Ecosystemic Structural Family Therapy – Family Based Mental Health Services (ESFT-FBMHS)

Families with an identified child or youth ages 3–21, who are at risk of out-of-home placement (e.g., psychiatric hospitalization, residential care, juvenile justice, foster care, or placement due to child welfare concerns) 

For children/adolescents ages: 3 - 21

For parents/caregivers of children ages: 3 - 21

Ecosystemic Structural Family Therapy – Family Based Mental Health Services (ESFT-FBMHS) is a program that provides an alternative to out-of-home placement by stabilizing youth with serious emotional and behavioral challenges and helping them remain safely at home. The program engages families to activate strengths, resources, and natural supports, to promote healing. The program works through the caregivers and is designed to strengthen attachments, enhance ability to regulate both emotionally and physiologically, increase executive functioning, and bolster the capacity of caregivers and their support system to work together effectively.  

Steve Simms, PhD, LMFT

• Title: Executive Director
• Agency/Affiliation: Philadelphia Child and Family Therapy Training Center
• Email: administration@pcfttc.com
• Phone: 267-738-5912

C. Wayne Jones, PhD

• Title: Executive Director 
• Agency/Affiliation: Center For Family Based Training
• Website: https://familybasedtraining.com/fbmhs-training/
• Email: Wayne@familybasedtraining.com
• Phone: 610-668-1492, x111

Tara Byers, EdD, NCC, LPC, ACS

• Title: Family Based Training Director
• Agency/Affiliation: Youth and Family Training Institute, UPMC, Western Psychiatric Hospital
• Email: Byerstl2@upmc.edu
• Phone: 717-304-3495

The goals of Ecosystemic Structural Family Therapy – Family Based Mental Health Services (ESFT-FBMHS) are:

For the Caregiver:

• Learn how to establish and maintain relationship rules and household routines
• Learn how to establish and maintain an emotionally safe, nurturing, and accepting relationship with the child
• Learn how to de-escalate conflict and problem-solve when tension is high

For the child/adolescent/young adult:

• Experience a reduction in documented symptoms and level of distress
• Participate more fully and adaptively in home, school, and community
• Feel safe, secure, and protected in their relationship with caregivers
• Reduce risk for psychiatric hospitalization, out-of-home placement, and other restrictive social services

The essential components of Ecosystemic Structural Family Therapy – Family Based Mental Health Services (ESFT-FBMHS) include:

•  Therapists attend to the intersection between the family’s social location, their unique cultural norms, and their values/beliefs to create a collaborative team
•  Treatment:
  • Delivered by a team
  • Delivered in the family’s home and community
  • Intensive with involving multiple highly focused sessions each week with the child, caregivers, and family.
• Interventions to help the child flow through their caregivers:
  • Therapists empower caregivers as primary change agents
  • o In sessions, therapists facilitate enactments of new interactional patterns targeting agreed-upon changes by assisting caregivers to:
    • Build on strengths
    • Promote resilience
    • Contain blame
  • This also includes:
    • Parent education
    • Case management and service coordination
    • Discharge planning and coordination
• Therapists also:
  • Build on and expand the family’s naturally occurring resources within the community and extended family
  • Put safety and stability first:
    • Use collaboratively constructed safety plans
    • Offer 24-7 on-call crisis availability
  • Coordinate care among multiple service agencies
  • Facilitate collaborative home-school relationships

Child/Adolescent Services

Ecosystemic Structural Family Therapy – Family Based Mental Health Services (ESFT-FBMHS) directly provides services to children and addresses the following:

• Severe emotional disturbance, impulsive and destructive behaviors (internalized and externalized), and risk of psychiatric hospitalization or out-of-home placement; mental and behavioral health diagnoses including developmental disabilities, autism spectrum disorder, and the influence of the family system’s enduring pattern of poor emotional regulation fueling extreme, high-risk reactions

Parent/Caregiver Services

Ecosystemic Structural Family Therapy – Family Based Mental Health Services (ESFT-FBMHS) directly provides services to parents/caregivers and addresses the following:

• Have a child who has been identified as having severe emotional disturbance with life-threatening and or life-altering challenges. experienced historic and/or generational trauma, highly stressed, grave chronic personal, social, and economic challenges impede caregiving and disrupt family functioning

Recommended Intensity

At the beginning of treatment, there is higher frequency of contact and longer sessions. Frequency and intensity of treatment at admission should align with the severity of the referral behavior and risk for out of home placement.

• At least 1 individual with the identified client (at an average of 45 minutes in length) per week, at the start of treatment and
• At least 1 caregiver(s) session (at an average of 60-90 minutes in length) per week at the start of treatment and
• At least 1 family session (at an average of 90-120 minutes in length) per week at the start of treatment.

Note: If a client is discharging from out-of-home placement back into their community there can be 30 days of overlap between services (out of-home service & in-home ESFT-FBMHS).
Note: Intensity of treatment, frequency and length of sessions, titrates down towards the end of treatment.

Recommended Duration

6-8 months (approx. 169-224 days)

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Community Daily Living Setting
• Community-based Agency / Organization / Provider
• Foster / Kinship Care
• Group or Residential Care
• Hospital
• Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
• Other
• Outpatient Clinic
• Public Child Welfare Agency (Dept. of Social Services, etc.)
• School Setting (Including: Day Care, Day Treatment Programs, etc.)
• Shelter (Domestic Violence, Homeless, etc.)
• Virtual (Online, Smartphone, Zoom, Telephone, Video, etc.)

Homework

This program does include a homework component.

Homework is assigned for the family/individual/subsystems to apply their experiences of deliberate practice (the new relational pattern), or resource access, etc. from the session, between sessions.The intention would be for the family/individual/subsystems to be activating strengths, resources, and accessing natural support, disrupting the old pattern that binds them in crisis.

Languages

Ecosystemic Structural Family Therapy – Family Based Mental Health Services (ESFT-FBMHS) has materials available in the following languages 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 in this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Services provided to clients occur in the home and community. Providers need to have a means of transportation to get from one location to the next. Providers are also required to provide a 24/7 crisis response system or on-call process. Providers need a way to maintain contact with families and collaterals by phone for in between session updates, support and scheduling. Finally, providers need to have a way to record both clinical and supervision sessions for review in training. This includes storage options that are HIPAA compliant.

Prerequisite/Minimum Provider Qualifications

Team Delivered/Co-Therapists: Teams at a minimum include – one Mental Health Worker (Bachelor’s degree level), and one Mental Health Professional (Master’s degree level-no license required or a graduate of the ESFT-FBMHS training curriculum). Teams can also have two Master’s level clinicians.

• Master’s degree must be in the field of human services, and the individual must have two years of clinical experience in a child-related service system.
• Bachelor’s degree must be in the field of human services, and the individual must have one year of experience in a child related service system.
• Individuals with a bachelor’s degree as outlined above and who are also graduates of the ESFT-FBMHS training program are considered a Master’s level equivalent staff member for the purposes of teaming requirements.

Clinical Supervisor (Full-time Program Director):

• Graduate degree in the field of Human Services and
  • Optimal, a minimum of 3 years of direct family therapy experience with children and adolescents
  • Optimal, a minimum of 2 years of mental health supervisory experience and administration experience.

Manual Information

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

Program Manual(s)

Manual details: 

• Lindblad-Goldberg, M., Dore, M. M., & Stern, L. (1998). Creating competence from chaos: A comprehensive guide to home-based services. WW Norton & Co.  

• Benjamin, J., Patel, P., & Simms, S. (2021). ESFT-FBMHS Manual v.2021. https://courses.pcfttc.com/product/ecosystemic-structural-family-therapy-family-based-mental-health-services-manual-v-2021/ 

• Jones, C. W. (2019). Setting the stage for change: An eco-systemic approach to in-home family-based treatment (2nd ed.). Center for Family Based Training. https://www.abebooks.com/9780984455317/Setting-Stage-Change-Eco-Systemic-Approach-0984455310/plp or Amazon. 

• Jones, C. W., Johnston, P., & Simms, S. (2021). Ecosystemic Structural Family Therapy (ESFT): An overview as applied to Pennsylvania’s Family Based Mental Health Services Program (rev 7-23-21). Philadelphia Child & Family Therapy Training Center.  https://courses.pcfttc.com/product-category/esft-fbmhs-manual/   

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

All training centers provide fee-based training via live in-person or virtual training room. These trainings are supplemented with in-person training and/or asynchronous training as deemed necessary by the training center.

Number of days/hours:

The current curriculum is designed for providers to engage in training while providing treatment.

• Clinical training for staff: 20 hours of orientation, plus 84 hours annually, for three years.
• Supervisor training: 20 hours of orientation, plus 114 hours annually (30 supervisor hours & 84 clinical hours), for three years.

• There are currently no published, peer-reviewed research studies on outcomes with the appropriate target population for the topic area(s) in which Ecosystemic Structural Family Therapy – Family Based Mental Health Services has been reviewed.

• Clossey, L., Simms, S., Hu, C., Hartzell, J., Duah, P., & Daniels, L. (2018). A pilot evaluation of the Rapid Response Program: A home-based family therapy. Community Mental Health Journal, 54(3), 302–311. https://doi.org/10.1007/s10597-018-0231-2

• Lindblad-Goldberg, M., & Northey Jr, W. F. (2013). Ecosystemic Structural Family Therapy: Theoretical and clinical foundations. Contemporary Family Therapy, 35(1), 147–160. https://doi.org/10.1007/s10591-012-9224-4 

• Simms, S., Jones, C. W., Mehta, P., & Johnston, P. (2021). A supervisory approach to implementing a pandemic-induced, practice-based change. Journal of Family Psychotherapy, 31(3-4), 141–156. https://doi.org/10.1080/2692398X.2020.1865768