Randomized Controlled Trial of Family Centered Treatment in North Carolina Treatment and Study Overview for NC County Departments of Social Services September 2019

Focus: Parameters of the randomized controlled trial (RCT) of Family Centered Treatment in North Carolina. Target population: Youths who meet medical necessity for both FCT and Residential Level III out-of-home treatment (OHT) Goal: Provide an overview of the study Outline the potential roles/responsibilities for County DSS’ for youth in care participating in the RCT Answer any questions Introduction

Collaborative Project Partners Include: The Duke Endowment (Funder) The Family Centered Treatment Foundation Cardinal Innovations Healthcare Partners Behavioral Health Management Trillium (tentative) North Carolina FCT Providers Residential Level III OHT Providers Duke University’s Center for Child and Family Policy Duke University’s Margolis Center for Health Policy Collaborative Project

Why is Additional Research on FCT Needed? Existing Evidence is Promising: Quasi-experimental studies have found positive outcomes with juvenile justice and child welfare specialty populations (i.e., domestic violence related). FCT has practice-based evidence: more than 15 years of data with the child mental health population. No RCT studies to date with the child mental health population. Why is Additional Research on FCT Needed?

The Current Study First FCT RCT Study: Focus on Youth within the Behavioral Health System

Study Design Study Goals: Target population: Youths (11-17) authorized for a Level III OHT Determine if FCT, relative to “treatment as usual” leads to: Increased safety and permanency Improved wellbeing outcomes for youth and their caregivers, and Improved family functioning The study began in October of 2018 and runs through June of 2023. 375 families/youth in the FCT intervention group 375 families/youth in the control group We expect to approach 1,000 and enroll 750 total. CCFP research staff will track these youth/families for up to 18 months, even after treatment has concluded. Study Design

Study Design Randomization Randomization would occur at the MCO level within the Utilization Management division at each MCO. Birthdays would serve as the method by which youth are randomized Youth born on even numbered days will be randomized into FCT group. Youth born on odd days will be randomized into the OHT group. Study Design

Study Recruitment for Youths in DSS Custody Youth Randomized into FCT Youth Randomized into OHT Study Recruitment for Youths in DSS Custody MCO to coordinate with DSS to see if FCT would be an appropriate fit for the youth. If youth meets study inclusion criteria, MCO and DSS coordinate to get FCT provider out to talk to caregiver. FCT providers would be provided information about youth/families randomized into FCT by the MCOs and approach caregiver about participating in FCT instead of OHT. DSS to obtain consent to contact for youth/carejgiver(s) to participate in Duke study. MCO to contact DSS to let them know youth is eligible for study DSS to obtain consent tp contact for youth/caregiver(s) to participate in Duke study.

Study Recruitment for Youths in DSS Custody Obtaining Consent to Contact for Duke Study Recruitment for Youths in DSS Custody There are no NCDSS policies that would prevent this. (Letter from DHHS included in your handouts) If parental rights for an eligible youth have not been terminated, a county DSS would have to obtain a consent to contact from a biological parent for the child to participate in the Duke study. If a biological parent agreed Duke could interview bio parent, foster parent (if they also agreed), and the youth; compensate all three. Duke would also need a consent to contact for the foster parent. If parental rights have been terminated, a county DSS can sign the consent form for the youth to participate.

FCT Intervention Group Procedures for FCT Providers: Once contact information is received, FCT providers have 48 hours to make contact with family. Clinician, clinical director, or intake specialist/supervisor to make initial contact. If the family responds to contact, FCT providers will present families with information about why they might want to choose FCT over the Level III OHT. FCT Intervention Group

The family/youth may decline to participate in FCT and/or the research study. A youth/family can decline FCT but still be in the study. CCFP research staff will collect all data for both the FCT intervention and control groups for 18 months. No data collection done by DSS, FCT or OHT providers. Study Recruitment

FCT Intervention Group If the family agrees to participate in FCT, rather than the Level III OHT, the FCT providers will: Submit PCP to receive FCT to MCO within two business days. FCT provider will also contact MCO to let them know the PCP has been submitted so that the process can be prioritized. FCT Intervention Group

FCT Intervention Group If the family does NOT agree to participate in FCT, rather than the Level III OHT, the FCT providers will: Let MCO’s know of the family’s choice to decline FCT within 2 business days FCT Intervention Group Talk about intent to treat design

Interviews: Consenting families will be asked to participate in a baseline interview and three follow-up interviews over 18-months (4 interviews total) with CCFP research staff. Incentives: Participants (youth and their caregivers) will receive $60 for participating in the baseline interview ($50 for caregiver; $10 for youth). The stipend will increase at each follow-up interview thereafter: $75 for 6-month ($60 for caregiver; $15 for youth), $100 for 12-month ($80 for caregiver; $20 for youth), and $165 for 18-month interviews ($115 for caregiver; $50 for youth). Study

Summary Responsibilities for County DSS’: Discuss option of FCT for youths with submitted Level III authorization and an even birthday For all children eligible for the study: Obtain consent to contact for Duke study from bio and foster parents for youths for whom parental rights have not been terminated Sign consent form for youths for whom parental rights have been terminated Number of youths/month/county: Likely < 2 Summary

Questions Possible challenges/issues? Other feedback? Questions for us? Questions