Model Effectiveness

Despite research demonstrating the efficacy of family-based interventions, such as FFT, in improving adolescent behavior problems and parent/family functioning, the treatment costs associated with applying these interventions may prohibit the widespread utilization of family interventions in community agencies. Moreover, the complexity of these interventions may overwhelm the typical service provider that work with youth in families in child welfare settings. As such, a first step in developing the FFT-CW® model involved Dr. James Alexander working closely with child welfare directors and staff at New York Foundling to develop a protocol that tailored the intensity of services to match the severity of the problems faced by the family. In this way, FFT-CW® was developed as a continuum of care model in which interventions are applied in a manner contingent upon the family’s initial risk status. Families are triaged into two levels of service based on the severity of the family’s presenting problems: FFT Child Welfare-High Risk (FFT CW HR) or FFT Child Welfare-Low Risk (FFT CW LR). This approach is an efficient, cost-effective way to use community resources for clients’ prevention and treatment needs.

A second adaptation in the creation of FFT-CW® involved systematically integrating a developmental focus into the FFT-CW® model that expanded the age range from 11-18 (which is a standard age range for the population that the evidence-based FFT model serves) to include youth from 0-18. Dr. Alexander directly supervised a graduate student and FFT LLC staff (trainers and consultants) to review the extant research literature to include information about developmental considerations for younger children. The infusion of these developmental considerations into the clinical model involved careful attention to understanding how the relational functions (interpersonal connection and relational hierarchy) vary as a function of youth development stage (age as well as cognitive ability). The integration of new parenting modules for younger children represents one of the most significant adaptations driven by this developmental focus.

A third adaptation involved expanding the treatment focus from the target youth (typically a delinquent or substance-abusing adolescent) to all family members in the FFT-CW® High Risk Track. The tested FFT model has historically addressed problems of other (non-target) family members. For example, in our earliest trial, we included systematic relaxation techniques for a parent with significant anxiety symptoms in a family with a severely delinquent youth. However, the consistency and range of these additional family targets is what makes FFT-CW® different from the tested FFT model. Also, the nature of the “problems” experienced by multiple family members is different when the referral source is primarily child welfare as opposed to juvenile justice, school or mental health. As such, significant adaptations were also required provide a comprehensive approach for addressing multiple behavioral and psychological issues. For example, as noted above, FFT has been applied primarily with behavior problem youth, and – although these youth often present with a number of co-occurring disorders – the behavioral issue is typically the primary target of treatment. In contrast, in FFT-CW® the focus is often on internalizing issues, such as depression, anxiety, PTSD, etc. In many ways, FFT-CW® was developed to function in a “general practitioner” model of practice. This was accomplished by systematically integrating specific (and state-of-the-science) strategies into the behavior change phase of the FFT-High Risk track. Under the leadership of Dr. Alexander and in collaboration with Drs. Robbins and Hollimon (FFT LLC), specific modules were developed for addressing substance use, depression, anxiety, PTSD (trauma), etc. These modules provide therapists with specific, evidence-based techniques for helping common syndromes or symptoms.

Finally, the FFT-CW® Low Risk Track described above was heavily influenced by the work that FFT LLC has led in training probation officers in Functional Family Probation Services. It is an adaptation of FFT that FFT LLC created and has been implemented with more than 300 probation officers nationally and internationally, as well as for 400 child welfare workers at the Bureau of Youth Care, Amsterdam, NL.

As in FFP®, the FFT-LR intervention is organized in three (as opposed to five) phases of intervention: engagement/motivation, support/monitor and generalization. Also, relational assessment is a central organizing principle in facilitating long-term change that is matched to families. The key difference is that in the Low Risk Track, interventionists are not expected to directly facilitate changes in the family. Rather, interventionists function in a case manager role by matching family members to interventions or programs in the community to address their needs in a way that matches each person’s relational functions. These linking functions are consonant with the skills and expertise typical in case workers in the child welfare system. However, the impact of this process is enhanced by creating changes that are consistent with the family processes considered to be essential for sustaining changes over time.

Results of FFT with Delinquent, Drug Using Youth: Support for FFT-HR

Early research on FFT showed the promise of the intervention for youth and families in child welfare (Barton et al., 1985). Specifically, this study demonstrated that youth at risk for outplacement who were treated by case workers in the child welfare system had significantly lower foster placement referrals (11%) than youth treated by case workers with no or limited training in FFT (49%). Also, there was a significant reduction in the units of service per family (14.7 to 6.2). These findings showed the promise of FFT in child welfare settings, not only with respect to clinical outcomes, but also with respect to costs. That is, the “…data suggest that the FFT trained workers did a better job and did it less expensively” (p. 21) (Barton et al., 1985).

Also, because the High Risk track (FFT-HR) is modeled after the tested FFT model, the evidence base for FFT provides broad support for the FFT-CW® model.

FFT Evidence Studies Implementation Information
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Comparison Between FFT-CW® and Usual Care Sample
 See Article