A Pilot Test of the Functional Family Therapy Coding and Rating Scale

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DESCRIPTION (provided by applicant): The objective of this project is to conduct a pilot study of the Functional Family Therapy Coding and Rating Scale (FFT CARS). The FFT CARS is a theory-driven observational research tool for rating and coding the presence of manual-based therapist interventions and techniques in sessions of FFT. As a theory- and manual-based process research tool, the FFT CARS will facilitate direct empirical tests of fundamental hypotheses about clinical components, processes, and mechanisms associated with sustained treatment outcomes in FFT. To date, no such observational instrument exists that could accomplish these critical FFT process research objectives. Such research is urgently needed to provide empirical support for the ongoing refinement and manualization of FFT and its transportation to community-based treatment settings across the United States and abroad. The specific aims of the proposed pilot study are to: (a) train two novice graduate student clinicians to utilize the FFT CARS to code and rate a sample of recorded FFT sessions; (b) establish and demonstrate satisfactory interrater agreement and reliability for the FFT CARS through a range of analytic approaches; and (c) assess the validity of the FFT CARS by using a range of clinical indicators derived from the instrument to predict therapist-family alliance formation, and pre- to post-treatment changes in family communication and adolescent treatment outcomes. Achieving these aims would establish the FFT CARS as a credible and bona fide process research instrument. Subsequently, the FFT CARS may be used to rate and code the massive volume of archived FFT clinical videotapes that has accumulated over the course of numerous randomized clinical trials over the past decade. A wealth of assessment data exists pertaining to change in adolescent drug use and other aspects of emotional, behavioral, and family functioning for the adolescent participants in these clinical trials. Using the FFT CARS to study how therapist behavior during treatment is linked to sustained improvement, non- improvement, or relapse in FFT would provide valuable clinical insights to inform the refinement of FFT in ways that can enhance its effectiveness and transportability. Ultimately, transporting effective treatments into community-based clinical settings is indispensable for reducing the prevalence of adolescent drug abuse to a degree sufficient to produce public health benefits.