An evidence-based intervention for antisocial teenagers, which offers therapy for the whole family, is coming to the end of the first year of a first UK trial.

Negotiations and groundwork training for the the introduction of Functional Family Therapy in the English seaside city of Brighton began in 2007.

Headed by Sajid Humayun from the Institute of Psychiatry, London, a randomized controlled trial proper began last August with a cohort of 30, 15 of whom will receive FFT while the remainder continue with services ordinarily offered in the city. 

As Humayun explains, getting the program off the ground has not been easy. “Therapists using FFT have to be very well trained and experienced. Practitioners almost have to unlearn what they know.” Not attributing blame and helping families express their concerns are key components of the FFT model, but they are not always part of everyday practice. 

The team in Brighton have had the full support of the program’s developers in the US, Humayun says. “Implementing FFT there is a very close link with the developers. They help set the team up, skill them up - it’s a long process.”

Control over the program is quite tight. The training is continuous and practitioners make weekly mentoring calls to the US developers. 

For the program to be disseminated more widely in the UK, the next step will be getting staff in Brighton accredited as official FFT trainers. 

Another challenge has been persuading young people and their families to take part. Participants are being drawn from sources including the Brighton Youth Offenders Panel and the local Antisocial Behaviour Team to guarantee a wide range of families and problems.

The researchers receive lists and contact details of eligible young people entering each of the participating organizations’ systems. All are aged between ten and 17 and must have been referred for antisocial behavior or offending. 

There is a preliminary visit to the family to explain why the research is being done and to obtain consent for an initial assessment. 

“The first assessment is the major challenge. Once you get your foot through the door, the majority agree to take part. But a lot of families are suspicious of social services, having had bad experiences in the past,” Hamayun says.

Families who sign up seem to be willing to stay the course. The research team has started collecting information about the children and families six months down the line and so far everyone has agreed to talk to them.

There is not enough data to be drawing any conclusions about the effect of FFT on the Brighton children, but the anecdotal feedback from families involved has so far been encouraging. 

Ultimately the study will be looking at whether FFT reduces offending, re-offending and antisocial behavior. Returns for Brighton will be compared with those from previous studies of FFT in the US. 

The team are also collecting information about the relationship between the parents and child, the strength of their attachment and general household dynamics. 

The “therapeutic alliance” - the bond that develops between the FFT practitioner and the child, and between the practitioner and the parents will also be under scrutiny. Previous studies have shown that it is a crucial indicator, especially in the early stages, of whether the program is going to work. 

Evaluators will be keeping a close eye on how closely the practitioners in Brighton are replicating the FFT model. With the families consent, each therapy session is being videotaped and assessed. 

[See also: Brighton is first to leap toward functionality