California’s Annual FFT California’s Annual FFT Symposium 2008Symposium 2008

SustainabilitySustainability

April 3, 2008April 3, 2008

FFT LLC, 2008

Strong FFT (or any EBT) implementation Strong FFT (or any EBT) implementation requires requires majormajor shifts in shifts in

Training and consultation Training and consultation Practice, both clinical and supervisoryPractice, both clinical and supervisory Assessment, and documentation, for youth and family, Assessment, and documentation, for youth and family,

and therapist and supervisorand therapist and supervisor A different type of accountability A different type of accountability Funding practiceFunding practice And in many cases referral practiceAnd in many cases referral practice

In order to achieve different (read successful) outcomes….In order to achieve different (read successful) outcomes….

FFT Core Implementation ComponentsFFT Core Implementation Components

• FFT training to create model adherenceFFT training to create model adherence To training and supervision protocols and manuals To training and supervision protocols and manuals

• Clinician group of 3-8; ‘teamness’ / mutual supportClinician group of 3-8; ‘teamness’ / mutual support Therapist selection, team cohesionTherapist selection, team cohesion

• Well managed caseloads/referral processWell managed caseloads/referral process• Case carrying FFT trained supervisor who follows FFT Case carrying FFT trained supervisor who follows FFT

supervision protocolssupervision protocols• Use of FFT web-based assessment systemUse of FFT web-based assessment system

Not overwhelming therapists or families with other agency/other Not overwhelming therapists or families with other agency/other assessment and documentation assessment and documentation

• Targeted Quality Assurance to avoid therapist/supervisor driftTargeted Quality Assurance to avoid therapist/supervisor drift Clinical adherence (with families)Clinical adherence (with families) System barriers System barriers Interim outcome data (i.e. client completion, low caseloads)Interim outcome data (i.e. client completion, low caseloads)

• Well defined target populationWell defined target population• FFT based discharge criteriaFFT based discharge criteria

Transporting FFT into the CommunityTransporting FFT into the Community National Training ProtocolNational Training Protocol

Training Goals: Training Goals: Model adherence Model adherence (successful replication) (successful replication) Clinical and supervisory competence Clinical and supervisory competence (model fidelity)(model fidelity) Increasing self-sufficiency of therapistIncreasing self-sufficiency of therapist Lasting and self sustaining sitesLasting and self sustaining sites Positive outcomes with families Positive outcomes with families

Step 1: Site readinessStep 1: Site readiness Request For Program/Site Application Request For Program/Site Application Review / Feedback …around target population, referral Review / Feedback …around target population, referral

process, team make up, service deliveryprocess, team make up, service delivery Site Start-UpSite Start-Up

Transporting FFT into the CommunityTransporting FFT into the Community National Training ProtocolNational Training Protocol

Training Phase I: CLINICAL TRAININGTraining Phase I: CLINICAL TRAINING

Primary Goals: Focus on the TeamPrimary Goals: Focus on the Team1.1. Initial Implementation/technical trainingInitial Implementation/technical training2.2. 2 day on site / 2 day off site clinical training (6 2 day on site / 2 day off site clinical training (6

months out)months out)3.3. Phone consultation (weekly w/ National Consultant)Phone consultation (weekly w/ National Consultant)4.4. Follow-up training ((National Consultant-3 Follow-up training ((National Consultant-3

visits/year)visits/year)5.5. ExternshipExternship6.6. Clinical ServicesClinical Services System (FFT-CSS)System (FFT-CSS)

Transporting FFT into the CommunityTransporting FFT into the Community National Training ProtocolNational Training Protocol

Phase 2: SITE SUPERVISOR TRAININGPhase 2: SITE SUPERVISOR TRAINING Primary goals:Primary goals: Focus on the SupervisorFocus on the Supervisor

• Site Supervisor Training (2 two day trainings)Site Supervisor Training (2 two day trainings)• Supervisor phone consultationSupervisor phone consultation• Continuing Education (group)Continuing Education (group)

Supervisor develops into the quality assurance role…Supervisor develops into the quality assurance role…• Quality assurance/improvement monitor for the siteQuality assurance/improvement monitor for the site• Therapist adherence/competence focusTherapist adherence/competence focus• Model focused clinical supervision-Supervisor is guided by FFT Clinical Model focused clinical supervision-Supervisor is guided by FFT Clinical

supervision modelsupervision model

Transporting FFT into the CommunityTransporting FFT into the Community National Training ProtocolNational Training Protocol

Phase 3: PARTNERSHIPPhase 3: PARTNERSHIP Primary goals: Focus on a Long Standing Primary goals: Focus on a Long Standing

SiteSite– Demonstrate Adherence/competenceDemonstrate Adherence/competence– Continuing clinical/supervisor educationContinuing clinical/supervisor education

Consultation/Quality Assurance StandardsConsultation/Quality Assurance Standards• Maintain appropriate caseloads of 12 to 15 cases at any given Maintain appropriate caseloads of 12 to 15 cases at any given

timetime• 2 hours/week consultation 2 hours/week consultation • CSS use as primary case management toolCSS use as primary case management tool• Attend all staffings/trainingsAttend all staffings/trainings• Individual therapist maintain adherence and competencyIndividual therapist maintain adherence and competency

Creating ACE: Adherence, Competence, EffectivenessCreating ACE: Adherence, Competence, EffectivenessThrough the FFT LensThrough the FFT Lens

AdherenceAdherence to the Clinical Model to the Clinical Model is the degree to which the therapist is doing the is the degree to which the therapist is doing the FFT program (clinical model) “as prescribed” with client families FFT program (clinical model) “as prescribed” with client families • Adherence to the Dissemination ProtocolAdherence to the Dissemination Protocol is the degree to which the therapist is the degree to which the therapist

is doing the FFT is doing the FFT programprogram (assessment protocol, staffing participation, CSS). (assessment protocol, staffing participation, CSS). Technical elementsTechnical elements Service delivery within protocol Service delivery within protocol

CompetenceCompetence reflects the reflects the skill skill of the therapist in providing FFT to families. of the therapist in providing FFT to families. Ability to be Ability to be clinically responsiveclinically responsive to individual families (translate the model to to individual families (translate the model to

the individual family) while the individual family) while Remaining model focused (goals and skills), Remaining model focused (goals and skills), consistently practicingconsistently practicing the the

model, and model, and Thinking complexlyThinking complexly about clients and the FFT therapy process about clients and the FFT therapy process

EffectivenessEffectiveness refers to refers to outcomesoutcomes (immediate, intermediate, long term) which (immediate, intermediate, long term) which reflects the complex intersection of many factors: Family member characteristics, reflects the complex intersection of many factors: Family member characteristics, Therapist adherence, Therapist competence, Referral system characteristics and Therapist adherence, Therapist competence, Referral system characteristics and processes, Agency system characteristics and processesprocesses, Agency system characteristics and processes

FFT Organizational ComponentsFFT Organizational Components

• Model selection fits with the agency mission; support Model selection fits with the agency mission; support for doing evidence-based/family-based interventions for doing evidence-based/family-based interventions

• Therapist/supervisor selection and support: willingness Therapist/supervisor selection and support: willingness to learn, ability to apply protocolsto learn, ability to apply protocols

• Broad Organizational Commitment toBroad Organizational Commitment to training and FFT site standardstraining and FFT site standards FFT assessment-web systemFFT assessment-web system QA – QI protocolsQA – QI protocols

• Commitment of resources to support programCommitment of resources to support program• Commitment to data-outcomesCommitment to data-outcomes• Strong relationships with referral agents/fundersStrong relationships with referral agents/funders

FFT External Influence FactorsFFT External Influence Factors

• Support for evaluated programs -- evidence Support for evaluated programs -- evidence based and outcome focused practice based and outcome focused practice

• Support for adequate referral numbersSupport for adequate referral numbers• Systemic support for fidelity: training & QA Systemic support for fidelity: training & QA

(funders, referral agents…) (funders, referral agents…) • Sustainable funding strategies (for services Sustainable funding strategies (for services

and QI)and QI)• Support for FFT congruent assessment / Support for FFT congruent assessment /

documentationdocumentation• Ongoing support for outcomesOngoing support for outcomes• Local ownership and choice (vs. top down)Local ownership and choice (vs. top down)

How not to sustainHow not to sustainLessonsLessons Implementation and agency selection based NOT on readiness but Implementation and agency selection based NOT on readiness but

rather conscription or political pressurerather conscription or political pressure Provide funding that doesn’t fund all aspects of the clinical model; Provide funding that doesn’t fund all aspects of the clinical model;

enforce productivity standards that not model congruentenforce productivity standards that not model congruent Use part time therapists whose non FFT activities overwhelm their Use part time therapists whose non FFT activities overwhelm their

focus focus Conscript therapists who have only worked with individuals in Conscript therapists who have only worked with individuals in

office settings where showing up for appointments = readiness to office settings where showing up for appointments = readiness to change and where therapy is completed when clients stop change and where therapy is completed when clients stop showing upshowing up

Use non model congruent assessment, have multiple assessment Use non model congruent assessment, have multiple assessment practices—one for funding, one for FFT, one from the agency practices—one for funding, one for FFT, one from the agency

Use multiple agency teams where agencies are competitive and Use multiple agency teams where agencies are competitive and have no experience working togetherhave no experience working together

Be impatient. Don’t create a learning or QI environment but one Be impatient. Don’t create a learning or QI environment but one of fearof fear

Don’t allow therapists, agencies, etc. to own the practice by Don’t allow therapists, agencies, etc. to own the practice by micromanaging themmicromanaging them

Assume referrals and referral practice will just fall into placeAssume referrals and referral practice will just fall into place

The spark, chemistryThe spark, chemistry Sometimes it’s a charismatic champion…Sometimes it’s a charismatic champion…

Sometimes it’s only one person–therapists, Sometimes it’s only one person–therapists, administrator, funder. administrator, funder. • Very well prepared, bright, know that they don’t knowVery well prepared, bright, know that they don’t know• Own the practice, distribute successOwn the practice, distribute success• Inspire, dogged, work harder but never say soInspire, dogged, work harder but never say so• Passion. Simply own the territoryPassion. Simply own the territory

When it’s more than one person, watch outWhen it’s more than one person, watch out Can be a well blended team—mutually supportive and Can be a well blended team—mutually supportive and

accountableaccountable

What’s keeps the spark going?What’s keeps the spark going?For therapists, supervisors, and sitesFor therapists, supervisors, and sites

““When the relentless work to engage a family pays off and the When the relentless work to engage a family pays off and the show up for sessions”show up for sessions”

““Seeing the family members experiences change”Seeing the family members experiences change” ““When we are effective and families benefit”When we are effective and families benefit” ““Having a supervisor that supports the work we do”Having a supervisor that supports the work we do” ““Having a model that gives therapeutic work an anchor and focus Having a model that gives therapeutic work an anchor and focus

for working with families”for working with families” ““Remaining non judgemental and blaming..respectfulness of the Remaining non judgemental and blaming..respectfulness of the

families and each other”families and each other” ““A strong team”A strong team” ““Being given the resources needed to ensure quality FFT services”Being given the resources needed to ensure quality FFT services”