Teaching Parents Strategies for Difficult Teens
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Section 26
Family Interventions with Adolescents

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Intensive family competence training
Young people are at particular risk of substance abuse where their parents abuse substances. Intensive programs that deliver home-based case management and skills training for both parents and children have been developed, targeting families in drug treatment. Successful examples of this approach include the Focus on Families program (Catalano et al. 1999), which demonstrated reduced parental drug use and improved family management, and the Strengthening Families Program, which demonstrated increased children's protective factors, reduced substance use in both adolescents and parents, and improved parenting behaviours (DeMarsh and Kumpfer 1985).

Universal family interventions
A smaller number of programs has evaluated universal (whole-population) family intervention strategies. These programs used a range of strategies to encourage healthy family communication. The more intensive programs of this type provided professionally-led, sequenced groups for parents and children. Amongst rural families in Iowa, the benefits of these programs delivered in late primary (middle) school included reductions in youth hostile and aggressive behaviour four years later (Spoth et al. 2000).

Less intensive strategies involved providing families with "homework". The Slick Tracy Home Team program was developed for late primary school and involved a set of activity books completed as homework tasks requiring parental assistance. In the context of broader community mobilisation efforts, delivery of the program was associated with increased communication regarding alcohol use, lower initiation of youth smoking, and less regular youth alcohol use (Perry et al. 1993).

Parent education
The above evidence demonstrates that positive improvements in adolescent functioning have been documented through a range of family intervention strategies. In attempting to understand these changes, theorists have suggested that a critical program element may involve changing parent behaviours (for example, Dishion and Andrews 1995). Some evaluated programs have worked only with parents. Parent education may range in intensity from the distribution of one-off messages, using social marketing strategies, through to sequenced curriculum packages that may involve professional contact over multiple sessions.

Much of the research examining parent intervention focuses on efforts to prevent escalation or persistence in problem behaviours. One of the more intensive interventions used social learning principles to develop a training curriculum for parents. Parents targeted for this intervention had adolescent children younger than 16 years who had at least two previous convictions. Evaluation of this small trial demonstrated faster reductions in offending and reduced reliance on incarceration, compared with standard juvenile justice contact (Bank et al. 1991). Bank et al. also reported that an average of 44 hours of professional contact yielded savings estimated in excess of $US100,000 over three years.

Using a similar strategy within an early-intervention framework, Dishion and Andrews (1995) evaluated a 12-week parenting skills program aimed at families where youth had exhibited behavioural problems as children. Exposure to this parent group intervention reduced youth initiation to tobacco use one year later. Reduced parent-adolescent conflict was associated with these positive changes. In a small trial of an interactive, computerised parent education program that presents options for potential parent responses to common dilemmas faced in parenting adolescents, exposure to the package improved effective parenting responses (Kacir and Gordon 1997).

An Australian program was designed to provide a cost-effective method of assistance to parents of a substance-abusing adolescent. Blyth et al. (2000) developed an eight-week, professionally led group intervention. High rates (87 per cent) of depression among participating parents at pre-test reduced to 24 per cent after eight weeks, and further improvements were reported for parental mental health, parental satisfaction and assertive parenting behaviours (Toumbourou et al. 2001a).

Interventions targeting all parents
A growing range of programs aim to provide training and information to all parents with early adolescents in a given population. For example, Preparing for the Drug Free Years is a school-based, five-session, professionally led program aimed at enhancing positive parent-child interactions, parent-child bonding and effective child management. The program was demonstrated to be effective in increasing young people's intention to abstain from alcohol and in enhancing family bonding. Follow-up revealed that benefits in the form of reduced youth alcohol use were sustained two years after the intervention.

Toumbourou and Gregg (2001) reported an evaluation of an Australian program, Parenting Adolescents a Creative Experience (PACE), for parents of early adolescents. Designed as a universal intervention, facilitated groups based on an adult learning model used a curriculum that included adolescent communication, conflict resolution, and adolescent development (Jenkin and Bretherton 1994). Evaluation investigated the impact of seven-week PACE groups on a national sample of 3000 parents and Year 8 adolescents. Although only around 10 per cent of parents were successfully recruited into PACE groups, pre-and post-intervention findings demonstrated that benefits extended more broadly across families in the schools where PACE was offered. Parents and adolescents reported a reduction in family conflict. Adolescents reported increased maternal care, less delinquency, and less substance use (the odds of transition to alcohol use were halved).

The evaluation demonstrated that the parents recruited into the intervention were more frequently sole parents and their children reported higher rates of family conflict and substance use. Four months later at post-test, family conflict and youth substance use had reduced markedly in these families. Evaluation suggested that the substance use of respondents was influenced by their best-friend's substance use. Thus improvements in troubled family relationships appeared to have an impact on a wide group of families linked through peer-friend-ship networks (Toumbourou and Gregg 2001).

Teaching families to control peer influence
Evidence that peer attachments may be risk factors for youth substance abuse has led to interventions to assist parents to better manage their children's peer relationships. Cohen and Rice (1995) evaluated an intervention that attempted to facilitate this adjustment. The intervention failed to produce changes in adolescent initiation of tobacco or alcohol use. Parent participation was poor, and even among those who participated, attempting to influence their child's choice of peer group was not considered a practical target. Interventions for families with adolescents must be carefully designed, as there are many tensions between issues such as youth requirements for autonomy and increasing family cohesion.

Integrating parent education within schools
Several research teams are currently active in developing multi-level family support programs for delivery within early secondary school. Dishion and Kavanagh (2000) reported a program in the United States that involves the integration of three levels of support within school (early in US middle school, when children are around 11 years old). At the universal level, all parents are invited to an in-school meeting, and written information and videos covering key parenting skills (cooperation in the home, supervision, problem solving and communication) are distributed.

At the next level, a four-hour "family check-up" offers a family assessment and motivational interviewing to encourage accurate appraisal of child risk behaviour and the use of appropriate parenting resources. For families where problems are evident, more extended parent training is offered.

Work is underway in Queensland schools to evaluate an adolescent version of the Triple-P Positive Parenting Program. Toumbourou et al. (2001b) are currently investigating the impact of an integrated multi-level secondary school intervention, Resilient Families, which incorporates communication training for students, an information night for parents, sequenced parent education groups, and brief family therapy. The project aims to further explore the assumption that community-based interventions can generate benefits beyond the minority of participants directly exposed to the intervention.

Conclusions
A range of work, much of it published in the past six years, suggests the practical potential of involving families in adolescent health promotion. A common thread among family interventions is that of improving communication and reducing conflict. Although there is a dearth of evaluated interventions in Australia, experience overseas and promising local approaches testify to the potential, both at targeted and universal levels, of interventions to support parents and families through the adolescent phase.

Although Australian governments have identified the reduction of adolescent health-compromising behaviours as a priority, significant investment in family-based adolescent health promotion has emerged only recently. There appear to be considerable opportunities to integrate family work in juvenile justice and drug abuse treatment settings. For example, Aos et al. (1998) reported the net economic benefit at around four dollars for each dollar invested in juvenile justice programs such as Functional Family Therapy. Further development of both targeted and whole-population family programs in late primary and early secondary school are promising prevention strategies, but further research will be required to quantify the benefits.
- Toumbourou, John & Elizabeth Gregg; Working with families to promote healthy adolescent development; Family Matters; Winter 2001; Issue 59.

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Personal Reflection Exercise #12
The preceding section contained information about family interventions with adolescents.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 26
What is the common thread among family interventions to promote adolescent health? Record the letter of the correct answer the CEU Answer Booklet.

 

CEU Answer Booklet for this course | Parenting
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