Study Design and Outcomes for Multiple Strengthening Families Program Studies by Diverse Researchers 1984 – 2012:
Study
Original NIDA SFP 6-12 Research Targeting High Risk Children of Substance Abusers in Treatment (N=208 families in etiological and intervention research)
(DeMarsh & Kumpfer, 1985; Kumpfer & DeMarsh, 1985)
Comments: This study found the 3-component program (SFP) was more effective in improving predictor variables for later drug use in 6-12 yr. old children of drug abusers and children’s self-reported tobacco, alcohol, and drug use. The interventions impacted behaviors more than attitudes.
Study Design
Design: True experimental randomized 4-group dismantling design assigning families to one of 4 groups:
- 14- session behavioral parenting program (PT)
- PT plus 14-session children’s skill training (PT/CT)
- Both PT & CT, plus 14-session family relationship program (SFP)
- No treatment, wait-Tx control group
Sample: N= 208 mixed ethnicity families in total NIDA study including pre-test needs assessment study. The randomized intervention study including a selective population of 90 families of drug abusers in treatment randomly assigned to each of the four groups (PT=20, PT/CT=20, SFP=20, Treatment As Usual (TAU) Control =30
Measures: Child Behavior Checklist (CBCL), Cowen, Moos Family Environment Scale, FACES II, Marital Adjustment Scale, Parenting Behaviors, Beck Depression Inventory.
Specific Outcomes
Data Analysis Methods and Results: Using an Analysis of Variance (ANOVA) statistical analysis, the following significant change results were found by the post-test:
- PT reduced children’s negative behaviors and increased parenting skills
- CT improved social competencies
- SFP reduced children’s self-reported alcohol and drug use, parent and child pro-drug attitudes, children’s problem behaviors, and improved emotional status, social skills, and peer relations.
- Improved parent’s parenting knowledge, skills, agreement on discipline, and reduced depression, and social isolation.
- Improved family cohesion, adaptability, communication, reduced sibling conflict, clarity of rules
Study
Rural African American SFP 6-12 in Selma, Alabama (N=51 Families) (Kumpfer, Turner, & Palmer, 1991, final report)
(Kumpfer, Alvarado, Smith & Bellamy, 2002)
Comments: This study suggested that SFP is effective in improving predictor variables for African American families. In the first year, only drug abusing mothers in treatment were recruited, but in the last four years mothers were recruited from housing communities, special education classes, and churches. Mothers not in treatment significantly reduced their alcohol and drug use after participation in SFP, possibly because of the reduced depression and stress.
Study Design
Design: A quasi-experimental, phase-in design with, pretest, posttest, and 2-year follow-up design. The generic 14-session SFP tested in the first two years and a more culturally sensitive version with new cartoons, cultural pride material tested in Years 3-5.
Sample: A selective population of N=62 African American mothers in drug treatment or recruited from the community (51 families completed for 82% retention rate, missing data on 2 families).
Experimental Group: 22 families with a high-drug-use single mother
Comparison Group: 27 families with a no drug abuse mother.
Measures: CBCL, Moos FES, Parent Attitude Test, Beck Depression, GAS, Parenting Behaviors, alcohol, tobacco, and drug use.
Specific Outcomes
Data Analysis Method and Results: Using a post-hoc statistical control group analysis an ANOVA compared results for families with little drug use with those with high drug use who had both completed SFP.
No or Low Substance Abuse Mothers:
- Children improved only on obsessive-compulsive behavior, aggression, and delinquency.
- Family organization improved
High Substance Abuse Mothers:
- Children improved global internalizing (depression, obsessive-compulsive, somatic complaints, social withdrawal, and schizoid) and externalizing (aggression, delinquency, and hyperactivity) scales and all CBCL scales (except the uncommunicative scale).
- Significant reductions in FES family conflict, increased organization.
- Significant reduction in parent drug use
Study
Detroit’s Safe Haven Program, the Inner City SFP 6-11 for African American Drug abusing Fathers (Aktan, Kumpfer & Turner, 1996; Aktan, 1995; 1999)
Comments: Both versions of SFP has significant positive effects on risk and protective factors for later drug use in the children and parents. The culturally sensitive version of SFP did not improve outcomes, but it did significantly improve recruitment and retention of the families by about 40% from about 45% of families retained to about 85% of families retained.
Study Design
Design: Quasi-experimental pretest, posttest, and 6-mo, 1-year follow-up phase-in design testing the generic versus the culturally specific version of SFP.
Phase I (Yr 1& 2) 14-session SFP
Phase II (Yr 3 & 4) was modified to be 12-sessions long and in Phase II (Years 3-5) an Afro-centric, culturally sensitive version with a video, language changes, and new cartoons/pictures was tested with African American families.
Sample: Phase I Generic SFP Study: A selective population of N= 88 families mostly of African American men in drug treatment in inner city Detroit (56 completed)
Experimental Group: 27 families with drug abusing parent (primarily fathers in drug treatment)
Comparison Group: 29 families with low-drug-use parents
Retention Rate: 68% at post-test, no evidence of differential dropout.
Measures: Achenbach and Edelbrock Child Behavior Checklist (CBCL), Moos Family Environment, Parent Attitude Test, alcohol and drug use. Independent evaluator in Years 3-5 and independent investigator in Years 1-5.
Specific Outcomes
Data Analysis Methods: Using a post-hoc quasi-experimental control analysis of variance (ANOVA), the following significant post-test change results were found in the two groups completing SFP or the total sample:
Results for Comparison Group of No or Low Drug-use Parents Completing SFP:
- Children reduced school problems, increased school bonding,
- Decreased family conflict, drug use.
Results for High Drug-use Parents:
- Significantly decreased all externalizing problem behaviors (aggression, hyperactivity, and delinquency, school problems) and all internalizing problem behaviors (depression, lack of communication, obsessive compulsive tendencies, social withdrawal, and schizoid tendencies).
- Increased school bonding and child doing chores. Parents reduced depression, drug use, increased perceived parent efficacy, and time spent with child.
Total sample (N=56)
- Significantly improved family relationships (composite score), cohesion, and family conflict, but not expressiveness or organization, or control.
- Increased parent self-efficacy, parents helped more with homework, inc. time with child, inc. school bonding, reduced school problems
Decreased parent depression and drug use
Study
Utah Community Youth Activity Project (CYAP) SFP 6-12 Multi-cultural Three County Study (Harrison, 1994; Harrison, Boyle, & Farley, 1997)
Comments: The positive results of this study suggested that SFP could be successfully implemented widely in three counties and with fidelity through multiple ethnic family serving agencies. The five-year follow-up showed reductions in the strength of the positive results at the posttest, but there were still major improvements including 68% of families still doing at least one family meeting per month and 37% weekly. This continues the impact of SFP with families holding weekly sessions for problem solving, communications, rewards, and fun family events.
Study Design
Design: Quasi-experimental pretest, posttest, and 3-month follow-up
Sample: 203 parents (421 completed pretest)
448 youth (703 completed pretest)
Selective population of high-risk families recruited from drug and mental health treatment centers and housing communities, ethnic family and youth services agencies (Asian/Pacific Islander, Hispanic)
Five Year Follow-up Study
87 Families interviewed by an independent researcher from Harvard University
Measures: Achenbach and Edelbrock Child Behavior Checklist (CBCL), Moos Family Environment Scale, Interview Protocol
Specific Outcomes
Significant improvements in the FES scales for family conflict and cohesion, parenting behaviors, and improvements in all the children’s CBCL subscales for behavioral and emotional status.
Five Year Follow-up SFP Results
- 97%-“catching their children being good”
- 99%-believed they were giving clear directions
- 95%-used reasonable consequences
- 84%-improved their problem solving with children
- 94%-enjoyed each other more
- 85% scheduled family play time regularly
- 68%-using family meetings monthly
- 37%-using family meetings weekly
- Lasting improvements in: family problems (78%), stress-conflict levels (75%), amount of family fun (62%), family talking together more (67%), and showing positive feelings (65%)
Study
SFP 6-12 Hispanic version Denver Area Youth Services (DAYS)
(Wanberg & Nyholm, 1998 final report)
(Hernandez, L. & Lucero, E., 1996)
Comments: The culturally adapted SFP 14-session version as implemented at DAYS has been very successful in recruiting and retaining 90% of participants from high-risk families recruited universally from housing communities and schools. The outcomes show significant reductions in 90-day family and child alcohol and drug use, family risk factors, and improvements in the child and family adjustment.
Study Design
Design: Quasi-experimental pretest, posttest, 6-months, 12-months, 24, 36-months follow-up.
Sample: N= 388 universal families (drug-using parents screened out of sample and referred to treatment)
- 200 SFP completers (90.4% retention rate at posttest)
- 151 in-school comparison prevention program (BPP—Basic Prevention Program)
Hispanic Cultural Adaptations: These included the following: 2 to 3 informal potluck open houses to establish trust, cultural and recreational excursions, program planning sessions with families, translation into Spanish, “big graduations” at hotels with food, entertainment, gowns, video tapes of graduation, gifts donated by police or fire department in Christmas gift baskets, family, friends, and community leaders invited to attend, etc. Parent graduates are hired as recruiters or “parent organizers” and also help the parent stay in the program.
Measures: CBCL, FES, Child Self-assessment Protocol (Wanberg, 1993), Parent Assessment
Specific Outcomes
Results: At post-test and 6-mo follow-up sig. improvements for SFP universal families in:
- FES Family cohesion, conflict, expressiveness, and organization.
- General child adjustment
- General family adjustment
- Child Adjustment (3 mo.)
At post-test only sig. improvements in:
- Child school adjustment
- Child 90-day alcohol and drug use
- Family 90-day alcohol and drug use
Hernandez & Lucero (1996) report that 68% of the SFP parents became more active volunteers in their community, joining Parent-Teacher Associations, site-based committees, heading support groups, or becoming parent recruiters for SFP.
Study
Strengthening Hawaii’s Families (SHF) (Kameoka, 1996)
Comments: The longer culturally adapted SHF had greater drop-out (45%) being 20 sessions long and the outcomes were stronger for family outcomes, but weaker for parent and child outcomes possibly because of cutting 4 SFP sessions. Later a new SHF was developed to more closely follow the original 14 session SFP.
Study Design
Design: Quasi-experimental, phase-in design (Phase I, SFP, Phase II: SHF), pretest, posttest, and nonequivalent no Tx control group design.
Cultural Adaptations: Strengthening Hawaii’s Families (SHF) is 10 new sessions on family values followed by 10 SFP parenting sessions or 20 total. New audio and video tapes made.
Sample:
N=71 total universal families completed SFP.
19 families completed SFP
52 families completed SHF
Attrition Rate=48% overall, but no consistent differences noted in drop-outs and completers, but Tx group higher risk than No Tx group, so used ANCOVA analysis to adjust for pre-test differences.
Measures: CBCL, FES, 30-day substance use
Research was conducted by an independent evaluator at University of Hawaii.
Specific Outcomes
- Pre- post-test comparisons inc. all 71 families (both SHF versions) found significant improvements in family conflict, family cohesion, and family organization.
- Improved parenting attitudes and skills, reduced parent depression, less somatization, interpersonal difficulties, anxiety, and hostility.
- No significant improvements in children’s problem behaviors.
- Comparing to the no-TX group, the culturally modified version reduced family conflict, but increased children’s substance use by parent report.
Study
Iowa’s Strengthening Families Program
SFP 10-14 (Molgaard, V.K., Spoth, R.L., and Redmond, C., 2000. OJJDP Juvenile Justice Bulletin, August 2000)
Comments: Two NIDA and NIMH R01 RCT grants tested the efficacy of SFP 10-14 Years with universal low risk families in Iowa. The follow-up studies of up to 6 and 10 years have found ISFP to be very effective in reducing adolescent substance initiation and use. A cost-benefit analysis found a large cost-benefit ratio of $9.60/$1 spent (Spoth, Guyll, & Day, 2002). This 7-session SFP version for universal families of junior high school students was developed and implemented by Kumpfer, Molgaard, & Spoth (1996). However, the evaluation research has been conducted independently at Iowa State University. Ten year follow-ups of SFP 10-14 to 22 year of age have resulted in two to three fold reductions in lifetime diagnosed mental health problems (depression, anxiety, phobias and personality disorders) (Trudeau & Spoth, 2005; Spoth, et al., 2005). Long-term outcomes were also positive for reduced methamphetamine use (Spoth, Clair, Shin, & Redmond, 2006).
Study Design
Design: Experimental design, random assignment of 33 schools to two comparison interventions or control with longitudinal follow-up study:
- Iowa’s SFP (161 families in 21 groups)
- Preparing for the Drug Free Years
- Minimal-contact control condition
Age and Universal Population Adaptations: ISFP is a 7-session family skills training program for 6th graders, tested in rural Iowa and based on resiliency skills (Kumpfer, Molgaard & Spoth, 1996
Measures: Standardized measures were used, but scales revised to match the measurement model.
Specific Outcomes
2 Year Follow-up Study Results
- Compared to control group, ISFP significantly reduced youth tobacco, alcohol, and drug use, conduct problems, school-related problems, affiliation with antisocial peers, inc. peer resistance.
- Significantly improved parenting behaviors (clarification of substance use rules and consequences, increased level of positive parent-child involvements), general child management (e.g., standard setting, monitoring, effective discipline) and parent-child affective quality (e.g., expressions of positive affect).
Cost-Effectiveness and Cost-Benefit Study Results (Spoth, Guyll & Day, 2002). These researchers compared SFP to Preparing for the Drug free Years and found a $9.60 cost-benefit ratio compared to $5.80 for PDFY.
Study
Strengthening Families Program for Ojibway American Indian in Iowa (Witbeck & Smith, 2001)
Study Design
Design: NIDA research study with randomized control design.
Cultural Adaptations: SFP was reduced in length to 8 to 10 sessions and modified to be culturally appropriate for Ojibway American Indian families. An SFP board game was created and sold at the reservation casino.
Specific Outcomes
- Significantly improved precursor risk and protective factors.
Study
Project SAFE (Kumpfer, Alvarado, Tait, & Turner 2002)
Comments: This study suggests that while both programs were effective, combining a compatible school-based social skills training program, I Can Problem Solve (ICPS) with SFP results in more statistically significant improvements in effect sizes over the no treatment control group and larger (additive) effect sizes.
Study Design
Design: Randomized 4-year longitudinal follow-up experimental design with elementary schools (N=12) as the unit of random assignment to 4 experimental conditions:
ICPS Only (N=256)
SFP plus ICPS (N=56)
SFP Parenting only group plus ICPS (N=21)
No treatment condition (N=322)
Sample: A universal population of N= 655 first grade youth and/or families from schools.
333 experimental group participants.
322 control group participants.
Recruitment and Retention: 59% of total 1st grade sample signed up for research,
84% retention in ICPS by 1yr follow-up,
77% retention in SFP (11 of 14 sessions completed)
(no evidence of differential attrition in groups)
Specific Outcomes
Data Analysis Methods and Results: Compared the four year longitudinal results for pre- to post-test and follow-up results using an ANCOVA analysis and d’ Effect Sizes for No TX Controls, significant improvements in Effect Sizes were found for:
- ICPS Only – school bonding and self-regulation
- SFP plus ICPS – school bonding, parenting skills, social competence, family relationships, and self-regulation.
- SFP Parenting only plus ICPS – social competence and self-regulation. Negative effect of parenting only on family relationships if full SFP with child and family sessions not included.
Study
NIDA Strengthening Washington, D.C. Families (Gottfredson, et al., 2006)
Comments: This study suggests that SFP 6-12 is effective in Phase 4: Health Services Research when implemented widely with reasonable fidelity with universal families (primarily African American) from schools or housing communities.
Study Design
Design: Randomized Experimental Design with 715 families randomly assigned to one of four groups:
- Minimal Contact Control (4 sessions)
- Parent Training (PT) (14 sessions)
- Children’s Skills Training (CT) 14 sessions
- Strengthening Families (14 sessions)
Recruitment and Retention Rates: Retention at posttest=70% no differential attrition correlated to outcome variables.
Sample: A universal population of families (N-715) recruited from schools, shopping malls, apartment complexes (75% African American, 25% other mixed race). Recruitment difficult because of no implementing agency as generally done in SFP replications. Drug treatment agencies as planned in the grant backed out as they didn’t want to do random assignment to SFP and their treatment as usual.
Outcome Measures: Gresham and Elliot Social Skills, Parent Observation of Children’s Activities (POCA, Kellam), Beck Depression Inventory, Moos Family Environment Scale, parent and child drug and alcohol use.
Specific Outcomes
Despite using an intent-to-treat design that included families that never attended SFP and lack of cultural adaptation for AA families as planned, SFP improved all 11 predictor outcome variables, including child antisocial behavior, hyperactivity, consistency of discipline, and family cohesion) with medium effect sizes; however, sig. increases in the MT group in these four outcomes resulted in statistically sig. differences in only 7 of the 11 outcome variables;
- Child school progress,
- Child social skills
- Child sociability
- Parenting confidence
- Parent depression
- Family organization
- Family conflict
Study
Strengthening Dutch Families (SFP 13-17 Years) (Onrust & Bool, 2006)
Comments: This was an independent evaluation of a Dutch cultural adaptation of SFP 12-16 by the Trimbos Institute for youth in residential drug treatment in multiple sites in Netherlands.
Study Design
Design: Quasi-experimental design with families of adolescents in drug and alcohol treatment involved assigned to one of two groups:
- SFP
- Wait-treatment Controls
Outcome Measures: Gresham and Elliot Social Skills, Parent Observation of Children’s Activities (POCA, Kellam), Beck Depression Inventory, Moos Family Environment Scale, parent and child drug and alcohol use, Family Strengths and Resilience Scale.
Specific Outcomes
Results. SFP improved all 18 predictor outcome variables, including all 6 parenting variables, 6 family outcomes, 9 child outcomes including child depression, social skills, overt and covert aggression with medium to large effect sizes.
Study
Strengthening Canadian Families Program 6-11 Years (Maguin, et al. submitted)
Comments: An independent NIAAA-funded RCT of the Canadian adaptation of SFP 6-11 produced positive results among alcoholic parents and their 6-11 year old children (Maguin, et al., submitted; DeWit, et al., submitted).
Study Design
Design: Randomized Experimental Design with 680 families with alcohol problems randomly assigned to one of two groups:
- SFP
- No Treatment Controls
Outcome Measures: Gresham and Elliot Social Skills, Parent Observation of Children’s Activities (POCA, Kellam), Beck Depression Inventory, Moos Family Environment Scale, parent and child drug and alcohol use, Family Strengths and Resilience Scale.
Specific Outcomes
Results. SFP improved all 21 predictor outcome variables, including all 6 parenting variables, 6 family outcomes, 9 child outcomes including child depression, social skills, overt and covert aggression with medium to large effect sizes;
Study
Strengthening Spanish Families Program (SFP 6-11 Years) (Orte, et al., 2007 a & b).
Comments: The independent research on this Spanish adaptation was funded by the Spanish and Balear government to the University of Balearic Islands. The quasi-experimental results suggest positive results among drug addicted parents and their 8-12 years old children with large effect sizes similar to other studies.
Study Design
Design: Quasi-experimental design with families of drug and alcohol involved parents in drug treatment assigned to one of two groups:
- SFP
- Wait TX SFP group
Outcome Measures: Gresham and Elliot Social Skills, Parent Observation of Children’s Activities (POCA, Kellam), Beck Depression Inventory, Moos Family Environment Scale, parent and child drug and alcohol use, Family Strengths and Resilience Scale.
Specific Outcomes
Results. SFP improved all 18 predictor outcome variables, including all 6 parenting variables, 6 family outcomes, 9 child outcomes including child depression, social skills, overt and covert aggression with medium to large effect sizes.
Study
Strengthening Irish Families SFP 12 to 16 Years (Kumpfer, Xie, & O’Driscoll, 2012),,
SFP 12-16 Years being implemented in most counties in Ireland by teams in coalitions of youth probation services, drug task forces, schools, family and youth services, and the garda. They have a National Ireland SFP Council to assure quality and fidelity.
Study Design
Design: Quasi-experimental pre- to posttest design with comparisons to Irish and USA SFP norms in many independent county coalition replications of SFP 12-16.
Outcome Measures: Gresham and Elliot Social Skills, Parent Observation of Children’s Activities (POCA, Kellam), Beck Depression Inventory, Moos Family Environment Scale, parent and child drug and alcohol use, Family Strengths and Resilience Scale.
Specific Outcomes
Results. For 250 families of indicated youth compared to SFP norms, found SFP significantly improved all 21 predictor outcome variables, including all 6 parenting variables, 6 family outcomes, 9 child outcomes including child depression, social skills, overt and covert aggression with medium to large effect sizes that were larger than those for US agencies;
A Mahoney, et al. (2014) analysis of 350 Irish participants found SFP was as effective for girls as for boys.
Study
Strengthening UK Families (SFP 10-14 Years) (Allen, Coombs & Foxcroft, 2006).
Study Design
Design: Quasi-experimental
Specific Outcomes
Results. Not released yet. Only the cultural adaptations published.
Study
Strengthening New Jersey Families (SFP 3-17 Years)
Comments: New comparisons of the shorter 7-session SFP 10-14 to the longer 14- session SFP 3-17 for higher risk families using the same populations and instruments found the longer version produced considerably larger outcome effect sizes (Kumpfer, Ahearn-Green, Cofrin, & Whiteside, 2007, 2011).
Study Design
Design: Quasi-experimental Design with 1,550 families participating in one of four groups:
- SFP 3-5
- SFP 6-11
- SFP 10-14
- SFP 13-17
Recruitment and Retention Rates: Retention at posttest=70% no differential attrition correlated to outcome variables.
Sample: A selective and indicated population of families (N-1,550) recruited from local referred populations, mixed race).
Outcome Measures: Gresham and Elliot Social Skills, Parent Observation of Children’s Activities (POCA, Kellam), Beck Depression Inventory, Moos Family Environment Scale, parent and child drug and alcohol use, Family Strengths and Resilience Scale.
Specific Outcomes
Results. SFP improved all 21 predictor outcome variables, including all 6 parenting variables, 6 family outcomes, 9 child outcomes including child depression, social skills, overt and covert aggression with medium to large effect sizes;
Study
Study Design
Specific Outcomes
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Maguine, E, Nochajski, T., Dewit, D., McDonald, S, Safyer, A., & Kumpfer, K.L. (Manuscript submitted for publication). The Strengthening Families Program (SFP 6-11 Years) and children of alcoholic’s families: Effects on parenting and child externalizing behaviors, American Psychology Quarterly.
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