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Model Program Seal

Functional Family Therapy (FFT)

Blueprints Program Rating: Model

A short-term family therapy intervention and juvenile diversion program helping at-risk children and delinquent youth to overcome adolescent behavior problems, conduct disorder, substance abuse and delinquency. Therapists work with families to assess family behaviors that maintain delinquent behavior, modify dysfunctional family communication, train family members to negotiate effectively, set clear rules about privileges and responsibilities, and generalize changes to community contexts and relationships.

Functional Family Therapy, as a type of family therapy, is a prime candidate for Medicaid funding. When FFT is targeted at youth to be diverted from out-of-home placement, the avoided cost of such a placement is usually more than adequate to fund the FFT intervention. A variety of federal formula and discretionary funds are aligned with the program and offer potential sources of start-up funding.

Another option is debt financing. For example, a Social Impact Bond, can provide start-up and initial implementation funding. A Reinvestment Compact is another innovative mechanism to consider for start-up.

Improving the Use of Existing Public Funds

Reinvestment: FFT can be funded with money saved by diverting youth from expensive out-of-home placements in the juvenile justice, child welfare, or behavioral health systems into FFT to fund the intervention.

Allocating State or Local General Funds

Many states have chosen to fund FFT with general funds as part of a commitment to evidence-based practices and in an effort to achieve better outcomes for youth, particularly youth involved with the juvenile justice and child welfare systems. Some counties and cities have made additional contributions to fund the program.

Maximizing Federal Funds

Entitlements: Medicaid is an option for funding FFT as a family therapy. This approach requires the state to provide state matching funds, with the state share percentage set by the federal government. This option is limited to the Medicaid eligible portion of the population to be served. States have adopted a variety of different billing structures.

Formula Funds:

  • Juvenile Accountability Block Grant (JABG) Funds are focused on reducing juvenile offending through efforts that promote accountability, including providing effective early intervention through mental health screening and treatment.
  • Office of Juvenile Justice and Delinquency Prevention (OJJDP) Formula Funds support a variety of improvements to delinquency prevention programs and juvenile justice programs in states. Evidence-based programs are an explicit priority for these funds, which are typically administered on a competitive basis from the state administering agency to community-based programs.
  • The Mental Health Services Block Grant (MHSBG) can fund a variety of mental health promotion and intervention activities and is a potential source of support for FFT programs.
  • Title IV-B, Parts 1 & 2 provides fairly flexible funding to state child welfare agencies for child welfare services including prevention and family preservation activities.

Discretionary Grants: Such grants have mostly been used for start-up expenses for FFT programs. Relevant grants are administered by the federal Office of Juvenile Justice and Delinquency Prevention (OJJDP), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Children’s Bureau within the Administration for Children and Families.

Foundation Grants and Public-Private Partnerships

A number of states have used foundation grants to provide start-up funding for FFT programs. Foundations are not as good a source of ongoing implementation funding. A Reinvestment Compact is an example of a relevant public/private partnership, where private funding initiates an intervention such as FFT with the potential of saving money from the avoidance of a costly alternative. Savings are then used to sustain the intervention.

Debt Financing

Program Related Investments, Social Impact Bonds or Municipal Bonds can all potentially be used for start-up and initial implementation funding for programs such as FFT, which target cost avoidance for youth who would otherwise need an expensive alternative such as out-of-home placement. Savings from avoided costs would repay the investment as well as sustain the intervention.

Generating New Revenue

While difficult to put in place, establishing state or local funding streams dedicated to evidence-based services and/or mental health services can provide a fairly stable source of ongoing funding for programs. Special Tax Levies and Sin Taxes have been used to generate revenue for evidence-based mental health services.

All information comes from the responses to a questionnaire submitted by the purveyor, FFT, Inc., to the Annie E. Casey Foundation.