Transcript Family Behavioral Therapy (FBT)

Presented by: Kimberly McCaskey-Lee, LCSW
Amy Punsky, MA, NCC & Kelly Pavelko, BA
Child to Family Connections
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
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.
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 substancedependent youth. Journal of Child & Adolescent Substance Abuse,
11, 1-41.
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
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
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.
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 roleplaying 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.
Initial Meetings and
Assessments
 Quick introduction to program and team
 Elicit initial commitment
 Complete consents and assessments
Assessments Used
 Youth Life Satisfaction
 Youth Self Report
Scale
 Child Behavior Checklist
 Youth Satisfaction with
Parent Scale
 Parent Satisfaction with
Youth Scale
 FBT Questionnaire
 Parenting Stress Index
FBT Interventions
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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
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
Program Orientation and
Treatment Planning
 Treatment Planning includes:
 Explaining interventions
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Adolescent ranks priority
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Caregivers rank priority
 Average of rankings = order of interventions
Therapeutic Style
 Positively focused agendas
 Emphasis on positive feedback and
encouragement
 Praising desired/ignoring undesired
 Role playing
Consequence Review
 Increasing or maintaining motivation to avoid drug
use and troublesome behavior
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
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
Level System
 Getting rewards from
caregivers when goals
(behaviors) are
accomplished
Self Control
 Learning to control impulses, urges, and thoughts that
increase drug use and trouble
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
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
Donohue, B., Allen, D. (2011). Treating adult substance abuse
using family behavior therapy: A step by step approach.
Hoboken, NJ: John Wiley & sons Inc.
Kimberly McCaskey-Lee, LCSW
Amy Punsky, MA, NCC
Kelly Pavelko, BA
Child to Family Connections
[email protected]
814.336.3007