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To be the premier provider of mental health services in the state of Georgia by utilizing a community based approach to offering creative & compassionate services which strengthen the integrity of the family thereby building a more safe and healthy community.
Family Intervention Specialists, Inc. was founded in 1998 in response to the need for high-quality mental health and substance abuse treatment services for children and families in poverty who were disenfranchised by mainstream mental health providers. Few private providers were willing to provide services to this lower income population, who were insured by Medicaid or PeachCare (if at all). Because of their limited economic resources, these children and families faced additional constraints caused by their geographic location and lack of transportation. It was difficult for families in both inner city and extremely rural areas to access services provided by the few providers that were willing to serve them without private insurance coverage. Without the ability to access needed mental health services, many of these children were at risk for entering out-of-home placement in the foster care system. Family Intervention Specialists, Inc. (FIS) was created with the intent of not only addressing the needs of an underserved population, but also overcoming the additional barrier of access to services by taking the services to the client through in-home services. FIS was created so that children and families at-risk could have access to the same high-quality services provided by supervised and trained professionals, that one would expect if they had the ability to afford insurance and see a service provider.
At the time FIS was created, in-home mental health services were a novel concept in Georgia. The Department of Family and Children Services provided skill- building wrap-around services in the home, but no therapy services. Family Intervention Specialist clinicians were trained and certified in Multi-Systemic Therapy (MST) and Brief Strategic Family Therapy (BSFT), both therapy modalities that advocate “whole family” approaches to treatment and are well-suited to in-home service delivery. Using a “team” approach, clients were seen in the home 2-5 times a week and the intensiveness of those services provided very positive measureable results.
The agency started operating in Fulton County with 3 clinicians and 1 administrator and served 50 clients in the first year of operation. Today, FIS covers 19 Georgia counties and employs or contracts with more than 225 staff members. In 2003, FIS became an approved Medicaid/PeachCare provider for the state of Georgia and was certified by the Georgia Department of Human Resources in June 2004. In May of 2006, FIS began partnering with the Paulding and Douglas County Juvenile Courts to assist in the development of a Family Drug Treatment Court, and also began providing services through Fulton County Juvenile Court. Today, the agency serves over 3,000 clients annually.
FIS was the first provider of Multi-Systemic Therapy (MST) in the state and the first provider of Intensive Family Intervention (IFI) services in Fulton County. In January of 2005, FIS was recognized by the National Center for Mental Health and Juvenile Justice as the only agency in the Southwest as a “Best Practice” agency. In November 2006, Family Intervention Specialists, Inc. obtained a 3-year Commission on Accreditation for Rehabilitation Facilities (CARF) accreditation with an exemplary rating for the Casey Life Skills Modules used in adolescent groups, Community Support Individual (CSI), and with Intensive Family Interventions (IFI) services.
STATEMENT OF COMMUNITY PROBLEM
FIS serves families that are broken. Their family unit has been weakened by issues stemming from mental illness, substance abuse, poverty, and domestic violence. They face challenges that may be life-threatening to members of the family, yet are ill-equipped with the resources (financial, cognitive, or emotional) to sort through and overcome these challenges. Children and families served by FIS are grappling with numerous life challenges, which lead to secondary threats of homelessness, incarceration, child abuse and neglect, and domestic violence. By systematically empowering the family to address each issue area, FIS works to strengthen the individual, the family, and by extension, the community.
Many of the families served by FIS are grappling with mental illness, either in parent or child, and sometimes spanning multiple generations. Mental illness strikes families without regard to race, gender, age, or socio-economic status. According to the National Institute of Mental Health (NIMH), mental illness is the primary source of disability in the United States. The Substance Abuses and Mental Health Services Administration (SAMHSA) estimates that there are between roughly a quarter to half a million adults in Georgia with a serious mental illness. It is also estimated that almost 20% of Georgia’s youth ages 9 to 17 are living with a serious emotional disturbance. A recent federally-funded study indicated that the collective mental health issues of children and adolescents up to age 24 alone cost the U.S. an estimated $247 billion annually. The study further reports that most mental, emotional and behavioral disorders have their roots in childhood and adolescence and more than half of diagnosed adults report a childhood/early adolescence onset of symptoms. Frequently, first symptoms occur as many as two to four years before the onset of a full-blow disorder, which creates a window of opportunity when preventive services might make a difference.
Over the past few years, the state of Georgia has seen a shift away from hospitalization to community-based care. The philosophical shift occurred faster than the practical one, which meant that closures of regional mental health hospitals caused an influx of people looking for community-based care capacity that did not even exist yet. For those fortunate enough to have private health care coverage, mental health services may not be fully covered or treatment resources may be limited. For those who fail to get the treatment they need due to lack of health coverage or financial constraints, mental illness can be completely and totally debilitating, leading to homelessness or incarceration and often serving as a contributing factor to child abuse and neglect.
Substance abuse and mental illness are so intrinsically linked that there is a name for the phenomena – co-occurring disorders. An estimated 50-75% of people with severe mental illness also have a substance abuse problem. The two can be so closely interrelated that it is difficult to say whether chronic drug abuse leads to mental illness or vice versa. In some cases, people suffering from untreated mental illness take illicit substances in an effort to self-medicate and mitigate the illnesses symptoms. In other cases, long-term chronic drug use can actually cause deficits in the brain that can lead to mental disorders. Historically, Georgia’s mental health system was set up such that people seeking treatment for both conditions had to go to different places to access needed services. Separate treatment of each condition frequently leads to constant bouncing between mental health and substance abuse treatment facilities, with little treatment success and often no communication between the facilities. Within the past few years, a federal endorsement of an integrated treatment approach has trickled down to the state level and now every mental health service provider licensed by the state to provide core services is required to have expertise in treating both illnesses.
Of specific concern to FIS’s service area is the rising prevalence of methamphetamine use. Meth is rapidly becoming the drug of choice in Georgia’s more rural areas (particularly the North and Central regions of the state) due to the fact that it is cheaply and easily manufactured. It is popular because it is not only inexpensive, but provides a high that is longer and stronger than most other drugs. It is also highly addictive. In Georgia, an estimated almost one million children are at risk of being removed from their families and entering state care as a result of parental use of methamphetamine and other drugs. The Department of Family and Children Services (DFCS) reports that 65% of child deprivation cases involve parents either manufacturing or using drugs and a survey of prison admissions show that two-thirds of those incarcerated have children. Unfortunately, people who manufacture methamphetamine in their homes often have children. In the years 2001-2004, law enforcement found over 240 children at seized clandestine meth labs in Georgia. This is of particular concern to child well-being because in addition to the risks already posed by parental drug use (physical abuse, sexual abuse, and neglect), the chemicals used to produce methamphetamine are highly toxic and involve exposure to chemical waste, potential fires and explosions, and drug paraphernalia, and ingestion by the child as well.
Poverty is another factor contributing to weakened family systems in FIS clients. The poverty line for a five-person household is currently $24,800. According to the most recent Kids Count data available (2007), 1 in 5 Georgian children are living in poverty. Minorities are particularly impacted, with 30% of African American and 25% of Hispanic children living below the poverty line, as opposed to 9% of Caucasian children. According to a 2001 Heritage Foundation study, the major underlying factors contributing to child poverty in the U.S. are single parenthood and welfare dependency. Compared with children living in families at or above the poverty line, children living below the poverty line are more likely to have difficulty in school, to become teen parents, and, as adults, to earn less and be unemployed more frequently. If single parenthood is a contributing factor to poverty, which leads to higher incidence of teen pregnancy (typically single parenthood), which then leads back to poverty, it’s not difficult to see what a vicious cycle poverty is for the family system. This is also true with welfare dependency, which leads to poverty, which leads to children who earn less and are employed less frequently as adults, which leads back to poverty. Clearly, significant external intervention is required to assist a family in breaking out of this cycle. FIS provides this crucial intervention.
With all of these other stressors on the family system, the incidence of family violence is high among families served by FIS. Family violence can include either domestic abuse among spouses of abuse/neglect of children in the family. Statistics on domestic violence are difficult to track because it often goes unreported, but it is estimated that a woman is battered in the US every nine seconds. In any given year in Georgia, almost 100,000 reports of child abuse or neglect are made to the Georgia Division of Family and Child Resources. Victims of family violence often have few resources or options because the abusive partner retains control of finances.
One emerging subset of the population that faces special challenges with family violence are military families. According to The Pentagon, one in five soldiers returning home after active combat duty experience Post Traumatic Stress Disorder (PTSD). Left untreated, family violence frequently becomes an unfortunate byproduct of the disorder. Additionally, many soldiers find themselves grappling with substance abuse addiction disorders as a result of painkillers prescribed for wartime injuries. Georgia is currently home to 14 military bases, and while the military is mandated to work with soldiers, there is no mandate to address the needs of the family. While the current war has resulted in more soldiers returning home from active duty, it has generated additional wartime budgetary pressures and a decreased focus on addressing the family violence issue. There are few services to address the needs of this population. FIS is in the beginning stages of putting services in place for families in the Ft. Stewart/Savannah area of the state.
URGENCY OF NEED
The demand for FIS’ services continues to increase. With the downturn in the economy, more and more families are facing unemployment and loss of insurance benefits, forcing them to seek services outside of privately paid mental health service providers. Additionally, the long-term effects of the recession on increased criminal activity (including drug use and trade) have yet to play out. Few scientific studies have addressed this issue because the factors that influence crime rates are far more varied and complex than any economic indicator, but historically increases in crime (in the late 1960’s/early 70’s and early 90’s) have occurred due to spikes in the drug trade. Studies of these timeframes have shown that average wages and unemployment rates are directly linked to the incidence of property crimes and that hard times also lead to more domestic abuse. All that to say, it is likely that the longer the recession lasts, the more the families and communities served by FIS will require the expertise of their services.
At the same time, public funding is being transferred out of the state mental health budget due to decreased state revenues and budget cuts. Georgia’s behavioral health services system for children and adolescents has faced major changes in recent years. In recent years, two significant policy and programmatic changes at the state Departments of Juvenile Justice and Human Resources have significantly impacted the availability of mental health services for our community’s most at-risk children. The first major philosophical shift began in FY 2007-2008 when the Department of Human Resources began a movement to begin shifting severely emotionally disturbed (SED) children in residential placements back into their homes, providing intensive wraparound therapeutic services from community providers. As a result, community-based service providers where overwhelmed with children and families seeking services at an acuity level not traditionally treated in outpatient settings.
At the same time, the state of Georgia moved from a grant-in-aid provider payment system to a fee-for-service managed care system. This approach left many providers unable to recoup the administrative costs of providing mental health services to children and families. In response to the system changes, FIS has streamlined operations by assigning clinicians in close proximity to client homes, implementing web-based supervision and treatment teams, realigning position responsibilities, and conducting some restructuring of programs. Many other providers have been unable to similarly realign adapt and have been forced to close their doors, further decreasing the number of service providers available to serve low income children and families. Currently, Georgia faces a significant gap between the need and availability of services and our community’s children are paying the ultimate price.
Impact on the Child
Children are significantly and irreparably affected by all of these issues. Developmentally speaking, the first five years of a child’s life are the most important, and yet countless children in our community at this age don’t even have their basic needs met. They go to sleep hungry. They live in unsanitary and unsafe living conditions and fail to receive basic medical care. They are exposed to toxic chemicals related to drug use and manufacturing. They may be abused or neglected. As they matriculate to school age, they continue to grapple with these basic inadequacies, as well as with mental health and emotional needs that have not been met. These issues manifest themselves emotionally and behaviorally, causing the child to set a pattern of inappropriately acting out. Meanwhile, the lack of parenting skills that contributed to these problems in the first place make it difficult for parents to respond appropriately and the child continues to spiral out of control. It is easy to see how by high school, these children have often fallen prey to the culture of drug use and poverty themselves. For many of these children, the services and supports provided by FIS are the child’s only hope of helping the family begin to heal.
PROGRAMS AND SERVICES
FIS provides specialized mental health and substance abuse treatment services to children, adolescents, and adults. The agency employs numerous researched-based and outcome-driven therapy modalities to empower and positively impact children and families. Clients enter FIS’s sphere of services through a number of programs.
Intensive Family Intervention (IFI) and Community Support Individual (CSI) services are delivered to children ages 5 to 19 and their families in the home. These programs were the initial focus of the agency at its inception and the need for these services has escalated dramatically. These referrals come through the child welfare and juvenile justice systems and FIS works to support the needs of these families in several ways. Each family is assigned a Community Support Individual (CSI) to provide skill building and advocacy support. The family’s CSI forges collaborations between child welfare and juvenile justice agencies and advocates for the needs of children and adolescents in the family. The program also uses effective therapeutic models to serve as a catalyst for family change by addressing the core issues that impact the members of the family through individual, family, and group therapy. IFI helps the family begin to decrease dependence on agency involvement in the lives of the children and adolescents by modeling effective parenting and life skills. By using effective program models to reduce the impact of mental health diagnosis, IFI increases life successes and reduces the recidivism rate of offenders.
Substance Abuse services are provided primarily through referral from the Paulding and Douglas County Juvenile Courts and Family Drug Dependency Courts. The primary goal of substance abuse services is to treat the substance abuse problem so that the family can be reunified. FIS provides a step down from residential treatment that empowers parents to stay clean while preparing to return the children to the home. Two models of treatment are utilized for these services.
In addition, clients in this program also receive CSI services and specialized individual/group therapy. Currently, FIS is exploring opportunities to acquire land/facilities to open a transitional housing program to support the unique needs of these families.
Domestic and Family Violence services are the newest programmatic offering at FIS. Recognizing the shortage of services to this population in need (there is only one shelter to serve the entire county), FIS began offering once-a-week support groups to women and children. Clients in this program also receive CSI services and specialized individual/group therapy. This program frequently accepts referrals from the the county’s battered women’s shelter, since FIS provides therapy and case management for women who are not living in the shelter, but require additional supports. Families also become involved in this program either through their work in FIS’ other programs or as self-referrals.
Therapeutic Services are interwoven into each client’s treatment plan as needed. These services are provided in the home or other community setting, as well as in the FIS offices, and employ varying approaches depending on the setting. FIS is an approved child and adolescent CORE mental health and addictive diseases provider by the Department of Human Resources. FIS offers a wide array of researched-based, outcome driven therapeutic modalities to support their work with children and families. FIS clinicians are highly trained to provide the following therapies:
Emergency Assistance support is provided to clients on an as-needed basis. Occasionally, FIS clients have emergency housing, utility, transportation and medical needs that if met, can prevent the family from tail spinning into a crisis situation. Frequently, other emergency assistance programs in the Metro area (such as United Way) either have a long waiting list for emergency funding or cannot meet the need quickly enough. Because FIS has an intimate working knowledge of the needs, strengths, and challenges the family faces, they are able to carefully consider emergency funding needs and respond quickly to dispense funds as appropriate. Last year, the agency provided almost $18,000 in direct emergency assistance funding for rent/mortgage, utilities, transportation, and other basic needs.
WHAT SETS FIS APART
Innovative. Compassionate. Collaborative. Community-Based. Pro-Family. Research-Based. Outcome-Driven. These are all hallmarks of the FIS culture. Family Intervention Specialists, Inc. provides cutting edge, high quality mental health services by offering an array of researched based, outcome driven services that are provided in the home and supervised by experienced licensed clinicians. In addition to the clinical leadership team, over 60 clinicians are fully licensed or have associate licenses. More than half of the paraprofessionals employed by FIS have a master’s level degree. FIS trains staff on an ongoing basis to ensure that the most recent and effective treatment intervention models are used. In addition, FIS incorporates a community-based approach to therapy that involves collaboration with community partners who can provide additional supports to the clients they serve. To ensure client satisfaction, FIS has numerous quality assurance mechanisms in place and provides all services with the highest ethical standards. FIS’ nonprofit status is more than just a tax status in a field where most providers are for profit entities. It’s an underlying philosophical approach to services. Revenue generated is driven back into the training of clinicians and the provision of pro bono services to families in the community in a constant effort to improve mental health services for children and families.