COVID Protocol

Working with Families During the Pandemic

Due to the ongoing COVID 19 pandemic, this continues to be a difficult and stressful time for us all. Below are some helpful reminders and tips for keeping both yourself and others safe as we continue to support the families we serve.

How Does COVID-19 Impact My Day-to-Day Job Responsibilities?

• Please continue to check in with your agency’s policy for the most updated information regarding how to continue working. 

• FFT Partners will continue providing clinical consultation based on the principles of FFT and the key markers of the clinical model, as well as considering the on-going context. FFT Partners is consistently communicating with your agency’s leadership to keep up to date of their protocols to inform the ongoing clinical consultation being provided.

Conducting FFT Online

When the pandemic began, many of the agencies that deliver FFT moved to an online delivery approach. FFT is well suited for online delivery when you follow some simple guidelines and actively use Care4 to monitor and track families.

Here are some quick guidelines for you to follow in using online or other remote means of conducting FFT:

1. Prepare: 
   • Make sure you are familiar with your video platform (if by video) and practice before you use it with a family for a session.
   • Use a device that is reliable and have headphones so that you can have a comfortable discussion.
   • Find a place that is quiet and will allow you to focus.
   • Be in a place with reliable internet or phone service.
   • Gather the email addresses and phone numbers needed to reach the client.
   • Get an emergency contact, verify the contact with the client and check to make sure it is a reliable contact number that you can reach in the event of a conflict or crisis.
   • Practice with the Care4 system for sending documents to clients via email and text.  If you need help; there is a training video available in Care4, you can reach out to the Care4 help desk or your consultant any time.
2. Give the family clear guidance about how you will be working:
   • We encourage you to have full sessions. Your meetings may not last as long but should continue to be focused on how they are doing through the FFT model.
   • Talk with the families about the shift to online sessions, identifying how things will be different and the same to get their engagement in the process.
   • In each contact you will want everyone there, or you will want to check in with everyone when you call or do a video meeting.
   • At the start of telehealth treatment, create a plan with the family if conflict occurs. Include how the family will let you know they need a break, what the plan will be to manage a break by taking space, and a course of action you and the family will take regarding a follow-up check in.
   • Video Conference or Phone appointments are just like any other session and families need to take part. If they don’t participate you will need to take the same action required if they did not attend sessions.
   • You will still be asking for SIS measures, either over the phone, via computer or by using text and email.
3. Important Considerations when using Telehealth
   • Increase Energy Level - As you are interacting “virtually” with your client(s), be aware of the positive impact of incorporating the “Triple P’s” into your interactions – Pitch, Pace, Passion.  
   • Changing your Pitch (by raising or lowering your voice) 
   • Pace of speech (by slowing down or speeding up), will re-engage the client who is starting to daydream.  
   • Passion refers to the enthusiasm and excitement you bring to your interactions.   
   • In face-to-face (“in person”) interactions, much of communication is non-verbal. Therefore, when conducting “virtual” therapy, you need to request feedback from your clients more frequently.  The more involved they are in the interaction, the more engaged they will be.  
   • Helpful tips include: 
     • Call on your clients by name frequently, both to solicit verbal feedback and/or to simply stop the client from daydreaming, 
     • Ask them to repeat back to you what they just heard you say to ensure that they understood you
     • Pay attention to the one non-verbal that is frequently visible – the head nod – and use that as a cue to solicit verbal feedback.  
4. Have a backup and emergency plan:
   • If there is conflict in the discussion utilize the plan established at the start of telehealth treatment. If there is an immediate cut off to communication (the phone call ends, or the video is interrupted) you will be following up as needed by calling them back or calling their emergency contact numbers to ensure their safety.
   • If your contact with the family is interrupted and you are worried about a family, follow the emergency procedures of your agency.
5. Use Care4 to help monitor families:
   • Using Care4 helps you monitor how the family is doing when you can’t see them.
   • Please log each family session into Care4 and note that it is a video/phone session. See the training tab of Care4 for guidance.
   • Complete your session planning documents as usual.
   • Send SISs to the email or text address of either each individual family member or the primary email of the caregiver.
6. Continue with Therapy Sessions:
   • Continue with sessions, don’t just hold check-ins.
   • Make a risk assessment and plan for how to move forward.
7. If shifting to telehealth from in person sessions, use the model to conduct an updated assessment of risks and protective factors:
   • Risk assessment
     • IMMEDIATE NEEDS
       • Reference the resources at the bottom of this document as needed.
     • FAMILY SAFETY/FUNCTIONING
       • How are they handling stress? How does the current situation play out in their relational pattern? How does the situation put additional pressure on their relational pattern?
       • Anticipate what struggles the family is having or will have and be prepared to bring it up in a helpful way.
       • What are their problem definitions? Changing the meaning of negative or blaming thoughts can build more hope and alliance between the family members (we are in this together!)
       • What are the interpersonal risks and each individual's challenge with this?
   • Protective Factors
     • Review Protective Factors, including Informal and Formal Supports that can be utilized 
     • REMAIN PHASE SPECIFIC:
     • In Engagement and Motivation:
       • Build engagement by talking about their current situation, reduce blame, by building Relational Themes around how they are going to survive this situation, address stressors in a relational way.
       • If there is enough of an alliance you can start to add some skills to help them manage their current circumstance, even if you are not ready to move to BC (see ground rules).
     • In Behavior Change:
       • Use your developed theme in EM to address your hypotheses about their current situation. Match the skills that you have worked on to this situation or add skills based on their current circumstance (conflict management, new family structure, how to deal with boredom, having to do schoolwork).
     • In Monitor and Support:
       • Use your developed theme in EM to address your hypotheses about their current situation. Use Problem Solving discussions to help the family talk through how they can manage the struggles they are having. Review what formal and informal supports they can access to support them during this time.
     • In Generalization:
       • Use your developed theme in EM to address your hypotheses about their current situation. Match skills that you have worked on to this situation or add skills based on their current circumstance (conflict management, new family structure, how to deal with boredom).
     • DETAILED GUIDANCE AROUND CONDUCTING SESSIONS VIA TELEHEALTH (VIDEO OR PHONE):
       • Setting Ground Rules
         • What to do if there is a fight
           • Discuss how to take a break and come back.
           • Use a visual, for example show a red card if you want to say something important.
       • What to do if they walk away.
         • Frame that as taking a break to calm down (good intention), discuss how to come back.
       • Organizing contact/sessions
         • Set a structure
         • Set a time frame that fits the family
         • Discuss how to take turns (maybe a visual, agree to a sign)
       • Structure the Session:
         • Discuss Goal of this call
         • Today we are going to talk about….I want to help you with….go over the ground rules.
         • Setting the agenda to frame the conversation for therapy.
         • Depending on goal or phase, share how you would like people to be positioned in the telehealth session (i.e., ensuring you can see key players in the camera, who may need to sit next to who, etc.).
       • Set realistic goals.
         • Think about what the one thing is you may want them to take away in the session. It allows both you and the family to feel successful in sessions.
       • Go over situation that can occur
         • Ending call, walking away, getting in argument.
         • Normalize that these challenges can occur and co-create a plan with the family.
         • Have an agreement on who to contact if the phone/ video disconnects at the onset.
         • Be creative with technology solutions. For example, if a family member is not physically present, propose a three-way call or video conference.
       • Safety planning if needed
         • Make a specific plan of what to do when a stressful situation potentially turns into (Physical) fight, when negativity turns into “abuse”, and when isolation could influence physical health.
       • Incorporate themes and reframes to build relevancy and buy-in to the safety plan.
       • Look for cues of escalation before they are at high points. This allows for the plan to be implemented when they will have the opportunity for success. 
       • Review and summarize what you wanted them to take away from the session
       • Be specific and clear, so the family has clear guidance on what to do next.