Advertisement

Prevention Science

, Volume 19, Issue 7, pp 939–953 | Cite as

Scaling-Up Evidence-Based Programs Using a Public Funding Stream: a Randomized Trial of Functional Family Therapy for Court-Involved Youth

  • Denise C. Gottfredson
  • Brook Kearley
  • Terence P. Thornberry
  • Molly Slothower
  • Deanna Devlin
  • Jamie J. Fader
Article

Abstract

The Affordable Care Act expanded access to Medicaid programs and required them to provide essential health benefits, which can include prevention services. This study assesses the costs and benefits to using Medicaid funding to implement a well-known evidence-based program, Functional Family Therapy (FFT), with a sample of juvenile justice-involved youth. The study also provides a rigorous test of FFT accommodated for a contemporary urban population that is gang at risk or gang-involved. One hundred twenty-nine predominantly minority and low income families were randomly assigned to receive an enhanced version of FFT or an alternative family therapy. Data from pre- and post-intervention interviews with youth and parents, court records of contacts with the justice system and residential placements, official records of community services, and the costs of placements and services are summarized. The intervention was implemented with fidelity to the FFT model using Medicaid funding. Treatment and control subjects received a wide range of community and residential services in addition to FFT. A higher percentage of treatment subjects than controls received services following random assignment, but the cost per youth served was lower for treatment than control youth, primarily because control youth were more often placed in residential facilities. Recidivism during the 18-month follow-up period was lower for FFT than for control youth. The combination of cost savings realized from avoiding more costly services and the expected future savings due to recidivism reduction suggest the expanded use of evidence-based practices using public funding streams such as Medicaid is warranted.

Keywords

Medicaid funding for prevention Family therapy for court-involved youth Randomized controlled trial Functional Family Therapy 

Notes

Acknowledgements

We are grateful for support from the Centers for Disease Control and Prevention and the Office of Juvenile Justice and Delinquency Prevention during the development phase and from Smith Richardson Foundation and the National Institute of Justice during the implementation phase of the study. We wish to thank the Honorable Lori Dumas, Chief Faustino Castro-Jimenez, William Cooney and many other partners in the Philadelphia Family Court system for their leadership and guidance, Mike Robbins and Helen Midouhas of FFT LLC for their support, and Courtney Harding and Joe Pitts of Temple University for data collection. We also thank Associate Editor Abigail Fagan and two anonymous reviews for their constructive comments on an earlier draft of this report.

Funding

The study was funded by Centers for Disease Control and Prevention, Office of Juvenile Justice and Delinquency Prevention, Smith Richardson Foundation and National Institute of Justice.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent or assent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11121_2018_936_MOESM1_ESM.docx (27 kb)
ESM 1 (DOCX 27 kb)
11121_2018_936_MOESM2_ESM.docx (54 kb)
ESM 2 (DOCX 54 kb)
11121_2018_936_MOESM3_ESM.docx (96 kb)
ESM 3 (DOCX 95 kb)

References

  1. Alexander, J. F., & Parsons, B. V. (1973). Short-term behavioral intervention with delinquent families: Impact on family process and recidivism. Journal of Abnormal Psychology, 81, 218–225.CrossRefGoogle Scholar
  2. Alexander, J. F., & Parsons, B. V. (1982). Functional Family Therapy: Principles and procedures. Carmel: Brooks & Cole.CrossRefGoogle Scholar
  3. Barnoski, R. (2004). Outcome Evaluation of Washington State’s Research-Based Programs for Juvenile Offenders (Document No. 04-01-1201). Olympia: Washington State Institute for Public Policy.Google Scholar
  4. Barton, C., & Alexander, J. F. (1981). Functional Family Therapy. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of family therapy (pp. 403–443). New York: Brunner.Google Scholar
  5. Biglan, A., Brennan, P. A., Foster, S. L., & Holder, H. D. (with Miller, T. R. et al.). (2004). Helping adolescents at risk: Prevention of multiple problem behaviors. New York: Guilford Press.Google Scholar
  6. Bumbarger, B. K., & Campbell, E. M. (2012). A state agency-university partnership for translational research and the dissemination of evidence-based prevention and intervention. Administration and Policy in Mental Health and Mental Health Services Research, 39, 268–277.CrossRefPubMedGoogle Scholar
  7. Campbell, E. M. & Bumbarger, B. K. (2012). Looking back, moving forward: the history and current state of evidence based intervention in Pennsylvania. Retrieved from: http://www.episcenter.psu.edu/EBIReports/lookingbackmovingforward.
  8. Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Science, 1, 98–101.CrossRefGoogle Scholar
  9. Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844.CrossRefPubMedGoogle Scholar
  10. Darnell, A. J., & Schuler, M. S. (2015). Quasi-experimental study of Functional Family Therapy effectiveness for juvenile justice aftercare in a racially and ethnically diverse community sample. Children and Youth Services Review, 50, 75–82.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Eisenberg, D., & Neighbors, K. (2007). Economics of preventing mental disorders and substance abuse among young people. (Report commissioned by National Research Council and Institute of Medicine Committee on the Prevention of Mental Disorders and Substance Abuse among Children, Youth and Young Adults).Google Scholar
  12. Fagan, A. A. (2013). Family-focused interventions to prevent juvenile delinquency: A case where science and policy can find common ground. Criminology and Public Policy, 12, 617–650.CrossRefGoogle Scholar
  13. Forman, S. G., Olin, S. S., Hoagwood, K. E., Crowe, M., & Saka, N. (2009). Evidence-based interventions in schools: Developers’ views of implementation barriers and facilitators. School Mental Health, 1, 26.CrossRefGoogle Scholar
  14. Hartnett, D., Carr, A., Hamilton, E, & O’Reilly G. (2016a). The effectiveness of Functional Family Therapy: A meta-analysis. Family Process.  https://doi.org/10.1111/famp.12256.CrossRefPubMedGoogle Scholar
  15. Hartnett, D., Carr, A., & Sexton, T. (2016b). The effectiveness of Functional Family Therapy in reducing adolescent mental health and family adjustment difficulties in and Irish context. Family Process, 55, 287–304.CrossRefPubMedGoogle Scholar
  16. Humayun, S., Herlitz, L., Chesnokov, M., Doolan, M., Landau, S., & Scott, S. (2017). Randomized controlled trial of Functional Family Therapy for offending and antisocial behavior in UK youth. Journal of Child Psychology and Psychiatry, 58, 1023–1032.  https://doi.org/10.1111/jcpp.12743.CrossRefPubMedGoogle Scholar
  17. Institute of Medicine. (2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders, Board on Health Care Services. Washington, DC: The National Academies Press.Google Scholar
  18. Institute of Medicine (IOM) & National Research Council (NRC). (2014). Strategies for scaling effective family-focused preventive interventions to promote children’s cognitive, affective, and behavioral health: Workshop summary. Washington, DC: The National Academies Press.Google Scholar
  19. Kessler, R. C. (2004). The epidemiology of dual diagnosis. Biological Psychiatry, 56, 730–737.CrossRefPubMedGoogle Scholar
  20. Kessler, R. C., Berglund, P. A., Bruce, M. L., Koch, J. R., Laska, E. M., Leaf, P. J., Manderscheid, R. W., Rosenheck, R. A., Walters, E. E., & Wang, P. S. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36, 987–1007.PubMedPubMedCentralGoogle Scholar
  21. Kessler, R. C., Berglund, P. A., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593–602.CrossRefPubMedGoogle Scholar
  22. Lee, S., S. Aos, E. Drake, A. Pennucci, M. Miller, & L. Anderson. (2012). Return on investment: Evidence-based options to improve statewide outcomes, April 2012 (Document No. 12-04-1201). Olympia: Washington State Institute for Public Policy.Google Scholar
  23. McLeod, J. D., Uemura, R., & Rohrman, S. (2012). Adolescent mental health, behavior problems, and academic achievement. Journal of Health and Social Behavior, 53, 482–497.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Study Adolescent Supplement (NCS-A). Journal of the American Academy of Child Adolescent Psychiatry, 49, 980–989.CrossRefPubMedGoogle Scholar
  25. Mihalic, S. F., & Irwin, K. (2003). Blueprints for violence prevention: From research to real-world settings—Factors influencing the successful replication of model programs. Youth Violence and Juvenile Justice, 1, 307–329.CrossRefGoogle Scholar
  26. Mihalic, S., Irwin, K., Fagan, A., Ballard, D., & Elliott, D. (2004). Successful program implementation: Lessons from Blueprints. Available at: http://www.ncjrs.gov/pdffiles1/ojjdp/204273.pdf.
  27. National Academy of Sciences. (2009). Preventing mental, emotional, and behavioral disorders: For policymakers. Washington, DC: The National Academies Press.Google Scholar
  28. National Research Council, & Institute of Medicine. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: The National Academies Press.  https://doi.org/10.17226/12480.CrossRefGoogle Scholar
  29. Obama, B. (2016). United States health care reform: Progress to date and next steps. Journal of the American Medical Association, 316, 525–532.CrossRefPubMedGoogle Scholar
  30. Pashler, H., & Wagenmakers, E. (Eds.). (2012). Editors’ introduction to the special section on replicability in psychological science: A crisis of confidence? Perspectives on Psychological Science, 7, 528–530.  https://doi.org/10.1177/1745691612465253.CrossRefPubMedGoogle Scholar
  31. Sickmund, M., Sladky, T. J., Kang, W., and Puzzanchera, C. (2017). Easy Access to the Census of Juveniles in Residential Placement. Available: http://www.ojjdp.gov/ojstatbb/ezacjrp/.
  32. Slesnick, N., & Prestopnik, J. (2009). Comparison of family therapy outcome with alcohol abusing, runaway adolescents. Journal of Marital and Family Therapy, 35, 255–277.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Spoth, R., & Greenberg, M. (2011). Impact challenges in community science-with-practice: Lessons from PROSPER on transformative practitioner-scientist partnerships and prevention infrastructure development. American Journal of Community Psychology, 48, 106–119.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Spoth, R., Guyll, M., Lillehoj, C. J., Redmond, C., & Greenberg, M. (2007). Prosper study of evidence-based intervention implementation quality by community–university partnerships. Journal of Community Psychology, 35, 981–999.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Spoth, R., Rohrbach, L. A., Greenberg, M., Leaf, P., Brown, C. H., Fagan, A., Catalano, R. F., Pentz, M. A., Sloboda, Z., Hawkins, J. D., & Society for Prevention Research Type 2 Translational Task Force Members & Contributing Authors. (2013). Addressing core challenges for the next generation of type 2 translation research and systems: The translation science to population impact (TSci impact) framework. Prevention Science, Published Online (Open Access).  https://doi.org/10.1007/s11121-012-0362-6.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Thornberry, T. P., Krohn, M. D., Lizotte, A. J., Smith, C. A., & Tobin, K. (2003). Gangs and delinquency in developmental perspective. New York: Cambridge University Press.Google Scholar
  37. Waldron, H. B., & Brody, J. L. (2010). Functional Family Therapy for adolescent substance use disorders. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 401–415). New York: Guilford Press.Google Scholar
  38. Waldron, H. B., & Slesnick, N. (1998). Treating the family. In W. R. Miller & N. Heather (Eds.), Treating Addictive Behaviors: Processes of Change (2nd ed., pp. 271–285). New York: Plenum.CrossRefGoogle Scholar
  39. Waldron, H. B., Slesnick, N., Brody, J. L., Turner, C. W., & Peterson, T. R. (2001). Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments. Journal of Consulting and Clinical Psychology, 69, 802–813.CrossRefPubMedGoogle Scholar
  40. Weisburd, D., Petrosino, A., & Mason, G. (1993). Design sensitivity in criminal justice experiments. Crime and Justice, 17, 337–379.CrossRefGoogle Scholar

Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  1. 1.Department of Criminology & Criminal Justice, 2220 LeFrak HallUniversity of MarylandCollege ParkUSA
  2. 2.The Institute for Innovation and ImplementationUniversity of Maryland School of Social WorkBaltimoreUSA
  3. 3.School of Criminal Justice, 135 Western Ave.University at AlbanyAlbanyUSA
  4. 4.Department of Criminal JusticeTemple UniversityPhiladelphiaUSA

Personalised recommendations