Functional Family Therapy— Accommodation for California’s Diverse Families Edward Cohen, Ph.D. & Lonnie Snowden, Ph.D., Co-Investigators Joanna Doran, M.S.W., & Maria Hernandez, M.S.W., Doctoral Student Researchers

“Phase II Study” Phase I looked at fidelity and outcomes using CSS and CPQ data Phase II (this study) is a one-year in-depth exploration at the adaptation and accommodation of FFT for California’s diverse families Both phases subcontracted by CiMH to U.C. Berkeley (Lonnie Snowden & Ed Cohen, Co-Principal Investigators) – Phase II study data collected and analyzed by Joanna Doran, M.S.W. & Maria Hernandez, M.S.W., Associate Researchers 2FFT Symposium 4/3/08--UC Berkeley Study

What questions did we ask? Primary: “To what extent does the original model, as specified in fidelity measures and phases of treatment, fit the needs and treatment patterns of ethnically diverse families?” – Strengths and challenges of using FFT for diverse families – Does the FFT model differ by ethnicity? – What ways did you implement the model with your families? 3FFT Symposium 4/3/08--UC Berkeley Study

How did we answer the questions? Focus groups and key informant interviews with FFT clinicians and supervisors – Interviews conducted Summer 2007 – Winter 2008 – Total number of those interviewed: 16 Counties: six from the originally piloted counties: Kern, Humboldt, Los Angeles, Placer, San Mateo, Yuba/Sutter Criteria for interview: clinician will have completed FFT course of treatment with at least one family FFT Symposium 4/3/08--UC Berkeley Study4

How did we design the study? Study design: qualitative, grounded theory approach—search for themes and their contexts, in order to eventually build a theoretical model about implementing EBP in community settings Where did the themes come from? – Research literature—EBP and diverse families – FFT training material – Research questions – Focus group interviews FFT Symposium 4/3/08--UC Berkeley Study5

Client Characteristics Racial & ethnic differences not a major factor in FFT success—Clinician: ”FFT is universal” Linguistic diversity is a challenge – The role of translators in sessions Literacy & verbal sophistication more important – Understanding of reframing concepts Acceptance of relational attitude towards identified problems facilitates treatment 6FFT Symposium 4/3/08--UC Berkeley Study

Clinician Characteristics Not every clinician is suited for FFT Flexibility is required! Intelligence—ability to do quick thinking Not overly tied to other modalities, accept FFT model Question remains: are these characteristics the same as those needed for clinicians in working with culturally different families (regardless of therapy modality)? 7FFT Symposium 4/3/08--UC Berkeley Study

County Characteristics Successful counties: Established commitment to EBP Policy support for implementation, commitment of managers Challenges for counties: Travel distances for office and home visits Separate data systems Need general improvements in recruitment of families and safety training for home visits 8FFT Symposium 4/3/08--UC Berkeley Study

Strengths of FFT Model with Diverse Families Families that “fall through the cracks” – Directly working on barriers Model requires “radical acceptance of family” – Obtainable change “Matching” makes clinicians proactively align with family members – Requires culturally sensitivity – Requires therapist become educated about cultural contexts of family – Accountability and assessment are key 9FFT Symposium 4/3/08--UC Berkeley Study

Questionnaires and Outcomes Supervisors: appreciate the documentation— allows them to monitor quality Clinicians: – Length and frequency of forms are disruptive – Family member unable to read are at disadvantage – Some family members reluctant to “criticize” clinician – Wording often seen as contradictory to strengths- based approach – Some wording problems in specific items 10FFT Symposium 4/3/08--UC Berkeley Study

Agency & County Response Families with higher levels of need pose challenges: – Crisis early in treatment – Case management needs Is this a deviation from FFT? Some disagreement among clinicians 11FFT Symposium 4/3/08--UC Berkeley Study

Evolution of FFT Model – Clearer definitions of intervention techniques – Increased flexibility for use of model Involvement of other service providers Treatment sessions no longer dependent on the presence of the entire family – Increased focus on individuality of family – Increase in strengths-based approach 12FFT Symposium 4/3/08--UC Berkeley Study

Training and Preparation Overall training has been well received – Inclusion of clinicians in externships Suggestions for FFT Training: – View complete videos – Include examples of home visits in videos – Would like more comprehensive overview of treatment phases in early trainings Clinicians pointed to differences among trainers – Emphasis of different components – Some inconsistency of definitions Suggestions for county-based training: – Conducting home visits – Safety training 13FFT Symposium 4/3/08--UC Berkeley Study

Accommodation throughout Phases – Reduced frequency of forms completion – Creative use of family translators – Finding ways to collaborate with service providers while trying to stay within model – Use of case management – Involving outside agency staff (such as P.O.s) to support family – Other therapeutic techniques used to accomplish Phase objectives – Motivational Interviewing used by some clinicians – CBT used by some clinicians 14FFT Symposium 4/3/08--UC Berkeley Study

Let’s talk… What else would you add? When does “accommodation” become “drift”? What are the implications of these findings? – For implementation? – For training? Based on what we heard from clinicians in the study, what would you recommend? FFT Symposium 4/3/08--UC Berkeley Study15