Functional Family Therapy

Mental Health Well Supported

Functional Family Therapy (FFT) is a short term prevention program for at-risk youth and their families. FFT aims to address risk and protective factors that impact the adaptive development of 11 to 18 year old youth who have been referred for behavioral or emotional problems. The program is organized in five phases that consist of 1) developing a positive relationship between therapist/program and family, 2) increasing hope for change and decreasing blame/conflict, 3) identifying specific needs and characteristics of the family, 4) supporting individual skill-building of youth and family, and 5) generalizing changes to a broader context. Typically, therapists will meet with the family face-to-face for at least 90 minutes per week and for 30 minutes over the phone, over an average of three to five months. Master’s level therapists provide FFT. They work as a part of a FFT-supervised unit and receive ongoing support from their local unit and FFT LLC.


Functional Family Therapy is rated as a well-supported practice because at least two studies with non-overlapping samples carried out in usual care or practice settings achieved a rating of moderate or high on design and execution and demonstrated favorable effects in a target outcome domain. At least one of the studies demonstrated a sustained favorable effect of at least 12 months beyond the end of treatment on at least one target outcome.


Sources

The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: The California Evidence-based Clearinghouse for Child Welfare, the program or service developer’s website, the program or service manual, and the studies reviewed.


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

Target Population

FFT is intended for 11 to 18 year old youth who have been referred for behavioral or emotional problems by juvenile justice, mental health, school, or child welfare systems. Family discord is also a target factor for this program.

Dosage

Therapists typically spend 90 minutes face-to-face and 30 minutes over the phone with each family every week. Most families complete the FFT program in an average of 12 to 14 sessions over the span of three to five months.

Location/Delivery Setting
Recommended Locations/Delivery Settings

Typically, FFT is conducted in clinic and home settings. It can also be delivered in schools, child welfare facilities, probation and parole offices, aftercare systems, and mental health facilities.

Location/Delivery Settings Observed in the Research

  • Mental Health Center, Treatment Center, Therapist Office
  • Community-based settings

Education, Certifications and Training

Sites that deliver FFT engage in three phases of training: clinical, supervision, and maintenance. In the clinical training phase, local clinicians are trained on the FFT model through weekly consultations and activities (typically over the span of 12 to 18 months). In the supervision phase, a local site staff is trained to serve as their FFT supervisor through a one-day onsite training, two two-day trainings, and monthly consultations. The maintenance phase, FFT LLC staff continue to review the delivery trends and client outcomes of the staff and provides an annual one-day onsite training.

For more information about this process, please refer to the FFT Certification Map.

Program or Service Documentation
Book/Manual/Available documentation

The FFT manual, Functional Family Therapy for Adolescent Behavioral Problems, provides an overview of the foundations and research support for the program, the program model, and guidance on administration of FFT.

Alexander, J. F., Waldron, H. B., Robbins, M. S., & Neeb, A. A. (2013). Functional Family Therapy for Adolescent Behavioral Problems. Washington, D.C.: American Psychological Association.

Available languages

Materials are available in languages other than English, including Dutch, Spanish, Swedish.

Other supporting materials

Phases of Implementation/Certification

Clinical Model

Contact Information for Developers

Website: https://www.fftllc.com/

Results of Search and Review Number of Studies Identified and Reviewed for Functional Family Therapy
Identified in Search 22
Eligible for Review 9
Rated High 2
Rated Moderate 4
Rated Low 3
Reviewed Only for Risk of Harm 0
Outcome Effect Size
and Implied Percentile Effect
N of Studies (Findings) N of Participants Summary of Findings
Child well-being: Behavioral and emotional functioning 0.16
6
4 (26) 390 Favorable: 2
No Effect: 23
Unfavorable: 1
Child well-being: Substance use 0.49
18
1 (18) 52 Favorable: 9
No Effect: 9
Unfavorable: 0
Child well-being: Delinquent behavior 0.05
1
5 (20) 8636 Favorable: 4
No Effect: 16
Unfavorable: 0
Adult well-being: Positive parenting practices 0.02
0
2 (9) 163 Favorable: 0
No Effect: 9
Unfavorable: 0
Adult well-being: Family functioning 0.30
11
1 (15) 52 Favorable: 1
No Effect: 14
Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.

Outcome Effect Size
and Implied Percentile Effect
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Child well-being: Behavioral and emotional functioning 0.16
6
4 (26) 390 Favorable: 2
No Effect: 23
Unfavorable: 1
-
Celinska, 2013
Strengths and Needs Assessment: Child Behavioral/Emotional Needs 0.50 *
19
- 72 - 0
Celinska, 2018
Strengths and Needs Assessment: Child Behavioral/Emotional Needs 0.07
2
- 155 - 0
Humayun, 2017
Conduct disorder symptoms 0.30
11
- 111 - 0
Conduct disorder symptoms 0.12
4
- 111 - 12
Oppositional defiant disorder symptoms 0.06
2
- 111 - 0
Oppositional defiant disorder symptoms 0.23
8
- 111 - 12
Conduct disorder diagnosis -0.66
-24
- 111 - 0
Conduct disorder diagnosis -0.65
-24
- 111 - 12
Oppositional defiant disorder diagnosis 0.00
0
- 111 - 0
Oppositional defiant disorder diagnosis -0.43
-16
- 111 - 12
Observed positive child behavior -0.35
-13
- 111 - 0
Observed positive child behavior -0.58 *
-21
- 111 - 12
Observed negative child behavior 0.12
4
- 111 - 0
Observed negative child behavior 0.42
16
- 111 - 12
Slesnick, 2009
Youth Self-Report: Internalizing Problems -0.06
-2
- 52 - 1
Youth Self-Report: Internalizing Problems 0.06
2
- 52 - 7
Youth Self-Report: Internalizing Problems 0.05
1
- 52 - 13
Youth Self-Report: Externalizing Problems -0.04
-1
- 52 - 1
Youth Self-Report: Externalizing Problems 0.32
12
- 52 - 7
Youth Self-Report: Externalizing Problems 0.56
21
- 52 - 13
Beck Depression Inventory: Depression 0.25
9
- 52 - 1
Beck Depression Inventory: Depression 0.76 *
27
- 52 - 7
Beck Depression Inventory: Depression 0.33
12
- 52 - 13
Computerized Diagnostic Interview Schedule for Children: Number of Psychiatric Diagnoses 0.43
16
- 52 - 1
Computerized Diagnostic Interview Schedule for Children: Number of Psychiatric Diagnoses 0.33
12
- 52 - 7
Computerized Diagnostic Interview Schedule for Children: Number of Psychiatric Diagnoses 0.00
0
- 52 - 13
Child well-being: Substance use 0.49
18
1 (18) 52 Favorable: 9
No Effect: 9
Unfavorable: 0
-
Slesnick, 2009
Form 90: Percent days of alcohol or drug use 0.60 *
22
- 52 - 1
Form 90: Percent days of alcohol or drug use 0.60 *
22
- 52 - 7
Form 90: Percent days of alcohol or drug use 0.80 *
28
- 52 - 13
Form 90: Percent days of only drug use 0.42
16
- 52 - 1
Form 90: Percent days of only drug use 0.49
18
- 52 - 7
Form 90: Percent days of only drug use 0.79 *
28
- 52 - 13
Form 90: Percent days of alcohol use 0.66 *
24
- 52 - 1
Form 90: Percent days of alcohol use 0.65 *
24
- 52 - 7
Form 90: Percent days of alcohol use 0.70 *
25
- 52 - 13
Form 90: Average Number of Standard Drinks 0.98 *
33
- 52 - 1
Form 90: Average Number of Standard Drinks 0.49
18
- 52 - 7
Form 90: Average Number of Standard Drinks 0.84 *
30
- 52 - 13
Adolescent Drinking Index 0.39
15
- 52 - 1
Adolescent Drinking Index 0.16
6
- 52 - 7
Adolescent Drinking Index 0.25
9
- 52 - 13
Computerized Diagnostic Interview Schedule for Children: Number of Substance Use Diagnoses 0.57
21
- 52 - 1
Computerized Diagnostic Interview Schedule for Children: Number of Substance Use Diagnoses -0.34
-13
- 52 - 7
Computerized Diagnostic Interview Schedule for Children: Number of Substance Use Diagnoses -0.32
-12
- 52 - 13
Child well-being: Delinquent behavior 0.05
1
5 (20) 8636 Favorable: 4
No Effect: 16
Unfavorable: 0
-
Barnoski, 2004
Any Misdemeanor or Felony Conviction 0.00
0
- 700 - 15
Any Felony Conviction 0.09
3
- 700 - 15
Any Violent Felony Conviction -0.06
-2
- 700 - 15
Any Felony Conviction -0.08
-3
- 700 - 3
Any Felony Conviction 0.02
0
- 700 - 9
Celinska, 2018
Reconvictions for Property Offenses 1.60 *
44
- 155 - 12
Re-institutionalizations 0.49
18
- 155 - 12
Total Reconvictions 0.42
16
- 155 - 12
Darnell, 2015
Any Out-of-home Placement 0.07
2
- 7618 - 33
Out-of-home Placement (Survival Analysis) Favorable *
not calculated
- 7618 - 0
Humayun, 2017
Self-Reported Delinquency 0.10
3
- 111 - 0
Self-Reported Delinquency 0.10
3
- 111 - 12
Offended in previous 6 months -0.31
-12
- 111 - 0
Offended in previous 6 months 0.08
3
- 111 - 12
Slesnick, 2009
National Youth Survey Delinquency Scale: Delinquent Behaviors 1.19 *
38
- 52 - 1
National Youth Survey Delinquency Scale: Delinquent Behaviors 0.33
13
- 52 - 7
National Youth Survey Delinquency Scale: Delinquent Behaviors 0.73 *
26
- 52 - 13
Problem Oriented Screening Instrument for Teenagers: Number of Problem Consequences -0.58
-21
- 52 - 1
Problem Oriented Screening Instrument for Teenagers: Number of Problem Consequences -0.22
-8
- 52 - 7
Problem Oriented Screening Instrument for Teenagers: Number of Problem Consequences 0.06
2
- 52 - 13
Adult well-being: Positive parenting practices 0.02
0
2 (9) 163 Favorable: 0
No Effect: 9
Unfavorable: 0
-
Humayun, 2017
Poor parental supervision 0.05
2
- 111 - 0
Poor parental supervision 0.20
8
- 111 - 12
Observed positive parent behavior -0.35
-13
- 111 - 0
Observed positive parent behavior -0.18
-7
- 111 - 12
Observed negative parent behavior 0.19
7
- 111 - 0
Observed negative parent behavior 0.17
6
- 111 - 12
Slesnick, 2009
Parental Bonding Instrument: Parental Care 0.05
2
- 52 - 1
Parental Bonding Instrument: Parental Care 0.08
3
- 52 - 7
Parental Bonding Instrument: Parental Care 0.01
0
- 52 - 13
Adult well-being: Family functioning 0.30
11
1 (15) 52 Favorable: 1
No Effect: 14
Unfavorable: 0
-
Slesnick, 2009
Family Environment Scale: Family Conflict 0.39
15
- 52 - 1
Family Environment Scale: Family Conflict 0.57
21
- 52 - 7
Family Environment Scale: Family Conflict 0.48
18
- 52 - 13
Family Environment Scale: Family Cohesion -0.15
-6
- 52 - 1
Family Environment Scale: Family Cohesion 0.10
4
- 52 - 7
Family Environment Scale: Family Cohesion 0.14
5
- 52 - 13
Conflict Tactics Scale: Verbal Aggression 0.54
20
- 52 - 1
Conflict Tactics Scale: Verbal Aggression 0.44
16
- 52 - 7
Conflict Tactics Scale: Verbal Aggression 0.75 *
27
- 52 - 13
Conflict Tactics Scale: Family Violence 0.14
5
- 52 - 1
Conflict Tactics Scale: Family Violence 0.33
12
- 52 - 7
Conflict Tactics Scale: Family Violence 0.27
10
- 52 - 13
Parental Bonding Instrument: Parental Overprotectiveness 0.38
14
- 52 - 1
Parental Bonding Instrument: Parental Overprotectiveness -0.04
-1
- 52 - 7
Parental Bonding Instrument: Parental Overprotectiveness 0.18
7
- 52 - 13

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers.

Studies Rated High

Study 10011

Slesnick, N., & Prestopnik, J. L. (2004). Office versus home-based family therapy for runaway, alcohol abusing adolescents: Examination of factors associated with treatment attendance. Alcohol Treatment Quarterly, 22(2), 3-19. doi:10.1300/J020v22n02_02

Slesnick, N., & Prestopnik, J. L. (2009). Comparison of family therapy outcome with alcohol-abusing, runaway adolescents. Journal of Marital and Family Therapy, 35(3), 255-277. doi:10.1111/j.1752-0606.2009.00121.x

Study 10008

Humayun, S., Herlitz, L., Chesnokov, M., Doolan, M., Landau, S., & Scott, S. (2017). Randomized controlled trial of Functional Family Therapy for offending and antisocial behavior in UK youth. Journal of Child Psychology and Psychiatry, 58(9), 1023-1032. doi:10.1111/jcpp.12743


Studies Rated Moderate

Study 10004

Celinska, K., Furrer, S., & Cheng, C.-C. (2013). An outcome-based evaluation of Functional Family Therapy for youth with behavioral problems. OJJDP Journal of Juvenile Justice, 2(2), 23-36.

Study 10077

Celinska, K., Sung, H. E., Kim, C., & Valdimarsdottir, M. (2018). An outcome evaluation of Functional Family Therapy for court?involved youth. Journal of Family Therapy. (Online Advance) doi:http://dx.doi.org/10.1111/1467-6427.12224

Study 10002

Barnoski, R. (2004). Outcome Evaluation of Washington State's Research-Based Programs for Juvenile Offenders. Olympia, WA: Washington State Institute for Public Policy.

Barnoski, R. (2002). Washington State's Implementation of Functional Family Therapy for Juvenile Offenders: Preliminary Findings. Olympia, WA: Washington State Institute for Public Policy.

Sexton, T., & Turner, C. W. (2010). The effectiveness of Functional Family Therapy for youth with behavioral problems in a community practice setting. Journal of Family Psychology, 24(3), 339-348. doi:10.1037/a0019406

Study 10069

Darnell, A. J., & Schuler, M. S. (2015). Quasi-experimental study of functional family therapy effectiveness for juvenile justice aftercare in a racially and ethnically diverse community sample. Children and Youth Services Review, 50, 75-82. doi:10.1016/j.childyouth.2015.01.013


Studies Rated Low

Study 10009

Peterson, A. (2017). Functional Family Therapy in a Probation Setting: Outcomes for Youths Starting Treatment January 2010 - September 2012. Olympia, WA: Center for Court Research, Administrative Office of Courts.

This study received a low rating because none of the target outcomes met measurement standards.
Study 10070

Datchi, C. C., & Sexton, T. L. (2013). Can family therapy have an effect on adult criminal conduct? Initial evaluation of Functional Family Therapy. Couple and Family Psychology: Research and Practice, 2(4), 278-293. doi:10.1037/a0034166

This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.
Study 10003

Waldron, H. B., Slesnick, N., Brody, J. L., Peterson, T. R., & Turner, C. W. (2001). Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments. Journal of Consulting and Clinical Psychology, 69(5), 802-813.

French, M. T., Zavala, S. K., McCollister, K. E., Waldron, H. B., Turner, C. W., & Ozechowski, T. J. (2008). Cost-effectiveness analysis of four interventions for adolescents with a substance use disorder. Journal of Substance Abuse Treatment, 34(3), 272-281. doi:10.1016/j.jsat.2007.04.008

This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.


Studies Not Eligible for Review

Study 10005

Flicker, S. M., Turner, C. W., Waldron, H. B., Brody, J. L., & Ozechowski, T. J. (2008). Ethnic background, therapeutic alliance, and treatment retention in Functional Family Therapy with adolescents who abuse substances. Journal of Family Psychology, 22(1), 167-170. doi:10.1037/0893-3200.22.1.167

Flicker, S. M., Waldron, H. B., Turner, C. W., Brody, J. L., & Hops, H. (2008). Ethnic matching and treatment outcome with Hispanic and Anglo substance-abusing adolescents in family therapy. Journal of Family Psychology, 22(3), 439-447. doi:10.1037/0893-3200.22.3.439

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10007

Gordon, D. A., Arbuthnot, J., Gustafson, K. E., & McGreen, P. (1988). Home-based behavioral-systems family therapy with disadvantaged juvenile delinquents. American Journal of Family Therapy, 16(3), 243-255.

Gordon, D. A., Graves, K., & Arbuthnot, J. (1995). The effect of Functional Family Therapy for delinquents on adult criminal behavior. Criminal Justice and Behavior, 22(1), 60-73.

This study is ineligible for review because the publication date is prior to 1990 (Study Eligibility Criterion 4.1.1).

Study 10071

Gottfredson, D. C., Kearley, B., Thornberry, T. P., Slothower, M., Devlin, D., & Fader, J. J. (2018). Scaling-up evidence-based programs using a public funding stream: A randomized trial of Functional Family Therapy for court-involved youth. Prevention Science, 19(7), 939-953. doi:10.1007/s11121-018-0936-z

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 10072

Hartnett, D., Carr, A., & Sexton, T. (2016). The effectiveness of Functional Family Therapy in reducing adolescent mental health risk and family adjustment difficulties in an Irish context. Family Process, 55(2), 287-304. doi:10.1111/famp.12195

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10075

Eeren, H. V., Goossens, L. M. A., Scholte, R. H. J., Busschbach, J. J. V., & Van der Rijken, R. E. A. (2018). Multisystemic Therapy and Functional Family Therapy compared on their effectiveness using the propensity score method. Journal of Abnormal Child Psychology, 46(5), 1037-1050. doi:10.1111/1745-9133.12064

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10076

Rohde, P., Turner, C. W., Waldron, H. B., Brody, J. L., & Jorgensen, J. (2018). Depression change profiles in adolescents treated for comorbid depression/substance abuse and profile membership predictors. Journal of Clinical Child and Adolescent Psychology, 47(4), 595-607. doi:http://dx.doi.org/10.1080/15374416.2015.111869

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10078

Turner, C. W., Robbins, M. S., Rowlands, S., & Weaver, L. R. (2017). Summary of comparison between FFT-CW and usual care sample from Administration for Children's Services. Child Abuse & Neglect, 69, 85-95. doi:http://dx.doi.org/10.1016/j.chiabu.2017.04.005

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 10079

Rohde, P., Waldron, H. B., Turner, C. W., Brody, J., & Jorgensen, J. (2014). Sequenced versus coordinated treatment for adolescents with comorbid depressive and substance use disorders. Journal of Consulting and Clinical Psychology, 82(2), 342-348. doi:http://dx.doi.org/10.1037/a0035808

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10080

van der Put, C. E., Asscher, J. J., Stams, G. J. J. M., van der Laan, P. H., Breuk, R., Jongman, E., & Doreleijers, T. (2013). Recidivism after treatment in a forensic youth-psychiatric setting: The effect of treatment characteristics. International Journal of Offender Therapy and Comparative Criminology, 57(9), 1120-1139.

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10081

White, S. F., Frick, P. J., Lawing, K., & Bauer, D. (2013). Callous–unemotional traits and response to Functional Family Therapy in adolescent offenders. Behavioral Sciences & The Law, 31(2), 271-285. doi:http://dx.doi.org/10.1002/bsl.2041

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10083

Zazzali, J. L., Sherbourne, C., Hoagwood, K. E., Greene, D., Bigley, M. F., & Sexton, T. L. (2008). The adoption and implementation of an evidence based practice in child and family mental health services organizations: A pilot study of Functional Family Therapy in New York State. Administration and Policy in Mental Health, 1-2, 38-49.

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10084

Gustle, L., Hansson, K., Sundell, K., Lundh, L., & Löfholm, C. A. (2007). Blueprints in Sweden. Symptom load in Swedish adolescents in studies of Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC). Nordic Journal of Psychiatry, 61(6), 443-451. https://doi.org/10.1080/08039480701773196

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10085

Greenwood, P. W. (2004). Cost-effective violence prevention through targeted family interventions. Annals Of The New York Academy Of Sciences, 1036, 201-214.

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).