Functional Family Therapy (FFT) & Parent-Child Interaction Therapy (PCIT) Tara Levin, Psy.D Licensed Clinical Psychologist

Transcription

1 Functional Family Therapy (FFT) & Parent-Child Interaction Therapy (PCIT) Tara Levin, Psy.D Licensed Clinical Psychologist

2 Functional Family Therapy (FFT) Founded in 1972 by Dr. James Alexander. FFT is an empirically grounded, well-documented and highly successful family intervention for atrisk youth ages 10 to 18 whose problems range from acting out to conduct disorders to alcohol and/or substance abuse. FFT is one of four model programs named by the US Surgeon General as a model program for seriously delinquent youth.

3 Clinical Application of FFT FFT is a short-term intervention program with an average of 12 sessions over a 3-4 month period. Services are conducted in both clinic and home settings, and can also be provided in a variety of settings including schools, child welfare facilities, probation and parole offices/aftercare systems, and mental health facilities.

4 FFT Focus FFT is a strength-based model. Main focus is on assessment of risk and protective factors that impact the adolescent and their environment, with specific attention on both intrafamilial and extrafamilial factors, and how they will affect and influence the overall therapeutic process.

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6 Phases of Treatment The program consists of five major components: 1. Engagement in change; 2. Motivation to change; 3. Relational/Interpersonal Assessment; 4. Behavior Change; and 5. Generalization across behavioral domains and multiple systems.

7 Engagement in Change Phase The goals of this phase involve: 1. Enhancing perception of responsiveness and credibility; 2. Demonstrating a desire to listen, help, respect, and match; and 3. Addressing cultural competence. Main focus is on immediate responsiveness and maintaining a strength-based relational focus. Activities include high availability, telephone outreach, appropriate language and dress, proximal services or adequate transportation, contact with as many family members as possible, matching and respectful attitude.

8 Motivation Phase The goals of this phase include: 1. Creating a positive motivational environment, 2. Minimizing hopelessness and low self-efficacy, and 3. Changing the meaning of family relationships to emphasize possible hopeful experience. Focus is on the relationship process; separating blaming from responsibility while remaining strength-based. Activities include the interruption of highly negative interaction patterns and blaming (e.g. divert and interrupt), changing meaning through a strength-based relational focus, pointing process, sequencing, and reframing of the themes by validating negative impact of behavior, while introducing possible benign / noble (but misguided) motives for behavior.

9 Relational Assessment Phase The goals of relational assessment include: 1. Eliciting and analyzing information pertaining to relational processes, and 2. Developing plans for Behavior Change & Generalization. The focus is directed to intrafamily and extrafamily factors (e.g., values, attributions, functions, interaction patterns, sources of resistance, resources, and limitations). Therapist activities involve observation, questioning; inferences regarding the functions of negative behaviors, and switching from an individual problem focus to a relational perspective.

10 Behavior Change Phase Behavior Change goals consist of: 1. Skill building, 2. Changing habitual problematic interactions and other coping patterns. Main focus is on communication training, using technical aids, assigning tasks, and training in conflict resolution. Phase activities are focused on modeling and prompting positive behavior, providing directives and information, developing creative programs to change behavior, all while remaining sensitive to family member abilities and interpersonal needs.

11 Generalization Phase The primary goals in the Generalization phase are: 1. Extending positive family functioning; 2. Planning for relapse prevention; 3. Incorporating community systems. The primary focus is on relationships between family members and community systems. Generalization activities involve knowing the community, developing and maintain contacts, initiating clinical linkages, creating relapse prevention plans, and helping the family develop independence.

12 fftinc.com

13 Efficacy Data from numerous studies of FFT outcomes suggest that when applied as intended, FFT reduces recidivism and/or the onset of offending between 25 and 60 percent more effectively than other programs (Alexander et al., 2000). Cost Effectiveness: Other studies indicate that FFT reduces treatment costs to levels well below those of traditional services and other interventions (Alexander et al., 2000).

14 Journal of family psychology JFP journal of the Division of Family Psychology of the American Psychological Association Division 43 (2010) Volume: 24, Issue: 3, Pages: The findings suggest that FFT was effective in reducing youth behavioral problems, although only when the therapists adhered to the treatment model. High-adherent therapists delivering FFT had a statistically significant reduction of (35%) in felony, a (30%) violent crime, and a marginally significant reduction (21%) in misdemeanor recidivisms, as compared to the control condition. The results represent a significant reduction in serious crimes 1 year after treatment, when delivered by a model adherent therapist. The low-adherent therapists were significantly higher than the control group in recidivism rates.

15 Efficacy Studies Efficacy Trials (Citations) Alexander, J., & Parsons, B. (1973). Short-term behavioral intervention with delinquent families: Impact on family process and recidivism. Journal of Abnormal Psychology, 81(3), doi: /h Parsons, B., & Alexander, J. (1973). Short-term family intervention: A therapy outcome study. Journal of Consulting and Clinical Psychology, 41(2), doi: /h Alexander, J., Barton, C., Schiavo, R., & Parsons, B. (1976). Systems-behavioral intervention with families of delinquents: Therapist characteristics, family behavior, and outcome. Journal of Consulting and Clinical Psychology, 44(4), doi: / x Klein, N., Alexander, J., & Parsons, B. (1977). Impact of family systems intervention on recidivism and sibling delinquency: A model of primary prevention and program evaluation. Journal of Consulting and Clinical Psychology, 45(3), doi: / x Friedman, A. (1989). Family therapy vs. parent groups: Effects on adolescent drug abusers. American Journal of Family Therapy, 17(4), doi: / Waldron, H., Slesnick, N., Brody, J., Turners, C.W., & Peterson, T.R. (2001). Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments. Journal of Consulting and Clinical Psychology, 69(5), doi: / x Effectiveness Studies/Quasi-Experimental Studies (Citations) Barton, C., Alexander, J. F., Waldron, H., Turner, C. W., & Warburton, J. (1985). Generalizing treatment effects of Functional Family Therapy: Three replications. American Journal of Family Therapy, 13(3), doi: / Gordon, D., & Arbuthnot, J. (1988). The use of paraprofessionals to deliver home-based family therapy to juvenile delinquents. Criminal Justice and Behavior, 15(3), doi: / Gordon, D., Arbruthnot, J., Gustaffson, K.E., & McGreen, P. (1988). Home-based behavioral-systems family therapy with disadvantaged juvenile delinquents. The American Journal of Family Therapy, 16(3), Gordon, D., Graves, K., & Arbuthnot, J. (1995). The effect of functional family therapy for delinquents on adult criminal behavior. Criminal Justice and Behavior, 22(1), doi: / Waldron, H.B., & Turner, C.W. (2008). Evidencebased psychosocial treatments for adolescent abuser: A review and meta-analysis. Journal of Clinical Child and Adolescent Psychology [Special Issue: Evidence Based Psychosocial Interventions for Clinical Child and Adolescent Disorders], 37, 1-24.

16 Certification (fftinc.com) Phase 1 Clinical Training: The initial goal of the first phase of FFT implementation is to impact the service delivery context so that the local FFT program builds a lasting infrastructure that supports clinicians to take maximum advantage of FFT training/consultation. By the end of Phase I, FFT Inc. s objective is for local clinicians to demonstrate strong adherence and high competence in the FFT model. Assessment of adherence and competence is based on data gathered through the FFT Clinical Service System, through FFT weekly consultations and during phase one FFT training activities. It is expected that Phase One be completed in one year, and not last longer than 18 months. Periodically during Phase I, FFT Inc. personnel provide the site feedback to identify progress toward Phase I implementation goals. By the eighth month of implementation, FFT Inc. will begin discussions identify steps toward starting Phase 2 of the Site Certification process. Phase II Supervision Training: The goal of the second phase of FFT implementation is to assist the site in creating greater self-sufficiency in FFT, while also maintaining and enhancing site adherence/competence in the FFT model. Primary in this phase is developing competent on-site FFT supervision. During Phase II, FFT Inc. trains a site s extern to become the on-site supervisor. This person attends two 2-day supervisor trainings, and then is supported by FFT Inc. through monthly phone consultation. FFT Inc. provides one 1-day on-site training or regional training during Phase II. In addition, FFT Inc. provides any on-going consultation as necessary and reviews the site s FFT CSS database to measure site/therapist adherence, service delivery trends, and outcomes. Phase II is a yearlong process. Phase III Maintenance Phase: The goal of the third phase of FFT implementation is to move into a partnering relationship to assure on-going model fidelity, as well as impacting issues of staff development, interagency linking, and program expansion. FFT Inc. reviews the CSS database for site/therapist adherence, service delivery trends, and client outcomes and provides a one-day onsite training for continuing education in FFT. Phase 3 is renewed on an annual basis.

17 Iowa FFT Sites Four Oaks - Cedar Rapids Orchard Place Child Guidance Center - Des Moines Quakerdale - New Providence Four Oaks Waterloo - Waterloo Families, Inc. - West Branch

18 Parent Child Interaction Therapy (PCIT)

19 What is PCIT? Parent-Child Interaction Therapy (PCIT) is an empirically-supported treatment for conduct-disordered young children that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns. In PCIT, parents are taught specific skills to establish a nurturing and secure relationship with their child while increasing their child s prosocial behavior and decreasing negative behavior.

20 What is PCIT continued Developed by Dr. Sheila Eyberg for families of children aged 2-7 who present with disruptive behavior. Combines elements of attachment and learning theories, systems theory, and behavior modification. Short-term (average of sessions that occur weekly). Direct coaching of parent with child; Gives parent responsibility, does not place blame.

21 Goals of PCIT Strengthen parent-child relationship. Provide education regarding effective behavior management. Increase positive parent/child interactions. Increase positive communications. Make new skills habitual and generalizable.

22 Two Basic Interactions This treatment focuses on two basic interactions: 1. Child Directed Interaction (CDI) is similar to play therapy in that parents engage their child in a play situation with the goal of strengthening the parent-child relationship; also referred to as relationship enhancement phase. 2. Parent Directed Interaction (PDI) resembles clinical behavior therapy in that parents learn to use specific behavior management techniques as they play with their child; discipline phase.

23 Child-Directed Interaction Parent-Directed Interaction Parents follow Play therapy skills Differential attention Increase warmth of parent-child relationship Parents lead Limit-setting Consistency Predictability Follow through

24 Child Directed Interaction DO Praise Reflect Imitate Describe Enthusiasm DON T Give Commands Ask Questions Criticize IGNORE annoying, obnoxious behavior STOP THE PLAY for dangerous or destructive behavior

25 Parent-Directed Interaction Effective Commands ( (next 8 slides) Be Direct Stay Positive (tell what to do not what to stop) Use Single Command Be Specific Use Age-Appropriate Communication Use Normal Tone of Voice Be Polite and Respectful Use only when Necessary

26 The Command... Command No Opportunity Obey Disobey Whoops! (Start over) Labeled Praise Back to Play YEA!

27 The Warning... If you don t [original command], you ll have to go to the time out chair Obey Disobey (UH-OH!) Labeled Praise Back to Play YEA!

28 The Chair

29 The Chair Child stays on chair 3 min plus 5 sec quiet Or doesn t (OH-OH!) Are you ready to [obey original command]? No Command Obey Acknowledge

30 The Backup CHILD GETS OFF CHAIR ROOM WARNING You got off the chair before I said you could. If you get off again, you ll go to the Time Out Room. CHILD GETS OFF AGAIN CHILD GOES TO TIME OUT ROOM 1 MIN + QUIET BACK TO CHAIR

31 The First Obey Child Stays on Chair 3 Min plus 5 Sec Quiet No Are you ready to [Obey Original Command]? Yes Acknowledge Obey

32 Command Finally! Obey Praise Back to play!!!

33 Efficacy At least 30 randomized clinical outcome studies have found PCIT to be useful in treating at-risk families and children with behavioral problems. Research findings include the following: Reductions in the risk of child abuse. In a study of 110 physically abusive parents, only one-fifth (19%) of the parents participating in PCIT had re-reports of physically abusing their children after 850 days, compared to half (49%) of the parents attending a typical community parenting group (Chaffin et al., 2004). Reductions in the risk of abuse following treatment were confirmed by another recent study among parents who had maltreated their children (Timmer, Urquiza, Zebell, & McGrath, 2005). Improvements in parenting skills and attitudes. Research reveals that parents and caretakers completing PCIT typically demonstrate improvements in reflective listening skills, use more prosocial verbalization, direct fewer sarcastic comments and critical statements at their children, improve physical closeness to their children, and show improvements in child behavior. A review of 17 studies that included 628 preschool-age children identified as exhibiting a disruptive behavior disorder concluded that involvement in PCIT resulted in significant improvements in child behavior functioning. Commonly reported behavioral outcomes of PCIT included both less frequent and less intense behavior problems as reported by parents and teachers, increases in clinic- observed compliance, reductions in inattention and hyperactivity, decreases in observed negative behaviors such as whining or crying, and reductions in the percentage of children who qualify for a diagnosis of disruptive behavior disorder (Gallagher, 2003).

34 Efficacy continued Benefits for parents and other caregivers. Examining PCIT effectiveness among foster parents participating with their foster children and biological parents referred for treatment because of their children's behavioral problems, researchers found decreases in child behavior problems and caregiver distress for both groups (Timmer, Urquiza, & Zebell, 2005). Lasting effectiveness. Follow-up studies report that treatment gains are maintained over time (Eyberg et al., 2001; Hood & Eyberg, 2003). Usefulness in treating multiple issues. Adapted versions of PCIT also have been shown to be effective in treating other issues such as separation anxiety, depression, self-injurious behavior, attention deficit hyperactivity disorder (ADHD), and adjustment following divorce (Johnson, Franklin, Hall, & Preito, 2000; Pincus, Choate, Eyberg, & Barlow, 2005). Adaptability for a variety of populations. Studies support the benefits of PCIT across genders and across a variety of ethnic groups (Capage, Bennett, & McNeil, 2001; Chadwick Center on Children and Families, 2004; McCabe, 2005).

35 Resources (Information on Iowa Providers and Certification)