Strengthening Families Programme (SFP) 10-14 in the UK

Strengthening Families Programme (SFP) 

Recent recommendations from the National Institute for Health and Clinical Excellence (NICE) to prevent or reduce alcohol and substance use in young people include guidance on family-based programmes (NICE, 2006; 2007). There is evidence to suggest that family based interventions may be effective in producing long term reductions in substance use (Jones et al., 2006). There is also evidence from a high-quality systematic review that three family based programmes, including the Strengthening Families Programme (SFP), can also produce long term reductions (greater than 3 years) in alcohol use (Jones et al., 2007). 

The SFP 10-14 is an alcohol and drug misuse prevention programme for young people aged 10 to 14 years old. It has been evaluated and shown to be effective for the prevention of alcohol use and misuse in the State of Iowa in the United States of America (USA) (http://www.extension.iastate.edu/sfp/inside/research.php). The programme resulted from the original Strengthening Families programme (SFP) which was developed by Dr. Karol Kumpfer and associates at the University of Utah in 1983, with funding from the US National Institute for Drug Abuse (NIDA).  

The original Strengthening Families Programme (SFP) 

The original programme involved both parents and children and was developed specifically as a selective prevention strategy for 6 to 12 year old high-risk children of substance-misusing parents. The aims of SFP were to improve children’s pro-social behaviours, mental status and grades, combined with reductions in aggression, violent behaviours and substance use. By improving family relationships, parenting skills and improving the young person’s social and life skills, SFP builds on recognised protective factors.

The original SFP curriculum consisted of three fourteen week courses: Parent Training, Children’s Skills Training and Family Life Skills Training. During the courses, parents learn to use attention and rewards to increase desired behaviours in their children. They learn the importance of clear communication, effective discipline, problem solving and limit setting and they also receive substance use education. Children are taught about communicating effectively and understanding feelings. They learn social skills, problem solving skills and how to resist peer pressure, along with the consequences of substance use and compliance with parental rules. Families are given the opportunity to engage in structured family activities and they learn to communicate effectively in family meetings. They practice therapeutic child play, effective discipline, reinforce positive behaviours in each other and plan family activities together. There are special incentives for good behaviour in children, homework completion and attendance.

The programme has been modified for African/American families, Asian/Pacific Islanders, Hispanic and American Indian families, families in rural areas and those with young teenagers and although it was originally aimed at the children of substance misusers, SFP is also used widely with non-substance misusing parents.

SFP 10-14 

This is a shorter version of the programme consisting of seven two hour sessions for 10 to 14 year olds. It was developed by Dr. Virginia Molgaard and Dr. Kumpfer with NIDA funding and was formerly known as the Iowa Strengthening Families programme (ISFP). The long-term aim of SFP 10-14 is reduced alcohol use, drug use and problem behaviour during adolescence. This is achieved by improving parenting skills and improving interpersonal skills among young people. The programme targets parents of all educational levels and makes extensive use of video materials.  

For the first hour, parents and young people attend separate groups learning the same skills and techniques taught in the original Strengthening Families Programme. During the second hour they come together for supervised family activities. Four booster sessions are included in SFP 10-14 and these are designed to be used six months to a year after the original sessions, in order to reinforce the skills gained in the original sessions.  

Youth Booster sessions focus on establishing friendships and handling conflict while Parent Booster sessions are concerned with handling parents’ stress and resolving partner conflict. 

The SFP 10-14 in the UK 

A recent Cochrane Collaboration Systematic Review, commissioned by the World Health Organisation and the UK Alcohol Education Research Council, reported that the SFP 10-14 was an effective and promising prevention intervention (Foxcroft, 2003). Furthermore, the effectiveness of SFP 10-14 seemed to increase over time, rather than decay, as with other prevention programmes. 

The SFP 10-14 has been introduced in a number of settings in the UK. The Child and Adolescent Mental Health Service in Barnsley, implemented the SFP 10-14 in 2002:

http://www.aerc.org.uk/documents/pdf/finalReports/SFP%20Barnsley%20research%20final%20report%20290106.pdf 

No formal evaluation was performed but both group leaders and participants were very positive about the intervention (Marsh and Male 2003). Similar findings were reported by Hoskin in relation to the SFP 10-14 run by the Kinara Family Resource Centre in Greenwich (Hoskin, 2004)  

Professor David Foxcroft and colleagues from The School of Health and Social Care, Oxford Brookes University carried out a systematic evaluation of the SFP 10-14. (Coombes et al., 2006ealth and Socisl Health and Social Care, Oxford Brookes University, England.).  The aims of the study were to evaluate the use of the SFP 10-14 in the UK based on the experience of facilitators and families in Barnsley; to explore facilitators’ and families’ experience of the SFP 10-14 in relation to family functioning, emotional health and well being, young person’s behaviour and substance use; and to identify changes that would be necessary to adapt existing SFP 10-14 materials and approach to the UK context.

The study took place in two phases over a nine month period in 2005. Approximately seventy families completed the SFP 10-14 in the Barnsley area. Ten families who met the inclusion/exclusion criteria for the study were selected to take part in the evaluation. Parents/caregivers and young people were interviewed in two tape-recorded focus groups that lasted approximately sixty minutes. The interviews focussed on the parent’s/caregiver’s and the young people’s experience of the 10-14 materials and approach. Fifteen facilitators were also interviewed in three tape-recorded focus groups which lasted approximately sixty minutes. Their interviews also focussed on their experience of the SFP 10-14 materials and approach. The tapes were transcribed and a content analysis of the transcriptions was undertaken.

The authors concluded in the Strengthening Families Program implementation report (2006) that families who took part in the study believed that participation in SFP 10-14 was useful in preventing young people’s alcohol and drug use. They reportedly learned more about alcohol and drugs, how to use knowledge and skills to reduce behaviours that might lead to alcohol and drug use and methods for coping with peer pressure. However, no objective assessment was made of these perceived outcomes.

The SFP 10-14 was shown to have had a positive effect on the emotional health and well being of the families that took part. They developed better anger management skills, a more constructive approach to problem solving, more explicit demonstration of love and care, greater feelings of safety and security, increased self respect and respect for other people, improved self esteem, greater empathy, better stress management and decreased feelings of failure.

The Oxford Brookes team reported that there were indications that during the programme the SFP 10-14 contributed to positive changes in the behaviour of the young people that took part and improved family functioning through strengthening the family unit, improving communication skills and using a more consistent approach to parenting.

It was reported that families did not want to be seen as “problem families” or having “failed”, although the timing and setting of the programme impacted on family attendance. Funding was also found to be an issue because adequate funding was needed for facilitators, child care support and incentives for participants. Pre-course literature and family meetings were found to be important in recruiting families and literacy was reported to be an issue for some families.

The report concluded that both participating families and facilitators perceived the SFP 10-14 in its adapted form to be useful and meaningful and that the programme might be a useful primary prevention intervention in helping to prevent alcohol and drug use in the UK. While using US materials was not a barrier, it was found that it was necessary to produce a UK version of the programme and materials. 

Debby Allen and colleagues in the School of Health and Social Care at Oxford Brookes University adapted the US 10-14 programme and undertook an exploratory trial of the UK version. In the report, they present the results of the adaptation process and exploratory pilot study of the adapted SFP 10-14 materials and approach in UK settings (Allen et al., 2006). See: http://www.aerc.org.uk/documents/pdf/insights/insight_53(ebook).pdf  

An advisory group was formed comprising professionals and families who had previously taken part in the SFP 10-14 programmes in the UK using the US programme materials. Four professionals, four mothers, two fathers and five young people agreed to join the advisory group. They reviewed the original SFP10-14 materials and made recommendations on how these could be adapted to suit a UK audience. The SFP 10-14 materials were then revised according to the advisory group’s recommendations. Focus groups were held in schools in Barnsley, Chester, Oxford and Peterborough. These were attended by parents/guardians and children from the schools. The focus groups critically reviewed the revised SFP10-14 materials and identified their strengths and weaknesses. The SFP 10-14 (UK) materials resulting from the adaptation and modelling process were then field tested in three locations. 

For the past nine months the Oxford Brookes team has been funded to train facilitators across the UK as part of the DCSF (Department for Children, Schools and Families) family intervention projects. Three hundred facilitators have been trained to date across the UK and many of them have run their first and second programmes. A protocol for a large-scale trial of the SFP 10-14 in the UK has been developed and is currently being submitted to funding agencies.

SFP 10-14 in Cardiff 

Grahame Howard, Family Support Services Development Officer for Cardiff Alcohol and Drug Team has been running the SFP 10-14 in the Cardiff area since September 2005. Originally tasked with looking at the needs of the family, he decided that there was a need to implement a family based programme and SFP 10-14 had already been identified. There was no budget to implement the programme initially, so Grahame approached various organisations for funding. The AERC provided a small grant and US trainers were brought to Cardiff to train the first co-hort of multi-agency workers. Approximately twenty workers were trained in the first instance.

Materials from the US were used in the early days of the programme and continued to be used until the team from Oxford Brookes University made UK adaptations. The Cardiff SFP began using the adapted materials during their second programme in 2006. The UK version of the programme was found to be more useful and relevant to Cardiff families, although the US materials presented no real problems. The US videos however, were thought to be rather dated and patronising by the families taking part and the language contained a lot of US terminology. There was also a US celebrity endorsing the programme and this had no relevance to young people in the UK. These problems aside, families, once engaged in the programme enjoyed the activities and the family meetings, realised the benefits of attending and stayed with the programme to the end.

The  8^th SFP 10-14 programme has now been implemented in Cardiff and around fifty to sixty families have taken part to date. 80%-90% of families that start the programme are retained.  

Grahame says the main strength of the programme is using a collaborative, multi-agency approach, where families have engaged with the programme through various organisations, for example: specialist substance misuse services; voluntary agencies; youth work organisations such as the YMCA; children’s services; the police and schools. “This has been good for the programme, good for families and good for the city”.

He believes that the families taking part in the SFP 10-14 all gain something different but one of the main benefits reported by parents is that they learn to understand their children/teenagers and are able to understand why young people behave the way they do. This gives parents confidence in supporting their children. “Parents value their time with children to understand their goals and dreams”.

The one-to-one aspect of the intervention seems to be appreciated by the young people taking part. They state it is important to have one-to-one time with a parent outside of a chaotic environment. The main benefit to the young people appears to be their newly gained ability to resist peer pressure and yet retain their friends. The programme helps young people to become “positive persuaders” helping their friends to think about their negative behaviour.

The main problem faced in implementing the SFP 10-14 was inconsistent funding. It was difficult to plan each subsequent programme as money was needed for food and transport, play workers and provision for younger children. Barriers to families attending included provision for younger siblings while the parents and older children took part in the activities, money for transport and the simple fact that the intervention took place in the evening i.e. around meal times.

Three years funding has now been secured from Cardiff Community Safety Partnership and these problems have been addressed. Single parents are helped with taxi fares to and from the programme and play workers can look after the younger children during the sessions. There is a break between the first and second hour so that those taking part can have tea, and food is provided. 

The SFP 10-14 is currently running in East Cardiff and will be implemented in North Cardiff in the Autumn, in schools in the area. The schools provide free facilities after hours. Places are offered to families who attend the school first but referrals are taken as well and there is generally a mixed community group taking part.

Cardiff University are coming to the end of an evaluation of the SFP 10-14 in Cardiff and a report is due in the summer.

SFP 10-14 in Norfolk 

SFP 10-14 was implemented in Norfolk five years ago by Felicity Warmsley and Sharon Phillips of the Family Solutions Team (part of Children’s Services at Norfolk County Council), after learning about the Barnsley programme. Felicity described how difficult it was to set the programme up initially but she and Sharon received training from Megan Marsh and Sarah Male, who originally brought SFP 10-14 to the UK.  

After the first few programmes, local schools became interested in SFP 10-14 and more facilitators were trained. Eight families took part in the first programmes and eventually they were rolled out in Yarmouth and Norwich where they developed well. Things progressed more slowly in rural areas and Felicity described how one particular barrier to families attending was transport.  

The US version of the SFP 10-14 was used in the beginning and again this was not a problem for the families taking part. However, once the Oxford Brookes UK version was developed, this was used throughout the Norfolk area. Felicity described how changes were made to some of the activities in both versions to suit the needs of the young people taking part. 

Felicity believes the SFP 10-14 is most useful as a preventative programme rather than an intervention for those families who are already facing problems with drugs and alcohol. She said it works particularly well in Norfolk with 12 year olds and one of the main strengths of the programme is the contact between parent and child. Both parents and young people benefit from the time they spend together and Felicity said this is one of the most important factors. “Communication skills are vastly important”. She described how parents learned to listen and to communicate with their children and equally children learned to listen and to accept/set limits. As in Cardiff, play workers are employed to engage the younger siblings while the older children join in the activities and this has been very successful. Food is provided for the families taking part.

In Norfolk, it has been more beneficial to the families attending to run the programmes in school hours rather than as after school sessions. Again this is partly due to the fact that transport is often difficult and once children leave school, they might not get back easily in the evening. Accommodation has also been difficult to find but more schools are becoming interested in the programme. Families are recruited via a home visit and this is followed up with a meeting in the school. 

Funding continues to prove problematic but tier 2 CAMHS services facilitate the programme in the Norfolk area and more and more schools are seeing the benefits to the children and families taking part. 

Felicity said there has not been an opportunity to follow up the families that took part in earlier programmes yet, but once they join the programme there is a high success rate for retention and once they have completed SFP 10-14 families are not referred back in for parenting work.

Next stages 

The next logical stage according to Debby Allen “would be to carry out an appropriately powered RCT” but she says funding for this would be very substantial.

She goes on to say “In short, the SFP 10-14 is being implemented now across the UK and continues to spread. We had our first national conference in October 2007. We are developing an academic award, which we hope to be able to offer later this year as part of a student designed award here at Oxford Brookes. We are also doing a training [session] in Scotland later this year – our first across the border!”

References:  

Allen, D., Coombes, L., Foxcroft, D. (2006) Cultural Accommodation of the Strengthening Families Programme 10-14: UK Phase I Study School of Health and Social care, Oxford Brookes University (England)  

Allen, D., Coombes, L., Foxcroft, D. (2008) Preventing Alcohol and Drug Misuse in Young People: Adaptation and Testing of the Strengthening Families Programme 10-14 (SFP 10-14) for Use in the United Kingdom. School of Health and Social care, Oxford Brookes University (England) 

Coombes, L., Allen, D., Marsh, M. and Foxcroft, D (2006) Implementation of the Strengthening Families Program (SFP) 10-14 in Barnsley: The Perspectives of Facilitators and Families. School of Health and Social care, Oxford Brookes University (England) 

Foxcroft, D. R., Ireland, D., Lister-Sharp, D.J., Lowe, G. and Breen, R.D.I. (2003) Longer-term primary prevention for alcohol use in young people: a systematic review. Addiction 98, 397-411 

Hoskin, C.(2004) Personal Communication (Currently unavailable).  

Jones, L., Sumnall, H., Witty, K., Wareing, M., McVeigh, J., Bellis, M.A. (2006) National Collaborating Centre for Drug Prevention, Centre for Public Health, Liverpool John Moores University 

Jones, L., James, M., Jefferson, T., Lushey, C., Morleo, M., Stokes, E., Sumnall, H., Witty, K., Bellis,M. (2007) Centre for Public Health, Liverpool John Moores University; Centre for Planning and Management, University of Keele; Cochrane Vaccines Field, Anguillara Saqbazia, Rome, Italy 

Marsh, M & Male, S.,(2003) Chat Back. Young Minds, October 

The reports from Oxford Brookes University can be accessed via:  

http://www.aerc.org.uk/publicationsFinalRep.htm

Strengthening Families Programme website:  http://www.mystrongfamily.co.uk/index.htm  

Strengthening Families Programme SFP 10-14 Report 2005/2007. Cardiff Alcohol & Drug Team Family Support Development Project