Program Profile: Strengthening Families Program: For Parents and Youth 10-14

This is a family-based intervention that seeks to reduce substance use and other problem behaviors in youth ages 10–14. The program is rated Promising. Treatment group youth showed a statistically significant greater number of intervention-targeted behaviors and alcohol refusal skills and a lower initiation of alcohol use, compared with the control group. Treatment group parents, compared with the control group parents, showed a statistically significant greater number of parenting competencies.

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

Strengthening Families Program: For Parents and Youth 10–14 (SFP 10–14) is a universal, family-focused intervention that is designed to reduce adolescent substance use and other problem behaviors by building youth skills, improving parenting practices, and strengthening relationships among family members. SFP 10–14 is adapted from the Iowa Strengthening Families Program (Spoth et al. 2003). Overall, the goal of the program is to reduce risk factors for and build protective factors against substance use and other problem behaviors in young adolescents.

Program Components

SFP 10–14 consists of six weekly 2-hour sessions for youth and their parents or caregivers. Adults and youth attend separate skill-building groups for the first hour and spend the second hour together in supervised family activities. Youth sessions generally concentrate on strengthening goal setting, communication skills, behavior management techniques, and peer pressure. Parent sessions generally discuss the importance of nurturing while simultaneously setting rules, monitoring compliance, and applying appropriate discipline. In the joint family sessions, families practice conflict resolution and communication skills, which involve games and activities designed to increase cohesiveness and the youth’s positive involvement in the family.

The intervention topics addressed in each of the six sessions are as follows:

• Session 1 addresses protective factors, including goal setting and planning; and risk factors, including poor communication skills.
• Session 2 addresses protective factors, including age-appropriate parental expectations and positive parent-child affect; and risk factors, including harsh and inappropriate discipline and poor parent-child relationships.
• Session 3 addresses protective factors, including emotional management skills and family cohesiveness; and risk factors, including harsh, inconsistent, or inappropriate discipline and poor communication of rules. A 15-minute video on family meetings is shown during the family portion of the session.
• Session 4 addresses protective factors, including youth’s reflective skills and empathy for parents; and risk factors, including poor parental monitoring and youth’s antisocial behavior.
• Session 5 addresses protective factors, including a cohesive, supportive family environment; meaningful family communication; and peer refusal skills; and risk factors, including an indulgent or harsh parenting style, family conflict, and negative peer influence. Also, during the youth training part of the session, youth are shown a 15-minute video on how to resist peer pressure.
• Session 6 addresses protective factors, including positive parent-child affect and clear parental expectations regarding substance use; and risk factors, including poor school performance and negative peer influence. During the family portion of the session, a 20-minute video shows parents how to help young adolescents with peer pressure. In their separate session, youth re-watch the video that was shown during session 5.

For each of the six sessions, parent sessions include a 50-minute video that presents the key concepts and provides structure for the discussion. For an expansive list of the addressed protective and risks factors for each session, see the study by Spoth and colleagues (2003).

In addition, four booster sessions are offered to all families (approximately 6 months to 1 year) after the end of the first seven sessions, to reinforce the skills gained in the original sessions.

Program Theory

SFP 10–14 is based on the biopsychosocial model (DeMarsh and Kumpfer 1986) and other empirically based family risk and protective factor models (Kumpfer et al. 1996; Molgaard et al. 2000), which center on addressing established risk and protective factors, appropriate developmental timing, application of empirically supported skills-training techniques, and effective strategies for engaging families.

Study

Spoth and colleagues (2003) conducted a randomized controlled trial to evaluate the adapted Strengthening Families Program: For Parents and Youth 10–14 (SFP 10–14), which was delivered to African American youth and their families. African American families were randomly drawn from an urban site that was part of a large, multisite longitudinal study (Cutrona et al. 2000). The original study used 1990 census data to identify block group areas in Des Moines, Iowa. Of the city’s population of 193,000, African American families comprised 10 percent or more of the population and 20 percent or more of families with children who lived below the poverty line. Public schools (within block group areas) were used to identify adolescents in the fourth through sixth grades. Of the 507 eligible families that were contacted for study participation, 77 percent agreed to participate in the present study (n = 390).

There were 348 families who completed the first wave of data collection; study authors randomly selected 200 families who were then randomly assigned to the SFP 10–14 group or a waitlist comparison group. Of the 200 families randomly selected from the larger longitudinal study, 85 were included (34 from the intervention group and 51 from the comparison group), after they had been successfully contacted by phone, agreed to participate, and provided sufficient data for inclusion in the analyses. The average age of the child participants was 10.5 years. Of the primary caregivers/parents (which included grandparents; foster/adoptive parents; and other biological relatives, stepparents, and nonrelatives), 82.7 percent were the children’s biological mothers, 93.6 percent were female, and the average age was 38.4 years. The caregivers/parents had an average of 3.5 children. There were no statistically significant between-group differences at baseline, except that the intervention group had a smaller average score on intervention-targeted child behaviors than the control group (this difference was adjusted for in the analyses).

Data were collected through telephone surveys (approximately 10 minutes in duration), which were administered at three time points: Time 1 (4 weeks prior to the intervention: pretest assessment), Time 2 (immediately following the 6-week intervention: posttest assessment), and Time 3 (4 weeks after the 6-week intervention was delivered to the waitlist control group: follow-up assessment). At Times 1 and 2, only the intervention group had received the intervention. Between Time 2 and Time 3, the control group received the intervention (the CrimeSolutions review of this study focused on results between Time 1 and Time 2).

Outcomes of interest included 1) caregiver reports of intervention-targeted parent behaviors, the number of family meetings (in the past month), child participation in family meetings, parent-child affective quality; and 2) youth reports of intervention-targeted child behaviors, alcohol-related refusal skills, and general peer pressure resistance skills. Intervention-targeted parenting behaviors were measured through responses to seven items (i.e., “I have explained the consequences of not following my rules concerning alcohol use.”) that corresponded to the primary skills training content, using a 5-point scale (1 = strongly agree through 5= strongly disagree). The number of family meetings was measured through caregivers’ answers to the following question, “During the past month, did you have any family meetings?” The “no” responses were assigned a value of 0, and the “yes” responses were followed up by the question, “How many meetings have you had?” to provide a different numeric value. Child participation in family meetings was also measured on a 5-point scale (1 = always through 5 = never) through caregivers’ responses to the following question, “How often did [target child’s name] participate in these family meetings?” Parent-child affective quality was measured through 10 items on a 5-point scale (1 = never through 5 = always), on the frequency of positive parent-child interactions (i.e., “I frequently tell [target child’s name] that I love him/her”). Intervention-targeted child behaviors were measured through responses to 11 of the 13 items on the Child Behavior Scale (1 = never through 5 = always), including items such as “I am able to sit down with my parent(s) to work on a problem without yelling or getting mad.” Alcohol-related refusal skills were measured on a 5-point scale (1= very unlikely through 5 = very likely) through adolescents’ responses to the likelihood of using peer resistance skills in response to a friend offering them an alcohol drink at a party (i.e., “How likely is it you would just refuse it and walk away?”). General peer resistance skills were measured through adolescents’ responses to eight questions on resisting pressure from friends to engage in delinquent or problem behavior (i.e., “How well can you resist pressure from your friends to drink beer, wine, wine cooler, and liquor?”), using a 4-point scale (1 = not well at all through 4 = very well). Repeated measures analyses of variance (RM-ANOVAs) were used to compare differences between the SFP 10–14 intervention and comparison groups. The study authors did not conduct subgroup analyses.

Study

Spoth and colleagues (2004) conducted a randomized controlled trial that evaluated the SFP 10–14 program in 33 rural public schools (within 19 neighboring counties) in a midwestern state. Schools within these communities had a population of 8,500 or fewer and were selected based on school lunch program eligibility (15 percent or more of district families were eligible for free or reduced lunch). Schools were randomized to one of three group conditions: 1) the SFP 10–14; 2) the Preparing for the Drug-Free Years (PDFY); or 3) a minimal-contact control group, in which families received a set of four parenting guidelines written by Cooperative Extension Service personnel that described aspects of adolescent development (e.g., physical and emotional changes, parent–child relationships). There were 11 schools assigned to each of the three conditions (the CrimeSolutions review of this study compared program impacts between students and their families assigned to SFP 10–14 and those in the minimal-contact control group).

All families with sixth graders were invited to participate in the study (n = 1,309 families). Of the total sample, 667 families completed the pretest questionnaire, with 238 in the SFP 10–14 intervention program and 208 families in the control group (the remaining 221 families were in the PDFY condition). Of the 446 families in the SFP 10–14 and control groups, each family had an average of 3.1 children, 86 percent of students were from dual-parent families, and 70 percent of students were living with both biological parents. Approximately 98 percent of participants (students and their families) were white. When evaluating sociodemographic variables (such as household income, parent education, parent age, child age, child gender, parent marital status, and number of children in the household), there were no statistically significant differences between families in the intervention and control groups, at pretest.

Data were collected across six waves (pretest to 6-year follow up), and the study authors used a listwise deletion method to handle cases with missing data to ensure that school-level substance initiation estimates exhibited a nondecreasing, monotonic pattern over time. At pretest (Wave 1) and at the 6-year follow up (Wave 6), parents and students were administered a self-report questionnaire to measure substance use initiation. Outcomes of interest included alcohol composite use index (ACUI) scores, lifetime marijuana use, and tobacco composite use index (TCUI) scores. The ACUI consisted of four items (lifetime use, lifetime use without parental permission, lifetime drunkenness, and past month use), as did the TCUI (lifetime use of cigarettes, lifetime use of chewing tobacco, past month use of cigarettes, and past month use of chewing tobacco) Study authors coded responses (0 = no use/no recent use or 1 = use/recent use) that were then averaged and yielded scale ranges of 0–1. Lifetime marijuana use was measured through self-report data and defined by the participant at each data collection point (if a participant reported a lifetime use behavior at one data collection, but not at a later data collection point, study researchers corrected the report to reflect the previously reported initiation of that behavior). Logistic growth curve analyses were used to determine initiation differences in substance use (in months) between students in the intervention and control groups, at the 6-year follow up. The study authors did not conduct subgroup analyses.

Study

Spoth and colleagues (2008) used a randomized block design to evaluate the long-term effects of SFP 10–14 on school success, in a follow up to Study 2 (Spoth et al. 2004). Specifically, the study authors concentrated on the indirect effects of the intervention at posttest.

As in Study 2, schools were located in midwestern rural communities with populations of 8,500 or fewer and were selected based on school lunch program eligibility (15 percent or more of district families were eligible for free or reduced lunch). However, this study analyzed data from participants only at the 22 schools assigned to the SFP 10–14 treatment intervention and control conditions (n = 446 families). Among intervention and control group families, 52 percent of families had a daughter as the target child, the average age of the mothers was 37.2 years, and the average age of the fathers was 39.4 years. There were no statistically significant differences between intervention and control group participants at baseline.

Data were collected across four time periods (6th-grade pretest, 6th-grade posttest, 8th-grade follow up, and 12th-grade follow up). At the 6th-grade posttest, outcomes of interest were parenting competencies (also referred to as effective parenting behaviors) and student substance-related risk. Parenting competency was measured through the following four indicators developed from a 13-item self-report questionnaire: 1) rules and consequences regarding alcohol use, 2) parental efforts to involve the child in family activities and decisions, 3) parental management of anger and strong emotion in the parent–child relationship, and 4) parental activities to communicate understanding of children’s feelings and goals as well as parental intentions. Student substance-related risk was measured through self-reported responses to questionnaire items based on three indicators: 1) the ACUI (which averaged four initiation-related items, such as “Have you ever drunk beer, wine, or liquor without your parent’s permission?”); 2) a single item that assessed the participant’s attitude toward alcohol use (1 = not at all wrong through 4 = very wrong); and 3) a single item that assessed the participant’s potential response to peer pressure for alcohol use (1 = very likely through 5 = very unlikely). Multiple-group structural equation analyses were conducted to assess the direct and indirect effects of the family competency training model. Direct effects of receiving the program (or not) were assessed through parenting competencies and student substance-related risk. The study authors did not conduct subgroup analyses.

The culturally adapted version of the Strengthening Families Program (SFP) 10–14, as evaluated in the Spoth and colleagues (2003) study, consisted of videos that included both African American and European American narrators and actors. African American consultants assisted in enhancing the cultural sensitivity of the project (such as using materials that presented photographs and videos of African American participants and program implementers) and suggested the project be referred to as Harambee (Swahili for “pulling together”).

To ensure that the implementation of the SFP 10–14 intervention was correctly administered to participants and provided a more appropriate, culturally sensitive, and welcoming program for African American families, trained observers were employed to assess how closely program facilitators adhered to the intervention protocol. Program facilitators were selected through job advertisements that were placed in the community and were hired primarily based on their experience and the skills necessary to deliver SFP 10–14 (Spoth et al. 2003).

In the culturally adapted version of SFP 10–14, African American university students and community members served as field researchers to collect data from families in their homes (Spoth et al. 2003). Program facilitators additionally attended 2 days of training, and observers also completed a training session on how to accurately use detailed adherence observation instruments. Specifically, observers tracked the extent to which facilitators completed the specific activities required by the intervention protocol by marking whether the facilitator covered each item within each program topic (Spoth et al. 2003).

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

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

Coatsworth, J. Douglas, Larissa G. Duncan, Mark T. Greenberg, and Robert L. Nix. 2010. “Changing Parent’s Mindfulness, Child Management Skills and Relationship Quality With Their Youth: Results From a Randomized Pilot Intervention Trial.” Journal of Child and Family Studies 19:203–17.

Cutrona, Carolyn E., Daniel W. Russell, Robert M. Hessling, P. Adama Brown, and Velma McBride Murry. 2000. “Direct and Moderating Effects of Community Context on the Psychological Well-Being of African American Women.” Journal of Personality and Social Psychology 79:1088–01.

DeMarsh, Joseph, and Karol L. Kumpfer. 1986. “Family-Oriented Interventions for the Prevention of Chemical Dependency in Children and Adolescents.” Journal of Children in Contemporary Society 18(1–2):117–51.

Kumpfer, Karol L., Virginia Molgaard, and Richard Spoth. 1996. “The Strengthening Families Program for the Prevention of Delinquency and Drug Use.” In R. D. Peters and R. J. McMahon (eds.). Preventing Childhood Disorders, Substance Abuse, and Delinquency. Thousand Oaks, Calif.: Sage, 241–67.

Molgaard, Virginia K., Richard L. Spoth, and Cleve Redmond. 2000. “Competency Training—The Strengthening Families Program: For Parents and Youth 10–14.” Juvenile Justice Bulletin. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.

Redmond, Cleve, Richard L. Spoth, Chungyeol Shin, and Heidi S. Lepper. 1999. “Modeling Long-Term Parent Outcomes of Two Universal Family-Focused Preventive Interventions: One-Year Follow-Up Results.” Journal of Consulting and Clinical Psychology 67(6):975–84.

Spoth, Richard L., Scott Clair, and Chungyeol Shin. 2006. “Long-Term Effects of Universal Preventive Interventions on Methamphetamine Use Among Adolescents.” Archives of Pediatric and Adolescent Medicine 160:876–82.

Spoth, Richard L., Max Guyll, and Susan X. Day. 2002. “Universal Family-Focused Interventions in Alcohol-Use Disorder Prevention: Cost-Effectiveness and Cost–Benefit Analyses of Two Interventions.” Journal of Studies on Alcohol 63:219–28.

Spoth, Richard L., Max Guyll, Linda Trudeau, and Catherine J. Goldberg–Lillehoj. 2002. “Two Studies of Proximal Outcomes and Implementation Quality of Universal Preventive Interventions in a Community–University Collaboration Context.” Journal of Community Psychology 30(5):499–518.

Spoth, Richard, Cleve Redmond, and Chungyeol Shin. 2001. “Randomized Trial of Brief Family Interventions for General Populations: Adolescent Substance Use Outcomes Four Years Following Baseline.” Journal of Consulting and Clinical Psychology 69(4):627–42.

Spoth, Richard L., Cleve Redmond, Linda Trudeau, and Chungyeol Shin. 2002. “Longitudinal Substance Initiation Outcomes for a Universal Preventive Intervention Combining Family and School Programs.” Psychology of Addictive Behaviors 16(2):129–34.

Spoth, Richard L., Linda Trudeau, Chungyeol Shin, and Cleve Redmond. 2008. “Long-Term Effects of Universal Preventive Interventions on Prescription Drug Misuse.” Addiction 103:1160–68.

Spoth, Richard L., Linda Trudeau, Chungyeol Shin, and Cleve Redmond. 2009. “Universal Intervention Effects on Substance Use Among Young Adults Mediated by Delayed Adolescent Substance Initiation.” Journal of Consulting and Clinical Psychology 77(4):620–32.

Trudeau, Linda, Richard L. Spoth, G. Kevin Randall, and Kari Azevedo. 2007. “Longitudinal Effects of a Universal Family-Focused Intervention on Growth Patterns of Adolescent Internalizing Symptoms and Polysubstance Use: Gender Comparisons.” Journal of Youth Adolescence 36:725–40.