Functional Family Therapy

1 Department of JusticeOffice of Justice ProgramsOffice of Juvenile Justice and Delinquency PreventionJohn J. Wilson, Acting AdministratorFrom the AdministratorWhile a number of States andcommunities are turning to punitiveapproaches to addressing juvenilecrime, research indicates that suchapproaches, despite their high cost,are largely ineffective. Juvenile offen-ders removed from their families andcommunities eventually return, andunless their underlying behavioralproblems have been treated effectively,these problems are likely to contributeto further Family Therapy (FFT)draws on a multisystemic perspectivein its Family -based prevention andintervention efforts. The program ap-plies a comprehensive model, proventheory, empirically tested principles,and a wealth of experience to thetreatment of at-risk and Bulletin chronicles FFT s evolu-tion over more than three decades;sets forth the program s core prin-ciples, goals, and techniques; andreviews its research implementation of FFTis described, and an example ofeffective replication is years of clinical researchindicate that FFT can prevent theonset of delinquency and reducerecidivism at a financial and humancost well below that exacted by thepunitive approaches noted believe this Bulletin will help youto consider the program s meritsfor your J.

2 WilsonActing AdministratorDecember 2000ineffective and costly. By removing adoles-cents from their families and communities,punitive programs inadvertently make ado-lescents problems more difficult to solvein the long run. Regardless of how adoles-cents problems manifest themselves, theyare complex behavioral problems embed-ded in adolescents psychosocial systems(primarily Family and community). Thus, Family -based interventions that adopt amultisystemic perspective are well suitedto treating the broad range of problemsfound in juveniles who engage in delin-quent and criminal Family Therapy (FFT) is afamily-based prevention and interventionprogram that has been applied successfullyin a variety of contexts to treat a range ofthese high-risk youth and their families.

3 Assuch, FFT is a good example of the currentgeneration of Family -based treatments foradolescent behavior problems (Mendel,2000; Sexton and Alexander, 1999). It com-bines and integrates the following elementsinto a clear and comprehensive clinicalmodel: established clinical theory, empiri-cally supported principles, and extensiveclinical experience. The FFT model allowsfor successful intervention in complex andmultidimensional problems through clinicalpractice that is flexibly structured and cul-turally sensitive and also accountable toyouth, their families, and the TherapyThe Office of Juvenile Justice and Delin-quency Prevention (OJJDP) is dedicated topreventing and reversing trends of increaseddelinquency and violence among adoles-cents. These trends have alarmed the publicduring the past decade and challenged thejuvenile justice system.

4 It is widely acceptedthat increases in delinquency and violenceover the past decade are rooted in a num-ber of interrelated social problems childabuse and neglect, alcohol and drug abuse,youth conflict and aggression, and earlysexual involvement that may originatewithin the Family structure. The focus ofOJJDP s Family Strengthening Series is toprovide assistance to ongoing efforts acrossthe country to strengthen the Family unit bydiscussing the effectiveness of Family inter-vention programs and providing resourcesto families and arising from juvenile crime are aserious concern for many local communi-ties. Expressions of adolescent behaviorproblems range from minor offenses ( ,curfew violations and trespassing) to seri-ous crimes ( , drug abuse, theft, andviolence) and result in staggering personal,economic, and social costs.

5 Until recently,most communities were left on their ownto determine how to address juvenilecrime, and many communities turned toexclusively punitive approaches such asincarceration. Mounting evidence, how-ever, indicates that such approaches areFamilyStrengtheningSeriesThomas L. Sexton and James F. Alexander2 Although commonly used as an interven-tion program, FFT is also an effective pre-vention program for at-risk adolescentsand their families. Whether implementedas an intervention or a prevention pro-gram, FFT may include diversion, proba-tion, alternatives to incarceration, and/orreentry programs for youth returning tothe community following release from ahigh-security, severely restrictive institu-tional on the results of extensive indepen-dent reviews, FFT has been designatedvariously as a blueprint program (Alex-ander et al.)

6 , 2000), an exemplary model program (Alexander, Robbins, and Sexton,1999), and a Family based empiricallysupported treatment (Alexander, Sexton,and Robbins, 2000). These designationsreflect FFT s 30 years of clinical andresearch experience and its use at a widerange of intervention sites in the UnitedStates and other targets youth between the ages of 11and 18 from a variety of ethnic and cul-tural groups. It also provides treatmentto the younger siblings of referred adoles-cents. FFT is a short-term intervention including, on average, 8 to 12 sessions formild cases and up to 30 hours of directservice ( , clinical sessions, telephonecalls, and meetings involving communityresources) for more difficult cases. Inmost cases, sessions are spread over a3-month period.

7 Regardless of the targetpopulation, FFT emphasizes the impor-tance of respecting all Family members ontheir own terms ( , as they experiencethe intervention process).Data from numerous studies of FFT out-comes suggest that when applied as in-tended, FFT reduces recidivism and/orthe onset of offending between 25 and60 percent more effectively than otherprograms (Alexander et al., 2000). Otherstudies indicate that FFT reduces treat-ment costs to levels well below those oftraditional services and other interven-tions (Alexander et al., 2000). As FFT hasevolved, it has adopted a set of guidingprinciples, goals, and techniques thatcan be used even when resources arelimited for example, in managed careand similar contexts that restrictopen-ended and non-outcome-basedresource Evolution ofFunctional FamilyTherapyMore than 30 years ago, it became appar-ent to FFT progenitors that although therate and severity of juvenile delinquency,violence, and drug abuse were growing ata frightening pace, intervention programsremained seriously underdeveloped(Alexander and Parsons, 1973).

8 In 1969,researchers at the University of Utah sPsychology Department Family Clinic de-veloped FFT to serve diverse populationsof underserved and at-risk adolescentsand their families. These populationslacked resources, were difficult to treat,and often were perceived by helping pro-fessionals as not motivated to these underserved populationswere diverse in terms of Family organiza-tion, relational dynamics, presentingproblems, and cultures, they often shareda common factor: They had entered theschool counseling, mental health, or juve-nile justice systems angry, hopeless, and/or resistant to developers of FFT recognized thatsuccessful treatment of these populationsrequired service providers who were sen-sitive to the needs of these diverse fami-lies and competent to work with them,and who understood why the families hadtraditionally resisted treatment.

9 Over thepast 30 years, FFT providers have learnedthat they must do more than simply stopbad behaviors; they must motivate fami-lies to change by uncovering Family mem-bers unique strengths, helping familiesbuild on these strengths in ways that en-hance self-respect, and offering familiesspecific ways to its development, FFT has been adynamic clinical system. It has retainedits core principles while adding clinicalfeatures that improve successful out-comes in the diverse communities inwhich it has been implemented. Morethan two decades ago, FFT began focusingon therapist characteristics and in-sessionprocesses from an integrated perspectivethat combines research and practice. Thisperspective, in turn, has contributed tothe training of therapists for subsequentinterventions by identifying specific step-by-step interventions and their impact onyouth and other Family the late 1990 s, FFT further articulatedits clinical change model by refining thephases of intervention (Sexton andAlexander, 1999; see table), developinga systematic approach to training andprogram implementation, and adding acomprehensive system of client, process,and outcome assessment.

10 The systemis implemented through a computer-based client tracking and monitoringsystem known as the Functional FamilyTherapy Clinical Services System (FFT CSS). This most recent iteration of FFThelps clinicians identify and implementgoals for therapeutic change in a way thatpromotes accountability through processand outcome evaluation. As a result, FFThas matured into a clinical interventionmodel that includes systematic training,supervision, process, and outcome as-sessment components all directed atimproving the delivery of FFT in Principles, Goals,and TechniquesFunctional Family Therapy is so named toidentify the primary focus of intervention(the Family ) and reflect an understandingthat positive and negative behaviors bothinfluence and are influenced by multiplerelational systems ( , are Functional ).