1 State of the Science in Functional Family TherapyA data driven model

2 Implementation / Dissemination StudiesSupervision Implementation Clinical Practice Training Sustainability Research Implementation / Dissemination Studies Effectiveness Studies Efficacy Studies Process Studies Basic Research

3 Example of Interplay in Action Negativity, Blame, Family ConflictBasic Research Alexander (1973): Delinquent vs. Non-Delinquent families Barton et al. (1988): How delinquent and Non-Delinquent families respond to different cognitive sets Morris et al. (1991): Re-attribution influencing set Process Research Robbins et al. (1996; 2000): Reframing and defensive communications in treatment Newell (1995): Content free indicators of process Clinical Model Change Focus Change Meaning Interventions

4 Implementation / Dissemination StudiesSupervision Implementation Clinical Practice Training Sustainability Research Implementation / Dissemination Studies Effectiveness Studies Efficacy Studies Process Studies Basic Research

5 Range of Outcomes Treatment Process Engagement RetentionFamily functioning Individual Conduct/ Delinquency Drug use HIV risk Depression Parent distress Out of Home Placement Incarceration Residential Foster placement Incarceration, residential, foster placement

6 Implementation / Dissemination StudiesSupervision Implementation Clinical Practice Training Sustainability Research Implementation / Dissemination Studies Effectiveness Studies Efficacy Studies Process Studies Basic Research

7 BOOST STUDY Primary ObjectiveTo examine the effects of observation-based supervision (BOOST) versus the standard supervision as usual (SAU) approach currently used by FFT LLC on the therapists’ ability to facilitate changes in the family. BOOST will examine the following outcomes: adolescent drug use conduct/delinquent behaviors. engaging youth/families in treatment enhancing therapist competence 

8 Engagement-RetentionMediating Variables Outcome Variables Engagement-Retention in Treatment AIM 2 AIM 4 Therapist Competence AIM 3a Supervision Condition AIM 4 AIM 3b AIM 4 Family Functioning Adolescent Substance Use AIM 1a, 1b Adolescent Conduct / Delinquency Conceptual Model of Hypothesized Relationships

9 Random Assignment of FFT Supervision TeamsSupervision as Usual 8 Teams - 3 Therapists Each (n=24) Observation-Based Supervision 8 Teams – 3 Therapists Each (n=24) Family Referral (n=288) Screening and Informed Consent Baseline Assessment Functional Family Therapy Follow-Up Assessments: 5-and 12-months after Baseline

10 Implementation / Dissemination StudiesSupervision Implementation Clinical Practice Training Sustainability Research Implementation / Dissemination Studies Effectiveness Studies Efficacy Studies Process Studies Basic Research

11 Innovations in Functional Family TherapyAdaptation, Accommodation, and Specialization

12 Functional Family Therapy through Child WelfareFFT-CW

13 Behavior Change Focus CHILD PARENT Self-Regulation FFTCW THERAPISTBehavior in Context CHILD Attach- ment PARENT Self-Concept Self-Regulation Cue Recognition Decision Making Skill /Behavioral Sets Cognitive Development Social Development Moral Development

14 Roll-Out Randomization Study:New York Foundling

15 Implementation / Dissemination StudiesSupervision Implementation Clinical Practice Training Sustainability Research Implementation / Dissemination Studies Effectiveness Studies Efficacy Studies Process Studies Basic Research

16 Ongoing Research Outcome Research International replications Drug useEngland (High vs. Low Risk) Belgium (Re-entry) New Zealand (Maori families) Chile (Feasibility in a developing country) Drug use BOOST Booster sessions

17 Ongoing Research Adaptations / Integrations Integration with CBTFFT-Trauma FFT with substance users Integration with Contingency Management Blue Sky—Delinquent substance users NIDA—Substance users FFT-Depression Sequencing FFT-Child Welfare New York Foundling

18 Implementation / Dissemination StudiesSupervision Implementation Clinical Practice Training Sustainability Research Implementation / Dissemination Studies Effectiveness Studies Efficacy Studies Process Studies Basic Research

19 University of MarylandFFT-Gangs University of Maryland

20 Gang Accommodations Primarily overlaps with core FFT AccommodationsParents in gangs Multiple risk factors Pilot and full study Issues in implementation

21 Functional Family TherapyAftercare in Functional Family Therapy

22 Considerations for ProvidingAftercare Services Many of the problems we work with are chronic and recurring, such as substance abuse, depression Generalization and termination must include a formal plan for maintaining change Referrals to services Relapse prevention Comprehensive planned “booster” sessions can dramatically reduce relapse However, simple telephone calls (from therapist) conducted each month can be just as effective

23 Florida Data

24 Tracking Data Results In:California FFT 2011 – January 1, 2011-December 31, N=1381 families

25 Completions by Category

26 Average Days In Program for Successfully Completed Cases

27 Average Days between Referral and First Session

28 CSS usage – taken from weekly case report for active cases