Strengthening Americas Families Program Funded by - Office of Juvenile Justice and Delinquency Prevention
 
This is the literature review taken from:

Kumpfer, K.L., (1993) Strengthening America's Families:

Promising Parenting Strategies for Delinquency Prevention-User's Guide Office of Juvenile Justice and Delinquency Prevention. Office of Juvenile Programs. U.S. Department of Justice, Washington, D.C.

This User's Guide was prepared under grant no. 87-JS-CX-K495 from the Office of Juvenile Justice and Delinquency Prevention. Office of Juvenile Programs. U.S. Department of Justice. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.

Promising Programs in Family and Parenting: Risk and Protective Factors in the Prevention of Delinquency Years of program development and research have provided effective strategies for strengthening America's families to prevent delinquency. This document has been written to help program planners, policy makers and service providers determine the most effective family-focused and parenting intervention strategies for the high-risk youth and families they serve. This guide will review what is currently known about the impact of family characteristics on risk for delinquency as well as the most promising family change interventions. Providers using the guide will be better able to choose or modify existing programs or create new interventions for high-risk youth.

Part I: Family Influence on Delinquency

Analyses how family strengthening approaches reduce delinquency among youth. It is not always easy to see the connection between early childhood parenting practices or family environment and later juvenile delinquency in youty. This section describes research literature on the most important family factors that should be addressed by a family program.

Part II: Review of Family Strengthening Programs

Describes a national search to find the best family intervention strategies. This guide reviews only those programs shown to be effective in preventing problems that often lead to delinquency. Critical issues such as recruitment, attrition, staff training, and program evaluation are also discussed.

PART I: Family Influence on Delinquency

An Historical Perspective

Strengthening high-risk and dysfunctional families to raise children successfully is one of the most critical social issues in America. Failure to deal directly with this problem will result in making the United States less competitive in the 21st Century. Unfortunately, economic circumstances, cultural norms, and federal legislation in the last two decades have helped to create an environment that is less supportive of strong, stable families.

Americans must face the reality that alterations in American society have weakened the ability of families to successfully raise children. Many unfortunate circumstances have converged to create this problem: a weak economy that forces many mothers into the workplace, increasing divorce rates, reducing marriage rates, increasing teen pregnancy rates and numbers of children born outside of marriage, reduced paternal responsibility for child support or childrearing, increased child abuse and neglect, and increasing numbers of children being raised by poorly educated parents, mother-only families, and in poverty.

It is difficult to assess the causes of this crisis in the family amidst such a complex interaction of circumstances. For example, as federal public assistance legislation reduced the numbers of fathers in low income families,the number of American children raised without fathers and in poverty doubled from 1960 to 1979. One in five American children are growing up in poor families headed by women (Levy, 1987). In 1991, 36% of the 11.7 million female-headed families were poor and these families represented half of all poor families compared to only 23% in 1959 (U.S. Bureau of the Census, 1991). According to Garfinkel and McLanahan (1986) "families headed by women with children are the poorest of all major demographic groups regardless of how poverty is measured" (p.11). The vast majority of these families remain poor for long periods because they have very low education levels and low earning capacity. They lack sufficient child support from absent fathers and receive low levels of public aid (Garfinkel & McLanahan, 1986).

Poverty has also become centralized in large urban areas. The number of metropolitan poor increased 62% from 1969 to 1982 and an urban black under-class emerged during this period (Wilson, 1987). In the United States, the rich have been getting richer and the poor poorer since the early 1970s, according to public policy analysts. Before 1970, family income distribution was moving toward equality, but since then, upper and lower family incomes have become increasingly less equal.

At the same time that these economic changes have occurred, the extended family support system has eroded. Between 1979 and 1982 the number of children being cared for by extended family members dropped by half. As other supports and role models have decreased, the burden on parents of socializing their children has increased. Hamburg and Takanishi (1989) of the Carnegie Corporation write:

Throughout most of human history, small communities provided durable networks, familiar human relationships, and cultural guidance for young people, offering support in time of stress and skills necessary for coping and adaptation. In contemporary societies, these social supports have eroded considerably through extensive geographical mobility, scattering of extended families, and the rise of single-parent families, especially those involving very young, very poor, and socially isolated mothers (p. 825).

Many research studies have found that children raised by socially deprived families are at higher risk of chronic, severe delinquency and drug use (Blumstein, Farrington, and Moitra, 1985; Farrington, 1985). Children from families with higher income and occupational status do engage in non-chronic delinquency and occasional alcohol use and marijuana experimentation (Simcha-Fagan and Gersten, 1986). Hawkins and his associates (Hawkins, Lishner, Jenson, and Catalano, 1987) have pointed out, however, that "persistent serious crime and the regular use of illicit drugs appear more prevalent among those raised in conditions of extreme social and economic deprivation (p.92)".

Public policy to strengthen American families has been slow to evolve. Americans have had to realize families were in trouble before they would consider changing public policy. In addition, they needed to believe that there were effective family strengthening strategies to attack the problem. Lisbeth Schorr's Within Our Reach: Breaking the Cycle of Disadvantage (1988) reviews a number of promising family programs and ends with the statement:

We know how to intervene to reduce the rotten outcomes of adolescence and to help break the cycle that reaches into succeeding generations. Unshackled from the myth that nothing works, we can mobilize the political will to reduce the number of children hurt by cruel beginnings. By improving the prospects for the least of us, we can assure a more productive, just, and civil nation for all of us (p.294).

According to a 1986 Louis Harris poll, three quarters of the American public favors programs to help children, and particularly children living in poverty. Harris warned, "Politicians who ignore these pleadings from the American people do so at their own peril. It is a plaintive and poignant demand that simply will not go away." Senator John D. Rockefeller, IV in his Chairman's Preface for the Final Report of the National Commission on Children (1991) accurately summarizes the Commission's "stark and urgent message to all Americans:"

As a nation, we must set a new course to save our children, strengthening their families, and regain control of our national destiny. There are no quick fixes to the problems than threaten the lives and prospects of so many of America's young people. But the solutions are within reach.

The knowledge gleaned from this national search for the most promising programs to strengthen the family to raise successful and non-delinquent children will help us meet the demand of Americans to strengthen America's families and improve child outcomes.

DEFINITION OF "FAMILY"

The family is the basic institutional unit of society primarily responsible for child-rearing functions. When families fail to fulfill this responsibility to children everyone suffers. Families are responsible for providing physical necessities, emotional support, learning opportunities, moral guidance and building self-esteem and resilience.

This paper considers the "family" to be the constellation of adults or siblings who care for a child. Non-traditional family arrangements include single parent families, divorced families with joint custody of the child, children living with extended family members, adoptive parents, protective custody (such as temporary or permanent foster homes, group homes or institutions), and step-parents, (sometimes in blended families with children from two or more prior marriages).

A structurally non-traditional family does not necessarily indicate a high-risk family. The relationships within the family and the amount of support and guidance provided the child are the most important variables in the prediction of delinquency. In general, if the remaining family is stable, supportive and well managed, children who have lost a parent to divorce or death do not appear to be at greater risk of delinquency (Mednick, Baker, & Carothers, 1990). However, as the recent final report to the National Commission on Children points out: "When parents divorce or fail to marry, children are often the victims. Children who live with only one parent, usually their mothers, are six times as likely to be poor as children who live with both parents (U.S. Department of Commerce, 1990)." Some researchers have found they are also more likely to suffer more emotional, behavioral, and intellectual problems resulting in a higher risk of dropping out of school, alcohol and drug use, adolescent pregnancy and childbearing, juvenile delinquency, mental illness, and suicide (Emery, 1988; McLanahan, 1980; Zill & Schoenborn, 1988)."

The results are quite conflicted as other researchers (Rosen & Neilson, 1982; Farnsworth, 1984; Gray-Ray & Ray, 1990; Parson & Mikawa, 1991; White, 1987) have found no association between single-parent families and delinquency. Some studies suggest that sons appear to develop more problems than daughters when the loss of a father is early in their development; however, adolescent girls are particularly vulnerable to emotional distress when they loose their fathers (Baltes, Featherman, & Learner, 1990; Hetherington, Anderson, & Stanley-Hagan, 1989; Heatherington & Parke, 1986; Zaslow & Hayes, 1986). Other researchers have not supported these differential age and gender effects (Wells & Rankin, 1991). Living in an abusive or conflict-ridden, two-parent home is considered by experts as generally more harmful for children than divorce. Loeber and Stouthamer-Loeber (1986) concluded after a reviewing about 40 studies examining family structure and delinquency that marital discord was a stronger predictor of delinquency than family structure. According to Wright and Wright (1992) four factors may explain the relationship between single-parent families and delinquency:

1) economic-deprivation,

2) reduced supervision, formal controls, social supports;

3) living in poverty neighborhoods characterized by high crime rates and alienation (McLanahan & Booth, 1989), and

4) an increased criminal justice system response to children from single-parent families.

Because of the importance of fathers reducing these factors by socializing and protecting children, providing additional monetary support and community leadership, marriage counselors are emphasizing solving family problems within marriage (Peterson & Zill, 1986; Taylor, 1991).

An increasing number of children live in complex, shifting, highly stressed family arrangements. These include homeless children and children living in foster care. In these cases, it is more difficult to describe the total family environment and the impact on the child. Few studies have been conducted on the impact of such family environments.

IMPACT OF FAMILIES ON YOUTH

From as early as the turn of the century experts in juvenile delinquency (Morrison, 1915) have recognized the family's early and primary role in influencing delinquency. A number of literature reviews or meta-analyses of research studies (Geismar & Wood, 1986; Henggeler, 1989; Loeber & Dishion, 1983; Loeber & Stouthamer-Loeber, 1986; Snyder & Patterson, 1987) all support the conclusion that family functioning variables have an early and sustained impact on family bonding, conduct disorders, school bonding and adaptation, and later delinquency in youth. Family dysfunction and poor parental supervision and socialization are major influences on children's subsequent delinquency. In fact, community environmental factors, such as poor schools and neighborhoods as correlates of poverty, have not been supported as powerful predictors of delinquency as family risk and protective factors discussed below.

Unfortunately, it has only been until recently that the impact of family factors in delinquency has received much attention or research funding. Implications of existing research are that the family environment can either protect children from subsequent delinquency or put them at greater risk. As more studies are conducted, the delinquency field will have a better picture of the indirect and direct influence of families on youth. More detailed information on what is known follows.

Family Correlates of Delinquency

Depending on the level of functioning, families can negatively impact a child's development. Loeber and Stouthamer-Loeber (1986) conducted an impressive meta-analysis of approximately 300 research studies. In longitudinal studies, socialization factors (i.e., lack of supervision, parental rejection of the child and child rejection of the parent, and lack of parent/child involvement) were found to be the strongest predictors of delinquency. Parental dysfunction, such as criminality, and poor marital relations were mid-level predictors and parental health and absence were weak predictors. In concurrent comparative studies, the strongest correlate of problem behaviors in children and youth was the child's rejection of the parents and/or the parent's rejection of the child. The importance of effective parental discipline was higher in these studies than in the longitudinal studies. The effect of these risk factors appear to be the same for boys and girls.

From this and other reviews (including Kumpfer, 1987; Wright & Wright, 1992) as well as other primary sources, a list of family correlates of delinquency can be assembled:

  • Poor socialization practices, including parents' modeling of antisocial values and behaviors, failure to promote positive moral development, and neglect in teaching life, social, and academic skills to the child.
  • Poor supervision of the child, including failure to monitor the child's activities, neglect, latch-key conditions, sibling supervision, and too few adults to care for the number of children.
  • Poor discipline skills, including lax, inconsistent, or excessive discipline, expectations unrealistic for the developmental level of the child (which creates a failure syndrome), and excessive, unrealistic demands or harsh physical punishment.
  • Poor parent/child relationships, including rejection of the child by the parents or of the parents by the child, lack of involvement and time together, and maladaptive parent/child interactions.
  • Excessive family conflict and marital discord with verbal, physical or sexual abuse.
  • Family chaos and stress often because of poor family management skills or life skills or poverty.
  • Poor parental mental health, including depression and irritability that cause negative views of the child's behaviors.
  • Family isolation and lack of community support resources.
  • Differential family acculturation and role reversal or loss of parental control over adolescents by parents who are less acculturated than their children.
Resiliency and Protective Family Factors

Though most reviews of the causes of delinquency and other problem behaviors have primarily focused on risk factors rather than protective factors, it is possible that protective factors are as important, or more important. Garmezy and his associates (Garmezy, 1985; Masten & Garmezy, 1985) contributed significantly to the prevention field with their studies of stress resistant "invulnerable" or resilient children as well as "vulnerable" children. One of the major findings in these studies of children of mentally disordered parents was that high intelligence is a protective factor.

Michael Rutter (1987b, 1990) has published recently on the concept of psychosocial resilience. From his own longitudinal research he has concluded that protective mechanisms operate at key junctures in youths' lives and that they must be given special attention. Resilient children and youth are better able to deal with stressors in their lives because they have coping skills to minimize negative impacts and focus on maintaining their self-esteem and gaining access to opportunities. In this way they develop self-efficacy. The process of developing resiliency in youth by teaching them skills for dealing with challenges and life traumas has been explored by Richardson and his associates (Richardson, Neiger, Jensen, and Kumpfer, 1990).

Having a dream, engaging in long-range planning and being able to delay gratification have also been shown to be important in resilient youths. In a longitudinal study of institutionally-reared women, Rutter and Quinton (1984) found that women with the most successful life adjustments and marriages were those who exercised "planning" in their life choices (e.g., marriage partner, job, pregnancies). Women who planned had better marriages to less deviant husbands, had much more positive school experiences, and had significantly lower teenage pregnancy rates (19% vs 48%). It appears that the ability to develop long range goals or a "dream" is critical in protecting youth from potentially disastrous life decisions.

Good marital relationships reduce delinquency (Rutter & Quinton, 1984).

However, when family or marital discord exists, positive interpersonal relationships with one caring parent is a major protective factor for conduct disorders, psychiatric disorders, and later delinquency and drug use (Minty, 1988; Rutter, 1987b; Werner, 1986). Most often the one caring parent is as the mother, hence maternal characteristics become critical. Researchers (McCord, 1991; Lytton, 1990) have found that competent mothers who are affectionate, self-confident, non-punitive, and have leadership skills produce children less likely to become delinquent.

Most integrated, etiological theories of delinquency stress the importance of family, school, and community bonding. This ability to "bond" is highly correlated with positive outcomes according to many empirical studies of delinquency (Hawkins & Weis, 1985; Kumpfer & Turner, 1991; Thornberry, 1987). The ability to develop a close, trusting relationship with someone else may be the actual resiliency factor. Therefore, in the absence of an opportunity to form a close attachment to a positive, caring parent attachments with another caring adults (grandparent, relative, older sibling, adoptive or foster parent, teachers, or "adopted surrogate parent" or friend's parents can provide the needed bond with "one caring adult". Some youth have been found to exercise self-agency (Bandura, 1989) by escaping rejecting, violent, or chaotic homes and finding more positive family or institutional settings. Desistance from delinquency (Mulvey & LaRosa, 1986) and reduced risk of alcohol and drug abuse (Wolin & Wolin, 1993) is related to the youth's ability to create a more positive "family" life for themselves. Children in abusive family situations are less likely to become delinquent if they have additional social supports from a close relationship with a sibling or teen sport coaches and team mates (Kruttschmitt, Ward, & Sheble, 1987).

Other protective factors that can be influenced by the family or caretaker include:

1) providing the right degree of hazard in life experiences so that youth have opportunities to develop coping skills and self-confidence (Rutter, 1987b),

2) maintaining family routines and rituals (Wolin, Bennett, & Noonan, 1979),

3) support with academic, social, and life skills development,

4) promoting positive normative and moral development (Damon, 1988) through family religious involvement and family values education, and

5) help in selecting positive friends and activities.

Families can help a child by teaching positive coping skills. Such skills protect children against life stressors that might push them into delinquent behavior. In addition, families can help youths to make good decisions that will influence their life for some time, such as educational or vocational training, job selection, choice of a mate, and social groups to join.

Longitudinal studies by Rutter and others have found that making positive choices at such critical life junctures can have a major impact on future problems (Rutter and Quinton, 1984). A supportive family with years of accumulated wisdom from elder members can help youths make good decisions.

In addition, supportive families are likely to discuss family values and attitudes about the world, including alcohol and drug use. They also can help youths to learn to delay gratification and develop dreams about what they want to be and do someday. Without a vision for themselves or a dream for the future, they are more prone to make unwise choices that would jeopardize their chances for success.

Structural Versus Functional Family Factors

Jones and DeMaree (1975) in their research on high-risk families, concluded that structural or demographic characteristics such as race, socioeconomic status, poverty, frequent family moves, low educational level, and unemployment are intricately interrelated with family functioning. These structural factors, often out of the control of family members, may contribute to family disruption, overcrowding and stress, depression and other interrelated factors.

Reviews concur that the final pathway in which family factors influence delinquency is the way that the family functions, rather than external demographic variables. According to Zill (in press): "It is important to look at the realities of how families are actually functioning, rather than labeling some types of families as inevitably bad and others as invariably good ", for instance "many single parents do manage to provide stable, secure, stimulating and supportive homes for their youngsters (p.22)." However, many structural factors tend to be positively correlated with family dysfunction. Some of these structural factors include:

  • Poverty, which is the overarching cause of many of the other structural and functional family factors. Parents who are poor do not have the money to provide the same opportunities for their children as more prosperous families. Many of the poor are single working mothers who do not have enough money to provide adequate child care, health care, or educational opportunities.
  • Neighborhood disorganization, which is related to increased crime. There are two possible reasons for this relationship. First, in disorganized neighborhoods, youth do not have close bonds with neighbors, and second, informal monitoring of youth in such neighborhoods is limited.
  • High density housing, which is related to juvenile crime and family dysfunction. Families are often socially isolated in public housing projects and live under a great deal of stress.
  • Reduced educational, cultural, and job opportunities. The economic robustness of a neighborhood often determines the quality of the schools, access to community cultural resources, and number of jobs available for youth.
  • Discrimination, which is also related to poor growth outcomes, whether caused by religious, ethnic, cultural, gender or family background factors. Youth who are not accepted by the mainstream youth in their school, church, or neighborhood are not likely to bond to these social institutions.

Multiple Pathways and Multiple Risk Factors in High-risk Families

There are many pathways to delinquency (Huizinga, Esbensen, & Weiher, 1991) and a variety of family circumstances contribute to negative behavior in children (Wright & Wright, 1992). Studies of family risk factors for delinquency conclude that the probability of a child becoming a delinquent increases rapidly as the number of family problems or risk factors increases (Rutter, 1987a). Children and youth generally appear to be able to withstand the stress of one or two family problems. When they are continually bombarded by family problems, however, their normal development is impeded.

Unfortunately, family risk factors often tend to cluster. For example, children of poverty typically contend with multiple problems, including parental absence because parents must work or because fathers unable to support their family have left; irritable and depressed parents or caretakers; lack of money for social or educational opportunities; and in severe cases, lack of adequate food and clothing, and even homelessness.

CHILD VERSUS FAMILY-FOCUSED INTERVENTIONS

In both the delinquency and substance abuse prevention or intervention fields, most programs are aimed at working with problem youths themselves, rather than the whole family. Historically, earlier approaches to rehabilitation and therapy assumed that it was the youth who had the problem, not the family. In addition, working with children and youths is easier than working with parents and other family members -- children and adolescents are generally more accessible through schools or community groups for participation in delinquency prevention activities than are entire families.

Although efforts focusing on youths themselves should be continued, mounting evidence demonstrates that strengthening the family has a more enduring impact on the child. In a review of both family- and child-focused approaches to the reduction of conduct disorders, McMahon (1987) concludes that child "skills training approaches have failed to demonstrate a favorable outcome or evidence of generalization in more naturalistic settings (p. 149)". Conversely, family-focused approaches have demonstrated outcomes that are both positive and enduring.

PART II: REVIEW OF FAMILY STRENGTHENING PROGRAMS

The previous review highlighted the need for family-level intervention in the prevention of delinquency. Today there are many different types of parenting and family strengthening programs designed to address the family problems discussed. Psychotherapy has stressed the importance of family interventions. Coleman and Stanton (1978, p. 479) wrote: "It is an understatement to say that family approaches to psychotherapy have increased in popularity and breadth during recent years." Family systems theory and family therapy techniques are widely taught in training programs for therapists.

The increased success of treatment when the family is involved is widely acknowledged by therapists and documented in the research literature (Gurman and Kniskern, 1978; Stanton and Todd, 1982). Most therapists are acutely aware of the damage that a family can do to client's therapeutic progress if the family is not supportive of the treatment goals or are unaware of their impact on the client. Obvious and subtle forms of sabotage occur as family members attempt to redevelop the former family balance and dynamic.

A number of prevention researchers (Loeber and Stouthamer-Loeber, 1986; Fraser, Hawkins and Howard, 1986; McMahon, 1987) strongly support family-focused prevention interventions as the most effective intervention strategy for delinquency and substance abuse (Kaufman and Kaufman, 1979; Kaufman, 1986; Stanton and Todd, 1982).

DEFINITION OF "FAMILY STRENGTHENING PROGRAMS"

For the purposes of this review, a family strengthening program will be defined as any intervention that works with either a parent or caretaker of a child or some members of a family (including at least one target child) with the goal of reducing risk or increasing protective factors for problem behaviors. Parent or family programs can vary from a single session to a much longer and more intensive series of sessions.

Programs that use volunteers or professionals working directly with a child are considered "surrogate" parenting programs. Examples of these programs include Big Brothers or Big Sisters, Partners, Foster Grandparent programs (if they work with the child and not the parent), intensive foster parent programs or professional group home programs. They technically do not meet the criteria for a parent or family strengthening program, but they are covered in this review, within a loose definition of "family" as child rearers.

A national search for the best methods for strengthening families yielded 25 different intervention strategies (as well as many variations or combinations). These do not exhaust all the possibilities. One of the reasons for such a wide diversity of family strengthening programs is that the needs of the families vary and programs must be tailored to meet those needs. As shown in Figure 1, major factors to consider in the selection of the most appropriate family program are the age of the child at risk and the level of identified dysfunction of the family.

At the top left are the earliest interventions possible, such as family or parent education in schools before young people even become parents. Family education can begin as early as elementary school in order to prepare youth for future family responsibilities. At the other extreme are programs for families in crisis who have a youth on probation for criminal involvement.

MODELS OF FAMILY STRENGTHENING PROGRAMS

Only the most popular and promising intervention strategies included in Figure 1 will be reviewed here. One major dichotomy of the intervention strategies are those that involve the parents or caretakers only, called parenting approaches, and those that involve the parents with at least the target child, often called family approaches. Some basic variants of each of these two major approaches will be discussed below, including several model programs.

Parenting Approaches

The major parenting approaches defined and described below include parent education, behavioral parent training, Adlerian parent training, parent support groups, in-home parent education or parent aid, and parent involvement in youth groups.

Parent Education Programs

Parent education programs are distinguished in this paper from parent training programs in that education programs generally involve fewer sessions and do not have the parents practice skills in the groups or do assigned homework. Parent education programs can range from a single motivational lecture to a series of lectures that may involve experiential exercises and self-ratings.

These programs generally involve teaching parents ways to improve their parenting or family relationships. Sometimes these programs involve increasing awareness of community resources to help their family or child. Parent education may include appropriate behavioral expectations, ways to better supervise and discipline children, tips for how to improve moral and ethical thinking in children, ways to discuss family values and ways to monitor stealing and lying. Such programs also often include information about the risks of alcohol and drug use, early warning signs of use, other behavioral or family risk factors, the family disease concept, and ways to talk with children about alcohol and drug abuse.

Parent education can be conducted in many different ways. For example, high-risk families may not have time to attend parenting classes, but most watch television. Popkin's Active Parenting Program has been shown on PBS in the state of Washington. Some parenting programs are available on audio tape or video tape to be reviewed at home. Magazines often carry feature or serial articles on improving parenting and family relations. Some businesses offer parenting classes during lunch hours (an excellent way to attract fathers). Some school alcohol and drug prevention programs include homework assignments to be done with the parents.

Popular anti-drug programs such as the Parents' Resource Institute for Drug Education (PRIDE) and the National Federation for Drug Free Youth include parent education components about such topics as teaching parents how to talk to their children about alcohol or drugs (as does the National Council on Alcoholism's "Talking With Your Kids About Alcohol" developed by the Prevention Research Institute).

Hawkins and his associates (Hawkins, Lishner, Jenson, and Catalano, 1987) have developed a risk factor based parent education program, called Preparing for the Drug-free Years, that can be implemented in five sessions with the support of video tapes. The program works well for statewide dissemination through schools and community agencies. The program is being tailored for high-risk and ethnic families.

Behavioral Parent Training Programs

This group of programs teaches parents of a difficult child how to discipline the child more effectively and control overt conduct disorders. The programs are highly structured and trainers use programmed instructional aids and manuals with special topics and exercises with homework assignments each week. Typically a course includes 8 to 14 weekly sessions lasting about 1 to 2 hours. Skills typically taught include behavioral shaping principles of positive reinforcement, attending to wanted behaviors and ignoring unwanted behaviors. Parents are taught first how to "catch your child being good" and reward the child for good behavior. These techniques improve the child's problem behavior and develop a more positive relationship between parents and children. Once parents have mastered paying attention to the good things their children do, they are taught to decrease inappropriate or unwanted behaviors by not attending to these behaviors or using mild punishments, such as time outs, natural consequences, and loss of privileges.

The basic parent education and training programs have been well documented to be effective in reducing problem behaviors in children. There is less evidence concerning the applicability of these programs to reduce delinquency, since the programs work primarily with younger children. The programs have, however, demonstrated effectiveness for reducing overt conduct disorder problems in children. Approximately 50% of all children diagnosed with conduct disorders develop delinquency in adolescence and the others often show other social and developmental problems (Kazdin, 1987).

There are many types of behavioral parent training programs, but most are variants of the parenting model developed by Patterson and his associates at the Oregon Social Learning Center. Patterson's book: Families: Applications of Social Learning to Family Life (1975) explains this type of parent training. Family members read his other book, Living with Children (1976) prior to starting the group. Another widely used parenting resource book is Becker's book called Parents are Teachers: A Child Management Program (1971).

Adlerian Parenting Programs

These programs are based on clinical psychology principles of improving the whole person. Dinkmeyer and McKay's (1976) Systematic Training for Effective Parenting (STEP) is based on the theoretical teachings of Alfred Adler. This program involves local groups of parents in 8 to 12 weekly two-hour sessions covering parenting topics such as understanding the child's behavior and emotions, using encouragement, listening and communicating more effectively, disciplining by using natural and logical consequences rather than punishment, establishing family meetings, and developing confidence as a parent. The goal of this program is to improve the child's self-concept and dignity.

The popular Parent Effectiveness Training (PET) program developed by Gordon (1970) is based on the self theory of Rogers. The primary focus of this program is enhancing the family's communication, problem-solving, and mediation skills. Parents are taught active and reflective listening skills and the use of open-ended questions. They are taught to consult with children regarding problems, but to leave the child to make his or her own choices. Parents also learn about parental power and the problems of being overly permissive or authoritarian.

Another popular program that stresses communication is Glenn's (1984) "Developing Capable Young People" program. This 10-session program focuses on the parent's role in socializing children in pro-social ways.

Parent Support Groups These groups are generally grassroots organizations of parents who provide support and education for members. Examples of these groups include The National Federation of Parents for Drug Free Youth, Toughlove, PRIDE, The Cottage's Families in Focus, Mothers at Home, Mothers of Pre-Schoolers (MOPS) and Families in Action. These national organizations provide parenting and alcohol and drug education materials. Their local chapters often offer parent support groups. In these support groups parents can share their concerns and problem-solve with the group. Some of these groups, like Toughlove, provide temporary respite care for parents having problems with their adolescents. Some organizations, like STRAIT, provide residential treatment for drug-using youths, followed by several months of living with other parents in the support group.

Parent Aid or In-home Parent Education

This type of program offers parent education to parents who find it difficult to come to group meetings. Teen Moms is an example of this type of program. Professional public health nurses and social workers often deliver in-home parent education and occasionally parent training to new mothers. If paid professionals are not available, parent aids are sometimes used to deliver these services. Parent aids are highly trained volunteers who are willing to work in homes to teach parents to improve care of an infant.

Parent Involvement in Youth Groups

This approach includes a wide variety of ways to get busy or distrustful parents to become more involved with their child through the child's participation in a preschool, school, church, or children's agency group or activity. High-risk parents, who would not volunteer for a parent training group, are gradually involved in the children's groups and are exposed to improved parenting skills through observing teachers or trainers work with the children. For example, City Lights in Washington, D.C. gradually gains the trust and interest of inner city, low SES parents by calling them to notify them about their child's achievements in their youth activities program. After a period of increasing contact, parents occasionally are willing to volunteer to help with the youth activities or join a parenting group.

Headstart and pre-school programs have for some time informally taught parenting skills by involving parents in preschool activities. The positive results of the Perry Pre-school Project may be mainly due to this direct modeling of appropriate ways to discipline, support, and help children. The parents learn by watching the teachers and by working with their own child and other children. In San Antonio, the Los Ninos Project includes three levels of parent involvement in the children's groups, ranging from no involvement to helping with food and materials for the groups, and, finally, to helping with the children's activities.

Family Prevention Approaches

Several major family interventions have been used to help prevent delinquency, substance abuse, and other teen problems. These include family education programs, family skills training programs, family therapy, family services, and in-home family crisis services or family preservation programs. Each intervention type is discussed below.

Family Education Programs

These programs provide the family with lectures or educational sessions on family values, responsibility to society and others, law-related education, family communications, alcohol and drug use, relationship enhancement techniques, and other family strengthening strategies. This approach has been used as either a single session or a series of lectures or experiential sessions conducted in schools, churches, community centers, juvenile courts, youth rehabilitation centers, adolescent group homes, alcohol and drug treatment centers and public agencies. Workbooks are also available for families to conduct independent family discussions at home.

Family Skills Training Programs

These programs are often called behavioral family therapy or behavioral parent training (if the child is included in the sessions). They specifically involve structured family training sessions. A number of behavioral family therapy programs have been reviewed by McMahon (1987).

Intensive family skills programs combine adapted behavioral parent training programs with children's social skills training programs and family relationship enhancement programs. Examples include the Strengthening Families Program (Kumpfer, DeMarsh, and Child, 1989a, b, c) and The Nurturing Program (Bavolek, Comstock and McLaughlin, 1983), and Families and Schools Together (McDonald, Plant, & Billingham, 1988).

Family skills training programs have been evaluated rigorously by researchers and found to be effective in reducing a number of family, parent, and child risk factors for delinquency. Kumpfer and DeMarsh (1986) state that they were able to reduce problem behaviors in youths and improve family functioning with their Strengthening Families Program.

Family Therapy Programs

This group of programs includes a number of different clinical approaches to the family such as structural family therapy (Minuchin, 1974; Szapocznik et al., 1983), functional family therapy (Alexander and Parsons, 1973, 1982), strategic family therapy (Haley, 1963), and structural-strategic family therapy (Stanton and Todd, 1982). These family intervention approaches depend on the discretion of the individual therapist to determine the appropriate application and timing of specific techniques and exercises.

The Functional Family Therapy approach was evaluated primarily for the prevention of delinquency in young status offenders by Alexander and Parsons (1973). They found reductions in recidivism and improvements in problem behaviors as well as a preventive impact on delinquency in younger siblings (Klein et al., 1977).

Family Services Models

This is the traditional family services model in which a large number of needed services are brokered by a caseworker or a case manager. High risk families often need more than family therapy or skills training. Rather, they often have immediate basic needs, such as food, clothing, medical care, and housing. Only after these emergency needs are met can the family begin to consider parenting and family enhancement program involvement.

In-home Family Preservation Programs

This approach includes a number of in-home crisis services that are often used for the preservation of the family when out-placement of a child is imminent. Homebuilders, the prototype program, was developed in Washington by Haapala and Kinney (1979). This model has been so successful in reducing placement of youths in state custody and institutions or group homes that it is currently being replicated in many states. In this model, a team of highly trained family services workers arrive at the family's home and provide whatever in-home services are needed. The intervention is very much like that delivered by the traditional social worker, but the services are more intensive and short term.

Surrogate Family Approaches

If the biological parents are not involved with the child or able to participate in parent or family programs, working with extended family members or other parent surrogates is possible. Parenting and family programs have been developed for adoptive parents, blended families, group home parents, foster grandparents, Big Brothers or Big Sisters, volunteer sponsors, and for foster parents (Guerney, 1974).

An application of behavioral parent training has been developed by Patterson and his associates for delinquent youths committed to state institutions. At the Oregon Social Learning Center's (OSLC) Specialized Foster Care Model, institutionalized or to-be-institutionalized delinquents are assigned to specially selected and trained foster care parents. The foster parents have daily contact with the OSLC staff and the youth's teacher. Chamberlain and Reid (1987) reported success in preventing recidivism among youth who completed the program.

The Teaching Family Model (TFM) was developed for married couples who run community-based residential programs for treating conduct disordered adolescents. The prototype of this type of surrogate family model is Achievement Place, which first opened in Kansas in 1967. There are now over 215 residential group homes employing this treatment model (Wolf, Braukmann, and Ramp, 1987). The teaching parents are rigorously trained in a one-year training program that culminates in certification by the National Teaching-Family Association.

The Teaching Family Model has been evaluated by the originators (Kirigin, Braukmann, Atwater and Wolf, 1982) and by an independent evaluation (Weinrott, Jones and Howard, 1982). Both evaluations found significant reductions in official records of delinquent behaviors in youths in the TFM program compared to youths in other group homes. These reductions lasted for the time they were in the residential homes, but did not continue in the following year. A longer term follow-up may reflect later "sleeper effects".

Chamberlain and Reid (1987) report that a similar approach to the foster parent TFM program developed by Patterson and colleagues has demonstrated reductions in conduct disorders over time.

OUTCOMES OF FAMILY STRENGTHENING PROGRAMS

Summary of Program Effectiveness

Overall, family-focused interventions have been shown to be superior to child-only interventions. McMahon (1987) discusses the relative failure of school-based children's programs for the reduction of conduct disorders and concludes that these skills training programs, though widely used, "have failed to demonstrate a favorable outcome or evidence of generalization in more naturalistic settings (p.149)".

McMahon (1987) summarizes the deficits in most children's skills training programs: It seems quite unrealistic to assume that altering a single skill deficit is likely to have a wide-ranging impact on youth with problems as pervasive as those typically seen in conduct disordered populations. A more clinically-defensible strategy would be the systematic evaluation of some of these interventions as adjuncts to family-based treatments, with particular attention being paid to the extent of the developmental progression of the conduct disordered behaviors and the identification of particular deficits for individual children (p.149).

The evaluations of family programs differ in quality and some have not been replicated by other researchers with other populations. Taken as a whole, however, these evaluations indicate the strength of family-focused approaches. Family skills training appears to be most the most promising family-focused approach. The target child, along with the rest of the family participates in structured activities designed to modify interaction patterns. This strategy is desirable for high-risk families in which the therapist should monitor the changes in the parents and child interaction patterns throughout the training process. Many variations of family skills training have been developed and can be tailored to the specific needs of the family.

Recommendations to Improve Effectiveness of Family Interventions

A number of program design and implementation issues can make the difference between success and failure of family intervention programs. Some of the most important issues are discussed below.

Provide Programs of Sufficient Intensity

High-risk families need considerable time and support before they are capable of making changes. Many family service programs find that standardized parenting or family training programs cannot even begin until staff spend a number of sessions getting to know the family's needs, locating support services, and developing trust. The more needy the family and parents, the more sessions this requires.

Kazdin (1987) suggests that parent training programs of less than ten hours duration are unlikely to be successful. In their study, Kumpfer and DeMarsh (1985) observed that some high risk and lower education level parents could have used more than the 14 sessions in their Strengthening Families Program, particularly if these parents missed a number of sessions and were having difficulty implementing the concepts at home. A number of family training specialists estimate that, with high-risk families, at least 30 to 40 contact hours are needed to have a positive and lasting impact.

Match the Program to the Family's Needs

Accurate assessment of the family's problems is needed to tailor the family interventions to the family's needs. One good example of how such tailoring can be accomplished is provided by L'Abate's (1977) Family Enrichment Program. L'Abate developed a clinical assessment tool that specifies the type of training and the number of sessions needed, depending on the family's scores on different family factor scales on a test. This tailoring approach is recommended for high-risk families who have multiple problems.

Assessments are required to determine whether a child's acting out behaviors are likely to evolve into serious problems later on. It would not be cost-effective to intervene with all non-compliant young children, as many of these children grow out of these behaviors. The literature suggests that children with a large number of risk factors are those most in need of prevention interventions because of their increased risk for delinquency.

Time Programs for Developmental Appropriateness

In order to be most effective, family interventions must be appropriately timed to the developmental stages of youth. For example, programs to teach parents to monitor their teenager's stealing and lying are probably too little, too late. Such parental training programs are needed from the 2nd to the 5th grades at the latest. Make Programs Culturally Relevant and Easily Understood

Most parenting and family programs have not been adapted for use by different ethnic groups. Generally, prevention programs are developed and evaluated for effectiveness with a broad general population before adapting them for special populations. In the last few years parent training programs have begun to be revised to be more culturally sensitive and appropriate. Alvy, Fuentes, Harrison and Rosen (1980) at the Center for the Improvement of Child Caring (CICC) in Ventura, California have developed a "Confident Parenting" program for African-American parents and another for Hispanic parents. Kumpfer, DeMarsh, and Child (1989) have developed a parent training programs for African-American, low SES substance abusing parents as part of their Strengthening Families Program. Hawkins and his associates have modified their training manual for "Preparing for the Drug-Free Years" to include the results of focus groups with different ethnic groups. A number of issues that should be considered in developing family programs for Hispanic families have been researched by Szapocznik and his associates (in press) at the University of Miami. Some of these cultural issues are discussed by Paul Cardenas in his manuscript for the project "Culture and Cultural Competency: Youth Focused Prevention and Intervention".

Program materials should also be appropriate to the reading and conceptual level of the population being served. This is one area that requires close scrutiny, because many high-risk families have very low reading and educational levels. If materials are too difficult to read or understand, program effectiveness is diminished.

Pay Attention to Parental Dysfunction

Parental dysfunction should be considered when screening for admission to a family program. Dumas (1986) found a composite index of maternal and paternal psychopathology, family violence, and SES disadvantage to be most predictive of outcomes in parent training. It is recommended that the Beck Depression Inventory and the Global Assessment Scale (GAS) be used as screening instruments. Potential clients with very high depression or mental health problem scores should be referred for treatment before admission to the family program. Kumpfer (1990) found in her modification of the Strengthening Families Program for African-American families that parents with low functioning scores on the GAS still had positive results in terms of changes in children's risk status. Hence, low functioning parents should be admitted as long as they can follow the program and gain from the experience. Excessively disruptive parents should be screened from the group, however, because of the detrimental impact on the group as a whole.

Pay Sufficient Attention to Recruitment and Retention

Family intervention programs for high-risk families generally have problems with recruitment and attrition. Successful programs modify their format to make it attractive for family members to attend. Therapists must recognize that a key step in helping families is promotion and recruitment. Many therapist are not trained to do recruitment and narrowly define their role as sitting in an office and "doing family therapy". Changes in attitudes through improved clinical training programs will be needed when training students to be successful therapist for high-risk families.

Many of the parent training and family therapy programs were developed and tested for relatively high-functioning parents. Patterson's basic behavioral parent training program requires parents to be motivated, organized, and capable of reading programmed tests and completing homework assignments.

Little time is programmed in the course to deal with crises and problems, which are frequent in high-risk families. Despite this lack of course material or specific topics on parental problems, Patterson and Chamberlain (1988) estimate that approximately 30% of the course time is spent dealing with such parental problems.

Kazdin (1987b) found that only about 25% of parents of conduct disordered children are willing to participate in the basic behavioral parent training program. What can be done for the other 75% parents of conduct disordered children to get them involved? Though the original parent training programs generally require fairly motivated and educated parents, adaptations have been made recently to reach more dysfunctional parents and those with low socio-economic status (Fleishman and Szykula, 1980; Sachs, 1986; Stanton and Todd, 1982).

The following principles are important in recruitment and retention of high-risk families:

  • Provide transportation, a safe convenient and non-stigmatizing place for the program, and child care;
  • Provide incentives for involvement until bonding to the leaders and group occurs. Examples include refreshments, toys for children, and prizes for completed homework or attendance;
  • Hold discussions during the first session on possible barriers to attendance, extend personal invitations to join the group and ask leaders and other group members to contact members who miss sessions;
  • Use indigenous trainers to increase program accessibility;
  • Involve parents in program modifications to foster a sense of program ownership.
Develop Strategies to Overcome Barriers

Despite almost universal theoretical agreement that involving family members in treatment or prevention interventions for high-risk youths is most effective, there are practical barriers to doing so. The first and most difficult problem, as discussed above, is to get family members to agree to participate in programs and to attend sessions once they have enrolled. Reasons for difficulties in recruitment and retention include transportation problems, lack of child care for the other children, lack of time, and lack of a perceived need to improve their parenting skills or family relationships, and fear of having children taken away.

Agency staff must develop strategies for dealing with each barrier to recruitment and attrition. A helpful tool for developing awareness of barriers is a self assessment test developed by Kumpfer and DeMarsh (1988) that includes questions about barriers to involvement in prevention activities and possible strategies to overcome these barriers.

Transportation problems can be overcome by providing bus tokens or arranging car pools or van pick-ups. Child care problems can be overcome by providing child care or by running a structured children's skills training group during the time of the parenting class, as does the Strengthening Families Program. If lack of time is an issue, for example, there are often ways to decrease the time cost by running the parenting group prior to a group that the parents regularly attend anyway, such as an Alcoholics Anonymous or therapy. Free child care can be offered during the time parents are in their support group, if they also attend a parent training group. Other strategies are to offer parent training at work sites on lunch hours or to show parenting videos while parents wait at general assistance offices or patient waiting rooms.

Meeting the overtly stated needs is often possible, but it is more difficult to overcome underlying, unstated barriers. Some of these unstated barriers include lack of ownership of the program, fear of the agency (for example, concern that the agency will report the parent to protective services), and perceived cultural or ethnic differences. In general, it is important to involve leaders from the target group of parents in the design of the program. These leaders can help recruit high-risk parents, help select program staff and provide feedback on the relevancy of the topics covered. The program should include time for personal sharing in order to build group support for members. If word gets around that trainers don't know anything about parents' real needs or about raising children, it will be very hard to recruit parents.

Provide Other Needed Services

Family interventions for the prevention of delinquency should be embedded within comprehensive family service agencies. It is nearly impossible to have much impact on high- risk families without providing a range of other supportive services to the family. Such family interventions should recognize the social environment of the family and strive to find ways to reduce stress and increase informal support networks. Volunteer family sponsorship programs may be a way to reach high risk families. Such programs may be particularly effective if they involve successful parents from the same neighborhoods or social groups. At one time other social institutions, such as neighborhood churches, provided informal community support for families. These supports, however, may no longer be as available to high risk families or may be underutilized by them.

Pay Attention to Cost-Effectiveness

A major issue in the selection or development of family programs for high-risk families is the availability, quality and cost of the manuals and of the support materials, such as videos, parent handbooks or workbooks, films, and evaluation materials.

Some of the reviewed programs have developed video, audio, and film materials to be used within the structured training course. Webster-Stratton's Videotape Modeling Group Discussion Program (VMGD) (1987) has put the entire program on video tape. Such an approach makes the program easy and inexpensive to disseminate.

Measure Program Effectiveness

Clinicians should be encouraged to measure the effectiveness of the program in changing behavior during and after the family intervention. Clinicians are often reluctant to carry out evaluations of program effectiveness. One way to encourage such evaluations would be for public and insurance funders to tie continued funding to demonstrated effectiveness.

Follow-up studies are also needed to track the longer term effectiveness of promising programs. Funding from the beginning of the program should be earmarked for the follow-up evaluation.

SUMMARY

This report presents highlights of a comprehensive literature review and discusses protective and risk factors within families that are related to delinquency. It also describes different family strategies, based on these factors, that can strengthen families' ability to raise youths who will not engage in delinquent activities.

Figure 1 presents a matrix to help organize the wide variety of possible parent and family programs and services according to the age of the child and the level of functioning of the family. This conceptualization will be useful in helping agencies determine the most appropriate family services for their target populations.

The main purpose of this review is to demonstrate that there is no one best family strategy for the prevention of delinquency. Instead, several types of parenting programs are needed. There are programs best suited for parents of infants, of children, or of adolescents. Some programs are best suited for well functioning families while others can be used by dysfunctional families. There is no single best program, but there are elements which make some family programs more effective. One key factor is the fit between the family's needs and the content and duration of the course. Other major factors in the success of the program include implementation issues, such as successful recruitment and retention strategies, and follow up.

Kazdin (1987b) suggests that we should not think in terms of "single shot" family inoculation programs. Multi-problem families with long-term problems are not likely to benefit from weak dose, single shot family programs. They need coordinated and long term help, including ongoing support and booster sessions with coordinated family services. Such intensive, comprehensive programs are likely to be most successful in helping high-risk families raise non-delinquent children.  

Dept. of Health Promotion and Education