Functional Family Therapy (FFT)

1  — Well-Supported by Research Evidence
Medium
2  — Supported by Research Evidence
Medium
2  — Supported by Research Evidence
Medium
2  — Supported by Research Evidence
Medium

About This Program

Target Population: 11-18 year olds with very serious problems such as conduct disorder, violent acting-out, and substance abuse

For children/adolescents ages: 11 – 18

Program Overview

FFT is a family intervention program for dysfunctional youth with disruptive, externalizing problems. FFT has been applied to a wide range of problem youth and their families in various multi-ethnic, multicultural contexts. Target populations range from at-risk pre-adolescents to youth with moderate to severe problems such as conduct disorder, violent acting-out, and substance abuse. While FFT targets youth aged 11-18, younger siblings of referred adolescents often become part of the intervention process. Intervention ranges from, on average, 12 to 14 one-hour sessions. The number of sessions may be as few as 8 sessions for mild cases and up to 30 sessions for more difficult situations. In most programs, sessions are spread over a three-month period. FFT has been conducted both in clinic settings as an outpatient therapy and as a home-based model. The FFT clinical model offers clear identification of specific phases which organizes the intervention in a coherent manner, thereby allowing clinicians to maintain focus in the context of considerable family and individual disruption. Each phase includes specific goals, assessment foci, specific techniques of intervention, and therapist skills necessary for success.

Program Goals

The goals of Functional Family Therapy (FFT) are:

  • Eliminate youth referral problems (i.e., delinquency, oppositional behaviors, violence, substance use)
  • Improve prosocial behaviors (i.e., school attendance)
  • Improve family and individual skills

Logic Model

The program representative did not provide information about a Logic Model for Functional Family Therapy (FFT).

Essential Components

The essential components of Functional Family Therapy (FFT) include:

  • 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 Assets:
      • 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

Program Delivery

Child/Adolescent Services

Functional Family Therapy (FFT) directly provides services to children/adolescents and addresses the following:

  • Conduct disorder, violent acting-out, and substance abuse
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Family of youth is involved in all therapy

Recommended Intensity:

One-hour weekly sessions unless needed more frequently

Recommended Duration:

12 to 14 sessions; the number of sessions may be as few as 8 sessions for mild cases and up to 30 sessions for more difficult situations. In most programs, sessions are spread over a three or four month period.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • Community-based Agency / Organization / Provider
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Functional Family Therapy (FFT) includes a homework component:

As noted in the Essential Components, homework is provided as needed throughout treatment, but particularly in the Behavior Change phase. This homework consists of building on the specific skills that were taught during sessions. For example, homework may involve practicing communication skills, problem solving, and other skills throughout the week.

Languages

Functional Family Therapy (FFT) has materials available in languages other than English:

Dutch, Spanish, Swedish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Sites must provide each therapist with on-going computer and internet access so they can record progress notes and complete the other assessment, adherence and outcome instruments that are utilized during the course of the intervention.

Meeting space and a speaker phone are needed for weekly consultation with an offsite program consultant.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Qualifications can vary for therapists, but to become an onsite Program Supervisor a minimum of Master’s level education is required.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contacts:
  • Holly DeMaranville
    Functional Family Therapy, Inc. (Founder, Dr. James F. Alexander)

    phone: (206) 369-5894
  • Thomas Sexton, PhD, ABPP
    Functional Family Therapy Associates

    phone: (812) 369-7202
Training Type/Location:

Please ask the trainer you choose to contact.

Number of days/hours:

Please ask the trainer you choose to contact.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Functional Family Therapy (FFT) as listed below:

There is an application process that is meant to help sites understand and review all of the readiness issues involved with implementation. For more information, please see www.fftllc.com or contact the program representative listed at the end of this entry.

Formal Support for Implementation

There is formal support available for implementation of Functional Family Therapy (FFT) as listed below:

Some states (California and Washington) that have formal FFT Statewide Coordinators who help sites with implementation and other issues.

Fidelity Measures

There are fidelity measures for Functional Family Therapy (FFT) as listed below:

FFT, Inc. includes intensive procedures for monitoring quality of implementation on a continuous basis. Information is captured from multiple perspectives (family members, therapists, and clinical supervisors). The two measures that are utilized to represent therapist fidelity to the model are the Weekly Supervision Checklist and the Global Therapist Ratings.

Weekly Supervision Checklist: Following every clinical staffing, the clinical supervisor completes a fidelity rating for the case that was reviewed for each therapist. This fidelity rating reflects the degree of adherence and competence for that therapist's work in that case in a specific session. Thus, the weekly supervision ratings are not global, but specific to a single case presentation. Over the course of the year, a therapist may receive up to 50 ratings, which provides the supervisor with critical information about the therapist’s progress in implementing FFT.

Global Therapist Ratings: Three times a year the clinical supervisor rates each therapist's overall adherence and competence in FFT. The Global Therapist Rating (GTR) allows for the supervisor to provide feedback to the therapist on their overall knowledge and performance of each phase and general FFT counseling skills. The GTR specifically targets time period measures with the hope of displaying therapist growth. With respect to the GTR, we encourage supervisors to utilize the comments box under each phase to target specific strengths and specific phase areas of growth.

Implementation Guides or Manuals

There are implementation guides or manuals for Functional Family Therapy (FFT) as listed below:

Training manuals are handed out to sites implementing FFT during their clinical training.

Research on How to Implement the Program

Research has not been conducted on how to implement Functional Family Therapy (FFT).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Alexander J. F., & Parsons, B. V. (1973). Short-term behavioral intervention with delinquent families: Impact on family process and recidivism. Journal of Abnormal Psychology, 81(3), 219–225.https://doi.org/10.1037/h0034537

Type of Study: Randomized controlled trial
Number of Participants: 86 families

Population:

  • Age — Youth: 13–16 years; Adults: Not specified
  • Race/Ethnicity — Youth: Not specified; Adults: Not specified
  • Gender — Youth: Not specified; Adults: Not specified
  • Status — Participants were recruited from referrals by the Salt Lake County Juvenile Court to the Family Clinic at the University of Utah made from October 1970 to January 1972.

Location/Institution: Family Clinic, University of Utah

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to examine the impact of a short-term behavioral intervention [now called Functional Family Therapy (FFT)] on the recidivism rates of delinquent teenagers and their families. Families were randomly assigned to either the short-term behavioral family intervention program or to one of three comparison groups: client-centered family groups program, psychodynamic family program (Mormon church-sponsored), or a no-treatment control group. Measures utilized include accuracy of perception (behavior specificity phase), accuracy of perception (vignette phase), interaction phase, and juvenile court records. Results indicate the no-treatment control group had a 50% recidivism rate, the client-centered family group had a 47% recidivism rate, the psychodynamic family treatment group had a 73% recidivism rate, and the short-term family behavioral treatment had a 26% recidivism rate. Limitations of the study include the small sample size in each group and the lack of specific substance-use-related outcome.

Length of postintervention follow-up: 6–18 months.

Parsons, B., & Alexander, J. (1973). Short-term family intervention: A therapy outcome study. Journal of Consulting and Clinical Psychology, 41(2), 195–201. https://doi.org/10.1037/h0035181

Type of Study: Pretest-posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 40

Population:

  • Age — Mean=Approximately 15 years
  • Race/Ethnicity — Not specified
  • Gender — 22 Females and 18 Males
  • Status — Participants were families of adolescents involved with the juvenile court system for behavioral offenses (runaway, deemed ‘ungovernable,’ or habitual truancy).

Location/Institution: Family Therapy Clinic at the University of Utah, Salt Lake City

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate whether a short-term family intervention program [now called Functional Family Therapy (FFT)], effectively reduced maladaptive behavior patterns in adolescents. Two treatment conditions and two control groups were used. Measures utilized include four interaction measures to assess activity levels (silence, frequency, and duration of simultaneous speech), as well as verbal reciprocity (equality of speech), accuracy of perception (behavior specificity phase), accuracy of perception (vignette phase), and interaction phase. Results indicate that treatment produced significant changes in the family interaction patterns with treatment families becoming less silent, talking more equally, and experiencing an increase in both the frequency and duration of simultaneous speech. Control families did not improve on any of the four interaction measures and the pencil-and-paper treatment components yielded no significant change among all groups. Limitations include unreliability with the paper-and-pencil components, a lack of comparison of individual therapy to the family systems approach, small sample size, and lack of follow-up.

Length of postintervention follow-up: None.

Klein, N., Alexander, J., & Parsons, B. (1977). Impact of family systems intervention on recidivism and sibling delinquency: A model of primary prevention and program evaluation. Journal of Consulting and Clinical Psychology, 45(3), 469–474. https://doi.org/10.1037/0022-006X.45.3.469

Type of Study: Randomized controlled trial
Number of Participants: 86 families

Population:

  • Age — Youth: 13-16 years; Adults: Not specified
  • Race/Ethnicity — Youth: Not specified; Adults: Not specified
  • Gender — Youth: 48 Females and 38 Males; Adults: Not specified
  • Status — Participants were families of adolescents involved with the juvenile court system for behavioral offenses.

Location/Institution: University of Utah Family Clinic, Salt Lake City

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the same sample as Alexander and Parsons (1973). The purpose of this study was to measure outcomes on three levels of evaluation: changes in the family interaction process at the termination of treatment (tertiary prevention); recidivism rates 6 to 18 months following treatment (secondary prevention); and rate of sibling contact with the court 2.5 to 3.5 years following intervention (primary prevention). Participants were randomly assigned to one of four treatment conditions: the treatment program [now called Functional Family Therapy (FFT)], one of two comparison groups, or a no-treatment control group. Measures utilized include juvenile court records. Results indicate the family systems approach, when compared to the other conditions, produced significant improvements in family interaction process measures and a significant reduction in recidivism. Limitations include study reports on prevention outcomes rather than the actual effects of the initial treatment measures, small sample size in each group, and the lack of specific substance use related outcome.

Length of postintervention follow-up: 6-18 months (recidivism only).

Friedman, A. (1989). Family therapy vs. parent groups: Effects on adolescent drug abusers. American Journal of Family Therapy, 17(4), 335–347. https://doi.org/10.1080/01926188908250780

Type of Study: Randomized controlled trial
Number of Participants: 169

Population:

  • Age — 14-21 years, Mean=17.9 years
  • Race/Ethnicity — 89% Caucasian and 11% Other
  • Gender — 60% Male and 40% Female
  • Status — Participants were families of emotionally disturbed adolescents with substance abuse.

Location/Institution: Six outpatient drug-free treatment programs

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate the effectiveness of a family therapy group method (now called Functional Family Therapy (FFT)). Participants were randomly assigned to the family therapy group method or parent group method. Measures utilized include the Client Interview Form, the Parent Interview Form, and the Drug Severity Index. Results indicate at follow-up evaluation, the clients and their mothers in both groups reported significant improvement on numerous outcome criteria, including reduction in substance use. There was no significant difference between the two groups in degree of improvement. Limitations include reliance on self-report of drug use, and generalizability due to ethnicity.

Length of postintervention follow-up: 9 months.

Waldron, H. B., Slesnick, N., Brody, J. L., Peterson, T. R., & Turner, C. W. (2001). Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments, Journal of Consulting and Clinical Psychology, 69(5), 802–813. https://doi.org/10.1037/0022-006X.69.5.802

Type of Study: Randomized controlled trial
Number of Participants: 120 families

Population:

  • Age — Youth: 13-17 years; Adults: Not specified
  • Race/Ethnicity — Youth: 56 Hispanic, 46 Anglo American, 9 Native American, and 9 Mixed/Other; Adults: Not specified
  • Gender — Youth: 96 Males and 24 Females; Adults: Not specified
  • Status — Participants were substance-abusing adolescents and their families. referred by the juvenile justice system, public school system, themselves, a parent, or other treatment agencies.

Location/Institution: University of New Mexico Center for Family and Adolescent Research, NM

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate individual cognitive-behavioral therapy (CBT), family therapy, combined individual and family therapy, and a group intervention for substance-abusing adolescents. Participants were randomly assigned to one of four treatment conditions: Functional Family Therapy (FFT), individual Cognitive Behavioral Therapy (CBT), a combination of FFT and CBT (joint), or a psychoeducational group. Measures utilized include the Timeline Follow-Back (TLFB) interview, collateral reports from parents and siblings of adolescents, urinalyses, the Problem Oriented Screening Instrument for Teenagers (POSIT), and the Child Behavior Checklist (CBCL). Results indicate adolescents in both of the family therapy conditions (FFT and joint CBT/FFT) had significant reductions in heavy marijuana use from pretreatment to the 4-month assessment, and this reduction persisted until the 7-month assessment. The initial changes in those in the CBT condition from pretreatment to 4 months, however, did not persist through the 7-month assessment. All the interventions in this study demonstrated some degree of treatment efficacy. Limitations include an unequal number of sessions across treatments, length of follow up, and the self-report nature of substance use.

Length of postintervention follow-up: 3 months.

Slesnick, N., & Prestopnik, J. (2004). Office versus home-based family therapy for runaway, alcohol abusing adolescents: Examination of factors associated with treatment attendance. Alcoholism Treatment Quarterly, 22(2), 3–19. https://doi.org/10.1300/J020v22n02_02

Type of Study: Randomized controlled trial
Number of Participants: 77

Population:

  • Age — Mean=15 years
  • Race/Ethnicity — 36 Hispanic, 20 Anglo, 10 Native American, 5 African American, and 6 Other
  • Gender — 46 Females and 31 Males
  • Status — Participants were recruited from two runaway shelters in a large southwestern city.

Location/Institution: University of New Mexico; Albuquerque

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to examine predictors of treatment attendance for runaway, substance abusing youth and their families. Participants were randomly assigned to either Ecologically Based Family Therapy (EBFT) or Functional Family Therapy (FFT). Measures utilized include the Youth Self-Report of the Child Behavior Checklist, as well as the Form 90 Interview. More families assigned to home-based EBFT were both engaged and attended more sessions compared to families assigned to the office-based FFT. 76% of the EBFT families participated in four or more sessions, while only 50% of the families assigned to FFT participated in four or more sessions. Adolescents' externalizing problems was associated with increased treatment attendance in EBFT, but not in FFT. However, severity of the adolescent's alcohol and drug use did not significantly predict treatment attendance in either EBFT or FFT. Limitations include sole focus on shelter-residing runaway youth with primary alcohol problems, reliability on self-reported measures, and lack of follow-up.

Length of postintervention follow-up: None.

French, M. T., Zavala, S. K., McCollister, K. E., Waldron, H. B., Turner, C. W., & Ozechowski, T. J. (2008). Cost-effectiveness analysis of four interventions for adolescents with a substance use disorder. Journal of Substance Abuse Treatment, 34(3), 272–281. https://doi.org/10.1016/j.jsat.2007.04.008

Type of Study: Randomized controlled trial
Number of Participants: 120

Population:

  • Age — 13-17 years
  • Race/Ethnicity — 45.2–62.1% Hispanic and 37.9–54.8% Anglo-American
  • Gender — 76–84% Male and 16–24% Female
  • Status — Participants were adolescents who were referred to the University of New Mexico’s Center for Family and Adolescent Research for substance abuse treatment.

Location/Institution: Albuquerque, New Mexico

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the same sample as Waldron et al. (2001). The purpose of this study was to attempt a cost-effectiveness analysis of four interventions, including family-based, individual, and group cognitive behavioral approaches, for adolescents with a substance use disorder. Participants were randomly assigned to individual Cognitive Behavioral Therapy (CBT), Functional Family Therapy (FFT), integrative treatment combining individual and family therapy (joint), or a skills-focused psychoeducational group (group). Measures utilized include the Form 90D version of the Timeline Follow- Back Interview (TLFB), the Delinquent Behavior subscale of the Child Behavior Checklist, the Youth Self-Report (YSR) version, and the Drug Abuse Treatment Cost Analysis Program (DATCAP). Results indicate that treatment costs varied substantially across the four interventions. Moreover, family therapy showed significantly better substance use outcome compared to group treatment at the 4-month assessment, but group treatment was similar to the other interventions for substance use outcome at the 7-month assessment and for delinquency outcome at both the 4- and 7-month assessments. These findings over a relatively short follow-up period suggest that the least expensive intervention (group) was the most cost-effective. Limitations include numerous data and methodological challenges in trying to supplement a completed clinical trial with an economic evaluation, the study is more conceptual than empirical, a largely male sample, and length of follow-up.

Length of postintervention follow-up: 3 months.

Slesnick, N., & Prestopnik, J. (2009). Comparison of family therapy outcome with alcohol-abusing, runaway adolescents. Journal of Marital & Family Therapy, 35(3), 255–277. https://doi.org/10.1111/j.1752-0606.2009.00121.x

Type of Study: Randomized controlled trial
Number of Participants: 119

Population:

  • Age — Youth: 12-17 years; Adults: Not specified
  • Race/Ethnicity — Youth: 44% Hispanic, 29% Anglo, 11% Native American, 11% Other, and 5% African American; Adults: Not specified
  • Gender — Youth: 55% Female and 45% Male; Adults: Not specified
  • Status — Participants were primarily adolescents with an alcohol problem and their primary caretakers from two runaway shelters.

Location/Institution: Albuquerque, NM

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate treatment for alcohol problem, runaway adolescents and their families. Participants were randomly assigned to either (a) home-based Ecologically Based Family Therapy (EBFT), (b) office-based Functional Family Therapy (FFT), or (c) service as usual (SAU) through the shelter. Measures utilized include the Youth Self-Report of the Child Behavior Checklist, the computerized version of the Diagnostic Interview Schedule for Children (CDISC), the Beck Depression Inventory (BDI), and the Conflict Tactics Scale (CTS). Results indicate measures of family and adolescent functioning improved over time in all groups. However, significant differences among the home- and office-based interventions were found for treatment engagement and moderators of outcome. Limitations include difficult to conclude whether the findings are the result of the context of treatment (home vs. office) or of treatment condition (FFT vs. EBFT), small sample size, and may not be generalizable to youth not in shelter care.

Length of postintervention follow-up: 6-11 months.

Sexton, T., & Turner, C. W. (2010). The effectiveness of functional family therapy for youth with behavioral problems in a community practice setting. Journal of Family Psychology, 24(3), 339–348. https://doi.org/10.1037/a0019406

Type of Study: Randomized controlled trial
Number of Participants: 917 families and 38 therapists

Population:

  • Age — Youth: 13-17 years; Adults: Not specified; Therapists: Not specified
  • Race/Ethnicity — Youth: 78% White, 10% African American, 5% Asian, 4% Not identified, and 3% Native American; Adults: Not specified; Therapists: 74% White, 4% African American, 4% Asian, 4% Mexican American, and 4% Multiracial
  • Gender — Youth: 79% Male and 21% Female; Adults: Not specified; Therapists: 79% Female and 21% Male
  • Status — Participants were juvenile offenders who had been remanded for probation services.

Location/Institution: A community juvenile justice setting

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to examine the effectiveness of Functional Family Therapy (FFT), as compared to probation services, in a community juvenile justice setting 12 months posttreatment. Participants were randomly assigned to either FFT or usual probation services. Measures utilized include the Washington State Juvenile Court Administration Risk Assessment (WSJCA-RA), a treatment adherence measure, and records of adjudicated posttreatment felony criminal behavior. Results indicate that FFT was effective in reducing youth behavioral problems, although only when the therapists adhered to the treatment model. High-adherent therapists delivering FFT had a statistically significant reduction in felony, and violent crime, and a marginally significant reduction in misdemeanor recidivisms, as compared to the control condition. The results represent a significant reduction in serious crimes one year after treatment, when delivered by a model adherent therapist. Limitations include that the method used to measure therapist adherence had methodological weaknesses, and that the measures of therapist model adherence also had limitations.

Length of postintervention follow-up: 12 months.

Celinska, K., Furrer, S., & Cheng, C. C. (2013). An outcome-based evaluation of Functional Family Therapy for youth with behavioral problems. Journal of Juvenile Justice, 2(2), 23–36. https://www.ojp.gov/pdffiles/251063.pdf#page=29 

Type of Study: Other quasi-experimental
Number of Participants: 72

Population:

  • Age — Treatment group: Mean=15.5 years; Comparison group: 15.1 years
  • Race/Ethnicity — Treatment group: 36% African American, 36% Latino, 19% White, and 8% Other; Comparison group: 44% African American, 33% Latino, 14% White, and 8% Other
  • Gender — Treatment group: 69% Male; Comparison group: 61% Male
  • Status — Participants were adolescents with a history of aggressive behavior, destruction of property, or chronic truancy.

Location/Institution: Middlesex County, New Jersey

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to compare intervention outcomes for youth who received Functional Family Therapy (FFT) with matched youth who received individual therapy or mentoring. Measures utilized include the Strengths and Needs Assessment (SNA) tool and the Services Tracking Form. Results indicate that although the analysis reveals significant positive improvements in a few domains for both the treatment and the comparison group, only youth who received FFT exhibited a significant reduction in emotional and behavioral needs and risk behaviors. Limitations include selection bias cannot be ruled out, nonrandomization, and lack of follow up.

Length of postintervention follow-up: None.

Humayun, S., Herlitz, L., Chesnokov, M., Doolan, M., Landau, S., & Scott, S. (2017). Randomized controlled trial of Functional Family Therapy for offending and antisocial behavior in UK youth. Journal of Child Psychology and Psychiatry, 58(9), 1023–1032. https://doi.org/10.1111/jcpp.12743

Type of Study: Randomized controlled trial
Number of Participants: 111

Population:

  • Age — Mean=15.0–15.1 years
  • Race/Ethnicity — 5–11% Non-white British
  • Gender — 71–72% Male
  • Status — Participants were youth and their parents or caregivers recruited through crime prevention agencies.

Location/Institution: England

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to examine the differences between Functional Family Therapy (FFT) plus Management as Usual (MAU) to MAU alone. Participants were randomly assigned to one of the two conditions. Measures include the Wechsler Abbreviated Scale of Intelligence (WASI), the Therapist Adherence Measure (TAM), the Self Report Delinquency scale, official records of offending, the Adolescent Parent Account of Child Symptoms (APACS), the Alabama Parenting Questionnaire short version (APQ-15), and the ‘Hot Topics’ measure. Results indicate that in both groups, there were large reductions over time in all measures of offending and antisocial behavior, but no significant changes over time in parenting behavior or the parent–child relationship. However, there were no differences between intervention and control groups at 6 or 18 months postrandomization on self-reported delinquency, police records of offending, symptoms or diagnoses of conduct disorders (CDs), parental monitoring or supervision, directly observed child negative behavior, or parental positive or negative behavior. Against predictions, the intervention group showed lower levels of directly observed child positive behavior at 18 months compared to controls. Limitations include fidelity was lower than recommended in 23% of cases seen, a larger sample size may have detected small differences between groups and, of those eligible, only 23% took part in the study.

Length of postintervention follow-up: 12 months.

Celinska, K., Sung, H. E., Kim, C., & Valdimarsdottir, M. (2019). An outcome evaluation of Functional Family Therapy for court‐involved youth. Journal of Family Therapy, 41(2), 251–276. https://doi.org/10.1111/1467-6427.12224

Type of Study: Other quasi-experimental
Number of Participants: 201

Population:

  • Age — Mean=15.4–15.6 years
  • Race/Ethnicity — 54.2–62.5% White, 22.9–30.8% Black, 6.3–13.1% Other, and 1.9–8.3% Asian
  • Gender — 48–60% Male and 40–52% Female
  • Status — Participants were court-involved youth.

Location/Institution: Middlesex County, New Jersey

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to examine the effectiveness of Functional Family Therapy (FFT). Participants were enrolled in either FFT or a comparison group from the Youth Case Management programme. Measures utilized include the Strengths and Needs Assessment (SNA) and court-obtained recidivism data. Results indicate adolescents in the treatment and in the comparison groups experienced statistically significant improvements in the majority of the SNA domains. Although youths in the treatment group improved more, the differences between the groups were not statistically significant. Analysis showed that youths in FFT had significantly lower odds of recidivism as measured by reconvictions for drug offences, property offences and technical violations. Limitations include the lack of analysis of drop-out cases, the study samples include only youth who completed interventions and who were involved with the Family Court, lack of randomization, high attrition rate, and lack of follow up.

Length of postintervention follow-up: None.

Additional References

Alexander, J., Barton, C., Gordon, D., Grotpeter, J., Hansson, K., Harrison, R., Mears, S., Mihalic, S., Parsons, B., Pugh, C., Schulman, S., Waldron, H., & Sexton, T. (1998). Functional Family Therapy: Blueprints for violence prevention, Book Three. Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.

Alexander, J. F., & Parsons, B. V. (1982). Functional Family Therapy: Principles and procedures. Brooks/Cole.

Alexander, J. A., Waldron, H. B., Robbins, M. S., & Neeb, A. (2013). Functional Family Therapy for adolescent behavior problems. American Psychological Association.

Contact Information

Holly DeMaranville, LLC
Title: FFT Communications Director
Agency/Affiliation: Functional Family Therapy, Inc.
Website: www.fftllc.com
Email:
Phone: (206) 369-5894
Fax: (206) 453-3631

Date Research Evidence Last Reviewed by CEBC: December 2020

Date Program Content Last Reviewed by Program Staff: July 2018

Date Program Originally Loaded onto CEBC: April 2010