Fennell Four Phase Model


Fennell Four Phase Model

The Fennell Four-Phase Model (FFPM) is a framework for explaining how people who are experiencing chronic illness or trauma can adapt to the changes in their lives. It outlines four phases that people commonly pass through as they learn to incorporate their altered physical abilities or psychological outlook into their personality and lifestyle.

It was developed by Patricia Fennell, MSW, LCSW-R, in 1992; first published in 1993 in "The CFIDS Chronicle" [Fennell, P.A. A Systematic Four-Stage, Progressive Model for Mapping The CFIDS Experience. The CFIDS Chronicle. Summer 1993.] ; subjected to validation research several times in the 1990s and 2000s [Fennell, P.A., Jason, L.A., Klein, S.M. Measuring phases of recovery in patients with CFS. Journal of Chronic Fatigue Syndrome. 1999; Volume 5, No. 3-4.] [Jason, L.A., Fricano, G., Taylor, R.R., Halpert, J., Fennell, P.A. Chronic fatigue syndrome: An examination of the phases. Journal of Clinical Psychology. 2000; Volume 56, No. 12.] [Jason, L.A., Fennell, P.A., Taylor, R.R., Fricano, G., Halpert, J. An empirical verification of the Fennell Phases of the CFS illness. Journal of Chronic Fatigue Syndrome. 2000; Volume 6, No. 1.] [Jason, L.A., Fennell, P.A., Klein, S., Fricano, G., Halpert, J. An investigation of the different phases of the CFS illness. Journal of Chronic Fatigue Syndrome. 1999; Volume 5, No. 3-4.] [ Van Hoof, E., Coomans, D., Cluydts, R., De Meirleir, K. The Fennell Phase Inventory in a Belgian Sample. Journal of Chronic Fatigue Syndrome. 2004;12(1):53-69.] ; and fully presented in Fennell's 2003 book, " [http://www.albanyhealthmanagement.com/books/mcibook.html Managing Chronic Illness: The Four Phase Approach] ". [Fennell, P.A. Managing Chronic Illness: The Four Phase Approach. John Wiley and Sons Inc., New York: 2003.]

The Fennell Four Phases

The Fennell Four Phases are: Crisis, Stabilization, Resolution, and Integration. Within each phase, FFPM addresses three domains: the physical/behavioral, the psychological, and the social/interactive.

In Phase 1 Crisis, the individual moves from onset of the condition to an emergency period when he or she knows that something is seriously wrong. Onset may be specifically detectable, such as a serious and disabling automobile accident, or may happen gradually, as in the case of multiple sclerosis, where a period of symptoms precedes diagnosis. The task of the individual, caregivers, and clinicians during this phase is to cope with and contain urgency and trauma.

In Phase 2 Stabilization, the individual discovers that he or she fails, sometimes repeatedly, to return to normal, regardless of interventions or behavior. The task in this phase is to initiate stabilization and life restructuring.

In Phase 3 Resolution, the individual recognizes deeply that his or her old life will never return. Early in this phase, many experience significant grief and loss. The task of this phase is to begin establishing an authentic new self and start developing a supportive, meaningful philosophy.

In Phase 4 Integration, the individual defines a new self in which illness may be an important factor, but it is not the only or even the primary one in his or her life. Integration of the illness into a meaningful life is the goal the individual seeks.

The experience of chronic illness or trauma does not remain the same over time. The physical, emotional, and social needs of an individual in the early stages of the chronic experience can be considerably different from the needs of an individual who has been ill for several years.

Additionally, unlike other phase- or stage-based models, such as the Kübler-Ross theory of death and dying, FFPM does not assume that individuals move through the FFPM phases in a linear fashion. Rather, physical or emotional setbacks can precipitate a temporary move back to a previous phase.

The Fennell Four-Phase Treatment (FFPT)™

The Fennell Four-Phase Treatment (FFPT)™ model was developed by Patricia Fennell based on her clinical work using the FFPM with patients with chronic fatigue syndrome, fibromyalgia, and other chronic conditions.

FFPT is a flexible clinical approach designed to enhance intervention approaches by helping the health care team determine what may be expected over time and the best ways to intervene to improve the patient’s quality of life at any given point. Patients may respond differently to various treatment modalities depending upon which phase of Illness they are in. Research has suggested that matching best medical practice to phase of illness can help both physicians and allied health professionals treat patients more effectively, increase compliancy, and save time and resources. [DiClemente, C.C. Motivational interviewing and the stages of change. In W. R. Miller & S. Rollnick (Eds.). "Motivational interviewing: Preparing people for change" (pp. 191-202). 1991; New York: Guilford Press.] [Prochaska, J.O., DiClemente, C.C., Norcross, J.C. In search of how people change: Applications to addictive behavior. American Psychologist. 1992; Volume 47, No. 9.] [Prochaska, J.O., Velicer, W. F. Misinterpretations and misapplications of the Transtheoretical model. American Journal of Health Promotion. 1997; Volume 12, No. 1.] [Prochaska, J.O., Norcross, J.C., and DiClemente, C.C. The Transtheoretical model of change and HIV prevention.” Health Education Quarterly, 1994; Volume 21, No. 4.] [Fennell, P.A., Bateman, Lucinda. A team approach to treating CFS: Matching best medical practices to phases of illness. CFS Research Review. The CFIDS Association of America. Summer 2005.]

By intervening with treatments suited to the patient’s particular phase -- a time when they are more likely to be compliant or capable of carrying out the intervention -- FFPT's goal is to aid health care providers in helping patients break out of a pattern of repeated crises. The goal of this approach is not pursuing the ever-elusive cure, but integrating the illness into the patient’s life. For patients and their families, FFPT™ helps them to organize a narrative of their experience, which in turn advances patient education and self-management and family support.

The Fennell Phase Inventory (FPI™)

The Fennell Phase Inventory is an assessment tool that can be used by practitioners to identify which phase an individual is currently experiencing. It has also been used as an outcome measure in research and clinical settings to determine the effectiveness of an intervention. [Van Hoof, E., Coomans, D., Cluydts, R. Association Between Fennell Phase Inventory Scores and Immune and RNase - L Parameters in Chronic Fatigue Syndrome. Journal of Chronic Fatigue Syndrome. 2005;12(2): 19-34.] [Van Hoof, E., Coomans, D., Cluydts, R., De Meirleir, K. The Fennell Phase Inventory in a Belgian Sample. Journal of Chronic Fatigue Syndrome. 2004;12(1):53-69.] [ Fennell, P. A., Jason, L.A., and Klein, S.M. Measuring Phases of Recovery in Patients with CFS; Journal of Chronic Fatigue Syndrome Vol. 5, 1999 No. 3/4, 88-89.]

Research and Application of FFPM and FFPT™

Research on FFPM and FFPT has most frequently been applied in the setting of chronic medical conditions, notably chronic fatigue syndrome, fibromyalgia, and multiple sclerosis in the United States, Belgium, and Australia. [Fennell, P.A., Jason, L.A., Klein, S.M. Measuring phases of recovery in patients with CFS. Journal of Chronic Fatigue Syndrome. 1999; Volume 5, No. 3-4.] [Jason, L.A., Fricano, G., Taylor, R.R., Halpert, J., Fennell, P.A. Chronic fatigue syndrome: An examination of the phases. Journal of Clinical Psychology. 2000; Volume 56, No. 12.] [Jason, L.A., Fennell, P.A., Taylor, R.R., Fricano, G., Halpert, J. An empirical verification of the Fennell Phases of the CFS illness. Journal of Chronic Fatigue Syndrome. 2000; Volume 6, No. 1.] [Jason, L.A., Fennell, P.A., Klein, S., Fricano, G., Halpert, J. An investigation of the different phases of the CFS illness. Journal of Chronic Fatigue Syndrome. 1999; Volume 5, No. 3-4.] [Van Hoof, E., Coomans, D., Cluydts, R., De Meirleir, K. The Fennell Phase Inventory in a Belgian Sample. Journal of Chronic Fatigue Syndrome. 2004;12(1):53-69.] Clinically, however, it has been used in a variety of trauma-inducing situations.

These situations include chronic medical conditions, like cancer, [ Fennell, P.A. Cancer, Post-Cancer Treatment, and the Fennell Four Phase Treatment Approach: Working with People Who Don’t Get Better. Psycho-Oncology. Vol. 16, Issue S1.] autism, lupus, depression, and so forth. They also include crime-associated situations such as rape, domestic violence, and murder; terrorism, including first-responders in the September 11th attacks; and natural disasters, such as hurricane survivors.

In the case of crime-related trauma, FFPT is applicable to all involved parties, including victims, perpetrators, family and close friends of victims and perpetrators, law enforcement, and treatment providers. [Rice, J.S., Fennell, P.A. Integrating Fennell's Four Phase Treatment Model Within Restorative Justice Practices to Address Trauma's Aftermath. Justice Connections. Issue 6, Summer 2008, pp 1, 13-15.] [Rice, J.S., Fennell, P.A. Integrating Fennell’s Four Phase Treatment Model Within Restorative Justice Practices To Address Trauma’s Aftermath. Women, Girls and Criminal Justice. Vol.9 No.2, February/March 2008, pp 19-22.]

Publications

There have been dozens of publications describing FFPM and FFPT in research and clinical settings. Some of the most notable are:

Fennell, P.A. [http://www.albanyhealthmanagement.com/books/ciwbook2.html The Chronic Illness Workbook: Strategies and Solutions for Taking Back Your Life] . Second Edition. Spring Harbor Press, Delmar, NY: 2006.

Fennell, P.A. [http://www.albanyhealthmanagement.com/books/mcibook.html Managing Chronic Illness: The Four Phase Approach] . John Wiley and Sons Inc., New York: 2003

Jason, LA, Fennell, P.A., Taylor, R. (editors), [http://www.albanyhealthmanagement.com/books/handbook.html Handbook of Chronic Fatigue Syndrome and Fatiguing Illnesses] . John Wiley and Sons Inc., New York: 2003.

Fennell, P.A. [http://albanyhealthmanagement.com/articles/matchingbestpractices.pdf A Team Approach to Treating CFS: Matching Best Medical Practices to Phases of Illness] The CFS Research Review. The CFIDS Association of America, Summer 2005; 6-11.

Fennell, P.A. [http://albanyhealthmanagement.com/articles/understandingphasescfs.htm Understanding the Different Phases of CFS] The CFIDS Research Review. The CFIDS Association of America, Spring 2000.

Jason, L.A., Fricano, G., Taylor, R.R., Halpert, J., and Fennell, P.A., Klein, S., Levine, S. (2000). Chronic fatigue syndrome: an examination of the phases. Journal of Clinical Psychology, 56(12):1497-1508.

Jason, L. A., and Fennell, P. A., Taylor, R. R., Fricano, G., Halpert, J., An Empirical Verification of the Fennell Phases of the CFS Illness; Journal of Chronic Fatigue Syndrome Vol. 6 N.1, 2000, p. 47-56.

Jason, L. A. and Fennell, P. A., Klein, S., Fricano, G., Halpert, J., An Investigation of the Different Phases of the CFS Illness; Journal of Chronic Fatigue Syndrome Vol. 5, 1999 No. 3/4, 35-53.

Fennell, P. A., Jason, LA, and Klein, S.M. Measuring Phases of Recovery in Patients with CFS; Journal of Chronic Fatigue Syndrome Vol. 5, 1999 No. 3/4, 88-89.

Fennell, P.A. A Systematic Four-Stage, Progressive Model for Mapping The CFIDS Experience. The CFIDS Chronicle 1993 (Summer): p. 40-46.

References

For Further Reading

[http://www.albanyhealthmanagement.com Albany Health Management Associates, Inc.]

[http://www.patriciafennell.com Patricia Fennell Website]

[http://chronicillnessworkbook.com/ The Chronic Illness Workbook]

[http://www.cfids.org The CFIDS Association of America]

[http://www.advocateprogram.com/aacjp American Association of Community Justice Professionals]

[http://snl.depaul.edu/StudentResources/TheChronicIllnessIni/index.asp DePaul Chronic Illness Initiative]


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