Projects and Grants

Juvenile Rehabilitation Administration

Family Integrated Transitions^TM (FIT^TM) Overview

Summary of the Family Integrated Transitions^TM Program

• In 2000, the Washington State Legislature established the Family Integrated Transitions^TM (FIT) pilot program in order to transition juvenile offenders with the co-occurring disorders of mental illness and chemical dependency back into their communities and families without conflict and reduced recidivism. Youth ages 11 to 17 and a half with substance abuse/dependency and mental health needs were the targeted population.
• Geographical areas at that time included Snohomish, King, Pierce, Kitsap, Thurston and Mason counties.
• Program works to create behavior change in youth’s home environment building on strengths of family, peers, school, neighborhood, and other systemic supports.
• Evidence demonstrates a 33% reduction in felony recidivism.

Background of Family Integrated Transitions^TM (FIT^TM)

In 2000, the Washington State Legislature established a treatment-oriented pilot program to transition juvenile offenders with the co-occurring disorders of mental illness and chemical dependency back into their community.

Because there was no existing model for this population, the specific approach adopted Washington State's Juvenile Rehabilitation Administration (JRA), called the Family Integrated Transitions^TM (FIT^TM) program, was designed and implemented by Eric Trupin, Ph.D., from University of Washington, and David Stewart, Ph.D., from Seattle Pacific Unversity.

To meet the needs of these high risk youth, several evidence-based programs were combined. Those are: Multisystemic Therapy (MST) as the core treatment model, plus:

• Dialectical Behavior Therapy (DBT)
• Motivational Enhancement Therapy (MET)
• Relapse Prevention/Community Reinforcement

MST is an empirically validated, cost-effective, and intensive family preservation model of community based treatment that addresses anti-social behavior in juvenile offenders.

DBT skills training, currently underway in JRA residential settings, includes behavioral analysis, self-monitoring, and the practice of specific emotion regulation skills.

MET is used to increase the motivation of youth and family to engage and remain in treatment and to reduce chemical dependency.  Families may be resistant to accepting an intervention that focuses on change at the level of the family system, rather than solely demanding change from the adolescent.  Motivational enhancement of both adolescents and families is therefore viewed as key to creating and sustaining change.

Relapse Prevention/Community Reinforcement is used to increase youth and family awareness of substance use and high-risk situations, increase the repertoire of effective coping strategies, and to establish a plan for resumption of treatment following relapse.


Current FIT^TM Target Population

• Ages 11 to 17.5, with a substance abuse/dependency and mental health need
• At least 2 months left on sentence
• Residing in Yakima, Benton Franklin, Kittitas (JRA Region 1), Snohomish (JRA Region 2), King (Region 2), Pierce, Kitsap (Region 3), with a family or  other stable placement
• Sex offenders are NOT excluded from the target population

• According to 2011-2012 data, FITTM served 82 JRA youths.
• 40% Anglo
• 29% African American
• 17% Hispanic
• 6% Native American
• 4% Other
• 3% Asian

FIT^TM Key Elements

• Family strength-based services begin 2 months prior to release to ensure engagement and strengthen community supports.  FIT^TM continues for 4 months after release.  The first and most important task of FIT^TM 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^TM coaches are available 24/7 and address family and community involvement.  They carry low caseloads of 4 – 6 families at a time. FIT ^TMservices 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^TM 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^TM 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^TM

• 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

• The 2000 Washington State Legislature directed that an independent outcome evaluation of FIT^TM 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^TM 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^TM 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^TM 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^TM successfully engages youth and families in specified, individualized transition services.
  
  
• FIT^TM maintains fidelity to MST while specifying interventions tailored to needs of transition for mentally ill and substance abusing offenders.

• FIT^TM referrals are identified at the JRA Headquarters through data entered by institution staff on JRA’s Automated Client Tracking System (ACT). 
  
• JRA residential and parole staff also make referrals to the FITTM program, providing a helpful balance of staff referring youth and confirming the database’s accuracy.

• Coaches for Snohomish, King, Pierce and Kitsap counties (JRA Regions 2, 3) are employed by Community Psychiatric Clinic, www.cpcwa.org.

• Coaches for Yakima, Benton, Franklin, and Kittitas counties (JRA Region 1) are employed by Central Washington Comprehensive Mental Health, www.cwcmh.org .These agencies have contracts with JRA and are part of the JRA continuum of care.

Each JRA institution and regions 1, 2, and 3 has a designated contact person, typically the Mental Health Coordinator, who helps to coordinate information between the FITTM coaches and other JRA staff.

Current Status

• Family Integrated Transitions^TM (FIT^TM) has evolved into a well-respected and much-watched evidence-based treatment program for delinquent youth with dual disorders. Currently there is active interest in implementing FIT^TM in jurisdictions within at least 4 other states. The DSHS Children's Mental Health Initiative (CMHI) has selected FIT^TM for expansion and utilization by the Mental Health Division youth consumers. 
  
  
• FIT^TM is 1 of only 2 Model Programs for re-entry of delinquents back into their communities evaluated as "effective" by the US Department of Justice, Office of Juvenile Justice and Delinquency Prevention (OJJDP).

• The Annie E. Casey Foundation recognized FIT^TM program effectiveness in their 2008 KIDS COUNT Data Book publication.

Eric Trupin, Ph.D., formed the Division of Public Behavioral Health and Justice Policy of the University of Washington’s School of Medicine, Department of Psychiatry and Behavioral Sciences in 1983.  The division was initially formed to design and supervise training programs.  Over the years, the division has greatly enlarged its mission to addressing the crisis in mental health care and treatment, particularly among minorities, the poor, and youth incarcerated in county and state jails and detention centers.  Dr. Trupin and his colleagues have been heavily involved in the development of JRA’s movement forward in identifying and providing mental health services for youth, including the FIT^TM program.  He has done numerous research projects involving JRA youth and other youth in justice systems nationwide.  He is a national expert on juvenile justice, mental health, and co-occurring disorders and involved with the Office of Juvenile Justice and Delinquency Prevention (OJJDP).  He is a strong advocate for the use of evidence based practices in mental health and juvenile justice settings.  Dr. Trupin is influential with Washington State Legislators and testifies regularly on his expert areas. 

David Stewart, Ph.D., now works for the Seattle Pacific University as an Associate Professor of Psychology.  He has done extensive research and practice with adolescents and substance abuse, co-occurring disorders, cultural competence, juvenile justice, evidence based practices, and family and community based interventions.

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