The implementation and the cultural adjustment of functional family therapy in a Dutch psychiatric day-treatment center

Interrelatedness of Family and Parenting Risk Factors for Juvenile Delinquency: A Network Study in U.S. and Dutch Juveniles

Family interventions that address a diversity of family and parenting factors are often used to prevent juvenile delinquency, but are effective to only a limited extent. This study applied a network approach to risk factors for juvenile delinquency and examined the interrelatedness of specifically family and parenting risk factors in a U.S. and separate Dutch sample of juveniles and their family members. Differences in interrelatedness between these samples were examined as well. Secondary analyses were conducted on data collected in the United States with the Washington State Juvenile Court Assessment (WSJCA) and on data collected in the Netherlands with a Dutch-adapted translation of the WSJCA. Network analyses were performed, separately for the U.S. (N = 13,613) and Dutch (N = 3,630) sample, on seven risk factors that were assessed with a three-point Likert scale ranging from each factor's protective side to a corresponding risk side. In the U.S. sample network, "inadequate parental punishment" and "lack of parental supervision" that both refer to an authoritarian parenting style were the most "central" factors and had the strongest associations with the other risk factors. In the Dutch sample network, "the family not providing opportunities" and "inadequate parental reward" were the most "central" factors, which refer to an authoritative parenting style. The family and parenting factors identified as most central in the networks may be promising to address in family interventions, as it can be expected that both the directly addressed problems and their correlated problems will improve. The current results may inform attempts to strengthen family interventions for juvenile delinquency in the United States and the Netherlands.

Adolescent Gender and Age Differences in Responsiveness to Functional Family Therapy

The current study contributes to a sparse literature on moderators of Functional Family Therapy (FFT) by examining whether responsiveness to FFT, measured by a broad range of outcomes, varies by adolescent gender, age, and their interaction. This study was informed by 687 families (n, adolescents = 581; n, caregivers = 933) and utilized a pre-post comparison design. Fixed-effects regressions with gender, age, and their interaction included as explanatory variables were conducted to calculate the average change in youth mental health, callous-unemotional traits, academic outcomes, substance use, and family functioning. Moderation analyses revealed that according to parent report, girls had significantly greater improvements in peer problems and family functioning, and boys benefited more in increased liking of school. There were differential effects by age, such that older youth had less beneficial mental health outcomes and a smaller decrease in frequency of hash use. The gender by age interaction was significant for adolescents' report of mental health and family functioning outcomes, which suggests that girls benefit from FFT less than boys during early adolescence, but benefit more than boys in late adolescence. This finding adds to literature which has evidenced that family functioning is particularly important for girls by suggesting that FFT is important for improving older girls' mental health and family functioning in particular. The study's results expand the examination of outcomes of FFT to include academic outcomes, and provide insight into key factors that should be considered in addressing adolescent behavioral problems and family functioning.

An International Examination of the Effectiveness of Functional Family Therapy (FFT) in a Danish Community Sample

Youth behavior problems have increased in prevalence in Scandinavian countries. Functional Family Therapy (FFT) has been shown to be an effective intervention across diverse populations and international contexts. The current study examines the effectiveness of FFT within a Danish-community sample in a pre-post comparison design and includes 687 families. Observed outcomes included both parent- and/or youth- reported domains of youth behavior, family dysfunction, school attendance and performance, and substance use. Significant improvements were found in youth behavior, family functioning, and school-related outcomes (e.g., like of school and truancy) despite experiencing a 60% attrition rate in our sample postintervention. This study provides evidence for the effectiveness of FFT on a wide scale in a Scandinavian context, adding to previous research that supports the transportability of this intervention.

The Implementation of Functional Family Therapy (FFT) as an Intervention for Youth Probationers in Singapore

Family functioning is predictive of youth recidivism in Singapore. However, there is a lack of family based interventions for youth offenders on community probation. Evidence-based family interventions developed in Western populations, such as Functional Family Therapy (FFT), have been found to be effective in mitigating subsequent youth criminal behavior. However, no study has examined whether such interventions can be implemented and adapted for use in Eastern cultures. Thus, this paper sought to detail the implementation of FFT in Singapore. Rationale for the adoption of FFT is discussed, and key activities undertaken during the first 18 months of implementation are described. Preliminary data suggest that initial implementation efforts were successful. Challenges encountered, and implications in relation to the broader literature are discussed.

Application of the Strengths and Difficulties Questionnaire Added Value Score in evaluating the effectiveness of Functional Family Therapy within local authority social work services

BACKGROUND

As 'Blueprints' evidence-based programmes, such as Functional Family Therapy (FFT), originating from the United States, are increasingly implemented in Social Work services, the importance of assessing their effectiveness in a UK context is crucial. To do this, it is not always practical for services to commission randomised control trials or quasi-experimental control trials. The Strengths and Difficulties Questionnaire (SDQ) Added Value Score has been shown to have utility in the evaluation of intervention programmes by controlling for regression to the mean, attenuation and the shifting nature of most childhood psychopathology.

METHOD

The SDQ Added Value Score was used to assess the effectiveness of FFT in two local authorities in Scotland. One hundred and sixty-four families who had finished FFT completed the Strengths and Difficulties Questionnaire, the Outcome Questionnaire and the Client Outcome Measure at pre- and postintervention.

RESULTS

Both parents' and adolescents' average psychosocial distress scores significantly decreased on all measures after FFT and many of the scores postintervention fell to a range equivalent with the general population. Furthermore, calculation of the SDQ Added Value Score indicated that adolescents' mean total difficulties scores were lower following FFT than what would have been expected had this intervention not been received, producing an effect size that compares favourably to other interventions.

CONCLUSIONS

Functional Family Therapy has been identified as an effective intervention for improving the psychosocial functioning of high-risk adolescents and their families.

Multisystemic Therapy and Functional Family Therapy Compared on their Effectiveness Using the Propensity Score Method

Multisystemic Therapy (MST) and Functional Family Therapy (FFT) have overlapping target populations and treatment goals. In this study, these interventions were compared on their effectiveness using a quasi-experimental design. Between October, 2009 and June, 2014, outcome data were collected from 697 adolescents (mean age 15.3 (SD 1.48), 61.9% male) assigned to either MST or FFT (422 MST; 275 FFT). Data were gathered during Routine Outcome Monitoring. The primary outcome was externalizing problem behavior (Child Behavior Checklist and Youth Self Report). Secondary outcomes were the proportion of adolescents living at home, engaged in school or work, and who lacked police contact during treatment. Because of the non-random assignment, a propensity score method was used to control for observed pre-treatment differences. Because the risk-need-responsivity (RNR) model guided treatment assignment, effectiveness was also estimated in youth with and without a court order as an indicator of their risk level. Looking at the whole sample, no difference in effect was found with regard to externalizing problems. For adolescents without a court order, effects on externalizing problems were larger after MST. Because many more adolescents with a court order were assigned to MST compared to FFT, the propensity score method could not balance the treatment groups in this subsample. In conclusion, few differences between MST and FFT were found. In line with the RNR model, higher risk adolescents were assigned to the more intensive treatment, namely MST. In the group with lower risk adolescents, this more intensive treatment was more effective in reducing externalizing problems.

Barriers and Facilitators to Implementing Functional Family Therapy in a Community Setting: Client and Practitioner Perspectives

While Functional Family Therapy (FFT) is known to be effective in addressing adolescent behavioral problems, there has been little exploration of issues relevant to its transport from the tightly controlled setting of clinical trials into routine service delivery. This study sought the views of key stakeholders, clients, and practitioners, on barriers and facilitators to the successful implementation of FFT. Undertaken in a community setting in Scotland, interviews were carried out with 12 adolescents, 14 parents/caregivers, and 6 practitioners. Results focus on: Referral process and pre-intervention contact; Engagement of families; Structure and delivery; Organizational factors. Although barriers to engagement were identified, FFT was viewed as an acceptable, appropriate and feasible intervention with the potential to improve adolescent wellbeing in 'real-world' settings.

Brief Strategic Family Therapy: implementing evidence-based models in community settings

OBJECTIVE

To review a 40-year collaborative partnership between clinical researchers and clinicians, in developing, investigating and implementing Brief Strategic Family Therapy (BSFT).

METHOD

First, to review theory, practice and studies related to this evidenced-based therapy intervention targeting adolescent drug abuse and delinquency. Second, to present the BSFT Implementation Model created for the BSFT intervention-a model that parallels many of the recommendations from the implementation science literature.

RESULTS

Specific challenges encountered during the BSFT implementation process are reviewed, along with ways of conceptualizing and addressing these challenges from a systemic perspective.

CONCLUSION

The BSFT implementation uses the same systemic principles and intervention techniques as those that underlie the BSFT clinical model. Building on our on-the-ground experiences, recommendations are proposed for advancing the field of implementation science.

The role of the therapist: what effective therapists do

After expressing enthusiastic agreement with Blow, Davis, and Sprenkle's (in press) call for research focused on what effective therapists do in therapy, this article dissents from two notions that serve as the foundation for these authors' ongoing advocacy of client-worldview/model-worldview matching as a privileged means of enhancing therapeutic outcome. In response to their assumption that client-worldview/model-worldview dissonance almost inevitably produces a therapy-threatening disruption of the therapeutic alliance, two scenarios are described in which such dissonance can not only be compatible with, but might also even contribute to, positive therapeutic outcome. In response to Blow and colleagues' notion that extant research supports the superior efficacy of client-model matching, this article underlines that the research they cite is substantially mute on the matter of switching models in order to accommodate to client worldview.

Therapist-worldview matching: not as important as matching to clients

In this essay, we respond to Simon's article (2012). We discuss our view that therapy works best when therapists can match therapeutic interventions to the worldview of clients. We see this matching to client worldview as rooted in research evidence, and we suggest that therapists can practice authentically and effectively using more than one divergent therapy approach. We conclude the paper by pointing out points of disagreement we have with Simon's use of Davis and Piercy's (Journal of Marital and Family Therapy, 2007a; 33, 298; Journal of Marital and Family Therapy, 2007b, 32, 515) study, a study Simon uses to ground his arguments.

Family therapy for drug abuse: review and updates 2003-2010

Just 15 years ago, Liddle and Dakof (Journal of Marital and Family Therapy, 1995; 21, 511) concluded, based on the available evidence, that family therapy represented a "promising, but not definitive" approach for the treatment of drug problems among adolescents and adults. Seven years later, Rowe and Liddle (2003) review described considerable progress in this specialty with encouraging findings on adolescent-focused models based on rigorous methodology, as well as advances with adult-focused family-based treatments. The current review brings the field up to date with highlights from research conducted in the intervening 7 years, cross-cutting issues, recommendations for new research, and practice implications of these findings. Adolescent-focused family-based models that attend to the ecology of the teen and family show the most consistent and strongest findings in recent studies. Adult-focused models based on behavioral and systems theories of change also show strong effects with drug abusers and their families. The overarching conclusion is that family-based models are not only a viable treatment alternative for the treatment of drug abuse, but are now consistently recognized among the most effective approaches for treating both adults and adolescents with drug problems.

Is who delivers the treatment more important than the treatment itself? The role of the therapist in common factors

In this article, we discuss the role of the therapist in change in couple and family therapy. We argue that the therapist is a key change ingredient in most successful therapy. We situate our discussion in the common factors debate and show how both broad and narrow common factor views involve the therapist as a central force. We review the research findings on the role of the therapist, highlight the strengths and weaknesses of this literature, and provide directions for future research. We then use this review as a foundation for our recommendations for theory integration, training, and practice.