Functional Family Therapy crosses cultural barriers to help Singapore’s youth offenders

Functional Family Therapy (FFT) is an effective holistic rehabilitation intervention even in non-Western cultures, leading to better probation completion rates, family functioning, and mental well-being among youth offenders in Singapore, according to a recent study.

“This trial is the first independent evaluation of FFT in Asia, and therefore the first study to examine the effectiveness of FFT in a non-Western culture,” the researchers said. “Importantly, it is one of only a handful of studies that has looked into FFT’s impact on clinically meaningful outcomes other than recidivism.”

Of the 120 youth probationers (mean age, 16.2±1.33 years) enrolled in the study, 57 underwent rehabilitation through the standard probation services (treatment-as-usual, TAU), while 63 were given additional FFT. Three domains of proximal outcomes were assessed: mental well-being, family functioning, and probation completion. Assessments were done before and after the programme, and after the probation period.

The researchers detected significant group-by-time interactions for scores on the Youth Outcome Questionnaire Self-Report Version 2.0 (YOQSR2.0; p=0.013). Posthoc t tests showed that in the FFT group scores had improved significantly by the end of the programme (p=0.011) and by the end of probation (p=0.001). [Fam Process 2021;doi:10.1111/famp.12630]

Graphical analysis further qualified the temporal change in mental well-being, showing that YOQSR2.0 scores dropped significantly over the duration of the programme. These gains were maintained until the final assessment time point.

The aggregate score changes also corresponded to marginal clinical improvements. At baseline, 34.4 percent and 48.9 percent of FFT and TAU participants, respectively, had YOQSR2.0 scores above the clinical threshold. The corresponding rates of clinical recovery were 42.9 percent and 18.2 percent. Chi-square tests showed that the difference in recovery rates was marginally significant (p=0.078).

Family functioning was assessed using the Family Assessment Device-General Functioning Scale (FAD-GFS). Aggregate changes in scores showed no significant group-by-time effect, though clinical recovery was statistically better in the FFT group (p=0.028).

Similarly, youths receiving the FFT intervention were more likely to complete their probation than their TAU counterparts (88.9 percent vs 70.2 percent).

Baseline recidivism (odds ratio [OR], 0.86, 95 percent confidence interval [CI], 0.76–0.99; p=0.031) emerged as a significant and negative predictor of probation completion, while FFT was a positive predictor, increasing the likelihood of completion by nearly four times (OR, 3.99, 95 percent CI, 1.46–10.9; p=0.007).

“[T]he study findings provide pioneering evidence of FFT’s effectiveness in a non-Western culture,” the researchers said, pointing out that “high-quality delivery of FFT is possible in a culture different from the one in which the program is developed.”

“Future experimental studies should seek to examine caregiver outcomes alongside youth outcomes. It may also be worthwhile for longitudinal evaluations to explore the association between intermediate outcomes and long-term outcomes such as recidivism rates,” they added.