(PS5-19) How do contextual factors influence implementation quality and youth outcomes; Data from a statewide evaluation of Functional Family Therapy

Abstract Text: Functional Family Therapy (FFT) is an intensive, short term evidence-based family counseling model designed for youth ages 11 to 18 years old who have been referred for emotional and/or behavioral problems. FFT employs a family-focused perspective to promote positive development and lessen at-risk behaviors. With the expansion of Medicaid, FFT has become more accessible to families by providing a less restrictive and a more cost-effective treatment option for youth. However, limited research has sought to explore whether funding source (e.g., Medicaid, private insurance) influences implementation quality and overall youth outcomes. Funding sources utilized by families are often determined by systematic factors including location, socioeconomic status, and/or juvenile justice involvement. One key impact of implementation quality varying by funding is the potential for vulnerable populations to have poorer outcomes due to access to specific funding streams, an important consideration for public policy makers aiming to address health disparities and develop effective systems of care.
This study aims to: 1) Assess the relationship between implementation quality (i.e., fidelity scores) and youth outcomes and 2) Examine the influence of different funding streams (including Medicaid, Department of Juvenile Justice, and Children’s Service Act) on youth outcomes. For both aims, another contextual factor, mandated versus voluntary therapy, will be included in the models.
Data were collected on youth and their families (N ≈ 400) participating in a larger statewide evaluation of FFT from April 2023 to current. Regression analyses will examine the extent to which therapist fidelity predicts outcomes on the Youth Outcome Questionnaire (YOQ). Similarly, we will use regression analyses to test if funding source is related to outcomes such that one funding source is associated with worse (or better) outcomes. For both of these analyses, referral type will be included in the models as a potential covariate. Preliminary analyses suggest that referral type (mandated versus voluntary therapy) was a predictor of post-intervention youth outcomes, F(2,119) = 3.30, p = .04, R2 = .05, R2adj = .04, but funding stream was not a significant predictor of overall youth outcomes, F(4,117) = 1.47, p = .22, R2 = .05, R2adj = .02. Overall findings will be discussed in terms of their clinical and policy implications. Additionally, ongoing data collection will be included in the final presentation.