No Effects - More than one study
Date: This profile was posted on February 27, 2012
An intensive family program for parents in methadone treatment and their children that combines relapse prevention, parenting skills training and home-based case management services. The program is rated No Effects. Although studies evaluating the effectiveness of the program on the behaviors of drug-using parents and their children showed some positive findings, the overall preponderance of evidence suggested null effects.
Program Goals/Target Population
Families Facing the Future (previously called Focus on Families) is an intensive family program for parents in methadone treatment and their children. It combines relapse prevention and parenting skills training with home-based case management services. Its goal is to address risk factors for relapse in addicts and risk and protective factors for future drug abuse and problem behaviors by their children.
The program is based on the Social Development Model (Catalano and Hawkins 1996), which organizes empirical information on risk and protective factors into a development theory of antisocial behavior. Families Facing the Future specifically addresses risk factors related to relapse among opiate addicts as well as risk and protective factors associated with drug use among their children.
The parenting skill training consists of 53 hours of training in small groups of 6 to 10 families. There is an initial 5-hour family retreat, with parents and children attending, and 32 ninety-minute meetings twice a week. Children attend 12 sessions so parents can practice skills while their children are supervised. Trainers with master’s-level experience lead the meetings and follow a curriculum created for the program. The curriculum incorporates motivation, discussion, modeling, guided practice, independent practice, and generalization. Parents are trained on skills such as:
- Relapse prevention and coping
- Anger management
- Child development and communication skills
- Holding family meetings
- Setting clear expectations of children
- Use of appropriate rewards and disciplinary consequences
The complete home-based case management component lasts about 9 months. It begins 1 month before the start of the parent training sessions and continues while parents are participating in the training meetings and for 4 months afterward. Visits are about 90 minutes once a week, plus two phone calls each week. With case managers’ assistance, families set goals, monitor progress toward the goals, and reinforce skills learned in the parent training meetings. Case managers help families hold family meetings, increase opportunities for positive family involvement, and promote opportunities for positive activities for children outside of the family.
Although studies evaluating the effectiveness of Families Facing the Future on the behaviors of drug-using parents and their children showed some positive findings, the overall preponderance of evidence suggested null effects.
Parent Problem-Solving Skills
Catalano and colleagues (1999) found no significant differences between groups on problem-solving skills at the 6-month follow-up. That changed at the 12-month follow-up, where treatment participants showed significantly better problem-solving skills—specifically for drug-related role-play situations—than participants in the control group. No significant difference was found for nondrug-related role-play situations.
Parent-Reported Family Cohesion
There were no significant differences in family bonding or conflict at the 6-month follow-up. At the 12-month follow-up, however, treatment participants reported significantly less domestic conflict and scored significantly higher on the nine-item scale of household rules.
Parent Drug Use
No significant differences were found for drug use (including marijuana, cocaine, and heroin) at the 6-month follow-up. Participants reported significantly less heroin use at the 12-month follow-up but there were no significant differences found for marijuana and cocaine.
Analysis on prevalence of drug use (including marijuana, cocaine, and heroin) was not significant at the 6-month follow-up. At 12 months, treatment participants were less likely to be using cocaine compared with control participants but there were no significant differences found for prevalence of marijuana and heroin use.
Child Problem Behaviors
There were no significant differences found for problem behaviors, negative peer networks, and delinquency.
Child Family Involvement
There was an age-by-group assignment interaction at the 6-month follow-up, showing that older children in the treatment group engaged in significantly fewer activities with their parents, while younger children in the same group engaged in significantly more activities with their parents.
Child Drug Use
No significant differences were found for child drug use, although the direction of differences favored the treatment group.
Reduced Drug Use
Haggerty and colleagues (2008) found no significant difference between treatment and control groups on any substance use, nor for alcohol, marijuana, cocaine, amphetamines, and opiates when analyzed separately.
Age Interaction on Reduced Drug Use
There were no significant interactions by age on occurrence of substance use disorders.
Gender Interaction on Reduced Drug Use
Looking at the entire sample, male study participants were three times as likely to develop an alcohol use disorder and twice as likely to develop a marijuana use disorder, compared with female participants. Males in the treatment group were at significantly less risk for any substance use disorder, compared with the male control participants. Female treatment participants had indicated a higher risk of substance use disorders, but the result was not significant. Treatment males were significantly less likely than control group males to develop alcohol and marijuana disorders. Treatment females had a higher likelihood of developing a substance use disorder; however, this was not significant.
Catalano and colleagues (1999) used a randomized experimental design to evaluate the effect of Families Facing the Future (known at the time as Focus on Families) on parental drug use and the prevention of drug use by their children. Participants were recruited while in two methadone clinics in Seattle, WA. To be eligible for the study, participants had to have been in treatment for at least 90 days, have at least one child between the ages of 3 and 14 who lived with them at least 50 percent of the time, and live within 25 miles of the methadone clinic. One hundred and thirty families enrolled and were randomized into treatment (n=75) or control (n=55) groups. One hundred and forty-four methadone-treated parents and 178 children (treatment n=97, control n=81) were included in the 130 families. Families in the treatment group received methadone services plus the supplemental Families Facing the Future services, while families in the control received methadone services with no supplemental services. Standard methadone services included methadone dispensing and some individual and group counseling.
Participating parents were mostly white (77 percent), female (75 percent), between the ages of 29 and 41, and longtime opiate users (15 years or more). While 60 percent of the parents lived with their partner or spouse, only 20 percent were married. A little more than half (54 percent) of the parents reported any illicit drug use in the month before baseline. Parents had spent an average of 15 months in methadone treatment before enrollment. Sixty-eight percent of the parents had been incarcerated at some point in their lives, and 66 percent had been unemployed in the last 3 months before their participation. Participating children were ages 8 to 12. Families were blocked on race, parents’ age at first drug use, whether parents lived with a spouse or partner, and ages of children before randomization. There was no significant difference between treatment and control groups at baseline. A higher proportion of eligible families were recruited to the treatment group because of attrition concerns. The attrition rate for parents and children was highest at the 12-month follow-up, with the study losing 8 percent of parents and 13 percent of the children. Attrition did not differ significantly by groups.
Parents were assessed at baseline, posttest, 6 months, and 12 months. Children were assessed at baseline, 6 months, and 12 months. Developmentally appropriate interviews were used for the age groups 6–8, 9–10, and 11 and older based on age at time of interview. Data was presented for children in the 9–10 and 11 and older groups. Responses for younger participants were included for questions common to those asked of the older children. Measures looked at family cohesion, problem behavior among parents and children as well as risk and protective factors for drug abuse in children. Problem-solving skills were measured using the Problem Situation Inventory. Twenty-five percent of the participating parents were randomly picked to provide a urine sample to test the validity of self-reported drug use. There were few false negatives, and there was no significant difference between false negatives in the treatment and control groups. Outcomes were examined using analysis of covariance and logistic regression.
Haggerty and colleagues (2008) conducted a follow-up of the Catalano and colleagues’ 1999 study and looked at the impacts 12 to 15 years after initial participation. Of the original sample, evaluators were able to locate 151 children. Since the sample was of families and included siblings, researchers randomly selected one child from each family to include in their analysis, leaving a total final sample of 126 children at follow-up (treatment=71, control=55).
At follow-up, children were mostly male (55 percent) and were ages 15 to 29, with an average age of 22. There were significantly more white children in the treatment group (67 percent) than in the control group (48 percent), despite parents’ being blocked on race during the original randomization. Mortality rates (added as a control variable) were significantly higher for parents of the intervention group (32 percent) than for the control (13 percent).
Substance abuse disorders as described by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were measured using the Composite International Diagnostic Interview. Evaluators used a Cox proportional hazard model to assess the outcomes, and an intent-to-treat analysis was conducted. Researchers examined the possible interactions that age and gender had on the impact of the intervention.
There is no cost information available for this program.
Evidence-Base (Studies Reviewed)
These sources were used in the development of the program profile:Study 1Catalano, Richard F., Randy R. Gainey, Charles B. Fleming, Kevin P. Haggerty, and Norman O. Johnson. 1999. “An Experimental Intervention With Families of Substance Abusers: One-Year Follow-Up of the Focus on Families Project.” Addiction 94(2):241–54.Study 2Haggerty, Kevin P., Martie L. Skinner, Charles B. Fleming, Randy R. Gainey, and Richard F. Catalano. 2008. “Long-Term Effects of the Focus on Families Project on Substance Use Disorders Among Children of Parents in Methadone Treatment.” Addiction 103:2008–16.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728465/
These sources were used in the development of the program profile:Catalano, Richard F., J. David Hawkins. 1996. “The Social Development Model: A Theory of Antisocial Behavior.” In J. David Hawkins (ed.). Delinquency and Crime: Current Theories. New York, N.Y.: Cambridge University Press, 149–97.Families Facing the Future. N.d. “Families Facing the Future.” Seattle, Wash.: Social Development Research Group. http://www.sdrg.org/fffsummary.aspGainey, Randy R., Kevin P. Haggerty, Charles B. Fleming, and Richard F. Catalano. 2007. “Teaching Parenting Skills in a Methadone Treatment Setting.” Social Work Research 31(3):185–90.
Haggerty, Kevin P., Charles B. Fleming, Richard F. Catalano, Renee S. Petrie, Ronald J. Rubin, and Mary H. Grassley. 2008. “Ten Years Later: Locating and Interviewing Children of Drug Abusers.” Evaluation and Program Planning
31:1–9.Skinner, Martie L., Kevin P. Haggerty, Charles B. Fleming, and Richard F. Catalano. 2009. “Predicting Functional Resilience Among Young-Adult Children of Opiate-Dependent Parents.” Journal of Adolescent Health 44:283–90.