Academic journal article Journal of Marital and Family Therapy

The Implementation and the Cultural Adjustment of Functional Family Therapy in a Dutch Psychiatric Day-Treatment Center

Academic journal article Journal of Marital and Family Therapy

The Implementation and the Cultural Adjustment of Functional Family Therapy in a Dutch Psychiatric Day-Treatment Center

Article excerpt

Because of the increasing severity of adolescent problem behavior, evidence-based practices are becoming of interest as an alternative to traditional treatment with the behavior problems of adolescents in juvenile justice settings. Despite interest in evidence-based practices, questions exist regarding whether or not evidence-based intervention models can be successfully transported to cultures other than those in which they were developed. This article describes the transportation process of an American evidence-based family therapy (Functional Family Therapy [FFT]) into the service delivery system of a psychiatric day treatment center for juvenile delinquents in Amsterdam. The characteristics of FFT that make it cross-culturally sensitive are discussed. Results from the changes in service delivery suggest FFT can be successfully implemented in international settings with adjustments to make the model fit the culture(s) of the Netherlands without changing the model of FFT itself.

In the Netherlands, as in most other countries, juvenile crime has become a major problem. Although juvenile delinquency as a whole has not increased in the last 20 years, both self-report measures and official police records indicate that approximately 37% of juveniles admit to having committed a criminal act in the last year. In addition, there has been a 300% increase in the growth of violent criminal acts among this age group over the last 20 years (Boendermaker & van Yperen, 2003). In response to the increasing trend of violent crime among adolescents and the accompanying rise in attention to adolescent behavior problems, juvenile delinquency has recently become a high priority in the Netherlands. As a result, both social and political pressures are calling for prolonged duration of punitive consequences (e.g., imprisonment) and residential treatment alternatives that remove youth from their families and communities in order to protect the community. This trend toward increased incarceration has continued despite research data documenting that both imprisonment (van der Laan, 2001) and residential treatment are related to high recidivism rates (40%-50%). As an alternative to a justice-based solution, a number of comprehensive treatment programs have been developed to provide an alternative to incarceration. These treatment programs aim to provide quality mental health care to juveniles (usually by means of individual-based social skills training and anger management training) and/or families (traditional family therapy) by use of traditional cognitive-behavioral methods. Unfortunately, these methods remain untested and unevaluated (Kazdin & Weisz, 2003; Sexton, Gilman, & Johnson-Erickson, 2005).

Because of the increasing severity of adolescent behavior problems, evidence-based practices are increasingly being adopted in community-based treatment settings (Kazdin & Weisz, 2003). This trend is also occurring in communities in countries other than the US. For example, evidence-based practices have become a major treatment focus to ameliorate juvenile behavior problems in the Netherlands. Following the publication of a national (Research, Statistics, and Documentation Center [WODC]; Wartna, Harbachi, & Laan, 2005) report on high recidivism after imprisonment, the minister of Justice of the Netherlands asserted that evidence-based practices are the best means to reduce juvenile recidivism, rather than increased criminal sentences. As a result, the ministries of Justice and Health asked the National Institute of Health Sciences (NIZW) to decide what would be the most effective interventions. To fill a need for evidence-based approaches, mental health service providers in the Netherlands have searched for well-established and highly evaluated American-based clinical intervention models because of the strong results of multiple outcome studies. In "The Right Help" NIZW (Boendermaker, 2005, p. 57) concluded: "Multi System Therapy and Functional Family Therapy lead to better functioning of the family and by this mechanism to an important reduction of recidivism compared to treatment as usual. …

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