Functional Family Therapy Child Welfare® (FFT - CW®)

About This Program

Target Population: Children and adolescents up to 17 years of age and their parent/caregivers and other family members who were referred to child welfare services for indicated or suspected child abuse or neglect.

For children/adolescents ages: 0 – 17

For parents/caregivers of children ages: 0 – 17

Program Overview

FFT - CW® is a family-system, cognitive-behavioral therapeutic intervention that addresses abuse, neglect, and associated risk/protective factors. Interventions are delivered by trained staff during conjoint sessions with youth and their families. Services are divided into two tracks based on initial level of risk. In lower risk cases, interventions are provided by case manager level providers and involve engaging and linking to community services. In higher risk cases, services are provided by therapists directly to family members. Sites may implement either or both tracks depending on need. Interventions are organized in distinct phases and include specific strategies for engaging young persons and family members into treatment, motivating them for change, assessing family patterns, implementing specific and individualized behavior change plans to address referral problems and relevant risk factors, and generalizing changes in multiple systems. Services last approximately 5 to 7 months. Location of services is flexible with most services offered in homes.

Program Goals

The goals of Functional Family Therapy Child Welfare® (FFT - CW®) are:

  • Reduce/eliminate within family violence, child abuse, harsh/punitive discipline practices, and family conflict
  • Prevent youth/family member outplacement
  • Prevent intensification/escalation of services
  • Improve parenting practices
  • Improve family communication
  • Develop specific skills to address risk/protective factors that are associated with abuse/neglect, such as (but not limited to) emotion regulation, coping, anger management, problem-solving, and decision-making

Essential Components

The essential components of Functional Family Therapy Child Welfare® (FFT - CW®) include:

  • Two tracks based on the level of risk of abuse/neglect by the caregivers or other family members:
    • High Risk Track:
      • Five distinct intervention phases:
        • Engagement: Introduction/Impression (Pre-Intervention)
        • Motivation: Induction/Therapy (Early sessions)
        • Relational Assessment (by conclusion of early sessions)
        • Behavior Change (Middle sessions)
        • Generalization (Later sessions)
      • Each phase has its own unique goals, risk and protective factors addressed, assessment focus, and therapist skills and intervention focus:
        • Engagement:
          • Goal: Maximize family initial expectation of positive change
          • Risk and Protective Factors Addressed:
            • Negative perception about or experiences with treatment
            • Reputation of treatment agency
            • Transportation
            • Therapist availability
            • Intake staff skills and attitudes
          • Assessment Focus: Superficial qualities inferred from referral source and initial screening
          • Therapist Skills/Intervention Focus:
            • High availability
            • Manage intake processes to present agency, self, and treatment in a way that matches to inferred family characteristics
            • Enhance perception of credibility
        • Motivation:
          • Goal: Create a motivational context for long-term change
          • Risk and Protective Factors Addressed:
            • Family negativity and blame
            • Hopelessness
            • Level of motivation
          • Assessment Focus:
            • Behavioral (presenting problem)
            • Relational risk and protective factors
          • Therapist Skills/Intervention Focus:
            • Interpersonal skills (validation, positive reattribution, reframing, relational)
            • Build balanced alliances
            • Reduce negativity and blame
            • Create hope
            • Enhance motivation to change
        • Relational Assessment:
          • Goal: Complete relational (functional) assessment of family relationships to provide foundation for changing behaviors in subsequent phases
          • Risk and Protective Factors addressed: none
          • Assessment Focus:
            • Relational Autonomy/Connectedness
            • Relational Hierarchy
          • Therapist Skills/Intervention Focus:
            • Perceptiveness
            • Observation
            • Facilitate interactions or information about patterns of interaction
        • Behavior Change:
          • Goal: Facilitate individual and interactive/ relational change
          • Risk and Protective Factors Addressed (note: below are examples, not an exhaustive list of potential factors that might be addresses in this phase):
            • Youth temperament
            • Parental pathology
            • Beliefs and values
            • Developmental level
            • Parenting skills
            • Conflict resolution/negotiation skills
            • Level of family support
            • Peer refusal skills
          • Assessment Focus:
            • Individual skills
            • Quality of relational skills
            • Relational problem sequence
            • Compliance with behavior change plans
          • Therapist Skills/Intervention Focus:
            • Directive/teaching /structuring skills
            • Modeling
            • Setting up, leading, and reviewing in-session tasks
            • Assigning homework
        • Generalization:
          • Goal: Maintain individual and family change, and facilitate change in multiple systems
          • Risk and Protective Factors Addressed (note: below are examples, not an exhaustive list of potential factors that might be addresses in this phase):
            • Youth bonding to school
            • Parent attitudes about school, peers, drugs, etc.
            • Level of social support
          • Assessment Focus:
            • Access to and utilization of community resources
            • Maintenance of change
          • Therapist Skills/Intervention Focus:
            • Interpersonal and structuring skills
            • Family case manager
            • Accessing appropriate formal and informal community resources
            • Anticipate and plan for future extra-familial stresses
    • Low Risk Track (3 Phases)
      • Engagement and Motivation are combined into a single track with the focus being engagement of family members into services
      • Generalization is the same as in the High Risk track
      • Support and Monitoring Phase replaces Behavior Change
  • Focus is to facilitate connections to external services/systems that are intended to address specific risk and protective factors
  • Interventionists support family members throughout their involvement with external systems and monitor that family members are receiving services

Program Delivery

Child/Adolescent Services

Functional Family Therapy Child Welfare® (FFT - CW®) directly provides services to children/adolescents and addresses the following:

  • Problems/symptoms such as oppositional behaviors; delinquent, criminal, acting-out behaviors; fighting, anger, impulsivity; substance use; depression; self-harm; anxiety; truancy/school performance; and outplacement (foster, residential, acute hospitalization)

Parent/Caregiver Services

Functional Family Therapy Child Welfare® (FFT - CW®) directly provides services to parents/caregivers and addresses the following:

  • Problems/symptoms such as abusive parenting behaviors; neglectful parenting behaviors (including educational neglect); violent behaviors (inside and outside of home); substance use; criminal involvement; depression; anxiety; and outplacement of children
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: FFT - CW® is a comprehensive, multisystemic intervention that addresses risk/protective factors across the entire youth/family members’ social ecology. As such, the involvement of family members, extended family members, fictive kin (nonfamily members that function in family-like roles) and formal (teachers, health providers) and informal (spiritual, social groups) is a key aspect of the intervention. All sessions are conjoint (e.g., with key family members). The involvement of external, family support networks is increasingly relevant in later phases of treatment and in long-term planning to ensure that maintenance of changes over time.

Recommended Intensity:

One weekly 45-60 minute session on average

Recommended Duration:

5-7 months on average

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care
  • Outpatient Clinic

Homework

Functional Family Therapy Child Welfare® (FFT - CW®) includes a homework component:

Homework is assigned at the conclusion of weekly sessions and is individualized to the needs of each family.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • A good quality speakerphone for conducting weekly clinical consultation
  • Provision for therapist/interventionist transportation and cellular phone if home-based services are being conducted
  • Ample meeting space for conducting family therapy if conducting services in an office/clinical setting
  • Adequate computer and internet access for each FFT - CW® therapist

Education and Training

Prerequisite/Minimum Provider Qualifications

In the high-risk track, the therapists should have a master’s degree. Site supervisors must hold a master’s degree or above. Previous experience in family therapy and/or work in child welfare settings is preferred.

In the low-risk track, interventionists should have at least a bachelor’s degree.

Education and Training Resources

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

Alexander, J. F., Niermann, A., Neeb, A, Kopp, D., Demaranville, H., Hollimon, A., & Robbins, M. S. (Oct. 2011). Functional Family Therapy Child Welfare® (FFTCW®) clinical manual. FFT_LLC, Seattle WA, unpublished manual see http://fftllc.com.

Training Contact:
Training is obtained:

Phase 1 training entails the following:

  • One 1-day on-site stakeholder orientation
  • One 2-day on-site clinical training
  • Weekly telephone consultation
  • Three 2-day on-site follow-up trainings
  • Off-site externship for Site Supervisor (Three 3-day events)

Phase 2 training entails the following:

  • Two 2-day off-site FFT Lead/Supervisor Trainings
  • Bi-monthly telephone consultation with Lead/Supervisor
  • One 1-day on-site follow-up training

Phase 3 training entails the following:

  • One 1-day on-site follow-up training
  • Monthly phone consultation with Lead/Supervisor
Number of days/hours:

Phase 1:

  • 1 day of training of Stakeholders/Administrators
  • 9 days of training for all therapists
  • 9 extra days of training for site supervisor
  • 52 hours of weekly 1-hour phone consultation for both therapists and supervisor

Phase 2:

  • 1 day of training for therapists
  • 4 days of training for site supervisor
  • 24 hours of bi-monthly 1-hour phone consultation for site supervisor

Phase 3:

  • 1 day of training for therapists and site supervisor
  • 12 hours of monthly 1-hour phone consultation for site supervisor

Relevant Published, Peer-Reviewed Research

Turner, C. W., Robbins, M. S., Rowlands, S. & Weaver, L. R. (2017). Summary of comparison between FFT - CW® and usual care from Administration for Children’s Services. Child Abuse and Neglect, 69, 85-95. doi:10.1016/j.chiabu.2017.04.005

Type of Study: Nonequivalent control group design with propensity score matching
Number of Participants: 3,875

Population:

  • Age — Caregivers: 15-70 years (Mean=39 years); Children: 0-19 years (Mean=9.7 years)
  • Race/Ethnicity — Caregivers: 49% Hispanic, 36% African American, 6% Non-Hispanic White, 4% Asian, 6% Other; Children: Not specified
  • Gender — Caregivers: 93% Female; Children: 49% Female
  • Status — Participants were families involved with the child welfare system.

Location/Institution: Five boroughs of New York City

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This evaluation compared the efficiency and effectiveness of Functional Family Therapy Child Welfare (FFT - CW®) to usual care (UC) in reducing child maltreatment. Measures utilized Family Assessment and Service Plan (FASP), the Clinician Rating Form and abuse and neglect reports from the State Central Register (SCR). Results indicate families receiving FFT - CW® completed treatment more quickly than UC and they were significantly more likely to meet all of the planned service goals. Higher treatment fidelity was associated with more favorable outcomes. Fewer FFT - CW® families were transferred to another program at closing, and they had fewer recurring allegations. FFT - CW® had fewer out-of-home placements in families with higher levels of risk factors. The FFT - CW® program was more efficient in completing service, and more effective than UC in meeting treatment goals while also avoiding adverse outcomes. Limitations include differential selection bias which could influence which families entered into the study samples, nonrandomization of participants, and lack of follow-up.

Length of postintervention follow-up: None.

Additional References

Alexander, J. A., Waldron, H. B., Robbins, M. S., & Neeb, A. (2013). Functional Family Therapy for Adolescent Behavior Problems. Washington, DC: American Psychological Association.

Alexander, J. A., & Parsons, B. (1982). Functional Family Therapy. Monterey, CA: Brooks/Cole Publishing Company.

Barton, C., Alexander, J. F., Waldron, H., Turner, C. W., & Warburton, J. (1985, Study 2). Generalizing treatment effects of Functional Family Therapy: Three replications. American Journal of Family Therapy, 13(3), 16-26. doi:10.1080/01926188508251260

Contact Information

Holly DeMaranville
Agency/Affiliation: FFT LLC
Website: www.fftllc.com
Email:
Phone: (206) 369-5894

Date Research Evidence Last Reviewed by CEBC: February 2019

Date Program Content Last Reviewed by Program Staff: July 2018

Date Program Originally Loaded onto CEBC: July 2019