1. 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

2. Goals of Today’s Training 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 Clinical Practice Issues…what will doing FFT mean for your daily work? Clinical Practice Issues…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……

3. Goals of Today’s Training 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 Things to help you along the way: Things to help you along the way: Learning Center at the FFT Website Learning Center at the FFT Website – www.functionalfamilytherapy.com www.functionalfamilytherapy.com To get started: To get started: – FFT Book – Introduction to FFT (on the website) – FFT/CFS help resources

4. 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

5. Overview of the Training Process

6. What you can expect from us What you can expect form us: What you can expect form us: 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 Experience suggests implementation goes best when we share expectations about: Experience suggests implementation goes best when we share expectations about: Training Training Service delivery Service delivery infrastructure infrastructure

7. Learning Functional Family Therapy One of biggest challenges is teaching the FFT clinical model…….Not that it is so difficult…..It is implementing it into: One of biggest challenges is teaching the FFT clinical model…….Not that it is so difficult…..It is implementing it into: Existing ways a clinician works/trained Existing ways a clinician works/trained Existing ways an organization works Existing ways an organization works Lessons over the last 10 years Lessons over the last 10 years Process of change Process of change Learning curve Learning curve

8. 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 Goal …. Goal …. clinically relevant therapist competence & model adherence clinically relevant therapist competence & model adherence Ability to use the model in ways that “fit” clients and context Ability to use the model in ways that “fit” clients and context High model Fidelity and Clinical relevance High model Fidelity and Clinical relevance

9. 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

10. Training Phases: Phase 1: Planning, Preparation, & Implementation Phase 1: Planning, Preparation, & Implementation Introductory webinars Introductory webinars FFT/CFS training FFT/CFS training “fitting” FFT into the work flow “fitting” FFT into the work flow Phase 2: Clinical Training Phase 2: Clinical Training 3 clinical training days 3 clinical training days 6 site “externship days 6 site “externship days 11 webinars 11 webinars 45 hours of team consultation 45 hours of team consultation Online discussion forum Online discussion forum FFT/CFS use FFT/CFS use

11. 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

12. 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

13. 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

14. Training Systematic Case Planning and Quality Assurance Monitoring Systematic Case Planning and Quality Assurance Monitoring FFT/CFS FFT/CFS 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

15. Learning Resources Learning Center (www.functionalfamilytherapy.com) Learning Center (www.functionalfamilytherapy.com)www.functionalfamilytherapy.com FFT Manual FFT 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 Email us Email us

17. Questions?

18. 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

19. Functional Family Therapy as an “evidence-based model” 1. Systematic Clinical Model 2. Clinical Intervention “Map” 3. Research support 4. Clinically responsive & transportable

20. Functional Family Therapy Clinical Model EarlyMiddleLate Reduce within family risk factors - negativity/blame -hopelessness -build engagement/ reduce dropout Behavior Change MotivationEngagement 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

21. 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

22. Core of FFT A therapy that is 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

23. 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 successful treatment episode Sessions in each treatment phase occur in a successful 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) Simultaneous/other Treatments? Simultaneous/other Treatments?

24. Functional Family Therapy Integrated Service Delivery Model Motivation Intervention AssessmentEngagement Behavior Change GeneralizationGeneralization EarlyMiddleLate Referral/Initial Assessment Your agency baseline assessment FFT baseline assessment A “quick” referral to treatment

25. 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 M easuring therapeutic Process & Client Progress 8-10 items completed by client online

26. Functional Family Therapy Integrated Service Delivery Model EarlyMiddleLate Motivation Interventio n AssessmentEngagement Behavior Change GeneralizationGeneralization Discharge FFT/CFS discharge of client Outcome Assessment Referral if necessary

27. 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

28. 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

29. 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

30. 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

31. 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

32. FFT/Clinical Feedback System (FFT/Care4) (FFT/Care4) 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?

33. 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 Each of which help improve treatment effectiveness and efficiency

36. FFT/CFS continuous quality improvement system for Functional Family Therapy Client Session Baseline Family Functioning Youth Symptom level Measure: Com-R) SFSS (full) Post Symptoms Family functioning Measures: -Com-R -SFSS (full) Motivation EngagementBehavior Change Generalization Session Even Sessions (2 nd, 4 th, 6 th, etc.) Youth Symptom Level (SFSS-Form A) Parent & Youth Odd Sessions (1 nd, 3 th, 5 th, etc.) Session Impact (SIS EM, SIS BC, SIS Gen) Parent & Youth Case Planning Progress Notes (PN) Case Planning Session Planning Guide (SPG)

37. Next Session Plan Specific session goals Specific areas of needed attention Before each session Match the model specifically to the family/situatio n/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

41. FFT Clinical Measurement Inventory Resource: FFT CMI Manual (on the web) Resource: FFT CMI Manual (on the web) Baseline Assessment Baseline Assessment Family Demographic Information (in CFS) Family Demographic Information (in CFS) Family Functioning (COM-r) Family Functioning (COM-r) youth & caregiver form youth & caregiver form Youth Symptom Level (SRFF-full Form) Youth Symptom Level (SRFF-full Form) Youth & caregiver form Youth & caregiver form

42. Discharge Assessment Discharge Assessment Family Demographic Information (in CFS) Family Demographic Information (in CFS) Family Functioning (COM-r) Family Functioning (COM-r) youth & caregiver form youth & caregiver form Youth Symptom Level (SRFF-full Form) Youth Symptom Level (SRFF-full Form) Youth & caregiver form Youth & caregiver form

43. 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 R ecorded presentation (1 Hour, 30 min) R ecorded presentation (1 Hour, 30 min) – Training Webinar 4: Research Foundations (35 minutes) R ecorded presentation (35 minutes) R ecorded presentation (35 minutes)

44. FFT/CFS System 3.Practice CFS – Training Webinar 5: Introduction to the FFT-CFS Powerpoint: FFT-CFS webinar Powerpoint: FFT-CFS webinar FFT-CFS webinar FFT-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 quick guide for each major function Review each on line video and quick guide for each major function 1.Entering a Client 2.Scheduling a Session 3.Holding a session 4.Completing measures 5.Discharging a client

45. FFT/CFS Enter/practice by: Enter/practice by: – Entering 3 fake clients (no base line data) – Entering 2 session for each client – Completing the measure for each session – View feedback 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

46. Resources FFT Learning Center FFT Learning Center – www.functionalfamilytherapy.com www.functionalfamilytherapy.com FFT/CFS FFT/CFS – https://beta.cfsystemsonline.com/login https://beta.cfsystemsonline.com/login Written Manuals Written Manuals – FFT in Clinical Practice (Sexton, 2010) – FFT Clinical Training Manual (Sexton & Alexander, 2004) – FFT Blueprint Manual (Alexander, Pugh, Parsons, & Sexton, 2000)

47. What’s next? This week: This week: – Read/learn about FFT – Review the Clinical Measurement Inventory – 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 4-5 hours of practice! It will take 4-5 hours of practice! – Find your questions….for the training!