Family Behavioral Therapy (FBT)

1. Family Behavioral Therapy (FBT) Presented by: Kimberly McCaskey-Lee, LCSW Amy Punsky, MA, NCC & Kelly Pavelko, BA Child to Family Connections

2. What is FBT? • Evidenced-based, cost-effective intervention approach that utilizes innovative behavioral therapies used to treat substance abuse and associated problems within the family context • Created by Bradley Donohue, Ph.D. • Associate professor UNLV • Director of the Achievement Center

3. Empirical Background Study 1 Azrin, N.H., McMahon, P.T., Donohue, B., Besalel, V.A., Lapinski, K.J., Kogan, E.S., et al. (1994). Behavior therapy for drug abuse: A controlled treatment outcome study. Behaviour Research and Therapy, 32, 857-866. Study 2 Azrin, N.H., Acierno, R., Kogan, E.S., Donohue, B., Besalel, V.A., & McMahon, P.T. (1996). Follow-up results of supportive versus behavioral therapy for illicit drug use, Behaviour Research and Therapy, 34, 41-46.

4. Empirical Background Study 3 Azrin, N. H., Donohue, B., Besalel, V. A., Kogan, E. S., & Acierno, R. (1994). Youth drug abuse treatment: A controlled outcome study. Journal of Child & Adolescent Substance Abuse, 3, 1-15. Study 4 Azrin, N. H., Donohue, B., Teichner, G. A., Crum, T. Howell, J., & DeCato, L. A. (2001). A controlled evaluation and description of individual-cognitive problem solving and family-behavior therapies in dually diagnosed conduct-disordered and substance-dependent youth. Journal of Child & Adolescent Substance Abuse, 11, 1-41.

5. How does FBT work? • Uses a team approach • Plans are individualized • Services are provided during weekly family sessions • Encourages increased family involvement • Utilizes interventions focusing on communication within the family as well as targeting substance abuse issues and troublesome behaviors

6. Target population • Youth between 12 -18 • At risk for problems associated with illicit drug and/or alcohol use • At risk of out-of-home placement or who have been placed previously • Youth and at least one adult support person willing to participate • Youth NOT involved with domestic violence or sexual abuse

7. What does FBT look like? • Typically consists of 16-20 home-based sessions, running for a 6 month period. • Incorporates an enlistment and retention strategy to improve attendance. • Family guided treatment plan with their own selection of skills. • Selected therapies are implemented successively and cumulatively. • Meaning each therapy is reviewed and built upon during all subsequent sessions to increase development of skills.

8. What does FBT look like? • All interventions are based on prompting lists used by therapists during sessions. • Protocols begin with a rationale, followed by modeling the skill, then therapist role-play of the skill, into role-playing with the client. • Client rates the helpfulness of each intervention on a Likert scale from 1 -7 (1 being extremely unhelpful to 7 being extremely helpful) with no obligation to give a high score. • Therapist rates client on compliance (attendance, participation, etc) on same Likert scale.

9. Initial Meetings and Assessments • Quick introduction to program and team • Elicit initial commitment • Complete consents and assessments

10. Assessments Used • Youth Life Satisfaction Scale • Youth Satisfaction with Parent Scale • Parent Satisfaction with Youth Scale • FBT Questionnaire • Youth Self Report • Child Behavior Checklist • Parenting Stress Index

11. FBT Interventions • Program Orientation • Treatment Planning • Annoyance Review • Stimulus Control • I’ve Got a Great Family • Level System • Self Control • Positive Request • Job Club • Last Session Review

12. Program Orientation and Treatment Planning • Orientation sets the tone for what treatment sessions will look like, obtaining commitments from adolescent & caregivers, communication guidelines, etc. • Review of attendance policy/cancellation expectations • Discussion of referral source and completed assessments • Commitment to stay drug free • Communication guidelines

13. Program Orientation and Treatment Planning • Treatment Planning includes: • Explaining interventions • Adolescent ranks priority • Caregivers rank priority • Average of rankings = order of interventions

14. Therapeutic Style • Positively focused agendas • Emphasis on positive feedback and encouragement • Praising desired/ignoring undesired • Role playing

15. Consequence Review • Increasing or maintaining motivation to avoid drug use and troublesome behavior

17. Stimulus Control • Learning to avoid people, places, and situations that increase the risk of using drugs and getting into trouble, and instead spending greater amounts of time with people, places, and situations that do not involve drug use or troublesome behavior

19. I’ve Got a Great Family • Increasing communication between family members about what they love and appreciate about each other, rather than focusing on what is not liked

21. Level System • Getting rewards from caregivers when goals (behaviors) are accomplished

25. Self Control • Learning to control impulses, urges, and thoughts that increase drug use and trouble

27. Positive Request • Learning how to best make requests so people are more likely to do what you want, as well as how to best settle disagreements

28. Job Club • Learning techniques to help get satisfying jobs at higher wages • How to obtain an interview • Mock interviews • How to present self for an interview

30. Donohue, B., Allen, D. (2011). Treating adult substance abuse using family behavior therapy: A step by step approach. Hoboken, NJ: John Wiley & sons Inc.

31. The EndQuestions, Comments? Kimberly McCaskey-Lee, LCSW Amy Punsky, MA, NCC Kelly Pavelko, BA Child to Family Connections cfcfbt1@windstream.net 814.336.3007