Kathryn Kavanagh

The family check-up with high-risk young adolescents: Preventing early-onset substance use by parent monitoring *

The Family Check-Up (FCU) is a brief, family-centered intervention focused on family-management practices. Within the context of a randomly assigned, multilevel family intervention, high-risk youth and families (n = 71) were selected for video-taped home observation that includes an interaction task assessing parent monitoring. Parents in the intervention group were offered annual feedback on the yearly assessment, including their home observation. Using an intention-to-treat design, analyses revealed intervention effects on early-adolescent substance use and observed parent monitoring by the first year of high school (Year 4 of follow-up). As in previous research, parents of high-risk adolescents were observed to decrease monitoring from grades 7 to 9. However, families randomly assigned to the family intervention maintained their monitoring practices. Regression analyses revealed the prevention effect of the FCU on substance use was mediated by changes in parental monitoring. Findings suggest the promise of linking developmental theory with innovation in cognitive behavioral intervention and prevention.

Preventing Early Adolescent Substance Use: A Family-Centered Strategy for the Public Middle School

The Adolescent Transitions Program (ATP) promotes student adjustment and reduces risk within a public school setting, focusing primarily on parenting practices using a tiered, multilevel prevention strategy. A description is given of the program, levels of engagement, and intervention effects. Within each school, multiethnic students (N = 672) and their families were randomly assigned at the individual level to a control condition or the ATP intervention. Analyses focus on the longitudinal effects of the ATP intervention on self-reported substance use through middle school and the 1st year of high school (Grades 6, 7, 8, and 9). Levels of engagement in the selected and indicated interventions were somewhat less than expected. Despite relatively low levels of engagement, the intervention reduced initiation of substance use in both at-risk and typically developing students. These findings are discussed with respect to lessons learned about parent engagement, optimizing strategies for schoolwide implementation, and the promise of embedding family interventions within the public school ecology.

Observation of client resistance

An observation system developed to measure client resistance was used to code videotaped therapy sessions at three phases of treatment for 27 families referred for child management problems. Resistance scores covaried with phase of treatment, probability of completing treatment, source of referral (i.e., agency vs. self), and therapist ratings of treatment outcome. The utility of a molecular coding system for quantifying client resistance in treatment and the construct validity of the observation system received moderate support.

Family-centered preventive intervention science: Toward benefits to larger populations of children, youth, and families

The field of family-centered preventive intervention science is well poised to seize an opportunity for larger-scale intervention implementation and greater public health impact. This opportunity has been created by earlier research in the areas of epidemiology, developmental etiology, and intervention outcome research. Both earlier and current research define a number of key tasks required to meet the many challenges involved in scaling-up for greater impact. Illustrations of how these tasks can be addressed are provided in articles on programs of family-centered research with infants, children, and adolescents. Each article in this special issue treats one or more tasks that concern (a) expansion of the set of rigorously evaluated, theory-driven interventions that have potential to reach large numbers of children, youth, and families; (b) effective strategies for family recruitment and retention; (c) cultural sensitivity of interventions; (d) application of a developmental life course perspective; (e) strategies for linking higher-risk population subgroups with potentially beneficial services; (f) improved diffusion mechanisms for sustained, quality delivery; and (g) policy making informed by research, including economic analysis. A summary of how articles address these tasks concludes with a discussion of the importance of futher strengthening a public service orientation in prevention science.

A multilevel approach to family-centered prevention in schools ☆: Process and outcome

The Adolescent Transitions Program (ATP) is a multilevel approach to family-based interventions within a middle-school setting. The intervention strategy is based on an ecological framework for studying social and emotional development in children and adolescents, emphasizing a network of contextual factors within which parenting is both directly and indirectly influential on the development of problem behavior. The ATP model includes a universal, selected, and indicated strategy for serving families with young adolescents. The model is designed to address the needs of families of young adolescents that present with a range of problem behavior and diverse developmental histories. The three interventions levels are described, and outcome data are presented, that support the effectiveness of the ATP model. This approach and the associated data are consistent with a broad literature supporting the effectiveness of family interventions, especially for high-risk youth. The effective implementation of family interventions within a school context suggests that these interventions can make a significant contribution to reducing problem behavior and substance use from a public health perspective.

An ecological approach to promoting early adolescent mental health and social adaptation: family-centered intervention in public middle schools.

This study examined the impact of the Family Check-Up (FCU) and linked intervention services on reducing health-risk behaviors and promoting social adaptation among middle school youth. A total of 593 students and their families were randomly assigned to receive either the intervention or middle school services as usual. Forty-two percent of intervention families engaged in the service and received the FCU. Using complier average causal effect analyses, engagement in the intervention moderated intervention outcomes. Families who engaged in the intervention had youth who reported lower rates of antisocial behavior and substance use over time than did a matched control sample. Results extend previous research indicating that a family-centered approach to supporting youth in the public school setting reduced the growth of antisocial behavior, alcohol use, tobacco use, and marijuana use throughout the middle school years.

A randomized, controlled trial of the family check-up model in public secondary schools: Examining links between parent engagement and substance use progressions from early adolescence to adulthood.

OBJECTIVE Substance use in adulthood compromises work, relationships, and health. Prevention strategies in early adolescence are designed to reduce substance use and progressions to problematic use by adulthood. This report examines the long-term effects of offering Family Check-up (FCU) at multiple time points in secondary education on the progression of substance use from age 11 to 23 years. METHOD Participants (N = 998; 472 females) were randomly assigned individuals to intervention or control in Grade 6 and offered a multilevel intervention that included a classroom-based intervention (universal), the FCU (selected), and tailored family management treatment (indicated). Among intervention families, 23% engaged in the selected and indicated levels during middle school. RESULTS Intention to treat analyses revealed that randomization to the FCU was associated with reduced growth in marijuana use (p < .05), but not alcohol and tobacco use. We also examined whether engagement in the voluntary FCU services moderated the effect of the intervention on substance use progressions using complier average causal effect (CACE) modeling, and found that engagement in the FCU services predicted reductions in alcohol, tobacco, and marijuana use by age 23. In comparing engagers with nonengagers: 70% versus 95% showed signs of alcohol abuse or dependence, 28% versus 61% showed signs of tobacco dependence, and 59% versus 84% showed signs of marijuana abuse or dependence. CONCLUSION Family interventions that are embedded within public school systems can reach high-risk students and families and prevent progressions from exploration to problematic substance use through early adulthood. (PsycINFO Database Record