Adaptation and Testing of the Strengthening Families Programme 10-14 (SFP10-14) for use in the United Kingdom

Summary
Introduction
Numerous studies in Europe report high rates of alcohol use among young people. A European School Project on Alcohol and Drugs (Hibbell 1999) reported that the UK had among the highest rates of drunkenness and binge drinking and alcohol consumption in Europe. Participants reported that 75% had had one episode of drunkenness, while nearly one third had 20 or more episodes in their lives or 10 or more episodes in the last year. Half had been intoxicated in the last month and a quarter intoxicated at least three times in the same period. The trends of the last decade are: more young people are drinking regularly (at least once a week); weekly drinkers are drinking more; regular young drinkers are drinking more alcohol per session; there are changes in the types of alcohol consumed (alcopops/designer drinks) (Alcohol Concern 2005).

The Strengthening Families Programme 10-14 (SFP10-14) is a seven session video based family skills training programme designed to increase resilience and reduce risk factors for alcohol and substance misuse, depression, violence and aggression, delinquency and school failure in The SFP10-14 has been evaluated for primary prevention effectiveness with young people and their parents living in mainly rural areas in Iowa, U.S.A. (Spoth et al 2001a; Spoth et al 2001b).
 
Whilst initial reports of implementation of the SFP10-14 in the UK are valuable it has been recognised that the US SFP10-14 programme materials and approach might need to be adapted to meet the needs of a UK audience and that a more systematic approach to evaluation of SFP10-14 in the UK was needed (Coombes et al 2006).
This report presents the results of the adaptation process and exploratory pilot study of the adapted SFP10-14 materials and approach in the UK.
Aims of the study
1. To adapt the US SFP10-14 materials and approach for the primary prevention of alcohol and drugs misuse in the U.K.
2. To model and explore the adapted SFP10-14 (UK) materials and approach with young people in the UK.
3. To develop a protocol for a large-scale evaluation study of the SFP10-14 (UK) including a cost-effectiveness assessment.

Method
Adaptation of US SFP10-14 materials
A small number of professionals and participants who had facilitated/attended SFP10–14 programmes in the United Kingdom using the United States programme materials was recruited and an advisory group formed. Four professionals, four mothers, two fathers and five young people agreed to join the advisory group. The advisory group was established with the remit to meet on one occasion only, with any further contact being by correspondence. The advisory group reviewed the original SFP10-14 materials and made recommendations about how the original programme should be adapted for a UK audience, using a nominal group technique to collect data. The advisory group was asked to review the US SFP10–14 materials and generate an individual list of positive features, and areas for improvement. A ‘round robin’ recording of individuals’ ideas into a single list was undertaken until all ideas were exhausted, and duplicates eliminated. The advisory group was then asked to discuss each item of the final list and to reach a consensus on the areas for improvement. The final list was the pooled results of individual opinions. The process of the nominal group’s work was recorded and the completed list of suggested improvements was then sent to all participants at a later date to check for accuracy
and agreement. The US SFP10–14 materials were then revised according to the agreed lists of improvements to produce the SFP10-14 (UK) materials.

Modelling of revised SFP10-14 materials
Focus group meetings involving parents/guardians and children were held in schools in four different geographical locations in the United Kingdom: Barnsley, Chester, Oxford and Peterborough (see Table 1). The sites and participants were selected purposively guided by time and resources. The focus groups critically reviewed the revised SFP10-14 (UK) materials, identifying what they felt were their strengths and weaknesses.
At the start of each focus group, short extracts from the original US SFP10–14 materials were shown. This was done to enable participants to provide a reference point for discussion of the adapted SFP10-14 (UK) materials. Participants were then asked for their opinions about the US SFP10–14 materials. This process was repeated for the SFP10-14 (UK) materials.

All focus group interviews were audiotape recorded and transcribed. The transcripts were coded and the codes were then aggregated to form larger conceptual categories. Conceptually meaningful themes were constructed from categories of the data. Validation of the thematic analysis was achieved through the use of independent individuals to check the analysis and interpretation of data; external checks on the inquiry process and debriefing with informants.

Exploratory pilot study of SFP10-14 (UK)
The SFP10-14 (UK) materials produced from the adaptation and modelling stages were field tested in three different geographical locations. In each of the three sites sufficient families were recruited to participate in the SFP10-14 (UK) delivery sessions. Subsequently, in each of the three sites a similar number of families were non-randomly selected into a comparison group. The comparison group children received the standard alcohol and drugs education delivered as part of the school curriculum. The SFP10-14 (UK) group received the standard alcohol and drugs education delivered as part of the school curriculum plus the SFP10-14 (UK) intervention.

Study self-report questionnaires were completed by youth and their parents/carers pre- and post- intervention, and at 3 months after completion of the programme. The study questionnaires were adapted from validated tools used in previous SFP10-14 evaluations in the US (Spoth et al 2001a; Spoth et al 2001b) and those used in ESPAD (European School Survey Project on Alcohol and Drugs) research studies. To supplement and enrich the quantitative data, focus groups were held to gain feedback from participating families. Two tape-recorded, focus group interviews lasting approximately 60 minutes were undertaken with the parents/caregivers and young people in Barnsley and Chester who had completed the SFP10-14 (UK) programme. Interviews focused on the parent’s/caregiver’s and young people’s experience of the SFP10-14 materials and approach. All interviews were tape recorded and transcribed and a content analysis of transcripts undertaken. The transcripts were coded and codes aggregated to form larger conceptual categories. Conceptually meaningful themes were constructed from categories of the data. Validation of the thematic analysis was achieved through the use of independent researchers to analyse and interpret single sets of data, external checks on the inquiry process and debriefing with informants.
Findings
Adaptation & Modelling of revised SFP10-14 materials
The results from the nominal group meeting and subsequent focus group meetings provided useful information on whether and how the original US SFP10–14 materials could be adapted for use in the United Kingdom, while at the same time retaining essential ingredients of the effective US programme. Twenty-one parents/caregivers and sixteen young people participated in the focus groups. The nominal and focus group study led to the development of newly revised programme materials, now referred to as SFP10–14 (UK), that were used in the subsequent exploratory pilot study.
Exploratory pilot study of SFP10-14 (UK)

There were 23 parent/caregivers and 24 young people from 3 sites in the SFP10-14 (UK) intervention group. There were 24 parent/caregivers and 22 young people from 3 sites in the non-random comparison group.
The study questionnaires were completed by all participants without difficulty, and analysis and interpretation was straightforward. Given the small sample size and short-term follow-up in this pilot study no statistically significant effects were predicted or found, though data are summarized here for completeness: overall, there were no clear or consistent outcomes associated with the SFP10-14 programme in terms of alcohol use, substance use, parenting behaviour, general child management, parent-child affective quality, or measures of supportive and controlling family environment.
16 adults and 14 young people participated in the focus groups. Feedback from parents, carers and young people was overwhelmingly positive. The following key themes have been selected for the summary:

Expectations and reasons for attending the SFP10-14: some participants commented that they did not have any idea what to expect before attending the programme, while others identified a particular aspect of the programme that they had come to find out about. What became clear during analysis of the focus group data was that the important aspect of the programme for many parents/guardians was not necessarily to do with drug and alcohol prevention, but more to do with strengthening family functioning.

Involving youth in the programme: participants acknowledged that in some cases it had not been easy to persuade their youth to attend the first group meeting. There were examples given that showed some youths were quite determined not to go with their parents at first. However, after participating in the first group, barriers and obstacles to attendance were overcome.

What worked well for participants: participants identified that the SFP10-14 (UK) had helped strengthen the family unit and had also helped them identify different strategies to manage situations. Their responses indicated that they felt that the SFP10-14 (UK) provided parents with a range of strategies (or ‘tools’) which they can draw on to help manage different situations. Some of these strategies involved a change in the adults’ behaviour and how they responded to challenging situations.
Some participants also observed that by working with a group that were all there to learn about parenting and improving their skills helped them to be open about their problems. The sessions that focused on peer pressure were identified as being particularly helpful by participants.
When speaking about the parent sessions of the programme, the group spoke positively about the support they felt they had from one another. They felt that everyone had participated and contributed to the sessions and therefore the group had gained from that.

Use of DVDs, actors and scenario: generally, participants found the DVDs useful to illustrate particular potentially problematic aspects of family life, and felt they could identify with the families (actors) homes and the locations that were used. Some participants felt the approach taken in the DVDs was patronising when they first saw it, but generally, they developed a more positive perception as they became more engaged with the programme. Participants felt that the actors and scenarios helped get discussion going in sessions by encouraging people to reflect on their own situations and how they dealt with these.

Exercises and activities in the programme: participants were very positive about the activities and family exercises to help families have fun and learn about each other, particularly enjoying activities such as creating the family tree and the family shield. However not all comments about this aspect of the course were entirely positive. Some participants found some of the exercises or games rather frivolous, although they did understand that there was a purpose behind the group activities.

What did not work so well for participants: participants were asked if they could identify aspects of the SFP10-14 (UK) that they felt did not work so well for them or for the group as a whole. One of the issues that was identified related to the tight control of time. The delivery of the SFP10-14 (UK) relies on strict time keeping within a two hour time frame: in the first hour parents and youth work separately, in the second hour they work together. It is critical that both sessions end together, on time, or the following family session will over-run and participants will be late leaving for home. Participants felt they were sometimes rushed with not enough time being available for discussion. However they also acknowledged that there is a need for some time limits.
 
Timing of the programme: the SFP10-14 (UK) is generally facilitated in the evening as this suits most families. The timing of the programme had been negotiated with parents and carers at the information evening held prior to the programme. Participants felt that this had worked well for most members of the group.
Crèche: the programme also offered a crèche for families who had younger siblings. This was viewed very positively by both the parents and the children who attended the crèche.
 
Positive outcomes:
 throughout the focus group sessions parents and carers spoke of what they had learned and how their parenting had changed since attending the programme. The following are a selection of some of the comments made:

• “What I’ve learnt is to really, really listen to my kids feelings. Even if the answer is going to be no to whatever the request is, because some have to be no, but they need to air their feelings”
• “It changed my behaviour towards my children, I listen to what they say, I don’t lose my temper so much”
• “I used to confront him and the situation would get worse and worse and it could spoil a whole evening…but by walking away its much better, it’s a really calm approach” 
• “We have definitely got closer since doing the course, I think what they (youth) have done in combination with what we have done – I think its made her think a bit more about her behaviour at home and I’m certainly thinking about my behaviour more”
• “I’m a single parent I’m on my own, it’s very hard to be a mum and a dad, but the tools gained from the course have been extremely beneficial”
• “I feel that you have never got enough skills as a parent, I’ve learned a lot from this course, my son’s learned a lot from this course and its brought us closer together and I think it would bring any family closer together”
• “I’ve got nothing but praise for what has happened, it’s a transformation. Getting called into school and they asked ‘what has changed in ****, what have you done that is different? There is a noticeable and marked difference in the way **** has adopted a more mature attitude’ and that, that’s the proof of the pudding isn’t it? As they say”
• 
Youth Feedback: the young people who had participated in the programme were equally enthusiastic in their evaluation of their experience. They enjoyed the companionship, the role play, games and exercises. They also commented that some of the tools and strategies used in the programme had worked for them in their family setting. One example of comments from one young person is:

• “I was like a bit nervous when I first came – but then enjoyed it. I liked the first week, especially the treasure map, and the fifth week with the shield. The last week was good with the role models. I liked working with mum and dad. I enjoyed the DVDs and having the family meetings. The role play and acting was good especially ‘setting up situations’. The games were good I liked the three legged game”
• “I liked it all – no negatives”
• “I learned about drugs and keeping out of trouble. And about rules – in the driving game”
• “It has been better at home. We use the points and I earned 8 points and that meant a meal in the pizza hut. 10 points and we have an Indian meal. I get the points when I clean my room, putting my shoes away. For cleaning the car or cutting the grass”

Conclusions
Although there were no clear or consistent outcomes associated with the SFP10-14 programme on examination of the quantitative data, we need to be cautious about our interpretation of these data. The purpose of this pilot study was primarily to test the adapted materials and the evaluation tools in a “live” programme delivery setting in the UK. Further research based on a randomised controlled trial design, with adequate sample size, is required to fully evaluate the potential of the programme in the UK.
The qualitative data that were obtained allow us to draw some conclusions about the perceived benefits of the SFP10-14 (UK) from the participant’s perspective. These results suggest that parents, carers and young people enjoyed and felt that they benefited from the intervention. Parents/caregivers and young people reported that 
the SFP10-14 (UK) had played a part in improving family functioning through: strengthening the family unit, improving parent/caregiver communication, using a more consistent approach, increasing the repertoire for dealing with situations, developing better positive and negative feedback, working more together as a team, identifying family strengths, strengthening family bonds, receiving group support, working more closely with mum and dad, learning to listen more, learning to get along with each other better, helping parents/caregivers more, better understanding of what parents/caregivers/young people are saying, changing the code of behaviour and developing more interaction among the family.
A protocol for a large-scale trial of the SFP10-14 in the UK has been developed and is being submitted to various funding agencies.

Source: Research Report No. 28 ISBN: 1-902606-25-6
www.brookes.ac.uk/schools/shsc/4