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Attitude and behavior development
Attitudes to health behaviours may be particularly malleable in late childhood and early adolescence, when decisions relevant to involvement in behaviours such as drug use are being made (Dielman 1994). Catalano and Hawkins (1996) summarised evidence suggesting that adolescent identification and modeling of parent attitudes and behaviours are typically mediated by family attachment, although not all studies concur (for example, Kandel and Andrews 1987).
Encouraging healthy adolescent separation
With decreasing influence of organised religion and little consensus in social values, sources of social integration outside the family can become more precarious than in the past. Adolescent separation from the family may be more difficult where the parent or adolescent has few social supports, is emotionally vulnerable, is unemployed, or has a lower capacity for independent functioning. By redoubling assistance to the adolescent, some parents temporarily avoid separation, but the consequence may be inhibited opportunity for the adolescent to develop independence. In other families, the adolescent may develop "problems" that require parental assistance (Stanton et al. 1982). Acknowledging the increasing complexity of the adolescent transition and providing social support for parents and adolescents are each important.
Reducing disharmony and family conflict
Conflict resolution skills can make an important contribution to family harmony and adolescent health through this phase. The parent's response through the early adolescent period represents a critical develop-mental transition factor. Acrimonious conflict with parents can undermine adolescent self-confidence, increase stress, and distance the adolescent from an important source of social support. For example, Brody and Forehand (1993) demonstrated that mother-adolescent conflict predicted early initiation of adolescent substance use.
In their management of the adolescent transition, parents model emotional and relationship skills that can influence the adolescent's approach to later social relationships and challenges. A number of parenting programs encourage parents to examine their own adolescent transition in understanding their response to the adolescent (for example, Jenkin and Bretherton 1994). Specific competencies developing through adolescence that appear to exert a later protective effect include anxiety management (Williams et al. 2000), problem solving (McCubbin et al. 1985), and conflict resolution (Paul et al. 2001).
Setting limits, enforcing consequences, encouraging responsibility
Weatherburn and Lind (1998) predicted crime trends in Australian communities by modeling youth availability for delinquent peer activities as a function of parenting neglect. Assisting parents to develop age-appropriate methods of supervision, and establish a basis for reciprocity in providing material and other support, are important aims for intervention.
A further important role for parents through this period is the establishment of appropriate demands for an increasing contribution to family and household responsibilities (Baumrind 1991). In this context, Azrin et al. (1994) demonstrated adolescent substance abuse was influenced by the way in which parents supported and rewarded adolescent behaviour.
Evaluated family interventions
The selection below, which includes only a few of many interventions, mirrors the historical development of the field by beginning with more intensive programs (designed for families with multiple risk factors) and then generalising to less intensive whole-population prevention and early-intervention applications. A principal but not exclusive focus of the interventions included here is on the prevention and/or treatment of substance abuse; delinquency and crime are among other foci.
The interventions included were evaluated using a design that enabled a causal relationship between intervention exposure and outcomes to be inferred. Such designs typically require randomised assignment or adequate matching to a control group and longitudinal follow-up.
It should be noted that although the "evidencebased" approach offers a practical strategy for measuring effectiveness, the moderating effect of client and context differences has received limited attention. Furthermore, while many evaluations appear promising, it remains unclear whether these positive findings can be generalised beyond the original study teams or to wider population impacts.
Recruiting and engaging families
Once parents enter interventions, a further challenge is that of engagement (of encouraging interest and retention). Typically, around 60-80 per cent of parents can be retained through all sessions of universal parent education interventions (Spoth et al. 1999).
Family interventions for those with multiple risk factors
The Addicts and Families Project was historically important in its use of a well-controlled evaluation to demonstrate the effectiveness of family therapy as a treatment for youth substance abuse (Stanton et al. 1982). The study demonstrated that, after six months, supplementing methadone treatment with family therapy reduced drug use in around two-thirds of cases.
Functional Family Therapy has provided leader-ship in the movement to disseminate brief family therapy using a clearly staged (readily taught) family counselling program involving as few as eight hours of therapist contact. Evaluations have demonstrated reductions in juvenile justice expenditure and prevention of offending amongst the younger siblings of targeted offenders (Klein et al. 1977).
The family is only one of the important social systems impacting on adolescent development.
The successful application of multisystem casework has inspired applications for younger adolescents. The Targeted Adolescent/Family Multisystems Intervention program uses an individual-focused intervention for high school students and parents. The program is designed for late primary/early high school students evidencing poor school performance and substance misuse or abuse. Bry et al. (1998) reported reduced substance use in the second year. The Families and Schools Together program also targets families where students are identified to have behaviour, learning, or attendance problems in late primary school (McDonald et al. (1991). The program has been successfully trialed in Victoria, beginning in 1997 (Grima 2000).
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