Functional Family Therapy (FFT) for Behavior Disordered Youth Aged 10–18: An Overview of Reviews

Abstract

Purpose: This overview of reviews analyses the existing evidence base of functional family therapy (FFT), which is a manualized, family-based intervention for youth with behavioral problems and their families. FFT has been implemented among youth aged 10–18 at risk of, or presenting with, behavioral problems such as delinquency, violence, substance abuse, sexual perpetration, and truancy. Method: A multipronged search was conducted across 15 databases, 10 websites, and expert contacts in February 2018. Results: The search yielded 159 hits of which 31 were included and critically appraised. Included reviews were published between 1986 and 2018 and the number of included studies ranged from 1 to 18 (including 20–5,344 participants). Main effects of the intervention on core outcomes (recidivism and substance abuse) were modest and out-of-home placement was not reported. Secondary outcomes were also modest but generally positive. Conclusions: Findings demonstrate that overall quality of reviews is low, which makes any certainties about FFT inconclusive; this overview provides a concise, valid, and methodologically sound synthesis of the research into FFT, which requires more rigorous investigation.

An International Examination of the Effectiveness of Functional Family Therapy (FFT) in a Danish Community Sample

“…None of the aforementioned studies measured school‐related behaviors (e.g., school performance, skipping school), which neglects an important dimension related to adolescent delinquency. A recent meta‐analysis of 31 FFT literature reviews between 1986 and 2018 stated that there were no school‐related outcomes reported in any of the articles examined (Weisman & Montgomery, ). Thus, a larger study with a broader set of outcomes is necessary to more fully examine the potential effectiveness of FFT within an international context, specifically in Denmark.…”

Call for Revision of Weisman and Montgomery’s Review of Functional Family Therapy

“…Additional social service and victim cost savings are associated with reduced recidivism. Consistent with the larger body of research on FFT, Weisman and Montgomery (2018) report that, compared to alternative treatment, FFT was shown to have “modest” reductions in youth reoffending (28% in FFT vs. 57% in alternative treatment), modest effects on youth substance use, and modest effects on secondary outcomes. Despite these positive results, they claim that FFT might be harmful to youth and families, and they call for suspending implementation efforts.…”

“…An extension of systematic reviews is the overview of reviews approach in which the source material is review articles, including meta-analyses, rather than original research articles (Weisman & Montgomery, 2018). We recognize the potentially important role that high-quality review of reviews can play in understanding RSIs but also recognize the quality of these reviews may be compromised for various reasons.…”

“…Although the lead author on both reviews were involved with FFT LLC, other participants in these reviews and the meta-analysis have no relationship to the FFT LLC dissemination organization. Weisman and Montgomery (2018) ignore the possibility that the investigators of FFT have a deep concern for the well-being of the adolescents receiving services. A central priority for these FFT researchers is to find ways to continuously improve the quality of services provided to these adolescents.…”

Implementation Issues in Functional Family Therapy: A Narrative Analysis of the Evidence

“…It is important to understand and identify the elements of the intervention which are working and result in positive outcomes, and possible areas that require modification or adaptation. Recent overview and meta-analytic evidence illustrates the variability in core outcomes, thus confounding any certainties regarding the implementation and usage of FFT with such a heterogenous population and across varied settings (Weisman & Montgomery, 2018;Hartnett et al, 2017).…”