1. Randomized Controlled Trial of Family Centered Treatment in North Carolina
Treatment and Study Overview for NC County Departments of Social Services
September 2019

2. Focus: Parameters of the randomized controlled trial (RCT) of Family Centered Treatment in North Carolina.
Target population: Youths who meet medical necessity for both FCT and Residential Level III out-of-home treatment (OHT)
Goal:
Provide an overview of the study
Outline the potential roles/responsibilities for County DSS’ for youth in care participating in the RCT
Answer any questions
Introduction

3. Collaborative Project
Partners Include:
The Duke Endowment (Funder)
The Family Centered Treatment Foundation
Cardinal Innovations Healthcare
Partners Behavioral Health Management
Trillium (tentative)
North Carolina FCT Providers
Residential Level III OHT Providers
Duke University’s Center for Child and Family Policy
Duke University’s Margolis Center for Health Policy
Collaborative Project

4. Why is Additional Research on FCT Needed?
Existing Evidence is Promising:
Quasi-experimental studies have found positive outcomes with juvenile justice and child welfare specialty populations (i.e., domestic violence related).
FCT has practice-based evidence: more than 15 years of data with the child mental health population.
No RCT studies to date with the child mental health population.
Why is Additional Research on FCT Needed?

5. The Current Study
First FCT RCT Study: Focus on Youth within the Behavioral Health System

6. Study Design Study Goals:
Target population: Youths (11-17) authorized for a Level III OHT
Determine if FCT, relative to “treatment as usual” leads to:
Increased safety and permanency
Improved wellbeing outcomes for youth and their caregivers, and
Improved family functioning
The study began in October of 2018 and runs through June of
375 families/youth in the FCT intervention group
375 families/youth in the control group
We expect to approach 1,000 and enroll 750 total.
CCFP research staff will track these youth/families for up to 18 months, even after treatment has concluded.
Study Design

7. Study Design Randomization
Randomization would occur at the MCO level within the Utilization Management division at each MCO.
Birthdays would serve as the method by which youth are randomized
Youth born on even numbered days will be randomized into FCT group.
Youth born on odd days will be randomized into the OHT group.
Study Design

8. Study Recruitment for Youths in DSS Custody
Youth Randomized into FCT
Youth Randomized into OHT
Study Recruitment for Youths in DSS Custody
MCO to coordinate with DSS to see if FCT would be an appropriate fit for the youth.
If youth meets study inclusion criteria, MCO and DSS coordinate to get FCT provider out to talk to caregiver.
FCT providers would be provided information about youth/families randomized into FCT by the MCOs and approach caregiver about participating in FCT instead of OHT.
DSS to obtain consent to contact for youth/carejgiver(s) to participate in Duke study.
MCO to contact DSS to let them know youth is eligible for study
DSS to obtain consent tp contact for youth/caregiver(s) to participate in Duke study.

9. Study Recruitment for Youths in DSS Custody
Obtaining Consent to Contact for Duke
Study Recruitment for Youths in DSS Custody
There are no NCDSS policies that would prevent this. (Letter from DHHS included in your handouts)
If parental rights for an eligible youth have not been terminated, a county DSS would have to obtain a consent to contact from a biological parent for the child to participate in the Duke study.
If a biological parent agreed Duke could interview bio parent, foster parent (if they also agreed), and the youth; compensate all three.
Duke would also need a consent to contact for the foster parent.
If parental rights have been terminated, a county DSS can sign the consent form for the youth to participate.

10. FCT Intervention Group
Procedures for FCT Providers:
Once contact information is received, FCT providers have 48 hours to make contact with family.
Clinician, clinical director, or intake specialist/supervisor to make initial contact.
If the family responds to contact, FCT providers will present families with information about why they might want to choose FCT over the Level III OHT.
FCT Intervention Group

11. The family/youth may decline to participate in FCT and/or the research study.
A youth/family can decline FCT but still be in the study.
CCFP research staff will collect all data for both the FCT intervention and control groups for 18 months.
No data collection done by DSS, FCT or OHT providers.
Study Recruitment

12. FCT Intervention Group
If the family agrees to participate in FCT, rather than the Level III OHT, the FCT providers will:
Submit PCP to receive FCT to MCO within two business days.
FCT provider will also contact MCO to let them know the PCP has been submitted so that the process can be prioritized.
FCT Intervention Group

13. FCT Intervention Group
If the family does NOT agree to participate in FCT, rather than the Level III OHT, the FCT providers will:
Let MCO’s know of the family’s choice to decline FCT within 2 business days
FCT Intervention Group
Talk about intent to treat design

14. Interviews:
Consenting families will be asked to participate in a baseline interview and three follow-up interviews over 18-months (4 interviews total) with CCFP research staff.
Incentives:
Participants (youth and their caregivers) will receive $60 for participating in the baseline interview ($50 for caregiver; $10 for youth).
The stipend will increase at each follow-up interview thereafter: $75 for 6-month ($60 for caregiver; $15 for youth), $100 for 12-month ($80 for caregiver; $20 for youth), and $165 for 18-month interviews ($115 for caregiver; $50 for youth).
Study

15. Summary Responsibilities for County DSS’:
Discuss option of FCT for youths with submitted Level III authorization and an even birthday
For all children eligible for the study:
Obtain consent to contact for Duke study from bio and foster parents for youths for whom parental rights have not been terminated
Sign consent form for youths for whom parental rights have been terminated
Number of youths/month/county: Likely < 2
Summary

16. Questions Possible challenges/issues? Other feedback?
Questions for us?
Questions