Family Centered Treatment (FCT)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Family Centered Treatment (FCT) has been rated by the CEBC in the area of: Family Stabilization Programs.

Target Population: Families with members at imminent risk of placement into, or needing intensive services to return from, treatment facilities, foster care, group or residential treatment, psychiatric hospitals, or juvenile justice facilities

For children/adolescents ages: 0 – 17

For parents/caregivers of children ages: 0 – 17

Brief Description

FCT is designed to find simple, practical, and common sense solutions for families faced with disruption or dissolution of their family. This can be due to external and/or internal stressors, circumstances, or forced removal of their children from the home due to the youth’s delinquent behavior or parent’s harmful behaviors. A foundational belief influencing the development of FCT is that the recipients of service are great people with tremendous internal strengths and resources. This core value is demonstrated via the use of individual family goals that are developed from strengths as opposed to deficits. Obtaining highly successful engagement rates is a primary goal of FCT. The program is provided with families of specialty populations of all ages involved with agencies that specialize in child welfare, mental health, substance abuse, developmental disabilities, juvenile justice and crossover youth. Critical components of FCT are derivatives of Eco-Structural Family Therapy and Emotionally Focused Therapy which were enhanced with components added based on experience with clients.

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

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.

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.

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 Change© (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.

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.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Agencies must be licensed and all clinicians certified. The training includes both face-to-face and on-line training courses. 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.

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

Since Family Centered Treatment (FCT) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

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

The Readiness Assessment is designed to evaluate applicant agency capacity to implement the components necessary for the provision of Family Centered Treatment© (FCT). In that FCT is both a management and clinical model, this process will include:

  • Completion of the FCT Readiness Assessment Matrix©, a 100-component tool designed to assess the scope and readiness of prospective organizations across nine different implementation domains.
  • A review of submitted materials such as philosophy or organizational design of management, to include the mission statement and other policy and procedures that demonstrate the support necessary to fulfill the Family Centered Treatment agency licensing process
  • Interview of the top management system
  • Willingness to enter contract for board/funding commitment and support to enable Family Centered Treatment Certification for all FCT therapists
  • Willingness to enter contract for board/funding commitment and support to ensure sustainability of adherence (fidelity) to the FCT model after the rollout of the training and certification of therapists, (oversight and management contract with Family Centered Treatment Foundation)
  • Willingness to enter contract for board/funding commitment and support to ensure a system to provide data collection and research as required to assure fidelity to the FCT model during the course of treatment for each client and outcome data provided upon discharge
  • Interview with key clinical staff and Executive Director regarding applicant agency’s rationale for the selection of FCT as the model of choice for the agency
  • Review of applicant agency’s accreditation, endorsement, and CABHA assignment records and responses
  • The process includes the agency’s provision of required materials and documents prior to the onsite visit. During the onsite evaluation, the applicant agency is expected to provide or make available specifically requested clinical and management staff and materials that prove capacity to implement specific components of the model as part of the FCT Readiness Assessment Matrix©.
  • Review and willingness of external stakeholders and funders to support FCT implementation.

The pre-implementation materials are available on the FCT website at http://www.familycenteredtreatment.com/becoming-a-fct-provider.html or via request through Timothy Wood from the Family Centered Treatment Foundation at (704) 787-6869.

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, and monitoring for implementation. It also provides adherence verification for provider agencies. Upon FCT licensure, the FCTF consults with organizations as necessary on the effective use and assessment of implementation tools. Various assessments and tracking mechanisms are incorporated to ensure that organizational development around the model is nearly as important as the clinical approach itself. Tools and trackers are utilized at varying intervals depending on their use and need.

Stage of implementation specific tools include:

  • FCT Readiness Assessment Matrix©
  • Fidelity Adherence Compliance Tracker (FACT)
  • Implementation Driver Assessment©
  • FCT Implementation Strategy Tool (FIST)
  • Licensing and Implementation Report

For more information, please contact Timothy Wood at (704) 787-6869 or go to the FCT website at www.familycenteredtreatment.org

Fidelity Measures

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

There are 15 core Family Centered Treatment® Adherence Measures that gauge fidelity to the model. They 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. As explanation, all of the measures, excepting the case review instrument, are client-participatory, FCT phase-of-treatment specific, and designed to be done with the family. Because the measures are phase-of-treatment specific, they are indicators of progress and also serve as quantification of the degree to which the model has been adhered.

As needed, assistance in the development of an information management system that enables maintenance of a record review for which electronic technology is required. This includes 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. An electronic information management system and devices are needed. The Family Centered Treatment Foundation will support FCT provisionally licensed agencies in developing the infrastructure during the implementation phase in accomplishing the requirements listed.

Implementation Guides or Manuals

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

Upon request to become an FCT-licensed organization, the Family Centered Treatment Foundation provides exploring and/or applicant agencies with a Program Design and Implementation Guide. This guide highlights implementation considerations, a programs development process, readiness, and adherence criteria including training, supervision, fidelity documentation, and data collection. Additionally, the guide highlights the highly specific FCT-implementation tools and process expected of all FCT licensed organizations.

Research on How to Implement the Program

Research has not been conducted on how to implement Family Centered Treatment (FCT).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Permanency

Sullivan, M. B., Bennear, L. S., Honess, B. S., Sullivan, M. B., & Painter W E., (2012). Family Centered Treatment - An alternative to residential placements for adjudicated youth: Outcomes and cost effectiveness. OJJDP Journal of Juvenile Justice, 2(1), 25-40.

Type of Study: Posttest only matched comparison study
Number of Participants: 1,335

Population:

  • Age — Mean=15 years
  • Race/Ethnicity — FCT: 59% African American, 31% Caucasian, and 8% Hispanic; Comparison Group: 59% African American, 33% Caucasian, and 8% Hispanic
  • Gender — FCT: 75% Male and 25% Female, Comparison Group: 73% Male and 27% Female
  • Status — Participants were youth discharged from Family Centered Treatment (FCT) or residential placements during the first 4½ years of FCT field implementation in Maryland.

Location/Institution: Maryland

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article evaluates the posttreatment outcomes and program expenditures for two groups of adjudicated youth and their families sharing similar risk factors that can affect treatment outcomes. The study compared youth who received Family Centered Treatment (FCT) as an alternative to residential placement and remained in their homes and communities with those who were placed in residential services (the comparison group). All youth whose histories and data were analyzed in this study qualified for both FCT and residential placement. The decision to place the youth in FCT as opposed to a residential setting was made by case managers/probation officers, the courts, and/or the parents before this study. Subjects in the FCT and comparison group were matched using a combination of standard matching and propensity-score matching to estimate the average treatment effect for each outcome. Results show that FCT provides significant, positive behavioral results and reduces posttreatment placements. In addition, a cost analysis demonstrates that the FCT model is a cost-effective alternative to residential placement. Limitations include lack of randomization, possible selection bias, and high attrition rates during follow-up.

Length of postintervention follow-up: 2 years.

References

Painter, W. E. (2012). A strategic approach to reunification for juveniles with placements out-of-home. FOCUS, 18(2), 11-13.

Schultz, D., Jaycox, L. H., Hickman, L. J., Chandra, A., Barnes-Proby, D., Acosta, J., … Honess-Morreale, L. (2010). National evaluation of Safe Start Promising Approaches Assessing Program implementation. Retrieved from the Rand Corporation’s website: http://www.rand.org/content/dam/rand/pubs/technical_reports/2010/RAND_TR750.pdf

Sullivan, J. P. (2006). Family Centered Treatment: A unique alternative. Corrections Today, 68(3).

Contact Information

Name: William Painter, MS
Agency/Affiliation: Family Centered Treatment Foundation
Website: www.FamilyCenteredTreatment.org
Email:
Phone: (704) 787-6869

Date Research Evidence Last Reviewed by CEBC: July 2016

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: November 2013