Humayun, Sajid ORCID: 0000-0003-3849-1629, Jolliffe, Darrick ORCID: 0000-0003-4590-6343 and Cleaver, Karen ORCID: 0000-0001-5303-1036 (2023) Functional family therapy-gangs for young people at risk of child criminal exploitation and county lines involvement: feasibility and pilot study. Project Report. Youth Endowment Fund (YEF) - University of Greenwich, London, UK.

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Abstract

Executive Summary
The project
Functional Family Therapy Gangs (FFT-G) is an intensive, home-based, family therapy programme for the families of young people with severe behavioural challenges. It aims to improve the safety, wellbeing and stability of children and families and reduce offending. Developed by FFT LLC, the programme in this project was delivered by Family Psychology Mutual (FPM) and targeted at 10-17 year olds at risk of involvement in County Lines Drug Networks or child criminal exploitation. Trained family therapists provided a bespoke number of therapy sessions to families over three to five months, beginning with an Engagement and Motivation phase to secure participation. This was followed by a Behaviour Change phase to teach new skills designed to interrupt problematic relational patterns, before a Generalisation phase asked families to practise the skills they had learned in other contexts (such as in school, in the community or in relationships with other professionals). Which family members were involved depended on who was regarded as important to the problem being addressed. In the early stages, contact was provided to families several times a week, with home visits lasting 60-90 minutes; in later stages of the intervention, contact was reduced to weekly.
The YEF funded a feasibility and pilot study of FFT-G. The feasibility study aimed to ascertain how feasible a randomised controlled trial (RCT) of the programme would be, exploring whether caseworkers would refer young people to an RCT, analysing what the most productive referral pathways were and evaluating whether enough referrals would be received to ensure adequate therapist caseloads. These questions were explored using 19 interviews with key professionals, organisational data gathering and a document review, and the intervention was delivered to 48 families in the London Borough of Redbridge (LBR). The Family Intervention Team (FIT), part of specialist services for vulnerable children within social care, referred young people to the programme. The feasibility study was delivered between October 2019 and March 2021. The pilot study then aimed to explore how many families were eligible for FFT-G; analyse the barriers to and implementation of trial recruitment; and examine a range of questions relating to the design of a potential future large-scale RCT (such as how many families can be randomised and how often, the rates of missing data at baseline testing, attrition rates and the effect sizes associated with the intervention). These questions were explored via the delivery of a pilot RCT, again delivered in LBR. Twenty-three young people’s families received the intervention, while 22 received services as usual (SAU). Nine interviews were also conducted with families. The pilot took place between March 2021 and July 2021. Both the feasibility and pilot studies were impacted by the COVID-19 pandemic, requiring both the delivery and evaluation teams to adapt to challenging circumstances.
In the feasibility study, FFT-G received a reasonable number of referrals (100 over 13 months), although this was lower than anticipated by therapists. The evaluator deemed completion rates to be adequate; where treatment data were collected, 61% of families enrolled completed the treatment.
The pilot study found that 95 families were identified over nine months in LBR to receive the programme – 73% (69) of them were eligible for the programme after full screening, out of which 66% (45) progressed through recruitment to be randomised into the pilot RCT.
In the pilot study, 74% of families received eight or more sessions, and 83% completed the programme. In terms of what the families in the service as usual group were receiving, approximately one third received an alternative parenting programme; 27% do not appear to have received any services.
Key conclusions
Interviews with caseworkers in the feasibility study suggested that they would, albeit reluctantly, refer young people and their families to the programme to participate in an RCT. The most common reason given was to ensure the continuation of the service. A waitlist control was preferred by some caseworkers, but the evaluator adjudged a parallel RCT to be preferable.
Missing data rates in the pilot RCT were low at baseline. The RCT then measured parent-reported family functioning and young person-reported conduct problems. There was a 20% attrition rate. The evaluator deemed that in a small efficacy RCT, recruitment would be possible using only one local authority (LA). Given sample size calculations, they predicted that a sample between 51 and 248 would be required and advised aiming for the higher end of this range.
Interpretation
Social workers who were interviewed in the feasibility study felt that FFT-G complemented their services well. They would, albeit reluctantly, refer young people to the programme to participate in an RCT. Those most familiar with the intervention were more likely to refer, while the most common reason given for accepting an RCT was the continuation of the service. Most social workers had only a basic understanding of RCTs, and some had concerns about carrying out an RCT with vulnerable young people. They worried about causing frustration among those not receiving FFT-G, while FFT-G therapists were also wary of the disappointment experienced by social workers if the families they had taken time to recruit and refer were not part of the intervention group. After the evaluator explained the design of a waitlist control trial (where the control group would also receive the programme later), social workers were open to this possibility, recognising the need to evidence impact to secure funding. However, the evaluator concluded that a parallel RCT (where all receive some service as usual, and the intervention group also receive FFT-G) is preferable; concerns were noted that families’ waiting to receive FFT-G in a waitlist design could alter their engagement with other usual services, while the wait for any support could be too long for such vulnerable young people.
In the feasibility study, FFT-G received a reasonable number of referrals (100 over 13 months). This was lower than expected by FFT-G therapists due to a number of reasons, including a lack of awareness by social workers around FFT-G, the cases not fitting the inclusion criteria and the length of time it takes to refer. The evaluator deemed completion rates to be adequate; where treatment data were collected, 67% received over eight sessions, and 61% of families completed treatment. The average number of sessions completed by families was 10.7.
The pilot study found that 95 families were identified over nine months in LBR to receive the programme. These were referred either by a Family Intervention Team panel, identified in meetings with service teams, or identified via screening of the borough’s case management system. Seventy-three per cent (69) of them were eligible for the programme after full screening, out of which 66% (45) progressed through recruitment to be randomised into the pilot RCT. Recruitment to the RCT began slowly; after simplifying the communication to potential families, expanding the age eligibility range (from 10-14 to 10-17) and conducting a screen of the case management system, recruitment improved. Missing data rates in the pilot RCT were low at baseline (0% for 16 out of 21 measures and between 2% and 16% for the remaining five). The RCT then measured parent-reported family functioning and young person-reported conduct problems. These measures were deemed to be broadly suitable, but the evaluator encourages caution when drawing firm conclusions on the future suitability of these measures given the small sample size. There was a 20% attrition rate (with eight families in the SAU arm and one in the FFT-G arm of the trial not completing assessments after six months). The evaluator deems that in a small efficacy RCT, recruitment would be possible using only one LA. Given sample size calculations, they predict that a sample between 51 and 248 would be required and advise aiming for the higher end of this range.
The dominant view expressed in interviews with families was that the randomisation process was acceptable, and getting additional attention and support for their child was a recurring motivation for many participating in the study. Some families also expressed a desire to participate in giving feedback on services with a view to them improving in future. Of those who received support during the study, the common view was that the support was useful, although some young people were unable to say what was helpful to them. Of those who received service as usual, most perceived the support on offer to be helpful. However, some families who received usual service expressed negative experiences with professionals and the wider system.
In the pilot study, 74% of families received eight or more sessions, and 83% completed the programme. The average number of FFT-G sessions per family was 11.4. Approximately one third of families in the SAU group received an alternative parenting programme; 27% do not appear to have received any services.
The study met the requirements for a full efficacy RCT by meeting four out of five ‘stop-go criteria’. The YEF has, therefore, opted to fund a further evaluation of FFT-G and will be setting up an efficacy RCT.

Item Type:	Monograph (Project Report)
Uncontrolled Keywords:	county lines; child criminal exploitation; family therapy; RCT
Subjects:	B Philosophy. Psychology. Religion > BF Psychology H Social Sciences > HN Social history and conditions. Social problems. Social reform R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Vulnerable Children and Families Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	01 Sep 2023 15:57
URI:	http://gala.gre.ac.uk/id/eprint/43842

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