Risk Reduction through Family Therapy (RRFT)

Scientific Rating:
3
Promising 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. Risk Reduction through Family Therapy (RRFT) has been rated by the CEBC in the area of: Trauma Treatment - Client-Level Interventions (Child & Adolescent).

Target Population: Trauma-exposed adolescents aged 13-18 years who experience co-occurring trauma-related mental health problems (e.g., posttraumatic stress disorder [PTSD], depression), substance use problems, and other risk behaviors (e.g., risky sexual behavior, non-suicidal self-injury)

For children/adolescents ages: 13 – 18

For parents/caregivers of children ages: 13 – 18

Brief Description

RRFT is an integrative, ecologically informed, and exposure-based approach to addressing co-occurring symptoms of PTSD (and other mental health problems), substance use problems, and other risk behaviors often experienced by trauma-exposed adolescents. RRFT is novel in its integration of these components, given that standard care for trauma-exposed youth often entails treatment of substance use problems separate from treatment of other trauma-related psychopathology. RRFT is individualized to the needs, strengths, developmental factors, and cultural background of each adolescent and family. The pacing and ordering of RRFT components are flexible and determined by the needs of each family and symptom severity in each domain. Substance use (as relevant) and posttraumatic stress (PTS) symptoms are monitored throughout treatment to help track progress and guide clinical decision making. The average frequency and duration of RRFT depends on the symptom level of each youth, but typically involves 18-24 weekly, 60-90 minute sessions with periodic check-ins between scheduled appointments.

Program Goals:

The goals of Risk Reduction through Family Therapy (RRFT) are:

  • Reductions in symptoms of trauma-related mental health problems (e.g., PTSD, depression)
  • Reductions in substance use and substance use risk factors (e.g., time spent with substance using peers) and increases in protective factors (e.g., coping skills/distress tolerance, parental monitoring, family activities, prosocial activities, etc.)
  • Improved family communication and cohesion
  • Increased knowledge and skills related to healthy dating and sexual decision making
  • Reductions in risk factors for revictimization

Essential Components

The essential components of Risk Reduction through Family Therapy (RRFT) include:

  • Service Delivery Method:
    • Individual and family psychotherapy sessions (Although RRFT can be implemented with teens who do not have a participating caregiver, RRFT clinicians work diligently to engage caregivers whenever possible and/or identify safe and appropriate adults who may become involved as a support to the teen moving forward.)
    • Brief contacts via phone or other means (e.g., text messages) between sessions
    • Frequency & Duration: Depends on the symptom level of each youth, but typically involves 18-24 weekly, 60-90 minute sessions with periodic check-ins between scheduled appointments
  • Setting: RRFT can be implemented in a variety of practice settings including:
    • Outpatient clinics
    • Residential treatment facilities
    • School-based outreach services
    • Home-based outreach services
  • Symptom Profile: Youth most likely to benefit from RRFT demonstrate:
    • Clinically significant symptoms of posttraumatic stress
    • Past or current substance use, or markedly elevated risk for future substance use (e.g., personal or family history of substance use; spends time with substance using peers)
  • Treatment Components:
    • Psychoeducation and Engagement
    • Family Communication
    • Coping
    • Substance Abuse
    • PTSD
    • Healthy Dating and Sexual Decision Making
    • Revictimization Risk Reduction

Child/Adolescent Services

Risk Reduction through Family Therapy (RRFT) directly provides services to children/adolescents and addresses the following:

  • PTSD, depression, substance use problems, risky sexual behavior, nonsuicidal self-injury, family conflict

Parent/Caregiver Services

Risk Reduction through Family Therapy (RRFT) directly provides services to parents/caregivers and addresses the following:

  • Poor parental monitoring; family conflict; caregiver of youth with trauma-related mental health problems, substance use problems, or other risky behaviors
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: When caregivers are not available, RRFT will work with the youth to identify safe and appropriate adults who may become involved as a support to the teen moving forward.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care
  • Outpatient Clinic
  • Residential Care Facility
  • School

Homework

Risk Reduction through Family Therapy (RRFT) includes a homework component:

Youth and caregivers are assigned weekly homework typically geared toward skill building and practice. RRFT clinicians utilize brief check-ins (e.g., by phone, text, etc.) to promote success in accomplishing homework assignments.

Languages

Risk Reduction through Family Therapy (RRFT) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

Private room for sessions, music and art supplies not required but highly recommended

Minimum Provider Qualifications

Graduate degree in counseling, clinical psychology, social work, or related field; competent TF-CBT Clinician; completion of RRFT training

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:

Please contact Dr. Danielson (danielso@musc.edu) for more information.

Number of days/hours:

Please contact Dr. Danielson (danielso@musc.edu) for more information.

Additional Resources:

There currently are additional qualified resources for training:

Please contact Dr. Danielson (danielso@musc.edu) for more information.

Implementation Information

Since Risk Reduction through Family Therapy (RRFT) 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 Risk Reduction through Family Therapy (RRFT).

Formal Support for Implementation

There is formal support available for implementation of Risk Reduction through Family Therapy (RRFT) as listed below:

Typically, ongoing telephone-based consultation is provided to participants of RRFT trainings and implementation projects. Please contact Dr. Danielson (danielso@musc.edu) for more information.

Fidelity Measures

There are fidelity measures for Risk Reduction through Family Therapy (RRFT) as listed below:

Fidelity measures have been developed for the research evaluations of RRFT, including the currently ongoing NIDA funded randomized controlled trial. These measures track how therapists are proceeding through the intervention components with the families they serve and whether/how key treatment elements are being implemented during and between sessions. The fidelity measure, along with the RRFT Supervision form that can aid in implementation with fidelity, is provided as part of the training package.

Implementation Guides or Manuals

There are implementation guides or manuals for Risk Reduction through Family Therapy (RRFT) as listed below:

The implementation manual is available to providers who have participated in RRFT trainings. It provides an overview of the rationale and development of RRFT, evidence supporting the treatment model, and descriptions and illustrative activities and case examples for each intervention component.

Research on How to Implement the Program

Research has not been conducted on how to implement Risk Reduction through Family Therapy (RRFT).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Danielson, C. K., McCart, M., de Arellano, M. A., Macdonald, A., Silcott, L., & Resnick, H. (2010). Risk reduction for substance use and trauma-related psychopathology in adolescent sexual assault victims: Findings from an open trial. Child Maltreatment, 15, 261-268. doi:10.1177/1077559510367939

Type of Study: One-group pretest–posttest study
Number of Participants: 10

Population:

  • Age — Children: 13-17 years, Parents: Not specified
  • Race/Ethnicity — Children: 5 Caucasian, 4 African American, and 1 Hispanic; Parents: Not specified
  • Gender — Children: 100% Female; Parents: Not specified
  • Status — Participants were adolescents who had experienced sexual assault.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of the current study was to evaluate the feasibility of implementation and initial efficacy of Risk Reduction through Family Therapy (RRFT) with adolescents who had experienced at least one memorable sexual assault in their lifetime. Measures utilized include the Time Line Follow Back Interview (TLFB), the UCLA PTSD Index for DSM–IV–Adolescent & Caregiver versions, the Child Depression Inventory (CDI), the Ecological Functioning Measure, and the Family Environment Scale (FES). Results indicate at 6-month follow-up, reductions were reported in substance use and substance use-related risk factors, as evidenced by modest improvements in family cohesion and conflict levels and by improvements in other areas of ecological functioning (e.g., increases in school/work attendance). In addition, large effects were found with regard to improvements in posttraumatic stress disorder (PTSD) and depression symptoms. Limitations include lack of control or comparison group, lack of randomization of participants, and small sample size.

Length of postintervention follow-up: 3 and 6 months.

Danielson, C. K., McCart, M., Walsh, K., de Arellano, M. A., White, D., & Resnick, H. S. (2012). Reducing substance use risk and mental health problems among sexually assaulted adolescents: A pilot randomized controlled trial. Journal of Family Psychology, 26, 628-635. doi:10.1037/a0028862

Type of Study: Randomized controlled trial
Number of Participants: 30

Population:

  • Age — Children: 13-17 years, Caregivers: Not specified
  • Race/Ethnicity — Children: 46% African American, 37.5% White, 4.2% Native American, 8.3% Biracial, and 4% Hispanic; Caregivers: Not specified
  • Gender — Children: 88% Female; Caregivers: Not specified
  • Status — Participants were caregivers and adolescents who had experienced sexual assault.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The current study evaluates the feasibility and efficacy of Risk Reduction through Family Therapy (RRFT) for reducing substance use risk and trauma-related mental health problems among sexually assaulted adolescents. Participants and their caregivers were randomized to RRFT or treatment as usual (TAU) conditions. Measures utilized include the Time Line Follow Back Interview (TLFB), the UCLA PTSD Index for DSM–IV–Adolescent & Caregiver versions, the Child Depression Inventory (CDI), and the Behavioral Assessment System for Children (BASC-2). Results indicated at 6-month follow-up, adolescents who received RRFT reported reduced substance use and improvements in substance use risk factors (e.g., increased family cohesion). Participants in both conditions experienced reductions in posttraumatic stress disorder (PTSD) and depression symptoms, although greater reductions were found for adolescents in the RRFT condition with regard to parent-reported PTSD, as well as adolescent-reported depression and internalizing symptoms. Limitations include small sample size, issues with the randomization of participants that resulted in differences between the groups at baseline, reliance on self-reported measures as reduction in symptoms were significant for adolescent reports but not for parent report, and generalizability due to the primarily female participant gender.

Length of postintervention follow-up: 3 and 6 months.

References

Danielson, C. K. (2014). Risk Reduction through Family Therapy. In B. Reece, R. Hanson, & J. Sargent (Eds), Treatment of child abuse: Common ground for mental health, medical, and legal professionals (2nd ed., pp. 154-167). Baltimore: John Hopkins University Press.

Danielson, C. K. (2007). Risk Reduction through Family Therapy (RRFT): Treatment manual. National Crime Victims Research & Treatment Center, Medical University of South Carolina.

Danielson, C. K., Begle, A. M., Ayer, L., & Hanson, R. H. (2012). Psychosocial treatment of traumatized juveniles. In E. Grigorenko (Ed.), Handbook of juvenile forensic psychology and psychiatry (pp. 467-484). New York: Springer.

Contact Information

Name: Carla Kmett Danielson, PhD
Agency/Affiliation: MUSC National Crime Victims Research & Treatment Center
Website: www.musc.edu/psychiatry/invictus
Email:
Phone: (843) 792-3599
Fax: (843) 792-3388

Date Research Evidence Last Reviewed by CEBC: April 2016

Date Program Content Last Reviewed by Program Staff: March 2016

Date Program Originally Loaded onto CEBC: July 2016