Risk Reduction through Family Therapy (RRFT)
About This Program
Target Population: Trauma-exposed adolescents aged 13-18 years who experience co-occurring trauma-related mental health problems (e.g., posttraumatic stress disorder [PTSD], depression), substance use problems, and other risk behaviors (e.g., risky sexual behavior, non-suicidal self-injury)
For children/adolescents ages: 13 – 18
For parents/caregivers of children ages: 13 – 18
Program Overview
RRFT is an integrative, ecologically informed, and exposure-based approach to addressing co-occurring symptoms of PTSD (and other mental health problems), substance use problems, and other risk behaviors often experienced by trauma-exposed adolescents. RRFT is novel in its integration of these components, given that standard care for trauma-exposed youth often entails treatment of substance use problems separate from treatment of other trauma-related psychopathology. RRFT is individualized to the needs, strengths, developmental factors, and cultural background of each adolescent and family. The pacing and ordering of RRFT components are flexible and determined by the needs of each family and symptom severity in each domain. Substance use (as relevant) and posttraumatic stress (PTS) symptoms are monitored throughout treatment to help track progress and guide clinical decision making. The average frequency and duration of RRFT depends on the symptom level of each youth, but typically involves 18-24 weekly, 60-90 minute sessions with periodic check-ins between scheduled appointments.
Program Goals
The goals of Risk Reduction through Family Therapy (RRFT) are:
- Reductions in symptoms of trauma-related mental health problems (e.g., PTSD, depression)
- Reductions in substance use and substance use risk factors (e.g., time spent with substance using peers) and increases in protective factors (e.g., coping skills/distress tolerance, parental monitoring, family activities, prosocial activities, etc.)
- Improved family communication and cohesion
- Increased knowledge and skills related to healthy dating and sexual decision making
- Reductions in risk factors for revictimization
Logic Model
The program representative did not provide information about a Logic Model for Risk Reduction through Family Therapy (RRFT).
Essential Components
The essential components of Risk Reduction through Family Therapy (RRFT) include:
- Service Delivery Method:
- Individual and family psychotherapy sessions (Although RRFT can be implemented with teens who do not have a participating caregiver, RRFT clinicians work diligently to engage caregivers whenever possible and/or identify safe and appropriate adults who may become involved as a support to the teen moving forward.)
- Brief contacts via phone or other means (e.g., text messages) between sessions
- Frequency & Duration: Depends on the symptom level of each youth, but typically involves 18-24 weekly, 60-90 minute sessions with periodic check-ins between scheduled appointments
- Setting: RRFT can be implemented in a variety of practice settings including:
- Outpatient clinics
- Residential treatment facilities
- School-based outreach services
- Home-based outreach services
- Symptom Profile: Youth most likely to benefit from RRFT demonstrate:
- Clinically significant symptoms of posttraumatic stress
- Past or current substance use, or markedly elevated risk for future substance use (e.g., personal or family history of substance use; spends time with substance using peers)
- Treatment Components:
- Psychoeducation and Engagement
- Family Communication
- Coping
- Substance Abuse
- PTSD
- Healthy Dating and Sexual Decision Making
- Revictimization Risk Reduction
Program Delivery
Child/Adolescent Services
Risk Reduction through Family Therapy (RRFT) directly provides services to children/adolescents and addresses the following:
- PTSD, depression, substance use problems, risky sexual behavior, nonsuicidal self-injury, family conflict
Parent/Caregiver Services
Risk Reduction through Family Therapy (RRFT) directly provides services to parents/caregivers and addresses the following:
- Poor parental monitoring; family conflict; caregiver of youth with trauma-related mental health problems, substance use problems, or other risky behaviors
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: When caregivers are not available, RRFT will work with the youth to identify safe and appropriate adults who may become involved as a support to the teen moving forward.
Recommended Intensity:
Weekly 60-90 minute sessions with brief, intermittent contact in between session (via phone, texts, etc.)
Recommended Duration:
18-24 sessions
Delivery Settings
This program is typically conducted in a(n):
- Adoptive Home
- Birth Family Home
- Foster / Kinship Care
- Outpatient Clinic
- Community-based Agency / Organization / Provider
- Group or Residential Care
- School Setting (Including: Day Care, Day Treatment Programs, etc.)
Homework
Risk Reduction through Family Therapy (RRFT) includes a homework component:
Youth and caregivers are assigned weekly homework typically geared toward skill building and practice. RRFT clinicians utilize brief check-ins (e.g., by phone, text, etc.) to promote success in accomplishing homework assignments.
Resources Needed to Run Program
The typical resources for implementing the program are:
Private room for sessions, music and art supplies not required but highly recommended
Manuals and Training
Prerequisite/Minimum Provider Qualifications
Graduate degree in counseling, clinical psychology, social work, or related field; competent TF-CBT Clinician; completion of RRFT training
Manual Information
There is a manual that describes how to deliver this program.
Training Information
There is training available for this program.
Training Contact:
- Carla Kmett Danielson, PhD
danielso@musc.edu
Training Type/Location:
Please contact Dr. Danielson (danielso@musc.edu) for more information.
Number of days/hours:
Please contact Dr. Danielson (danielso@musc.edu) for more information.
Additional Resources:
There currently are additional qualified resources for training:
Please contact Dr. Danielson (danielso@musc.edu) for more information.
Implementation Information
Pre-Implementation Materials
There are no pre-implementation materials to measure organizational or provider readiness for Risk Reduction through Family Therapy (RRFT).
Formal Support for Implementation
There is formal support available for implementation of Risk Reduction through Family Therapy (RRFT) as listed below:
Typically, ongoing telephone-based consultation is provided to participants of RRFT trainings and implementation projects. Please contact Dr. Danielson (danielso@musc.edu) for more information.
Fidelity Measures
There are fidelity measures for Risk Reduction through Family Therapy (RRFT) as listed below:
Fidelity measures have been developed for the research evaluations of RRFT, including the currently ongoing NIDA funded randomized controlled trial. These measures track how therapists are proceeding through the intervention components with the families they serve and whether/how key treatment elements are being implemented during and between sessions. The fidelity measure, along with the RRFT Supervision form that can aid in implementation with fidelity, is provided as part of the training package.
Implementation Guides or Manuals
There are implementation guides or manuals for Risk Reduction through Family Therapy (RRFT) as listed below:
The implementation manual is available to providers who have participated in RRFT trainings. It provides an overview of the rationale and development of RRFT, evidence supporting the treatment model, and descriptions and illustrative activities and case examples for each intervention component.
Research on How to Implement the Program
Research has not been conducted on how to implement Risk Reduction through Family Therapy (RRFT).
Relevant Published, Peer-Reviewed Research
Child Welfare Outcome: Child/Family Well-Being
Danielson, C. K., McCart, M., de Arellano, M. A., Macdonald, A., Silcott, L., & Resnick, H. (2010). Risk reduction for substance use and trauma-related psychopathology in adolescent sexual assault victims: Findings from an open trial. Child Maltreatment, 15(3), 261–268. https://doi.org/10.1177/1077559510367939
Type of Study:
One-group pretest–posttest study
Number of Participants:
10
Population:
- Age — 13–17 years
- Race/Ethnicity — 5 Caucasian, 4 African American, and 1 Hispanic
- Gender — 100% Female
- Status — Participants were adolescents who had experienced sexual assault.
Location/Institution: Not specified
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the feasibility of implementation and initial efficacy of Risk Reduction through Family Therapy (RRFT) with female adolescents who had experienced at least one memorable sexual assault in their lifetime. Measures utilized include the Time Line Follow Back Interview (TLFB), the UCLA PTSD Index for DSM–IV–Adolescent & Caregiver versions, the Child Depression Inventory (CDI), the Ecological Functioning Measure, and the Family Environment Scale (FES). Results indicate that at 6-month follow-up, reductions were reported in substance use and substance use-related risk factors, as evidenced by modest improvements in family cohesion and conflict levels and by improvements in other areas of ecological functioning (e.g., increases in school/work attendance). In addition, large effects were found with regard to improvements in posttraumatic stress disorder (PTSD) and depression symptoms. Limitations include lack of control or comparison group, lack of randomization of participants, heterogeneity in symptom presentation limited ability to uncover signals of efficacy, and small sample size.
Length of controlled postintervention follow-up: 3 and 6 months.
Danielson, C. K., McCart, M., Walsh, K., de Arellano, M. A., White, D., & Resnick, H. S. (2012). Reducing substance use risk and mental health problems among sexually assaulted adolescents: A pilot randomized controlled trial. Journal of Family Psychology, 26(4), 628–635. https://doi.org/10.1037/a0028862
Type of Study:
Randomized controlled trial
Number of Participants:
30
Population:
- Age — 13–17 years
- Race/Ethnicity — 46% African American, 38% White, 8% Biracial, 4% Native American, and 4% Hispanic
- Gender — 88% Female
- Status — Participants were caregivers and adolescents who had experienced sexual assault.
Location/Institution: Not specified
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the feasibility and efficacy of Risk Reduction through Family Therapy (RRFT) for reducing substance use risk and trauma-related mental health problems among sexually assaulted adolescents. Participants and their caregivers were randomized to RRFT or treatment as usual (TAU) conditions. Measures utilized include the Time Line Follow Back Interview (TLFB), the UCLA PTSD Index for DSM–IV–Adolescent & Caregiver versions, the Child Depression Inventory (CDI), and the Behavioral Assessment System for Children (BASC-2). Results indicate that at 6-month follow-up, adolescents who received RRFT reported reduced substance use and improvements in substance use risk factors (e.g., increased family cohesion). Participants in both conditions experienced reductions in posttraumatic stress disorder (PTSD) and depression symptoms, although greater reductions were found for adolescents in the RRFT condition with regard to parent-reported PTSD, as well as adolescent-reported depression and internalizing symptoms. Limitations include small sample size, issues with the randomization of participants that resulted in differences between the groups at baseline, reliance on self-reported measures as reduction in symptoms were significant for adolescent reports but not for parent report, and lack of generalizability due to the primarily female participant gender.
Length of controlled postintervention follow-up: 3 and 6 months.
Danielson, C. K., Adams, Z., McCart, M. R., Chapman, J. E., Sheidow, A. J., Walker, J., Smalling, A., & de Arellano, M. A. (2020). Safety and efficacy of exposure-based risk reduction through family therapy for co-occurring substance use problems and posttraumatic stress disorder symptoms among adolescents: A randomized clinical trial. JAMA Psychiatry, 77(6), 574–586. https://doi.org/10.1001/jamapsychiatry.2019.4803
Type of Study:
Randomized controlled trial
Number of Participants:
124
Population:
- Age — 13–18 years (Mean=15.4 years)
- Race/Ethnicity — 63% White, 29% Black, 6% Latino, 5% Hispanic, and 2% Biracial
- Gender — 87% Female and 13% Male
- Status — Participants were adolescents with substance use problems and posttraumatic stress disorder.
Location/Institution: Community-based child advocacy centers in the Southeastern United States
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to determine whether Risk Reduction through Family Therapy (RRFT) resulted in improved outcomes relative to a treatment-as-usual (TAU) control condition consisting primarily of trauma-focused cognitive behavioral therapy. Participants were randomized to RRFT or treatment as usual (TAU) conditions. Measures utilized include the Time Line Follow Back Interview (TLFB), and the UCLA PTSD Index for DSM–IV–Adolescent & Caregiver versions. Results indicate that for primary outcomes relative to TAU, RRFT yielded significantly greater reductions in substance-using days from baseline to month 12 and month 18. Significant reductions in PTSD symptoms were observed within RRFT groups from baseline to months 3 and 18 and for TAU from baseline to months 3, 6, 12, and 18; however, between-group differences were not observed. Limitations include length of treatment was not equivalent for RRFT and TAU, reliance on self-reported measures, and lack of generalizability due to the primarily female participant gender.
Length of controlled postintervention follow-up: 12 months.
Additional References
Danielson, C. K. (2014). Risk Reduction through Family Therapy. In B. Reece, R. Hanson, & J. Sargent (Eds), Treatment of child abuse: Common ground for mental health, medical, and legal professionals (2nd ed., pp. 154-167). Baltimore: John Hopkins University Press.
Danielson, C. K. (2007). Risk Reduction through Family Therapy (RRFT): Treatment manual. National Crime Victims Research & Treatment Center, Medical University of South Carolina.
Danielson, C. K., Begle, A. M., Ayer, L., & Hanson, R. H. (2012). Psychosocial treatment of traumatized juveniles. In E. Grigorenko (Ed.), Handbook of juvenile forensic psychology and psychiatry (pp. 467-484). New York: Springer.
Contact Information
- Carla Kmett Danielson, PhD
- Agency/Affiliation: MUSC National Crime Victims Research & Treatment Center
- Website: medicine.musc.edu/departments/psychiatry/research/invictus-lab/research
- Email: danielso@musc.edu
- Phone: (843) 792-3599
- Fax: (843) 792-3388
Date Research Evidence Last Reviewed by CEBC: July 2023
Date Program Content Last Reviewed by Program Staff: March 2016
Date Program Originally Loaded onto CEBC: July 2016
