Program Profile: Families Facing the Future

This is an intensive family program combining relapse prevention and parenting skills training. This program is rated Ineffective. Treatment group parents demonstrated statistically significantly less heroin use, fewer domestic conflicts, and higher refusal skills than control parents did. There were no statistically significant differences in other drug use by parents, child drug and alcohol use, child delinquency, child-reported negative peers, or child school attachment.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals/Target Population

Families Facing the Future (previously called Focus on Families) is an intensive family program for parents in methadone treatment and their children. It combines relapse prevention and parenting skills training with home-based case management services. Its goal is to address risk factors for relapse in addicts and risk and protective factors for future drug abuse and problem behaviors by their children.

Program Theory

The program is based on the Social Development Model (Catalano and Hawkins 1996), which organizes empirical information on risk and protective factors into a development theory of antisocial behavior. Families Facing the Future specifically addresses risk factors related to relapse among opiate addicts as well as risk and protective factors associated with drug use among their children.

Program Components

The parenting skill training consists of 53 hours of training in small groups of 6 to 10 families. There is an initial 5-hour family retreat, with parents and children attending, and 32 ninety-minute meetings twice a week. Children attend one or two sessions so parents can practice skills while their children are supervised. Trainers with master’s-level experience lead the meetings and follow a curriculum created for the program. The curriculum incorporates motivation, discussion, modeling, guided practice, independent practice, and generalization. Parents are trained on skills such as:

• Relapse prevention and coping
• Anger management
• Child development and communication skills
• Holding family meetings
• Setting clear expectations of children
• Use of appropriate rewards and disciplinary consequences

The complete home-based case management component lasts about 9 months. It begins 1 month before the start of the parent training sessions and continues while parents are participating in the training meetings and for 4 months afterward. Visits are about 90 minutes once a week, plus two phone calls each week. With case managers’ assistance, families set goals, monitor progress toward the goals, and reinforce skills learned in the parent training meetings. Case managers help families hold family meetings, increase opportunities for positive family involvement, and promote opportunities for positive activities for children outside of the family.

Study

Catalano and colleagues (1999) used a randomized experimental design to evaluate the effect of Families Facing the Future (known at the time as Focus on Families) on parental drug use and the prevention of drug use by their children. Participants were recruited while in two methadone clinics in Seattle, WA. To be eligible for the study, participants had to have been in treatment for at least 90 days, have at least one child between the ages of 3 and 14 who lived with them at least 50 percent of the time, and live within 25 miles of the methadone clinic. There were 130 families enrolled and randomized into treatment (n = 75) or control (n = 55) groups. There were 144 methadone-treated parents and 178 children (treatment n = 97, control n = 81) included in the 130 families. Families in the treatment group received methadone services plus the supplemental Families Facing the Future services, while families in the control received methadone services with no supplemental services. Standard methadone services included methadone dispensing and some individual and group counseling.

Participating parents were mostly white (77 percent), female (75 percent), between the ages of 29 and 41, and longtime opiate users (15 years or more). While 60 percent of the parents lived with their partner or spouse, only 20 percent were married. A little more than half (54 percent) of the parents reported any illicit drug use in the month before baseline. Parents had spent an average of 15 months in methadone treatment before enrollment. Sixty-eight percent of the parents had been incarcerated at some point in their lives, and 66 percent had been unemployed in the last 3 months before their participation. Participating children were ages 8 to 12. Families were blocked on race, parents’ age at first drug use, whether parents lived with a spouse or partner, and ages of children before randomization. There was no significant difference between treatment and control groups at baseline. A higher proportion of eligible families were recruited to the treatment group because of attrition concerns. The attrition rate for parents and children was highest at the 12-month follow-up, with the study losing 8 percent of parents and 13 percent of the children. Attrition did not differ significantly by groups.

Parents were assessed at baseline, posttest, 6 months, and 12 months. Children were assessed at baseline, 6 months, and 12 months. Developmentally appropriate interviews were used for the age groups 6–8, 9–10, and 11 and older based on age at time of interview. Data was presented for children in the 9–10 and in the 11 and older groups. Measures looked at family cohesion, problem behavior among parents and children, and risk and protective factors for drug abuse in children. For parents, problem-solving skills (such as relapse/refusal skills) were measured using the Problem Situation Inventory. Parent drug use was measured by self-reports, asking parents how many times they used drugs (marijuana, heroin, and cocaine) in the previous month. In addition, 25 percent of the participating parents were randomly selected to provide a urine sample to test the validity of the self-reports. There were few false negatives, and there was no significant difference between false negatives in the treatment and control groups. Parents were also asked about family factors, such as domestic conflict (i.e., how often they yelled at or threatened to hit a partner).

For children, problem behaviors were self-reported, asking children, for example, whether they drank alcohol (more than a sip) in the previous 6 months, whether they used marijuana in the previous month, and about the frequency of delinquent acts in the past 6 months (i.e., how frequently they cheated on a test or shoplifted). Children were also asked about peer factors (i.e., number of negative peers who get into serious trouble or use drugs) and attachment to school.

All outcomes were examined using analysis of covariance and logistic regression. Subgroup analyses were not conducted.

Study

Haggerty and colleagues (2008) conducted a follow-up of the Catalano and colleagues’ 1999 study and looked at the impacts 12 to 15 years after initial participation. Of the original sample, evaluators were able to locate 151 children. Since the sample was of families and included siblings, researchers randomly selected one child from each family to include in their analysis, leaving a total final sample of 126 children at follow-up (treatment n = 71, control n = 55).

At follow-up, children were mostly male (55 percent) and were ages 15 to 29, with an average age of 22. There were significantly more white children in the treatment group (67 percent) than in the control group (48 percent), despite parents’ being blocked on race during the original randomization. Mortality rates (added as a control variable) were significantly higher for parents of the intervention group (32 percent) than for the control (13 percent).

Substance abuse disorders as described by the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV) were measured using the Composite International Diagnostic Interview. Evaluators used a Cox proportional hazard model to assess the outcomes, and an intent-to-treat analysis was conducted. Subgroup analyses were conducted to examine the possible interactions that gender had on the impact of the intervention.

Facilitators follow a curriculum and an accompanying workbook which are available through the Social Development Research Group (SDRG) of the School of Social Work at the University of Washington. Information can be found on the Families Facing the Future website: http://www.sdrg.org/fffsummary.asp

Subgroup Analysis

With regard to subgroup findings, Haggerty and colleagues (2008) conducted analyses to determine the possible interactions that gender had on the effectiveness of the intervention. They found that the intervention statistically significantly reduced the likelihood of a diagnosed alcohol or marijuana abuse disorder in males. However, females in the intervention group demonstrated a higher likelihood of being diagnosed with a substance use disorder, though this difference was not statistically significant.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile: