Program Profile: Strengthening Families Program

The program is a multicomponent family skills training program that targets substance-abusing families. The program is rated Promising. There were overall mixed results across three studies. One study found no significant effects on measures of child problem behavior, risk/protective factors, and family factors. However, one study found significant impacts on children’s problem behavior, and another study found significant impacts on time to reunification for child welfare-involved families.

A Promising rating implies that implementing the program may result in the intended outcome(s).

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

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals

The Strengthening Families Program (SFP) is a multicomponent, family skills training program that was developed to prevent drug abuse in children whose parents are in treatment for abusing drugs. The goals of SFP are to improve children’s behavioral health outcomes (such as substance abuse, delinquency, and mental health) by increasing family strengths and resilience and reducing risk factors for problem behaviors in high-risk children. SFP builds on protective factors by improving family relationships, parenting skills, and the children’s social and life skills. SFP focuses on parenting skills and supervision/monitoring, behavior management techniques, child skills training, and family skills enhancements, including organization and positive communication to increase family cohesion and harmony. 

Target Population

SFP has been used as a universal, primary prevention intervention with families in schools and communities, as well as a selective prevention intervention with high-risk groups and as an indicated prevention intervention for families involved in the child welfare system. SFP targets parent behaviors, child behaviors, and overall family functioning among families dealing with issues of substance abuse, criminality, and depression and other behavioral health disorders.

Program Theory

SFP is based on cognitive–behavioral social learning theory and family systems theory, including Patterson’s (1976) behavioral-parenting model, Shure and Spivack’s (1979) social skills training program, and Forehand and McMahon’s (1981) family therapy curriculum.

Program Components

SFP is a parenting and family skills training program that consists of 14 weekly, 2-hour, skill-building sessions. Each session begins with a family-style meal, to which all family members are invited to attend. After the meal, parents and children attend separate skills training sessions, and then jointly participate in a family session practicing the skills they learn in class. Two booster sessions are available at 6 months to 1 year after the primary course. Sessions are divided up into three groups, as follows:

• The parenting skills sessions are designed to help parents learn to increase desired behaviors in children by increasing parent–child attachment through special playtime, and by using attention and rewards, clear communication, effective discipline, substance use education, problem solving, and limit setting. Two trained facilitators lead the parent group — ideally, these facilitators should include a man and a woman from the same cultural group to promote local and cultural adaptation, which is a required element of SFP.
• The children’s life skills sessions are designed to help children learn better behavioral and emotional control, effective communication, how to understand and control their feelings, improve social and problem-solving skills, resist peer pressure, understand the consequences of substance use, and comply with parental rules. Two trained facilitators also lead the children group.
• The family life skills sessions encourage families to engage in structured family activities, practice therapeutic child play, conduct family meetings, learn communication skills, practice effective discipline, reinforce positive behaviors in each other, and plan family activities together. This component includes ongoing family support groups and booster sessions that encourage use of skills learned in SFP. The family support group allows the parents and children to practice what they learn in their individual sessions through experiential exercises. All four trained facilitators lead the family group.

Study

Brook, McDonald, and Yan (2012) evaluated SFP as part of a child welfare service intervention. The purpose of this study was to evaluate the impact of the provision of SFP on family reunification among substance-involved families in a Midwestern state area. The study included families who had a child in an out-of-home placement, who had a case plan goal of family reunification, and for whom substance abuse was determined by the caseworker to be a contributing factor in the child welfare case. Staff in six private foster-care provider agencies received six trainings as SFP leaders and were trained in two age-specific versions of the SFP program curriculum (target child ages 3–5 and 6–11).

Data for the analyses came from the information provided by the SFP site providers for federal reporting purposes. Data included 214 SFP participants and 423 matched nonparticipants who were tracked from February 2008 through September 2010. The comparison group was selected from a pool based on the following criteria: 1) children who were discharged due to emancipation were excluded; 2) as the formal starting date for the demonstration project was October 1, 2007, all children who were reunified prior to September 31, 2007 were excluded; and 3) consistent with SFP participant children, only children who were removed later than January 1, 2002, were younger than 15 at removal, and younger than 17 on April 22, 2010, were included for matching. There were no significant differences between the SFP treatment group and the comparison groups on covariates such as time in placement, child’s birthday, child’s gender, and race/ethnicity. Survival analysis was used to study the time to a particular event (in this study, it was time to reunification). Time was measured in two ways: 1) time from removal to reunification for cases that were reunified, and 2) time from entry into SFP to reunification for cases that were reunified. Time was measured as the time period in which the case was observed (that is, time from removal until the last day of observation on October 30, 2010).

Study

Maguin and colleagues (2007) recruited 674 families in the United States and Canada to participate in an ongoing binational study of SFP. Families with at least one child between the ages of 9–12, and a parent who had had alcohol problems within the past five years, were eligible to participate. The majority of families were recruited through advertisements in local newspapers; through posters hung in local treatment agencies, social service agencies, or other family settings; and through presentations by project staff to therapists and social service personnel.

Parents were screened to verify that they had responsibility for a child between the ages of 9 and 12, and that the child’s parent or caretaker had had a diagnosable alcohol problem within the past five years as evidenced by a report of 1) treatment at an alcohol treatment agency, 2) sustained involvement in Alcoholics Anonymous, or 3) positive responses to at least two of five problem criteria from the Research Diagnostic Criteria established by the study authors. In cases where the parent with alcohol problems had left the family and could not be contacted, the report of the remaining parent was sufficient to qualify the family, provided that the potentially qualifying parent had demonstrated a significant level of alcohol problems and treatment involvement. If a family had more than one child in the 9–12 age range, one child was randomly selected as the target.

There were a total of 334 study participants from Canada, and 340 participants from the United States. In the U.S. study sample, the average age of the child was 11 years old. The sample was predominately Black (63.0 percent), followed by white (33.7 percent), Aboriginal (5.0 percent), Hispanic (4.1 percent), and Asian (0.3 percent). The Canadian study sample was different in terms of demographics. The average age of the children was 10.8 years. The vast majority of the sample was white (88.8 percent), followed by Aboriginal (10.9 percent), Black (5.2 percent), Hispanic (2.4 percent), and Asian (1.5 percent). The families were grouped into cohorts of those who had agreed to attend a program at a certain location and beginning on a certain date. The cohort ranged from 7 to 29 families per group, with an average size of 15. The families were interviewed separately, face-to-face, prior to the scheduled start of the SFP program. Following the pretest assessment, families were randomly assigned to SFP or to the comparison group. Families completed a second assessment following the completion of the SFP program. Although there were differences between the two subgroups in the study (Canadian versus U.S. participants), there were no significant differences between the SFP treatment group and comparison group.

The primary outcomes of interest were the behavior problems of the children, as measured by 31 items from the Ontario Child Heath Study. Parents responded to the items on a 3-point scale (never/not true, somewhat/sometimes true, or very true/often true). Thirteen of the items corresponded to symptom criteria for conduct disorder, and nine corresponded to symptom criteria for oppositional defiant disorder. The remaining items corresponded to other types of externalizing behavior problems, such as getting into fights or hanging around kids who get into trouble. An intent-to-treat design was used to analyze the data.

Study

Gottfredson and colleagues (2006) examined intervention fidelity and effectiveness of the Strengthening Families Program (SFP) using a four-group experimental design with a sample of 715 predominately African American families in an urban setting. Families were recruited at schools and local events by five organizations in the Washington, D.C., area. One site was a prerelease center for incarcerated parents; the other agencies recruited from schools and the community. Some 1,400 families from high-risk neighborhoods were approached, and 715 (51 percent) were enrolled. Eligible families had a child between the ages of 7 and 11 years and were able to read, speak, and understand English. Participating parents were predominately African American (75 percent) and female (94 percent), and more than half (52 percent) reported a combined family annual income of less than $20,000.

Eligible families were randomly assigned to one of four conditions: child skills training (CT) only (n = 176), parent skills training (PT) only (n = 177), parent and child skills training plus family skills training (FT; n = 188), and minimal treatment (MT) control group (n = 174). The FT treatment group received the fourteen 3-hour sessions of the SFP that included a) 1 hour of pre-class activities, b) 1 hour of parent skills training and a simultaneous child skills training class, and c) 1 hour of family skills training conducted in two multifamily groups, each led by two group leaders. The other two intervention groups received either the parent training or the child training component of the SFP, but not all three components. Pretests and posttests were administered to small groups of parents and children before interventions began, and then approximately 1 week after the intervention ended.

Three different outcome surveys were derived from previous tests constructed from standardized scales: a 56-item survey for younger children (ages 7 and 8), a 138-item survey for older children (ages 9 through 11), and a 195-item survey for parents. The content of the surveys, which included both parent and child reports, consisted of child problem behaviors, child risk and protective factors, and family factors.

The parent- and child-reported outcomes were analyzed with analysis of covariance that included a dummy variable to account for the various sites and pretest scores as covariates in each analysis.

Training fees are $3,700 for 2-day Strengthening Families Program (SFP) group leader training for 16 or fewer trainees, or $4,400 for training 36 or fewer trainees. More information on costs and training is available at the SFP website: http://www.strengtheningfamiliesprogram.org/training.html The master sets of SFP course materials are on CDs. The set includes a Parents Group Leaders Manual, Children’s Group Leader Manual, Family Group Leader Manual, Parents and Children’s Handouts, SFP Implementation Manual, and copying directions. The 6-book master set is $450. The program developers have also created the SFP 7-17 DVD for home, clinic, or school use. The DVD costs only $5 and includes the full SFP in digital video format with handouts and home practice assignments that are downloadable from the DVD. The SFP 7-17 group class version includes video clips; lessons for parents, teens, and children; and a family practice session, which are also available for $450. For additional information on costs and ordering, please see the SFP Web site: http://www.strengtheningfamiliesprogram.org/ordering.html.

Since its initial development in 1983, the Strengthening Families Program (SFP) has been adapted for various age groups (i.e., 3- to 5-year-olds, 6- to 11-year-olds, and 12- to 17-year-olds) in high-risk families of diverse backgrounds and from various community settings. SFP has been culturally adapted for different ethnic or socioeconomic groups (rural and urban, African Americans, Hispanics, Asian Americans, and Pacific Islanders), for developing countries (including the Balkans, Central Asia, Central America and Brazil), and for other national groups (French and English Canadians, and Australians). For more information, please see the program’s website: http://www.strengtheningfamiliesprogram.org/

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

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

Aktan, Georgia B., Karol L. Kumpfer, and Christopher W. Turner. 1996. “Effectiveness of a Family Skills Training Program for Substance Use Prevention With Inner City African American Families.” Substance Use and Misuse 31(2):157–75.

Fox, Danielle Polizzi, Denise C. Gottfredson, Karol L. Kumpfer, and Penny D. Beatty. 2004. “Challenges in Disseminating Model Programs: A Qualitative Analysis of the Strengthening WDC Families Project.” Clinical Child and Family Psychology Review 7(3):165–76.

Forehand, Rex, and Robert J. McMahon. 1981. Helping the Noncompliant Child: A Clinician's Guide to Parent Training. New York: Guilford Press.

Kumpfer, Karol L. 1998. “Selective Prevention Interventions: The Strengthening Families Program.” In Rebecca S. Ashery, Elizabeth B. Robertson, and Karol L. Kumpfer (eds.). Drug Abuse Prevention Through Family Intervention. NIDA Research Monograph Series No. 177: U.S. Department of Health and Human Services Pub. No. 99–4135.

Kumpfer, Karol L., and Rose Alvarado. 2003. “Family Strengthening Approaches for the Prevention of Youth Problem Behaviors.” American Psychologist 58(6/7):457–65.

Kumpfer, Karol L., Rose Alvarado, Paula Smith, and Nikki Bellamy. 2002. “Cultural Sensitivity in Universal Family-Based Prevention Interventions.” Prevention Science 3(3):241–44.

Kumpfer, Karol L., Rose Alvarado, Connie Tait, and Charles W. Turner. 2002. “Effectiveness of School-Based Family and Children’s Skills Training for Substance Abuse Prevention Among 6- to 8-Year-Old Rural Children.” Psychology of Addictive Behaviors 16(4):65–71.

Kumpfer, Karol L., Rose Alvarado, Henry O. Whiteside, and Connie Tait. 2005. “The Strengthening Families Program (SFP): An Evidence-Based, Multicultural Family Skills Training Program.” In José Szapocznik, Patrick H. Tolan, and Soledad Sambrano (eds.). Preventing Substance Abuse. Washington, D.C.: American Psychological Association Books, 3–14.

Patterson, Gerald R. 1976. Living with Children: New Methods for Parents and Teachers. Champaign, IL: Research Press.

Shure, Myrna B., and George Spivack.1979. “Interpersonal Cognitive Problem Solving and Primary Prevention: Programming for Preschool and Kindergarten Children.” Journal of Clinical Child Psychology 8(2):9–94.