# Presentation: 103858

## Issues of Adaptation & Fidelity in Strengthening Families Program

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- Karol L. Kumpfer, Ph.D.
- Associate Professor, University of Utah
- .

## Background: Strengthening Families Program (SFP)

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- Background: Strengthening Families Program (SFP)

- History
- 1st research-based prevention program  designed for high-risk children of substance abusers and found effective on NIDA grant
- Many cultural adaptations developed on CSAP grants with positive effects
- Junior high SFP version found effective on NIDA and NIMH grants with long-term follow-up studies
- Two recent randomized trials show SFP effective for general families recruited from schools and communities.

## SFP Family Skills Training Model

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**1 Hour Simultaneously**
**+**
**1 Hour**

- Family Style Meal

- Child
- Group

- Parent
- Group

- 2 Family Groups

- Childcare

- Transportation

- Improve Family Relations
- Increase Parenting Skills
- Increase Children’s Skills

- Major Objectives

## SFP Outcomes

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- Reduced family conflict
- Increased family organization and cohesion
- Decreased children’s depression and conduct problems
- Increased school success/grades
- Reduced parent & child AOD use

## Successful Program Implementation

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- Effective and well-trained leaders & staff
- Sufficient resources
- incentives
- child care
- transportation
- food
- Interactive/experiential techniques
- Booster or reunion sessions

## Essential Core Components

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- All Skills Courses: Parent, Child, Family Skills Training (determined by dismantling design)
- All 14 Sessions in right order (determined by CSAP adaptation studies: when order was changed results were worse compared to original SFP order)
- Supporting Components:
- Meal
- Child Care
- Transportation
- Incentives
- (determined over twenty years field experience)

## Planning Process for Implementation

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- Select best version of SFP based on age, needs assessment, and culture.
- Purchase CD-ROM including:
-  Parent, Child, and Family Skills Training Manuals
-  Parent and Children’s Handbooks
-  Implementation Manual (literature review and
-     process issues addressed)
-  Evaluation Instruments (including fidelity tools)

## Fidelity Tools

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- Fidelity Issues Addressed in Training of Group
-      Leaders
- Sample Fidelity Tools Supplied
-  Group Leader Session Evaluation Form
-  Session Fidelity Checklists  for Observers
-  Attendance and Engagement Forms
-  Outcome Pre-Post Test Measures
-  Client Satisfaction with Leaders rated

## SFP Replications & Cultural Modifications

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- SFP Replications & Cultural Modifications

- African-American Rural Families: Alabama Strengthening African-American Families Program
- African-American Urban Families: Detroit Safehaven
- Multi-Cultural: Hispanic, Asian, Pacific Islanders, Whites
- 5 Year Follow-up: 3 Counties in Utah (1995)
- Asian & Pacific Islander Families: Hawaii SFP
- Hispanic/Latino Families: Denver Strengthening Hispanic Families Program
- Rural Families: Iowa SFP - 7 Session 11-14 Year Olds
- French & English Canadian Families: Montreal & Toronto
- Australian Families: Queensland, Australia
- Shoshone-Bannock Indian Tribe: Idaho

## Results of SFP Cultural Adaptations(Kumpfer, Alvarado, Smith, & Bellamy, Prevention Science, 2002 

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- Results of SFP Cultural Adaptations(Kumpfer, Alvarado, Smith, & Bellamy, Prevention Science, 2002

- Varied in depth – cultural gloss to in-depth
- Evaluated results of adaptations compared to original SFP implemented in first two years in five studies found:
- Recruitment and retention were significantly improved by about 40% for cultural adaptations
- Outcomes basically identical, but slightly worse if adaptation involved reducing number of sessions or changing order
- Cultural adaptations also accomplished by hiring culturally-competent group leaders
- Culturally-adapted and age adapted SFP versions
-    available
- Spanish language SFP currently being tested

## Common Questions about Adaptation

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- “Can we compress the course length?”
-  Yes, can be taught twice a week instead of once.
- “Can we cut the number of sessions?”
- No, not without reducing the program’s effectiveness.
- “Can we skip the meal if our budget is tight?”
- No, the meal is working time for group leaders; families sit together as families and group leaders can coach and become acquainted.
- “Do we have to have two group leaders for parents
-     and two for the children?”
- It’s highly desirable, but if your groups are small, participants are motivated, leaders experienced, parents’ group can have one leader; children’s group needs two group leaders.

## Principles of Effective SFP Adaptations

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- Hire Culturally, Age, Gender-competent Staff
- Understanding and empathetic
- Share similar life experiences
- Professionally well trained
- Communication skills
- Warmth, genuineness, and empathy
- Openness and willingness to share
- Sensitivity to family and group processes

*“**The best family and parenting programs are only as effective as the quality of the staff delivering the program.”*

## Principles of Effective Adaptation

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- Develop an Adaptation Team
- Include the program developer, cultural consultants, local parents and children, and the group leaders and supervisors
- Review the existing curriculum manuals, recruitment methods, and the mode of delivery
- Make recommendations for changes
**“****All recommended changes should be approved by the original program developer, otherwise core critical elements of the original program may be omitted.”  **

## Principles of Effective Adaptation 

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- Principles of Effective Adaptation

- Base Adaptations on Sub-group Needs Assessments
- Determine the most salient risk and protective factors in the proposed cultural sub-group
- Needs assessment data
- Etiological baseline data

## Principles of Effective Adaptations

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- Pilot Test First-Cut Adaptations
- Changes in the language
- The names and places mentioned in stories
- Exercises to locally common places and names
- Omit Culturally or Locally Inappropriate Practices
- Promote Ethnic Identify and Cultural Pride
*“**Youth who identify with their ethnic group and practice  traditional protective rituals and traditions are less likely to use illegal drugs.”*

## Principles of Effective Adaptations

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- Promote Ethnic Pride
*“**Youth who identify with their ethnic group and practice traditional protective rituals and traditions are less likely to use illegal drugs.”*
- Include sessions on cultural pride or history
- Cultural dances, art, and theater
- Employ attractive role models to increase cultural pride
- Add stories and history of the cultural sub-group
- Parents can teach children cultural arts, such as art, beading, dancing, music, songs, flute-making, and costume or dress

## Principles of Effective Adaptations

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- Modify Teaching Methods to be More Experiential
- Storytelling
- Experiential practice
- Visual graphic material

## Principles of Effective Adaptations

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- Add Local and Cultural Values and Storytelling
- Pass on culture
- Character traits needed for youth to succeed in life
- Incorporate Traditional Ceremonies and Rites of Passage
- Blessing or prayer by spiritual leader
- A talking circle
- Traditional songs, music or dances
- Traditional food to share

## Principles of Effective Adaptations

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- Develop Matched Graphics
- Add visual graphics that include pictures of similar families
- Pilot Test and Modify Evaluation Instruments/Methods
- Review by adaptation team
- Pilot test with group family
- Focus group
- Administer a retrospective pre-test