Functional Family Therapy
What
Is Functional Family Therapy (FFT)?
Functional Family Therapy is a family-based prevention and intervention program that has been applied successfully in a variety of situations to assist youth and their families.
The FFT program is supported by 30 years of clinical research, which supports its foundation as an evidence-based practice for youth with substance abuse problems or antisocial behavior problems. FFT has been applied to a wide range of youth and their families in various multi-ethnic, multicultural contexts and with pre-adolescents and adolescents diagnosed with conduct disorders, violent acting out and substance abuse (Sexton & Alexander, 2000).
In December of 2000, Office of Juvenile Justice of Delinquency Prevention issued a Juvenile Justice Bulletin on FFT by the founders of FFT (Sexton & Alexander, 2000). The OJJDP Bulletin cited recidivism rates for the FFT treated population at just over 20% while the residential treatment cases had a recidivism rate of approximately 90%. These figures are not inconsistent with the New York State experience where estimates of recidivism after placement in a juvenile justice facility approach or exceed 90% while some intensive aftercare models have succeeded in reducing recidivism rates to approximately 20%. Outcome studies suggest that when applied as intended, FFT can reduce recidivism between 25% and 60% (Sexton & Alexander, 2000).
Family, Youth, Cultural PerspectivesThe development of the descriptions for each OMH Priority Set for Evidence-Based Practices included extensive involvement from clinical experts, mental health recipients, youth and family members, and people who represent culturally diverse viewpoints. Their perspectives are critical to the understanding of these important practices and programs in mental health.
Family Perspective
In a recent article regarding FFT in King County Washington, parents noted that FFT worked for their children because of "the emphasis on working with the youth as part of the family (Loughran, 2002). The therapist focused on real, every day solutions to dealing with missed curfews, truancy and drug use. Families learned not to blame the youth or the parents but to talk about differences and talk about attainable goals as a group. A therapist usually meets with families in their homes, at their convenience, and provides continued support after the formal sessions have concluded" (Loughran, 2002).
Youth Perspective
It is important that young people are seen as part of the family in this therapy model. In addition, FFT should be accessible to all and according to need. FFT should promote communication between the parents and the young person. The focus of this model needs to be on the total family, not just the young person's issues. Additionally, FFT should consider working with interventions that have made a positive difference in the family.
Cultural Perspective
Culture and language affect the
perception, utilization, and potentially the outcomes of mental health services.
Therefore, the provision of culturally and linguistically appropriate services
designed to meet the needs of diverse racial and ethnic populations should include
language access for persons with limited English proficiency, services provided
in a manner that is congruent, rather than conflicting with cultural norms;
and the capacity of the provider to convey understanding and respect for the
client's worldview and experiences. (DHHS 2001)
The flexible integration of clinical theory and in home engagement and sustaining
strategies as part of FFT design offers an opportunity to meet families where
they are most comfortable, understand and encourage their natural social networks
and to provide culturally and linguistically responsive services as truly part
of the treatment process. As with any "in home" intervention, staff's cultural
knowledge needs to include understanding of the many cultural considerations
influencing the effectiveness of treatment. Care should be taken to assure written
materials are not only translated but are at a literacy level that does not
raise additional barriers for the family members. In servicing children, care
and attention needs to be directed towards family and community norms and values
around help seeking, secrecy and confidentiality, family roles, child rearing
and spiritual practices. Effective engagement is essential to effective clinical
practice.
By following key principles, FFT can reduce or prevent recidivism and delinquency. These results can be achieved at treatment costs well below those of traditional services and interventions.
FFT combines and integrates the principles of established clinical theory, empirically supported principles and extensive clinical experience. An FFT team is made up of 3-8 clinicians who receive intensive, sustained training, and ongoing phone supervision over a 12-month period. Over the longer term, an FFT Practice-Research Network allows clinical sites to participate in the development and dissemination of FFT model information.
The model consists of a systematic and multi-phase intervention map that provides a framework for clinical decisions, within which the therapist can adjust and adapt the goals of the phase to the individual needs of the family. The three intervention phases are as follows:
Phase 1: Engagement and motivation
Phase 2: Behavioral change
Phase 3: Generalizations are sequentially linked to specific goals for each family interaction.
The range of treatment is three to 30 sessions over a three-month period, with a median timeframe of 12 sessions. This is consistent with current practice and can be applied across agencies for youth with multiple needs. FFT can be conducted in a clinic setting, as a home based model or as a combination of clinic and home visits. FFT program implementation targets teams of up to eight clinicians who work together by regularly staffing cases, attending follow-up training, and participating in ongoing telephone supervision.
Implementing FFT in New York StateCurrently there are 15 sites in New York State. OMH will concentrate FFT training in New York State in order to bring about measurable change in practice. Areas to be targeted include the Central, Western, Long Island and New York City regions of New York State. Field Offices will be asked to identify providers who can commit to the intensive training in the FFT model.
Children and Adolescent Service System Principles
All OMH Children's Initiatives are based upon the principles of the Child and Adolescent Service System Principles (CASSP). View the CASSP.
Loughran, E. J. (April 2002). King County’s family functional therapy approach is working. Council of Juvenile Correctional Administrators (CJCA) Newsletter (phone at 508-238-0073) or website http://www.corrections.com/cjca/