Strengthening America's Families:
Exemplary Parenting and Family Strategies
For Delinquency Prevention


TOC  :  OVERVIEW  |  PART I  |  PART II  |  PART III  |  PART IV  |  REFERENCES

PART II: REVIEW OF FAMILY STRENGTHENING PROGRAM

Today there are many different types of parenting and family strengthening programs designed to address the family problems previously 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 & Kniskern, 1978; Stanton & 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 & 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 & Kaufman, 1979; Kaufman, 1986; Stanton & Todd, 1982).

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 review 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 premature childbearing, juvenile delinquency, mental illness, and suicide (Emery, 1988; McLanahan, 1980; Zill & Schoenborn, 1988).

These findings are opposed by other researchers (Rosen & Neilson, 1982; Farnsworth, 1984; Gray-Ray & Ray, 1990; Parson & Mikawa, 1991; White, 1987) who 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). The work of other researchers has 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 generally more harmful for children than divorce. Loeber and Stouthamer-Loeber (1986) concluded after 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, 1987; 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.

Family Strengthening

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, choice of peers, and later delinquency in youth. Although research suggests that peer influence is the final pathway for most youth to delinquency and drug use, the major predictor of whether youth associate with delinquent or drug using peers is their family relationship (Kumpfer & Turner, 1990/1991; Oetting, 1992; Oetting & Beauvais, 1987; Newcomb, 1992). In fact parental support has been found to be one of the most powerful predictors of reduced substance use in minority youth (King, Beals, Manson, & Trimble, 1992). Also, Dishion (Dishion, French, & Patterson (1995) and Hansen and associates (1987) have found that increased parental supervision is a major mediator of peer influence. Models testing more finely the aspects of the family dynamics related to youth problem behaviors (antisocial behavior, substance abuse, high risk sex, and academic failure) find family conflict associated with reduced family involvement at the first time they surveyed which is significantly predictive of inadequate parental supervision and peer deviance at the second time they surveyed. Ary, Duncan, Duncan, & Hops (1999) found direct paths from parental supervisions and peer deviance to problem behaviors, suggesting not all family risk processes are mediated by deviant peer involvement.

This etiological research suggests parenting and family interventions improving family conflict, family involvement, and parental monitoring should reduce problem behaviors including substance abuse (Mayer, 1995). Parenting skills training programs are effective in reducing coercive family dynamics (Webster-Stratton, Kolpacoff & Hollingsworth, 1988) and improving parental monitoring (Dishion & Andews, 1995). Other researchers like Bry, Schutte, and Fishman (1991) believe improving parenting practices is the most effective strategy for reducing later adolescent behavior problems. Strengthening families could significantly reduce delinquency, youth violence, and drug abuse.

Recent research suggest that the most critical family factors that help youth to avoid associations with delinquent peers is parental supervision and monitoring that is closely linked with parental care and support (Ary, Duncan, Duncan, & Hops, 1999). 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.

Increasing research suggests that conduct disorders and other behavioral and temperament traits that increase a youth's vulnerability to delinquency develop as a fairly stable pattern as early as five years of age. Characteristics of these young children that appear to developmentally vector them in the direction of a comorbid developmental psychopathology of delinquency, drug abuse, and other developmental problems (Alexander & Pugh, 1996) include:

impulsivity, reduced ego control, and attention deficit disorder (Farrington, et al., 1990; Hinshaw, et al., 1993; Cicchetti, Rogosch, Lynch, & Holt, 1993);

difficult temperment (Patterson, 1986; Rothbart, Adadi, & Hershey, in press); below average verbal IQ (DeBaryshe, et al., 1993; Tremblay, Masse, Perron, & Leblanc, 1992) and academic underachievement (Hinshaw et al., 1993);

negative affect (Compas, 1987) and difficulties with emotional regulation (Cole & Zahn- Waxler, 1992);

social incompetence (Blechman, Prinz, & Dumas, 1995); aggression and coercion as means to rewards (Patterson, Reid, & Dishion, 1992; Quay, 1993).

The overlap of these delinquency risk factors with those for drug abuse and alcoholism are striking (see Kumpfer, 1987; Kumpfer, 1989). In fact, family epidemiological research suggests that many psychiatric disorders run in the same families. At first, the "Unholy Triad" of anti-social personality, substance abuse, and Briquet's Syndrome with psychosomatic tendencies were found to be co-morbid family diseases (Robins & Ratcliff, 1979). Since early onset is often a sign of higher genetic loading for an emotional or behavioral disorder, Kumpfer (1991) suggested that early onset delinquency as manifest in chronic career delinquents can be considered a "family disease". Aggressive subtypes of conduct disorders are suggested to have underlying biological predispositions (Quay, 1993).

The stability of these "pre-delinquent" characteristics should not seem as such mystery when one considers that genetics, family environment, and the characteristics of their caretakers remain fairly stable. Children are socialized and learn their patterns of behavior, their values, and emotional responses within the context of the family. If they live in a non-traditional, counter culture environment, they will develop non-traditional norms (Richters & Cicchetti, 1993 a & b).

Although prevalent mythology assures parents that they are not responsible for their adolescents actions because, peers are the primary influences, research suggests that family influences remain roughly comparable to peer influences for quite some time (Loeber, 1990). In fact, in the areas of substance abuse, which typically develop several years later than delinquency, research by Coombs, Paulson, and Richardson (1991) suggest the primary reason for youth to use drugs is peer influence; however, the primary reason not to use drugs is parental disapproval. Hence, it is possible that research with prosocial youth would show that parental influence is still the primary influence during adolescence. This does not mean that these prosocial youth don't make their own decisions, simply that if they had to choose between parental or peer wishes, they would more likely follow the recommendations of their parents.

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 Table 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.

The most popular and promising intervention strategies address problem types by age of child and severity of family or child problems listed in Table 1. One major dichotomy of the intervention strategies are those that involve the parents with at least the target child, often called family approaches, and those that involve the parents or caretakers only, called parenting approaches. Basic applications and variants of each of these two major approaches will be discussed below, including several exemplary programs.



Table 1. Matrix of Program Types by Age of Child and Severity of Family or Child Problems
AGE GENERAL
POPULATION
FAMILY PROGRAMS
HIGH-RISK FAMILY
PROGRAMS
IN-CRISIS FAMILY
PROGRAMS
PRE-PARENT High school parent education
Parent/teen sex education
Teen pregnancy prevention
Pre-parenting
High school pre-parenting
Pregnancy prevention/sex education
Pre-parenting education for foster care youth
Pre-parenting for delinquents in custody
PRENATAL Infant parenting and health care
Parent education
Prenatal substance abuse prevention program
Infant mortality case management
Teen pregnancy case managing
Pregnant teen school
Pregnant teen residency
INFANCY & TODDLER Parent education (TV, video)
Parent Support
In-home parent education (PHS, nurse, social worker)
Parent side
Case work
Family services
Parent support
Protective services
Nurturing program for child abuse/neglect
Foster parents
Teen parent support services
Young parents school
CHILDHOOD Parent education
School-based home; school achievement programs
Media-based prevention
Preschool parent training
School and treatment agency
Parent training
Parent aid
Family skills training
Parent Involvement
Family services
Family skills training
Foster parent training
Protective services
Family preservation
Family unification
Family treatment
Residential shelter
Day treatment
Parent aid
Parent training
PRETEEN & ADOLESCENT Parent education
Family education
Family meetings and activities
Sex education
Family communication and relationship enhancement
Parent support groups
Family volunteers
Parent involvement in youth group
Surrogate parent training
Parent/school/treatment-truancy
Juvenile diversion/gang prevention
Parent education
Parent skills training
Drop-out education prevention
Family therapy
Family services
Parent or family support
Protective services
Family preservation
Intense probation
Teaching family model
Day treatment/alternative school
Foster parent program
Residential treatment

Family-focused interventions appear to be more effective than either child-focused or parent-focused approaches. Child-only approaches, not combined with parenting or family approaches, can have negative effect on family functioning (Szapocznik & Kurtines, 1989, Szapocznik, 1997). If high-risk youth are aggregated, deteriorated youth behaviors can occur (Dishion & Andrews, 1995). Reviews of early childhood programs (Dadds et al., 1992; Mitchell, Weiss, & Schultz, 1995; Yoshikawa, 1994), elementary school-aged children's programs (Kazdin, 1993; Kumpfer & Alvarado, 1995; Patterson, Dishion, & Chamberlin, 1993), and adolescent programs (CSAP/PEPS, in press; Szapocznik, 1997) support the effectiveness of family-based interventions. In fact, a number of adolescent family programs have found significant reductions in substance use (Henggler, Pickrel, & Brondino, in press; Lewis, Piercy, Sprendle, & Trepper, 1990; Szapocznik, 1997). In recent years there has been a shift from focusing therapeutic activities primarily on the child, to improving parents' parenting skills and, to recognizing the importance of changing the total family system (Szapocznik, 1997; Parsons & Alexander, 1997).

Newly developed family-focused skills training programs are more comprehensive and include structured parent skills training, children's social skills, and parent/child activities sometimes called behavioral family therapy, behavioral parent training, or family skills training. The new family skills training approaches often also offer a number of additional family support services (i.e., food, transportation, child care during sessions, advocacy, and crisis support). A few examples of these structured family-focused interventions include the author's Strengthening Families Program (Kumpfer, DeMarsh, & Child, 1989) effective with substance-abusing parents and ethnic parents (Kumpfer, Molgaard, & Spoth, 1996); Focus on Families (Haggerty, Mills, & Catalano; 1991) for methadone maintenance parents (Catalano, Haggerty, Gainey, & Hoppe, submitted; Gainey, Catalano, Haggerty, & Hoppe, submitted); the Nurturing Program (Bavolek, Comstock, & McLaughlin, 1983) for physically and sexually abusive parents; Families and Schools Together (FAST) (McDonald, Billingham, Dibble, Rice, & Coe-Braddish (1991) for high-risk students in schools; and the Family Effectiveness Training (FET) (Szapocznik, Santisteban, Rio, Perez-Vidal, & Kurtines, 1985). See Kumpfer (1993a and 1993b, 1997), Kumpfer & Alvarado (1995), and CSAP/PEPS (in press) for reviews these family programs.

Other researchers are employing these broad-based family skills programs as part of even more comprehensive school-based, intervention strategies. The FAST TRACK program (Bierman, Greenberg, & the Conduct Problems Prevention Research Group (CPPRG), 1996; McMahon, Slough, & the CPPRG, 1996), one of the largest prevention intervention research projects ever funded by the National Institute for Mental Health, is one exemplary example. This selective prevention program implemented with high-risk kindergartners nominated for the program because of risk factors including conduct disorders, is being implemented in several different sites in the nation with a large team of nationally recognized prevention specialists, including Drs. Lochmann, Coie, Biersman, McMahon, Greenberg, Dodge and Slough. FAST TRACK includes McMahon's behavioral parent training, which is also incorporated in SFP. Parents were found to be quite satisfied with this type of parent training that involves therapist coaching and interactive practice between the parent and the child (McMahon, Tiedemann, Forehand, & Grist, 1994).

One distinguishing feature of these new parent and child skills training programs, which the author calls family skills training programs, is that they provide structured activities in which the curriculum addresses improvements in parent-child bonding or attachment (Bowlby, 1969; 1982) by coaching the parent to improve play time with the child during Child's Game. This "special therapeutic play" has been found effective in improving parent-child attachment (Egeland & Erickson, 1987; 1990). Using intervention strategies developed by Kogan (1980) and Forehand & McMahon (1981), the parents learn through observation, direct practice with immediate feedback by the trainers and video tape, and trainer and child reinforcement how to improve positive play (Barkeley, 1986), by following the child's lead and not correcting, bossing, criticizing, or directing. Teaching parents therapeutic play has been found to improve parent-child attachment and improve child behaviors in emotionally disturbed and behaviorally-disordered children (Egeland & Erickson, 1990; Kumpfer, Molgaard, & Spoth, 1996). These family programs encourage family members to increase family unity and communication and reduce family conflict as found in prior SFP studies.

FAMILY PREVENTION APPROACHES

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

Family Skills Training Program

The multi-component family skills training approach appears to impact the largest number of measured family and youth risk/protective factors according to a separate outcome analysis conducted by Dr. Kumpfer for PEPS and presented at the National Institute for Drug Abuse family conference (Kumpfer, 1996b). Because multi-component family skills training programs generally incorporate behavioral parent training, children's skills training, and behavioral family therapy, they address more risk and protective factors.

Research by Aktan, Kumpfer, and Turner (1996) evaluated the Safe Haven Program for the prevention of substance abuse through a nonequivalent comparison, repeated measures, quasi- experimental design. The Safe Haven Program is a family skills training program for African American families which have one parent who is a substance abuser. The program was found to be effective in increasing parenting efficacy and behaviors toward children, improving children's risk and protective factors and behaviors, and supporting treatment reductions in the parent and family illegal substance use (Aktan, Kumpfer, and Turner, 1996).

McMahon (1987) has reviewed a number of behavioral family therapy programs. These programs are often called behavioral family therapy (if trained therapist work with the individual families) or behavioral family training (if multifamily groups are used), and include separate structured skills-training groups for the parents and the children in the first hour using a guided participant modeling by trainers (Rosenthal & Bandura, 1978). In the last hour, the family is brought together to practice learned skills and participate in fun family activities. The Nurturing Program (Bavolek, Comstock, & McLaughlin, 1983), Families and Schools Together, the Strengthening Families, in press), and Family Effectiveness Training (Szapocznik, Santisteban, Rio, Perez-Vidal, & Kurtines Program (SFP) (Kumpfer, DeMarsh, & Child, 1989), Focus on Families (Catalano et. al., 1989) have all been used for substance and delinquency prevention. 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.

Several of these programs have undergone rigorous research evaluation designs. The Strengthening Families Program (SFP) was developed after a research project funded by the National Institute on Drug Abuse (NIDA) demonstrated that combining parent and youth skills training with family skills training was more effective in decreasing risk factors than either parent training or child training only (DeMarsh & Kumpfer, 1986). The program is an intensive 14-week parenting and youth skills-training program specifically for drug abuse prevention with 6-to 12-year old children of drug- or alcohol-abusing parents. Strengthening Family Parent Program has been modified to be culturally relevant, and has been found effective in decreasing child and family behavioral and emotional precursors of drug use for rural and urban African American families (the Safehaven Program; Kumpfer, Bridges, & Williams, 1993), Hispanic families, and Asian and Pacific Islander families. Strengthening Families Program II (Molgaard & Kumpfer, 1994) is a 7-week adaptation of SFP for sixth-grade rural youth and low-income parents. This school-based family program, complete with videotapes, is currently being evaluated by Iowa State University (Spoth, Redmond, Lepper, 1999) in a massive large-scale dissemination trial in Iowa funded by the National Institute of Mental Health. In addition, these researchers are evaluating the efficacy of the Hawkins and Catalano's, Preparing for the Drug-Free Years Program. This five-session parent program (one session includes the youth) includes videotapes and works well for statewide dissemination through schools and community agencies. Focus groups have been conducted to tailor the program for high-risk and ethnic families. Catalano and associates (in press) are currently testing the effectiveness of a 33-session, parent and child skills-training program, called Focus on Families, for methadone maintenance patients that also includes in-home case management and starts with a 5 hour family retreat. The children attend 2 parent sessions to practice developmentally appropriate skills with their parents.

More details concerning program design and evaluation of these and other exemplary programs are located in Part IV of this document.

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 Therapy

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),
Strategic Family Therapy (Haley, 1963),
Structural-Strategic Family Therapy (Stanton and Todd, 1982), and
Functional Family Therapy (Alexander and Parsons, 1973, 1982),
Multisystemic Family Therapy (Henggeler & Borduin, 1990).

Structural family approach targets the interactions between family members as a basis for changing maladaptive patterns (Powell & Dosser, 1992). Structural family therapy facilitates families coping skills and autonomy. The therapeutic goal is to empower families by increasing the present quantity, quality, complexity, and accessibility of coping strategies and helping them to discover their own new patterns of response in the future (Powell & Dosser, 1992).

Strategic family therapy suggests that therapist will be Apragmatic, problem focused, and goal directed in their interventions (Szapocznik & Kurtines, 1989). So that therapist can work quickly they need to be pragmatic, using strategies that may seem unconventional; narrowing the problem focus so that interventions may be specific and well thought-out (Szapocznik & Kurtines, 1989). Structural-strategic family therapies combine the elements of structure (patterns of interaction) and strategic (goal-directed and problem-specific) to their interventions. An example of this approach is the Brief Strategic Family Therapy (BSFT) (Szapoznick & Kurtines, 1989). The Brief Strategic Family Therapy is one of the exemplary programs and is written in further detail in Part IV.

The cornerstone of the functional family therapy approach is the assumption that people create an interpersonal world they respond to. Response feedback from the family to this interpersonal world characterizes a member=s function. This perceived function is presumed to be an important motivator of behavior (Alexander, Waldron, Newberry, and Liddle, 1988). The approach incorporates four steps: 1) identify behavioral patterns that distinguish deviant from nondeviance, 2) matching-to-sample philosophy identifies those variables that maintain deviant behavior, 3) selection of a subset of potentially modifiable variables, and 4) development of an intervention program to modify the subset of variables (Alexander, Waldron, Newberry, and Liddle, 1988). In 1973, Alexander and Parsons evaluated the functional family approach primarily for the prevention of delinquency in young status offenders. 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). The Functional Family Therapy program by Alexander and Parsons (1973) is one the exemplary programs listed in Part IV.

The multi-systemic approach to prevention of behavior problems in children and adolescents uses interventions that are present-focused and action-oriented. Multi-Systemic Therapy (MST) works through intra-personal (e.g., cognitive) and systemic (i.e., family, peer, school) factors that are known to be associated with adolescent antisocial behavior (Bourduin, et. al., 1994; Henggeler & Borduin, 1990). Individualized and flexible interventions are necessary for MST because different combinations of these factors are relevant for different adolescents and their families (Bourduin, et. al., 1995). 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 MST of Henggeler & Borduin (1995) is also one of the exemplary programs listed in Part IV.

Family Services

This is the traditional family service 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. Emphasis on family services is to target the family early, prenatal and early infancy interventions. Decreasing tobacco, alcohol, and drug use in pregnant women may have added benefits of preventing later substance abuse in both the mother and the child (Resnick et. al., 1997). Only after these emergency needs are met can the family begin to consider parenting and family enhancement program involvement. Several programs being tested to prevent problems in 0 to 5 years olds include: the nurse home visitation trails (Olds & Pettitt, 1996), family services and family support (Yoshikawa, 1994), family paraprofessional case management programs (Kumpfer, Sasagawa, & Cheng, 1995), infant stimulation, toy making and language development support in home by trained staff and programs to reduce conduct problems in 3 to 5 year olds (Maguin, et.al., 1994; Nye, et. al., 1995). Yoshikawa (1994) has provided some preliminary assessment results that look promising on these multi-component programs. These programs are relatively new, therefore research is still forthcoming to determine the level of effectiveness for multi-component programs.

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.

Recently, support has been generated to abandon family preservation as a child welfare practice, the prevention of child placement outside the family, but rather a focus on the delivery of family services (Wells & Tracy, 1996). Danzy and Jackson (1997) researched family preservation and support services in connection to kinship care. Kinship care looks to family relatives to assist in providing services such as child care or tutoring. They found that kinship care has a historical significance in preserving the African American family and should be included development plans for family preservation programs (Danzy & Jackson, 1997).

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). This approach may often occur in community group home setting for victims of domestic violence or homelessness (Whitman, 1995). There is usually no cost to the client and entry into the shelter is provided on first come first served basis (Whitman, 1995). The home may offer therapeutic services and interventions for the children. Thus, the home or shelter becomes an extended family (Whitman, 1995).

At the Oregon Social Learning Center's (OSLC) Specialized Foster Care model, institutionalized or to-be-institutionalized delinquents are assigned 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.

PARENTING APPROACHES

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

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).

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. Program topics include a wide range of ideas on how to improve youth behavior and values.

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 audiotape or videotape 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. The parent education components discuss 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.

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.

Home visitation varies enormously in dosage levels, content, skill, and context. Yet there are common effects reported across all these variations. These common effects may be linked to a common core of home visitation is a visitor who cares about child raising sitting down in a home with a parent and a child. Visitors can be nurses, social workers, preschool teachers, psychologists or paraprofessionals. They can provide cognitive information, emotional support, or both. They can actively teach parents, by directly working with the children in the home or they can passively watch and listen, providing constructive feedback. Home visitors can be trained in health, human development, cognitive and social skills or some mixture of these subjects. Despite the type of home visitor, they provide a bridge between the parent, usually a mother, and instruction. The Prenatal & Early Childhood Nurse Home Visitation is a program that sends nurses to the homes of pregnant women who are predisposed to infant health and developmental problems (i.e., at risk of pre term delivery and low-birth weight children) (Olds, 1986, 1989). This program is one of the exemplary programs that can be found in more detail in Part IV of this literature review.

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 Ni?os 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.

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.

Unfortunately, it is still very difficult to determine whether or not Adlerian parenting programs really work. To date, there have been no effective results, this may be because studies have not shown that they work.

PREVENTION IS COST-EFFECTIVE

Delinquency and drug abuse is preventable and cost effective. The costs of incarcerating and treating juveniles are conservatively estimated at $34,000 to $64,000 per year (Camp & Camp, 1990; Cohen, 1994). The cost of a young adult's (ages 18-23) serious, criminal career is estimated at $1.1 million (Cohen, 1994). In contrast, Head Start intervention programs that involve the parents are effective in reducing predictors of delinquency like school academic failure for as little as $4,300 per year. Unfortunately, few prevention programs have calculated their costs and benefits, but programs that have show cost-benefit ratios in the range of 8:1 (Kim et. al., 1995). According to a meta-analysis review of delinquency prevention programs by Lipsey (1992), a California delinquency prevention program saved law enforcement and juvenile justice systems $1.40 for every $1 spent on the program. Program evaluations of delinquency prevention programs highlighted in Delinquency Prevention Works (Office of Juvenile Justice and Delinquency Prevention (OJJDP), 1995) suggest there are effective programs in reducing delinquency as well as precursor risk factors.

A study conducted by the RAND Corporation in 1996 entitled, Diverting Children from a Life of Crime Measuring Cost and Benefits determined the benefits of programs that divert youth who have not yet committed crimes from doing so, and at what cost (Greenwood, Model, Rydell, & Chiesa, 1996). A comparison was made based on the crime reduction estimates of four interventions programs to the California three-strikes program. The three-strikes program was believed to effect a twenty-one percent (21%) reduction in crime worth $5.5 billion a year. Four different approaches to early intervention for at-risk children were considered:

Home visitations by child-care professionals beginning before birth and extending through the first two years of childhood, followed by four years of day care.

Parent training and family therapy with young children who have shown aggressive behavior in school.

Incentives (e.g., cash, other) to induce disadvantaged high school students to graduate.

Supervision of high-school-age youth who have already exhibited delinquent behavior.

Costs included the delivery of a set of services to at-risk youth or their families beginning in the current year and the eventual benefits in terms of crimes prevented over time for that group of youths. According to Greenwood and associates (1996), an estimate of the cost and benefits of these approaches relative to the California's three-strikes law findings suggested that three of the four approaches compared favorably in terms of serious crime prevented per dollar expended. Specific findings were as follows:

The cost of preventing crimes with a well-designed graduation incentive program is estimated to be approximately $4,000 per crime. The effects of such a program are felt in a short time period, less than 5 years, because the targeted youth are close to the most crime-prone years.

Parent-training and family therapy intervention programs were found to be relatively cost-effective over the long run at a cost of approximately $6,500 per serious felony prevented. However, the effect of this type of intervention usually does not show any significant consequences for at least 10 years because -participating youths are usually in the seven-to-ten-year age range.

Delinquent supervision programs cost nearly $14,000 per serious crime prevented. The impact of such programs is almost immediate because the intervention comes just prior to the peak age of criminal behavior 16 to 20 years of age.

Early home visitation and day care intervention were not as cost effective because of an almost 15-year delay between when the intervention is applied and when it begins affecting serious street crimes. The cost per crime prevented is estimated to be $29,400 per child over a period of 5 years. However, early childhood intervention has been shown to reduce rates of child abuse about fifty (50%) percent.

From this study, it is apparent that cost-benefit approach to reduce long-term delinquency effects should be comprehensive. A comprehensive approach would include: 1) incentives to promote high-school graduation and reducing school drop-out rates, 2) parent-training programs and family interventions, and 3) supervision programs during early onset of delinquent behavior may be several times more cost-effective in reducing serious crime than long mandatory sentences for repeat offenders. The authors suggest that the previous type of cost-effective programs could reduce the financial burden of prisons and divert youth from a life of crime.

There are cost-effective strategies that can prevent delinquency by successfully reducing risk factors and strengthening protective factors in the lives of at-risk children. Some of these strategies are included in the OJJDP Guide for Implementing the Comprehensive Strategy for Serious, Violent, and Chronic Juvenile Offenders (Howell, Krisberg, Hawkins, Catalano, et al., 1995) and the former Strengthening American's Families: Promising Parenting Strategies for Delinquency Prevention (Kumpfer, 1993). The National Institute of Justice (NIJ) and OJJDP are promoting many of these prevention strategies in partnership with state and local communities. The National Juvenile Justice Action Plan also supports OJJDP's Comprehensive Strategy for Serious, Violent, and Chronic Juvenile Offenders (Wilson & Howell, 1993) by providing local communities with lists of resources, a summary of research, and examples of model programs that can be adapted to meet local needs.

OJJDP's Action Plan (1996) advocates strengthening families' capabilities to supervise and nurture the positive development of their children. Family strengthening programs can provide assistance through teaching effective parenting skills, therapeutic child play, family communication, and supervision and monitoring (Kumpfer & Alvarado, 1995). The review of the top twenty-five family programs for the prevention of delinquency, titled Strengthening America's Families (Kumpfer, 1993), includes some family strengthening models that provide additional family support for very high-risk families through home visitations, family therapy, family preservation or family reunification intensive services, on-going neighborhood parent support groups and even in-home family therapy for youth on house arrest (Kumpfer, 1993).

Failure to strengthen families to raise productive, competent, pro-social children will make the United States less competitive in the 21st Century. Unfortunately, economic circumstances, cultural norms, and federal legislation in the last two decades have created an environment that is less supportive of strong, stable families.

Because these reviews suggest there is no one single best family intervention program, providers in the field must carefully select the best program for their target population. Providers can use guidelines to determine the most effective program from a larger number of effective programs. NIDA has specified a number of principles for prevention that can be used to guide that selection process (Sloboda & David, 1997). Following is a listing of principles usefuin reviewing and selecting family programs for implementation.

Parenting and family interventions must be tailored to the developmental stage of the child and specific risk factors in the families served. Unfortunately, some programs ultimately fail to have long-term impact on negative outcomes, (delinquency and drug use) in special high-risk populations, because they are insufficient to impact the large number of risk factors effecting high-risk children. Some general principles for best practices in family programs to have maximum impact in improving parenting, family relationships and youth functioning have been discovered, namely:




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