William R Mcfarlane

Maine Medical Center Research Institute | MMCRI · Department of Psychiatry

Recreational cannabis use has recently gained considerable interest as an environmental risk factor that triggers the onset of psychosis. To date, however, the evidence that cannabis is associated with negative outcomes in individuals at clinical high risk (CHR) for psychosis is inconsistent. The present study tracked cannabis usage over a 2-year p...

Objective Despite the appeal of early intervention in psychosis, there is concern that identifying youth as having high psychosis risk (PR) may trigger stigma. This study employed a pre-post design to measure change in PR participants' emotions about PR upon being told of their PR status and according to whether this was the first time receiving th...

Background Identifying risk factors of individuals in a clinical-high-risk state for psychosis are vital to prevention and early intervention efforts. Among prodromal abnormalities, cognitive functioning has shown intermediate levels of impairment in CHR relative to first-episode psychosis and healthy controls, highlighting a potential role as a ri...

Background: As efforts intensify to intervene early among those at risk for psychosis, examination of the relationship between presenting psychopathology and long-term functional outcome may guide treatment decision-making and offer a means to prevent or reduce chronic disability. Methods: Data were collected through the Early Detection and Inte...

Background In spite of advances in early intervention in major mental illness, concerns linger regarding the risks of identifying youth as at clinical high risk (CHR) for psychosis. In particular, stigma in this population has been associated with increased emotional distress, social withdrawal, non-engagement in treatment, and suicide risk. Being...

Background: Identifying young people as at clinical high-risk (CHR) for psychosis affords opportunities for intervention to possibly prevent psychosis onset. Yet such CHR identification could plausibly increase stigma. We do not know whether these youth already perceive themselves to be at psychosis-risk (PR) or how their being told they are at PR...

Background The clinical high-risk state for psychosis syndrome (CHR) offers substantial potential benefits in terms of early identification and treatment for at-risk youth. Early treatment might lead to decreased symptoms, thus leading to reduced symptom-related stigma. However, stigma of the clinical high-risk state for psychosis designation might...

Cognitive deficits have an important role in the neurodevelopment of schizophrenia and other psychotic disorders. However, there is a continuing debate as to whether cognitive impairments in the psychosis prodrome are stable predictors of eventual psychosis or undergo a decline due to the onset of psychosis. In the present study, to determine how c...

Aim: To identify and compare the sensory characteristics of young people at clinical high risk (CHR) for psychosis to those of peers at clinical low risk (CLR), and to national normative data. CHR and CLR participants were recruited from 6 US regions. Method: A descriptive cohort design was used to analyse baseline data collected as part of the...

Background: As efforts intensify to identify and intervene early among those at risk for psychosis, examination of the predictive relationship between presenting psychopathology and functional outcome may guide treatment decision-making and offer a means to prevent or reduce chronic disability. Methods: Data were collected through the Early Detecti...

Background: While the clinical high risk state for psychosis syndrome (CHR) offers substantial benefits, being identified as CHR may also elicit stigma. Specifically, the comparative impacts upon youths’ self-concept of being “told” by others, versus initial self-identification of being at-risk (i.e., what CHR youth themselves “think”) remains unkn...

Objective: As part of the second phase of the North American Prodrome Longitudinal Study (NAPLS-2), Cannon and colleagues report, concurrently with the present article, on a risk calculator for the individualized prediction of a psychotic disorder in a 2-year period. The present study represents an external validation of the NAPLS-2 psychosis risk...

Family psychoeducation as a treatment for schizophrenia was developed 40 years ago almost simultaneously and independently by investigators who at the time were not family therapists. Although the original goal was to decrease high expressed emotion as a means of preventing relapse, later variations have gone beyond to focus on social and role func...

Objective: This study assessed the effects of a community outreach and education model implemented as part of the Early Detection, Intervention and Prevention of Psychosis Program (EDIPPP), a national multisite study in six U.S. regions. Methods: EDIPPP's model was designed to generate rapid referrals of youths at clinical high risk of psychosis...

AimThe Scale of Prodromal Symptoms (SOPS) was developed to identify individuals experiencing early signs of psychosis, a critical first step towards early intervention. Preliminary dimension reduction analyses suggested that psychosis-risk symptoms may deviate from the traditional symptom structure of schizophrenia, but findings have been inconsist...

Objective: To test effectiveness of the Early Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving functioning in a national sample of at-risk youth. Methods: In a risk-based allocation study design, 337 youth (age 12–25) at risk of psychosis were assigned to treatment groups based...

Objective: This study examined whether the incidence of hospitalization for psychosis was reduced by a communitywide system of early identification and intervention to prevent onset of psychosis. Methods: The Portland Identification and Early Referral program (PIER) was initiated in 2001. Youths and young adults ages 12-35 were identified by pro...

psychoeducational approach [to family therapy] is in use most extensively with families of patients with schizophrenia / deal primarily with theoretical issues and clinical techniques primarily relevant to [schizophrenia] healthy or well-functioning family / dysfunctional family / assessment of system functioning / goal setting / structure of the...

Schizophrenia and related psychotic disorders are associated with significant neuropsychological (NP) impairments. Yet the onset and developmental evolution of these impairments remains incompletely characterized. This study examined NP functioning over one year in a sample of youth at clinical high risk (CHR) for psychosis participating in a treat...

This article reviews the theoretical, conceptual and empirical background for the current and growing research on early identification and early intervention to obtain improved outcomes in psychotic disorders. The goal is to prevent episodes of psychosis and the functional disability that accompanies them. Described are the studies linking duration...

Objective: To describe the rationale, design, intervention, and sample characteristics of the Early Detection, Intervention, and Prevention of Psychosis Program (EDIPPP), a multi-site study of the effectiveness of Family-Aided Assertive Community Treatment (FACT) in preventing the onset of psychosis in a nationally representative sample of at-risk...

Among potential resources for people with serious mental illnesses (SMI) and their families, professionally delivered family psychoeducation (FPE) is designed to engage, inform, and educate family members, so that they can assist the person with SMI in managing their illness. In this article, we review research regarding FPE outcomes and implementa...

The Oklahoma City Veterans Affairs (VA) Medical Center modified an evidence-based model of family psychoeducation (the multifamily group model; McFarlane, 2002) and implemented it for the first time in a VA setting and with veterans living with posttraumatic stress disorder (PTSD). Named the REACH Program (Reaching out to Educate and Assist Caring,...

Long a desired goal but increasingly a focus of research on clinical practice, prevention of psychosis has emerged as one of the most promising and effective areas of investigational interest and effort in psychiatry. Spurred by long-term studies that have associated outcome with duration of untreated psychosis, current research is focused on impro...

Multifamily group psychoeducation (MFG) has been shown to reduce relapse rates among individuals with first-episode psychosis. However, given the cognitive demands associated with participating in this intervention (e.g., learning and applying a structured problem-solving activity), the cognitive deficits that accompany psychotic disorders may limi...

The Portland Identification and Early Referral (PIER) Program, a mental health treatment research program in Portland, Maine, has developed a successful community outreach model for the identification of young people at risk for severe mental illness. Historically, PIER has focused its outreach efforts on educational and healthcare professionals bu...

Characterizing neuropsychological (NP) functioning of individuals at clinical high risk (CHR) for psychosis may be useful for prediction of psychosis and understanding functional outcome. The degree to which NP impairments are associated with general cognitive ability and/or later emergence of full psychosis in CHR samples requires study with well-...

Reports an error in "Adapting the multifamily group model to the Veterans Affairs system: The REACH Program" by Michelle D. Sherman, Ellen P. Fischer, Kristen Sorocco and William R. McFarlane (Professional Psychology: Research and Practice, 2009[Dec], Vol 40[6], 593-600). The copyright for this article was incorrectly listed. This article is in the...

The Portland [Maine] Identification and Early Referral (PIER) program was established in 2000 as a prevention system for identifying and treating youths at high risk of an initial psychotic episode. During six years, 7,270 professionals from the educational, medical, and mental health sectors were provided information on prodromal symptoms and mean...

[Correction Notice: An erratum for this article was reported in Vol 41(4) of Professional Psychology: Research and Practice (see record 2010-17073-006). The copyright for this article was incorrectly listed. This article is in the Public Domain. The online version has been corrected.] The Oklahoma City Veterans Affairs (VA) Medical Center modifie...

Family psychoeducation (FPE) is one of six evidence-based practices endorsed by the Center for Mental Health Services for individuals suffering from chronic mental illnesses. Multiple family group psychoeducation (MFG) has been shown to be an effective component of FPE in reducing symptom relapses and rehospitalizations for individuals with schizop...

Does the McFarlane et al study 1 provide a model for practical trials? Unfortunately, not. The methodological problems are here reviewed and used as a springboard to set out methodological criteria that might define such a model.

This article summarizes the published results of the Employment Intervention Demonstration Program (EIDP), a federally-funded, multi-site study examining the effectiveness of supported employment programs for 1273 unemployed individuals with psychiatric disabilities in the U.S. Findings confirm the effectiveness of supported employment across diffe...

This study compared components of expressed emotion (EE; rejection, warmth, protectiveness, and fusion) across three samples: two in which the subjects had an established schizophrenic or mood disorder, and a third in which the subjects were at high risk for an initial psychosis. Family members rated themselves on the Social Adjustment Scale-III an...

Psychoeducational multifamily group treatment based on the McFarlane model was implemented for adult patients experiencing a first episode of psychosis and for the families of 301 patients. Patients were participants in a research project in Norway and Denmark. Of 301 patients 246 were invited to participate and 147 agreed. Patients' reluctance to...

Effects of co-occurring disorders on work outcomes were explored among individuals with severe mental illness who were participating in a multisite randomized study of supported employment. At seven sites, 1,273 people were randomly assigned to an experimental supported employment program or a control condition and followed for 2 years. Multivariat...

The Ticket to Work and Work Incentives Improvement Act of 1999 removes work disincentives and promotes access to vocational services for people with disabilities. This study calculated the amount of payments that would have been made to employment service providers if study participants had been enrolled in the Ticket program. Data were from 450 So...

This concise introduction to evidence-based social work practice culls the most salient chapters from the interdisciplinary Evidence-Based Practice Manual to form a student-friendly overview of the issues and interventions they will encounter throughout their BSW or MSW program. LPart I defines terms and critical issues, introducing students to the...

Research has shown that supported employment programs are effective in helping psychiatric outpatients achieve vocational outcomes, yet not all program participants are able to realize their employment goals. This study used 24 months of longitudinal data from a multisite study of supported employment interventions to examine the relationship of pa...

Few studies have sought to determine which specific supported employment services improve employment outcomes for people with pyschiatric disabilities. This study examined the effects of job development and job support among other services on acquisition and retention of competitive employment. Data used in the analysis came from seven sites of the...

Although large-scale surveys indicate that patients with severe mental illness want to work, their unemployment rate is three to five times that of the general adult population. This multisite, randomized implementation effectiveness trial examined the impact of highly integrated psychiatric and vocational rehabilitation services on the likelihood...

National probability surveys indicate that most individuals with schizophrenia and other severe mental illnesses are not employed. This multisite study tested the effectiveness of supported employment (SE) models combining clinical and vocational rehabilitation services to establish competitive employment. We randomly assigned 1273 outpatients with...

This paper describes psychoeducation and its applications for mental health and health professions across system levels and in different contexts by reviewing the range of applications that have appeared in the recent literature. The theoretical foundations of clinically based psychoeducation are reviewed and the common elements of practice are ide...

Family psychoeducation has emerged as a treatment of choice for schizophrenia, bipolar disorder, major depression, and other disorders. More than 30 randomized clinical trials have demonstrated reduced relapse rates, improved recovery of patients, and improved family well-being among participants. Interventions common to effective family psychoeduc...

Comments on the article by G. Lemmens et al (see record 2003-02684-007) that investigated differences in perception of helpful events between a therapeutic team and families with a chronic pain patient in Family Discussion Groups. The commentator highlights various contributions of this article including the emphasis on participant views. It is st...

As the number of studies related to the early identification of and intervention in the schizophrenia prodrome continues to grow, it becomes increasingly critical to develop methods to diagnose this new clinical entity with validity. Furthermore, given the low incidence of patients and the need for multisite collaboration, diagnostic and symptom se...

Outpatient and inpatient mental health service outcomes for outpatients with schizophrenia or schizoaffective disorder who received psychoeducational multiple-family group treatment were compared with outcomes for similar patients who received standard care. A total of 106 outpatients with schizophrenia or schizoaffective disorder who were receivin...

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 p...

The aim of this study was to determine whether it is possible at the time of staff training to predict whether a mental health center will succeed in implementing family psychoeducation services. Fifteen mental health agencies in Maine and 51 in Illinois in which clinicians and administrators were trained in multifamily psychoeducation were studied...

Among all medical disorders, schizophrenia is one of the costliest and most severe, creating nearly continuous disability for a lifetime in the great majority of cases. 1% of the population suffers from this disorder, even though the incidence is low, about 1/10,000 per year. It is a devastating disorder for families, who often assume major caretak...

Outcomes for negative symptoms over a one-year period were examined in two groups of patients, one receiving psychoeducational multiple-family group treatment and one receiving standard care. A total of 63 outpatients, ages 18 to 45 years, with DSM-IV diagnoses of schizophrenic disorders were randomly assigned to standard care or multiple-family gr...

Family-aided assertive community treatment (FACT) was enhanced by adding vocational specialists to help persons with severe mental illness obtain competitive employment. Results were then tested against those of conventional vocational rehabilitation (CVR). The FACT cohort demonstrated significantly better employment rates than did the CVR, while n...

Expert Consensus Guidelines for Schizophrenia 1999

The cornerstone of any psychiatric evaluation, the mental status exam, requires an assessment of insight -- a term commonly employed by clinicians to describe a patient’s awareness (or lack thereof) of having a mental disorder. However, the relationship between the accuracy of self-knowledge and mental health is complex, and as a result the term “i...

Family Psychoeducation and Assertive Community Treatment are both state-of-the-art service systems with rich empirical foundations, demonstrating unusual effectiveness in randomized clinical trials. Recent research suggests a possible additive effect on selected outcomes when the two approaches are integrated. This paper reviews the role of family...

The study examined differences in outcomes for patients with schizophrenic disorders who were receiving assertive community treatment based on whether their families were involved in their treatment more intensively in psychoeducational multifamily groups or episodically in crisis family intervention. Sixty-eight individuals who met DSM-III-R crite...

To compare outcomes in psychoeducational multiple-family group treatment vs psychoeducational single-family treatment. A total of 172 acutely psychotic patients, aged 18 to 45 years, with DSM-III-R schizophrenic disorders were randomly assigned to single- or multiple-family psychoeducational treatment at six public hospitals in the state of New Yor...

Earlier studies of family psychoeducation and clinical reports on multiple family groups (MFGs) have reported substantial reductions in relapse rates for patients with schizophrenia. These groups offer an expanded social network and thereby may confer a margin of protection against relapse. However, to date, there has not been an empirical trial of...

Objective: To compare outcomes in psychoeducational multiple-family group treatment vs psychoeducational single-family treatment. Method: A total of 172 acutely psychotic patients, aged 18 to 45 years, with DSM-III-R schizophrenic disorders were randomly assigned to single- or multiple-family psychoeducational treatment at six public hospitals in...

The New York Family Support Demonstration Project was begun in 1984 to translate the results of research on family psychoeducation in the treatment of schizophrenia into general practice. Goals were to compare experimentally a single-family psychoeducation model with a multiple-family group format, to replicate successful outcomes in ordinary clini...

By combining the therapeutic and rehabilitative effects of assertive community treatment, family psychoeducation, and the multifamily group, better use of an expanded social network yields a more coordinated clinical effort and an enhanced level of community adaptation for patients with chronic schizophrenia.

The prevailing approach to rehabilitation in residential care emphasizes goal attainment. This approach often produces considerable stress for residents, most of whom have schizophrenia. Based on the view that low-demand environments, incorporating graduated expectations, may be more appropriate for this patient population, a three-component model...

Family psychoeducation and multi-family groups have demonstrated remarkable effects on relapse rates and rehabilitation outcomes for schizophrenia. The components of this approach include techniques for 1) establishing an empathic collaboration with family members, 2) providing information about the illness and specific guidelines for ongoing manag...

Schizophrenia, as a failure to achieve maturity and independence, has always had distressing effects on a patient's family. Unfortunately, scientific theories that propose the family itself as a contributing factor have eroded the alliance between professionals and family members and added to the burden of family guilt. The initiative in designing...