Functional Family Therapy (FFT) is a family-based prevention and intervention program for high-risk youth that addresses complex and multidimensional problems through clinical practice that is flexibly structured and culturally sensitive. The FFT clinical model concentrates on decreasing risk factors and on increasing protective factors that directly affect adolescents, with a particular emphasis on familial factors.
The program is for at-risk youths ages 11 to 18 and has been applied in a variety of multiethnic, multicultural contexts to treat a range of youths and their families. Targeted youths generally are at risk for delinquency, violence, substance use, or other behavioral problems such as Conduct Disorder or Oppositional Defiant Disorder.
FFT consists of 8 to 12 one-hour sessions for mild cases and incorporates up to 30 sessions of direct service for families in more difficult situations. Sessions are generally spread over a 3-month period and can be conducted in clinical settings as an outpatient therapy and as a home-based model.
FFT integrates several elements (clinical theory, empirically supported principles, and clinical experience) into a comprehensive clinical model. The model has five specific phases: engagement, motivation, relational assessment, behavior change, and generalization.
In the engagement phase, therapists concentrate on establishing and maintaining a strengths-based relationship with clients. The goals of this phase are to enhance the perception that the FFT therapeutic process will be responsive and credible, and demonstrate to clients that therapists will listen to, help, and respect them.
During the motivational phase, therapists concentrate on the relationship process between adolescents and their family. One goal of this phase is to create a motivational context, so that adolescents and their families will want to continue therapy and not drop out. In addition, therapists concentrate on decreasing the negativity often characteristic of high-risk youths and families, such as hopelessness and low self-efficacy. During this phase, the idea is emphasized and reiterated that a positive experience in therapy can lead to a lasting change.
The relational assessment involves analyzing the relational processes of the family, in addition to creating treatment places for the behavior change and generalization phases. The emphasis shifts during this phase from an individual problem to a relational perspective. Therapists work on intrafamily and extrafamily capabilities, such as values, interaction patterns, sources of resistance, and resources.
The behavior change phase aims to reduce and eliminate the problem behaviors and accompanying family relational patterns through individualized behavior change interventions (skill training in family communication, parenting, problem-solving, and conflict management). Therapists work to develop change in behavior, while remaining aware of family members’ abilities and interpersonal needs.
The goal of the generalization phase is to increase the family’s capacity to adequately use multisystemic community resources and to engage in relapse prevention. The emphases are on relationships between family members and multiple community systems.
FFT can be delivered by a wide range of professionals, including licensed therapists, trained probation officers, and other specialists with a mental health degree and background (e.g., MSW, Ph.D., M.D., R.N., MFT, and LCP).
Gordon and colleagues (1988) used a quasi-experimental design to evaluate Functional Family Therapy (FFT) with lower socioeconomic status juvenile offenders, most of whom had multiple offenses. All 54 participants were white, court-referred juveniles from a rural
The participants were all white and were living in an economically depressed community with high rates of unemployment and single-parent households. Status offenses—habitual truancy, unruliness, and running away—accounted for 57 percent of all offenses committed. Misdemeanors accounted for 30 percent of offenses committed and consisted of petty theft, vandalism, criminal trespass, and menacing. Felonies, which accounted for 13 percent of offenses committed, included breaking and entering, grand theft, and rape. Participants in both groups continued to meet with their probation officer one or two times each month. Participants in the treatment group attended a median number of 16 family sessions (range: 7 to 38), lasting an average of 1½ hours each and extending over a mean of 5½ months.
The outcome—recidivism rate—was calculated for each group as the percentage of juveniles convicted of one offense or more. The mean follow-up period for measuring recidivism rates was 27.8 months for the treatment group and 31.5 for the comparison group. Since these periods differed slightly, the recidivism rate was annualized to reveal the rate for any 12-month period.
Adult recidivism at 5 to 6 years after placement on probation—when participants, generally, were 20 to 22 years of age—was reported by Gordon,
The Sexton and Turner (2010) evaluation included a comparison of FFT with probation services. This community-based evaluation was conducted within a statewide juvenile justice system of a large western state. Data collection and group assignments were conducted by an independent state evaluation center. A total of 917 families in 14 counties in both rural and urban settings participated.
The participating juvenile offenders had been remanded for probation services and were stratified at the county level and randomly assigned to either FFT or a control group receiving usual probation services. Intervention youths received an average of 12 FFT family-based sessions in their homes over a 3- to 6-month period. FFT was provided by a community-based therapist. Control youth received traditional probation services in their local county with no additional treatment services. Each group included more than 400 adolescents. All participants were followed for 18 months when 1-year posttreatment assessments were collected.
Participants’ ages were evenly distributed from 13 to 17 years. Seventy-nine percent were male, and 21 percent were female. Seventy-eight percent of participants were white, 10 percent African American, 5 percent Asian, 3 percent Native American, and 4 percent were not identified. Most of the participants had committed felony crimes (56.2 percent), and many had committed misdemeanors (41.5 percent).
Measures included family-focused risk and protective factors sections of the Washington State Juvenile Court Assessment completed by a probation officer. Other measures included a treatment adherence measure and a measure of the youth’s adjudicated felony criminal behavior in the 12-month period following randomization to treatment.
The primary outcome measure was the youth’s adjudicated posttreatment felony criminal behavior in the 12-month period following randomization to treatment.
A four-step statistical analysis was used. First, preliminary multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA) analyses were conducted to assess potential outside variables that might influence the hypothesis testing. Second, hierarchical linear modeling and logistic regression analyses were used to test the main hypothesis that the FFT condition was associated with a lower level of adjudicated felony recidivism compared with the control group. Third, a secondary hypothesis concerning effects of therapist model adherence (low versus high) was analyzed using logistic regression. Fourth, analyses examined possible interaction effects between pretreatment family and peer risk factors (low family risk, high family risk, and high peer risk) and therapist adherence as predictors of felony recidivism.
Gordon and colleagues (1988) found that for any 12-month period, the recidivism rate averaged 1.29 offenses for the Functional Family Therapy (FFT) group and 10.29 offenses for the comparison group. The average annual recidivism rates for the groups during the entire follow-up period (27.8 and 51.5 months, respectively) were 5 percent for the treatment group and 25.0 percent for the comparison group.
The analysis for adult outcomes reported by Gordon and colleagues (1995) was conducted using data on 45 of the original 54 study participants. Results indicated that the recidivism rate for combined misdemeanor and felony offenses was significantly lower for the treatment group (4.3 percent) than for the comparison group (27.3 percent). For misdemeanors only, the respective recidivism rates differed at the 0.10 level with a treatment rate of 4.3 percent and comparison group rate of 27.3 percent. For felonies only, the difference between the rates for the two groups (4.3 percent and 13.6 percent) was not significant.
This large-scale trial of FFT conducted by Sexton and Turner (2010) and delivered by community-based therapists found that, when the analysis was collapsed across all therapists, FFT was no more effective in lowering felony recidivism than the supervised probation services that the control group received. However, the therapist level of adherence to the FFT model (low versus high) and the client pretreatment risk and protective level both had moderating effects on recidivism. When adherence to the FFT model was high, FFT resulted in a significant reduction in felony crimes (34.9 percent), a significant reduction in violent crimes (30 percent), and a nonsignificant decrease in misdemeanor crimes (21.1 percent).
The study also found that FFT delivered by high-adherent therapists resulted in significantly lower recidivism rates (20 percent) for youths with the highest levels of family and peer risk levels in the sample.