California’s Annual FFT Symposium 2008

1. California’s Annual FFT Symposium 2008 Sustainability April 3, 2008 FFT LLC, 2008

2. Strong FFT (or any EBT) implementation requires major shifts in • Training and consultation • Practice, both clinical and supervisory • Assessment, and documentation, for youth and family, and therapist and supervisor • A different type of accountability • Funding practice • And in many cases referral practice In order to achieve different (read successful) outcomes….

3. FFT Core Implementation Components • FFT training to create model adherence • To training and supervision protocols and manuals • Clinician group of 3-8; ‘teamness’ / mutual support • Therapist selection, team cohesion • Well managed caseloads/referral process • Case carrying FFT trained supervisor who follows FFT supervision protocols • Use of FFT web-based assessment system • Not overwhelming therapists or families with other agency/other assessment and documentation • Targeted Quality Assurance to avoid therapist/supervisor drift • Clinical adherence (with families) • System barriers • Interim outcome data (i.e. client completion, low caseloads) • Well defined target population • FFT based discharge criteria

4. Transporting FFT into the CommunityNational Training Protocol Training Goals: • Model adherence (successful replication) • Clinical and supervisory competence (model fidelity) • Increasing self-sufficiency of therapist • Lasting and self sustaining sites • Positive outcomes with families Step 1: Site readiness • Request For Program/Site Application • Review / Feedback …around target population, referral process, team make up, service delivery • Site Start-Up

5. Transporting FFT into the CommunityNational Training Protocol Training Phase I: CLINICAL TRAINING Primary Goals: Focus on the Team • Initial Implementation/technical training • 2 day on site / 2 day off site clinical training (6 months out) • Phone consultation (weekly w/ National Consultant) • Follow-up training ((National Consultant-3 visits/year) • Externship • Clinical ServicesSystem (FFT-CSS)

6. Transporting FFT into the CommunityNational Training Protocol Phase 2: SITE SUPERVISOR TRAINING • Primary goals:Focus on the Supervisor • Site Supervisor Training (2 two day trainings) • Supervisor phone consultation • Continuing Education (group) • Supervisor develops into the quality assurance role… • Quality assurance/improvement monitor for the site • Therapist adherence/competence focus • Model focused clinical supervision-Supervisor is guided by FFT Clinical supervision model

7. Transporting FFT into the CommunityNational Training Protocol Phase 3: PARTNERSHIP • Primary goals: Focus on a Long Standing Site • Demonstrate Adherence/competence • Continuing clinical/supervisor education • Consultation/Quality Assurance Standards • Maintain appropriate caseloads of 12 to 15 cases at any given time • 2 hours/week consultation • CSS use as primary case management tool • Attend all staffings/trainings • Individual therapist maintain adherence and competency

8. Creating ACE: Adherence, Competence, EffectivenessThrough the FFT Lens • Adherence to the Clinical Model is the degree to which the therapist is doing the FFT program (clinical model) “as prescribed” with client families • Adherence to the Dissemination Protocolis the degree to which the therapist is doing the FFT program (assessment protocol, staffing participation, CSS). • Technical elements • Service delivery within protocol • Competence reflects the skill of the therapist in providing FFT to families. • Ability to be clinically responsive to individual families (translate the model to the individual family) while • Remaining model focused (goals and skills), consistently practicing the model, and • Thinking complexly about clients and the FFT therapy process • Effectiveness refers to outcomes(immediate, intermediate, long term) which reflects the complex intersection of many factors: Family member characteristics, Therapist adherence, Therapist competence, Referral system characteristics and processes, Agency system characteristics and processes

9. FFT Organizational Components • Model selection fits with the agency mission; support for doing evidence-based/family-based interventions • Therapist/supervisor selection and support: willingness to learn, ability to apply protocols • Broad Organizational Commitment to • training and FFT site standards • FFT assessment-web system • QA – QI protocols • Commitment of resources to support program • Commitment to data-outcomes • Strong relationships with referral agents/funders

10. FFT External Influence Factors • Support for evaluated programs -- evidence based and outcome focused practice • Support for adequate referral numbers • Systemic support for fidelity: training & QA (funders, referral agents…) • Sustainable funding strategies (for services and QI) • Support for FFT congruent assessment / documentation • Ongoing support for outcomes • Local ownership and choice (vs. top down)

11. How not to sustain Lessons • Implementation and agency selection based NOT on readiness but rather conscription or political pressure • Provide funding that doesn’t fund all aspects of the clinical model; enforce productivity standards that not model congruent • Use part time therapists whose non FFT activities overwhelm their focus • Conscript therapists who have only worked with individuals in office settings where showing up for appointments = readiness to change and where therapy is completed when clients stop showing up • Use non model congruent assessment, have multiple assessment practices—one for funding, one for FFT, one from the agency • Use multiple agency teams where agencies are competitive and have no experience working together • Be impatient. Don’t create a learning or QI environment but one of fear • Don’t allow therapists, agencies, etc. to own the practice by micromanaging them • Assume referrals and referral practice will just fall into place

12. The spark, chemistry • Sometimes it’s a charismatic champion… • Sometimes it’s only one person–therapists, administrator, funder. • Very well prepared, bright, know that they don’t know • Own the practice, distribute success • Inspire, dogged, work harder but never say so • Passion. Simply own the territory • When it’s more than one person, watch out • Can be a well blended team—mutually supportive and accountable

13. What’s keeps the spark going?For therapists, supervisors, and sites • “When the relentless work to engage a family pays off and the show up for sessions” • “Seeing the family members experiences change” • “When we are effective and families benefit” • “Having a supervisor that supports the work we do” • “Having a model that gives therapeutic work an anchor and focus for working with families” • “Remaining non judgemental and blaming..respectfulness of the families and each other” • “A strong team” • “Being given the resources needed to ensure quality FFT services”