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Program Profile: Family Centered Treatment

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on January 21, 2020

Program Summary

This is a short-term, family-based program, which is designed to reduce out-of-home placements for juvenile justice-involved youth. The program is rated Promising. Youth who received Family Centered Treatment were less likely to experience future conviction or incarceration in either the juvenile or adult justice systems, compared with youth who were placed in a group home.

Program Description

Program Goals/Target Population
Family Centered Treatment (FCT) is a short-term, family-based intervention intended to reduce out-of-home placements for justice-involved youth. FCT seeks to include the entire family in the intervention process, rather than only the youth, in order to provide them with community resources and wraparound services. FCT is designed to find solutions for families faced with disruption or dissolution of their family.

The objective of the program is to provide help for families with issues in child welfare, mental health, substance abuse, developmental disabilities, or juvenile justice and serve as an alternative to family separation or sending juveniles to group homes (Bright et al. 2015). The main focus is to understand and treat the root of the youth’s dysfunctional behavior rather than the symptoms. FCT is specifically designed for youth at immediate risk of being removed from their homes and who have not responded to traditional forms of treatment (Sullivan et al. 2012). The ultimate goal of FCT is to reduce out-of-home placements for youth involved in the juvenile justice system.

Program Components/Key Personnel
FCT is provided to families with children of all ages involved with agencies that specialize in child welfare, mental health, substance abuse, developmental disabilities, juvenile justice and crossover youth. FCT takes place in the home or in a community setting and is conducted by a trained FCT practitioner across multiple weekly sessions. On average, these weekly sessions take place for about 6 months. An FCT provider receives training that includes program knowledge and theory, core skills development in executing FCT, and practical utilization.

The four phases of FCT are as follows: 1) joining and assessment, 2) restructuring (including individual or family trauma treatment if necessary), 3) value changing, and 4) generalization. Phase 1, joining and assessment, consists of identifying specific additions or changes needed to improve family functioning skills. This stage explores family resiliency and establishes goals. Phase 2, the restructuring phase, targets repetitive transactional patterns that drive how the family handles day-to-day life. This phase is intended to address the origins of dysfunctional behaviors in both individual youth and their families. In Phase 3, which focuses on changing values, the family is directed to recognize and appreciate the new behaviors they have developed. An important aspect of this phase is to ensure that the family values their new behaviors and sees them as necessary for progress. Finally, Phase 4, the generalization phase, focuses on evaluation of the new skills the family has learned and helps to provide them with appropriate closure, as they now possess the tools to solve their problems internally and without an FCT provider (Bright et al. 2015; Sullivan et al. 2012).

Program Theory
FCT is derived mostly from eco-structural family therapy and emotionally focused therapy (EFT). Eco-structural family therapy incorporates the environment of the family and the social context into the therapy. EFT is a systematic model that relies upon eco-structural family therapy for its base but focuses on the practice of enactments in therapy. Both models concentrate on emotional tone and interaction among family members and build upon restructuring these areas of functioning to improve family life (Bright et al. 2015).

Evaluation Outcomes

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Study 1
Conviction
Bright and colleagues (2015) found that youth who participated in Family Centered Treatment (FCT) experienced lower rates of new convictions in either the juvenile justice or adult criminal justice system, compared with the matched comparison group. Among youth who participated in FCT, 32.6 percent experienced a new conviction, compared with 36.4 percent of the comparison group youth. This difference was statistically significant.

Incarceration
Youth who participated in FCT experienced lower rates of either a new commitment in the juvenile justice system or a sentence of incarceration in the adult criminal justice system, compared with the matched comparison group. Among youth who participated in FCT, 26.2 percent experienced a new commitment or sentence of incarceration, compared with 31.8 percent of the comparison group youth. This difference was statistically significant.
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Evaluation Methodology

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Study 1
Bright and colleagues (2015) conducted a quasi-experimental design study to examine the effectiveness of Family Centered Treatment (FCT). Propensity score matching (PSM) was used to create statistically equivalent groups. Juveniles were considered eligible for the study if they had been recently adjudicated delinquent in the State of Maryland and were given treatment services by Family Centered Treatment (FCT) in a group home care facility. The treatment group comprised youth who received FCT between 2009 and 2013, and the control group comprised youth who received other services from group homes within the same timeframe. These groups were matched using the covariates of age, age at first delinquency complaint, race, gender, location (urban, suburban, or rural), prior adjudication for violent offenses, and number of prior placements. Both treatment and control groups had been involved in the Maryland Department of Juvenile Services (DJS) and had been adjudicated delinquent prior to receiving any services.

The study consisted of 1,246 youth who participated in FCT (treatment group) and 1,441 youth who were admitted to a group home or treatment group home (control group), for a total of 2,687 participants. The treatment group was 79 percent male, and the control group was 75 percent male. The treatment group was 67 percent black, 27 percent white, 5 percent Hispanic, and 1 percent other. The control group was 71 percent black, 23 percent white, 5 percent Hispanic, and 1 percent other. The average age of the treatment group was 16.6 years old, and the average age of the control group was 16.4 years old. Of the treatment group, 53 percent were from suburban, 34 percent were from rural, and 13 percent were from urban locations. Of the control group, 44 percent were from suburban, 31 percent were from rural, and 24 percent were from urban locations. In the treatment group, 36 percent of participants had a prior DJS residential placement, whereas in the control group, 44 percent of participants had a previous residential placement. There were no statistically significant differences between the groups on characteristics or demographics at baseline.

The outcomes of interest were future conviction and future incarceration. Conviction was measured by both juvenile re-adjudication and adult conviction, while incarceration accounted for both DJS commitment and incarceration in the adult system. Data for the FCT program were collected from the Institute of Family Centered Services (IFCS), which delivered FCT to treatment group youth. Youth-level information and juvenile justice outcomes were collected from the Maryland DJS, and adult criminal justice outcomes were collected from the Maryland Department of Public Safety and Correctional Services (DPSCS).

Descriptive and bivariate analyses allowed for the characterization of the sample and assessment of baseline differences between the treatment and the control groups. Logistic regression was conducted to compare data on recidivism and incarceration rates between the FCT treatment group and group home control group. The study authors (Bright et al., 2015) conducted subgroup analyses on female youth and older youth (i.e., youth older than 16 at the beginning of treatment).
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Cost

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Results from a cost analysis showed that Family Centered Treatment (FCT) was found to cost, on average, $80 per day. As the average length of treatment was 151 days, the average cost of FCT per youth was $12,074. Comparatively, the average cost per day of a youth in a group home was $210. When the average length of treatment was taken into account (201 days), the average cost per youth in a group home was $42,244. Thus, FCT is less costly by about $30,170 per youth. These costs were based on treatment received in the State of Maryland (Bright et al. 2015).
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Implementation Information

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Upon licensing to provide Family Centered Treatment (FCT), the FCT Foundation provides onsite and web-based direction, technical assistance, formal coaching, consultation, oversight, and monitoring for implementation. It also provides adherence verification for provider agencies. Various assessments and tracking mechanisms are incorporated at varying intervals depending on their use and need.

To become certified, FCT staff must complete three components of training: 1) a self-study online training course, 2) field-based practice of FCT core skills, and 3) a performance evaluation completed by a certified FCT trainer. Following this, FCT staff receive an average 5 hours of individual supervision a week by a trained FCT supervisor (Family Centered Treatment Foundation, Inc. N.d.).

More information about the program can be found at the program’s website: www.familycenteredtreatment.org.
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Other Information (Including Subgroup Findings)

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Bright and colleagues (2015) conducted subgroup analyses looking at the treatment effects on female youth and older youth (i.e., youth ages 16 and older at the beginning of treatment). Females in the treatment group receiving FCT (n = 257) were compared with females in the control group (n = 361) who were receiving treatment in a group home. The outcomes studied were future juvenile re-adjudication, juvenile commitment, adult conviction, and adult incarceration. However, none of the findings were statistically significant: females in the treatment group were no more likely to be re-adjudicated or committed as a juvenile, or convicted or incarcerated as an adult, compared with females in the comparison group.

Older youth in the sample were also examined (898 youth in the FCT treatment group and 930 youth in the group care control group). Only the adult outcomes were considered when looking at older youth, due to the short time they were at risk for juvenile justice repercussions following treatment. However, none of the findings were statistically significant: older youth in the treatment group were no more likely to experience a conviction or incarceration in the adult criminal justice system, compared with older youth in the comparison group.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Bright, Charlotte Lyn, Sara Betsinger, Jill Farrell, Andrew Winters, D. Dutrow, Bethany R. Lee, and J. Afkinich. 2015. Youth Outcomes Following Family Centered Treatment in Maryland. Baltimore, Md.: University of Maryland, School of Social Work.
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Additional References

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These sources were used in the development of the program profile:

Bright, Charlotte Lyn, Jill Farrell, Andrew M. Winters, Sara Betsinger, and Bethany R. Lee. 2018. “Family Centered Treatment, Juvenile Justice, and the Grand Challenge of Smart Decarceration.” Research on Social Work Practice 28(5): 638–45.

Family Centered Treatment Foundation, Inc. N.d. Family Centered Treatment: Program Design and Implementation Guide. Great Falls, Va.: Family Centered Treatment Foundation, Inc.

Sullivan, Melonie B., Lori Snyder Bennear, Karen F. Honess, William E. Painter Jr., and Timothy J. Wood. 2012. “Family Centered Treatment–An Alternative to Residential Placements for Adjudicated Youth: Outcomes and Cost-Effectiveness.” Journal of Juvenile Justice 2(1):25-40. (This study was reviewed but did not meet CrimeSolutions.gov’s criteria for inclusion in the overall program rating.)

Painter, W. E. and Smith L. B., Jr. 2010. The Definitive Report for Family Centered Treatment®, Revised 2018. Denver, NC: Institute for Family Centered Services & Family Centered Treatment Foundation, Inc.

The Indiana University Evaluation Team and the Department of Child Services. N.d. Indiana Department of Child Services Child Welfare Title IV-E Waiver Demonstration Project. Final Report. (This study was reviewed but did not meet CrimeSolutions.gov’s criteria for inclusion in the overall program rating.)
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Program Snapshot

Age: 15 - 17

Gender: Both

Race/Ethnicity: Black, Hispanic, White, Other

Geography: Rural, Suburban, Urban

Setting (Delivery): Home, Other Community Setting

Program Type: Alternatives to Detention, Family Therapy, Group Therapy, Individual Therapy, Wraparound/Case Management

Targeted Population: Families

Current Program Status: Active

Program Developer:
John Sullivan
President
Family Centered Treatment Foundation, Inc.
PO Box 225
Great Falls VA 22066
Phone: 703.757.6243
Fax: 703.757.0855
Website
Email

Program Director:
Tim Wood
Executive Director
Family Centered Treatment Foundation, Inc.
PO Box 225
Great Falls VA 22066
Phone: 703.757.6243
Fax: 703.757.0855
Website
Email

Researcher:
William Painter
Innovations and Research Committee Chair, Board of Directors
Family Centered Treatment Foundation, Inc.
PO Box 225
Great Falls VA 22066
Phone: 703.757.6243
Fax: 703.757.0855
Website
Email

Training and TA Provider:
Janet L. Fuller-Holden
Operations Director
Family Centered Treatment Foundation, Inc.
PO Box 225
Great Falls VA 22066
Phone: 703.757.6243
Fax: 703.757.0855
Website
Email