Meeting Family First fidelity requirements

December 20, 2021


With the introduction of the Family First Prevention Services Act (FFPSA), a new world of opportunities has opened up for states and counties to transform child welfare by implementing evidence-based programs that provide expanded services to at-risk families and prevent foster care entry. The FFPSA creates new pathways for states to draw down federal funding, but with this comes new requirements for reporting and fidelity measurement. These requirements can be overwhelming, expensive, and time-consuming for jurisdictions who may not be set up to meet them.

Lyssn’s AI platform can help states and jurisdictions across the country meet the new requirements to evaluate sessions at scale and demonstrate fidelity of evidence-based practices.

Why the FFPSA is so important

The Family First Prevention Services Act (FFPSA) of 2018 is one of the most significant and historic reforms to the federal child welfare policy in decades. The Act calls on states to radically rethink their approach to serving families who are at risk of entering the child welfare system, and it offers more reimbursement funding for prevention services than ever before.

This significant expansion of prevention services could make an impact for countless families at risk for having children removed from their care – specifically families in which mental health, substance abuse or other abuse or neglect has occurred. One of the goals of Family First is to keep children safely with their families, when possible, by providing supportive services to parents.

The challenge of expanding social services

While the FFPSA can provide increased federal funding for an unprecedented number of social services, this also creates several new challenges. Jurisdictions that choose to implement an FFPSA program are required to adhere to their states’ written, trauma-informed prevention plan, and the programs and services they offer must be evidence-based and approved by the Title IV-E Prevention Services Clearinghouse and Children’s Bureau.

To comply with trauma-informed prevention plans that are approved by the Children’s Bureau some jurisdictions have decided to add other evidence-based practices to their services – primarily Motivational Interviewing (MI).

Motivational Interviewing is a popular approach because it is rated favorably by the Clearinghouse and a precedent has been set with several states already receiving approval from the Children’s Bureau to apply MI as a cross-cutting family engagement strategy. In addition, a big draw to MI is that non-clinical providers (nurses, caseworkers, etc.) can apply it within their services.

For many agencies MI will be new to their workflow, and for the majority there aren’t any systems in place to track the application of MI.

“It can be a big challenge for organizations to meet the deliverables,” said Jenny Cheng, Family First Coordinator at Lyssn. “If you don’t have the staff, don’t have a way to collect data of this kind, don’t have the funds to bring in new programs or people, or have never done this type of evaluation before, it can be overwhelming to know where to start.”

Lyssn can help meet FFPSA requirements

While jurisdictions figure out what approved programs map on to their needs, they must also figure out how to continuously and rigorously evaluate programs to demonstrate data-driven quality improvement efforts. The new requirements mean jurisdictions are preparing to take on model adherence measurement and a level of metric-driven reporting that is well beyond any previous reporting.

The capacity to execute the high standards of the Act can also vary from jurisdiction to jurisdiction, and some contracted community-based agencies will be responsible for fidelity monitoring and reporting. Building out new systems for quality assurance plans, tracking performance metrics, and implementing coding systems can be very costly, time-consuming, and difficult to accomplish at scale.

“This is where Lyssn can help,” said Jenny. “Jurisdictions need an affordable out-of-the-box solution, and that is what Lyssn can provide. The autogenerated evaluation of sessions accurately tracks the application of MI, provides monitoring of fidelity at scale on an ongoing basis, and can also provide meaningful feedback to caseworkers and clinicians who may be new to MI.”

How Lyssn’s reporting works

There are two primary coding systems that measure adherence to Motivational Interviewing: Motivational Interviewing Skill Code (MISC) and Motivational Interviewing Treatment Integrity (MITI). Both are well researched, reliable, validated systems. Organizations and agencies tend to choose one or the other. Lyssn codes for both. MISC is the more comprehensive of the two but can also be difficult to use in a real-world setting. MITI is a briefer tool, only coding a portion of a session rather than the full session, but it can be more accessible to use. By supporting both systems, the Lyssn platform can accurately code MI within sessions, and offer actionable feedback and overall performance metrics and trends for an organization, regardless of which coding system is used.

In addition to Motivational Interviewing, Lyssn codes for Cognitive Behavioral Therapy (CBT) adherence using the Cognitive Therapy Rating Scale (CTRS) – a gold standard for CBT fidelity measurement. Jurisdictions implementing Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) can use Lyssn’s automated CTRS codes for general CBT adherence, allowing agencies to focus on the specific components unique to TF-CBT.

The Lyssn platform provides more than 50 types of validated metrics. Along with MI and CBT metrics, the platform can report on general therapy metrics like talk time, empathy, active listening and more. The near-accurate transcripts help caseworkers and clinicians look back on sessions and determine what worked and areas for improvement. The platform is also completely secure and cloud-based, which removes the concerns of sessions being stored on personal devices.

“Lyssn’s automated evaluation of fidelity paired with our in-house coding experts, bring a level of super rigorous and high-level support to smaller agencies that traditionally wouldn’t have been available to them,” said Jenny. “That ultimately means more access to high quality evaluation, without the high costs of hiring expensive coding teams or contracting with universities or research groups.”e.

Are you a jurisdiction in need of FFPSA support?

Thanks for taking the time to read more about Lyssn. If interested in future updates, you can sign up for blog updates.