The evaluation of Functional Family Therapy in the Netherlands

In the last 20 years there has been a 300% increase in the growth of violent criminal acts among adolescents in the Netherlands. In response to the increasing trend of violent crime and the accompanying rise in attention to adolescent problem behavior, identifying successful methods to treat juvenile delinquency has recently become high priority in the Netherlands. The Ministry of Justice recently adopted Functional Family Therapy (FFT) as one of the primary “treatments of choice.”. FFT is an evidence based, family focused treatment model, which has been developed in the USA and is being adopted by juvenile justice systems in communities across this country. FFT is built on a systematic articulation of goals and therapist activities described in the published intervention manual. Unfortunately, outcomes of FFT thus far have been restricted to studies in the US. and the cultural variation needed to successfully apply the model have not been systematically studied. Much is still unknown about the conditions to successfully apply the model tot Dutch populations with its cultural variations. Among the many issues to be understood, four questions emerge as most critical: (1) Does FFT produce similar outcomes in a culture other than the one in which it was developed? (2) How might consideration of cultural variations result in the successful application of the model? (3) Is the model equally effective with diverse ethnic groups, and (4) What is the role of therapist model fidelity in the successful implementation of FFT in the Netherlands? The proposed study is a Multi Site Replication Study of FFT in Netherlands. The quality of the study is evidenced by the systematic selection of FFT treatment centers, ethnically diverse clients, an analysis of model fidelity using established FFT fidelity measures on multiple client outcomes including individual and family relational functioning and youth recidivism. The sample of clients will consist of adolescents diagnosed with externalizing behavior disorders seeking mental health service. These youth may be from the justice system and/or the child protection systems. A total of 480 families will be assigned to one of two treatments. The treatment group consists of youth that receive FFT. Youth assigned to the comparison group, will receive the traditional individually focused treatment (treatment as usual or TAU). If random assignment is not possible adolescents will be assigned to the two conditions in a matched control design. The study utilizes well established measures of therapist treatment fidelity, client outcome, and implementation. Data collection will take place in three ways: (1) the Dutch MONITOR data system, which is in development and will be used by all centers involved in the project. The monitor will provide data on out of home placements and pre and post criminal behaviors; (2) the FFT Clinical Services system (FFT-CSS), which is an international web-based treatment monitoring system used by all FFT sites and therapists through the world, contains therapist model fidelity measures, client pre treatment demographic data, and service delivery (dropout) data; and (3) interviews with FFT therapists, supervisors at a sample of clients at each site will be held, in order to make an inventory of potential FFT model adjustments and Training changes.