Proven Program for Community Supervision Settings

1. Proven Program for Community Supervision Settings Todd Sosna, Ph.D. Proven Programs for Community Supervision Settings

2. 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 Proven Programs for Community Supervision Settings

3. 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 Proven Programs for Community Supervision Settings

4. Proven Programs • Functional family therapy • Multidimensional therapeutic foster care • Multi-systemic therapy • Fostering individualized assistance program (FIAP) wraparound Proven Programs for Community Supervision Settings

5. 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 Proven Programs for Community Supervision Settings

6. 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 Proven Programs for Community Supervision Settings

7. 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 Proven Programs for Community Supervision Settings

8. 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 Proven Programs for Community Supervision Settings

9. 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 Proven Programs for Community Supervision Settings

10. 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 Proven Programs for Community Supervision Settings

11. 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 Proven Programs for Community Supervision Settings

12. 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 Proven Programs for Community Supervision Settings

13. 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 Proven Programs for Community Supervision Settings

14. 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 Proven Programs for Community Supervision Settings

15. 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 Proven Programs for Community Supervision Settings

16. 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 Proven Programs for Community Supervision Settings

17. 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 Proven Programs for Community Supervision Settings

18. 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 Proven Programs for Community Supervision Settings

19. 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 Proven Programs for Community Supervision Settings

20. 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 Proven Programs for Community Supervision Settings

21. 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 Proven Programs for Community Supervision Settings

22. 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 Proven Programs for Community Supervision Settings

23. 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 Proven Programs for Community Supervision Settings

24. 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 Proven Programs for Community Supervision Settings

25. 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 Proven Programs for Community Supervision Settings

26. 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 Proven Programs for Community Supervision Settings