Strengthening America's Families:
Exemplary Parenting and Family Strategies
For Delinquency Prevention

PART III: PRINCIPLES OF EFFECTIVE FAMILY PROGRAMS

COMPREHENSIVE INTERVENTIONS

Comprehensive interventions are more effective in modifying a broader range of risk or protective factors and processes in children. Interventions attending to the entire range of developmental outcomes of the child (i.e., cognitive, behavioral, social, emotional, physical, and spiritual) through improvements in all environmental domains (i.e., society/culture, community/ neighborhood, school, peer group, and family/extended family) naturally demonstrate increased effectiveness on positive developmental changes in youth. Our research reviews of different programs (Kumpfer, 1996a; Kumpfer, 1997) suggests that many programs are effective in the areas they target for changes in youth, parents, or families, but many focus too narrowly and hence have more limited results.

FAMILY-FOCUSED

Family-focused programs are more effective than child-focused or parent-focused only. The first wave or phase of child development interventions taught therapists, teachers, prevention specialists and other youth workers to provide enrichment or therapeutic experiences for children. In order to maximize dosage and reduce cost, the second phase of child development interventions focused on training the parent or caretaker to better nurture and care for the child's needs. As the concept of comprehensive prevention or treatment interventions dealing with many different precursor domains emerged, interventions addressing the child, parent, and interactive family system became more popular. Research comparing the effectiveness of these three types of program foci on the broader range of children's anti-social and prosocial behaviors find the combined approach of all three programs most effective (DeMarsh & Kumpfer, 1985). A number of early childhood education program reviews (Yoshikawa, 1994) have also concluded that comprehensive, holistic, family-focused programs are the wave of the future and should be the central target of future research (Mitchell, Weiss, & Schultz, in press).

LONG-TERM AND ENDURING

Family programs should be long-term and enduring. Short-term interventions with high-risk or in-crisis families are only bandaids on dysfunction of the family. Such efforts do not result in functional changes within the family that allow long term solutions rather than a temporary reduction of the external symptoms. Although recruitment for long term programs can be very difficult, once high-risk families are involved in a family intervention, they often to not want to terminate participation.

SUFFICIENT DOSAGE OR INTENSITY

Sufficient dosage or intensity is critical for effectiveness. The needier the family is in terms of number of risk factors/processes, the more time is needed to modify those family dysfunctional processes. Time must be allow for developing trust, determining the family's needs, providing or locating support services for basic needs, and comprehensively addressing deficit areas (CSAP, 1993). To produce longitudinal effectiveness, the family intervention must be of sufficient dosage (at least 45 hours with high-risk families). Kazdin (1995) has estimated that at least 30-40 contact hours are needed for a positive and lasting impact of family programs, particularly because high-risk families frequently miss sessions and have difficulty implementing the skills taught at home (Kumpfer & Alvarado, 1995; Kumpfer & DeMarsh, 1985). Some parent and family programs fail to have much impact, because they do not spend enough time on each skill or principle taught. Skills training interventions need to build on prior learned skills and require demonstration of those prior learned skills while simultaneously learning new skills. Many parent education or training interventions fail with high-risk families because they are too short to really reduce risk-producing processes and behaviors and increase protective processes and behaviors in these parents. Short-term parent education programs are essentially for normal families. These short-term educational programs stress that such programs must be short to attract parents to attend. While this assumption may be true for very busy working parents of children with few problems, it is not as true of high risk or in-crisis families who want help.

CULTURALLY SENSITIVE

Tailoring the parent or family intervention to the cultural traditions of the families involved improves recruitment, retention, and outcome effectiveness. Understanding the cultural parenting assumptions of different ethnic groups participating in the parenting or family programs improves program success (Catalano, et.al., 1993, Kumpfer & Alvarado, 1995). Many traditional cultures may have exceptionally strong ties to extended family members, may stress cooperation and sharing rather than competition and individual autonomy. Some cultures may exhibit a more authoritarian approach to parenting with extremely high expectations for children's performance. Understanding why these parents hold these values and their beliefs about children help the program developers and group leaders improve the program's effectiveness for these parents. For instance, Interviews with African American parents participating in the Detroit Strengthening Family Program, Safehaven program revealed that these parents believe that their children must be more obedient because of the potentially lethal dangers of the inner city streets. Because of differences (e.g., levels of child supervision, research terminology, Wilson, 1987) in cultural understandings and lack of background in the psychological principles underlying many parent education programs, many so called "high- risk" parents may actively reject the underlying assumptions of intervention efforts or merely take more time to really understand.

Ethnic families want parenting and family programs developed specifically for their parenting issues, family needs, and cultural values. Kazdin (1993) has recommended deriving culturally relevant principles to guide modifications of existing model programs rather than developing separate models for each diverse ethnic group. Unfortunately, few existing model family programs (e.g., those developed and tested within National Institute of Drug Abuse/National Institute of Mental Health clinical research trials aimed at preventing drug use and delinquency) have been modified for ethnic families to the degree that they now have culturally appropriate training and parent/child handbooks, video tapes, films, or evaluation instruments translated into different languages. Research-based exceptions include Szapocznik's individual structural family therapy model (Szapocznik, Kurtines, Santisteban, & Rio, 1990; Santisteban, et al., 1993) and Family Effectiveness Training or Bicultural Effectiveness Training Program (Szapocznik, et al., 1986, 1989) for high-risk pre-adolescents and adolescents; Alvey's Confident Parenting Program for parent training models for African-American and Hispanic families (Alvey, Fuentes, Harrison, and Rosen (1980), and Kumpfer's Strengthening Families Program for rural and urban African- American, Hispanic, Asian, Pacific Islanders, English or French Canadian families, and Australian families (Kumpfer, Molgaard, & Spoth, 1996). In any case, cultural modifications of proven programs with general population families for ethnic families require an organized, culturally sensitive, theoretical framework to guide these changes (Ho, 1992).

DEVELOPMENTALLY-APPROPRIATE

Addressing developmentally-appropriate risk and protective factors or processes at specific times of family need, when participants are receptive to change is important. Tailoring the intervention to specific family needs can be done on an individual family assessment basis (L'Abate, 1977) or based on focus or research assessment data from similar families in the special population being addressed. Occasionally, a very short-term program can have high impact on some participants if the material covered exactly addresses a few major needs of the parent or child. In addition, research demonstrates that interventions are most effective if the participants are ready for change process (Spoth & Redmond, 1996a & b). Parents in the Iowa Project Family were targeted for a family intervention in the sixth grade, because this is an age when even normally well adjusted youth begin having behavioral and emotional adjustment problems. Parents are "ready" to participate and change, because they already see the beginnings of oppositional behavior. Outcome results suggest that the Iowa Strengthening Families Program (Molgaard & Kumpfer, 1994) was effective in reducing risk factors for drug use (Spoth, Redmond, & Shin, in press).

The four major types of parenting interventions appear to be developed with an eye to the cognitive and developmental competencies of children at different ages and parenting tasks. They include the following:

family support
parent training
family skills training
family therapy

For instance, in-home family support and cognitive/language development exercises are most effective with children from birth to 3 years (Yoshikawa, 1994). Professional medical support from home visits by a nurse is most often used with high-risk families from conception to age three (Olds & Pettitt, 996). Behavioral parent training programs or family skills training programs (behavioral family therapy involving the parent and child in structured skills training activities) are most effective with children 3 to 12 years of age (CSAP, in press). Family therapy or family skills training combined with behavioral parenting stressing parental monitoring is most effective with early adolescents and adolescents (Kumpfer, 1996).

CHANGE ONGOING FAMILY DYNAMICS

Family programs are most enduring in effectiveness if they produce changes in the ongoing family dynamics and environment. There is suggestive evidence that family programs that encourage families to hold family meetings weekly after the program ends have the longest effectiveness, because they change the internal family organization and communication patterns of the family in positive and enduring ways (Catalano, Haggerty, Fleming, & Brewer, 1996; Kumpfer, 1996a). Improving parenting skills produces an ongoing intervention that is more effective over time than short-term interventions with children or adolescents only (McMahon, 1996). Effectiveness of family interventions decay gradually with time (Harrison & Proschauer, 1995), but probably can be strengthened with new developmentally-appropriate booster sessions as recommended by Botvin (1995).

EARLY START

If parents are very dysfunctional, interventions beginning early in the lifecycle (i.e., prenatally or early childhood) are more effective. Trying to improve the parenting of problem junior high or high school students is an uphill battle. For every family program we have implemented and evaluated, we have wished that for some children, the intervention had begun earlier. After the initial NIDA SFP clinical trials, the Project Reality, methadone maintenance clinic began targeting pregnant drug-abusing women for improved parenting skills. Since pregnancy has generally been found to be a time when many women are willing to decrease drug use and also to sign up for classes to improve their parenting, many federal and state drug abusing women's programs (CSAP, CSAT, NIDA, and NIAAA) target pregnancy for recruitment and family interventions. Improved pregnancy outcomes and increased services have been documented so far, but long term improvements on the children have not been documented (Rahdert, 1996).

FAMILY RELATIONS, COMMUNICATION, AND PARENTAL MONITORING

Components of effective parent and family programs include addressing strategies for improving family relations, communication, and parental monitoring. Although research has shown that the final pathway to delinquency and drug use is through peer influence (Kumpfer & Turner, 1991; Newcomb, 1995; Swain, Oetting, Edwards, & Beauvais, 1989), the family precursors are lack of parental monitoring that is moderated by parental caring and positive parent/child relationships (Duncan, Duncan, & Hops, 1996; Brook, et al., 1984; 1990). Effective programs start first with improving the parent/child relationship and then focus on family communication and parent monitoring and discipline (Kumpfer, 1996b). The more effective behavioral skills training programs are distinguished from parent education, because they include a structured and sequenced series of parenting skills that are role played and practiced in the group or in homework assignments, resulting in increased success in the implementation of such skills.

RECRUITMENT AND RETENTION

High rates of recruitment and retention are possible with families. Although many family intervention providers have a very poor turnout for their first attempts at implementing family programs, with increasing experience the retention rates can generally be significantly improved if barriers to attendance are reduced. An 80% to 85% retention rate is possible for most programs if transportation, meals or snacks, and child-care are provided (Aktan, 1995). The intervention should be located in a non-threatening environment and provided by sensitive, trained, and caring professional staff members. Recruitment rates will vary with the type of program, incentives, types of clients targeted and time of day offered (Spoth & Redmond, 1996b). While program length may be an issue in recruiting families, it is generally not an issue in retention, because many families do not want the program to end once they have attended more than three or four sessions. An ongoing parent support group or booster sessions can help address this need for continuation of the program.

VIDEOTAPING OF EFFECTIVE PARENTING SKILLS

Videos of families demonstrating good and poor parenting skills helps with program effectiveness and client satisfaction. Video tape vignettes and video-based programs are demonstrating significant long-term program effectiveness (Webster-Stratton, 1990a; Webster- Stratton, 1996) even when self-administered (Webster-Stratton, Kolpacoff, & Hollinsworth, 1988; Webster-Stratton, 1990b). Families generally want to see videos that include local issues and that are racially matched. Having the children watch the parenting videos or the parents watch the children's videos, improves generalization and implementation of the video content. Computer interactive videos, allowing self pacing, self-testing, and selection of major content areas based on needs, may be even more effective (Gordon, 1996; 1997).

TRAINER'S PERSONAL EFFICACY

The effectiveness of the program is highly tied to the trainer's personal efficacy and characteristics. Although little data exists on how much of the effectiveness of a family program is due to the trainer versus the standardized curriculum, estimates range from 50% to 80%. Qualitative evaluations of trainer effectiveness, participant satisfaction ratings, and long-term follow-up interviews with participants (Harrison, Proschauer, & Kumpfer, 1995) delineate nine important staff characteristics for program effectiveness: 1) communication skills in presenting and listening, 2) Warmth, genuineness, and empathy first detailed in studies of therapist's effectiveness by Carkhuff and Truax (1969), 3) openness and willingness to share, 4) sensitivity to family and group processes, 5) dedication, care and concern for families, 6) flexibility, 7) humor, 8) credibility, and 9) personal experience with children as parent or child care provider.

Parent trainers with backgrounds in the type of program being implemented are best. Staff who share the same general philosophy and background as the program is promoting are most effective. Personal, caring, empathetic and experienced staff members are rated the highest by the program participants, retain families better, and produce better results. The best family and parenting programs are only as effective as the quality of the staff delivering the program. See Aktan (1995) for some guidelines for hiring high quality staff for family programs.