Strengthening Families and Protecting Children from Substance Abuse

Section III - Guidelines for Implementing Family-Based programs

Providing Leadership
Carrying Out Strategic Planning
Collaborating Across Agencies to Marshal Community Resources
Attending to Cultural Traditions
Selecting Sponsoring Agencies and Sites
Promoting the Program
Preparing Staff
Recruiting and Retaining Families
Building Partnerships Among Prevention Practitioners and Researchers

Whether you are a local or state planner or a local practitioner, you face many of the same implementation issues that challenged developers of family-based programs: how to provide leadership to a new program, involve families, prepare staff, and promote the program in the community.

The following nine guidelines speak to a key task specified in theCAPT framework: implement,as part of the strategic planning process. They represent recommendations, drawn from across science-based programs and EDC's experience in implementing local programs, that can assist you in adapting or designing a family-based program that will meet local needs and draw on the strengths and resources of staff, agencies, and the community as a whole.

• Providing leadership
• Carrying out strategic planning
• Collaborating across agencies to marshal community resources
• Attending to cultural traditions
• Selecting sponsoring agencies and sites
• Recruiting and retaining families
• Promoting the program
• Preparing staff
• Building partnerships among prevention practitioners and researchers

PROVIDING LEADERSHIP

Behind most successful programs is a "champion" who is committed to bringing about change at the local level. This may be the agency director, a board member, or a staff person determined to institute a new effort and adept at working with a team through the following steps, which are necessary to institute a new effort:

Enlist key people and draw from their strengths.

A mix of staff skills will be needed to decide on the design, adaptation, or adoption of a science-based program; to select program sites and promote the program; to recruit families; to train staff; and to maintain liaisons with other agencies and organizations in the community.Success depends on finding staff with the right skills and matching them to the tasks. Effective leaders provide the right degree of guidance and then allow their staff to take ownership of the work to be done.

Develop organizational practices and policies and implement a systems-focused approach.

As part of setting up a family-based program, it is important to review and articulate what the agency believes and how it operates. Be certain to become familiar with relevant policies that will affect the program, and consider any others that may need to be established. Establish internal systems for addressing such issues as policies on overall confidentiality and legal requirements for reporting child abuse. Systems for ensuring good communications, supervision, and record-keeping will also contribute to the smooth implementation of the program.

Communicate effectively with staff, parents, and the community at large.

In addition to working directly with client families, it is important to communicate plans and developments about the program with other staff in the agency and the wider community of parents, especially those in a position to voice support for the program or to be involved in future recruitment. It is also valuable to maintain communication with other agencies and organizations in the community. (See Promoting the Program).

CARRYING OUT STRATEGIC PLANNING"CARRYING OUT STRATEGIC PLANNING">CARRYING OUT STRATEGIC PLANNING

Programs tend to be most effective when communities engage in a rigorous strategic planning process that focuses on assessment, design, implementation, and evaluation (see again the CAPT framework).

• Base your program on a thorough assessment of objective data about the substance abuse needs and assets in the community you serve.
• Establish a set of measurable outcomes that are supported by clearly defined goals and activities.
• Establish corresponding short-term outcomes to serve as proximal measures of success.
• Design and implement activities to achieve those outcomes, based on research or evaluation demonstrating that the strategies used prevent or reduce substance abuse, violence, or disruptive behavior among youth.
• Evaluate your program periodically to assess progress toward achieving short- or long-term outcomes; use evaluation results to refine, improve, and strengthen your program; and refine goals and objectives appropriately.

COLLABORATING ACROSS AGENCIES TO MARSHAL COMMUNITY RESOURCES

Practitioners who work with families can increase the impact of their own services by creating informal partnerships or more formal collaborations with other agencies. Joining together offers opportunities for several community partners to work in a coordinated way on more broad-based prevention efforts and get "on the same page" in terms of delivering science-based prevention messages. Collaboration at the local level (as agencies or at the national level) can help avoid duplication of efforts and wasteful use of scarce resources, and can enhance the training and services provided directly to families.

Sell the idea of collaboration at different levels:

Sell it to your board, staff, parents, and the staff from other agencies. Together, you can address some challenges common to all collaborations. Are the players speaking the same language? Is the level of commitment there? Is there constituent support for the collaboration? Are parallel systems in place? Specify the benefits. By creating links with schools, for instance, you may create a more community-centered program and avoid overlap, duplication, or usurping of existing activities.

Build links with health and social service agencies.

Families in crisis may need numerous health and social services, sometimes when they are least able to find and access them on their own. Often the services they need are fragmented. Families who find they must work with several provider representatives, filling out duplicative, agency-specific paperwork, may be less receptive to prevention strategies. Interagency collaboration and coordination and integrated case management are essential. By inviting important partners to the table, you can begin the process of writing formal and informal agreements. A special contract or some other mechanism is necessary to spell out roles and services such as joint referral, intake, and assessment procedures. Any effort you can make to simplify the process can help families in crisis obtain the services they need and make them more confident in your ability to help them in other ways. As partnerships become more established, regular multidisciplinary interagency trainings can be helpful.

Seek the cooperation and support of agencies that may have a legal mandate for specific youth.

This is especially important in planning programs that target youth and families at high risk. By collaborating with juvenile justice, social welfare, and mental health agencies, as well as the schools and family court, you can maximize the benefits that your own family-based program offers.

Work to integrate family-based approaches into other substance abuse programs.

For example, if your agency collaborates with the school district, you can help design school-based interventions that will include a parent and family-skills training component. A multiservice agency might provide parent-training classes in conjunction with the PTO and provide ongoing support and services to parents in need.

Recruit neighborhood-based family workers to form a bridge between agencies and families.

Neighborhood-based workers can help families interact with agencies and manage the services received; they also provide ongoing emotional support and a consistent flow of accurate information. They can help providers form alliances with formal and informal support networks in the community, which in turn can strengthen family functioning.

Try to ensure that families. basic needs are met before, during, and after intervention.

Prevention strategies are not likely to succeed for families who are preoccupied with immediate worries about food, shelter, employment, literacy, and physical and mental health. Help families access these services through links with programs in your organization or other organizations. Other, auxiliary services such as student counseling, psychiatric interventions, self-help programs, and other educational services can help sustain behavioral changes over time.

Address multiple family and community contexts, such as reducing social isolation, building peer-support networks, and increasing awareness of community resources, as well as teaching parents skills for coping with depression and parenting stress.

ATTENDING TO CULTURAL TRADITIONS

Practitioners need to understand the ways in which culturally based beliefs affect the conversations that take place. The meaning inherent in the messages conveyed is rooted in culturally based beliefs, values, and assumptions.^[55] Culture—as much as language differences. can disrupt interactions between family members and practitioners. Culture can also serve as the core around which to initiate changes in family dynamics and roles. For example, it is deeply ingrained in the Hispanic heritage that the family is the basic building block of the Hispanic culture. Because Hispanics are so strongly oriented toward relating, interventions can usefully focus on changing the nature of relationships.^[56]  Here are some guidelines to consider:

Begin by knowing yourself.

Being clear about your own assumptions, expectations, and limitations (or at least being willing to examine them in the light of other information) can help bridge the cultural communication gap. Otherwise, the temptation is strong for people to jump to conclusions quickly on the basis of the cultural and personal frame of reference they know best.^[57]

Understand the cultural values, beliefs, and traditions of the families you serve.

Look for opportunities to be mindful of cultural traditions in many of the program decisions you make. For instance, traditionally, who is seen as the main caregiver? What is the cultural attitude toward conflict? Is it the expectation that the program leader will be "reflective" or take an active role in suggesting change? Families will benefit from culturally relevant parenting and family programs developed specifically for them. In all cultures, there is also wide variation among different families. As you consider other elements, from program location to outreach and promotion, you will want to be sensitive to the needs of clients and familiar with the resources available in the community where they live. You will want to work with the families you serve to understand their values and traditions.

Think about the experience and ethnicity of the trainer or facilitator.

Many program designers find it helpful to match participants and trainers or caseworkers as closely as possible in terms of ethnicity and cultural background. Trainers can then modify language, examples, and exercises so that they are appropriate to the local culture. When this is not possible, empathy for and understanding of the customs of a group of participants become paramount.

Tailor family-based interventions to the cultural traditions of the families involved.

This improves recruitment, retention, and outcome effectiveness.^[58] Find ways to make role plays, case scenarios, and other types of exercises relevant to the participants; for instance, having a role play where a father comes home drunk and late for dinner that was prepared by the mother may not be relevant for single mothers.^[59] Be sensitive to families. existing beliefs and honor them; do not expect families to throw away an entire belief system about child rearing, but work with that system to move one step at a time in a more productive direction. Also be aware that there may be unintended effects of delivering a program designed for one population to a quite different ethnic group: subtle differences in assumptions or traditions may bring about results different from what was intended.

Recognize that very rural as well as very urban areas may have specific cultures,independent of a particular ethnicity, race, or religion.

In rural areas, for example, families may not always have telephones or reliable transportation; they often operate from a strong ethic of "making do" without help from outsiders. A program for this audience would need to acknowledge and work with those realities and build on the strengths that are present.

Understand that for some parents the tradition and the norm may run counter to accepted prevention practice.

For some parents, the practice of using physical punishment and chastising children frequently is one way to demonstrate that parents have extremely high expectations for their children's performance. For others, use of tobacco and particular drugs may have deep traditional and spiritual meaning. Such differences in cultural ideas, along with a lack of understanding of the psychological principles underlying family-based programs, may cause parents in families at high risk to actively reject the underlying assumptions of intervention efforts or not to take the time to really understand them.^[60]

SELECTING SPONSORING AGENCIES AND SITES">SELECTING SPONSORING AGENCIES AND SITES

Collaboration can also help you select the right implementation site. It helps if parents and the community already know and respect the sponsoring agency and look to it for guidance. The agency should have a reputation for being parent friendly (as opposed to one, for instance, that investigates families).

Try to conduct prevention programs in settings and locations that are comfortable, natural, and easily accessible to parents and children.

While a treatment or mental health center may develop and sponsor a family-based program, its own facilities may not be the best location or may not offer space that is most conducive to success. It is ideal if you can bring the intervention to the target populations, using their workplaces, homes (including family support centers in public-housing communities), churches, and community centers.

Consider carefully whether the school is the right setting.

For rural families especially, using local schools as sites may reduce the distance families need to travel to participate in a program. In any community, conducting a program in a school may increase the involvement of school staff and improve communication between parents and the school. The school may be a particularly suitable setting when children are in preschool or elementary grades because parents tend to be in the school more frequently when the children are young. When children are in high school, however, it may be less common to find parents in the school. For some families at high risk, memories of difficult meetings or conversations that took place at the school may make this setting problematic. A space that is more neutral may be more effective in drawing and keeping families in the program.

PROMOTING THE PROGRAM

Family-based interventions can be more easily integrated into the community if you seek community support from the beginning. Community outreach can educate important community leaders, such as clergy, physicians, and educators, about the program and its purpose. Here are some ideas to use in promoting your program:

Conduct focus groups of potential clients.

This will serve to inform your program design and at the same time begin to inform the community about the program.

The connections you have with other groups can help you publicize your program. Think about developing a coordinated set of promotional materials to use with different media; then approach other agencies and organizations to explore how they can help disseminate your information through their newsletters, bulletins, bulletin boards, and letters tailored to individuals or groups of individuals. Personal word of mouth is also very powerful. Involving the staff of your agency and others in speaking engagements and drawing on personal contacts to get the message across to individual families can be extremely effective ways to promote the program.

Develop multilingual outreach materials.

If your audience's primary language is not English, you may need additional materials for recruitment and promotion. Make outreach materials user friendly. Use graphics on brochures; think about appropriate language level and cultural sensitivity. In communicating ideas about the program, try to use language that is neutral or positive: the phrase "parent training" may have a negative connotation for some parents.

Hold a block party or a series of coffee klatches.

Informal meetings with families and with neighborhood leaders can help provide a wider base of support for your effort.

Consider establishing a parent advisory group.

It can provide ongoing communication between parents and the sponsoring agency; it can build an ongoing involvement of the target audience and offer a mechanism for two-way communication when issues arise.

Contact local Head Start and other early childhood education centers.

Head Start, the largest family-development program in the country, has a long-standing commitment to strengthening the entire family, not only providing services to children. Head Start families may be interested in knowing about your program, as may parents in other day care, childcare, and early childhood programs.

Link with business associations, the chamber of commerce, Rotary, unions, and/or professional associations.

If you will conduct your program, or part of it, in workplace settings, professional and business connections such as these offer ways to get the word out, in print and in person.

Promote the program in local media.

Posters on buses, local radio announcements, and notices in local community newspapers can spread the message broadly. Once the program is established, you may want to do an interview about the program and its impact (while maintaining client confidentiality) and publish it locally, or consider having a central staff person appear in a local cable TV show.

Coach your own staff carefully if they are going to speak for the program.

Select other prevention experts carefully as well. Individuals involved in community education need to remember not to present themselves as authorities who identify problems in others and provide the answers "from above." They need to assume the role of information providers and resource experts. In this role, they can provide information on a range of health and mental health issues; teach families to recognize when a problem requires professional attention; provide information on options and resources in the community; and teach families how to gain access to resources.

PREPARING STAFF

Training for staff who will work directly with families is an essential part of program planning. If you are adopting an existing family-based prevention program, it may require that your local staff be trained directly by trainers certified by that program. In other cases, local leaders may undertake the task of providing the necessary training.

Training should be relevant to the staff's needs, both identified and perceived, and should be presented in a planned way and in a professional context. During effective training, staff will develop a feel for the program; get feedback on how to improve their delivery of the program elements; experience all the program sessions; and discuss and role-play possible implementation problems and their solutions. Here are some guidelines to consider

Select good candidates.

Recruit staff who listen well, ask good questions, and avoid being judgmental or hostile. They should be warm, parent friendly, and nonblaming, and able to model the parenting skills they are teaching, in their home and work lives. Staff who will work directly with families will need experience in facilitating groups and processing events as they occur, as well as experience in the specific skills the program seeks. In some cases, they will need well-developed clinical skills.

From many years of designing and conducting training programs, we know that certain personal qualities, skills, and professional credentials are essential. Effective trainers need to be:

• respectful of and able to relate to people of varied cultural and religious backgrounds
• committed to parents. rights as primary educators of their children
• aware of the community's needs
• nonjudgmental, flexible, and reliable
• able to facilitate open and honest discussions rather than instruct in a didactic way
• enthusiastic, with a sense of humor
• able to show a comfort level with sensitive issues
• clear communicators
• knowledgeable, with accurate and up-to-date information
• careful about details
• able to act as caring, sensitive, and empathetic listeners
• knowledgeable about legal responsibilities for protecting youth
• able to develop organizational support
• seen as credible by parents and other community members

It is ideal if you can match staff closely to training participants in ethnicity and cultural background. In any case, potential staff need to be perceived as credible sources of information, known and trusted in the community.

Conduct Needs Assessment.

Before designing a training, learn what areas of strength the trainers bring and in what areas they will need extra support.This will help you set concrete goals and objectives for the training and identify the resources, supplies, and personnel needed to meet them. It will be important to know, for instance, if staff members are familiar with agency policies and procedures or if they are new and will need to learn about these as well as the program.

Apply principles of adult learning theory.

The staff you are training will learn best (1) when they are treated as equals; (2) when learning incorporates their previous experiences, knowledge, and skills and supports their values; and (3) when they are actively involved. The process of gaining expertise, while exciting, involves several stages:^[61]

Initiation:

At the outset, staff will know little or nothing about the program and will want to learn about it. what they need to have and do to be able to use it, what kind of support they will receive, and how committed the agency is to its use. Training for staff at this stage should provide descriptions of the program, opportunities to ask questions, and demonstrations of commitment from the agency.

Implementation:

Before implementing a program, staff need to learn and practice the skills involved in carrying it out. Training helps staff to develop any new skills required and to practice and review existing skills. It allows them to experience specific activities and anticipate and solve implementation problems.

Institutionalization:

As staff apply the strategies of a family-based program, they need continued supervision and support, such as opportunities for sharing ideas through get-togethers, meetings, or conferences that enhance staff skills and relevant knowledge.

Design effective training activities

Training for professionals needs to include a mix of activities that provide participants with the opportunity to:

• listen to and learn new information (through didactic presentations)
• analyze and discuss new learnings (through paper-and-pencil exercises and small-group discussions)
• observe new skills, especially interactive skills (through observation, fishbowl exercises, videotapes)
• practice new skills (imitation and role play)
• debrief the practice and receive corrective feedback (through small-group discussions)
• apply new skills to new situations (through simulations)

Social learning theory stresses that people learn by seeing others model particular behaviors and values. For practitioners, it is critical that training in family-based strategies include chances to observe, model, and analyze particular skills needed to interact with families.

Address attitudes and possible biases of staff.

Staff who deliver the programs influence the individuals and families with whom they work through their own attitudes and behaviors. Their manner in speaking to individuals expresses their respect or disrespect, for instance. An attitude that expresses the belief that parents can be successful in making changes and that the program is a collaborator in the process can help retain families in the program. Insensitivity to a parent's situation or to an entire family. s culture, on the other hand, can destroy the work of the program for that individual or family. Staff comfort level with the topics, their communication skills, and their ability to improvise rapidly when something unexpected occurs are all critical to program success. When staff recognize their own concerns or problems, they can more successfully work with the program material.

Use care in addressing sensitive issues.

Certain topics, situations, discussions, or questions may cause feelings of embarrassment among clients: the possibility of domestic or child abuse, for example, or discussions of family planning. In preparing staff to confront such challenges effectively, emphasize that people react differently when they feel embarrassed. Some blush and withdraw; others may laugh, become sarcastic, or even disruptive. Encourage training participants to first recognize their feelings of embarrassment and to manage them in ways that do not interfere with others in the training. When staff recognize their own concerns or problems, they can more successfully work with clients in a professional way when these matters arise during family-based programs.

RECRUITING AND RETAINING FAMILIES

Research demonstrates that parents of children with conduct problems, even those with multiple problems, are often successfully retained in parent training, despite the conventional wisdom among prevention specialists that retention is nearly impossible. It may be because parents view the program as a helpful and acceptable form of intervention or because the program increases their sense of hope and competence.

Successful recruitment begins when you promote the program in ways that create a climate of support and select a site that is accessible to families (geographically convenient and psychologically accessible). Here are some additional steps that can help keep families in the program:

Train neighborhood and community volunteers to give lectures on depression, anxiety, and child problem behaviors.

Topics such as these, which can have strong appeal for families and provide value in their own right, also offer a bridge to the challenging topic of substance abuse. Offered in collaboration with churches, schools, and community centers, such outreach activities can serve as a way to recruit families into programs.

Encourage families to become partners in any assessment of family needs in the community.

Focus assessments and service plans not only on problems but also on the strengths, competencies, and capabilities that help the family survive. When evaluating family strengths, include the family's readiness to change and the parents. ability to invest in learning parenting skills. Assessment should include a family's perspectives on the nature of the problems and on ways in which those problems could be solved, and should reflect the family's perceptions of its goals, objectives, and timelines. Including the family in this process is in itself an intervention that can increase families. ability to take stock of problems around them and make decisions.

Make parents feels that they are part of a community effort to address a community-wide problem.

Some effective strategies include asking community members to make personal contact with others within an ethnic or neighborhood group; using male staff to contact men in targeted families; and inviting participants by using local meeting places such as churches, other faith-based organized organizations, social groups, and schools. Get fathers involved as well as uncles, older brothers, and grandfathers. Traditionally, it is women who attend parenting programs. Use outreach strategies to get the men. as well as other significant family members. involved. Where possible, invite all household caregivers to participate. Include families in planning, decision making, and problem solving

Make family-based interventions more attractive and accessible by providing vital auxiliary services that remove barriers to participation.

For example, transportation barriers can be addressed by providing bus tokens or arranging carpools or van pickups and helping families get transportation with other families as well as childcare and meals. Food can be a good incentive; if the session is scheduled at a mealtime, whole families can be fed. One program center added a washer and dryer. Translation services may be key in some situations.

Provide mechanisms for families to be in contact with one another outside of program time.

Offer social mixing activities, interspersed with the actual program. Provide activities that are fun. Sometimes programs begin with a group picnic or outing that makes connections so that family members feel comfortable together before they start the scheduled skill-building activities. Between sessions, staff sometimes use phone calls, send meeting reminder notices, or publish a newsletter to maintain contact with families.

Consider incentives that can encourage families to show up consistently.

Programs have used door prizes; tickets for sporting, cultural, and educational events; household items; children's toys or holiday gifts; recreational activities for adolescents; support or tutoring groups for older siblings; and even cash—$10 if parents make it to four out of six sessions, for instance, or $10 for a visit at home. Sometimes programs increase the incentive if families show up for a certain number of sessions in a row. Help with clothing or home repairs may also act as inducements to participate.

Work toward flexibility in scheduling.

If a family misses a few sessions, flexibility in scheduling makeup classes can make the difference in whether the family drops out altogether or stays in the program. When scheduling in-family support home visits, be flexible about the time of day and day of the week. Make sure that staff understand they will need to work evenings and Saturdays.

BUILDING PARTNERSHIPS AMONG PREVENTION PRACTITIONERS AND RESEARCHERS

Local practitioners may also act as researchers, applying their immediate and relevant knowledge in a systematic way that contributes to the science base of the field as a whole. There is a tremendous need to build and sustain active partnerships among prevention practitioners and researchers. Both groups have skills, knowledge, and expertise to share.

Researchers benefit from knowing the practical steps that practitioners take to address core implementation issues. If advances in knowledge are to be made, researchers need the help of practitioners in designing and implementing studies that capitalize not only on their valuable input but also on that of community experts, residents, and parents. Researchers, for their part, continue to seek answers to the many questions that challenge the practitioner in designing and implementing prevention programs.

Practitioners need to receive recognition for what they know. They need training to make their own field conversations and observations, reflections, and documentation more rigorous, purposeful, thoughtful, and meaningful to themselves and to their program evaluation. Practitioners can and should be trained to collect information from the field in a systematic, organized, and consistent way. Finally, they should be trained to narrate this extremely valuable information in ways that satisfy funders and policymakers.^[62]

Program designers, whether at the regional level within a state or at the local level, can benefit from having a systematic evaluation, one that uses methods and techniques that are designed to increase the certainty about the validity of the judgments made about the program. There are a number of reasons for conducting an evaluation:^[63]

• to determine how well the program works (outcome evaluation)
• to determine if the program was implemented as planned (process evaluation)
• to meet the funder's requirement for evaluation
• to increase the program's appeal to potential funders
• to test (and improve) the efficacy or efficiency of program components
• to address political controversy or public concern

In summary, these nine guidelines can be applied to local program design that can benefit families in the community. The main focus of family-based prevention strategies is to strengthen families; alter existing patterns of behaviors in ways that enhance children. s abilities and skills; and decrease the risk factors and increase the protective factors that can buffer children from substance abuse as they grow older. Practitioners, furthermore, can apply knowledge from community systems theory and environmental change theory to enhance the ways in which they work together to improve the dynamics of individual families, and to bring about changes in family climate and the larger environment.