Key TakeawaysFunctional Family Therapy(FFT) did not show superior outcomes compared to Treatment as Usual (TAU) for adolescents with disruptive behavior in Norway’s Child Welfare Services.Both FFT and TAU groups showed significant improvements in parent-reported aggressive behavior, rule-breaking behavior, internalizing problems, and social skills between pretest and posttest.No significant differences were found between FFT and TAU groups in short-term outcomes (pretest to posttest) across parent-, youth-, and teacher-reported measures.One long-term effect favoring TAU over FFT was found for parent-reported youth internalizing problems between posttest and follow-up.Factors like treatment type, severity of disruptive behavior, and voluntary participation may affect the effectiveness of interventions for adolescent disruptive behavior.The research has certain limitations such as high dropout rates and potential differential attrition between treatment groups.This study highlights the importance of evaluating evidence-based interventions in different cultural contexts and service settings.
Key Takeaways
Rationale
Adolescent disruptive behavior is associated with severe long-term consequences for youths and society (Colman et al., 2009; Caspi et al., 2016). While the importance of early intervention is well-established, effective treatments for this population are limited (McCart et al., 2023).
Functional Family Therapy(FFT) is an evidence-based intervention aimed at reducing adolescent disruptive behavior, with extensive testing in juvenile justice populations showing positive outcomes compared to treatment as usual (TAU) (Vardanian et al., 2020).
However, less is known about its effectiveness in non-juvenile justice settings and in comparison to TAU in different cultural contexts (McCart et al., 2023).
In Norway, where there is no separate juvenile justice system, FFT is offered through Child Welfare Services (CWS) for youths with severe disruptive behavior.
The effectiveness of FFT compared to the diverse range of treatments typically offered in Norwegian CWS (constituting TAU) has not been previously examined.
This comparison is crucial because TAU in Norway may differ significantly from TAU in other countries where FFT has been studied, potentially including evidence-based practices like Multisystemic Therapy (Ogden & Hagen, 2018).
This study aims to examine the effectiveness of FFT compared to TAU in a context where criminal charges or justice system involvement is not a requirement for referral.
By directly comparing FFT to the existing services (TAU) in Norway’s CWS, this research addresses an important gap in understanding how FFT performs relative to established practices in diverse settings and populations.
This comparison is essential for informing policy decisions about implementing new interventions versus enhancing existing services in the Norwegian child welfare context.
Method
The study employed arandomized controlled trial designwith two treatment conditions: Functional Family Therapy (FFT) and Treatment as Usual (TAU).
TAU refers to the standard or typical treatment that participants would receive if they were not part of the study. It represents the existing services or interventions that are normally available and provided in the regular care setting.
TAU serves as a control condition, allowing researchers to compare the new or experimental treatment (in this case, FFT) against the current standard of care. This comparison helps determine if the new treatment offers any advantages over existing practices.
Participants were assessed at three time points: pretest (intake), posttest (6 months after pretest), and follow-up (18 months after pretest).
Procedure
Between 2013 and 2017, families were recruited from Child Welfare Services (CWS) in Norway. After initial assessment and consent, participants were randomly assigned to either FFT or TAU.
At each time point, data was collected from youths, parents, and teachers.
Sample
The study included 159 youths (45.9% female) with a mean age of 14.72 years (SD = 1.47). Participants were referred to CWS for severe disruptive behavior.
The sample included youths with immigrant backgrounds (15.2%) and various family situations (26.1% parents living together, 67.3% parents living apart, 6.5% in long-term foster care or adoption).
Measures
Statistical measures
The study used latent curve models (LCMs) to analyze treatment effects. Unconditional LCMs examined overall change in the entire sample, while conditional LCMs assessed differences between FFT and TAU groups. Multiple imputation was used to handle missing data.
Results
Hypothesis 1: FFT would lead to greater reduction in parent-reported youth problem behavior and greater increase in parent-reported social skills compared to TAU.
Result: Not supported. No significant differences were found between FFT and TAU groups in parent-reported outcomes from pretest to posttest.
Hypothesis 2: FFT would lead to greater improvement in teacher-reported school performance and social skills, and greater reduction in teacher-reported problem behavior compared to TAU.
Result: Not supported. No significant differences were found between FFT and TAU groups in teacher-reported outcomes from pretest to posttest.
Hypothesis 3: FFT would lead to greater reduction in youth self-reported delinquency, drug abuse, and contact with deviant peers compared to TAU.
Result: Not supported. No significant differences were found between FFT and TAU groups in youth-reported outcomes from pretest to posttest.
Additional finding: A significant intervention effect favoring TAU over FFT was found for parent-reported youth internalizing problems between posttest and follow-up.
Insight
The key finding of this study is that Functional Family Therapy (FFT) did not show superior outcomes compared to Treatment as Usual (TAU) for adolescents with disruptive behavior in Norway’s Child Welfare Services.
This result is particularly informative because it challenges the assumption that evidence-based interventions like FFT will consistently outperform usual care across different contexts and populations.
The findings suggest that the effectiveness of interventions may vary depending on factors such as the target population’s characteristics, the severity of disruptive behavior, and the quality of usual care services available.
Further research could explore:
Strengths
Limitations
These limitations may affect theinternal and external validityof the findings, potentially underestimating or overestimating treatment effects.
Clinical Implications
The results of this study have significant implications for clinical practice and policy in adolescent mental health services:
References
Primary reference
Olseth, A. R., Hagen, K. A., Keles, S., & Bjørnebekk, G. (2024). Functional family therapy for adolescent disruptive behavior in Norway: Results from a randomized controlled trial.Journal of Family Psychology, 38(4), 548–558.https://doi.org/10.1037/fam0001213
Other references
Caspi, A., Houts, R. M., Belsky, D. W., Harrington, H., Hogan, S., Ramrakha, S., Poulton, R., & Moffitt, T. E. (2016). Childhood forecasting of a small segment of the population with large economic burden.Nature Human Behaviour, 1(1), Article 0005.https://doi.org/10.1038/s41562-016-0005
Colman, I., Murray, J., Abbott, R. A., Maughan, B., Kuh, D., Croudace, T. J., & Jones, P. B. (2009). Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort.The BMJ, 338, Article a2981.https://doi.org/10.1136/bmj.a2981
McCart, M. R., Sheidow, A. J., & Jaramillo, J. (2023). Evidence base update of psychosocial treatments for adolescents with disruptive behavior.Journal of Clinical Child and Adolescent Psychology, 52(4), 447–474.https://doi.org/10.1080/15374416.2022.2145566
Ogden, T., & Hagen, K. A. (2018).Adolescent mental health: Prevention and intervention(2nd ed.). Routledge.https://doi.org/10.4324/9781315295374
Vardanian, M. M., Scavenius, C., Granski, M., & Chacko, A. (2020). An international examination of the effectiveness of Functional Family Therapy (FFT) in a Danish community sample.Journal of Marital and Family Therapy, 46(2), 289–303.https://doi.org/10.1111/jmft.12405
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
