About the Strengthening Families Program

Our mission is to train parents in positive nurturing skills, and youth in prosocial life skills, to create happy, stable families and protect our youth from the negative effects of alcohol, tobacco, and drugs, which can damage the teen developing brain.

The Strengthening Families Program (SPF) developed by Dr. Karol Kumpfer, professor at the University of Utah, is an evidence-based, internationally recognized parenting and youth life-skills training program which parents and children attend together. Typically, SFP classes begin with a meal as an incentive to come. Classes last 2 hours (not including the 30 minute meal.) After dinner, families separate into a 1-hour Parent class, a Teen class, and a Child class. (Those younger than age 6 go to a baby-sitting class.). During the second hour, parents and youth rejoin in a “Family Session” to practice the skills they learned in class. The skill practice helps solidify the newly learned skills, increase family bonding, and help parents and youth know what the expectations are – and practice doing them together.

History:

Created in 1982 as the first family intervention specifically designed to improve outcomes for children of parents with substance use disorders, SFP was tested and found effective on a NIDA randomized control trial research grant to help 6 to 11 year old’s of substance abusers reduce their risk factors for substance abuse (Kumpfer & DeMarsh, 1986; DeMarsh & Kumpfer, 1985). SFP has been tested and found effective by independent researchers in 36 countries (Kumpfer, Pinyuchon, de Melo, & Whiteside, 2008; Kumpfer, Magalhães, Xie, & Kanse, 2015). Based on its success, later cultural and age adaptations have been developed, for ages birth to 3 (SFP0-3), 3-5 (SFP3-5) and SFP12-16). Each comes with its own separate parent, youth, and family manuals which have been translated into Spanish, as well as other languages.

In 2011 an entertaining low-cost ($5) Home-Use DVD/ online videos for families to review SFP skills at home was created (SFPvideos.org). A matching set of SFP curricula for ages 7-17 was developed that includes video clips of key SFP skills for the Parent, Teen, Child, and Family Practice sessions. New information was added on Mindfulness, how the brain develops, and is harmed by alcohol and drugs during adolescence. The SFP 7-17 Parent lessons are also in Spanish.

Cultural adaptations are a core component of SFP fidelity, as is suggested by the UNODC Guide on implementing family interventions for substance abuse prevention (UNODC, 2009). SFP meets all US federal agencies’ standards for evidence-based prevention programs.

Who needs SFP?

SFP is for all families – not just at-risk families. SFP 7-17 emphasizes the parenting skills of Bonding, setting Boundaries, and Monitoring, and is designed for all parents who need to improve family relationships and develop a family prevention program to keep their kids safe from alcohol and drug use. It is, however, specifically created to correct the Risk Factors (below) in a child’s life that can lead to substance abuse or mental illness (now recognized as a developmental disorder).

By increasing capacities for emotional-regulation, self-expression and behavioral control through skills training, SFP diminishes aggression, delinquency, and anti-sociality. It does this by rerouting the brain’s behavioral paths which consistently lead to impulsive acts, oppositional behavior and aggression toward others. It also gives parents and youth new tools to reduce “family risk factors” and diffuse the charged family situations which frequently result in violence.

Below is a list of risk factors which make a child more susceptible to alcohol and drug use, delinquency, and depression, followed by the protective factors. It is interesting that the risk factors for both substance abuse and children’s mental illness are nearly identical. (see World Health Organization Report on children’s mental health issues, 2012). If a child has these risk factors, in his or her life, an SFP intervention is needed:

SFP addresses the following Risk Factors (for substance abuse & youth mental illness):

  • Neglect; lack of love, care, & support
  • Family conflict
  • Difficulties in communicating respectfully
  • Lax or harsh discipline
  • Lack of supervision
  • Substance use by parents (or child)
  • Stressful life events
  • Exposure to violence/abuse
  • Low expectations for school success / failure at school
  • Lack of family customs, traditions
  • Low self-esteem

SFP trains parents in skills to increase Protective Factors:

  • Strong, loving parent-child bonds
  • Functional, well-managed home
  • Mild, consistent discipline
  • Clear rules against substance use
  • Monitoring of child’s activities & friends
  • High expectations; involved parent
  • School attendance and success
  • Family customs & traditions
  • Parents set a good substance use example

Settings Where SFP Classes are Implemented

For over nearly thirty years, SFP classes have been implemented in schools, churches, drug treatment centers, family and youth service agencies, child protection and foster care agencies, community mental health centers, housing projects, refugee services, homeless shelters, drug courts, family courts, juvenile courts, and prisons.

How is the Strengthening Families Program Taught?

The Strengthening Families Program curriculum can be taught in multiple ways:

  1. Originally, SFP was taught in a Multi-Class setting, with parents, teens, and children taught in separate one-hour skills classes. During the second hour of class, families rejoined in a Family Session to practice the skills they learned in their classes. It is the family practice that ensures success. SFP classes usually begin with a family-style dinner, because it increases attendance and helps families bond as they eat. This Multi-Class model requires four to six Family Coaches (facilitators) to teach the Parent, Teen, Children and Family classes.
  2. An organization can teach the same SFP skills via a “SFP DVD Family Discussion Group.” In that SFP model, two Family Coaches conduct a joint parent – youth skills class with or without dinner. Using the SFP DVD as the main teacher, families watch the DVD together, while the Family Coaches pause it at set intervals, ask scripted discussion questions, and help families practice the skills. The outcomes are nearly as good as the original version.
  3. The third SFP model is a universal SFP Home-Study model, where parents and children watch the SFP Home-Use DVD at home, pause where indicated, practice the skills, and use the handouts and tracking sheets provided. In a study of 83 families, they reported 80 % of the positive outcomes of attending a class.
  4. The fourth SFP model is an “In-home Coach” model where a SFP Family Coach visits a family in their home, plays the SFP DVD, pauses it at intervals, teaches skills, asks discussion questions, and helps the family practice the skills. Here is a report from a Family Coach in Durham, NC:“Alex (not his real name) was referred to our Intensive In-Home program for aggressive, defiant, manipulative/lying, and non-compliance at school. They had moved to NC from NJ approximately 1 year ago and had been homeless/living at a shelter for families. When we met, the family had moved into an apartment. Because of my enthusiasm for SFP (having practiced the skills myself), Alex’s mother, who has two other children ages 3 and 1, was vocally supportive of SFP from the moment I introduced the program. Her energized engagement was a key part of the success, and I could see the difference that it made with regard to Alex paying attention throughout the session and utilizing tracking sheets on a consistent basis. What shocked me was that he was interested in learning SFP skills even when his mother could not participate in the lesson. The impact that SFP had on Alex’s problem behaviors is staggering. I watched his defiance, complaints, non-compliance, lying, and inappropriate negative behavior reduce in frequency and intensity and then melt away in about 3 months. The following three months were spent challenging Alex and setting difficult yet achievable goals related to his behavior. As we moved through the lessons, problems related to Alex’s behavior had reduced to the point where he was setting goals to go consecutive weeks without displaying any negative behaviors. By the end of the treatment period, Alex started the school year without any behavior problems at school or home. He now looks for opportunities to teach his siblings and he has been observed using leadership skills in unstructured settings with peers. SFP impact on this home is nothing short of miraculous.” (A.R. Marino, MA, LPC)
  5. A fifth SFP method is to distribute the SFP DVD through the Middle School Health Classes with Parent-Child homework assignments to watch the SFP DVD and answer the questions. Salt Lake City School District had a 50% drop in 8th Grade binge drinking when using SFP.

SFP skills training can thus be accessed either in a class, online videos, or via a Home-Use DVD. Depending on how it is taught, SFP can be a “universal” prevention program for low-risk families; but also as a “selective” or “indicated” program for higher-at-risk populations with higher doses.

Outcomes

SFP has been evaluated many times by independent researchers in randomized control trials and health services research with very positive results in reducing substance abuse and delinquency risk factors by improving family relationships. Outcomes include increased family strengths and resilience and reduced risk factors for problem behaviors in high risk children, including behavioral problems, emotional, academic and social problems. SFP builds on protective factors by improving family relationships, parenting skills, youth’s social, life, and refusals skills.

SFP is recommended for all families, and has been shown to:

  • Increase family bonding
  • Increase parental involvement
  • Increase positive parenting skills
  • Increase positive communication
  • Increased family organization
  • Decrease family conflict
  • Decrease youth depression
  • Decrease youth aggression
  • Increase youth cooperation
  • Increase number of pro-social friends
  • Increase youth social competencies
  • Increase youth school grades

Program Contents (details in table below)

The parenting sessions review appropriate developmental expectations, teach parents to interact positively with children (showing enthusiasm and attention for good behavior and letting the child take the lead in play activities called “My Time,” increasing attention and praise for positive children’s behaviors, and reducing criticism. It teaches positive family communication including active listening, validating, respectful I-Messages, and asks families to eliminate yelling or talking in cross, angry voice tones, swearing, and sarcasm from their communication. Weekly Family Meetings are introduced to improve order and organization. Effective and consistent positive discipline is also taught, with parents learning the 7-Steps of Positive Discipline that begins with teaching and practicing the behaviors parents want, and giving mild, short, consistent negative consequences for misbehavior. Families make their own family rules, and parents learn how to set clear, firm rules on no underage drinking or drug use. Parents also learn stress reduction, problem solving and anger management skills. Family practice in experiential exercises is a key component of SFP, because it enables the new behaviors to become permanent

The children’s skills training includes communication skills to improve relationships with parents, peers, and teachers. They learn to discover their goals and dreams, how to problem-solve, identify emotions, and deal with criticism. They also learn stress reduction, anger management, and coping skills. All of these skills are practiced with parents / caregivers during the family hour, which increases the children’s capacity for emotional resilience. They also learn about the harms of alcohol, tobacco, and drugs to their developing brain, and practice peer resistance skills to say “no” in a way that allows them to maintain their friendships (a major fear for youth).

Recognition

SFP is rated at the top of the Evidence-based lists by international and national review groups:

  • SAMHSA Model Programs / NREPP (2000)
  • NIDA Red Book (one of 10 programs)
  • OJJDP Strengthening America’s Families (1 of 7 replicated programs)
  • US Dept. of ED (one of 8 programs)
  • CSAP Model Program
  • World Health Org. EBP list 2006
  • Cochrane Collaboration – Oxford Univ. found SFP best substance abuse prevention program in the world (Foxcroft, et al., 2003)

Cost Effectiveness

According to comparative effectiveness reviews including the Cochrane Reviews (Foxcroft, et al., 2003; Foxcroft & Tsertsvadze, 2012) and CSAP’s cost-benefit analysis (Miller & Hendrie, 2008), the most successful evidence-based program (EBP) to prevent youth substance use is the Strengthening Families Program (SFP).

Intervention Theories used in developing SFP

The Strengthening Families Program (SFP) is based on family systems intervention theories elaborated by Bowen (1991) and others (see Kumpfer & Hansen, 2013 for a review of intervention theories). These family therapists observed in their clinical work that children’s problems were rooted in the way parents dealt with or treat their children. However, they needed effective intervention methods to improve family bonding, communication, organization, and reduce conflict.

The skills training format was influenced by the effective behavior change techniques of B. F. Skinner’s operant conditioning techniques and confirmed by Bandura’s social learning theory or cognitive behavioral theories and self-efficacy theories at Stanford University (Bandura, 2001).

Teaching parents to use positive reinforcement (attention, praise) for wanted behaviors and ignoring unwanted behaviors were developed into highly effective clinical methods by Gerald Patterson at the University of Oregon. His cognitive behavioral change theories or skills training methods (Patterson & Banks, 1989) developed to reduce psychopathology in children and families became the basis of most of the effective parenting and family skills training interventions.

These family-focused interventions proved to be particularly effective in reducing behavioral health disorders, drug use and intermediate risk factors, such as conduct disorders, aggression, and family conflict, as well as improving protective factors such as social competencies, peer resistance skills, family and school bonding, school performance, and family organization and cohesion (Kumpfer & Alvarado, 2003).

The importance of family influences is supported in the etiological theory, the Social Ecology Model of Adolescent Substance Abuse (Kumpfer, Alvarado, & Whiteside, 2003). This SEM-tested causal model found that the family cluster variables of family attachment or bonding, parenting skills and supervision, and communication of positive family values were the most critical in protecting youth from substance abuse particularly for girls (Kumpfer, Smith & Summerhays, 2008).

Never predicted was the strong pathway between family bonding and academic performance that is protective for later drug use if children are successful in school (Kumpfer, 2014). Similar SEM models have been tested for school failure, delinquency, and teen pregnancy as well as alcohol and drug use with similar results (Ary, et al., 1999; Fothergill & Ensminger, 2006).

Causal Factors – Substance Abuse –

The exact etiological causes of substance abuse are still unclear; however, previous research concludes there is a complex interaction between genetic, biological and environmental factors (Schuckit, 2009). In the addiction field, substance abuse have been described as a “family disease” that is validated by findings that children of substance abusers are two to 18 times more likely to also become drug abusers depending on their level of inherited genetic risk and family disorganization and stress (Chassin, Carle, Nissim-Sabat, & Kumpfer, 2004; Kumpfer & Johnson, 2007). Short alleles of the 5-HTTLPR serotonin transporter gene and 7-repeat dopamine gene have been linked to increased behavioral health problems, but expression can be prevented by nurturing parenting. Family EBIs increase positive parenting and decrease family conflict and stress, which has been found to reduce behavioral health care costs related to substance abuse, depression and anxiety, HIV and sexually transmitted diseases (Brody, et al, 2012), family violence including child maltreatment (Brooks, McDonald, & Yan, 2012; Printz, Sanders, Shapiro, Whitaker & Lutzker, 2009), teen drunk driving, and binge drinking.

Epigenetic Substance Abuse Risks and Nurturing Parenting Protection

Epigenetic research (Jirtle, 2010) with mice has demonstrated that even mice bred for certain genetic diseases can be protected by a nurturing “licking and grooming” mother mouse; thus, leading to the hypothesis that nurturing parenting skills can reduce genetic risk of substance abuse and other inherited “diseases of lifestyle” (Kumpfer, Fenollar, Xie, & Bluth Dellinger, 2012). Recent randomized schools RCT research with African American youth by Dr. Brody and associates (2012; 2013) strengthened the evidence that genetically at-risk youth who participate in an evidence-based family skills training program with their parents, namely the Strengthening Families Program 10-14 Years (Kumpfer, Molgaard & Spoth, 1996) adapted for African American 6th graders report 50% lower alcohol and drug use, depression/anxiety and delinquency and HIV status five years later. Genetic risk was determined by saliva samples to find the average 40% of youth with risky genes. Youth who had one or two short alleles for the 5-HTTLPR serotonin transporter gene were classified as high risk for addictions, depression and delinquency. A later analysis found a significant reduction in behavioral health problems in these same youth who had the 7-repeat dopamine risky gene (Brody, et al., 2013).