Strengthening Families 10-14 (SFP) - family protection and resilience-building processes for adolescents and their parents
At a glance
Country of origin
- USA
Strengthening Families 10-14 is a seven-session programme for families with young adolescents that aims to strengthen family protection and resilience-building processes and reduce family risk related to adolescent substance abuse and other problem behaviours. The weekly two-hour sessions include separate parent and child skills-building followed by a family session where parents and children practise the skills they have learned independently, work on conflict resolution and communication, and engage in activities to increase family cohesiveness and positive involvement of the child in the family.
Parents are taught how to clarify expectations based on child development norms relating to adolescent substance use, how to use appropriate disciplinary practices, how to manage strong emotions regarding their children and how to communicate effectively. Children are taught refusal skills to help them deal with peer pressure and other skills for personal and social interaction. These sessions are led by three-person teams and include an average of eight families per session.
Keywords
No dataLinks to this programme in other registries
Implementation Experiences
Read the experiences of people who have implemented this programme.Contact details
Dr Cathy Hockaday, PhD
Iowa State University
1087 Lebaron Hall
Ames, IA 50011-4380
United States of America
Phone: 1 (515) 294-7601
E-mail: hockaday[a]iastate.edu
Website: www.extension.iastate.edu/sfp
Overview of results from the European studies
Studies overview
The Strengthening Families Programme was developed by Karol Kumpfer for children ages 6-11 in the 90ies and is known as the Utah version. Since that time the Utah Strengthening Families Program has been modified for younger children (ages 3-5) and young teens (ages 13-17). Researchers at Iowa State University collaborated to adapt and study SFP for families with early adolescents (SFP for Parents and Youth 10-14), which is known at the Iowa version or SFP 10-14.
Varying versions of the programme have been evaluated in several randomised controlled trials (RCTs) in Europe in, respectively, Germany (Baldus et al. 2016; Bröning et al., 2017)), Poland (Foxcroft et al., 2017), , the UK (Moore, 2009; Segrott et al. 2022) and Sweden (Skärstrand et al. 2014; Jalling et al., 2016), all with the SFP 10-14 version. Quasi experimental evaluations were conducted in the UK (Coombes et al., 2012), Ireland (Kumpfer, 2012), Portugal (Magalhães and Kumpfer, 2015) and Spain (Ballester et al., 2020; Orte et al., 2015), mostly with the Utah version. Moreover the program is cited by one of the developers (Kumpfer et al., 2018; Magalhães and Kumpfer, 2015) to be implemented in Italy, the Netherlands, Norway, Slovenia, Austria and France.
In the German RCT (Baldus et al., 2016; Bröning et al., 2017), families with a young person aged 12-13 years were eligible to participate. The programme had a booster session 4-6 months later, and assessments were conducted at post-test, six months (i.e. after the booster) and 18 months after post-test. The primary outcomes were self-reported lifetime tobacco, alcohol and cannabis use at 18 months. Parents and young people also reported on behaviour problems. Only the outcome of lower lifetime tobacco use among the SFP 10-14 group compared to the control group was significant. A secondary analysis in this very small sample and relatively young sample indicates that high-risk groups in the SFP-D condition achieved the best results compared with all other groups, especially in mental health and quality of life.
In the Polish RCT (Foxcroft et al., 2017), communities were randomised and families with children aged 10-14 could participate. The primary outcomes were self-reported alcohol, cigarette and other drug use, alcohol use without parent permission, drunkenness and binge drinking in the past 30 days at 12 months and 24 months after baseline. There were no effects on primary outcomes, parenting skills, parent-child relations or child problem behaviour. Foxcroft et al. (2017) state that their null findings may be due to the 24-month follow-up being insufficient to detect positive effects, selection bias resulting from four communities not being randomised to study conditions, a high level of attrition and the fact that one third of subjects were aged 13-14.
The Swedish cluster RCT study (Skärstrand et al., 2014) involved children aged approximately 12 years and the programme included additional material on alcohol and drugs. It conducted three yearly assessments i.e. mid-programme, post-test and a one-year follow-up. There was no statistically significant effect at any time-point on any measure of self-reported smoking, alcohol or drug use. The evaluators contend that the failure to replicate the positive effects found in USA based studies could be due to failure to implement the program with sufficient fidelity, cultural differences or significant alterations to the content of the SFP 10-14.
In the other Swedish RCT (Jalling et al., 2016), at-risk young people aged 12-18 years (indicated by one of delinquent behaviour, bullying, repeated conflicts regarding family rules, use of alcohol, tobacco or drugs, or excessive computer use) were randomised to ParentSteps (described as the Swedish shortened version of the Strengthening Families Program 10–14 although it only involves parent sessions), Comet (a programme aiming to help parents develop parenting skills) or a control group. No effects were found for parent-reported problem child behaviour or adolescent-reported anti-social behaviour, delinquency, alcohol or drug use or psychosocial functioning.
The English study (Moore, 2009) involved children aged 10-14 years. Segrott and colleagues (2022) evaluated this adapted UK version (SFP10-14UK, seven weekly sessions) which brought together families who identified as likely or not likely to experience or present with challenges within a group setting. This pragmatic cluster-randomised controlled effectiveness trial, with families as the unit of randomization (n=715) measured occasions young people reported drinking alcohol in the last 30 days; and drunkenness during the same period, and alcohol/tobacco/substance behaviours (age of initiation, frequency, related problems). No statistically significant differences between the two study conditions were observed at the 24-month follow-up on either of the two primary outcomes (previous 30-day alcohol use and having been drunk in the previous 30 days) (Segrott et al., 2022). The authors highlight the importance of evaluating interventions when they are adapted for new settings.
The evaluation of the implementation in Spain (Orte et al., 2013 & 2015) was not included here because of significant drop-out at follow-up, the lack of ITT and attrition analysis, the fact that the sample size is considered to be limited for inferential analysis and because it remains unclear what the adaptation from the original intervention consisted of.
The programme has been rated as Promising by Blueprints for Healthy Youth Development based on a review of studies conducted world-wide.
Countries where evaluated
- Germany,
- Poland,
- Sweden,
- United Kingdom
Characteristics
Protective factor(s) addressed
- Family: attachment to and support from parents
- Family: opportunities/rewards for prosocial involvement with parents
- Family: parent social support
- Individual and peers: refusal skills and decision making
- Individual and peers: skills for social interaction
Risk factor(s) addressed
- Family: family conflict
- Family: family management problems
- Family: neglectful parenting
- Family: parental attitudes favourable to alcohol/drug use
- Individual and peers: early initiation of drug/alcohol use
- Individual and peers: favourable attitude towards alcohol/drug use
- Individual and peers: favourable attitudes towards anti-social behaviour
- Individual and peers: interaction with antisocial peers
Outcomes targeted
- Academic performance
- Depression or anxiety
- Other mental health outcomes
- Relations with parents
- Alcohol use
- Use of illicit drugs
- Smoking (tobacco)
- Other behaviour outcomes
Description of programme
The seven-session programme for families with young adolescents is based on the biopsychosocial model and aims to strengthen family protection and resilience-building processes and reduce family risk. Sessions are conducted once weekly for seven weeks. The first six sessions last two hours, consisting of one hour of separate parent and child skills-building followed by a one-hour family session where parents and children practise the skills they have learned independently, work on conflict resolution and communication, and engage in activities to increase family cohesiveness and positive involvement of the child in the family. The final session is a one-hour family interaction session without the concurrent parent and child training sessions.
Parents are taught means of clarifying expectations based on child development norms relating to adolescent substance use, how to use appropriate disciplinary practices, how to manage strong emotions regarding their children and how to communicate effectively. Essential programme content for the parent skills training sessions is contained on videotapes that include family interactions illustrating key concepts. Children are taught refusal skills to help them deal with peer pressure and other skills for personal and social interaction. During the family sessions, family members practise conflict resolution and communication skills and engage in activities designed to increase family cohesiveness and the positive involvement of the child in the family. These sessions are led by three-person teams and include an average of eight families per session. The length of the intervention may depend on where it is delivered, that is, in a school, in a group or at home. The programme is delivered by certified group leaders, site coordinators or supervisors.
The Strengthening Families Programme was developed by Karol Kumpfer for children ages 6-11 in the 90ies and is known as the Utah version. Since that time the Utah Strengthening Families Program has been modified for younger children (ages 3-5) and young teens (ages 13-17).
Researchers at Iowa State University collaborated to adapt and study SFP for families with early adolescents (SFP for Parents and Youth 10-14), which is known at the Iowa version or SFP 10-14.
Intervention variation
In Sweden, a version of the Strengthening Families 10-14 programme adapted to Swedish conditions, including through some modifications to the programme format agreed with the programme’s developer, is implemented. The Swedish version consists of two parts. Part one comprises seven sessions, delivered over seven consecutive weeks in grade 6 (12 years of age); there are six separate sessions for children and their parents, with one joint family session. Part two comprises five sessions, delivered over five consecutive weeks in grade 7 (13 years of age); there are four separate sessions for children and their parents, with one joint family session. This differs from the original programme, where each weekly session includes a separate hour for parent and child, and then one hour with parents and children together.
The programme content is similar to the original Strengthening Families 10-14 programme to a large extent, although some family session topics are omitted due to the change in format/delivery. Whereas the original programme is held in community centres with parent and child sessions run at the same time, for practical reasons, the child sessions in the Swedish version are run during school hours and parent sessions are run separately in the evening, so ‘some family components were lost’. Youth sessions are conducted by class teachers, with the assistance of a group leader. Group leaders conduct parent sessions. All group leaders are trained by certified Strengthening Families 10-14 trainers. The Swedish version also includes some new material in part two, designed to enhance the alcohol and drug content.
Implementation Experiences
Contact details
Cátia Magalhães
catiacmagalhaes[a]gmail.com
Main obstacles
With respect to individual professionals
- Recruitment of families when an agency or school start up is always difficult until there is positive word of mouth and agency staff buy-in to get referrals.
- Select and implement and evidence-based programme instead of other programmes that are on offer.
With respect to social context
Once in a while, the resistance to adopting EBPs from other countries arises because of the perceived difficulties in adapting them to new cultures or new situations.
- Initially the weeks of the programme and the number of sessions.
With respect to organisational and economic context
- Financial issues (raise the funds from local foundations and agencies).
- Selecting and implementing EBPs instead of other programmes that are on offer (and can be shorter and less expensive, although with less positive results).
How they overcame the obstacles
With respect to individual professionals
- Called and talked with families and targeted schools.
- Talked with people from the representative agencies of the targeted populations.
- Spread and disseminated EBPs and practices through professionals.
With respect to social context
- Adapt the programme to the unique needs and situational/social context while preserving the programme´s core content.
- Overcome barriers to programme implementation and implement strategies to increase recruitment and retention.
With respect to organisational and economic context
- Spread and disseminate evidence-based programmes and practices through local agencies and local government.
- Cost-effectiveness of EBPs compared with non-EBPs and practices.
- Explain risk and protective factors of the context.
Lessons learnt
With respect to individual professionals
- It is important to select, train and supervise staff (group leader or facilitator) to assure quality implementation.
- Supervision from programme implementer or national/local coordinator.
- Cultural adaptations are needed to maintain fidelity to the original programme.
With respect to social context
- Parents and families want universal family values. So it’s important to become familiar with the targeted population’s cultural values, priorities and characteristics.
- We can adopt EBPs from other countries and have similar positive and significant results.
Strengths
- The programme is durable and has large positive outcomes in its first implementation in Portugal, like in other several countries.
-The material and format are easy to use.
- Sensitivity towards language barriers and cultural factors.
- Topics and session contents.
- Three groups/moments: parents, children and family (parents and children together).
Weaknesses
- Group version is staff-intensive and costly.
Opportunities
- Having existing paid staff or volunteers from the community to implement the programme can help to reduce the staff costs.
- Working with local agencies and government services (e.g. social services, children protection commissions).
Threats
- Financial issues (taking into account economic, national and local context).
Recommendations
With respect to individual professionals
- Good staff selection and training/supervision.
- Training staff in EBPs and core components of the programme.
- Ethnically and linguistically matched to the target population.
With respect to social context
- Disseminate the results and effectiveness of the programme.
- Carefully identify the most pressing problems/risks and protective conditions (helps to guarantee better outcomes).
- Include cultural adaptation of the programme.
With respect to organisational and economic context
- Disseminate the results and effectiveness of the programme.
- Cost-effectiveness studies.
- Develop practical collaborations between practitioners, clients, policymakers, researchers, etc. to improve programme implementation and dissemination.
Number of implementations
Country
Contact details
Joan Amer
joan.amer[a]uib.es
Main obstacles
With respect to individual professionals
Lack of training and need of understanding of the theory of change of the programme. Temporary jobs, which mean lack of stability: changes in professionals from one application to other.
With respect to social context
Need of network and social support within neighbourhoods. Need of cooperation between social services and educational services.
Seasonal job market. Lack of bond with communities, due to unstable housing.
With respect to organisational and economic context
- Eventually, in some applications, specific support had to be implemented for some children who disrupted the functioning of the sessions.
- In other cases, the protocol had to be implemented in order to exclude some participants that fullfilled the requirements of exclusion criteria. This is the case of some children with active antisocial behaviour. This rarely happened and it was because these children were not detected at the selection process prior to the programme.
How they overcame the obstacles
With respect to individual professionals
Improvement of the system of selection of professionals, better connections with those NGOs with competent and experimented professionals.
Increase and improvement of training: further hours of training, more dedication to emotional techniques and roleplaying.
With respect to social context
Better networking with professionals in the communities: preparatory sessions, linking and bonding with relevant educational professionals.
Utilisation of social networks (web etc.) for improving communication.
With respect to organisational and economic context
- Once the specific educational needs were identified, the implementation team (educators, coordinator and members of our research group) would decide the type of adapations of the programme.
- Principally, specific support to the child would be implemented (sometimes with the participation of some collaborator from the university).
- Different strategies were also prepared for the child to make sure that she or he acquires the essential contents and participates as much as possible in the dynamics of the group.
Lessons learnt
With respect to individual professionals
The importance of experienced professionals, but also of availability for learning and adherence to the programme.
With respect to social context
The counterpart: social service, school and/or NGO that you are working with is critical for the quality of the implementation.
With respect to organisational and economic context
The opportunity to implement a standardised academic programme with elements of community and family intervention.
Strengths
- Taking into account the results and the evaluation of the Spanish programme, we are able to state that SFP can be successfully adopted without compromising effectiveness. Our results suggest that the validated programme for the Spanish population (PCF) accomplishes its objectives and is valid for positively modifying protection and risk factors. Furthermore, effectiveness of the culturally adapted programme is tested in parents, children and families. Training for parents increases their parenting skills; training for children enhances their social capacities and personal development; and family training improves both positive relations at home and parental implication.
- This programme addresses issues that an "insider" or "autochthonous" (using the terms of the questionnaire) may not have considered. Different aspects are incorporated. External perspective offers new ideas and proposals.
- The allochthonous component of the programme makes the results more valuable. It is feasible to implement succesfully a programme of these characteristics: results of the applications in the Spanish adaptation are consistent with those obtained by SFP in reference applications (Kumpfer, 2003; Kumpfer et al., 2008), demonstrating its effectiveness.
- Spanish adaptation of the programme (PCF) has demonstrated that the programme is valid to work with populations that are socially and culturally different. Results of this adaptation demonstrate that the programme is able to be effective both in Spain and internationally.
- Overall evaluation is positive. We are satisfied with the results. Last, we specially appreciate and highlight the innovative component of the programme within family intervention
- The protocol has been implemented without major or significant difficulties. In the case of families with uncovered basic needs, we had the support of professionals from social services. These professonials also monitored the demands of those families.
Weaknesses
Previous to the implementation of the programme, aspects such as physical punishment were not included in the Spanish adaptation.
Opportunities
- It is important to share the specific experiences, implementations and outcomes in different countries and settings in order to exchange experience and improve/polish the programme. In this sense, initiatives such as this questionnaire are very useful.
- Adaptations were made taking into account both the curriculum and the objectives of the programme. Adaptations implied modifications of formal aspects such as language and the presentation of resources. New activities and proposals were introduced to facilitate the performance of the sessions. Also incentives for children were revised.
- Context adaptation consisted mostly of modifications in language aspects, teaching proposals, games, illustrations, songs.
- Recent restrictive legislation on tobacco has had an important impact on levels of consumption.
- Advertising of alcohol (allowed) — even though legislation is becoming more restrictive.
Threats
- The Balearic Islands are an important mass tourism destination in Western Europe. Different implementations of the programme have been executed in coastal populations with high risk levels of social exclusion. Social exclusion in tourist resorts is principally due to the characteristics of the labour force in the tourism sector in the Balearic Islands: it is an unskilled, seasonal, intensive and low-wage workforce.
- In the case of our applications in the Balearics, seasonality of the tourist economy impacts in the scheduling of the programme. Parents can have serious difficulties attending the sessions during peak tourist season.
- The Balearic Islands have the highest rate of school drop out in Spain, greater than the average of the European Union.
- Age restrictions for going out — there is a permissive culture. The phenomenon of "Botellón": outdoor alcohol drinking.
- Negative attitudes towards illicit drug users — stereotypes or social prejudice can arise. It is frequently associated with crime.
Recommendations
With respect to individual professionals
Proper selection of trainers, and proper training. Training with both a theoretical background but also a practical focus (emotional techniques, leading group skills, roleplaying, etc.).
With respect to social context
It is important, first, to be aware of the level of cultural adaptation needed in each country or context and, second, to make use of the evaluation as a tool for permanent improvement of the programme.
With respect to organisational and economic context
- Organisational culture of the institution where the implementation takes place is important.
- Regarding economic context, characteristics of jobs of parents influence the level of participation. In our case, seasonal and unskilled jobs are predominant. Also the environment for adolescents is relevant. In the case of the Balearic Islands (Spain), there is easy acces to the job market (abandoning school) and a high presence in the resorts of leisure lifestyles with drug abuse due to the type of tourism.
Note from the authors
Family Competence Program (Spanish SFP)
PCF7-12 (Spanish adaptation of SFP6-11); 2015 on the PCF12-16 (adaptation)
Number of implementations
Country
Contact details
Robert O'Driscoll
robert.odriscoll[a]hse.ie
Main obstacles
With respect to individual professionals
Staffing.
With respect to social context
The need to make sure that a needs assessment was conducted in the communities where the programme was intended to be implemented.
With respect to organisational and economic context
A lack of consistent organisational support.
How they overcame the obstacles
With respect to individual professionals
We developed an interagency implementation model. The key stakeholders included the Health Service Executive, local and regional drugs and alcohol task forces, the Child and Family Agency (TUSLA), the Gardaí (Community Policing) and Young Person’s Probation.
With respect to social context
Consulted with local service providers, who in turn consulted with service users around the need for and their willingness to participate in the SFP.
With respect to organisational and economic context
Sometimes sheer determination was required to overcome the lack of support from senior management and administrators.
Lessons learnt
With respect to individual professionals
The important lessons learnt were multi-level. Funding and management support were necessary at all levels; well-trained staff and facilities committed to the programme implementation and sustainment were needed. Including the families as much as possible in the planning, implementation and evaluation of programmes was necessary. It is important to create a space within the implementation infrastructure and architecture for the implementers to come together and work through the tensions and dilemmas that are likely to arise throughout the implementation process, so that the problems do not become embedded or become obstacles to the implementation process. Having well-qualified coordinators to guide the implementation process and to ensure programme fidelity and support the programme team was important.
With respect to social context
- Implementing an evidence-based programme requires a well thought out implementation plan with commitment from all major stakeholders. It was interesting to see the competition among stakeholders for recognition of individual and agency-level commitments and the political climate that a successful implementation can create. It is worth noting that each agency wants to be recognised and associated with a successful programme, sometimes above and beyond the level of commitment they may have given to the implementation process, and very few want to work on or be associated with working through the problems that arise during the implementation.
- An implementation team needs to be created around the SFP so that experience can accumulate over time.
With respect to organisational and economic context
A successful and sustained implementation of SFP requires a local “Champion” to promote the programme within and outside the organisational context. Programmes must be evaluated and the findings shared within the wider network of service providers, regionally at least and nationally if possible. The evidence will support the future sustainability of the programme in terms of funding and political support and contribute to an accumulating evidence base for the programme. An alliance with the programme developer can help to overcome organisational obstacles to the successful implementation of SFP.
Strengths
The evidence base for the programme is the strength of SFP.
Weaknesses
The resource-intensive nature of the programme.
Opportunities
The interagency model of service delivery can be used for other types of programme implementation but also contributes to the development of a strong network of distributed expertise that can be harnessed on behalf of vulnerable service users.
Threats
The political environment that can accrue around an evidence-based programme like SFP. Administrators and funders trying to implement a programme without the necessary knowledge and skills around the nuances of practice.
Recommendations
With respect to individual professionals
Make every effort to train staff well in the programme and to ensure that they have the requisite skills to work with families individually and in a group setting. To make evidence-based programmes like SFP part of the undergraduate curriculum.
With respect to social context
Undertake a needs analysis of the communities where SFP is intended to be implemented to make sure it is the correct fit for the local context.
With respect to organisational and economic context
Ensure adequate funding by evaluating programmes and publishing the results. Keeping administrative and funding support out of the practice environment while balancing the need for ongoing management support to sustain the programme with fidelity over time.
Number of implementations
Country
Main obstacles
With respect to individual professionals
We implemented the RCT in 19 schools in Stockholm. The main obstacle was recruiting leaders to the programme to deliver both the children’s sessions, the parents’ sessions and the family sessions. We were planning to train teachers to deliver the children’s sessions, but they were not allowed to work extra hours during the evenings for the parents’ and family sessions.
With respect to social context
Recruiting schools, as this was an RCT and schools were randomly allocated to the programme and control groups.
With respect to organisational and economic context
Since this was a study, we had a limited budget.
How they overcame the obstacles
With respect to individual professionals
We resolved that obstacle by training retired schoolteachers to be in charge of the parents’ sessions in the evenings (on the same day that their children had their sessions). The retired schoolteachers also took part in the children’s sessions during the day, so they could make links between the children’s and parents’ sessions. We also changed the original programme format, in that we only had two family sessions in order to make it possible for children and parents to be together in the evening.
With respect to social context
We offered the control schools the chance to implement the programme after the study was over.
With respect to organisational and economic context
We had to make some alterations to the programme format and limit the family sessions.
Lessons learnt
With respect to individual professionals
It is hard to balance cultural adaptation and programme fidelity.
With respect to social context
Go out in person to the schools and talk about the study and the importance of taking part.
Strengths
The Swedish version does not differ significantly from the SFP 10-14 in terms of content. All the core components, like communication skills, family bonding, peer resistance skills, stress management, handling emotions, and communicating rules and consequences in relation to household chores, as well as expectations concerning substance use, are intact. Even though some of the family session components were omitted, we tried to make up for this by introducing links between the children’s and parents’sessions, and by adding extra weight to the content of the two existing family sessions.
Weaknesses
We were not able to hold all the family sessions.
Threats
It is not an easy task to adapt intervention programmes from one context or country to another. You must be able to culturally adapt the programme without losing the core components.
Note from the authors
Steg-för-Steg - a Swedish version of the Strengthening Families Program 10-14 (SFP 10-14)
Number of implementations
Country
Main obstacles
With respect to individual professionals
- Dominant practices to help parents are group discussions under the supervision of psychologists. Evidence-based educational and manualised programmes are not used.
- Multiplicity of actors and actions
- Heterogeneity and low level of training for family support professionals
- Inexperience and reluctance to implement educational programmes for parents
- No culture of scientific evaluation
- Reluctance in relation to the project itself, in particular the commitment of families over time (14 weeks)
With respect to social context
- Multiplicity of actors to inform and convince
- Astonishment to see support for parenthood in the field of health
- Frequent opposition in principle by the professionals involved in traditional forms of support to parenthood (standardised programme, Anglo-Saxon programme, caricature of behaviouralism)
- Difficulties in choosing families: risk of touching "those who do not need it"
With respect to organisational and economic context
- Municipal doubts during the first implementation of the programme:
- Fear f not having qualified staff to play the role of facilitator
- Financial cst (average announced = 15,000 euros for year 1)
- appointment of a municipal coordinator of the programme plus four facilitators
- funding of their working hours, training and facilitation of the 14 sessions
- logistics: organisation of information meetings, provision of rooms adapted for the training and animation of the sessions
- Low external "visibility" of the project for elected representatives (few families, unlike the "conference" mode)
How they overcame the obstacles
With respect to individual professionals
- Slow progress of implementation on each site
- On each site of implementation:
- Several meetings setting up detailed infrmation about the programme: origin, concepts, principles, philosophy and ethics, results
- Systematic invitatin of professionals involved in supporting families at our meetings
- Distributing infrmation to the largest possible number of professionals from various fields (social, education, sport, culture) in contact with families
- Positioning of the programme in the educational field, in complementarity with other parenting support actions
- Presentation of the work done for SFP's cultural adaptation
- Reinforcement of the training of those responsible for the programme’s implementation (at the theoretical level and at the level of action) highlighting the programme’s philosophy and its ethics
With respect to social context
- Enthusiasm and perseverance
- Clear and explicit, intense and diversified communications with elected representatives, funders, professionals and parents
- Involvement and appreciation of local partners in reflection and implementation
- Identification of cities as privileged partners in the implementation, valuing the benefits to them, in terms of training their teams
- Targeting living areas of low income families
With respect to organisational and economic context
- For the first implementations of PSFP in France:
- Natinal funding
- Supprt of decentralised departmental services: prefecture, social cohesion, city policy
- Inclusion or support of PSFP to a device already in place: city health workshop, local education plan
- Enthusiasm of professionals during the discovery of the programme
- Interest, enthusiasm and satisfaction of parents
- Interest of the elected officials
Lessons learnt
With respect to individual professionals
- Interest in and necessity of a long phase of presentation and explanations to the greatest possible number of professionals on each site of implementation
- Interest in and need to broaden the base of the professionals concerned; mobilisation of professionals in contact with families, not just those already involved in parenting support
- Interest in and need for strengthening training, both in its content and in the number of people benefiting from it
- Added value of the implementation and training process:
- Individual: strengthening the prfessional skills in parenting support
- Collective: better mutual knowledge and articulation between the professionals on each side
With respect to social context
- Relevance of the association with the cities, recognized as a strong local partner, identified in the diversified support for families (social, educational, prevention, culture, sports, leisure) and already working in a network
- Give incentives to cities (elected policy makers and local professionals) for the implementation and management of the programme
- Need to obtain a commitment from elected representatives through a partnership agreement
With respect to organisational and economic context
- Adaptation to the context and searching for local support are essential
- Support from the cities in their search for funding
Strengths
- The programme itself:
- Its cncrete and experiential aspect for parents
- The assciation of 3 time periods: parents / children / families
- Quick enthusiasm frm trained professionals and parents
- The ethics f facilitation
- Orientation to parenting skills, mental health promotion
Weaknesses
- Heaviness of initial investment, especially financial
Opportunities
- Expansion of programme’s positioning
- In the fight against the misuse f screen time
- In the fight against social inequalities in health
Threats
- Enough rigour to keep the programme in its original form, in 14 sessions and 3 time-periods (parents / children / families) and avoid losing fidelity
- Enough perseverance in the training of professionals who develop and facilitate
Recommendations
With respect to individual professionals
- Involve local professionals in setting up the programme
- Analyse the training needs of developers and professionals
- To be attentive to ethics of the facilitation of a programme that values parents
- Strengthen training
With respect to social context
-
Analyse the appropriateness of the programme to local standards of support for parenting
-
Carefully choose target audiences
-
Broaden the objectives of the programme in the fight against the abuse of screens
With respect to organisational and economic context
- Rely on existing partners or networks
- Provide funding
Note from the authors
Programme de Soutien aux Familles et à la Parentalité 6-11 ans - French adaptation of the Strengthening Families Program
Number of implementations
Country
Contact details
Dina Kyritsi (Psychologist, MA, MBPsS)
Main obstacles
With respect to individual professionals
Competition between the facilitators, especially in the youth sessions (which are delivered by two professionals ), was an issue that we tried to overcome. Not all our facilitators had attended the same training course and most of them had never worked together as a team. The Strengthening Families Programme SFP10-14 presupposes good chemistry between the three facilitators who are responsible for a given group of families. In addition, it was important for the programme’s facilitators to always come very well prepared for the sessions. Their initial training was not enough, without investing personal time in preparing and practising for the sessions. Cultural accommodation of the SFP10-14 for Greece provided strong grounds to warrant a pre-implementation stage in future planning, wherein all the facilitators meet and go through every activity of the sessions together to ensure a uniform understanding of its function and purpose within the session. It is hard to evaluate how well the SFP10-14 was implemented in every group or the variation in the implementation between different groups. The post-implementation interview data could possibly point to weaknesses in the programme itself or how well the programme was executed. At the moment, there is no standardised tool to measure how well the sessions were delivered (external observers or a self-evaluation by the facilitators themselves could perhaps have served this purpose).
With respect to social context
It was hard for our participants to follow the English-language DVDs with Greek subtitles that we utilised during the first implementation of the programme (we ended up reshooting the DVDs with Greek actors). In several vignettes (e.g., the shoplifting vignette), the responses of parents in the video were much milder than what would be ‘natural’ for a Greek parent, which made the DVD families ‘too good to be true’ in our participants’ eyes. It was hard to find something equivalent to replace such scenes, as this would have required rewriting the script, without having the option to consult or obtain permission from the programme’s US authors. Using ‘chores’ as a behaviour management tool was another core concept of the US programme that we found hard to intregrate into Greek family practice, as assisting with the household chores is usually not a highly valued behaviour in Greece for an adolescent pupil (frequently not even by his or her parents, who would prefer that he or she studies instead).
As regards the general social context, the parents were reluctant at some points to consider the methods proposed by the programme; they felt that they were somehow ‘American’ and they would be realistically hard to implement with their youth. In addition, several parameters related to background work for the implementation were very different from the US. For example, fortunately volunteerism is still common in the US, whereas in Greece - especially after our deep economic recession - there is no place for volunteerism, as everybody is striving to make ends meet. We had to consider not only the SFP10-14 families, but also our facilitators, who often had to leave their own, young children unsupervised, in order to undertake unpaid work for the programme.
With respect to organisational and economic context
It was hard to obtain license from the Greek Ministry of Education to access public schools, in order to inform parents and young people about the programme and recruit participants. Our country is not very open to innovative healthcare initiatives that are not centrally organised by the state.
Furthermore, as already argued, much of the facilitators’ work went beyond the SFP10-14 sessions. A flexible financial planning was able to account for the extra work that typically arises at the stage of adaptation (e.g., private, one-to-one time with the families who faced special challenges, identified when special needs came up during the sessions, or feedback from the facilitators, such as the observation diaries that they were asked to complete following each session). The financial demands are quite different between countries in which the SFP10-14 has been implemented for years and is running smoothly and countries in which the programme is being first introduced, such as Greece.
How they overcame the obstacles
With respect to individual professionals
An effort was made to build positive relations, empathy and team spirit within the Greek SFP10-14 team and to ensure the best match between the facilitators and our groups of families. In addition, we prepared plans and small maps for the facilitators’ use, as ‘personal assistants’, and we organised the various materials that the facilitators would need to use during each session. The Greek SFP10-14 manual has also included helpful tips proposed by the facilitators who had already delivered the programme in Greece.
With respect to social context
We reshot the DVDs using much simpler language. We replaced specific activities and chores that were considered ‘too American’ (e.g., billiards, bowling, gardening, cleaning the basement etc.) with more plausible alternatives. We replaced a few scenes that seemed ‘unnatural’ (e.g., the parents’ response to shoplifting). We also made sure that our DVDs did not include families of ethnicities that rarely immigrate to Greece (e.g., no coloured families were included, as in the UK DVD set; the Greek video portays an immigrant family of Filipino descent instead).
In addition, the adaptation of the DVDs has had to account to an extent for the difference in parenting values. It also required skilful handling on the part of the facilitators, who often anticipated the families’ concerns or opposition, before they were explicitly expressed in the group by the families.
With respect to organisational and economic context
We made every effort to highlight the affiliation of the US SFP10-14 with the Agia Sophia Hospital for Children, which is a University Clinic and the largest paediatric hospital in Greece and has formed for years the official basis of the Greek programme. This affiliation added weight to our endeavour in the eyes of officials in the Ministry of Education and the School Division of the Municipality of Athens as well as in the eyes of the participant families.
As to the financial demands, volunteer work was additionally required, in order to overcome financial shortage.
Lessons learnt
With respect to individual professionals
Our practice pointed to the need for supervision and evaluation of the programme’s facilitators, not only of the programme. Given that the pool of certified facilitators in Greece is necessarily limited (as very few training sessions have been offered), there were not many alternatives in case that something did not work out as planned. As with every project, tasks and deliverables need to be extremely clear right from the start (which is not easy when adapting an allochthonous programme, where several things may come up that were not prescribed, creating tension when several deliverables are not predicted from the outset).
With respect to social context
It is important not to get carried away with the original material and to make sure that you test every adaptation of the original material on several samples from the target population in advance, so as to ensure that all parts of the programme are meaningful in terms of language and cultural norms. When implementing an allochthonous programme , you need to be faithful yet creative.
With respect to organisational and economic context
The programme’s protocol should explicitly allow time for the work required outside the sessions, instead of focusing on session delivery only. Especially in Greece where the SFP10-14 has not received any backing from the national health system or well-established agencies (which have supported the program in the US and the UK), project planning should allow time, space and a budget for the introduction, familiarisation, promotion and dissemination of the programme, rather than implementation only.
Strengths
1) The SFP10-14 can be adapted successfully to other contexts (wider community/society, multiple settings) without compromising effectiveness.
2) An allochtonous programme draws on the scientific advances of a different country. Most programmes produced in the same cultural context draw on a similar pool of resources and are based on the same mentality, the same ‘air’, the same dead ends. An allocthonous programme can bring a very refreshing innovation with a different perspective, which therefore prevents it from encountering the same, old dead ends. In addition, the Greeks generally trust scientifically based and tested allocthonous interventions (at least healthcare initiatives from North America and the UK).
3) Therefore, it is feasible to successfully implement an allochthonous programme without compromising effectiveness.
4) All parts of the US protocol were effective and continued to play their part; surprisingly, even the slogans (i.e, the SFP10-14 creeds or mottos), which are not common in Greece (except in advertisements) and thus would not normally be expected to work well in the context of a healthcare programme.
The US SFP10-14 addresses a very diverse socioeconomic and structural context. As long as you maintain this feauture, the programme will remain effective. For example, the home of a poor family in Greece may be different from the home of a poor family in the US, but the DVDs for both countries explicitly include both affluent and less affluent households, so that a Greek family of low socioeconomic status would also feel included.
Weaknesses
1) Assessment of the effects of the SFP10-14 should not focus on prevention only. The budget for any cultural accommodation of the SFP10-14 in Europe was offered by the alcohol industry, perhaps with the effect that assessment focused heavily on alcohol prevention. Our implementation suggested that the true potential of the programme is highlighted only, when measures of family well-being are introduced. It is the Strengthening Families Program, after all! Our results (obtained from a battery of valid tests coupled with participant interviews) suggest that the programme did make a significant difference to the families’ lives (in terms of communication, conflict resolution, quality time together etc.), although we obtained non-significant results for most alcohol-related measures. A question of course would be how long after implementation do we measure the programme’s effectiveness as prevention (only longitudinal research could achieve this with validity) and also how can one measure effects in prevention, when the majority of the adolescent participants have zero contact with alcohol or drugs as a starting point during the sessions (floor effects are to be expected…). When an allochthonous programme is introduced, it is only natural that you have to adapt not only the programme, but also the allochthonous assessment, which usually depends on the funding resources of a foreign country and thus may obscure the true potential of the specific programme in your own country.
2) 10-14 does not necessarily correspond to the same age range across cultures. In several cases, our Greek participant parents reacted negatively, when the sessions made reference to drug use (e.g., the mention of ‘cannabis’), as they felt that their adolescents were too young to know about drugs. The SFP10-14 probably encompasses two quite different age groups already, with quite different challenges and needs.
Opportunities
1) There is a fine line between being faithful to the original programme and coming up with materials that are too ideal for the country’s reality and are therefore perceived as artificial. It is important that the participants feel as if the programme were written exclusively for them, rather than as if they are being pushed towards believing that the programme is relevant to their own lives. In practice, things that seem awkward need to be replaced (even if 3 in a sample of 10 say that they are OK), rather than having the facilitators try to persuade the participants that they are OK, because the original programme includes them. The SFP is effective, only if the participants feel that it is.
2) All references to non-relevant cultural context were omitted and replaced with their nearest, culturally appropriate equivalent. As an example, nobody gets a driving licence in Greece before the age of 18. Therefore, the mother’s anxiety in the video that her teenage son might drive drunk was replaced by anxiety that the boy might get into the car of an older friend who drinks and drives, or anxiety that he might get into a stranger’s car, when invited to do so, because of alcohol that is impeding his judgement. All such alterations were based on common sense, testing, feedback from the SFP10-14 pilot participants, survey feedback from an independent advisory group (our ‘panel of experts’) and data gathered from all our facilitators, who recorded their own subjective experience in delivering each session.
3) We adjusted the time allocated to each activity during the SFP10-14 sessions, depending on the participants’ ability to follow as well as the relative weight of each activity. All our facilitators found it impossible to follow the rigid US time plan.
4) As an exception, we allowed younger siblings (below 10 years) to attend, if a family really wanted to attend, but had nowhere to leave their younger child (We could not afford day care for the younger siblings’ during our sessions, as the US programme did).
5) Finally, we provided extra services to several participant families for free, which was not included in the programme’s protocol. All the participant parents asked for some private counselling time, some feedback about special issues that the facilitators might have identified in relation to their child or their family during the sessions as well as feedback about their test results. Our team of psychologists did give them this extra time, but focused on remaining facilitators rather than family therapists. We also referred families to external services (e.g., the Municipality, public hospitals etc.), where they could continue receiving support after the programme, depending on the nature of their needs. We made use of our professional status, in order to intervene and ensure that they booked an appointment quickly, when it was hard for them to do so on their own. We helped a few families become eligible for discounts in specific supermarkets in the city. All the above were not included in the SFP protocol, but professional responsibility and human concern did not allow leaving individual families without any support, after they completed the programme.
Threats
By nature, the SFP10-14 targets a variety of heterogeneous domains and has a variety of objectives. A real threat to the programme would be to split it into parts, with each part being used independently. In this way, apart from unity, the programme would lose its validity and effectiveness. We witnessed such an attempt, when official agencies of status that work with addiction in Greece expressed their interest in showing the videos for sessions 5 and 6 only (i.e., the DVDs that focus on addiction) to the families of young people with addictions. Other professionals expressed a wish to use only the SFP10-14 tools and materials that specifically address stress and coping, etc. The possibility that the programme could be split into pieces in this way is still a big threat, as there is no centralised supervision at the moment and the holder of the original copyright is so far away from Greece (in kilometres).
Recommendations
With respect to individual professionals
It is crucial that the facilitators are higly motivated and very well prepared for each session that they deliver. The sessions entail much more than executing the instructions of the SFP10-14 manual (which nevertheless need to be very simple and explicit, so that the sessions are implemented in a uniform manner).
With respect to social context
1) Implementation requires envisaging the actual practice of the sessions, deciding which activities you could save time from (i.e., time management — more than the ‘optional activities’ of the manual) and anticipating possible resistance from parents to the parts that feel too foreign to them. How will you defend the cultural appropriateness of your SFP?
2) A group with a lot of children in the younger age range (10-12 years) will probably be more challenging, making it harder to fulfil the session targets. Youth sessions need to carefully invite a relatively uniform, in terms of age, group of pupils.
With respect to organisational and economic context
1) The SFP10-14 utilises a pool of very impressive materials and posters, which, however, need to be covered very quickly in the sessions, due to time constraints. In practice, this might prove impossible, when the participants are not fluent readers (as in the case of our participant immigrant parents). You may need to sacrifice aesthetic quality, in order to maximise comprehension (colours, typeface, language) and to minimize the related costs of course.
2) Finally, there has to be a uniform policy about how to handle very personal or ‘touchy’ issues that might be disclosed during the sessions, as the participants gradually open up. For example, at family session 6 (when all our parents were certain that their children were too young to know about drugs and a few even asked the facilitators to refrain from talking about drugs, because ‘the kids are still innocent’), a 10-year-old boy disclosed in front of the group that he had smoked hashish at school. The boy was really innocent: he did not realise the significance of what he was saying. How do you handle this? Implementation needs to include a uniform policy about such issues, to be followed by all faciliators for the benefit of the programme.
Note from the authors
Strengthening Families Program, SFP10-14
Implemented in Athens between 2009-2013
