Family-Focused Treatment for Adolescents (FFT-A)

Scientific Rating:
2
Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Family-Focused Treatment for Adolescents (FFT-A) has been rated by the CEBC in the area of: Bipolar Disorder Treatment (Child & Adolescent).

Target Population: Adolescents with bipolar disorder and their family members

For children/adolescents ages: 9 – 17

For parents/caregivers of children ages: 9 – 17

Brief Description

FFT-A is a psychosocial treatment for youth with bipolar disorder, consisting of family psychoeducation, communication enhancement training, and problem-solving skills training. It is given alongside of medications in the period just after an episode of bipolar disorder. The clients are the adolescent, mother/father, and where possible, siblings and extended relatives.

Program Goals:

The overall goals of Family-Focused Treatment for Adolescents (FFT-A) are:

  • Encourage a greater understanding of the adolescent's current symptoms and how they reflect the syndrome of bipolar disorder
  • Assist the adolescent and parents in understanding his/her vulnerability to future relapses and develop relapse prevention plans
  • Encourage a greater acceptance of the need for psychotropic medications to maintain mood stability
  • Help the adolescent and family distinguish mood symptoms from ordinary development or personality/temperament
  • Help the adolescent and family to recognize and minimize the effects of stressors that may elicit symptoms
  • Enhance the functioning of the family unit in terms of its communication and problem-solving skills

Essential Components

The essential components of Family-Focused Treatment for Adolescents (FFT-A) include:

  • Psychoeducation: Providing information about bipolar disorder, what causes it and what happens to people over time; why medications are important; how to recognize the early signs of a recurrence, and how to develop early intervention plans to stave off relapse.
  • Communication Enhancement Training: Teaching family members skills such as active listening, offering positive feedback, making positive requests for change, and delivering constructive criticism.
  • Problem-Solving Skills Training: Teaching youth and families the process of defining a specific problem, generating solutions, evaluating the pros and cons of each possible solution, choosing a solution, and developing an implementation plan.

Child/Adolescent Services

Family-Focused Treatment for Adolescents (FFT-A) directly provides services to children/adolescents and addresses the following:

  • Having a diagnosis of bipolar disorder

Parent/Caregiver Services

Family-Focused Treatment for Adolescents (FFT-A) directly provides services to parents/caregivers and addresses the following:

  • Having a child diagnosed with bipolar disorder

Delivery Setting

This program is typically conducted in a(n):

  • Outpatient Clinic

Homework

Family-Focused Treatment for Adolescents (FFT-A) includes a homework component:

Families have homework each week, such as completing a mood chart, practicing communication or problem-solving skills, and practicing identifying early warning signs.

Languages

Family-Focused Treatment for Adolescents (FFT-A) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • One family therapist
  • A room large enough to see a family of 5-6
  • Audio recording capability

Minimum Provider Qualifications

Some experience in working with bipolar patients; an understanding of the disorder and how it is treated (much of this is in the treatment manual); 1-2 years of counseling or therapy experience; and family therapy experience preferred but not a requirement.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Regional or by contract with individual settings

Number of days/hours:

8 hours

Additional Resources:

There currently are additional qualified resources for training:

  • Elizabeth George, PhD, Co-trainer
    phone: 303-207-1161
  • Dawn Taylor, PhD, Co-trainer
    phone: 303-473-4435

Implementation Information

Since Family-Focused Treatment for Adolescents (FFT-A) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Family-Focused Treatment for Adolescents (FFT-A).

Formal Support for Implementation

There is no formal support available for implementation of Family-Focused Treatment for Adolescents (FFT-A).

Fidelity Measures

There are fidelity measures for Family-Focused Treatment for Adolescents (FFT-A) as listed below:

There is a 13-item Therapy Competence and Adherence Scale for FFT-A. This scale is rated by supervisors who listen to session tapes.

Implementation Guides or Manuals

There are implementation guides or manuals for Family-Focused Treatment for Adolescents (FFT-A) as listed below:

The FFT-A manual is available for download from http://www.semel.ucla.edu/champ/resources or able to be purchased in book form: Miklowitz, D. J. (2010). Bipolar disorder: A Family-Focused Treatment approach, 2nd Ed. New York: Guilford.

Research on How to Implement the Program

Research has not been conducted on how to implement Family-Focused Treatment for Adolescents (FFT-A).

Relevant Published, Peer-Reviewed Research

This program is rated a "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 6 months has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Miklowitz, D. J., George, E. L., Axelson, D. A., Kim, E. Y., Birmaher, B., Schneck, C., Brent, D. A. (2004). Family-Focused Treatment for Adolescents with bipolar disorder. Journal of Affective Disorders, 82(Suppl 1), 113-128.

Type of Study: One group pretest-posttest design
Number of Participants: 20

Population:

  • Age — 13-17 years
  • Race/Ethnicity — 10% Non-Caucasian and 90% Not specified
  • Gender — 55% Male and 45% Female
  • Status — Participants were adolescents with bipolar disorder who were recruited from clinical settings.

Location/Institution: University of Colorado and University of Pittsburgh

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the efficacy of Family-Focused Treatment for Adolescents (FFT-A) in a sample of adolescents with bipolar disorder. Adolescents and their families participated in family-focused psychoeducational treatment for bipolar adolescents along with pharmacotherapy. Adolescents were assessed at intake, 3-, 6-, 9-, and 12-month follow-ups using the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL), Camberwell Family Interview and Coding System, and the Child Behavior Checklist (CBCL). Results indicated that the combination of FFT-A and mood-stabilizing medications was associated with improvements in depression symptoms, mania symptoms, and behavior problems over 1 year. Limitations include the small sample size and lack of a control group.

Length of postintervention follow-up: 1 year.

*Miklowitz, D. J., Axelson, D. A., Birmaher, B., George, E. L., Taylor, D. O., Schneck, C. D., & Brent, D. A. (2008). Family-Focused Treatment for Adolescents with bipolar disorder: Results of a 2-year randomized trial. Archives of General Psychiatry, 65(9), 1053-1061.

Type of Study: Randomized controlled trial
Number of Participants: 58

Population:

  • Age — 12–17 years
  • Race/Ethnicity — 3 Hispanic, 3 Biracial, 1 Asian/Pacific Islander, 1 Native American, 1 African American, and remainder unspecified
  • Gender — 57% Female and 43% Male
  • Status — Participants were adolescents with bipolar disorder who were recruited through direct referral by community psychiatrists or the inpatient units of Children’s Hospital of Denver.

Location/Institution: University of Colorado & University of Pittsburgh School of Medicine

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the efficacy of Family-Focused Treatment for Adolescents (FFT-A) in a sample of adolescents with bipolar disorder. Participants were randomly assigned to a FFT-A treatment group with protocol pharmacotherapy or to a control group of enhanced care (EC) and protocol pharmacotherapy. Adolescents were assessed at intake, every 3 months during year 1 of the study, and every 6 months during year 2. Measures used included the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL), K-SADS Depression and Mania Rating Scales (DRS and MRS), and the Child’s Global Assessment Scale (C-GAS). Results indicated that participants in FFT-A recovered from depressive symptoms faster than patients in EC. Also, patients in FFT-A had greater overall reductions in mood severity scores (including mania, hypomania, and depression symptoms) than patients in EC over 2 years. Limitations of the study include the small sample size, variability in treatment length among participants, and lack of ethnic diversity in the sample.

Length of postintervention follow-up: 15 months.

*Miklowitz, D. J., Axelson, D. A., George, E. L., Taylor, D. O., Schneck, C. D., Sullivan, A. E., Birmaher, B. (2009). Expressed emotion moderates the effects of Family-Focused Treatment for bipolar adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 643-651.

Type of Study: Randomized controlled trial
Number of Participants: 52

Population:

  • Age — 12-17 years
  • Race/Ethnicity — 2% Hispanic, 6% Biracial, 2% Asian/Pacific Islander, 2% Native American, 2% African American, and remainder unspecified
  • Gender — 63% Female and 37% Male
  • Status — Participants were adolescents with bipolar disorder who were recruited through direct referral by community psychiatrists or the inpatient units of Children’s Hospital of Denver.

Location/Institution: University of Colorado and University of Pittsburgh School of Medicine

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: The study used the same sample as the Miklowitz et al. (2008) study. The study evaluated the moderating effects of parental expressed emotion on the 2-year symptomatic outcomes of adolescent bipolar disorder patients assigned to Family-Focused Treatment for Adolescents (FFT-A) or a brief psychoeducational treatment (enhanced care). Measures included the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL), K-SADS Depression and Mania Rating Scales (DRS and MRS), Child’s Global Assessment Scale (C-GAS), Camberwell Family Interview for EE, and the Family Adaptability and Cohesion Scale-II (FACES-II). Results indicated that parents rated high in parental expressed emotion described their families as lower in cohesion and adaptability than parents rated low in parental expressed emotion. Adolescents in high-parental expressed emotion families showed greater reductions in depressive and manic symptoms in FFT-A than in enhanced care, suggesting that parental expressed emotion moderates the impact of family intervention on the symptomatic trajectory of adolescent bipolar disorder.  

Length of postintervention follow-up: 15 months.

Miklowitz, D. J., Schneck, C. D., George, E. L., Taylor, D. O., Sugar, C. S., Birmaher, B., … Axelson, D. A. (2014). A 2-year randomized trial of pharmacotherapy and family-focused treatment for adolescents with bipolar I and II disorders. American Journal of Psychiatry, 171(6), 658-667.

Type of Study: Randomized controlled trial
Number of Participants: Mean=15.6 years

Population:

  • Age — Mean=15.6 years
  • Race/Ethnicity — 17% Nonwhite and 9% Hispanic
  • Gender — 54% Female
  • Status — Participants were children with Bipolar I or II disorders and a DSM-IV-TR manic, hypomanic, depressive, or mixed episode in the previous 3 months.

Location/Institution: University of Colorado, the University of Pittsburgh School of Medicine, and the Cincinnati Children’s Hospital Medical Center

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined whether pharmacotherapy and Family-Focused Treatment for Adolescents (FFT-A) with bipolar disorder was more effective than pharmacotherapy and brief psychoeducation (enhanced care; EC) in decreasing time to recovery from a mood episode, increasing time to recurrence, and reducing symptom severity over 2 years. Participants were randomly assigned, with family members, either to pharmacotherapy and FFT-A or to pharmacotherapy and three weekly sessions of EC. Measures included the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version (K-SADS-PL), the Therapist Competency and Adherence Scale, and the Adolescent Longitudinal Interval Follow-up Evaluation. Results indicated that the time to recovery or recurrence and proportion of weeks ill did not differ between the two treatment groups. Secondary analyses revealed that participants in FFT-A had less severe manic symptoms during year 2 than did those in enhanced care. Limitations include the high attrition rates at the later follow-up time points.

Length of postintervention follow-up: Varies (3, 6, 9, 12, 18, 24 months).

References

Miklowitz, D. J. (2010). Bipolar disorder: A Family-Focused Treatment approach (2nd ed.). New York: Guilford Press.

Miklowitz, D. J. (2011). The bipolar disorder survival guide (2nd ed.). New York: Guilford Press.

Miklowitz, D. J., & George, E. L. (2008). The bipolar teen: What you can do to help your teen and your family. New York: Guilford Publications.

Contact Information

Name: David J. Miklowitz, PhD
Agency/Affiliation: University of California-Los Angeles
Website: www.semel.ucla.edu/faq/common-subject-areas/how-bipolar-disorder-treated-champ-clinic
Email:
Phone: (310) 267-2659
Fax: (310) 206-4446

Date Research Evidence Last Reviewed by CEBC: March 2016

Date Program Content Last Reviewed by Program Staff: April 2014

Date Program Originally Loaded onto CEBC: September 2010