Transcript Rock County Human Services Department

Rock County Human Services
Department
Functional Family Case Management
(FFCM)
Functional Family Therapy (FFT)
Did you know…
“… a vast majority of youth in the juvenile justice
system, approximately 70% suffer from mental
disorders, with 25% experiencing disorders so
severe that their ability to function is
significantly impaired.”
Functional Family Case
Management Initiative 2013
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FFCM is an evidenced-based case
management model.
CPS On-Going Unit pilot
Implementation of FFT services
Functional Family Case
Management Services (FFCM)
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FFCM is:
– An integrative supervision and case
management model for engaging,
motivating, assessing and working
successfully with high risk youth and
families.
Functional Family Therapy
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FFT mirrors FFCM, and focuses on behavior change instead of monitoring and
supervision
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The Juvenile Justice & Prevention Services Division
has adopted the use of evidenced-based practices and
programs.
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FFT is an evidence based intervention process that is one of the 11 Blueprint
Programs identified as effective by SAMHSA
FFT is one of only a handful of models that is both prevention and treatment and
has been shown to have a positive effect on offending, recidivism. ADOA and MH
issues, family cohesion and younger sibling offenses
FFT targets youth between 11-18 with delinquency and/or mental health issues
FFT is a short term, family based program
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Summary of the Models
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FFCM and FFT have:
A philosophy and belief system about people which
includes a core attitude of respectfulness of culture,
individual difference, ethnicity, family form, etc.
A family-focused intervention involving alliance and
involvement with all family members (balanced
alliance) with therapists and case managers who do
not take sides and who avoid being judgmental.
A change model that is focused on risk and
(especially) protective factors- strength-based
Summary of the Models
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Utilize interventions that are specific and individualized
for the unique challenges, diverse qualities, and
strengths (cultural, personal, experiential, and family
forms) of all families and family members.
Have an overriding relational (vs. individual problem)
focus.
Identify realistic and obtainable outcomes
Are strengths based
Research Outcomes in Washington
State, 2011
1. At 12 months following release from an institution there is a 17.9%
reduction in felony crime and at 18 months a 15.31% reduction in
recidivism rates for those youth who received highly adherent FFP as
compared to a matched control group.
2. At 12 months post release, youth in the FFP group had significantly fewer
parole revocations as compared to traditional parole services. FFP youth
had 14.7% fewer parole revocations.
3. At 12 months post parole, those youth with above average pre-crime
severity index scores who received the FFP intervention had significantly
lower post-parole crime severity behavior indicating that the most difficult
youth received more benefit from FFP.
4. Parents and youth who received FFP report identified improvements in
youth behaviors, overall family functioning, parental supervision, family
communication, and family conflict.
FFCM Effect on Revocation
Length of Revocation
90
80
70
Population
60
Dec, 2007:
Implementation
of Risk/Needs
Assessment
(PACT) to drive
decision making
Nov, 2008: Initial staff
training/implementation of FFP
for all moderate, moderatehigh, and high risk offenders
(all of those considered at-risk
for out-of-home placement)
Total Outof-home
50
40
Local
Detention
30
20
10
0
Residential
Treatment
Long-term
custody
The Culture of FFCM & FFT
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Family and relationally focused (vs. focusing
just on the youth
Alliance-based (vs. fear based)
Strength-focused (vs. problem focused)
Proactive (vs. crisis focused
Doing the right thing at the right time (vs. static
case management- in the absence of a plan
and understanding of where to focus, then
crisis rules the day)
Characteristics of an FFCM Worker and
FFT Therapist
See the whole person (the sum total)
 Recognize “noble intent” behind all
behavior
 Respectful
 Work “with” (empower) rather than
working “on” (manage)
 Work to motivate and engage the family
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Intensive Case Managers and
Therapists:
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Meet with families (vs. working with the youth
alone)
Work relentlessly to understand and to respect
youth and families on their own terms, to both
understand (assess) and create a working
relationship.
Work hard to uncover hopes/strengths and
family challenges (vs. find problems)
Intensive Case Managers and
Therapists
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Use skill set to create motivation based on
alliance (vs. fear)
Work hard to create a balanced alliance with
everyone in the family (vs. supporting one
party over another)
Strive to create credibility (vs. exercising
authority)
Matching
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A philosophy as much as a “technique”
A fundamental requisite for effectively engaging and
changing families
A guide for intensive supervision activities
Match to clients (do what it takes for them to feel you are
working hard to respect/understand them)
– Match to phase of your responsibility (do the right thing at the
right time
– Match “outcome” goals to them: tailor goals for each youth and
family culturally, contextually, and individually.
MISMATCH results in “resistance”- current process is not
perceived as beneficial to one or more family members.
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Phase 1: Engage and Motivate
FFCM
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Goals
-Engage them
-Reduce early risk factors
-Set expectations
-Develop balanced alliance
-Establish trust and credibility
-Decrease hopelessness
-Understand family challenges
-Apply information from intake/referral/assessments
-Maximize family initial expectation of positive change; get family
to attend initial session
-Create motivational context, first to undertake change process,
then to maintain change long-term
Phase 1: Engage and Motivate
FFCM
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Skills
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Structuring Skills: provide direction and focus
during family meetings
Interpersonal Skills: validate, positive
interpretation, reattribution, reframing, sequencing
Relationship Skills: trust, warmth, humor, nonblaming, respect
Phase 2: Support and Monitor
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Goals
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Facilitate individual and interactive and relational change
Develop support and intervention plan
Know community resources
Main and use community contacts
Locate resources that fit risk and needs
Link family to programs that fit
Eliminate barriers to services
Support providers and family through monitoring and
understanding
Fine tune family change
Phase 2: Support and Monitor
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Skills
-Relational, structuring and organizing skills to
identify, maintain, and help families use
community contacts and resources
Phase 3: Generalization
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Goals
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Maintain individual and family change to continue
once case is closed
Additional skill building that is consistent with
“treatment”
Generalize changes as new situations come up
Incorporate relevant community resources as
support
Help maintain changes
Phase 3: Generalization
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Skills
– Identify resources needed to maintain
positive change
– Structure activities that maintain changes
– Relapse prevention around successful
changes
FFCM vs. Intensive Supervision as
Usual (ISAU)
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FFCM
– Research-based- clear what the ICM is supposed to do and
when
– Proactive and planful
– Involves entire family
– Home-based
– Strength-based
– Alliance-based
– ICM is responsible for engaging youth and families,
motivating them to participate in services, and linking to
resources
– Focus on generalization of skills
– Quality Assurance built in (outcomes and adherence)
FFCM vs. Intensive Supervision As
Usual (ISAU) cont.
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ISAU
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Varies from ICM to ICM
Supervise to conditions
Reactive- “crisis du jour”
Meet primarily with youth
Office-based
Individual-focused
Problem-focused
Fear-based
Youth responsible for complying with expectations
Lack of future planning to avoid further system involvement
Lack of oversight and difficult to evaluate impact of supervision
provided
Research Outcomes for FFT
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The results of using FFT have been studied repeatedly for 30+
years
FFT builds data collection and feedback into the model.
Therapists administer standardized measures and can see their
results
When used with fidelity and competence FFT delivers:
– 25 – 60% reductions in recidivism
– Child welfare: 39% reduction in out of home placement and
decreased units of service by half
– Sustainable effects, demonstrated repeatedly
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From 1 – 5 years after intervention
3 yr follow up prevention effects for siblings – “ripple effect”
Phase I: Engage and motivate - FFT
Goals
 Reduce negativity and blame
 Build a relational focus
 Increase hope
 Build a balanced alliance
 Reduce dropout potential
Phase I: Engage and motivate - FFT
Skills
 Therapists are responsive and available
 Strength-based relational focus
 Change focus to relationships, strengths, and
underlying emotions
 Change the meaning
 Give the family a new story, a new experience
with each other
Phase 2: Behavior Change - FFT
Goals
 Develop and implement individualized change
plans
 Address and/or eliminate referral problems
 Improve family interactions
 Build relational skills
Phase 2: Behavior Change - FFT
Skills
 Creating a well thought out plan
 Structuring a session
 Teaching, modeling, directing
 Monitoring, coaching
Phase 3: Generalization - FFT
Goals
 Generalize changes to new problems and
situations
 Maintain changes, the family is stable and
empowered
 Support the changes with relapse prevention
and community resources
Phase 3: Generalization - FFT
Skills
 Continue to support and build upon the skills
that were taught in Behavior Change
 Plan for future challenges and relapse
 Provide case management by linking the family
to formal and informal systems
FFT Referral Considerations
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Inclusion: 11-18 year old who is in the community or
ready to return to the community and has a family that
is available. Younger children may be referred on a
case by case basis
Exclusion: in foster care, living independently or no
concurrent therapy in place.
Clinical issues that FFT can address: Conduct
disorder, Oppositional Defiant disorder, Drug
use/abuse, violence, school problems, anxiety, mood
disorders, ADHD and Parent-child/family conflicts.
FFT Additional Information
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Interventions are sequenced and FFT is typically most
beneficial as a front line treatment intervention with
referrals to other services taking place during Phase 3
Multiple services are evaluated and used strategically
so the family is not overwhelmed
Services are “Matched” to each family’s unique needs
and strengths
What FFT needs for ongoing
success
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Recognition – that the referring behavior is a family system, not
individual, concern
Patience – with individuals and their fmailies that are participating
in FFT
Trust – in the therapists who are working with the families. They
are fully trained and receive weekly consultation and coaching
Open Communication – with the therapist, the more involved the
more support to the family and higher probability of success
Acknowledgement – that every family has strengths and that
families will rely on these strengths long after we’re out of their
lives
What Parents Say
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“I am very pleased with the JCC and really like her.”
“Wish you could clone more people like my son’s JCC.”
“Keep doing what he/they are doing. Great job!! Thank
you.”
“This is my first experience with a JCC. It has been
very helpful.”
“Things are moving in a positive direction. We are
extremely grateful for our JCC for staying with us
through a difficult season. We feel he is the perfect
JCC for our family.”
What Parents Say
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“I think it is a very good program nowadays.”
“Working with a JCC helps me get through and creates
my strong belief that he can and will succeed. Thanks!”
“I believe our JCC is very helpful, is open and listens to
help what is best for me and my family, even when we
don’t agree all the time. She does a very good job.”
“She is a very nice person and does her job very well!
My son and I really respect her as a person and as a
JCC.”
“She’s great. Very calm and objective.”
What Youth Say
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“I like my JCC. She is nice and helpful.”
“She is very respectful and helps me with a lot of
personal stuff to help me succeed in life.”
“I really like my JCC. I’m gald they appointed her to
me. She is a wonderful and helpful JCC.”
“My JCC is great!!!!!!!!!”
“He is doing a good job with me.”
“I think the JCC system is great and it does not need
to be changed.”