Keshet A cognitive communication course for Parents, spouses, siblings and other family members Noami Hadas-Lidor (PhD), Dorit Redlich, Rapaport Andrea, Penina Weiss (PhD),
background • The State of Israel has a population of 8 million citizens. Out of them, an estimated 120 thousand people, cope with psychiatric diseases, and usually have family members that share the struggle. • 3.5 thousand are hospitalized, and over 25 thousand receive community based rehabilitation services. 2
Families in which one member suffers from a mental health illness: • The onset of severe mental illness in one of the family members is a traumatic experience for all family members. • Studies have identified and documented feelings of stress and burden within the family. • Families that are identified as a high risk population are those with: • A high divorce rate (70%) with the mother remaining as main caregiver • A high rate of morbidity • Financial – loss of working days
Rational • Many parents and family members, strive to improve the quality of both their and their son/s or daughter/s lives, despite the disability. • They wish to be involved in and to be an active part of the treatment and rehabilitation process.
Many parents feel frustrated from searching for ways of coping with the situation; explaining to friends and neighbors what their son/s or daughter/s is suffering from
why he hasn ’ t yet found a job? why he didn ’ t go to university? • why he never joined the army? • and why he isn ’ t married? •
• We too, the members of Keshet, share these aspirations. • We believe in the need to "come out" of professional fortifications and the mysterious atmosphere surrounding them.
•Our objective •"Insurance policy"
The Overall plan of Keshet The Keshet program is an academic course.
The Keshet program was initiated, founded and is currently directed by Dr. Noami Hadas-Lidor, along with a growing team of parents and expert health related professionals.
Keshet ’ s founder
Penina Noami Andrea Aya Dorit
Definition of the problem Due to changes in the mental health system and the incorporation of the family as a meaningful partner in the community mental health system; Suitable intervention structured around family members, was needed to be created.
- תשק Keshet • In Hebrew, “ Keshet ” means rainbow • The initials stand for: ק - Advancement ש - Sharing and ת - Communication .
• Keshet does not support or psycho education groups: • It does not focus on the illness, but rather it emphasizes a universal outlook on cognitive modifiability and cognitive communication (mediation). • It provides tools for enhanced coping for the parent within the family and in dealings with mental health services personnel. • It is an academic structured standardized course.
The Objectives of Keshet • Instruction • Implementation • Empowerment
What do parents want? • Improve communication • Encourage the son/s or daughter/s self responsibility. • To improve the son/s or daughter/s awareness and consideration of his/her environment • To improve the son/s or daughter/s independence his/ her everyday activities and functions. 17
• To improve communication within the family. • To improve communication with health care professional's. • To learn how to be an active, involved, and responsible parent, participating in the • treatment of the son/s or daughter/s .
The course takes place in academic facilities It includes 15 biweekly 3 academic hour meetings Every course has 3 instructors: 2 experts in the clinical field and theory of D.C.I. 1 parent (who had previously participated in a Keshet Course)
The course consists of: • Lectures • Workshops • Group analysis of daily life episodes, submitted by course participants • Home assignments. • Group discussions
• Viewing and analyzing films that deal with recovery issues and dynamic cognitive intervention. • Reading of articles. • Writing and analyzing exercises (daily life episodes).
Course Content Central Issues • What is cognition • Cognition as a different way to understand behavior. • The ability to change in order to improve family life: change of content change of process change of structure.
• The connection between cognition, emotion and behavior. • Mediated Learning Experiences-M.L.E • Acquiring of cognitive milestones for enhancing sharing and reciprocity.
The Theoretical Bases of KESHET • Structural Cognitive Modifiability (SCM) , 1991 ) (Feuerstein, Rand, & Hoffman,1979 • Dynamic Cognitive Intervention (DCI) (Hadas-Lidor & Weiss, 2005. 2011, 2018) • Recovery (Anthony, 1993; Deegan, 1996).
Structural Cognitive Modifiability (SCM) The belief in a persons ability to change regardless of age health status and diagnosis ( Feuerstein, Rand, & Hoffman,1979) Feurstein ’ s work is implemented for adults and • children with special needs in over 42 countries worldwide. • We adopted his concept and adjusted it to the DCI model in the KESHET project. (Hadas-Lidor, Weiss & Kozulin 2004, 2006, 2011, 2018)
R. Feuerstein- “The Father” of the Concept
DCI is an expansion of SCM. DCI started in Israel in 1994. DCI views client as an equal partner in the therapeutic process. This attitude leads to the empowerment of all those involved in the therapeutic process, a concept recognized as crucial also in recovery terminology. (Hadas-Lidor & Weiss, 2005, 2011, 2018)
Conditions for change Mediated Learning experience- M.L.E Suitable environments.
Mediated Learning Experience (MLE) • MLE – is a special intentional interaction between a mediator learner and stimulus. • The goal of the mediator is to adjust the stimulation, and to process it, so that it will be understood by the student.
Model of learning through mediation
12 Mediation Components
The 4 Essential Components for a Mediated Interaction . I ntentionality and Transference Reciprocity Competence Meaning
Meaningful Interactional Life Event My son called me to tell me that he had enrolled in a drug rehabilitation program. Me: "Excellent, I hope this time you stick with the program.” A few days later I called to remind him- “The first meeting is today!” He replied, sounding annoyed- “I know!” He is so impatient, I want to help him persist in the program…He always drops out…I need help!
Where are we today • 16 years • 50 courses • 600 family • At the beginning Financial support for 6 Courses was given by the Israeli National Insurance Foundation. • Now the Ministry of Health funds 80% of the course cost
• Today courses take place in: Tel-Aviv, Jerusalem, Haifa, Netania, Bear- Sheva and In Arab and ultra-Orthodox society. • At the request of graduates from the first courses, a follow-up course was opened. It enhanced learning and assimilation and was led by a graduate parent.
• “ The course introduced me to a new language. I learned that in order to be flexible in thought and behavior, I needed to enrich both my husband's and my tool box. “ • “ Now I know how to organize events in my life, I learned how to arrange them, and how to deal with them one by one. “
A few Results • The son who started talking after six years of silence. • The son who loves books so much he finally went to the book store by himself. • The couple who traveled for two weeks alone. Something they hadn't done since their son became ill. • “I got my wife back”.
Finally • It is important to notice that the KESHET project has been accompanied by EBP research from its beginning.
A staff meeting at Noami ’ s home
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