Effectiveness, feasibility, and acceptability of an online Family Empowerment Program (FEP) for people negatively impacted by their relative's substance use and mental health conditions.

Community Reinforcement and Family Training (CRAFT) is an evidence-based counselling program based on cognitive behavioural therapy and motivational interviewing techniques that helps family members to improve their wellbeing, reduce substance use by their relative and support that relative to engage in treatment. In this trial we are delivering CRAFT online and calling it the Family Empowerment Program (FEP). The randomized wait-list control trial will assess the effectiveness, feasibility and acceptability of online FEP with a parallel group, two-arm, superiority design with a 1:1 allocation ratio comparing online FEP with a wait-list control. Given the lack of information regarding substance use interventions for families of people with a mental health condition qualitative methods will explore the experiences of study participants as well as clinicians and referral agents. Clinicians delivering FEP will attend 2 days face to face training on the program procedures delivered by an accredited trainer. Training will be held one month before recruitment into the trial commences. The training manual is attached in project materials. They will be subsequently accredited by the same trainer via submitting recordings of FEP counselling sessions that will be evaluated against the standard CRAFT procedures. Clinicians must be registered or provisional psychologists, social workers, occupational therapists or mental health nurses with at least 2 years experience in counselling. Clinicians delivering FEP will be trained and accredited using the standard procedures and assessments established by Robert J. Meyers (therapist certification - Robert J. Meyers, Ph.D. - Workshops (robertjmeyersphd.com) . The study will be conducted in Australia. The FEP program will be delivered online to people meeting the inclusion criteria who live in a rural area (Modified Monash Model 2-7) of NSW, Victoria and QLD. The program will be delivered from the worksites of the clinicians trained and accredited and employed to deliver it using Zoom as the delivery platform. The Family Empowerment Program Online comprises 6 sessions of 60 minutes each delivered to individuals. A further two sessions will be available if participants wish to consolidate any skills or revisit a topic. The key focus of sessions is on learning new skills and how to use them, so that participants can change the way they behave and interact with their loved ones. Skills that participants will learn include effective communication and problem-solving skills; how to be more assertive while not provoking conflict and how to improve their own sense of well-being. FEP Program schedule Six sessions make up the FEP program. The order of sessions can be moved around if required. Session 1, building motivation and self-care, includes introducing the family member to FEP rationale, psychoeducation, and establishing self-care goals. Session 2, communication, includes general positive communication strategies and role plays. Session 3, functional analysis of client substance use, includes identifying the client's typical substance use behavior, internal and external triggers, short-term positive consequences, and long-term negative consequences. Session 4, positive reinforcement, includes reinforcement of recovery-oriented non-substance use behaviors. Session 5 problem-solving and natural consequences, includes practice of problem-solving procedures, provides guidelines for allowing for natural consequences of substance use to occur. Session 6, discussing treatment engagement, includes “windows of opportunity” and “motivational hooks” for engaging a loved one in treatment. Program review and next steps, includes a summary and review of program topics, planning to maintain progress and skill work, and providing additional resources or 2 extra sessions if required by the participant. Milestone conversations (weeks 2,3 & 6) Designed to reduce the family members assumptions about what is important and rewarding about substance use to their relative and to ascertain the relative’s views on substance treatment. (1) What is most important to their relative currently? What are they looking forward to? What do they enjoy doing? (2) What are their relative's substance use patterns and what benefits do they get? (3) How does their relative feel about substance treatment? What is their experience with it? Milestone conversations are planned during the session in week 2, 3 or 6 and intended to be undertaken by the study participant with their relative before the next session. Milestone conversations will take 15 minutes to plan.