Program Goals

The goals of Family Centered Treatment (FCT) are:

• Enable family stability or reunification by fostering necessary shifts in family functioning that underly the causes of family dissolution.
• Address maladaptive behaviors affecting family functioning by experientially practicing new interactions and learning the underlying function of the behaviors.
• Develop an emotional and functional balance so the family can cope effectively with present and future challenges.
• Support discovery and effective use of the intrinsic strengths necessary for sustaining change by incorporating generational, cultural, and systemic influences of trauma while harnessing the power of giving and instilling hope.

Logic Model

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

Essential Components

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

• While FCT shares some fundamental components with other models, its distinctiveness lies in its intensive training, supervision, implementation process and management system.
• This structure not only demands but also empowers families to meet high expectations during treatment. In practice, the rigorous peer and individual supervision process supports staff in delivering services designed to inspire meaningful change in families.
• Components of treatment include:
• Joining and Assessment Phase:
• This interactive, participatory, and sensory-based phase provides families with tangible visual tools to reinforce their decisions about necessary adjustments within their family system. Key components include:
• Solution Cards
• Ecomaps
• A Structural Family Assessment
• A Family Life Cycle Assessment.
• Additionally, families engage in trauma screening and family functioning assessment tools. All of these elements contribute to the development of a Family Centered Evaluation©, which serves as a guide for family system goals throughout treatment.
• Restructuring Phase:
• This phase offers families real-time, practical guidance during key moments when they interact most. Instead of a "for them" or "to them" approach, families actively practice new behaviors (enactments) alongside FCT practitioners. Emotional blocks from past trauma, which may hinder the adoption of these behaviors, are often uncovered during this phase.
• Trauma Identification and Treatment: This process is initiated in response to any of the following:
• The discovery of emotional blocks
• A disclosure during an enactment
• Scores from standardized assessments, such as the Child Traumatic Stress Care Process Model (CPM), Family Assessment Device (FAD), or Trauma Symptom Checklist-40 (TSC-40)
• The sharing of trauma during the Joining and Assessment Phase
• Valuing Changes Phase:
• By the end of Restructuring, the family is starting to make significant changes. Unlike many home-based treatment models FCT incorporates two additional phases considered essential for ensuring lasting change.
• During the Valuing Changes stage, practitioners adjust their techniques to help families evaluate the reasons behind the changes they have made throughout treatment.
• Changes driven by conformity or compliance are challenged, creating value conflicts that encourage deeper reflection.
• This process allows families to consciously select and internalize meaningful changes, ensuring they are sustained long after treatment ends and helping to prevent the recurrence of past dysfunction.
• Generalization Phase:
• This phase helps families anticipate and prepare for challenging events that are likely to occur based on past patterns.
• As part of this predictive process, families explore upcoming life cycle stages, and any fears associated with them.
• They design and role-play family system responses to both expected and unforeseen challenges, applying the strengths and skills they have integrated throughout treatment.
• A key component of this phase is the Family Giving Project, in which families design, develop, and implement a project to give back to their community or those in need.
• This "power of giving" reinforces FCT goal of helping families recognize their inherent worth and dignity.

• All best practices for home-based treatment are integral to FCT, including, but not limited to:
• On-call support from the family's primary practitioner
• Involvement of multiple staff at critical moments
• Ongoing collaboration with all stakeholders on a weekly or, when necessary, daily 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 above), child welfare involvement, family system trauma, domestic violence, and substance abuse

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Throughout all phases of FCT, families are actively and intensively engaged in treatment. Phase-specific activities are conducted with the family, and the resulting activities/components require their direct involvement. As a family systems model of home-based treatment, FCT recognizes that while the referred client is central to the process, treatment intensity may also focus on other family members whose behaviors or roles are critical to progress. During the Joining & Assessment phase, families define their ‘family constellation,’ identifying members who are then invited by the family to participate in selected FCT service components such as the Structural Family Assessment. Additionally, external support systems play a vital role in the success of FCT. At a minimum, they are informed of treatment progress and, based on the family's expressed needs, can be actively involved in the process.

Recommended Intensity:

On average, at least 2 multi-hour sessions per week are expected, excluding the initial ramp-up period (first month) and the gradual transition during the Generalization Phase. Longer and more frequent sessions are available based on assessed needs. Additionally, on-call support is accessible 24/7, 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 approximately 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:

Throughout all phases of treatment, families are assigned homework to practice new behaviors and interactions independently, between sessions, without the presence of their practitioner. These assignments are tailored to the family’s specific Area of Family Functioning and are designed to build on the enactments practiced during the session. In follow-up sessions, progress is reviewed to reinforce the application of newly learned strategies in daily life. Each assignment is personalized for the family and documented in session notes.

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 staff member; Wheels of Change© 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 a 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 device

The Family Centered Treatment Foundation (FCTF) 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 and funding sources, such as Medicaid, often determine the minimum qualifications for FCT practitioners. Nationally, FCT practitioners are evenly split between Master’s level/licensed professionals and Bachelor’s level personnel.

• Bachelor’s level staff typically hold a credential such as Qualified Professional or Qualified Behavioral Health Professional (QBHP), requiring a social sciences degree and documented work experience with the population served.
• Certification in Family Centered Treatment® (FCT) is mandatory for all practitioners. This includes a comprehensive online, participatory training course with demonstration-based competency assessments.

FCT Supervisor Requirements Supervisors must hold state-recognized credentials and licenses aligned with their professional discipline, such as: Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), and/or Licensed Professional Counselor (LPC).

Additionally, supervisors must complete an FCT supervision certification course, which includes online, group-cohort training, demonstration-based competency coaching.

The FCTF collaborates with provider organizations to align with state-specific regulations. Allowing personnel with a bachelor's degree and/or lived experience helps broaden the workforce and ensures stronger alignment between practitioners and the families they serve. The rigorous training, oversight, and consultation provided by the FCTF ensures that practitioners, regardless of educational background, are equipped for success.

Manual Information

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

Program Manual(s)

Manual details:

• Painter, W. E., & Smith, M. M. (2004). Wheels of change—Family centered specialists handbook and training manual. Institute for Family Centered Services.

The online manual and other supportive resources are securely housed within the FCT Learning Management System and are accessible only to individuals enrolled through their FCT -licensed organization.

Training Information

There is training available for this program.

Training Contact:

• Stephanie Glickman, LCSW, CCTP, VP of Clinical Services
  Family Centered Treatment Foundation
  www.familycenteredtreatment.org
  contact@familycenteredtreatment.org
  phone: (980) 269-4390

Training Type/Location:

Individuals pursuing FCT Certification must be employed by an FCT-licensed organization. Family Centered Treatment (FCT) offers five levels of practitioner certification: Level 1, Level 2, FCT Supervisor, Level 3, and Level 4. Each certification level follows a three-part approach, combining curriculum-based learning through the FCT Learning Management System, demonstration-based observations of core skills, and in-person classroom-style education through skills labs.

The curriculum, titled Wheels of Change®, consists of varying modules tailored to the desired certification level. Additionally, training includes a peer supervision component, where FCT Practitioners engage in a weekly FCT Team to support ongoing learning, professional development, information sharing, model fidelity oversight, and case consultation.

FCT uses a "train-the-trainer" approach, where initial training is provided by the FCTF. As staff show progress and advance through certification levels, training becomes a combination of both the FCTF's training and internal training led by the organization's certified staff. This approach allows for a gradual shift from external to internal training as staff gain expertise.

FCTF Implementation Directors provide on-site training at varied intervals based on the organization’s stage of implementation which could range from monthly to quarterly.

Along with structured curriculum-based training and skills labs, FCT personnel also have access to role play session videos, explainer videos, a digital library containing all FCT -related documentation and materials, an FCT podcast, and an intervention warehouse with hundreds of family interventions to use during sessions.

Number of days/hours:

Family Centered Treatment Level 1 Certification (L1): Full Certification achievement typically takes approximately one year. Trainees must demonstrate their skills in real-time with families, as a substantial portion of the learning occurs through active application while delivering FCT services.

Recertification is required every two years, with opportunities for advancement to higher certification levels. To support ongoing development and recertification, continuing education, training, and support are available annually across all training modalities.

Family Centered Treatment Level 2 Certification (L2): Requires a Pre-requisite of Level 1 Certification or FCT Supervisor Certified. L2 Trainees must demonstrate their skills in real-time, as a substantial portion of the learning occurs through active applications while delivering FCT training services.

Recertification is required every three years, with opportunities for advancement to higher certification levels. To support ongoing development and recertification, continuing education, training, and support are available annually across all training modalities.

Family Centered Treatment Supervisor Certification: Full Supervisor Certification achievement typically takes approximately one year. Supervisor Trainees must demonstrate their skills in real-time with supervisees, as a substantial portion of the learning occurs through active application while delivering FCT supervision to supervisees.

Family Centered Treatment Level 3 and Level 4: Pre-requisite of L2 and Supervisor Certified. L3 and L4 Trainees must demonstrate their skills in real-time, as a substantial portion of the learning occurs through active application while delivering FCT training services.

Recertification is required every five years. To support ongoing development and recertification, continuing education, training, and support are available annually across all training modalities.

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 FCTF’s Readiness Assessment process evaluates an applicant agency’s capacity and commitment to implementing quality, sustainable FCT services. To support this process, the FCTF provides multiple tools to assess a provider organization’s readiness to implement and deliver the FCT model.

Initial Steps & Preliminary Discussions

Before formal assessment, the FCTF facilitates discussions regarding:

• Program size, scope, and location
• Mission and agency culture
• Organizational intent and vision for FCT

These discussions allow the FCTF to learn about the prospective provider while also providing an overview of the FCT model and implementation expectations. Once an organization submits a formal written request to become a provider, the FCTF initiates the Readiness Assessment Process, granting access to the following resources:

• Prospective Organization Portal
• Readiness Assessment Matrix (RAM)
• Readiness Assessment Management Plan (RAMP)

Prospective Organization Portal

The Prospective Organization Portal serves as a centralized resource outlining the Readiness Assessment process. It includes:

• Information on program costs, services, and supports offered by the FCTF
• Implementation science, change management strategies, and timelines
• A Readiness Assessment Guide, which details how to prepare for and navigate the assessment

Additionally, the portal provides access to the Readiness Assessment Matrix (RAM)—the primary tool used during the formal assessment process. Readiness Assessment Matrix (RAM). Developed in consultation with the National Implementation Resource Network (NIRN), the Readiness Assessment Matrix (RAM) evaluates readiness across 10 implementation drivers and approximately 100 sub-drivers linked to successful FCT implementation.

The RAM process mirrors the Joining and Assessment phase of the FCT clinical model, fostering a collaborative approach between the FCTF and the prospective provider organization. This tool:

• Establishes a baseline for readiness
• Identifies organizational strengths and areas for growth
• Incorporates feedback loops to ensure ongoing quality improvement

Findings from the RAM are presented using graphs and summaries to assess trends and patterns. The FCTF Executive Leadership Team reviews these results to determine whether the organization is a good fit for FCT.

Readiness Assessment Management Plan (RAMP)

Upon approval, the FCTF works with the provider to develop a Readiness Assessment Management Plan (RAMP). This tool is derived from RAM findings and serves as a roadmap for early implementation. The RAMP includes:

• Provider demographics and target population
• Funding sources
• Implementation goals and strategies, aligned with the 10 implementation drivers

Beyond guiding implementation, the RAMP also functions as a training tool, demonstrating how data-driven strategies are used to set practical, measurable goals. Once implementation begins, the RAMP is integrated into Weekly Implementation Meetings (see Formal Support for Implementation section).

Accessing Pre-Implementation Materials

All pre-implementation materials, including the Readiness Assessment Guide, RAM, and RAMP, are available on the Prospective Organization Portal. Access can be requested via the training contact listed above.

Formal Support for Implementation

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

The FCTF employs a multi-faceted implementation strategy that includes onsite and web-based direction, guidance, technical assistance, training, coaching, and consultation across clinical, operational, and systemic levels. Additionally, FCTF provides quality assurance, oversight, and monitoring to ensure effective implementation.

Upon FCT licensure, organizations receive training not only on the clinical model but also on implementation best practices. FCTF operates from the perspective that implementation is just as critical as the FCT model itself. To support this, a Co-Occurring Process integrates:

• Various assessments and tracking mechanisms
• Change management strategies
• Systems intervention and facilitative administration
• Workforce recruitment and retention
• Organizational culture development
• Leadership training
• Quality assurance practices

Once an organization is licensed as an FCT provider, FCTF provides structured guidance through the stages of implementation. Achieving full implementation or sustainability is a long-term process that varies by organization. Built-in feedback loops ensure continuous data collection, quality improvement, and provider ownership of the process.

As with the Readiness Assessment Matrix (RAM) and Readiness Assessment Management Plan (RAMP), implementation tools and processes are designed to be collaborative, working with providers rather than imposing requirements on them.

Key Implementation Tools & Strategies

To support ongoing implementation, FCTF employs structured tools and processes at regular intervals, adapting them to the organization’s development stage:

• Weekly Implementation Meetings – The primary driver of implementation. These multi-functional meetings between provider organizations and FCTF adjust in frequency as the provider gains competency, confidence, and commitment.
• Implementation Driver Assessment (IDA) – Conducted every six months (starting after the RAMP period), the IDA assesses implementation progress using 10 implementation drivers and 100 sub-drivers. The results determine the organization’s stage of implementation and guide FCTF’s level of direction and support.
• FCT Implementation Tool (FIT) – A living document developed from IDA data, the FIT tracks and monitors implementation goals and strategies. FITs are updated every six months and integrated into Weekly Implementation Meetings for continuous refinement.
• Licensure Implementation Report (LIR) – An annual report reviewing all implementation progress, training, performance metrics, outcomes, fidelity, stakeholder engagement, and systemic challenges. The LIR includes practitioner and stakeholder surveys and is reviewed with the organization’s executive leadership to ensure their active participation.

FCT Team Primacy Model

A high-performing team is the #1 administrative priority of an FCT provider organization. The effectiveness of FCT depends on a team-driven approach, grounded in Team Development and Peer Supervision. To support this, FCTF provides:

• Team Development Diagnosis Tool – Used by FCTF consultants and supervisors to measure team behaviors at both individual and group levels.
• Peer Professional Development – A tool that fosters peer supervision to enhance individual practitioner development.

Implementation Guides & Manuals

Implementation guides and manuals provide agency leadership, managers, and supervisors with strategies for organizational-level support of FCT implementation. Unlike treatment manuals, which focus on clinical delivery, these guides cover topics such as:

• Sustainability planning
• Collaboration with external agencies
• Staff training and development
• Data collection and evaluation
• Leadership involvement in implementation

Fidelity Measures

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

FCT fidelity and adherence are determined through multiple objective measures that assess training completion, treatment intensity adherence, core treatment component implementation, and driver metrics.

FCT adherence measures are integrated into the treatment process for each client, utilizing actual written records that become part of the client’s file. These adherence measures are directly tied to treatment progression—each activity required to produce a written record cannot occur without the corresponding advancement in treatment.

All fidelity measures, except for the case review instrument (MIGS), involve client participation and are specific to the phase of treatment. Because they align with treatment phases, these measures serve as both progress indicators and quantifications of model adherence.

Staff Competency & Implementation:

• FCT staff are permitted to implement adherence measures only after successfully completing training specific to the relevant phases and measures.
• Each staff member must demonstrate competency through observation before independently performing or implementing a measure.

For additional details on fidelity measures or to obtain a Program Design and Implementation Guide, please contact the program developer.

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
• Stages of Implementation
• FCT Certification and Licensure Process

FCTF implementation is practical and fully integrated into the daily operations of an FCT provider organization. The Program Design and Implementation Guide serves as a reference tool, supporting active implementation across multiple organizational levels and operational structures.

A structured agenda for the Weekly Implementation Team meeting ensures that implementation is collaborative and provider-driven, guiding the process in real-time. These meetings address both internal and external factors that impact the quality and sustainability of an FCT program.

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

Hamburger, J., Marino, K., Wright, R., (2024). The Family Centered Treatment (FCT) Model: Impacts in Child Protective Services. Journal of Psychological Research. 6(4): 27-49. https://doi.org/10.30564/jpr.v6i4.7738

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Permanency

Additional References