Since its successful first trial back in the early 1970s, Functional Family Therapy (FFT)has been acquiring an impressive reputation for consistently and in a variety of conditions improving the prospects of young people with behavior problems.

Originating at the University of Utah where it was devised by a team led by Dr Jim Alexander, it is now being delivered to over 30,000 children a year across 44 US states.

It seems to cope well with cultural differences, producing similar outcomes among African Americans and Hispanics communities who are over represented in the juvenile justice system.

And FFT travels well: by the end of 2009, it will have been rolled out in six other countries including the UK, the Netherlands and New Zealand. Materials are already available in five languages. 

Long pedigree means that it has been ahead of the game in meeting what are now widely acknowledged to be translational challenges, and the lessons it has learned are increasingly relevant.

As well as continuing to gather robust evidence on impact, the developers have assembled a comprehensive support network with a certification process backed up by a web-based clinical management system. 

Some locations pose a much greater challenge than others. Chief Executive Doug Kopp explains how recent implementation in New Zealand involved the developers, the New Zealand government and the Maori leadership, as well as local funders, charities and social services. 

 “A key question is whether FFT can be implemented within its core principles – respect-based, alliance-based, family-focused etc – in any given context,” he says. 

“In New Zealand we ended up altering the timing and pace of parts of the protocol, to make travel more efficient, but that was really the only modification.” 

Some adaptations have required bigger change. For the Dutch to “get” FFT, the tone and register of language had to be altered. In the US version the therapist compliments clients repeatedly. It was felt that in Holland this would seem both superficial and artificial. When therapists were giving advice, they found that they had to take a far more direct approach. 

Rene Breuk from the de Bascule research center in Amsterdam reports that getting FFT up and running in his country required much more hands-on support than in equivalent sites in the US. This was due to basic translation issues, cultural adaptation and the challenges of embedding the model in an unfamiliar system.

Doug Kopp regards building relationships and adapting the program to local conditions as a necessary and valuable investment. 

“Often, during these first steps in a country where there is no FFT, we are dealing with 'early adopters' who are highly motivated and who may ultimately become partners in dissemination should FFT be expanded,” he says.

See Alexander J and Sexton T (1999), Functional Family Therapy: Principles of clinical intervention, assessment, and implementation, Functional Family Therapy Inc, Henderson NV
and
Breuk R, Sexton T, van Dam A, Disse C, Doreleijers T, Slot W and Rowland M (2006), “The Implementation and the Cultural Adjustment of Functional Family Therapy in a Dutch Psychiatric Day-Treatment Center”, Journal of Marital and Family Therapy, 32, 4, pp.515-529