The FFT Dog N Pony Show
In the brand-spankin-new clinical manual, page 5 talks about the need during the pretreatment phase for a “positive mindset of the referral source” and having a collaborative relationship with referring sources (Alexander, 2009). What I present here are some basic steps for the “FFT Dog n Pony Show”… the means for developing a “positive mindset” in referral sources. I believe without this preliminary work we are bound to make referring sources unhappy as we will not meet their unwarranted expectations—only “unwarranted” because they don’t know what to expect if we don’t tell them. They expect “business as usual” and FFT is anything but. They expect extended case management, they expect “individual therapy,” they expect “wraparound” or intensive in-home case management models. What they don’t expect is efficacious treatment in 12-20 sessions.
1- BRIEFLY explain the model. Don’t give too many details because it doesn’t make sense, but be very very clear about WHAT FFT is. It is family therapy, clear and simple. It is NOT case management. It is NOT wraparound. This is a common misconception. It is “intensive” because families are intense, but it is not necessarily time intensive. Yes, we may meet with a family initially more than once a week (the gold standard is 3 times in 10 days), but our idea of intensive and the referrers’ ideas of intensive may be very different. So be clear: once a week, in home, about an hour, 12-20 sessions, preferably with no other treatment.
2- Spend time to talk about outcomes. This is FFT’s selling point to other systems. Have slides or handouts with national data. Explain the reduced recidivism, reduced sibling recidivism, decreased system contact. WHY they want to use FFT, in a nutshell. Be a cheerleader!!
3- Then talk about the requirements! Generally we talk to families about decreasing other outside treatment modalities if possible. We ask other providers to take a short hiatus (e.g. TBS) especially during engagement motivation. We must communicate clearly with those systems to be on the same page when they do re-enter the family (as needed or required). Explain why we do this (different direction, ethics, family focus). Other requirements are an identifiable family (one they are going to be with or have been with for a long period of time), age limitations (11-18), and cognitive limitations (generally important with very young or special education referrals). If you have site specific requirement (e.g. MediCal) insert that here.
4- Talk to probation about how to best support FFT during the initial stage—don’t arrest if at all possible so the family can get some work in. We’re talking about a paradigm shift for some probation officers!!! Be gentle, use your excellent engagement abilities, and help them understand the importance of supporting and empowering the family—they can’t and don’t want to be with this family forever! Another important topic is how probation can support the family in Behavior Change, such things as allowing the parent/family to come up with consequences for misbehavior before probation becomes involved have been very successful.
5- Appropriate referrals: pretty much any kid in probation, most kids in mental health and AB3632. Cognitive requirements, age requirements, voluntary (of sorts)… Explain what an appropriate referral is. Often times FFT providers don’t get enough referrals because people don’t think of FFT—they think “this is an out of control kid” rather than “this is a family that needs FFT!” Kids do not live in a vacuum and cannot change in isolation. Be sure to talk to any system that touches kids—probation, mental health, education, medical staff at managed care or low income health clinics, Teens as Parents programs… you get the picture!
Reference:
Alexander. J. F., (2009). Functional Family Therapy Clinical Training Manual. (2nd Edition) Functional Family Therapy (FFTLLC/ FFTINC): Seattle , WA