FS01. CRAFT Connect Overview
Welcome to the Family Support Group Program.
Here you can download the session PDF below by clicking on the button or continue scrolling to the online version. The videos password is craft.
Session Online Version
CHECK-IN SECTION – Maximum time 20 minutes
Mindful Minute. Take a break, step away from what you have been doing, breathe deeply and recharge.
1. Find a comfortable seated position with both feet grounded on the floor. Put a hand on your stomach. Close your eyes.
2. Take a deep breath in through your nose and out through your mouth. Notice your thoughts and feelings and any tensions in your body.
3. As you inhale and exhale, breathe deeply so your belly fills and empties with air. The hand on your stomach helps you practice belly – not chest breathing.
4. For the next minute make breathing in and out your only focus. Let your thoughts come and go without trying to control them. If you find an area of tension in your body, relax it and let the tension go.
5. At the end the minute slowly open your eyes. Gently bring your presence back to your surroundings.
Our Purpose
CRAFT Connects’ Family Support groups are for parents, partners, families and other Concerned Significant Others (CSOs) who have a loved one that is struggling with a substance use or mental health disorder. We know from first-hand experience that loving someone with these challenges can be a difficult, lonely journey. To create a safe place for honest sharing of our lived experience we use appropriate language and behavior. We are empathetic, nonjudgmental, genuine, respectful, steer clear of confrontation and imposing our own solutions. We encourage hope and compassion for all. CRAFT Connect helps to reframe and energize connections between you, your loved one and behavioral health professionals into a “therapeutic alliance” that leads to progress and healing. There is a lot we can learn from one another.
What experience did you have practicing CRAFT Connect principles and skills? ________________________________________________________________________________________________________________
What did you do to purposefully take care of yourself and show self-compassion? ________________________________________________________________________________________________________________
LEARN SECTION: Maximum time 30 minutes
Think: Please summarize what you learned completing the Self-Assessment activities. If, you have yet completed these self-assessment, please do so before your next CRAFT Connect group meeting.
________________________________________________________________________________________________________________
1. Hope is the foundation of change and recovery. Hope is the belief that the challenges and conditions associated with substance use and mental health disorders can be overcome. Hope is a powerful force to help you maintain motivation. CRAFT Connect offers hope for a fresh start for you and your loved one -- you can both have a “life worth living”.
Discuss: How has hope helped you cope with your loved one’s struggles?________________________________________________________________________________________________________________
2.When our loved one developed their disorder(s), unwanted behaviors appeared that we may have never seen before. At the same time, many attributes or wanted behaviors we may have counted on from our loved one diminished. For many Concerned Significant Others (CSOs) this “double edge sword” of behavioral health disorders started the process of confusing who their loved one really is with their illness.
Discuss: How have you been able to separate who your loved one really is, from their disorder?
________________________________________________________________________________________________________________
3. You didn’t CAUSE IT; you can’t CONTROL IT and you CAN’T CURE your loved one’s behavioral health disorder. Instead, parents, spouses, siblings, children, friends, co-workers, members of the community and other Concerned Significant Others (CSOs) are crucial collaborators in their loved one’s recovery from mental health and substance use disorders. CSO engagement and involvement offers a promising pathway toward better-quality health care, more-efficient care, and improved health and wellbeing for everyone.
Discuss: How does understanding you are not responsible for your loved one’s unwanted behaviors help you and them?
________________________________________________________________________________________________________________
4. Your loved one’s “Clinical” recovery involves diagnosis, objective measures of symptom management and remission, and psychosocial functioning, as rated by behavioral health professionals. Their “Personal” recovery is an ongoing, lifelong, and highly subjective process. Key concepts in their recovery process include hope personal responsibility, self-advocacy, wellness, empowerment, self-determination and acceptance (Davidson & Roe, 2007; Slade, 2009; Deegan, 1996a; Spaniol, 1997; Mead & Copeland, 2000; Ahern & Fisher, 1999, 2001; Frese & Davis, 1997);
Watch: “Harvard Study of Adult Development” video.
5. Recovery is also about connections. Our relationships and how happy we are in our relationships has a powerful influence on our physical and mental health. Connecting with friends, family and community is an indication that your loved one has returned to basic functioning and underlines the importance of social relationships in recovery. Being supported by others, “Relational” recovery, is critical for those trying to live interdependently in the community. (Young and Ensing , 1999, (Jacobson and Greenley, 2001), (Schon, 2009) , (Davidson et al., 2005)
Discuss: Why do you think close relationships keep people happy and healthy throughout their lives? ________________________________________________________________________________________________________________
6. Think about where you and your loved one are in the process of “Relational” recovery. As you reflect on your experience with your loved one has your lecturing been falling on deaf ears? Does punishing your loved one’s unwanted behaviors feel like it works in the short term but doesn’t have a lasting impact? Do family and friends advise you to use ‘tough love’ or detach completely and let the consequences pile up so that your loved one hits ‘rock bottom’? With CRAFT Connect there is a better way – You can raise the bottom up!
7. Movies, books, and magazines often portray that people must “hit bottom” before they can be helped. However, this representation is a myth. People do not need to bottom out to be helped. Research shows that early identification of the problem is a much more effective solution for substance use and mental health disorders. Identification can be done via health care screenings, employee assistance program, or a family member. In general, all people are better equipped to work on recovery if their problems are discovered and confronted early on.
Treatment in the early stages of a disorder is likely to be less intense, less disruptive, and cause less anxiety. Taking steps to begin treatment and recovery early can be a painful process. However, it is the only path that holds promise for something better. (https://drugfree.org/article, July 1, 2019).
Discuss: People don’t need to bottom out to be helped. How does understanding your loved one does NOT need to “hit rock bottom” help you and them?________________________________________________________________________________________________________________
8. CRAFT Connect is a combination of recovery related principles and skills curated from these Evidence-Based Programs (EBPs). EBP is a process in which behavioral health practitioners combine well-researched interventions with clinical experience and ethics, client preferences and culture to guide and inform the delivery of treatments and services. See “Evidence-Based Programs Handout”.
· CRAFT (Community Reinforcement and Family Training),
· Peer Support,
· DBT (Dialectical Behavioral Therapy),
· Wellness,
· MI (Motivational Interviewing),
· Mindfulness, and
· Expressive Writing.
9. CRAFT is a respectful, non-confrontational and effective set of skills that teaches how to help encourage our struggling loved ones to make choices that lead to progress and healing. Collaborative and practical, it is focused on behavior change that helps your loved one, you and your family (Meyers and Wolfe, 2004) and enhances longer-term change. Although CRAFT was developed for families with a loved one who has a substance use disorder, CRAFT Connect will benefit families struggling with behavioral health disorders. Key ideas include
· Motivation to change can be influenced by family members.
· Something powerful will have to replace unwanted behaviors: rediscovering meaning, building and maintaining connections with others, physical and mental activities, and developing new abilities will help fill this ‘gap’ (Meyers and Wolfe, 2004).
· Positive reinforcements and natural consequences (in action and communication) are more effective than confrontation (https://drugfree.org/article/skills-to-help-your-child-and-family-heal/, July 1, 2019).
Watch: "CRAFT vs. Alternatives” video.
10. CRAFT is the leading evidence-based ‘unilateral’ family therapy practice that doesn’t involve our loved ones. Our own changes are an invitation for our loved one to also change. Overall, those who studied and applied CRAFT principles and skills successfully encouraged approximately two-thirds of their loved ones to attend treatment, typically after four to six CRAFT counseling sessions (Meyers and Wolfe, 2004).
11. A major thrust of the CRAFT Connect program is to teach new skills, including how and when to use them. Role plays and exercises during sessions and homework assignments in-between sessions make this a very active program for you. Developing any skill requires consistent practice. Behavior change is a time-consuming process. Eventually you and your loved one will reap the benefits of the enacted skills as they help pave the way to a life worth living (Meyers and Wolfe, 2008).
12. Clinical trials have shown that when family members engage their loved ones using positive, supportive, non-confrontational techniques, not only do they find ways to get their loved one into and stay in treatment, but the wellbeing of family members themselves increases. Family members report significant reductions in anger, anxiety, depression and negative physical symptoms using these methods. Well supported scientific research shows that family members benefit emotionally even if their loved one does not enter treatment (Meyers and Wolfe, 2004).
GROUP SHARING SECTION – Maximum time 30 minutes
13. We will now begin the sharing portion of the meeting. You are invited to share from 3 to 5 minutes about your experience as it relates to your loved one’s recovery, this week’s session or what you are currently working on. Please focus your sharing on potential solutions rather than the problems. We will conclude the sharing five minutes before the end of the meeting. Who would like to begin?
MY COMMITMENTS SECTION – Maximum time 10 minutes
14. Please remember that what has been shared here is confidential and that the opinions expressed are of the individuals who shared them. These are our group commitments, we will start the next CRAFT session by reporting on them. This week I will:
A. Do the in-between session assignments.
· Complete the Self-Assessment Worksheet accompanying this session.
B. Share what I am learning with my family, friends and community.
C. Show kindness to myself by having self-compassion and taking care of myself.
As you listen to the “Rainbow Connection" song think about what you learned in this session. Write your thoughts and personal commitments below.
Watch: “Rainbow Connection” video.
What are the most important things I learned in this session? ________________________________________________________________________________________________________________
What will I do differently because of what I learned? ________________________________________________________________________________________________________________
Evidence Based Programs Handout
CRAFT Connect is a combination of principles and skills curated from Evidence-Based Programs (EBPs). EBP is a process in which behavioral health practitioners combine well-researched interventions with clinical experience and ethics, client preferences and culture to guide and inform the delivery of treatments and services. (See the U.S. federal government’s SAMSHA’s Evidence-Based Practices Resource Center, https://www.samhsa.gov/ebp-resource-center).
CRAFT Connect includes elements of these EBPs:
Community Reinforcement and Family Training (CRAFT)
Peer Support
Dialectical Behavioral Therapy (DBT)
Wellness, and
Motivational Interviewing (MI)
The five levels of CRAFT Connect Family Support are based on “The Pyramid of Family Care” framework included in the United Kingdom, Canadian, Australian, New Zealand and other government behavioral health programs.
Evidence For CRAFT
CRAFT was developed to teach families and other Concerned Significant Others (CSOs) how to positively impact their loved one. It is the leading evidence-based ‘unilateral’ family therapy practice. Clinical trials have shown that when family members engage their loved ones using these positive, supportive, non-confrontational techniques, not only do they find ways to get their loved one into treatment, but the wellbeing of family members themselves increases. Family members report significant reductions in anger, anxiety, depression and negative physical symptoms using the CRAFT method. Research shows that family members benefit emotionally even if their loved one does not enter treatment (Meyers and Wolfe, 2004).
CRAFT/Johnson Intervention/Al-Anon/Nar-Anon comparison chart
The following chart compares studies done to determine the effectiveness of several techniques to engage loved ones in treatment for their addictions. CRAFT has a 64% to 74% success rate at getting those struggling with a substance use disorder to accept professional help. It has been shown to produce four times more patient engagement than Al-Anon/Nar-Anon and almost three times the engagement of the Johnson Institute-style intervention. Overall, those who studied and applied CRAFT principles and skills successfully encouraged approximately two-thirds of their loved ones to attend substance abuse treatment, typically after four to six CRAFT sessions (Meyers and Wolfe, 2004).
Study A – Engaging the Unmotivated in Treatment for Alcohol Problems: A Comparison of Three Strategies for Intervention Through Family Members, William R. Miller, Robert J. Myers, J. Scott Tonigan – University of New Mexico, (c) 1999 American Psychological Association, Inc.
Study B – COMMUNITY REINFORCEMENT AND FAMILY TRAINING (CRAFT): Engaging Unmotivated Drug Users in Treatment, Robert J. Meyers, William R. Miller, Dina E. Hill, J. Scott Tonigan – University of New Mexico, (c) 1999 Elsevier Science Inc.
Study C – A Randomized Trial of Two Methods for Engaging Treatment-Refusing Drug Users Through Concerned Significant Others, Robert J. Meyers, William R. Miller, Jane Ellen Smith, J. Scott Tonigan, (c) 2002 Journal of Consulting and Clinical Psychology
Study D – Engaging resistant adolescents in drug abuse treatment, Holly Barret Waldron, Sheryl Kern-Jones, Charles W. Turner, Thomas R. Peterson, Timothy J. Ozechowski, (c) 2007 Journal of Substance Abuse Treatment
Study E – Community reinforcement training for family and significant others of drug abusers: a unilateral intervention to increase treatment entry of drug users, Kimberly C. Kirby, Douglas B. Marlowe, David S. Festinger, Kerry A. Garvey, Vincent LaMonaca, (c) 1999 Drug and Alcohol Dependence
Research studies (selection)
Community Reinforcement and Family Training: A Pilot Comparison of Group and Self-directed Delivery. Manuel JK, Austin JL, Miller WR, McCrady BS, Tonigan JS, Meyers RJ, Smith JE, Bogenschutz MP. J Subst Abuse Treat. 2012 Jul;43(1):129-36. doi:10.1016/j.jsat.2011.10.020. Epub 2011 Dec 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3331969/
The Community Reinforcement Approach: An Update of the Evidence, Meyers RJ, Roozen HG, Smith JE. Alcohol Res Health. 2011;33(4):380-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860533/
The Community-Reinforcement Approach, Miller WR, Meyers RJ, Hiller-Sturmhöfel S. Alcohol Res Health. 1999;23(2):116-21, https://pubs.niaaa.nih.gov/publications/arh23-2/116-121.pdf
Dutcher, L. W., Anderson, R., Moore, M., Luna-Anderson, C., Meyers, R. J., Delaney, H. D., & Smith, J. E. (2009). The community reinforcement and family training (CRAFT): An effectiveness study. Journal of Behavioral Analysis in Health, Sports, Fitness, and Medicine, 2(1), 80–90.
Evidence for Peer Support
Peer Support or family support services, offers hope, guidance, advocacy, and camaraderie for parents and caregivers (CSOs) of children and youth receiving services from mental health, substance use, and related service systems. Parent support providers deliver peer support through face-to-face support groups, phone calls, or individual meetings. They bring expertise based on their own experience parenting children or youth with social, emotional, behavioral, or substance use challenges, as well as specialized training, to support other parents and caregivers. Working within a peer support framework that recognizes the power of mutuality and experiential understanding, parent support providers deliver education, information, and peer support (Obrochta et al., 2011). Parents trying to identify and access appropriate services for their child (loved one) may find child-serving systems (e.g., mental health, education, juvenile justice, child welfare, substance use treatment) complicated and overwhelming. Peer Support can help parents (and spouses) navigate systems more effectively, learn from the experiences of other families, feel less alone, and gain hope, ideas, and information. This support can help parents meet their children’s needs more efficiently, and with greater confidence and hope. (Kutash et al., 2011, Hoagwood et al., 2009).
Peer Support helps give family members and other CSOs:
Increased sense of collaboration. Receiving skills training and support helps family members collaborate effectively with treatment professionals.
Increased confidence in family members abilities to care for their child.
Increased empowerment to take action. Receiving education about service systems, navigation skills, advocacy skills, and rights helps empower families to become active participants in their child’s services.
Decreased internalized blame. Providing education and connections with others helps family members reframe their experiences and debunk damaging myths about behavioral health conditions and emotional distress.
Recognition of the importance of taking care of yourself. Help families increase their awareness of the need for self-care.
Decreased family isolation. Support family members with identifying and accessing community supports that help them feel less alone.
Research studies (selection)
Eversen, C., & Tierney M. (2012). Results of evaluation of JJA data. Memo to keys for networking for the No Place Like Home project. Washington, DC: American Institutes for Research.
Hoagwood, K.E., Cavaleri, M.A., Olin, S.S., Burns, B.J., Slaton, E., Gruttadaro, D., Hughes, R. Family Support in Children’s Mental Health: A Review and Synthesis. Clinical Child and Family Psychology Review (2010) 13:1-45.
Koroloff, N. M., Friesen, B. J., Reilly, L., & Rinkin, J. (1996). The role of family members in systems of care. In B. A. Stroul (Ed.), Children’s mental health: Creating systems of care in a changing society. Baltimore, MD: Paul H. Brookes Publishing Co.
Kutash, K., Duchnowski, A.J., Green, A.L., & Ferron, John M. Supporting Parents Who Have Youth with Emotional Disturbances Through a Parent-to-Parent Support Program: A Proof of Concept Study Using Random Assignment. Administrative Policy in Mental Health and Mental Health Services Research (2011) 38:412-427.
Leggatt, M., & Woodhead, G. (2015). Family peer support work in early intervention youth mental health service. Early Intervention in Psychiatry. doi: 10.1111/eip.12257
Obrochta, C., Anthony, B., Armstrong, M., Kalil, J., Hust, J., & Kernan, J. (2011). Issue brief: Family-to-family peer support: Models and evaluation. Atlanta, GA: ICF Macro, Outcomes Roundtable for Children and Families. Retrieved from https://www.
Purdy, F. (2010). The core competencies of parent support providers. Rockville, MD: National Federation of Families for Children’s Mental Health. Retrieved from https:// www.ffcmh.org/sites/default/files/%234%20-%20Competencies%20of%20PSP.pdf
Robbins, V., Johnson, J., Barnett, H., Hobstetter, W., Kutash, K., Duchnowski, A. J., & Annis, S. (2008). Parent to parent: A synthesis of the emerging literature. Tampa, FL: University of South Florida, The Louis de la Parte Florida Mental Health Institute, Department of Child & Family Studies. Retrieved from http://cfs.cbcs.usf.edu/_docs/ publications/parent_to_parent.pdf
ffcmh.org/sites/default/files/Issue Brief - Family to Family Peer Support Outcomes Roundtable 2011.pdf
Evidence For Dialectical Behavioral Therapy (DBT)
There is a wealth of evidence supporting the effectiveness of DBT. The first randomized controlled trial (RCT) of DBT was published in 1991, in which Dr. Marsha Linehan and her colleagues found that DBT resulted in significant improvements for chronically suicidal and self-injuring women with borderline personality disorder, a clinical population that had previously been viewed as untreatable (Linehan et al., 1991). In the decades since this landmark study, DBT has been extensively researched for individuals with a wide range of mental health conditions receiving treatment in diverse practice settings around the world. RCT and Non-RCT Summaries.
Research studies
Research on DBT is rapidly expanding, and new studies are being published at increasingly accelerated rates. A PsycInfo search shows an average of 8 published and peer-reviewed DBT articles per year from 1993 to 2000, 41 publications per year from 2001 to 2010, and 78 per year since 2011. As a result, staying current on the latest findings in DBT research can be quite challenging. You can review DBT research updates on Behavioral Tech.org. This webpage is updated regularly to provide researchers, clinicians, clients, and their families with the most up-to-date evidence available on DBT.
Click below for archived, printable summaries of RCT and non-RCT studies.
Evidence for Wellness
Adopting a healthy lifestyle through health promotion and disease prevention efforts is universally applicable to people of all ages and does not differ for persons who experience behavioral health disorders versus those who do not. Studies have shown that health promotion programs which focus on improving functioning across a spectrum of diagnoses and a range of age groups can reduce secondary conditions and visits to health care providers. Lifestyle interventions that are comprised of structured approaches that help consumers engage in physical activity, manage their weight, eat a balanced and healthier diet, and engage in health promotion activities have been found to be of benefit. Moreover, these lifestyle or behavioral modification interventions can be implemented during psychiatric care to help manage body weight and improve quality of life. In fact, intensive interventions that include multiple contacts during individual or group sessions over extended periods of time for adult consumers who are overweight or obese and have known cardiovascular risk factors (hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome) have been proven effective. (Glassheim, B., A Guide to Evidence-Based Wellness Practices, 2016)
Research studies (selection)
Dunn, H. L. (1961). High-Level Wellness. Arlington, VA: Beatty Press.
Fagiolini, A., Frank, E., Scott, J. A., Turkin, S., & Kupfer, D. J. (2005). Metabolic syndrome in bipolar disorder: Findings from the Bipolar Disorder Center for Pennsylvanians. Bipolar Disorders, 7(5), 424–430.
McEvoy, J. P., Meyer, J. M., Goff, D. C., et al. (2005). Prevalence of the metabolic syndrome in patients with schizophrenia:Baseline results from the Clinical Antipsychotic Trials of
Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia Research, 80(1), 19–32.
Newcomer, J. W. (2005). Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs,19 (suppl 1), 1–93.
Pan, A., Okereke, O., Sun, Q., Logroscino, G., Manson, J., Willett, W., et al. (2011). Depression and incident stroke in women. Stroke, 42, 2770–2775.
Parks, J., Radke, A. Q., & Mazade, N. A. (Eds.). (2008). Measurement of health status for people with serious mental illness.Alexandria, VA: NASMHPD Medical Directors Council. Retrieved from http://www.nasmhpd.org/docs/publications/MDCdocs/NASMHPD%20Medical%20Directors%20Health%20Indicators%20Report
Parks, J., Svendsen, D., Singer, P., & Foti, M. E. (Eds.). (2006). Morbidity and mortality in people with serious mental illness. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. Retrieved from http://www.nasmhpd.org/docs/publications/MDCdocs/Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf
Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29(4), 311–314.
The Substance Abuse and Mental Health Services Administration. (n.d.). Trauma definition. Retrieved from http://www.samhsa.gov/traumajustice/traumadefinition/definition.aspx
Evidence for Motivational Interview (MI)
Basic MI research illustrates its effectiveness as a prelude to other treatments or combined with additional psychotherapy techniques or modalities. Diverse and adaptable, MI shows positive outcomes in validity, reliability, and potential to be carried out in a multitude of settings and contexts. MI is named an EBP, reporting efficacious outcomes in over 300 peer-reviewed research studies. In one of the largest analyses done on motivational interviewing’s overall effectiveness, researchers reviewed over 115 studies to sum the average effects that influence MI outcomes.5 They examined treatment length, the most effective time to use MI, diverse deliveries of MI, manual use, ideal populations, specific problematic behaviors, and use with other evidence-based practices and levels of care. Results varied slightly between study and format, but overall they were able to generate the following effects of motivational interviewing:
MI was effective for 75% of all participants, significantly effective overall compared to no treatment, and as effective as other evidence-based treatments for substance use disorder (e.g. cognitive-behavioral therapy, Twelve-Step Facilitation);
MI is most effective when used as a prelude to other treatments or in addition to other treatments;
MI is typically completed in one to two sessions and/or four to six sessions with Motivational Enhancement Therapy (MET). Research is unclear on ideal treatment length; however, more sessions tend to lead to better long-term outcomes;
No MI manual use in sessions is significantly more effective than strict use of a manual;
MI is ideal for all populations regardless of gender, age, or problem severity and shows the greatest impact in minority populations when compared to other common substance use disorder treatments;
MI can increases client engagement up to 15 % and increase treatment retention when given at intake assessment.
Evidence for The Pyramid of Family Care
The Pyramid of Family Care was designed in Australia to provide a framework for implementing integrated and coordinated care and support for CSOs with loved ones who have behavioral health disorders. It is based on two premises: (1) if all CSOs have their basic needs met, then only a small proportion will require more specialized services, and (2) it is within the scope and competence of front line behavioral health workers and peers to engage, assess and address the basic needs of most CSOs.
The Pyramid features five hierarchical levels of tasks for meeting the support needs of CSOs. As one moves up the pyramid, the intensity of intervention increases while the number of CSOs who are likely to require the intervention decreases. The bottom two levels of the pyramid. Levels 1 (connection and assessment) and 2 (general education) are the minimum level of service that should be available to all CSOs.
Research results show that if the pyramid is implemented as it was intended family caregivers indicated that they found the following helpful:
Skill building and information sharing;
Help navigating the system;
Advocacy in times of crisis; and
Family meetings.
Research studies (selection)
Pyramid of Family Care: A framework for family involvement with adult mental health services.
Mottaghipour Y. & Bickerton A., 2005)
MacCourt P., Family Caregivers Advisory Committee, Mental Health Commission of Canada. (2013). National Guidelines for a Comprehensive Service System to Support Family Caregivers of Adults with Mental Health Problems and Illnesses. Calgary, AB: Mental Health Commission of Canada. Retrieved from: http://www.mentalhealthcommission.ca