riverside county department of mental health it takes a village and a family: substance abuse...

Riverside County Department of Mental Health

It Takes a Village AND a Family: Substance abuse treatment with the

juvenile justice population by combining MDFT and Wraparound

Presented By:Patty Myers, LMFT Multidimensional Family Therapy (MDFT), Expansion Mental Health Services Supervisor

Jennifer Vasquez, LMFT Western Wraparound Mental Health Services Supervisor

Cynthia Rowe ,PhD Associate Director of Multidimensional Family Therapy (MDFT) International

Panel: Marisol - Mom

Saul – Youth

Maria T. Gonzalez - Wraparound Parent Partner

Explain MDFT – MultiDimensional Family Therapy: History, What it Does, and How it Works

Show how MDFT + Wraparound are Similar (and Different)

Explain how RCDMH combined both Programs (it wasn’t easy!)

Introduce our Panel

Answer Questions

Today’s Workshop Will:

Wraparound Challenges:◦ Model does not focus on providing therapy◦ Dysfunctional family dynamics can interfere with

the planning process

MDFT Challenges:◦ Therapy can lose momentum if external

circumstances interfere◦ Program model only has 1 “Therapist Assistant” to

address case management needs

Addressing A Need

Who Put the Peanut Butter In My Chocolate?

Who Put the Chocolate In My Peanut Butter?

MDFT has been developed based on theory/research in the following areas:

1. Adolescent Development

2. Parenting Practices and Family Functioning

3. Risk and Protective Factors for Adolescent Problems

4. Ecological Perspective

5. Family Therapy: Structural and Problem Solving Therapies

History of MDFT

MDFT Theory of Change

Adolescents need to develop a positive, supportive relationship with parents

Symptom reduction and enhancement of prosocial and normative developmental functions occurs by:

a) Targeting the family

b) Facilitating curative processes across life domains teen, parent, family, extrafamilial)

MDFT Theory of Change (cont.) Problem behavior can desist when

meaningful, concrete alternatives are created, accepted, attempted and adopted

If it has been multiple risk factors and a network of influences that have created and maintained adolescents’ problems, then the same complex of interrelated influences must be systematically targeted for change

Pieces of MDFT Approach

AdolescentFamily MDFT

Parent(s)

Extra familial

Summary of Treatment Outcomes

Substance use reductions (41 to 66% reduction from intake to discharge)

Individual psychological functioning

School and job functioning

Parenting practices and psychological functioning

Family environment - family interaction

No or fewer arrests

Decreased involvement with drug abusing/deviant peers

Suspensions

Expulsions

Arrests

Mental Health Emergencies

Physical Emergencies

Riverside County MDFT Outcomes August 2006 –March 2014

84%86%

59%

73%

82%

CombiningMDFT & Wraparound

A Work In Progress…

MDFT/Wraparound Pilot Program

November, 2013 – January, 2015

Values: Family Focus Team Intervention Strengths Outcomes “Do whatever it takes”/ Persistence

Similarities

Areas: Financial School Housing Social Legal Substance Use Psychological

Goals + Population: Prevention of Placement; Adolescents on Probation; Delinquency Behavior; Substance Use/Abuse Issues; Mental Health Issues

MDFT

Phases/Stages: Foundation/Alliance/

Motivation “Work the Themes”

& Request Change Seal the Changes

& Exit

Wraparound

Engagement/Initial Plan Development

Implementation

Transition

Similarities (continued)

Other:

Optimism / “Holders of the Hope”Problem Solving / Skill Building

Helping the Whole Family

MDFT Evidence Based Time Limited (6 mo.) Substance/Delinquency Work on Emotions One Therapist for all

family members Therapist Assistant for

all Case Management Therapy to create

connectedness

Wraparound Evidence Informed No Time Limit Myriad Issues Work on Goals Multiple Team Roles

All Team members help with Case Management

Family Plan to create structure

Differences

◦ Changes in timeframe of initial implementation

◦ Prioritizing focus to enable combined programs

◦ Changes in session structure to enable simultaneous implementation

◦ Extensive coordination between Program Supervisors required for planning, implementation, and monitoring

Making Adjustments:

Beginning Stages Work Flow

Screening of Referrals Orientation: Present information to youth/family

regarding both programs

Safety Plan: Done without MDFT therapist

Assessemnt/Engagement Beginning Family Team Meetings: Identify

1 – 2 Goals for Wraparound Family Plan Initial 1:1’s: Parents/Caregivers +Youth and PP + BHS

Middle Stage Work Flow

WA Implementation Phase / MDFT Stage 2 work:

◦ MDFT Sessions 3x’s/week

◦ Wraparound FTM’s: 2x’s/month for duration of MDFT treatment

◦ BHS + PP 1:1’s – weekly or only as needed

◦ Case Coordination: weekly/ongoing between WA Team and MDFT Therapist

MDFT Model: “Seal the Changes” and Exit

Coordination with Ongoing Wraparound

Wraparound Transition Phase

If started together, MDFT treatment will probably finish before Wraparound

Or: MDFT can start in the middle of Wraparound services, then both usually finish at the same time

Ending Phase

Careful Planning and Coordination

Role Clarification

Coordination of MDFT Ending Phase

Confidentiality/Handling of Secrets

Celebrations - Conflict of timing with Wraparound celebration of accomplishment

Extra-Familial Domain - Balancing “who does what”

Lessons Learned

Wraparound graduation rates for Probation

Youth have been reported between30% - 40%:

Los Angeles Co. Wraparound Report, 2010

Riverside Co. Wraparound Report 2014

Santa Barbara Co. at Institute for Well Being, 2014

Riverside County MDFT-Wraparound Outcomes November, 2013 – March, 2015

However, during the Pilot implementation:

5 out of 8 youth and families receivingcombination MDFT – Wraparound services completedor will soon complete both programs successfully!

Although only a few families so far,

this is a 62.5% graduation rate forboth MDFT and Wraparound!

Riverside County MDFT-Wraparound Outcomes November, 2013 – March, 2015 Continued

Positive reception from County Juvenile Justice◦ Frequent requests from judges, DA’s and Public

Defenders for “MDFT-Wraparound”

Expansion Plan ◦ 1 MDFT Therapist assigned to each DMH

Wraparound Program 4 RCDMH Wraparound Programs 1 Therapist / 3 Teams per Program

Going Forward

Today’s Panel:

Marisol – Mom

Saul – Youth

Maria Gonzalez – Wraparound Parent Partner

Not here today:Girlyanne Lacson – FacilitatorJohn Young – Behavioral Health SpecialistRobert Cescolini – Probation OfficerBrooke Fiorelli – MDFT-Wraparound Therapist

And Now – The REAL Story!

Questions?

Thank You!Patty Myers:

PAMyers@rcmhd.org (951) 358-5730

Jennifer Vasquez: JLVasquez@rcmhd.org (951) 358-3640

Cynthia Rowe: crowe@mdft.orgWebsite: www.mdft.org

Maria Gonzalez: MariaTGonzalez@rcmhd.org

(951) 358-3640