riverside county department of mental health it takes a village and a family: substance abuse...
TRANSCRIPT
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:
[email protected] (951) 358-5730
Jennifer Vasquez: [email protected] (951) 358-3640
Cynthia Rowe: [email protected]: www.mdft.org
Maria Gonzalez: [email protected]
(951) 358-3640