Proven Program for Community Supervision Settings

April 3-4, 2003 Garden Grove

Proven Programs for Community Supervision Settings

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Proven Program for Community Supervision Settings

Todd Sosna, Ph.D.



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California’s Juvenile Justice Mental Health Needs 126,312 youth booked into juvenile halls 14,216 daily average detention 7,000 youth in the 11 Youth Authorities About 53,000 youth on probation and parole 1,097 youth in detention received psychiatric

medications 19% have suicidal thoughts 73% of SED youth who dropped out of school

were rearrested within 5 years



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Juvenile Justice Mental Health Needs 50-90% show conduct disorder 45% ADHD 6-40% anxiety disorders 30-80% mood disorders 1-6% psychotic disorders 25-50% substance use disorders 25-35% history of abuse 6-28% history of suicide attempts 12-26% history of psychiatric hospitalization 40-65% history of outpatient mental health treatment



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Proven Programs

Functional family therapy Multidimensional therapeutic foster care Multi-systemic therapy Fostering individualized assistance

program (FIAP) wraparound



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Functional Family Therapy Targets at-risk and juvenile justice involved youth Based on theory, clinical experience and scientific research Builds on protective factors, and reduces risk factors Therapist assumes responsibility for

– Engagement– Develops interventions that give family members hope even

before behavior change occurs– Work with families to develop a “roadmap” for change– Provide them tools to be successful in the context of their own

values and culture Treatment is conducted in phases

– Phases have specific goals, assessment foci, specific techniques of intervention, and clinical skills necessary for success

– Engage and motivate, change behavior, generalize



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Functional Family Therapy Wide range of interventionists

– Paraprofessionals, social workers, marriage and family therapists, psychologists, psychiatrists and nurses

Full time therapist will serve 12-15 families at one time Average duration of service is 3-4 months Cost effective

– On average costs $2,100 per youth– 8-30 sessions of direct service

Site certification and training– Teams of 3-8 interventionists



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Functional Family Therapy Demonstrates strong outcomes

– Reduces recidivism from 25-60%– Reduction in violent behavior– Reduces siblings’ entry into high risk behaviors– Low drop out from treatment– Reduces family conflict– Improves family communication– Improves parenting

Washington State Institute for Public Policy– The average size of the crime reduction effect -.25– Net direct cost of the program per client $2,161– Net benefits per participant $14,149 to $59,067



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Engage and Motivate Engagement and motivation are essential and need to occur prior to

initiating behavior change techniques Decreasing the intense negativity (Blaming, hopelessness) Therapist uses respect, sensitivity and reattribution techniques Therapists work to develop respect for each family member Therapist need to use relational skills including

– Sensitivity to personal and cultural issues and values– Ability to link behavior to affect and to cognition– Willingness to “hear the pain” of all family members without

taking sides or balanced alliance Use of positive reframing is important NOTE: Reframes and supportive interventions are associated with

positive effects , as opposed to reflective, structuring, and acknowledging techniques



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Change Behavior

Reduce and eliminate problem behaviors and accompanying family relational patterns through individualized behavior change interventions

Therapists need to use structuring skills– Ability and willingness to plan interventions that are

individualized and respectful to all family members– Match behavior change techniques to the interpersonal

functions of all family members Cognitive/attributional component integrated into skill-training

– Communication training, Family-specific tasks, Technical aides, Basic parenting skills, Contracting and response-cost techniques, Problem solving, Conflict management



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Generalize Increase family’s capacity to utilize community resources, across

service systems Increase family’s capacity to engage in relapse prevention Therapists will intervene directly into service systems, if needed,

until family develops the ability to do so Therapists need to

– Know the community including have a current list of providers/agencies, know the transportation system, know the school system, know juvenile laws

– Develop contacts with specific individuals in each agency – Be prepared to address release of information regulations and

reporting laws– Refer to follow-up services consistent with family members’

relational needs, culture and abilities



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Site Certification Step 1: Request FFT general information packet; & Order an

FFT Blueprint form the Center for Violence Prevention Step 2: Complete FFT site application Step 3: Submit completed FFT application Step 4: FFT steering committee reviews site application Step 5: FFT steering committee approves site application Step 6: Contract executed Step 7: Site prepares for FFT training

– Site purchases needed items (eg computer software)– FFT site interviews and hires therapists– Site schedules 2 day CSS Implementation & 3 day Clinical training– Site purchases FAM III YOQ, OQ-45, and POSIT– New FFT therapists complete CSS Web Tutorial– Site installs FFT Clinical Service System software



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Site Certification

Step 8: One day FFT overview and site review; & two day FFT Clinical Service System

Step 9: Three day on-site clinical training for all FFT therapists Step 10: Therapists begin to serve youth Step 11: Weekly telephone supervision; one team member

attends the externship, three 2-day follow-up visits

Step 12: Year end site assessment



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Phases of FFT Implementation

Phase I-Clinical Training– Build an infrastructure necessary for strong adherence to the

treatment model and strong outcomes– Clinical Services System (CSS) is a software program that

supports adherence to the treatment model and tracking of outcomes including client assessment, client tracking, process tracking and outcome assessment

Phase II-Supervision Training– Build greater self-sufficiency– The site’s extern receives training to be a site supervisor

Phase III-Practice Research Network– Move into a partnering relationship to assure on-going

model fidelity



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Multidimensional Therapeutic Foster Care Targets teenagers with delinquency histories Designed as an alternative to incarceration or group home care Youth is place in a Therapeutic Foster Home

– One youth per home– 24/7 support for foster parent and natural parents

Youth receive weekly individual therapy with focus on developing effective:– Problem solving skills– Social skills– Emotional regulation skills

Parents attend weekly family therapy with focus on effective parenting and family management

Youth attend public school, with daily monitoring of attendance and performance



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Multidimensional Therapeutic Foster Care

Training and support for foster parents– 20 hours of pre-service training based on social learning

theory & taught to use a daily behavior management program in their homes

– Foster parents attend a weekly group meeting run by a program case manager where ongoing supervision is provided

– Supervision and support through daily telephone calls Services for youth's family

– Family therapy for the youth's biological (or adoptive) family– Intensive parent training--parents are taught to use the

structured system that is being used in the foster home– Supervised home visits – Parents have frequent contact with the case manager



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Multidimensional Therapeutic Foster Care Coordination between the case manager and the

youth's parole/probation officer, teachers, work supervisors, and other involved adults

12 month of follow up services following reunification Total ongoing program costs are about $120 per day Total training, consultation and clinical supervision

costs for the first year are about $40,000



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Multidimensional Therapeutic Foster Care Demonstrates strong outcomes

– Fewer arrests (less than half the rate of the control group)– Fewer incarceration and group home placement days– Greater completion of treatment and fewer AWOLs– Improved school performance– Less hard drug use– Improved emotional well being– Average length of stay is seven months – Average costs $2,691 per month

Washington State Institute for Public Policy– The average size of the crime reduction effect -.37– Net direct cost of the program per client $2,052– Net benefits per participant $21,836 to $87,622



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Training and Supervision

Initial two-day site visit with cross agency stakeholders focusing on program model and structural/staffing requirements

Training at the Eugene, Oregon training site, three-days

Foster parent recruitment consultation Second site visit, two-days training foster parents and

starting the Parent Daily Report Weekly telephone consultation with case managers Three subsequent, follow-up visits, two-days each



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Staffing Program director to oversee the program One full time case manager for every 10 youth

– Master’s level clinician with supervisor experience– Supervises the treatment team, responsible for coordination– Available 24/7

One half-time individual therapist for every 10 youth– Master’s level clinician

One half-time family therapist for every 10 youth– Master’s level clinician

Full time foster care recruiter/trainer & Parent Daily Report caller– Experienced with foster care and the program, may be a former foster

parent Skills trainer, about 15 hours weekly for 10 youth

– Bachelor’s education– Often involving after-school activities



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Multisystemic Therapy Targets chronic, violent, or substance abusing offenders at

high risk of out of home placements, and their families Demonstrates strong outcomes

– Fewer arrests– Fewer days of incarceration– Significantly less out of home placements– Improved family functioning– Less hard drug use

Average costs $4,500 per youth Washington State Institute for Public Policy

– The average size of the crime reduction effect -.31– Net direct cost of the program per client $4,743– Net benefits per participant $31,661 to $131,918



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Multisystemic Therapy Home based model of service delivery Low caseloads (4-6 families per therapist) Time limited duration of treatment (typically 3-5 months) Providers responsible for engaging the family in treatment Use cognitive-behavioral, behavioral , and family therapy

interventions Provides intensive levels of flexible services Support available 24/7 Build youth and parental skills Outcomes monitored continuously Supervision with clinicians focus on attaining outcomes Program fidelity is highly emphasized



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Staffing A MST Team

Two to four therapists and a supervisor– Master’s or highly skilled bachelor’s level– Supervisor is typically doctoral level clinician

Provide support 24/7 support Access to a small flexible fund 4-6 families per therapist



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Multisystemic Therapy

Pre-training site assessment, and assistance developing quality control and outcome tracking system

Five days of intensive on-site orientation training Four, quarterly, 1.5 day booster trainings Ongoing, weekly telephone consultation Completion of MST treatment session logs Training and supervision costs range from $15,000 to

$24,000 per MST team



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Fostering Individualized Assistance Program--Wraparound

Targets youth 7-15 with history of out-of-home placements– In one study, 2.6 years in placement and four

placements per year on average

Demonstrates Positive Outcomes– Reduces delinquency– Increases likelihood of permanent living

arrangements



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Fostering Individualized Assistance Program--Wraparound Strength-based child and family assessment Life domain area service planning to support and

enhance permanency plans Clinical case management of individualized,

wraparound service plans Follow-along supports and services Family specialist responsible for case management,

collaborating with parents and providers, and home based counseling



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Recommendations Establish a wraparound team for each child

– Use a family specialist (clinical case manger) empowered to provide wraparound services

– Complete a comprehensive assessment– Ensure unconditional commitment, not deny but adjust services

Remove incentives for not providing effective, individualized family centered care– Family specialist caseload not to exceed 10 youth– Empower family specialist to broker and purchase services, monitor

participation and outcomes, and make adjustments– Protect against premature termination of parental rights– Include natural parents in treatment planning and decision making– Provide family specialist weekly clinical supervision

Link permanent parents with naturally occurring supports Advocate with school staff to ensure each child receives appropriate

educational services

Documents

Proven Program for Community Supervision Settings