2. Riverside County Department of Mental Health It Takes a Village AND a Family: Substance abuse treatment with the juvenile justice population by combining MDFT and Wraparound Presented By: Patty Myers, LMFT Multidimensional Family Therapy (MDFT), Expansion Mental Health Services Supervisor Jennifer Vasquez, LMFT Western Wraparound Mental Health Services Supervisor Cynthia Rowe,PhD Associate Director of Multidimensional Family Therapy (MDFT) International Panel: Marisol - Mom Saul – Youth Maria T. Gonzalez - Wraparound Parent Partner

3.  Explain MDFT – MultiDimensional Family Therapy: History, What it Does, and How it Works  Show how MDFT + Wraparound are Similar (and Different)  Explain how RCDMH combined both Programs (it wasn’t easy!)  Introduce our Panel  Answer Questions

4.  Wraparound Challenges: ◦ Model does not focus on providing therapy ◦ Dysfunctional family dynamics can interfere with the planning process  MDFT Challenges: ◦ Therapy can lose momentum if external circumstances interfere ◦ Program model only has 1 “Therapist Assistant” to address case management needs

5. Who Put the Peanut Butter In My Chocolate? Who Put the Chocolate In My Peanut Butter?

6. MDFT has been developed based on theory/research in the following areas: 1. Adolescent Development 2. Parenting Practices and Family Functioning 3. Risk and Protective Factors for Adolescent Problems 4. Ecological Perspective 5. Family Therapy: Structural and Problem Solving Therapies History of MDFT

7.  Adolescents need to develop a positive, supportive relationship with parents  Symptom reduction and enhancement of prosocial and normative developmental functions occurs by: a) Targeting the family b) Facilitating curative processes across life domains teen, parent, family, extrafamilial)

8. MDFT Theory of Change (cont.)  Problem behavior can desist when meaningful, concrete alternatives are created, accepted, attempted and adopted  If it has been multiple risk factors and a network of influences that have created and maintained adolescents’ problems, then the same complex of interrelated influences must be systematically targeted for change

9. Pieces of MDFT Approach Adolescent Family MDFT Parent(s ) Extra familial

10.  Substance use reductions (41 to 66% reduction from intake to discharge)  Individual psychological functioning  School and job functioning  Parenting practices and psychological functioning  Family environment - family interaction  No or fewer arrests  Decreased involvement with drug abusing/deviant peers

12. Combining MDFT & Wraparound A Work In Progress… MDFT/Wraparound Pilot Program November, 2013 – January, 2015

13. Values:  Family Focus  Team Intervention  Strengths  Outcomes  “Do whatever it takes”/ Persistence Areas:  Financial  School  Housing  Social  Legal  Substance Use  Psychological Goals + Population: Prevention of Placement; Adolescents on Probation; Delinquency Behavior; Substance Use/Abuse Issues; Mental Health Issues

14. MDFT Phases/Stages:  Foundation/Alliance/ Motivation  “ Work the Themes” & Request Change  Seal the Changes & Exit Wraparound  Engagement/Initial Plan Development  Implementation  Transition Other: Optimism / “Holders of the Hope” Problem Solving / Skill Building Helping the Whole Family

15. MDFT  Evidence Based  Time Limited (6 mo.)  Substance/Delinquency  Work on Emotions  One Therapist for all family members  Therapist Assistant for all Case Management  Therapy to create connectedness Wraparound  Evidence Informed  No Time Limit  Myriad Issues  Work on Goals  Multiple Team Roles  All Team members help with Case Management  Family Plan to create structure

16. ◦ Changes in timeframe of initial implementation ◦ Prioritizing focus to enable combined programs ◦ Changes in session structure to enable simultaneous implementation ◦ Extensive coordination between Program Supervisors required for planning, implementation, and monitoring

17.  Screening of Referrals  Orientation: Present information to youth/family regarding both programs  Safety Plan: Done without MDFT therapist  Assessemnt/Engagement  Beginning Family Team Meetings: Identify 1 – 2 Goals for Wraparound Family Plan  Initial 1:1’s: Parents/Caregivers +Youth and PP + BHS

18.  WA Implementation Phase / MDFT Stage 2 work: ◦ MDFT Sessions 3x’s/week ◦ Wraparound FTM’s: 2x’s/month for duration of MDFT treatment ◦ BHS + PP 1:1’s – weekly or only as needed ◦ Case Coordination: weekly/ongoing between WA Team and MDFT Therapist

19.  MDFT Model: “Seal the Changes” and Exit  Coordination with Ongoing Wraparound  Wraparound Transition Phase If started together, MDFT treatment will probably finish before Wraparound Or: MDFT can start in the middle of Wraparound services, then both usually finish at the same time

20.  Careful Planning and Coordination  Role Clarification  Coordination of MDFT Ending Phase  Confidentiality/Handling of Secrets  Celebrations - Conflict of timing with Wraparound celebration of accomplishment  Extra-Familial Domain - Balancing “who does what”

21. Wraparound graduation rates for Probation Youth have been reported between 30% - 40%:  Los Angeles Co. Wraparound Report, 2010  Riverside Co. Wraparound Report 2014  Santa Barbara Co. at Institute for Well Being, 2014

22. However, during the Pilot implementation: 5 out of 8 youth and families receiving combination MDFT – Wraparound services completed or will soon complete both programs successfully! Although only a few families so far, this is a 62.5% graduation rate for both MDFT and Wraparound!

23.  Positive reception from County Juvenile Justice ◦ Frequent requests from judges, DA’s and Public Defenders for “MDFT-Wraparound”  Expansion Plan ◦ 1 MDFT Therapist assigned to each DMH Wraparound Program  4 RCDMH Wraparound Programs  1 Therapist / 3 Teams per Program

24. Today’s Panel: Marisol – Mom Saul – Youth Maria Gonzalez – Wraparound Parent Partner Not here today: Girlyanne Lacson – Facilitator John Young – Behavioral Health Specialist Robert Cescolini – Probation Officer Brooke Fiorelli – MDFT-Wraparound Therapist

26. Thank You! Patty Myers: PAMyers@rcmhd.orgPAMyers@rcmhd.org (951) 358-5730 Jennifer Vasquez: JLVasquez@rcmhd.orgJLVasquez@rcmhd.org (951) 358-3640 Cynthia Rowe: crowe@mdft.orgcrowe@mdft.org Website: www.mdft.orgwww.mdft.org Maria Gonzalez: MariaTGonzalez@rcmhd.orgMariaTGonzalez@rcmhd.org (951) 358-3640