Multifaceted Prevention Programs Reach At-Risk Children Through Their Families

Two NIDA-funded studies are finding that working with the family is more effective in reducing risks of drug abuse than working with parents or children alone. Both projects target families at risk. The Strengthening Families Program works with parents and children in families where the parents abuse drugs, while Focus on Families works with parents who are in methadone treatment. Children from such families, research shows, are at risk for becoming drug abusers themselves.

Strengthening Families

The Strengthening Families Program is aimed at 6- to 10-year-old children of drug abusers and their parents.

"We work on improving parent-child relationships - their time together, their communication patterns," says Dr. Karol Kumpfer of the University of Utah in Salt Lake City, the project's principal investigator. "We try to change the family dynamics, to create a more democratic family where they actually have family meetings, talk together, and plan activities together. Then the child feels that he or she belongs to something, that 'we are a family, we believe certain things, we stand for certain things, and we work together as a unit.'"

Dr. Kumpfer devised her program after reviewing more than 500 family drug abuse prevention programs. From this survey, she designed a study to compare three promising approaches: a 14-session parent training program; the same program combined with a children's skills training program; and a three-way merger of the parent and child programs with a family skills training program.

Her study, done in Salt Lake City, involved families with parents who were in methadone treatment programs or who were substance-abusing outpatients at community mental health centers. The research showed that the three-part intervention was the most powerful in reducing problem behaviors. Compared with families that did not receive any intervention, families that went through the three-part program showed significant improvements in adults' parenting skills, children's social skills, and family relationships. Children achieved significant reductions in aggressiveness and other problem behaviors. Older children significantly reduced their use of tobacco, drugs, and alcohol, and parents reduced their depression and drug use substantially.

The three-part curriculum became the Strengthening Families Program and has since been adapted and tested with different ethnic populations across the country. Although these modified versions of the program differ in cultural content, all use the same basic framework: parent training, children's training, and family skills training. In each of 14 weekly sessions, groups of parents and children are taught separately for the first hour. In the second hour, they come together to practice their new skills. Afterward, the whole group shares dinner and a movie or other entertainment.

In their sessions, children learn how to be direct, to talk about problems, and to ask for what they need. For example, "A lot of the kids say that they would like to tell their parents to stop using drugs, and they just don't know how - so we teach them those skills," says Donna Lee Picaso, a caseworker with the Denver Area Youth Services Agency who led children's classes in the Denver study. Children also learn how to resist peer pressure, handle anger, deal with criticism, and cope with problems without resorting to drugs.

Parents are trained in techniques such as establishing goals, giving incentives and reinforcements, and setting limits. "They're right up front with saying they have very limited skills, and they're anxious to learn new ones," says Donna Martinez, a social worker in the Denver study.

Sessions are held in facilities that are easy for participants to reach such as family support centers in urban housing projects, community centers, local churches, and schools. Group size has ranged from 5 to 14 families. Session leaders are recruited from local social service agencies and have counseling or social work experience.

Focus on Families

Average Drug Use During Past 30 Days By Parents, 12 Months After Finishing Focus on Families Program. Parents in the Focus on Families parenting program, all recruited from methadone treatment clinics, reported using heroin and cocaine less often than did clinic parents who did not participate in Focus on Families.

A different approach is taken in Focus on Families, a parenting program for methadone treatment patients developed by Dr. Richard Catalano and his colleagues at the University of Washington in Seattle. The goal of this program is to reduce parents' use of illegal drugs by teaching them how to cope with problems without resorting to drug abuse and how to manage their families better.

The program was tested in Seattle with families recruited from two Seattle-area methadone clinics. Although all parents were in methadone treatment to reduce their drug use, 54 percent reported that they had used heroin, marijuana, cocaine, and other illegal drugs in the month before entering the family program. Families were randomly assigned to the experimental group, which went through the Focus on Families program, or the control group, which did not.

After families attended an initial 5-hour retreat, parents completed 4 months of twice weekly 90-minute training sessions. Children attended 12 of the sessions to practice communication skills with their parents.

Case managers visited each family at home every week for 9 months to help apply new skills and solve family problems. These house calls were critical, says Kevin Haggerty of Dr. Catalano's research team. "Families need hands-on coaching to reinforce the skills they learn and to deal with the never-ending crises in the lives of addicted parents."

To assess the program's impact, parents were interviewed before the program, right after their 4-month training, and again at 6, 12, and 24 months after the end of training. Children age 6 and older in the treatment families, as well as control group families, were interviewed at the same intervals.

At the 12-month interview, program parents reported dramatic reductions in their heroin and cocaine use and significantly better parenting skills compared with the control group, Dr. Catalano reports. At the 24-month followup, parenting and problem-solving skills remained significantly better, but "we lost the significant treatment effects on drug use," says Haggerty. "Family interventions need to be ongoing with parents who are drug addicts," he concludes.

The program had a mixed impact on the children, who ranged in age from 3 to 14 years. At the 24-month followup, program children reported a trend toward less delinquent behavior and marijuana use, and those 9 years and older reported lower rates of alcohol initiation. The program appears to have had a greater impact on younger children than older ones. This finding suggests that children of addicts may benefit more if they are exposed to improved parenting earlier and longer, the researchers conclude.

Next Steps

Despite promising results from these models, there is much to learn about preventing drug abuse in families, says Dr. Rebecca Ashery of NIDA's Prevention Research Branch. More research is needed on issues such as:

• how to adapt successful programs to different cultural and ethnic groups as was done with the Strengthening Families Program.
• how males and females respond differently to drug abuse prevention training.
• how to attract and retain families in prevention studies.
• intervening with the extended family.
• intervening with the most dysfunctional families - for example, parents who take drugs, are physically or emotionally abusive, and suffer from major mental illnesses.

Another next step is to put more emphasis on very young children. "Through research we're finding out that it's not too soon to intervene early in school or even before school," says Dr. Ashery.

"In the long run, what it will take is a comprehensive approach. You can't do the family in isolation, the school in isolation, the community in isolation," she says. "You have to do it all in concert: school, family, and community together."

Sources

• Catalano, R.F.; Haggerty, K.P.; Fleming, C.B.; and Brewer, D.D. Focus on Families: Scientific findings from family prevention intervention research. NIDA Research Monograph, in press.
• Kumpfer, K.L.; Molgaard, V.; and Spoth, R. The "Strengthening Families Program" for the prevention of delinquency and drug use. In: Peters, R., and McMahon, R., eds. Preventing Childhood Disorders, Substance Abuse, and Delinquency. Thousand Oaks, CA: Sage Publications, pp. 241-267, 1996.

For more information:

• About the Strengthening Families Program, contact Dr. Karol Kumpfer, Department of Health Education, University of Utah, Salt Lake City, UT 84112, (801) 581-7718.
• About Focus on Families, contact Kevin Haggerty, Social Development Research Group, University of Washington, 9725 Third Ave. N.E., Ste. 401, Seattle, WA 98115, (206) 543-3188.