Families Moving Forward (FMF) Program

About This Program

Target Population: Children aged 3 to 12 years old with prenatal alcohol exposure (PAE) or fetal alcohol spectrum disorders (FASD) and their caregivers

For children/adolescents ages: 3 – 12

For parents/caregivers of children ages: 3 – 12

Program Overview

The Families Moving Forward (FMF) Program is a manualized, yet individualized, behavioral consultation intervention. FMF is tailored for families raising children 3–12 years with prenatal alcohol exposure (PAE) or fetal alcohol spectrum disorders (FASD), and clinically concerning behavior problems.

The FMF Program offers a specialized intervention approach delivered by trained providers. Clinically, FMF combines positive behavior support techniques with motivational interviewing and cognitive-behavioral treatment. FMF offers:

  • Caregiver support and coaching
  • Psychoeducation on PAE effects, treatment-relevant FASD information, and advocacy
  • Anticipatory guidance and skill building in caregiver use of proactive parenting strategies (e.g., accommodations)
  • Behavior planning
  • Targeted school and provider consultation, and community resource linkages, are also offered.

Program Goals

The goals of the Families Moving Forward (FMF) Program are:

For Parents and Caregivers:

  • Increase knowledge of FASD and advocacy.
  • Improve attitudes, including an increased sense of efficacy and satisfaction in parenting/caregiving.
  • Increase ability to meet family needs.
  • Increase self-care.
  • Help child identify and decrease disruptive behaviors.
  • Increase use of targeted parenting practices.

For Children:

  • Identify disruptive behaviors.
  • Decrease disruptive behaviors.

Logic Model

The program representative did not provide information about a Logic Model for Families Moving Forward (FMF) Program.

Essential Components

The essential components of the Families Moving Forward (FMF) Program include:

  • Sets up an individual counseling relationship between a trained FMF Specialist and eligible family:
    • Any family structure or any demographic group is eligible.
    • Family cannot be involved in hazardous substance abuse.
  • Uses a brief preintervention–postintervention assessment that covers:
    • Current disruptive child behavior at both time points
    • Current parenting sense of competence
  • Optionally assesses at posttest:
    • Family needs that were met
    • Treatment satisfaction
  • Develops a good working alliance between practitioner and caregiver(s) by using motivational interviewing and cognitive-behavioral therapy techniques with an emphasis on caregiver support.
  • Addresses currently troubling major child problem behaviors.
  • Teaches parents generalizable skills for dealing with problem behaviors in the future.
  • Actively involves parents throughout the intervention with:
    • Discussion
    • Viewing of videos of children with FASD and their families
    • Reading fact sheets
    • Completing worksheets designed to be relevant and interesting.
  • Delivers a manualized, yet customizable, family curriculum in an intervention flow that covers a comprehensive set of topics tailored to families raising children with FASD or PAE.
  • Provides 15+ sessions every other week if using the 90-minute version of the intervention, typically for 9–11 months, but can be as short as 7 months.
    • Can be provided in 20+ weekly sessions if using the 60-minute version, typically for 6–9 months.
    • If a practitioner’s agency allows, follow-up can be provided beyond the program’s usual length.
  • Offers psychoeducation to parents on a neurodevelopmental viewpoint (i.e., understanding the effects of prenatal alcohol exposure, FASD, and their own child’s functional profile of strengths and challenges across a wide range of developmental domains). This is called reframing in the FMF Program.
  • Collaborates with parents to help them learn to understand the value of preventative, proactive, practical strategies for modifying the child’s various environments (including home and school), and caregiver behavior, to head off many problem behaviors.These strategies are called accommodations in the FMF Program.
  • Collaborates with parents to help them learn user-friendly and creative methods of practical behavior management, using positive behavior support (PBS) principles. This is designed to result in parents learning to make behavior plans for specific, troubling problem behaviors. These PBS strategies are called brainstorming in the FMF Program.
  • Offers psychoeducation on other important topics including advocacy, self-care, and anticipatory guidance (i.e., looking forward to the future).
  • Offers psychoeducation on optional topics parents choose, such as calming for kids or respite.
  • Works together with parents to link them to needed community services and supports such as.
    • Individual therapy for the parent
    • Connection of the family with practical or social service resources like adoption support or DDA funding
    • Coordinating care with the primary care provider or other child therapist.
  • Helps parents work through the emotional side of raising a child with invisible disabilities that may not be recognized by schools or society.
  • Provides targeted consultation to schools, including a school visit or school contact done collaboratively with the parent.
  • Offers targeted consultation to other providers working with the child.
  • Encourages practitioners to adhere to the intervention and to customize with available program materials.
  • Focuses on helping parents feel more effective, satisfied, positive about their child and the parent-child relationship, and to engage in more self-care and getting family needs met.

Program Delivery

Child/Adolescent Services

Families Moving Forward (FMF) Program directly provides services to children/adolescents and addresses the following:

  • Has been diagnosed with FASD or PAE, disruptive behaviors; at high-risk for secondary disabilities, including later lifestyle and daily function problems such as mental health problems, disrupted school experiences, and disrupted placements

Parent/Caregiver Services

Families Moving Forward (FMF) Program directly provides services to parents/caregivers and addresses the following:

  • Parent/caregiver(s) of a child with PAE or FASD who has clinically concerning behavior problems (e.g., attention problems, hyperactivity, internalizing symptoms, and/or atypical social-emotional skills), the child could also have other exposures, trauma, etc.
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Secondary caregivers such as members of the extended family (e.g., grandparents) or childcare provider (e.g., nanny) may participate in FMF sessions or receive collateral contact (with informed consent). Also, as an essential component, the FMF Program links families with other community resources, offers targeted school consultation, and offers targeted provider consultation.

Recommended Intensity:

Twice per month for 90 minutes or four times per month for 60 minutes

Recommended Duration:

6-11 months depending on the length and frequency of the sessions

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • Hospital
  • Outpatient Clinic
  • Telehealth (Online, Telephone, Video, etc.)

Homework

Families Moving Forward (FMF) Program includes a homework component:

Every session has a psychoeducation Fact Sheet and a related core Worksheet (an enactive procedure, typically done as homework). There are also optional Worksheets, should customized homework be needed. This can be added into core or optional sessions. There is also a behavior plan, put into effect by the end of approximately the 4th session, also on a Worksheet. Development, use, and troubleshooting of the behavior plan (with ongoing modification as needed) is a homework activity throughout at least two-thirds of the FMF Program intervention.

Languages

Families Moving Forward (FMF) Program does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

Personnel:

  • Trained FMF Specialists
  • Access to an agency clinical supervisor

Space/room requirements:

  • Home visits: transportation, a device (e.g., tablet or small portable computer), a comfortable and secure space within the home, and some type of access to the internet
  • Clinic visits: confidential clinic space with access to the internet and room for coaching if the child attends
  • Telehealth: confidential, secure space where the family can do telehealth, an appropriate videoconferencing platform (PHI-protected, allows screen-sharing), a device (e.g., tablet or small portable computer), and access to the internet

Trained FMF Specialists need access to these resources:

  • Printer, preferably with color printing capacity to produce needed program materials
  • Printer paper
  • One 1.5 inch binder for each client, ideally including portable 3-hole punch, and section separators with labels prepared using the printer
  • One case folder for each client and secure place to lock files when not in use, per agency guidelines
  • Access to the internet, preferably in the form of a tablet or small portable computer, and sufficient bandwidth and data to show a limited number of videos during the intervention

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Service Providers: Master’s level training in an appropriate psychosocial field (e.g., social work, counseling, child development, marriage and family counseling, applied psychology, and similar) and appropriate licensure or certification

Supervisors: Master’s level training in an appropriate psychosocial field see above); appropriate licensure or certification; and at least 2 years of supervision experience; higher education level may be required if standardized testing used with the FMF Program

Manual Information

There is not a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Trainings are advertised on the FMF website and arranged through the FMF Central Office, located at the Seattle Children's Research Institute (SCRI), where the FMF Central Office is located.>/p>

Quarterly trainings are offered in-person at the SCRI. In addition, regional trainings are offered in-person through The Florida Center for Early Childhood (The Florida Center), as well as approved locations with FMF Trainers located in California, Michigan, and New York. For an additional fee, both trainers from SCRI and The Florida Center can provide on-site trainings at an agency.

Training via remote videoconferencing is also available for individuals in the United States and Canada, as well as international participants dependent on time zone. Visit the FMF website for a list of upcoming trainings.

Number of days/hours:

Length of training for providers is 30 hours across 5 days for in-person; and 30 hours across six days for remote.

Length of training for supervisors is 3 hours over 1 or 2 days, plus monthly follow-up via individualized or group phone consultations. Supervisors are encouraged to attend the full FMF Specialist training and are also required to attend the 10 hours of intervention fidelity consultation, which occurs monthly.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Families Moving Forward (FMF) Program.

Formal Support for Implementation

There is formal support available for implementation of Families Moving Forward (FMF) Program as listed below:

Length of training for providers is 30 hours across 5 days for in-person; and 30 hours across six days for remote.

Length of training for supervisors is 3 hours over 1 or 2 days, plus monthly follow-up via individualized or group phone consultations. Supervisors are encouraged to attend the full FMF Specialist training and are also required to attend the 10 hours of intervention fidelity consultation, which occurs monthly.

Fidelity Measures

There are fidelity measures for Families Moving Forward (FMF) Program as listed below:

Each session and module has a self-report checklist (outline) that is used to guide the FMF Specialist through the visit. There are also consultation outlines for contacts with school staff and providers. These are provided on the FMF website and are a central focus of the basic FMF Specialist Training. These act as an internal check on intervention fidelity.

As an outside check on intervention fidelity, there is a video review process used to provide formal intervention fidelity feedback. Each FMF Specialist going through this process is required, with parent consent, to submit two videos of particular sessions delivered in the intervention (with back-up suggested sessions, should there be some problem in obtaining a video). It is suggested this be done with the second case carried by the clinician. A trained FMF Consultant, or appropriate member of the FMF Central Office, reviews the video, which must capture the majority of the session, including the beginning routine. An Internal Video Review Scoring Form (IVRSF) is used. There is training on use of the IVRSF, and the form requires both ratings of concrete skills and overall ratings of six domains (e.g., Use of Motivational Interviewing Techniques or Mechanics of the Intervention). <./p>

A clinician must meet the current standard—as defined via a scoring algorithm—to pass each video review. The FMF Consultant generates a narrative of the clinician’s strengths and tips for improvement. If the clinician meets current standard for both videotapes, they are considered to have met intervention fidelity requirements. If the FMF Specialist does not meet current standard for one of the videotapes, they must move through a formal quality assurance (QA) process. This QA process is defined in guidelines provided to FMF Specialists and FMF Supervisors. Working collaboratively with the FMF Specialist, FMF Supervisor, and FMF Consultant, a customized QA plan is developed. The Session, Module, and Consultation Outlines are a central focus during FMF Specialist and FMF Supervisor training. The IVRSF is used only by approved FMF Consultants and appropriate staff of the FMF Central Office, and training for that is provided by FMF Central Office personnel on an as-needed basis.

Fidelity is assessed internally through the Session, Module, and Consultation Outlines (self-report); through video recordings evaluated with use of the Internal Video Review Scoring Form (IVRSF); the narrative of strengths and tips for improvement; and quality assurance (QA) plan, as necessary.

Implementation Guides or Manuals

There are implementation guides or manuals for Families Moving Forward (FMF) Program as listed below:

The FMF Program Implementation Support manual addresses the following topics:

  • How to evaluate need for the FMF Program
  • What are requirements for integrating the FMF Program into an agency
  • What leadership involvement is needed
  • What implementation support looks like, why it is needed, and what it costs
  • What agency-level implementation coordination looks like and why it is important
  • How staff are trained
  • How supervision should be set up
  • How to recruit eligible and appropriate families
  • What preparation time is needed for FMF Specialists and caseload requirements
  • How to bill
  • How to arrange for intervention fidelity consultation
  • How to arrange for the video review and quality assurance process/
  • How to evaluate pre-post outcomes and outcome expectations/li>
  • Issues involved in using standardized data within the intervention (optional process)
  • How to resolve barriers to FMF Program utilization at the person-level and systems-level

For information about the manual, contact the FMF Central Office at familiesmovingforward@seattlechildrens.

Implementation Cost

There are no studies of the costs of Families Moving Forward (FMF) Program.

Research on How to Implement the Program

Research has been conducted on how to implement Families Moving Forward (FMF) Program as listed below:

Petrenko, C. L. M., Pandolfino, M. E. & Robinson, L. K. (2017). Findings from the Families on Track pilot trial for children with fetal alcohol spectrum disorders and their families. Alcoholism: Clinical and Experimental Research, 41(7), 1340–1351. https://doi.org/10.1111/acer.13408

Petrenko, C. L. M., Demeusy, E. M. & Alto, M. E. (2019). Six-month follow-up of the Families on Track intervention pilot trial for children with fetal alcohol spectrum disorders and their families. Alcoholism: Clinical and Experimental Research, 43(10), 2242–2254. https://doi.org/10.1111/acer.14180

Relevant Published, Peer-Reviewed Research

Interventions for Children with Fetal Alcohol Spectrum Disorders Research Consortium. (2009). Interventions for children with fetal alcohol spectrum disorders (FASDs): Overview of findings for five innovative research projects. Research in Developmental Disabilities, 30(5), 986–1006. https://doi.org/10.1016/j.ridd.2009.02.003

Type of Study: Randomized controlled trial
Number of Participants: 52

Population:

  • Age — Children: 5-11 years (Mean=8.06 years); Adults: Not specified
  • Race/Ethnicity — Children: 50% non-Hispanic White and 25.9% African American or Black; Adults: Not specified
  • Gender — Children: 51.9% Male; Adults: Not specified
  • Status — Participants were school-aged children with a variety of behavior and learning problems referred to a fetal alcohol spectrum disorders (FASD) diagnostic clinic network.

Location/Institution: Washington State FAS Diagnostic and Prevention Network (FAS DPN) of diagnostic clinics

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate the Families Moving Forward (FMF) program’s ability to improve caregiver self-efficacy, meet family needs, and reduce child problem behaviors when compared with the community standard of care. Families were randomized to either the FMF intervention group (n=26) or to the community standard of care group (n=26). Measures utilized include the Parenting Sense of Competence (PSOC)’s Efficacy Scale, the Eyberg Child Behavior Index (ECBI)’s Problem Scale, the Multidimensional Assessment of Parental Satisfaction (MAPS), and the Parenting Stress Index (PSI)’s Child Domain Scale. Results indicate that compared with caregivers in the community standard of care group, from baseline to follow-up, caregivers participating in the FMF intervention showed a significantly improved sense of parenting self-efficacy immediately posttreatment. A greater percentage of caregivers in the FMF intervention group reported engaging in more self-care behaviors than parents in the community comparison group. No group differences emerged for change in child-related parenting stress. A highly significant group difference revealed that the FMF intervention group reported their family’s needs were met more often than did the comparison families. Caregivers receiving FMF services reported immediately after treatment that their children with FASDs showed a significantly decreased number of challenging disruptive behavior problems. Limitations include small sample size and no specific information on length of follow-up.

Length of postintervention follow-up: None.

Additional References

Olson, H. C., & Montague, R. A. (2011). An innovative look at early intervention for children affected by prenatal alcohol exposure. In S. Adubato & D. Cohen (Eds.). Prenatal alcohol use and FASD: Diagnosis, assessment and new directions in research and multimodal treatment (pp. 64–107). Bentham Science Publishers. https://doi.org/10.2174/97816080503141110101

Petrenko, C. L. M., & Alto, M. E. (2017). Interventions in fetal alcohol spectrum disorders: An international perspective. European Journal of Medical Genetics, 60(1), 79–91. https://doi.org/10.1016/j.ejmg.2016.10.005

Reid, N., Dawe, S., Shelton, D., Harnett, P., Warner, J., Armstrong, E., LeGros, K., & O'Callaghan, F. (2015). Systematic review of fetal alcohol spectrum disorder interventions across the life span. Alcoholism: Clinical and Experimental Research, 39(12), 2283–2295. https://doi.org/10.1111/acer.12903