Strengthening America's Families:
|PRE-PARENT||High school parent education
Parent/teen sex education
Teen pregnancy prevention
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
|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)
|In-home parent education (PHS, nurse, social worker)
Nurturing program for child abuse/neglect
Teen parent support services
Young parents school
School-based home; school achievement programs
|Preschool parent training
School and treatment agency
Family skills training
Family skills training
Foster parent training
|PRETEEN & ADOLESCENT||Parent education
Family meetings and activities
|Family communication and relationship enhancement
Parent support groups
Parent involvement in youth group
Surrogate parent training
Juvenile diversion/gang prevention
Parent skills training
Drop-out education prevention
Parent or family support
Teaching family model
Day treatment/alternative school
Foster parent program
Family-focused interventions appear to be more effective than either child-focused or
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
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.
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
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
More details concerning program design and evaluation of these and other exemplary programs are located in Part IV of this document.
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.
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.
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.
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).
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.
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.
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 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.
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.
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.
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.
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"
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.
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
Home visitations by
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
There are cost-effective strategies that can prevent delinquency by successfully reducing risk
factors and strengthening protective factors in the lives of
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
Failure to strengthen families to raise productive, competent,
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