Functional Family Therapy
An evidence-based approach to working with adolescents with
externalizing behavior disorders
Implementing Functional Family Therapy
Webinar #1
Thomas L. Sexton, Ph. D., ABPP
FFT Associates
©FFT Associates. Not intended for Duplication or Distribution
1
Goals of Today’s Training
• Introduction to the Training Program
• Overview of the FFT clinical model & its
value
• Clinical Practice Issues…what will doing FFT
mean for your daily work?
– What can you expect when doing FFT (how long, how
often, where…)
– Your FFT Clinical Work Flow……
Goals of Today’s Training
• Practicing with the FFT/CFS
• Measures of Progress & Process
–
FFT Measures…how you will know FFT is working?
• Case conceptualizing—progress notes and session
planning guides
• Things to help you along the way:
• Learning Center at the FFT Website
–
www.functionalfamilytherapy.com
• To get started:
–
–
–
FFT Book
Introduction to FFT (on the website)
FFT/CFS help resources
Preparing Yourself….
• Number of training activities in the next two
weeks—it will take some time
• If you prepare…training will be more relevant
and applicable
• Your will practice will be better
• You will have more time for the many practice
events you will need to do in the next few
weeks
Overview of the Training Process
What you can expect from us
• What you can expect form us:
• Our role
• Consultants in learning FFT
• Clinical responsibility lies with you
• We will communicate anything important we
see/Please do the same
• Experience suggests implementation goes best
when we share expectations about:
• Training
• Service delivery
• infrastructure
Learning Functional Family Therapy
• One of biggest challenges is teaching the
FFT clinical model…….Not that it is so
difficult…..It is implementing it into:
• Existing ways a clinician works/trained
• Existing ways an organization works
• Lessons over the last 10 years
• Process of change
• Learning curve
Our Training Philosophy
• Principles:
• Based on adult learning/educational psychological
principles of learning
• Short, relevant, repetitive, and clinically specific
• Goal….
• clinically relevant therapist competence & model
adherence
• Ability to use the model in ways that “fit” clients and context
• High model Fidelity and Clinical relevance
Phases of Training
• Phase 1: Planning, Preparation, &
Implementation
• Phase 2: Clinical Training
• Phase 3: Site Supervisor Training
• Phase 4: Partnership/Site Certification
Training Phases:
• Phase 1: Planning, Preparation, & Implementation
• Introductory webinars
• FFT/CFS training
• “fitting” FFT into the work flow
• Phase 2: Clinical Training
•
•
•
•
•
•
3 clinical training days
6 site “externship days
11 webinars
45 hours of team consultation
Online discussion forum
FFT/CFS use
Training Goals
1. Competent FFT Therapist
•
•
•
Able to adherence to the model consistently
Able to competently practice the model with diverse
families in a way that “fits” their unique situation
Improves outcomes with youth and families
2. Supportive Organization
•
Supports the implementation of FFT through
–
–
–
Clinical procedures
Funding
Staffing time/resources
3. Effective & Efficient FFT services
Training Methods
• On-line Learning
– Way to present material in an interactive way over the
web in “small doses”
• Discussion Forum
– Learning “places” where topics are discussed and where,
over time, the community of FFT therapists take part in
posing questions and answering them
• Traditional Training
– Presentation and interaction with an FFT expert focusing
on the clinical principles and techniques
Training
• Case Consultation
– Small group discussion of specific cases
– Following a “developmental” model that builds from
basic core principles to complex clinical intervention
• Observation/Practice
– Of video tapes (of actual sessions)
– In ongoing practice
Training
• Systematic Case Planning and Quality
Assurance Monitoring
• FFT/CFS
• Ongoing measurement of FFT process and client
progress
• Systematic case planning…..with the FFT progress
notes and session plans
• Case Experience
Learning Resources
• Learning Center
(www.functionalfamilytherapy.com)
• FFT Manual
• Articles/PowerPoint's
• FFT/CFS help/training website
• Weekly Video Case Consultation
• Ask on the discussion forum
• Email us
Questions?
Practicing Functional Family Therapy
• How it is delivered
• What you can expect
• Systematic Clinical Decision making
• Ongoing measurement of process and client progress
to better plan and intervene
Functional Family Therapy
as an “evidence-based model”
1. Systematic Clinical Model
2. Clinical Intervention “Map”
3. Research support
4. Clinically responsive & transportable
Functional Family Therapy
Clinical Model
Engagement
Reduce within family
risk factors
Early
-negativity/blame
Behavior Change
Generalization
Build within family
Assessment
protective factors
Middle
-behavior
competencies
-hopelessness
-build engagement/
reduce dropout
Build family to context
protective /reduce risk
Late
factors
-interaction
change
Intervention
-peers/school/
-that increase probability of
community
- behavior
Motivation
Behavior Change
Early
Middle
Generalization
Late
Goal
Goal
Goal
Functional Family Therapy
Clinical Model
-phase/intermediate
-phase/intermediate
-phase/intermediateobjectives
objectives
objectives
Skills
Skills
Skills
-therapist
-therapist
-therapistactions
actions
actionsthat
that
thathave
have
havehigh
high
highprobability
probability
probability
of
reaching
those
goals
of
ofreaching
reachingthose
thosegoals
goals
Engagement
Behavior Change
Generalization
Assessment
Intervention
Motivation
Behavior Change
Early
Middle
Generalization
Late
Core of FFT
A therapy that is both systematic and individualized?
Goal of a therapy is to BOTH…..
• Match to the Family
–
–
Everything is client centered and personal to the life of the client
It is responsive to the unique and multisystemic nature of the client
• Relational “needs”
• Obtainable change for the family
• Unique relational organization
• Match to the Model
–
–
–
Model as primary clinical decision making tool
Model to direct treatment plans….sessions plans
Follow BOTH:
• Core principles clinical procedures
What you can expect
• FFT lasts 8-14/16 sessions
• Conjoint (whole family/major players)
• Delivered weekly (maybe more in E/M, less in
Gen)
• Sessions in each treatment phase occur in a
successful treatment episode
•
•
•
Engagement motivation
Behavior Change
Generalization
• Assessment as short as possible (get to treatment quickly)
• Simultaneous/other Treatments?
Functional Family Therapy
Integrated
ServiceAssessment
Delivery Model
Referral/Initial
Your agency baseline assessment
FFT baseline assessment
A “quick” referral to treatment
Engagement
Behavior Change
Generalization
Assessment
Intervention
Motivation
Early
Behavior Change
Middle
Generalization
Late
Functional Family Therapy
Integrated
Service
Delivery Model
•Weekly
FFT Sessions
•Schedule & hold session in FFT/CFS
•Case Planning—FFT Progress Note
•Measuring therapeutic Process & Client
Progress
Engagement
Behavior
Change
Generalization
•8-10 items
completed
by client online
Assessment
Interventio
n
Motivation
Early
Behavior Change
Middle
Generalization
Late
Functional Family Therapy
Integrated Service Delivery Model
Discharge
•FFT/CFS discharge of client
•Outcome Assessment
Engagement
Behavior Change
Generalization
Referral if necessary
Assessment
Interventio
n
Motivation
Early
Behavior Change
Middle
Generalization
Late
Who is a good client for FFT
• Adolescent
• Mental health issues
• Juvenile justice/conduct problems
• Alcohol and drug problems
• Stable family placement
• With no emergency “needs”
• Acute need for hospitalizations
• Stable meds/psychiatric care
• Use a “rule out” philosophy
Session Delivery
• Where? in the home or in the office
• How long? Approximately 60 minutes
• How frequent? Weekly
– Early may be twice a week
– In the middle phases 1 each week
– Generalization phase…..titrate out session over
time
Session with who?
• Family….FFT is a “conjoint” therapy
– Adolescent
– Parents/Step-parents
– Involved siblings
• Sessions are with the family…..
– No individual session…miss opportunities
What if the cancel/no-show
• Overcome barriers
• Engage/work on the phone
• Make room in your schedule and see them the
next day/ or that day after that
How long Does FFT Last?
• Each phase completed
• 10 to 18 sessions
• Over 4 to 6 months
• What if they come back?
• Same therapist….pick up in generalization phase
FFT/Clinical Feedback System
(FFT/Care4)
1.Case conceptualizing
• progress notes and session planning guides
2.Measures of Progress & Process
•
FFT Measures…how you will know FFT is working?
Why this way of working helps
• Allows for:
–
–
–
–
•
Individualization
Clinical specification
Inclusion of the family voice
Measurement of phases & goals to provide reliable clinician decision
making
Each of which help improve treatment effectiveness and
efficiency
FFT/CFS
continuous quality improvement system for Functional Family Therapy
Even Sessions
(2nd, 4th, 6th, etc.)
Odd Sessions
(1nd, 3th, 5th, etc.)
Youth Symptom Level
(SFSS-Form A)
Parent & Youth
Session Impact
(SIS EM, SIS BC, SIS Gen)
Parent & Youth
Baseline
Family
Functioning
Youth Symptom
level
Measure:
Com-R)
SFSS (full)
Client
Engagement
Behavior Change
Generalization
Measures:
-Com-R
-SFSS (full)
Motivation
Behavior Change
Case Planning
Progress Notes
(PN)
Post
Symptoms
Family
functioning
Generalization
Case Planning
Session Planning Guide
(SPG)
Progress Notes
Specific
• What happened
• After each session
• Used by the
therapist to
understand the
case better/plan
• Used by the
Consultant to
help the therapist
learn
Next Session Plan
• Specific session goals
• Specific areas of needed
attention
• Before each session
• Match the
model
specifically to
the
family/situatio
n/needs of the
time
Treatment Session
Clinical Decision Making
Therapist Input
(Progress Notes)
-Assessment
-Anticipated Session Goals
- Observed Session Progress
Session
Individualized
Next Session Plan
Clinical Feedback
(type of session/
contact/time/treatmetn
phase)
updated treatment goals
adjusted session goals
technique adjustment
-treatment goals & progress
-client reports (symptom level,
Family Input
to…
Individualize and fit the family better
to improve implementation of FFT
weekly impact, progress)
Youth & Caregiver reprots on:
-youth symptoms
-impact of therapy
-perceived progress
CPQ
Youth and Caregiver
Client:
Compl eted by:
Date:
INSTRUCTIO NS:
Please a n swer t h e f ol lowi ng q uestio ns a s h onestly a s yo u can b ased o n you r i nd ividu al e xp er ience o f
the c oun sel i ng sessi on t h at you h ave j ust atten ded. You r an swer s t o t h ese q uest ion s w i l l N OT be u sed
to eval uate t he t herapi st.
Completely
Disagree
Family &
Youth reported
Symptom
Severity
This Youth’s Be havior s, T hought s
and F eelings
SFSS-Full Caregiver
Cl ient:
Completed by:
Date:
IN ST RUCTI ONS:
Pl easea n swer t hef ollow ingq uestion sa sh onest ly a sy ou ca n b ased o n you r e xper ien ceo f you r a do lescentsb ehavi or.
1. . ..fee l u n happyo r s ad?
2 . . ..get i n to t r ou ble?
3 . . ..have li ttl e o r n o e n er gy?
Ne ver
Hardl y E ver
So met im es
Often
V ery O ft en
1
2
3
4
5
1
1
2
2
3
3
4
4
Family &
Youth reported
session Impact
2
3
4
5
SIS-EM
2
3
4
5
Youth and Car egiver
1
2
3
4
2
3
4
5
2
3
4
5
1
1
2
2
3
3
4
4
Ne ver
Client :
Completed by:
Date:
INSTRUCTIONS:
Belo w are s everal statement s about t h e session o r m eet ing y o u just h ad w it h yo ur co un selo r.
So m e tim es
Of te n
V ery O ften
1
2
3
4
5
1
2
3
4
5
1
1
2
2
3
3
4
4
5
5
5. . ..th r eaten o r b ul ly oth e rs?
1
2
3
4
5
6. . ..fe el a fr aid th at oth er k id sw o ul d l au gh
at y o u?
1
2
3
4
5
1
2
3
4
5
8 . ...fe el n er vou sa n d/or s hy a r ound oth er
pe o ple ?
1
2
3
4
5
9. . ..h ave ah ard t i me s it tin g sti ll?
1
2
3
4
5
10 . . ..cry e asi ly?
5
11. . ..ann oy oth e r p e op le o n p ur po se ?
5
H ardl y E ver
1. . ..fee l u n happy o r s ad ?
2 . . ..get i n to t r o ub le?
7. . ..h ave ah ar d t i me w aitin g yo ur t ur n?
5
1
1
9. . ..h ave ah ar d t i me s itti ngs t ill ?
10 . . ..cr ye asi ly?
Date:
IN ST RU CTI ONS:
Please an swer t h e f ollow ing q uestio ns as honestl y as you ca n based o n y our i nd ividu al exp er ience.
4. ...d iso bey a d ul ts( not d o w hat a d ult st o ld
you t o d o)?
1
1
6. . ..fe el a frai d th at oth e r k i dsw oul d laugh
at yo u?
7. . ..h ave ah ar d t im e w aiti ngy ou r t ur n?
Client:
Completed by:
3. . ..have l i ttl e o r n o e ne rgy?
5
5
4 . ...di sobeya du lts( not d o w hat a d ult st o ld
you t o d o )?
5 . . ..thr eaten o r b ull yoth er s?
8 . ...fe el n er vousa nd /or s hya ro und oth er
pe o ple?
Your Be havior s, Thoughts and Feelings
SFSS-Week ly-Youth
1
1
2
2
3
3
4
4
5
5
12 . . ..argu e w ith a du lts?
1
2
3
4
5
1. I f e el b lam ed f or th e p ro b lem si n m y
fa mi ly.
13. ...d r ink a l coh ol (b e er, w ine , h ard
li qu or) ?
1
2
3
4
5
5
2. I f ee l ne gative t ow a rd oth er m em b er so f
m y fa mil y.
14. ...w an t t o r un aw ay ( go A WOL) ?
1
2
3
4
5
14 . ...thr ow th i ngsw h en h e /she w asm ad?
1
2
3
4
5
3. I u n de rstan d b ett er so me thi ng a b ou t
oth er s( my p arents/chi ld , b roth er s/sis-
15 . . ..int err up t oth er s?
1
2
3
4
5
11. . ..ann oyoth er p eo p le o n p ur po se?
1
2
3
4
5
12 . . ..argu e w ith a d ul ts?
1
2
3
4
5
13 . ...dr ink a l coh ol (b ee r, w in e, h ard
li qu or) ?
1
2
3
4
Not at all
Onlyal itt le
Some
Alot
Entirely
Family &
Youth reported
Treatment
Progress
ters).
4. I th i nk w e a re a l l p art o f th e p ro ble msi n
o ur f amily.
5. I th i nk w e c an fi n d aso lu tio n t o th e
p ro b le msi n o ur f am il y.
6. W hat w e a re d oi ng i si m p or tan t a nd I a m
t aki ng p ar t .
INSTRUCTIONS:
Not at all
Onlyal ittle
Some
Alot
Entirely
1. Thin gsh ave g ot ten b et ter i n o u r f ami ly
sinc e w e fi r st c ame t o th er apy.
2. I t r ie d t o d o w hat m y co u nsel or s u gge sted.
3. I u sed th i ngsI l ear ne d i n c ounselin g.
ONGOING TREATMENT
1
2
3
1. T he ther apist c ares about me.
0
1
2
3
2. The th erapist and I agree on w hat m y
st ruggles are.
0
1
2
3
4
5
Co mplet el y
Agree
4
5
6
4
5
6
3. I now see how both m y f amily a nd I h ave
some r esponsibility f or th e pro blems
that b rought us t o c ounseling.
0
1
2
3
4
5
6
4. I believe that m y f amily and I c an help
each oth er solve th e problems th at have
brought us t o c ounseling.
0
1
2
3
4
5
6
5. I think w hat is going o n in counseling is
impor t ant and I am t aking par t.
0
1
2
3
4
5
6
© copyri ght FFT Associ ates, not to beused wi thout per missi on.
FFT Clinical Measurement Inventory
• Resource: FFT CMI Manual (on the web)
• Baseline Assessment
• Family Demographic Information (in CFS)
• Family Functioning (COM-r)
• youth & caregiver form
• Youth Symptom Level (SRFF-full Form)
• Youth & caregiver form
• Discharge Assessment
• Family Demographic Information (in CFS)
• Family Functioning (COM-r)
• youth & caregiver form
• Youth Symptom Level (SRFF-full Form)
• Youth & caregiver form
Next Steps
1. Complete Reading the Blue Manual
2. Complete the following webinar’s (after completing
the book)
–
Training Webinar 2: Adolescent behavior problems, Evidence-Based
Practices & FFT
•
–
Training Webinar 3: Overview of FFT
•
–
Recorded Presentation (1 hour 38 min)
Recorded presentation (1 Hour, 30 min)
Training Webinar 4: Research Foundations (35 minutes)
•
Recorded presentation (35 minutes)
FFT/CFS System
3. Practice CFS
–
Training Webinar 5: Introduction to the FFT-CFS
•
•
Powerpoint: FFT-CFS webinar
Webex recording (53 min)
– Your assignment: using the login info and the on
line help tools….
• Review each on line video and quick guide for each
major function
1. Entering a Client
2. Scheduling a Session
3. Holding a session
4. Completing measures
5. Discharging a client
FFT/CFS
• Enter/practice by:
– Entering 3 fake clients (no base line data)
– Entering 2 session for each client
– Completing the measure for each session
– View feedback
• This is practice….learning curve
• We will review it in training/weekly
consultation/ and a future webinar
Resources
• FFT Learning Center
– www.functionalfamilytherapy.com
• FFT/CFS
– https://beta.cfsystemsonline.com/login
• Written Manuals
–
FFT in Clinical Practice (Sexton, 2010)
–
FFT Clinical Training Manual (Sexton & Alexander, 2004)
–
FFT Blueprint Manual (Alexander, Pugh, Parsons, & Sexton, 2000)
What’s next?
• This week:
– Read/learn about FFT
– Review the Clinical Measurement Inventory
– Talk in your team about how you will organize
this into your work flow….
–
–
Identify barriers
Identify possible solutions
– FFT/CFS practice
• It will take 4-5 hours of practice!
– Find your questions….for the training!