Strengthening Families Program Research Articles

Cultural accommodation of the Strengthening Families Programme 10-14: UK Phase I study

Social and cultural differences between the United States and the United Kingdom mean that positive results from US prevention programmes may not translate to the United Kingdom. The Strengthening Families Programme 10-14 (SFP10-14) has been evaluated in a large Phase III randomized controlled trial in rural Iowa in the United States and shown to be effective for delaying alcohol and drug initiation. This paper reports the first stage of the adaptation and evaluation of the SFP10-14 for the United Kingdom through a process of cultural accommodation of the SFP10-14 materials and format. Themes that emerged in nominal group and focus group research with young people and their parents indicated that changes to the US SFP10-14 materials needed to consider language, narrators, realism, acceptability of exercises/games, perceived religiosity and ethnic representativeness. However, not all changes reflected straightforward cultural differences, as adaptations were also required to improve the quality and to update the material, indicating that cultural accommodation does not necessarily imply cultural diversity.

Long-term Effects of Universal Preventive Interventions on Methamphetamine Use Among Adolescents

To examine the long-term effects of universal preventive interventions on methamphetamine use by adolescents in the general population during their late high school years. Two randomized, controlled prevention trials. Public schools in the Midwest from 1993 to 2004. Study 1 began with 667 sixth grade students from 33 rural public schools; the follow-up included 457 students. Study 2 began with 679 seventh grade students from 36 rural public schools; the follow-up assessment included 597 students. In study 1, schools were assigned to the Iowa Strengthening Families Program (ISFP), Preparing for the Drug Free Years, or a control condition. In study 2, schools were assigned to a revised ISFP (SFP 10-14) plus Life Skills Training (SPF 10-14 + LST), LST alone, or a control condition. Self-reports of lifetime and past-year methamphetamine use were collected at 6(1/2) years past baseline (study 1) and at 4(1/2) and 5(1/2) years past baseline (study 2). In study 1, the ISFP past-year rate was 0.0% compared with 3.2% in the control condition (P = .04). In study 2, SFP 10-14 + LST showed significant effects on lifetime and past-year use at the 4(1/2) year follow-up (eg, 0.5% lifetime use in the intervention condition vs 5.2% in the control condition, P = .006); both SFP 10-14 + LST and LST alone had significant lifetime use effects at the 5(1/2) year follow-up. Brief universal interventions have potential for public health impact by reducing methamphetamine use among adolescents.

Universality of Effects: An Examination of the Comparability of Long-Term Family Intervention Effects on Substance Use Across Risk-Related Subgroups

This study extends earlier investigation of family risk-related moderation of two brief, family-focused preventive interventions. It examines effects on the trajectories of substance initiation over a period of six years after a pretest assessment, evaluating whether effects were comparable across higher- and lower-risk subgroups. The two interventions, designed for general-population families of adolescents, were the seven-session Iowa Strengthening Families Program (ISFP) and the five-session Preparing for the Drug Free Years program (PDFY). Thirty-three rural public schools were randomly assigned to either the ISFP, the PDFY, or a minimal contact control condition. Curvilinear growth curve analyses were used to evaluate the universality of intervention effectiveness by testing for risk moderation of intervention effects on school-level substance use trajectories of initiation of alcohol and illicit substance use. Results were most consistent with the interpretation that both interventions provided comparable benefits for both outcome measures, regardless of family risk status. Findings are discussed in terms of their implications for implementing universal preventive interventions in general populations.

The Cultural Education of Academic Evaluators: Lessons from a University‐Hmong Community Partnership

This article explores some of the lessons a university-based evaluation team learned while attempting to hire, retain, and work with staff members from a local Hmong community. These staff members were hired to assist a federally-funded community collaborative with implementing and evaluating a family strengthening program for Hmong families with adolescents. Over the course of two years, a succession of individuals were hired and resigned from a key staff position. These resignations occurred at critical points in the project, undermining a critical component of the program's evaluation. Through interviews, observations, self-reflection, and feedback from colleagues and reviewers, a better understanding of the reasons for these difficulties began to emerge. The challenges examined in this article help to illustrate some of the complexities faced by academics when conducting a community-based project with an underserved racial ethnic population. The article concludes by discussing some of the lessons learned and what they might suggest for others doing similar types of work.

The Strengthening Washington D.C. Families Project: A Randomized Effectiveness Trial of Family-Based Prevention

The Strengthening Washington DC Families Project (SWFP) examined implementation fidelity and effectiveness when a selective, evidence-based prevention program was implemented with a sample of 715 predominantly African American families across multiple settings in an urban area. Using a true experimental design, this study reports on the differential effectiveness of four conditions (child skills training only, parent skills training only, parent and child skills training plus family skills training, and minimal treatment controls) in reducing child antisocial behavior and its precursors. Major challenges with recruitment and retention of participants and uneven program coverage were documented. No statistically significant positive effects for any of the program conditions were observed, and a statistically significant negative effect on child reports of Negative Peer Associations was observed for children of families assigned to the family skills training condition. Two marginally significant findings were observed: Child's positive adjustment favored families assigned to family skills training condition relative to minimal treatment and child training only, and family supervision and bonding was lower for children in family skills training than in the other three conditions. Hypotheses about potential explanations for the weaker than expected effects of this program are offered, as are thoughts about the infrastructure necessary to successfully implement family strengthening programs and the future of prevention science.

Cultural Adaptations to a Family Life Skills Program: Implementation in Rural Appalachia

Numerous parent education programs have been developed to provide parents with the skills and support necessary to effectively improve their parenting abilities. The Strengthening Families Program (SFP) employs a "family skills training" approach for parents and their children (ages 6 to 10). This study focuses on the implementation and outcomes of a culturally adapted SFP in southwestern Virginia, an area known for its Appalachian culture. Two groups were compared (those that received an adapted curricula and those that did not) on retention rates, parental outcomes, child outcomes, and program satisfaction. Retention rates were significantly improved for those participants in the adapted curricula group; however, parent and child outcomes were not affected. Statistically significant improvements for parents were found in effective discipline practices, family cohesion, family conflict, confidence in parenting, and punishment practices; and for both groups of children in increased child social skills and closeness to mothers between pre- and post-test times.

Interventions for prevention of drug use by young people delivered in non-school settings

Interventions intended to prevent or reduce use of drugs by young people may be delivered in schools or in other settings. This review aims to summarise the current literature about the effectiveness of interventions delivered in non schools settings. (1) - To summarise the current evidence about the effectiveness of interventions delivered in non-school settings intended to prevent or reduce drug use by young people under 25;(2) - To investigate whether interventions' effects are modified by the type and setting of the intervention, and the age of young people targeted;(3) - To identify areas where more research is needed. We searched Cochrane Central Register of Controlled Trials (CENTRAL - The Cochrane Library Issue 4, 2004), MEDLINE (1966-2004), EMBASE (1980-2004), PsycInfo (1972-2004), SIGLE (1980-2004), CINAHL (1982-2004) and ASSIA (1987-2004). We searched also reference lists of review articles and retrieved studies. Randomised trials that evaluated an intervention targeting drug use by young people under 25 years of age, delivered in a non-school setting, compared with no intervention or another intervention, that reported substantive outcomes relevant to the review. Two authors independently assessed trial quality and extracted data. Results were tabulated, as studies were considered too dissimilar to combine using meta-analysis. Seventeen studies, 9 cluster randomised studies, with 253 clusters, 8 individually randomised studies with 1230 participants, evaluating four types of intervention: motivational interviewing or brief intervention, education or skills training, family interventions and multi-component community interventions. Many studies had methodological drawbacks, especially high levels of loss to follow-up. There were too few studies for firm conclusions. One study of motivational interviewing suggested that this intervention was beneficial on cannabis use. Three family interventions (Focus on Families, Iowa Strengthening Families Program and Preparing for the Drug-Free Years), each evaluated in only one study, suggested that they may be beneficial in preventing cannabis use. The studies of multi component community interventions did not find any strong effects on drug use outcomes, and the two studies of education and skills training did not find any differences between the intervention and control groups. There is a lack of evidence of effectiveness of the included interventions. Motivational interviewing and some family interventions may have some benefit. Cost-effectiveness has not yet been addressed in any studies, and further research is needed to determine whether any of these interventions can be recommended.

Community Alternatives for Love and Limits (CALL): A community-based family strengthening multi-family intervention program to respond to adolescents at risk

Family strengthening has become a source of growing interest, research, and program design in the fields of prevention and treatment for problems of youth delinquency, school failure, alcohol, tobacco and other drug abuse (ATOD). Despite many studies that illustrate the positive outcomes of family strengthening programs and family-focused interventions, their use in communities has not advanced commensurate with their promise. This article offers a rationale for why programming efforts should continue to be directed towards family strengthening efforts as opposed to youth-focused only interventions. In addition, a community-based, family-strengthening alternative is described that addresses issues of youth delinquency while reducing barriers associated with availability, accessibility, and cost.

FINGERS BURNT: A COMMENT ON FOXCROFT (2005)

FINGERS BURNT: A COMMENT ON FOXCROFT (2005)

Family-Based Treatment Models Targeting Substance Use and High-Risk Behaviors Among Adolescents

Recent reviews of services for families with youths coping with a wide variety of problems have strongly urged inclusion of families in all services. This manuscript will review family-based intervention models that have considerable empirical support for treating adolescent substance abuse and have demonstrated success in preventing substance use. Major interventions reviewed include: Multisystemic Family Therapy, Strengthening Families Program, Brief Strategic Family Therapy, Multidimensional Family Therapy, and Integrated Behavioral Family Therapy.

Challenges in Disseminating Model Programs: A Qualitative Analysis of the Strengthening Washington DC Families Program

This article discusses the challenges faced when a popular model program, the Strengthening Families Program, which in the past has been implemented on a smaller scale in single organizations, moves to a larger, multiorganization endeavor. On the basis of 42 interviews conducted with program staff, the results highlight two main themes that address program and organizational characteristics. The themes relate to the cultural relevance of the program, the accessibility of program partners, the organization of program services, and the coordination of program activities. The article also offers a discussion of how to better prepare sites for program delivery. This discussion focuses explicitly on the need for good communication among program partners, extensive community outreach, and the ability to secure additional resources.

Parent/Child Transactional Processes Predictive of Resilience or Vulnerability to “Substance Abuse Disorders”

This article discusses implications of a theoretical model of resilience—the Resilience Framework, including the impact of parent/child transactional processes in moderating or mediating a child's biological or environmental risks and later substance misuse. Research is presented on behavioral and emotional precursors of substance abuse disorders in children of substance users. Detrimental processes within dysfunctional family environments are presented followed by a listing of strategies for increasing resilience in youth by improving family dynamics. The value in elucidating these interactive processes is to increase our understanding of ways to reduce the impact of risk factors. Prevention providers should use these strategies as benchmarks for selecting or developing effective family-focused prevention programs. Resources are presented for finding effective family interventions as well as an example of a family intervention based on resilience principles, namely the Strengthening Families Program. Recommendations are made for future research and better dissemination of evidence-based family interventions.

Exploratory Study of a Preventive Intervention with General Population African American Families

The authors report the intervention implementation and outcome evaluation of the Strengthening Families Program: For Parents and Youth 10-14 (SFP 10-14),involving a sample of African American families with young adolescents. Implementation feasibility clearly was demonstrated. A sufficient number of families was recruited successfully, retention rates were strong, and observer ratings showed high adherence to the intervention protocol. Control group comparisons at posttest showed positive results for intervention-targeted child behaviors and for child participation in family meetings but not for other outcome measures. Findings of the investigation are discussed in terms of their relevance to ongoing intervention research with minority populations and considered in light of study limitations.

Longer-term primary prevention for alcohol misuse in young people: a systematic review.

To identify and summarize rigorous evaluations of psychosocial and educational interventions aimed at the primary prevention of alcohol misuse by young people aged up to 25 years, especially over the longer term (>3 years). Cochrane Collaboration Systematic Review. A comprehensive search of 22 databases and recursive checking of bibliographies for randomized and non-randomized controlled trials and interrupted time-series studies. Objective or self-report measures of alcohol use and misuse. Fifty-six studies were selected for inclusion in the systematic review. Twenty of the 56 studies showed evidence of ineffectiveness. No firm conclusions about the effectiveness of prevention interventions in the short- and medium term were possible. Over the longer term (>3 years), the Strengthening Families Programme (SFP) showed promise as an effective prevention intervention. The Number Needed to Treat (NNT) for the SFP over 4 years for three alcohol initiation behaviours (alcohol use, alcohol use without permission and first drunkenness) was 9 (for all three behaviours). One study also highlighted the potential value of culturally focused skills training over the longer-term (NNT = 17 over 3.5 years for 4+ drinks in the last week) (1) Research into important outcome variables needs to be undertaken; (2) the methodology of evaluations needs to be improved; (3) the SFP needs to be evaluated on a larger scale and in different settings; (4) culturally focused interventions require further development and rigorous evaluation; and (5) an international register of alcohol and drug misuse prevention interventions should be established and criteria agreed for rating prevention interventions in terms of safety, efficacy and effectiveness.

Family-Based Interventions for Substance Use and Misuse Prevention

Because “substance abuse” is a “family disease” of lifestyle, including both genetic and family environmental causes, effective family strengthening prevention programs should be included in all comprehensive substance abuse prevention activities. This article presents reviews of causal models of substance use and evidence-based practices. National searches by the authors suggest that there is sufficient research evidence to support broad dissemination of five highly effective family strengthening approaches (e.g., behavioral parent training, family skills training, in-home family support, brief family therapy, and family education). Additionally, family approaches have average effect sizes two to nine time larger than child-only prevention approaches. Comprehensive prevention programs combining both approaches produced much larger effect sizes. The Strengthening Families Program (SFP) is the only one of these programs that has been replicated with positive results by independent researchers with different cultural groups and with different ages of children. Few research-based programs have been adopted by practitioners, partly because of technology transfer issues. Overall, research on ways to improve dissemination, marketing, training, and funding is needed to improve adoption of effective prevention programs.

Primary prevention for alcohol misuse in young people.

Alcohol misuse is a cause of concern for health services, policy makers, prevention workers, the criminal justice system, youth workers, teachers and parents. 1. To identify and summarize rigorous evaluations of psychosocial and educational interventions aimed at the primary prevention of alcohol misuse by young people. 2. To assess the effectiveness of primary prevention interventions over the longer-term (> 3 years). Databases searched (no time limits): Project CORK, BIDS, PSYCLIT, ERIC, ASSIA, MEDLINE, FAMILY-RESOURCES-DATABASE, HEALTH-PERIODICALS-DATABASE, EMBASE, BIDS, Dissertation-Abstracts, SIGLE, DRUG-INFO, SOMED, Social-Work-Abstracts, National-Clearinghouse-on-Alcohol-and-Drug-Information, Mental-Health-Abstracts, DRUG-database, ETOH (all searched Feb-June 2002). 1. randomised controlled and non-randomised controlled and interrupted time series designs. 2. educational and psychosocial primary prevention interventions for young people up to 25 years old. 3. alcohol-specific or generic (drugs; lifestyle) interventions providing alcohol outcomes reported. 4. alcohol outcomes: alcohol use, age of alcohol initiation, drinking 5+ drinks on any one occasion, drunkeness, alcohol related violence, alcohol related crime, alcohol related risky behaviour. Stage 1: All papers screened by one reviewer against inclusion criteria. Stage 2: For those papers that passed Stage 1, key information was extracted from each paper by 2-3 reviewers. 20 of the 56 studies included showed evidence of ineffectiveness. No firm conclusions about the effectiveness of prevention interventions in the short- and medium-term were possible. Over the longer-term, the Strengthening Families Program (SFP) showed promise as an effective prevention intervention. The Number Needed to Treat (NNT) for the SFP over 4 years for three alcohol initiation behaviours (alcohol use, alcohol use without permission and first drunkeness) was 9 (for all three behaviours). One study also highlighted the potential value of culturally focused skills training over the longer-term (NNT=17 over three-and-a-half years for 4+ drinks in the last week). 1. Research into important outcome variables needs to be undertaken. 2. Methodology of evaluations needs to be improved. 3. The Strengthening Families Programme needs to be evaluated on a larger scale and in different settings. 4. Culturally-focused interventions require further development and rigorous evaluation. 5. An international register of alcohol and drug misuse prevention interventions should be established and criteria agreed for rating prevention intervention in terms of safety, efficacy and effectiveness.

Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs.

This study evaluated the substance initiation effects of an intervention combining family and school-based competency-training intervention components. Thirty-six rural schools were randomly assigned to 1 of 3 conditions: (a) the classroom-based Life Skills Training (LST) and the Strengthening Families Program: For Parents and Children 10-14, (b) LST only, or (c) a control condition. Outcomes were examined 1 year after the intervention posttest, using a substance initiation index (SII) measuring lifetime use of alcohol, cigarettes, and marijuana and by rates of each individual substance. Planned intervention-control contrasts showed significant effects for both the combined and LST-only interventions on the SII and on marijuana initiation. Relative reduction rates for alcohol initiation were 30.0% for the combined intervention and 4.1% for LST only.

Neglect: Opportunities for collaboration between health and welfare: The Strengthening Families Program at the Royal Children's Hospital

Persistent neglect is thought to be just as harmful to a child as abuse. However, neglect is often difficult to assess for two reasons: firstly it often resembles poverty; and secondly, neglecting families tend to have disorganised patterns of accessing health care and social support. This article looks at the importance of joint health and welfare input in interventions with families at risk of neglecting their children. The Strengthening Families Program at Melbourne's Royal Children's Hospital provides a model for interdisciplinary and intersectoral (welfare and health) collaboration, which offers care management to individual families and is working towards systemic changes in the hospital's response to these families.

Improving hospital systems for disadvantaged children and babies

In this paper, I will discuss the importance of early intervention with vulnerable families where children and babies may be at risk of neglect and disadvantaged by their social circumstances in accessing appropriate, preventative support services. I will describe the Strengthening Families Program located in the Social Work Department of the Royal Children's Hospital, which provides a model for interdisciplinary and intersectoral (welfare and health) collaboration. The Program offers care management to individual families and is working towards systemic changes in the hospital's response to these families. Finally, I will illustrate aspects of the work of the Royal Children's Hospital Strengthening Families Program with a case study wherein a recent history of domestic violence impacted on the family's capacity to access health and welfare services for both mother and children.

Cultural sensitivity and adaptation in family-based prevention interventions.

Because of the substantial impact of families on the developmental trajectories of children, family interventions should be a critical ingredient in comprehensive prevention programs. Very few family interventions have been adapted to be culturally sensitive for different ethnic groups. This paper examines the research literature on whether culturally adapting family interventions improves retention and outcome effectiveness. Because of limited research on the topic, the prevention research field is divided on the issue. Factors to consider for cultural adaptations of family-focused prevention are presented. Five research studies testing the effectiveness of the generic version of the Strengthening Families Program (SFP) compared to culturally-adapted versions for African Americans, Hispanic, Asian/Pacific Islander, and American Indian families suggest that cultural adaptations made by practitioners that reduce dosage or eliminate critical core content can increase retention by up to 40%, but reduce positive outcomes. Recommendations include the need for additional research on culturally-sensitive family interventions.