Program Profile: Family Check-Up (FCU) for Adolescents

This is a family-centered intervention designed to assist families with high-risk adolescents. The goal is to reduce the growth of adolescents’ problem behaviors and substance abuse. The program is rated Promising. Participants showed statistically significantly less growth of antisocial behavior and in alcohol, tobacco, and marijuana use compared with the control group. Participants also had stable GPAs from the start of middle school into high school and fewer school absences.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals/Target Population

Family Check-Up (FCU) for Adolescents is a family-centered preventive intervention based on a health maintenance model.  It is designed to assist families with high-risk adolescents, ages 11–17 by targeting parental engagement and motivating parents to improve their parenting practices. Moreover, it offers a menu of family-centered interventions that support effective family management practices and promote the well-being and improved behavior of children and adolescents. The goal of FCU is to reduce the growth of adolescents’ problem behaviors and substance abuse, improve parenting skills, and reduce family conflict.  

Program Activities

Participation in the FCU is voluntary: families can either elect to receive services or opt out of the intervention. The FCU is a three session intervention based on motivational interviewing and modeled after the Drinker’s Check-Up (Miller & Rollnick, 2002). Each session is guided by a professional therapist in a school setting over an extended length of time. The session participants include parents, adolescents, and teachers. 

The 3-step intervention sessions are tailored to families, concentrating specifically on the needs of the adolescents served. Parents and adolescents are all involved in the interactive sessions, while the information is collected through self-reporting surveys given to the parents, adolescents, and teachers at specified intervals. The three sessions consist of the following: 

• Initial interview: This is a 1-hour interview in which both parents and adolescents meet with a therapist or parent consultant regarding the family’s needs. The interview covers the parents’ goals and concerns with regard to the interactions within the family and the motivation to change. After the interview, the family receives the FCU intervention specific to their needs.
• Assessment procedure: The second session involves an assessment process in which the family’s interaction and engagement in a variety of assessment tasks are videotaped. The families are also given a questionnaire after the assessment. A brief assessment packet is also given to the parents, adolescents, and teachers to complete.
• Feedback session: This strength-based session involves the therapist or parent consultant who summarizes the family’s results of the assessment using motivational interviewing strategies. The discussion includes an overview of the behaviors and practices that may need additional attention. If the families decide to receive additional services, they are able to meet with both a therapist and school officials to receive further assistance. The main goals in the last session are to provide families with the motivation to change, and identify the applicable resources for the family’s specific needs.

Key Personnel

To implement the FCU intervention, the facilitators (e.g., the parent consultants) must be trained in both risk- and needs- assessment, and must complete the necessary requirements to assess families. Trained facilitators may include therapists, social workers, program developers, and psychologists.

Program Theory

The FCU is integrated into an ecological approach to family intervention and treatment known as EcoFIT. EcoFIT is designed to target specific principles and behavioral objectives, using engagement and treatment during a developmental transition within a public school setting. Grounded in developmental research, the EcoFIT model provides multiple benefits to families with adolescents, such as quality of family life, family interactions, and the long-term health maintenance of adolescents by reducing long-term risks.  A critical feature of the model is the use of assessments and interventions tailored to fit the circumstances of families, taking into account specific needs of the individual families and adolescents (Stormshak and Dishion, 2009).

Study

Stormshak and colleagues (2011) conducted an evaluation of the Family Check-Up (FCU) intervention using a sample of (n = 593) students, ages 11–13, from three schools in an urban area of the country. All three schools were Title I schools, and approximately 20 percent of the school population qualified for special education services. Youth and families were recruited in sixth grade across two cohorts. Parents of all sixth-grade students were invited to participate in the study, and 80 percent of all parents agreed to do so. The sample comprised 51 percent male participants and 49 percent female participants. The ethnicity of the sample was as follows: European American (36 percent), Latino ⁄ Hispanic (18 percent), African American (16 percent), Asian (8 percent), American Indian (3 percent), and biracial ⁄ mixed ethnicity (19 percent).

An unbalanced approach to randomization was used to enhance the power to detect intervention effects specifically for families electing to engage with the selected level of intervention. As such, 386 families (65 percent) were randomly assigned to the intervention condition, and 207 families (35 percent) were randomly assigned to the control condition in which families experienced ‘‘school as usual,’’ including regular services offered by the schools, but no access to any of the intervention services available to families in the intervention condition.

Assessments in the form of a questionnaire, which measured a variety of problem behaviors, were given to students over the 3-year time frame, from grades 6 to 8, in the spring semester of each year. The outcomes of interest included substance abuse and antisocial behavior of adolescents.

Outcomes were analyzed using a complier average casual effect (CACE) analysis. The CACE model, most commonly used a studies that include randomized control trials, addressing issues of noncompliance by the reduction of threats and biases. The CACE analysis measured the impact of the intervention on adolescent self-reported substance abuse and antisocial behavior. Substance abuse included alcohol, tobacco, and marijuana usage over the 3-year period. Engagement status was focused on the families in the intervention group who either elected to receive services or opted out of the intervention. Using the CACE model, the effects of the intervention were examined on a linear rate of change in problem behaviors within the families who engaged in the FCU. Subgroup analyses were conducted to determine potential effects gender had on program outcomes.

Study

In the 2009 study by Stormshak, Connell, and Dishion, FCU intervention services were examined in a longitudinal study using students and their families recruited from the 6th grade of three different middle schools in a diverse, northwestern metropolitan community of the United States. Students were assessed over three years, between grades 6 and 9, and participated in a follow-up session in grade 11. The overall purpose of the study was to assess the long-term impact on academic outcomes associated with the FCU intervention, particularly grade point average (GPA) and school absences.

Parents of all sixth grade students in two cohorts were approached for participation using an active consent protocol, and 90 percent (n = 998) agreed to participate in the study. The control group (n = 498) and the intervention group (n = 500) were assigned randomly during the spring semester of the 6th grade. Approximately 80 percent of these youth were retained across the majority of the study (wave 2, n = 857; wave 3, n = 829; wave 4, n = 820; wave 6, n = 794). Of the intervention group, 25 percent (n = 115) were successfully engaged and received the intervention, whereas the remaining families decided to not engage in the intervention; however, there is no specific information on the characteristics of the families who were randomized to the FCU intervention group but did not engage in services.

The study authors collected data on outcome measurements using a student survey questionnaire, which was given in the spring semester from the 6th through 9th grades, and again in the 11th grade. The measurements included yearly GPA and yearly school absences. Although both groups completed the follow-up in the 11th grade, there was a significant loss in student participation (control group, n = 99; intervention group, n = 106). The CACE analysis was used to conduct a series of analyses for youth outcomes, examining indicated levels of the FCU intervention on yearly GPA and yearly school absences over the span of the study. No subgroup analyses were conducted.

Implementation information on Family Check-Up is available at the program’s website.

Subgroup Analysis

Stormshak and colleagues (2011) conducted subgroup analyses to determine to potential effect gender had on program outcomes. Boys demonstrated higher initial levels of antisocial behavior compared with girls. However, there was no statistically significant difference between the groups at the follow up.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Jo, B. 2002. “Estimation of Intervention Effects with Noncompliance: Alternative Model Specifications.” Journal of Educational and Behavioral Statistics 27:385–409.

Metzler, C.W., A. Biglan, J.C. Rusby, and J.R. Sprague. 2001. “Evaluation of a Comprehensive Behavior Management Program to Improve School-Wide Positive Behavior Support.” Education and Treatment of Children 24:448–79.

Soberman, L. “Psychometric Validation of a Brief Teacher Screening Instrument (TRISK).” PhD diss. Eugene, Ore.: University of Oregon, 1994.

Stormshak, Elizabeth A., and Thomas Dishion. 2009. “A School-Based, Family-Centered Intervention to Prevent Substance Use: A Family Check-Up.” The American Journal of Drug and Alcohol Abuse 35:227–32.

Following are CrimeSolutions-rated programs that are related to this practice:

Interactive Programs for Preventing Marijuana Use in Middle School Students

This practice consists of skill-building and interaction-based activities integrated into school-based programs for grades 6–8 that are aimed at preventing marijuana use among adolescents ages 12–14. This practice is rated Effective for preventing marijuana use.

Evidence Ratings for Outcomes

Drugs & Substance Abuse - Marijuana

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?