Functional Family Therapy (FFT)  

What is it?

Functional Family Therapy (FFT) is a family-based therapy for children aged between 10 and 17, and their families. It is intended for families where there is conflict between individuals in the family. It seeks to improve communication and relationships between family members.   

FFT is a manualised programme delivered by trained therapists and can be used with children at risk of or already involved in violence, crime or substance abuse. Programmes typically provide weekly sessions over a 12-week period, which usually includes 12 to 14 therapy sessions. This may vary, depending on the family’s needs. These sessions usually take place at home or in a therapy room. Therapists often provide ‘out of hours’ support and will take phone calls from family members to provide advice or support.  

FFT typically involves five phases:  

1. Engaging the child and their family members and promoting a positive outlook that participation in the programme will help to create positive outcomes.  

2. Helping family members to modify negative emotions, such as hopelessness or blaming, and improve motivation to change behaviours.  

3. Assessing the strengths and problems in the current functioning of the family.  

4. Providing bespoke training to the child and family members, based on their specific needs. For example, listening skills, anger management, and parental supervision.  

5. Generalising new skills and behaviours to help maintain changes over time. This involves practicing using new skills in relationships outside of the home, such as with schools, community organisations and other professionals.  

The approach focuses on helping families understand the underlying causes, triggers, and consequences of their behaviours, and helps them to make positive changes. FFT suggests that improvements in communication, behaviour and support between family members should lead to reductions in behavioural difficulties and involvement in violence or crime.  

Is it effective?

On average, Functional Family Therapy (FFT) is likely to have a moderate impact on violent crime. However, the research on FFT is weak and there is a lot of variation in the results.  

Some studies suggested that the impact was higher, and others suggested it was lower. Some studies show greater effects six to twelve months after the programme, and others show lower effects eighteen months after the programme. Two studies show a moderate impact on offending after two years.   

The research also shows mixed results for impact on behaviour. Some studies show a low impact on behavioural difficulties six to twelve months after the programme, and others show a moderate impact after eighteen months. Some studies show small increases in antisocial behaviour between six and eighteen months after the programme.  

One study involving children and young people involved in the criminal justice system in the UK found a moderate impact on reducing offending.  

How secure is the evidence?  

We have low confidence in our estimate of the average impact on violent crime. 

Our confidence is low because our estimate is based on six studies, and there is a lot of variation in the findings of those studies.  

Only one of the six studies that informed the impact rating was undertaken in the UK.  

How can you implement it well?

Create an accessible and reliable relationship between the therapist and the family.  

Functional Family Therapy relies on a good relationship between the family and the therapist. Families are more likely to engage in the programme when therapists work in a collaborative way with parents, when they are easily accessible to family members, and when they work with the same therapist for the full programme.      

Prepare key stakeholders for additional systems and processes. 

Running an FFT programme may require an additional system for case management. Build in time with relevant local authority teams to design and implement a process that minimises additional administrative work.  

Identify and manage multiple service demands on families.  

Many of the children, young people and families that are eligible for FFT may be involved in other services and activities and this may reduce their willingness to take part. Ensure there is effective and timely communication between families, therapists, local authorities, and youth justice teams, to plan sessions that work across diaries.  

What programmes are available? 

How much does it cost?  

On average, the cost of Functional Family Therapy is likely to be high.  

This estimate is based on programmes delivering between 12 to 14 sessions, over a period of three to six months. This cost can vary significantly based on the needs of the family, where some may need as few as eight hours, and others may need as many as 30 hours. The main cost involved in this programme is the trained therapist, and small additional costs related to printed materials to support sessions. The Step Change programme implemented in London reported an average cost of £3,465 per child.        

YEF projects and evaluations   

YEF funded a pilot study of Functional Family Therapy Gangs (FFT-G) delivered by Family Psychology Mutual. Intensive home-based support was provided over three to five months for young people aged 10-to-17 years old at risk of involvement in county lines drug networks or child criminal exploitation. The programme aimed to improve the safety, well-being and stability of children and families, and reduce offending. Read the evaluation here.  

Topic summary 

• Functional Family Therapy (FFT) is a family-based therapy for children and young people aged between 10 and 17, and their families.  This approach seeks to reduce behavioural difficulties by improving communication and relationships between family members.   
• On average, Functional Family Therapy (FFT) is likely to have a moderate impact on violent crime. However, we have low confidence in this estimate because the evidence on FFT is weak and studies show mixed results.  
• The children and families that FFT is designed to help may already be involved in other services and activities with local authorities and youth justice services. Willingness to engage in FFT is fundamental to its success, and this could be facilitated through coordinating appointments and ensuring therapists build strong relationships with families.  
• FFT is a high-cost approach that involves intensive provision delivered by a trained therapist.  

Take away messages

• Invest in clinically-led provision and increase access for children at-risk or already involved in violence, and for families where there is conflict between individuals in the family.  
• Ensure referrals and needs assessments take place quickly. 
• Put strategies in place to reach children and families from racially minoritised communities and to keep them engaged throughout the intervention.  
• Put in place rigorous monitoring processes to identify and resolve any overlapping services or interventions being provided to the children and families on the FFT programme.  

External links 

Functional Family Therapy Logic Model  

Logic Model created by the Evidence-based Prevention and Intervention Support Center (EPISCenter) at Penn State University.  

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