Bright Spot: Strengthening Families

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This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.

Overview

Detailed Description

The Strengthening Families Program (SFP) is a family skills training program designed to increase resilience and reduce risk factors for behavioral, emotional, academic, and social problems in children 3-16 years old. SFP comprises three life-skills courses delivered in 14 weekly, 2-hour sessions. The Parenting Skills sessions are designed to help parents learn to increase desired behaviors in children by using attention and rewards, clear communication, effective discipline, substance use education, problem solving, and limit setting. The Children's Life Skills sessions are designed to help children learn effective communication, understand their feelings, improve social and problem-solving skills, resist peer pressure, understand the consequences of substance use, and comply with parental rules. In the Family Life Skills sessions, families engage in structured family activities, practice therapeutic child play, conduct family meetings, learn communication skills, practice effective discipline, reinforce positive behaviors in each other, and plan family activities together. Participation in ongoing family support groups and booster sessions is encouraged to increase generalization and the use of skills learned.

Expected Outcomes

The expected outcomes include reducing substance abuse and delinquency risk factors by improving family relationships. Increased family strengths and resilience and reduced risk factors for problem behaviors in high risk children, including behavioral problems, emotional, academic and social problems are other outcomes.

Cost Details

As of July 2014, the cost of this intervention is as follows:

COST (estimated in U.S. dollars)

Cost considerations for implementing this Model Program for one cohort of 10 families as recommended by the developer:

Four group leaders x 14 weeks x $14/hour x 3.5 hrs/week - $2,744
Food (14 sessions x 10 families x $10/family) - $1,400
Child care x 14 weeks x 2 staff x $10/hour x 3 hours - $840
Supplies (paper products and toys) - $300 Completion incentives ($50 x 10 families) - $500
Manual duplication ($15 parents = 15 children x $4) - $120
Manual duplication (4 trainers x 6 manuals x 4 trainers) - $96
Per booster session (trainers, food, child care, and incentives) - $856

TRAINING:

2- day training - $2, 700 plus travel expenses 3-day training - $3,700 plus travel expenses(recommended for groups over 25 and evaluated grants)

MATERIALS:

Multicultural SFP 6-manuals, plus evaluation package on CD with limited site license to photo copy as many manuals as needed for agency - $200 SFP 6-manual, plus evaluation, hard copy (all of the below materials) - $200
Family Skills Training Group Leader's Manual - $35
Parent Skills Training Group Leader's Manual - $35
Children's Skills Training Group Leader's Manual - $35
Parent's Handbook - $35 Children's Handbook (6-12 years) - $35
Implementation Manual - $35 SFP Evaluation Package (pretests, post tests, followup tests, instructions) - $35
SFP for Spanish-speaking Families (CD with 6-manuals and evaluations in Spanish including site license to photocopy manuals for own agency use) - $200
Strengthening African American Families (each manual listed above, no CD) - $35
Strengthening American Indian Families (on CD) - $200

For the latest cost details, please contact the Strengthening Families Program directly.

Key Steps for Implementation

Implementing the Strengthening Families Program involves the following activities:

1. Hiring and training at least four effective group leaders, two to run the children's' groups and two for the parent's groups, and a program or site coordinator.

2. Recruiting families by stressing improvements in family relationships, parenting skills, and youth's behaviors and grades.

3. Using creative recruitment and retention strategies matched to the needs of participating families, such as special incentives, family meals, transportation, and child care.

4. Implementing the full Strengthening Families Program once per week for 14 weeks or in alternative formats, such as twice per week or at retreat weekends.

5. Eating meals together as a family, attending separate parent training classes and children's skills training classes. Then, in the second hour, participating in structured family activities including practice sessions in therapeutic child-play, family meetings, communication skills, effective discipline, reinforcing positive behavior and planning fun family activities together.

6. Conducting a needs assessment and evaluating the program using standardized family, parent, and child outcome measures and using the outcome and process measures for continuous quality improvement.

The SFP curriculum is a 14-session behavioral skills training program of 2 hours each. Parents meet separately with two group leaders for an hour to learn to increase desired behaviors in children by increasing attention and rewards for positive behaviors.

They also learn about clear communication, effective discipline, substance use, problem solving, and limit setting. Children meet separately with two children's trainers for an hour, to learn how to understand feelings, control their anger, resist peer pressure, comply with parental rules, solve problems, and communicate effectively. Children also develop their social skills and learn about the consequences of substance abuse.

During the second hour of the session, families engage in structured family activities, practice therapeutic child play, conduct family meetings, learn communication skills, practice effective discipline, reinforce positive behaviors in each other, and plan family activities. Booster sessions and ongoing family support groups for SFP graduates increase generalization and the use of skills learned.

Required Staffing (FTEs)

A part-time site coordinator or program coordinator (.50 FTE) is generally hired from the agency staff to supervise the four group leaders and all other needed services (e.g., food, transportation, babysitting, etc.). If more than one group or cohort is being run at a time, the job should be full time. Four group leaders (two for children, two for parent training) are generally hired on contract for about 5 hours per week. Warm, empathetic, genuine, and creative leaders are most effective. Community or church volunteers are often used to provide the meals, transportation, and babysitting for infants and preschoolers. Also 12- to 16-year-old youth from the attending families are sometimes interviewed and used as assistants in the children's and baby sitting groups. Some agencies with a youth leadership training focus used coalition youth as training assistants in the children's groups.

Special Infrastructure

Two large training rooms equipped with flip charts and extra space and tables for meals and childcare.
Two large training rooms equipped with flip charts and extra space and tables for meals and childcare.
Family meals, transportation, and childcare should be provided (reduces barriers to attendance).

Training

Staff must receive 2 to 3 days of training from SFP-certified trainers. Two Lutra Group-certified trainers generally offer SFP training for group leaders. Costs can be reduced by cost sharing with other agencies or inviting local referral or sponsoring agencies to also send trainees. Sometimes individual/families wanting training join an already sponsored training workshop in their area. To reduce cost, the training host generally supplies copies of the training manuals to all trainees once a single set is purchased on a CD-ROM. Training addresses content and process issues for implementing the three training manuals and includes videos, games, role plays, group discussion or recruitment, retention, and cultural adaptation issues as well as didactic presentations on the risk and protective factors for drug abuse addressed by family programs and SFP research outcomes.

Types of Staff

The group leaders should be enthusiastic about SFP and positive changes in the families, warm, empathetic, genuine, and creative in order to be effective.

Return on Investment Details

According to the Washington State Institute for Public Policy, the program/strategy returns $5,805 per Individual/family in savings that would otherwise be associated with education, substance abuse, teen pregnancy, child abuse and neglect, or criminal justice system.

First page of Cost analysis of the strengthening families program in reducing time to family reunification among substance-affected families

Cost Analysis of the Strengthening Families Program in Reducing Time to Family Reunification Among Substance-Affected Families

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Outcome Measures

The standardized SFP Parent Interview Questionnaire (195-items) with client satisfaction and recommendations for SFP improvements added for the Follow-up Parent Interviews.
The SFP Children's Interview Questionnaire (150-items)
SFP Teacher/Trainer Interview Questionnaire (about 160-items), used in prior SFP studies modified by the local site evaluator recommendations and an pilot tests of the instruments.
Well-known, standardized CSAP Family Core Measures and GPRA measures with high reliability, change sensitivity, and validity that match the hypothesized subject change objectives are used. To reduce testing burden, only sub-scales of selected instruments that match the hypothesized dependent variables are used in the construction of the testing batteries. Since changes are hypothesized in the child, the parents, and the family environment, all three of these areas of change are measured through the three major data sources: parent, child, and therapist/trainer.
The subscales measure the hypothesized outcomes for SFP, namely: Family
Relationships, including family conflict, communication, cohesions, and organization
Parenting, including parenting style, discipline, monitoring, parenting self-efficacy
Children's social skills and resiliency, grade|Children's aggression, depression, and conduct disorders
Parent's depression
Association with using or anti-social peers|Children's and parents' tobacco, alcohol, and other drug use
The students or parents will be requested to bring their report cards to the trainers so this objective school achievement data (grades, times absent, times tardy, effort) can be recorded in the Management Information System (MIS), where the parent attendance and participation data is recorded.

Process Measures

The process evaluation includes at least two forms:

The Family Attendance Form, including the attendance, participation, and homework completion for each session for each participant.
A Group Leader (trainer or therapist) Session Rating for each session that documents any changes that the leaders made in the sessions, their satisfaction with the session, who well the families understood the material, and any suggestions for improvement.