Functional Family Therapy (FFT)
Blueprints Program Rating: Model
A short-term family therapy intervention and juvenile diversion program helping at-risk children and delinquent youth to overcome adolescent behavior problems, conduct disorder, substance abuse and delinquency. Therapists work with families to assess family behaviors that maintain delinquent behavior, modify dysfunctional family communication, train family members to negotiate effectively, set clear rules about privileges and responsibilities, and generalize changes to community contexts and relationships.
- Delinquency and Criminal Behavior
- Illicit Drug Use
- Family Therapy
- Juvenile Justice, Other
- Juvenile Justice Setting
- Mental Health/Treatment Center
- Social Services
- Transitional Between Contexts
Continuum of Intervention
- Selective Prevention (Elevated Risk)
- Indicated Prevention (Early Symptoms of Problem)
- Early Adolescence (12-14) - Middle School
- Late Adolescence (15-18) - High School
- Male and Female
- All Race/Ethnicity
- : Effective
- : Model
- : Effective
Program Information Contact
- James F. Alexander, Ph.D
- University of Utah
Brief Description of the Program
Functional Family Therapy (FFT) is a short-term (approximately 30 hours), family-based therapeutic intervention for delinquent youth at risk for institutionalization and their families. FFT is designed to improve within-family attributions, family communication and supportiveness while decreasing intense negativity and dysfunctional patterns of behavior. Parenting skills, youth compliance, and the complete range of behaviors (cognitive, emotional, and behavioral) domains are targeted for change based on the specific risk and protective factor profile of each family. FFT should be implemented with a team of 3-8 master's level therapists, with caseloads of 10-12 families, with oversight by a licensed clinical therapist.
See: Full Description
Studies across several locations demonstrated program benefits for recidivism among juveniles:
- In a Utah study, FFT families showed significant improvement compared to no treatment and alternative treatment groups in rates of reoffense (26% versus 47%-73%), juvenile court records of siblings of targeted youth (20% versus 40%-63%), and recidivism among serious delinquent youth (60% versus 89%-93).
- In an Ohio study, FFT families showed significant improvement compared to usual services in recidivism after 28 months (11% versus 67%) and after 60 months (9% versus 41%).
- In a Swedish study with a 2-year follow-up, FFT families showed improvement compared to a usual-treatment group in recidivism (41% versus 82%) and in youth and parent reports of externalizing and internalizing symptoms.
- In a Washington State study, FFT families who worked with a competent therapist showed significant improvement in 18-month recidivism (44% versus 50%-54%) compared to families in control groups or working with not competent therapists.
- A meta-analysis of effect size for eight evaluations of FFT (Aos et al., 2011) reported an adjusted mean effect size of -.32.
One study done in Albuquerque examined outcomes relating to marijuana use:
- FFT youth (either alone or in combination with another therapy) showed significant reductions at four months in marijuana use (55% to 25% and 57% to 38%, respectively), while the other therapy and control groups did not.
- FFT youth showed significant reductions in heavy to minimal marijuana use at four months (87% to 55%), as did the other therapy and the combined FFT and therapy groups, while the control group did not.
Program effects on Risk and Protective Factors:
- Improvements in family interaction patterns (Alexander & Parsons, 1973)
FFT has been applied with a wide range of population demographics, with non-White youth representing 10-60 percent of the sample.
Risk and Protective Factors
- Individual: Antisocial/aggressive behavior, Early initiation of antisocial behavior, Early initiation of drug use, Favorable attitudes towards antisocial behavior, Favorable attitudes towards drug use, Hyperactivity, Rebelliousness, Substance use*
- Peer: Interaction with antisocial peers, Peer substance use
- Family: Family conflict/violence, Family history of problem behavior, Neglectful parenting, Parental attitudes favorable to antisocial behavior, Parental attitudes favorable to drug use, Poor family management, Violent discipline
- Individual: Clear standards for behavior, Problem solving skills, Prosocial behavior, Prosocial involvement, Skills for social interaction
- Peer: Interaction with prosocial peers
- Family: Attachment to parents, Non-violent discipline, Opportunities for prosocial involvement with parents, Parent social support, Rewards for prosocial involvement with parents
*Risk/Protective Factor was significantly impacted by the program.
Training and Technical Assistance
Training Certification Process
The primary goal of the FFT implementation and certification process is the successful replication of the FFT program as well as its long-term viability at individual community sites. The FFT Site Certification is a 3-phase process:
Phase 1 - Clinical Training: The initial goal of the first phase of FFT implementation is to impact the service delivery context so that the local FFT program builds a lasting infrastructure that supports clinicians to take maximum advantage of FFT training/consultation. By the end of Phase I, FFT's objective is for local clinicians to demonstrate strong adherence and high competence in the FFT model. Assessment of this goal is based on data gathered through the FFT Clinical Service System, FFT weekly consultations, and during phase I FFT training activities. Phase I should last between one year and 18 months. Periodically during Phase I, FFT personnel provide the site feedback to identify progress toward Phase I implementation goals. By the eighth month of implementation, FFT will begin discussions to identify steps toward starting Phase II of the Site Certification process.
Phase II - Supervision Training: The goal of the second phase of FFT implementation is to assist the site in creating greater self-sufficiency in FFT, while also maintaining and enhancing site adherence/competence in the FFT model. The essential goal of this phase is to develop competent on-site FFT supervision. During Phase II, FFT trains a site's extern to become the on-site supervisor. This person attends two 2-day supervisor trainings, and then is supported by FFT through monthly phone consultation. FFT provides one 1-day on-site training or regional training during Phase II. In addition, FFT provides any ongoing consultation as necessary and reviews the site's FFT CSS database to measure site/therapist adherence, service delivery trends, and outcomes. Phase II is a yearlong process.
Phase III - Practice Research Network: The goal of the third phase of FFT implementation is to move into a partnering relationship to assure ongoing model fidelity, as well as impacting issues of staff development, interagency linking, and program expansion. FFT reviews the CSS database for site/therapist adherence, service delivery trends, and client outcomes, and provides a one-day on-site training for continuing education in FFT.
Phase I "Clinical Training" Activities include:
STEP 1: One-day on-site implementation/assessment and CSS training. This initial visit covers implementation issues for both administration and staff. It includes: a 2-hour overview of best practices and the FFT clinical model for referral agents, stakeholders, funders, and agency staff. Additional time is spent in addressing site-specific implementation challenges (i.e., referral criteria, referral process, integration of services, working w/ referral agents, supervision, computers,etc.). The identified FFT team of clinicians is trained in the FFT Clinical Service System, including use of FFT software and assessment protocols.
STEP 2: Two-Day On-Site Clinical Training. The two-day on-site introduction covers the core constructs, phases, assessment and intervention techniques of FFT. Didactic materials include handouts and videotape examples.
STEP 3: Begin Cases (using FFT, the Assessment protocol, and the CSS).
STEP 4: Ongoing Telephone Supervision. Each team receives telephone supervision as a group for one hour per week. Supervision focuses particularly on individual cases and model adherence.
STEP 5: Externship. This intensive, hands on, training experience with actual clients includes supervision from behind the mirrored window. The externship consists of three separate training experiences for three consecutive months. The clinician expected to be trained in Phase Two as the on-site FFT supervisor typically attends this training.
STEP 6: Two-Day Follow-up Visits (3 per site during year 1). The three on-site follow-up training sessions, each of two days in duration, represent more specific focus on implementation issues and processes.
STEP 7: Two-Day Clinical Training. The entire FFT Clinical Team goes to an off-site location for additional team and individual training in the FFT model.
ONGOING: Implementation and Consultation
Implementation and consultation services are directed at helping sites implement FFT with respect to such issues as staff development, interagency linking, and program expansion.
Brief Evaluation Methodology
FFT is supported by 38 years of investigation that has demonstrated improvements with difficult to treat adolescents and their families in a range of settings and delivery sites. FFT has been evaluated in multiple studies in samples across the United States, and in Sweden. Study design has ranged from random assignment to treatment conditions, to quasi-experimental designs that involved matched but not randomly assigned comparison groups, to comparisons with base rates for that population.
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.
Aos, S., Lee, S., Drake, E., Pennucci, A., Klima, T., Miller, M., Anderson, L., Mayfield, J., & Burley, M. (July, 2011). Return on Investment: Evidence-Based Options to Improve Statewide Outcomes (Document No. 11-07-1201A). Olympia: Washington State Institute for Public Policy.
Barnoski, R. (2004, January). Outcome evaluation of Washington State's research-based programs for juvenile offenders (Document No. 04-01-1201). Olympia: 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 behavior problems. OJJDP Journal of Juvenile Justice, 2(2), 23-36.
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. R. Ross, D. H. Antonowicz, & G. K. Dhaliwal (Eds.), Going straight: Effective delinquency prevention and offender rehabilitation (pp.163-178). Ottawa, Ontario, Canada: Air Training and Publications.
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.
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.
Klein, N. C., Alexander, J. F., & Parsons, B. V. (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, 469-474.
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.
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.