Functional Family Therapy (FFT)

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Category	Type	Target Age Group	Setting	Outcomes	Source of Rating
Proven Programs	Delinquency & Recidivism	High School Middle School	In-Home Institution	18.1% reduction in recidivism	Close Blueprints for Violence Prevention (Blueprints) The Blueprints for Violence Prevention list has been developed by a research team headed by Delbert Elliott, Ph.D. at the Center for the Study and Prevention of Violence at the University of Colorado. For Blueprints to certify a brand name program as “model,” the program must demonstrate its effects on problem behaviors with a rigorous experimental design, show that its effects persist after youth leave the program and be successfully replicated at least once. In order for a brand name program to be certified as “promising,” the program must demonstrate effects using a rigorous experimental design. The Blueprints Web site (www.colorado.edu/cspv/blueprints/) lists 11 “model” programs and 19 “promising” programs. Selection Criteria: Lasting positive effects in well designed evaluations & emphasis on replication. Applicability:  Excellent for crime, violence, delinquency & substance abuse. Reliability:  Excellent Currency:  Up to Date Advantages:  Easy to use. Plentiful peer and tech support. Predictability of outcomes. Limitations:  Covers only a small number of brand name programs. Blueprints Close Washington State Institute for Public Policy (WSIPP) The Washington State Institute for Public Policy (WSIPP) uses the meta-analysis methodology to conduct evaluations of evidence-based practices, but also considers the cost of such programs and strategies to taxpayers and crime victims and weighs these costs against possible benefits (i.e., costs avoided through reduced crime). Programs and strategies are not ranked, but effect on recidivism is measured and the number of evaluations is reported. Recidivism, cost to tax payers and crime victims, and benefits are estimated using data specific to Washington State. For the purposes of this paper, all cost and benefit information refers to the analysis conducted by WSIPP for the State of Washington. Accordingly, the information should be considered an estimate for the potential cost and dollar benefits for California. The data used for this project can be found in the article by Elizabeth K. Drake, Steve Aos and Marna G. Miller, titled “Evidence-Based Public Policy Options to Reduce Crime and Criminal Justice Costs: Implications in Washington State” (2009), and can be downloaded from their Web site, www.wsipp.wa.gov. Selection Criteria:  Meta-analysis & cost-benefit analysis. Applicability:  Meta-analysis & cost-benefit analysis. Reliability:  Excellent Currency:  Analyses are revised every few years. Advantages:  Predictability of outcomes; ability to compare cost effectiveness. Limitations:  Costs & benefits are based on WA data. WSIPP

Description:

FFT is a short-term, high quality intervention program with an average of 12 sessions—and generally no more than 26—of direct service for the most severe problem situations over a 3-4 month period. Services are conducted in both clinic and home settings, and can also be provided in a variety of settings including schools, child welfare facilities, probation and parole offices/aftercare systems, and mental health facilities.

FFT is a strength-based model. At its core is a focus and assessment of those risk and protective factors that impact the adolescent and his or her environment, with specific attention paid both intra-familial and extra-familial factors, and how they present within and influence the therapeutic process.

Target Population

Youth ages 11-18, at risk for and/or presenting with delinquency, violence, substance use, Conduct Disorder, Oppositional Defiant Disorder, or Disruptive Behavior Disorder. Often these youth present with additional co-morbid challenges such as depression.

 

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References and/or Published Evaluations

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.

Alexander, 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.

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Additional Information

Provided by www.fftinc.org, October 2010

• Has this program been replicated at other sites? If so, how many and where are they?
  FFT Inc. began with 10 dissemination sites in 1999 and during its first decade grew 30 times its original size. The company now partners to provide the implementation of and quality assurance for FFT sites in almost 50 states, with numerous sites in Europe, and New Zealand. FFT Inc. provides training and consultation services for thousands of therapists from hundreds of agencies serving tens of thousands of families each year. In terms of a global footprint, FFT Inc. works with more families per year than any other evidence based intervention. There are 39 FFT teams in California.
  

• Is there a formal curriculum or program guidelines in place? What is the approximate cost for these materials?
  See below. The approximate cost to become a fully-certified FFT provider is $70,000 to $80,000.
  

• What kind of training and technical assistance is available for this program?
  Functional Family Therapy (FFT) is committed to the highest standards of training, consultation, and service. Our experience in national dissemination has given us the opportunity to work with a wide range of diverse communities, service delivery systems, and social service agencies. FFT trains and certifies groups of 3-8 therapists. We ask potential sites to begin by completing the application for site certification (available at www.fftinc.com). Through a mutual commitment to the training process and to developing adherence and competence in the FFT model, the following implementation process has proven highly successful in community replication of FFT.
  
  Functional Family Therapy Site Certification is a 3-phase process:
  
  Phase I—Clinical Training: The initial goal of the first phase of FFT implementation is to impact the service delivery context so that the local FFT program builds a lasting infrastructure that supports clinicians to take maximum advantage of FFT training/consultation. By the end of Phase I, FFT’s objective is for local clinicians to demonstrate strong adherence and high competence in the FFT model. Assessment of adherence and competence is based on data gathered through the web based Clinical Services System and at FFT weekly consultations and phase one FFT training activities. The goal is for Phase One be completed in one year, and not last longer than 18 months. Periodically during Phase I, FFT personnel provide the site feedback to identify progress toward Phase I implementation goals. By the eighth month of implementation, FFT will begin discussions to identify steps toward starting Phase 2 of the Site Certification process, including likely candidates at the site to be trained as an FFT on-site supervisor. If sites are unable to achieve minimum caseloads of 5-7 families per therapist by the first month and a half of training, then phase one may be delayed, necessitating additional training and costs.
  
  Phase II—Supervision Training: The goal of the second phase of FFT implementation is to assist the site in creating greater self-sufficiency in FFT, while also maintain and enhancing site adherence/competence in the FFT model. Primary in this phase is developing competent on-site FFT supervision. During Phase II, FFT trains a site’s extern to become the site supervisor. This person attends two 2-day supervisor trainings, and then is supported by FFT through monthly phone consultation and the web-based FFT supervision assessment system. FFT provides one 1-day on-site training during Phase II. In addition, FFT provides any on-going consultation as necessary and reviews the site’s FFT CSS database to measure site/therapist adherence, service delivery trends, and outcomes. Phase II is a yearlong process.
  
  Phase III and On Going Partnership – Maintenance Phase: The goal of the third phase of FFT implementation is to move into a partnering relationship to assure on-going model fidelity, as well as impacting issues of staff development, interagency linking, and program expansion. FFT reviews the CSS database for site/therapist adherence, service delivery trends, and client outcomes and provides a one-day on-site training for continuing education in FFT. Therapists and supervisors maintain case, outcome and adherence tracking in the FFT CSS system Phase III requirements are renewed annually, and their base of oversight and consultation is considered necessary for a FFT site to remain certified.
  
  FFT sites are responsible for all training and consultation fees. The site is also responsible for costs to provide appropriate computer access to run the CSS and for costs related to administering the OQ™45.2, YOQ™2.01 and YOQSR™ (see the Application for Site Certification for details). The site is responsible for expenses for on-site training and for expenses for their staff to attend Externship off site.
  

• Once the program has been implemented, can an organization obtain assistance with fidelity monitoring or quality assurance?
  Yes, see above, Phase III.
  

• Can an organization obtain assistance with data collection or measurement of outcomes?
  Yes, see above, Phase III.

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