Youth behavior problems have increased in prevalence in Scandinavian countries. Functional Family Therapy (FFT) has been shown to be an effective intervention across diverse populations and international contexts. The current study examines the effectiveness of FFT within a Danish-community sample in a pre-post comparison design and includes 687 families. Observed outcomes included both parent- and/or youth- reported domains of youth behavior, family dysfunction, school attendance and performance, and substance use. Significant improvements were found in youth behavior, family functioning, and school-related outcomes (e.g., like of school and truancy) despite experiencing a 60% attrition rate in our sample postintervention. This study provides evidence for the effectiveness of FFT on a wide scale in a Scandinavian context, adding to previous research that supports the transportability of this intervention.
ASJC Scopus subject areas
- Social Psychology
- Clinical Psychology
- Social Sciences (miscellaneous)
- Sociology and Political Science
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An International Examination of the Effectiveness of Functional Family Therapy (FFT) in a Danish Community Sample. / Vardanian, Maria Michelle; Scavenius, Christoffer; Granski, Megan; Chacko, Anil.In: Journal of Marital and Family Therapy, Vol. 46, No. 2, 01.04.2020, p. 289-303.
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TY - JOUR
T1 - An International Examination of the Effectiveness of Functional Family Therapy (FFT) in a Danish Community Sample
AU - Vardanian, Maria Michelle
AU - Scavenius, Christoffer
AU - Granski, Megan
AU - Chacko, Anil
N1 - Funding Information: Data for the current study was collected as part of a commissioned evaluation of FFT in Denmark. In 2013, FFT was introduced through five teams in Denmark, and in 2014, the National Board of Social Services commissioned an expansion with an additional six teams. The teams consisted of nine municipal social service teams and two private teams that received families from municipalities. The current analysis utilizes data from all 11 teams, collected between September, 2015 and September, 2018. Participant inclusion in the FFT intervention was determined with two steps. First, the municipality's child welfare services determined families? eligibility for family training and referred the families to therapy; second, the therapeutic team determined whether the family should receive FFT or some other appropriate service (e.g., a youth mentor or other family training as per Danish policy, which provides services to families in need of support for at-risk children). The specific choice of service was based on the team's professional and resource availability perspective. If, for example, the team expected that all family members were able and willing to engage with therapy and the team had an available FFT-therapist, the family was likely to be offered FFT. If, however, the team expected that they could not engage the family in therapy, the team chose another service. Families were not offered incentives to participate in this study. Altogether, 687 families and 61 therapists participated in the study. FFT teams and therapists provided referral and registration data at baseline for each family. Participants in therapy (caregivers and adolescents) provided self-reported demographic and clinical characteristics at baseline and posttreatment. Data were primarily collected from one caregiver, with the majority of caregivers being mothers, and one target adolescent (i.e., the adolescent with the main identified behavior problem) as well as siblings. At baseline, the total sample included 515 responses from maternal caregivers, 314 responses from paternal caregivers, 82 responses from other adults in the family, 576 responses from focal adolescents, and 63 responses from siblings in therapy. In the analysis, mothers, fathers, and other adults were pooled together and were identified as ?parents? (N?=?911). All of the adults were included in the analyses as they each participated in the family therapy and were considered important figures in the adolescent's life as well as key figures in the process of behavior change for the adolescent. In order to represent more focused outcomes, siblings were dropped from the analysis, resulting in only the targeted adolescent being included (N?=?576) into the category of adolescent's. Approximately half were female (n?=?295, 51.2%) and 14.5-years-old (SD?=?1.9) on average when they began FFT (see Table for additional participant demographic details). Number of observations (N??=?individuals); mean (M) and standard deviation (SD). Attrition bias from regression estimates from STATA module 'reg' of Y??=???+??attrition??+???, where Y is characteristic of individual i and the binary (0/1) variable 'attrition' indicates survey attrition of individual i. Two-sided tests with p-values (*p?<.05) adjusted for clusters at the family level. Data for the current study was collected as part of a commissioned evaluation of FFT in Denmark. In 2013, FFT was introduced through five teams in Denmark, and in 2014, the National Board of Social Services commissioned an expansion with an additional six teams. The teams consisted of nine municipal social service teams and two private teams that received families from municipalities. The current analysis utilizes data from all 11 teams, collected between September, 2015 and September, 2018. Participant inclusion in the FFT intervention was determined with two steps. First, the municipality's child welfare services determined families? eligibility for family training and referred the families to therapy; second, the therapeutic team determined whether the family should receive FFT or some other appropriate service (e.g., a youth mentor or other family training as per Danish policy, which provides services to families in need of support for at-risk children). The specific choice of service was based on the team's professional and resource availability perspective. If, for example, the team expected that all family members were able and willing to engage with therapy and the team had an available FFT-therapist, the family was likely to be offered FFT. If, however, the team expected that they could not engage the family in therapy, the team chose another service. Families were not offered incentives to participate in this study. The FFT intervention is structured to be delivered to at-risk youth aged 11?18-years-old in an average of 12 one-hour sessions over the course of three to four months. In this study, the FFT intervention was delivered in an average of 17 75-minute sessions, with an additional 30?min per session spent on extra contact with the family. FFT is comprised of three main phases of clinical intervention (i.e., engagement and motivation, behavior change, and generalization). The first phase, engagement and motivation, includes aiming to build a balanced alliance (both between family members and between each family member and the therapist), reduce between-family blame, and negativity, and identify shared definitions of target problems (Sexton,). This phase focuses on building rapport and a positive relationship amongst participating members as well as establishing motivation to fully engage in treatment. Behavior change constitutes the second phase of FFT, which focuses on modifying specific risk or disruptive behavior problems presented by the youth and family by incorporating protective skills within the family system (e.g., communication, parenting, supervision, problem solving, conflict management). The behavior change phase aims to change youth and family risk patterns in such a way that is consistent with their context and values. The third and final phase comprises of generalization, which focuses on the family's interactions with the broader scope of its whole environment. This phase aims to apply behavior modifications achieved in the previous phase to other areas in the family system, working to maintain the changes that have been made through relapse prevention strategies, support, and the incorporation of relevant community resources. All participating families received the FFT intervention program. Treatment took place either in the family home, a youth center, or family center, with the majority of sessions conducted in the latter. The FFT intervention engaged the whole family, broadly understood as all persons living with the adolescent, thus both biological parents, step-parents, siblings, step-siblings, and the referred adolescent could potentially participate in the same session. As a minimum, the target adolescent and one adult participated in each treatment session. Treatment was delivered by FFT-trained (five old teams) or trainee therapists (six new teams). The training of new teams was undertaken during the first 2?years of their creation and consisted of three phases: two implementation phases and one maintenance phase. Phase one began with three days of intensive training for all team members, including both supervisors and therapists. The teams then began the intake process for youth families in treatment, and were supported by weekly supervision provided by an FFT consultant and an additional 8?days of supplemental support. In phase two, team supervisors took over from the FFT consultants while receiving two monthly sessions of supervision from FFT consultants. The team supervisor training consisted of three-times-three days of externship, where they conducted treatment and received observation-based guidance on their clinical work. Additionally, they participated in two-times-two-day workshops. Phase two also included an additional training day for the whole team. Phase three focused on maintenance and involved annual guidance of the team from an FFT consultant. The team leader received monthly supervision from an FFT consultant and an annual assessment of model adherence, fidelity, and competence. Prior to FFT training, the majority of therapists in Denmark had educational qualifications equivalent of a bachelor's degree (pedagogue) with supplementary training. The FFT Client Service System (CSS), an information technology database that FFT therapists continuously updated throughout their work, was developed to house all FFT treatment-related data conducted in Denmark. The database included a treatment fidelity rating scale considering both therapist competencies (e.g., sophistication of intervention and tailoring treatment to families) as well as therapist adherence (e.g., applying the model as intended). This computer-based system aims to improve therapist skill by providing them with the complete outcome information needed to evaluate case success and focusing them on intervention-related goals, modules, and strategies related to each phase of FFT (Sexton & Alexander,). Fidelity was rated on a scale from zero to six, where six represented the highest possible fidelity score. Cut-off scores indicated whether the therapist demonstrated satisfactory fidelity levels. A score of three or above was considered satisfactory by the FFT-LLC organization. Fidelity ratings were made by the team supervisor following supervision sessions each week. The supervisor rated fidelity based on the therapist's written and oral presentation of their work, and in some cases, on the basis of video recordings. To guide this score, the supervisor used fixed criteria from the FFT Supervisor Manual (see Sexton & Turner, for more information). Primary outcomes include three parent-reported and two youth-reported instruments on youth behavior and family dysfunction. Other, secondary outcomes include school attendance, school performance and alcohol, smoking, and drug use. The Strengths and Difficulties Questionnaire (SDQ; Goodman,) is a 25-item self-report scale with youth, parent, and teacher versions, which measures negative and positive aspects of child or adolescent behavior, emotions, and peer relationships. The SDQ is comprised of five subscales of five items each, which assess emotional symptoms (?I am often unhappy, down-hearted or tearful?), conduct problems (?I get very angry and often lose my temper?), hyperactivity/inattention (?I am restless, I cannot stay still for long?), peer relationship problems (?Other people my age generally like me?), and prosocial behavior (?I try to be nice to other people.?) Participants respond to each item on a 3-point Likert scale which ranges from 0 (?Not True?) to 2 (?Certainly True?). The total difficulties score, which is comprised of all subscales except for the Prosocial scale, ranges from 0 to 40 and each subscale scale score ranges from 0 to 10; higher scores indicate problematic behavior. The Danish version was translated in 2001 (Obel, Dalsgaard, Stax, & Bilenberg,). The SDQ has been shown to have acceptable reliability in both the English and Danish versions (Goodman & Scott,; Niclasen et al.,), and convergent validity with other measures of psychopathology (Hill & Hughes,). Norm-scores for Danish populations are currently being collected, so here we compared to British norms of 11?15-year-olds (Meltzer, Gatward, & Goodman,). In this sample, Cronbach's alpha for the total parent-reported SDQ score was 0.78 and 0.79 at baseline and follow-up and 0.76 and 0.79 for the youth-reported score at baseline and follow-up. The Systemic Clinical Outcome and Routine Evaluation (SCORE-15; Stratton, Bland, Janes, & Lask,) is a 15-item, youth and parent self-report measure that assesses clinical outcomes that change over the course of family therapy. It was developed in the United Kingdom, and it was designed to be administered to individuals 12?years and older in routine evaluations of systemic family therapy. The scale has three subscales?family strengths (?We trust each other?), family communication (?It feels risky to disagree in our family?), and family difficulties (?In my family we blame each other when things go wrong?) ?with each subscale comprising of five items. Respondents rate each item on a 5-point Likert scale from 1 (?describes us very well?) to 5 (?describes us not at all?). The total score and subscale scores are calculated as the mean of items in the scale; lower scores indicate better family adjustment. The SCORE-15 also includes an open-ended question that asks participants to indicate what they perceive to be the biggest problem in the family and rate its severity on a 10-point scale. The SCORE-15 has demonstrated convergent validity with other measures of family, parent, and child adjustment (Fay et al.,), criterion validity in its ability to distinguish between clinical and nonclinical cases (Fay et al.,; Hamilton, Carr, Cahill, Cassells, & Hartnett,), and acceptable reliability (Stratton et al.,). In this sample, Cronbach's alpha for the total parent-reported score was 0.91 and 0.91 at baseline and follow-up and 0.90 and 0.93 for the youth-reported score at baseline and follow-up. The Inventory of Callous-Unemotional Traits short version (ICU-12; Hawes et al.,) is a 12-item parent-report scale designed to assess callousness and lack of guilt, empathy, and emotional expression. The measure was derived from the 24-item ICU (Frick, Ray, Thornton, & Kahn,). The total ICU scale is comprised of a 7-item callousness subscale (?Other's feelings are unimportant to him/her?) and a 5-item uncaring subscale (?Does things to make others feel good?). Participants rate each item on a 4-point Likert scale from 0 (?not at all true?) to 4 (?definitely true?). Higher scores indicate more problematic traits. To reduce the total length of the youth questionnaire, we only collected the ICU from adult caregivers. Hawes et al. () 12-item scale demonstrated high internal consistency, good discrimination across the continuum of the callous-unemotional construct, adequate test-retest reliability, and convergent and discriminant validity with measures of behavior problems and social competence. Cronbach's alpha for the total parent-reported score in the current sample was 0.90 and 0.89 at baseline and follow-up in this sample. School attendance, school performance, and drug and alcohol use were reported by adolescents and parents using a binary scale (i.e., yes?=?1, no?=?0). These questions were selected together with therapists and leaders in municipalities (i.e., municipalities funded the intervention), thus the chosen questions represented multi-level interests in school-related outcomes. Previous literature (Archambault, Janosz, Fallu, & Pagani,) has demonstrated the utility of similar assessments in capturing school-related issues for adolescents in other areas of research (e.g., school engagement and school dropout). This study employed a nonexperimental, within-subject design with multiple respondents, where average change between individual pre- and postoutcomes implicitly reflected the effects of FFT. The statistical method utilized attempted to account for two challenges in the sample: sample attrition and nonindependence of respondents? outcomes. To account for sample attrition, we first performed a test of attrition bias, examining differences in baseline characteristics of panel and attrition samples. We then applied a regression adjustment strategy. To adjust regression estimates, we used fixed-effects (FE) regressions, which are also called within regressions (see Stata, 2017 and references therein). FE regressions only use within respondent variation (i.e., individual variation over time) to estimate the effects of FFT; effectively, FE regressions are similar to OLS regressions with N individual intercepts or N dummy variables, one for each respondent (in our sample, N?=?911 and N?=?576 for parent and adolescent samples, respectively). These dummy variables adjusted FE estimates for time-invariant characteristics of respondents, including time-invariant determinants of sample attrition (e.g., gender, baseline age, level of education, constant motivation). We therefore applied a rigorous adjustment strategy to reduce potential bias from sample attrition. The FE regression accounted for nonindependence of respondents as individual dummy variables estimated shared within-group variation. Outcomes of individuals within the same group were correlated because individuals were nested within families, nested within therapists, and nested within teams. Thus, individuals within groups shared the same environment and may have reported outcomes for the same focal youth. Individual dummy variables, however, will absorb within-group variance at all higher levels of nesting. We modeled within-group variance as fixed-effect terms rather than random-effect terms. In the sample of parents, where we may have had multiple respondents within families, we further clustered standard errors at the family level, which adjusted N in test statistics for sampling of families rather than individuals. Finally, we reported Cohen's d to determine the relative magnitude of each change, in which values around 0.20 suggest a relatively small effect, values around 0.50 a medium effect, and values around 0.80 a relatively large effect (Cohen,). The relationship between early youth disruptive behavior problems and increased risk of experiencing later adversities (e.g., crime, poor educational outcomes, substance abuse, domestic violence unemployment, reduced life expectancy) has been researched extensively (Fergusson, Horwood, & Ridder,; Mordre, Groholt, Kjelsberg, Sandstad, & Myhre,). These behavior problems, which are often formally diagnosed as Oppositional Defiant Disorder [ODD], Conduct Disorder [CD], and/or Attention Deficit/Hyperactivity Disorder [ADHD], have increased in prevalence over the last decade in a number of Scandinavian countries (Atlad?ttir, et al.,; Madsen, Ersb?ll, Olsen, Parner, & Obel,). In Denmark, offense-reports nearly tripled in the 1970s due to the increase of youth offenders, although youth crime has stabilized in recent years (Kyvsgaard,). Still, Denmark has historically experienced elevated levels of youth incarceration and has sanctioned youth to restrictive institutional placements despite records of high recidivism rates (Lappi-Sepp?l?,; Storgaard,). Juvenile conviction rates have increased from 13% in 1995 to 21% in 2010, and juveniles are twice as likely to be involved in a crime compared to adults (Smit & Bijleveld,). While data on child offenders is limited in Denmark (Kyvsgaard,), reports indicate that specific types of offenses (e.g., violence, shoplifting) have increased for youth. Additionally, disruptive behavior problems and substance use have been linked to school absenteeism, which has been associated with school dropout and lower academic performance in Danish youth. Currently, the mean rate of school absences has risen to 5.6% in Denmark (Thastum et al.,). Attention toward youth with disruptive behavior problems and encounters with the juvenile justice system has increased in Scandinavian countries, with particular interest in evaluating viable intervention models (Breuk et al.,; Kyvsgaard,). Currently in Denmark, families with children in need of special support are provided access to preventative and/or corrective services (e.g., municipal mental health services, residential institutions). Families may request these services voluntarily or be referred via school or official authorities that have determined that the youth needs supports to ensure their healthy development and wellbeing (The Service Act,). Recently, there has also been an increase in the promotion to use behavioral parent trainings for child problem behaviors by both the National Board of Social Services (Socialstyrelsen,) and the Danish Health Authority (Chacko & Scavenius,). Family processes, such as harsh parental discipline practices (Odgers et al.,) and youth-caregiver communication (Burke, Pardini, & Loeber,) have been shown to maintain youth disruptive behavior problems. Interventions targeting these family-level processes have been of major focus (Acri, Chacko, Gopalan, & Mckay,; Gopalan et al.,; Rowe & Liddle,). A meta-analysis examining the efficacy of family therapy found family interventions significantly more effective in improving key outcomes compared to control conditions (e.g., conduct problems) with a moderate effect size (d?=?0.58) at posttest (Shadish & Baldwin,). There is a general consensus that family therapy will, on average, reduce maladaptive youth behavior problems and improve other areas of concern (e.g., substance use, school-related outcomes; Waldron & Turner,; Weisz et al.,). Functional Family Therapy (FFT) is a family-focused, evidence-based intervention that is a viable program for children and adolescents who are at-risk of or currently experiencing significant disruptive behavior problems (Sexton & Turner,). The theoretical principles of FFT posit that behavior is part of a multisystemic relational system that includes multiple, mutually interactive components (e.g., the youth, caregivers, family system). FFT aims to identify obtainable goals and ensure that outcomes are sustainable following the intervention (Sexton,). FFT has been established as an evidence-based program in the treatment of youth drug use and abuse, ODD, CD, ADHD, truancy, and related family problems, in a wide range of multiethnic, multicultural, and geographic contexts. However, it is important to note that there are inconclusive results on the effects of participant demographics (e.g., gender) on outcomes of FFT. For instance, Slesnick and Prestopnik () reported that adolescent males, but not females, in FFT experienced a significant reduction in substance use. With regard to age, studies suggest that older adolescents in FFT may benefit more compared to younger youth (i.e., Celinska, Furrer, & Cheng,; Slesnick & Prestopnik,). Nevertheless, FFT has been implemented in over 300 communities in the United States (Sexton,), with growing attention toward examining the utility of FFT internationally. A number of recent studies have assessed the transportability of FFT to countries in Europe, including Ireland, Britain, Scotland, Norway, and Sweden, as well as in Asian countries. For example, the Norwegian Center for Child Behavioral Development implemented the provision of FFT to an ethnically diverse population of child-welfare involved youth in 2007. In 2011, the center reported a reduction in risk level from moderate to low (13.0 to 5.8, respectively) on the Youth Level of Service assessment, demonstrating the FFT's success in a Scandinavian context (M?rkrid & Christensen,). In a recent effort to implement FFT within an Eastern cultural context (e.g., Singapore), Gan et al., () reported similar rates of engagement, dropout, and total number of sessions as compared to the United States (i.e., California) and New Zealand, demonstrating the transportability of the program across multiple cultural contexts. Several efficacy and effectiveness studies of FFT have also been conducted in Sweden and the United Kingdom. In a randomized control trial conducted in Ireland, Hartnett et al. () compared youth behavior and mental health outcomes between FFT and a wait-list control group. The sample consisted of 97 Irish participants from predominantly lower socioeconomic status (SES) groups. Significant decreases in parent-reported total behavioral difficulties as well as in parent- and adolescent-reported family problems were found for the FFT group. Effect sizes ranged from small to large, with parent-reported measures having medium (d?=?0.64) to large (d?=?1.19) effects while adolescent-reported measures had small (d?=?0.27) to medium (d?=?0.73) effects, suggesting that families in the FFT intervention were better adjusted than the wait-list control group. These effects were maintained at a three-month follow-up. Two studies utilizing pre-post quasi-experimental designs found that FFT was associated with improved outcomes for youth and parents. Marshall, Hamilton, and Cairns () examined data from two local community authorities in Scotland that provided the FFT intervention to at-risk adolescents using a pre-post design. Of the 164 Scottish families who received treatment, caregivers reported experiencing a significant reduction in total difficulties, symptom distress, interpersonal relations, and social roles scores. There were also significant differences in all sections of the parent-reported Strengths and Difficulties Questionnaire, with a moderate effect size (d?=?0.53). Furthermore, adolescent-reported measures demonstrated significant reductions in total difficulties, hyperactivity/attention difficulties, and life impact scores. They also reported a significant increase in prosocial behaviors. In 2004, Hansson and colleagues examined the effectiveness of FFT in Sweden in another pre-post design (Hansson, Johansson, Drott-Englen, & Benderix,). The study consisted of 62 Swedish families, although only 45 were included in the analysis, and examined family functioning and youth problem behavior as outcomes. They found significant improvements in family functioning as well as youth-reported problem behavior (e.g., aggressiveness, attention problems, externalized symptoms). These results suggest that FFT may be exportable to other countries outside of the United States and can be effective in community-based counseling settings that serve socially disadvantaged families. Despite evidence of FFT's effectiveness in improving family functioning and youth behavior, two of the aforementioned studies found no significant results regarding changes in peer relationships. Hartnett et al. () found no significant decrease in adolescent-reported total difficulties and Marshall et al. () found no significant difference in youth peer problems. However, these studies did not examine FFT in comparison to an active control, thus, findings should be interpreted with this limitation in mind. Humayun et al. () recently examined the effectiveness of FFT in a randomized control study in Britain that included an active control receiving alternate services. They found that the intervention group did not demonstrate any significant reductions in antisocial behavior, improvements in parenting, or improvements in the parent?child relationship compared to the control group, contradictory to previous research findings. There were no significant differences in self-reported delinquency, in the proportion of youth who had an officially recorded offence, in CD or ODD symptoms, in parenting, and in youth behavior at both six-month and 18-month follow-ups with the participants. These conflicting results with varying research designs demonstrate the need for FFT to be more closely examined within an international context. Moreover, it is important to note that one of the international FFT studies conducted in Sweden (Hansson, Cederblad, & Hook,) was not available in English. As such, there is still a substantial need to expand the knowledge about juvenile delinquency in an international context and the effectiveness of family therapy within diverse populations. A majority of the FFT evaluation studies described above have utilized relatively small samples (N?=?89, Hansson et al.,; N?=?62, Hansson et al.,; N?=?97, Hartnett et al.,; N?=?111, Humayun et al.,), with a focus on select outcomes (i.e., focusing mainly on parent- and/or adolescent- reports of disruptive behavior, family adjustment, family relationships). None of the aforementioned studies measured school-related behaviors (e.g., school performance, skipping school), which neglects an important dimension related to adolescent delinquency. A recent meta-analysis of 31 FFT literature reviews between 1986 and 2018 stated that there were no school-related outcomes reported in any of the articles examined (Weisman & Montgomery,). Thus, a larger study with a broader set of outcomes is necessary to more fully examine the potential effectiveness of FFT within an international context, specifically in Denmark. The aim of the current study was to assess the efficacy of FFT in a community-based setting implemented within Denmark with an examination of pre- and postintervention outcomes. This study represents the only study of FFT in Denmark and uses the largest sample of adolescents and families evaluating the effectiveness of FFT in a community-based setting. We examined multiple outcome variables from both parent and youth reports related to youth disruptive behavior as well as school-related observations as secondary outcomes. We hypothesized that both parents and youth would report a significant decrease in youth disruptive behavior problem outcomes, and that that there would be a significant decrease in the number of days of school skipped as well as an increase in school performance. Finally, we hypothesized that effect sizes for this study will be similar to others seminal studies on FFT (i.e., benchmarks).
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Youth behavior problems have increased in prevalence in Scandinavian countries. Functional Family Therapy (FFT) has been shown to be an effective intervention across diverse populations and international contexts. The current study examines the effectiveness of FFT within a Danish-community sample in a pre-post comparison design and includes 687 families. Observed outcomes included both parent- and/or youth- reported domains of youth behavior, family dysfunction, school attendance and performance, and substance use. Significant improvements were found in youth behavior, family functioning, and school-related outcomes (e.g., like of school and truancy) despite experiencing a 60% attrition rate in our sample postintervention. This study provides evidence for the effectiveness of FFT on a wide scale in a Scandinavian context, adding to previous research that supports the transportability of this intervention.
AB - Youth behavior problems have increased in prevalence in Scandinavian countries. Functional Family Therapy (FFT) has been shown to be an effective intervention across diverse populations and international contexts. The current study examines the effectiveness of FFT within a Danish-community sample in a pre-post comparison design and includes 687 families. Observed outcomes included both parent- and/or youth- reported domains of youth behavior, family dysfunction, school attendance and performance, and substance use. Significant improvements were found in youth behavior, family functioning, and school-related outcomes (e.g., like of school and truancy) despite experiencing a 60% attrition rate in our sample postintervention. This study provides evidence for the effectiveness of FFT on a wide scale in a Scandinavian context, adding to previous research that supports the transportability of this intervention.
UR - http://www.scopus.com/inward/record.url?scp=85073769935&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073769935&partnerID=8YFLogxK
U2 - 10.1111/jmft.12405
DO - 10.1111/jmft.12405
M3 - Article
C2 - 31515824
AN - SCOPUS:85073769935
VL - 46
SP - 289
EP - 303
JO - Journal of Marital and Family Therapy
JF - Journal of Marital and Family Therapy
SN - 0194-472X
IS - 2