# Presentation: 732297

## Family-Focused Prevention of Substance AbuseKarol L. Kumpfer, Ph.D.  Director, CSAP

***Family-Focused Prevention of Substance Abuse******Karol L. Kumpfer, Ph.D.  ******Director, CSAP***

## Introduction

***Introduction***

- Strengthening the ability of families to raise successful, non-violent and non drug-using children is a critical social goal.
- Failure to deal with this issue will result in a lower quality of life and make the United States less competitive in the 21st Century.

## Critical Role of Families

***Critical Role of Families***

- The family is the social unit primarily responsible for child  rearing functions.
- When families fail to fulfill this responsibility, the entire society suffers.
- Families are responsible for providing:
- physical necessities,
- emotional support,
- learning opportunities,
- moral guidance, and
- building self-esteem and resilience.

## Pathways to Substance Abuse in High Risk Youth

- .76

- (n=8,576)

**Academic **
**Self-Efficacy**

- .24

- .70

- .19

**Self-Control**

**Family **
**Supervision**

**Family **
**and Peer **
**Norms**

**No**
**Substance **
**Use**

- .59

- .40

- -.88

**Family **
**Bonding**

- .14

**Social and **
**Community **
**Prevention **
**Environment**

***Pathways to Substance Abuse ******in High Risk Youth***

## Pathways to Substance Abuse in High Risk Youth

**Substance **
**Use**

**Family **
**Supervision**

**Family **
**and Peer **
**Norms**

**Family **
**Bonding**

***Pathways to Substance Abuse in High Risk Youth***

## Project Family Studies of Competency BuildingControlled Outcome Study IIAlcohol Initiation Index Trajectories forISFP Intervention vs. Control a,b

***Project Family Studies of ******Competency Building****Controlled Outcome Study II**Alcohol Initiation Index Trajectories for**ISFP Intervention vs. Control **a,b*

## CSAP Family PEPS (1998)

***CSAP Family PEPS (1998)***

- 	Effective Family Intervention Strategies
- 	1.	Parent Training
- 	2.	Family Skills Training
- 	3.	Family In-Home Support
- 	4.	Family Therapy

## Strengthening America’s Families Exemplary Family Programs

***Strengthening America’s Families Exemplary Family Programs***

- Parent Training
- Helping the Noncompliant Child (3-7 Years; Parent Training)
*	**Robert McMahon, Ph.D., Seattle, WA*
- Parents and Children’s Series (3-8 Years; Comprehensive)
*	**Carolyn Webster-Stratton, Ph.D., Seattle, WA*
- Raising a Thinking Child:  I Can Problem Solve Program for Families (4-7; Parent Training)
*	**Myrna Shure, Ph.D., Philadelphia, PA*
- Treatment Foster Care (12-18 Years; Parent Training)
*	**Patricia Chamberlain, Ph.D., Eugene, OR*

## Exemplary Family Programs

***Exemplary Family Programs***

- Family Skills Training
- Strengthening Families Program (6-10 Years: Family Skills Training)
- 	*Karol Kumpfer, Ph.D., SLC, UT*
- Iowa Strengthening Families Program with Pre-& Early Teens (10-14; Family Skills)
- 	*Richard Spoth, Ph.D., Ames, IA*
- Preparing for the Drug Free Years (8-14 Years; Parent & Child Training)
- 	*David Hawkins, Ph.D., Seattle, WA*

## Exemplary Family Programs

***Exemplary Family Programs***

- Family In-Home Support
- Prenatal & Early Childhood Nurse Home Visitation (0-5; Family In-Home Support)
- 	*David Olds, Ph.D., Denver, CO*
- Family Therapy
- Structural Family Therapy  (0-18 Years; Family Therapy)
- 	*Jose Szapocznik, Ph.D., Miami, FL*
- Functional Family Therapy (6-18 years; Family Therapy)
- 	*James T. Alexander, Ph.D., SLC, UT*
- Multisystemic Therapy Program (10-18 Years; Comprehensive)
- 	*Scott W. Henggeler, Ph.D., Charleston, SC*

## Principles of EffectiveFamily-Focused Programs

***Principles of Effective******Family-Focused Programs***

- 1.	There Is No One Best Family-Focused Program
- Select Programs Based On:
- Ages of Child
- Cultural Appropriateness
- General Level of Family Needs (Universal Low Risk Families)
- Specific Family Needs.  Different Types of Family Interventions Are Used to Modify Different Risk and Protective Factors.

## Principles of EffectiveFamily-Focused Programs

***Principles of Effective******Family-Focused Programs***

- 1.	There Is No One Best Family-Focused Program (continued)
- Behavioral Parent Training Programs, If Sufficient Dosage (45 Hours for High-risk Families) Are Generally Effective in Reducing Children’s Conduct Disorder (Kumpfer, 1996).
- Family Therapy and Family Skills Training Programs are Generally Most Effective in Improving Family Communications, Family Control Imbalances, and Family.

## Principles of EffectiveFamily-Focused Programs

***Principles of Effective******Family-Focused Programs***

- 2.	Effective Interventions Must be Developmentally Tailored
- Early Childhood (Birth to 3 Years)
- In-home Parent Support Cognitive/Language Development Exercises (Yoshikawa, 1995).
- Nurse Home Visitor (Olds & Pettit, 1996).
- Childhood (3-12 Years)
- Behavioral Parent Training, Family Skills Training, Behavioral Family Therapy (CSAP, 1998).
- Early and Late Adolescence
- Family Therapy, Family Skills Training (Kumpfer & Alvarado, 1996)

## Principles of EffectiveFamily-Focused Programs

***Principles of Effective******Family-Focused Programs***

- 3.	Family Programs are Most Enduring In Effectiveness If They Produce Changes In the Ongoing Family Dynamics and Environment
- Family Meetings Increase Longevity (Catalano, 1996; Kumpfer, 1996).
- Improving Parenting Skills More Effective than Short-term Interventions (McMahon, 1996).
- Sufficient Dosage Needed (at least 45 hours with high-risk families) (Patterson, 1989).
- In-home Family Support or Parent Support Programs Improve Social Support (Yoshikawa, 1995).

## Principles of EffectiveFamily-Focused Programs

***Principles of Effective******Family-Focused Programs***

- 3.	Enduring (continued)
- In-home or Office-based Case Management Family Services Are Effective in Increasing the Family’s Access to Needed Services.
- Parent Education Programs Improve Parent’s Knowledge, But Do Not Necessarily Change Behavior.
- Children’s Social Skills Training Improves Children’s Prosocial Skills (Kumpfer, Williams, & Baxley, NIDA, 1997).

## Principles of EffectiveFamily-Focused Programs

***Principles of Effective******Family-Focused Programs***

- 4.	Components of Effective Parent and Family Programs Include Addressing Family Relations, Communication, and Parental Monitoring
- Final Pathway to Drug Use is Peer Influence, But Family Precursors Are Strongest Protective Factor (Ary, Duncan, Duncan, & Hops, in press; Brooks, et al., 1995)
- Start First with the Parent/Child Relationship and Then Communications and Parent Monitoring and Discipline (Kumpfer, NIDA, in press)
- Behavioral Parent Training Programs Include Practice and Role Plays of Parenting Skills and Homework Assignments.

## Principles of EffectiveFamily-Focused Programs

***Principles of Effective******Family-Focused Programs***

- 5.	High Rates of Recruitment and Retention Are Possible With Families
- An 80% to 85% Retention Rate is Possible If:
- 1.	Incentives
- 2.	A Nonthreatening Environment
- 3.	Sensitive, Trained and Caring Professional Staff (Kumpfer, 1992).
- Recruitment Rates Vary By:
- 1.	Type of Program
- 2.	Incentives
- 3.	Types of Clients Targeted
- 4.	Time of Day Offered (Spoth and Redmond, 1995).

## Principles of EffectiveFamily-Focused Programs

***Principles of Effective******Family-Focused Programs***

- 5.	High Rates of Recruitment and Retention Are Possible With Families (continued)
- Length of the Program is Not Generally an Issue After 3-4 Sessions.
- An Ongoing Parent Support Group and Booster Sessions Can Help Address This Need For Continuation.

## Principles of Effective Family-Focused Programs

***Principles of Effective Family-Focused Programs***

- 6.	Videos of Families Demonstrating Good and Bad Parenting Skills Helps with Program Effectiveness and Client Satisfaction
- Clients Like Racially Matched Videos Including Local Issues.
- Having the Children Watch the Parenting Videos or the Parents Watch the Children’s Videos, Improves Generalization.
- Computer Interactive Videos, Including Self Pacing, Self-testing, and Selection of Major Content Areas Based on Needs, May Be Even More Effective (Gordon, 1996).

## Principles of EffectiveFamily-Focused Programs

***Principles of Effective******Family-Focused Programs***

- 7.	Professional Staff With Parenting Experience Are Best
- Parent Trainers With Backgrounds in the Type of Program Being Implemented Are Best.
- Staff Who Share the Same General Philosophy and Background are Most Effective.
- Personal, Caring, Empathetic and Experienced Staff Are Rated the Highest, Retain Families Better, and Produce Better Results.

## Principles of Effective Family-Focused Interventions

***Principles of Effective Family-Focused Interventions***

- 1.	Comprehensive Interventions are More Effective in Modifying a Broader Range of Risk or Protective Factors and Processes in Children.
- 2.	Family-Focused Programs are More Effective than Child-Focused or Parent-Focused Only.
- 3.	Sufficient Dosage or Intensity is Critical for Effectiveness.
- 4.	Family Programs Should be Long-Term and Enduring.
- 5.	Tailoring the Parent or Family Intervention to the Cultural Traditions of the Families involved Improves Recruitment, Retention, and Outcome Effectiveness.

## Principles of Effective Family-Focused Interventions

***Principles of Effective Family-Focused Interventions***

- 6.	Addressing Developmentally Appropriate Risk and Protective Factors or Processes at Specific Times of Family Need when Participants are Receptive to Change is Important.
- 7.	Family Programs are Most Enduring in Effectiveness if They Produce Changes in the Ongoing Family Dynamics and Environment.
- 8.	If Parents are Very Dysfunctional, Interventions Beginning Early in the Lifecycle (i.e., Prenatal or Early Childhood) are More Effective.

## Principles of Effective Family-Focused  Interventions

***Principles of Effective Family-Focused  Interventions***

- 9.	Components of Effective Parent and Family Programs include Addressing Strategies for Improving Family Relations, Communication, and Parental Monitoring.
- 10. High Rates of Recruitment and Retention are Possible with   Families.
- 11.Videos of Families Demonstrating Good and Bad Parenting Skills Helps with Program Effectiveness and Client Satisfaction.
- 12.The Effectiveness of the Program is Highly Tied to the Trainer’s Personal Efficacy and Characteristics.