Program Goals

The goals of Family Centered Treatment (FCT) are:

• Enable family stability via preservation of or development of a family placement
• Enable the necessary changes in the critical areas of family functioning that are the underlying causes for the risk of family dissolution
• Bring a reduction in hurtful and harmful behaviors affecting family functioning
• Develop an emotional and functioning balance in the family so that the family system can cope effectively with any individual member's intrinsic or unresolvable challenges
• Enable changes in referred client behavior to include family system involvement so that changes are not dependent upon the therapist
• Enable discovery and effective use of the intrinsic strengths necessary for sustaining the changes made and enabling stability

Logic Model

View the Logic Model for Family Centered Treatment (FCT).

Essential Components

The essential components of Family Centered Treatment (FCT) include:

• While the basic primary components of FCT have some commonality with other models, the distinctiveness of FCT is derived from the intensive training, supervision, and management system that requires and aims to enable exceptionally high expectations of families in treatment. Practically speaking the intense peer and individual supervision process (combined average of 5 hours per week) supports staff in the delivery of services that are designed to inspire families to make changes. Components of treatment include:
• Joining and Assessment Phase: A fun, participatory, sensory-based phase of treatment that provides the family with tangible visual documents that reinforce their decisions about what they need to adjust as a family system (goals). Included in this Family Centered Evaluation are: Ecomaps, a multiple staff led Structural Family Assessment, and a Family Life Cycle assessment.
• Restructuring Phase: A phase that provides the family with practical real-time suggestions during the most needed times (primarily nights and weekends). This process is one that is done with them as they practice new behaviors (enactments) rather than a "for them" or "to them" approach. The inability to integrate new behaviors for change due to emotional blockages from past trauma often is discovered during the Restructuring Phase.
• Trauma Treatment: This treatment is provided when prompted by any of the following:
• The discovery of emotional blockages as noted
• A disclosure during an enactment
• Scores from one of the standardized assessments (Child and Adolescent Needs and Strengths [CANS], Family Assessment Device [FAD], or Trauma Symptom Checklist-40 [TSC-40])
• Sharing of trauma during the Joining and Assessment Phase
• Valuing Changes Phase: Although unusual for home-based treatment models, this phase is considered critical if the changes made during treatment are to be sustained. Specific adjustments in the clinician's techniques during this phase provide the family an opportunity for evaluating the reasons behind the changes they have made thus far in the treatment process. Changes made for conformity or compliance are challenged and create value conflict. This component results in the family's selection and internalization of changes that are to be sustained long after treatment has ended with the goal of avoiding repeating events and dysfunction.
• Generalization Phase: This phase provides the family an opportunity to predict the difficult-to-handle events that, based on the events of the past, will probably occur in the future. Included in this predictive process is an exploration of family life cycle stages to come and fears associated with the stages. This process includes designing and role-playing family system responses to the predictable and other unforeseen events. They are coached as a family system to use strengths and skills they have integrated into their family functioning in order to generalize responses that work well for them. Integral to this phase is a required Family Giving project in which they design, develop and implement a project designed to give back to society, others in need, or their community. This "power of giving" is one way in which FCT works to position families to discover their inherent worth and dignity.
• All of the best practices for home-based treatment are integral to FCT, including, but not limited to, on-call support from the family's own clinician, multiple staff involved at critical junctures, and collaborative team work with all stakeholders on a weekly (or daily if needed) basis.

Program Delivery

Child/Adolescent Services

Family Centered Treatment (FCT) directly provides services to children/adolescents and addresses the following:

• Adjustment disorder, posttraumatic stress disorder (PTSD), attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, depression, mood disorder, bipolar, disruptive behavior, abusive and neglectful family situations, exposure to violence and domestic violence, and involvement in juvenile crime

Parent/Caregiver Services

Family Centered Treatment (FCT) directly provides services to parents/caregivers and addresses the following:

• Parents of children with special needs (see description under Child/Adolescent above), domestic violence, and substance abuse

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: All phases of FCT involve the family intensively in treatment. The required phase-specific activities occur with the family and the documents produced from the activities require the family system to be involved. FCT is a family system model of home-based treatment and while the referred client is integral to the treatment process, the intensity of treatment can and does occur with other members when their behaviors or roles are critical to the progress of the referred family member (client). In addition, during the assessment phase, the family defines their "family constellation" and those members are invited by the nuclear family members to participate in the structural family assessment. Other support systems are critical to the success of FCT and are, at minimum, informed and kept abreast of treatment progress, and can be integrally involved per the family's expressed need.

Recommended Intensity:

A minimum of 2 multiple-hour sessions per week excluding the ramping up period (1st month) and the slowing down period (last month of treatment). Lengthier and more frequent sessions are available based on assessed need. On call support is available 24 hours a day every day of the year.

Recommended Duration:

While the length of treatment is driven by family need and progress, the average length of treatment is 6 months.

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Foster / Kinship Care

Homework

Family Centered Treatment (FCT) includes a homework component:

During the Restructuring and Valuing Changes Phases of treatment, families determine to practice new behaviors on their own when the clinician is not present and thus this aspect of treatment might be considered homework. The determination of the specific new behaviors to be practiced and how they will be executed is an outgrowth of the practice times that occur with the clinician present.

Languages

Family Centered Treatment (FCT) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Effective delivery of FCT is contingent upon a three-part approach of management. All levels of management must support effective treatment over business pragmatism. This includes assuring that funding is in place for the:

• Training to ensure that all direct FCT personnel (clinician, supervisor, trainer) demonstrate theoretical knowledge and field skills competency
• Fidelity measures built into the clinical process and the ensuing monitoring systems
• Rigorous research and data collection systems

Practically speaking this means that FCT requires a commitment of management to provide:

• The intensive on-line and field-based competency training process to enable certification for each FCT clinician; Wheels of Changé (over 100 hours of training) which will require electronic information device accessibility, capability, and capacity
• Training of supervisors to enable certified FCT supervisor status; a six-month process that is both on-line and live demonstration which will also require phone system, web access, and electronic information devices and capacity
• Peer supervision via a weekly team meeting process which requires office space and materials for face-to-face training and peer supervision of staff members. High performing teams are optimized at personnel counts of 8-12.
• Monthly staffing of each FCT case utilizing a family systems model of review known as a MIGS (Mapping, Issues, Goals, Strategies) which requires space for the team to meet, printing and copying capacity, and white boards
• Weekly supervision to assure fidelity to the FCT model which requires an office or Health Insurance Portability and Accountability Act (HIPAA)-compliant location for meeting
• Key treatment-related documents that must be produced for each case that are critical to each phase of FCT treatment and that provide the hard documents to demonstrate fidelity to the model require printing and copying capacity
• Access to an information management system that enables maintenance of a record review for electronic technology used
• A tracking process necessary to assure maintenance of fidelity (15-individual phase specific treatment activities and dosage requirements) to the model for individual cases and for evaluation of outcomes in the aggregate which requires an electronic information management system and devices

The Family Centered Treatment Foundation will assess and support FCT provisionally licensed agencies in developing the infrastructure during the Installation and Initial implementation phases to accomplish the requirements listed.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

State-specific credentialing often drives the minimum qualifications, but most FCT direct service clinicians are Master's level professionals with human service degrees (psychology, social work, counseling, marriage and family therapy, etc.) Certification in Family Centered Treatment^® is a requirement; an online 100-hour participatory and tested training course with field based competency requirements. Supervisors are likewise credentialed and licensed per their course of study (Licensed Clinical Social Worker [LCSW], Licensed Marriage and Family Therapist [LMFT], Licensed Professional Counselor [LPC], etc.) Supervisors also must be certified via a FCT supervision course; an on-line and group cohort training course with field based competency testing typically lasting six months.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

The manuals are:

• Painter, W. E., & Smith, M. M. (2004). Wheels of change—Family centered specialists handbook and training manual. Institute for Family Centered Services.
• Wood, T. J, (2020). Family Centered Treatment® design and implementation guide. Family Centered Treatment Foundation, Inc.
• Painter, W. E., & Smith, L. B., Jr., (2020). The definitive report for Family Centered Treatment®. Institute for Family Centered Services & Family Centered Treatment Foundation, Inc.

Upon completion of an agency’s readiness assessment and successful agreement to incorporate Family Centered Treatment into their program, training of the model via FCT Foundation will ensue.

Training Information

There is training available for this program.

Training Contact:

• Timothy Wood
  Family Centered Treatment Foundation
  www.familycenteredtreatment.org
  phone: (704) 787-6869

Training Type/Location:

Agencies must be licensed and all clinicians certified. Training for FCT entails a comprehensive and sophisticated online and field-based competency program known as the Wheels of Change—Family Centered Specialists Handbook and Training Manual (WOC). The WOC is composed of multiple components which require satisfactory completion to achieve certification. Extensive training programs are available including certification, supervision certification, peer supervision, staffing the FCT case utilizing a family systems model of review, weekly supervision to assure fidelity, and understanding key FCT-related documents.

FCT training and certification is highly emphasized in FCT. Performance and outcomes are only as good as the training regimen. These tools are used to monitor and improve the training and certification process for FCT Supervisors, Trainers, and Practitioners:

• Training Contracts are developed and signed in supervision. They include training components and expectations for completion. Practitioner/supervisor project specific completion dates and monitor in supervision.
• FCT Training and Certification Schedule operationalizes the training contract with specific dates and training processes.
• Team Training and Certification Tracker is used to project and monitor training compliance, completion, and accountability for the entire organization.

To achieve Certification in FCT, practitioners must complete:

• A guided self-study process using the Wheels of Change© online audio/visual training course.
• The electronic on-line portion is a timed and tracked audio visual guided process incorporating 18 units of study that cover the subjects critical for implementing FCT.
• The units cover the theory and knowledge components of the phases of FCT and the treatment skills needed for effective performance of FCT.
• Each unit contains step-by-step explanations, preliminary discussion questions that permit assessment of knowledge provided in the unit, identification of required skills, and a required testing.
• Oversight and tracking of the progress of trainees permits or prompts involvement of supervisory or trainer staff to provide intensive coaching, as needed, on the material via a review and role-play approach.
• The electronic online portion permits a “go at one’s own pace” process but is designed to be completed in an efficient manner.
• Field-based practice of the required FCT core skills and supervision occurs simultaneously as they take the online course.
• A field-based performance evaluation to assess the competency level of the trainee in the core skills. Certified FCT Trainers evaluate the field-based performance and utilize internal reliability measures for accuracy.

Number of days/hours:

For the provider certification process, the trainee attends an approximately 8-week 100-hour process that can extend up to 12 weeks dependent upon knowledge and skill of the participant.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Family Centered Treatment (FCT) as listed below:

Family Centered Treatment Foundation (FTCF) provides a Readiness Assessment for applicant agencies upon written request to become a provider of the Family Centered Treatment and after preliminary discussions related to program size, scope, location, mission, agency culture, intent, etc. The Readiness Assessment is designed to evaluate the applicant agency’s capacity to implement the components necessary for the provision of FCT. Within each step of the Readiness Assessment are specific components required for review. The FCT Readiness Assessment Matrix was developed in consultation with the National Implementation Resource Network. There are feedback loops built into the process so that information and data is not only collected, but also cycled back into the program for quality improvement.

The Readiness Assessment Matrix (RAM) is a tool designed to measure a program’s pre-readiness for FCT. Several meetings are conducted prior to the Readiness Assessment meeting (where this tool is completed). The RAM is used to get a baseline for readiness and identify specific readiness strengths and areas of growth. The RAM is used to develop a Readiness Assessment Report.

The RAM Goals and Strategies Worksheet is a document used to develop and monitor initial implementation goals and strategies derived from the RAM. This is also an exercise to train new providers how data is used to develop goals and strategies. This information is woven into the Weekly Implementation Meetings (see Formal Support for Implementation section for more information).

The pre-implementation materials are available on the FCT website at or via request through training contact above.

Formal Support for Implementation

There is formal support available for implementation of Family Centered Treatment (FCT) as listed below:

Family Centered Treatment Foundation (FCTF) provides onsite and web-based direction, technical assistance, formal coaching, consultation, oversight/monitoring for implementation. It also provides adherence verification for provider agencies. Upon FCT licensure, the FCTF trains organizations not only on the clinical model but also on the effective use and assessment of implementation tools. Various assessments and tracking mechanisms are incorporated to ensure that organizational development around the model occurs as this is as important as the clinical approach itself (Co-Occurring Process).

Upon licensure as an FCT organization, the Family Centered Treatment Foundation will guide the organization through the stages of implementation. This process encompasses the general timelines, stages of implementation, tools for use, and other considerations. Achieving full implementation or sustainability often takes time/years to attain, although the timeline is different for each organization.

Tools and trackers are utilized at specified intervals but are tuned to the development level of the organization. There are feedback loops built into the process so that information and data is not only collected, but also cycled back into the program for quality improvement.

• Weekly Implementation Meetings are the engine that drives implementation. This is a multifunction meeting between provider organizations and FCTF. Frequency is dependent upon Degree of Implementation.
• There are two versions of the Implementation Driver Assessment (IDA), the initial IDA is used during the first 12–18 months of implementation and the Emergent IDA is used after 18 months. The data from the IDAs are used to develop the FCT Implementation Tool (FIT), which is a fluid document used to create and monitor implementation goals and strategies. IDAs/FITs are completed every 6 months and are woven into the Weekly Implementation Meetings every 3 months or as needed. FCTF staff present IDAs/FITs to their team for support, feedback, and accountability.
• Licensure Implementation Report (LIR) is an annual document developed by FCTF staff that reviews all implementation, training, performance measures, outcomes, fidelity, stakeholder relationships, systems issues, etc. This comprehensive report summarizes all work completed over the past year, provides an implementation status and recommendations to address areas of growth (weaknesses). It also includes practitioner and stakeholder surveys.

Team or Team Primacy is an integral component to FCT. The effectiveness of a program is dependent on a program developing a high performing team. FCT teams are built on the principles of Team Development and Peer Supervision. The following are the tools and processes used to implement the FCT Team model.

• Team Development Diagnosis Tool is used by FCTF consultants and FCT program supervisors to measure team behaviors at the team and individual levels.
• Peer Professional Development is used to activate the peer supervision process toward individual practitioner development.

For additional information, questions or support please contact Jon McDuffie, Implementation Director FCTF, jon.mcduffie@familycenteredtreatment.org

Fidelity Measures

There are fidelity measures for Family Centered Treatment (FCT) as listed below:

FCT fidelity and adherence is determined through numerous objective measures covering training, treatment intensity adherence, core treatment component completion and implementation driver metrics.

The FCT adherence measures that gauge fidelity to the model are produced during the treatment process for each client and utilize actual written records that become file documents. The activities that enable the production of the individual written record (adherence measure) cannot occur without the corresponding progression in treatment. All of the measures, except for the case review instrument (MIGS), involve client participation and are FCT phase of treatment specific. Because the measures are phase of treatment specific, they are indicators of progress and serve as quantification of the degree to which the model has been adhered.

FCT staff are only permitted to implement the adherence measures after successful completion of the training pertaining to the specific phases and the measures involved in the phase. Each staff is observed and determined as competent before they can implement or perform the measure alone.

Program developer can be contacted for additional information fidelity measure information and a Program Design and Implementation Guide.

Fidelity Measure Requirements:

Fidelity measures are required to be used as part of the program implementation.

Established Psychometrics:

Edwards, J, T. (2003). A systems oriented approach working with families, guidelines and techniques. Foundation Place Publishing.

McCormick, K. M., Stricklin, S., & Nowak, T. M., & Rous, B. (2008). Using eco-mapping to understand family strengths and resources. Young Exceptional Children, 11(2), 17–28. https://doi.org/10.1177/1096250607311932

Implementation Guides or Manuals

There are implementation guides or manuals for Family Centered Treatment (FCT) as listed below:

There is a Program Design and Implementation Guide. The purpose of this guide is to assist providers in learning about the history, purpose, and method of implementing the FCT model. It is comprised of the following content areas:

• Program Design & Implementation
• History
• FCT Program Implementation Considerations
• FCT Program Development Process
• Readiness Assessment
• FCT Training
• FCT Supervision
• Monitoring & Adherence to Fidelity and Treatment Intensity
• Outcome Evaluation and Research
• Implementation Process
• Implementation Drivers-Implementation Tool-KPIs-Licensure Reports
• FCT Certification and Licensure Process

Implementation Cost

There have been studies of the costs of implementing Family Centered Treatment (FCT) which are listed below:

Bright, C. L., Betsinger, S., Farrell, J., Winters, A., Dutrow, D., Lee, B. R., & Afkinich, J. (2015). Youth outcomes following Family Centered Treatment® in Maryland. University of Maryland School of Social Work. https://www.familycenteredtreatment.org/s/Youth-Outcomes-Following-FCT-in-MD-UM-SOSW-2015.pdf

Sullivan, M. B., Bennear, L. S., Honess, K. F., Painter Jr, W. E., & Wood, T. J. (2012). Family Centered Treatment®--an alternative to residential placements for adjudicated youth: Outcomes and cost-effectiveness. Journal of Juvenile Justice, 2(1), 25-40. https://www.ojp.gov/pdffiles/240461.pdf

Research on How to Implement the Program

Research has been conducted on how to implement Family Centered Treatment (FCT) as listed below:

Muniute, E. I., & Alfred, M. V. (2007, Feb.). Team Primacy Concept (TPC) based employee evaluation and job performance. Paper presented at the Academy of Human Resource Development International Research Conference in The Americas (Indianapolis, IN). https://eric.ed.gov/?id=ED504342

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Permanency

Additional References