WHAT IS FAMILY BASED MENTAL HEALTH SERVICES (FBMHS)?
Family Based Mental Health Services (FBMHS) is an Evidence Based Practice model designed to service children between 3 and 17 years of age and their families (parents, guardians, caretakers and siblings). These
children have a serious mental illness or emotional disturbance, are at risk for out-of-home placement into residential treatment facilities, psychiatric hospitals or other settings. The focus of treatment is on the
child and family system. Family Based Mental Health Services treat these children and adolescents in their homes, communities and schools thus allowing the youth to remain in the home. Services are available 24
hours per day and 7 days a week via on call therapist and include crisis intervention as a part of the service.
How Family Based Mental Health Services Work:
On a highly individualized basis, treatment goals and interventions are developed in collaboration with the
family, and family strengths are used to promote therapeutic change. Clinicians facilitate and support change,
by coaching family members in individual, parent(s)-child, parental, marital, or family sessions to engage in
growth producing interactions with each other and with community resources.
Can Family-Based Mental Health Services:
• Decrease the use of more restrictive forms of mental health care of children?
• Shorten the length of out-of-home placements of children with SED in psychiatric in-patient settings?
• Help to insure that such placements are planned?
• Prevent out-of-home placement of children in other child-serving systems, including child welfare,
juvenile justice and substance abuse treatment?
Is improvement in family functioning associated with:
• Improvement in functioning of a child with SED?
• Better post-treatment outcomes for a child with SED?
Is there a relationship between pre-treatment service system involvement of families and:
• Changes in family functioning during treatment?
• Post-treatment outcomes for children with SED?
FBMHS were developed to serve children at risk for out-of-home placement due to psychiatric diagnoses
indicating severe emotional or behavioral disturbances (SED). They also target children and adolescents who
need to be reunified with their biological or substitute care families following discharge from inpatient
hospitals or psychiatric residential placements. Overall program goals include not only preventing out-of-
home placement of children in residential treatment facilities but also reducing the number of crises-driven
emergency room visits for mental health problems and increasing intentional planning for psychiatric
hospitalizations that do occur. Since their inception in 1988, the continuing development of FBMHS has been
encouraged by public and private managed care as a clinically effective, preferred alternative to
Inpatient hospitalization or psychiatric residential placement.
What is Functional Family Therapy?
Functional Family Therapy(FFT) is an evidence based treatment model. FFT is a short-term structured intervention. The model is provided statewide and administered primarily within the family’s home.
Who is Functional Family Therapy for?
Functional Family Therapy is used for youth ages 10-18 and their families that are struggling with behavioral problems and significant family conflict. Target populations range from at-risk preadolescents to youth with very serious problems such as conduct disorder, violent acting-out, and substance abuse. It’s been applied in various multi-ethnic, multicultural contexts.
Functional Family Therapy Overview
Functional Family Therapy has been successful in treating youth in long-term foster care, youth involved in the juvenile justice system and youth with school related issues, who are at risk for disciplinary problems such as truancy and drop out. This therapy has also been used to treat families with developmentally and intellectually disabled youth. The model combines a multi-disciplinary approach including family therapy and supportive case management. This inventive approach helps meet the family’s basic needs. It will also provide the family with continuing support while they integrate newly learned skills into their lives. These skills will be the tools the family needs to successfully maintain the changes they’ve made.
Functional Family Therapy Success
FFT has been recognized nationally for its successful youth outcomes by, The Office of Juvenile Justice and Delinquency Prevention, The Center for Disease Control and Prevention, The American Youth Policy Forum and the US Department of Justice. This model was also one of four model programs named by the US Surgeon General as a model program for seriously delinquent youth. FFT is an amazing model and FFT therapist are very skilled, creative and self-motivated.
For More Information:
You can find more information about Functional Family Therapy by visiting the FFT website at Click Here for More Information on Functional Family Therapy
This summary was submitted by Dr. Teneshia T. Winder, Ph.D., MSC., LAMFT, Program Manager at Children & Families First www.cffde.org
What are families saying about FFT?
“I thank God for my therapist”
“FFT has given us hope”
“FFT has helped our family to grow”
“My family hasn’t been then same, since we’ve completed FFT”.
The Center for Disease Control (CDC) developed the Youth Risk Behavior Surveillance System (YRBSS) to monitor high-risk behaviors among teens and young adults. One of the behaviors monitored are suicides. The Center for Drug and Health Studies (CDHS) at the University of Delaware conducts Delaware’s Youth Risk Behavior Survey (YRBS). It administers the Youth Risk Behavior Survey to middle school and high school students across the state.
Statistics: Delaware High School Students in 2015
14% considered suicide in the prior 12 months – 4 students in a class of 28
11% made a plan in the prior 12 months.
7.6% attempted suicide in the prior 12 months – this represents about 3000 students a year
2.3% attempted suicide and received medical care as a result.
Although Delaware is below the national average in each of these categories, this should be of little comfort since thousands of lives are at risk.
What This Means:
The two last numbers above, 7.6% and 2.3%, show that many more students attempt suicide but only a relatively small number 2.3% seek medical assistance. This means that most suicidal students do not get help since nobody knows about the attempt! An attempt for a student might be taking four pills at bedtime planning to die but waking up the next morning and going to school. Typically, students do not tell anyone about what they did, except possibly a friend.
The Lifelines Suicide Prevention program, which was taught to 15,000 middle school students in Delaware from 2012 to 2014 under DPBHS’ SAMHSA Garret Lee Smith Grant. This program focused on educating middle school students to get help for her friend if she learns a friend is suicidal. All students and adults should respond to a statement related to suicide very seriously.For a student, it would mean telling an adult about his/her suicidal friend. For adults, it would mean offering to help them seek a mental health professional to complete an evaluation. Crisis services are available, for both children and adults, to complete suicide assessments.
Mobile Response and Stabilization Services (children/youth): 1-800-969-HELP (4357)
Crisis Intervention (Adult): 800-652-2929 (Northern Delaware)
800-345-6785 (Southern Delaware)
Suicide Warning Signs:
Get immediate attention for a child or teen who makes statements or displays behaviors related to wanting to harm themselves or die. Warning signs indicate a child or teen is struggling. Too many warning signs might indicate a child or teen is suicidal. Lifelines* uses the word FACTS to remember the warning signs.
Psychosis is an illness affecting the structures and chemicals of the brain that enable us to experience emotions, make judgments, and perceive the world around us. The three most common problems associated with this illness are hallucinations (seeing or hearing things that are not there), delusions (beliefs that are odd or untrue), and disorganization (becoming confused and fragmented when attempting to think or speak). Other symptoms include fearfulness, difficulty making decisions, strong sensitivity to light and noise, problems paying attention, and emotional distress.
Psychotic experiences are actually fairly common. About 10-25% of youth and young adults report having at least one such experience in their lifetime, but in most cases these are mild and do not last very long. For 1 out of 50 youth, these experiences become sufficiently intense, frequent or long-lasting and interfere with daily routines and well-being.
Problematic psychosis tends to appear between the ages of 12 to 25. These are the ages when youth grow from being dependent on adults to assuming responsibility for making life decisions, taking care of one’s self and, eventually, taking care of others. Supporting a young person with psychosis is particularly challenging because the illness sometimes requires that he or she be heavily dependent on family and friends. Meanwhile, the people providing the support have to balance that individual’s need for support with his and her developmental need for independence. Sometimes it can be hard to know what to do.
What is Delaware CORE?
One aspect of treatment for psychosis that is reliably linked to better outcomes is the period of time that symptoms are left untreated, or as it is commonly referred to: “the duration of untreated psychosis” or just DUP. Researchers have long agreed that the more one waits to get treatment the greater the potential for harm. People who engage early on improve their chances for avoiding (or mitigating) episodes and maintaining a more meaningful quality of life.
Over the past two years, a program entitled Community Outreach and Early Intervention (CORE) has been working in Delaware for the purpose of shortening DUP by engaging young people (ages 12-25) who are experiencing their very first signs or symptoms of psychosis. With start-up funding from the Substance Abuse and Mental Health Services Administration (SAMHSA), Delaware CORE has been implementing a program that was developed by the Maine Medical Center nearly a decade ago.
That parent program, called the Portland Identification and Early Referral (or PIER) program, has been effectively improving the quality of life for youth or young adults with early psychosis for nearly a decade. The program’s developers attribute program success to the combined insight of a diverse professional team (e.g., prescribers, occupational therapist, educational specialist, social workers) and careful tracking of an individualized treatment plan for each enrollee. PIER philosophically rejects medicine as a stand-alone intervention and promotes stress reduction and practical problem solving as essential parts of the recovery process. Team members also maintain an aggressive outreach program to help raise public awareness and reduce stigma.
Back in July of 2015, Delaware CORE convened its first two teams (i.e., eight clinicians). Those teams now serve the entire state. The program offers a broad array of services including psychiatric consultation, occupational evaluation and therapy, supportive services for school or work, and inter-family group meetings to promote networking and support. Over sixty individuals and their families have enrolled.
Preliminary outcomes – based on the first 46 enrollees in CORE – are promising.
To learn more about Delaware CORE or arrange to have a team member come speak to you or your organization, call (888) 284-6030 or go to www.delawarecore.com
Our Medical Director, Richard Margolis MD, helps us make sense of new information in psychiatry, addiction, and behavioral health. This article summaries a New England Journal of Medicine review of current literature on neonatal abstinence syndrome, including clinical characteristics, prevention, identification, and treatment.
The incidence of the neonatal abstinence syndrome has increased substantially in the past decade.
The increase in cases of the neonatal abstinence syndrome corresponds with the reported rise in opioid use during pregnancy, which is attributed to the more liberal use of prescribed opioids for pain control in pregnant women, illicit use of opioids such as oxycodone and heroin, and a dramatic increase in opioid-substitution programs for the treatment of opioid addiction. The pattern of opioid use has also shifted from an inner-city, low-income population to a more socioeconomically and demographically diverse population that includes pregnant women. The causes of the neonatal abstinence syndrome are similarly diverse, including in utero exposure to prescribed or illicit opioids and to agents used for the treatment of maternal opioid addiction.
Illicit opioid use is often complicated by a chaotic lifestyle that includes drug-supporting and drug-seeking behaviors. This lifestyle may hinder access or commitment to medical and social services, leading to substantial risks of illness and death. These risks can be mitigated with opioid-substitution treatment, which has benefits for both health and social outcomes. Methadone is currently the most commonly prescribed treatment for opioid addiction during pregnancy, although the evidence suggests that buprenorphine may be associated with less severe neonatal withdrawal than methadone.
The neonatal abstinence syndrome refers to a postnatal opioid withdrawal syndrome that can occur in 55 to 94% of newborns whose mothers were addicted to or treated with opioids while pregnant. Other terms have also been used to describe the syndrome, including the neonatal withdrawal syndrome, the neonatal drug withdrawal syndrome, and neonatal withdrawal. Although the neonatal abstinence syndrome is the term used most frequently in the literature, neonatal withdrawal is probably a more accurate description of the syndrome.
The neonatal abstinence syndrome has been described as a complex disorder that primarily involves the central and autonomic nervous systems and the gastrointestinal system. The clinical manifestations of the syndrome vary ranging from mild tremors and irritability to fever, excessive weight loss, and seizures. Clinical signs typically develop within the first few days after birth, although the timing of their onset, as well as their severity, can vary. This variation is poorly understood and is believed to be multi-factorial. In particular, the type of opioid and the dose and timing of exposure may alter the risk of withdrawal. Clinical manifestations may develop later in infants who have been exposed to opioids with a longer half-life (e.g., methadone and buprenorphine) than in infants exposed to short-acting opioids.
Primary-prevention strategies are needed to address the epidemic of opioid use and the associated development of the neonatal abstinence syndrome. Ongoing surveillance is essential to inform public health–related efforts aimed at prevention. Evidence suggests that in the United States, states with the highest rates of prescription opioid use also have the highest rates of the neonatal abstinence syndrome. Therefore, targeted initiatives to address prescribing practices may help to reduce opioid use in women of childbearing age and prevent the subsequent development of the neonatal abstinence syndrome. Efforts are under way to address the over-prescribing of opioids, such as the introduction of programs to monitor opioid-drug prescribing practices, regulation of pain-management clinics, and establishment of opioid dosage thresholds. Health care providers are encouraged to practice safe and judicious prescribing of opioids to women of childbearing age.
The increased incidence of the neonatal abstinence syndrome and soaring increases in associated health care costs warrant a consistent and comprehensive approach to mitigating the negative outcomes for affected infants, their mothers, and the health care system. Recent innovations in management include standardized protocols for treatment, which have positive effects on important outcomes such as the duration of opioid treatment, the length of the hospital stay, and the use of adjunctive drugs. In addition, evidence from pharmacokinetic models supports the development of empirically based dosing protocols. Breast-feeding and rooming-in are promising non-pharmacologic strategies that may also improve outcomes for infants and mothers, including maternal satisfaction with and involvement in the care of the newborn.
Our Medical Director, Richard Margolis MD, helps us make sense of new information in psychiatry, addiction, and behavioral health. This blog post is a follow up to last week’s post on the Surgeon General’s Report on Alcohol, Drugs, and Health.
This article includes information from reports by the Washington Post-Kaiser Family Foundation, the Center for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA). The article highlights how addicting prescription medications are, the rise in deaths attributable to opioids, including prescription pain relievers, and demographic information on vulnerable populations including Medicaid recipients and women.
A Washington Post-Kaiser Family Foundation survey published in the Washington Post’s December 9 Health & Science section reported that, “One-third of Americans who have taken prescription opioids for at least two months say they became addicted to, or physically dependent on, the powerful painkillers.”
The article added that “Virtually all long-term users surveyed said that they were introduced to the drugs by a doctor’s prescription, not by friends or through illicit means. But more than 6 in 10 said doctors offered no advice on how or when to stop taking the drugs. And 1 in 5 said doctors provided insufficient information about the risk of side effects, including addiction.”
The Center for Disease Control and Prevention (CDC) reported in March 2016, “More people died from drug overdoses in 2014 than in any year on record. The majority of drug overdose deaths (more than six out of ten) involve an opioid. And since 1999, the number of overdose deaths involving opioids (including prescription opioid pain relievers and heroin) nearly quadrupled. From 2000 to 2014 nearly half a million people died from drug overdoses. 78 Americans die every day from an opioid overdose.”
The CDC report added “We now know that overdoses from prescription opioid pain relievers are a driving factor in the 15-year increase in opioid overdose deaths. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report. Deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have also quadrupled since 1999.”
The Substance Abuse and Mental Health Services Administration (SAMHSA) published in August 2016, A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders: Practice and Policy Considerations for Child Welfare and Collaborating Service Providers.
The section titled Opioid Use Trends reported “Opioid use and related consequences also vary by several key demographics. For example, the Medicaid patient population is more likely to receive prescriptions for opioid pain medications and to have opioids prescribed at higher doses and for longer periods of time than the non-Medicaid patient population. Opioid medication overdose deaths are also more common among Medicaid-eligible populations.”
The demographic section described the increase in opioid use among women. “The overall rate of first time heroin use increased among all women, from 0.06 percent in 2002–2004 to 0.10 percent in 2009–2011, estimated to be an increase from 43,000 women to 77,000 women (SAMHSA, 2013). Among women, the number of overdose deaths due to the use of prescription opioid pain medications has increased significantly since 2007, surpassing deaths from motor vehicle-related injuries. Overdose deaths due to opioid medication increased among women more than 5-fold between 1999 and 2010, totaling 47,935 during that period (CDC, 2013).”
There has been a similar increase in opioid use among pregnant women leading to a rise in the Neonatal Abstinence Syndrome. This syndrome and its consequences will be addressed in a future article.
Our Medical Director, Richard Margolis MD, helps us make sense of new information in psychiatry, addiction, and behavioral health. This article summarizes the Facing Addiction in America, a report on alcohol, drugs, and health issued by the Surgeon General.
Facing Addiction in America, the Surgeon General’s Report on Alcohol, Drugs, and Health was published last fall. This report provides an extremely thorough and definitive public health report on substance use in America.
The report is organized into 7 chapters that present an overview, a description of the neurobiology of substance use, prevention programs and policies, early intervention/treatment/management, recovery, health care systems, and a vision for the future.
In Chapter 3, Prevention Programs and Policies, risk factors and protective factors are defined. Risk factors are “factors that increase the likelihood of beginning substance use, of regular and harmful use, and of other behavioral health problems associated with use.” Protective factors are “factors that directly decrease the likelihood of substance use and behavioral health problems or reduce the impact of risk factors on behavioral health problems.”
The report explains, “Although there are exceptions, most risk and protective factors associated with substance use also predict other problems affecting youth, including delinquency, psychiatric conditions, violence, and school dropout. Therefore, programs and policies addressing those common or overlapping predictors of problems have the potential to simultaneously prevent substance misuse as well as other undesired outcomes.”
Table 3.1: Risk Factors for Adolescent and Young Adult Substance Use lists individual/peer, family and community risks which are summarized below.
o Early initiation of substance use defined as engaging in alcohol or drug use at a young age.
o Early and persistent problem behavior defined as emotional distress, aggressiveness, and “difficult” temperaments in adolescents.
o Rebelliousness defined as high tolerance for deviance and rebellious activities.
o Favorable attitudes toward substance use defined as positive feelings towards alcohol or drug use, low perception of risk.
o Peer substance use defined as friends and peers who engage in alcohol or drug use.
o Genetic predictors defined as genetic susceptibility to alcohol or drug use.
o Family management problems defined as poor management practices, including parents’ failure to set clear expectations for children’s behavior, failure to supervise and monitor children, and excessively severe, harsh, or inconsistent punishment.
o Family conflict defined as conflict between parents or between parents and children, including abuse or neglect.
o Favorable parental attitudes defined as parental attitudes that are favorable to drug use and parental approval of drinking and drug use.
o Family history of substance misuse defined as persistent, progressive, and generalized substance use, misuse, and use disorders by family members.
o Academic failure beginning in late elementary school defined as poor grades in school.
o Lack of commitment to school defined as when a young person no longer considers the role of the student as meaningful and rewarding, or lacks investment or commitment to school.
o Low cost of alcohol defined as low alcohol sales tax, happy hour specials, and other price discounting.
o High availability of substances defined as high number of alcohol outlets in a defined geographical area or per a sector of the population.
o Community laws and norms favorable to substance use defined as community reinforcement of norms suggesting alcohol and drug use is acceptable for youth, including low tax rates on alcohol or tobacco or community beer tasting events.
o Media portrayal of alcohol use defined as exposure to actors using alcohol in movies or television.
o Low neighborhood attachment defined as low level of bonding to the neighborhood.
o Community disorganization defined as living in neighborhoods with high population density, lack of natural surveillance of public places, physical deterioration, and high rates of adult crime.
o Low socioeconomic status defined as a parent’s low socioeconomic status, as measured through a combination of education, income, and occupation.
o Transitions and mobility defined as communities with high rates of mobility within or between communities.
An understanding and identification of risk factors and protective factors can help guide our prevention, direct care and care management services.
You can review the full report, and additional materials on the Surgeon General website, by visiting https://addiction.surgeongeneral.gov/
Raising children is a major, and often challenging, responsibility for every parent and guardian. When childhood mental illness is added to the mix, it can become even more demanding. It is important for every Delaware parent and guardian, regardless of their circumstance, to know that help is available.
One evening every month families gather in each county for a free casual dinner and support. Each Family Partner gathering begins with adults and children sharing a meal and a question: “What’s the best thing that happened to you this week?”
The adults share their experiences in a relaxed, informal and non-judgmental environment with a facilitator. It’s a peer-to-peer kind of support group where parents and guardians can speak openly about their situations, ask questions and discuss ideas on ways to improve whatever circumstances they’re dealing with at any given time. It’s a safe space where families with lived-in experience lift each other up and connect.
The children move to another space for fun activities, which might include games, puzzles, arts and craft projects, etc. The children are doing more than playing though. Just like the adults, they are making connections with their peers. For example, some children who had shared experiences in residential and day treatment at common facilities talk among themselves about their treatment, goals, friends they made, how they were treated, their diagnosis, the medicine they were prescribed and their experiences.
We all need a helping hand sometimes and Family Partners can be an empowering experience for adults and children. Family Partners is a free event open to all parents and guardians statewide. The atmosphere is welcoming; the food is delicious; and the support is exceptional!
To learn more about times and locations for Family Partners in your area contact Anne Marie Gromis, 302-212-7444 or ChachiMom123@aol.com. You can also review the upcoming meeting schedule here: Family Partners Meetings Jul-Dec 2017
The Delaware Department of Services for Children, Youth, and their Families (DSCYF), is sponsoring several events the first week in August. These events are sure to fill August with fun and excitement for Delaware’s young people.
The Delaware Independent Living Program invites current and former foster youth aged 14 years and older to attend the 15th Annual Youth Advisory Council Conference on Wednesday, August 2, 2017. The conference will be held at Delaware State University (Martin Luther King, Jr. Student Center), in Dover. There is no cost to attend.
Workshops will focus on communication, anger management, conflict resolution, building self-esteem, team building and much more. It will be a fun day!
For more information, please visit: http://kids.delaware.gov/fs/il-yac-conference.shtml
The popular Delaware Teen Idol competition returns to downtown Wilmington’s Playhouse on Rodney Square on Friday, August 4, 2017. Youth from all over the state will sing and dance their hearts out as they perform original songs, poetry, rap, dance, and spoken word. All performances at this family friendly event will encourage youth to engage in healthy lifestyle behaviors, and to stay away from drugs, violence and criminal behavior. This year’s special guest judge is Delaware’s own Nadjah Nicole, who was a contestant on NBC’s The Voice. For tickets and more information, please visit http://aidsdelaware.org/events/delaware-teen-idol-august-4-2017/
The Delaware Prevention Coalition will present Teen Summit – Hollywood Invades Delaware on Saturday, August 5, 2017, 8:30am to 4:00pm at the Chase Center on the Riverfront in Wilmington. The Summit is free for youth to attend, and is geared toward ages 13-17 for a day of workshops, fun, and celebrities. Youth attendees will participate in work groups to discuss contemporary issues affecting today’s adolescents. Workshops will focus on bully prevention, building self-esteem, gun violence, and a variety of additional hot-button issues. Please visit http://www.delawarepreventioncoalition.org/ for more information.
The week wraps up Saturday night, August 5, 2017 with the Duffy’s Hope 15th Annual Celebrity Basketball Game. Held this year at the University of Delaware’s Bob Carpenter Center in Newark, the annual game promotes the importance of adult involvement in the lives of youth and the need for continual financial support of youth based programs.
Over the years, the star-studded event has featured celebrity guests including singer/actress Brandi; teen sports star Mo’Ne Davis; actress/singer Zendaya; singer LeToya Luckett; actor Wesley Jonathan; media personality Quincy Harris; actress Raven Simone; actress Nia Long; actor Lance Gross; and actor/author Hill Harper. For tickets please visit http://duffyshopeinc.org/. Tip off is at 5:00pm.
We hope you join us, and our community-based partners, for one or more of these exciting events!
You may hear the term Evidence-Based Practice, or EBP, to describe a skills-development or treatment program and wonder what that really means. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines Evidence-Based Practice as a practice that based on rigorous research that has demonstrated effectiveness in achieving the outcomes it is designed to achieve.
In practical terms, this means a treatment or program is provided to children and families in a way that was successful for other people with similar needs. When agencies implement a program as designed, children and families are more likely to see positive results. Many evidence-based practice programs can help children and families learn skills and strategies that help them manage challenges their family faces and improve communication.
Program models need time before they can become an evidence-based practice. Researchers review information reported during program participation, including outcome data. They also consider how long changes last after the program ends. Improvements and change must match the goals of the program. If a practice does not achieve the intended goals, changes may be made to the model. When others provide the same program, the results should be similar to show that the program model does what it says it does.
Delaware has been increasing use of evidence-based practices in the child and adult serving systems. There is a lot of research about prevention, early intervention, treatment, and skills development programming. This information helps agencies, like ours, and community-based providers choose effective programs that will be helpful to Delawareans.
The Division of Prevention and Behavioral Health Services offers a number of evidence-based practices. We are working to improve our ability to deliver evidence-based services and add new research-proven methods into our system.
You can learn more about our treatment services here: http://kids.delaware.gov/pbhs/services-offered.shtml and our prevention programs here: http://kids.delaware.gov/pdfs/pbh-guide-to-programs-and-services.pdf
To learn more about evidence-based practices, visit the following web-based resources: