FFT CFS slideshow 1

1. Functional Family Therapy
An evidence-based treatment for youth and families
Functional Family Therapy & CFS:
The unique synergy of two evidence based
treatments
Thomas L. Sexton, Ph. D., ABPP
Center for Adolescent and Family Studies
Indiana University-Bloomington
©FFT Associates Inc./Thomas Sexton

2. Goals
 Why FFT & CFS are such a good fit
 Advantages of the integration of two evidence-based treatments
 How the synergy of both helps with the individualized delivery of FFT in
child/youth mental health
 Clinical Examples:
 How to get a good start
 How to make early adjustments
 When it doesn’t go well

3. Functional Family Therapy
• Research-based prevention and intervention program for at-risk
adolescents and their families
• Systematic, client centered, evidence based, family-based program
• Implemented in diverse cultures, with diverse youth & families
• Targets youth between 11-18….
• Prevention intervention--status/diversion kids
• Treatment intervention--moderate and serious delinquent youth
• Short-term
• 12-16 sessions normally
• 26-30 for more serious cases spread over 3 to 6 month
• Evidence-based model
• Phases, session goals, and related techniques
• Outcome evidence, process studies to verify the change mechanism
• Systematic Training & Implementation System
• Fidelity monitoring system

4. Functional Family Therapy
Clinical Model Specific Change Mechanisms
•Increase behavioral competency of all/family
•Consistent performance of competency
in “real” problem situation
Engagement Behavior Change Generalization
Assessment
Intervention
Specific Change Mechanisms
Motivation
•Alliance between family Behavior Change Generalization
with therapist Specific Change Mechanisms
•Family/relationally •Generalize new “view” and experience of problem wit
based problem problem focus new problem that arise
•Reduced family member •Maintain new skill - working together
negativity/blame with new problems
•Increased motivation •Support changes by using relevant outside resources

5. We need more than models
 Models provide clinical structure to follow in implementing FFT
 Scaffolding of treatment
 Is it enough?
 Emerging Questions regarding EBT in community settings
 Not translating into community settings (50% reduction in effect sizes)
 Adherence Research (Sexton & Turner, 2010) ∂

6. Model Fidelity and Clinical Outcomes
(Sexton & Turner, 2010)
35.0% 38%* reduction in
30.0% felony crime
50%* reduction in
25.0% violent crime
20.0% $14.67* return for
each $1 invested
15.0%
10.0% $2400-2800 per
5.0% family cost to
deliver
0.0%
6 month 12 months 18 months
Adherent Non-Adherent
* Statistically significant outcome as
compared to the random control condition

7. We need more than models
 More is needed:
 Individualization
 Clinical specification
 Inclusion of the family voice
 Measurement of phases & goals to provide reliable clinician decision
making

8. Unique Synergy of FFT/CFS
FFT Brings…. CFS Brings…..
 Systematic Treatment • Systematic
Protocol to guide measurement protocol
treatment
for core relational
 Ways to measure the core processes
change mechanisms
necessary for good • Method for integrating
outcome in each phase. measurement into
 Method to integrate treatment
feedback into treatment
through case • Techniques to
conceptualization & feedback information
session planning tools relevant to clinical
 Measure of model practice in a practical
adherence and intuitive
• An evaluation system
for practice based

9. FFT/CFS is a Dashboard-Driven System
 Organized to show information and actions relevant to the user’s workflow
 Easily see vital information at a glance
 Quickly reach more detailed information
9

10. Dashboard organization is designed for easy use
 Separate tables contain
information for:
 Organizational hierarchy
 Programs
 Clinicians
 Clients
 Sessions
 Look at data the way you want
 Choose different time periods
 Sortable columns within tables
 Filtering across tables
10

11. Dashboard: Filtering Content allows flexibility
11

12. Clinical Feedback Report – easy to add measures
Features:
 Easy to add
constructs and
associated questions
 Allows for
customizations on
the fly
 Gives the ability to
modify and get
results to
monitor, measure
and respond
12

13. Supervising with CFS is different –it’s based on data
3
21
25 60% 20% 100% 20% 40%
16 90% 75% 100% 75% 100%
19 75% 75% 100% 75% 100%
 To whom do I assign a new case?
 Which clinician could use my support to improve treatment
engagement?
13

14. Comprehensive feedback: Five additional reports
Five Report Types Available at Each Level of Organization:
 Enrollment
 Service History
 Aggregate Clinical
 Fidelity – includes adherence to evidence based treatments
 QA/Administrative
You choose:
 Timeframe
 Unit (from the top-level all the way down to a clinician)
14

15. Comprehensive Feedback: Enrollment
Current and historical information on
client enrollment in CFS, such as:
 Activity level of
enrolled clients
 Data on discharged
clients
 Details of certain
intake data
 Information
customized for your
organization
15

16. Comprehensive Feedback: Service History: Sessions
Current and historical information on service history
data relevant to treatment planning, such as:
 Session completion
(held / not held
and reason why)
 Caregiver
participation
 Length of
treatment
16

17. Comprehensive Feedback: Aggregate Clinical
Current and historical information on clinical data
relevant to treatment planning, such as:
For any measure:
 Current ratings
 Significant changes
in scores
 Trend over time
17

18. View data by program
 Example View of Data by Program
18

19. Clinical Feedback Report – bullet charts
Features:
 Bullet Charts provide a
visual representation of
the clients current score
against the benchmarks
 Color scheme is intuitive
and it is easy to Bullet graph
interpret
red, yellow, green
 Quickly assess areas of
concern visually. The
picture tells the story.
Improved
Declined
No change
No previous score
19

20. FFT Clinical Measurment System
Session Caregiver
Model Impact Strain
Specific (immediat Youth
Questionnair Symptom and
Adherence e family Therapeutic
e-Short Form Functioning
(CQP)
changes) (CGSQ-SF) Alliance
(SFSS)
(TA)
Client
Post
Treatment
Baseline Engagement Behavior Change Generalization
Family
Family
Functionin
Functioni
g Measure
ng
(Com-R)
(Com-R)
Motivation
Behavior Change Generalization
Treatment
Planning Session
(Progress Planning
Notes) (Session
Planning
Guide)

21. Individualizing FFT to Youth/Family
Case Conceptualization-
Therapist
(Therapist
Progress
Note)
• Needs of the
• Case
client/situati
Conceptualizatio
on
Session
n Next
• Unique
• Technique Session
features of
family/proble
adaptation Plan
m
• Individualization
Family • “in the room”
Input relational
(FFT process & Progress
Measures
process
CFS core process Measures)

22. How is FFT/CFS useful
 In actual practice assessment, treatment planning, and
individualization of treatment is difficult
 FFT/CFS provides data to:
 prioritize and individualize the process more quickly and effectively
 gives youth and families a voice in treatment
 Multisystemic by considering multiple points of view
 Monitor the therapeutic process
 Data based method to make clinical decisions
– What goals fit this family in the next session
– What client issues/concerns are important to address
– How it is going/what to adapt
– When it is time to move forward to next phase of treatment

23. Clinical Example #1
Individualizing FFT to the youth and family
It was a difficult first session. mother was so hurt and angry that he
yelled at the youth who responded in kind. The level of emotion in the
session required the therapist to be very active and focused on the
immediate relational interactions. She missed some of the information
that will be necessary to successfully intervene. Before the next session
she wants to bring together all she knows to adapt the session plan to
identify the important goals of the family. The First session focus is on
engagement but in second session need to focus on family specific
issues also (individualization)

24. Clinical Example #1
 Learned from FFT/CFS (SFSS Baseline-Youth)
 Youth…..not only has the outward behavior his parents and
other see
 But a lot going on inside that you can’t see
 We discovered he has been bullied at school and has
severe anxiety when he goes

25. Clinical Example #1
 Learned from FFT/CFS (Session Impact Scale)
 CFS Alliance Scale
 FFT Specific process information (CPQ-EM)
Counseling Process (Rated by Adult)
2.1
Score Total
1. Therapist helps family solve problems 1
2. Family works together to solve problems 2
3. Therapist informs family of other services 1
4. Will use community-based services if
3
needed
5. Counseling is important and I am taking
3
part

26. Clinical Example #1
 Session Plan
 General
• Assess school issues and internal struggles of the youth
• Use reframing to engage youth and discuss these in a non-blaming way that might help the mother reduce anxiety
 Youth
• feels blamed
» Use reframing to increase Mother’s contribution to problem
• is not engaged
» Increase acknowledgement (part of reframing) to increase youth engagement
• has little hope
» Therapist needs to become more active and demonstrate that she can change family dynamics “in the room”
» Identify family strengths
» Focus on the “solvable” part of the family problems
 mother
• Doesn’t feel therapist support
» Increase acknowledgement part of reframing to demonstrate understanding and support
» When using reframing need to be more direct and explicit about the issues raised by the mother
• Blames youth
» Reframing to build mother responsibility
» Reframe youth behavior (to a noble intention)

27. Clinical Examples #2
Adapting along the way
The 5th session was difficult. The mother and son spent much of the session yelling
and struggling to stay out of the relational patterns that take them into dysfunctional
anger. Like the first, this session required the full attention of the therapist on
reducing the symptoms in the room. The question for the therapist is “what is going
on….?” “is it going badly or was this just a difficult session?…..what is the most
useful Therapist knew he was missing something, yet didn’t have a big picture or
know what to adapt to help move forward
 Learned from FFT/CFS (Session Impact Scale)

28.  Specific Area of Focus (SIS-BC)
Youth
Adult
1 2 3 4 5

29. Clinical Example #1
 Session Plan
 Youth
• Felt blame for family problems has returned
» Use reframing to increase mother’s contribution to problem
» Reframe youths behavior(noble intention)
» Point out reduction in mother’s blame
• Does not think things have gotten better
» Asses the barriers to BC targets (what is getting in the way)
» Make BC targets more specific and individualized
 mother
• Is doing well…but reacting to the youth’s struggle and doesn’t think it can keep up
» Focus on barriers to BC
» Identify how mother can help youth
• Acknowledge the session mother feels more specifically

30. Contact Information
thsexton@indiana.edu