Functional Family Therapy (FFT) is an intensive intervention for families with a young person aged between 10 and 18 years involved in serious antisocial behaviour and/or substance misuse. It is delivered by a family therapist or social worker to young people and their parents through 8 to 30 weekly, one-hour sessions, depending on the needs of the family.
The information above is as offered/supported by the intervention provider.
10 to 18 years old
Individual
Functional Family Therapy (FFT) is for families with a young person aged between 10 and 18 years involved in serious antisocial behaviour and/or substance misuse. The young person is typically referred into FFT through the youth justice system at the time of a conviction.
FFT is delivered to the young person and parents through 8 to 30 weekly sessions for as long as the family needs. Families with moderate needs typically require 8 to 14 sessions; families with more complex needs may require up to 26 to 30 sessions spread over a six-month period.
FFT is applied in five distinct phases: Engagement, Motivation, Relational Assessment, Behaviour Change, and Generalisation. Each phase has associated specific goals, techniques, and important therapist relationship and structuring skills.
The primary goal of the initial phases is to increase family members’ motivation for change by helping all members interact more positively with each other. Therapists do this by ‘reframing’ parents and children’s behaviour, so that family members gain a deeper insight into each other’s actions and are less likely to attribute blame.
During the middle phases, the therapist will suggest new strategies for family interaction that are carefully matched to the needs and capabilities of each member. These strategies typically include positive methods of communication, family problem-solving exercises, methods for managing moods and anger, methods for managing cravings and relaxation exercises. A primary aim of the middle phases is to improve interactions within the family context.
During the final phase, family members learn to ‘generalise’ these skills to contexts outside of the immediate family, including the young person’s school, peers and the wider family system.
Families also learn how to identify situations that could create future risks and generate methods for preventing these risks. The therapist also helps family members identify sources of ongoing support that can be used once the therapy has concluded.
A unique feature of FFT is the specific focus on skills in the context of assessed relational functions of behaviour (e.g. separation, contact) within each relationship within the family system (for example, mother/father; father/child; mother/child). The focus of change is on replacing maladaptive behaviours used to maintain relationship functions.
Readiness for therapy is based on the family demonstrating the generalisation of new skills and behaviours to the home and environment outside the therapy session, the maintenance of treatment gains, and the ability to function independently from the therapist.
10 to 18 years
Young people aged between 10 and 18 years involved in serious antisocial behaviour and/or substance misuse
Disclaimer: The information in this section is as offered/supported by the intervention provider.
Science-based assumption
Every family member’s behaviour serves a function within the family system
Poor family functioning may increase the risk of young people engaging in substance misuse or re-engaging with antisocial or criminal behaviour.
Science-based assumption
Understanding behaviours, their function in the family system, and their consequences provides an opportunity to change and improve them.
Science-based assumption
Young people aged between 10 and 18 years involved in serious antisocial behaviour and/or substance misuse.
Intervention
FFT therapists help family members identify positive and negative functions of family behaviours (including the young person’s antisocial behaviour) and develop strategies for changing them within the family system.
Short-term
Family members experience less conflict and improved communication.
Medium-term
Young people are better able to manage their emotions and behaviour.
Long-term
Young people are less likely to reoffend and misuse substances
Young people are more likely to remain with family and attend school.
Young people aged between 10 and 18 years involved in serious antisocial behaviour and/or substance misuse.
FFT is applied in five distinct phases: Engagement, Motivation, Relational Assessment, Behaviour Change, and Generalisation. Each phase has associated specific goals, techniques, and important therapist relationship and structuring skills.
In the first phase, the focus is on enhancing therapist credibility and expectations.
In the second phase, the focus is on building motivation for change by reducing negativity and blame, creating hope and a relational focus, and developing balanced alliances with family members.
Relational assessment involves identifying the interactional and functional aspects of specific behaviours, attributions, and feelings of family members and extrafamilial significant others (e.g. close relatives, peers).
This assessment sets the stage for designing and implementing the behaviour change phase.
Motivation to participate in the change process is enhanced by effecting changes in the attitudes and feelings of family members about each other and problematic behaviours.
The behaviour change phase involves training and applying maintenance technology (e.g. parent–child communication training, behavioural contracting). Skills training interventions such as problem-solving and other behavioural intervention strategies are included using a menu-driven process from the behaviour therapy literature (e.g. listening skills, anger management, parent-directed behavioural consequences, improved parental supervision).
The practitioner who delivers this intervention is a master’s qualified (or higher) psychologist, social worker, or family therapist.
The therapist undergoes 24 hours of face-to-face training prior to the first meeting with the client. An additional 48 hours of face-to-face training is required during the course of the first year. Booster training of practitioners is recommended.
Practitioner supervision is provided through the following processes:
Intervention fidelity is maintained through the following processes:
Contact person: Holly DeMaranville
Organisation: Functional Family Therapy
Email address: holly@fftllc.com
Website: www.fftllc.com
*Please note that this information may not be up to date. In this case, please visit the listed intervention website for up to date contact details.
Functional Family Therapy (FFT) has an evidence rating of 3+ ‘mixed’ based on findings from four evaluations conducted in the US and UK.
The first study was an RCT conducted in the United States with evidence consistent with Foundations’ Level 3 evidence strength criteria. This study observed statistically significant reductions in FFT young people’s reports of marijuana use in comparison to young people not receiving the intervention.
The second study was an RCT conducted in the United States with evidence consistent with Foundations’ Level 2+ evidence strength criteria. This study observed statistically significant reductions in the rates of criminal recidivism among FFT youths compared to young people not receiving the intervention.
The third study was a matched comparison groups study conducted in the United States with evidence consistent with Foundations’ Level 2+ evidence. This study observed statistically significant improvements in FFT young people’s out-of-home placement immediately after intervention completion compared to young people not receiving the intervention. However, these benefits faded in the months following treatment – resulting in no differences between the FFT and comparison group nine months post-intervention.
The fourth study was an RCT conducted in the UK with evidence consistent with Foundations’ Level 3 evidence strength criteria. This study observed no benefits for FFT young people or their families in comparison to those not receiving the intervention.
FFT can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome.
Reduced recidivism
Improvement index
Interpretation
Study
Reduced days using marijuana
Immediately after the intervention
Improvement index
Interpretation
Study
| Identified in search | 29 |
| Studies reviewed | 4 |
| Meeting the L2 threshold | 1 |
| Meeting the L3 threshold | 1 |
| Contributing to the L4 threshold | 2 |
| Ineligible | 25 |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 120 young people between ages of 13 and 17 who were diagnosed with a primary substance abuse disorder |
| Race, ethnicities, and nationalities |
|
| Population risk factors | Study participants on average started using drugs when they were 11 to 12. Most adolescents were mandated to treatment by court order, by probation officers in lieu of court order, or by schools in lieu of suspension or other consequence. Marijuana abuse was found to be most common across the sample. 89.8% were found to have a more-than-average delinquent behaviour. 29.7% were over the mean in terms of anxiety/depression, 27.3% in terms of attention difficulties, 47.7% in terms of externalising behaviour, and 45.4% internalising behaviour. |
| Timing |
|
| Child outcomes | Reduced marijuana use (Youth self-report) |
| Other outcomes | None |
| Study rating | 3 |
| Citations | Waldron, H. B., Slesnick, N., Brody, J. L., Turner, C. W. & Peterson, T. R. (2001) Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments. Journal of Consulting and Clinical Psychology. 69, 802–813. |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 86 young people aged 13 to 16 who had been arrested or detained at the Juvenile Court for a behavioural offence |
| Race, ethnicities, and nationalities | Not reported |
| Population risk factors | Not reported |
| Timing |
|
| Child outcomes | Reduced recidivism (Administrative measure) |
| Other outcomes | None measured |
| Study rating | 2+ |
| Citations | 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, 219–225. |
| Study design | QED |
| Country | United States |
| Sample characteristics | 8,713 11- to 18-year-old African American and Latino youth who were recently released from court-ordered out of home placement and who could not remain in the home due to circumstances of the child’s case and home life (e.g. family risk, maltreatment history, child behavioural health needs). |
| Race, ethnicities, and nationalities |
|
| Population risk factors | The child participants had around two prior arrests on average. Prior petitions included offences like assault with deadly weapon, battery, burglary, petty theft, robbery, and vandalism. On average, they were first arrested at age 14 to 15. |
| Timing | Over 36-month period post-release |
| Child outcomes | No |
| Other outcomes | None |
| Study rating | NE |
| Citations | Darnell, A. J. & Schuler, M. S. (2015) Quasi-experimental study of Functional Family Therapy effectiveness for juvenile justice aftercare in a racially and ethnically diverse community sample. Children and Youth Services Review. 50, 75–82. |
| Study design | RCT |
| Country | United Kingdom |
| Sample characteristics | 111 young people between the ages of 10 and 17 who have been sentenced for offending or were receiving agency intervention following contact with the police for antisocial behaviour. |
| Race, ethnicities, and nationalities | 90% White British |
| Population risk factors |
|
| Timing |
|
| Child outcomes | No |
| Other outcomes | None |
| Study rating | NE |
| Citations | 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. |
The following studies were identified for this intervention but did not count towards the intervention’s overall evidence rating. An intervention receives the same rating as its most robust study or studies.
Baglivio, M. T., Jackowski, K., Greenwald, M. A. & Wolff, K. T. (2014) Comparison of multisystemic therapy and functional family therapy effectiveness: A multiyear statewide propensity score matching analysis of juvenile offenders. Criminal Justice and Behavior. 41 (9), 1033–1056.
Barnoski, R. (2002) Washington State’s implementation of Functional Family Therapy for juvenile offenders: Preliminary findings. Washington State Institute for Public Policy
Barnoski, R. (2004) Outcome evaluation of Washington State’s research-based programs for juvenile offenders (Document No. 04-01-1201). Washington State Institute for Public Policy.
Barton, C., Alexander, J. F., Waldron, H., Turner, C. W. & Warburton, J. (1985) Generalizing treatment effects of Functional Family Therapy: Three replications. The American Journal of Family Therapy. 13, 16–26.
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.
Friedman, A. (1989) Family therapy vs. parent groups: Effects on adolescent drug abusers. The American Journal of Family Therapy. 17 (4), 335–347.
Gordon, D. A. (1995) Functional family therapy for delinquents. In R. P. Ross, D. H. Antonowicz & G. K. Dhaliwal (Eds.), Going straight: Effective delinquency prevention and offender rehabilitation (pp. 163–178).
Gordon, D. A., Arbuthnot, J., Gustafson, K. E. & McGreen, P. (1988) Home-based behavioral-systems family therapy with disadvantaged juvenile delinquents. American Journal of Family Therapy. 16 (3), 243–255.
Gordon, D. A., Graves, K. & Arbuthnot, J. (1995) The effect of Functional Family Therapy for delinquents on adult criminal behavior. Criminal Justice and Behavior. 22 (1), 60–73.
Gustafson, K., Gordon, D. A. & Arbuthnot, J. (1985) A cost-benefit analysis of in-home family therapy vs. probation for juvenile delinquents. Paper presented at the annual Banff Conference on Behavioral Sciences, Banff, Alberta, Canada.
Hansson, K. (1998) Functional family therapy replication in Sweden: Treatment outcome with juvenile delinquents. Paper presented to the Eighth Conference on Treating Addictive Behaviours, Santa Fe, NM.
Hansson, K., Cederblad, M. & Hook, B. (2000) Functional Family Therapy: A method for treating juvenile delinquents. Socialvetenskaplig tidskrift. 3, 231–243.
Hansson, K., Johansson, P., Drott-Emnglen, G. & Benderix, Y. (2004) ‘Funktionell familjeterapi I barnpsykiatrisk praxis: Om behandling av ungdomskriminaliet utanfor universitesforskningen. Nordisk Psykologi. 56 (4), 304–320.
Hops, H., Ozechowski, T. J., Waldron, H. B., Davis, B., Turner, C. W., Brody, J. L. & Barrera, M. (2011) Adolescent health-risk sexual behaviors: Effects of a drug abuse intervention. AIDS and Behavior. 15 (8), 1664–1676.
Klein, N. C., Alexander, J. F. & Parsons, B. V. (1977) Impact of family systems interventions on recidivism and sibling delinquency: A model of primary prevention and program evaluation. Journal of Consulting and Clinical Psychology. 45, 469–474.
Lantz, B. L. (1982) Preventing adolescent placement through Functional Family Therapy and tracking (Grant No. CDP 1070 UT 83-0128020 87-6000-545-W). Utah Department of Social Services.
Parsons, B. V. & Alexander, J. F. (1973) Short-term family intervention: A therapy outcome study. Journal of Consulting and Clinical Psychology. 41 (2), 195–201.
Regas, S. & Sprenkle, D. (1982) Functional Family Therapy with hyperactive adolescents. Paper presented at the meeting of the American Association for Marital and Family Therapy, Dallas, TX.
Rohde, P., Waldron, H. B., Turner, C. W., Brody, J. & Jorgensen, J. (2014) Sequenced versus coordinated treatment for adolescents with comorbid depressive and substance use disorders, Journal of Consulting and Clinical Psychology. 82 (2), 342–8.
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.
Slesnick, N. & Prestopnik, J. (2009) Comparison of family therapy outcome with alcohol-abusing, runaway adolescents. Journal of Marital and Family Therapy. 35 (3), 255–277.
Stanton, M. D. & Shadish, W. R. (1997) Outcome, attrition, and family–couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies. Psychological Bulletin. 122 (2), 170–191.
Stout, B. D. & Holleran, D. (2013) The impact of evidence-based practices on requests for out-of-home placements in the context of system reform. Journal of Child and Family Studies. 22 (3), 311–321.
White, S. F., Frick, P. J., Lawing, K. & Bauer, D. (2013) Callous-unemotional traits and response to functional family therapy in adolescent offenders. Behavior Sciences & the Law. 31 (2), 271–285.
Note on provider involvement: This provider has agreed to Foundations’ terms of reference (or the Early Intervention Foundation's terms of reference), and the assessment has been conducted and published with the full cooperation of the intervention provider.
Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.
Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.
Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.
Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.
Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.
Set up and delivery cost is not applicable, not available, or has not been calculated.
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Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing child maltreatment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Enhancing school achievement & employment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
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Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.
Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.
Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.
Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.
Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.
Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.
Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.
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