comparison CRAFT and P-REACH


1		Author: Lara Okoloko, LICSW can be reached at lara.okoloko@caresnw.com			This section edited with help from Cordelia Kraus and Ken Carpenter
2		Note: The notes in the communication section are all part of the Positive Communication CRAFT Procedure.
3		CRAFT - Community Reinforcement and Family Training	Psychosis REACH - Recovery by Enabling Adult Carers at Home	Motivational Interviewing	Invitation to Change	SPACE -Supportive Parenting for Anxious Childhood Emotions, adaptation for "failure to launch" emerging adults

4	Communication
5	express Understanding	Make an understanding statement "I get it, you are feeling really worried"	Use empathic statements "I can see why that would worry you"	Reflective listening "You are worried about that." (OARS skill)	Make an understanding statement "I get it, you are feeling really worried" (SURF skill)	Express a supportive attitude towards the genuine distress experienced by the adult child
6	Normalize	N/A	Normalize: "I would be worried too, if I thought I was being harmed irreparably"	N/A	Offer Validation: "It makes sense that you feel that way" (LOVE skill)
7	Questions	N/A	Curious questioning "Tell me more about the sensations you are noticing. When else have you felt a sesnation like this?"	Open ended questions:"Tell me more about the sensations you are noticing. When else have you felt something like this?" (OARS skill)	Open ended questions: "Tell me more about the sensations you are noticing. When else have you felt something like this?" (from Motivational Interviewing's OARS skill)
8	Collaboration	Share responsibility: "I know its hard to talk about this because I have been pretty harsh in the past and said some judgemental things."	Collaboration without collusion: "That is not my experience but I can see how that would be very frightening"	Spirit of MI: collaborative, compassionate, respect autonomy	Share responsibility: "I know its hard to talk about this because I have been pretty harsh in the past and said some judgemental things." (SURF skill)
9	Collaboration	Offer to help: "Could I give you a ride to your therapist tomorrow?" or "Lets avoid this arguement next time, would it be helpful if I also didn't drink at the party next weekend?"	N/A	N/A	N/A
10	Positive language	State things "in the positive" as requests instead of complaints; identify prefered behavior rather than requesting to stop a behavior, be specific. "I would appreciate if you would leave your keys here and take an uber if are planning on drinking tonight."	N/A	Spirit of MI: collaborative, compassionate, respect autonomy	N/A
11	Positive language	Be positive - avoid blaming, name calling, over-generalizing or negative tone	N/A		Conversational Traps "The Labeling Trap"
12	Feelings	Make I-feel statements "I feel on edge when its after midnight and I have not heard from you yet."			Label your feelings: "I feel sad about what happened." (SURF skill)
13	Affirmation	N/A	N/A	Affirmation: "You handled that situation really well." (OARS skill)	Affirmation: "You handled that situation really well." (from Motivational Interviewing's OARS skill)
14	Summarize	N/A	FIRST skill: Review the information you have learned in conversation with your loved one, summarize	Offer a summary of key points you have heard (OARS skill)	Offer a summary of key points you have heard (from Motivational Interviewing's OARS skill)
15	Communication guidelines	Be brief			Awareness of Conversational Traps: Red and Green Lights (looking for times when convo more likely to start with a green).
16	Communication guidelines	Idenify sober times or other good opportunities to talk
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18	Other Skills
19	Each skill area is color blocked to account for multiple tasks in some areas. Use n/a to note if your approach does not have a task for a particular skill.
20	Relationship Improvement	Helping CSO's Enrich their own Lives Procedure: Family relationship satisfaction is on the happiness scale, some CSo's will choose relationship improvement for goal setting in this procedure	Fall back on relationship: shared goal setting	Be genuine and authentic
21			Fall back on relationship: befriend/shared interests	Affirm autonomy of the other person: "Its your choice to quit or not"
22			Try out the skills together, get feedback	Offer positive regard: all people have inherent worth, be respectful, treat people with dignity
23	Psycho-education	Rewarding non-using behavior Procedure : part of this procedure is ask CSO to identify signs of drug use	psycho-education about psychosis		Ambivalence is Normal offers guidance on the role that ambivalnce can play in the change process
24		Inviting IP to enter treatment Procedure: part of this procedure includes coaching about how to find appropriate treatment			Onse size does not fit all: provides information about the change process and the numerous factors that can infleunce the function of substance use for individuals, expands the idea of what treatment can look like for each individual.
25		Use non-stigmatizing language, non-judgemental attitude			Marathon not a sprint, Non Attachment to Outcome. Family is the Expert in their situation.
26	Self care	Helping CSO's Enrich their own Lives Procedure happiness scale + self care goal setting	stress bucket handout		Caring for oneself involves the practice of bringing awareness to one's experiences (internal and extrnal); clarifying values, and the role of adopting an open stance to one's experiences when acting in accordance with one's values (from ACT therapy)	Engaging support from outside the nuclear family to reduce isolation and shame
27			practice coping skills with your loved one		Uses Kristin Neff's self compassion model to introduce the concept for building resilience and navigating shame
28	Problem Solving	Problem Solving Procedure Problem solving brainstorm procedure and narrow down to create behavioral goal for the CSO	Skill development: problem solve with your loved one on how to use skills
29	Shared goal setting	N/A	Identify and communicate about shared goals with your loved one
30	Understanding Behavior	Functional Analysis Procedure that assists the CSO to chart external triggers, internal triggers, behaviors, positive and negative consequences for IP's drug use behavior, IP's sober behavior, and CSO's own behavior	Instructs carer to make links between thoughts, behaviors, feelings when talking to their family member		Stepping Away and Limit Setting. Behavioral reducing strategies focus on removing positive reinforcers for unwanted behavior. Boundaries/limits are discussed in terms of a value driven, act of self-compassion for the CSO.	Coaches parents to identify ways in which they are accomodating the lack of function in their adult child, and work to systematically reduce the accomodation to promote gradually better function. For example, if parents have barred visitors from the home due to the distress social interactions cause to their adult child, they can opt to open their home to guests and invite guests to express support and care to the adult child.
31		Allowing Natural Negative Consequences of Use Procedure Instructs CSO to allow natural consequences when safe to allow, address obsticles to doing so			Behaviors Make Sense: Provides CSO's with the lenses that behaviors or a behavioral repertiore is a function of reinforcement. The fucntional analysis procedure is one tool used to accomplish this.
32		Rewarding non-using behavior Procedure Has CSO identify target positive behaviors and identify rewards to apply			Natural Consequence Frames the concept of natural consequences and offers a worksheet to think through its applicability the context of the CSOs circumstances.	Example: making internet access at home contingent on some functional progress by the adult child, such as job applications
33		Withdrawing Rewards for using behavior Procedure Has CSO withhold reward when positive target behavior is not present ("the big chill")			Positive Reinforcement for strengthening behaviors CSOs would like to support; including behaviors that are non-substance use	Example: turning off of internet during the day to allow the adult child to "experience the boredom that would naturally result from lack of productive endeavours."
34					Coaches willingness of the CSO have difficult internal experiences (thoughts, emotions, body sensations, images, memories, etc.) and also act in a way that is in service of values. (Ex: willingness to feel awkward in order to practice skills in a role play as building skills is more important than the avoidance of feeling awkward.)
35	Violence	Not a procedure, but instructs CRAFT helper to screen for violence
36	Treatment Engagement	Inviting IP to enter treatment Procedure Treatment engagement procedure prepares the CSO to establish appropriate treatment options, use positive communication to encourage "sampling" or beginning treatment			Positioned in the communication skills. Aligns with CRAFT in terms of providing 'motivational hooks' and looking for opportunities to engage in the conversation (aligned with red and green light framing and SURF skills).
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