A family-based intervention providing services to families with children up to age 18 with behavioural problems in the child welfare system.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
- Targeted and specialist
Australian Study
Risk of Bias
Cost
Target Age Group
About
Functional Family Therapy – Child Welfare® (FFT-CW®) is a family-based intervention that provides services to families with children up to age 18 who have been referred for behavioural or emotional problems by the juvenile justice, mental health, school or child welfare systems. The goal of the program is to improve family functioning while keeping children and young people in their existing homes or foster care placements. FFT-CW® is an adaptation of the Functional Family Therapy (FFT) model and is tailored to provide intensive services to match the severity of problems faced by the family in an efficient, cost-effective way.
Families are triaged to one of 2 levels of service based on the severity of presenting problems:
- High Risk Track involves a series of family-based in-session therapy to engage parents and family members to change behaviours.
- Low Risk Track supports therapeutic therapy in the community through case management, to match family members to interventions or programs in the community to address specific needs.
Aims
- Improve child mental health and behaviours
- Reduce or eliminate family violence
- Reduce or eliminate child abuse and neglect
- Reduce or eliminate harsh discipline
- Improve family functioning
- Prevent out-of-home placement
- Prevent contact with child protection services.
Impact
Evidence suggests that FFT-CW® was effective in reducing recurring allegations 18 to 24 months after case closure. There was negative effect found for reducing out-of-home care. FFT-CW® families reported higher rates of out-of-home placements than those in usual care but this difference was small.
The outcomes for engagement is mixed. The results showed that the program was effective in helping families achieve their planned service goals more efficiently especially for those identified with multiple complex risk patterns but this did not necessarily lead to positive outcomes post treatment.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Child protection system contact | Yes | Not found | Not found |
| System | Out-of-home care | Not found | Not found | Yes |
| Implementation | Engagement | Yes | Not found | Yes |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
FFT-CW® has an evidence rating of Supported+.
This means that FFT-CW® has evidence from one randomised controlled trial (RCT) or quasi-experiment (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on one research output of QE design. FFT-CW® has not received a Well-supported rating as it has not yet replicated its results in another RCT or QE with a different population or setting.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | Not identified or included |
| Quasi-experiment | 1 |
The evidence has some concerns with risk of bias.
The quality of the evidence of the QE is low and results should be interpreted with caution.
The study was conducted in the United States and does not include Aboriginal children and families. FFT-CW® is delivered in Australia to Aboriginal children and families but local studies may not have met the inclusion criteria to be included on the Menu.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The study was conducted in 5 boroughs across New York, United States.
Sample
- A total of 60 families each month enrolled in the program with staggered implementation. 1,625 individuals participated in the intervention and 2,250 individuals in the control.
- 60% of the families had at least one child over age 10.
- Participants identified as Hispanic (50%), African American (35%), Non-Hispanic White (5%), Asian (3%) and other. This ethnicity/racial diversity reflected the profile of referrals to the New York Foundling Prevention Services.
Implementation
Delivery model and mode
- FFT-CW® is delivered in-person and over the phone, to the parent only, child only or parent and child together.
Target cohort
- Families with children up to age 18 with indication of child maltreatment or other evidence of concern for the child’s safety or health
- Family members exhibiting severe mental or behavioural problems requiring more intensive services, or abusive parenting behaviours.
Program delivery
- Case workers match youth during the intake process to an appropriate level of services based on the level of youth and family risk. Families are assigned to either the lower risk case management approach or higher risk intensity service track, while receiving weekly supervision from a trained expert.
- There are 2 levels of services:
- Low Risk (FFT-LR): A case management approach where prevention workers provide services to families in the community. The program is implemented in 3 distinct phases: 1) Engage/Motivate, 2) Support/Monitor and 3) Generalisation.
- High Risk (FFT-HR): A family intervention approach with 5 phases: 1) Engagement, 2) Motivation, 3) Relational assessment, 4) Behaviour change and 5) Generalisation. FFT-CW® therapists are trained to identify and tailor treatment based on families’ at-risk status. Services range from parenting strategies to in-session therapist techniques and family interaction to address mental health, domestic violence and substance abusing adolescents.
- As problems faced by multiple family members is different, adaptations may be required to provide a comprehensive approach to address multiple behaviour and psychological issues such as depression, anxiety and post-traumatic stress disorder.
Duration and intensity
- Services last approximately 5 to 7 months and comprise at least one weekly 45 to 60-minute session, with interventions organised in distinct phases.
Manuals and guides
- There is a manual that describes how to deliver FFT-CW®.
Additional information
- The Functional Family Therapy website has more information about FFT-CW®, including the clinical model and model effectiveness.
Staffing
- FFT-CW® is delivered by a team comprised of staff who have been trained to deliver FFT-CW®. At a minimum, each FFT-CW® registered/accredited site is required to have a site manager, lead supervisor/practitioner and 3 trained therapists whose role is dedicated to delivering FFT-CW®.
- Staff should have at least a bachelor’s degree. In the high-risk track, therapists should have a master’s degree. Site supervisors must hold a master’s degree or above. Previous experience in family therapy and/or work in child welfare settings is preferred.
Training
- FFT-LLC provides training and supervision in FFT nationally and internationally.
- Training entails 3 phases that include 8 days of didactic, on-site workshops and group consultation calls led by expert FFT-LLC consultants over one year.
To our knowledge, there are authorised FFT sites in Victoria, New South Wales (NSW) and the Australian Capital Territory.
In Victoria, OzChild and Anglicare are funded by the Department of Families, Fairness and Housing to deliver FFT-CW®.
In NSW, FFT-CW® is funded by the Department of Communities and Justice (DCJ).
Cost
No direct vendor information regarding implementation and delivery costs for the Australian context were found. Indicative costs for the Victorian context calculated by KPMG for a 2016 report for Anglicare Australia showed the FFT-CW® cost of continued support through Integrated Family Services is approximately $7,500, per family supported.
Assuming that one FFT-CW® team comprises 5.5 EFT positions, supporting a maximum of 16 families per annum, with an average case duration of 6 months, the operational costs of one FFT-CW® team in Victoria is $0.87 million per annum. This does not include establishment costs of approximately $0.17 million. Note: Costs were based on unit prices drawn from the DHHS, Policy and Funding Guidelines 2016 and the caseload estimates supplied by Children Australia Inc.
References
Studies identified and included in the review
- Turner, et al. (2017). Summary of comparison between FFT-CW and Usual Care sample from Administration for Children's Services, Child Abuse & Neglect, 69, 85-95.
Studies identified but not counted towards the evidence rating due to study quality
No studies that were identified were excluded due to study quality.