Our Kids of Miami-Dade/Monroe, Inc., in partnership with the Florida Department of Children and Families Southern Region, Family Central Inc., Federation of Families Miami-Dade Chapter, Inc., South Florida Behavioral Health Network, the Village South Westcare Foundation , the University of South Florida, and Miami-Dade Community Based Care (CBC) Alliance, builds upon existing community relationships and services available to address the needs of child welfare involved families whose children are at-risk of removal who are affected by substance use disorders.
Miami-Dade IMPACT Project is developing a system and continuum of care that adequately addresses the needs of families affected by addiction that are non- treatment seeking, and at-risk of losing their children due to child abuse and neglect. The project provides eligible families an array of services incorporating the promising practice of Multi-Dimensional Family Therapy (MDFT) - Family Recovery with Intensive Family Preservation Services (based on the Institute for Family Developments HOMEBUILDERS ® program), Continuing Care Peer Specialists, and access to an entire continuum of services for children and parents. Through the service array, IMPACT Project is: (1) increasing child functioning, (2) decreasing parent substance use and mental health symptoms, (3) bettering child safety and child welfare outcomes and (4) improving family functioning.
The project includes an extensive evaluation using formative and summative approaches to examine IMPACT partnership, implementation, and outcomes. The project has elected to implement a Randomized Control Trial to study the effectiveness of evidence-based/promising practices, trauma informed care, and coordination of services to meet individual needs and the family as a whole.
The IMPACT Project serves families referred to Our Kids of Miami-Dade/Monroe, Inc. for diversion or prevention programs; have children ages 0-11; and who are determined to be “High to Very High Risk – with no safety threat” or “Moderate to Very High Risk – and Conditionally Safe,” and have suspected or verified substance use indicators.
Major Program Goals
The overriding goal is to develop a system and continuum of care that increases the well-being and improves permanency outcomes for children and their families affected by addiction where parents are non-treatment seeking, and are at high risk of child removal due to child abuse and neglect related calls to the hotline. Additional goals of the project are:
- To improve connection to and retention in services for the participating families
- To improve children’s functioning and developmental outcomes particularly related to mental health status, recovery from trauma, healthy attachment and social development
- To reduce parent/caregiver’s substance use and risk for child abuse; prevent re-referral or further involvement in the child welfare system
Major Program Services
The IMPACT Project core components include the promising practice of Multi-Dimensional Family Therapy (MDFT) - Family Recovery and Intensive Family Preservation Services (based on the HOMEBUILDERS® model) over an extended period. In addition, a Continuing Care Peer Specialist assists parents/caregivers to maintain their goals for recovery and self-sufficiency, support, and advocate for retention in services, monitors their progress, provides overall support and encouragement, reinforces coping skills and self-reliance, and otherwise helps the parents and families maintain stability.
The program facilitates access to an entire continuum of services through an established provider network who provide evidence-based practices such as Motivational Enhancement Therapy, Cognitive Behavior Therapy, Wraparound Services, Seeking Safety, Twelve Step, Psycho Educational Multi-Family Groups, Anger Management, Brief Strategic Family Therapy, Life Skills Training, Dyadic Family Therapy and Healthy Steps based on the needs of the family. In addition, the program design includes strategies to address:
- Trauma: An essential component of the IMPACT Project is to address trauma related issues of children and adults randomized into the intensive service group. The IMPACT Project implements within a trauma informed environment. The Trauma Informed Care Committee (TIC), under the umbrella of the Substance Abuse Mental Health Planning Council (SAMH) in the DCF, furthers development and improvement of trauma informed services in the community
- Child Well-Being: The project addresses the needs of children through a multi-faceted approach that incorporates the Intensive Family Preservation Services, Multi-Dimensional Family Therapy (MDFT) - Family Recovery program with linkages to an array of coordinated community based services to address children's well-being
Partner Agencies and Organizations
The IMPACT Project builds upon existing collaboration in the community that will be strengthened and enhanced through the grant initiative. Miami-Dade Community Based Care Alliance will lead an Advisory Committee to ensure cross-system integration. The Advisory Committee helps facilitate incorporation of the project's activities into ongoing practices. In addition, the project staff meets with SAMH partners to consider creation of a task force that pertains more specifically to helping families receive treatment in a timely matter.
Most of the original grant partners and stakeholder continues to engage in the partnership and several new partners have joined. Partners include:
- Our Kids of Miami-Dade/Monroe, Inc.
- Florida Department of Children and Families Southern Region
- Family Central Inc.
- Federation of Families Miami-Dade Chapter, Inc.
- Banyan Health Systems (Spectrum Programs/Miami Behavioral Health Center)
- South Florida Behavioral Health Network
- University of South Florida Department of Child and Family Studies (CFS)
- University of Miami Miller School of Medicine, Department of Pediatrics-Division of Neonatology-Perinatal CARE Program
- Miami-Dade Community Based Care Alliance
- The Village South Westcare Foundation
- Jessie Trice - Jefferson Reeves House Substance Abuse Residential Center
- AGAPE Network
- Concept Health Systems
The evaluation of the IMPACT Project relies on a mixed method design. The project evaluation is comprised of three components: an implementation study, a partnership study, and an outcomes study, that elaborates the results of a randomized controlled trial testing of Multi-Dimensional Family Therapy (MDFT) – Family Recovery intervention. The implementation and partnership portions of the evaluation makes use of formative evaluation methods and focuses on documenting and describing the operation of the IMPACT Project through all stages of development and service delivery over the project’s five-year period. The implementation study, in particular, examines and documents key aspects of the design and implementation of the enhanced Intensive Family Preservation Services intervention, which incorporates Multi-Dimensional Family Therapy (MDFT) – Family Recovery, including selection of program participants, retention, and attrition of participants, and performance of selected outcome measurement. The measurement of outcome objectives will provide the Advisory Committee and all IMPACT Project stakeholders with a true representation of the effect that the proposed project services are having on the children and families plagued by substance use and at-risk for having their children removed.
The grantee examines the impact of the Miami IMPACT Project using a randomized-controlled trial design. Members of both the program and comparison groups receive referral to substance use treatment and Intensive Family Preservation Services (IFPS) that has been renamed Family Services due to changes in the new safety methodology adopted by the Department of Children and Families. For the program group, IFPS or Family Services lasts 16 weeks. For the comparison group, Family Services lasts 9 to 12 weeks. Members of the program group also receive Multi-Dimensional Family Therapy (MDFT) – Family Recovery and support from a peer specialist. The evaluation will include 288 families split evenly across the program and comparison groups (144 families in each group). The evaluation also includes an implementation study and a partnership study.
Outcome Study Design
All eligible families referred to Our Kids are assigned to receive intensive in-home services (known as Family Services) in the Our Kids array of services. Family Services are provided through the contractor participating in the IMPACT Project. Families are random assigned to either the program or the comparison group. Those families in the program group are assigned to a therapist trained in both IFPS and of Multi-Dimensional Family Therapy (MDFT) – Family Recovery, while those in the comparison group are assigned to a Family Service therapist. The therapists inform the families about the study and ask if they are willing to participate. Families who choose not to participate will receive business-as-usual services and will not be included in the evaluation.
Outcomes are collected in each of five domains: child well-being, permanency, safety, family functioning and recovery. Data sources include administrative data and information collected by data collectors using standardized instruments. Administrative data on safety and permanency comes from Florida’s child welfare information system, the Florida Department of Children and Families’ (FDCF) Florida Safe Families Network (FSFN). Recovery data comes from the South Florida Behavioral Health Network (SFBHN). The evaluation team has established a data-sharing agreement with FDCF allowing access to FSFN. As the lead community-based care agency in Miami-Dade County, Our Kids has access to FSFN, and has an existing agreement with SFBHN.
An Our Kids staff member conducts data collection with standardized instruments for both the program and comparison groups. Data is collected three times for each family: (1) when families begin services, (2) six months later (at the end of IMPACT Project services for the program group and three months after the end of business-as-usual services for the comparison group), and (3) six months after that (that is, 12 months after the start of services).
Additional Evaluation Components
In addition to the outcomes study, the evaluation includes an implementation evaluation that examines fidelity to the Multi-Dimensional Family Therapy (MDFT) – Family Recovery model, organizational climate and how it is associated with implementation of the IMPACT Project, and therapist perceptions of the intervention. The partnership study assesses how the RPG partners work together, how their collaboration evolves over time and their perceptions of challenges and successes.
RPG National Cross-site Evaluation Participation
The grantee is participating in the RPG cross-site evaluation studies of family and child outcomes, program implementation, and collaboration among RPG grantees and partners.
Sustainability Strategies and Activities
The Miami-Dade IMPACT Project design begins with an eye on sustainability. The project builds upon existing community resources that will be strengthened and enhanced through the Project. The community, supported by the Community Based Care Alliance, guides an Advisory Committee, ensuring cross-system integration. The Advisory Committee continually identifies opportunities to make IMPACT Project activities sustainable through collaboration and partnership.
IMPACT Project staff facilitate sustainability through a “Train the Trainers” model, whereby Clinical Supervisors are trained as of Multi-Dimensional Family Therapy (MDFT) – Family Recovery trainers, so that at the end of the project period the region has the capacity to sustain and expand on the intervention.
The ultimate sustainability goal is to institutionalize program strategies and activities into organizational policy and infrastructure. Since child welfare and behavioral health is privatized and local, the community funds and expands the project when federal funding ceases if, in fact, the data shows positive outcomes.