California Implementation of Functional Family Therapy (FFT)

California Institute for Mental Health (CiMH)Todd Sosna Ph.D., Senior Associate, Center for Child and Family Services

Pam Hawkins, Associate II, Center for Child and Family Services

California Annual FFT Symposium April 3-4, 2008

California Administration of Functional Family Therapy (FFT)

• California Institute for Mental Health: Intermediary Organization for the Dissemination of Evidence-Based Practice - System Change

• Community Development Team Model

• History of FFT in California

• FFT Statewide Administrative Coordination

Systems Change

• New practices do not fare well in old organizational structures and systems

• System change is disruptive• System change requires new resources• System change requires courage• System change requires dogged persistence

Dean Fixsen & Karen Blasé, National Implementation Research Network (NIRN)

Ineffective Methods of ChangeExcellent experimental evidence for what does not work

• Diffusion/dissemination of information by itself does not lead to successful implementation

• Training alone, no matter how well done, does not lead to successful implementation

• Implementation by edict by itself does not work• Implementation by “following the money” by itself does not work• Implementation without changing supporting roles and functions

does not work

Paul Nutt (2002). Why Decisions Fail

Initiate Systems ChangeDean Fixsen & Karen Blasé, National Implementation Research Network (NIRN)

Initiate & Manage Change

Develop Sustainable Infrastructure

For transformation managementAnd continuous consumer benefit

Implement Innovations and other new ways of work

Community Development Team Goals

• High quality, model adherent (high fidelity) and sustainable implementation of Functional Family Therapy (FFT)

• Prepare practitioners to be proficient in the use of FFT

• Prepare agencies to support and sustain FFT teams

Community Development Team Features

• Clinical training and consultation provided by FFT LLC (national training center)

• Implementation planning and administrative supports provided by CIMH associates

• Channels of communication to support peer-to-peer assistance (conference calls, listserv)

Community Development Team Administrative Supports

• Individualized technical assistance– CIMH associates respond to implementation (system and

program level) issues• Support with outcome evaluation

– Collection, analysis, interpretation and reporting of FFT outcomes across agencies

• Scheduled monthly administrators conference calls– Share successes, raise concerns, and offer solutions

• Listserv– Support communication between Team members

• Coordination with FFT national training center

Community Development Team Expectations

• Each agency is committed to participating fully in all training and consultation activities

• Each agency is committed to implementing FFT with fidelity• Each agency will diligently use the CSS and evaluate

outcomes• Agencies will establish HIPPA agreements to support sharing

of information for clinical consultations and outcome evaluation

California FFT Teams• FFT Community Development Team I (California Endowment Grant)

– 2004– 6 Teams currently in Phase III

• FFT Community Development Team 2 (California Alliance for Child and Family Services)– 2006– 7 Teams currently in Phase II

• FFT Community Development Team 3 (“MIOCR”)– 2007– 10 Teams currently in Phase I

• FFT Community Development Team 4 (Los Angeles Katie A.)– 2007– 3 Teams currently in Phase I

• Projected: FFT Community Development Team 5– 2008– 4 Teams projected

California FFT Sites

California FFT Administrative Coordination

• Monitoring Site Quality Improvement

• Monitoring Site Quality Assurance

• Statewide FFT Coordinator

Monitoring Site Quality Improvement

• Consultation with Sites – Statewide consultants monitor individual sites for quality

improvement and model-adherence• Consultation with Statewide Consultant

– Statewide Consultants participate in regularly scheduled administrative monitoring

• Consultation with National Consultant – Statewide Consultants participate in regularly scheduled

consultation with FFT LLC (national training center)• FFT Annual Symposium

– Statewide Consultants participate in annual FFT Symposium that will provide advanced treatment skills focusing on more difficult treatment issues and circumstances for model-adherence and sustainability of FFT

Monitoring Site Quality Assurance

• Evaluation of Sites – Outcome evaluation reports generated for California FFT implementation

and each individual site • Community Development Team (CDT) Process

– Monthly meetings with each CDT to provide TA in the implementation of model adherent practice

– Identify and mitigate technical, procedural and system barriers to implementation

– Update sites on training– Problem solving, procedural skills development– Peer-to-peer exchange

• Replacement Training Series – Schedule 2 Replacement Training series per year

Statewide FFT Coordinator• Supports and promotes implementation of FFT in California• On-going support, assistance and oversight of statewide FFT

implementation in existing sites• Coordinates all California FFT Training events• Collaborates with FFT LLC and administrators of California FFT sites• Coordinates FFT site Quality Improvement/Quality Assurance

process for California • Collaborates with California Statewide FFT Consultants• Maintains and develops partner relationships through outreach and

FFT presentations