Table of Contents
An Outcome-based Evaluation of Functional Family Therapy for Youth with Behavioral Problems
Katarzyna Celinska, John Jay College of Criminal Justice, New York
Susan Furrer and Chia-Cherng Cheng, University of Medicine & Dentistry of New Jersey, Piscataway, New Jersey
Katarzyna Celinska, Department of Law, Police Science, and Criminal Justice Administration, John Jay College of Criminal Justice; Susan Furrer, Center for Applied Psychology, Rutgers University; Chia-Cherng Cheng, Violence Institute of New Jersey at the University of Medicine & Dentistry of New Jersey.
Correspondence concerning this article should be addressed to: Katarzyna Celinska, John Jay College of Criminal Justice, 899 Tenth Ave. 422.32T, New York, NY 10019; E-mail: email@example.com
Acknowledgments: This research project was conducted under the auspices of the Violence Institute of New Jersey at the University of Medicine & Dentistry of New Jersey. The authors wish to thank the CARRI-YIIP therapists, the YCM managers, and the clients for participating in this research. We are also grateful to the anonymous reviewers and the editors for their helpful suggestions.
KEYWORDS: Behavior problems, family therapy, juvenile delinquency, intervention, needs assessment
This article presents results of an evaluation of Functional Family Therapy (FFT), an intervention implemented to address the behavioral problems of at-risk youth in the state of New Jersey. FFT is a model clinical family intervention designed to assist adolescents and their families in preventing further delinquency and violent behavior by enhancing support and communication within the family. We employed a pre-post comparison group design to compare intervention outcomes for youth who received FFT with matched youth who received individual therapy or mentoring. The dependent variable was a change in the risk and protective factors for both youth and their parents, as derived from the Strengths and Needs Assessment (SNA) tool. Although the analysis reveals significant positive improvements in a few domains for both the treatment and the comparison group, only youth who received FFT exhibited a significant reduction in emotional and behavioral needs and risk behaviors. The effectiveness of the intervention may vary by gender, race, age, and ethnicity. We present recommendations for policy and future research.
Practitioners, policymakers, and researchers continually seek effective interventions to reduce delinquent and predelinquent behavior among adolescents. Despite a significant reduction in juvenile arrests in recent years, their arrest rates for violent offenses remain high. In 2010 in the United States, nearly 13% of arrestees were under age 18. Data indicate that juveniles committed more than 13% of all violent crimes and nearly 23% of all property crimes (Uniform Crime Reports, 2010).
Although youth are commonly believed to be more capable of behavioral changes and more amenable to intervention than are adults, many programs fail to show positive effects on delinquency. Some researchers claim that many interventions focus narrowly on youth individual characteristics and fail to address contextual sources of delinquent behavior among youth (Alexander & Sexton, 2002; Gordon, Graves, & Arbuthnot, 1995). According to Andrews and colleagues (1990), for an intervention to be successful, it should address multiple levels of needs and risks among young offenders. Lipsey (2009) reviewed 548 study samples and found that “therapeutic” interventions that included counseling or skills training were more effective than interventions that focused on deterrence and control. Both Andrews and colleagues (1990) and Lipsey (2009) reported that, overall, cognitive-behavioral therapeutic interventions based on social learning and skill building were the most effective types of interventions for adolescents. One example of such intervention is family therapy. In fact, a number of researchers believe that family therapy is the most effective and comprehensive form of therapeutic intervention for at-risk youth (Alexander & Sexton, 2002; Alexander, Pugh, Parsons, & Sexton, 2000; Gordon et al., 1995; Henggeler & Bourdin, 1990).
Among the various types of family therapy approaches, Functional Family Therapy (FFT) and Multisystemic Therapy (MST) have been recognized by various governmental (Office of Juvenile Justice and Delinquency Prevention) and nongovernmental agencies (Center for the Study and Prevention of Violence at the University of Colorado) as model programs for delinquent youth. Lipsey, Howell, Kelly, Chapman, and Carver (2010) found both interventions to be effective but point out that the variations in implementation and in the characteristics of participating youth influence their effectiveness. FFT is a model clinical family intervention designed to assist at-risk adolescents and their families in preventing further delinquency and violent behavior by enhancing support and communication within the family. While FFT focuses on improving family dynamics, MST intervenes in the wider network of institutions (e.g., family, peers, school, treatment agencies, etc.) in which delinquent youth are enmeshed (Henggeler & Bourdin, 1990).
This article presents the results of a quasi-experimental evaluation comparing the outcomes of at-risk youth enrolled in FFT with matched youth who were placed in individual therapy or mentoring. In our study, FFT was provided by the Children at Risk Resources and Interventions— Youth Intensive Intervention Program (CARRIYIIP), whereas individual therapy or mentoring was provided by Youth Case Management (YCM). CARRI-YIIP is a program that provides services to youth and families that include parenting education, home visits, and counseling. YCM is a management program that refers children and youth with behavioral and emotional problems to various programs within the community.
The primary goals of the interventions were to prevent future delinquency by reducing the dangerous behavior of adolescents, decreasing family levels of need, and increasing the strengths of youth and their caregivers.
We employed the Strengths and Needs Assessment (SNA) (Lyons, 2009; Lyons, Weiner, & Lyons, 2004; Caliwan & Furrer, 2009), an information management decision support tool, to gather information in a standardized way with a focus on youth functioning across life domains. This tool not only provided a clinical evaluation for the clients but also measured research outcomes for this study.
The SNA was completed in consultation with each client and family by the therapists for the treatment group and by the case managers for the comparison group. The SNA was completed in the beginning and at the end of each intervention, thus allowing for a pre- and post-assessment.
Early FFT evaluation studies were experiments; however, they tended to exclusively employ small samples of White adolescent males. Our study is atypical in several respects. Focusing on the effectiveness of FFT as implemented by the CARRI-YIIP in New Jersey, the sample came from a single county in New Jersey. Although the sample area was geographically narrow, our sample of 72 adolescents and families was larger and more diverse with respect to gender, race, and ethnicity than the samples in the early studies and more accurately reflected the population of at-risk youth in the United States as a whole. Our sample also represented a more diverse group of youth in terms of reasons for their referral to the program.
Although a randomized experiment would have been preferable, we think that the pre-post design with matching control group is an appropriate design alternative. In our evaluation study, we examined whether FFT in its present form is effective with youth and whether its impact varies by gender, age, race, and ethnicity. We also think that our dependent variable, based on risk and protective factors, is an important advance in researching the effect of an intervention on specific life domains. In sum, the current study contributes to the body of literature on FFT and the effectiveness of youth interventions in general.
Prior Research on Functional Family Therapy
Originally developed in the late 1960s and early 1970s, FFT is designed to serve at-risk youth ages 11 to 18 (Sexton & Alexander, 2004). Parents or other caregivers are included in the therapy. The siblings (or other significant family members) can also be included in the intervention.
FFT is a short-term intervention, usually completed within 3 months. FFT comprises three discrete stages: engagement and motivation, behavioral change, and generalization. During the engagement and motivation phase, the therapist focuses on building an alliance with families and on reducing negativity and blaming. The behavioral change stage is devoted to altering behaviors of adolescents and their family members that have led to conflict. During this stage, the therapists typically work on positive communication and parenting, problem solving, and conflict management. During the generalization phase, families learn how to generalize and sustain positive behavioral and relational changes and how to use relevant community resources (Sexton & Alexander, 2004).
FFT is a highly structured intervention. Each therapist is trained, supervised, and monitored for fidelity to the model through a Web-based system and offsite supervision (Sexton & Alexander, 2004). A successful FFT therapist must not only adhere to the model but also must be flexible in dealing with diverse clients and their particular circumstances.
Some of the research on FFT has focused exclusively on the therapists and their role in delivering this intervention. Although not directly related to this study, research on the therapists helps to illuminate the nature of this intervention. In 2010, Sexton indicated in his study with youth on probation that the effectiveness of FFT in reducing recidivism depended on therapist adherence to the FFT model. However, Alexander, Barton, Schiavo, and Parsons (1976) found that although “training skills” might be necessary for therapists to ensure that their clients return for another session, such skills are at the same time insufficient to secure successful therapy outcomes. Positive emotions during therapy sessions seem to play a particularly helpful role in the engagement phase of a family intervention (Sexton & Schuster, 2008). A strong client-family-therapist alliance is also crucial in reaching positive outcomes in family therapy. Unbalanced alliances are predictive of early withdrawal from therapy (Robbins, Turner, Alexander, & Perez, 2003). This pattern suggests that active participation on the part of all clients should be emphasized from the beginning of therapy (Mas, Alexander, & Turner, 1991).
The effectiveness of FFT has been rigorously evaluated, but most of those studies date from shortly after its inception. Alexander and Parsons (1973) reported that only 26% of adolescents randomly assigned to FFT reoffended, compared with 47% and 73% of adolescents assigned to control groups who received other types of family therapy. In another study, Klein, Alexander, and Parsons (1977) randomly assigned 86 families to four treatment conditions. The researchers found a significant reduction in recidivism among FFT participants (20%) compared with those who received no treatment (40%) or who participated in an alternative treatment (59% and 63%). In 1985, Barton, Alexander, Waldron, Turner and Warburton reported that status offenders in the FFT group had recidivism levels of 26% compared with those in the control group, at 51% (Alexander & Sexton, 2002). Subsequently, Gordon, Arbuthnot, Gustafson, & McGreen (1988) compared delinquent youth who received FFT intervention with those who received only probation. They found that the treatment group had a recidivism rate of 11% after 2.5 years, while the comparison group’s recidivism rate was 67%. The most recently published study by Sexton (2010) indicates that FFT is effective in significantly reducing recidivism rates among young parolees when the therapists delivering FFT adhere to the model.
On the other hand, in 2007 Aultman-Bettridge reported no significant differences in post-program risk factors and recidivism between delinquent girls participating in FFT and delinquent girls who did not participate. Aultman-Bettridge’s research calls for more studies on the effectiveness of FFT among different groups of clients.
Data and Methods
This study was approved by the New Brunswick/ Piscataway IRB at the University of Medicine & Dentistry of New Jersey (UMDNJ) and by the John Jay College of Criminal Justice IRB in New York City. The goal of this research was to compare the outcomes of youth who received FFT with those who received individual therapy or mentoring. To reduce selection bias, we used pre-post matched comparison group design. We chose a quasiexperimental design because random assignment to either the treatment or the comparison group was impossible.
The Strengths and Needs Assessment
The source of data for this study was the SNA, a comprehensive clinical and research tool (Lyons, 2009). The Services Tracking Form, an instrument created specifically for this research project by the first author, provided supplementary data on the basic facts regarding treatment, such as the number of sessions and the types of referrals.
The SNA is a slightly revised version of the Child and Adolescent Needs and Strengths (CANS) assessment (Lyons, Weiner, & Lyons, 2004). The goal of the SNA is to provide clinical data that can be easily translated into service delivery. The most unique and advantageous feature of the SNA is its ratings of the strengths and needs of adolescent clients and their parents. The scores on each item guide decisions about treatment placement and offer valuable information on client outcomes (Anderson, Lyons, Giles, Price, & Estle, 2003; Lyons, Griffin, & Fazio, 1999). In addition, aggregated item scores give standardized psychometric measures for outcome evaluation (Lyons, 2009).
Research on the CANS and SNA suggests that they exhibit face, construct, concurrent, and predictive validity and also show good interrater and auditor reliability (Anderson & Estle, 2001; Anderson et al., 2003; Lyons, 2009; Lyons et al., 2004). In this study, the reliability of the SNA was further enhanced through a training module and a review of client records. The CARRI-YIIP therapists and YCM case managers were trained either in person or through a secure Internet site and subsequently received a Web-based SNA certification. The training included scoring vignettes of real cases (Caliwan & Furrer, 2009). Since the SNA was used for clinical decisions and treatment placement, the accuracy of the SNA was also continuously assessed and affirmed.
The SNA includes seven dimensions: Life Domain Functioning (13 items), Child Strengths (9 items), Acculturation (3 items), Caregiver Strengths (6 items), Caregiver Needs (5 items), Child Behavioral/Emotional Needs (9 items), and Child Risk Behaviors (10 items). The therapists rate both the youth and the caregiver with respect to each item within each subscale, on a scale ranging from 0 (no evidence of problem; no need for service) to 3 (severe; need and priority for an intervention). We recoded the items so that higher scores represented improvement. Each scale was computed as the mean of the relevant items. We obtained seven scales: the Life Domain Scale, the Child Strengths Scale, the Acculturation Scale, the Caregiver Strengths Scale, the Caregiver Needs Scale, the Child Behavioral/Emotional Needs Scale, and the Child Risk Behaviors Scale.
The life domains (13 items) included items related to dimensions of family, school, and vocational functioning. Family life, personal achievements, and community involvement were potential sources of child strengths (9 items). Acculturation (3 items) dealt with language and culture. The caregiver strengths (6 items) were based on caregivers’ involvement with their child and on the level of stability they provided at home. Mental and physical health problems were some of the needs recorded for caregivers (5 items). The child behavioral and emotional needs assessed in the SNA (9 items) were impulsivity, depression, anxiety, anger control, and substance abuse, along with others. Child risk behaviors (10 items) enumerated in the SNA included suicide risk, selfmutilation, danger to others, sexual aggression, running away, delinquency, and fire setting.
We administered the SNA before and after the intervention. Our sample consisted of 72 adolescents: 36 in the treatment and 36 in the comparison group. The data were collected between 2005 and 2007. The treatment group included youth referred to the CARRI-YIIP by Probation (42%), Family Crisis Intervention Unit (25%), Family Court (14%), and Divisions of Youth and Family Services (8%), among others. Eighty-one percent of the cases were mandated to participate in the FFT. To be eligible for either group, youth had to be between the ages of 11 and 17; live with a parent or guardian; and have a history of aggressive behavior, destruction of property, or chronic truancy. Youth with serious criminal behavior, drug or alcohol use, or mental health problems were not eligible.
Fidelity to the FFT model was ensured in a number of ways. Each therapist had to complete annual FFT Site Certification Training. Therapists were monitored via a Web-based system (FFT Clinical Services System) and assisted weekly by an offsite national FFT consultant via conference calls. An onsite FFT certified supervisor also provided ongoing supervision and oversight.
The comparison group consisted of 36 youth managed by YCM, a case management program that makes referrals to service providers in the community, including CARRI-YIIP. Rather than using a single treatment provider for the comparison group, we selected YCM because this agency refers clients to treatment providers across Middlesex County. The comparison group therefore included youth referred to any treatment provider in the county, with the exception of CARRI-YIIP.
This study’s comparison group was selected by the YCM case managers and overseen by the YCM supervisor. The youth were originally referred from various sources, including Children Mobile Response and Stabilization Services, the Division of Youth and Family Services, and parents. All these youth met CARRI-YIIP’s eligibility criteria. The YCM case manager linked youth to services needed to stabilize them in the community while they remained with their families. Several training sessions were conducted by research staff, with YCM case managers to assist them in identifying appropriate cases for this study. The youth in this comparison group were referred either to individual therapy (34 adolescents) or mentoring (2 adolescents).
On average, the FFT intervention lasted 3.4 months and the YCM interventions lasted 4.5 months. Because quantitative data collected from the YCM sample was stripped of all identifying information, participant consent for the release of information was not required.
Demographic Characteristics and the Test of Difference Between Treatment and Control Groups
The majority of the 72 youth who participated in this study were males (approximately two-thirds in both groups) with an average age slightly older than 15. The treatment group was 36% African American and 36% Latino; the comparison group was 44% African American and 33% Latino. Intergroup differences in race, ethnicity, and age distribution were not statistically significant. More characteristics of the sample are presented in Table 1.
Table 1. Demographic Characteristics of Adolescents (N = 72) by Groups
|CARRI-YIIP (N=36)||YCM (N=36)|
We conducted a one-way ANOVA to test for differences in the duration of treatment and in the seven SNA dimensions. We were unable to employ other more sophisticated statistical techniques, such as propensity score matching, because our sample size was not large enough. Using propensity score with small sample sizes might have led to skewed results (Shadish, Cook, & Campbell, 2002).
As Table 2 shows, we found no significant differences between the treatment and comparison groups. These results suggest that the treatment and the comparison groups were comparable with respect to gender, race, ethnicity, length of stay in the program, and all seven SNA dimensions. This permitted further analysis and simple between-group comparison of the outcomes.
Table 2. F-test to Test for Matching the Samples (N=72)
|Variables||CARRI-YIIP Mean (S.D.)||YCM Mean (S.D.)||F||d.f.||p|
|Length of time in program||249(107)||273(143)||.621||1||.433|
|Life Domain Scale (LD)||3.16(.31)||3.04(.35)||2.262||1||.137|
|Child Strengths Scale (CS)||2.78(.47)||2.64(.52)||1.609||1||.209|
|Acculturation Scale (AC)||3.84(.31||3.87(.29)||.208||1||.650|
|Caregiver Strengths Scale (CRS)||3.43(43)||3.47(.48)||.141||1||.708|
|Caregiver Needs Scale (CN)||3.82(.22)||3.86(.22)||.646||1||.424|
|Child Behavior Emotional Needs Scale (CB)||3.17(.45)||3.17(.37)||.001||1||.978|
|Child Risk Behavior Scale (CR)||3.61(.22)||3.51(.27)||2.628||1||.109|
In analyzing differences within the samples, we were interested in finding out whether there was a variation in admission to CARRI-YIIP and YCM by age or gender. We employed seven scales derived from the initial SNA to compare genders and age groups within each sample. As expected, after conducting the t-test, we found that nearly all variances were not significant. However, a couple of significant differences were evident. First, males scored higher on the Child Strengths Scale than females in the treatment group (t = 2.163, p < 0. 05). Second, in the treatment group, older adolescents (ages 15–17) scored higher on the Life Domain Scale (t = 4.892, p < 0. 001) and on the Acculturation Scale (t = 3.232, p < 0.01) than younger adolescents (ages 11–14).
These results indicate that males enter the CARRI-YIIP program with a higher number of identifiable strengths than females. This suggests the interesting possibility of a divergent threshold for girls and boys, above which they are labeled as at-risk and included in the treatment group. The findings also show that older adolescents tend to score higher than younger adolescents on measures of life functioning and acculturation. This pattern could reflect greater maturity among older adolescents.
The goal of the study was to measure the effects of FFT relative to services received in the comparison group. Pre- and post-intervention comparisons (see Table 3) reveal that neither the treatment nor the comparison group changed significantly from pre- to post-intervention on the Acculturation Scale, the Caregiver Strengths Scale, or the Caregiver Needs Scale. In contrast, both groups showed significant improvement on the Life Domain Scale, the Child Strengths Scale, and the Child Risk Behaviors Scale. The difference between initial and discharge assessment on the Life Domain Scale (t = 5.712), Child Strengths Scale (t = 3.312), and the Child Risk Behaviors Scale (t = 4.288) for youth in the treatment group was significant (p < 0.001). Similarly, the difference between initial and discharge assessment on the Life Domain Scale (t = 3.843), Child Strengths Scale (t = 2.332), and Child Risk Behaviors Scale (t = 2.684) for youth in the comparison group was also significant (at p < 0.001 for the first scale and at p < 0.01 for the latter two scales). These findings suggest that the treatment interventions provided by both the CARRI-YIIP and YCM had a positive effect on adolescents, particularly in reducing risk behavior, increasing their strengths, and improving their functioning across key life domains (i.e., home, school, and community).
Table 3. Pre- and post-intervention comparisons between the Treatment and Comparison Groups (T-test, N=72)
|CARRI-YIIP (N=36)||YCM (N=36)|
We did note one significant difference between the treatment and the comparison groups. Specifically, we found a significant positive change on the Child Behavioral/Emotional Needs Scale in the treatment group (t = 3.979, p < .0 001) but not in the comparison group. FFT appeared to exert a positive influence on behavioral and emotional needs among youth, but the interventions from YCM did not.
Notable Significant Differences Between Groups by Demographic Characteristics
To further this analysis, we examined the changes between the initial and discharge SNA according to age and gender in the domains that were significant in the prior analysis: Life Domain, Child Strengths, Child Behavioral/Emotional Needs, and Child Risk Behaviors. As presented in Table 4 and measured by t-test comparisons, we found significant pre-post improvements on the Life Domain, Caregiver Strengths, and Child Behavioral/Emotional Needs scales for both males and females in the treatment group. However, changes in the Child Strengths Scale occurred for male adolescents only. The interventions provided by YCM also seemed to be more effective with male than female adolescents. The pre- and post-intervention comparison for YCM youth showed significant improvement for males but not for females on the Life Domain, Child Strengths, and Caregiver Strengths scales.
Table 4. T-test by Subsamples (N=72)
|CARRI-YIIP (N=36)||YCM (N=36)|
|Scalea||Subsamples||Mean (I)||Mean (D)||t||P||Mean (I)||Mean (D)||t||P|
|11–14 years old||3.42||3.57*||2.538||0.044||3.09||3.27*||2.201||0.048|
|15–17 years old||3.1||3.46***||5.44||0||3.02||3.25**||3.109||0.005|
|11–14 years old||3.02||3.21||2.121||0.078||2.76||2.82||0.82||0.428|
|15–17 years old||2.73||2.87*||2.67||0.013||2.57||2.69*||2.278||0.033|
|11–14 years old||3.19||3.68*||2.818||0.03||3.21||3.29||0.964||0.354|
|15–17 years old||3.16||3.38**||3.048||0.005||3.14||3.2||1.462||0.158|
|11–14 years old||3.7||3.89||2.24||0.066||3.56||3.59||0.671||0.515|
|15–17 years old||3.59||3.75**||3.645||0.001||3.49||3.56**||3.206||0.004|
Although we noted several significant improvements in both female and male adolescents who participated in FFT, we also found the statistical significance of these changes was lower for females than for males. This pattern could reflect a smaller number of female adolescents in our sample. It could also be partially due to the fact that females enter FFT with a smaller number of strengths (as identified in the Child Strengths Scale) than do males.
Our results indicate the effectiveness of FFT may vary by ethnicity, race, and age. Latino adolescents enrolled in FFT improved significantly in the domains captured by the Life Domain and the Child Risk Behaviors scales, but White adolescents improved only on the Child Strengths Scale, and African American adolescents improved only on the Child Behavioral/Emotional Needs Scale. On the other hand, interventions overseen by YCM seem to have had a more pronounced effect on African American youth (as demonstrated by improvements in the Child Behavioral/ Emotional Needs and Life Domain scales) and on Latino youth (as evidenced by improvements in the Life Domain scale) than on White youth. Age appears to be another determinant of treatment effectiveness. Older clients in the treatment group showed more significant improvement than younger clients on the Life Domain, Child Strengths, Child Behavioral/Emotional Needs, and Child Risk Behaviors scales. Older clients in the comparison group showed greater improvement than younger clients on the Child Strengths and Child Risk Behaviors scales.
Some notable similarities are evident between treatment and comparison groups. Overall, male adolescents in both groups improved more than females on the Life Domain and Child Strengths scales while reducing their risks, as demonstrated by improvements on the Child Risk Behavior Scale. Similarly, in both groups, the older adolescents were more successful than their younger counterparts in reducing risks, as demonstrated by improvements in the Child Risk Behavior Scale and increasing strengths, as evidenced by improvements in the Child Strengths Scale.
Significant Differences Between the Treatment and Comparison Groups on the SNA scales
The final step in the data analysis was to examine the “difference in the differences” between the treatment and the comparison groups. Specifically, we compared the two groups in the average improvement on the SNA. We used ANCOVA, the test for analysis of covariance, because it allowed us to correct for a correlation between the initial and discharge assessment by reducing variation between two groups due to the intervention itself. The ANCOVA results are presented in Table 5.
Table 5. ANCOVA to Test for Differences in Changes between Initial and Discharge SNA Assessments (N=72)
The results indicate no significant differences between treatment and comparison groups in improvement on the Child Strengths, Acculturation, Caregiver Strengths, and Caregiver Needs scales. These results suggest that all interventions equally helped youths and their parents to build strengths, increase acculturation, and decrease caregiver needs. However, FFT participants, relative to those in the comparison group, improved more on the Life Domain Scale (F = 5.571, p < 0.05), the Child Behavioral/ Emotional Needs Scale (F = 8.137, p < 0.01), and the Child Risk Behaviors Scale (F = 12.459, p < 0.001). The reduction in risk behavior was especially noteworthy, as unsafe and delinquent behaviors are generally the principal reasons youth are placed in these programs in the first place. We also suggest that the Child Risk Behaviors Scale could be the strongest correlate of recidivism.
This study aimed to evaluate FFT with a more diverse sample and across a wider range of outcomes than had been used in previous studies. Our analysis yielded a number of important findings with possible policy implications. First, both FFT and interventions provided by YCM seem to have a positive effect on referred youth. However, adolescents who participated in FFT improved across a wider range of domains than did their comparison group’s counterparts. Specifically, only youth enrolled in FFT showed improved functioning in life domains, which include such areas as living situation, school behavior, achievement, and attendance, and legal and vocational concerns. A central aim of FFT is to prepare youth and their families to function positively within the community following therapy. Accordingly, during the final phase of the intervention, the therapist assists the youth and family in finding appropriate resources within the community. This distinct aspect of FFT might explain its relative success in these realms.
ANCOVA also uncovered a significant reduction in emotional and behavioral needs and in risk behavior among participants, following FFT only. This finding is especially promising because it suggests that FFT addressed the problems that most likely resulted in the FFT referral. The improvements in these critical domains bode well for the possibility that FFT may have longterm effects. This prospect merits longitudinal research. In addition, this research suggests that the SNA may be a viable, more positive, and more comprehensive alternative than recidivism as an indication of the effect of interventions on youth functioning in the community.
The analysis also revealed a number of differences among subgroups within the treatment and comparison groups. Specifically, only male FFT and YCM participants improved on the Child Strengths Scale. The fact that FFT males had more identifiable strengths than females could mean a higher threshold of admission for females (i.e., females are viewed as less troublesome despite fewer observed strengths), although the small sample of females limits our willingness to press this conclusion. Nonetheless, broader literature suggests that the needs of female adolescents are different from those of males, making genderspecific approaches the most viable and effective (Chesney-Lind, Morash, & Stevens, 2008; Hubbard & Matthews, 2007; Mallett, Quinn, & Stoddard- Dare, 2012; Worthen, 2011, 2012). Hubbard and Matthews (2007) argue that there is not enough research on specific groups of offenders, including females, to support such widespread use of cognitive-behavioral interventions. Gender differences should be considered when using interventions such as family therapy.
Finally, we found that responsiveness to the interventions may also vary by age, race, and ethnicity. Older clients showed more significant improvements on the Life Domain, Child Strengths, Child Behavioral/Emotional Needs, and Child Risk Behaviors scales in the treatment group, and on the Child Strengths and Child Risk Behaviors scales in the comparison group. These results could be partially explained by the higher scores in general life skills and functioning, and acculturation that older FFT clients had when they entered the program. African American adolescents in both FFT and YCM programs reduced their behavioral and emotional needs. Similarly, life functioning areas improved for Latinos who were in FFT and in YCM. On the other hand, only Latinos who received FFT significantly reduced their risk behavior. These differences should be explored further with larger samples.
Some limitations of this study are important to bear in mind. An experimental design was impractical. Although we employed a pre-post quasi-experimental design with comparable treatment and comparison groups, selection bias cannot be ruled out. Fortunately, clear and strict criteria for inclusion in the treatment and comparison groups produced treatment groups that were well matched along numerous dimensions. Although our sample was large enough for analyses of main program effects, a larger sample would have permitted a more reliable and thorough analysis of differences between demographic subgroups.
Future research should systematically examine variations on the effectiveness of FFT by age, gender, and ethnicity in studies with larger samples that permit more reliable subgroup comparisons. Process evaluations could also shed light on divergent subgroup outcomes. Differences in treatment outcomes for boys and girls suggest the need for further research with larger samples that examines whether FFT effects are gender specific. In future research, we intend to use longer-term measures of program effectiveness, enriched with qualitative data from youth and their parents focusing on their impressions about the interventions.
This study has important practical implications regarding FFT and youth interventions more generally. For programs that seek short-term improvements in psychosocial adjustment for atrisk youth, especially those with minor behavioral problems, both FFT and YCM seem to be effective strategies. The improvements in the Child Risk Behaviors Scale extend prior work in evaluating FFT, affirming the effectiveness of FFT in reducing delinquency. Our findings are also in keeping with findings of prior research demonstrating that interventions with therapeutic components are effective with delinquent youth (Lipsey, 2009).
While any therapeutic intervention can have a positive effect on youth (see also Lipsey et al., 2010), our findings suggest that FFT may be more helpful in improving at-risk behavior, easing emotional and behavioral needs, and enhancing overall life functioning among youth. Improvements in these areas may be pivotal in preventing further delinquency and troubled behavior.
About the Authors
Katarzyna Celinska, PhD, is an assistant professor in the Department of Law, Police Science, and Criminal Justice Administration at the John Jay College of Criminal Justice, New York, New York. Her research interests include women’s incarceration and the evaluation of prevention programs. She is currently writing a book on the influence of criminological theory on criminal justice policies.
Susan Furrer, PsyD, is executive director of the Center for Applied Psychology, Rutgers University, Piscataway, New Jersey; at the time of this writing, Dr. Furrer was executive director of the Behavioral Research and Training Institute and the Violence Institute of New Jersey at the University of Medicine & Dentistry of New Jersey, Piscataway, New Jersey.
Chia-Cherng Cheng, MS, is data system coordinator at the Violence Institute of New Jersey at the University of Medicine & Dentistry of New Jersey, Piscataway, New Jersey.
Alexander, J. F., Barton C., Schiavo R.S., & Parsons, B. V. (1976). Systems-Behavioral Interaction with families of delinquents: Therapist characteristics, family behavior, and outcome. Journal of Consulting and Clinical Psychology, 41(4), 656–664.
Alexander, J. F., & Parsons, B. V. (1973). Short-term family intervention: A therapy outcome study. Journal of Consulting and Clinical Psychology, 2, 195–201.
Alexander, J. F., Pugh, C., Parsons, B. V., & Sexton, T. L. (2000). Functional Family Therapy. In D. S. Elliott (Ed.), Blueprints for violence prevention (2nd ed., Book 3). Boulder, CO: University of Colorado, Institute of Behavioral Science, Center for the Study and Prevention of Violence.
Alexander, J. F., & Sexton, T. L. (2002). Functional family therapy: A model for treating high risk, acting-out youth. In F. W. Kaslow (Ed.), Comprehensive handbook of psychotherapy: Integrative/eclectic (Vol. 4, pp. 111–132). New York: John Wiley & Sons.
Anderson, R. L., & Estle, G. (2001). Predicting level of mental health care among children served in a delivery system in a rural state. Journal of Rural Health, 17(3), 259–265.
Anderson, R. L., Lyons, J. S., Giles, D. M., Price, J. A., & Estle, G. (2003). Reliability of the Child and Adolescent Needs and Strengths-Mental Health (CANS-MH) scale. Journal of Child and Family Studies, 12(3), 279–289.
Andrews, D. A., Zinger, I., Hoge, R. D., Bonta, J., Gendreau, P., & Cullen, F. T. (1990). Does correctional treatment work? A clinically relevant and psychologically informed meta-analysis. Criminology, 28, 369–404.
Aultman-Bettridge, T. (2007). A gender-specific analysis of community-based juvenile justice reform: The effectiveness of family therapy programs for delinquent girls. (Doctoral dissertation, University of Colorado at Denver, 2007.) Retrieved from ProQuest Dissertations and Theses (AAT 3267887).
Barton, C., Alexander, J. F., Waldron, H., Turner, C. W., & Warburton, J. (1985). Generalizing treatment effects of Functional Family Therapy: Three replications. American Journal of Family Therapy, 13(3), 16–26.
Caliwan, J., & Furrer, S. (2009). A statewide implementation of an information management and decision support system for children and families in New Jersey. In J. S. Lyons & D. A. Weiner (Eds.), Behavioral health care: Assessment, service planning, and total clinical outcomes management (pp. 525–531). Kingston, NJ: Civic Research Institute.
Chesney-Lind, M., Morash, M., & Stevens, T. (2008). Girls’ troubles, girls’ delinquency, and gender responsive programming: A review. Australian and New Zealand Journal of Criminology, 41(1), 162–189.
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.
Henggeler, S., & Bourdin, C. M. (1990). Family therapy and beyond: A multisystemic approach to treating the behavior problems of children and adolescents. Pacific Grove, CA: Brooks/Cole Publishing.
Hubbard, D. J., and Matthews, B. (2007). Reconciling the differences between the “Gender-Responsive” and “What Works” literatures to improve services for girls. Crime and Delinquency, 54(2), 225–258.
Klein, N. C., Alexander, J. F., & Parsons, B. V. (1977). Impact of family systems interventions on recidivism and sibling delinquency: A model of primary prevention and program evaluation. Journal of Consulting and Clinical Psychology, 41(3), 469–474.
Lipsey, M. W. (2009). The primary factors that characterize effective interventions with juvenile offenders: A meta-analytic overview. Victims and Offenders, 4, 124–147.
Lipsey, M. W., Howell, J., Kelly, M., Chapman, G., & Carver, D. (2010). Improving the effectiveness of juvenile justice programs: A new perspective on evidence-based practice. Washington, DC: Georgetown University, Public Policy Institute, Center for Juvenile Justice Reform.
Lyons, J. S. (2009). Communimetrics: A communication theory of measurement in human service settings. Dordrecht, the Netherlands: Springer.
Lyons, J. S., Griffin, E., & Fazio, M. (1999). Child & Adolescent Needs & Strengths: An information integration tool for children and adolescents with mental health challenges (CANS-MH Manual). Winnetka, IL: Buddin Praed Foundation.
Lyons, J. S., Weiner, D. A., & Lyons, M. B. (2004). Measurement as communication: The Child and Adolescent Needs and Strengths tool. In M. Mariush (Ed.), The use of psychological testing for treatment planning and outcome assessment (vol. 2, pp. 461–476). Mahwah, NJ: Lawrence Erlbaum Associates.
Mallett, C. A., Quinn, L. M., & Stoddard-Dare, P. (2012). Significant gender differences in factors related to the detention of youthful offenders. Women and Criminal Justice, 22(4), 309–326.
Mas, C. H., Alexander, J. F., & Turner, C. W. (1991). Dispositional attributions and defensive behavior in high- and low-conflict delinquent families. Journal of Family Psychology, 5(2), 176–191.
Robbins, M. S., Turner, C. W., Alexander, J. F., & Perez, G. A. (2003). Alliance and dropout in family therapy for adolescents with behavior problems: Individual and systemic effects. Journal of Family Psychology, 17(4), 534–544.
Sexton, T. L. (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.
Sexton, T. L., & Alexander, J. F. (2004). Functional family therapy clinical training manual. Seattle, WA: Annie E. Casey Foundation.
Sexton, T. L., & Schuster, R. A. (2008). The role of positive emotion in the therapeutic process of family therapy. Journal of Psychotherapy Integration, 18(2), 233–247.
Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Boston: Houghton Mifflin.