The SCORE (Systemic Clinical Outcome and Routine Evaluation) is a 40‐item questionnaire for completion by family members 12 years and older to assess outcome in systemic therapy. This study aimed to investigate psychometric properties of two short versions of the SCORE and their responsiveness to therapeutic change. Data were collected at 19 centers from 701 families at baseline and from 433 of these 3–5 months later. Results confirmed the three‐factor structure (strengths, difficulties, and communication) of the 15‐ and 28‐item versions of the SCORE. Both instruments had good internal consistency and test–retest reliability. They also showed construct and criterion validity, correlating with measures of parent, child, and family adjustment, and discriminating between clinical and nonclinical cases. Total and factor scales of the SCORE‐15 and ‐28 were responsive to change over 3–5 months of therapy. The SCORE‐15 and SCORE‐28 are brief psychometrically robust family assessment instruments which may be used to evaluate systemic therapy.

A systematic review of self-report family assessment measures was conducted with reference to their psychometric properties, clinical utility and theoretical underpinnings. Eight instruments were reviewed: The McMaster Family Assessment Device (FAD); Circumplex Model Family Adaptability and Cohesion Evaluation Scales (FACES); Beavers Systems Model Self-Report Family Inventory (SFI); Family Assessment Measure III (FAM III); Family Environment Scale (FES); Family Relations Scale (FRS); and Systemic Therapy Inventory of Change (STIC); and the Systemic Clinical Outcome Routine Evaluation (SCORE). Results indicated that five family assessment measures are suitable for clinical use (FAD, FACES-IV, SFI, FAM III, SCORE), two are not (FES, FRS), and one is a new system currently under-going validation (STIC).

A systematic review of published and unpublished English language articles identified 14 studies containing 18 comparisons between functional family therapy (FFT) and another condition in the treatment of adolescent disruptive behavior and substance use disorders. In 11 of these comparisons, assignment to conditions was random, while nonrandom assignment occurred in seven studies. For both random and nonrandom comparisons, separate meta-analyses were conducted for subgroups of studies depending on the type of comparison group used. Data from studies of untreated control groups (CTL), treatment as usual (TAU), and well-defined alternative treatments (ALTs) were analyzed separately. Effect sizes from these six meta-analyses were as follows: random assignment FFT versus CTL (k = 3, d = 0.48, p < .01); random assignment FFT versus TAU (k = 3, d = .20, ns); random assignment FFT versus ALT (k = 5, d = .35, p < .05); nonrandom assignment FFT versus CTL (k = 2, d = .90, ns); nonrandom assignment FFT versus TAU (k = 2, d = .08, ns); and nonrandom assignment FFT versus ALT (k = 3, d = .75, p < .001). These results provide support for the effectiveness of FFT compared with untreated controls and well-defined ALTs, such as cognitive behavior therapy, other models of family therapy, and individual and group therapy for adolescents.

Despite the widespread adoption of manualized model-driven approaches to family therapy, little is known about how therapists implement and families experience the specific guiding practices involved in individual models. The aim of the present study was to use a qualitative methodology to describe therapist implementation and family experiences of the three phases of Functional Family Therapy (FFT). Five FFT therapists and four parents of families who had been treated by those therapists were interviewed and thematic analysis performed to analyse the data. Results suggest that both common factor and model-specific treatment elements, flexibility within model delivery, and strategies which aim to improve parental self-efficacy and communication are key elements of successful therapy when practised within a manualized model-driven framework. Limitations such as the retrospective nature of the study, and avenues for future research, such as the inclusion of the entire client family, are discussed. Practitioner points• Early in FFT, combine basic therapeutic skills such as empathy, warmth and unconditional positive regard with model specific skills such as reframing • In the middle sessions of FFT, match the development of specific behaviour change skills (e.g. communication, conflict management, and emotional regulation) to families' particular goals • In later sessions of FFT, support the generalization of gains made within therapy to other contexts and future situations to prevent relapse

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