The Strengthening Families Program (SFP) is a unique family-based prevention intervention that combines parenting, youth, and family skills training to reduce adolescent behavioral health disorders, including delinquency and the use of alcohol and drugs. The multicomponent program is highly interactive and involves one-hour sessions earmarked for parents to improve their parenting skills and separately for youth to provide skills that reduce vulnerability to drug use and other behavioral problems (e.g., see Kumpfer, Magalhães, Whiteside, and Xie, 2016 for a review of program ingredients). At the conclusion of the separate training sessions, parents and youth come together for another hour to practice and rehearse newly acquired skills, view videos exemplifying positive behavior, structure opportunities, including role playing to achieve family harmony, and receive positive feedback from implementation staff.
Briefly, the program blends family systems theory (Forehand & McMahon, 1981; Guerney, Coufal, & Vogelson, 1981) and the social ecology domain model of risk and resilience (Kumpfer & Turner 1990/1991) to construe youth drug use as part of a “family affair”, contextually bound by family dynamics, peer influences, and the social ecology of the home. Using techniques drawn from therapeutic traditions (e.g., Bowen, 1991), social learning theory (e.g., Bandura, 1977), and clinical coaching and skills training methods (e.g., Patterson, 1982), parents are taught effective parenting strategies including how to communicate with their child, setting boundaries and limits (controls and restrictions), appropriately reward their child in a non-punitive environment, and different ways to bond and increase family cohesion. Following program exposure, they should be better teachers, better listeners, more empathic, and more understanding of their child’s world. Children receive training in social and personal competency skills that will help them refuse drug offers and improve their social-emotional regulation, problem solving, and effective communication. To be clear, SFP is not a “one-size-fits-all” intervention; rather, the program has different age versions complementing developmental periods from childhood through high school (SFP 0–3 Years, SFP 3–5, SFP 6–11, SFP 12–16, and SFP 7–17) and is adaptive to different child risk-levels1.
Early Evidence
5. DeMarsh and Kumpfer (1986) and Kumpfer and DeMarsh (1985) reported on the first trial conducted with a 14-session version of SFP with children ages 6–11. The four-year trial, funded in 1982 by the National Institute of Drug Abuse (NIDA), used a dismantling design randomly assigning 25 percent of the recruited chemically dependent parents2 in treatment and their children either to receive the full SFP, the parent training only, parent training plus a child’s skills component, or no additional treatment. The Utah state substance abuse agency subcontracted recruitment to drug treatment agencies who relied on drug counselors to obtain family participation. The outcome evaluation focused on parents’ discipline and punishment practices, parent-child communication, family environment (i.e., harmony) and included a wide range of child behaviors (internalizing and externalizing, delinquency, competence, peer relations, and parent bonding). Parents and children assigned to the full condition offering skills training to both parent and child fared better compared to the remaining three conditions. These improvements included fewer problems reported by parents handling their child with greater awareness of child management.
Parents also reported their children were more manageable, showed improvements around the home, with fewer behavioral problems compared to their same age peers. Consistent with a reasoned action approach, children reported fewer intentions to smoke and drink, which are important intermediate measures.
Since its initiation, SFP has been tested in 12 randomized control trials: six conducted with independent research teams (Brody, Murry, Kogan, et al., 2006; Brook, McDonald, & Yan, 2012; Coatsworth, Duncan, Berrena, et al., 2014; Gottfredson, Kumpfer, Polizzi-Fox, et al., 2006; Maguin, Safyer, Nochajski, DeWitt, MacDonald, & Kumpfer, 2004; Puffer, Annan, Sim, Salhi, & Betancourt, 2017), producing favorable intervention effects by reducing risk and increasing protective factors that are etiologically linked with alcohol, tobacco, and drug use. The program also improves mental health outcomes, increases personal resilience, reduces delinquency, violence, and aggression, and has positive effects on academic performance by reducing school behavior problems including early dropout (e.g., Kumpfer, Xie, & Hu, 2011). Importantly, SFP has been shown to work well with all types of families—not just those that are considered “high-risk,” in different settings including rural (Kumpfer, Alvarado, Tait, & Turner, 2002; Marek, Brock, & Sullivan, 2006) and urban settings (Gottfredson et al., 2006) and with different age groups (Kumpfer, Greene, Allen, & Miceli, 2010).
To reduce costs and increase fidelity, a low-cost ($5) SFP 7–17 Years Home-Use DVD was created. It was tested and found effective in homes, schools, clinics, detention centers, and behavioral health home visits (Kumpfer, et al., in review). The low-cost SFP 7–17 Years Home-Use DVD version features eleven 30-minute lessons with built-in “pause and practice” segments and downloadable handouts and tracking sheets. It also includes a mindfulness component to increase emotional regulation. The SFP DVD has sound-tracks in both English and Spanish. The SFP DVD has been used by families at home and as an adjunct to family classes in schools, family services agencies, homeless shelters, refugee communities, and juvenile courts. The low-cost DVD version dramatically improved the cost-benefit ratio of SFP. Future directions include reducing costs more by putting SFP 7–17 on the web and on smartphones. The SFP Home-Use DVD version was implemented in one inner-city school district using a unique recruitment method. Seventh grade health teachers assigned three SFP DVD lessons (the introduction lesson and lessons 8 and 9) as homework for students and their parents to watch the SFP DVD together at home, and then fill out and turn in joint homework sheets. The next year, when they became eigth-graders, school district binge drinking rates of eigth-graders (which had been rising) decreased dramatically from 12.6 percent to 6.4 percent in one year (Bach-Harrison, 2015). A SFP 7–17 group class version, with curricula for parents, teens, children, and a family practice session, was also created. In limited trials, the DVD combined with the group-class version had slightly larger effect sizes compared to the regular 14-session SFP group versions.
1 Actual program length is 2.5 hours per session with a coordinated meal for the first half hour. The sessions are led by gender-balanced and ethnically matched trained implementers.
2 The trial was designed as a substance abuse prevention strategy for parents with opiate, narcotic, and polydrug use dependencies. The parents readily recognized they were dysfunctional, spending less time with their child, frequently using negative punishment, and lacking positive parenting and child management skills. The program focused primarily on parenting skills training but included some drug education components taught using didactic methods. By all accounts, this version of the program was “selective;” however, it has since been recast as a universal prevention program, targeting lower-risk families with fewer personal and child management problems.
