The Family Intervention Team (FIT) and Intensive Family Intervention Team (IFIT) in Circuit 2

1. The Family Intervention Team (FIT) and Intensive Family Intervention Team (IFIT) in Circuit 2 Presented by Jay Reeve, PhD President and Chief Executive Officer Apalachee Center Tallahassee, FL

2. Apalachee Center History • First organized in 1948 in Tallahassee. • Expanded in 1971 to serve 7 surrounding counties across 5500 square miles. • Over 350 employees. • Served approximately 5600 persons last year. • The largest community mental health center between Pensacola and Gainesville.

3. Service Area - Franklin – Gadsden – Jefferson – Leon Liberty – Madison – Taylor – Wakulla Counties

4. Who Are We? • Apalachee Center is a not-for-profit 501c3 organization governed by a 14-person volunteer Board of Directors. Current Board members include present and former County Commissioners, present and former judges, attorneys, school administrators, businessmen and women, and other professionals. The agency employs a 12 person Medical Staff, psychologists, social workers, nurses, mental health assistants, counselors and a wide variety of support staff and administrators.

5. What Do We Do? Apalachee Center provides treatment across the full range of behavioral health, from acute inpatient hospitalization to outpatient psychotherapy. Our services include: • Inpatient Psychiatric Treatment (46 beds) • Crisis Stabilization (24 beds) • Children’s Crisis Stabilization (4 beds) • Detox (12 beds) • Residential facilities (68 beds) • Outpatient Treatment across 5500 square miles including: • Assertive Community Treatment (FACT) • Substance Abuse and Mental Health Treatment • Psychotherapy • In-Home Family Treatment • Integrated Physical and Behavioral Health Services • Psychosocial Rehabilitation • Targeted Case Management • Telemedicine

6. The Family Intervention Team (FIT) • The Family Intervention Team (FIT) began in May 2008 as a way to work collaboratively with Department of Children and Families (DCF) investigators to provide intensive mental health and co-occurring treatment to families in need in order to promote family safety and preventing child removal.

7. Where Did FIT Come From? • In 2008, The DCF Circuit 2 Child Welfare Program identified mental illness and/or substance abuse as the root cause of many cases of abuse or neglect. This was frequently found once a psychological or psychiatric assessment was completed – often 6 months after a removal of the child. • DCF further identified a high recidivism rate of abuse reports of those families without adequate treatments, preventions and interventions.

8. Where Did FIT Come From? • After identifying these issues, DCF approached Apalachee Center about developing a program to dramatically decrease the wait-time between an investigator referral and a mental health/substance abuse screening and referral for treatment. • The program has seen upwards of 800 cases since May, 2008, and has contributed to a significant decrease in secondary removals.

9. How Does FIT Work? • DCF Investigators identify a potential MH/SA issue involved with a family who have been reported for abuse or neglect. • DCF investigators fax the FIT referral form, abuse reports, any other documentation necessary for treatment to the FIT point person at Apalachee. • The case is staffed with either the FIT case manager or his/her supervisor to determine appropriateness for services and concerns that they investigator may want addressed. Within 72 hours of the referral, the FIT Team makes contact with referred families. • The FIT Team member completes an initial screening with the referred individual and their family, which includes an orientation to and discussion of eligibility for TANF benefits.

10. How Does FIT Work? • During the initial screening, the FIT Team member screens for suicidal ideation, homicidal ideation, domestic violence and current safety concerns. • If a client or family member is found to meet initial criteria for admission, they are offered an opportunity to receive a full intake and be brought into services either at Apalachee Center or another community agency if one may better serve their needs.

11. How Does FIT Work? • Following admission into treatment, the FIT Team member documents his/her initial clinical impressions and treatment recommendations. • An intake packet including a Medical Questionnaire is completed by the individual or client’s parent or guardian. A referral will be made to a Healthcare provider if indicated. • Also completed at this time is a Medication List / Verification form to document an accurate up-to-date list of medications the client is currently taking at the time of admission to the program. • The clients and their families’ will also be asked to sign a Primary Care Physician notification form and an authorization to release information form in an effort to ensure coordination of care with the primary care physician. • If admitted to Apalachee Center, an Apalachee psychiatrist will complete a psychiatric evaluation within thirty days of intake.

12. How Does It Work? • Once all necessary assessments are done, the FIT Team Member develops an individualized treatment plan within 30 days with the client and/or their family members. • The treatment plan is developed with the recovery model, which emphasizes on recovery from mental illness/substance abuse through the identification and attainment of client selected goals and the identification and development of appropriate community resources to help individual and families achieve those goals. • A Family Systems approach that recognizes the need to assess the child within the context of the family and the need to refer/link family members with necessary supports to improve functioning is used. • Substance abuse issues are assessed through use of the MINIKid. • Evidenced based parenting classes are provided as well as in-home crisis stabilization. • The Florida Clinical Consultation for Treatment Improvement Project provided consultation and recommendations to the children’s program during the past year.

13. Who May Be Served? • Admission criteria • Family who is involved in dependency cases with some types of mental health and co-occurring disorders • Family who is at risk of child removal • Resident of Franklin, Gadsden, Jefferson, Leon, Liberty or Wakulla County in Circuit 2 • There is reasonable expectation that the family will benefit from services • Services are medically necessary for the treatment of the client’s behavioral health disorder • The client and their family are motivated, engaged and/or agrees to comply with treatment plans • The risk of relapse or decomposition and consequent impairment of age-appropriate functioning in academic and/or familial settings is high enough that periodic monitoring of functioning and service need is required for early detection and intervention • Risk to self or others is not an imminent danger, although without treatment the risk may increase • The client does not require a more intensive level of medical care for medical needs.

14. How is FIT funded? • Apalachee Center is not currently part of the local Community Based Care core group of providers, and does not receive funding from the CBC for this program. • The initial screening includes and is legitimately billed as TANF Outreach. This use of TANF has been exhaustively vetted by The Department, and was initially arrived at in conference with the SAMH program office in Circuit 2, Child Welfare, and Department TANF oversight personnel. • The enormous majority of children assessed have access to some form of Medicaid funding, and that funding supports treatment once the child and family have been admitted to Apalachee Center.

15. Intensive Family Intervention Team • The Intensive Family Intervention Team (IFIT) began in February 2010 as a way to bring even more intensive services to the most high-risk cases in the dependency system. • The model includes the deployment of one case manager who is certified in both child and adult targeted case management that could serve the entire family on an intensive basis up to 20 hours a week if needed. • This case manager has a minimum of 5cases and no more than 10 cases on their caseload. • IFIT cases often involve court-ordered supervision and require a partnership between the IFIT worker, investigator, dependency case manager, and any other entity working with the family (ie. Guardian Ad Litem, Department of Juvenile Justice, school, etc.) • The IFIT worker’s treatment plan goals may become a part of the court-order case plan, differentiating this program from the voluntary FIT program. • The IFIT case manager only has IFIT cases and spends 40 hours a week managing this caseload.

16. Intensive Family Intervention Team (IFIT) • Admission criteria for the IFIT program are as follows: • Must have Medicaid ( not Magellan) • Involved in dependency cases with some types of mental health and co-occurring disorders • At risk of child removal • Resident of Leon County • There is reasonable expectation that the family will benefit from intensive services which directly relates to family cohesiveness such as parenting skills, communication skills, social skills, and independent skills • The risk of relapse or decomposition and consequent impairment of age appropriate functioning in academic and/or familial settings is high enough that periodic monitoring of functioning and service need is required for early detection and intervention • Does not require a more intensive level of medical care • Does not have criminal charges pending that may not allow for treatment

17. Referrals and Staffing • The major referral source for both FIT and IFIT is Department of Children and Families Child Protective Investigators that identify families who would benefit from mental health, substance abuse and/or co-occurring disorder treatment in Circuit 2 area. In the past, we received close to500 referrals and served most of these referred cases. 99% of the time, we have been able to prevent child removal. • Bi-weekly meetings occur to staff IFIT cases with the providers, DCF, case management entities and any other parties deemed necessary for input.

18. Personnel • Minimum qualifications for FIT Team Recovery Specialisst are a Bachelor’s degree from an accredited University or College with a major in counseling, social work, psychology, criminal justice, nursing, rehabilitation, special education, health education, or a related human services field and one year related mental health experience or other Bachelor’s degree from an accredited University or College with 2 yrs full time or equivalent experience working with population experiencing serious mental illness. • Minimum qualifications for Master’s Level Therapist are a Master’s degree from an accredited University of College with a major in the field of counseling, social work, psychology, or other related human services field and two years of full time experience with knowledge of substance abuse.

19. Staff Supervision/Training • Apalachee Center is co-occurring enhanced across all program components. Recovery Specialists are trained on Minkoff’s Co-occurring principals, utilizing the TIP (Treatment Improvement Protocol) 42 manual. The TIP manuals were developed by the Center for Substance Abuse Treatment, SAMHSA and the Department of Health and Human Services. • Clinical supervision incorporates ongoing assessment of staff development regarding competency to assess and treat individuals with multiple primary axis one diagnoses. • Staff continues to receive on-site and off-site training related to co-occurring disorders and best practice guidelines. Recently, suicide protocols were revised through consultation with Professor Joiner at FSU’s Department of Psychology. • The FIT program supervisor spends 10 hours a month providing supervision, staffing cases with investigators/supervisors, and attending meetings on cases. The IFIT program is managed between two supervisors and requires an additional 10 hours a month for supervision and IFIT staffing.

20. For More Information • Contact Jay Reeve, PhD, • Apalachee Center CEO • jayr@apalacheecenter.org • (850)523-3213