|
Guide
to Effective Programs
for Children and Youth |
Functional Family Therapy
OVERVIEW
Functional Family Therapy (FFT) has been implemented in multiple settings since 1969 as a prevention and intervention program for adolescents at risk of, or already engaging in, problem behaviors. The program has 8 to 12 one-hour sessions and is designed to motivate change and eliminate obstacles that may encourage behaviors such as delinquency and violence, substance abuse, and various conduct disorders. Experimental evaluations have consistently found that Functional Family Therapy not only helps treat existing behavioral problems but also prevents the need for more extensive and costly treatments in the future. FFT has also been associated with decreased recidivism, re-institutionalization, and the likelihood that younger siblings enter the criminal system.
Functional Family Therapy is designed to reduce problem behaviors in adolescents and youth. FFT is organized into three distinct phases that build upon each other. Each phase consists of two components which include an assessment and an intervention. The assessment is intended to better understand the characteristics of the family system and the individual members. The intervention, in turn, addresses how families will accomplish the goals set forth by each phase.
In order to promote positive outcomes and deter problem behaviors, FFT focuses largely on the interpersonal relationships that exist within a family system. Many of the targeted interventions, therefore, emphasize communication skills, family interaction, problem-solving and promoting constructive behaviors. Although each phase is organized around a specific goal, it is the responsibility of the FFT therapist to alter the timing and techniques used according to the specific needs of each family. The first of the aforementioned three phases emphasizes engagement and motivation. The primary focus of this phase is to encourage sustained program participation. It involves techniques such as reframing, pointing process, divert/interrupt and sequencing. Taken together, these techniques are intended to change the way in which family members view problem behaviors; point out how individual members experience family processes; divert and interrupt negativity; and understand who and how family members interact. The second phase concentrates on behavior change and includes techniques such as communication training and parenting training to help families function more effectively. The third and final phase, generalization, is intended to help families apply what they have learned through the program to broader contexts and to maintain those changes over time. Techniques in this final phase include relapse prevention and mobilizing community resources, and helping families to become self-reliant.
FFT is delivered by one or two person teams of paraprofessionals, probation officers, and mental health technicians or professionals. FFT consists of one-hour sessions that typically occur over the course of three months. Depending on the severity of the child’s conditions, families may receive as few as eight sessions and as many as thirty, with 8 to 12 being average. The direct service sessions can be conducted at home, at court or at a clinic.
Functional Family Therapy is recognized for the ease with which it can be replicated. The program can be delivered in clinical or home-based settings and the specific training model suggests that professionals can be trained in as few as two to three days, provided there is subsequent supervision. Finally, there is an extensive FFT client tracking system.
Although FFT has been widely adopted, issues concerning implementation have arisen. Some of the limitations and issues include state licensure restrictions on FFT supervisors and adapting training and supervision to the diverse types of supervisors. Logistical problems are also frequent because FFT can be implemented in varying settings. Finding appropriate materials, meeting space, and working within the confines of other institutions can often present problems.
Evaluated populations: Subjects are typically at-risk adolescents and delinquents; however some studies have included families and siblings. Sample sizes range from 27 to 166 adolescents and although the majority of evaluations took place in Salt Lake City, Utah, others were conducted in Pennsylvania, Indiana, and Sweden.
Approaches: The Functional Family Therapy (FFT) treatment group was typically compared with one to three control groups that received no treatment, received FFT and individual therapy, or received alternative therapies or other social services. The follow-up period for each evaluation ranged from program termination up to 30 or 40 months.
Evaluations focused on a variety of risk and protective factors. Some of these factors include negativity, positive communication, parent-child and family processes, self-esteem, relationship quality, family concept, as well as behavior and mental health problems. The majority of studies also assessed recidivism, one of the larger aims of the FFT intervention.
Results: In general, the FFT treatment groups performed significantly better than the control groups across outcomes. FFT participation was associated with significant improvements in positive communication, family interaction processes, and a positive family concept. FFT was also associated with better program/therapy participation, as evidenced by greater parent involvement and decreased family dropout rates. Finally, studies found that FFT reduced maternal depression, as well as anxiety among adolescents.
Although rates of recidivism range among the samples, studies consistently show that FFT participants are less likely than control groups to engage in future offenses. Recidivism rates among FFT participants range from 26 percent to 50 percent, whereas rates among control groups range from 47 percent to 88 percent. Finally, an evaluation that incorporated siblings of delinquents found that recidivism in siblings who received FFT was 20 percent compared with 63 percent of those who received an alternative family therapy.
Alexander, J. F. (1971). Evaluation summary: Family groups treatment program. Report to Juvenile Court, District 1, State of Utah, Salt Lake City.
Alexander, J. F., & Barton, C. (1976). Behavioral systems therapy with families. In D. H. Olson (Ed.), Treating relationships. Lake Mills, Iowa: Graphic Publishing Company.
Alexander, J. F., & Barton, C. (1980). Intervention with delinquents and their families: Clinical, methodological, and conceptual issues. In J. Vincent (Ed.), Advances in family intervention, assessment and theory. Greenwich, CT: JAI Press.
Alexander, J. F., & Parsons, B. V. (1973). Short term behavioral intervention with delinquent families: Impact on family process and recidivism. Journal of Abnormal Psychology, 81, 219-225.
1Alexander, J., Pugh, C., Parsons, B., & Sexton, T. (2000). Functional Family Therapy. In D. S. Elliott (Ed.), Blueprints for Violence Prevention (Vol. 3). Boulder, CO: Venture Publishing.
Barton, C., Alexander, J. F., Waldron, H., Turner, C. W., & Warburton, J. (1985). Generalizing treatment effects of Functional Family Therapy: Three replications. American Journal of Family Therapy, 13, 16-26.
Friedman, A. S. (1989). Family therapy vs. parent groups: Effects on adolescent drug abusers. American Journal of Family Therapy, 17, 335-347.
Klein, N. C., Alexander, J. F., & Parsons, B. V. (1977). Impact of family systems intervention on recidivism and sibling delinquency: A model of primary prevention and program evaluation. Journal of Consulting and Clinical Psychology, 45, 469-474.
Parsons, B. V. & Alexander, J. F. (1973). Short term family intervention: A therapy outcome study. Journal of Consulting and Clinical Psychology, 41, 195-201.
Regas, S. & Sprenkle, D. (1982). Functional family therapy with hyperactive adolescents. Paper presented to the Annual Meeting of the American Association for Marital and Family Therapy, October.
Website: http://www.fftinc.com/
Evaluated participant ages: 11-18
Program age ranges in the Guide: adolescence, youth
Program components: clinic-based, provider-based, or miscellaneous; counseling/therapy; parent or family component
Measured outcomes: social and emotional health and development; behavioral problems; mental health
Program information last updated 3/14/07
|
|
© Child Trends 2004 |