Program

Nov 01, 2012

OVERVIEW

Familias Unidas is Hispanic-specific, family-based a program that aims to increase parents’ involvement in their adolescent’s home- and school-life. Through facilitator-led group discussion sessions with other parents and in-home discussions with their adolescent, parents gain an understanding of the importance of their engagement, and how to use parenting skills to decrease problem behaviors such as behavior problems, substance use, and sexual risk behaviors.

Evaluations of Familias Unidas reveal, for the most part, positive impacts on adolescent program behaviors and family functioning.  For example, several of the evaluations, showed positive program impacts on parental investment and family function as well as on adolescent behavior problems or externalizing behaviors. Two evaluations showed positive program impacts on cigarette use and illicit drug use, and two showed positive program impacts on incidence of STD infection and on risky sexual behavior (sex without a condom or sex under the influence of alcohol or illicit drugs) among those who had had sex.  One evaluation also showed positive impacts on numbers of sexual partners as well as on parent-child communication.

DESCRIPTION OF PROGRAM

Target population: Hispanic adolescents and their parents.

Familias Unidas uses several strategies to promote parent-child engagement and interaction.  Parental involvement is encouraged through offering problem-scenarios and participatory exercises.  Group discussion is used to help parents understand their importance in protecting their child from harm.  Program activities allow parents to interact with their child’s peers, connect to their child’s peer network, and facilitate their child’s interaction with positive peer influences. School counselors visit parents to increase their connection with their child’s school experience.  Planned in-home parent-child discussion sessions are designed to strengthen bonds within the family.  Parent groups meet with facilitators. During the first stage of the group, the goal is to engage parents in the program and create cohesion among the group.  In the second stage, facilitators discuss parents’ concerns about the child: in the family, with peers, and in school.  In the third stage, parents learn the skills necessary to decrease adolescent problem behavior and increase bonding with school and academic achievement.  Home visits are used during the third stage.

Group facilitators are trained in sensitivity towards Hispanic and American culture.  Facilitators are trained across three 8-hour days and facilitate six sessions. The program package, which includes training, adherence- monitoring and supervision, and evaluation assistance, costs $50,000.

EVALUATIONS

Pantin, H., Coatsworth, J. D., Feaster, D. J., Newman, F. L., Briones, E., Prado, G., Schwartz, S. J., & Szapocznik, J. (2003). Familias Unidas: The efficacy of an intervention to promote parental investment in Hispanic immigrant families.  Prevention Science, 4(3), 189-201.

Evaluated population: The evaluated population included 167 Hispanic 6th and 7th grade students residing with at least one Hispanic immigrant parent and having no history of psychiatric hospitalization.  Participants were from low-income areas of Miami, FL (median household income was between $15,000 and $20,000).  The mean age of adolescents was 12.4 years, and ancestry among the group was 39 percent Cuban, 29 percent Central American, 17 percent South American, 5 percent Puerto Rican or Dominican, and 10 percent “other” Hispanic.  94 percent of parents, and 49 percent of students, were born outside of the United States.  The median amount of time that the parents had lived in the U.S. was 11 years.

Approach: After meeting study inclusion criteria, 96 adolescents and their families were randomly assigned to the Familias Unidas experimental condition, and 71 adolescents and their families were randomly assigned to a no-treatment control condition. Parent groups met weekly for one-hour sessions over the course of nine months.

Participants were assessed at baseline, and at 3, 6, 9, and 12 months post-baseline, on a variety of measures.  Parental investment was assessed by a composite score on five measures: parent- and adolescent-reports of parental involvement and of parenting practices and adolescent-repots of social support.  Adolescent behavior problems were assessed by a composite score on eight measures: parent-reports of conduct disorder, socialized aggression, attention problems, and motor excess in addition to adolescent-reports of anger control and hyperactivity, aggression, and behavior. Finally, adolescent school bonding/academic achievement was assessed by a composite score on 10 measures: parent- and adolescent-reports of school bonding, school achievement (measured on two distinct scales), and disinterest in school, as well as adolescent-reports of academic competence and intellectual/school self-concept.

Results: Over the course of 12 months, Familias Unidas demonstrated significant positive impacts on parental investment (that is, an increase in parental investment) and on adolescent problem behaviors (a decrease in problem behaviors).  However, comparing the Familias Unidas group with the control group, there were no differences in school bonding/academic achievement.

Prado, G., Pantin, H., Briones, E., Schwartz, S. J., Feaster D., Huang, S., Sullivan, S., Tapia, M. I., Sabillon, E., Lopez, B., & Szapocznik, J. (2007). A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents. Journal of Consulting and Clinical Psychology, 75(6), 914-926.

Evaluated population: A sample of 266 Hispanic 8th graders and their primary caregivers across two cohorts (one from May 2001-July 2004 and one from May 2002-July 2005) was evaluated. Adolescent participants had an average age of 13.4 years and their parents had a mean age of 40.9 years. Of the 266 adolescents, 128 were male and 138 were female; 34 of the enrolled parents were male and 232 were female. The majority of the families (81 percent) reported annual incomes of less than $30,000.

Forty percent of the adolescents were born in the United States. Parents and non-native born adolescents were from Cuba (40 percent), Nicaragua (25 percent), Honduras (9 percent), Columbia (4 percent), and other Hispanic counties (22 percent). Of the foreign-born adolescents, one-half (50 percent) had lived in the U.S. for less than three years, 34 percent for between three and ten years, and 16 percent for more than ten years.

Approach: Participants were recruited from their 7th grade homeroom classrooms with a letter from study staff. Interested parents contacted study staff and were screened to see if they met the eligibility criteria: at least one parent was born in a Spanish-speaking country in the Americas, the adolescent was living with the primary caregiver, the family would not be moving out of the area in the next three years, and the caregiver could attend weekly weekday meetings,  the child was attending school at one of three participating middle schools, the adolescent would be in the 8th grade in the next school year, and neither the adolescent or parent had been hospitalized for psychiatric reasons.

The adolescents were randomly assigned to one of three treatment groups. The groups were randomized to ensure balance on gender, years living in the United States, having initiated substance use, and having initiated oral, vaginal, or anal sex. The three treatment groups were: Familias Unidas plus Parent Preadolescent Training for HIV Prevention (Familias Unidas+PATH); English for Speakers of Other Languages plus PATH (ESOL+PATH); or ESOL plus HeartPower! for Hispanics (ESOL+HEART).  The latter included an American Heart Association program aimed at promoting cardiovascular health as an “attention control” for PATH meaning that it provided unrelated program content which offered the same program dose and facilitator contact as was provided in the treatment group.  Likewise, in both of the two control groups (ESOL+PATH and ESOL+HEART), ESOL served as an attention control for Familias Unidas.  Thus all three groups received 49 hours of program content.  Participants participated in their group’s first module (Familias Unidas or ESOL) in the fall of the intervention period and then participated in the second module (PATH or HEART) in the spring. Both programs were administered in Spanish.

Self-administered surveys were completed at baseline and at 6, 12, 24, and 36 months post baseline. Parents and adolescents completed questionnaires with questions about their demographic characteristics.  Adolescents also completed questions about their level of acculturation.  Parents completed questions about family functioning (relate to parental involvement, positive parenting, family support, and parent-adolescent communication).  Finally, adolescents completed questions about their substance use (whether they had ever smoked, consumed alcohol, or used an illicit drugs in their lifetime and in the past 90 days; those who answered yes to the latter were asked about frequency of use) and about their sexual activity (whether they had ever has sex in their lifetime and in the past 90 days; those who answered yes were asked if they had sex without a condom during their most recent sex (or in the past 90 days, if applicable), whether they were using alcohol or drugs at their most recent sex, and whether they had ever contracted a sexually transmitted diseases).

Results: Growth curve analyses revealed that, over the course of 36 months, Familias Unidas+PATH did not have significant impacts on alcohol use, compared with either of the two control groups.  This treatment did have significant positive impacts on cigarette use (meaning the treatment reduced cigar, compared with the two control groups, and it also had significant positive impacts on initiation of cigarette use.  Similarly, Familias Unidas+PATH had significant positive impacts on illicit drug use, compared with the ESOL+HEART group (no differences were found comparing Familias Unidas+PATH with ESOL+PATH).   Familias Unidas+PATH also had significant positive impacts on family functioning, compared with the control groups (and family functioning appeared to mediate the relationship between Familias Unidas and cigarette and illicit drug use).

Adolescents in Familias Unidas + PATH also had a lower incidence of STD infection than adolescents in the other two groups, although very few adolescents in any of these groups reported having had an STD. There were inadequate numbers of participants who reported past 90-day unprotected sex, to examine the impact on this outcome, but the Familias Unidas+PATH group were less likely than the two control groups to engage in unsafe sex (defined as unprotected sex at last intercourse and alcohol or drug use before last intercourse) at most recent sex.

The effect size (Cohen’s d) of the program effect on cigarette use was ranged from 0.54 to 0.80, depending on the comparison group. The effect size of the program, compared with the ESOL+HEART group, on illicit drug use was 0.58.

Pantin, H., Prado, G., Lopez, B., Huang, S., Tapia, M. I., Schwartz, S. J., Sabillon, E., Brown, C. H., Branchini, J. (2009). A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavioral problems. Psychosomatic Medicine, 71(9), 987-995.

Evaluated population: The evaluated population included 213 Hispanic 8th grade students (136 boys and 77 girls).  Participants were recruited from three predominantly Hispanic, middle schools located within the Miami-Dade County, Florida school district. School counselors identified eligible adolescents who had at least one behavior problem (including conduct disorder, socialized aggression, and attention problems), who were then consented and screened.  Adolescents were included in the evaluation if they provided assent and were in 8th grade, resided in the catchment area of the three middle schools in the study (and were not planning to move in the next three years), were of Hispanic origin (with at least one Hispanic immigrant parent), and had a parent or adult primary caregiver who was willing to participate in the study.  Additionally, parents had to identify the child as having at least one behavior problem.

Among the evaluation population, were primarily from low-income households (with only 13 percent reported household incomes of greater than $30,000). The mean age of adolescents was 13.8 years. Adolescents and parents in the study came primarily from Honduras, Cuba, and Nicaragua.  Of the foreign-born adolescents, 37 percent had been living in the United States for less than three years, 45 percent between three to 10 years, and 18 percent for more than 10 years.

Approach: After meeting study inclusion criteria, 109 adolescents and their families were randomly assigned to the Familias Unidas experimental condition, and 104 were assigned to a community control condition, in which families were given three referrals to agencies that serve youth with behavior problems. Participants in the Familias Unidas group received nine 2-hour group sessions and ten 1-hour family visits, followed by four 1-hour booster sessions at roughly 10, 16, 22, and 28 months after baseline.

Participants were assessed at baseline, and at 6, 18, and 30 months, on a variety of measures including family functioning (including measures of parent involvement, positive parenting, family support, parent and adolescent communication, and parental monitoring), substance use (including smoking, drinking, or using illicit drugs in the past 30 days – and, among those who reported using these substances, the frequency of use of marijuana, cocaine, amphetamines, methamphetamines, and barbiturates), sexual risk behaviors (including having had vaginal, anal, or oral sex in their lifetime or in the past 90 days – and, among those who reported having had sex, their frequency of condom use), and externalizing behavior problems (including attention deficit hyperactivity disorder, oppositional definite disorder, and conduct disorder).

Results: There were positive treatment impacts on adolescents’ past 30 day substance use and, among those who had sex, on adolescents’ frequency of condom usage.  Likewise, there were positive impacts on family functioning, comparing the treatment group with the control group (although examining the indicators of family functioning individually, there were no group differences in parent involvement or family support). There were no differences in parent-reported youth externalizing behavior problems over time; however the incidence of externalizing behaviors post-baseline were lower in the Familias Unidas group.

Prado, G., Pantin, H., Huang, S., Cordova, D., Tapia, M. I., Velazquez, M.-R., Calfee, M., Malcom, S., Arzon, M., Villamar, J., Jimenez, G. L., Cano, N., Brown, C. H., & Estrada, Y. (2012). Effects of a family intervention in reducing HIV risk among high-risk Hispanic adolescents. Archives of Pediatric and Adolescent Medicine, 166(2), 127-133.

Evaluated population: The evaluated population consisted of 242 adolescents aged 12 to 17 who: self-identified as being of Hispanic origin (at least one parent had to have been born in a Spanish-speaking Central or Latin American country); had plans to remain residents of South Florida for the duration of the study; and were delinquent (defined as having been arrested or having committed at least one of the following offenses: trespassing, breaking and entering, burglary, assault, serious fighting, hazing, vandalism, possession of alcohol or a controlled substance, or possession of a weapon).  These 242 adolescents also had to have a parent or primary caregiver who provided consent for their participation and who agreed to participate in the program.

Approach: Using a random-numbers table, the 242 families (the adolescents and their parents or primary caregivers) were randomized into one of two groups following their completion of the baseline survey; these two groups were the Familias Unidas treatment group (120 families) or the control group (122 families).  The control group, called the “community practice” group, received treatment-as-usual (that is, the standard services provided to youth and parents of delinquent youth, including the HIV prevention program provided by the local public school system).  Those in the treatment group received eight 2-hour group sessions, four 1-hour family visits over a three-month period.  Group sessions involved parents or caregivers only; the group visits involved both the parents or caregivers and the adolescents.

Data collection from adolescents and their parents occurred at baseline and at a follow-up six months post-baseline.  Participants received $60 for their completion of the baseline survey and $70 for their completion of the follow-up survey.  The primary outcome of interest was HIV risk behavior.  Adolescents were first asked whether they had ever had sex; those who had were asked if they had ever had a sexually transmitted disease (STD).  They were then asked about the following behaviors during the 90 days prior to the follow-up condom use during vaginal sex; condom use during anal sex; condom use during vaginal sex while under the influence of drugs or alcohol; and number of vaginal sex partners). Secondary outcomes included measures of family functioning, parent-child communication, positive parenting, and parental monitoring of adolescents’ peers.

Results: At follow-up, adolescents who had ever had sex and who were in the Familias Unidas group were less likely than their counterparts in the control group to report inconsistent condom use during vaginal or anal in the previous 90 days.  Likewise, they reported fewer instances of unprotected sex while under the influence of alcohol or drugs.  They were also less likely to report that their most recent vaginal or anal sex occurred without a condom.  Further, they were less likely to report ever having an STD, and they had significantly fewer partners in the previous 90 days.  Finally, those in the treatment group reported more parent-child communication and more positive family functioning and parenting than those in the control group.  There were no differences between those in the treatment and control groups with regard to parental monitoring of peers.

Effect sizes (Cohen’s d) revealed that the effect of Familias Unidas on HIV risk behaviors ranged from small (inconsistent condom use during vaginal sex in past 90 days, unprotected sex at most recent vaginal sex, and STDs), to medium (inconsistent condom use during anal sex in past 90 days, inconsistent condom use during sex under the influence of alcohol or drugs in the past 90 days, and number of sex partners in the past 90 days), to large (unprotected sex at most recent anal sex).

SOURCES FOR MORE INFORMATION

Hilda Pantin, Ph.D.

Center for Family Studies

Department of Epidemiology and Public Health

Miller School of Medicine

University of Miami

1425 NW 10th Ave, 3rd Floor

Miami, FL 33136

hpantin@med.miami.edu

305-243-2343

References:

Pantin, H., Coatsworth, J. D., Feaster, D. J., Newman, F. L., Briones, E., Prado, G., Schwartz, S. J., & Szapocznik, J. (2003). Familias Unidas: The efficacy of an intervention to promote parental investment in Hispanic immigrant families. Prevention Science, 4(3), 189-201.

Pantin, H., Prado, G., Lopez, B., Huang, S., Tapia, M. I., Schwartz, S. J., Sabillon, E., Brown, C. H., Branchini, J. (2009). A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavioral problems. Psychosomatic Medicine, 71(9), 987-995.

Prado, G., Pantin, H., & Briones, E. (2007). A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents. Journal of Consulting & Clinical Psychology, 75(6), 914-926.

Prado, G., Pantin, H., Huang, S., Cordova, D., Tapia, M. I., Velazquez, M.-R., et al. (2012). Effects of a family intervention in reducing HIV risk behaviors among high-risk Hispanic adolescents. Archives of Pediatric & Adolescent Medicine, 166(2), 127-133.

KEYWORDS: Adolescence (12-17), Males and Females (Co-ed), Hispanic/Latino, Urban, Cost Information is Available, Home-based, Clinic-based, Home Visitation, Parent and Family-Component, Conduct/Disruptive Disorders, Academic Achievement/Grades, Academic Motivation/Self-Concept/Expectations/Engagement, Tobacco Use, Marijuana/Illicit/Prescription Drugs, Alcohol Use, Parent-Child Relationship, Sexual Activity, STD/HIV/AID, Condom Use and Contraception.

Program information last updated 11/1/12.

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