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 1 ©FFT Associates. Not intended for Duplication or Distribution

Today’s Goals Welcome & Introductions Welcome & Introductions Introduction to the Training Program Introduction to the Training Program Overview of the FFT clinical model & its value Overview of the FFT clinical model & its value What will doing FFT mean for your daily work? 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……

Today's goals Practicing with the FFT/CFS Practicing with the FFT/CFS Measures of Progress & Process Measures of Progress & Process – FFT Measures…how you will know FFT is working? Case conceptualizing—progress notes and session planning guides Case conceptualizing—progress notes and session planning guides Developing shared expectations Developing shared expectations Starting the Learning Process: Starting the Learning Process: Learning Center at the FFT Website Learning Center at the FFT Website –

Preparing Yourself…. Number of training activities in the next two weeks—it will take some time Number of training activities in the next two weeks—it will take some time If you prepare…training will be more relevant and applicable If you prepare…training will be more relevant and applicable Your will practice will be better 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 You will have more time for the many practice events you will need to do in the next few weeks

What you can expect from us What you can expect form us: What you can expect form us: Push you…help you…teach you…work together with you Push you…help you…teach you…work together with you Our role Our role Consultants in learning FFT Consultants in learning FFT Clinical responsibility lies with you Clinical responsibility lies with you We will communicate anything important we see/Please do the same We will communicate anything important we see/Please do the same We are always open to help, suggestions, requests We are always open to help, suggestions, requests

Overview of the Training Process

Learning Functional Family Therapy Learning the model is exciting and challenging—takes time Learning the model is exciting and challenging—takes time Implementation is a challenge--- FFT works best when implemented it into : Implementation is a challenge--- FFT works best when implemented it into : Existing ways a clinician works/trained Existing ways a clinician works/trained Existing ways an organization works Existing ways an organization works

Training Goals 1.Competent FFT Therapist Able to adherence to the model consistently Able to adherence to the model consistently Able to competently practice the model with diverse families in a way that “fits” their unique situation Able to competently practice the model with diverse families in a way that “fits” their unique situation Improves outcomes with youth and families Improves outcomes with youth and families 2.Supportive Organization Supports the implementation of FFT through Supports the implementation of FFT through – Clinical procedures – Funding – Staffing time/resources 3.Effective & Efficient FFT services

Phases of Training Phase 1: Planning, Preparation, & Implementation Phase 1: Planning, Preparation, & Implementation Phase 2: Clinical Training Phase 2: Clinical Training Phase 3: Site Supervisor Training Phase 3: Site Supervisor Training Phase 4: Partnership/Site Certification Phase 4: Partnership/Site Certification Introductory webinars Recorded Presentations Reading manuals FFT/CFS training 3 clinical training days 6 site “externship days 11 webinars 45 hours of team consultation FFT/CFS use

Our Training Philosophy Principles: Principles: Based on adult learning/educational psychological principles of learning Based on adult learning/educational psychological principles of learning Short, relevant, repetitive, and clinically specific Short, relevant, repetitive, and clinically specific Addressing multiple learning styles.. Addressing multiple learning styles.. Using multiple methods Using multiple methods Theory into practice based Theory into practice based Collaborative and Alliance based Collaborative and Alliance based

Training Methods On-line Learning On-line Learning – Way to present material in an interactive way over the web in “small doses” Discussion Forum 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 Traditional Training – Presentation and interaction with an FFT expert focusing on the clinical principles and techniques

Training Case Consultation Case Consultation – Small group discussion of specific cases – Following a “developmental” model that builds from basic core principles to complex clinical intervention Observation/Practice Observation/Practice – Of video tapes (of actual sessions) – In ongoing practice

Training Systematic Case Planning and Quality Assurance Monitoring Systematic Case Planning and Quality Assurance Monitoring FFT-Clinical Feedback System FFT-Clinical Feedback System Ongoing measurement of FFT process and client progress Ongoing measurement of FFT process and client progress Systematic case planning…..with the FFT progress notes and session plans Systematic case planning…..with the FFT progress notes and session plans Case Experience Case Experience

Learning Resources Learning Center ( Learning Center ( FFT Manual/FFT-CFS Manual FFT Manual/FFT-CFS Manual Articles/PowerPoint's Articles/PowerPoint's FFT/CFS help/training website FFT/CFS help/training website Weekly Video Case Consultation Weekly Video Case Consultation Ask on the discussion forum Ask on the discussion forum us us

Questions?

Practicing Functional Family Therapy How it is delivered How it is delivered What you can expect What you can expect Systematic Clinical Decision making Systematic Clinical Decision making Ongoing measurement of process and client progress to better plan and intervene Ongoing measurement of process and client progress to better plan and intervene

Functional Family Therapy Clinical Model EarlyMiddleLate Reduce within family risk factors - negativity/blame -hopelessness -build engagement/ reduce dropout Behavior Change Motivation Engagement GeneralizationGeneralization Build within family protective factors - behavior competencies -interaction change -that increase probability of - behavior Build family to context protective /reduce risk factors -peers/school/ communityEarlyMiddleLateAssessment Intervention

Functional Family Therapy Clinical Model Motivation Intervention Assessment Engagement Behavior Change Generalization Generalization EarlyMiddleLate 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

Both systematic and individualized Goal of a therapy is to BOTH….. Match to the Family 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” Relational “needs” Obtainable change for the family Obtainable change for the family Unique relational organization Unique relational organization Match to the Model Match to the Model – Model as primary clinical decision making tool – Model to direct treatment plans….sessions plans – Follow BOTH: Core principles clinical procedures Core principles clinical procedures

What you can expect FFT lasts 8-14/16 sessions FFT lasts 8-14/16 sessions Conjoint (whole family/major players) Conjoint (whole family/major players) Delivered weekly (maybe more in E/M, less in Gen) Delivered weekly (maybe more in E/M, less in Gen) Sessions in each treatment phase occur in a successfu l treatment episode Sessions in each treatment phase occur in a successfu l treatment episode Engagement motivation Engagement motivation Behavior Change Behavior Change Generalization Generalization Assessment as short as possible (get to treatment quickly) Assessment as short as possible (get to treatment quickly) Sim ultaneous/other Treatments? Sim ultaneous/other Treatments?

Who is a good client for FFT Adolescent Adolescent Mental health issues Mental health issues Juvenile justice/conduct problems Juvenile justice/conduct problems Alcohol and drug problems Alcohol and drug problems Stable family placement Stable family placement With no emergency “needs” With no emergency “needs” Acute need for hospitalizations Acute need for hospitalizations Stable meds/psychiatric care Stable meds/psychiatric care Use a “rule out” philosophy Use a “rule out” philosophy

Session Delivery Where? in the home or in the office Where? in the home or in the office How long? Approximately 60 minutes How long? Approximately 60 minutes How frequent? Weekly 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 Family….FFT is a “conjoint” therapy – Adolescent – Parents/Step-parents – Involved siblings Sessions are with the family….. Sessions are with the family….. – No individual session…miss opportunities

What if the cancel/no-show Overcome barriers Overcome barriers Engage/work on the phone Engage/work on the phone Make room in your schedule and see them the next day/ or that day after that Make room in your schedule and see them the next day/ or that day after that

Functional Family Therapy Integrated Service Delivery Model Motivation Intervention AssessmentEngagement Behavior Change GeneralizationGeneralization EarlyMiddleLate Initial Assessment Your agency baseline assessment FFT baseline assessment -family functioning/youth symptoms

Functional Family Therapy Integrated Service Delivery Model Motivation Interventio n AssessmentEngagement Behavior Change GeneralizationGeneralization EarlyMiddleLate Weekly FFT Sessions Schedule & hold session in FFT/CFS Case Planning—FFT Progress Note Measuring therapeutic impact, symptoms & progress 8-10 items completed by client online

Functional Family Therapy Integrated Service Delivery Model EarlyMiddleLate Motivation Interventio n AssessmentEngagement Behavior Change GeneralizationGeneralization Discharge Outcome Assessment Youth symptoms Family functioning Referral if necessary

How long Does FFT Last? Each phase completed Each phase completed 10 to 18 sessions 10 to 18 sessions Over 4 to 6 months Over 4 to 6 months What if they come back? What if they come back? Same therapist….pick up in generalization phase Same therapist….pick up in generalization phase

FFT/Clinical Feedback System 1.Case conceptualizing progress notes and session planning guides progress notes and session planning guides 2.Measures of Progress & Process FFT Measures…how you will know FFT is working? FFT Measures…how you will know FFT is working?

Synergy of Three Systems FFT Measurement System -Comprehensive, functional, reliable and clinically relevant Care4 TM Platform -Cutting Edge Technology -Conceptual model

Care4 System ™ Adaptable to any treatment method/model Adaptable to any treatment method/model Adaptable to different settings Adaptable to different settings Functionality: Functionality: Scheduling (management of service delivery) Scheduling (management of service delivery) Client information (easy access, info about practice) Client information (easy access, info about practice) Treatment Planning (treatment plans, session plans, session notes) Treatment Planning (treatment plans, session plans, session notes) Therapeutic Process (core benchmarks for change/impact, progress, & symptoms) Therapeutic Process (core benchmarks for change/impact, progress, & symptoms) Client Outcomes (specified to client population) Client Outcomes (specified to client population) Local benchmarks Local benchmarks Program evaluation & local action based research Program evaluation & local action based research Comprehensive Evidence-based Supervision Comprehensive Evidence-based Supervision Core tool in training & implementation project Core tool in training & implementation project

Conceptual “ Scaffolding” (Care4) Comprehensive, clinically relevant, practical & reliable Comprehensive, clinically relevant, practical & reliable Fit into work flow Fit into work flow Integrates into clinical decision making Integrates into clinical decision making Levels of Feedback (increasingly specific) Levels of Feedback (increasingly specific) Status Status Trends Trends Individual items Individual items Multiple perspectives Multiple perspectives Therapist Therapist Client/family/couple Client/family/couple Outside observer Outside observer Ongoing measurement integrated into treatment Ongoing measurement integrated into treatment

FFT-CFS Information Domains 1.Sessions Characteristics (length, location, who etc.) Characteristics (length, location, who etc.) Impact Impact Outcome (progress) Outcome (progress) 2.Clients Assessment of core areas of functioning Assessment of core areas of functioning Demographics Demographics Referral info Referral info 3.Therapist Service delivery patterns Service delivery patterns Model fidelity Model fidelity 4.Clinical Decision Making Session Goals/Case Planning guides Session Goals/Case Planning guides Treatment Plans Treatment Plans

Comprehensive Measurement 5. Treatment Progress & process – Impact, progress & symptom level – Core process/intermediate goals of specific model 6. Treatment Outcome – Pre-post changes in core areas of intervention

Clinical Feedback “Feedback” in the CFS The CFS system provides real- time clinical feedback through a series of dashboard-based reports in four areas so that client reported information is easily available for case and session planning At-a-Glance Clinical Feedback  Status (current status of the progress, impact, and symptom levels)  Trend (progress, impact, and symptom level over time by respondent)  Feedback report (extensive and detailed level of information)  Alerts (a select group of items for which clinical alert is issued) Click for more detailed information  Comparisons to other case & to FFT standards  Differences between caregivers and young people views  Trends over time  Individual specific information on symptoms, impact, and progress to identify who to target and focus on in treatment An Integral part of ongoing Clinical Decision Making, Supervision & Evaluation Combining FFT with systematic feedback on treatment progress and processes provides the guidance that therapists need to tailor FFT to the youth thus improving youth and family outcomes. For the therapist FFT-CFS is a treatment planning tool used to record the events of each encounter with the family, make next session plans, and integrate each of the core elements of the clinical model into practice. It keeps therapists focused on the relevant goals, skills, and interventions for each phase of FFT and identify when cases are going poorly, when family are not responding, and when service delivery profile is not model adherence Agencies use it as an outcome measurement and program evaluation tool Researchers use it to gather participant based research data It helps supervisors with specific, focused, and session- by-session information that reflects how the therapist thinks, the decisions they make, and the outcomes of their work “Feedback” in the CFS The CFS system provides real- time clinical feedback through a series of dashboard-based reports in four areas so that client reported information is easily available for case and session planning At-a-Glance Clinical Feedback  Status (current status of the progress, impact, and symptom levels)  Trend (progress, impact, and symptom level over time by respondent)  Feedback report (extensive and detailed level of information)  Alerts (a select group of items for which clinical alert is issued) Click for more detailed information  Comparisons to other case & to FFT standards  Differences between caregivers and young people views  Trends over time  Individual specific information on symptoms, impact, and progress to identify who to target and focus on in treatment An Integral part of ongoing Clinical Decision Making, Supervision & Evaluation Combining FFT with systematic feedback on treatment progress and processes provides the guidance that therapists need to tailor FFT to the youth thus improving youth and family outcomes. For the therapist FFT-CFS is a treatment planning tool used to record the events of each encounter with the family, make next session plans, and integrate each of the core elements of the clinical model into practice. It keeps therapists focused on the relevant goals, skills, and interventions for each phase of FFT and identify when cases are going poorly, when family are not responding, and when service delivery profile is not model adherence Agencies use it as an outcome measurement and program evaluation tool Researchers use it to gather participant based research data It helps supervisors with specific, focused, and session- by-session information that reflects how the therapist thinks, the decisions they make, and the outcomes of their work The CFS system provides real- time clinical feedback through a series of dashboard-based reports in four areas so that client reported information is easily available for case and session planning At-a-Glance Clinical Feedback  Status (current status of the progress, impact, and symptom levels)  Trend (progress, impact, and symptom level over time by respondent)  Feedback report (extensive and detailed level of information)  Alerts (a select group of items for which clinical alert is issued) Click for more detailed information  Comparisons to other case & to FFT standards  Differences between caregivers and young people views  Trends over time  Individual specific information on symptoms, impact, and progress to identify who to target and focus on in treatment The CFS system provides real- time clinical feedback through a series of dashboard-based reports in four areas so that client reported information is easily available for case and session planning At-a-Glance Clinical Feedback  Status (current status of the progress, impact, and symptom levels)  Trend (progress, impact, and symptom level over time by respondent)  Feedback report (extensive and detailed level of information)  Alerts (a select group of items for which clinical alert is issued) Click for more detailed information  Comparisons to other case & to FFT standards  Differences between caregivers and young people views  Trends over time  Individual specific information on symptoms, impact, and progress to identify who to target and focus on in treatment The CFS system provides real- time clinical feedback through a series of dashboard-based reports in four areas so that client reported information is easily available for case and session planning At-a-Glance Clinical Feedback  Status (current status of the progress, impact, and symptom levels)  Trend (progress, impact, and symptom level over time by respondent)  Feedback report (extensive and detailed level of information)  Alerts (a select group of items for which clinical alert is issued) Click for more detailed information  Comparisons to other case & to FFT standards  Differences between caregivers and young people views  Trends over time  Individual specific information on symptoms, impact, and progress to identify who to target and focus on in treatment At-a-Glance Clinical Feedback Status (current status of the progress, impact, and symptom levels) Trend (progress, impact, and symptom level over time by respondent) Feedback report (extensive and detailed level of information) Alerts (a select group of items for which clinical alert is issued) Click for more detailed information Comparisons to other case & to FFT standards Differences between caregivers and young people views Trends over time Individual specific information on symptoms, impact, and progress to identify who to target and focus on in treatment

Why this way of working helps Allows for: 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

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 Recorded Presentation (1 hour 38 min) Recorded Presentation (1 hour 38 min) – Training Webinar 3: Overview of FFT – Training Webinar 3: Overview of FFT Recorded presentation (1 Hour, 30 min) Recorded presentation (1 Hour, 30 min) – Training Webinar 4: Research Foundations (35 minutes) Recorded presentation (35 minutes ) Recorded presentation (35 minutes )

FFT/CFS System 3.Practice CFS – Training Webinar 5: Introduction to the FFT-CFS PowerPoint: FFT-CFS webinar PowerPoint: FFT-CFS webinarFFT-CFS webinarFFT-CFS webinar Webex recording (53 min) Webex recording (53 min) Webex recording (53 min) Webex recording (53 min) – Your assignment: using the login info and the on line help tools…. Review each on line video and manual Review each on line video and manual 1.Entering a Client 2.Scheduling a Session 3.Holding a session 4.Completing measures 5.Discharging a client

FFT/CFS Enter/practice by: Enter/practice by: – Entering 1 fake clients (no base line data) – Entering 2 sessions for each client – Completing the measures for each session – View feedback (learn how it works) This is practice….learning curve This is practice….learning curve We will review it in training/weekly consultation/ and a future webinar We will review it in training/weekly consultation/ and a future webinar

Resources FFT Learning Center FFT Learning Center – FFT/CFS FFT/CFS –

What’s next? The next 2 weeks The next 2 weeks – Read/learn about FFT – 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 1-2 hours of practice! It will take 1-2 hours of practice! – Find your questions….for the training!