Program

Nov 14, 2011

OVERVIEW

The Strengthening Families Program (SFP) (10-14), formerly the Iowa Strengthening Families Program (ISFP), is a 7-week-long intervention aimed to reduce substance use among 10- to 14-year-olds and improve the parent-child relationship by teaching various communication, problem-solving, and perspective-taking skills to parents and adolescents.  Experimental evaluations compared the SFP with a second experimental condition, the 5-session Preparing for the Drug Free Years program (PDFY), and a control condition.  Results from the evaluations indicate that the SFP’s positive outcomes for children, including prevention of alcohol use, reduction of aggressive and destructive behavior, and delayed initiation into substance use, continued years after the program’s end.

DESCRIPTION OF PROGRAM

 Target population: Middle school students

The Strengthening Families Program (10-14) aims to teach life skills to 10- to 14-year-olds and improve the parent-child relationship.  Participants are given instruction on various communication, problem-solving, and perspective-taking skills.  The first hour of program sessions consists of separate parent and adolescent trainings.  Among other topics, parents learn about appropriate disciplinary practices, how to manage strong emotions, and how to communicate effectively with their children.  The adolescents learn skills for dealing with peer pressure (refusal skills) and other personal and social skills, including management of stress and strong emotions, and problem solving.  In the subsequent hour of joint training, family members practice conflict resolution and communication skills, and engage in activities designed to improve family cohesiveness.

Program materials are available for purchase through Iowa State University (http://www.extension.iastate.edu/sfp/inside/order.php). As of October, 2012, the video series cost $298.00 and curriculum notebooks cost $175.00 each.

EVALUATION(S) OF PROGRAM

Study 1a: Spoth, R., Redmond, C., & Shin, C. (1998). Direct and indirect latent-variable parenting outcomes of two universal family-focused preventive interventions: extending a public health-oriented research base. Journal of Consulting and Clinical Psychology, 66, 385-399.

Evaluated population: A total of 523 6th-grade students and their families from 33 rural school districts in the Midwest, selected based on school lunch program eligibility and small community size, served as the sample for this evaluation. Nearly all participants (98%) were white. The majority of families (86%) were headed by two parents.

Approach: A total of 1,309 families were recruited for the study; however, only 667 (51%) completed a baseline assessment. Families from 11 schools were randomly assigned to participate in each of the following three study groups: a) ISFP, b) PDFY, or c) the minimal-contact control condition. Minimal-contact control group families received four leaflets in the mail describing adolescent development. All families retained in the sample completed a baseline in-home assessment in which researchers measured parent-child affective quality, general child management, and intervention-targeted parenting behaviors. Upon completion of the interventions, all families completed the same measures that were given at baseline. Measured outcomes included parental warmth (parent and child reports); child management; and parenting behaviors, such as substance use rules and consequences, teaching anger management, and involvement of the child in family activities. The 523 families included in this evaluation (178 ISFP, 176 PDFY and 189 control) were those that had both pretest and posttest data.

Results: To obtain accurate estimates of effect size, the ISFP and PDFY conditions were separately compared with the control condition, but not with each other. Findings for the ISFP are presented here. Analyses adjust for the fact that schools were randomly assigned. Compared with families in the control group, families receiving the ISFP intervention experienced a significant improvement in intervention-targeted parenting behaviors (i.e., a latent construct including substance use rules and consequences, teaching anger management, and involvement of the child in family activities). A medium effect size for this impact (.51) was obtained.

Study 1b: Spoth, R., Redmond, C., Lepper, H. (1999). Alcohol initiation outcomes of universal family-focused preventive interventions: One- and two-year follow-ups of a controlled study. Journal of Studies on Alcohol, 13, 103-111. (Supplement 13).

Evaluated population: A total of 446 families of sixth-graders at 22 public schools from low-income areas in Iowa were evaluated. Fifty-two percent of the children in the sample were female, and 98 percent of parents were white. Most (86 percent) families were dual-parent families.

Approach: This study examined the impact of the Strengthening Families Program (SFP) on aggressive behavior of adolescents four years post-participation.  See study a for randomization procedures.  Alcohol use frequency was obtained through self-report at baseline, posttest, and one year and two years post intervention.

Results: Adolescents in the control group reported significantly less alcohol use at the one-year follow-up (effect size = .26) and at the two-year follow-up (effect size = .39).

Study 1c: Spoth, R., Redmond, C., & Shin, C. (2000). Reducing adolescents’ aggressive and hostile behaviors.  Archives of Pediatrics & Adolescent Medicine, 154, 1248-1257.

Evaluated population: See Study 1b.

Approach: This study examined the impact of the Iowa Strengthening Families Program (ISFP) on the aggressive behavior of adolescents four years after participation.  See study a for randomization procedures. Aggressive and hostile behavior, in sixth through tenth grades was measured through independent observations, family reports of parent-child interactions, and adolescent self-reports of aggressive and destructive behavior towards people and property.

Results: The study found a significant reduction for the intervention group compared with the control group in independently observed aggressive and hostile behaviors in adolescents’ interactions with parents.  Significant findings were limited to interactions involving mothers.  There were also reductions for the intervention group in adolescent-reported aggressive and destructive conduct.  These differences persisted four years after baseline.  At 10th grade, there were reductions in self -reported aggressive and destructive conduct ranging from 32 to 77 percent.  There were no significant differences for family-reported aggressive behavior in parent-child interactions, perhaps owing to lack of a uniform benchmark for behavior among family members.  Because the majority of the sample was white, two-parent families, the study has limited generalizability to more culturally diverse populations.

Study 1d: Spoth, R., Redmond, C., Shin, C., & Azevedo, K. (2004).  Brief family intervention effects on adolescent substance initiation: School-level growth curve analysis 6 years following baseline.  Journal of Consulting and Clinical Psychology, 72, 535-542.

Evaluated population: A total of 667 6th-grade students from 33 rural Midwestern schools were evaluated.

Approach: See study a for randomization procedures. Data were collected through a written questionnaire.  Several measures of substance use were taken, including the alcohol composite use index (ACUI), which consists of four items: lifetime use, lifetime use without parental permission, lifetime drunkenness, and past-month use.

Results: Adolescent self-reports of lifetime use of alcohol, cigarettes, and marijuana indicated that, on average, students in the ISFP group began using controlled substances at a later age compared with students in the control group.  Similarly, , the control group reached its maximum growth rate on the alcohol composite-use measure 13.1 months earlier than did the ISFP group.

Study 2a: Spoth, R., Redmond, Trudeau, & Shin (2002). Longitudinal substance use initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive behaviors, 16(2), 129-134.

Evaluated Population: A total of 1,372 seventh-grade students and their families from 36 schools were evaluated.

Approach: Thirty-six rural schools were randomly selected to participate in this study. A randomized-block design was used, such that schools were matched based on similar characteristics and then randomly assigned to one of three groups: 1) ISFP + Life Skills Training, 2) Life Skills Training Alone, or 3) the control condition. All seventh-graders in these schools were recruited to participate in the study.  A total of 1,664 students completed pretest surveys. The analytic sample included students with one-year follow-up data (N=1,372).

Substance use initiation was measured using self-reported lifetime use of alcohol, cigarettes, and marijuana. Students completed questionnaires at pretest (baseline), posttest, and at a one-year follow-up. Analyses compared follow-up scores with posttest scores, adjusting for pretest covariates. Appropriate analytic methods were used to adjust for clustering at the school level.

Results: Both interventions had impacts on the initiation of substance use; however, the combined intervention resulted in significantly greater reductions in the rate of alcohol use initiation, such that youth participating in the combined intervention were much less likely to start using alcohol than those in the two other conditions.

Study 1e/2b: Spoth, R., Clair, S., Shin, C., & Redmond, C. (2006). Long-term effects of universal preventive interventions on methamphetamine use among adolescents. Archives of Pediatric Adolescent Medicine, 160, 876-882.

Evaluated Population: Follow-up results from study 1 and 2 are reported. Study 1 included 457 sixth-graders and their families from 33 rural schools in Iowa, and Study 2 included 597 students from 36 rural schools.

Approach: Randomization and data collection methods are reported for two studies (these are the same as those described in Studies 1a and 2a). This study examined the impact of the ISFP on methamphetamine use 3.5, 4.5, and 5.5 years following program completion.

Results: Study 1, conducted 5.5 years after program completion, found significant impacts on self-reported, past-year methamphetamine use. Study 2 also found long-term impacts on methamphetamine use. Decreases in lifetime use were detected at the 4.5-year follow-up, and decreases in lifetime and past-year use were detected at the 3.5 year follow up.

Spoth, R., Trudeau, L., Guyll, M., Chungyeol, S., & Redmond, C. (2009). Universal intervention effects on substance abuse use among young adults mediated by delayed adolescent substance initiation. Journal of Consulting and Clinical Psychology, 77(4), 620-632.

Evaluation Population: In total, 667 sixth-grade students and their families were evaluated.  Students were enrolled in 33 rural schools in 19 contiguous counties in a Midwestern state.  Schools included in the study were in districts where 15 percent or more of families were eligible for free or reduced-cost school lunches and in communities with population of 8,500 or fewer.

Approach: Thirty-three schools were randomly assigned to one of three experimental conditions: the seven-session Iowa Strengthening Families Program (ISFP), the five-session PDFY, or a minimal-contact control condition.  Pre-test, 6-month posttest, and four follow-up assessments (approximately 18, 30, 48, and 72 months following the pretest) were conducted through self-administered questionnaires.  Another follow-up assessment was completed by phone when participants were approximately 21 years old.  Threats to internal validity from attrition were assessed, and were found to be neglible.  Measured adult outcomes at wave seven included frequency of drunkenness, alcohol-related problems, cigarette  smoking, illicit druguse, and scores on a polysubstance use index. Adolescent outcomes measured at waves one through six consisted of five separate measures of substance initiation that map onto the types of use measured at wave seven.

Results:  Both the ISFP and PDFY interventions had significant impacts on adolescent substance initiation, although PDFY impacts were less robust.  The ISFP intervention had significant impacts on drunkenness frequency and the polysubstance abuse index, and a marginally significant direct impact on frequency of cigarette smoking .

SOURCES FOR MORE INFORMATION

Link to program curriculum: http://www.extension.iastate.edu/sfp/inside/order.php

References

Spoth, R., Clair, S., Shin, C., & Redmond, C. (2006). Long-term effects of universal preventive interventions on methamphetamine use among adolescents. Archives of Pediatric Adolescent Medicine, 160, 876-882.

Spoth, R., Redmond, C., Lepper, H. (1999). Alcohol initiation outcomes of universal damily-focused preventive interventions: One- and two-year follow-ups of a controlled study. Journal of Studies on Alcohol, 13, 103-111. (Supplement 13).

Spoth, R., Redmond, C., & Shin, C. (2000). Reducing adolescents’ aggressive and hostile behaviors. Archives of Pediatrics & Adolescent Medicine, 154, 1248-1257.

Spoth, R., Redmond, C., & Shin, C. (1998). Direct and indirect latent-variable parenting outcomes of two universal family-focused preventive interventions: extending a public health-oriented research base. Journal of Consulting and Clinical Psychology, 66, 385-399.

Spoth, R., Redmond, C., Shin, C., & Azevedo, K. (2004).  Brief family intervention effects on adolescent substance initiation: School-level growth curve analysis 6 years following baseline.  Journal of Consulting and Clinical Psychology, 72, 535-542.

Spoth, R., Redmond, Trudeau, & Shin (2002). Longitudinal substance use initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive behaviors, 16(2), 129-134.

Spoth, R., Trudeau, L., Guyll, M., Chungyeol, S., & Redmond, C. (2009). Universal intervention effects on substance abuse use among young adults mediated by delayed adolescent substance initiation. Journal of Consulting and Clinical Psychology, 77(4), 620-632.

KEYWORDS: adolescents (12-17), middle school, males and females (co-ed), white/Caucasian, rural, school-based, cost information is available, manual is available, parent or family component, skills training, marijuana/illicit/ prescription drugs, alcohol use, parent-child relationship, aggression, other behavioral problems, tobacco use

Program information last updated 11/14/11.

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