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Intervention Summary

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Functional Family Therapy for Adolescent Alcohol and Drug Abuse

Functional Family Therapy for Adolescent Alcohol and Drug Abuse is a behaviorally based intervention for youth ages 13-19 years with substance abuse and delinquency, HIV risk behaviors, and/or depression (or other behavioral and mood disturbances) and their families. The intervention is grounded in family systems theory (i.e., all family members are connected through a system of overlapping and intertwining relationships) and views a youth's substance abuse problem in the larger context of dysfunctional interrelationship patterns within the family's social structure. By involving the entire family, as well as the youth, Functional Family Therapy for Adolescent Alcohol and Drug Abuse aims to reduce the youth's substance abuse, decrease the youth's delinquent behavior, and increase family cohesion through improvements in family interaction patterns and parent-youth relationships. The intervention uses a strengths-based, nonjudgmental therapeutic approach that integrates cognitive behavioral strategies within a comprehensive, family systemic model. Functional Family Therapy for Adolescent Alcohol and Drug Abuse is organized around five therapeutic phases:

  • Engagement, which focuses on engaging the family in therapy and developing a therapeutic relationship
  • Motivation, which emphasizes enhancing the family's readiness and motivation for change, strengthening family cohesion by reducing blaming and hostility, instilling hope through a relational focus, reframing individual-oriented complaints, and actively managing negative family interactions
  • Assessment, which involves the identification of relevant, maladaptive aspects of individual and family functioning to guide the design and implementation of a behavior change plan
  • Behavior change, which involves the implementation of various techniques to improve family relationships (e.g., communication, problem solving) and to avoid substance use (e.g., coping with urges and cravings, substance-refusal skills, mood management)
  • Generalization, which emphasizes the consolidation and maintenance of new skills and behaviors, relapse prevention, and community systems available to support the family and recovering youth

A trained, certified therapist delivers the intervention through 12-16 sessions, lasting 60-75 minutes each, over a period of 4-5 months. Sessions are initially held twice weekly, then tapered to once weekly to space out learning and allow time between sessions for practice and homework, which is tailored to the tasks in each phase. When families are able to maintain new behaviors independently, sessions are scheduled several weeks apart. Following the 12-16 sessions, 2 months of biweekly aftercare booster sessions may be delivered by telephone. The sessions, which are no more than 30 minutes each, reinforce treatment gains and offer general support to families.

In the studies reviewed by NREPP, Functional Family Therapy for Adolescent Alcohol and Drug Abuse was delivered through 12-14 weekly sessions lasting 1 hour each. In addition, one of the studies included three types of aftercare booster sessions.

Descriptive Information

Areas of Interest Substance abuse treatment
Outcomes Review Date: February 2014
1: Marijuana use
2: Delinquent behavior
3: Family cohesion
Outcome Categories Crime/delinquency
Drugs
Family/relationships
Ages 13-17 (Adolescent)
18-25 (Young adult)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Hispanic or Latino
White
Race/ethnicity unspecified
Settings Outpatient
Home
Geographic Locations Urban
Suburban
Rural and/or frontier
Tribal
Implementation History Functional Family Therapy for Adolescent Alcohol and Drug Abuse has been implemented in 14 different sites since 1995. More than 750 families of adolescents referred for substance abuse and related problem behaviors have received the intervention. Although most implementations have occurred within the United States, the intervention also has been implemented in Spanish in Chile and Peru. It has been evaluated in seven separate clinical trials, with four additional trials underway.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations The intervention has been culturally adapted for use with adolescents in Santiago, Chile, and Lima, Peru, and all of the intervention materials have been translated into Spanish.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: February 2014

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

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.  Pub Med icon

Waldron, H. B., Ozechowski, T. J., Brody, J., Turner, C. W., & Hops, H. (2013). Randomized clinical trial evaluating Functional Family Therapy and individual and group cognitive behavioral therapies for adolescent marijuana abuse: Outcome trajectories and mechanisms of change. Unpublished manuscript.

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

Study 2

Waldron, H. B., Ozechowski, T. J., Brody, J. L., Turner, C. W., Hops, H., & Scherer, D. (2013). Intensive in-home family systems intervention, clinic-based group therapy, and telephone-based counseling: A comparison of three transitional continuing care interventions following Functional Family Therapy for adolescent substance abuse. Unpublished manuscript.

Supplementary Materials

Miller, W. R., & Del Boca, F. K. (1994). Measurement of drinking behavior using the Form 90 family of instruments. Journal of Studies on Alcohol, Suppl. 12, 112-118.  Pub Med icon

Sobell, L. C., & Sobell, M. B. (1992). Timeline follow-back: A technique for assessing self-reported alcohol consumption. In R. Z. Litten & J. Allen (Eds.), Measuring alcohol consumption: Psychosocial and biological methods (pp. 41-72). Totowa, NJ: Humana Press.

Tonigan, J. S., Miller, W. R., & Brown, J. M. (1997). The reliability of Form 90: An instrument for assessing alcohol treatment outcome. Journal of Studies on Alcohol, 58(4), 358-364.  Pub Med icon

Waldron, H. B., & Brody, J. (2010). Functional Family Therapy for adolescent substance use disorders. In J. Weisz & A. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 401-415). New York, NY: Guilford Press.

Waldron, H. B., & Turner, C. W. (2008). Evidence-based psychosocial treatments for adolescent substance abuse. Journal of Clinical Child and Adolescent Psychology, 37(1), 238-261.  Pub Med icon

Outcomes

Outcome 1: Marijuana use
Description of Measures Marijuana use was measured with the Form 90D version of the Timeline Followback (TLFB) interview, a semistructured calendar-based method for reconstructing days of substance use over a specified time period. At baseline (pretreatment), adolescent participants' marijuana use was measured for the prior 90 days, and at all follow-up assessments, marijuana use was measured to the date of the prior assessment. On the basis of this information, the percentage of days of marijuana use and the percentage of adolescents reporting minimal marijuana use (defined as use on less than 10% of the days) were calculated.
Key Findings A randomized clinical trial (RCT) was conducted with adolescents who were referred to a university-based research clinic for substance abuse treatment, met DSM-IV criteria for a primary substance abuse disorder, and lived at home with a primary caretaker also willing to participate in the study. Adolescents who abused only alcohol and/or tobacco were excluded from participation, and marijuana was the substance typically abused. Most adolescents were mandated to treatment by court order, by probation officers in lieu of a court order, or by the schools in lieu of suspension or other consequences. Adolescents and their families were assigned to one of four types of treatment: (1) Functional Family Therapy for Adolescent Alcohol and Drug Abuse, (2) an individual cognitive behavioral therapy (CBT-I) coping skills training program, (3) joint Functional Family Therapy for Adolescent Alcohol and Drug Abuse plus CBT-I, and (4) psychoeducational group therapy. Participants assigned to the Functional Family Therapy for Adolescent Alcohol and Drug Abuse, CBT-I, and psychoeducational group therapy conditions were offered 12 total hours of treatment, and those assigned to the joint Functional Family Therapy for Adolescent Alcohol and Drug Abuse plus CBT-I condition were offered 24 total hours of treatment. Assessments were conducted at baseline (pretreatment) and at 4, 7, and 19 months after treatment initiation (follow-up assessments). (The 4- and 7-month follow-up assessments were intended to coincide generally with the completion of treatment and 3 months after treatment, respectively.) Findings regarding the percentage of days of marijuana use included the following:

  • At the 4-month follow-up assessment, the percentage of days of marijuana use by adolescents who received Functional Family Therapy for Adolescent Alcohol and Drug Abuse was lower than the use by adolescents who received CBT-I (24.95% vs. 52.09%; p < .003) and adolescents who received psychoeducational group therapy (24.95% vs. 55.73%; p < .003). These between-condition differences were associated with a medium effect size (eta-squared = .120).
  • At the 4-month follow-up assessment, there was no significant difference in the percentage of days of marijuana use between adolescents who received Functional Family Therapy for Adolescent Alcohol and Drug Abuse and those who received joint Functional Family Therapy for Adolescent Alcohol and Drug Abuse plus CBT-I.
  • From the 4- to 7-month follow-up assessments, there were no significant differences in the percentage of days of marijuana use between the four study conditions.
  • From the 4- to 19-month follow-up assessments, the percentage of days of marijuana use by adolescents who received Functional Family Therapy for Adolescent Alcohol and Drug Abuse was lower than the use by adolescents who received CBT-I (p = .03) and adolescents who received psychoeducational group therapy (p < .01).
  • From the 4- to 19-month follow-up assessments, there was no significant difference in the percentage of days of marijuana use by adolescents who received Functional Family Therapy for Adolescent Alcohol and Drug Abuse and those who received joint Functional Family Therapy for Adolescent Alcohol and Drug Abuse plus CBT-I, and there was no significant difference in the percentage of days of marijuana use by adolescents who received joint Functional Family Therapy for Adolescent Alcohol and Drug Abuse plus CBT-I and those who received psychoeducational group therapy or CBT-I.
Findings regarding minimal marijuana use (defined as use on less than 10% of the days) included the following:

  • At the 4-month follow-up assessment, the percentage of adolescents who reported minimal marijuana use was higher for those in the Functional Family Therapy for Adolescent Alcohol and Drug Abuse study conditions (i.e., adolescents who received Functional Family Therapy for Adolescent Alcohol and Drug Abuse and those who received joint Functional Family Therapy for Adolescent Alcohol and Drug Abuse plus CBT-I) compared with those who received psychoeducational group therapy (p < .013); in addition, there was no significant difference in the percentage of adolescents who reported minimal marijuana use between those in the Functional Family Therapy for Adolescent Alcohol and Drug Abuse study conditions and those who received CBT-I.
  • From the 4- to 7-month follow-up assessments, there was no significant difference in the percentage of adolescents who reported minimal marijuana use between those in the Functional Family Therapy for Adolescent Alcohol and Drug Abuse study conditions and those who received psychoeducational group therapy.
  • At the 7-month follow-up assessment, the percentage of adolescents who reported minimal marijuana use was higher for those in the Functional Family Therapy for Adolescent Alcohol and Drug Abuse study conditions compared with those who received CBT-I (p < .028).
Another RCT was conducted with adolescents who were referred to a university-based research clinic for substance abuse treatment, met DSM-IV criteria for a primary substance abuse disorder, and lived at home with a primary caretaker willing to participate in the study. Adolescents who abused only alcohol and/or tobacco were excluded from participation, and marijuana was the substance typically abused. Adolescents were referred to the study by multiple sources, including the public school system, the juvenile justice system, and health care facilities. Participants received 12-14 sessions of Functional Family Therapy for Adolescent Alcohol and Drug Abuse, then the adolescents and their families were randomly assigned to one of three aftercare interventions for 8 weeks: (1) biweekly telephone contacts with families; (2) weekly, intensive home-based sessions with families and individual sessions with each adolescent; and (3) weekly group counseling sessions. Assessments were carried out at baseline (pretreatment) and at 4, 7, and 12 months after treatment initiation (follow-up assessments). (The 4- and 7-month follow-up assessments were intended to coincide generally with the completion of treatment and 3 months after treatment, respectively.) Findings included the following:

  • From pretreatment to the 4-month follow-up assessment, the percentage of days of marijuana use decreased from 49.04% to 36.97% for the entire adolescent participant sample (p = .005).
  • At the 7-month follow-up assessment, the percentage of days of marijuana use by adolescents who received home-based family sessions and individual sessions as aftercare was lower than the use by adolescents who received group counseling as aftercare (28.47% vs. 42.80%; p = .0001).
  • At the 12-month follow-up assessment, the percentage of days of marijuana use by adolescents who received telephone contact as aftercare was lower than the use by adolescents who received group counseling as aftercare (39.79% vs. 57.99%; p < .015).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 2: Delinquent behavior
Description of Measures This outcome was measured with the Delinquent Behavior subscale of the Youth Self-Report (YSR). The 13-item Delinquent Behavior subscale is one of the YSR's eight self-report behavior problem subscales that measure emotional and behavioral problems among youth. Using a 3-point scale ranging from 0 (not true) to 2 (very true or often true), adolescents rate the degree to which the item is characteristic of themselves (e.g., "I hang around with kids who get in trouble," "I cut classes or skip school"). Higher scores indicate higher levels of delinquent behavior.
Key Findings A randomized clinical trial (RCT) was conducted with adolescents who were referred to a university-based research clinic for substance abuse treatment, met DSM-IV criteria for a primary substance abuse disorder, and lived at home with a primary caretaker also willing to participate in the study. Adolescents who abused only alcohol and/or tobacco were excluded from participation, and marijuana was the substance typically abused. Most adolescents were mandated to treatment by court order, by probation officers in lieu of a court order, or by the schools in lieu of suspension or other consequences. Adolescents and their families were assigned to one of four types of treatment: (1) Functional Family Therapy for Adolescent Alcohol and Drug Abuse, (2) an individual cognitive behavioral therapy (CBT-I) coping skills training program, (3) joint Functional Family Therapy for Adolescent Alcohol and Drug Abuse plus CBT-I, and (4) psychoeducational group therapy. Participants assigned to the Functional Family Therapy for Adolescent Alcohol and Drug Abuse, CBT-I, and psychoeducational group therapy conditions were offered 12 total hours of treatment, and those assigned to the joint Functional Family Therapy for Adolescent Alcohol and Drug Abuse plus CBT-I condition were offered 24 total hours of treatment. Assessments were conducted at baseline (pretreatment) and at 4, 7, and 19 months after treatment initiation (follow-up assessments). (The 4- and 7-month follow-up assessments were intended to coincide generally with the completion of treatment and 3 months after treatment, respectively.) Findings included the following:

  • From baseline to the 4-month follow-up assessment, adolescents who received Functional Family Therapy for Adolescent Alcohol and Drug Abuse had lower scores on the Delinquent Behavior subscale of the YSR compared with adolescents who received psychoeducational group therapy (p = .01).
  • From baseline to the 4-month follow-up assessment, there was no significant difference in Delinquent Behavior subscale scores between adolescents who received Functional Family Therapy for Adolescent Alcohol and Drug Abuse and those who received joint Functional Family Therapy for Adolescent Alcohol and Drug Abuse plus CBT-I.
  • From the 4- to 19-month follow-up assessments, adolescents who received Functional Family Therapy for Adolescent Alcohol and Drug Abuse had lower scores on the Delinquent Behavior subscale of the YSR compared with adolescents who received psychoeducational group therapy (p = .02).
  • From the 4- to 19-month follow-up assessments, there was no significant difference in Delinquent Behavior subscale scores between adolescents who received Functional Family Therapy for Adolescent Alcohol and Drug Abuse and those who received joint Functional Family Therapy for Adolescent Alcohol and Drug Abuse plus CBT-I.
Another RCT was conducted with adolescents who were referred to a university-based research clinic for substance abuse treatment, met DSM-IV criteria for a primary substance abuse disorder, and lived at home with a primary caretaker willing to participate in the study. Adolescents who abused only alcohol and/or tobacco were excluded from participation, and marijuana was the substance typically abused. Adolescents were referred to the study by multiple sources, including the public school system, the juvenile justice system, and health care facilities. Participants received 12-14 sessions of Functional Family Therapy for Adolescent Alcohol and Drug Abuse, then the adolescents and their families were randomly assigned to one of three aftercare interventions for 8 weeks: (1) biweekly telephone contacts with families; (2) weekly, intensive home-based sessions with families and individual sessions with each adolescent; and (3) weekly group counseling sessions. Assessments were carried out at baseline (pretreatment) and at 4, 7, and 12 months after treatment initiation (follow-up assessments). (The 4- and 7-month follow-up assessments were intended to coincide generally with the completion of treatment and 3 months after treatment, respectively.) Findings included the following:

  • From pretreatment to the 4-month follow-up assessment, the score for the Delinquent Behavior subscale of the YSR decreased from 8.29 to 6.51 for the entire adolescent participant sample (p < .05).
  • From the 4- to 12-month follow-up assessments, scores for the Delinquent Behavior subscale of the YSR were lower for adolescents who received telephone contact as aftercare compared with adolescents who received group counseling as aftercare (p = .0053).
  • From the 4- to 12-month follow-up assessments, scores for the Delinquent Behavior subscale of the YSR were lower for adolescents who received home-based family sessions and individual sessions as aftercare compared with adolescents who received group counseling as aftercare (p < .013).
  • From the 4- to 12-month follow-up assessments, there was no significant difference in Delinquent Behavior subscale scores between adolescents who received telephone contact as aftercare and those who received home-based family sessions and individual sessions as aftercare.
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.4 (0.0-4.0 scale)
Outcome 3: Family cohesion
Description of Measures Family cohesion was measured with the parent-reported Cohesion subscale of the Family Environment Scale (FES). The 9-item Cohesion subscale is 1 of the FES's 10 subscales that assess various dimensions of family and individual functioning. The Cohesion subscale measures the degree of commitment and support family members provide for one another. Using a dichotomous true/false response, parents respond to each item. Subscale scores range from 0 to 9, with higher scores indicating greater family cohesion.
Key Findings An RCT was conducted with adolescents who were referred to a university-based research clinic for substance abuse treatment, met DSM-IV criteria for a primary substance abuse disorder, and lived at home with a primary caretaker willing to participate in the study. Adolescents who abused only alcohol and/or tobacco were excluded from participation, and marijuana was the substance typically abused. Adolescents were referred to the study by multiple sources, including the public school system, the juvenile justice system, and health care facilities. Participants received 12-14 sessions of Functional Family Therapy for Adolescent Alcohol and Drug Abuse, then the adolescents and their families were randomly assigned to one of three aftercare interventions for 8 weeks: (1) biweekly telephone contacts with families; (2) weekly, intensive home-based sessions with families and individual sessions with each adolescent; and (3) weekly group counseling sessions. Assessments were carried out at baseline (pretreatment) and at 4, 7, and 12 months after treatment initiation (follow-up assessments). (The 4- and 7-month follow-up assessments were intended to coincide generally with the completion of treatment and 3 months after treatment, respectively.) Findings included the following:

  • From pretreatment to the 4-month follow-up assessment, the score for the Cohesion subscale of the FES increased from 5.62 to 6.01 for all families of adolescents in the participant sample (p < .05).
  • From the 4- to 12-month follow-up assessments, scores for the Cohesion subscale of the FES increased more for families of adolescents who received telephone contact as aftercare compared with families of adolescents who received group counseling as aftercare (p = .0021).
  • From the 4- to 12-month follow-up assessments, scores for the Cohesion subscale of the FES increased more for families of adolescents who received home-based family sessions and individual sessions as aftercare compared with families of adolescents who received group counseling as aftercare (p < .03).
  • From the 4- to 12-month follow-up assessments, there was no significant difference in scores for the Cohesion subscale of the FES for families of adolescents who received telephone contact as aftercare and families of adolescents who received home-based family sessions and individual sessions as aftercare.
Studies Measuring Outcome Study 2
Study Designs Experimental
Quality of Research Rating 3.2 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 80% Male
20% Female
46.7% Hispanic or Latino
38.3% White
7.5% American Indian or Alaska Native
7.5% Race/ethnicity unspecified
Study 2 13-17 (Adolescent)
18-25 (Young adult)
82.4% Male
17.6% Female
52.7% Hispanic or Latino
39.2% White
8.1% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Marijuana use 3.8 3.6 2.8 3.5 3.0 3.3 3.3
2: Delinquent behavior 3.8 4.0 2.8 3.5 3.0 3.5 3.4
3: Family cohesion 3.0 3.5 2.5 3.5 3.0 3.5 3.2

Study Strengths

The TLFB interview is a well-known self-report instrument with high test-retest reliability for collecting substance use frequency. Internal consistency reliability for the TLFB interview was high in both studies for the past 90 days, and its convergent validity for marijuana use in both studies was demonstrated by collateral parent and sibling reports (using Form 90D of the TLFB interview) and by urinalysis at assessments. The YSR is also a well-known self-report instrument with documented internal consistency and test-retest reliability in the field. The YSR also has criterion and concurrent validity with other self-report instruments of youth psychopathology. The Delinquent Behavior subscale of the YSR has convergent validity with other measures of delinquent behavior, and its validity has been independently demonstrated across numerous studies in the field. The developers of the FES report internal consistency for the subscales and test-retest reliabilities at 2-month intervals, and discriminant validity has been established for distinguishing normal from disturbed families, including families in which one or more members abuse alcohol. The intervention is manual driven, and efforts were made to ensure fidelity: the intervention was delivered by experienced therapists who received extensive training and ongoing supervision, and intervention sessions were videotaped and rated on a 10-point adherence checklist, with feedback provided to the therapists to prevent drift. In both studies, the investigators used highly sophisticated statistical procedures for handling missing data. Random assignment controlled for many potential confounds, and youth outcomes were followed longitudinally for a lengthy period of time: 19 months in one study and 12 months in the other study. An intent-to-treat approach was used in both studies. In one study, Bonferroni adjustments to the cutoff for statistical significance were used to correct for a higher experimentwise error rate associated with multiple statistical contrasts, and effect sizes for the between-group differences were included. The statistical modeling of the datasets in both studies was rigorous and very sophisticated.

Study Weaknesses

The percentage of youth reporting minimal marijuana use (i.e., use on less than 10% of the days) was calculated for the two studies; therefore, independent reliability estimates are not available. Because this minimal use measure is a lesser known way of conceptualizing treatment outcomes, its validity is less definite. The reliability of parent-reported family cohesion is questionable without confirmatory observational measures of parenting, since findings in the literature suggest poor correspondence between parents' self-report and independently observed measures of family cohesion by trained raters. The investigators did not report specific ratings for the intervention adherence checklists and the interrater reliability in treatment integrity ratings. Treatment dosage differed across groups by design in both studies. In one study, six of the originally randomized youth did not complete either the 4- or 7-month follow-up assessment and were dropped from the analyses. In the other study, attrition was high at the 12-month follow-up assessment (32.4%), a level that can lead to a distorted understanding of the study outcomes over time in a longitudinal study.

Readiness for Dissemination
Review Date: February 2014

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Alexander, J. F., Waldron, H. B., Robbins, M. S., & Neeb, A. A. (2013). Functional Family Therapy for adolescent behavior problems. Washington, DC: American Psychological Association.

Client handouts:

  • Alternatives to Using Drugs or Alcohol
  • Anger Management--Reminder Sheet
  • Personal Triggers/Alternatives to Using Drugs or Alcohol
  • SORC Model
  • Twelve Roadblocks in Family Interactions

Program Web site (under construction), www.lifft.co

Quality assurance forms:

  • Family Assessment: Parent/Caregiver
  • Family Assessment: Youth
  • FFT Treatment Adherence & Session Planning--Behavior Change Session
  • FFT Treatment Adherence & Session Planning--Engagement, Motivation, Assessment
  • FFT Treatment Adherence & Session Planning--Generalizing Sessions
  • Functional Analysis for Non-Drug Use Behavior
  • Functional Analysis for Substance Use
  • Functional Family Therapy--Therapist Adherence Rating Scale

Waldron, H. B. (2013). Functional Family Therapy (FFT): Principles of clinical intervention, assessment, and implementation. Seal Rock, OR: LIFFT.

Waldron, H. B. (n.d.). Functional Family Therapy for adolescent substance abuse and dependence [PowerPoint slides].

Waldron, H. B. (n.d.). Functional Family Therapy for adolescent substance use disorders: Training manual. Albuquerque, NM: Center for Family and Adolescent Research, Oregon Research Institute.

Waldron, H. B., & Brody, J. L. (2010). Functional Family Therapy for adolescent substance use disorders. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 401-415). New York: Guilford Press.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.0 2.8 3.0 2.9

Dissemination Strengths

Program materials clearly describe the implementation process, along with steps for certification and data collection requirements. The intervention book includes a rich description of the clinical foundations of Functional Family Therapy, the research background, and implementation examples. Features of successful implementation are clearly defined, including details about therapist qualities and organizational characteristics. A training manual with step-by-step processes and intervention examples is provided, with an array of handouts to facilitate intervention delivery. Training and support are offered for implementation of the model, including a structured and well-developed process for certification, which is designed to build clinical competence and adherence to the model. Supervisors are trained to use the adherence monitoring forms to help therapists adhere to the model, increase skill and competence in implementation, and track fidelity of the model.

Dissemination Weaknesses

The distinction between this intervention and other dissemination systems or versions of Functional Family Therapy is not clear; implementation, training, and quality assurance materials describe the intervention using varied names, leaving readers uncertain about which materials are specifically developed for the implementation of Functional Family Therapy for Adolescent Alcohol and Drug Abuse. Access to training and support services is limited; because the program Web site is under construction, new implementers must contact the developer by phone or email to obtain information on training and support opportunities. It is unclear how the developer's outcomes and adherence monitoring online database operates and how this system supports implementers of Functional Family Therapy for Adolescent Alcohol and Drug Abuse.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Functional Family Therapy for Adolescent Behavior Problems (book) $59.95 each Yes
Functional Family Therapy for Adolescent Substance Use Disorders: Training Manual (includes client handouts and quality assurance forms) Free Yes
Functional Family Therapy for Adolescent Substance Use Disorders (book chapter) Free Yes
Functional Family Therapy for Adolescent Substance Abuse and Dependence (PowerPoint slides) Free Yes
Stage 1 Training (includes 2 on-site trainings and guided practice) $26,000-$43,500, plus trainer travel expenses, for 3-8 therapist participants Yes
Stage 2 Training (includes 2 on-site trainings and guided practice) $13,000, plus trainer travel expenses, for 1 supervisor participant Yes
Stage 3 Training (includes 1 on-site training) $5,000, plus trainer travel expenses, per site Yes
Therapist certification $500 per therapist Yes

Additional Information

Therapists are required to be certified annually for the first 2 years of implementation, then biennially if they continue to meet certification standards.

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

Hops, H., Ozechowski, T. J., Waldron, H. B., Davis, B., Turner, C. W., Brody, J. L., et al. (2011). Adolescent health-risk sexual behaviors: Effects of a drug abuse intervention. AIDS and Behavior, 15(8), 1664-1676.  Pub Med icon

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.  Pub Med icon

* Waldron, H. B., Ozechowski, T. J., Brody, J. L., Turner, C. W., Hops, H., & Scherer, D. (2013). Intensive in-home family systems intervention, clinic-based group therapy, and telephone-based counseling: A comparison of three transitional continuing care interventions following Functional Family Therapy for adolescent substance abuse. Unpublished manuscript.

Waldron, H. B., Turner, C. W., Brody, J. L., & Ozechowski, T. J. (2012). Functional Family Therapy and cognitive behavioral treatments for adolescent alcohol misuse: A randomized clinical trial. Unpublished manuscript.

Contact Information

To learn more about implementation, contact:
Aleah MontaƱo
(505) 453-8984
aleah@lifft.co

To learn more about research, contact:
Charles W. Turner, Ph.D.
(732) 501-9505
cturner@ori.org

To learn more about implementation or research, contact:
Holly B. Waldron, Ph.D.
(541) 563-7001
holly@lifft.co

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.