Functional Family Therapy (FFT)
Functional Family Therapy (FFT) is an empirically grounded, well-documented and highly successful family intervention that focuses on children and teens who are at-risk or already involved with juvenile justice. Through clinical sessions with a trained FFT therapist, FFT works to develop family members’ inner strengths and sense of being able to improve their situations. These characteristics provide the family with a platform for change and future functioning that extends beyond the direct support of the therapist and other social systems. In the long run, the FFT philosophy leads to greater self-sufficiency, fewer total treatment needs, and considerably lower costs.
Youth ages 10–18, whose problems range from acting out to conduct disorder to alcohol/substance abuse, and their families. Participating families tend to have limited resources, histories of failure, a range of diagnoses, and exposure to multiple systems.
FFT can be provided in a variety of contexts, including schools, child welfare, probation, parole/aftercare, mental health, and as an alternative to incarceration or out-of-home placement. The FFT model allows for successful intervention in complex and multidimensional problems through clinical practice that is flexibly structured and culturally sensitive.
FFT is a short-term intervention—on average, 8 to 12 sessions are needed for mild cases and up to 30 hours of direct service (e.g., clinical sessions, telephone calls, and meetings involving community resources) for more difficult cases. In most cases, sessions are spread over a 3-month period. FFT is a multi-systemic prevention program that focuses on the multiple domains and systems within which the participants live. The FFT intervention is also multi-systemic and multi-level as it includes the treatment system, family and individual functioning, and the therapist as major components.
Empirically grounded and well-documented, FFT has three specific intervention phases—engagement and motivation, behavior change, and generalization. Each phase has distinct goals and assessment objectives, addresses different risk and protective factors, and calls for particular skills from the interventionist or therapist providing treatment.
- Phase 1: Engagement and Motivation. This phase maximizes factors that enhance intervention credibility (i.e., the perception that positive change might occur), while minimizing factors likely to decrease credibility (i.e., poor program image, difficult location, insensitive referrals, personal and/or cultural reframing). Also included are related techniques to address maladaptive perceptions, beliefs, and emotions.
- Phase 2: Behavior Change. During this phase, FFT clinicians develop and implement intermediate and long-term behavior change plans that are culturally appropriate, context sensitive, and tailored to the unique characteristics of each family member. Clinicians 2 provide concrete behavioral intervention to guide and model specific behavior changes.
- Phase 3: Generalization. This FFT phase is guided by the need to apply positive family change to other problem areas and/or situations. FFT clinicians help families maintain change and prevent relapses. To ensure long-term support of changes, FFT links families with available community resources. FFT clinicians intervene directly with the systems in which a family is embedded until the family is able to do so itself.
Assessment
An on-going, multi-faceted assessment process is part of each phase of the FFT clinical model. In FFT, assessment focuses on understanding the ways in which behavioral problems function within family relationship systems. The focus of assessment depends on the phase treatment.
FFT has a systematic training and implementation model for community agencies hoping to implement FFT as a clinical model. The training and implementation model is based upon clinical training for all staff, advanced clinical training of team leaders, follow-up visits, and ongoing supervision. It is a three phase process with each phase lasting approximately one year. Training is suitable for a wide range of interventionists, including para-professionals under supervision, trained probation officers, mental health technicians, and degreed mental health professionals (e.g., M.S.W., Ph.D., M.D., R.N., M.F.T.).
The training components involve:
- Two two-day clinical training for all FFT therapists in a working group (one on site and one off site)
- An externship training for one working group member, who will become the clinical lead for the working group
- Three follow-up visits/year (two days each, on-site)
- Supervision consultations (four hours of monthly phone consultation)
- Supervision training for the site supervisor
Holly DeMaranville, Communications Coordinator
Functional Family Therapy, LLC
2538 57th Avenue, SW
Seattle, WA 98116
Phone: (206) 369-5894
Fax: (206) 664-6230
Email: hollyfft@comcast.net
Web site: www.fftinc.com
Implementation costs for Functional Family Therapy in one working group are approximately $29,500 for phase one and start-up costs (not including travel). The project cost, including training and implementation, is approximately $2,000 per family. Phase two training fees are $12,000 and Phase 3 training fees are $5,000 (not including travel).
Both randomized trials and non-randomized comparison group studies show that FFT significantly reduces recidivism for a wide range of juvenile offense patterns. Studies show that when compared with no treatment, other family therapy interventions, and traditional juvenile court services (e.g., probation), FFT can reduce adolescent re-arrests by 20–60 percent. In addition, studies have found that FFT dramatically reduces the cost of treatment. A recent Washington State study, for example, shows savings of up to $14,000 per family.
FFT is supported by a systematic assessment, tracking and outcome assessment system. During the course of FFT, therapists administer a number of different assessments both preand post-therapy to various family members. While many of the assessments have been developed by FFT, therapists also utilize four specific instruments that sites must purchase and have on-site prior to the beginning of site certification training. Assessments are: The FAMIII General Scale, the POSIT, the OQ-45.2, and the Y-OQ2.0. FFT therapists will administer these assessments to all families as described during on-site CSS training and in the FFT/CSS Manual.
- Blueprints Model Program
- American Youth Policy Forum Effective Program
- Communities That Care- Developmental Research and Programs Effective Program
- Strengthening America's Families Exemplary 1
- Surgeon General's Report (2001) Model 1
- Title V (OJJDP) Exemplary Program
- This program was part of a cost-benefit analysis completed by the Washington State Institute for Public Policy on several violence prevention and reduction programs, including six Blueprints programs: Watching the Bottom Line: Cost-Effective Interventions for Reducing Crime in Washington.
D.S. Elliott. (Ed.) Blueprints for Violence Prevention (Book 3), 2d ed., Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.
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