Family-Focused Treatment for Adolescents (FFT-A)

The information in this program outline is provided by the program representative and edited by the CEBC staff. This program has been rated by the CEBC in the following Topic Areas:

About This Program

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.

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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

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

Last CEBC Contact Date: February 2018

Date Program Content Last Reviewed by Program Staff: April 2014

Date Program Originally Loaded onto CEBC: September 2010