Program Goals

The goals of Functional Family Therapy Child Welfare® (FFT - CW®) are:

• Reduce/eliminate within family violence, child abuse, harsh/punitive discipline practices, and family conflict
• Prevent youth/family member outplacement
• Prevent intensification/escalation of services
• Improve parenting practices
• Improve family communication
• Develop specific skills to address risk/protective factors that are associated with abuse/neglect, such as (but not limited to) emotion regulation, coping, anger management, problem-solving, and decision-making

Logic Model

The program representative did not provide information about a Logic Model for Functional Family Therapy Child Welfare® (FFT - CW®).

Essential Components

The essential components of Functional Family Therapy Child Welfare® (FFT - CW®) include:

• Two tracks based on the level of risk of abuse/neglect by the caregivers or other family members:
• High Risk Track:
• Five distinct intervention phases:
• Engagement: Introduction/Impression (Pre-Intervention)
• Motivation: Induction/Therapy (Early sessions)
• Relational Assessment (by conclusion of early sessions)
• Behavior Change (Middle sessions)
• Generalization (Later sessions)
• Each phase has its own unique goals, risk and protective factors addressed, assessment focus, and therapist skills and intervention focus:
• Engagement:
• Goal: Maximize family initial expectation of positive change
• Risk and Protective Factors Addressed:
• Negative perception about or experiences with treatment
• Reputation of treatment agency
• Transportation
• Therapist availability
• Intake staff skills and attitudes
• Assessment Focus: Superficial qualities inferred from referral source and initial screening
• Therapist Skills/Intervention Focus:
• High availability
• Manage intake processes to present agency, self, and treatment in a way that matches to inferred family characteristics
• Enhance perception of credibility
• Motivation:
• Goal: Create a motivational context for long-term change
• Risk and Protective Factors Addressed:
• Family negativity and blame
• Hopelessness
• Level of motivation
• Assessment Focus:
• Behavioral (presenting problem)
• Relational risk and protective factors
• Therapist Skills/Intervention Focus:
• Interpersonal skills (validation, positive reattribution, reframing, relational)
• Build balanced alliances
• Reduce negativity and blame
• Create hope
• Enhance motivation to change
• Relational Assessment:
• Goal: Complete relational (functional) assessment of family relationships to provide foundation for changing behaviors in subsequent phases
• Risk and Protective Factors addressed: none
• Assessment Focus:
• Relational Autonomy/Connectedness
• Relational Hierarchy
• Therapist Skills/Intervention Focus:
• Perceptiveness
• Observation
• Facilitate interactions or information about patterns of interaction
• Behavior Change:
• Goal: Facilitate individual and interactive/ relational change
• Risk and Protective Factors Addressed (note: below are examples, not an exhaustive list of potential factors that might be addresses in this phase):
• Youth temperament
• Parental pathology
• Beliefs and values
• Developmental level
• Parenting skills
• Conflict resolution/negotiation skills
• Level of family support
• Peer refusal skills
• Assessment Focus:
• Individual skills
• Quality of relational skills
• Relational problem sequence
• Compliance with behavior change plans
• Therapist Skills/Intervention Focus:
• Directive/teaching /structuring skills
• Modeling
• Setting up, leading, and reviewing in-session tasks
• Assigning homework
• Generalization:
• Goal: Maintain individual and family change, and facilitate change in multiple systems
• Risk and Protective Factors Addressed (note: below are examples, not an exhaustive list of potential factors that might be addresses in this phase):
• Youth bonding to school
• Parent attitudes about school, peers, drugs, etc.
• Level of social support
• Assessment Focus:
• Access to and utilization of community resources
• Maintenance of change
• Therapist Skills/Intervention Focus:
• Interpersonal and structuring skills
• Family case manager
• Accessing appropriate formal and informal community resources
• Anticipate and plan for future extra-familial stresses
• Low Risk Track (3 Phases)
• Engagement and Motivation are combined into a single track with the focus being engagement of family members into services
• Generalization is the same as in the High Risk track
• Support and Monitoring Phase replaces Behavior Change
• Focus is to facilitate connections to external services/systems that are intended to address specific risk and protective factors
• Interventionists support family members throughout their involvement with external systems and monitor that family members are receiving services

Program Delivery

Child/Adolescent Services

Functional Family Therapy Child Welfare® (FFT - CW®) directly provides services to children/adolescents and addresses the following:

• Problems/symptoms such as oppositional behaviors; delinquent, criminal, acting-out behaviors; fighting, anger, impulsivity; substance use; depression; self-harm; anxiety; truancy/school performance; and outplacement (foster, residential, acute hospitalization)

Parent/Caregiver Services

Functional Family Therapy Child Welfare® (FFT - CW®) directly provides services to parents/caregivers and addresses the following:

• Problems/symptoms such as abusive parenting behaviors; neglectful parenting behaviors (including educational neglect); violent behaviors (inside and outside of home); substance use; criminal involvement; depression; anxiety; and outplacement of children

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: FFT - CW® is a comprehensive, multisystemic intervention that addresses risk/protective factors across the entire youth/family members' social ecology. As such, the involvement of family members, extended family members, fictive kin (nonfamily members that function in family-like roles) and formal (teachers, health providers) and informal (spiritual, social groups) is a key aspect of the intervention. All sessions are conjoint (e.g., with key family members). The involvement of external, family support networks is increasingly relevant in later phases of treatment and in long-term planning to ensure that maintenance of changes over time.

Recommended Intensity:

One weekly 45-60 minute session on average

Recommended Duration:

5-7 months on average

Delivery Settings

This program is typically conducted in a(n):

• Birth Family Home
• Foster / Kinship Care
• Outpatient Clinic
• Community-based Agency / Organization / Provider

Homework

Functional Family Therapy Child Welfare® (FFT - CW®) includes a homework component:

Homework is assigned at the conclusion of weekly sessions and is individualized to the needs of each family.

Resources Needed to Run Program

The typical resources for implementing the program are:

• A good quality speakerphone for conducting weekly clinical consultation
• Provision for therapist/interventionist transportation and cellular phone if home-based services are being conducted
• Ample meeting space for conducting family therapy if conducting services in an office/clinical setting
• Adequate computer and internet access for each FFT - CW® therapist

Manuals and Training

Prerequisite/Minimum Provider Qualifications

In the high-risk track, the therapists should have a master's degree. Site supervisors must hold a master's degree or above. Previous experience in family therapy and/or work in child welfare settings is preferred.

In the low-risk track, interventionists should have at least a bachelor's degree.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

• Alexander, J. F., Niermann, A., Neeb, A, Kopp, D., Demaranville, H., Hollimon, A., & Robbins, M. S. (Oct. 2011). Functional Family Therapy Child Welfare® (FFTCW®) clinical manual. FFT_LLC.

The manual can be accessed through the program contact below.

Training Information

There is training available for this program.

Training Contact:

• Holly DeMaranville
  www.fftllc.com
  holly@fftllc.com
  phone: (206) 369-5894

Training Type/Location:

Phase 1 training entails the following:

• One 1-day on-site stakeholder orientation
• One 2-day on-site clinical training
• Weekly telephone consultation
• Three 2-day on-site follow-up trainings
• Off-site externship for Site Supervisor (Three 3-day events)

Phase 2 training entails the following:

• Two 2-day off-site FFT Lead/Supervisor Trainings
• Bi-monthly telephone consultation with Lead/Supervisor
• One 1-day on-site follow-up training

Phase 3 training entails the following:

• One 1-day on-site follow-up training
• Monthly phone consultation with Lead/Supervisor

Number of days/hours:

Phase 1:

• 1 day of training of Stakeholders/Administrators
• 9 days of training for all therapists
• 9 extra days of training for site supervisor
• 52 hours of weekly 1-hour phone consultation for both therapists and supervisor

Phase 2:

• 1 day of training for therapists
• 4 days of training for site supervisor
• 24 hours of bi-monthly 1-hour phone consultation for site supervisor

Phase 3:

• 1 day of training for therapists and site supervisor
• 12 hours of monthly 1-hour phone consultation for site supervisor

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Functional Family Therapy Child Welfare® (FFT - CW®) as listed below:

The FFT - CW® Site application can be found on the FFT website (www.fftllc.com).

Formal Support for Implementation

There is formal support available for implementation of Functional Family Therapy Child Welfare® (FFT - CW®) as listed below:

There are three phases of FFT - CW® training and FFT LLC always maintains a relationship with all certified teams. During Phase 1, the focus is on training in the concepts of the model and building therapist competent (e.g., fidelity) implementation of the FFT - CW® model. During Phase 2, the focus is on training a local supervisor to ensure that the team remains competent in their implementation of the model. During Phase 3, the focus is on maintenance of fidelity and sustainability of outcomes.

Fidelity Measures

There are fidelity measures for Functional Family Therapy Child Welfare® (FFT - CW®) as listed below:

FFT LLC uses a proprietary measure that is completed by an FFT LLC Consultant during Phase 1 of training and an on-site supervisor in Phase 2 and 3 of implementation. The measure is intended to be completed on a weekly basis for each therapist on a team, and scores are based on therapists’ case notes and description of their activities during a session with a family, and is specific to treatment phase in which the session was conducted. Scores are summarized on a 7-point Likert-type scale, ranging from 0 (low fidelity) to 6 (high fidelity).

Fidelity Measure Requirements:

Fidelity measures are required to be used as part of program implementation.

Established Psychometrics:

Cosgrove, J. A. (2020). Fidelity and alliance effects on youth outcomes of Functional Family Therapy. [Dissertation, University of Maryland]. Baltimore ProQuest Dissertations Publishing. Available at this link.

Turner, C. W., Robbins, M. S., Rowlands, S., & Weaver, L. R. (2017). Summary of comparison between FFT-CW® and Usual Care from Administration for Children's Services. Child Abuse and Neglect, 69, 85–95. https://doi.org/10.1016/j.chiabu.2017.04.005

Implementation Guides or Manuals

There are implementation guides or manuals for Functional Family Therapy Child Welfare® (FFT - CW®) as listed below:

All certified teams receive training slides and manuals throughout the training process. They are not publicly available.

Implementation Cost

There have been studies of the costs of implementing Functional Family Therapy Child Welfare® (FFT - CW®) which are listed below:

Shakeshaft, A., Economidis, G., D’Este, C., Oldmeadow, C., Tran, D. A., Nalukwago, S., Jopson, W., Farnbach, S., & Doran, C. (2020, June). The application of Functional Family Therapy-Child Welfare (FFT-CW®) and Multisystemic Therapy for Child Abuse and Neglect (MST-CAN®) to NSW: An early evaluation of processes, outcomes, and economics. https://doi.org/10.26190/unsworks/28306

Whittle, S. (2020). Update report: March 2020. Edge of Care Interventions Board, Leicester City Council. Leicester, UK.

Research on How to Implement the Program

Research has not been conducted on how to implement Functional Family Therapy Child Welfare® (FFT - CW®).

Relevant Published, Peer-Reviewed Research

Additional References