Issues of Adaptation Fidelity in Strengthening Families Program

Issues of Adaptation & Fidelity in Strengthening Families Program Karol L. Kumpfer, Ph. D. Associate Professor, University of Utah

Background: Strengthening Families Program (SFP) • History – 1 st 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 followup studies – Two recent randomized trials show SFP effective for general families recruited from schools and communities.

SFP Family Skills Training Model Child Group Family Style Meal Parent Group üChildcare 1 Hour Simultaneously 2 Family+Groups 1 Hour üTransportation • Major Objectives • • Improve Family Relations Increase Parenting Skills Increase Children’s Skills

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

Essential Core Components • 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 • 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 • 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 • 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 – 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 • “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 “The best family and parenting programs are only as effective as the quality of the staff delivering the program. ” • 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

Principles of Effective Adaptation • 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 • 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 • 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 • 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 • Modify Teaching Methods to be More Experiential – Storytelling – Experiential practice – Visual graphic material

Principles of Effective Adaptations • 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 • 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