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Parent/Family Skills Training to Prevent Substance Abuse (EE)
This initial or rough draft of a summary (formatted in an encyclopedia entry format) has been started by the International School Health Network from a previous Canadian project. Visitors to and members of this wiki-based web site are welcome to edit the draft (using the Easy Edit" tool found at the top of the page or to comment on the draft by using the "thread" tool found at the bottom of the page. (All previous versions of this page are automatically saved by the system, so don't hesitate to edit this page). Eventually, when time and resources permit, this initial draft will be formatted in accordance with the outline for encyclopedia entries used in this knowledge exchange program for health,safety, educational and social development interventions.
This summary discusses family skills programs that are geared to meet the needs of families and parents who are at higher risk of substance abuse and other social/health problems.
Universal family programs (school-linked)
It appears that programs that work with families (that is, parents and children together) have more promise than those working with parents only.[i] Programs need to focus on skill development rather than on simple education about appropriate parenting practices. Promising family strategies for preventing substance use include structured, home-based parent-child activities, and family skills training.
Parent and family programs directed to at-risk families have more research support than universally delivered programs. It has been suggested that selective programs that have proven effective in reducing substance use be tested with universal populations.[ii]
The seven-session Iowa Strengthening Families Program (ISFP) is one such program, having recently been tested with all families in late primary school (6th grade). The ISFP program is delivered within parent, youth, and family sessions using videos that portray typical youth and parent situations. Sessions are interactive and include role-playing, discussions, learning games, and family projects. The sessions are structured such that children and parents are in separate groups for the first hour and come together to practice skills for the second hour. Young people’s sessions in the ISFP focus on strengthening positive goals, dealing with stress and building social skills. Parent sessions focus on communication, monitoring and conflict resolution.[iii]
At the five-year follow up, effects on alcohol use and aggressive behaviour were found and a cost-benefit analysis found a return of US$9.60 for every dollar invested (see Section VII for further discussion on cost effectiveness).[iv] [v] Importantly, the effectiveness of this intervention seemed to increase over time, reflecting the developmental orientation of the intervention. The program needs to be evaluated on a larger scale and in different settings to confirm these results.[vi]
Australia’s Triple P (Positive Parenting Program) employs a broad multi-component approach recognizing that parenting practices occur in a community and societal context that is not always supportive. Triple P hypothesizes that parents have varying needs for information, support and assistance, depending on their circumstances, and that optimally, various levels of programming need to be available to respond. The Triple P model includes media based universal messaging, brief information, universal parenting programs focusing on children’s transitions, more intensive parenting programs for at risk families, and therapeutic interventions for families experiencing significant problems all accessible in a manner that promotes parents’ sense of self-efficacy,[vii] Small trials of Triple P interventions delivered by researchers have shown positive results at one-year follow-up.[viii]
School-linked targeted family programs
It appears that “family-based” interventions are more effective than “parent-only” or “child only” programming in building protective factors and reducing substance use.[i] For example, the Focus on Family Program, which provided for parent skill building without including an intervention for children showed no effect on children’s substance use.[ii] Typically, effective family programming aims to build relationship and communication skills separately among the parents and the children, along with opportunities to learn and practice skills as a family unit. These programs have shown positive effects on a number of risk and protective factors and have brought about reductions in youth substance use. The provision of transportation, food and childcare during sessions, as well as advocacy and crisis support programs increase the likelihood of attracting and retaining families and are considered important elements of these programs.[iii]
The Strengthening Families Program (SFP) is a well-replicated example of a family program that has been shown to be effective with targeted as well as universal populations (See Section D, Comprehensive Whole School Approaches). The program involves whole families coming together in a school, community centre, or other public place. The format for each week of the 14 session SFP involves parents and children first participate in skill-building activities after which families come together to practice the skills (e.g. communication and conflict-resolution skills). Free meals, transportation, and childcare are provided.
The SFP has been evaluated in several randomized control trials over a five-year follow-up period. The results showed that, compared with the control group, children in the experimental groups were significantly less likely to use substances and engage in other adolescent problem behaviours. The program has been adapted with positive results for lower risk families, families with older children and families of various cultural backgrounds.[iv]
A recent adaptation involved a three-year multi-site randomized controlled trial with Ontario families (along with families in New York State) recently affected by alcohol problems. To be eligible for the study, parents must have had an alcohol problem in the past five years and primary parenting responsibility for a child age 9-12 years. Over the 14-week period, the Ontario SFP families met once a week in the evening for three hours. The program contained four components: dinner hour, Child Skills Training Program, Parent Skills Training Program, and Family Skills Training Program. Four trained facilitators delivered the program sessions (two in the parent session and two in the child session). SFP participants also attended a two-hour booster session delivered immediately after the first study follow-up assessment designed to reinforce the skills taught in the 14-week program. In addition to the assessment immediately following the program, families were assessed at 4 months and 12 months after program completion. The control group received the Parent Intervention Program which comprised written material on parenting and local contact information.
Although the trial has not published its results, the author has reported immediate and sustained positive effects for several family and child psychosocial outcomes and included: improved family functioning, more effective parenting techniques, reduced parent hostility and aggression, reduced symptoms of parent depression, reductions in children’s externalizing behaviour problems, better child social skills and better child coping skills. SFP children also displayed a 37% reduction in alcohol sipping relative to controls.[v]
A review of targeted family programs has concluded that effective programs:[vi]
Webster-Stratton and Taylor (2001) note that family or parent training can mistakenly assume that parent training simply involves didactically sharing information or teaching about child management strategies or behaviour modification principles. They assume that this is relatively simple, that it makes little difference how clinically skilled the instructor is, and that the relationship focus is secondary to teaching parents particular skills. For higher risk families experiencing multiple stressors, or for those whose children already exhibit high levels of behaviour problems, they suggest a more clinically sophisticated therapeutic approach is needed when conducting parent training.[vii]
This summary discusses family skills programs that are geared to meet the needs of families and parents who are at higher risk of substance abuse and other social/health problems.
Universal family programs (school-linked)
It appears that programs that work with families (that is, parents and children together) have more promise than those working with parents only.[i] Programs need to focus on skill development rather than on simple education about appropriate parenting practices. Promising family strategies for preventing substance use include structured, home-based parent-child activities, and family skills training.
Parent and family programs directed to at-risk families have more research support than universally delivered programs. It has been suggested that selective programs that have proven effective in reducing substance use be tested with universal populations.[ii]
The seven-session Iowa Strengthening Families Program (ISFP) is one such program, having recently been tested with all families in late primary school (6th grade). The ISFP program is delivered within parent, youth, and family sessions using videos that portray typical youth and parent situations. Sessions are interactive and include role-playing, discussions, learning games, and family projects. The sessions are structured such that children and parents are in separate groups for the first hour and come together to practice skills for the second hour. Young people’s sessions in the ISFP focus on strengthening positive goals, dealing with stress and building social skills. Parent sessions focus on communication, monitoring and conflict resolution.[iii]
At the five-year follow up, effects on alcohol use and aggressive behaviour were found and a cost-benefit analysis found a return of US$9.60 for every dollar invested (see Section VII for further discussion on cost effectiveness).[iv] [v] Importantly, the effectiveness of this intervention seemed to increase over time, reflecting the developmental orientation of the intervention. The program needs to be evaluated on a larger scale and in different settings to confirm these results.[vi]
Australia’s Triple P (Positive Parenting Program) employs a broad multi-component approach recognizing that parenting practices occur in a community and societal context that is not always supportive. Triple P hypothesizes that parents have varying needs for information, support and assistance, depending on their circumstances, and that optimally, various levels of programming need to be available to respond. The Triple P model includes media based universal messaging, brief information, universal parenting programs focusing on children’s transitions, more intensive parenting programs for at risk families, and therapeutic interventions for families experiencing significant problems all accessible in a manner that promotes parents’ sense of self-efficacy,[vii] Small trials of Triple P interventions delivered by researchers have shown positive results at one-year follow-up.[viii]
[i] Kumpfer, K.L., Alvarado, R., & Whiteside, H.O. (2003). Family-based interventions for substance use and misuse prevention. Substance Use and Misuse, 38(11-13), 1759-1787.
[ii] Holder, H. (2003, Feb). Strategies for reducing substance abuse problems: What research tells us. Paper presented at the NDRI International Research Symposium: Preventing Subsance Use, Risky Use, and Harm: What is Evidenced-Based Policy?, Fremantle, Australia.
[iii] Mitchell, P., Sanson, A., Spooner, C., Copeland, J., Vimpani, G., Toumbourou, J.W., Howard, J., & Sanson, A. (2001). The role of families in the development, identification, prevention and treatment of illicit drug problems. Retrieved September 30, 2007, from http://www.nhmrc.gov.au/publications/synopses/_files/ds8.pdf
[iv] Spoth, R.L., Redmond, C., Trudeau, L., & Shin, C. (2001). Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviors, 16(2), 129-134.
[v] Spoth, R., Guyull, M., & Day, S. Universal family-focused interventions in alcohol-use disorder prevention: Cost effectiveness and cost-benefit analyses of two interventions. Journal of Studies on Alcohol, 63, 219–228.
[vi] Foxcroft, D., Ireland, D.J., Lister-Sharp, D., Lowe, G., & Breen, R. (2003). Longer-term primary prevention for alcohol misuse in young people: A systematic review. Addiction, 98, 397-411.
[vii] Sanders, M. (2003). Triple p - positive parenting program: A population approach to promoting competent parenting. Australian e-Journal for the Advancement of Mental Health (AeJAMH), 2(3). Retrieved August 31, 2007, from http://www.auseinet.com/journal/vol2iss3/sanders.pdf
[viii] Loxley, W., Toumbourou, J.W., & Stockwell, T. (2004). The prevention of substance use, risk and harm in Australia: A review of the evidence. Retrieved September 30, 2007, from http://www.aodgp.gov.au/internet/wcms/publishing.nsf/content/health-pubhlth-publicat-document-mono_prevention-cnt.htm
School-linked targeted family programs
It appears that “family-based” interventions are more effective than “parent-only” or “child only” programming in building protective factors and reducing substance use.[i] For example, the Focus on Family Program, which provided for parent skill building without including an intervention for children showed no effect on children’s substance use.[ii] Typically, effective family programming aims to build relationship and communication skills separately among the parents and the children, along with opportunities to learn and practice skills as a family unit. These programs have shown positive effects on a number of risk and protective factors and have brought about reductions in youth substance use. The provision of transportation, food and childcare during sessions, as well as advocacy and crisis support programs increase the likelihood of attracting and retaining families and are considered important elements of these programs.[iii]
The Strengthening Families Program (SFP) is a well-replicated example of a family program that has been shown to be effective with targeted as well as universal populations (See Section D, Comprehensive Whole School Approaches). The program involves whole families coming together in a school, community centre, or other public place. The format for each week of the 14 session SFP involves parents and children first participate in skill-building activities after which families come together to practice the skills (e.g. communication and conflict-resolution skills). Free meals, transportation, and childcare are provided.
The SFP has been evaluated in several randomized control trials over a five-year follow-up period. The results showed that, compared with the control group, children in the experimental groups were significantly less likely to use substances and engage in other adolescent problem behaviours. The program has been adapted with positive results for lower risk families, families with older children and families of various cultural backgrounds.[iv]
A recent adaptation involved a three-year multi-site randomized controlled trial with Ontario families (along with families in New York State) recently affected by alcohol problems. To be eligible for the study, parents must have had an alcohol problem in the past five years and primary parenting responsibility for a child age 9-12 years. Over the 14-week period, the Ontario SFP families met once a week in the evening for three hours. The program contained four components: dinner hour, Child Skills Training Program, Parent Skills Training Program, and Family Skills Training Program. Four trained facilitators delivered the program sessions (two in the parent session and two in the child session). SFP participants also attended a two-hour booster session delivered immediately after the first study follow-up assessment designed to reinforce the skills taught in the 14-week program. In addition to the assessment immediately following the program, families were assessed at 4 months and 12 months after program completion. The control group received the Parent Intervention Program which comprised written material on parenting and local contact information.
Although the trial has not published its results, the author has reported immediate and sustained positive effects for several family and child psychosocial outcomes and included: improved family functioning, more effective parenting techniques, reduced parent hostility and aggression, reduced symptoms of parent depression, reductions in children’s externalizing behaviour problems, better child social skills and better child coping skills. SFP children also displayed a 37% reduction in alcohol sipping relative to controls.[v]
A review of targeted family programs has concluded that effective programs:[vi]
- take a skills enhancing perspective · have broad-based content; program content includes cognitive, behavioural, and affective components
- have a program length typically greater than 20 hours for children and families at elevated risk of developing problems
- intervene as early as the risk factors can be clearly identified
- are developmentally focused. (i.e., targeted at specific ages)
- use a collaborative process with parents, teachers, and children
- focus on parents’ and children’s strengths (not deficits)
- utilize performance training methods; for example, programs that utilize videotape methods, live modeling, role-play or practice exercises, and weekly home practice activities are more effective than programs relying on didactic presentations
- educate participants not only in strategies, but also in the developmental and behavioural principles behind them · promote partnerships between parents and teachers
- emphasize the clinical skills of the intervention staff · are sensitive to barriers for low socioeconomic families and are culturally sensitive
- have been empirically validated in control and comparison group studies using multiple methods and provide follow-up data
Webster-Stratton and Taylor (2001) note that family or parent training can mistakenly assume that parent training simply involves didactically sharing information or teaching about child management strategies or behaviour modification principles. They assume that this is relatively simple, that it makes little difference how clinically skilled the instructor is, and that the relationship focus is secondary to teaching parents particular skills. For higher risk families experiencing multiple stressors, or for those whose children already exhibit high levels of behaviour problems, they suggest a more clinically sophisticated therapeutic approach is needed when conducting parent training.[vii]
[i] Kumpfer, K.L., Alvarado, R., & Whiteside, H.O. (2003). Family-based interventions for substance use and misuse prevention. Substance Use and Misuse, 38(11-13), 1759-1787.
[ii] Roe, S., & Becker, J. (2005). Drug prevention with vulnerable young people: A review. Drugs: education, prevention and policy, 12(2), 85-99.
[iii] Kumpfer, K.L., Alvarado, R., & Whiteside, H.O. (2003). Family-based interventions for substance use and misuse prevention. Substance Use and Misuse, 38(11-13), 1759-1787.
[iv] ibid
[v] Dewit, D. (n/d). Strengthening Families for the Future. Executive Summary of Outcome Evaluation.
[vi] Webster-Stratton, C., & Taylor, T. (2001). Nipping early risk factors in the bud: Preventing substance abuse, delinquency, and violence in adolescence through interventions targeted at young children (0–8 Years). Prevention Science, 2(3).
[vii] ibid
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