Issues of Adaptation

1
Issues of Adaptation Fidelity in Strengthening
Families Program

• Karol L. Kumpfer, Ph.D.
• Associate Professor, University of Utah
• .

2
Background Strengthening Families Program (SFP)

• History
• 1st research-based prevention program designed
  for high-risk children of substance abusers and
  found effective on NIDA grant
• Many cultural adaptations developed on CSAP
  grants with positive effects
• Junior high SFP version found effective on NIDA
  and NIMH grants with long-term follow-up studies
• Two recent randomized trials show SFP effective
  for general families recruited from schools and
  communities.

3
SFP Family Skills Training Model
Family Style Meal
Child Group
Parent Group
1 Hour Simultaneously 1 Hour

• Childcare

2 Family Groups

• Transportation

• Improve Family Relations
• Increase Parenting Skills
• Increase Childrens Skills

Major Objectives
4
SFP Outcomes

• Reduced family conflict
• Increased family organization and cohesion
• Decreased childrens depression and conduct
  problems
• Increased school success/grades
• Reduced parent child AOD use

5
Successful Program Implementation

• Effective and well-trained leaders staff
• Sufficient resources
• incentives
• child care
• transportation
• food
• Interactive/experiential techniques
• Booster or reunion sessions

6
Essential Core Components

• All Skills Courses Parent, Child, Family Skills
  Training (determined by dismantling design)
• All 14 Sessions in right order (determined by
  CSAP adaptation studies when order was changed
  results were worse compared to original SFP
  order)
• Supporting Components
• Meal
• Child Care
• Transportation
• Incentives
• (determined over twenty years field experience)

7
Planning Process for Implementation

• Select best version of SFP based on age, needs
  assessment, and culture.
• Purchase CD-ROM including
• Parent, Child, and Family Skills Training
  Manuals
• Parent and Childrens Handbooks
• Implementation Manual (literature review and
• process issues addressed)
• Evaluation Instruments (including fidelity
  tools)

8
Fidelity Tools

• Fidelity Issues Addressed in Training of Group
• Leaders
• Sample Fidelity Tools Supplied
• Group Leader Session Evaluation Form
• Session Fidelity Checklists for Observers
• Attendance and Engagement Forms
• Outcome Pre-Post Test Measures
• Client Satisfaction with Leaders rated

9
SFP Replications Cultural Modifications

• African-American Rural Families Alabama
  Strengthening African-American Families Program
• African-American Urban Families Detroit
  Safehaven
• Multi-Cultural Hispanic, Asian, Pacific
  Islanders, Whites
• 5 Year Follow-up 3 Counties in Utah (1995)
• Asian Pacific Islander Families Hawaii SFP
• Hispanic/Latino Families Denver Strengthening
  Hispanic Families Program
• Rural Families Iowa SFP - 7 Session 11-14 Year
  Olds
• French English Canadian Families Montreal
  Toronto
• Australian Families Queensland, Australia
• Shoshone-Bannock Indian Tribe Idaho

10
Results of SFP Cultural Adaptations(Kumpfer,
Alvarado, Smith, Bellamy, Prevention Science,
2002

• Varied in depth cultural gloss to in-depth
• Evaluated results of adaptations compared to
  original SFP implemented in first two years in
  five studies found
• Recruitment and retention were significantly
  improved by about 40 for cultural adaptations
• Outcomes basically identical, but slightly worse
  if adaptation involved reducing number of
  sessions or changing order
• Cultural adaptations also accomplished by hiring
  culturally-competent group leaders
• Culturally-adapted and age adapted SFP versions
• available
• Spanish language SFP currently being tested

11
Common Questions about Adaptation

• Can we compress the course length?
• Yes, can be taught twice a week instead of once.
• Can we cut the number of sessions?
• No, not without reducing the programs
  effectiveness.
• Can we skip the meal if our budget is tight?
• No, the meal is working time for group leaders
  families sit together as families and group
  leaders can coach and become acquainted.
• Do we have to have two group leaders for parents
• and two for the children?
• Its highly desirable, but if your groups are
  small, participants are motivated, leaders
  experienced, parents group can have one leader
  childrens group needs two group leaders.

12
Principles of Effective SFP Adaptations
The best family and parenting programs are only
as effective as the quality of the staff
delivering the program.

• Hire Culturally, Age, Gender-competent Staff
• Understanding and empathetic
• Share similar life experiences
• Professionally well trained
• Communication skills
• Warmth, genuineness, and empathy
• Openness and willingness to share
• Sensitivity to family and group processes

13
Principles of Effective Adaptation

• Develop an Adaptation Team
• Include the program developer, cultural
  consultants, local parents and children, and the
  group leaders and supervisors
• Review the existing curriculum manuals,
  recruitment methods, and the mode of delivery
• Make recommendations for changes
• All recommended changes should be approved by
  the original program developer, otherwise core
  critical elements of the original program may be
  omitted.

14
Principles of Effective Adaptation

• Base Adaptations on Sub-group Needs Assessments
• Determine the most salient risk and protective
  factors in the proposed cultural sub-group
• Needs assessment data
• Etiological baseline data

15
Principles of Effective Adaptations

• Pilot Test First-Cut Adaptations
• Changes in the language
• The names and places mentioned in stories
• Exercises to locally common places and names
• Omit Culturally or Locally Inappropriate
  Practices
• Promote Ethnic Identify and Cultural Pride
• Youth who identify with their ethnic group and
  practice traditional protective rituals and
  traditions are less likely to use illegal drugs.

16
Principles of Effective Adaptations

• Promote Ethnic Pride
• Youth who identify with their ethnic group and
  practice traditional protective rituals and
  traditions are less likely to use illegal drugs.
• Include sessions on cultural pride or history
• Cultural dances, art, and theater
• Employ attractive role models to increase
  cultural pride
• Add stories and history of the cultural sub-group
• Parents can teach children cultural arts, such as
  art, beading, dancing, music, songs,
  flute-making, and costume or dress

17
Principles of Effective Adaptations

• Modify Teaching Methods to be More Experiential
• Storytelling
• Experiential practice
• Visual graphic material

18
Principles of Effective Adaptations

• Add Local and Cultural Values and Storytelling
• Pass on culture
• Character traits needed for youth to succeed in
  life
• Incorporate Traditional Ceremonies and Rites of
  Passage
• Blessing or prayer by spiritual leader
• A talking circle
• Traditional songs, music or dances
• Traditional food to share

19
Principles of Effective Adaptations

• Develop Matched Graphics
• Add visual graphics that include pictures of
  similar families
• Pilot Test and Modify Evaluation
  Instruments/Methods
• Review by adaptation team
• Pilot test with group family
• Focus group
• Administer a retrospective pre-test