1. 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

2. “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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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