Family Skills Training for Parents and Children

U.S. Department of Justice Office of Justice Programs Office of Juvenile Justice and Delinquency Prevention

John J. Wilson, Acting Administrator April 2000

engthen tr ing S S ly e i r m ie Family Skills a s F From the Administrator Training for Parents Often juvenile crime and violence are rooted in an array of interrelated problems, such as child maltreatment and and Children neglect, drug and alcohol abuse, and youth conflict, that may originate within the family. As part of its mission to prevent juvenile delinquency and protect Karol L. Kumpfer and Connie M. Tait children, the Office of Juvenile Justice and Delinquency Prevention (OJJDP) is The Office of Juvenile Justice and Delin- their children avoid drug use. Program committed to working to enhance the quency Prevention (OJJDP) is dedicated to developers (Kumpfer and DeMarsh, 1983) positive influence of families through preventing and reversing trends of increased believed that, to reduce risk factors in proven family-strengthening programs. delinquency and violence among adoles- children of substance abusers, one must cents. These trends have alarmed the pub- improve the family environment and the This Bulletin, one of OJJDP’s Family lic during the past decade and challenged parents’ ability to nurture and provide Strengthening Series, features the the juvenile justice system. It is widely ac- appropriate learning opportunities for Strengthening Families Program. The cepted that increases in delinquency and their children. SFP was initially tested program reflects research that indicates violence over the past decade are rooted in with clients who were participating in that the most effective interventions a number of interrelated social problems— either outpatient treatment for drug build parent, child, and family skills. child abuse and neglect, alcohol and drug abuse or a methadone maintenance pro- abuse, youth conflict and aggression, and gram through community mental health Originally designed as a drug abuse prevention program to help drug- early sexual involvement—that may origi- services. The families in the experimental nate within the family structure. The focus group were randomly assigned to one of abusing parents and their children, the Strengthening Families Program of OJJDP’s Family Strengthening Series is to three groups, each of which attended a provide assistance to ongoing efforts across different type of session: a 1-hour parent has developed into a family-change program that has served the needs of cul- the country to strengthen the family unit by training session; separate 1-hour training discussing the effectiveness of family inter- sessions for parents and for children; or turally and geographically diverse families and their children across the Nation. vention programs and providing resources separate 1-hour classes for parents and to families and communities. for children, followed by a 1-hour session Several examples of such varied ad- for the entire family. Families in the con- aptations of the program’s strategy trol group received no treatment. Each are described in these pages. Sug- History group met for 14 weeks and received in- gestions for implementing the pro- The Strengthening Families Program (SFP) centives, including transportation, child- gram in communities are also pro- began in 1983 as a 4-year prevention re- care, snacks, and prizes for attendance vided, as are additional resources search project funded by the National In- and homework completion, to increase that should prove useful. stitute on Drug Abuse (NIDA). Because of retention. the project’s promising results, SFP has When we strengthen the family, we The research results indicated that the been replicated, revised, and adapted for strengthen the child—and the future intervention that combined all three com- diverse population groups throughout the of our Nation. ponents (parent skills, child skills, and Nation. The program was designed as a family skills) was the most successful. SFP John J. Wilson drug abuse prevention program for high- increased children’s positive behavior Acting Administrator risk, drug-abusing parents to help them and prosocial skills, improved adults’ improve their parenting skills and help parenting skills, and enhanced the family environment by improving communica- have been developed for English-speaking for announcements, and some programs tion, clarifying family rules, and decreas- Australian families and French- and English- provide a snack or a small meal. Follow- ing family conflict. speaking families in Canada. The Texas ing this group time, parents and children Commission on Alcohol and Drug Abuse spend the first hour in their respective (TCADA) is funding replications in Texas. groups. They spend the second hour to- Purpose NIDA has selected SFP as one of 10 exem- gether in family skills training. Research The Strengthening Families Program is one plary delinquency prevention programs has demonstrated that, for both the par- of the most powerful family change pro- and funded research on SFP in the Wash- ents and children, family skills practice grams in the Nation because it involves the ington, DC, area. helps families make and sustain improve- whole family instead of the parents or the ments in their interactions. children alone (Kumpfer, 1994a). The initial The SFP curriculum includes 6 manuals goal was to design and test the relative Appropriate Target covering each of the 3 components of the effectiveness of three family-based and Populations 14-session courses. The manuals are the behavior-oriented prevention interventions The original Strengthening Families Pro- following: (a Parent Training Program, a Children’s gram has been culturally adapted and Skills Training Program, and a Family Skills tested with urban and rural families with ◆ A Parent Trainer’s Manual and Parent Training Program) in reducing the risk elementary school-age children. (Kumpfer, Handbook, which include behavioral that children (ages 6 to 10) living with 1995; Aktan, Kumpfer, and Turner, 1996). and cognitive strategies and homework substance-abusing parents would be- SFP has proven successful with high-risk exercises for 14 sessions, to help par- come substance abusers themselves. children whose parents are not drug or ents improve their parenting, communication, and nurturing skills. SFP was designed to reduce environmen- alcohol abusers and with families of di- tal risk factors and improve protective verse backgrounds. Separate training ◆ A Children’s Skills Trainer’s Manual and factors with the ultimate objective of in- manuals have been developed for African Children’s Handbook, which include creasing personal resiliency and minimiz- American families. The African American life and social skills training and home- ing susceptibility to drug use in high-risk manuals contain the same basic content work exercises for 14 sessions, to help youth. The program is theoretically based as the original SFP but have culturally youth improve their behavior and on the Values-Attitudes-Stressors-Coping appropriate pictures and language with social competence. some specific information regarding Afri- (VASC) Skills and Resources Model theory ◆ A Family Skills Trainer’s Manual, can American families and communities. of drug abuse (Kumpfer and DeMarsh, which includes family involvement 1985) and the social ecology model of and homework exercises for 14 ses- adolescent substance abuse (Kumpfer Program Description sions, to allow family members to and Turner, 1990–91). These models practice what they have learned in SFP is presented in 14 consecutive weekly suggest that family environment is an their separate parent and youth sessions, each approximately 2 hours important factor in deterring the use sessions. of␣ alcohol and/or other drugs in youth. long. The program has two versions: SFP ◆ Family climate and parenting factors are for elementary school children and their An Implementation Manual for trainers, the major determinants of self-efficacy families and SFP for parents and youth which includes training and setup in- and the second major determinant, after 10 to 14 years of age. Each version information, materials, program logis- peer pressure, of alcohol and other drug cludes skills training for parents, children, tics, group facilitation techniques, and use. Recent research (Ary et al., 1999) and families. Parents and children meet ethical questions. finds family attachment, supervision, and together at the beginning of each session family norms are strategies and pathways that protect youth from drug use. Because family environment influences every aspect of a child’s life, improving parent- child relations should be a major goal of any prevention/intervention program. SFP has been tested, evaluated, and replicated in a variety of settings. Positive results have been documented in inner-city Detroit, MI; rural Alabama and Iowa; Ha- waii; and urban Utah. SFP has been modified to provide culturally appropriate interventions for African American, Hispanic, Asian/Pacific Islander, and low-income rural families. These modifications have been funded by a series of independent Center for Substance Abuse Prevention (CSAP) Federal grants to prevention/ treatment agencies that target different ethnic populations. New versions of SFP

2 Parent Skills Training Each session begins with a review of homework and concepts covered during the previous week. The training material is presented in a variety of ways including exercises, videos, lectures, discussions, and role-plays. New concepts are then reviewed and new homework is assigned. The optimum number of participants for parenting groups is 8 to 12 sets of parents. Child care should be available for participants with children under age 6. The Parent Training Therapist Manual includes group exercises and homework forms, a communication section adapted from the Relationship Enhancement Pro- gram (Guerney, 1997), and sections on developmental age/stage-appropriate behaviors and drug education. A session spinners are described as a way to en- ◆ Development/Implementation of be- for parents on changing problem behavior courage good behavior. Charts list and havior programs: This session reviews has been empirically demonstrated to record the child’s progress on target the process of implementing the abbre- increase the endurance of appropriate behaviors the parent wants to improve viated behavioral program. Parents behavior. (e.g., making the bed, brushing teeth, develop a plan for the first week of a or cleaning the bedroom). The spinner behavior program for their child. Outline of Parent Skills has rewards for achieving target be- ◆ Generalization and maintenance: This Training Sessions haviors the parent and child have session teaches parents to fade re- chosen together. ◆ Introduction and group building: This wards (rewarding every other time for session presents group building exer- ◆ Communication I: This session teaches several weeks and then rewarding only cises and a short lecture on learning parents about listening and speaking, occasionally if the desired behavior theory. Goals include discussing “I” messages, and roadblocks to continues), look for naturally occurring change, focusing on positive thoughts, communication. rewards, troubleshoot, and maintain and encouraging parents to observe ◆ Communication II: This session rein- behavioral changes in their children. their child’s good behavior. forces concepts covered in the previ- ◆ Developmental expectancies and ous session with extensive role-play. Children’s Skills stress management: This session dis- ◆ Alcohol, drugs, and families: This ses- Training cusses physical, mental, social, and sion introduces the parent’s role in pre- In each SFP session, the children meet emotional development with a focus vention of children’s problem behaviors on appropriate and realistic expecta- in groups to learn how to increase their and awareness of at-risk behaviors. communication, social, and peer resis- tions for children at different ages. A ◆ Problem solving, giving directions: section on stress and anger manage- tance skills. The curriculum was designed This session teaches the basic steps of to teach a variety of prosocial skills using ment teaches parents what to do problem solving and reinforces them when they feel overwhelmed. a modified Social Skills Training Program with role-play. Making requests, giving (Spivack and Shure, 1979). ◆ Rewards: This session covers reward- clear directions, and delivering effec- ing children for good behavior, “at- tive commands are discussed. Ideally, there should be two trainers per tends” (describing and emphasizing group. The optimum number of partici- ◆ Limit setting I: This session introduces positive behavior), and providing so- pants in the children’s group is 6 to 8. timeouts, overcorrection, positive cial rewards. Parents are encouraged Like the parents’ sessions, each children’s practice, and the parents’ game. to “catch their children being good.” session begins with a review of homework ◆ Limit setting II: This session covers the assigned and concepts presented during ◆ Goals and objectives: This session fo- issue of punishment, including how to the previous week’s meeting. Children are cuses on setting general goals, defining solve a child’s problem behavior by then taught new material through exer- good behavior, setting behavioral goals setting appropriate limits. cises, games, coloring and workbook ac- and objectives, and making positive tivities, role-plays, puppet shows, and dis- ◆ Limit setting III: This session helps par- statements to children. cussions. The trainers then review the ents continue to solve problems in a ◆ Differential attention/Charts and spin- material and assign new homework. Chil- variety of situations, including those ners: This session teaches parents the dren may receive prizes for good behavior. supplied in the handbook, that may be skill of rewarding good behavior and relevant to their individual needs. ignoring bad behavior. Charts and

3 During the second phase of these sessions, elements of the Family Relationship Enhancement Program (Guerney, 1997) are introduced. The parents practice appropriate behavior modeled by the facili- tator. Two facilitators introduce a problem and model appropriate problem solving and communication skills. The families then role-play problem situations using the communications skills they have learned and observed. The therapist provides immediate reinforcement by praising appropriate actions. In the third phase of sessions, parents learn to control their children’s play. The parents practice setting appropriate limits and rewarding good behavior. The Family Skills Training program, each session of which lasts 1 hour, includes Outline of Children’s Skills ◆ Introduction to parents’ game: This both parents’ and children’s groups. The Training Sessions session teaches children to give effec- format includes both didactic and experi- tive directions through discussion and ential activities. At least two trainers ◆ Hello and rules: This session welcomes demonstration. per group are needed to assist with the children to the group with games and children’s and parents’ games and to songs. Group rules and a Dynamic ◆ Coping skills I: This session teaches provide individual support. The didactic Doer’s chart are developed. children to recognize feelings in themselves and others and to understand activities include brief lectures on behav- ◆ Social skills I: This session discusses ior change, rewards, giving directions, that different people may have differ- conversation skills, especially listen- ent feelings about the same situation. and commands. The experiential activi- ing. Role-play reinforces the concept ties include families participating in the of social skills. ◆ Coping skills II: This session focuses children’s game, parents’ game, and role- on how to give and receive criticism. ◆ Social skills II: This session covers plays on communication and problem speaking skills such as eye contact, ap- ◆ Coping skills III: This session allows solving. propriate distance, appropriate voice children to discuss things that make volume, praise, and complimenting. them mad and offers strategies for cop- Outline of Family Skills ing with, controlling, and expressing ◆ Creating good behavior: This session Training Sessions anger. teaches children the secret rules of ◆ Introduction and group building: This success. Children role-play relevant ◆ Graduation, resources, and review: session presents the rationale, format, situations to practice the rules. This session teaches children about and mechanics of the family compo- other resources that can help them if nent and begins the children’s game. ◆ How to say “no” to stay out of trouble: they have problems when their parents This session teaches children four ◆ Children’s game: This session helps are unavailable. Children then review basic steps to stay out of trouble parents conceptualize problems in the all 14 sessions. through discussion, games, stories, context of the parent-child interaction and role-plays. and begins training for the children’s game. ◆ Communication I: This session dis- Family Skills Training cusses family talks and “I feel” mes- This intervention program, the final com- ◆ Children’s game/Rewards: Parents and sages. A family meeting is assigned ponent in SFP, brings parents and children children practice the children’s game as homework. together. It incorporates the curriculum while trainers review attending skills ◆ Communication II: Using puppets and described in Helping the Noncompliant (describing good behavior the parent sees and emphasizing good behavior role-plays, this session illustrates the Child (Forehand and McMahon, 1981). concept of asking a friend for help. The Family Skills Program follows the the parent wants). parents’ and children’s groups. These ◆ Goals and objectives: Parents and chil- ◆ Alcohol and drugs: This session sessions are designed to help parents teaches children the effects and conse- dren continue to practice the children’s empathize with and enjoy their children. game. quences of alcohol and drug use with The nonpunitive environment helps chil- ◆ stories, lectures, and discussion. dren and parents express their feelings Differential attention/Charts and spin- ◆ Problem solving: This session presents and thoughts with the support of program ners: Families make charts and spinners and continue the children’s game. seven steps to solving problems. Chil- facilitators. The goal of the family session dren role-play several examples to re- is to increase the cooperation of all family ◆ Communication I: Families prac- inforce the concept. members. tice level 1 communication skills

4 (i.e., addressing nonthreatening is- ◆ Group facilitation techniques. toral dissertation with a general popula- sues that have nothing to do with the ◆ Ethical questions. tion of high-risk families recruited through families). elementary schools. Three years of follow- Trainers are the program’s most valuable ◆ up data, through the ninth grade, found Communication skills II: Families prac- resource. SFP functions best with differ- tice communication skills at levels 2, 3, significantly less substance abuse among ent trainers and cotrainers for the par- youth participating in the Iowa SFP than and 4. In level 2, the topic of conversa- ents’ and children’s skills-training groups. tion is again restricted to areas that do among their nonparticipating peers During the family skills sessions, if the (Spoth, 1998). not involve the families to concentrate numbers are large and the families are on using their skills. In level 3, the divided into two groups, two trainers are The first 5 years of CSAP grants have families begin discussing a topic of needed for each group. If the families re- yielded positive results for the SFP sites interpersonal relevance. In level 4, main in one group, it is recommended in Colorado. The results are available in families begin discussing actual prob- that all four trainers facilitate the family an evaluation report that has not yet been lems or issues in their families. session. In SFP for youth ages 10 to 14, published. Changes reported by partici- ◆ Learning from parents: Families con- the entire program is on videotape, so pating families are clinically significant tinue to practice communication skills, only one trainer is required for the par- reductions in family conflict (p=0.002) and this time discussing drug and alcohol ents’ training and two additional trainers improvements in family communication issues. are needed for the children’s training. (p=0.000) and organization (p=0.000) as ◆ measured at the 0.05 level by the Moos Parents’ game/Problem solving, giving The selection of trainers is based on the (1974) Family Environment Scale. Reduc- directions: This session introduces giv- requirements of the target populations. tions in youth conduct disorders, aggres- ing effective commands and requests For example, when the program was con- siveness, and emotional problems, such and using timeouts. ducted with parents who were concur- as depression, were demonstrated using ◆ Parents’ game/Giving commands: rently enrolled in treatment for alcohol the Achenbach (1991) Child Behavior Families continue the parents’ game and/or other drug abuse problems, pro- Checklist. and practice giving clear and specific gram implementers were staff members of commands. treatment facilities or community mental Research indicates similar results with several different ethnic groups. Because ◆ health centers who received special train- Parents’ game/Consequences for coming in conducting the parent and child of these positive results in culturally pliance and noncompliance: Families components of the Strengthening Families modified adaptations of SFP, the program continue to practice the parents’ game Program. When implementing SFP with has been selected by NIDA as the only and introduce consequences for not rural African American families, staff from family program disseminated in the Tech- following directions. community crisis and counseling centers nology Transfer Program Packets on Pre- ◆ Parents’ game/Family talks: This ses- in the target areas were trained. When vention. In addition, a videotape, Coming sion introduces families to family meet- SFP was implemented in inner-city De- Together on Prevention, describes the pro- ings with a sample agenda. troit, MI, a wide range of youth and family gram for Hispanic families in Denver, CO, and its impact.1 ◆ Development/Implementation of be- service providers, including teachers and havior programs: Trainers encourage clergy, were hired to work hourly in the parents to apply the skills they have evening to accommodate working parents CSAP Replication learned to any problem situations and (Aktan, 1995). Since SFP involves both to continue practicing the children’s behavioral and cognitive changes, train- Studies game. ers who are knowledgeable in behavioral Because of SFP’s positive results, agen- training and communication and/or cogni- cies in five States succeeded in attracting ◆ Termination and graduation: This last tive therapy are well suited to facilitate demonstration/evaluation research fund- family session is a graduation party for the program. ing from CSAP. These five grants involved all participants. Families receive cer- eight different community agencies serv- tificates of completion and play games. ing high-risk families. The studies in- Evaluation Research cluded the Alabama State Department of Implementation Studies Mental Health and Mental Rehabilitation Manual The Strengthening Families Program has study of low-income, African American, been evaluated in 12 research studies by drug-using mothers in rural Alabama and The Implementation and Training Manual independent evaluators. Research results the Detroit City Health Department’s assists trainers in facilitating the from a grant funded by NIDA found posi- study of inner-city African American Strengthening Families Program by pro- tive effects for alcohol- and drug-abusing drug abusers. Both studies documented viding information and answering ques- families. SFP’s effectiveness has been dem- positive results (Aktan, 1995; Aktan, tions about getting started. The following onstrated in CSAP program evaluations Kumpfer, and Turner, 1996; Kumpfer, are some of the topics included in the with rural and urban low-income African Molgaard, and Spoth, 1996). Additional manual: American families (Aktan, Kumpfer, and ◆ Training, setup, and materials. Turner, 1996), Asian/Pacific Islander fami- 1 lies (Kameoka and Lecar, 1996), families The videotape can be ordered from the National ◆ Logistics. Clearinghouse on Alcohol and Drug Information in three counties in Utah with a 5-year (NCADI) or online from www.health.org. ◆ Problem solving. followup (Harrison, 1994), and in a doc-

5 studies demonstrated similar improve- the children showed problems in the on their homework. These parental re- ments among low-income Hispanic fami- clinical or subclinical diagnostic range ports matched trainer reports on behav- lies from housing complexes in Denver, on the intake measures before the pro- ioral improvements in the participating CO (Kumpfer, Wamberg, and Martinez, gram began. SFP was equally effective families. 1996); Asian/Pacific Islanders and His- with mothers of every education level in panic families in three Utah counties improving their parenting style and the served by four agencies (Harrison, behavior of their children. Utah Community Proskauer, and Kumpfer, 1995); and Youth Activity Asian/Pacific Islander families in Hawaii Because this study used a quasi-experimental comparison group design without a ran- Project Research (Kameoka and Lecar, 1996). A study of one SFP that was linguistically and cul- domly assigned, no-treatment control The Utah State Division of Substance group, it is impossible to determine turally modified for high-risk French Abuse implemented a quasi-experimental Canadian families and funded by the whether these positive results can be pretest, posttest, and 3-month followup attributed to SFP participation. How- Canadian Government is complete, and study comparing the effectiveness of a new culturally modified SFP for English- ever, the results are consistent with the the 14-session SFP with an 11-session positive findings of other studies of di- speaking families in Canada and Australia parenting program (Communities Empow- has been developed and implemented. verse populations. ering Parents Program) that did not include the family skills component. The Urban African American SFP study was implemented in three counties African American The SFP for African American parents in Utah with CSAP funds. Researchers SFP Results developed for the State of Alabama was recruited 421 parents and 703 high-risk modified for use in the 12-session Safe youth (ages 6 to 13) to attend one of the Rural African American SFP Haven Program in Detroit, MI (Kumpfer, two programs. Sixty-nine percent of the Bridges, and Williams, 1993). Parents in families were ethnic minorities, including The Alabama SFP program was imple- Asian/Pacific Islanders, Hispanic, and mented in Selma, AL, by the Cahaba Men- substance abuse treatment were invited to volunteer for the program. Fifty-eight American Indians. Completion of the tal Health Center. In a quasi-experimental, pretest program was very high, averaging CSAP-funded study involving a pretest, families met the program completion criteria of attending 10 of the 12 SFP ses- 85 percent across the three county sites. posttest, and 1-year followup, researchers Unfortunately, because of a lack of compared low-drug-use families whose sions, and the average completion rate was 82 to 86 percent after 3 cohorts fin- completion incentives, only 203 parents use was limited to alcohol with high-drug- and 448 youth completed the posttest. use families that used both alcohol and ished the program (Aktan, 1995). The re- illegal drugs. Sixty-two families partici- sults indicated that SFP had a significant Analysis of the pretest and posttest pated in the program, and 51 families (82 positive impact on the participating fami- change scores in Utah suggested signifi- percent) completed at least 12 of the 14 lies (Aktan, Kumpfer, and Turner, 1996), cant improvements in family environment, sessions. Pretest and posttest compari- including a marked increase in family co- parenting behaviors, and children’s be- sons of the two experimental groups re- hesion in the total sample and decreased havior and emotional status. Although vealed significant reductions in family family conflict in the low-drug-use sample. conflict in high-drug-use families and in- The families reported spending more time creased organization in low-drug-use fami- together and participating in more parent- lies (Kumpfer, 1990, 1991a). One unex- child activities. pected benefit of the family program was Parents reported decreases in drug use, that even without substance abuse treat- depression, and use of corporal punishment, high-drug-use mothers significantly ment and an increase in their perceived reduced their substance use as measured effectiveness as parents. According to by a composite index of the quantity and parental reports, children’s behavior frequency of alcohol and drug use over a problems decreased significantly in 30-day period. aggression and hyperactivity and ap- By the end of the program, the children of proached a significant decrease in delin- high-drug-use mothers were rated as sig- quency. Significant pretest to posttest nificantly improved on both the internaliz- improvements in other behavioral prob- ing and externalizing scales and on all lems—school-related difficulties, general subscales, except the subscale that mea- psychological and emotional problems, sures communicativeness. Children of low- and more specific measures of depres- drug-use mothers improved only on the sion, uncommunicativeness, obsessive- clinical scales for which they manifested compulsive tendencies, social with- relatively higher scores on the intake pre- drawal, and schizoid tendencies—were test, namely obsessive-compulsive be- found only among the children of high- havior, aggression, and delinquency. drug-use parents. Parents in both the These results suggested that SFP was high- and low-drug-use groups reported effective in reducing maternal reports that their children had more bonding ex- of children’s problem behaviors when periences at school and spent more time

6 the comparison program also yielded posi- An independent evaluation was con- mental health by reducing their hostility, tive results, they were less significant ducted (Kameoka, 1996) using a quasi- depression, anxiety, somatization (psy- (Harrison, Proskauer, and Kumpfer, 1995). experimental, pretest-posttest, non- chological distress manifested in physical equivalent control group design to symptoms), interpersonal problems, pho- In a 5-year followup study of participants evaluate the effectiveness of hypoth- bias, and paranoia. The SHF program, in in the three-county Utah Community Youth esized outcome variables on program contrast, had a positive impact only on Activity Project/SFP study (Harrison, objectives. The original 14-session SFP hostility, paranoia, and depression. Sub- Proskauer, and Kumpfer, 1995), 87 families was implemented in 4 sites and com- stance use decreased for SFP parents, were interviewed confidentially. The results pared with the 20-session, culturally re- siblings, and children but increased sig- suggested that SFP had a long-term positive vised SHF program implemented in 9 nificantly for SHF children and nonsignifi- impact on members of the subsample fami- sites. The measurement battery, which cantly for SHF parents. It is not clear why lies (Kumpfer, Molgaard, and Spoth, 1996). was culturally modified by altering the original SFP was more effective than A majority of families were still using skills words and expressions not common in the culturally tailored SHF. The shift from they had learned years earlier in SFP. Hawaii, included several different as- a behavior- to a values-based program Ninety-seven percent of the families were sessment instruments. may have decreased the emphasis on “catching their children being good,” 99 behavior change. percent believed they were giving clear Because of SFP’s high attrition (48 per- directions, 95 percent used reasonable cent) and the lack of risk-level equiva- consequences, 84 percent improved their lence between the SFP and SHF groups, The Strengthening problem solving with children, 94 percent results of the outcome comparisons enjoyed each other more, and 85 percent must be interpreted with caution. The Hispanic Families scheduled regular family playtime. Most sample size was small, the population Program important to the continued success of the was low drug users, and the curriculum The Denver Area Youth Services (DAYS) family program, 62 percent of all families was adapted to a value-based versus a in Denver, CO, modified the Strengthening interviewed continued family meetings up social learning/social skills curriculum. Families Program for greater effectiveness to 5 years after participating in SFP. Family The evaluator interpreted the SHF pro- with Hispanic children and families in meetings bring parents and children to- gram as an educational program de- several inner-city housing projects. This gether weekly to discuss family issues, signed for families not in treatment or 5-year program with high-risk youth, schedules, children’s chores and responsi- therapeutic programs. Participants re- funded by a grant from CSAP, was recently bilities, and plans for enjoyable family ac- ceiving professional mental health ser- completed. Preliminary results suggest tivities. The parents reported fewer family vices were eliminated from the data that the program was successful in at- problems, reduced stress-conflict levels, analysis to reduce bias due to their tracting and maintaining high-risk families more family fun, and greater expression of clinical status. in SFP. positive feelings. The outcome evaluation results indicated SFP and a child-only Basic Prevention that both SFP and SHF programs attained Program (BPP) comparison intervention The Strengthening the goal of strengthening family relation- were implemented with 311 participants. Hawaii Families ships and produced significant improve- Twenty-five percent of referrals came ments in areas such as family conflict, from schools and other community agen- Program family cohesion, and family organization. cies, and 75 percent came from DAYS’ ag- The Coalition for Drug-Free Hawaii has Only the original SFP resulted in statisti- gressive outreach efforts in housing com- revised SFP to be more culturally appro- cally significant (p<0.01) improvements plexes. The children ranged in age from priate for Hawaiian Asian/Pacific Island- in attitudes and ability to reward positive 5 to 12. One major success of this pro- ers. The Strengthening Hawaii Families behavior. Treatment and nontreatment gram was its high completion rate of 92 (SHF) Program has a 20-session curricu- groups differed significantly on parenting percent, which was based on two criteria: lum that emphasizes awareness of family attitudes toward physical punishment. attending at least 70 percent of the ses- values, family relationships, and commu- The mean posttest for the nontreatment sions and participating in the graduation nication skills. A 10-session family and group was 1.66, compared with 2.39 for ceremony to receive a certificate of parenting values curriculum precedes the treatment group on this variable. Be- completion (Kumpfer, Wamberg, and the 10-session SFP family management cause of low numbers and high variance, Martinez, 1996). curriculum to increase parental readi- however, this positive result can be re- ness for change. The revised curriculum ported only as a nonsignificant trend. Retention was an integral part of the followup design; 87 percent of families covers topics such as connecting with Similarly, the original SFP resulted in a one another, using caring words, build- larger mean decrease from pretest to completed the 6-month followup, and 75 percent completed the 1-year followup. A ing generational continuity, appreciating posttest in parental depression compared culture, communicating, ensuring hon- with the culturally modified SHF. Because relatively low level of risk factors is being reported for these children, possibly be- esty, making choices, building trust, of its larger sample size, which gave more expressing anger, and developing problem- power to the analysis, however, only SHF cause, unlike the original NIDA research or Alabama, Michigan, and Utah studies, solving, decisionmaking, and stress man- produced a statistically significant result. agement skills. Audiotapes and videotapes Even with a smaller sample size, SFP was this program was not targeted to children of substance abusers. Also, families often accompany the new curriculum manuals. more effective in improving children’s underreport problems at the pretest stage

7 because they are unsure about the confi- control condition. Families in the control community has been a successful method dentiality of the information they provide condition received four Cooperative Exten- of recruitment. Schools, local churches, (Kumpfer, 1991a). Baseline data suggest sion Service leaflets that provided informa- drug treatment agencies, housing authori- that the greatest increase in exposure to tion on the developmental changes of pre- ties, mental health centers, youth and so- tobacco, alcohol, and other drugs occurs teens and teens in physical, emotional, cial service agencies, and tribal councils in these Hispanic children at age 8 or 9. cognitive, and relational domains. are examples of groups that have sup- As in the Utah studies, many of the His- ported SFP and other family interven- To facilitate universal implementation panic children (33 percent) reported be- tions. Collaborative efforts with local ing sad or depressed, and 28 percent said among families of all sixth graders, the leaders can greatly enhance the ability number of sessions was reduced from 14 they have thought about hurting them- to contact and attract hard-to-reach fami- selves or committing suicide. As many as to 7. The standard SFP content and format lies (Kumpfer, 1991a). were used, including separate parenting 20 percent of these elementary school children were having difficulties adjusting and youth sessions for the first hour and a Retention is also an important issue for family session for the second hour. A total program success. An interesting program to school, and 44 percent had been involved in fistfights. of 161 families, including 114 families that that meets families’ needs and involves completed an inhome pretest assessment, them in meaningful activities is crucial to The levels of satisfaction and perception participated in 21 SFP groups at 11 differ- retention. Parents and youth can become of usefulness reported by children and ent schools. Approximately 94 percent of involved in the practical aspects of the parents in each of the two comparison pretested participants completed five or program by bringing snacks or meals, programs were almost identical. Parents more sessions, 88 percent attended at helping with attendance, and setting up rated SFP slightly higher in almost all cat- least six sessions, and 62 percent attended the room. Group leaders must be able to egories, but they rated BPP about 20 per- all seven sessions. communicate and develop positive rela- cent higher than SFP on the variables of tionships with participants. Incentives, helping children do better at school and Outcome evaluations included the use of such as coupons for food or video rentals, multi-informant, multimethod measure- making friends. The children considered payments for testing time, graduation both programs equally useful. ment procedures at pretest, posttest, gifts, prizes for completion of homework, 1-year, 2-year, and 3-year followup data- and small gifts (e.g., pencils, pens, or collection points (Molgaard, Kumpfer, and stickers) for the children based on good Spoth, 1994). The assessment included The Iowa behavior, can also enhance retention. inhome videotapes of families in struc- Hawkins and colleagues (1992) found that Strengthening tured family interaction tasks, inhome Families Program reducing barriers to participation was a interviews, and standardized instrument critical aspect of retention. They sug- measures. The Center for Family Research in Rural gested the following: Mental Health at Iowa State University se- Fidelity of program delivery was randomly ◆ Provide transportation; a safe, conve- lected SFP for a clinical research trial tar- monitored by trained research staff who geting 10- to 14-year-old youth and their nient, and nonstigmatizing place for attended two sessions each of youth and the program; and childcare. families in 19 economically disadvantaged parent groups. These skilled researchers counties in rural Iowa. SFP was modified to used detailed checklists to guide their ob- ◆ Increase the sense of ownership and place greater emphasis on youth resiliency servations and ratings of adherence to cultural relevance by using indigenous (Kumpfer, 1994b; Richardson et al., 1990). standardized SFP content and quality of leaders and involving parents in pro- The modified program focused on protec- leader delivery. Analysis of the pretest- gram modifications. tive factors associated with seven basic posttest followup data showed significant ◆ Hold discussions on possible barriers resiliency characteristics in youth (opti- changes and improvements in the parents’ mism, empathy, insight, intellectual com- to attendance. and children’s behavior, knowledge, and ◆ petence, self-esteem, direction or purpose skills. Most important, 3 years after the Extend personal invitations and con- in life, and determination or perseverance) tact participants who miss sessions. program ended, substance abuse among and seven coping or life skills (emotional SFP youth was still significantly lower than management skills, interpersonal social that of the control group counterparts. Program Site, Location, and skills, reflective skills, academic and job Youth in the control group also consumed Group Size skills, ability to restore self-esteem, plan- greater quantities of alcohol than youth in The group size and location of the pro- ning skills, and life skills and problem- the ISFP group (Spoth, 1998). gram are important factors to consider solving abilities). when implementing a family prevention Thirty-three schools were selected on the program. SFP requires at least two rooms basis of the high percentage of families par- Suggestions for for the separate youth and parent ses- ticipating in free or reduced-price school Implementation sions, with one room large enough to hold lunch programs. The true experimental de- the combined family session. Site loca- sign randomly assigned each school to one Recruiting and Retaining tions can include family support centers of three conditions: (1) Iowa Strengthening High-Risk Families in housing projects, community centers, local churches, and schools. Holding the Families Program (ISFP), (2) Preparing for Recruiting and retaining families is a chal- the Drug-Free Years (Hawkins, Catalano, lenge for any family-focused prevention program in schools increases involvement by school personnel and enhances and Miller, 1992), a five-session youth and program. Enlisting the support and assis- family program; or (3) a minimal-contact tance of family-serving agencies in the parent-school communication. Churches

8 are good locations because they are likely tings. Positive results have been shown in For more information about the Strength- to have child-friendly rooms and social inner-city Detroit, MI; rural Alabama; the ening La Familia Program, contact: halls with kitchens to prepare and serve islands of Hawaii; agricultural areas of Donna Martinez meals; they also can provide access to Iowa; and metropolitan communities of basic needs (e.g., clothes, housing, and Utah. SFP has been implemented and Denver Area Youth Services Program 1240 West Bayaud food) and volunteers for childcare and tested with African Americans, Hispanics, meal preparation. Asian/Pacific Islanders, American Indians, Denver, CO 80223 303–698–2300 and rural families in low socioeconomic The developers of SFP originally deter- groups. mined the ideal group size to be 8 to 12 families. The SFP projects found that The Strengthening Families Program is References groups of as few as 5 families and as based on the VASC Theory of Drug Abuse Achenbach, T.M. 1991. Teacher Report many as 14 families can also be effective. and the Social Ecology Model of Adolescent Form (TRF). Burlington, VT: Center for Substance Abuse. These models suggest Children, Youth, and Families, University Training of Facilitators that family environment is an important of Vermont. factor in deterring the use of alcohol and/or SFP can be delivered by teachers, commu- other drugs in youth. Improving parent- Aktan, G. 1995. Organizational frameworks nity agency staff, counselors, or persons child relations should be a major goal of of a substance use prevention program. hired from the community who are skilled any prevention/intervention program. International Journal of the Addictions at facilitating groups of parents or chil- 30(2):185–201. dren. Groups of 10 to 30 facilitators are trained for 2 days in the underlying con- For Further Information Aktan, G., Kumpfer, K.L., and Turner, C. cepts, program mechanics, recruitment 1996. Effectiveness of a family skills train- For more information about the Strength- and retention of families, curriculum, ing program for substance use prevention ening Families Program, contact: group facilitation, ethical situations, and with inner city African-American families. Substance Use and Misuse role-plays. Videotapes illustrate key con- Connie Tait, Ph.D. 31(2):157–175. cepts. Participants may choose to present University of Utah Ary, D.V., Duncan, T.E., Biglan, A., Metzler, a portion of a session for parents or chil- Department of Health Promotion C.W., Noell, J.W., and Smolkowski, K. 1999. dren to experience leading an SFP group and Education Development of adolescent problem be- with feedback from the trainer. Training 300 South 1850, East Room 215 havior. Journal of Abnormal Child Psychol- typically takes place at the requesting Salt Lake City, UT 84112–0920 ogy 27(2):141–150. agency. Additional consultation and tech- 801–585–9201 nical assistance concerning program 801–585–8498 Forehand, R.L., and McMahon, R.J. 1981. implementation and evaluation are avail- 801–581–5872 (fax) Helping the Noncompliant Child: A Clinician’s able on a program-by-program basis. E-mail: [email protected] Guide to Parent Training. New York, NY: Guilford Press. For more information about the Strength- Conclusion ening Families Program for Parents and Guerney, B.G., Jr. 1997. Relationship En- Youth 10–14, contact: hancement Skills Training Program for The Strengthening Families Program is a Therapy, Problem Prevention and Enrich- powerful and comprehensive program for Virginia Molgaard, Ph.D. ment. San Francisco, CA: Jossey-Bass. family change based on the most recent Institute for Social and Behavioral research. SFP has demonstrated a number Research Harrison, S. 1994. Evaluation Report on of positive results, including decreased 2565 North Loop, Suite 500 Utah CSAP/CYAP Project. Submitted to the use of and intention to use alcohol, to- Iowa State University Utah State Division of Substance Abuse. bacco, and other drugs; a reduction in Ames, IA 50010 Salt Lake City, UT: University of Utah, other youth behavior problems; and a 515–294–8762 Graduate School of Social Work, Social lowering of risk factors. At the same time, 515–294–3613 (fax) Research Institute. SFP has enhanced children’s protective E-mail: [email protected] Harrison, S., Proskauer, S., and Kumpfer, factors by improving family relations and Internet: www.extension.iastate.edu/ K.L. 1995. Final Evaluation Report on Utah expanding adults’ parenting skills, includ- pages/families/sfp.html CSAP/CYAP Project. Submitted to the Utah ing parental knowledge of appropriate State Division of Substance Abuse. Salt child-rearing, supervision, and relationship For more information about the Strength- Lake City, UT: University of Utah, Gradu- skills, and developmental expectations. A ening Hawaii Families Program, contact: ate School of Social Work, Social Research number of evaluation and demonstration Sandra L.W. Lacar Institute. projects have assessed the effectiveness Executive Director of SFP for children of substance abusers, Coalition for Drug-Free Hawaii Hawkins, J.D., Catalano, R.F., and Miller, children at risk for placement outside the 1130 North Nimitz Highway, Suite A–259 J.Y. 1992. Risk and protective factors for family because of child abuse and neglect, Honolulu, HI 96817 alcohol and other drug problems in ado- and low-income rural and urban parents of 808–545–3228 lescence and early adulthood: Implica- different ethnic groups. 808–545–2686 (fax) tions for substance abuse prevention. Psychological Bulletin 112(1):64–105. The SFP program has been tested, evalu- E-mail: [email protected] ated, and replicated in a variety of set- Internet: www.drugfreehawaii.org

9 Kameoka, V.A. 1996. The effects of a University of Utah. Salt Lake City, UT: Uni- Kumpfer, K.L., Wamberg, K., and Martinez, family-focused intervention on reducing versity of Utah. D. 1996 (October). Strengthening Families risk for substance abuse among Asian and Program. Workshop at second National Kumpfer, K.L., and DeMarsh, J.P. 1983. Pacific-Island youths and families: Evalua- Training Conference in Strengthening Strengthening Families Program: Parent tion of the Strengthening Hawaii’s Fami- America’s Families, Snowbird, UT. Training Curriculum Manual. Salt Lake City, lies Project. Honolulu, HI: University of Hawaii, Social Welfare Evaluation and UT: University of Utah, Graduate School of Molgaard, V., Kumpfer, K.L., and Spoth, R. Social Work, Social Research Institute. 1994. The Iowa Strengthening Families Pro- Research Unit. gram for Pre- and Early Teens. Ames, IA: Kameoka, V.A., and Lecar, S. 1996. The ef- Kumpfer, K.L., and DeMarsh, J.P. 1985. Iowa State University. Prevention of chemical dependency in fects of a family-focused intervention on Family Environment reducing risk for substance abuse among children of alcohol and drug abusers. Moos, R.H. 1974. NIDA Notes 5(5):2–3. Scale. Palo Alto, CA: Consulting Psycholo- Asian and Pacific-Island youths and fami- gist Press, Inc. lies: Evaluation of the Strengthening Kumpfer, K.L., Molgaard, V., and Spoth, R. Hawaii’s Families Project. Available from 1996. Family interventions for the preven- Richardson, G.E., Neiger, B.L., Jensen, S., the Coalition for a Drug-Free Hawaii, Uni- tion of delinquency and drug use in spe- and Kumpfer, K.L. 1990. The resiliency versity of Hawaii. cial populations. In Proceedings of the model. Health Education 21:33–39. 1994 Banff International Conference, Kumpfer, K.L. 1990 (March). Services and edited by R. Peters and R. McMahon. Thou- Spivack, G., and Shure, M. 1979. Interper- programs for children and families. Paper sonal cognitive problemsolving and pri- sand Oaks, CA: Sage Publications. presented at the National Forum on the mary prevention: Programming for pre- Future of Children and Families: Work- Kumpfer, K.L., and Turner, C.W. 1990– school and kindergarten children. Journal shop on Children and Parental Illicit Drug 1991. The social ecology model of adoles- of Clinical Child Psychology 8(2):89–94. Use. Washington, DC: National Academy cent substance abuse: Implications for Spoth, R. 1998 (September). Results of of Sciences. prevention. International Journal of the Addictions 25(4A):435–463. ISFP over 2 years. Presentation at the Kumpfer, K.L. 1991a. How to get hard-to- National Prevention Network Research reach parents involved in parenting pro- Conference, San Antonio, TX. grams. In Parenting as Prevention: Prevent- ing Alcohol and Other Drug Abuse Problems in the Family, edited by D. Pines, D. Crute, Additional Resources and E. Rogers. Publication No. (ADM) 91– 1715. Washington, DC: U.S. Department of In addition to this Bulletin, the following Family Strengthening Series Bulletins are Health and Human Services, pp. 87–95. available from the Juvenile Justice Clearinghouse (JJC): Kumpfer, K.L. 1991b. Safe haven African Effective Family Strengthening Interventions. NCJ 171121. American parenting project: Final evaluation report. Manuscript submitted for Parents Anonymous: Strengthening Families. NCJ 171120. publication. Salt Lake City, UT: University Preventing Violence the Problem-Solving Way. NCJ 172847. of Utah, Department of Health Education, Health Behavior Laboratory. Preparing for the Drug-Free Years. NCJ 173408. Kumpfer, K.L. 1994a (December). Predic- Treatment Foster Care. NCJ 173421. tive validity of resilience for positive life Families and Schools Together: Building Relationships. NCJ 173423. adaptation. Paper presented at NIDA conference, The Role of Resilience in Drug To order the publications listed above, contact JJC and request the appropriate Abuse, Alcohol Abuse, and Mental Illness, NCJ numbers. Washington, DC. Juvenile Justice Clearinghouse Kumpfer, K.L. 1994b. Strengthening Fami- P.O. Box 6000 lies Program: Implementation Manual. Salt Rockville, MD 20849–6000 Lake City, UT: University of Utah, Gradu- 800–638–8736 ate School of Social Work, Social Research 301–519–5212 (fax) Institute. E-mail: [email protected] Internet: www.ncjrs.org Kumpfer, K.L. 1995. Strengthening Hawaii’s Families Demonstration/Evaluation grant For online access to JJC’s library, search the NCJRS Abstracts Database submitted to OSAP/ADAMHA on Novem- at www.ncjrs.org/database.htm. Directions for obtaining documents from the library ber 14, 1990. are available at www.ncjrs.org/cgi/help.html. Kumpfer, K.L., Bridges, S., and Williams, K. 1993. The safe haven program: Strength- ening African-American families. Submit- ted to the Detroit City Health Department by the Department of Health Education,

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