Functional Family Therapy An evidence-based approach to working with adolescents with externalizing behavior disorders Implementing Functional Family Therapy Training new Therapists in existing FFT teams Webinar #3 Thomas L. Sexton, Ph. D., ABPP Astrid van Dam FFT Associates 1 ©FFT Associates. Not intended for Duplication or Distribution

Today’s Goals Welcome Welcome Overview training activities in Phase 2 Overview training activities in Phase 2 BC phase – transition from E/M to BC BC phase – transition from E/M to BC Goals in BC and asses progress Goals in BC and asses progress - Using CFS to prepare for BC - Using CFS to prepare for BC session session

Phases of Training Phase 1 Introductions and E/M phase Phase 1 Introductions and E/M phase Month 1-3 Month 1-3 Phase 2 BC phase Phase 2 BC phase Month 4-6 Month 4-6 Phase 3 GE phase Phase 3 GE phase Month 6-8 Month 6-8

Phases of Training Phase 2 BC phase Phase 2 BC phase Reading and watching (manuals and webinars ) Reading and watching (manuals and webinars ) Participating group supervision and individual supervision with Site FFT supervisor ((TAM scores will be made of every discussed case) Participating group supervision and individual supervision with Site FFT supervisor ((TAM scores will be made of every discussed case) Seeing cases (minimum of 5) Seeing cases (minimum of 5) Using FFT/CFS for every case Using FFT/CFS for every case webinars for new Therapists webinars for new Therapists

Learning activities Phase 1 Read Read blue Manual and Red book blue Manual and Red book Watch Watch Clinical Traning 2 Clinical Traning 2 Webinar 8,9 Webinar 8,9

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

Implementing Behavior Change Build on Engagement & Motivation progress Build on Engagement & Motivation progress – Changes in family climate because of engagement & motivation phase – Negativity lower – Blame reduced – Responsibility increased – A family focus to the problem The way is cleared for specific changes in the problem sequence The way is cleared for specific changes in the problem sequence Foundation is build Foundation is build

Developing motivation and alliance Creating a “family focus” to the presenting problem Creating a “family focus” to the presenting problem – Redefine the problem (away from presenting one) Family enters with “problem definition” that is part of what has them stuck Family enters with “problem definition” that is part of what has them stuck New problem definition that is less blaming, negative, and individually focused New problem definition that is less blaming, negative, and individually focused Create a relational focus--a family focus for the problem… Create a relational focus--a family focus for the problem… Each family member has a “part” (responsibility without blame)…everyone involved in some way Each family member has a “part” (responsibility without blame)…everyone involved in some way Each “part” linked to the challenge that the family currently faces (family focused) Each “part” linked to the challenge that the family currently faces (family focused) Sets the stage for different solutions (behavior change) Sets the stage for different solutions (behavior change)

Behavior change sessions Goals Specify the behavior change “individualized plan” Link BC targets to the organizing theme to build relevance and motivation Build compliance match to the client check if the BC target works to solve conflict Assessment Identifying prosocial family based skill that fits youth/family problem sequence Find barriers to adoption of BC skill Determine if the target is being performed (compliance) Interventions reframing Modeling Teaching Overcome barriers/adapt

What do you need – Clear target for change (well specified) – What is the problem? – Where in the problem sequence – In response to which risk factor – Building which protective factor – Relational Assessment (to match to the family/client) – Making it relevant – What and how you talk about the goal – Implementing the plan

Finding the target starts with identifying the problem Clinical problems are NOT because of: Clinical problems are NOT because of: – the family/youth’s anger – the family/youth’s lack of “motivation” We expect them to be discouraged, lack motivation, angry, unhappy with the systems We expect them to be discouraged, lack motivation, angry, unhappy with the systems – history or biology – peers – bad choices – inability to “just say no” – “mental health” issues – Drug abuse They are…. They are…. – Stuck families

Behavior Change Targets 1.Is it Relevant? – What would feel to the family like success – What make a “difference” 2.Is it Obtainable? – Can they do it – Will it derail therapy because it is to hard now 3.Does it “fit” them – Relational functions – Organizing them

What therapy changes Problem Behavior (currently defined “prblem” Mom/mother figure Dad/father figure Adolescent 1. Change Climate in the family the family 2. Change the current problem 3. Prepared for the next “problem” -cope/deal with in a new way -empowered with a “way” To solve future

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