Jay's World of Abstracts

Jay's World of Abstracts 00001

Jay's Introduction

One of my jobs is to try to find programs and ideas that actually work in increasing the healthy lifestyles of our communities. As we try and find money from the public or private sources, they really want to see us doing things that have been proven effective. What I present here is an abstract of research on prevention and intervention programs that may be adapted for use in our area.

Most people have a focus on "child-focused approaches" to prevention or intervention. A common method of doing this is to create programs that work out of schools or community centers to get directly with the kids themselves as individuals. There are other models for prevention and intervention; one of which is the "family approach."

The family approach tries to prevent destructive behavior by improving family conditions instead of focusing exclusively on the child. Programs that work with families see children as a members of a family group rather than just as autonomous individuals. In fact, many of these programs work primarily with the parents of at-risk children instead of the children themselves. Some of these programs are based in the client family's own home: their "natural" setting. For those unfamiliar with this model, it may seem very unconventional and unlikely to help children. Research has shown that the family approach often produces better and more lasting positive outcomes for children and teens than "child-focused" approaches.

The following abstracts comes from a "What Works" paper that was commissioned by the Department of Justice. Though its focus is programs that aim to prevent delinquency, it can also be applied to programs that hope to prevent substance abuse, teen pregnancy, and other behaviors.

Abstracts

In both the delinquency and substance abuse prevention or intervention fields, most programs are aimed at working with problem youth, rather than the whole family. Historically, earlier approaches to rehabilitation and therapy assumed that it was the youth who had the problem, not the family. Additionally, working with children and youth is also much easier than working with parents and other family members. Children and adolescents are generally more accessible through schools or community groups for participation in delinquency prevention activities than are entire families. Garnering a commitment from parents who may face numerous obstacles to participation, can be a challenge but well worth the investment in terms of not only individual parent/child changes but also the overall impact on the family. Although efforts focusing on youth should be continued, mounting evidence demonstrates that strengthening the family has a more enduring impact on the child.

In a review of both family and child-focused approaches to the reduction of conduct disorders, McMahon (1987) concludes that children’s "skills training" approaches have failed to demonstrate a favorable outcome or evidence of generalization in more naturalistic settings (p. 149)". Conversely, McMahon (1987) concludes that family-focused approaches have demonstrated outcomes that are both positive and enduring.
{Jay's translation: Programs that try to teach children "skills" don't seem to work. Though the skills are learned at places like school, children don't tend to display these skills at home or on the streets (their "more naturalistic settings"). These "skills" may include anger management, assertiveness training, keeping your room clean, vacuuming, or other "life-skills."}

Two family characteristics were found to impact ... delinquency, namely poor family attachment and poor parenting behavior. Higher levels of delinquency and drug use were associated with both of these family risk factors.

While many tested theories of problem behaviors (Oetting, 1992; Oetting & Beauvais, 1987; Newcomb, 1992; 1995) find peer cluster influence as the major reason to initiate drug use or delinquent behaviors, parental disapproval has also been shown to be a major reason NOT TO ENGAGE IN DELINQUENT ACTS OR TO USE DRUGS (Coombs, Paulson, & Richardson, 1991).

The home is the most fertile breeding ground for violent behavior. Children, who see a parent or other family members abused, or abusing another, are more likely to view violence as a way to solve problems. Children who are exposed to domestic violence are more likely to abuse others, as they grow older (American Psychological Association, 1996).

Several empirically tested models of delinquency and substance abuse have found that parent/child relationships or processes such as support and supervision are the precursors of peer influences--the final pathway to delinquency (Duncan, Ary, Hops, & Bigland, in press; Kumpfer & Turner, 1990/1991). In other words, youth who like and respect their traditional parents are less likely to become involved with antisocial peers and delinquency.

Lack of supervision and monitoring appears to be particularly salient as a cause of violent offenses. Violent crimes peak just after the close of school at about 3:00 pm (Snyder & Sickmund, 1995) suggesting lack of parental supervision and latch key status. The Carnegie Council on Adolescent Development (1994) study found that about 40 percent of adolescent's non-sleeping time is spent alone, with peers without adult supervision, or with adults who might negatively influence their behavior.

It is argued that poverty, structural disadvantage, and economic loss diminish parental capacity for consistent and involved parenting, exacerbates conflict, undermines the quality of the family’s interactions, and reduces parents capacity to exert informal social control.
{Jay's translation: "structural disadvatage" refers to the family structure. One structural disadvantage can be single parenting as opposed to couple parenting.}

Three aspects of household structure should be considered in developing family-based programs to prevent delinquency according to Snyder, Sickmund, & Poe-Yamagata (1996):

1. HOUSEHOLD ENVIRONMENT
   • With whom does the child live?
   • How well do the family and household members get along?
   • How often do individuals in the household change?
2. CARE PROVIDERS
   • Who takes care of the child by providing nurturance, supervision, and intellectual stimulation?
   • Does the care provider live in the household?
   • Is the primary care provider a relative or someone outside the extended family?
3. OTHER KEY FIGURES
   • Who else beyond household members and child care providers is important to the child?
   • Does the child have access to other members of the extended family such as grandparents, cousins, aunts, or uncles?
   • Does a nonresident father influence the child --perhaps serving as a role model?

The objective of family-focused prevention programs should be to not only decrease risk factors, but to also increase ongoing family protective mechanisms. According to Bry and associates (in press), the five major types of protective family factors include: 1) supportive parent-child relationships (Brook, 1993; Dishion, et al., 1988; Werner & Smith, 1992), 2) positive discipline methods (Catalano, et al., 1993; Dishion et al., 1988; Kellam, et al., 1983); 3) monitoring and supervision (Ary, Duncan, Duncan, & Hops, submitted; Chilcoat et al., 1995; Loeber & Stouthhamer-Loeber, 1986); 4) family advocacy for their children (Brunswick, et al., 1992; Kandel & Davis, 1992; Krohn & Thornberry, 1993); and 5) seeking information and support for the benefit of their children (Nye, Zucker, & Fitzgerald, 1995). The longitudinal study of urban delinquency (Huizinga, Loeber, & Thornberry, 1995) supported that parental supervision, attachment to parents, and consistency of discipline were the most important family protective factors in promoting resilience to delinquency in high-risk youth.

The characteristics of strong resilient African-American families have been found to be:

1. a strong economic base,
2. achievement orientation,
3. role adaptability,
4. spirituality,
5. extended family bonds,
6. racial pride,
7. respect and love,
8. resourcefulness,
9. community involvement,
and
10. family unity

{Jay's summary: The definition of the family is a very touchy topic. Some research supports the "natural" family (father and mother as a married couple and their biological/adopted children) as a protective measure over other forms while other research does not. Single parenting also has similarly mixed results. Research does point to the importance of fathers in the home in the development of both boys and girls. Many therapists advocate for solving family problems within marriage before resorting to divorce. Research also shows that a poor or abusive ongoing marriage can cause more problems for children than divorce.}

From as early as the turn of the century experts in juvenile delinquency (Morrison, 1915) have recognized the family's early and primary role in influencing delinquency. A number of literature reviews or meta-analyses of research studies (Geismar & Wood, 1986; Henggeler, 1989; Loeber & Dishion, 1983; Loeber & Stouthamer-Loeber, 1986; Snyder & Patterson, 1987) all support the conclusion that family functioning variables have an early and sustained impact on family bonding, conduct disorders, school bonding and adaptation, choice of peers, and later delinquency in youth. Although research suggests that peer influence is the final pathway for most youth to delinquency and drug use, the major predictor of whether youth associate with delinquent or drug using peers is their family relationship (Kumpfer & Turner, 1990/1991; Oetting, 1992; Oetting & Beauvais, 1987; Newcomb, 1992). In fact parental support has been found to be one of the most powerful predictors of reduced substance use in minority youth (King, Beals, Manson, & Trimble, 1992). Also, Dishion (Dishion, French, & Patterson (1995) and Hansen and associates (1987) have found that increased parental supervision is a major mediator of peer influence.
{Jay: emphasis added.}

This etiological research suggests parenting and family interventions improving family conflict, family involvement, and parental monitoring should reduce problem behaviors including substance abuse (Mayer, 1995). Parenting skills training programs are effective in reducing coercive family dynamics (Webster-Stratton, Kolpacoff & Hollingsworth, 1988) and improving parental monitoring (Dishion & Andews, 1995). Other researchers like Bry, Schutte, and Fishman (1991) believe improving parenting practices is the most effective strategy for reducing later adolescent behavior problems. Strengthening families could significantly reduce delinquency, youth violence, and drug abuse.
{Jay's translation: "coersive family dynamics" refers to using family influence for selfish or destructive purposes. An example might be a father sexually abusing his daughter in the name of "loving his kids."}

Recent research suggest that the most critical family factors that help youth to avoid associations with delinquent peers is parental supervision and monitoring that is closely linked with parental care and support (Ary, Duncan, Duncan, & Hops, submitted). Family dysfunction and poor parental supervision and socialization are major influences on children's subsequent delinquency. In fact, community environmental factors, such as poor schools and neighborhoods as correlates of poverty, have not been supported as powerful predictors of delinquency as family risk and protective factors ...

Although prevalent mythology assures parents that they are not responsible for their adolescents actions because, peers are the primary influences, research suggests that family influences remain roughly comparable to peer influences for quite some time (Loeber, 1990). In fact, in the areas of substance abuse, which typically develop several years later than delinquency, research by Coombs, Paulson, and Richardson (1991) suggest the primary reason for youth to use drugs is peer influence; however, the primary reason not to use drugs is parental disapproval. Hence, it is possible that research with prosocial youth would show that parental influence is still the primary influence during adolescence. This does not mean that these prosocial youth don't make their own decisions, simply that if they had to choose between parental or peer wishes, they would more likely follow the recommendations of their parents.

Family-focused interventions appear to be more effective than either child-focused or parent-focused approaches. Child-only approaches, not combined with parenting or family approaches, can have negative effect on family functioning (Szapocznik & Kurtines, 1989, Szapocznik, 1997). If high-risk youth are aggregated, deteriorated youth behaviors can occur (Dishion & Andrews, 1995). Reviews of early childhood programs (Dadds et al., 1992; Mitchell, Weiss, & Schultz, 1995; Yoshikawa, 1994), elementary school-aged children's programs (Kazdin, 1993; Kumpfer & Alvarado, 1995; Patterson, Dishion, & Chamberlin, 1993), and adolescent programs (CSAP/PEPS, in press; Szapocznik, 1997) support the effectiveness of family-based interventions. In fact, a number of adolescent family programs have found significant reductions in substance use (Henggler, Pickrel, & Brondino, in press; Lewis, Piercy, Sprendle, & Trepper, 1990; Szapocznik, 1997). In recent years there has been a shift from focusing therapeutic activities primarily on the child, to improving parents' parenting skills and, to recognizing the importance of changing the total family system (Szapocznik, 1997; Parsons & Alexander, 1997).

One distinguishing feature of these new parent and child skills training programs, which the author calls family skills training programs, is that they provide structured activities in which the curriculum addresses improvements in parent-child bonding or attachment (Bowlby, 1969; 1982) by coaching the parent to improve play time with the child during Child's Game. This "special therapeutic play" has been found effective in improving parent-child attachment (Egeland & Erickson, 1987; 1990). Using intervention strategies developed by Kogan (1980) and Forehand & McMahon (1981), the parents learn through observation, direct practice with immediate feedback by the trainers and video tape, and trainer and child reinforcement how to improve positive play (Barkeley, 1986), by following the child's lead and not correcting, bossing, criticizing, or directing. Teaching parents therapeutic play has been found to improve parent-child attachment and improve child behaviors in emotionally disturbed and behaviorally-disordered children (Egeland & Erickson, 1990; Kumpfer, Molgaard, & Spoth, 1996). These family programs encourage family members to increase family unity and communication and reduce family conflict as found in prior SFP studies.

Some general principles for best practices in family programs to have maximum impact in improving parenting, family relationships and youth functioning have been discovered, namely:

• Comprehensive interventions are more effective in modifying a broader range of risk or protective factors and processes in children.
• Family-focused programs are more effective than child-focused or parent-focused only.
• Family programs should be long-term and enduring.
• Sufficient dosage or intensity is critical for effectiveness.
• Tailoring the parent or family intervention to the cultural traditions of the families involved improves recruitment, retention, and outcome effectiveness.
• Addressing developmentally-appropriate risk and protective factors or processes at specific times of family need, when participants are receptive to change is important.
• Family programs are most enduring in effectiveness if they produce changes in the ongoing family dynamics and environment.
• If parents are very dysfunctional, interventions beginning early in the lifecycle (i.e., prenatally or early childhood) are more effective.
• Components of effective parent and family programs include addressing strategies for improving family relations, communication, and parental monitoring.
• High rates of recruitment and retention are possible with families.
• Videos of families demonstrating good and poor parenting skills helps with program effectiveness and client satisfaction.
• The effectiveness of the program is highly tied to the trainer's personal efficacy and characteristics.