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Program Profile: Functional Family Therapy-Child Welfare (FFT-CW®)

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on March 30, 2020

Program Summary

This adapted version of Functional Family Therapy is designed to improve functioning for child welfare-involved families. This program is rated Promising. Treatment families showed a statistically significant greater likelihood of achieving all treatment goals and a lower likelihood of being referred to another program at case closing, compared with control families. However, there were no statistically significant differences between groups in out-of-home placements.

Program Description

Program Goals/Target Population
Functional Family Therapy-Child Welfare (FFT-CW®) is an adaptation of the Functional Family Therapy (FFT) program, which is designed to address the complex needs of children and families with a documented history of child maltreatment. The original FFT model is a family-based prevention and intervention program for high-risk youth, which addresses their complex and multidimensional problems through clinical practice that is flexibly structured and culturally sensitive. FFT concentrates on decreasing risk factors and on increasing protective factors that directly affect youth, with an emphasis on familial factors.

The primary goal is to improve the functioning of all child welfare clients by tailoring treatment to the family’s needs. The FFT model adapted for child welfare-involved families incorporates a developmental focus to meet the needs of youth between the ages of 0–18 who are at risk for or who have experienced maltreatment. This broadly includes children who have experienced abuse or neglect, repeated school tardiness or truancy, family court contact, factors beyond the parents’ control, parental substance abuse or mental health problems, previous maltreatment allegations, and prior out-of-home placement. FFT-CW is a relational approach that matches interventions to the relational configurations of families. For example, for adolescents who are delinquent or abuse substances, the intervention would involve accommodating to families whose children’s problem behavior may motivate them to start treatment. For younger children, however, the approach may involve a more “parent-driven” intervention strategy, to build skills and create a family context where youth can do better.

Program Components
The program matches families to interventions based on an assessment completed by a caseworker, who considers numerous factors, including family strengths, needs, and risks. Children are rated on seven dimensions: 1) physical health, 2) mental health, 3) child development, 4) cognitive skills, 5) child behavior problems, 6) alcohol/drug use, and 7) child-family relationships. The primary caregiver is rated on his or her relationship with other caregivers, ability to cope with stress, motivation/readiness to change, expectations of children, acceptance of children, discipline of children, and problem-solving skills. An additional risk assessment is completed based on the family’s housing, financial resources, available social support; domestic violence; alcohol or drug abuse; serious mental health condition; cognitive skills; debilitating physical condition, realistic expectations of children, and recognition or attention to needs of children. Based on this assessment, families are assigned to the FFT-CW Low Risk intervention (FFT–LR) or the FFT-CW High Risk intervention (FFT–HR).

The FFT–LR intervention is a manualized, case management approach that is implemented in three distinct phases: 1) engagement/motivation, 2) support/monitoring, and 3) generalization. The first phase focuses on engaging and motivating youth and families to be a part of a change process by decreasing family conflict and increasing their hopes about the possibility for change. Intervention strategies include reframing (i.e., changing one’s perspective on an issue), creating a strength-based relational focus (i.e., recognizing the interpersonal payoffs for individual family members’ behaviors), and interrupting family conflict. During the second phase, resources and interventions are identified that best suit the family, and support linkages to those programs are provided. The caseworker assigned to the family monitors the intervention to ensure it supports the family’s needs as intended. In the final phase, the focus shifts to helping youth and families incorporate change into other areas of their lives and to anticipate and plan for potential barriers or future challenges.

The FFT–HR intervention is designed for at-risk and juvenile justice-involved families. The model includes five phases: 1) engagement, 2) motivation, 3) relational assessment, 4) behavior change, and 5) generalization. Each phase includes a cognitive component integrated into systemic training that aims to improve family communication, parenting skills, conflict management, and numerous other issues that contribute to problem behaviors (Alexander et al. 2013).

Evaluation Outcomes

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Study 1
All Goals Met
Turner and colleagues (2017) found that families who participated in Functional Family Therapy-Child Welfare (FFT-CW®) were more likely to achieve all planned treatment goals, compared with families who received services as usual. This finding was statistically significant.

Transfers to Other Programs at Case Closing
Treatment families were less likely to be transferred to other programs at case closing, compared with families who received services as usual. This indicates that the treatment families had achieved enough progress during their participation in FFT-CW that they did not need to be referred to another program at the closing date (indicating there was no need for continued services). This finding was statistically significant.

Out-of-Home Placement
There were no statistically significant effects between the groups in out-of-home placements.
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Evaluation Methodology

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Study 1
Turner and colleagues (2017) conducted a quasi-experimental study to examine the effectiveness of Functional Family Therapy-Child Welfare (FFT-CW®) on families at risk for or with a history of maltreatment, across the five boroughs of New York City. Families were matched using stratified propensity scoring on their pre-service risk status (i.e., low-risk or high-risk) and were followed for 16 months after the case open date. Approximately 60 families per month, across 36 months, were enrolled in the FFT-CW treatment group (n = 1,625) at one of the New York Foundling (NYF) service sites throughout Brooklyn, the Bronx, Manhattan, Queens, and Staten Island. The control group (n = 2,250), which received services as usual, comprised approximately 60 families per month who received services at one of 58 agencies that provide child welfare preventive services across New York City.

In the treatment group, the average caregiver age was 37.63 years, and the average child age was 9.22 years. Ninety-three percent of primary caregivers were female, and 49 percent reported having a spouse or other parent figure in the home. Forty-eight percent of the children were female. In terms of race/ethnicity of families, 54.3 percent were Hispanic, 33 percent were black, 5.2 percent were non-Hispanic white, 1 percent were Asian, and 6 percent identified as other or unknown. Among black families, the average family size was 4.35 persons. For Hispanic families, the average family size was 4.39 persons. The average family size of all other families was 4.34 persons. In the control group, the average caregiver age was 36.75 years, and the average child age was 8.35 years. Ninety-two percent of primary caregivers were female, and 52 percent reported having a spouse or other parent figure in the home. Forty-nine percent of control group children were female. Approximately, 44.2 percent of the families were Hispanic, 37 percent were black, 5 percent were non-Hispanic white, 5.7 percent were Asian, and 8.3 percent identified as other or unknown. Among black families, the average family size was 4.36 persons. Among Hispanic families, the average family size was 4.33 persons. The average family size of all other families was 4.11 persons. Across all families, 92 percent of primary caregivers were biological parents, 3 percent were grandparents, and the remainder were extended family members. There were no statistically significant differences in these areas between groups; however, there were several statistically significant differences in terms of referral source; referral reasons; pre-service-indicated investigations (allegations); and pre-service, out-of-home spells for the primary caregiver and other family members. Treatment group families were less likely to be referred due to abuse or neglect, child school truancy, family court contact, factors beyond the parents’ control, risk of replacement, substance abuse, mental health, allegation history, transfer from a previous preventive service provider, and caregiver foster care or other foster care reasons, compared with the control group. The researchers used propensity matching to stratify the two samples on the multiple indicators that differentiated them, to assess the interaction of these risk factors and control for differences between the groups. Information was not provided on how many families received FFT-CW Low Risk Intervention or FFT-CW High Risk Intervention.

Outcomes included whether all clinical goals were met, whether families were transferred to other programs at case closing (indicating a need for continued services), and whether out-of-home placement (e.g., foster care) occurred. Outcomes were assessed using a range of measures that were distributed at three time periods: 1) pre-evaluated service, before the case open date; 2) evaluated service, the time between case open and closing dates; and 3) post-evaluated service, after the case closing date. Information on the outcome measures was extracted from various administrative data sets. Some measures were linked to individual family members (e.g., indicated investigations or allegations, out-of-home placements). Other measures were associated with the family or case, including referral source, service open and closing dates, closing status, and referral reasons. The researchers assessed the outcomes by calculating effect sizes using Cohen’s d. They conducted subgroup analyses on clinical goals met by race or ethnicity.
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Cost

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Information on costs of Functional Family Therapy-Child Welfare can be found on the Functional Family Therapy LLC website: https://fftllc.com/fft-child-welfare/
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Implementation Information

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The individuals (n = 62) who delivered Functional Family Therapy – Child Welfare interventions held at least a B.A. and had prior experience in the child welfare system. Most were trained therapists who had a M.A. or MSW (n = 55). The interventionists were recruited from the communities involved in the study, and they represented the ethnic/cultural background of residents. Interventionists and therapists received 8 days (four, 2-day trainings) of didactic, onsite workshops and participated in 1-hour weekly group consultation calls led by expert Functional Family Therapy (FFT) LLC consultants over 1 year (Turner et al. 2017).

More information can be found on the FFT LLC website: https://fftllc.com/fft-child-welfare/
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Other Information (Including Subgroup Findings)

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Turner and colleagues (2017) conducted subgroup analyses on clinical goals met by race or ethnicity. Findings indicated that Hispanic and black families who received Functional Family Therapy-Child Welfare had a statistically significant greater likelihood of success in achieving planned treatment goals, compared with the control group families who received usual services. However, this outcome was not found for non-Hispanic white or Asian families, compared with control group families.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Turner, Charles W., Michael S. Robbins, Sylvia Rowland, and Lisa R. Weaver. 2017. “Summary of Comparison between FFT-CW® and Usual Care Sample from Administration for Children’s Services.” Child Abuse & Neglect 69:85–95.
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Additional References

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These sources were used in the development of the program profile:

Alexander, James F. 2007. Functional Family Therapy Clinical Training Manual, Second Edition. Seattle, Wash.: FFT LLC.

Alexander, James F., Holly Barret Waldron, Michael S. Robbins, and Andrea A. Neeb. 2013. Functional Family Therapy for Adolescent Behavior Problems. Washington, D.C.: American Psychological Association.

Alexander, James F., Christie Pugh, and Bruce V. Parsons. 1998. “Functional Family Therapy.” In Delbert S. Elliott (ed.). Blueprints for Violence Prevention (Book 3). Boulder, Colo.: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.
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Related Practices

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Following are CrimeSolutions.gov-rated practices that are related to this program:

Family-based Treatment for Adolescent Delinquency and Problem Behaviors
In general family-based treatment practices consist of a wide range of interventions that are designed to change dysfunctional family patterns that contribute to the onset and maintenance of adolescent delinquency and other problem behaviors. This practice is rated Effective for reducing recidivism, and Promising for reducing antisocial behavior and substance use, and improving psychological functioning and school performance.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Promising - One Meta-Analysis Mental Health & Behavioral Health - Externalizing behavior
Promising - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
Promising - One Meta-Analysis Mental Health & Behavioral Health - Psychological functioning
Promising - One Meta-Analysis Education - Academic achievement/school performance
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Program Snapshot

Age: 3 - 15

Gender: Both

Race/Ethnicity: Black, Asian/Pacific Islander, Hispanic, White, Other

Geography: Urban

Setting (Delivery): Home, Other Community Setting

Program Type: Family Therapy, Wraparound/Case Management, Children Exposed to Violence

Targeted Population: Children Exposed to Violence, Families

Current Program Status: Active

Researcher:
Charles Turner
Oregon Research Institute
1776 Millrace Drive
Eugene OR 97403
Email