Trampoline - a selective prevention programme to prevent substance use disorders in children from vulnerable families

At a glance

Country of origin
Germany
Last reviewed 
07.10.2020
Age group
6-10 years
11-14 years
Target group 
Children/young people (8 to 12 years)
Programme setting(s)
Community
Family
Level(s) of intervention
Selective prevention

TRAMPOLINE is a selective prevention programme that aims to prevent substance use disorders (SUD) in children from families affected by substance use. It is a nine-session addiction-focused modular group programme for children aged 8 to 12 years with at least one substance-using parent. The main objective of the programme is to teach participants effective strategies to cope with stress;  it seeks to reduce the psychological stress resulting from parental substance abuse or dependency by extending children´s knowledge about alcohol and drugs, their effects on people and the consequences of substance-related disorders for affected persons and their family. Moreover it aims to improve feelings of self-worth and self-efficacy, and to help develop a positive concept of self.

The programme evaluation focuses on factors derived from literature that promote resilience and reduce risk for SUD in children of alcohol or drug using parents; given the age of the children, and funding constrictions, substance use was not directly investigated.

Contact details 

Dr. rer. nat. Diana Moesgen
MSc. Psych., Psych. Psychotherapeutin
Deutsches Institut für Sucht-und Präventionsforschung
Katholische Hochschule NRW
Phone: 0221-7757-173
Fax: 0221-7757-180
Email: d.moesge[a]katho-nrw.de
Website: www.katho-nrw.de/katho-nrw/forschung-entwicklung/institute-der-katho-nrw/disup/

Prof. Dr. Michael Klein
German Institute on Addiction and Prevention Research
Wörthstraße 10
Köln Germany
UKE Hamburg
Email: info[a]uke.de
Website: www.dzskj.de

Prof. Dr. med. Rainer Thomasius
Universitätsklinikum Hamburg-Eppendorf
Zentrum für Psychosoziale Medizin
Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ)
Hamburg
Tel.: 040-7410-52206
Fax: 040-7410-56571
Email:thomasius[a]uke.de
http://www.projekt-trampolin.de/

Overview of results from the European studies

Last reviewed 
07.10.2020
Evidence rating  
Additional studies recommended

Studies overview

The programme has been evaluated in two multicentre RCTs in Germany.

The first German multicentre RCT (2012) was conducted among 218 children from substance-affected families. In total, 27 outpatient facilities from different settings, distributed equally in Germany, delivered the intervention. Six months after the intervention, the children of both the intervention and the control groups had significantly less avoidable stress management compared to their baseline (general and addiction-specific), less constructive palliative emotion regulation, less negative stress management strategies both general and search specific, lower psychological burden, improved cognitive skills, peer acceptance, improved self-esteem, an overall improved self-concept and a better quality of life in relation to parents and autonomy. One of the effects can only be identified in the short term: an improvement in mental well-being cannot be recognized after six months.

Because of high adherence rates the authors assume that the evidence of efficacy of "trampoline" can be attributed to the program and that confounding can be ruled out. The intervention did change both the cognitions of children about what is happening in the addiction family context and their own role in it, as well as the emotions of children, especially their psychological distress, but above all, six months later, it keeps dropping. Both effects are still statistically significant, even when adjusted for the influence of age and gender.

The most pronounced effects of the programme are shown in the reduced burden of parental addiction with a small effect (ES: 0.14) and with a medium effect (ES: 0.64) on a greater knowledge of substances. There is an approximately average effect (ES: 0.31) in the reduction of psychological stress.

The second German multicentre RCT (2019) was conducted with 8 to 12 years old children of substance using parents in 27 German counselling centres. The results for the preventive group intervention “TRAMPOLINE” (a psycho-educational (PE) program) were compared with a non‐educational (NE) group. Children from both groups reported reduced mental distress, reduced avoidance in coping with family stress, improved self‐perceived autonomy, and a better parent–child relationship. It was concluded that both forms of intervention (PE and NE) can generate positive changes in children with substance using parents. However, it was not possible to demonstrate that PE was a more efficient type of intervention. The conclusions also state that the study is slightly underpowered, which makes it difficult to detect statistically significant effects.

References of studies

Countries where evaluated

Germany

Characteristics

Protective factor(s) addressed
Individual and peers: Problem solving skills
Individual and peers: skills for social interaction
Risk factor(s) addressed
Family: aggressive or violent parenting
Family: Family history or involvement with substance abuse/problem behaviour
Family: neglectful parenting
Family: parental attitudes favourable to alcohol/drug use
Outcomes targeted
Emotional well-being
Other mental health outcomes
Positive relationships
Relations with parents

Description of programme

TRAMPOLINE was developed for children aged 8-12 years that have at least one substance-abusing or -dependent caregiver. The intervention is specifically geared to the issues and needs of children of substance-abusers (COS). The name TRAMPOLINE was chosen because it creates positive associations in children, but also because it combines the ability to jump higher with the protection of a soft landing. The programme aims to empower the participation of children and at the same time to provide them with support and a safe place.

The TRAMPOLINE manual includes nine weekly 90-minute modules for children, as well as two optional sessions for their parents. The programme modules include: 1 – getting to know each other, 2 – self-worth: how I feel about myself, 3 – alcohol and/or drug problems in my family, 4 – knowledge: what I need to know about drugs and addiction, 5 – handling difficult emotions, 6 – self-efficacy: what I can do to solve problems, 7 – learning new patterns of behaviour in my family, 8 – what I can do to find help and support, and 9 – a positive good-bye.

All subjects are delivered in an interactive and age-appropriate way, with a large proportion of the sessions devoted to exercise and role-play. Special attention is paid to devise small rituals and a recurring structure to the sessions, both of which children in substance-affected homes often lack. Each session follows the same structure: it begins with an exchange on how children feel that day, followed by a discussion of the “homework” from the previous session; the new topic is then introduced, and developed through a variety of didactics. In between learning activities, there are “fun-and-play” activities such as songs or creative exercises. The sessions end with a relaxation exercise.

The parent sessions can be attended independently; providers should not assume that parents from volatile families will come to both, or even one, of the sessions. The first session, at the start of the programme, seeks to inform parents about the programme and about risk and protective factors children face when growing up in a substance-affected environment. Parents share the hopes they have with regards to living with their children, and are encouraged to consider parenting skills and their importance for their children. The second session, at the end of the programme, seeks to inform parents on how the programme went (from the trainer’s perspective), to answer questions about issues that may have come up at home in the course of the programme, and to sensitize parents to the needs of children in substance-affected families and how caregivers may be empowered in the future. Parents are encouraged to seek and accept further support in their parenting role. The manual for parents provides questions, group discussion and practical exercises.

The programme evaluation explores the role of psycho-education on children’s well-being by comparing the effects of TRAMPOLINE to an intervention for COS that is very similar with regard to setting, dose, and trainer qualification, but does not include addiction-related content or activities. We hypothesize that addiction-specific education, activities and role play will enhance the effectiveness of a prevention program compared with a prevention program without educational components.

Implementation Experiences

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