Family-based Prevention Programs Research Articles

Family-Based Drug Abuse Prevention Programs: A Review

Key elements of promising family-based drug abuse prevention strategies include: (1) program content based on proven prevention theory and research; (2) comprehensive approaches that begin early, extend across the life span, address multiple risk and protective factors, and generalize across settings; (3) developmentally appropriate material; (4) sensitivity to the culture and community; (5) sufficient dosage and follow-up; (6) use of interactive teaching techniques; (7) training for prevention program providers; and (8) evaluation to know that the intervention had the desired effect on behavior. In addition, an issue with major implications for prevention is how to reach the broadest possible audience or those who may most benefit from prevention services.

Parent Training via CD-ROM: Using Technology to Disseminate Effective Prevention Practices

Family-based prevention programs have demonstrated effectiveness in reducing risk factors for substance abuse. The lack of efficient methods for training staff and insuring treatment integrity and the limited time that program progenitors have for dissemination impede the spread of these programs. Additionally, there are barriers to families who use these programs such as stigma associated with a parent education or mental health approach, transportation and access difficulties, and inability to commit to months of treatment sessions. New developments in technology can surmount most of these barriers. The author describes a video-based interactive CD-ROM for training parents and families in child management and relationship enhancement skills. The program's development was based on two premises which are well-supported in the literature. One premise is that interactive videodisk programs increase knowledge and performance more efficiently than do standard methods of instruction. The other is that videotaped modeling of parenting skills is as effective in producing improvements in child behavior as are parent education discussion groups and parent training with a therapist. The CD-ROM program is self-administered, highly interactive, and brief, requiring no trained staff for its delivery. Users receives feedback about their choices from the computer, not a person, thus minimizing defensiveness. Controlled evaluations show improvements in knowledge and parenting skills, and reductions in child behavior problems. Many teens moved from the clinical range of behavior problems to the normal range after their mothers used the program. Replication efforts by service providers and universities are underway due to the program's ease of implementation and evaluation. Gaps in knowledge about this approach include general long-term effects, and, more specifically, how the program will affect ethnically diverse populations, how repetition and use by other family members affects outcomes, and how to overcome mental health professionals' resistance to the technology. Prevention practice can be improved with this approach since it can be disseminated relatively quickly and inexpensively, with very high treatment integrity. The convenience and lack of stigma can increase participation by parents prior to their becoming distressed by their children's behavior problems. Existing programs can incorporate and evaluate CD-ROM parent training, while new efforts will be encouraged by such an inexpensive program. Program changes, based upon research feedback, can be incorporated rapidly without the difficulty of retraining program staff.

Primary Socialization Theory: It All Begins with the Family

This commentary is a discussion of primary socialization theory emphasizing the centrality of family processes on adolescents' affiliation with deviant peers and subsequent deviant behaviors. The focus of the discussion is the persistent influence of family processes well into adolescence. An empirical model illustrating these processes is presented. The model is based on a sample of 257 runaway adolescents and indicates that the effects of an abusive family on adolescent behaviors are largely transmitted via affiliation with deviant peers. The author concludes that primary socialization theory would be strengthened by greater emphasis on the persistent influence of family on adolescent behaviors. Implications for family-based prevention programs are discussed.

Preventing Serious Antisocial Behavior in Inner-City Children: An Empirically Based Family Intervention Program

This article describes a 22-week family intervention program, specifically designed to prevent antisocial behavior in ur nority children. This program was developed as one component of the Metropolitan Area Child Study, a multiyear delinquen prevention field trial. A theoretical model for strengthening aritical family processes related to the emergence of anti havior is presented, and specific intervention goals, moldalities, and activities are described. Recommendations for the ment, implementation, and evaluation of family based prevention programs are highlighted. AN EMPIRICALLY BASED FAMILY INTERVENTION PROGRAM* Patrick H. Tolan and Mary McKernan McKay Early displays of antisocial behavior are a serious public health issue. Urban areas in particular have crime rates 4 to 10 times higher than the national average, with the violent crime rate highest among inner-city African American and Latino young men (Fingerhut & Kleinman, 1990; Hammond & Yung, 1991). Because urban violence has risen dramatically since the 1950s, the prevention of antisocial behavior has become a national priority (Tolan & Guerra, 1994; Tolan & Loeber, 1993). Family factors have been consistently implicated in studies as among the most powerful predictors of aggressive behavior (Loeber & Stouthamer-Loeber, 1987; Tolan, Cromwell, & Brasswell, 1986). Also, intervention at a family level has shown significant promise in reducing the emergence of serious antisocial beahvior (Alexander, Barton, Schiavo, & Parsons, 1976; Henggeler, Melton, & Smith, 1992; Patterson, Chamberlain, & Reid, 1982; Tolan & Mitchell, 1989; Webster-Stratton, 1990). There are indications, however, that it is difficult to secure the involvement of families with children who display high levels of aggression or conduct disorders in mental health services (Reid, 1991). Further, once aggression level becomes a clinically significant problem and a conduct disorder is established, intervention effectiveness may be limited (Tolan & Loeber, 1993). Thus, there are clear advantages to implementing preventive interventions prior to the formation of serious, chronic problems and to focusing prevention on families. Previous studies have found that family intervention programs are less successful in involving families who are of low socioeconomic status, experience more stressors, and/or have fewer social resources (Miller & Prinz, 1990; Wahler & Dumas, 1989; Webster-Stratton, 1990). It is children from these segments of society who are most at risk for serious behavioral difficulties, yet they are the least focused upon in prevention programming. This article describes one effort to reach at-risk children and their families with a 22-week family intervention program specifically designed to prevent the development of serious antisocial behavior in urban minority children. We describe the critical family processes related to the emergence of childhood behavioral difficulties that guide the intervention design, features that enhance participation, and common impediments to family-oriented prevention. The family program described here was developed as part of the Metropolitan Area Child Study (MACS), a multiyear, delinquency prevention field trial (Guerra, Tolan, Huesmann, VanAcker, & Eron, 1990). The MACS program is a combined universal and selected prevention program meant to impact norms that support aggression in the general population and to reduce aggressive behavior in a high-risk sample. Prevention efforts can be differentiated by the population of interest (Gordon, 1983; Institute of Medicine, 1993; Tolan & Guerra, 1994). Universal programs focus on the whole population, are usually less extensive, and are designed to lessen subsequent prevalence. Selected programs target at-risk groups to lessen the proportion who later exhibit the problem to be prevented. Indicated populations programs focus on those exhibiting early forms or predisposing characteristics for the outcome to be prevented. …

Coalitions and Family Problem Solving with Preadolescents in Referred, At‐Risk, and Comparison Families

This study tested the hypothesis that the mother-father coalition, parent-child coalitions, and parental warmth expressed toward the child are associated with family problem solving in families with a preadolescent child referred for treatment of behavior problems (n = 30), families with a child at-risk for conduct disorder (n = 68), and a sample of comparison families (n = 90). Referred and at-risk families displayed less effective problem solving. A regression analysis, which controlled for gender of the child, family structure, family income, marital satisfaction, and severity of child problems, showed that strong parental coalitions were linked to low levels of family problem solving in at-risk and referred families. Parent-child coalitions had little apparent impact while parental warmth was highly correlated with better family problem solving. The results may be interpreted as evidence for a tendency for parents in at-risk and referred families to "scapegoat" a preadolescent during family problem-solving sessions. This may undermine progress on family problem solutions and may complicate family-based prevention and treatment programs that use family problem-solving sessions.