Effective - More than one study
Program Goals/Target Population
The Positive Family Support (PFS) program, formerly known as Adolescent Transitions Program (ATP), is a multilevel, family-centered intervention targeting children at risk for problem behaviors or substance use and their families. Designed to address family dynamics related to the risk of adolescent problem behavior, the program is delivered to parents and their children in a middle school setting. Parent-focused segments of PFS concentrate on developing family management skills such as making requests, using rewards, monitoring, making rules, providing reasonable consequences for rule violations, problem solving, and active listening.
The program’s intermediate goal is to improve parents’ family management and communication skills. The long-term goal is to hinder the development of adolescent antisocial behaviors and drug experimentation. To accomplish these goals, the intervention uses a “tiered” strategy and links universal, selected, and indicated intervention services available to families and youths. The PFS framework’s core feature is that specific intervention services are individually determined for each family in order to adapt the provided treatment to their needs and motivational levels. The program promotes self-selection of the most appropriate intervention services based on a systematic assessment of parent and child functioning.
PFS integrates universal, selected, and indicated family-centered strategies. Each level builds on the previous level. These tiers are also designed to dovetail and enhance (through family engagement and involvement) current school-wide behavior programs [e.g., Positive Behavioral Interventions and Supports (PBIS)] and other tiered intervention approaches (e.g., Response to Intervention).
Universal intervention. The universal level is directed to the parents of all students. This level’s goals include engaging parents, establishing norms for parenting practices, and disseminating information about risks for problem behaviors and substance use. At this level, a family resource center is established at participating middle schools to provide parent-centered services such as brief consultations or access to books and videotapes. A Parent Consultant is also available to parents who have concerns or interest in supporting their child’s adjustment to school. In addition, at the universal level, students are provided with six in-class lessons referred to as Success, Health, and Peace. This curriculum was modeled on the LifeSkills Training Program. The foci of the six sessions are:
Each week, an interactive parent–child homework activity that emphasizes and encourages family management is assigned. The universal intervention is designed to support positive parenting practices and engage parents of high-risk youths in the selected intervention.
- school success
- health decisions
- building positive peer groups
- the cycle of respect
- coping with stress and anger
- solving problems peacefully
Selected intervention. The second level of PFS engages the family in support of second tier school interventions such as PBIS’s Check-in/Check-out and also includes the Family Check-Up (FCU). The FCU is a brief, three-session family intervention that consists of an initial interview, an assessment session, and a motivational feedback session. During the initial interview, the therapist facilitates a discussion with parents about goals, concerns, and their personal motivation for change. The assessment session includes a short assessment packet, which is provided to the parents, child, and teacher, as well as a videotaped family interaction assessment (which is optional). Finally, during the feedback session, the therapist discusses results of the assessment in terms of providing motivation to change and identifying one or more intervention options from a family-centered intervention menu. The FCU is based on motivational interviewing techniques designed to enhance family engagement and stimulate the behavior change process (Miller and Rollnick 2002).
Indicated intervention. At the third level, direct professional support is provided to parents (based on the results of the FCU) through services including behavioral family therapy, monitoring systems for academic and social behavior, parenting groups, referral services, and case management services. Intervention options focus on three strategies:
Program activities are directed by parent consultants and can include parent group meetings, individual family meetings, as well as booster sessions, depending on the choices a family makes regarding services. Meetings and sessions may include discussion and practice of a targeted skill, group exercises (either oral or written, depending on group needs), role plays, and setting up home practice activities. Many of the skill-building exercises include activities for parents and children to complete together. Each curriculum also has six accompanying videotapes that demonstrate the program’s targeted skills and behaviors.
- using incentives and encouragement to promote positive behavior change
- limit setting and limit monitoring
- family communication and problem-solving skills
The curriculum for teens takes a social learning approach and concentrates on setting realistic goals for behavior change, defining reasonable steps to achieve goals, developing and providing peer support for prosocial and abstinent behavior, setting limits, and learning problem solving. Strategies targeting parents are based on research about the role of coercive parenting strategies in the development of youth problem behaviors.
Dishion and colleagues (2002) found that, by the first year of high school, Positive Family Support (PFS) was associated with a significant reduction in substance use initiation among at-risk and typically developing students, controlling for previous substance use in middle school. Students in the PFS treatment group reported significantly less substance use in grade nine than students in the control group.
Substance Use and Antisocial Behavior
Connell and colleagues (2007) found intervention status was significantly related to all diagnostic outcomes. This means the PFS intervention group reported significantly less use of tobacco, alcohol, and marijuana compared with the control group. In addition, the intervention group exhibited significantly less antisocial behavior compared with the control group.
Intervention status was also significantly related to the number of arrests from grades six to eleven. The PFS intervention group had significantly fewer arrests compared with the control group.
Dishion and colleagues (2002) examined the longitudinal effects of the Positive Family Support (PFS) program on self-reported substance use measures. Note that at the time of the evaluation, the program was called Adolescent Transitions Program, however it will be referred to as PFS as it is currently known. The study included sixth-grade students (n=672) (and their families) recruited from three middle schools within a metropolitan community. After receiving consent from parents, students were assigned randomly at the individual level to the PFS group (n=331) or control group (n=341).
The sample was 52.2 percent male and 41.4 percent European American, 32.3 percent African American, 7.3 percent Hispanic, 5.5 percent Asian, and 2.2 percent Native American (the remaining 11.3 percent was not reported in the study). There were no significant differences in demographic characteristics between the treatment and control groups.
Students were followed from grades six to nine (the first year of high school). Each year, student surveys were conducted primarily in the school setting. A brief teacher rating, the Teacher Perception of Risk (TRISK), was also collected for all students. If students left their original schools, they were followed to their new locations.
To recruit families for the PFS selected intervention, students were identified using the TRISK. Items from the TRISK were entered into a hierarchical cluster analysis to create an objective standard of risk for the study. Examination of the clusters indicated there were two groups of students that provided the best clustering strategy: at-risk (AR) students and typically developing (TD) students. In the treatment group, AR students made up 22.1 percent of the sample; in the control group, 20.4 percent were AR students. Although outcome results were presented separately for AR and TD students in the study, the underlying question about the program’s effect on substance use was comprehensively addressed.
The primary outcome of interest was substance use. In the yearly self-report survey, two questions were asked concerning substance use: 1) “How many cigarettes have you smoked, even a puff, in the last month?” and 2) “How many drinks of alcohol have you had in the last month?” The alcohol and tobacco use items were collapsed because of their low base rates, which were unreliable as dependent variables. The two items were aggregated by taking the maximum frequency for tobacco and alcohol use.
Outcome analyses were conducted using an intention-to-intervene strategy. Drug use by the intervention group in grade nine was examined using logistic regression, and controlled for substance use in grades six, seven, and eight.
Connell and colleagues (2007) examined PFS’s effect on substance use and antisocial behavior in students ages 11 to 17. The study included 998 adolescents (and their families) who were recruited in sixth grade from three middle schools within a metropolitan community in the Northwest region of the United States. Youths were randomized at the individual level to the PFS intervention group (n=500) or control group (n=498).
The sample was 52.7 percent male and 42.3 percent white, 29.1 percent African American, 6.8 percent Hispanic, 5.2 percent Asian American, and 16.4 percent of other ethnicities (including biracial). There were no significant differences in demographic characteristics between the treatment and control groups.
In the spring semester, from sixth through ninth grade and again in the eleventh grade, students were surveyed with an instrument developed by the study authors at the Oregon Research Institute. Each year, student surveys were conducted primarily in the school setting. If students left their original schools, they were followed to their new locations.
Primary outcomes of interest were adolescent substance use, problem behavior, and arrests. Youths completed a self-report survey about their drug use and antisocial behaviors at ages 11, 12, 13, 14, and 16–17. Students were asked to report the frequency with which they had used alcohol, tobacco, and marijuana in the previous month. Youths’ reports of engagement in problem behaviors were assessed by averaging across six items that measured the following: 1) lying to parents, 2) skipping school, 3) staying out all night without permission, 4) stealing, 5) panhandling, and 6) carrying a weapon. For measures of arrest, court records were searched for every county where youths said they had lived from age 11 to 16–17. Arrest was defined as a police contact for problem behavior regardless of adjudication.
The study used Complier Average Causal Effect analysis to examine program effects on outcome measures. A full description of this analytic strategy is available in the study (Connell et al. 2007:572).
The first year of training costs for the school-based Positive Family Support (PFS) is $19,100 exclusive of the readiness process and trainer travel costs. The travel costs for the trainers are approximately $2,500 for 2-day trainings (including airfare, hotel, and per diem). The initial site/setting readiness process costs $2,000. The total costs for year one of implementing the program would be about $23,600. For a school implementing the program for 500 students, this would cost about $47 per student.
Information on implementing the Positive Family Support (PFS), including information on training workshops, can be found on the University of Oregon’s Children and Family Center Web site
Evidence-Base (Studies Reviewed)
These sources were used in the development of the program profile:Study 1
Dishion, Thomas J., Kathryn Kavanagh, Alison Schneiger, Sarah Nelson, and Noah K. Kaufman. 2002. “Preventing Early Adolescent Substance Use: A Family-Centered Strategy for the Public Middle School.” Prevention Science
Connell, Arin M., Thomas J. Dishion, Miwa Yasui, and Kathryn Kavanagh. 2007. “An Adaptive Approach to Family Intervention: Linking Engagement in Family-Centered Intervention to Reductions in Adolescent Problem Behavior.” Journal of Consulting and Clinical Psychology
These sources were used in the development of the program profile:
Andrew, David W., and Thomas J. Dishion. 1995. “The Adolescent Transitions Program for High-Risk Teens and Their Parents: Toward a School-Based Intervention.” Education & Treatment of Children
Dishion, Thomas J., and David W. Andrews. 1995. “Preventing Escalation in Problem Behaviors With High-Risk Young Adolescents: Immediate and 1-Year Outcomes.” Journal of Consulting and Clinical Psychology
Dishion, Thomas J., David W. Andrews, Kate Kavanagh, and L.H. Soberman. 1996. “Preventive Interventions for High-Risk Youth: The Adolescent Transitions Program.” In Ray D. Peters and Robert J. McMahon (eds.). Preventing Childhood Disorders, Substance Abuse, and Delinquency
. Thousand Oaks, Calif.: Sage, 184–214.
Dishion, Thomas J., Joan McCord, and Francois Poulin. 1999. “When Interventions Harm: Peer Groups and Problem Behavior.” American Psychologist
Dishion, Thomas J. and Kathryn Kavanagh. 2000. “A Multilevel Approach to Family-Centered Prevention in Schools: Process and Outcome.” Addictive Behaviors
Irvine, A. Blair, Anthony Biglan, Keith Smolkowsk, Carol W. Metzler, and Dennis V. Ary. 1999. “The Effectiveness of a Parenting Skills Program for Parents of Middle School Students in Small Communities.” Journal of Consulting and Clinical Psychology
Miller, William, and Stephen Rollnick. 2002. Motivational Interviewing: Preparing People for Change
(2nd ed.). New York, N.Y.: Guilford Press.
Poulin, Francois, Thomas J. Dishion, and Bert Burraston. 2001. “3-Year Iatrogenic Effects Associated With Aggregating High-Risk Adolescents in Cognitive–Behavioral Preventive Interventions.” Applied Developmental Science
Stormshak, Elizabeth A., and Thomas J. Dishion. 2009. “A School-Based, Family-Centered Intervention to Prevent Substance Use: The Family Check-Up.” American Journal of Drug and Alcohol Abuse
Stormshak, Elizabeth A., Thomas J. Dishion, John Light, and Miwa Yasui. 2005. “Implementing Family-Centered Interventions Within the Public Middle School: Linking Service Delivery to Change in Student Problem Behavior.” Journal of Abnormal Child Psychology