A Pilot Study of Functional Family Therapy in New Zealand

Conduct problems including Conduct Disorder and Oppositional Defiant Disorder affect approximately 5% to 10% of New Zealand young people, with males and Maori being at greatest risk. There is substantial New Zealand and international research which shows that young people with these problems are at increased risk for a wide range of adverse outcomes in adolescence and young adulthood including crime, substance abuse, mental health problems, reduced life expectancy, domestic violence, poor educational achievement, unemployment, welfare dependency and conflict with parents and teachers (Fergusson, Horwood, & Ridder, 2005; Kratzer & Hodgins, 1997; Offord & Bennett, 1994). Interventions for conduct problems have been well researched in the international literature and a number of programmes have been identified as effective in authoritative reviews (Eyberg, Nelson, & Boggs, 2008). Although some research has been conducted with respect to interventions for younger children (Fergusson, Horwood & Stanley 2013, Fergusson, Horwood & Stanley 2009) there has been very little research published in New Zealand with respect to interventions for older children and adolescents with conduct problems; a study of Multi-systemic Therapy, Curtis, Ronan, Heiblum and Crellin (2009), appears to be the only example. Of concern in the New Zealand context is the high rate of conduct problems identified amongst Maori youth with rates of conduct disorder ranging from 1.9 to 4.5 times that of the non-Maori population as ascertained in two large longitudinal studies (Fergusson, Poulton, Horwood, Milne and Swain-Campbell, 2003). As one investigation of Maori youth offending notes "On average Maori youth are three times more likely to be apprehended, prosecuted and convicted than non-Maori youth" (Owen, 2001, cited in Curtis, Ronan, Heiblum, Reid & Harris, 2002). Although comprising 15% of the population in the 2013 census as of 2016 Maori comprise 51% of the prison population (Statistics New Zealand, 2016). These proportions are mirrored by the high rate of involvement of Maori youth and families in programmes for the treatment of conduct problems; within Youth Horizons, New Zealand's largest provider of evidence based interventions for conduct problems, 45% of children participating in treatment were Maori in 2015 (Youth Horizons, 2015). A number of interventions have been systematically evaluated for the treatment of child and adolescent conduct problems in recent decades. Family interventions have shown particular promise and one such intervention is Functional Family Therapy (FFT). FFT is the oldest and one of the most widely disseminated of the evidence based interventions for youth conduct problems. Emerging in the late 1960's FFT is now implemented in 220 sites across five countries and claims to work with more families per year than any other evidence based intervention (fftllc.com). FFT is also recognised as cost effective with better than average cost-benefit ratios when compared to other juvenile justice interventions (Washington state institute for public policy, 2016). FFT marries family systems, behavioural and cognitive-behavioural approaches to intervention in a synthesis based on clinical experience and research-based theory. From Family Systems Theory is derived the concept that the unit of treatment is the family (not just the individual youth) and the family is a system characterised by dynamic relationships between individuals. From the behavioural tradition in psychology comes an emphasis on change in overt behaviour and its immediate causes within the family. FFT also uses cognitive-behavioural techniques such as reframing and emotion-management strategies. FFT is a short-term intervention of 8-12 sessions over a period of 2-4 months. Treatment is progressed in three phases. The initial phase is termed "engagement and motivation" and is designed to identify and modify intra-family risk factors (e. …