Functional Family Therapy: analysis of effect and implementation

Purpose: Functional Family Therapy (FFT) is a manualized intervention for youth aged 10-18 with behavioural problems (e.g. delinquency, violence, substance abuse, and truancy) and their families. This thesis examined the evidence surrounding FFT using an overview and an implementation analysis. Methods: The overview used Cochrane Guidelines as a framework, and included a multi-pronged, highly sensitive search strategy. The narrative implementation analysis was based on the Oxford Implementation Index, and examined the effects of dose, delivery, uptake, context and biases. A reflexive discussion of the research process highlighted the presence of allegiance bias and possibly ethical misconduct by FFT developers. Results: The overview included 31 reviews and demonstrated effects of the intervention on core outcomes (recidivism and substance abuse) were modest and out-of-home placement was not reported. Secondary outcomes were also modest but generally positive. The implementation analysis included 16 studies involving 5320 participants. Improved training and supervision were associated with better core outcomes; class and ethnicity were important effect moderators whereas there was no apparent dose relationship. Conclusions: The overall quality of included reviews was low, which makes evidence concerning FFT inconclusive. Implementation elements were shown to affect core outcomes and the likelihood of allegiance bias is very high