Family Integrated Transitions (FIT)

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Category	Type	Target Age Group	Setting	Outcomes	Source of Rating
Promising Programs	Delinquency & Recidivism	Elementary School High School Middle School	Community Institution	10.2% reduction in recidivism	Close Washington State Institute for Public Policy (WSIPP) The Washington State Institute for Public Policy (WSIPP) uses the meta-analysis methodology to conduct evaluations of evidence-based practices, but also considers the cost of such programs and strategies to taxpayers and crime victims and weighs these costs against possible benefits (i.e., costs avoided through reduced crime). Programs and strategies are not ranked, but effect on recidivism is measured and the number of evaluations is reported. Recidivism, cost to tax payers and crime victims, and benefits are estimated using data specific to Washington State. For the purposes of this paper, all cost and benefit information refers to the analysis conducted by WSIPP for the State of Washington. Accordingly, the information should be considered an estimate for the potential cost and dollar benefits for California. The data used for this project can be found in the article by Elizabeth K. Drake, Steve Aos and Marna G. Miller, titled “Evidence-Based Public Policy Options to Reduce Crime and Criminal Justice Costs: Implications in Washington State” (2009), and can be downloaded from their Web site, www.wsipp.wa.gov. Selection Criteria:  Meta-analysis & cost-benefit analysis. Applicability:  Meta-analysis & cost-benefit analysis. Reliability:  Excellent Currency:  Analyses are revised every few years. Advantages:  Predictability of outcomes; ability to compare cost effectiveness. Limitations:  Costs & benefits are based on WA data. WSIPP

Description:

The FIT program provides integrated individual and family services to juvenile offenders who have mental health and chemical dependency disorders during their transition from incarceration back into the community. The goals of the FIT program include lowering the risk of recidivism, connecting the family with appropriate community supports, achieving youth abstinence from alcohol and other drugs, improving the mental health of the youth, and increasing pro-social behavior.

Key Elements of FIT:

• Family strength-based services begin two months prior to release to ensure engagement and strengthen community supports. FIT continues for four months after release. The first and most important task of FIT is to engage the family in treatment. Then the program strives to promote behavioral change in the youth’s home environment, emphasizing the systemic strengths of family, peers, school, and neighborhoods to facilitate change. The strengths and needs of each family are assessed and services tailored to the family's individualized needs and strengths.
• Masters trained FIT coaches are available 24/7 and address family and community involvement. They carry low caseloads of 4-6 families at a time. FIT services are provided in the family home.
• Both on-going supervision and expert consultation occur with the supervisors and coaches for at least an hour a week each. The consultation and monthly booster training on core treatment elements are provided by the University of Washington.
• The MST component of the model includes Therapist Adherence Measures (TAM-R’s), which are completed monthly by a family member reporting on the FIT coach’s performance. The University of Washington staff make phone calls to family members to obtain this information. In this way, families are empowered to communicate about the FIT coach's performance and the coach can make real-time adjustments to their interventions to match to the needs of the family.

Goals of FIT:

• Lower risk of re-offending
• Enhance family strengths
• Improve educational level and vocational opportunities
• Increase linkage with appropriate community services
• Achieve abstinence
• Improve mental health status and stability of the youth
• Convert structured abstinence to motivated abstinence and have an early focus on relapse prevention
• Strengthen the family’s ability to support their youth, including teaching specifics of interventions begun in the institution
• Increase pro-social behavior

Target Population

1. Any youth 17 ½ years or younger, being released from residential commitment to four months or more of parole supervision; WITH
2. Any substance use disorder; AND
3. Mental health concerns as evidenced by:
   1. Any Axis I Disorder (except for youth who have only a diagnosis of Conduct Disorder, Oppositional-Defiant Disorder, substance use disorder and/or a Paraphilia; youth with other Axis I disorders in addition to these disorders meet the mental health concern criteria for FIT), AND/OR
   2. Currently prescribed psychiatric medication, AND/OR
   3. Engaging in self-harm behavior in the last four months.

 

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References and/or Published Evaluations

The 2000 Washington State Legislature directed that an independent outcome evaluation of FIT be conducted by the Washington State Institute for Public Policy. Those results are published in a December 2004 report. The highlights of the report are that:

• FIT reduces recidivism in comparison to transition as usual for co-occurring offenders from 40.6% to 27.0%. This is a 33% reduction in felony recidivism.
• The benefit-cost ratio related to the reduction in crime is a savings of $3.15 for every dollar spent – or total of $19,247 per youth for the $8,968 spent per youth in the FIT program.
  • The benefit-cost analysis includes an application of a 25 percent reduction in the recidivism rate because of some concerns of selection bias.
  • This evaluation of savings only estimates the effect that FIT has on crime outcomes. Other potential benefits, such as decreases in substance abuse or increases in education levels were not measured.
• Decreases in misdemeanors and violent felony offenses did occur, but were not statistically significant. If the trend continues, additional research with more participants may demonstrate statistically significant reductions in those areas as well.
• FIT successfully engages youth and families in specified, individualized transition services.
• FIT maintains fidelity to MST while specifying interventions tailored to needs of transition for mentally ill and substance abusing offenders.

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Additional Information

Provided by the University of Washington, Department of Psychiatry & Behavioral Science, Division of Public Behavioral Health & Justice Policy, September 2010

• Has this program been replicated at other sites? If so, how many and where are they?
  Currently we have five sites in Washington State using FIT with families, and are about to start up a randomized trial in New York City (as well as working with 2-3 other states who are interested). We'd be happy to connect you with these programs to discuss their experiences and impression.
  

• Do you have a formal curriculum or program guidelines in place? What is the approximate cost for these materials?
  Every team that does FIT has to be licensed as an MST team prior to being able to do FIT (FIT is listed as an adaptation of MST on their website, and we utilized many of the program guidelines/protocols with FIT). There is a FIT manual which has the DBT/MET materials included, so there are no additional materials that need to be purchased other than the start-up materials that are included in new team development.
  

• What kind of training and technical assistance is available for this program?
  There is a robust training and on-going consultation process that is a part of the program. Each team has an initial 5-day MST training, and then a 4-day FIT specific training. Every two months there is an additional 1.5 day "booster" training session, which is designed to focus on on-going skill acquisition/practice/support. The teams also present their cases weekly during a one hour consultation phone call, which is designed to assess whether teams are adhering to the model and provides support if the teams are encountering barriers in treatment progression. We have the capacity to provide training at organizations on a case-by-case basis.
  

• Once the program has been implemented, can an organization obtain assistance with fidelity monitoring or quality assurance?
  See above for some of the on-going fidelity/quality assurance. In addition what was described above, families are contacted monthly to complete a Therapist adherence measure which is a tool that has been validated to identify if clinicians/coaches are adhering to the model. We also track outcomes for cases at discharge (using the website developed by MST Services- www.mstinstitute.org) so we can identify outcomes by teams/clinician/agency etc. There is also a formalized clinician/supervisory development process as well as a biannual organization review to track outcomes.
  

• Can an organization obtain assistance with data collection or measurement of outcomes?
  Please explain. We have the capacity to assist in data collection, and are available to consult with agencies to help them develop a systemic way to measure outcomes. We can assist with evaluation design and data analysis.
  

• Which local stakeholders (law enforcement, local govt., CBOs, etc.) have to participate in order for this program to be successful?
  As the program is focused on systemic changes in addition to the individual changed, it is of paramount importance that all key stakeholders who are vested in the youth participate in the initial program development in order to assess the level of buy-in. We usually rely on the local agency to assist us in identifying who are the stakeholders. We do need to have buy-in from the juvenile facilities who are housing the youth prior to referral to ensure there is clear support to have the youth transition successfully.
  

• Do you recommend the use of a risk assessment tool in identifying referrals for this program? If so, which one?
  See above entry criteria; we will also work with you and any tools you currently use to facilitate referral to the FIT program.

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