Program

Mar 14, 2007

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.

DESCRIPTION OF
PROGRAM

Target population:11-18
year-olds at risk for or already displaying problem behaviors

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.

EVALUATION(S) OF
PROGRAM

To
date, there have been numerous evaluations of the FFT program. Assessments vary
in design and include outcomes evaluations, quasi-experimental and experimental
evaluations. For purposes of this report, only the experimental evaluations (8)
will be summarized. For more detailed information on specific evaluations
please see Alexander, J., Pugh, C., Parsons, B., & Sexton, T. (2000) 1.

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.

SOURCES FOR MORE
INFORMATION

References

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/

KEYWORDS: Children, Adolescents, Youth, High-Risk, Co-ed, Juvenile Offenders, Aggression, Anxiety Disorders/Symptoms, Clinic/Provider-Based, Conduct/Disruptive Disorders, Counseling/Therapy, Delinquency, Depression/Mood Disorders, Family Therapy, Home-Based, Parent or Family Component, Parent Training/Education, Parent-Child Relationship, Self-Esteem/Self-Concept

Program
information last updated 3/14/07

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