The Family Intervention Team (FIT) and Intensive Family Intervention

download report

Transcript The Family Intervention Team (FIT) and Intensive Family Intervention

Presented by Jay Reeve, PhD
President and Chief Executive Officer
Apalachee Center
Tallahassee, FL
First organized in 1948 in Tallahassee.
Expanded in 1971 to serve 7 surrounding
counties across 5500 square miles.
Over 350 employees.
Served approximately 5600 persons last
The largest community mental health
center between Pensacola and Gainesville.
Apalachee Center is a not-for-profit 501c3
organization governed by a 14-person volunteer
Board of Directors. Current Board members
include present and former County
Commissioners, present and former judges,
attorneys, school administrators, businessmen
and women, and other professionals. The agency
employs a 12 person Medical Staff,
psychologists, social workers, nurses, mental
health assistants, counselors and a wide variety
of support staff and administrators.
Apalachee Center provides treatment across the full range of
behavioral health, from acute inpatient hospitalization to
outpatient psychotherapy. Our services include:
 Inpatient Psychiatric Treatment (46 beds)
 Crisis Stabilization (24 beds)
 Children’s Crisis Stabilization (4 beds)
 Detox (12 beds)
 Residential facilities (68 beds)
 Outpatient Treatment across 5500 square miles including:
 Assertive Community Treatment (FACT)
 Substance Abuse and Mental Health Treatment
 Psychotherapy
 In-Home Family Treatment
 Integrated Physical and Behavioral Health Services
 Psychosocial Rehabilitation
 Targeted Case Management
 Telemedicine
The Family Intervention Team (FIT) began in
May 2008 as a way to work collaboratively
with Department of Children and Families
(DCF) investigators to provide intensive
mental health and co-occurring treatment to
families in need in order to promote family
safety and preventing child removal.
In 2008, The DCF Circuit 2 Child Welfare
Program identified mental illness and/or
substance abuse as the root cause of many
cases of abuse or neglect. This was frequently
found once a psychological or psychiatric
assessment was completed – often 6 months
after a removal of the child.
DCF further identified a high recidivism rate
of abuse reports of those families without
adequate treatments, preventions and
After identifying these issues, DCF
approached Apalachee Center about
developing a program to dramatically
decrease the wait-time between an
investigator referral and a mental
health/substance abuse screening and
referral for treatment.
The program has seen upwards of 800 cases
since May, 2008, and has contributed to a
significant decrease in secondary removals.
DCF Investigators identify a potential MH/SA issue
involved with a family who have been reported for
abuse or neglect.
DCF investigators fax the FIT referral form, abuse
reports, any other documentation necessary for
treatment to the FIT point person at Apalachee.
The case is staffed with either the FIT case manager
or his/her supervisor to determine appropriateness
for services and concerns that they investigator may
want addressed. Within 72 hours of the referral, the
FIT Team makes contact with referred families.
The FIT Team member completes an initial screening
with the referred individual and their family, which
includes an orientation to and discussion of eligibility
for TANF benefits.
During the initial screening, the FIT Team
member screens for suicidal ideation,
homicidal ideation, domestic violence and
current safety concerns.
If a client or family member is found to meet
initial criteria for admission, they are offered
an opportunity to receive a full intake and be
brought into services either at Apalachee
Center or another community agency if one
may better serve their needs.
Following admission into treatment, the FIT Team member
documents his/her initial clinical impressions and treatment
An intake packet including a Medical Questionnaire is completed
by the individual or client’s parent or guardian. A referral will be
made to a Healthcare provider if indicated.
Also completed at this time is a Medication List / Verification
form to document an accurate up-to-date list of medications the
client is currently taking at the time of admission to the
The clients and their families’ will also be asked to sign a Primary
Care Physician notification form and an authorization to release
information form in an effort to ensure coordination of care with
the primary care physician.
If admitted to Apalachee Center, an Apalachee psychiatrist will
complete a psychiatric evaluation within thirty days of intake.
Once all necessary assessments are done, the FIT Team Member
develops an individualized treatment plan within 30 days with the
client and/or their family members.
The treatment plan is developed with the recovery model, which
emphasizes on recovery from mental illness/substance abuse
through the identification and attainment of client selected goals
and the identification and development of appropriate community
resources to help individual and families achieve those goals.
A Family Systems approach that recognizes the need to assess the
child within the context of the family and the need to refer/link
family members with necessary supports to improve functioning is
Substance abuse issues are assessed through use of the MINIKid.
Evidenced based parenting classes are provided as well as in-home
crisis stabilization.
The Florida Clinical Consultation for Treatment Improvement Project
provided consultation and recommendations to the children’s
program during the past year.
Admission criteria
Family who is involved in dependency cases with some types of
mental health and co-occurring disorders
Family who is at risk of child removal
Resident of Franklin, Gadsden, Jefferson, Leon, Liberty or Wakulla
County in Circuit 2
There is reasonable expectation that the family will benefit from
Services are medically necessary for the treatment of the client’s
behavioral health disorder
The client and their family are motivated, engaged and/or agrees
to comply with treatment plans
The risk of relapse or decomposition and consequent impairment
of age-appropriate functioning in academic and/or familial
settings is high enough that periodic monitoring of functioning
and service need is required for early detection and intervention
Risk to self or others is not an imminent danger, although
without treatment the risk may increase
The client does not require a more intensive level of medical care
for medical needs.
Apalachee Center is not currently part of the local
Community Based Care core group of providers, and
does not receive funding from the CBC for this
The initial screening includes and is legitimately
billed as TANF Outreach. This use of TANF has been
exhaustively vetted by The Department, and was
initially arrived at in conference with the SAMH
program office in Circuit 2, Child Welfare, and
Department TANF oversight personnel.
The enormous majority of children assessed have
access to some form of Medicaid funding, and that
funding supports treatment once the child and family
have been admitted to Apalachee Center.
The Intensive Family Intervention Team (IFIT) began in February
2010 as a way to bring even more intensive services to the most
high-risk cases in the dependency system.
The model includes the deployment of one case manager who is
certified in both child and adult targeted case management that
could serve the entire family on an intensive basis up to 20 hours
a week if needed.
This case manager has a minimum of 5cases and no more than
10 cases on their caseload.
IFIT cases often involve court-ordered supervision and require a
partnership between the IFIT worker, investigator, dependency
case manager, and any other entity working with the family (ie.
Guardian Ad Litem, Department of Juvenile Justice, school, etc.)
The IFIT worker’s treatment plan goals may become a part of the
court-order case plan, differentiating this program from the
voluntary FIT program.
The IFIT case manager only has IFIT cases and spends 40 hours a
week managing this caseload.
Admission criteria for the IFIT program are as follows:
Must have Medicaid ( not Magellan)
Involved in dependency cases with some types of mental
health and co-occurring disorders
At risk of child removal
Resident of Leon County
There is reasonable expectation that the family will benefit
from intensive services which directly relates to family
cohesiveness such as parenting skills, communication
skills, social skills, and independent skills
The risk of relapse or decomposition and consequent
impairment of age appropriate functioning in academic
and/or familial settings is high enough that periodic
monitoring of functioning and service need is required for
early detection and intervention
Does not require a more intensive level of medical care
Does not have criminal charges pending that may not
allow for treatment
The major referral source for both FIT and IFIT is
Department of Children and Families Child
Protective Investigators that identify families who
would benefit from mental health, substance
abuse and/or co-occurring disorder treatment in
Circuit 2 area. In the past, we received close
to500 referrals and served most of these referred
cases. 99% of the time, we have been able to
prevent child removal.
Bi-weekly meetings occur to staff IFIT cases with
the providers, DCF, case management entities
and any other parties deemed necessary for
Minimum qualifications for FIT Team Recovery Specialisst
are a Bachelor’s degree from an accredited University or
College with a major in counseling, social work,
psychology, criminal justice, nursing, rehabilitation,
special education, health education, or a related human
services field and one year related mental health
experience or other Bachelor’s degree from an accredited
University or College with 2 yrs full time or equivalent
experience working with population experiencing serious
mental illness.
Minimum qualifications for Master’s Level Therapist are a
Master’s degree from an accredited University of College
with a major in the field of counseling, social work,
psychology, or other related human services field and two
years of full time experience with knowledge of substance
Apalachee Center is co-occurring enhanced across all program components.
Recovery Specialists are trained on Minkoff’s Co-occurring principals,
utilizing the TIP (Treatment Improvement Protocol) 42 manual. The
TIP manuals were developed by the Center for Substance Abuse
Treatment, SAMHSA and the Department of Health and Human
Clinical supervision incorporates ongoing assessment of staff
development regarding competency to assess and treat individuals
with multiple primary axis one diagnoses.
Staff continues to receive on-site and off-site training related to cooccurring disorders and best practice guidelines. Recently, suicide
protocols were revised through consultation with Professor Joiner at
FSU’s Department of Psychology.
The FIT program supervisor spends 10 hours a month providing
supervision, staffing cases with investigators/supervisors, and
attending meetings on cases. The IFIT program is managed between
two supervisors and requires an additional 10 hours a month for
supervision and IFIT staffing.
Contact Jay Reeve, PhD,
Apalachee Center CEO
[email protected]