Joey Wahler (Host): It's a counseling approach proven to help at-risk youth and their families overcome behavior problems including substance abuse. So, we're discussing UK HealthCare's Functional Family Therapy Program. Our guest, Jenn Conner-Godbey. She's a licensed clinical social worker and Assistant Professor in the Psychiatry Department for UK Health.

Host: This is UK HealthCast, a podcast from UK HealthCare. Thanks for listening. I'm Joey Wahler. Hi, Jen. Thanks for joining us.

Jenn Conner-Godbey: Hi, Joey. Thank you for having me.

Host: Great to have you on board. So first, Functional Family Therapy, also called FFT is part of UK HealthCare's SMART Clinic, SMART being an acronym, which I believe stands for Supportive Mental Health and Addiction Recovery Treatment. So before we discuss functional family therapy or FFT what services in general does the SMART clinic provide?

Jenn Conner-Godbey: Yeah. So here in the Department of Psychiatry at UK, we have the SMART Clinic on the second floor, like you mentioned. And we provide addiction and recovery treatment services, including but not limited to medication assistance, group therapy, individual therapy, trauma-focused therapies and case management support, knowing that recovery is a really vulnerable and difficult time for people. We offer FFT in that clinic and also upstairs on our third floor outpatient general clinic, so it's available to a wider variety of patients, those who are dealing with other issues as well.

Host: Gotcha. Now, FFT is an approach that's really grown internationally. So, who does that treat and how does it work at UK HealthCare?

Jenn Conner-Godbey: Yeah. So, it has grown internationally. We started here about nine years ago now in coordination with FFT partners. That's a group currently based in Bloomington, Indiana, and they have programs all over the world in Australia, in Ireland, across the US, Canada, Hawaii, which I'm still waiting to go to a training there. I think that sounds pretty awesome. But it's pretty exciting to see all the different applications of FFT with different populations. So, it's been studied and used in residential programs with juveniles who are at risk and struggle to live at home or are dealing with abuse or neglect situations. It's been used in a lot of home visiting programs as well as outpatient clinics like our own here at UK HealthCare.

Host: So, a youth's substance abuse and/or any other mental health issues typically affect their family naturally. So, how important is it having a patient's loved ones involved in this treatment as well?

Jenn Conner-Godbey: I think it's the most important, and maybe I'm biased. But I would say it's the most important because if you ask people what is most important to them in their lives, family's at the top of the list. And sometimes we don't focus much on this level of intervention in mental health treatment, but it can be the most effective way of helping motivate and move people towards sobriety or recovery, as well as helping them get motivated to deal with other issues around anxiety, depression, having reasons to live or deal with eating disorders and other things that affect families. Oftentimes, we maybe overlook that these relationships are the foundation for people's brain development and life experiences. And oftentimes when they are not working together to get what they want, so you might have well-intentioned family members who want to help the family members who are struggling, but oftentimes make it worse inadvertently. By bringing the whole family in, we can address where there's been generational trauma or these inadvertent misses where people continue to stay stuck.

Like in our clinic, we often see multiple individuals from the same family. They may all be working on issues related to similar problems, but would be better and more efficiently served with a family intervention. There is a wealth of data on how FFT has been serving at-risk youth and across multiple settings, and we want to help all families function. So, this works with all kinds of families. It doesn't matter if it's the single-parent family, LGBTQ+ families with any combination. We have lots of families who are involved in kinship care, adoption, foster families. We would encourage anybody to think about how working together at the family level might decrease blame and negativity for the person who is experiencing the most distress and share the burden across family members in order to support each other to get better. Sometimes they're just not sure how or what to do. I often see parents or siblings saying, "I want to help. I just don't know what to do." And I think what's great about this way of working is that offers an opportunity to help people address the patterns that they're stuck in. So, we can work on those underlying issues and recognize how they really do want to get along and try to build on the strengths and progress that they've already made.

In addition, oftentimes, I don't know how many teenagers you've been around, Joey, but sometimes they're reluctant to engage in therapy. It doesn't feel like their first choice about what to do in a given day. And so, engaging the whole family and making it about everybody really keeps the blame and negativity down and helps adolescents be more willing and open to engaging.

And I really do think this is one of the most effective parts about doing family therapy because the individual lens misses the context in which the problems exist and continue. Kind of like a virus on a computer, we can't just fix one device. They're all connected, they're all interacting. So, the family or the system will keep getting the virus again. Parents tend to keep trying to do their best to do what they know when their kid's struggling. But when the family's the target of the intervention, they have an opportunity to see directly the impact they're having on the system and possibly be more aware of what the alternatives are that they could use to have the desired effect.

Host: Well, you answered there beautifully one of the subsequent questions I was going to ask, which is since as you mentioned, for many younger people, this is a first time therapy experience, how do you overcome that challenge? Obviously, their family being involved is a big part of that, as you said. How about the shape, the actual form in terms of commitment that this takes for a patient and their family? What kind of hours, what kind of number of sessions per week, per

month are we talking about?

Jenn Conner-Godbey: Yeah. So typically, though we try to be flexible and match what's going on with any given family and their schedule and their unique situation, most families could be expected to be scheduled with a therapist weekly for one hour per week for 12 to 16 weeks. So, that'll be about three or four months. And during that time, we'll meet in-person or telehealth or both to accommodate as many families as we can. Since we've started doing telehealth for mental health therapy, we can include families onsite and remotely or both, and that's really opened up the possibility to make sure that we can meet with everybody who's living in the home. That would be our expectation that we try to meet with everybody who's living in the home.

Host: Other than family involvement, which we've discussed,

anything in particular about this type of therapy and functional family therapy that's different from what most people would think of as "traditional therapy"?

Jenn Conner-Godbey: Yeah. So, we do a clinical feedback system that helps us get real-time information about how a family's functioning, the problems they're having, and the strain they experience. So at the first session, you complete a survey asking about all those things. And then, each session you have an impact form just about eight or 10 questions that let us know how that session went for each family member, so we can include all their perspectives. And at the end, we do another longer survey. We also check in with the clinician starts working with their family right away by listening to what goes on between family members, paying attention to the process, not just the content of how things go. This is the functioning part of FFT. So, we would identify what the sequence is between each and every person and how each of them see the situation differently, how we can revisit what their common goals and values are. Then, we create a theme to help us work on moving towards working together on those common goals. We identify where the problems and issues or behaviors that each person has that gets people stuck, and then we start to identify how to practice self-awareness to stop doing the things that are making it worse and start practicing new skills to try instead. We practice each session with coaching from the therapist, then encourage family members to practice at home when they're ready. And by the third or fourth month, we hope that everybody feels confident to know what they need to do when the time comes. We'll practice what could be the future problems and do some relapse prevention as well.

The last few sessions, we really try to plan for that and look at what are the other supports that family might need in order to stay successful. And if you come to do FFT, you can expect that the family therapist is respectful and curious about each different family members' cultures, beliefs. So, we don't teach families one way to be, but more to help them function with their values and their beliefs, how they best feel. They can work together as a team. So, we're committed to working with FFT partners on model adherence and performance. So, we get supervision. I provide supervision for the therapists here in our clinic, and then I get supervision from them and we continue to monitor and track this through the clinical feedback system, so we always know how we're doing. And that makes it a little different than other therapies I've tried.

Host: Gotcha. A couple of other things. Patients can be referred to you. It might be the Juvenile Justice System or another government agency. It might be a school. So, there can be a referral, but they need not be referred. So, talk a little bit about that please.

Jenn Conner-Godbey: Yeah. So, anybody can reach out to us. We're currently offering services to families with children, young adults, adolescents aged 12 to 25 who find themselves stuck or having conflict or want to work together in ways that they're struggling with now. So, they can call our clinic directly, the number's 859-323-6021 and refer themselves. If they have questions though, they could also talk to their psychiatrist here in our department or a therapist. Or they can email us directly to get more information and see if this might be a good fit. All kinds of families are welcome, like I said. So, I think that it has the opportunity to really benefit this whole community. My vision is to be able to work with training clinicians in other departments at UK HealthCare and to be able to offer this intervention more broadly in the community by training outside therapists as well.

Host: And again, Jen, right there, as part of that answer, you also answered once more one of the last questions I was going to ask you about who's eligible for this type of therapy. So, great job with that. How about in summary here, give us please an idea of the difference you think you're making in the community as a result of what really is a pretty new and advanced type of therapy involving both the patient and the family.

Jenn Conner-Godbey: Yeah. Luckily, I can tell you that in the words of family members because we are getting real time feedback. Luckily, Joey, I just was entering data this morning and the quote that stuck out to me from one of the dads that participated was that this therapy was life-changing for him and his family, that they all could see some things differently, had concrete skills to use and no longer felt hopeless or frustrated when their adolescent had behaviors that were hard to deal with or that when they were in an argument or disagreement about what to do about that.

And that's my hope for everyone who participates in this, is that they don't feel stuck anymore. And that's generally what folks who have participated have told us that this has given them hope, that each family member knows what to do, not just one person has the burden of trying to make things better. And that they know going forward how to get unstuck when they feel really overwhelmed or emotionally dysregulated and have in the past turned to substance abuse or other more destructive behaviors. Now, they have an alternative and know what to do instead.

Host: Life changing, as you said. I think that sums it up best. Folks, we trust you are now more familiar with UK HealthCare's FFT, Functional Family Therapy Program. Jenn Conner-Godbey, keep up the great work and thanks so much again.

Jenn Conner-Godbey: Thank you.

Host: And let me repeat that information from earlier. For more info or to speak to a SMART Clinic specialist, you can call 859-323-6021. Again, 859-323-6021. Now, if you found this podcast helpful, please share it on your social media. And thanks again for listening to UK HealthCast, a podcast from UK HealthCare. Hoping your health is good health. I'm Joey Wahler.