It Takes a Village AND a Family:
Substance abuse treatment with the
juvenile justice population by combining
MDFT and Wraparound
Presented By:
Patty Myers, LMFT Multidimensional Family Therapy (MDFT), Expansion Mental Health Services Supervisor
Jennifer Vasquez, LMFT Western Wraparound Mental Health Services Supervisor
Cynthia Rowe ,PhD Associate Director of Multidimensional Family Therapy (MDFT) International
Panel: Marisol - Mom
Saul – Youth
Maria T. Gonzalez - Wraparound Parent Partner
Riverside County Department of Mental Health
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Explain MDFT – MultiDimensional Family
Therapy: History, What it Does, and How it Works
Show how MDFT + Wraparound are Similar
(and Different)
Explain how RCDMH combined both Programs
(it wasn’t easy!)
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Introduce our Panel
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Answer Questions
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Wraparound Challenges:
◦ Model does not focus on providing therapy
◦ Dysfunctional family dynamics can interfere with
the planning process
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MDFT Challenges:
◦ Therapy can lose momentum if external
circumstances interfere
◦ Program model only has 1 “Therapist Assistant” to
address case management needs
Who Put the Peanut Butter
In My Chocolate?
Who Put the Chocolate In
My Peanut Butter?
History of MDFT
MDFT has been developed based on
theory/research in the following areas:
1.
Adolescent Development
2.
Parenting Practices and Family Functioning
3.
Risk and Protective Factors for Adolescent
Problems
4.
Ecological Perspective
5.
Family Therapy: Structural and Problem Solving
Therapies
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Adolescents need to develop a positive,
supportive relationship with parents
Symptom reduction and enhancement of
prosocial and normative developmental
functions occurs by:
a)
Targeting the family
b)
Facilitating curative processes across life
domains teen, parent, family, extrafamilial)
MDFT Theory of Change (cont.)
 Problem behavior can desist when
meaningful, concrete alternatives are
created, accepted, attempted and adopted
 If it has been multiple risk factors and a
network of influences that have created
and maintained adolescents’ problems,
then the same complex of interrelated
influences must be systematically targeted
for change
Pieces of MDFT Approach
Parent(s)
Family
MDFT
Extra familial
Adolescent

Substance use reductions (41 to 66% reduction
from intake to discharge)

Individual psychological functioning

School and job functioning

Parenting practices and psychological functioning

Family environment - family interaction

No or fewer arrests

Decreased involvement with drug abusing/deviant
peers
Combining
MDFT & Wraparound
A Work In Progress…
MDFT/Wraparound Pilot Program
November, 2013 – January, 2015
Goals + Population:
Prevention of Placement; Adolescents on
Probation; Delinquency Behavior; Substance
Use/Abuse Issues; Mental Health Issues
Values:
Areas:
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Family Focus
Team Intervention
Strengths
Outcomes
“Do whatever it takes”/
Persistence
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Financial
School
Housing
Social
Legal
Substance Use
Psychological
MDFT
Wraparound
Phases/Stages:
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Foundation/Alliance/
Motivation
“Work the Themes”
& Request Change
Seal the Changes
& Exit
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Engagement/Initial Plan
Development

Implementation
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Transition
Other:
Optimism / “Holders of the Hope”
Problem Solving / Skill Building
Helping the Whole Family
MDFT
Wraparound
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Evidence Based
Time Limited (6 mo.)
Substance/Delinquency
Work on Emotions
One Therapist for all
family members
Therapist Assistant for
all Case Management
Therapy to create
connectedness
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Evidence Informed
No Time Limit
Myriad Issues
Work on Goals
Multiple Team Roles
All Team members help
with Case Management
Family Plan to create
structure
◦ Changes in timeframe of initial implementation
◦ Prioritizing focus to enable combined programs
◦ Changes in session structure to enable
simultaneous implementation
◦ Extensive coordination between Program
Supervisors required for planning, implementation,
and monitoring
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Screening of Referrals
Orientation: Present information to youth/family
regarding both programs
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Safety Plan: Done without MDFT therapist
Assessemnt/Engagement
Beginning Family Team Meetings: Identify 1 – 2
Goals for Wraparound Family Plan
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Initial 1:1’s:
Parents/Caregivers +Youth and PP + BHS
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WA Implementation Phase / MDFT Stage 2
work:
◦ MDFT Sessions 3x’s/week
◦ Wraparound FTM’s: 2x’s/month for duration of
MDFT treatment
◦ BHS + PP 1:1’s – weekly or only as needed
◦ Case Coordination: weekly/ongoing between WA
Team and MDFT Therapist
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MDFT Model: “Seal the Changes” and Exit
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Coordination with Ongoing Wraparound
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Wraparound Transition Phase
If started together, MDFT treatment will
probably finish before Wraparound
Or: MDFT can start in the middle of
Wraparound services, then both usually finish
at the same time
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Careful Planning and Coordination
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Role Clarification
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Coordination of MDFT Ending Phase
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Confidentiality/Handling of Secrets
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Celebrations -
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Extra-Familial Domain -
Conflict of timing with Wraparound
celebration of accomplishment
Balancing “who does what”
Wraparound graduation rates for Probation
Youth have been reported between
30% - 40%:
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Los Angeles Co. Wraparound Report, 2010
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Riverside Co. Wraparound Report 2014
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Santa Barbara Co. at Institute for Well Being, 2014
However, during the Pilot implementation:
5 out of 8 youth and families receiving
combination MDFT – Wraparound services completed
or will soon complete both programs successfully!
Although only a few families so far,
this is a 62.5% graduation rate for
both MDFT and Wraparound!
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Positive reception from County Juvenile
Justice
◦ Frequent requests from judges, DA’s and Public
Defenders for “MDFT-Wraparound”
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Expansion Plan
◦ 1 MDFT Therapist assigned to each DMH
Wraparound Program
 4 RCDMH Wraparound Programs
 1 Therapist / 3 Teams per Program
Today’s Panel:
Marisol – Mom
Saul – Youth
Maria Gonzalez – Wraparound Parent Partner
Not here today:
Girlyanne Lacson – Facilitator
John Young – Behavioral Health Specialist
Robert Cescolini – Probation Officer
Brooke Fiorelli – MDFT-Wraparound Therapist
Thank You!
Patty Myers:
PAMyers@rcmhd.org
(951) 358-5730
Jennifer Vasquez:
JLVasquez@rcmhd.org
(951) 358-3640
Cynthia Rowe:
crowe@mdft.org
Website: www.mdft.org
Maria Gonzalez:
MariaTGonzalez@rcmhd.org
(951) 358-3640