Family Driven Care Coordination (FDCC)

What is Family Drive Care Coordination?

The Family-Driven Coordinated Care (FDCC) model is an innovative approach to coordinating care with children, youth, and young adults experiencing behavioral health needs. Derived from High Fidelity Wraparound (HFW), FDCC is a strengths-based, youth and family-driven planning model that emphasizes empowerment, community-based care, team collaboration, cultural sensitivity, and measurable outcomes. By actively involving youth and families in the planning process, FDCC tailors services to their unique needs, enhancing traditional supports. This team-based approach includes various stakeholders such as the youth and family, additional family members or natural supports, community resources, mental health professionals, and system partners.

FDCC operates on structured phases and principles designed to support individuals and families in achieving lasting recovery while fostering independence within their communities. Rooted in the belief that individuals and families possess inherent strengths, FDCC focuses on what works well to build confidence, resilience, and self-efficacy. This approach not only addresses immediate needs but also fosters long-term well-being by empowering youth and families to navigate challenges independently, ultimately promoting sustainable recovery.

The FDCC model seeks to transform care by unifying systems around a common planning model that supports families and youth in identifying priority needs and effectively utilizing existing resources. Central to the FDCC model are the Family Driven Action Plan (FDAP) and Family Driven Crisis Plan (FDCP), which leverage natural supports and system partners to develop successful, measurable, and adaptable plans. Planning meetings, led by a Care Coordinator, ensure that all voices are heard, with the youth and family as equal partners in the process.

Phases of FDCC

  1. Engagement: Build trust, assess strengths, stabilize immediate crises, identify potential team members.
  2. Planning: Build teams, develop crisis and action plans tailored to family needs.
  3. Implementation and Skill Development: Support action plan goals, refine strategies, build skills, and self-efficacy.
  4. Transition: Work toward independence, assess skill development and support networks, support independence from services by facilitating transition to natural supports.

HFW Principles in FDCC

  1. Youth and Family Voice and Choice: Youth and families are central to decision-making, with action plans reflecting their unique preferences, values, and priorities.
  2. Team-Based: A multidisciplinary team collaborates to develop and implement a unified action plan tailored to the family’s needs.
  3. Natural Supports: Emphasis on identifying and utilizing informal supports from the family’s community and social networks.
  4. Collaboration and Integration: FDCC staff work cooperatively, fostering a team approach for developing, implementing, monitoring, and evaluating action plans.
  5. Community-Based: Services and supports are delivered within the family’s community to ensure accessibility.
  6. Culturally Competent: Action plans align with the cultural values, beliefs, and practices of the individual and family, enhancing engagement and buy-in.
  7. Individualized: Each action plan is uniquely tailored to address the specific strengths, needs, and goals of the individual and family.
  8. Strengths-Based: Focuses on leveraging existing competencies and resources to empower families and instill hope for recovery.
  9. Persistence: FDCC staff remain committed to achieving goals despite challenges, revising plans as needed to ensure progress.
  10. Quality Improvement and Outcome-Based: Continuous monitoring ensures measurable outcomes are achieved, with adjustments made based on feedback.

FDCC and Peer Support Services

Support offered by Family Peers and Youth and Young Adult Peers can be integrated into the model, offering emotional support and guidance from individuals with lived experience. Youth and family peers can be integrated throughout this entire process to support the planning needs of the youth and family. They can be included on the team as a community-based natural support or professional support depending on the role.

Types of Peer Support

  • Family Peer Support (FPS): Partners with caregivers to offer empathy and guidance with lived experience, empowering families to advocate for themselves.
  • Certified Peer Support (CPS): Provided by Certified Peer Specialists, this support helps youth develop action plans while promoting hope and recovery for transition-aged youth and young adults (TAYYA).
  • Youth and Young Adult Peer Support (YPS): Support from peers from other models (HFW, Certified Recovery Specialist) connecting youth and young adults with mental health conditions or substance use disorders with young adults who have experienced similar challenges and completed specialized training to learn how to use their experience to support others.

Benefits of FDCC Implementation

  • Improved Engagement: Better engagement in service delivery and creative action plans that fit the needs of the youth and families.
  • Enhanced Service Coordination: Improved coordination among service providers, leading to more effective and cohesive action plans.
  • Increased Emotional Support: Greater integration of natural supports and community resources, enhancing the support network for youth and families.
  • Empowerment and Self-Efficacy: Enhanced empowerment, optimism, and self-esteem for youth and families, helping them to navigate challenges more effectively.
  • Improved Mental Health and Functioning: Better mental health outcomes, improved functioning in all settings, increased resilience and quality of life, and decreased caregiver stress and strain.
General Implementation
Luzerne County Implementation

Contact Information

Daniel Fisher
Director of Training and Implementation
Youth and Family Training Institute
Email: fisherdj@upmc.edu

Scroll to Top