Marjorie Gutman, Renu Mittal, Carol Foltz,

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Philadelphia Strengthening Families Project
Feasibility and Effectiveness
Marjorie Gutman, Renu Mittal, Carol Foltz,
A. Thomas McLellan Karol Kaltenbach
Treatment Research Institute University of
Pennsylvania Supported by The Center for
Substance Abuse Prevention
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Background

• SFP shown effective in original random assignment
  study with mainly Euro-American families with
  parent in SA treatment.
• Several non-random published studies since have
  shown positive results with other racial/ethnic
  groups.
• One published study with urban, AA families in
  residential treatment indicated positive results.
  

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Aim Research Questions

• Extend the one published study of SFP with urban,
  African-American families to outpatient substance
  abuse treatment setting (80).
• How feasible is implementation of the SFP with
  clients in outpatient substance abuse treatment?
• Is the SFP effective with parents in outpatient
  treatment and their children?

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Hypotheses
Compared to those who do not receive SFP
(substance abuse treatment only) --

• Mothers who receive SFP will have higher
  parenting skills.
• Families who receive SFP will have more positive
  family environment.
• Children who receive SFP will demonstrate
• Higher prosocial skills
• Lower problem behaviors
• Lower intentions to use alcohol, tobacco,
  cannabis and inhalants.
• Fewer of them will initiate use of alcohol,
  tobacco, cannabis and inhalants.

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SFP Intervention

• Family skills training model for substance abuse
  involved families
• Children 6-12 years old and parent(s)
• Group 6-10 families
• 14 sessions once per week, 3 hours
• Parent and child sessions separately and together

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SFP Skills Training Areas

• MOTHERS
• Communication skills
• Positive involvement
• Positive discipline
• Behavior management (set objectives, set up do
  rewards)
• Family meetings
• Set rules and routines
• Developmentally- appropriate expectations
• Effects of addiction

• CHILDREN
• Communication skills
• Problem solving skills
• Asking for help
• Coping with feelings

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Methods

• Quasi-experimental design
• 6 similar outpatient tx programs
• -- 3 in intervention
• -- 3 in comparison
• Repeated interviews Baseline,
• 4 months and 10 months
• Sample
• 193 mother/child pairs
• In treatment any duration
• (mean 205 d (125)
• Child 6-11 yrs, living with
• mother at least part-time

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Implementation Analysis

• Recruitment and Enrollment
• 66.5 enrolled (of eligible)
• 13 refused
• 20.5 couldnt be located again
• Fidelity to SFP intervention
• ( of specific content delivered)
• (n103, 11 groups)
• Overall -- 86
• Per component -- at least 83
• Follow-up rate 93, 90

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Attendance Level (11 groups, n103)
Av. of session 7.89
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Statistical Analysis-- Outcomes

• Initial
• Measures check internal consistency (alpha)
• Comparability of intervention and comparison
  groups (t-tests, chi-square)
• Main and secondary analysis -- Repeated measures
  analysis using mixed effects models
• GEE for dichotomous outcomes
• 3 time points (B, 4m, 10m)
• Checked site effects none
• Control for Tx duration
• Dose-response analysis
• Number of SFP sessions as continuous variable
• N 103

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Outcome Measures
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Outcome Measures (secondary)
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Mothers Demographic Characteristics
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Child Characteristics
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Mothers Social and Mental Health Problems

Women



(30 Days)
p lt .05 p lt .01 p lt .001
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Mothers Substance Use




Women
(30 Days)
(30 Days)
(30 Days)
(Ever)
(Ever)
(Ever)
(Ever)
p lt .05 p lt .01 p lt .001
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Parenting Skills --Total
Av. Scale Score
TIMESFP F(2,172) 4.89, p 0.008 Cohens
Effect Size f .24 (med .25)
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Parenting Skills Consistency of Discipline
Av. Scale Score
TIMESFP F(2,172) 6.25, p 0.002 Cohens
Effect Size f .27 (med .25)
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Family Environment Level of Organization
Av. Scale Score
TIMESFP F(2,173) 3.24, p 0.04 Cohens
Effect Size f .19 (small .1, med .25)
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Summary/Conclusions

• SFP is feasible though challenging with this
  population urban AA women in outpatient
  treatment.
• Inconclusive results on effectiveness
• SFP improved parenting skills at
  post-intervention and maintained for 6 months.
• SFP improved one component of family environment
  level of organization at post-intervention and
  maintained for 6 months.
• No significant improvement in prosocial skills,
  child problem behaviors or school progress.
• Could not analyze change in child intention to or
  initiation of ATOD use.
• No positive results from dose-response
• analysis.

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Limitations/Future Directions

• Quasi-experimental design
• Child behavior and other variables based solely
  on mothers report and self-report.
• Lack of variance/low prevalence rate in child
  intentions to use and initiation of use.
• Secondary outcome mothers substance use
• Examine outcomes beyond 6 months
  post-intervention
• Increase potency of SFP for this population.