Designate a staff person to 

oversee your FPE initiative.

Step 2 Form advisory groups to build 

support, plan, and provide feedback for 

your FPE initiative.

Step 3 Establish program standards

that support implementation. Make 

adherence to those standards part of 

licensing criteria.

Step 4 Address financial issues and align 

incentives to support implementation.

Step 5 Develop a training structure tailored 

to the needs of different stakeholders.

Step 6 Monitor fidelity and outcomes

to maintain and sustain program 

effectiveness.
Building Your Program 11 Tips for Mental Health Authorities

 Create a vision

Agencies commonly set out to implement 

one program, but end up with something 

entirely different. Sometimes these variations 

are intentional, but often they occur for the 

following reasons:

n One administration starts an initiative and 

another with a different vision and priorities 

subsequently assumes leadership.

n The model wasn’t clearly understood from 

its inception.

n The staff drifted back to doing things in a way 

that was more familiar and comfortable.

Articulating the vision that providing FPE helps 

families and consumers recover from mental 

illnesses is essential for successfully implementing 

an FPE program. Place the FPE initiative in 

the context of the larger recovery paradigm. 

Talk about how FPE programs help agencies 

fulfill their mission—assisting consumers in their 

recovery process.

To ensure that your vision is clearly communicated, 

designate a staff person who has experience with 

the evidence-based model to oversee your FPE 

initiative. Some mental health authorities designate 

an office or staff with whom agencies may consult 

throughout the process of building and sustaining 

their FPE programs. Designated staff may also 

have oversight responsibility for FPE programs 

across the state.

 Form advisory groups

You can ensure that the FPE model is implemented 

appropriately if you contractually mandate 

that stakeholder advisory groups guide the 

implementation initiative. Your FPE initiative 

can benefit in many ways from an advisory group. 

Among other things, an advisory group can help 

you do the following:

n Build internal and external support;

n Increase program visibility; and

n Seek advice about ongoing planning efforts.

Consider forming both local and state-level advisory 

groups. State-level advisory groups may include the 

following members:

n Representatives of state agencies that would be 

invested in the initiative;

n Leadership from implementing agencies; and

n Representatives from consumer and family 

advocacy organizations.

Local advisory groups can serve as liaisons between 

the community and agencies that are implementing 

FPE programs. Community stakeholders who have 

an interest in the success of FPE programs include 

the following:

n Local consumer organizations;

n Local family organizations;

n Agency administrators; and

n FPE practitioners.
Tips for Mental Health Authorities 12 Building Your Program

Facilitating your advisory group

From the beginning, lead your advisory groups 

in understanding and articulating what FPE 

is and how it is going to be developed in your 

mental health system. For training materials that 

you can use to help stakeholders develop a basic 

understanding of FPE, see Using Multimedia to 

Introduce Your EBP in this KIT.

Advisory groups should continue to meet well 

after you have established your FPE program. 

We suggest that they meet about once a month for 

the first year, once every 2 months for the second 

year, and quarterly for the third year. In the second 

and third years, advisory groups may help FPE 

programs sustain high fidelity by assisting with 

fidelity evaluations and outcomes monitoring or 

translating evaluation data into steps for continuous 

quality improvement. For more information about 

the role of advisory groups, see Getting Started 

with EBPs in this KIT.

Planning your Family 

Psychoeducation initiative

With a vision firmly in place, the process of 

unfolding FPE programs across the service system 

can begin. Carefully planning this process will 

help ensure a successful outcome. Implementing 

FPE programs first in pilot or demonstration 

sites may be useful. Working with pilot sites can 

help you manage problems as they arise and 

also give constituents the opportunity to see that 

the evidence-based model works. Multiple pilot 

sites are preferable to just one. When only one 

site is used, idiosyncratic things can happen that 

misrepresent the model. In contrast, when mental 

health authorities do a system-wide rollout, it is 

difficult to adequately train all FPE program staff. 

In that case, system problems that may have been 

resolved easily on a smaller scale with a few FPE 

programs can cause havoc.

 Establish program standards

Studies of agencies that have tried to replicate 

evidence-based practices have found that agencies 

that did not achieve positive outcomes failed to 

implement all of the components of the evidencebased model (Becker et al., 2001; Bond & Salyers, 

2004). As a mental health authority, you can ensure 

that the system has incentives to implement the 

evidence-based model as outlined in the FPE 

Fidelity Scale (see Monitor fidelity and outcomes

below). Attention to aligning these incentives in a 

positive way (such as attaching financial incentives 

to achieving improved outcomes) is vital to 

successfully implementing FPE programs.

States have the authority to adopt regulations that 

govern services to consumers. These regulations set 

standards for the quality and adequacy of programs, 

including criteria that govern these areas:

n Admission and discharge;

n Staffing;

n Service components;

n Program organization and communication;

n Consumer medical records;

n Consumer rights; and

n Supervision and program evaluation.

Support FPE implementation by explicitly referring 

to the evidence-based model in licensing standards 

and other program review documents (for example, 

grant applications, contracts, and requests for 

proposals). Review current administrative rules and 

regulations to identify any barriers to implementing 

programs. Work closely with agency administrators 

to ensure that state-level policies support highfidelity practice.
Building Your Program 13 Tips for Mental Health Authorities

 Definition of FPE Services

The following language has been used to reimburse FPE services in Maine. 

Covered services include Family 

Psychoeducation provided in multifamily 

groups and in single-family sessions. 

Covered services include Family 

Psychoeducation as defined under 

program elements, provided to related 

and non-related care-takers, as well as to 

the eligible person. Covered services may 

be provided to the participating people 

with or without the eligible person being 

present, if all other program requirements 

and elements are being provided.

Program elements of the covered services 

include joining sessions, usually involving 

eligible Medicaid recipients and their 

family member, who may meet separately 

or together, depending on clinical 

condition and other considerations to be 

determined by the eligible provider. These 

sessions focus on exploring the following:

n Precipitants of current and/or past 

acute episodes of illness;

n Prodromal signs and symptoms;

n Coping strategies and strengths;

n Family and social supports;

n Grief and mourning in relation to the 

illness; and

n Treatment goals and planning.

There may be three or more joining 

sessions, as early in the course of an 

episode or illness as possible.

Educational workshops involve 

identified family members and, at 

the determination of the practitioners 

leading the workshop, eligible 

Medicaid recipients. These workshops 

offer extensive information about 

the biological, psychological, and 

social aspects of mental illnesses; the 

nature, effects, and side effects of 

psychiatric treatments; what families 

can do to help recovery and prevent 

relapse; and guidelines for managing 

mental illnesses.

Ongoing Family Psychoeducation 

sessions occur biweekly in a multifamily 

or single-family format, usually with 

the eligible Medicaid recipient present. 

These sessions follow an empirically 

tested format and focus on solving 

problems that interfere with treatment, 

illness and symptom management, and 

coping skills. Case management may 

also be provided during these sessions. 
Tips for Mental Health Authorities 14 Building Your Program

 Address financial issues

Each state is different. Typically, FPE programs 

are funded by a combination of state mental 

health dollars, Medicaid, and private insurance. 

Funding approaches that have been used in some 

states include the following:

n Reallocating some psychosocial or psychotherapy 

services for FPE services;

n Adopting a case-rate approach where the agency 

is reimbursed monthly for each consumer to 

cover bundled direct and indirect costs; or

n Seeking Medicaid reimbursement.

In some states, Medicaid authorities support 

funding for FPE because emergency room visits 

and hospital admission costs are greatly reduced. 

The following chart is an example of how FPE 

has been defined for the purpose of Medicaid 

reimbursement.

 Develop a training structure

Agencies who implement evidence-based practices 

are often challenged in their efforts because people 

misunderstand the model or because they lack 

information. It is important that key stakeholders 

(consumers, families, and other essential 

community members) and agency-wide staff 

develop a basic understanding of FPE.

We encourage you to support agency administrators 

in their efforts to develop a training structure 

for implementing FPE. The training plan 

should include basic training for key community 

stakeholders including the following:

n Consumers;

n Families;

n Mental health authority representatives; and

n Staff from key community organizations.

The training plan should also include basic training 

for staff at all levels within participating agencies 

and intensive training for FPE practitioners (staff 

who are designated to provide FPE services).

Some mental health authorities develop a few FPE 

programs at a time so that staff from the first FPE 

program can help train those in newly developed 

programs. Generally, it takes about a year for staff 

to feel confident providing the evidence-based 

model, but this can vary depending on how much 

structural change is needed. FPE practitioners who 

are reluctant to accept new models can take longer 

to change.

It may take 2 to 3 years for an agency to become 

sufficiently proficient in the evidence-based model 

before it can assume the added responsibility 

of training other agencies’ FPE practitioners. 

Agencies that have become training sites indicate 

that involving their staff in training staff from new 

FPE programs reinforces the practice principles 

and their knowledge of the evidence-based model.
Building Your Program 15 Tips for Mental Health Authorities

Choose your trainer

Intensive training plans for FPE practitioners 

may be designed in several different ways. The 

first decision is related to who will conduct the 

training. The family intervention coordinator (a 

staff member who is designated to oversee FPE 

programs) may facilitate the initial training for FPE 

practitioners by using the training tools in Training 

Frontline Staff in this KIT.

Some mental health authorities choose to hire 

external trainers to train practitioners across 

the state. Other mental health authorities have 

established training centers or enhanced existing 

education and training centers that offer education, 

training, and ongoing consultation or supervision.

One successful strategy for training FPE 

practitioners entails having new FPE practitioners 

visit an existing, well-functioning, high-fidelity FPE 

program to observe how the program works. New 

FPE practitioners will benefit most from this visit if 

they have a basic understanding of the FPE model.

Once trained, family intervention coordinators and 

practitioners will be able to use the tools in Using 

Multimedia to Introduce Your EBP in this KIT to 

provide basic training to key stakeholders.

Offer ongoing training and consultation

Throughout the first year of your FPE program, 

participating agencies should offer intermittent 

booster training sessions to FPE practitioners. 

After the first year, consider establishing an annual 

statewide conference on the evidence-based model. 

Routine onsite and telephone consultation is also 

important, particularly for family intervention 

coordinators, since leading an FPE program 

requires a complex set of administrative and 

clinical skills. For example, family intervention 

coordinators provide clinical supervision, which 

may require a shift in thinking from how services 

were traditionally provided. Family intervention 

coordinators have administrative responsibilities 

such as preparing administrative reports, 

developing policies and procedures, and hiring.

Perhaps more important, family intervention 

coordinators are responsible for ensuring that the 

FPE program operates with fidelity to the evidencebased model, including ensuring the quality and 

content of practitioner-consumer-family interactions 

(See Monitor fidelity and outcomes on the next 

page). It is very difficult for any family intervention 

coordinator to grasp everything that has to be 

learned in a brief time. Also, understanding what 

must be done and translating that understanding 

into action are different and equally difficult. Strong 

daily leadership is essential to ensure that the FPE 

model is faithfully carried out.
Tips for Mental Health Authorities 16 Building Your Program

For at least the first year after a new program has 

started, family intervention coordinators need 

someone who is experienced in the evidencebased model to give ongoing consultation on 

organizational and clinical issues. Consultation 

ranges from advice on how to integrate evidencebased practice principles into the agency’s policies 

and procedures to consulting on cases. A state- or 

county-wide coordinator who is experienced with 

the evidence-based model can also help new FPE 

programs through ongoing contact, assessment, and 

troubleshooting.

 Monitor fidelity and outcomes

Providing FPE involves incorporating a new 

program into the service delivery system. The 

best way to protect your investment is to make 

certain that agencies actually provide services 

that positively affect the lives of consumers on an 

ongoing basis.

Programs that adhere more closely to the evidencebased model are more effective than those that do 

not follow the model. Adhering to the model is 

called fidelity.

The FPE Fidelity Scale measures how well 

programs follow key elements of the evidencebased model. Research tells us that the higher an 

agency scores on a fidelity scale, the greater the 

likelihood that the agency will achieve the favorable 

outcomes (Becker et al., 2001; Bond & Salyers, 

2004). For this reason, it is important to monitor 

both fidelity and outcomes.

As a central part of the initial planning process, you 

must address how you will monitor the fidelity and 

outcomes of FPE programs. Too many excellent 

initiatives began with enthusiastic support but 

floundered at the end of a year because they did 

not plan how they would maintain the program. 

Monitoring fidelity and outcomes on an ongoing 

basis is a good way to ensure that your FPE 

programs will continue to grow and develop. For 

more information about monitoring fidelity and 

outcomes, see Evaluating Your Program in this KIT.

Consider developing routine supervision and 

evaluations of FPE programs. If state or countylevel monitoring is not possible, use strategies (for 

example, rules, contracts, financial incentives) to 

support fidelity and outcomes monitoring on the 

local level or within individual agencies.

For the characteristics of an FPE program that 

would have a perfect score on the FPE Fidelity 

Scale, see the next page. For the entire FPE Fidelity 

Scale, see Evaluating Your Program in this KIT.
Building Your Program 17 Tips for Mental Health Authorities

Characteristics of a Family Psychoeducation Program That Would Have a Perfect Score 

on the FPE Fidelity Scale

Family intervention 

coordinator

A designated clinical administrator oversees the FPE program and performs 

specific tasks.

Session frequency Consumers and families participate every 2 weeks in FPE sessions.

Long-term FPE Consumers and families are provided with long-term FPE. At least one family member 

for each consumer participates in FPE sessions for at least 9 months.

Quality of practitionerconsumer-family alliance

FPE practitioners engage consumers and family members with warmth, empathy, 

acceptance, and attention to individual needs and desires.

Detailed family reaction FPE practitioners identify and specify families’ reaction to their relative’s mental illness.

Precipitating factors FPE practitioners, consumers, and families identify and specify precipitating factors for 

consumers’ mental illnesses.

Prodromal signs 

and symptoms

FPE practitioners, consumers, and families identify and specify prodromal signs and 

symptoms of consumers’ mental illnesses.

Coping strategies FPE practitioners identify, describe, clarify, and teach coping strategies.

Educational curriculum FPE practitioners use a standardized curriculum to teach families about 

mental illnesses. 

Multimedia education Consumers and family members receive educational materials about mental illnesses in 

several formats (for example, paper, video, and Web sites).

Structured group sessions FPE practitioners follow a structured procedure in conducting multifamily 

group sessions.

Structured problem solving FPE practitioners use a standardized approach to help consumers and families with 

problem solving.

Stage-wise provision 

of services

FPE services are provided in the following order:

n Engagement;

n Three or more joining sessions;

n The educational workshop; and

n Multifamily group sessions.

Assertive engagement 

and outreach

FPE practitioners assertively engage all potential consumers and family members by 

phone, by mail, or in person (in the agency or in the community) on an ongoing basis.

Building Your Program 19 Tips for Mental Health Authorities

Building Your Program

Tips for Agency Administrators 

and Family Intervention Coordinators

Whether your agency is interested in enhancing an existing program or 

developing a new program, you will need a broad range of activities to 

successfully implement Family Psychoeducation. This section outlines the 

range of implementation activities in which agency administrators and 

family intervention coordinators are often involved.

Recruit your staff

Family Psychoeducation (FPE) 

programs typically consist of two or more 

practitioners and a family intervention 

coordinator. Broadly speaking, you can 

consider agency staff who are involved 

in providing FPE as a team, including 

the family intervention coordinator, FPE 

practitioners, and the agency director.

Choose a family 

intervention coordinator

It is important to hire or designate 

a leader for your FPE program. We 

suggest that FPE leaders (called family 

intervention coordinators) are full-time 

employees whose time is completely 

dedicated to the FPE program.
Family intervention coordinators are often midlevel managers who have the authority to make or 

suggest administrative changes within the agency. 

Successful family intervention coordinators have 

authority and both administrative and clinical skills.

As part of their administrative responsibilities, they 

undertake the following tasks:

n Develop and monitor FPE policies and 

procedures such as the intake and engagement 

process;

n Assign potential FPE consumers to FPE 

practitioners;

n Monitor and adjust FPE practitioner caseloads; 

and

n Arrange for training new FPE practitioners and 

continuing education of existing FPE staff.

Along with the agency director, family intervention 

coordinators are often responsible for hiring FPE 

practitioners, monitoring the program’s fidelity 

to the FPE model, and overseeing other quality 

control and financial mechanisms.

As part of their clinical responsibilities, family 

intervention coordinators provide weekly group 

supervision and individual supervision as needed. 

During supervisory sessions, family intervention 

coordinators give FPE practitioners program 

feedback. They also act as a liaison with other 

agency coordinators and key stakeholders to 

maintain support for the FPE program.

Because family intervention coordinators must 

have an active role in setting up the structures and 

processes needed to support the FPE program, you 

should make the KIT available to candidates during 

the hiring process so they understand what they 

must do.

Select the best Family 

Psychoeducation practitioners

FPE practitioners can come from a wide range of 

clinical backgrounds, including the following:

n Social work;

n Occupational therapy;

n Counseling;

n Case management;

n Nursing;

n Psychology; and

n Psychiatry.

In some carefully supervised situations, 

paraprofessionals working closely with a masterslevel clinician have effectively conducted FPE 

sessions. However, some agencies have experienced 

difficulty being reimbursed for services provided 

by non-licensed staff. For this reason, review the 

regulations of FPE funding mechanisms when you 

make staffing decisions.

Success as an FPE practitioner appears to have 

less to do with academic credentials and more 

to do with personal style and philosophy. Positive, 

high-energy, and enthusiastic people who have a 

“can do” attitude tend to do well. We recommend 

recruiting FPE practitioners who understand 

serious mental illnesses, believe that consumers 

can live full and productive lives in the community, 

and believe that families can support the 

recovery process.

Effective FPE practitioners are warm, kind, and 

empathic. Good listening skills are important, 

including the ability to reflect back what consumers 

and families say and seek clarification when 

necessary. Good eye contact, a ready smile, and 

a good sense of humor are other helpful attributes 

that put people at ease.
Building Your Program 21 Tips for Administrators and Coordinators

Specific teaching and facilitation skills are also 

helpful. FPE practitioners must be able to structure 

sessions that follow a predictable pattern. They 

must also be able to establish clear objectives and 

expectations, set goals, and follow through on 

those goals.

Another important attribute for practitioners is 

the ability to take a shaping approach to increasing 

consumers’ knowledge and skills. Shaping means 

that practitioners recognize that people often 

need a significant period of time to learn new 

information and skills. You must give consumers 

positive feedback for their efforts and acknowledge 

small successes along the way. Having a shaping 

attitude means that you acknowledge and value 

even very small steps and encourage consumers to 

achieve their personal goals.

In addition, FPE practitioners must be able to 

work both independently and as team members—

providing cross-coverage for consumers and 

participating in group supervision.

Reflect your community’s cultural diversity

FPE teams should reflect the cultural diversity 

of the communities in which they operate. More 

important, FPE practitioners must be aware of 

and sensitive to cultural differences and consumer 

preferences. FPE teams should include bilingual 

practitioners as needed to reflect the cultural 

diversity of the communities in which they provide 

services. If bilingual staff are not available, you 

should provide translators as needed.

Having a balance of male and female FPE 

practitioners may also be helpful. In addition, your 

FPE program must have resources available to 

allow practitioners to work with consumers who 

have hearing and visual impairments.

Consider these hiring tips

Thoroughly check references for job candidates. 

The best predictor of work performance is likely 

to be candidates’ performance in previous jobs, 

particularly jobs that required some of the same 

skills and personal qualities that are desirable 

for FPE practitioners. The family intervention 

coordinator should talk to previous supervisors, 

ask in detail about candidates’ previous work 

responsibilities and performance, and seek opinions 

about their capabilities.

Invite all candidates who are being seriously 

considered for employment to spend a half-day or 

more in your FPE program so that they can see 

practitioners at work firsthand. Candidates can then 

better evaluate how well they might fit in and will 

be able to make a more informed decision about 

taking the job.

This visit will also give FPE practitioners a chance 

to talk with and observe candidates. Ask them to 

offer their feedback during the hiring process. This 

type of screening may help you weed out people 

who may not be appropriate for your FPE program.

Requirements for FPE Practitioners

n Have specific knowledge of mental 

illnesses

n Be willing and able to actively involve 

consumers and families in making 

decisions about their own treatment and 

services

n Have strong clinical and rehabilitative 

skills

n Be warm, kind, positive, empathic people 

with good listening and teaching skills

n Be willing to work both independently 

and collaboratively as a team
Tips for Administrators and Coordinators 22 Building Your Program

Build support for your program

Developing a successful FPE program depends 

on the support and collaboration of a number of 

stakeholders. Internally, it is important that the 

director and staff across the agency understand and 

support implementing FPE. Your program is more 

likely to achieve high fidelity if the agency director 

is informed and involved in the implementation 

process from the start.

It is important that the agency director take the 

lead in promoting the FPE program and addressing 

any misconceptions. Articulate internal and 

public support for the FPE program by telling 

key stakeholders that consumers can recover 

from mental illnesses and families can support 

the recovery process. Inform key stakeholders 

that the core components of FPE are linked to 

positive consumer outcomes and emphasize the 

importance of your FPE program by demonstrating 

how practitioners help consumers get on with 

life beyond illness to achieve their personal 

recovery goals.

Once the agency director has articulated a clear 

vision for implementing the evidence-based model, 

continue to bolster internal support for your 

program by giving all agency staff basic information. 

For more information, see Develop a training plan

later in this booklet. 

 Form advisory committees

Forming a local advisory committee for your 

FPE program is an effective way to gain key 

stakeholders’ support. Identify community 

stakeholders who have an interest in the success 

of your FPE program to serve on your committee. 

Committees often include the following people:

n Representatives from local consumer 

organizations;

n Members of local family organizations such as 

the National Alliance on Mental Illness (NAMI);

n Representatives from local mental health 

authority;

n Representatives from local mental health 

agencies;

n Key agency staff; and

n FPE practitioners.

To start, your mental health authority 

representatives or agency director should voice 

support for the FPE initiative. Next, provide basic 

training to help advisory group members understand 

the evidence-based model. Once established, 

advisory groups may help implement your program 

in a variety of ways. For more information, see 

Getting Started with EBPs in this KIT.

 Sustain support for your program

Building support for your FPE program should 

be an ongoing effort. Once your program is 

operational, find ways to recognize and reward 

the achievements of FPE practitioners and 

consumers. For example, organize meetings with 

key stakeholders during which consumers share 

their success stories and administrators highlight 

staff achievements.

Another option is to sponsor a banquet to celebrate 

your program’s accomplishments with consumers, 

family members, policymakers, and agency staff 

members. Banquets are particularly helpful if a 

wide array of stakeholders (such as physicians, 

administrators, and key public officials) attend.

Your agency director and family intervention 

coordinator should meet regularly to review 

program evaluation data, discuss roadblocks, and 

plan ways to improve your FPE program. Building 

support from internal staff and key community 

stakeholders is essential to implementing an 

effective FPE program.
Building Your Program 23 Tips for Administrators and Coordinators

Develop effective policies 

and procedures

Starting a new FPE program means developing 

policies and procedures that support the activities 

of the FPE model.

Develop admission and discharge criteria

Set up a process to identify consumers who are 

appropriate for your FPE program and acquaint 

referral sources with your procedures. Initially 

many agencies choose to offer FPE to consumers 

with schizophrenic disorders since the evidence 

for this model is strongest with this group. Once 

practitioners have provided FPE services to 

consumers with schizophrenic disorders and their 

families, it relatively easy to modify your FPE 

program to provide services to consumers who 

have other diagnoses and their families. For more 

information on adapting FPE for specific diagnoses, 

see The Evidence in this KIT.

FPE is effective for a wide variety of consumers. 

No evidence suggests that consumers’ race, gender, 

or age is related to consumer and families’ ability 

to benefit from FPE. In addition, consumers may 

benefit from FPE regardless of how long they have 

experienced symptoms of their mental illnesses.

Some evidence shows that FPE is particularly 

beneficial for consumers and families with the 

following characteristics (McFarlane, 2002):

n Consumers who have recently experienced their 

first episode of mental illness or are early in the 

course of illness;

n Consumers who are experiencing acute 

psychiatric crisis;

n Consumers who experience frequent 

hospitalizations or prolonged unemployment;

n Consumers or families who have asked to learn 

more about serious mental illnesses;

n Families who have previously benefited from a 

family education program and want to learn how 

to better support their relative; or

n Families who are especially exasperated or 

confused about the illness.

Agency Directors Can Lead 

This Effort

n Articulate clear support for the FPE 

program to internal staff and key 

community stakeholders.

n Attend some FPE trainings, supervision, 

and advisory group meetings.

n Meet monthly with the family 

intervention coordinator to address 

roadblocks to providing FPE.

n Facilitate ongoing planning and program 

improvement efforts.

n Engage local and state mental health 

authority representatives.

What Policies and Procedures 

Should Cover

n Admission and discharge criteria

n Staffing criteria

n Service components

n Program organization and 

communication

n Consumer records requirements

n Consumers’ rights

n Program and team member performance 

evaluation
Tips for Administrators and Coordinators 24 Building Your Program

FPE is particularly effective in working with 

families and consumers who are early in the course 

of illness since most consumers and families report 

the most extreme distress during this time. Often 

in this early period, major rifts develop between 

consumers and families that may exacerbate 

symptoms and disability. FPE has prevented 

and often healed those rifts, as participants stop 

blaming themselves or one another and cooperate 

to help in the overall treatment and rehabilitation 

process. Consider targeting your FPE program to 

consumers based on these criteria.

Defining family

Participating in FPE is the consumers’ choice. In 

FPE, the term family includes anyone consumers 

believe is supportive and would like to participate 

in FPE. For FPE to work, consumers must identify 

supportive people they would like to involve in 

the FPE program. Some consumers may choose 

a relative. Others may identify a friend, employer, 

colleague, counselor, or other supportive person.

Set up referral procedures

Agency administrators and family intervention 

coordinators must also develop referral procedures. 

Modify intake forms to prompt agency staff to 

tell consumers who are new to the agency about 

the FPE program and elicit their interest in 

participating. Also include a section on your 

assessment or treatment planning forms that 

prompts similar questions so that practitioners 

routinely provide information about the 

FPE program. 

Some agencies also encourage referrals through 

the following sources:

n Treatment team meetings;

n Internal or external service providers;

n Community presentations; or

n Consumer self-referrals.

Put your procedures into operation by identifying 

and educating referral sources about the FPE 

program. Procedures for advertising your FPE 

program will depend on your referral approach. For 

example, if your FPE program primarily depends 

on referrals from treatment team members and 

other internal service providers, routinely conduct 

agency-wide presentations to develop a basic 

understanding of your FPE program.

Consumers do not have to accept that they 

have a mental illness to be referred to the FPE 

program. FPE practitioners can effectively work 

with consumers even if they do not believe that 

they have a given diagnosis. Develop a process for 

explaining your FPE program to consumers in a 

way that helps them make an informed decision 

about accepting services.

Review confidentiality policies

Confidentiality policies vary from state to state. 

In many states, policies do not specifically discuss 

releasing confidential information to family 

members of consumers with mental illnesses. As a 

result, practitioners may be reluctant to speak with 

family members or they may be confused about the 

types of information that they may share (Marshall 

& Solomon, 2003).

Review your agency’s confidentiality policies. 

Find out if consumers must complete a Release 

of Information Form to give permission to share 

confidential information with their family members. 

If so, review your agency’s current forms to see if 

they are appropriate for this purpose. For example, 

Release of Information Forms created solely for 

sharing information between agencies may be 

limited to 30, 60, or 90 days. Using these forms for 

your FPE program may cause undue burden on FPE 

practitioners who would be required to complete 

multiple forms for each consumer over the course 

of the program. In such cases, consider revising 

your forms to meet the needs of the FPE program. 

For resources to help you modify your Release of 

Information Forms, see The Evidence in this KIT.
Building Your Program 25 Tips for Administrators and Coordinators

Establish staffing criteria

Your policies and procedures should also specify 

the staffing criteria for your program. Include clear 

and useful job descriptions in your staffing criteria. 

For job applicants, a good position description 

clarifies whether a particular position matches their 

skills and expectations.

Include the following in your job descriptions:

n Task-specific position descriptions;

n Main task categories; and

n Specific duties.

Clear job descriptions allow family intervention 

coordinators to effectively supervise new employees 

and also allow employees to focus on the basic 

elements of their jobs.

When offering FPE in the multifamily group 

format, designate two FPE practitioners to facilitate 

each group. The recommended size of a FPE 

multifamily group is five to eight consumers.

More information is provided above under 

Recruiting your staff.

Discuss program organization 

and communication

Policies and procedures for your FPE program 

should include criteria for how the FPE program 

is organized and how practitioners communicate. 

To be effective, FPE practitioners must be able to 

work both independently and as team members, 

especially if they are providing FPE in the 

multifamily group format.

As team members, FPE practitioners should 

communicate regularly and provide cross-coverage 

for consumers. They should also attend weekly 

group supervisory meetings that the family 

intervention coordinator facilitates. These meetings 

give FPE practitioners the opportunity to discuss 

and problem-solve consumers’ cases.

FPE practitioners should be part of a 

multidisciplinary treatment team. When working 

with treatment team members, FPE practitioners 

should model evidence-based practice treatment 

skills. Your policies should outline clear procedures 

for how FPE practitioners will communicate 

with multidisciplinary treatment team members. 

They should also coordinate services with other 

team members to ensure that treatment supports 

recovery goals.

Offer Family Psychoeducation in both 

individual or group formats

Your policies should specify that ongoing FPE 

sessions may be provided either in the singlefamily or multifamily group format. The format 

that you choose depends on consumer and family 

preferences and needs.

In general, single-family formats tend to be used 

for the following:

n Consumers and families with strong social 

support networks;

n Consumers and families who exhibit unusual 

resilience or strong coping skills; or

n Consumers who respond positively to 

medications.

Multifamily groups tend to be used for the 

following:

n Consumers who are experiencing their first 

episode with mental illness;

n Consumers who are not responding well to 

medication and treatment;

n Consumers who are experiencing complicating 

issues such as other medical illnesses;

n Families experiencing high stress;

n Families who have separated from their relative 

with mental illness; and

n Families who have been through divorce.
Tips for Administrators and Coordinators 26 Building Your Program

Participating in the multifamily group format 

has other benefits for both consumers and their 

families. For example, the social stigma related 

to mental illnesses causes many consumers 

and families to feel socially isolated. FPE in a 

multifamily group format connects consumers and 

families to others who have had similar experiences. 

It gives them a forum for peer support and mutual 

aid by allowing participants to share solutions that 

have worked for them. For this reason, whenever 

possible, we recommend offering ongoing FPE 

services in a multifamily group format.

FPE practitioners commonly work in both 

multifamily or single-family group formats. For 

example, when multifamily group members are 

unable to attend specific group sessions, FPE 

practitioners may offer single-family sessions to 

accommodate scheduling difficulties.

For information for practitioners about providing 

FPE in both individual and group formats, see 

Training Frontline Staff in this KIT.

Determine the length of your sessions 

and program

In your FPE policies and procedures, outline the 

length of FPE sessions and the program. FPE 

services are provided in three phases:

n Joining sessions;

n An educational workshop; and

n Ongoing FPE sessions.

During the joining sessions in the first phase, FPE 

practitioners meet with each FPE consumer and 

their respective family members at least three times 

for about 1 hour. You may hold joining sessions with 

consumers and their respective family members 

together or meet separately with them. (That 

means you would conduct six or more sessions 

instead of three or more.)

FPE practitioners base their decisions about 

offering joining sessions to consumers and family 

members jointly or separately on consumer 

and family preferences, diagnosis, and illness 

characteristics. For information to help FPE 

practitioners make these decisions, see Training 

Frontline Staff in this KIT. 

During the second phase of the FPE program, a 

1-day educational workshop is offered. Typically, 

the workshop is conducted solely with families—

not with consumers—to give families a chance to 

speak freely about their experiences and to interact 

with others who are in similar situations.

Some agencies involve consumers in part of the 

workshop to ensure that they receive the same 

educational information as their families. Others 

offer this information to consumers individually 

or in a separate consumer forum. Typically, this 

workshop is offered only once to participants in 

the FPE program. You should offer it within 1 or 2 

weeks after joining sessions are completed.

You may offer the last phase of the FPE program—

ongoing FPE sessions—in either the single-family 

or multifamily group format. FPE multifamily 

groups consist of five to eight consumers and their 

respective family members. They meet every 2 

weeks for 11⁄2 hours. Two FPE practitioners cofacilitate the group.

In the single-family format, one FPE practitioner 

meets individually with consumers and their 

respective family members. Meetings are usually 

every 2 weeks for 1 hour. Offer both single-family 

and multifamily sessions for 9 months or more.
Building Your Program 27 Tips for Administrators and Coordinators

Ensure stage-wise provision of services

In your policies and procedures specify that 

all three phases of the FPE program should be 

provided in order. Also, FPE practitioners should 

complete the first phases of the FPE program in 

full before offering the next. 

Coordinating the timing of the phases requires 

some planning and organizing. If FPE occurs 

in the multifamily group format, the two FPE 

practitioners who will facilitate the group divide 

the responsibility for conducting joining sessions. 

For example, out of eight consumers and their 

respective family members, each practitioner 

would join with four. Offer the 1-day educational 

workshop within 1 to 2 weeks after joining sessions 

have been completed. 

To achieve the stage-wise provision of services, 

set aside time for planning meetings during the 

first phase of the program. Begin the planning 

process by developing a list of potential consumer 

participants. When both FPE practitioners begin 

joining sessions simultaneously, it will be easier 

to coordinate the timing of the second and third 

phases. Include in your policies and procedures 

that FPE practitioners should meet weekly during 

this time period to ensure that you provide services 

in stages.

Adjust practitioners’ caseloads

In the first 3 months of implementing your FPE 

program, practitioners are involved in a number of 

activities including training activities and planning 

meetings. Consequently, initially they will have an 

increased workload.

To effectively implement FPE, reduce 

practitioners’ caseload until the first two phases 

of the FPE program are completed. Once 

practitioners have completed their first joining 

sessions and 1-day educational workshop and your 

family intervention coordinator has developed 

procedures to routinely identify and refer 

consumers to the FPE program, workload demands 

will be substantially decreased. You can restore 

caseload size.

Structure your Family 

Psychoeducation sessions

Policies and procedures for your FPE program 

should also outline the structure of FPE sessions. 

Following a prescribed structure helps FPE 

practitioners provide effective FPE services. 

Specifically, FPE practitioners complete a 

prescribed set of tasks for each joining session. 

The tasks are outlined in the sample Progress 

Notes on the next few pages.

In the second phase of the FPE program, FPE 

practitioners offer a 1-day educational workshop 

that follows a standardized educational curriculum. 

The structure of the workshop is also outlined in 

a sample Progress Note on the next few pages.

Ongoing FPE sessions follow a structured approach 

shown below:

Multifamily Group Session Agenda

Socialize 15 minutes

Identify current issues—go-around 20 minutes

Select a single problem 5 minutes

Use structured problem solving 45 minutes

Socialize 5 minutes

Total 90 minutes
Tips for Administrators and Coordinators 28 Building Your Program

The structured problem-solving approach is also 

outlined in a sample Progress Note on the next 

few pages.

In your FPE policies and procedures, encourage 

practitioners to follow the suggested structure 

during each phase of the FPE program.

Offer other core service components

Your FPE policies should also discuss how to 

assertively engage consumers and families. 

Engaging consumers and families in FPE starts the 

moment that they are referred to the program and 

continues throughout the program.

FPE practitioners assertively engage consumers 

and family members by phone, by mail, or in 

person (in the agency or in the community). To 

keep consumers and families engaged in services, 

encourage FPE practitioners to routinely reassess 

the issues that consumers and families are facing 

and offer services to meet their needs. 

FPE practitioners also keep consumers and family 

engaged in FPE services by routinely offering 

educational materials tailored to their own needs. 

Policies and procedures should encourage FPE 

practitioners to provide educational materials 

in several formats (for example, paper, video, 

and Web sites).

 Document Family Psychoeducation services

Outline the policies and procedures for 

documenting FPE services. Instruct FPE 

practitioners to complete Progress Notes to 

document the following:

n Meeting the goals of each joining session;

n Providing a standardized educational curriculum 

to each FPE family participant; and

n Following the structured problem-solving 

approach during ongoing FPE services.

For sample Progress Notes tailored to each phase 

of the FPE program, see the next pages. For 

printable copies, see the CD-ROM for this KIT. We 

strongly encourage you to adapt these forms and 

incorporate them into your routine paperwork.
Building Your Program 29 Tips for Administrators and Coordinators

 / / 

Progress Note Joining Session 1

Consumer’s name: Consumer’s 

I.D. number:

Family or other supporter’s name: Relationship 

to consumer:

Family or other supporter’s name: Relationship 

to consumer:

Date __________________________________

Start time:

Stop time:

Completed by:

Past or present crisis:

Precipitating events:

Early warning signs:
Tips for Administrators and Coordinators 30 Building Your Program

Progress Note Joining Session 1

Family or other 

supporter’s experience:

Strengths and helpful 

coping skills:

Past unsuccessful strategies 

or interventions:

Action steps:
Building Your Program 31 Tips for Administrators and Coordinators

Progress Note Joining Session 2

Consumer’s name: Consumer’s 

I.D. number:

Family or other supporter’s name: Relationship 

to consumer:

Family or other supporter’s name: Relationship 

to consumer:

Date __________________________________

Start time:

Stop time:

Completed by:

Feelings or reactions to illness:

Social support system:

Genogram:

 / / 
Tips for Administrators and Coordinators 32 Building Your Program

Progress Note Joining Session 2

Past experiences with the 

mental health system:

Educational information shared:

Action steps:
Building Your Program 33 Tips for Administrators and Coordinators

Progress Note Joining Session 3

Consumer’s name: Consumer’s 

I.D. number:

Family or other supporter’s name: Relationship 

to consumer:

Family or other supporter’s name: Relationship 

to consumer:

Date __________________________________

Start time:

Stop time:

Completed by:

Personal strengths (hobbies, 

interests, work, school, etc.):

Short-term goals

Long-term goals:

Concerns about participating in 

the educational workshop or 

multifamily group:

 / / 

Building Your Program 35 Tips for Administrators and Coordinators

Progress Note 1-day Educational Workshop

Consumer’s name: Consumer’s 

I.D. number:

Family or other supporter’s name: Relationship 

to consumer:

Family or other supporter’s name: Relationship 

to consumer:

Date __________________________________

Start time:

Stop time:

Completed by:

Was the consumer present for 

the workshop?

 Yes

	 No

	 In part

	 Attended a separate consumer forum

	 Received individual education

Was the family member present for 

the workshop?

 Yes

	 No

	 In part

	 Provided individual education

Which of the following topics 

were presented?

 Psychobiology of the specific mental illness including basics of brain 

function and dysfunction and the potential causes of the mental illness

	 Diagnosis including symptoms and prognosis

	 Treatment and rehabilitation including an overview of the treatment options 

and how they promote effective coping and illness management strategies

	 Impact of mental illness on the family including how mental illnesses affect 

families as a whole

	 Relapse prevention including prodromal signs and symptoms and the role of 

stress in the precipitating episodes

	 Family guidelines or recommended responses to help families maintain a 

home environment that promotes relapse prevention

In which of the following 

formats were educational 

materials presented?

 Handouts

	 Slides

	 Video

	 Web Sites

	 Other _____________________________________

 / / 

Building Your Program 37 Tips for Administrators and Coordinators

Multifamily Group Problem Solving Worksheet

Consumer’s name: Consumer’s 

I.D. number:

Family or other supporter’s name: Relationship 

to consumer:

Family or other supporter’s name: Relationship 

to consumer:

Date __________________________________

Start time:

Stop time:

Completed by:

Step 1: Define the problem

Step 2: Generate solutions

 / / 
Tips for Administrators and Coordinators 38 Building Your Program

Multifamily Group Problem Solving Worksheet

Step 3: Discuss advantages 

and disadvantages

Possible solution Advantages Disadvantages

Step 4: Choose the best solution

Step 5: Form an action plan

Step 6: Review the action plan
Building Your Program 39 Tips for Administrators and Coordinators

How Administrators and Family 

Intervention Coordinators Can Help 

Provide Recovery-Oriented Services

n Clearly explain consumer rights in FPE 

policies and procedures.

n Offer training on recovery principles and 

consumer rights to practitioners, consumers, 

and families.

n Hold community forums using the 

multimedia tools in this KIT. 

n Involve consumers in local advisory groups. 

Describe how to maintain 

consumer records

In the policies and procedures for your FPE 

program, describe how you will maintain 

consumers’ records. You must keep records for 

each consumer and safeguard them against loss, 

tampering, and unauthorized use. The records 

should be consistent with requirements of 

organizations to whom you bill (e.g., the Centers 

for Medicaid and Medicare Services) or that 

accredit your agency (e.g., the Joint Commission 

on Accreditation of Rehabilitation Facilities, etc.).

If you are setting up a new recordkeeping 

system, you will need materials to create records 

(for example, binders and forms) and to store 

them appropriately. You also need written 

policies and procedures for documenting and 

maintaining records.

Make sure that FPE practitioners are familiar with 

your policies and procedures for documenting and 

maintaining records. Supervise them in completing 

the required documentation and monitor that 

records are properly stored and protected.

Discuss how to ensure

consumers’ rights

In the policies and procedures for your FPE 

program, discuss how you will ensure that 

consumers’ rights are upheld. FPE practitioners 

should do the following:

n Be aware of the state and federal consumer 

rights requirements;

n Inform consumers of their rights in a meaningful 

way; and

n Help consumers exercise their rights. 

Also, your policies and procedures should reflect 

the model’s recovery orientation. Traditional 

services were developed with a biomedical 

approach to mental health treatment; they focus 

on reducing symptoms and preventing relapse. In 

contrast, the evidence-based model is based on the 

concept of recovery. In the recovery framework, 

the expectation is that consumers can have lives in 

which mental illnesses are not the driving factors. 

Recovery means more than maintaining people 

with mental illnesses in the community. Recoveryoriented services encourage consumers to define 

and fulfill their personal goals.

FPE practitioners must believe in and be true 

to the recovery principles in the evidence-based 

model. Be careful not to replicate those elements 

of traditional services that simply emphasize 

containing symptoms and complying with 

medication.

The value of consumer choice in service delivery 

and the importance of consumer perceptions 

must be infused in how you provide FPE. Most 

practitioners have never examined their own 

attitudes and behaviors about consumer recovery 

and uncritically accept many clinical traditions 

without paying attention to how disempowering 

these practices are for consumers.
Tips for Administrators and Coordinators 40 Building Your Program

In recovery-based services, establishing a 

trusting relationship is critical. Interactions with 

consumers should be based on mutuality and 

respect. Challenge FPE practitioners to listen to, 

understand, and respect consumers’ perspectives 

and take into account consumers’ reasons 

for noncompliance.

FPE practitioners should also focus on consumerdefined needs and preferences and accept 

consumer choice in service delivery. Providing 

services with a recovery orientation means that you 

support and empower consumers to achieve their 

individual goals.

Develop procedures to evaluate 

program and staff performance

When it is properly implemented, FPE is 

associated with a variety of positive consumer 

and family outcomes. Evaluating the performance 

of your FPE program will help you provide 

high-quality services and assure stakeholders of 

your program’s effective performance. Develop 

procedures to evaluate your program early using 

the guidelines in Evaluating Your Program in 

this KIT. Also, develop procedures for how you 

will supervise and evaluate your FPE team. To 

a large extent, clinical supervision is the process 

that will determine whether FPE staff understand 

and are consistently applying the evidence-based 

practices for family psychoeducation or whether 

further leadership, training, and accountablility 

are required to meet this goal.

Family intervention coordinators should provide 

weekly group supervision to FPE practitioners. 

Group supervision should review all consumers 

involved in the FPE program and problemsolve ways to help them better meet their 

individual goals. 

Family intervention coordinators also should 

provide individual, side-by-side supervision 

to achieve the following goals:

n Assess performance;

n Give feedback; and

n Model interventions.

Family intervention coordinators may schedule 

regular meetings with FPE practitioners to review 

specific cases. They should be regularly available 

to consult with FPE practitioners, as needed.

Some aspects of the FPE practitioner’s job are 

hard to understand without seeing them done 

by an experienced FPE practitioner. Once family 

intervention coordinators thoroughly understand 

the evidence-based model, they should model 

aspects of the job—such as engagement or 

educational techniques—and directly coach 

them in their work. For training tools and 

recommendations, see Training Frontline Staff 

in this KIT.

If the FPE program is working with a consultant, 

the family intervention coordinator should involve 

the consultant in group supervision, treatment team 

meetings, and FPE multifamily group sessions. 

If the attendance of an outsider disrupts the 

group process, consider periodically videotaping 

sessions for purposes of supervision. Many new 

FPE programs have found that feedback from 

an external consultant is a crucial component 

for improving staff performance and the quality 

of their program as a whole.
Building Your Program 41 Tips for Administrators and Coordinators

Develop a training plan

Developing an FPE team is a complex undertaking. 

Recruiting and retaining practitioners who know 

the FPE model or who know how to treat people 

with serious mental illnesses can be difficult. 

Agencies that have successfully implemented 

FPE indicate that offering one-time training 

for FPE practitioners is not enough. Instead, 

assess the knowledge level of key stakeholders 

(See Evaluating Your Program in this KIT) and 

develop a training plan.

Practitioners who implement evidence-based 

practices are often stymied in their efforts 

because people misunderstand the model or lack 

information. It is important that key stakeholders 

(consumers, families, and other essential 

community members) and agency-wide staff 

develop a basic understanding of FPE. This training 

will build support for your FPE program. Your 

staff will find that they are better able to generate 

referrals for their program, engage consumers, and 

provide effective treatment.

In addition to these internal basic training activities, 

consider organizing routine educational meetings 

for consumers, families, or other key stakeholders 

in the community where consumers who have 

received services through FPE programs share 

their experiences. These key stakeholders may 

hold misconceptions about the goals of the FPE 

program. It is important to correct false beliefs 

before they impede implementing the evidencebased model.

Next, consider how you will offer FPE staff 

intensive training to allow them to learn and 

master the evidence-based model. We suggest 

organizing a group training series that includes 

at least five half-day sessions. The FPE KIT 

includes Training Frontline Staff, which 

gives FPE practitioners in-depth information 

about the evidence-based model and skills 

for providing effective services to consumers. 

Family intervention coordinators may facilitate 

a structured group training using these materials.

Once FPE practitioners have a basic understanding 

of the model, they should visit an existing, wellfunctioning, high-fidelity FPE program to observe 

how FPE practitioners work with consumers, 

interact with one another, and collaborate in 

multidisciplinary treatment teams. Once trained, 

family intervention coordinators and practitioners 

will also be able to use the basic training materials 

in the KIT to conduct routine community 

workshops and inservice seminars. For materials 

to support basic training, see Using Multimedia 

to Introduce Your EBP in this KIT.

What Should Your Training Plan Include?

n Basic training for staff at all levels across the 

agency.

n Basic training for key stakeholders, including 

consumers, families, mental health 

authorities, and members of key community 

organizations such as the National Alliance 

on Mental Illness (NAMI).

n Intensive training for FPE practitioners.
Tips for Administrators and Coordinators 42 Building Your Program

 Hire an external consultant and trainer

Establishing the initial processes that must be 

in place to provide quality services requires great 

attention to detail. Consequently, during the first 1 

to 2 years after forming a new FPE program, many 

agencies have found it helpful to work with an 

experienced external consultant and trainer.

Consultants and family intervention coordinators 

often work together to ensure that the FPE 

program is structured appropriately. They integrate 

evidence-based practice principles into the agency’s 

policies and tailor procedures to meet local needs.

Once the FPE program has been launched, it 

is important that you not allow FPE practitioners 

to revert to older and more familiar ways of doing 

things. External consultants and trainers who 

are experienced in running FPE programs can 

provide ongoing technical assistance, side-byside supervision, and periodic booster training 

sessions. This type of assistance, along with ongoing 

evaluation of fidelity and outcomes, has been found 

to be critical in maintaining adherence to the 

evidence-based practices.

Select a location for your Family 

Psychoeducation program

You can conduct FPE sessions in almost any 

location that is convenient for practitioners, 

consumers, and families. For example, you could 

conduct joining sessions in the following locations:

n Your mental health agency;

n Consumers’ homes; or

n Consumers’ family members’ home.

When selecting a location for the 1-day educational 

workshop and multifamily groups, consider 

the following:

n The number of participants;

n Type of multimedia you plan to use;

n Comfort and convenience of the location; and

n The ability to serve refreshments.

Regardless of the location, FPE practitioners 

should strive to create an environment that is quiet, 

free of unnecessary distractions, and conducive to 

sharing and learning from one another.
Building Your Program 43 Tips for Administrators and Coordinators

Review your program budget 

and revenue sources

It is important that you understand the budget 

for your FPE program and revenue sources so 

that you can actively participate in the budgeting 

process, make informed management decisions, 

and understand where collateral revenue sources 

are most needed.

What are the costs?

The initial implementation costs are about $250 

per practitioner for recruitment, preparation, and 

associated costs for training. Other agency costs 

include agency administration time, planning 

meetings, supervision, consultation, and costs 

associated with reducing practitioner caseloads 

during the first two phases of the FPE program.

Ongoing FPE sessions in the multifamily group 

format require about 1 hour of staff effort per 

month for each consumer in addition to the time 

spent in group. Based on East Coast salary levels, 

when using a master’s-level practitioner, the costs 

of providing ongoing FPE session in a multifamily 

group format is about $350 per year, per consumer 

in staff time. Single-family format is roughly twice 

the cost per consumer.

The FPE budget should also include funds to cover 

the costs of refreshments for the 1-day educational 

workshop and multifamily groups, as well as 

multimedia educational materials.

What are the revenue sources?

Financing mechanisms for FPE programs vary 

from state to state. Typically, FPE programs are 

funded by a combination of state mental health 

dollars, Medicaid, and other insurers.

In some mental health systems, programs receive a 

fixed rate for each consumer who receives services. 

In other systems, programs are only reimbursed 

based on the specific services provided. In that 

case, you should be familiar with how services must 

be tracked to capture billing from various funding 

streams. You will also need to know the billing 

process and billing codes.

Financial barriers can slow implementation. 

Be aware that over time the mission and activities 

of programs can become defined by the funding 

that supports them. Know the principles of the 

evidence-based model and be vigilant that funding 

opportunities support the model rather than shape 

and corrupt it. For useful ideas and strategies, 

consult with agencies and system administrators 

who have been successful in this area.

In summary, building an effective, well-functioning 

FPE program is a developmental process. 

We encourage you to periodically revisit the 

information in this KIT throughout the first year 

after you start your new program. We believe that 

these materials will take on a new meaning as the 

process of implementing an FPE program evolves.


26172.0709.7765020404

HHS Publication No. SMA-09-4422

Printed 2009