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

FFCM is an evidenced-based case management model.

CPS On-Going Unit pilot Implementation of FFT services

Functional Family Case Management Services (FFCM)

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

FFT mirrors FFCM, and focuses on behavior change instead of monitoring and supervision

The Juvenile Justice & Prevention Services Division has adopted the use of evidenced-based practices and programs.

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

Summary of the Models

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

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

The Culture of FFCM & FFT

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

behaviorRespectfulWork “with” (empower) rather than

working “on” (manage)Work to motivate and engage the family

Intensive Case Managers and Therapists:

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

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

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.

Phase 1: Engage and Motivate FFCM

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

Skills– Structuring Skills: provide direction and focus

during family meetings– Interpersonal Skills: validate, positive

interpretation, reattribution, reframing, sequencing– Relationship Skills: trust, warmth, humor, non-

blaming, respect

Phase 2: Support and Monitor

Goals– 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

Skills

-Relational, structuring and organizing skills to identify, maintain, and help families use community contacts and resources

Phase 3: Generalization

Goals– 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

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)

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.

ISAU– 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

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

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

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

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

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

“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

“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

“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.”