Projects and Grants

Juvenile Rehabilitation Administration Family
Integrated Transitions (FIT) Overview

Summary of the Family Integrated Transitions Program

• In 2000, the Washington State Legislature established the Family Integrated Transitions (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 area of 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 (FIT)

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 by JRA, called the Family Integrated Transitions (FIT) 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
• Motivational Enhancement Therapy
• 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 and self-monitoring.

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 establish a plan for resumption of treatment following relapse.


FIT 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 Snohomish, King, Pierce, Kitsap, Thurston and Mason counties (JRA Regions 3, 4, 5 and 6) with a family or stable placement
• Note:  New contract in Thurston, Mason counties in 2007.  Region 5 (Pierce and Kitsap counties) should be back on Interim contract for new referrals starting September 1, 2007 with a potential new provider starting in 2008.  Proposed FIT expansion into Yakima, Benton and Kittitas counties in 2008.
• Sex offenders are NOT excluded from the target population
• According to 2004-5 data, FIT has served an average of 80 JRA youth per year. 
  • 59% Anglo
  • 29% African American
  • 6% Asian
  • 4% Native American
  • 2% Hispanic
  • 2% Other

FIT Key Elements

• Family strength-based services begin 2 months prior to release to ensure engagement and strengthen community supports.  FIT continues for 4 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.
  
  
• Master Level therapists are available 24/7 and address family and community involvement.  They carry low caseloads of 4 – 6 families at a time.
  
  
• Both on-going supervision and expert consultation occur with the supervisors and therapists 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 by a family member in regard to the therapist’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 a therapist’s performance and a therapist can make real-time adjustments to their interventions to match to the needs of the family. 

Goals of FIT

• Lower risk of re-offending
• Focus on family strengths and empowerment
• Improve educational level and vocational opportunities
• Connect 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
• Emphasis on family and community involvement
• Individualized services to meet the unique needs of each family
• Services provided in the family’s home or community
• Connection with on-going services upon discharge, if needed
• Increase pro-social behavior

Demonstrated Outcomes of FIT

• 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.

Referral Process

• FIT referrals are identified at Central Office through data entered by each institution on the Co-Occurring Database on JRA’s Activity Client Tracking System (ACT). 
  
  
• JRA residential and parole staff also make referrals to the FIT program, giving a helpful balance of staff referring youth and confirming the database’s accuracy

FIT Providers

• Coaches for Snohomish, King, Pierce and Kitsap counties (JRA Regions 3,4,5) are from Community Psychiatric Clinic (CPC).  A new contract with CPC to provide FIT services in Region 5 started 1/1/08.  Youth in Pierce and Kitsap counties (JRA Region 5) are receiving FIT services from Prime Time thru an interim contract that will end after February 2008.

• Coaches for Thurston and Mason counties are from Behavioral Health Resources (BHR).  Services started 2/1/07.

• Coaches for Yakima, Benton, and Kittitas counties (JRA Region 2) are from Central Washington Comprehensive Mental Health (CWCMH).  Services started 1/1/08.

• These agencies have contracts with the JRA and are part of the JRA continuum of care.

• Each institution and involved region has a JRA FIT contact person who helps to coordinate information between the FIT providers and other JRA staff.  For the most part these are the Mental Health Coordinators.

• FIT has evolved into a respected and much-watched and presented program both in Washington and the nation.  The model developers have increasingly delineated the program elements and clearly stated expectations for treatment providers. 
  
  
• Through Eric Trupin’s advocacy, additional funding was obtained for the program for 2005 – 2007.
  
  
• FIT is one of the Evidenced Based Programs (EBP’s) targeted for possible expansion for 2007-2009.  JRA intends to expand FIT into Yakima, Benton and Kittitas counties in 2008.
  
  
• JRA’s contracts with the University of Washington and the contracted providers have evolved to incorporate more specific expectations about provided services.  The next step with provider contracts is to improve the language around quality expectations and model adherence. 
  
  
• Ongoing work around integrated Functional Family Parole with Family Integrated Transitions - both on the day-to-day level and at the model level – is occurring.  Not all parole counselors are clear about how FIT incorporates into the FFP model they are trained to deliver. 
  
  
• The DSHS Children’s Mental Health Initiative (CMHI) has selected FIT for expansion and utilization by the Mental Health Division youth consumers. 
  
  
• Legislators may be interested in hearing about what outcomes we currently can demonstrate with FIT (i.e. reduction in violent felonies) as well as any plans for additional use of the program.
  
  
• The Washington State Institute for Public Policy has expressed interest in a second look at the FIT data with a larger sample size who have been out of JRA and FIT for over 2 or 3 years.

Model Developers

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 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.

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

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