Overview of Functional Family Therapy

1. Sarah Sussman

2. Brief Overview
Founded by Dr. James
Alexander in the 1970s
• Short-term, culturally sensitive, strengths based treatment
strategy
• Focuses on motivating at-risk youth and strengthening the
families through:
(a) Crime prevention
(b) Prevention of Community victimization

3. Rationale
EBP that successfully remedies
adolescent delinquency within the
community
Functional Family Therapy (FFT)
addresses behavioral and/or emotional
issues in the adolescent population
Juvenile offenses, violent behaviors, and
substance abuse are all areas in which
FFT can be applied

4. “Evidence-based programs have been
shown to successfully treat delinquent
youth in the community & decrease out of
home placement cost between $1300 and
$5,000 per family per year, while
incarcerating just one youth will cost over
$50,000 per year with the likelihood of
poorer outcomes for both the youth &
their family.”
Evidence Based Practices for Juvenile Justice Reform in
Louisiana, (2010).

5. Need for concern?
Social workers should
be concerned because:
• at-risk population
needs an effective,
evidence based
intervention model
that can serve as a
blueprint to
formulate an
effective model in
any community
Society should be
concerned because:
• at risk population
jeopardizes their
safety and also costs
them money via the
costs of incarcerating
the delinquent youth
that live within their
community

6. Synopsis of the Program
Functional Family Therapy is comprised of FIVE main
concepts:
Engagement
Motivation
Relational assessment
Behavior change
Generalization
There are particular interventions and tactics utilized to
assist in the accomplishment of the goals specific to each
area within the FFT program.

8. Demonstration Videos
Dr. James Alexander, the creator of Functional Family
therapy, gave a presentation in Utah in February of 2013.
While the entire video is interesting. at 37:40, he
demonstrates what Functional Family Therapy is all
about.
https://www.youtube.com/watch?v=8a_RmrcwpDM
Professor Sexton offers an example of the type of
children Functional Family Therapy works with at 12:10
of this video:
https://www.youtube.com/watch?v=a7Ohnv8SRqk

9. Assessment from the
Originator
According to Professor James Alexander, “it’s a
therapy for MOST people and it is designed to help
the greatest number of people at the lowest cost”
It is a universal technique; however, it requires
individualization
Regarding efficacy and efficiency: there 36 published
studies, most of which were done by independent
people who have replicated Dr. James Alexander’s
work

10. Secondary Assessment
According to Dr. Michael Robbins, Senior Scientist at
the Oregon Research Institute and Director of
Research for Functional Family Therapy, Inc, FFT
“works”.
He reports the use of FFT demonstrates that 80-90%
of families not only are engaged but are also
successfully treated compared to the 70% that were
not getting a full dose of treatment prior to FFT

11. Third Assessment
According to Professor Sexton, “Somewhere in
the world, everyday, FFT is done in one of 8 or
9 different languages. That’s kind of a
remarkable accomplishment for a psychological
therapy, most of which (most of them are)
culturally and language based. The reason that
FFT has been able to that is because the
process of it is not about the content of what
people say, it’s about the process of what goes
on between people. And it seems that those
processes between people are universal”

12. My Assessment
Functional Family Therapy is:
Flexible delivery (in-home or in-community)
Culturally Competent
Evidenced-Based
I find FFT to be a useful blueprint, if you will, for work with
families, adolescents, and even communities; however, I
believe the key to success is the ability to individualize the
program for the needs of the particular case at hand

13. FFT & Child Abuse/Neglect
FFT is effective in engaging and motivating both adolescents
and families, including adults.
There is evidence supporting FFT’s effectiveness in keeping
adults out of the criminal system.
FUNCTIONAL FAMILY THERAPY WORKS TO:
• Developing family communication and supportiveness
• Improving school performance and behavior in the home
• Decreasing negative feelings and reducing blame
• Understanding the importance of respecting all family
members
• Making positive changes and promoting effective solutions
CHR, 2014

14. Verdict…
The vast majority of research demonstrates the
effectiveness of FFT with adolescent behavior issues;
however, FFT has been used with children who report
physical and/or sexual abuse.
In fact, when asked about what “target populations” FFT
serves, James Alexander explains that in just one of their
projects, approximately 50% of the children come in with
documented instances of either physical or sexual abuse.

15. Where?
This program is being implemented both in-community
and in-home.
Specifically, FFT has been implemented state-wide in the
following places: Washington (juvenile parole and
probation), Florida (Florida Redirections project),
Louisiana, and Pennsylvania.
County programs include locations like Ohio (South
Community Behavioral Healthcare) and New York (The
Catholic Charities of Broome County).
FFT has also been implemented in Norway at the Center
for Child and Behavioral Development

16. Evaluation of FFT
Because FFT is often tailored for specific issues and
populations, the evaluation of outcomes and success
differs among programs
However, some means of evaluation include:
Assessing completion rates
Measuring re-arrest and recidivism rates
Calculating the amount of money taxpayers save as a
result of the program

17. Statewide Program Outcome Examples
FFT ‘s Washington State Project
continues to improve the cost
benefit to taxpayers of
Washington State. For every
dollar spent on FFT $18.98 is
saved through reductions in
felony recidivism.
FFT worked with The Norwegian
Center for Child Behavioral
Development over the last four years
to provide FFT to an ethnically diverse
population of youth. Since its
inception, completion rates have
increased by 22%, and 2011 saw a
reduction in risk level from 13.0
(moderate range) to 5.8 (low range) as
measured on the Youth Level of
Service (YLS).
When the Commonwealth
invests in FFT, it receives a cost
benefit of $14.56 for every dollar
spent on its program, a potential
statewide economic benefit of
$136 million. For 2010, 1642
youth were served in FFT, an
The historical recidivism rate for
Louisiana juveniles has been
approximately 50%. FFT’s
Louisiana FFT programs have a
6% re-arrest rate and an 84%
completion rate.

18. County/Local Program Outcome Examples
FFT has been partnering with
The Catholic Charities of
Broome County, Binghamton
NY to provide FFT since 2003.
60% of the youth served have a
mental health disorder in
addition to probation
involvement. This site has seen
a 94% average placement
prevention rate since 2007.
2011 saw 99% with no new
felony offenses and 89% with no
new misdemeanor offenses.
In 2006, FFT and South
Community Behavioral
Healthcare came together to
become part of a multi-agency
collaborative in Montgomery
County’s LIFE Program. This
program utilized FFT to provide
home based mental health
services in conjunction with
juvenile justice programming to
youth and families. Of the 634
youth the LIFE Program has
served since its program
inception, only (0.9%) were sent
to an Ohio Department of Youth
Services facility at any time
following their enrollment.

19. Community Interest?
Through the Redirection
program implementing FFT,
Florida is already seeing
decreased numbers of youth
being detained or committed
across the state since the
implementation of FFT. The
Department of Juvenile Justice
reported, “an 11% decrease in
youth being placed on
probation from 2009-2011.”
Since 2007, FFT has increased
completion rates by 31%.
Currently 80% of families who
enter FFT complete the
program, and recidivism rates
are 8% lower. (Quarterly Update Report,
Redirection Program Facts:
-Youth Served Since 2004: 7,149
-Males Served: 71%
-Females Served: 29%
R
Capacity: Approximately 1,250
youth per year
Total Cost Avoidance: $193
Million

20. Summarization of Thoughts
Prevention and Intervention Program for adolescents and
families both in-home and in-community
Functional Family Therapy successfully works with
behavior problems and juvenile delinquency, including
drug abuse and violence.
It is cost effective, culturally competent, and unique in
nature
It serves as an effective blueprint for a variety of
community programs
It is evidence based and systematic in nature

21. References
Alexander, J. (2009, May 13). Jim Alexander functional family therapy.
(YouTube Video). Retrieved from
https://www.youtube.com/watch?v=bcyhb85RQxc
Alexander, J. (2013, February 28). Professor Jim Alexander on functional
family therapy. (YouTube Video). Retrieved from
https://www.youtube.com/watch?v=8a_RmrcwpDM
Alexander, J., & Sexton, T. (2000, December). Functional family therapy.
Office of Juvenile Justice and Delinquency Prevention: Juvenile Justice
Bulletin. Retrieved from
https://www.ncjrs.gov/html/ojjdp/jjbul2000_12_4/contents.html
Baglivio, M., Greenwald, M., Jackowski, K., & Wolff, K. (2014, September).
Comparison of multisystemic therapy and functional family therapy
effectiveness: A multiyear statewide propensity score matching analysis of
juvenile offenders. Criminal Justice and Behavior 41(9), 1033-1056. doi:
10.1177/0093854814543272
CHR. (2014). Functional family therapy. Retrieved from
http://www.chrhealth.org/uploads/FINAL%20CHR%20FFT%200711.pdf
Davey, A., Davey, M., & Duncan, T. (2010, December). Transporting
functional family therapy into community-based programs. The Family

22. References(continued)
Functional Family Therapy, LLC. (n.d.). About FFT training. Retrieved
from http://www.fftllc.com/about-fft-training/project-outcomes.html
Janer, N. (2012). Quarterly Update Report. Retrieved from
http://www.fftllc.com/documents/redirectionQ4_11.pdf
Onedera, J. (2006, June). Functional family therapy: An interview with
Dr. James Alexander. The Family Journal 14(3), 306-311. doi:
10.1177/1066480706287802
Robbins, M. (2013, March 14). Functional family therapy. (YouTube
Video). Retrieved from
https://www.youtube.com/watch?v=VFHGM7bHOH0
Sexton, T. (2013, March 26). Prof. Tom Sexton on functional family
therapy. (YouTube Video). Retrieved from
https://www.youtube.com/watch?v=a7Ohnv8SRqk
Sexton, T., & Turner, C. (2010, June). 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