Functional Family Therapy (FFT)

Brief Description

The Functional Family Therapy (FFT) program is a multistep intervention that targets youth who are at risk of, or already demonstrating, delinquency, violence, substance use, conduct disorder, oppositional defiant disorder, or disruptive behaviour disorder. FFT services may be coupled with supportive system services such as remedial education, job training and placement, and school placement.

The program is centered on family therapy; parent training; and substance prevention/treatment.

Goals

The main goals of the FFT program are to:

• Enhance the services provided to youth (increase efficiency, decrease costs) by targeting known risk and protective factors;
• Engage and motivate the families of the youth who participate in the program; and
• Change the maladaptive behaviours of youth (delinquent acts, violence, substance use) and their families as well as reducing the personal, societal, and economic devastation that the disruptive behaviour of youth may cause.

Clientele

The appropriate clientele for the FFT program is youth between the ages of 11 and 18 who are at risk for, or are engaging in, delinquent acts, violence, substance use, conduct disorder, oppositional defiant disorder, or disruptive behaviour disorder. Many youth targeted by the program are at risk for institutionalization if their behaviour does not change.

Participants are referred to the program through the families themselves, as well as schools, community service providers, the courts, and other social service agencies. A specific referral process for program participation will need to be put in place in order to target at-risk youth.

Core Components

The FFT program includes 8 to 30 hours of direct services for youth and their families, depending on individual needs. Generally, sessions are spread over a 3-month period of time. The program has several key steps which are designed to build on one another to enhance protective factors to reduce risk. These phases consist of:

• Engagement
• Motivation
• Assessment
• Behaviour Change
• Generalization

Implementation Information

Some of the critical elements for the implementation of this program or initiative include the following:

• Organizational requirements: A clinical director often assists the program with issues that are governed by organizational policies and procedures. An organization must become a FFT-certified site in order to implement the FFT program.
• Partnerships: Organizations should collaborate with potential referral sources.
• Training and technical assistance: Therapists implementing FFT must be trained in all aspects of the program. There are 3 phases of training that occur over a 3 year period. FFT also has extensive procedures for monitoring aspects of sites during implementation, including booster trainings.
• Risk assessment tools: Limited information on this topic.
• Materials & resources: The FFT program has developed and implemented a sophisticated web-based application designed to monitor highly structured FFT therapist progress notes, as well as supervisor and client ratings of therapist competence. To support implementation, FFT has well-developed treatment/training and supervision manuals.

International Endorsements

The most recognized classification systems of evidence-based crime prevention programs have classified this program or initiative as follows:

• Blueprints for Healthy Youth Development: Model
• Crime Solutions/OJJDP Model Program Guide: Effective (more than one study)
• SAMHSA's National Registry of Evidence-based Programs and Practices: Not applicable.
• Coalition for Evidence-Based Policy: Not applicable.

Gathering Canadian Knowledge

Canadian Implementation Sites

Public Safety Canada’s National Crime Prevention Strategy provided funding to implement the FFT program in Calgary, Alberta from 2014-2019. The program is being offered by Calgary Family Services in Calgary, Alberta.

Main Findings from Canadian Outcome Evaluation Studies

As part of Public Safety Canada’s funding, an outcome evaluation study of the Calgary Collaborative Functional Family Therapy Implementation Project was completed by Guyn Cooper Research Associates Ltd. A quasi-experimental design was used to evaluate the program.

Results from this evaluation showed the following:

• Both parents and children reported higher family functioning post-program, with statistically significant improvements in the family environment and family conflict domains as well as the Youth Level of Service/Case Management Inventory (YLS/CMI) risk scores.
• Both the child and parent Youth Outcome Questionnaire (YOQ) results indicate that the program had a significant positive impact on mental health.
• Although FFT participants demonstrated positive improvements in behaviours associated with delinquency, the program had little impact on the attitudes associated with delinquency.
• Participants showed no improvement on substance abuse indicators and small improvements in education outcomes.
• Male participants demonstrated a reduction in criminal involvement. A stratified analysis of male participants showed a “success” rate (meaning no charges at follow-up) of 92.4% for FFT completers, compared with 78.4% for FFT dropouts/refusals with a moderate effect size of .202.

For more information, refer to Guyn Cooper Research Associates Ltd.’s (2019) publication.

Cost Information

Blueprints for Healthy Youth Development (2015) has provided a cost example with therapist caseloads of 12 and supervisors seeing 5 youth/families with an average service length of 12 weeks. In this example, the program could serve approximately 600 youth/families and the average youth/family cost would be $2,800 (USD).

In 2019, as part of Guyn Cooper Research Associates Ltd.’s outcome evaluation study, it was found that the average cost per participant in the Calgary Collaborative Functional Family Therapy Implementation Project was $15,927 (CAD).

References

Guyn Cooper Research Associates Ltd. (2019). Families Functioning Together (FFT). Final Evaluation Report. Submitted to Public Safety Canada. (Unpublished report).

For more information on this program, contact:

Functional Family Therapy LLC
1251 Northwest Elford Drive
Seattle, Washington 98177
Telephone: (206) 369-5894
E-mail: holly@fftllc.com
Website: http://www.fftllc.com/