Widely used youth behavior treatment may be ineffective

A long-established treatment used around the world to help troubled young people and their families tackle behavioural problems may not be as effective as its practitioners claim - a new study reveals.
Functional Family Therapy (FFT) is a short-term, evidence-based intervention provided at over 270 sites worldwide - mostly within the US, but also in Belgium, Ireland, The Netherlands, New Zealand, Norway, Sweden and the UK.

Researchers at the University of Birmingham recommend that greater examination of FFT is needed, after evaluating 31 existing reviews of research on the treatment's effectiveness in treating young people, aged 10 to 18.

They found that the quality of evidence in reviews was mixed and adversely affected by small sample sizes, no critical appraisal methods and a failure to examine evidence for risk of bias.

Paul Montgomery, Professor of Social Intervention in the University of Birmingham's School of Social Policy, said: "Our overview of FFT illuminates some real areas of concern around this treatment. It appears that in nearly 40 years of existence, there remain a number of unanswered questions about the effectiveness and implementation of FFT.

"FFT is intensive and costly. It may not be advisable to continue using the therapy without re-examining and testing its effects. Many reviews currently available are written by people developing and delivering FFT, demonstrating the need for independent and robust trials."

The study, published in Research on Social Work Practice, reveals that median rates of reoffending with FFT were 28 per cent; as opposed to 57 per cent for usual care. Impact on substance abuse was modest and reducing rates of out-of-home placements was not reported, despite being considered a main outcome of FFT.

Juvenile delinquency represents a major cost in many countries, with the US spending over $5.7 billion annually on incarcerating minors. In the UK, over 42 per cent of minors typically re-offend, up from ten years ago.

Family and youth dysfunction may lead to higher rates of abandonment, higher rates of alcohol and substance use, untreated mental health issues and other negative behaviours. These issues contribute to behavioural disorders resulting in higher likelihood of school drop-out, imprisonment, unemployment and anti-social activities.

FFT is designed to treat the behaviours and acting-out activities that take a toll on youth, families and communities. Additionally, FFT may be used as a re-entry programme for young people being released from institutional settings or at risk for removal from the home.