FISP

Family Intervention and

Support Program

Presented by:

Linda Dugas, CFC

Michelle Glover, CAS

Sherri Hardy, CFC

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Introduction

The Family Intervention Program has been created as a result of the Child Welfare Transformation Agenda.

Purpose of transformation agenda is to expand the capacity of broader children’s service systems to respond to the needs of children who are or will be in need of Child Welfare Services.

The main focus is to improve OUTCOMES for CHILD WELFARE CLIENTS in the areas of safety, permanence and well-being.

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What is FISP?

It is a coordinated collaborative community response by CAS and CFC in cases where a child is deemed at risk and the child’s behaviors coupled with the parent’s care giving skills or response to the child have created a crisis within the family unit.

FISP helps families presenting mental, emotional, health or behavioral issues that require protection intervention.

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Target Population and Eligibility Criteria

There are protection concerns that exist but are not extreme or immediately threatening to the child’s safety.

Appears to be a need of clinical intervention.

Clients appear capable of benefiting from clinical intervention.

Clinical intervention could reduce the need for more intrusive child protection services.

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Target Population and Eligibility Criteria

Parent/Child Conflict: Out of control adolescents, children presenting with defiant/oppositional behaviors.

Emotional Harm: Parent’s response to child that is not appropriate.

Harm by Omission: Care givers response to a child’s mental, emotional or developmental condition.

Physical Harm/Maltreatment: Inappropriate physical discipline which can sometimes be related to increased levels of frustration and lack of appropriate parenting skills when dealing with more challenging children.

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Target Population and Eligibility Criteria

Sexualized Behaviors of Children: Children displaying inappropriate sexual knowledge or behaviors. Often the caregiver’s response and the underlying issues of the child’s behavior require a more clinical, mental health intervention versus a strict child protection intervention.

Care Giving Skills: Often relate to care giving skills to very young children.

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Referral Process

Referrals come directly from CAS from either the Intake teams or Family Services Teams.

Referral forms are completed by the CAS worker. Form to indicate the desired outcome.

The CAS Supervisors approve the referrals and they are then sent to the CFC Program Manager for assignment.

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Case Assignment At the time of assignment, the CFC worker will contact the

CAS worker to arrange a first contact with the family within seven (7) days.

In exceptional cases, the response time could be 12 hours however these would be rare cases and are discussed between CAS Supervisor and CFC Program Manager.

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First Contact and Treatment Process

During the first contact, both CAS and CFC describe their respective roles, CFC emphasizing the volunteer nature of the service.

CFC will complete an assessment and treatment plan within the seven (7) days of first contact.

During the assessment phase, the Clinician will conduct a formal interview. The CYW will schedule time to complete observations at critical times to support assessment phase.

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First Contact and Treatment Process

During the treatment phase, the CYW will go into the home and do programming as indicated in the treatment plan.

Transition planning or relapse prevention planning is an

essential piece to this Program considering our brief stay. FISP will remain involved for a maximum of eight (8) weeks.

If longer term services with CFC are required, a BCFPI will be completed through CCN and the case will be transferred to its respective cultural team.

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Case Management CFC will assume clinical leadership of the case while CAS

maintains the community case management.

Due to the collaborative nature of this Program a CAS worker is present at 1st contact, signing of treatment plan and at case closure.

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Documentation

CFC clinician will provide a copy of the assessment, treatment plan, transition plan and closing summary

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Program Evaluation Questions

What are some of the challenges or barriers in meeting the expected capacity of the Program?

Is this Program effective in treating the mental health needs of children and youth?

Is this Program reducing the risks of protection concerns?

How effective is the Program in its service delivery.

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Methodology CAS referral patterns Eligibility spectrum Number meeting criteria but not referred Surveys/parents/youth/CAS staff Focus interview with FISP Clinicians Follow-up forms Outcome measures with clients who completed

treatment (N=24)

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CAS Referral Patterns

As part of our review of services in the first year implementation of this Program an analysis of referral trends is essential to ensuring that;

the Program is being used to its full potential families that can benefit from the Program are being

referred the criteria for referral, as designed, are reflective of

client need

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Referral PatternsInvestigations Opened vs. FISP Referrals

February 1, 2007 to January 31, 2008

0

20

40

60

80

100

120

140

160

180

CAS FISP

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Referral Patterns

There is no correlation between the number of referrals investigated at intake and the number of referrals made to FISP.

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Clients Meeting Criteria but not Referred

A manual review of all cases open as of February 1, 2008, with an Eligibility Spectrum coding that meets FISP criteria, was completed with a focus on identifying those cases that were not referred and the rationale. The following chart provides a breakdown of reasons for non-referral:

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Clients not ReferredBarriers To FISP Service

Rural16%

Child(ren) in Care29%

Alternate Caregiver7%

CFC Clinician/Other Services

13%

Other26%

Possible Referrals Identified

9%

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Reasons why Families were not Referred

16% of families reside in rural areas. 13% are already involved with a CFC Clinician or

other services. 29% of children were in care. 7% of children reside with an alternate care giver. 9% are possible referrals. 26% other (clinical judgment of CAS Worker).

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Referral Outcomes February 5, 2007 - February 20, 2008

FISP ONGOING: 15

1. TREATMENT COMPLETED 19

2. NO SERVICE/CONTACT 7

3. TERMINATED AFTER 1ST 18

4. TERMINATED DURING TREATMENT 4

5. TERMINATED AFTER ASSMT 3

Total 66

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Referral Outcomes February 5, 2007 to February 20, 2008

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…further analysis

The question is whether there were differences in outcomes of families referred in the first six (6) months of operation compared to families who were referred in the second

half.

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FISPFebruary 1, 2007- July 31, 2007

FISP ONGOING: 0

1. TREATMENT COMPLETED 15

2. NO SERVICE/CONTACT 6

3. TERMINATED AFTER 1ST 13

4. TERMINATED DURING TREATMENT 2

5. TERMINATED AFTER ASSMT 3

Total 39

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FISP February 1, 2007 - July 31, 2007

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FISP August 01, 2007- February 01, 2008

FISP ONGOING: 14

1. TREATMENT COMPLETED 2

2. NO SERVICE/CONTACT 1

3. TERMINATED AFTER 1ST 4

4. TERMINATED DURING TREATMENT 0

5. TERMINATED AFTER ASSMT 0

Total 21

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FISP August 01, 2007- February 01, 2008

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Outcome A significant decrease in the number of closures

after 1st contact. This may be attributed to two (2) key areas:

Experience of FISP clinicians in dealing with this population (due to a smaller caseload clinicians were able to spend more time in engaging and rapport building)

CAS Workers are making more appropriate referrals and are better able to assess client readiness.

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LENGTH OF PROTECTION CLOSING AFTER FISP COMPLETION

Preliminary review of files where FISP treatment has been completed indicates that 72% of files have since closed to protection.

On average the child protection file closing occurred within 66 days of the completion of the FISP treatment.

A review also indicates that in only 20% of these cases has there been a re-opening of a child protection file.

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Survey Outcomes: PARENT SURVEY ANALYSIS

19 surveys completed. The response rate was lower than

anticipated.

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Parent Survey Analysis 84.2 % of respondents agreed or strongly agreed with the statement that

they had been involved in choosing their treatment goals and 94.7 % of respondents felt they had been treated with respect while involved with FISP.

79 % of respondents agreed or strongly agreed with the statement that they felt more capable in managing their child’s behavioural and emotional needs and were satisfied with the services they received.

74 % of respondents indicated that involvement with FISP helped them address the protection concerns identified by CAS.

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Anecdotes from Families “Helped with communication, talking instead of yelling, taking time apart.”

“Choose your battles” was helpful and “learn to have more patience with certain issues.”

“This was a hell of a lot better than the other Programs that we took.”

“The in-depth and length of each session. The feeling I had inside of me halfway through the Program, I could feel inroads being made by my daughter and by how we were treating & talking with each other – more respectful attitude ... and hope to use what I learned throughout my life and my daughter’s life.”

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Youth Survey

4 completed Youth Surveys.

They all agreed or strongly agreed with survey statements with one exception.

2 youth did not feel they were involved in choosing the treatment goals.

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Staff Survey Surveys were completed by Intake and Family Services workers to measure

various aspects of the Program. in total surveys were received relating to staff feedback on 58 families that were involved with the Program.

93% of staff felt that they understood FISP in order to make appropriate referrals to the Program and 100% felt the referral process was “user friendly”. This speaks to the level of training and ongoing communication that was provided in the training.

100% of staff who had initiated the referral to FISP, felt the referral process was “user friendly.”

Of the 58 family referrals that staff responded to, and where the family followed through in some level of participation with the Program, 71% of staff felt involvement in the Program was beneficial to their families.

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Staff Survey (continued)

The following recommendations were received from staff to improve the service (note: many of these recommendations have been incorporated into the annual review and are already being implemented).

Production of a Brochure outlining the nature of the Program as a useful tool in engaging clients of the referral process from the outset.

Increased availability of FISP Clinicians and CYWs during non-office hours to accommodate the needs of families.

Clear communication between FISP staff and CAS staff to ensure a joint message is provided to the family and that both agencies are involved with the family in the determination of the treatment goals recognizing that to be successful, the Program must be a “joint” endeavour in all respects

Improved information provided at time of case closure to assist with ongoing CAS intervention and planning.

Ability to access the Program when involved with other mental health sector programming.

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Staff Survey (continued)

Positive feedback from CAS staff included:

“... involved me in the family plan ... action plan was detailed and beneficial to the family as they continued to use it. The file was closed to protection shortly after FISP intervention.”

“Services for the family in particular that I worked with were very helpful. The risk factors were reduced significantly. Excellent Program! File closed shortly after transfer to Family Services.”

“... as the FISP Program was a phenomenal success. I am closing the file this month as the measured improvements have not receded. The family is very appreciative.”

“As a worker with CAS and the clients we serve this allowed an immediate positive opportunity/response to assist the client...”

“In this case, the success was far reaching and inspiring.” “Family gained tools/strengths with regards to discipline and

consistency. There have been no further referrals or concerns with this family since file closed ...”

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Focus Interview/FISP Clinicians Overall, referrals were appropriate. However, some families required

extensive support to commit and become engaged with the Program. 10-15% required community links to the adult mental health sector. 85% of the families did not have a sound understanding of the

Program at the time of intervention; more training is required for CAS staff.

The majority of clients are considered to be in the “Pre-Contemplation Stage” of readiness for change.

Some of the youth are further ahead and more ready for change than their caregivers.

CAS workers are committed to a joint working relationship; communication issues between CAS and FISP is an identified issue.

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Recommendations from Clinicians on how to Improve the FISP Model

Parenting group/support group after FISP. Booster Program- “refresher” session to

reinforce learning. Increase length of Program. Allow referrals from CFC Day Treatment

Program.

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Effectiveness of Program in theTreatment of Mental Health Problems of Children and

Youth

Outcome Measurement: CAFAS ( Child and Adolescent Functional Assessment Scale).

Age and gender distribution.

T-test.

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Outcome Measure As an MCYS funded agency, the Child and Family Centre administers,

as an outcome measurement, the Child and Adolescent Functional Assessment Scale (CAFAS) to all the children admitted in their Programs.

The scale is administered to children/youth between the ages of 6 and 18. The scores are ratings received from the Clinicians and Child Care Consultants, based on his/her knowledge of the child/youth’s functioning.

CAFAS is the tool that will be used to measure outcomes in FISP.

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Outcome Results for FISP

For the period from February 2007 to March 31, 2008.

Outcomes are based on all clients who were admitted (N=24) and discharged during the period (N=20).

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Gender Ratio

Gender Ratio at Entry

Male23%

Female77%

Male

Female

N=24

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Age Ratio

Age Ratio at Entry

32%

23%

27%

18%

<10

10 to 12

12 to 14

14 to 17

N=24

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Age Range at Entry by Gender

• Male (N = 6)

• Range 7.15 – 9.63• Mean9.63 ± 2.55

• Female (N = 18)

• Range 6.83 – 15.75• Mean11.87 ± 2.67

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Outcome Measurement Scale The Total Youth Score (TYS) is the sum of 8 scales,

reflecting the functioning in various areas, yielding a range from 0 to 240. A TYS.

Between 40 and 70 may require outpatient services. Between 80 and 100, may require outpatient services with additional

supportive services. Between 110 and 130, may need intensive community based

services. Over 140, may need very intensive, possibly inpatient or residential

services.

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Distribution of Cases According to Severity Ratings at ENTRY and EXIT

ENTRY (N=24) EXIT (N=20)

Sub-clinical (0-30) 13.6% 66.8%

May need out-patient services

(40-70)50.0% 5.5%

May need out-patient services with additional support (80-100)

27.4% 11.1%

May need intensive community support (110-130)

4.5% 5.5%

May need in-patient or residential services (140+)

4.5% 11.1%

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Psychometry 101 A “t-test” on repeated measures is the statistical procedure that was

used to measure the difference between means or between group averages.

The purpose of the “t-test” is to determine if the difference between two (2) means represents a true difference or is due to chance. In other words, was treatment effective?

How do we statistically measure change (and success)?

a first measure is taken at entry (T-1); a treatment procedure is applied; the measure is repeated at completion of treatment (T-14); and the statistical test is applied to establish the true difference or effectiveness of

the treatment procedure.

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t-test on TYS Following Treatment (N = 20)

Mean S.D. df Sign.

Before Treatment

73.89 35.33 -- --

After Treatment

51.22 47.88 -- --

Difference 22.78 33.04 19 < .01

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t-test on TYS Following Treatment by Age Group

Mean S.D. df Sign.

6 to 12

(N = 9)

Before Treatment 68.75 14.58 -- --

After Treatment 23.75 9.16 -- --

Difference 45.00 18.52 8 <.001

12 to 18

(N=11)

Before Treatment 78.00 46.38 -- --

After Treatment 73.00 55.38 -- --

Difference 5.00 31.71 10 n.s.

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What does this mean? Higher ratio of females following through with treatment.

Higher ratio of adolescents.

Better outcomes in treatment with children under the age of 12.

Not as successful in treatment with adolescents.

Further training to enhance the Program’s capacity to more efficiently serve adolescents.

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Changes Made…Eligibility Spectrum The current eligibility codes that meet referral criteria

represent 68 cases out of 422 that were open as of February 01, 2008, which is just 16% of cases. The Program has been expanded to include the following:

Extremely Severe-Physical Harm- Prime Caregiver - (11A) after the initial 12 hour response is met and the child’s immediate safety has been planned; and

Moderately Severe–Caregiver with a Problem - (53B) when parents are refraining from abusing substances or mental health is stabilized, and they are now struggling to regain their parenting role.

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CAS Clients with CFC CliniciansIn 13% of cases there is already a CFC clinician involved. Previously, these families could not be referred to FISP.

Families involved with a CFC Clinician for more than six (6) months, and child protection concerns have not been alleviated or reduced, can be transferred to FISP for a more intensive intervention.

Families involved with the Section 23 classroom or receiving services, can be referred to FISP and parallel services will be provided.

Families involved with the Children’s Mobile Crisis Program can be transferred to FISP.

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Rural Clients

16% of cases involve families that reside in rural areas and therefore not eligible for referral to FISP.

A pilot project has been initiated to allow 1 to 2 families residing in the Sudbury East area to be referred to FISP (this may be expanded).

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Intake

Currently CAS clients receiving services with CFC clinician must remain open with CAS.

Cases assessed as benefiting from the FISP Program however do not warrant ongoing CAS involvement will be considered for referral to FISP (parent/ child conflict and inappropriate discipline).

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Length of Treatment

Under special circumstances, treatment will be extended to 16 weeks to a maximum of 24 weeks.

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Conclusion The first year has been rewarding and challenging.

Joint planning/communication and ongoing evaluations are essential to the success of this Program.

Preliminary analysis is demonstrating that families are benefiting from services.

Further analysis is required to ensure the service is used to its full potential and to ensure appropriate referrals are made.

Ongoing Program evaluation on the efficiency of services is essential to ensure that family needs are being met.

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Future Considerations

Length of time a file is open at CAS. Frequency of re-opening cases. Rates of admission to care. History of involvement with CAS and success

of intervention with FISP.