Proven Program for Community
Supervision Settings
Todd Sosna, Ph.D.
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
1
California’s Juvenile Justice
Mental Health Needs
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
2
Juvenile Justice Mental Health
Needs
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
3
Proven Programs
Functional family therapy
 Multidimensional therapeutic foster care
 Multi-systemic therapy
 Fostering individualized assistance
program (FIAP) wraparound
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April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
4
Functional Family Therapy
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
5
Functional Family Therapy
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
6
Functional Family Therapy
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
7
Engage and Motivate
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
8
Change Behavior
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
9
Generalize
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
10
Site Certification
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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
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
11
Site Certification
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
12
Phases of FFT Implementation
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
13
Multidimensional Therapeutic
Foster Care
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
14
Multidimensional Therapeutic
Foster Care
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
15
Multidimensional Therapeutic
Foster Care
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
16
Multidimensional Therapeutic
Foster Care
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
17
Training and Supervision
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Initial two-day site visit with cross agency
stakeholders focusing on program model and
structural/staffing requirements
 Training at the Eugene, Oregon training site, threedays
 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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
18
Staffing
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
19
Multisystemic Therapy
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Targets chronic, violent, or substance abusing
offenders at high risk of out of home placements, and
their families
Demonstrates strong outcomes
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
20
Multisystemic Therapy
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
21
Staffing A MST Team
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Two to four therapists and a supervisor
– Master’s or highly skilled bachelor’s level
– Supervisor is typically doctoral level clinician
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Provide support 24/7 support
 Access to a small flexible fund
 4-6 families per therapist
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
22
Multisystemic Therapy
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
23
Fostering Individualized Assistance
Program--Wraparound
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Targets youth 7-15 with history of out-ofhome placements
– In one study, 2.6 years in placement and four
placements per year on average
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Demonstrates Positive Outcomes
– Reduces delinquency
– Increases likelihood of permanent living
arrangements
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
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Fostering Individualized Assistance
Program--Wraparound
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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
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
25
Recommendations
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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
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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
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Link permanent parents with naturally occurring supports
Advocate with school staff to ensure each child receives
appropriate educational services
April 3-4, 2003
Garden Grove
Proven Programs for Community
Supervision Settings
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