Final Report Summary - RFB_IT_BAI_EARB (Reinforcing Family Bonding: International Training of Behavioural and Affective Evidence Based Intervention Against Early Adolescents Risk Behaviours)
Final Publishable Summary Report
There is quite clear evidence that family-oriented programs are effective in decreasing adolescent alcohol consumption (e. g. Foxcroft et al. 2003: Koutakis et al., 2008), substance use (Dishion, et al., 2002; Mason, Kosterman, Hawkins, Haggerty, & Spoth, 2003; Spoth, Randall, Trudeau, Shin, & Redmond, 2008; Spoth, Trudeau, et al., 2008), and delinquency (Mason et al., 2003). However, despite promising results, we must acknowledge a total lack of evidence-based family programs that aim to prevent substance use in the Mediterranean countries.
The purpose of the present research was to investigate whether family interventions may be introduced to a Mediterranean country, such as Italy. To achieve this goal, the researcher conducted a study aimed at assessing the implementation and the effects of two evidence based family programs. The first program (SFP, Strengthening Family Program 10-14) is based on behavioural approach. It has shown to be effective in reducing alcohol abuse and problem behaviours in children (for a review see Foxcroft, et al., 2003; Kumpfer, Alvarado, Whiteside, 2003), but it has never being tested in Italy. The second one (Connect, Moretti and Osbuth, 2009) is an attachment-based program that has shown its effectiveness in improving adolescent relationships with their parents; and in reducing problematic behaviours among a Canadian sample of high risk early adolescents (see Moretti and Osburth, 2009). The specific objectives of the study were twofold. First, the effects of such family based interventions in decreasing externalising problems in early Italian adolescents were tested in the short and the medium period. Secondly, the two types of interventions were compared to establish which is the most suitable, in terms of acceptance and effectiveness, for Italian families.
Phase I: The implementation of SFP and Connect
The implementation consisted in three steps:
1) The certification as program leaders. The researcher received the training by professionals authorised by the two developers of the programs. She received the qualification of SFP trainer at the course held in Barnsley (UK) under the responsibility of Oxford University. She also became official group facilitator of Connect, after attending a tree days course at Vancouver University (Canada), held by Marlene Moretti.
2) The cultural adaptation of the programs. The researcher conducted a preliminary research to culturally adjust the two programs to Italian context. To achieve this goal, she interviewed a number of families with different socioeconomic backgrounds. She also conducted focus groups with teachers, health practionners and social workers. Following suggestions of families and health practionners, programs were adjusted to the Italian contex without modifying their core components.
3) The recruitment of the families. Researcher contacted municipality, youth associations and schools through personal contact with principals and teachers. She organised meetings to present the two programs. Families that accepted to participate were divided in groups of 10-15 families and received Connect or SFP.
Phase II: Evaluation of the interventions
Evaluation concerned two aspects: process assessment and impact assessment, which are presented in the following.
1) The first part of the evaluation concerns the process implementation and the acceptance of the program. This part is of extremely relevance for people that are involved in health system and that provide services for families in need or for promoting wellbeing, such as health practionners, social workers, policy makers. Indeed, evidence-based family programs are not common and developed in Italy. Thus, knowledge about the impact of the introduction of these programs as prevention tools was needed.
The present study has shown two contradictory phenomena. To start with, parents participation was quite low. First, potentially 600 parents might get involved. However, only a small percentage of them (around 20 %) showed up at the information session. Moreover, a lot of parents dropped out after the first session of the program. Both phenomena might be explained by the fact that structured family interventions are still quite rare in Italy. As a consequence, parents find it hard to grasp what intervention programs are designed for, and the need to attend. And, they are unlikely to understand the reasons for participating in all the sessions. Most parents are used to attending one-day meetings or seminars organised by health workers or psychologists. So, in spite of our efforts to involve families, the attendance was lower than what it should be.
Nevertheless, when families participated in the program, they were very satisfied and they recognise the utility of the program itself and the positive climate in the groups. As a consequence, the attrition after the first session was very low. For this reason, there is a need to find strategies and ways of getting parents to enter into universal prevention programs and making them understand the necessity of participating in all their session.
1) The second part of the evaluation concerns the efficacy of these two programs in preventing adolescent problem behaviours through improvement in their parents? practices. The researcher adopted a pre post follow up quasi experimental design with a control group. At pre test, 62 families participated to Connect, 33 to SFP, while 82 families composed the control group. Children mean age was 12. 40 years (sd = .75). Results in short terms have shown that Connect was able to decrease parents reactions of coldness and rejection and to reduce alcohol use among early adolescents, compared to SFP. On the contrary, in the long term, SFP achieves the best results. Indeed, parents that attended Connect or SFP increased their attempts to understand children behaviours compared to control group. In addition, parents that participated in SFP decreased their emotional outburst reactions compared to control group. Moreover, adolescents that participated in SFP decreased alcohol use, deviant behaviours, and increased disclosure to their parents, compared to control group, while children of the parents that attended Connect decreased their internalising problems, such as level of anxiety.
There are two orders of conclusions that can be drawn from this study. First of all, both the types of programs are likely to affect children or family wellbeing. However, a program that involves also children (SFP) seems to be likely to affect their externalising problematic behaviours while a program attended only by parents (Connect) is likely to affect children internalising problems. On the other side, the participation of such types of the program is critical because parents are not familiar with these kinds of programs.
This study has a relevance for health practionners as it suggests that evidence based family programs might increase parents and children wellbeing also in Italy. On the other hand, it claims for policy strategies that incentive the introduction and the diffusion of such programs in the Italian health system and that sustain their correct application.
There is quite clear evidence that family-oriented programs are effective in decreasing adolescent alcohol consumption (e. g. Foxcroft et al. 2003: Koutakis et al., 2008), substance use (Dishion, et al., 2002; Mason, Kosterman, Hawkins, Haggerty, & Spoth, 2003; Spoth, Randall, Trudeau, Shin, & Redmond, 2008; Spoth, Trudeau, et al., 2008), and delinquency (Mason et al., 2003). However, despite promising results, we must acknowledge a total lack of evidence-based family programs that aim to prevent substance use in the Mediterranean countries.
The purpose of the present research was to investigate whether family interventions may be introduced to a Mediterranean country, such as Italy. To achieve this goal, the researcher conducted a study aimed at assessing the implementation and the effects of two evidence based family programs. The first program (SFP, Strengthening Family Program 10-14) is based on behavioural approach. It has shown to be effective in reducing alcohol abuse and problem behaviours in children (for a review see Foxcroft, et al., 2003; Kumpfer, Alvarado, Whiteside, 2003), but it has never being tested in Italy. The second one (Connect, Moretti and Osbuth, 2009) is an attachment-based program that has shown its effectiveness in improving adolescent relationships with their parents; and in reducing problematic behaviours among a Canadian sample of high risk early adolescents (see Moretti and Osburth, 2009). The specific objectives of the study were twofold. First, the effects of such family based interventions in decreasing externalising problems in early Italian adolescents were tested in the short and the medium period. Secondly, the two types of interventions were compared to establish which is the most suitable, in terms of acceptance and effectiveness, for Italian families.
Phase I: The implementation of SFP and Connect
The implementation consisted in three steps:
1) The certification as program leaders. The researcher received the training by professionals authorised by the two developers of the programs. She received the qualification of SFP trainer at the course held in Barnsley (UK) under the responsibility of Oxford University. She also became official group facilitator of Connect, after attending a tree days course at Vancouver University (Canada), held by Marlene Moretti.
2) The cultural adaptation of the programs. The researcher conducted a preliminary research to culturally adjust the two programs to Italian context. To achieve this goal, she interviewed a number of families with different socioeconomic backgrounds. She also conducted focus groups with teachers, health practionners and social workers. Following suggestions of families and health practionners, programs were adjusted to the Italian contex without modifying their core components.
3) The recruitment of the families. Researcher contacted municipality, youth associations and schools through personal contact with principals and teachers. She organised meetings to present the two programs. Families that accepted to participate were divided in groups of 10-15 families and received Connect or SFP.
Phase II: Evaluation of the interventions
Evaluation concerned two aspects: process assessment and impact assessment, which are presented in the following.
1) The first part of the evaluation concerns the process implementation and the acceptance of the program. This part is of extremely relevance for people that are involved in health system and that provide services for families in need or for promoting wellbeing, such as health practionners, social workers, policy makers. Indeed, evidence-based family programs are not common and developed in Italy. Thus, knowledge about the impact of the introduction of these programs as prevention tools was needed.
The present study has shown two contradictory phenomena. To start with, parents participation was quite low. First, potentially 600 parents might get involved. However, only a small percentage of them (around 20 %) showed up at the information session. Moreover, a lot of parents dropped out after the first session of the program. Both phenomena might be explained by the fact that structured family interventions are still quite rare in Italy. As a consequence, parents find it hard to grasp what intervention programs are designed for, and the need to attend. And, they are unlikely to understand the reasons for participating in all the sessions. Most parents are used to attending one-day meetings or seminars organised by health workers or psychologists. So, in spite of our efforts to involve families, the attendance was lower than what it should be.
Nevertheless, when families participated in the program, they were very satisfied and they recognise the utility of the program itself and the positive climate in the groups. As a consequence, the attrition after the first session was very low. For this reason, there is a need to find strategies and ways of getting parents to enter into universal prevention programs and making them understand the necessity of participating in all their session.
1) The second part of the evaluation concerns the efficacy of these two programs in preventing adolescent problem behaviours through improvement in their parents? practices. The researcher adopted a pre post follow up quasi experimental design with a control group. At pre test, 62 families participated to Connect, 33 to SFP, while 82 families composed the control group. Children mean age was 12. 40 years (sd = .75). Results in short terms have shown that Connect was able to decrease parents reactions of coldness and rejection and to reduce alcohol use among early adolescents, compared to SFP. On the contrary, in the long term, SFP achieves the best results. Indeed, parents that attended Connect or SFP increased their attempts to understand children behaviours compared to control group. In addition, parents that participated in SFP decreased their emotional outburst reactions compared to control group. Moreover, adolescents that participated in SFP decreased alcohol use, deviant behaviours, and increased disclosure to their parents, compared to control group, while children of the parents that attended Connect decreased their internalising problems, such as level of anxiety.
There are two orders of conclusions that can be drawn from this study. First of all, both the types of programs are likely to affect children or family wellbeing. However, a program that involves also children (SFP) seems to be likely to affect their externalising problematic behaviours while a program attended only by parents (Connect) is likely to affect children internalising problems. On the other side, the participation of such types of the program is critical because parents are not familiar with these kinds of programs.
This study has a relevance for health practionners as it suggests that evidence based family programs might increase parents and children wellbeing also in Italy. On the other hand, it claims for policy strategies that incentive the introduction and the diffusion of such programs in the Italian health system and that sustain their correct application.