The Evidence 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

Family 

Psychoeducation

The

Evidence

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services
Acknowledgments

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

(SAMHSA), U.S. Department of Health and Human Services (HHS) under contract numbers 

280-00-8049 with the New Hampshire-Dartmouth Psychiatric Research Center and 270-03-6005 

with Westat. Neal Brown, M.P.A., and Crystal Blyler, Ph.D., served as SAMHSA 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 

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Recommended Citation

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

Evidence. 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
Family 

Psychoeducation

The Evidence

The Evidence introduces all stakeholders to the research literature 

and other resources on Family Psychoeducation (FPE). This booklet 

includes the following:

 A review of the FPE research literature;

 A selected bibliography for further reading;

 References for the citations presented throughout the KIT; and

 Acknowledgements of KIT developers and contributors.
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
Family 

Psychoeducation

What’s in The Evidence

Review of Research Literature. . . . . . . . . . . . . . . . . . . . 1

Selected Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . 11

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

The Evidence 1 Review of Research Literature

The Evidence

Review of the Research Literature

A number of research articles summarize 

the effectiveness of Family 

Psychoeducation (FPE). This KIT includes 

a full text copy of one of them:

Dixon, L., McFarlane, W. R., Lefley, H., 

Lucksted, A., Cohen, M., Falloon, I., 

et al. (2001). Evidence-based practices 

for services to families of people with 

psychiatric disabilities. Psychiatric 

Services, 52, 903-910.

This article describes the critical 

components of the evidence-based model 

and its effectiveness. Barriers to 

implementation and strategies for 

overcoming them are also discussed, based 

on experiences in several states.

This article may be viewed or printed from 

the CD-ROM in your KIT. For a printed 

copy, see page 3.

The Evidence 3 Review of Research Literature

Reprinted with permission from the Psychiatric Services, Copyright (2001). American Psychiatric Association.

Evidence-Based Practices for

Services to Families of People 

With Psychiatric Disabilities

2001

Dedicated to 

EvidenceBased 

Psychiatry 

Lisa Dixon, M.D., M.P.H.

William R. McFarlane, M.D.

Harriet Lefley, Ph.D.

Alicia Lucksted, Ph.D.

Michael Cohen, M.A.

Ian Falloon, M.D.

Kim Mueser, Ph.D.

David Miklowitz, Ph.D.

Phyllis Solomon, Ph.D.

Diane Sondheimer, M.S., M.P.H.

Family psychoeducation is an evidence-based practice that has been 

shown to reduce relapse rates and facilitate recovery of persons who 

have mental illness. A core set of characteristics of effective family 

psychoeducation programs has been developed, including the provision of emotional support, education, resources during periods of crisis, and problem-solving skills. Unfortunately, the use of family psychoeducation in routine practice has been limited. Barriers at the level of the consumer and his or her family members, the clinician and 

the administrator, and the mental health authority reflect the existence of attitudinal, knowledge-based, practical, and systemic obstacles to implementation. Family psychoeducation dissemination efforts 

that have been successful to date have built consensus at all levels, including among consumers and their family members; have provided 

ample training, technical assistance, and supervision to clinical staff; 

and have maintained a long-term perspective. (Psychiatric Services 

52:903–910, 2001) 

Dr. Dixon and Dr. Lucksted are affiliated with the Center for Mental Health Services 

Research at the University of Maryland School of Medicine in Baltimore and with the Department of Veterans Affairs Capitol Health Care Network Mental Illness Research, Education, and Clinical Center, 701 West Pratt Street, Room 476, Baltimore, Maryland 

21201 (e-mail, ldixon@umaryland.edu). Dr. McFarlane is affiliated with the Maine 

Medical Center in Portland. Dr. Lefley is with the University of Miami School of Medicine. Mr. Cohen is with the New Hampshire chapter of the National Alliance for the 

Mentally Ill in Concord. Dr. Falloon is with the University of Auckland in Auckland, 

New Zealand. Dr. Mueser is with Dartmouth Medical School in Hanover, New Hampshire. Dr. Miklowitz is with the University of Colorado. Dr. Solomon is with the University of Pennsylvania School of Social Work in Philadelphia. Ms. Sondheimer is with 

the Child, Adolescent, and Family Branch of the Center for Mental Health Services in 

Rockville, Maryland. 

Family members and other 

persons involved in the lives 

and care of adults who have 

serious mental illnesses often provide emotional support, case management, financial assistance, advocacy, and housing to their mentally ill 

loved ones. Although serving in this 

capacity can be rewarding, it imposes considerable burdens (1–4). Family members often have limited access to the resources and information they need (5–7). Research conducted over the past decade has 

shown that patients’ outcomes improve when the needs of family 

members for information, clinical 

guidance, and support are met. This 

research supports the development 

of evidence-based practice guidelines for addressing the needs of 

family members. 

Several models have evolved to address the needs of families of persons with mental illness: individual 

consultation and family psychoeducation conducted by a mental health 

professional (8,9), various forms of 

more traditional family therapy (10), 

and a range of professionally led 

short-term family education programs (11,12), sometimes referred 

to as therapeutic education. Also 

available are family-led information 

PSYCHIATRIC SERVICES ♦ July 2001 Vol. 52 No. 7 903
Review of Research Literature 4 The Evidence

and support classes or groups, such 

as those provided by the National Alliance for the Mentally Ill (NAMI) 

(13,14). Family psychoeducation has 

a deep enough research and dissemination base to be considered an evidenced-based practice. However, 

the term “psychoeducation” can be 

misleading: family psychoeducation 

includes many therapeutic elements, 

often uses a consultative framework, 

and shares characteristics with other 

types of family interventions. 

In general, evidence-based practices are clinical practices for which 

scientific evidence of improvement 

in consumer outcomes has been consistent (15). The scientific evidence 

of the highest standard is the randomized clinical trial. Often, several 

clinical trials are pooled by use of a 

technique such as meta-analysis to 

identify evidence-based practices. 

Quasi-experimental studies, and to a 

lesser extent open clinical trials, can 

also be used. However, the research 

evidence for an evidence-based 

practice must be consistent and sufficiently specific for the quality and 

outcome of the intervention to be 

assessed. 

The purpose of this article, as part 

of a larger series on evidenced-based 

practices for persons with severe 

mental illnesses (15), is to describe 

family psychoeducation, the basis for 

its identification as an evidence-based 

practice, and barriers to its implementation. We also propose strategies 

for overcoming these barriers. 

What is family psychoeducation? 

A variety of family psychoeducation 

programs have been developed by 

mental health care professionals 

over the past two decades (8,9). 

These programs have been offered 

as part of an overall clinical treatment plan for individuals who have 

mental illness. They last nine months 

to five years, are usually diagnosis 

specific, and focus primarily on consumer outcomes, although the wellbeing of the family is an essential intermediate outcome. Family psychoeducation models differ in their 

format—for example, multiple-family, single-family, or mixed sessions— 

the duration of treatment, consumer 

participation, location—for example, 

clinic based, home, family practice, 

or other community settings—and 

the degree of emphasis on didactic, 

cognitive-behavioral, and systemic 

techniques. 

Although the existing models of 

family intervention appear to differ 

from one another, a strong consensus about the critical elements of 

family intervention emerged in 1999 

under the encouragement of the 

leaders of the World Schizophrenia 

Fellowship (16). 

Goals and principles 

for working with families 

The main goals in working with the 

family of a person who has a mental 

illness are to achieve the best possible 

outcome for the patient through collaborative treatment and management and to alleviate the suffering of 

the family members by supporting 

them in their efforts to aid the recovery of their loved one. 

Treatment models that have been 

supported by evidence of effectiveness have required clinicians to adhere to 15 principles in working with 

families of persons who have mental 

illness: 

♦ Coordinate all elements of treat

ment and rehabilitation to ensure that 

everyone is working toward the same 

goals in a collaborative, supportive relationship. 

♦ Pay attention to both the social 

and the clinical needs of the consumer. 

♦ Provide optimum medication 

management. 

♦ Listen to families’ concerns and 

involve them as equal partners in the 

planning and delivery of treatment. 

♦ Explore family members’ expectations of the treatment program and 

expectations for the consumer. 

♦ Assess the strengths and limitations of the family’s ability to support 

the consumer. 

♦ Help resolve family conflict by 

responding sensitively to emotional 

distress. 

♦ Address feelings of loss. 

♦ Provide relevant information for 

the consumer and his or her family at 

appropriate times. 

♦ Provide an explicit crisis plan 

and professional response. 

♦ Help improve communication 

among family members. 

♦ Provide training for the family in 

structured problem-solving techniques. 

♦ Encourage family members to 

expand their social support networks—for example, to participate in 

family support organizations such as 

NAMI. 

♦ Be flexible in meeting the needs 

of the family. 

♦ Provide the family with easy ac

cess to another professional in the 

event that the current work with the 

family ceases. 

-

Overview of the research 

Studies have shown markedly higher 

reductions in relapse and rehospitalization rates among consumers whose 

families received psychoeducation 

than among those who received standard individual services (17–20), with 

differences ranging from 20 to 50 

percent over two years. For programs 

of more than three months’ duration, 

the reductions in relapse rates were at 

the higher end of this range. In addition, the well-being of family members improved (21), patients’ participation in vocational rehabilitation increased (22), and the costs of care decreased (4,20,23,24). 

As a result of this compelling evidence, the Schizophrenia Patient 

Outcomes Research Team (PORT) 

included family psychoeducation 

among its treatment recommendations. The PORT recommended that 

all families who have contact with a 

relative who has mental illness be offered a family psychosocial intervention that spans at least nine months 

and that includes education about 

mental illness, family support, crisis 

intervention, and problem solving 

(25). Other best-practice standards 

(26–28) have recommended that families participate in education and support programs. In addition, an expert 

panel that included clinicians from 

various disciplines as well as families, 

consumers, and researchers emphasized the importance of engaging 

family members in the treatment and 

rehabilitation of persons who are 

mentally ill (29,30). 

Delivering the appropriate components of family psychoeducation for 

patients and their families appears to 

be an important determinant of outcomes for both consumers and their 

904 PSYCHIATRIC SERVICES ♦ July 2001 Vol. 52 No. 7 
The Evidence 5 Review of Research Literature

families. It has been demonstrated 

that programs do not reduce relapse 

rates if the information presented is 

not accompanied by skills training, 

ongoing guidance about management 

of mental illness, and emotional support for family members (31). 

In addition, these interventions 

that present information in isolation 

tend to be brief: a meta-analysis of 16 

studies found that family interventions of fewer than ten sessions had 

no substantial effects on the burden 

of family members (32). However, 

the number of sessions could not 

completely explain the differences in 

outcomes. The outcomes may have 

been influenced by the total duration 

of treatment rather than the number 

of sessions, or by the individual therapist’s approach to dealing with the 

emotional reactions of patients and 

their families. The behaviors and disruptions associated with schizophrenia, in particular, may require more 

than education to ameliorate the burden on the family and enhance consumer outcomes. 

Most studies have evaluated family 

psychoeducation for schizophrenia or 

schizoaffective disorder only. However, the results of several controlled 

studies support the benefits of both 

single- and multiple-family interventions for other psychiatric disorders, 

including bipolar disorder (33–38), 

major depression (39–41), obsessivecompulsive disorder (42), anorexia 

nervosa (43), and borderline personality disorder (44). Gonzalez and colleagues (45) have extended this research to deal with the secondary effects of chronic physical illness. 

Family psychoeducation thus has a 

solid research base, and leaders in the 

field have reached consensus on the 

essential components and techniques 

of family psychoeducation. This form 

of treatment should continue to be 

recommended for use in routine 

practice. However, several important 

gaps remain in the knowledge required to make comprehensive evidence-based practice recommendations and to implement them with a 

wide variety of families. 

First, although the members of the 

World Schizophrenia Fellowship and 

others have delineated the core components of a successful family interPSYCHIATRIC SERVICES ♦ July 2001 Vol. 52 No. 7 905

vention, the minimum ingredients 

are still not clear. This gap was highlighted by a study of treatment strategies for schizophrenia, which found 

no significant difference in relapse 

rates between families who received a 

relatively intensive program—a simplified version of cognitive-behavioral 

family intervention plus a multiple 

family group—and those who received a less intensive psychoeducational, or supportive, multiple-family 

group program (46). However, both 

programs provided levels of support 

and education to families that far surpassed those provided by usual services. It will be necessary to conduct 

studies designed to identify the least 

intensive and smallest effective 

“dose” of family psychoeducation. 

Family 

psychoeducation 

has a solid research base, 

and leaders in the field have 

reached consensus on its 

essential components 

and techniques. 

Second, increasing the sophistication, variety, and scope of indicators 

that are used to measure “benefit” is 

essential. Commonly used benchmarks are subject to complicated intervening variables and need to be 

correlated with other results. For example, a greater number of hospitalizations for a mentally ill person during the year after family psychoeducation could be a positive sign if it indicates that a previously neglected 

consumer is getting care and that the 

family is getting better at identifying 

prodromal symptoms that indicate an 

impending relapse (4). The well-being and health of the family should be 

routinely measured as well. 

A third knowledge gap involves the 

relationship between family psychoeducation and other programs. Since 

the conception of family psychoeducation, other psychosocial programs 

have developed a substantial evidentiary base, including supported employment and assertive community 

treatment (47,48). For example, assertive community treatment combined with family psychoeducation 

has been associated with better noncompetitive employment outcomes 

than assertive community treatment 

alone (22). The combination of assertive community treatment, family 

psychoeducation, and supported employment has been associated with 

better competitive employment outcomes than conventional vocational 

rehabilitation, although the contributions of each component could not be 

assessed in that study (49). The opportunities for family psychoeducation to be combined with or compared with these new psychosocial 

models have not been fully explored. 

Fourth, research is needed to refine the interventions so that they 

better address different types of families, different situations, and different time points throughout the course 

of illness. For example, there is some 

evidence that individualized consultation may be more beneficial than 

group psychoeducation for families 

who have existing sources of support 

or who already belong to a support 

group (50–52). 

Fifth, although family psychoeducation has been tested in a wide range 

of national and global settings, there 

is still a need to assess modifications 

in content and outcome among particular U.S. subcultures and in other 

countries. In the United States the 

one study involving Latino families 

had mixed results (53,54). However, 

studies in China (55–57) as well as 

studies that are under way among 

Vietnamese refugees living in Aus

tralia have had results comparable to 

those of studies conducted in Caucasian populations. 

-

Finally, what happens after a family 

has completed a psychoeducation 

program? Families of consumers with 

long-term problems and disability 

may need ongoing support and enhanced problem-solving skills to deal
Review of Research Literature 6 The Evidence

with the vicissitudes of illness. Lefley 

(58) has described ad hoc psychoeducation in informal settings, such as an 

ongoing family support group conducted through a medical center. McFarlane (4,59) has used a usually 

open-ended multiple-family group 

structure. NAMI’s Family-to-Family 

program is limited to 12 sessions of 

formal education but offers continuity in the NAMI support and educational group structure (14). 

Barriers to implementation 

Despite the gaps in the research, the 

extensive documentation of the basic 

benefits of family psychoeducation 

prompts the question of why this 

service is rarely offered. In general, 

low levels of contact between clinical 

staff and family members in public 

and community-based settings may 

preclude the more substantial educational or support interventions. Also, 

the availability of any intervention is 

limited by the availability of people to 

provide it and the training necessary 

to equip those people. The requisite 

clinicians, resources, time, and reimbursement have not been forthcoming. These deficits imply the existence of larger obstacles related to attitudes, knowledge, practicality, and 

systems. 

Consumers and family members 

Implementation of family psychoeducation may be hindered by realities in 

the lives of potential participants. 

Practical impediments such as transportation problems and competing 

demands for time and energy are 

common (50). If family members perceive that the training provided 

through family psychoeducation involves expectations of additional caregiving responsibilities, they may stay 

away (16). Sessions must be scheduled during periods when facilitators 

are available, but these times may not 

suit the clients and their families. 

Family members face significant burdens that may pose barriers to attending family psychoeducation sessions, 

even though attendance could lighten 

these burdens (60,61). 

In addition, stigma is common— 

family members may not want to be 

identified with psychiatric facilities. 

They may feel uncomfortable revealing that there is psychiatric illness in 

their family and airing their problems 

in a public setting. They may have 

had negative experiences in the past 

and be hesitant to expose themselves 

to the possibility of further negative 

experiences. Most people have not 

had access to information about the 

value of family psychoeducation and 

so may not appreciate the potential 

utility of these programs (16). They 

may believe that nothing will help. 

Consumers may have similar apprehensions and may worry about losing 

the confidential relationship with 

their treatment teams or about losing 

autonomy. 

Clinicians and 

program administrators 

The lack of availability of family psychoeducation may reflect an underappreciation on the part of mental 

health care providers of the utility 

and importance of this treatment approach (16,18,31,50). Providers may 

choose medication over psychosocial 

interventions, and family involvement may seem superfluous. In addition, some providers may still adhere 

to theories that blame family dynamics for schizophrenia. Bergmark (62) 

noted the persistence of psychodynamic theories as a potential barrier, 

because many families perceive these 

theories as blaming. The findings on 

expression of emotion—the original 

basis for family psychoeducation— 

are often perceived similarly despite 

researchers’ attempts to avoid implying blame (16,50). 

Although the knowledge and underlying assumptions of individuals 

are important, they are only part of 

the picture. Wright (63) found that 

job and organizational factors were 

much better predictors of the frequency of mental health professionals’ involvement with families than 

were professionals’ attitudes. The 

clinician’s work schedule and professional discipline were the strongest 

predictors, but other organizational 

factors posed barriers as well. Dissemination of the multiple-family 

psychoeducation group model developed by McFarlane and colleagues 

(64,59) has been hindered by a paucity of programmatic leadership, conflicts between the model’s philosophy 

and typical agency practices, insufficient resources, and inadequate attention to human dynamics at the 

system level. For example, reasonable concerns about confidentiality 

may be seen as roadblocks to family 

involvement rather than as opportunities to create useful innovations 

(65). Similar barriers to implementation of family treatment approaches 

have been identified in studies in 

Italy (66). 

Mental health professionals have 

also expressed concern about the cost 

and duration of structured family 

psychoeducation programs (67), even 

though medication and case management services for clients usually have 

to be continued for much longer periods than family programs. The lack 

of reimbursement for sessions with 

families that do not involve the mentally ill relative—a characteristic of 

many family psychoeducation programs—is a significant disincentive 

to providing such services. Caseloads 

are universally high, and staff’s time 

is stretched thin. Therefore devoting 

substantial human resources to training, organizing, leading, and sustaining family psychoeducation is seen as 

a luxury (16). In such an atmosphere, 

horizons tend to be short. The longterm payoff of fewer crises and hospitalizations and lower total costs of 

treatment is overshadowed by immediate organizational crises or shortterm goals (16). 

Mental health authorities 

At the health-system level, pressures 

to focus on outcomes, cost-effectiveness, and customer satisfaction seem 

in principle to favor the widespread 

adoption of family information and 

support interventions. However, other tenets of the current health care 

environment—such as the emphasis 

on short-term cost savings, technical 

rather than human-process-oriented 

remedies, and individual pathology—discourage clinicians from providing such services, which may be 

viewed as ancillary. At this level, it 

seems that the evidence for family 

psychoeducation has not been accepted. Many of the consumer- and 

program-level impediments we have 

mentioned are paralleled in the larger administrative systems: lack of 

906 PSYCHIATRIC SERVICES ♦ July 2001 Vol. 52 No. 7 
The Evidence 7 Review of Research Literature

awareness of evidence, ingrained assumptions about how care should be 

structured, and inadequate resources. 

Overcoming barriers 

to implementation 

Research on technology transfer has 

identified four fundamental conditions that must be met for change to 

occur at the individual or system level: dissemination of knowledge, evaluation of programmatic impact, 

availability of resources, and efforts 

to address the human dynamics of resisting change (68). Implementation 

strategies must include clear, widespread communication of the models 

and of their benefits to all stakeholders. This communication must occur 

through channels that are accessible 

and acceptable to the various stake

holders (16), including families, consumers, providers, administrators, 

and policy makers. It must be accompanied by advocacy, training, and supervision or consultation initiatives to 

raise awareness and support at all organizational levels (69). 

The consumer and family members 

At the level of the individual consumer and members of his or her 

family, effective treatment models 

include strategies for overcoming 

barriers to participation, such as 

stigma and a sense of hopelessness. 

Such strategies include offering to 

hold sessions in the home of the 

client or family member; helping 

family members understand that the 

intervention is designed to improve 

the lives of everyone in the family, 

not just the patient; being flexible 

about scheduling family meetings; 

and providing education during the 

engagement process to destigmatize 

mental illness and engender hope 

(70,71). 

Recent efforts to disseminate family psychoeducation in New York 

State, Los Angeles, Maine, and Illinois have illustrated clearly the importance of including clients and 

their families in the planning, adaptation, and eventual implementation of 

family psychoeducation (72). In New 

York, dissemination was initiated and 

sponsored by the state NAMI chapter (73). Dissemination in Maine and 

PSYCHIATRIC SERVICES ♦ July 2001 Vol. 52 No. 7 907

Illinois had dramatically different 

outcomes, partly because NAMI’s 

Maine chapter provided strong formal support for the effort in that 

state, whereas the effort in Illinois 

did not involve NAMI’s Illinois chapters (73). 

Experience and now some empirical data illustrate the need to include 

consumers and their families in efforts to disseminate family psychoeducation. The tension often encountered between some consumer advocacy groups and family advocacy organizations can be bridged by emphasizing the complementarity of the 

outcomes in family work: as consumers’ symptoms are alleviated and 

their functioning improves, their 

families become more engaged in 

and satisfied with community life, 

and both the family burden and med

ical illness decrease (22,74,75). 

-

Clinicians and 

program administrators

Among professionals working in 

community mental health services, 

awareness and evidence, although 

necessary, are often not sufficient for 

adoption of new programs. Although 

interventions must adhere to parameters of the family psychoeducation 

model if good client and family outcomes are to be achieved, they also 

have to be responsive to local organizational and community cultures. 

Engagement and implementation 

strategies, as well as the interventions 

themselves, must be tailored to local 

and cultural characteristics, workload 

and other stresses faced by clinicians 

and agencies, particular diagnoses, 

relationships, the duration of illness 

and disability, and whether the client 

is currently receiving medical treatment (50,76,77). 

Perhaps even more critical to the 

adoption of family psychoeducation 

is the need to match both administrative support and expectations for evidence-based practice with a rationale 

and explication of the advantages of 

this treatment approach that are 

meaningful to clinicians. Advantages 

can include avoidance of crises, more 

efficient case management, gratitude 

from families and consumers, and a 

more interesting, invigorating work 

environment for clinicians. Recent 

studies have shown that on the 

whole, knowledge about empirical 

advantages of family psychoeducation, such as reductions in relapse 

and rehospitalization rates, carry almost no weight in convincing working clinicians to change their attitudes toward families and adopt new 

clinical practices (73). 

Consensus building among agency 

staff and directors—including a wide 

range of concerned parties—in a 

process of planning from the bottom 

up is critical but must be tailored to 

address local operational barriers and 

contrary beliefs. In addition, successful implementation of family psychoeducation has required ongoing 

supervision, operational consultation, and general support. In a sense, 

these characteristics help to build 

consensus on an ongoing basis. For 

example, the PORT found that it was 

possible to change current practice 

by providing a high level of technical 

assistance and a supportive environ

ment that reflected staff agreement 

with the principles and philosophy of 

the new program (67). The recent 

dissemination of a family psychoeducation program in Los Angeles County succeeded because of the persistent advocacy of the local NAMI 

group, the support of top management, a nine-month training period, 

the high aptitude and strong commitment of the trainees, and the skill of 

the trainer (72). 

-

Mental health authorities 

and government 

Although it is tempting to assume 

that implementation of family psychoeducation could be mandated 

centrally by state mental health authorities, experience suggests that a 

more complex approach is required. 

Dissemination of a family psychoeducation program in New York State 

succeeded partly because of a partnership between the state, the NAMI 

affiliate, and an academic center. Unfortunately, the state’s mental health 

authority abruptly terminated this 

large dissemination program before a 

widespread impact could be made. 

Maine’s recent success was initiated 

by a state trade association of mental 

health centers and services, with support from but little involvement by
Review of Research Literature 8 The Evidence

the state mental health authority, 

which recently began exploring a formal partnership to continue and 

deepen this largely successful effort. 

A simultaneous effort in Illinois, initiated by the state authority but distinctly lacking consensus among center directors or the state NAMI chapter, has been less successful (73). 

One state that has had some success 

is New Jersey, which was able to disseminate family psychoeducation by 

setting expectations and requirements at the state level. 

With the exception of the New Jersey effort, experience suggests that 

the most promising strategy is one in 

which provider organizations take 

the initiative with support from consumer and family organizations, the 

state mental health authority, and the 

key insurance payers. Appropriate 

reimbursement for family psychoeducation will follow. Experience also 

suggests that several years of consistent effort and ongoing monitoring 

are required for success. Fortunately, 

this process is not necessarily an expensive one: Maine implemented its 

family psychoeducation program in 

more than 90 percent of agencies for 

about 25 cents per capita over four 

years, including evaluation costs. The 

principal costs are in human effort, 

especially the effort required to overcome resistance to change. 

Delivery of services to families 

must be subject to accountability and 

tracking. Although many states encourage the delivery of services to 

families, few monitor such services or 

make funding contingent on the services being delivered (78). One system-level option is for mental health 

centers to create a position for an 

adult family intervention coordinator, 

who would serve as the contact person for interventions, facilitate communication between staff and families, supervise clinicians, and monitor 

fidelity (79). 

Family-to-Family 

Education Program 

In the absence of family psychoeducation programs, voluntary peer-led 

family education programs have developed, epitomized by NAMI’s 

Family-to-Family Education Pro

gram (FFEP) (14,80–82). FFEP is 

-

currently available in 41 states, many 

of which have waiting lists. FFEP 

and other mutual-assistance family 

programs are organized and led by 

trained volunteers from families of 

persons who have mental illness. 

These community programs are offered regardless of the mentally ill 

person’s treatment status. They tend 

to be brief—for example, 12 weeks 

for FFEP—and mix families of persons with various diagnoses, although 

they focus on persons with schizophrenia or bipolar disorder. On the 

basis of a trauma-and-recovery model of a family’s experience in coping 

with mental illness, FFEP merges 

education with specific support 

mechanisms to help families through 

the various stages of comprehending 

and coping with a family member’s 

mental illness (14). The program focuses first on outcomes of family 

members and their well-being, although benefits to the patient are 

also considered to be important (50). 

Uncontrolled research on FFEP 

and its predecessor, Journey of Hope, 

suggests that the program increases 

the participants’ knowledge about 

the causes and treatment of mental 

illness, their understanding of the 

mental health system, and their wellbeing (13). In a prospective, naturalistic study, FFEP participants reported that they had significantly less 

displeasure and concern about members of their family who had mental 

illness and significantly more empowerment at the family, community, 

and service-system levels after they 

had completed the program (83). 

Benefits observed at the end of the 

program had been sustained six 

months after the intervention. Preliminary results from a second ongoing study with a waiting-list control 

design have revealed similar findings. 

Although FFEP currently lacks 

rigorous scientific evidence of efficacy in improving clinical or functional 

outcomes of persons who have mental illness, it shows considerable 

promise for improving the well-being 

of family members. In recent research and practice, attempts have 

been made to optimize the clinical 

opportunities provided by family psychoeducation and peer-based programs such as FFEP by developing 

partnerships between the two strategies. For example, family psychoeducation programs have used FFEP 

teachers as leaders, and participation 

in FFEP has facilitated eventual participation in family psychoeducation. 

Conclusions 

The efficacy and effectiveness of 

family psychoeducation as an evidence-based practice have been established. To date, the use of family 

psychoeducation in routine clinical 

practice is alarmingly limited. Research has recently begun to develop 

dissemination interventions targeted 

at the programmatic and organizational levels, with some success. On

going research must continue to develop practical and low-cost strategies to introduce and sustain family 

psychoeducation in typical practice 

settings. Basic research that identifies the barriers to implementing 

family psychoeducation in various 

clinical settings is also needed—for 

example, the impact of clinicians’ attitudes, geographic factors, funding, 

disconnection of patients from family 

members, and stigma—as well as the 

extent to which variations in these 

factors mediate the outcomes of educational interventions. 

Dissemination could also be facilitated by further exploring the integration of family psychoeducation 

with psychosocial interventions— 

such as assertive community treatment, supported employment, and 

social skills training—and other evidence-based cognitive-behavioral strategies for improving the treatment 

outcomes of persons with mental illness. Promising efforts have combined the energy, enthusiasm, and 

expertise of grassroots family organizations such as NAMI with professional and clinical programs. ♦ 

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PSYCHIATRIC SERVICES ♦ July 2001 Vol. 52 No. 7 
The Evidence 11 Selected Bibliography

The Evidence

Selected Bibliography

Literature reviews

Drake, R. E., Merrens, M. R., & 

Lynde, D. W. (2005). Evidence-based 

mental health practice: A textbook, New 

York: WW Norton.

n Introduces readers to the concepts 

and approaches of evidencebased practices for treating severe 

mental illnesses.

n Describes the importance of research 

in intervention science and the 

evolution of evidence-based practices.

n Contains a chapter for each of five 

evidence-based practices and provides 

historical background, practice 

principles, and an introduction 

to implementation. Vignettes 

highlight the experiences of staff and 

consumers.

n Is an excellent, readable primer for 

the Evidence-Based Practices KITs.
Selected Bibliography 12 The Evidence

Resources for family intervention 

coordinators and mental health 

authorities

Anderson, C. M., Griffin, S., Ross, I. A., 

Pagonis, I., Holder, D. P., & Treiber, R. (1986). 

A comparative study of the impact of education 

vs. process groups for families of patients with 

affective disorders. Family Process, 25, 185-205.

Batalden, P. B., & Stoltz, P. K. (1993). A framework 

for the continual improvement of healthcare: 

Building and applying professional and 

improvement knowledge to test changes in daily 

work. The Joint Commission Journal on Quality 

Improvement, 19, 424-445.

Falloon, I. R. H., McGill, C. W., & Boyd, J. L. 

(1992). Family management in the prevention 

of morbidity in schizophrenia: Social outcome 

of a two-year longitudinal study. Psychological 

Medicine, 17, 59-66.

McFarlane, W. R., Dushay, R. A., Deakins, S. M., 

Stastny, P., Lukens, E. P., Toran, J., et al. (2000). 

Employment outcomes in family-aided Assertive 

Community Treatment. American Journal of 

Orthopsychiatry, 70, 203-214.

Essential reading for practitioners

The following four books are recommended for 

those who want to master this approach. The first is 

especially helpful for practitioners offering FPE in 

the single-family format. The third reference is 

recommended for practitioners facilitating 

multifamily groups.

Anderson, C., Hogarty, G., & Reiss, D. (1986). 

Schizophrenia and the family. New York: 

Guilford Press.

Falloon, I., Boyd, J., & McGill, C. (1984). Family 

care of schizophrenia. New York: Guilford Press.

McFarlane, W. R. (2002). Multifamily groups in 

the treatment of severe psychiatric disorders.

New York: Guilford.

Miklowitz, D. J., & Goldstein, M. (1997). Bipolar 

disorder: A family-focused treatment approach.

New York: Guilford Press.

Additional resources for 

practitioners

Amenson, C. (1998). Schizophrenia: A family 

education curriculum. Pasadena, CA: Pacific 

Clinics Institute.

Provides 150 slides with lecture notes for 

conducting educational workshops for families 

who have a relative with schizophrenia. Includes 

information about the illness, medication, 

psychosocial treatments, and the role of the 

family in promoting recovery.

Amenson, C. (1998). Schizophrenia: Family 

education methods. Pasadena, CA: Pacific 

Clinics Institute.

A companion handbook to Schizophrenia: A 

Family Education Curriculum. Provides guidance 

on forming a class, optimizing learning for 

families, and dealing with typical problems that 

arise in conducting educational workshops.

Kuipers, E., Leff, J. & Lam, D. (2002). Family 

work for schizophrenia: A practical guide.

London: Gaskill.

Linehan, M. (1993). Cognitive-behavioral 

treatment of borderline personality disorder.

New York: Guilford.

Mueser, K. T., & Glynn, S. (1999). Behavioral 

family therapy for psychiatric disorders.

Oakland, CA: New Harbinger Publications.
The Evidence 13 Selected Bibliography

Psychopharmacology

Gorman, J. (1995). The essential guide to 

psychiatric drugs. New York: St. Martin’s Press.

Profiles individual medications in easy-tounderstand terms.

Lickey, M., & Gordon, B. (1991). Medicine and 

mental illness. New York: W. H. Freeman.

Presents principles of diagnosis, neurophysiology, 

and psychopharmacological treatment of mental 

illnesses. Describes why psychopharmacology 

exists and how it works.

Special topics

Manoleas, P. (Ed.) (1996). The cross-cultural 

practice of clinical case management in mental 

health. Binghamton, NY: Haworth Press.

Presents a collection of articles about the roles 

of gender, ethnicity, and acculturation in seeking 

treatment and response. Gives guidelines for 

engaging and intervening with specific ethnic and 

diagnostic groups in varying treatment contexts.

Russell, L. M., & Grant, A. E. (1995). Planning for 

the future: Providing a meaningful life for a child 

with a disability after your death. Evanston, IL: 

American Publishing Company. 

Russell, L. M., & Grant, A. E. (1995). The life 

planning workbook: A hands-on guide to 

help parents provide for the future security 

and happiness of their child with a disability 

after their death. Evanston, IL: American 

Publishing Company.

Offers guidance to parents on providing for the 

future security of adults with mental illnesses.

Silver, D. (1992). A Parent’s guide to wills and 

trusts. Los Angeles, CA: Adams-Hall.

Provides financial planning suggestions for 

parents of adults with mental illnesses.

Solomon, P., Mannion, E., Marshall, T., & 

Farmer, J. (2001). Social workers as consumer 

and family consultants. In K. Bentley (Ed.), 

Social work practice in mental health: 

Contemporary roles, tasks, and techniques

(pp. 230–253). Pacific Grove, CA: Brooks/Cole 

Publishing Co.

Provides a model Release of Information form 

for sharing information with families on an 

ongoing basis.

Wrobleski, A. (1991). Suicide survivors: A 

guide for those left behind. Minneapolis, MN: 

Afterwords Publishing.

Offers coping strategies to families who have had 

a relative commit suicide.

Resources for families

Adamec. C. (1996). How to live with a mentally 

ill person: A handbook of day-to-day strategies.

New York: John Wiley and Sons.

This comprehensive, easy-to-read book, written 

by a parent, reviews methods for accepting 

illness, dealing with life issues, developing coping 

strategies, negotiating the mental health system, 

and more.

Keefe, R., & Harvey, P. (1994). Understanding 

schizophrenia: A guide to the new research 

on causes and treatment. New York: The 

Free Press.

Describes research and presents the science of 

schizophrenia in understandable terms.
Selected Bibliography 14 The Evidence

Marsh, D., & Dickens, R. (1997). Troubled 

journey: Coming to terms with the mental 

illness of a sibling or parent. New York: 

Tarcher/Putnam.

Written for siblings and adult children of people 

with mental illnesses. Discusses the impact of 

mental illnesses on childhood.

Mueser, K., & Gingerich, S. (1994). Coping with 

schizophrenia: A guide for families. Oakland, 

CA: New Harbinger Publications.

Offers a comprehensive guide to living with 

schizophrenia. Provides practical advice on 

topics including medication, preventing relapse, 

communication, family rules, drug use, and 

planning for the future. Includes forms and 

worksheets for solving typical problems.

Torrey, E. F. (1995). Surviving schizophrenia: 

A family manual (3rd ed.) New York: Harper 

& Row.

First-person accounts

Devesch, A. (1992). Tell me I’m here: One 

family’s experience with schizophrenia. New 

York: Penguin.

A United Nation’s Media Peace Prize winner and 

founder of Schizophrenia Australia describes her 

family’s experience.

Dickens, R., & Marsh, D. (1994). Anguished 

voices: Siblings and adult children of persons 

with psychiatric disabilities. Boston, MA: 

Center for Psychiatric Rehabilitation.

Collection of eight stories describing the impact 

of mental illnesses on siblings and children. Deals 

with the issues across the life span that must be 

addressed when someone grows up with mental 

illness in the family.

Duke, P., & Hochman, G. (1992). A brilliant 

madness: Living with manic depressive illness.

New York: Bantam Books.

Combines personal experience with clinical 

information to describe manic depression in 

understandable terms and gives guidelines for 

coping with it.

Hyland, B. (1986). The girl with the crazy 

brother. London: Franklin Watts.

Written for adolescents.

Jamison, K. R. (1995). An Unquiet Mind. New 

York: Alfred A. Knopf, Inc.

A compelling and emotional account of author’s 

awareness, denial, and acceptance of her bipolar 

disorder. It offers readers hope for recovery.

Riley, J. (1984). Crazy quilt. New York: 

William Morrow.

Fictional account of a 13-year-old girl whose 

mother has schizophrenia. Written for children 

and adolescents.

Sheehan, S. (1982). Is there no place on earth for 

me? New York: Houghton-Mifflin.

Describes the experience of living with 

schizophrenia. Provides information about 

legal, funding, and treatment issues. Won the 

Pulitzer Prize.

Schiller, L., & Bennett, A. (1994). The quiet room: 

A journey out of the torment of madness. New 

York: Warner Books.

Wasow, M. (1995). The skipping stone: Ripple 

effects of mental illness on the family. Palo Alto, 

CA: Science and Behavior Books.
The Evidence 15 Selected Bibliography

Self-help

Burns, D. (1989). The feeling good handbook.

New York: Penguin.

Self-help book presents a rationale for cognitive 

therapy for depression with specific ideas and 

exercises to help change thought patterns 

associated with depression and other problems.

Copeland, M. E. (1992). The depression 

workbook. Oakland, CA: New Harbinger 

Publications.

Helps consumers take responsibility for wellness 

by using charts and techniques to track and 

control moods.

Lewinsohn, P., Munoz, R., Youngren, M. A., 

& Zeiss, A. (1979). Control your depression. 

Englewood Cliffs, New Jersey: Prentice Hall.

Self-help book assesses what contributes to 

depression. Includes techniques and activities 

such as relaxation, social skill-enhancement, and 

modification of self-defeating thinking patterns.

Papolos, D., & Papolos, J. (1997). Overcoming 

depression. (3rd ed.). New York: Harper & Row.

A comprehensive book written for consumers 

and families.

Videotapes

Amenson, C. S. Exploring schizophrenia.

Produced by the California Alliance for the 

Mentally Ill. (Available from the California 

Alliance for the Mentally Ill, 1111 Howe 

Avenue, Suite 475, Sacramento, CA 95825. 

Phone: (916) 567-0163.)

Uses everyday language to describe 

schizophrenia. Provides coping guidelines to 

consumers and their families.

American Psychiatric Association (Producer). 

(1997). Critical connections: A schizophrenia 

awareness video. (Available from American 

Psychiatric Association, 1000 Wilson Boulevard, 

Suite 1825, Arlington, VA 22209. Phone: 

(703) 907-7300.)

This 30-minute video provides a hopeful, 

reassuring message about new medications and 

psychosocial treatments for schizophrenia. 

McFarlane, W. R. (Producer). (1999). 

Schizophrenia explained. (Available from W. 

R. McFarlane, Maine Medical Center, 22 

Bramhall Street, Portland, ME 04102. Phone: 

(207) 871-2091. mcfarw@mmc.org.)

Provides a full review in lay language of the 

psychobiology of schizophrenia, emphasizing 

stress reduction, optimal environments, and 

interactions for recovery, and family support. May 

be used in FPE 1-day educational workshops.

Vaccaro, J. V. (1996). Exploring bipolar disorder.

Produced by the California Alliance for the 

Mentally Ill. (Available from the California 

Alliance for the Mentally Ill, 1111 Howe 

Avenue, Suite 475, Sacramento, CA 95825. 

Phone: (916) 567-0163.)

This 1-hour video describes the bipolar disorder, 

recovery, and the role of the family. Consumers 

contribute valuable insights.

The Evidence 17 References

Anderson, C. M., Griffin, S., Ross, I. A., 

Pagonis, I., Holder, D. P., & Treiber, 

R. (1986). A comparative study of the 

impact of education vs. process groups 

for families of patients with affective 

disorders. Family Process, 25, 185–205.

American Psychiatric Association. (1997). 

Practice guidelines for the treatment 

of patients with schizophrenia. The 

American Journal of Psychiatry. 154(4) 

Suppl., 1–63.

Becker, D. R., Bond, G. R., McCarthy, D., 

Thompson, D., Xie, H., McHugo, G. J., 

et al. (2001). Converting day treatment 

centers to supported employment 

programs in Rhode Island. Psychiatric 

Services, 52, 351–357.

Becker, D. R., Smith, J., Tanzman, B., 

Drake, R. E., & Tremblay, T. (2001). 

Fidelity of supported employment 

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The Evidence

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The Evidence 23 Acknowledgments

The materials included in the Family Psychoeducation (FPE) KIT were 

developed through the National Implementing Evidence-Based Practices 

Project. The Project’s Coordinating Center—the New Hampshire-Dartmouth 

Psychiatric Research Center—in partnership with many other collaborators, 

including clinicians, researchers, consumers, family members, and 

administrators, and operating under the direction of the Substance Abuse 

and Mental Health Services Administration, Center for Mental Health Services, 

developed, evaluated, and revised these materials.

We wish to acknowledge the many people who contributed to all aspects 

of this project. In particular, we wish to acknowledge the contributors and 

consultants on the following pages.

The Evidence

Acknowledgments
Acknowledgments 24 The Evidence

Michael English

Division of Service and Systems Improvement

Rockville, Maryland

Neal B. Brown

Community Support Programs Branch

Division of Service and Systems Improvement

Rockville, Maryland

Sandra Black

Community Support Programs Branch

Division of Service and Systems Improvement

Rockville, Maryland

Crystal R. Blyler

Community Support Programs Branch

Division of Service and Systems Improvement

Rockville, Maryland

Pamela J. Fischer

Homeless Programs Branch

Division of Service and Systems Improvement

Rockville, Maryland

Lisa Dixon

University of Maryland School of Medicine

Baltimore, Maryland 

Donna Downing

Maine Medical Center

Portland, Maine

Sushmita Shoma Ghose

Community Support Programs Branch

Division of Service and Systems Improvement

Rockville, Maryland

Patricia Gratton

Division of Service and Systems Improvement

Rockville, Maryland

Betsy McDonel Herr

Community Support Programs Branch

Division of Service and Systems Improvement

Rockville, Maryland

Larry D. Rickards

Homeless Programs Branch

Division of Service and Systems Improvement

Rockville, Maryland

SAMHSA Center for Mental Health Services, Oversight Committee

Co-Leaders

William R. McFarlane

Maine Medical Center

Portland, Maine
The Evidence 25 Acknowledgments

Contributors

Curtis Adams

University of Maryland School of Medicine 

Baltimore, Maryland

Christopher S. Amenson

Pacific Clinics Institute

Pasadena, California

Carol Anderson

University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania

Charity Appell

Ascutney, Vermont

Cynthia Bisbee

Montgomery, Alabama

Gary Bond

Indiana University–Purdue University 

Indianapolis, Indiana 

Judy Burk

Bangor, Maine

Jose Canive

University of New Mexico Health Sciences Center

Albuquerque, New Mexico

Diane Chambers

Vermont Department of Health 

Agency of Human Services

Burlington, Vermont 

Michael J. Cohen 

National Alliance on Mental Illness (NAMI) 

Concord, New Hampshire 

Cathy Donahue

Calais, Vermont 

Dennis Dyck

Washington State University

Spokane, Washington

Kana Enomoto 

Substance Abuse and Mental Health Services 

Administration

Rockville, Maryland

Ian Falloon

University of Auckland

Auckland, New Zealand 

Laurie Flynn

Alexandria, Virginia

Risa Fox

Community Support Programs Branch

Division of Service and Systems Improvement

Rockville, Maryland

Shirley M. Glynn

U.S. Department of Veteran Affairs

Greater Los Angeles Healthcare System 

Los Angeles, California

Linda H. Jacobson

Maine Medical Center

Portland, Maine 

Dale Johnson 

University of Houston

Houston, Texas

Gabor Keitner

Brown University

Providence, Rhode Island

Alex Kopelowicz

University of California

Los Angeles School of Medicine

Los Angeles, California

Mary Beth Lapin

Portland, Maine

Julian Leff

Kings College, Institute of Psychiatry 

London, United Kingdom 
Acknowledgments 26 The Evidence

Charles A. Rapp 

The University of Kansas

Lawrence, Kansas 

Dennis Ross 

Marshfield, Vermont

Nina R. Schooler

Georgetown University 

School of Medicine

Washington, D.C.

Jacqueline Shannon

San Angelo, Texas 

Mary Kay Smith

University of Toledo 

College of Medicine

Toledo, Ohio

Phyllis Solomon

University of Pennsylvania, 

School of Social Policy and Practice Philadelphia, 

Pennsylvania 

Diane Sondheimer

SAMHSA Center for Mental Health Services

Rockville, Maryland

Bette Stewart 

University of Maryland School of Medicine

Baltimore, Maryland

Karin Swain 

Dartmouth Psychiatric Research Center

Lebanon, New Hampshire

William Torrey

Dartmouth Medical School

Hanover, New Hampshire

Suzanne Vogel-Scibilia

Western Psychiatric Institute and Clinic

Pittsburgh, Pennsylvania

Harriet P. Lefley

University of Miami 

School of Medicine

Miami, Florida

Steven R. Lopez

University of California

Los Angeles Department of Psychology

Los Angeles, California

Ken Lutterman 

National Institutes of Health 

Bethesda, Maryland

David W. Lynde 

Dartmouth Psychiatric Research Center

Concord, New Hampshire

Doug Marty

The University of Kansas

Lawrence, Kansas 

Gregory J. McHugo

Dartmouth Psychiatric Research Center 

Lebanon, New Hampshire

Matthew Merrens 

Dartmouth Psychiatric Research Center

Lebanon, New Hampshire

David J. Miklowitz

University of Colorado 

Department of Psychology and Psychiatry

Boulder, Colorado

Kim T. Mueser

Dartmouth Psychiatric Research Center

Concord, New Hampshire

Ernest Quimby

Howard University

Washington, D.C.
The Evidence 27 Acknowledgments

Consultants to the National Implementing Evidence-Based Practices Project

Dan Adams

St. Johnsbury, Vermont 

Diane C. Alden

New York State Office of Mental Health 

New York, New York

Lindy Fox Amadio 

Dartmouth Psychiatric Research Center

Concord, New Hampshire

Diane Asher

The University of Kansas

Lawrence, Kansas

Stephen R. Baker

University of Maryland School of Medicine

Baltimore, Maryland

Stephen T. Baron 

Department of Mental Health

Washington, D.C.

Deborah R. Becker 

Dartmouth Psychiatric Research Center

Lebanon, New Hampshire

Nancy L. Bolton

Cambridge, Massachusetts

Patrick E. Boyle

Case Western Reserve University

Cleveland, Ohio

Mike Brady

Adult and Child Mental Health Center

Indianapolis, Indiana

Ken Braiterman

National Alliance on Mental Illness (NAMI) 

Concord, New Hampshire 

Janice Braithwaite

Snow Hill, Maryland

Michael Brody 

Southwest Connecticut Mental Health Center

Bridgeport, Connecticut

Mary Brunette 

Dartmouth Psychiatric Research Center

Concord, New Hampshire

Sharon Bryson

Ashland, Oregon

Barbara J. Burns 

Duke University School of Medicine 

Durham, North Carolina

Jennifer Callaghan

The University of Kansas

School of Social Welfare

Lawrence, Kansas

Kikuko Campbell

Indiana University–Purdue University 

Indianapolis, Indiana

Linda Carlson 

University of Kansas

Lawrence, Kansas 

Diana Chambers

Department of Health Services 

Burlington, Vermont

Alice Claggett

University of Toledo College of Medicine

Toledo, Ohio

Marilyn Cloud

Department of Health and Human Services

Concord, New Hampshire

Melinda Coffman 

The University of Kansas

Lawrence, Kansas 
Acknowledgments 28 The Evidence

Jon Collins

Office of Mental Health and Addiction Services

Salem, Oregon

Laurie Coots

Dartmouth Psychiatric Research Center

Lebanon, New Hampshire

Judy Cox

New York State Office of Mental Health

New York, New York 

Harry Cunningham

Dartmouth Psychiatric Research Center

Concord, New Hampshire

Gene Deegan

University of Kansas

Lawrence, Kansas

Natalie DeLuca

Indiana University–Purdue University 

Indianapolis, Indiana

Robert E. Drake 

Dartmouth Psychiatric Research Center

Lebanon, New Hampshire

Molly Finnerty 

New York State Office of Mental Health

New York, New York 

Laura Flint

Dartmouth Evidence-Based Practices Center

Burlington, Vermont

Vijay Ganju 

National Association of State Mental Health 

Program Directors Research Institute

Alexandria, Virginia

Susan Gingerich

Narberth, Pennsylvania

Phillip Glasgow

Wichita, Kansas

Howard H. Goldman

University of Maryland School of Medicine

Baltimore, Maryland

Paul G. Gorman

Dartmouth Psychiatric Research Center

Lebanon, New Hampshire

Gretchen Grappone

Concord, New Hampshire

Eileen B. Hansen

University of Maryland School of Medicine 

University of Maryland, Baltimore 

Kathy Hardy 

Strafford, Vermont 

Joyce Hedstrom 

Courtland, Kansas 

Lon Herman 

Department of Mental Health

Columbus, Ohio 

Lia Hicks

Adult and Child Mental Health Center

Indianapolis, Indiana

Debra Hrouda

Case Western Reserve University

Cleveland, Ohio

Bruce Jensen

Indiana University–Purdue University 

Indianapolis, Indiana

Clark Johnson 

Salem, New Hampshire 

Amanda M. Jones

Indiana University–Purdue University 

Indianapolis, Indiana

Joyce Jorgensen

Department of Health and Human Services

Concord, New Hampshire

Hea-Won Kim

Indiana University–Purdue University 

Indianapolis, Indiana
The Evidence 29 Acknowledgments

David A. Kime

Transcendent Visions and Crazed Nation Zines

Fairless Hills, Pennsylvania 

Dale Klatzker 

The Providence Center

Providence, Rhode Island 

Kristine Knoll

Dartmouth Psychiatric Research Center

Lebanon, New Hampshire

Bill Krenek

Department of Mental Health 

Columbus, Ohio

Rick Kruszynski

Case Western Reserve University

Cleveland, Ohio

H. Stephen Leff 

The Evaluation Center at the Human Services 

Research Institute

Cambridge, Massachusetts

Treva E. Lichti

National Alliance on Mental Illness (NAMI) 

Wichita, Kansas 

Wilma J. Lutz

Ohio Department of Mental Health

Columbus, Ohio

Anthony D. Mancini

New York State Office of Mental Health 

New York, New York

Paul Margolies

Hudson River Psychiatric Center

Poughkeepsie, New York 

Tina Marshall 

University of Maryland School of Medicine

Baltimore, Maryland

Ann McBride 

Oklahoma City, Oklahoma

William R. McFarlane

Maine Medical Center

Portland, Maine

Mike McKasson

Adult and Child Mental Health Center

Indianapolis, Indiana 

Alan C. McNabb

Ascutney, Vermont 

Meka McNeal 

University of Maryland School of Medicine

Baltimore, Maryland

Ken Minkoff

ZiaLogic

Albuquerque, New Mexico

Michael W. Moore 

Office of Mental Health and Addiction Services

Salem, Oregon

Roger Morin 

The Center for Health Care Services

San Antonio, Texas 

Lorna Moser

Indiana University–Purdue University 

Indianapolis, Indiana

Kim T. Mueser

Dartmouth Psychiatric Research Center

Concord, New Hampshire

Britt J. Myrhol

New York State Office of Mental Health

New York, New York

Bill Naughton 

Southeastern Mental Health Authority

Norwich, Connecticut 

Nick Nichols

Department of Health 

Burlington, Vermont
Selected Bibliography 30 The Evidence

Bernard F. Norman

Northeast Kingdom Human Services

Newport, Vermont

Linda O’Malia

Oregon Health and Science University

Portland, Oregon

Ruth O. Ralph

University of Southern Maine

Portland, Maine 

Angela L. Rollins

Indian University–Purdue University 

Indianapolis, Indiana

Tony Salerno

New York State Office of Mental Health 

New York, New York

Diana C. Seybolt

University of Maryland School of Medicine

Baltimore, Maryland

Patricia W. Singer 

Santa Fe, New Mexico

Mary Kay Smith

University of Toledo

Toledo, Ohio 

Diane Sterenbuch 

Bethesda, Maryland 

Bette Stewart 

University of Maryland School of Medicine

Baltimore, Maryland

Steve Stone 

Mental Health and Recovery Board

Ashland, Ohio

Maureen Sullivan

Department of Health and Human Services

Concord, New Hampshire

Beth Tanzman

Vermont Department of Health

Burlington, Vermont

Greg Teague 

University of Southern Florida

Tampa, Florida

Boyd J. Tracy

Dartmouth Psychiatric Research Center

Lebanon, New Hampshire 

Laura Van Tosh 

Olympia, Washington

Joseph A. Vero

National Alliance on Mental Illness (NAMI) 

Aurora, Ohio

Barbara L. Wieder

Case Western Reserve University

Cleveland, Ohio

Mary Woods

Westbridge Community Services

Manchester, New Hampshire
The Evidence 31 Acknowledgments

The following organizations for their generous contributions:

n The John D. & Catherine T. MacArthur Foundation

n West Family Foundation

Carolyn Boccella Bagin

Center for Clear Communication, Inc.

Rockville, Maryland

Sushmita Shoma Ghose

Westat

Rockville, Maryland

Julien Hofberg

Westat

Rockville, Maryland

Glynis Jones

Westat

Rockville, Maryland

Special thanks to

Production, editorial, and graphics support

Chandria Jones

Westat

Rockville, Maryland

Tina Marshall

Gaithersburg, Maryland

Mary Anne Myers

Westat

Rockville, Maryland

Robin Ritter

Westat

Rockville, Maryland


26174.0609.7765020404

HHS Publication No. SMA-09-4422

Printed 2009