Trial lecture - time and place
Place: Auditorium 2, Helga Engs hus
Time: 10:00 - 10:45
Title: TBA
Public Defence
Place: Auditorium 2, Helga Engs hus
Time: 12:00 -
Adjudication committee
- 1st opponent: Associate Professor Sajid Humayun, School of Human Sciences, University of Greenwich, UK
- 2nd opponent: Senior Researcher Kyrre Breivik, Regional Centre for Child and Youth (RKBU Vest), Norway
- Chair of committee: Professor Lisa-Christine Girard, Department of Special Needs Education, University of Oslo
Chair of defence
- Vice Director of SpedAims and Coordinator of Research Education, Professor Christian Brandmo, Department of Special Needs Education, University of Oslo
Supervisors
- Principal supervisor: Professor Gunnar Bjørnebekk, Department of Special Needs Education
- Co-supervisor: Managing Director Kristine Amlund Hagen, The Norwegian Center for Child Behavioral Development
- Co-supervisor: Professor Serap Keles, Knowledge Centre for Education, University of Stavanger
Summary
Problem behavior in adolescence is a well-known phenomenon and may result in severe negative short- and long-term consequences for youths, their families, and the communities in which they live. Family-based treatments for such problems are among the highly recommended treatment alternatives, and improving family functioning is expected to help ameliorate or prevent adolescent problem behavior. Functional Family Therapy (FFT) is an evidence-based treatment model developed to reduce adolescent problem behavior by altering risk and protective factors, with a particular emphasis on family functioning. The overarching aim of this doctoral work was to evaluate the effectiveness of FFT compared with treatment as usual (TAU) for youths referred to the Norwegian Child Welfare Services (CWS) due to problem behavior. Additionally, the aim was to examine whether change in family functioning was central to achieving the goal of reducing problem behavior, as expected in the logic model of FFT.
In the first article presented in this thesis, my colleagues and I examined effects on outcomes such as aggressive and delinquent behaviors that typically lead to referral to CWS, and on other relevant domains of adolescent functioning such as internalizing problems, school performance, social skills and association with deviant peers. In the second article, we examined effects on aspects of family functioning such as family conflict, communication, support, and the parent-youth relationships. Finally, in a third article, we examined whether patterns of change in family functioning and problem behavior in families receiving FFT treatment supported the hypothesized treatment process described in FFT’s logic model, namely that changing family functioning was central for achieving change in problem behavior. Taken together, the articles evaluated both the comparative effectiveness of FFT under regular service conditions and whether the intervention operated through its proposed change process.
The articles presented in this thesis draw their data from a randomized controlled trial (RCT) conducted in Norway between 2013 and 2019. In this RCT, a total of 161 youths and their families were randomly assigned to either FFT or TAU. Study participants were recruited from youths and families referred to the Norwegian CWS due to youth problem behavior, and intake to treatment followed regular processes and procedures in the CWS. In contrast to several settings in which FFT has previously been examined, involvement with the juvenile justice system was not required for receiving treatment, and participation in treatment was voluntary. The TAU condition included a heterogeneous range of interventions, including other family based interventions such as Multisystemic Therapy, parent training, and family counseling. Data on problem behavior, youth functioning, and family functioning were collected before treatment (pretest), and then at six months and 18 months after pretest. The data were collected from parents, youths, and teachers, and covered a wide range of domains across different settings in youths’ lives. Treatment effects were examined using latent change models based on intention-to-treat principles, and the examination of the logic model of FFT was conducted using within-participant two-condition mediation analyses with a subset of families in the FFT group that had received a minimum of eight treatment sessions.
The results showed no support for the superiority of FFT over TAU on any of the outcomes. No between-group differences favored FFT during either the initial six months or 12-month follow-up period, while one difference in parent-reported internalizing problems favored TAU during the follow-up period. The mediation analyses did not support the hypothesized causal pathway. Changes in family functioning were not associated with concurrent or longer-term changes in aggressive and rule-breaking behavior in the manner expected based on FFT’s logic model. These results did not provide evidence that FFT offered additional benefit over TAU on the outcomes measured in the Norwegian CWS. In addition, the results of the mediation analyses suggest that the treatment did not operate through changes in family functioning to achieve changes in problem behavior in this context.
Furthermore, the results are discussed in relation to methodological issues concerning the study and analyses, as well as potential substantive explanations for the lack of support for the hypotheses. These include the fit between FFT and the Norwegian treatment context and the services available in the TAU condition. This doctoral work contributes to knowledge about interventions for youth problem behavior and identifies several implications for policy, practice, and future research. First, with respect to the Norwegian context, the results contribute to knowledge about FFT as offered to the target population within the CWS, which may be relevant when considering the role of FFT within the Norwegian CWS. Key implications and future directions include the need to further examine FFT’s logic model, intake criteria, and treatment content in Norway. Furthermore, there is a need to follow up on the finding of a potential delayed effect in favor of TAU to determine whether aspects of treatment delivery or procedures within the CWS may account for this result. Second, beyond the Norwegian context, the results add to the limited evidence from RCTs examining FFT in settings similar to the Norwegian CWS, particularly settings in which involvement with the justice sector, such as being arrested or charged with a crime, is not a requirement for receiving treatment. As part of the wider evidence base, the findings may contribute to understanding the conditions under which FFT may or may not provide added benefit over existing services. Finally, the results contribute to the even more limited literature empirically examining treatment processes in FFT and in family-based interventions for adolescent problem behavior more generally. These results suggest a need for further research examining such processes across different contexts and target populations.