Functional Family Functional Family TherapyTherapy

An evidence-based approach to working with An evidence-based approach to working with adolescents with externalizing behavior disordersadolescents with externalizing behavior disorders

Implementing Functional Family Implementing Functional Family TherapyTherapyWebinar #1Webinar #1

Thomas L. SextonThomas L. Sexton, , Ph. D., ABPPPh. D., ABPPFFT AssociatesFFT Associates

1©FFT Associates. Not intended for Duplication or Distribution

Goals of TodayGoals of Today’’s Trainings Training

• IntroductionIntroduction to the Training Program to the Training Program

• OverviewOverview of the FFT clinical model & its of the FFT clinical model & its valuevalue

• Clinical Practice Issues…what will doing Clinical Practice Issues…what will doing FFT mean for your daily work?FFT mean for your daily work?– What can you expect when doing FFT What can you expect when doing FFT (how (how

long, how often, where…)long, how often, where…)

– Your FFT Clinical Work Flow……Your FFT Clinical Work Flow……

Goals of TodayGoals of Today’’s Trainings Training

• Practicing with the FFT/CFSPracticing with the FFT/CFS• Measures of Progress & ProcessMeasures of Progress & Process

– FFT Measures…how you will know FFT is working?FFT Measures…how you will know FFT is working?

• Case conceptualizing—progress notes and Case conceptualizing—progress notes and session planning guidessession planning guides

• Things to help you along the way:Things to help you along the way:• Learning Center at the FFT WebsiteLearning Center at the FFT Website

– www.functionalfamilytherapy.comwww.functionalfamilytherapy.com

• To get started:To get started:– FFT BookFFT Book– Introduction to FFT (on the website)Introduction to FFT (on the website)– FFT/CFS help resourcesFFT/CFS help resources

Preparing Yourself….Preparing Yourself….• Number of training activities in the Number of training activities in the

next two weeks—it will take some next two weeks—it will take some timetime

• If you prepare…training will be If you prepare…training will be more relevant and applicablemore relevant and applicable

• Your will practice will be betterYour will practice will be better• You will have more time for the You will have more time for the

many practice events you will need many practice events you will need to do in the next few weeks to do in the next few weeks

Overview of the Training Overview of the Training ProcessProcess

What you can expect from usWhat you can expect from us• What you can expect form us:What you can expect form us:• Our roleOur role

• Consultants in learning FFTConsultants in learning FFT• Clinical responsibility lies with youClinical responsibility lies with you• We will communicate anything important we We will communicate anything important we

see/Please do the samesee/Please do the same

• Experience suggests implementation goes Experience suggests implementation goes best when we share expectations about:best when we share expectations about:• TrainingTraining• Service deliveryService delivery• infrastructureinfrastructure

Learning Functional Family TherapyLearning Functional Family Therapy

• One of biggest challenges is teaching the One of biggest challenges is teaching the FFT clinical model…….Not that it is so FFT clinical model…….Not that it is so difficult…..difficult…..It is implementing it intoIt is implementing it into::

• Existing ways a clinician works/trainedExisting ways a clinician works/trained

• Existing ways an organization worksExisting ways an organization works

• Lessons over the last 10 yearsLessons over the last 10 years• Process of changeProcess of change

• Learning curveLearning curve

Our Training PhilosophyOur Training Philosophy

• Principles:Principles:• Based on adult learning/educational Based on adult learning/educational

psychological principles of learningpsychological principles of learning• Short, relevant, repetitive, and clinically Short, relevant, repetitive, and clinically

specificspecific

• GoalGoal….….• clinically relevant therapist competence & clinically relevant therapist competence &

model adherencemodel adherence• Ability to use the model in ways that “fit” clients and Ability to use the model in ways that “fit” clients and

contextcontext• High model Fidelity and Clinical relevanceHigh model Fidelity and Clinical relevance

Phases of TrainingPhases of Training

• Phase 1Phase 1: Planning, Preparation, & : Planning, Preparation, & ImplementationImplementation

• Phase 2Phase 2: Clinical Training: Clinical Training

• Phase 3Phase 3: Site Supervisor Training: Site Supervisor Training

• Phase 4Phase 4: Partnership/Site Certification: Partnership/Site Certification

Training Phases:Training Phases:

• Phase 1: Planning, Preparation, & Phase 1: Planning, Preparation, & ImplementationImplementation

• Introductory webinarsIntroductory webinars• FFT/CFS trainingFFT/CFS training• ““fitting” FFT into the work flowfitting” FFT into the work flow

• Phase 2: Clinical TrainingPhase 2: Clinical Training• 3 clinical training days3 clinical training days• 6 site “externship days6 site “externship days• 11 webinars11 webinars• 45 hours of team consultation45 hours of team consultation• Online discussion forumOnline discussion forum• FFT/CFS useFFT/CFS use

Training GoalsTraining Goals

1.1. Competent FFT TherapistCompetent FFT Therapist• Able to adherence to the model consistentlyAble to adherence to the model consistently• Able to competently practice the model with Able to competently practice the model with

diverse families in a way that diverse families in a way that ““fitsfits”” their unique their unique situationsituation

• Improves outcomes with youth and familiesImproves outcomes with youth and families

2.2. Supportive OrganizationSupportive Organization• Supports the implementation of FFT throughSupports the implementation of FFT through

– Clinical proceduresClinical procedures– FundingFunding– Staffing time/resourcesStaffing time/resources

3.3. Effective & Efficient FFT servicesEffective & Efficient FFT services

Training MethodsTraining Methods

• On-line LearningOn-line Learning– Way to present material in an interactive way Way to present material in an interactive way

over the web in over the web in ““small dosessmall doses””

• Discussion ForumDiscussion Forum– Learning Learning ““placesplaces”” where topics are discussed and where topics are discussed and

where, over time, the community of FFT where, over time, the community of FFT therapists take part in posing questions and therapists take part in posing questions and answering themanswering them

• Traditional TrainingTraditional Training– Presentation and interaction with an FFT expert Presentation and interaction with an FFT expert

focusing on the clinical principles and techniquesfocusing on the clinical principles and techniques

TrainingTraining

• Case ConsultationCase Consultation– Small group discussion of specific casesSmall group discussion of specific cases– Following a Following a ““developmentaldevelopmental”” model that model that

builds from basic core principles to complex builds from basic core principles to complex clinical interventionclinical intervention

• Observation/PracticeObservation/Practice– Of video tapes (of actual sessions)Of video tapes (of actual sessions)– In ongoing practice In ongoing practice

TrainingTraining

• Systematic Case Planning and Systematic Case Planning and Quality Assurance MonitoringQuality Assurance Monitoring

• FFT/CFSFFT/CFS• Ongoing measurement of FFT process and Ongoing measurement of FFT process and

client progressclient progress• Systematic case planning…..with the FFT Systematic case planning…..with the FFT

progress notes and session plansprogress notes and session plans

• Case ExperienceCase Experience

Learning ResourcesLearning Resources

• Learning Center Learning Center (www.functionalfamilytherapy.com)(www.functionalfamilytherapy.com)

• FFT ManualFFT Manual• Articles/PowerPoint'sArticles/PowerPoint's

• FFT/CFS help/training websiteFFT/CFS help/training website• Weekly Video Case ConsultationWeekly Video Case Consultation

• Ask on the discussion forumAsk on the discussion forum

• Email usEmail us

Questions?Questions?

Practicing Functional Family Practicing Functional Family

Therapy Therapy • How it is deliveredHow it is delivered

• What you can expectWhat you can expect

• Systematic Clinical Decision makingSystematic Clinical Decision making

• Ongoing measurement of process and Ongoing measurement of process and

client progress to better plan and client progress to better plan and

interveneintervene

Functional Family TherapyFunctional Family Therapyas an as an ““evidence-based modelevidence-based model””

1. Systematic Clinical Model 1. Systematic Clinical Model

2. Clinical Intervention 2. Clinical Intervention ““MapMap””

3. Research support3. Research support

4. 4. Clinically responsive & transportableClinically responsive & transportable

Functional Family TherapyFunctional Family Therapy

Clinical ModelClinical Model

EarlyEarly MiddleMiddle LateLate

Reduce within family Reduce within family

risk factors risk factors

--negativity/blamenegativity/blame

-hopelessness-hopelessness

--build engagement/build engagement/

reduce dropoutreduce dropout

Behavior ChangeBehavior ChangeMotivationMotivation

EngagementEngagement Behavior ChangeBehavior Change GeneralizationGeneralization

GeneralizationGeneralization

Build within family Build within family

protective factors protective factors

--behavior competenciesbehavior competencies

-interaction change-interaction change

-that increase probability of -that increase probability of

- behavior- behavior

Build family to contextBuild family to context

protective /reduce riskprotective /reduce risk

factors factors

-peers/school/-peers/school/

communitycommunity

EarlyEarly MiddleMiddle LateLate

AssessmentAssessment

InterventionIntervention

Functional Family TherapyFunctional Family Therapy

Clinical ModelClinical Model

MotivationMotivation

Intervention

Assessment

EngagementEngagement Behavior ChangeBehavior Change

Behavior ChangeBehavior Change

GeneralizationGeneralization

GeneralizationGeneralization

Early Middle Late

Goal-phase/intermediate objectives

Skills -therapist actions that have high probability

of reaching those goals

Goal-phase/intermediate objectives

Skills -therapist actions that have high probability

of reaching those goals

Goal-phase/intermediate objectives

Skills -therapist actions that have high probability

of reaching those goals

Core of FFTCore of FFT

A therapy that is both systematic and A therapy that is both systematic and individualized?individualized?

Goal of a therapy is to BOTH…..Goal of a therapy is to BOTH…..

• Match to the FamilyMatch to the Family– Everything is Everything is client centeredclient centered and and personal personal to the life of to the life of

the clientthe client– It is responsiveIt is responsive to the unique and multisystemic nature to the unique and multisystemic nature

of the clientof the client• Relational Relational ““needsneeds””• Obtainable change for the familyObtainable change for the family• Unique relational organizationUnique relational organization

• Match to the ModelMatch to the Model– Model as primary clinical decision making toolModel as primary clinical decision making tool– Model to direct treatment plans….sessions plansModel to direct treatment plans….sessions plans– Follow BOTH:Follow BOTH:

• Core principles clinical proceduresCore principles clinical procedures

What you can expectWhat you can expect

• FFT lasts 8-14/16 sessionsFFT lasts 8-14/16 sessions• Conjoint (whole family/major players)Conjoint (whole family/major players)• Delivered weekly (maybe more in E/M, less Delivered weekly (maybe more in E/M, less

in Gen)in Gen)• Sessions in each treatment phase occur in a Sessions in each treatment phase occur in a

successful treatment episodesuccessful treatment episode• Engagement motivationEngagement motivation• Behavior ChangeBehavior Change• GeneralizationGeneralization

• Assessment as short as possible Assessment as short as possible (get to (get to treatment quickly)treatment quickly)

• Simultaneous/other Treatments?Simultaneous/other Treatments?

Functional Family TherapyFunctional Family Therapy

Integrated Service Delivery ModelIntegrated Service Delivery Model

MotivationMotivation

Intervention

Assessment

EngagementEngagement Behavior ChangeBehavior Change

Behavior ChangeBehavior Change

GeneralizationGeneralization

GeneralizationGeneralization

Early Middle Late

Referral/Initial AssessmentReferral/Initial AssessmentYour agency baseline Your agency baseline

assessmentassessment

FFT baseline assessmentFFT baseline assessment

A “quick” referral to A “quick” referral to treatment treatment

Functional Family TherapyFunctional Family Therapy

Integrated Service Delivery ModelIntegrated Service Delivery Model

MotivationMotivation

Intervention

Assessment

EngagementEngagement Behavior ChangeBehavior Change

Behavior ChangeBehavior Change

GeneralizationGeneralization

GeneralizationGeneralization

Early Middle Late

•Weekly FFT Sessions•Schedule & hold session in FFT/CFS

•Case Planning—FFT Progress Note

•Measuring therapeutic Process & Client Progress

•8-10 items completed by client online

Functional Family TherapyFunctional Family Therapy

Integrated Service Delivery ModelIntegrated Service Delivery Model

Early Middle Late

MotivationMotivation

Intervention

Assessment

EngagementEngagement Behavior ChangeBehavior Change

Behavior ChangeBehavior Change

GeneralizationGeneralization

GeneralizationGeneralization

Discharge•FFT/CFS discharge of client

•Outcome Assessment

Referral if necessary

Who is a good client for FFTWho is a good client for FFT• AdolescentAdolescent

• Mental health issuesMental health issues• Juvenile justice/conduct problemsJuvenile justice/conduct problems• Alcohol and drug problems Alcohol and drug problems

• Stable family placementStable family placement

• With no emergency With no emergency ““needsneeds””• Acute need for hospitalizationsAcute need for hospitalizations• Stable meds/psychiatric careStable meds/psychiatric care

• Use a “rule out” philosophyUse a “rule out” philosophy

Session DeliverySession Delivery

• Where? in the home or in the officeWhere? in the home or in the office• How long? Approximately 60 How long? Approximately 60

minutesminutes• How frequent? WeeklyHow frequent? Weekly

– Early may be twice a weekEarly may be twice a week– In the middle phases 1 each weekIn the middle phases 1 each week– Generalization phase…..titrate out Generalization phase…..titrate out

session over timesession over time

Session with who?Session with who?

• Family….FFT is a Family….FFT is a ““conjointconjoint”” therapytherapy– AdolescentAdolescent– Parents/Step-parentsParents/Step-parents– Involved siblingsInvolved siblings

• Sessions are with the family…..Sessions are with the family…..– No individual session…miss No individual session…miss

opportunitiesopportunities

What if the cancel/no-showWhat if the cancel/no-show

• Overcome barriersOvercome barriers

• Engage/work on the phoneEngage/work on the phone

• Make room in your schedule and Make room in your schedule and see them the next day/ or that day see them the next day/ or that day after thatafter that

How long Does FFT Last?How long Does FFT Last?

• Each phase completedEach phase completed• 10 to 18 sessions10 to 18 sessions• Over 4 to 6 monthsOver 4 to 6 months

• What if they come back?What if they come back?• Same therapist….pick up in Same therapist….pick up in

generalization phasegeneralization phase

FFT/Clinical Feedback SystemFFT/Clinical Feedback System

(FFT/Care4)(FFT/Care4)

1.1.Case conceptualizingCase conceptualizing• progress notes and session planning guidesprogress notes and session planning guides

2.2.Measures of Progress & ProcessMeasures of Progress & Process• FFT Measures…how you will know FFT is working?FFT Measures…how you will know FFT is working?

Why this way of working helpsWhy this way of working helps

• Allows forAllows for::– Individualization Individualization – Clinical specificationClinical specification– Inclusion of the family voiceInclusion of the family voice– Measurement of phases & goals to provide reliable Measurement of phases & goals to provide reliable

clinician decision making clinician decision making

• Each of which help improve treatment Each of which help improve treatment effectiveness and efficiencyeffectiveness and efficiency

FFT/CFSFFT/CFScontinuous quality improvement system for Functional continuous quality improvement system for Functional

Family TherapyFamily Therapy

Client SessionBaselineFamily

Functioning Youth

Symptom level

Measure:Com-R)

SFSS (full)

PostSymptoms

Family functioning

Measures: -Com-R

-SFSS (full)Motivation

Engagement Behavior Change

Behavior Change

Generalization

Generalization

Session

Even Sessions(2nd, 4th, 6th, etc.)

Youth Symptom Level(SFSS-Form A)Parent & Youth

Odd Sessions(1nd, 3th, 5th, etc.)

Session Impact(SIS EM, SIS BC, SIS Gen)

Parent & Youth

Case PlanningProgress

Notes (PN)

Case PlanningSession Planning

Guide (SPG)

Next Session Plan• Specific session goals• Specific areas of

needed attention• Before each session

• Match the model

specifically to the

family/situation/needs of the time

• Match the model

specifically to the

family/situation/needs of the time

• Used by the therapist to understand

the case better/plan

• Used by the Consultant to

help the therapist

learn

• Used by the therapist to understand

the case better/plan

• Used by the Consultant to

help the therapist

learn

FFT Clinical Measurement FFT Clinical Measurement InventoryInventory

• Resource: FFT CMI Manual (on the Resource: FFT CMI Manual (on the web)web)• Baseline AssessmentBaseline Assessment• Family Demographic Information (in CFS)Family Demographic Information (in CFS)

• Family Functioning (COM-r)Family Functioning (COM-r)• youth & caregiver formyouth & caregiver form

• Youth Symptom Level (SRFF-full Form)Youth Symptom Level (SRFF-full Form)• Youth & caregiver formYouth & caregiver form

• Discharge AssessmentDischarge Assessment• Family Demographic Information (in Family Demographic Information (in

CFS)CFS)

• Family Functioning (COM-r)Family Functioning (COM-r)• youth & caregiver formyouth & caregiver form

• Youth Symptom Level (SRFF-full Youth Symptom Level (SRFF-full Form)Form)• Youth & caregiver formYouth & caregiver form

Next StepsNext Steps

1.1. Complete Reading the Blue ManualComplete Reading the Blue Manual2.2. Complete the following Complete the following webinar’s (webinar’s (afterafter

completing the book)completing the book)– Training Webinar 2:  Adolescent behavior problems, Training Webinar 2:  Adolescent behavior problems,

Evidence-Based Practices & FFTEvidence-Based Practices & FFT• Recorded PresentationRecorded Presentation (1 hour 38 min) (1 hour 38 min)

– Training Webinar 3:  Overview of FFT Training Webinar 3:  Overview of FFT •   RRecorded ecorded presentationpresentation (1 Hour, 30 min) (1 Hour, 30 min)

– Training Webinar 4:  Research FoundationsTraining Webinar 4:  Research Foundations (35 (35 minutes)minutes)1.1. RRecorded presentationecorded presentation (35 minutes) (35 minutes)

FFT/CFS SystemFFT/CFS System

3.3. Practice CFSPractice CFS– Training Webinar 5:  Introduction to the FFT-CFSTraining Webinar 5:  Introduction to the FFT-CFS

• Powerpoint:  Powerpoint:  FFT-CFS webinarFFT-CFS webinar• Webex recordingWebex recording (53 min) (53 min)

– Your assignment: using the login info and Your assignment: using the login info and the on line help tools….the on line help tools….• Review each on line video and quick guide for Review each on line video and quick guide for

each major functioneach major function

1.1. Entering a ClientEntering a Client

2.2. Scheduling a SessionScheduling a Session

3.3. Holding a sessionHolding a session

4.4. Completing measuresCompleting measures

5.5. Discharging a clientDischarging a client

FFT/CFS FFT/CFS • Enter/practice by:Enter/practice by:

– Entering 3 fake clients (no base line data)Entering 3 fake clients (no base line data)– Entering 2 session for each clientEntering 2 session for each client– Completing the measure for each sessionCompleting the measure for each session– View feedbackView feedback

• This is practice….learning curveThis is practice….learning curve• We will review it in training/weekly We will review it in training/weekly

consultation/ and a future webinarconsultation/ and a future webinar

ResourcesResources• FFT Learning CenterFFT Learning Center

– www.functionalfamilytherapy.comwww.functionalfamilytherapy.com

• FFT/CFSFFT/CFS– https://beta.cfsystemsonline.com/loginhttps://beta.cfsystemsonline.com/login

• Written ManualsWritten Manuals– FFT in Clinical Practice (Sexton, 2010)FFT in Clinical Practice (Sexton, 2010)

– FFT Clinical Training Manual (Sexton & Alexander, 2004)FFT Clinical Training Manual (Sexton & Alexander, 2004)

– FFT Blueprint Manual (Alexander, Pugh, Parsons, & Sexton, 2000)FFT Blueprint Manual (Alexander, Pugh, Parsons, & Sexton, 2000)

What’s next?What’s next?• This week:This week:

– Read/learn about FFTRead/learn about FFT– Review the Clinical Measurement InventoryReview the Clinical Measurement Inventory– Talk in your team about how you will Talk in your team about how you will

organize this into your work flow….organize this into your work flow….– Identify barriersIdentify barriers– Identify possible solutionsIdentify possible solutions

– FFT/CFS practice FFT/CFS practice • It will take 4-5 hours of practice!It will take 4-5 hours of practice!

– Find your questions….for the training!Find your questions….for the training!