California’s Annual FFT Symposium 2008 Supervision April 4, 2008

1. California’s Annual FFT Symposium 2008SupervisionApril 4, 2008

2. Overview of Your Responsibilities as The FFT Site Supervisor • Help develop therapists on your team who can practice FFT with high levels of ACE (Adherence, Competence, Effectiveness) • To that end, provide Quality Assurance & Quality Improvement (QA/QI) • Continue your Consultant’s development and maintenance of a working group and site that will sustain model over time

3. You Meet Your Goals In Large Part Through • TQA Therapist Quality Assurance • Monitoring Adherence/competence (individual therapist) • Monitoring Site adherence (administrative/organizational) • Monitoring Service delivery practices (site and therapist) using observation, the CSS, input from independent sources, and your own experience - using the FFT supervision model to structure this process • TQI (Therapist Quality Improvement) involves: • Supervision interventions • Informal improvement plans • Formal improvement plans

4. 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

5. Functional Family Therapy Clinical Supervision Model

6. Functional Family Therapy SupervisionTargets of Supervision • Therapist • Enhancing adherence and competence • Increasing FFT based clinical supervisions • Service delivery System • Context for FFT (billing, scheduling etc.) • Agency/community context • FFT as a service in community • Organization within which FFT exists as a service • Referral and Service delivery system

7. Functional Family Therapy SupervisionGuiding Principles of Supervision 1. Model-based/focused • Thinking through he lens, model based clinical decisions 2. Respect-based • individual differences/perspectives…non-blaming 3. Relationally-based • Alliance-based working relationships, Alliance based motivation • Supervision interventions that “match to…” 4.Multisystemic/multiple domains of attention & action • Integrative in domains of attention (therapist, service delivery system, context) • Phasic based model • Assessment (monitoring) and systematic intervention 6. Evidence-based…data driven • HOW DOES THIS DIFFER FROM FFT? It differs the same way that family clients differ from colleagues! While we are relationally based , we must (as Supervisors) also set limits, represent FFT and the Agency and our therapists.

8. Functional Family Therapy SupervisionMajor Components Working together to…. 1. Assess… • Monitoring for quality assurance and improvement • Competence & Adherence within the model • Developmental status of the group • Systematically Intervene to: • Build adherence/competence • Through: • Case Planning • Session Planning • Group development ….within the clinical staffing meeting

9. Quality Improvement The “intervention” part of supervision • Based on understanding/assessment of: • Therapist (adherence/competence) • Group Maturity level • Context (site service delivery context) • Phase of supervision process Deciding on what to do… • Structuring the supervision consultation meeting • Identifying a supervision target • Adherence/competence • Matching intervention to therapist

10. Case Staffing • Primary “modality” of supervision • Advantages: • Multisystemic impact • -efficiency • Challenges…..Developing a way to structure the team discussions in order to… • Guide the team to model focused thinking about the family and the change process through a systematic staffing model • Models how to think through the lens • But….matching the structure to the complexity of the therapist/group

11. Case Staffing…doing supervision • Preparing for the meeting…questions to ask • Where in the supervision phases? • Primary goals for this session? • What specific adherence/competence issues? • Review PRN and monthly reports • Managing your time • Have everyone talk equally (over sessions-not within each) • Look for general adherence/competence themes that fit the whole group

12. Teaching….. • Focus on core principles • Identify the core principle • “mini lesson” • Focus on central protocol • Requires: • You know the construct well • Can explain in a way that is relevant to the situation at hand

13. Teaching in group supervision: • Identify the issue….. • Focuses the issue ….(this is about…) • Teach (mini discussion of specific issue) • Collaboratively suggest….(what you might do is….) • Demonstrate…..(give an example) • With mature group…. • Group involvement (you manage the group….)

14. Critical Components when staffing a case….. Understanding the Family (where are we with the case?) • Family Presentation/brief review of presenting “problem” and other relevant patterns you’ve observed or had reported • Progress in all E&M elements: Matching, Strength based relational, Pointing process and sequencing (esp strength based), reframes and themes • Organizing “theme(s)” that seemed effective • Relational Assessment (relatedness/hierarchy) • Individualized change plan (targets and pathway) • Outside systems that will help support/maintain or impede What to do in the next session (Next Session Plan) • Phase of next session • Phase goals to address in next session (which is important/progress) • What do we need to know after the next session (assessment?) • Specifically what do we do to accomplish phase goals in the next session (intervention)

15. Group Supervision Plan • Planning • What is the “theme?” • What are your goals? • What does the “data” say? • Supervision • Identify the theme • Identify cases to be discussed (to fit theme) • Structure discussion • Acknowledge • Identify adherence issues • Intervene (teach/model/example) • Apply to the case • Identify other questions • Complete weekly ratings (on CSS)

16. Group Maturity • Group developmental level • “maturity” of the group • Its ability to work together • Its ability to identify the necessary task, participate in accomplishing that task • Its ability to “take” ideas, guidance • Its ability to “generate” ideas, solutions High Moderate Low

17. Tools • Therapist Adherence Rating (TAM) • Weekly supervision ratings • At each staffing • Global therapist ratings (GTR) • 3 times each year • CSS