Study of Adolescents' Family Experiences

INTERVENTION: 1. Functional Family Therapy group: FFT works by working improving outcomes for families by addressing a number of factors that may contribute to the likelihood of a young person offending. Key amongst these are family circumstances and styles of parenting, which have been shown to be correlated strongly with delinquency and anti‐social behaviour. FFT aims to assist young people and their families to make meaningful changes in their functioning. This is accomplished by reducing negativity in the family and focusing on significant yet obtainable behavioural changes that will have a lasting impact on family relationships. These changes may have the immediate effect of changing a specific functional problem or difficulty and the longer term effect of empowering a family to continue to apply changes to future circumstances. A key duty of the therapist is to assume some of the functional duties of a "family case manager" to assist the family to identify and interact with relevant community resources that will help the family sustain their changes over time. In this way, FFT aims to increase the family's capacity to manage problems, enabling a reduced reliance on service providers and their resources. It is a home‐based assertive outreach model. The intervention process involves, on average, 12 one hour sessions over a period of 3 to 4 months delivered in the family home, with more complex cases requiring up to 30 hours of direct service. Thus young people in the FFT group will receive treatment as usual as normally provided by agencies and FFT. Experienced family therapists have been hired to provide the intervention. They have been trained to the highest standard by the originator of the programme, Professor James Alexander, and will receive weekly supervision. Given that the SAFE project is an effectiveness trial the therapists will be located within, and will work as part of, the Brighton and Hove Youth Offending Team. 2. Dose Control group: The use of standard CONDITION: Conduct disorder, antisocial behaviour ; Mental and Behavioural Disorders ; Conduct disorders SECONDARY OUTCOME: 1. Peer relationships:; 1.1. Peer delinquency: Smith and McVie Peer Delinquency Self‐Report Questionnaire (measured at T1, T3, T4); 1.2. YP peer relationship problems: Strength and Difficulties Questionnaire (PC and self‐report) (measured at T1, T2, T3, T4); 1.3. Child prosocial behaviour: Strength and Difficulties Questionnaire (PC and self‐report) (measured at T1, T2, T3, T4); 2. Young peoples mental health:; 2.1. YP internalising disorders: Strength and Difficulties Questionnaire (PC and self‐report) (measured at T1, T3, T4); 2.2. YP hyperactivity/inattention: Strength and Difficulties Questionnaire (PC and self‐report), Conner's Rating Scale for ADHD (measured at T1, T4); 2.3. Child autistic spectrum disorder: the Childhood Asperger Syndrome Test (PC questionnaire) (measured at T1); 2.4. Child psychosis: Psychotic‐Like Experiences Questionnaire (self‐report) (measured at T1); 2.5. Child post‐traumatic stress disorder: Impact of Events Scale (self‐report questionnaire) (measured at T1); 3. Young peoples education attainment and intelligence quotient (IQ):; 3.1. Child school attendance, exclusions, academic achievement and statements of special educational needs: school records (measured at T1, T3, T4); 3.2. IQ: Wechsler Abbreviated Scale of Intelligence (measured at T1); 4. Family relationships and parenting:; 4.1. Child attachment: Child Attachment Interview (measured at T1, T4); 4.2. Parental relationship: the Index of Marital Satisfaction Questionnaire and Conflict Tactics Scales Questionnaire (PC questionnaire) (measured at T1, T3, T4); 4.3. Disorganisation and chaos in the home environment: Confusion, Hubbub and Order Scale (PC questionnaire) (measured at T1); 4.4. Parenting behaviour: Alabama Parenting Questionnaire (PC [measured at T1, T2, T3, T4] and other parental figures in family [measured at T1, T3, T4], child self‐report [measured at T1, T3, T4]) ; 4.5. Parental attribution of intent: when interviewing primary caregivers we ask them to imagine their child doing a number of things that could be regarded as positive or negative. We then ask them why they think their child is doing these things. This allows us to assess their attribution of intent: whether they think their child's behaviour is driven by positive or negative motives (PC interview) (measured at T1, T2, T3, T4); 4.6. PC self‐efficacy: Carer Confidence Questionnaire: 9 item PC questionnaire assessing sense of control and agency (PC questionnaire) (measured at T1, T2, T3, T4); 4.7. Reflective functioning: Parent Development Interview (PC interview) (measured at T1, T3, T4); 4.8. Expressed emotion: Psychosocial Assessment of Childhood Experiences Coding Scheme (PC interview) (measured at T1, T3, T4); 4.9. PC and YP interaction: video observations coded with Problem Solving & Dyad Interaction Coding Scheme (video observation of YP and PC) (measured at T1, T3, T4); 5. Parental mental health:; 5.1. PC depression: the Depression, Anxiety and Stress Scales (PC self‐report questionnaire) (measured at T1, T3, T4); 5.2. Parental history of antisocial behaviour: Mother's and Father's Antisocial Personality Questionnaire (PC questionnaire) (measured at T1); 5.3. PC alcohol and drug misuse: The Alcohol and Drug Use Disorders Identification Tests questionnaire (PC self‐report) (measured at T1); 6. DNA:; 6.1. Child DNA: collected with cheek swab (measured at T1); 6.2. PC DNA: collected with cheek swab (if biological parent) (measured at T1); 7. Health economics:; 7.1. Service use and demographics: Client Service Receipt Inventory (PC interview) (measured at T1, T3, T4); 7.2. Quantity and type of treatment as usual received by young people: Youth Offending Service and other agency databases (measured at T1, T2, T3); 8. Process variables:; 8.1. FFT therapists' adherence to model and competence: assessments undertaken by FFT trainers (measured at T1, T2, T3); 8.2. Client‐therapist alliance: standard FFT including questionnaires (measured at T1, T2, T3); ; Timepoints:; T1: baseline assessment directly before randomisation and treatment; T2: 3 months post‐randomisation; T3: 6 months post‐randomisation; T4: 18 months post‐randomisation INCLUSION CRITERIA: 1. Young people aged 10 ‐ 17 years (either sex) and their families (mainly primary caregivers but also others with a parental role) 2. Clients of a CYPT agency being seen for offending or antisocial behaviour receiving a casework‐based intervention PRIMARY OUTCOME: Young people's offending and antisocial behaviour:; 1. Young Person (YP) offending, reoffending and breach of orders: youth offending service databases and police national database (measured at T1, T3, T4); 2. YP delinquency, conduct disorder and antisocial behaviour: ; 2.1. Smith and McVie Self‐report Delinquency questionnaire (measured at T1, T3, T4); 2.2. Adolescent Parent's Account of Child Symptoms interview (measured at T1, T3, T4); 2.3. Strength and Difficulties Questionnaire (Primary Caregiver [PC] and YP self‐report) (measured at T1, T2, T3, T4); 2.4. Antisocial Process Screening Device (parent and self‐report) (measured at T1, T3, T4); ; Timepoints:; T1: baseline assessment directly before randomisation and treatment; T2: 3 months post‐randomisation; T3: 6 months post‐randomisation; T4: 18 months post‐randomisation