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March 2018 1 FFT and MST: Frequently Asked Questions S takeholders often ask, “ what is FFT? what is MST? ” and how can communities benefit by providing evidence-based treatment models to at-risk youth and their families? This document is designed to help the reader understand each of these evidence-based treatment models and to support community stakeholders as they strive to address the needs of at-risk youth by keeping them safely at home, in school, and out of trouble with the law. FFT is a Blueprints Model program ( http://www.blueprintsprograms.com/ ).with special endorsements from the Office of Juvenile Justice and Delinquency Prevention, the Center for Disease Control and Prevention, the American Youth Policy Forum, and the US Department of Justice. MST is a Blueprints Model PLUS program, receiving this honor in 2016 as one of only two programs, and the only youth intervention in the world, that meet this highest standard of evidence-based models, including independent replication of research findings. http://www.blueprintsprograms.com/ . MST is also endorsed by United Nations on Drugs and Crime, Center for Medicare and Medicaid Services, U.S. Department of Justice Office of Justice Program, the National Institute of Health, National Institute of Drug Abuse, and Substance Abuse and Mental Health Administration. FREQUENTLY ASKED QUESTIONS What are the target populations of FFT and MST? What are the outcomes of FFT? What are the outcomes of MST? What is the theoretical rational behind FFT? behind MST? How are the FFT and MST treatment models similar? How does FFT and MST work? How intensive are the services? What is the average length of stay for each program? How do FFT and MST handle crisis situations? Can FFT and MST therapists keep the referral source informed? Are there differences in staffing and caseloads for FFT and MST? How many opened referrals are needed to sustain an FFT or MST program? Are FFT and MST cost effective? How does a community decide to support FFT and MST? What are the target populations of FFT and MST? FFT has been studied with youth ages 10 to 18 years old. FFT research supports the utilization of the intervention across all levels of risk, low, moderate, and severe, for adolescent behavior problems and substance use/abuse. FFT includes youth with multiple serious offenses including felonies and youth returning home following incarceration. FFT serves youth from multiple referral sources including, juvenile justice, child welfare, mental Health, and schools. Research on these youths has demonstrated reductions

March 2018 2 in recidivism, earlier cessation of drug and alcohol use, as well as reductions in future criminogenic behaviors. Youth may demonstrate co-occurring internalizing symptoms, such as anxiety and depression; however, acting out behaviors, must be present to the degree that functioning is impaired. At least one adult caregiver must be available to provide support and willing to be involved in treatment . Research has shown MST to be effective for youth with chronic or severe antisocial behavior, including youth with histories of violence or felonious behavior and youth with histories of incarceration. For standard MST, inclusionary criteria include youth between the ages of 12-17 who are living with a caregiver, at risk of placement due to anti-social or delinquent behaviors, which may include problematic use of substances, youth involved in the child protective services, juvenile justice, and/or mental health systems, and youth who have committed sexual offenses in conjunction with other anti-social behavior. Exclusionary criteria include youth living independently, sex offending behavior in the absence of other anti-social behavior, youth with moderate to severe autism (difficulties with social communication, social interaction, and repetitive behaviors) and youth whose psychiatric problems are primary reasons leading to referral or have severe and serious psychiatric problems. An adaptation of Multisystemic Therapy for youth with Problem Sexual Behaviors (MST-PSB) is also available in some counties. MST-PSB is a clinical adaptation of MST that has been specifically designed and developed to treat youth (and their families) for problematic sexual behavior. Building upon the research and dissemination foundation of standard MST, the MST-PSB model represents a state-of-the- art, evidence-based practice uniquely developed to address the multiple determinants underlying problematic juvenile sexual behavior. MST-PSB is a Blueprints Model program. What are the outcomes of FFT? What are the outcomes of MST? Outcome assessment in FFT and in MST focuses on the “ ultimate outcomes” of keeping youth at home, in school, and out of trouble with the law, and “instrumental outcomes” such as improved family relationships, improved parenting skills, involvement with prosocial peers, and increases in the family’s social su pport network. Research suggests that these instrumental outcomes contribute to the ultimate outcomes. FFT has been developed and tested for almost 50 years, with 44 published studies documenting the development, implementation, and outcomes supporting the FFT model. FFT has been shown to be highly effective across all levels of risk, including 12 evaluations in the past 10 years with more than 14,000 youth and their families. MST has been studied for over 40 years with 67 published outcomes, implementation, and benchmarking studies. MST is the only intervention for high risk youth where results have been repeatedly replicated by independent research. To date the research on MST has involved over 55,000 families. Research shows that both treatment models achieve the following short-term (immediate) outcomes: greater likelihood the youth remains at home, improved family functioning, reduced substance use, and fewer youth mental health symptoms and/or behavior problems. In-session research studies of the FFT model have informed the development of specific evidence-

March 2018 3 based strategies for addressing youth and family factors that have been shown to be associated with failure to engage or complete treatment. FFT has also been shown to weaken the link between callous-unemotional traits and negative outcomes. Research on MST has also found improved peer relations, improved school performance, and increased likelihood that the youth will attend school. In the long-term, both models have been shown to reduce criminal recidivism and arrest rates, decrease substance use, and decrease behavioral health problems. The longest follow-up studies have been at 5 years for FFT and 25 years for MST. Research has also shown that the younger siblings of youth who participate in FFT are less likely to have contact with the court 2 ½ - 3 ½ years later. For MST, a 25-year follow up study demonstrated a 40-percent reduction in the nearest age sibling ’s overall arrest rates and a 55-percent reduction in felony arrest rates as compared to individual therapy siblings, who had a 3.36 times higher arrest rate for any crime. What is the theoretical rationale behind FFT? behind MST? Both models draw from family systems theory and integrate behavioral approaches. FFT is based on the theory that youth’s problem behaviors serve a function within the family. Family members develop ways of interacting that help them to get their relational needs for closeness or distance met, but these patterns of interacting may also create or maintain behavior problems. FFT achieves changes by improving family interactions (e.g., improving communication, problem-solving, and parenting skills) and developing family member skills that are directly linked to risk factors (e.g., emotion regulation, decision making) or the youth’s behavior problems. MST draws from social-ecological and family systems theories of behavior. MST views the youth as embedded within a number of interrelated systems (e.g., family, school, peer, community, and individual), each of which has an influence on the youth through both protective and risk factors. By identifying the here-and- now factors that “drive” a problem behavior and intervening to modify those factors, change will occur. MST therapists use interventions that have documented research support, such as cognitive-behavioral, behavioral, behavioral parent training, social-leaning theory, and strategic and structural family therapy approaches. How are the FFT and MST treatment models similar? There are some similarities between the two clinical models. Both models: • Are strength-based. • Strive to empower family members. • Engage caregivers, who are viewed as essential participants in the youth’s treatment. View improved family functioning as the path to resolving referral behaviors.

March 2018 4 • Meet with families in their homes, at times convenient to the family. Adjust the frequency of sessions to meet the clinical needs of the family. • Tailor treatme nt to the family’s unique situation. • Include the development of parenting skills and enhancement of family relationships when clinically indicated, and often include “homework assignments” between sessions. • Help families build natural supports. • Require that therapists receive group supervision on a weekly basis and spend a considerable amount of time between sessions planning interventions. Both models include some form of ongoing consultation from model experts to ensure ongoing model fidelity. • In MST, this consultation occurs via weekly phone consultation from an MST model Expert. How does FFT and MST work? The chart below provides a quick at-a-glance view of each of the models. MST (Multisystemic Therapy) FFT (Functional Family Therapy) •Treatment Site In the field: home, school, neighborhood and community. Sessions in the field or the office, depending on family need. •Provider Single full-time therapist (as part of, and supported by generalist team) Single therapist (as part of, and supported by generalist team) •“Team” size 2 to 4 therapists plus a supervisor 3 to 8 therapists including the supervisor •Treatment Total behavioral health care (some exceptions for long-term care services such as psychiatric care, see more below under “Case Management Function”) with an emphasis on addressing all systems in the youth and family’s ecology that effect youth behaviors, and on empowering the family to manage challenges on their own. Phase-based family therapy model that directly addresses youth behavior problems by systematically targeting risk and protective factors at multiple levels in the youth’s ecology. Systemic and cognitive-behavioral interventions are included to change/replace maladaptive emotional, behavioral, and psychological processes within the individual, the family, and with relevant extra-family systems •Case Management Function Service provider rather than broker of services – success of referrals to long-term care providers, such as psychiatric care, are seen as responsibility of the MST therapist After youth & family have adopted positive coping patterns will link with other resources to enhance skills and provide additional resources •Approach to other co-occurring treatments Family makes the decision regarding what co-occurring treatments are pursued, though MST therapists help the family minimize other services as much as possible Exclude families currently engaged in family therapy

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