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Substance Use &Misuse, 31(2), 157-175, 1996 Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families Georgia B. Aktan, Ph.D.,1121* Karol L. Kumpfer, Ph.D.,3 and Charles W. Turner, Ph.D.3 'Safe Haven Program, City of Detroit Department of Health, Bureau of Substance Abuse, 2Michigan Department of Public Health, Center for Substance Abuse Services, Lansing, 3University of Utah, Salr take City, Utah Detroit, Michigan Michigan ABSTRACT The effectiveness of the Safe Haven Program for the prevention of substance use, a family skills training program for African-American families, was evaluated through a nonequivalent comparison, repeated measures, quasi-experimental design which included pre- and posttest parent and child interviews, including the Moos Family Environment Scale and the Achenbock and Edelbrock Child Behavior Checklist. The results indicate that the Safe Haven Program is effective in in- creasing parenting efficacy and behaviors toward children, improving the childrens' risk and protective factors and behaviors, and supporting treatment reductions in the parent and family illegal substance use. *To whom requests for reprints should be addressed at Needs Assessment Studies, MDPHICSAS, 3423 ML King Jr. Blvd., P.O. Box 30195, Lansing, MI 48909. 157 Copyright 0 1996 by Marcel Dekker, Inc. Subst Use Misuse Downloaded from informahealthcare.com by Nyu Medical Center on 11/09/14 For personal use only.

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Page 1: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

Substance Use &Misuse, 31(2), 157-175, 1996

Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

Georgia B. Aktan, Ph.D.,1121* Karol L. Kumpfer, Ph.D.,3 and Charles W. Turner, Ph.D.3

'Safe Haven Program, City of Detroit Department of Health, Bureau of Substance Abuse,

2Michigan Department of Public Health, Center for Substance Abuse Services, Lansing,

3University of Utah, Salr take City, Utah

Detroit, Michigan

Michigan

ABSTRACT

The effectiveness of the Safe Haven Program for the prevention of substance use, a family skills training program for African-American families, was evaluated through a nonequivalent comparison, repeated measures, quasi-experimental design which included pre- and posttest parent and child interviews, including the Moos Family Environment Scale and the Achenbock and Edelbrock Child Behavior Checklist. The results indicate that the Safe Haven Program is effective in in- creasing parenting efficacy and behaviors toward children, improving the childrens' risk and protective factors and behaviors, and supporting treatment reductions in the parent and family illegal substance use.

*To whom requests for reprints should be addressed at Needs Assessment Studies, MDPHICSAS, 3423 ML King Jr . Blvd., P.O. Box 30195, Lansing, MI 48909.

157

Copyright 0 1996 by Marcel Dekker, Inc.

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Page 2: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

158 AKTAN, KUMPFER, A N D TURNER

Key words. Drugs; Alcohol; Prevention; African-American; Families

INTRODUCTION

The Safe Haven Program is a substance use prevention program for Af- rican-American families in the city of Detroit. The Foal of the program is to reduce the risk factors for substance use in families where one parent is a known substance user. Children in such families are known to be at risk for substance use (Cotton, 1979; Goodwin, 1985; Cloninger et al., 1985; Johnson et al., 1984; Kandel et al., 1978; Kumpfer, 1987; Kumpfer and Alvarado, in press; McDermott, 1984). The Safe Haven Program is a modification for in- ner city African-American substance-using families of the 14-session Strength- ening Families Program (Kumpfer et al., 1989a, 1989b, 1989c) developed for children of substance users (DeMarsh and Kumpfer, 1986). The primary sig- nificance of the Safe Haven Program is that it takes a family skills training program which has been reported to reduce risk factors and actual use in chil- dren of substance users and modifies it for use with an African-American ur- ban population. The program is composed of 12 weekly structured sessions designed to increase the parent’s parenting efficacy; increase the parent’s bond- ing with the child; increase child’s positive behavior; increase the child’s school performance; increase the child’s school bonding and associations with posi- tive peers; increase family cohesion; increase positive family communication; and increase family expressiveness and organization. Periodic revisions to the program to make i t more culturally-specific to the local African-American community are an integral part of the program.

REVIEW OF THE LITERATURE

Risk Factors for Alcohol and Other Drug Use

Parental alcoholism and use of illicit drugs increase the risk of alcoholism, drug use initiation, and drug usdmisuse in children (Cotton, 1979; Goodwin, 1985; Cloninger et al., 1985; Johnson et al., 1984; Kandel et al., 1978; Kump- fer, 1987; Kumpfer and Alvarado, in press; McDermott, 1984). Children of substance users are imputed to have increased vulnerability to substance use due to multiple biological and environmental risk factors.

The biological risk factors for alcohol and other drug use include increased temperament vulnerabilities (e.g., high activity level, ADD emotional liability, thrill-seeking) which can lead to aggression and delinquency (Tarter et al., 1985); increased neuropsychological vulnerabilities leading to poor problem- solving abilities; increased neurological and physiological vulnerabilities leading to increased reactivity to stress; and a unique individual reaction to alcohol which makes alcohol more pleasurable and stress-dampening (Finn and Pihl, 1988).

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Page 3: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

EFFECTIVENESS OF A FAMILY SKILLS TRAINING PROGRAM 159

Environmental risk factors include poor family environments characterized by high levels of family conflict, negative family communication patterns, excessively high developmental expectations, enmeshed family cohesion, poor parent supervision and discipline, and little time spent with children (Kumpfer and DeMarsh, 1985).

While some risk factors have been found to be more salient in some types of children of substance users, there is little evidence available regarding the relative importance and interactions of various risk factors in the etiology of substance use/misuse. It is not known, for example, which factors or combi- nations of factors are specific to substance use and which are the most influ- ential and modifiable. Bry (1983) reported that the number of risk factors predicts substance use better than any particular risk factor or set of risk fac- tors.

Family-Focused Prevention Interventions

Few family-focused substance use prevention programs have been devel- oped for high risk children, despite the fact that the application of parent train- ing and family skills training programs to other problems in children has been highly effective (Patterson et al., 1975; Miller, 1975; Gordon, 1970; Dink- meyer and McKay, 1976; Forehand and McMahon, 1981; Guerney, 1964; Kumpfer and Alvarado, in press; L’Abate, 1977).

There has been little experimental research conducted to evaluate the ef- fectiveness of parent and family skills training for substance use prevention. Dishion et al. (1989) reported positive trends for parent training treatment groups on parent-child interaction, levels of tobacco use, and reduction of depression. DeMarsh and Kumpfer (1986) reported that the family can be in- fluential in the alleviation of risk factors for substance use in children, regard- less of the parents’ stage of dysfunctionality in terms of their own substance use.

PROGRAM DESCRIPTION

The Safe Haven Program is comprised of three self-contained courses conducted simultaneously to have maximum impact on the risk factors. These three courses are the parent training, the children’s skill training, and the fam- ily skills training. The parent training program is based on a model by which parents are taught more appropriate methods to cope with their children’s prob- lem behaviors and to increase the number of positive interactions. The child- ren’s skills training is designed to teach a variety of prosocial skills such as coping with loneliness, making choices, controlling anger, recognizing feelings,

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Page 4: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

160 AKTAN, KUMPFER, AND TURNER

and coping with peer pressure. The family skills training involves both the parents and the children as a family unit wherein the parents learn to apply appropriate limit-setters and to reward good behaviors.

The Safe Haven trainers carry out the program curriculum utilizing the program materials. The trainers are present during all sessions and can pro- vide immediate reinforcement and cuing of the appropriate parental behaviors. In addition, the parents are video-taped by the trainers to assure that they meet criterion on their demonstration of essential parenting skills. Trainers are se- lected from a pool of qualified, African-American, male and female substance use counselors. All trainers participate in a 3-day training in the program philosophy and curriculum followed by periodic observations.

The youth targeted by the Safe Haven Program are the six to twelve-year- old African-American children of known substance users in the City of Detroit. The family unit is loosely defined and may be comprised of one or both par- ents of the children, other adult relatives in the children’s household, and any other adults closely involved with the care of the children.

Potential participants in the Safe Haven Program are drawn from all par- ents admitted to treatment for substance use at the Salvation Army Harbor Light Residential Drug and Alcohol Treatment Center in Detroit, Michigan. After a qualification process, the Safe Haven Program is included as part of the client’s overall treatment. The qualification process is as follows: if the client has children within the age ranges suitable for the program (6-12 years) and living within the city of Detroit, the client’s name is placed on a list of potential candidates for the Safe Haven Program. The potential client is inter- viewed by the liaison to the program who describes the program philosophy and structure. The liaison gathers additional information about the family and assesses the client’s level of interest and potential commitment to complete the 12-week program. If the client is interested and potentially committed to the program, he/she is interviewed by the Program Director. The Program Direc- tor, with the client, contacts the primary care-giver and others involved with the day-to-day care of the children. In the final qualifications step, all family members must acknowledge the importance of regaining stability in their fami- lies and commit to participating in the full 12-week program. Following the acknowledgment, they are given a tentative date for the first session.

A detailed description of the Safe Haven Program, including the target population, participant recruitment, program setting, and program content, is reported by Aktan (1995).

EVALUATION METHODS

The goal of the Safe Haven Program is to reduce the risk factors for sub- stance use in families where a parent is a known substance user. The desired

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Page 5: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

EFFECTIVENESS OF A FAMILY SKILLS TRAINING PROGRAM 161

outcomes are to increase the parent’s parenting efficacy; increase the parent’s bonding with the child; increase child’s positive behavior; increase the child’s school performance; increase the child’s school bonding and associations with positive peers; increase family cohesion; increase positive family communica- tion; and increase family expressiveness and organization.

The Safe Haven Program evaluation involves a process evaluation com- prised of satisfaction and attendance records and an outcome evaluation com- prised of pre- and posttest measurements on a standardized test battery of the parents and “targeted” children in the program. Only one child per family could be included in the outcome evaluation due to the extensive nature of the test battery which made collection of data on all children participating unwork- able. In most cases the families participating in the program had more than one child. One child was “targeted” or chosen by the parentslcare-givers in each family based on the parentskare-givers’ perceptions of their need for assistance in parenting. Care was taken in selecting the “targeted” child to emphasize the parents’kare-givers’ need for parenting skills rather than any specific difficulty with the child. In addition to the pretest and posttest, a 6- and 12-month fol- low-up is also conducted.

The process evaluation forms, comprised of satisfaction and attendance records, are completed by the trainers after every session using a five-point rating scale. Satisfaction ratings completed by the trainers include: an overall rating of the session content, completion of material, leader delivery, group enthusiasm, appropriateness of presentation, usefulness of homework, flow of presentations, usefulness of activities, usefulness of particular session, and dif- ficulty of session. The attendance records consist of the trainers rating the participants on the following group interaction variables: attendance, prompt- ness, completion of homework, attention and participation, amount of disclo- sure and sharing, appropriateness of sharing, supportiveness of others, inter- est level, motivation level, and competency in concept taught. The different dimensions were selected based on the hypothesis that active participation in the group process might affect outcomes.

The outcome evaluation instruments consist of a parent interview sched- ule and a child interview schedule. The parent interview is comprised of ques- tions on the child’s school behaviors, the child’s characteristics, family and friends, parenting attitude, alcohol and drug use, and depression. Items are drawn from the Moos Family Environment Scale (Moos, 1974) and the Achen- bach and Edelbrock Child Behavior Checklist. The child’s interview contains questions on social acceptance, school attitude, emotional behavior, alcohol and drug behavior and attitudes, family relations and responsibilities, problem behaviors, parental response to problem behaviors, problem solving, peer re- sistance, and self-concept.

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Page 6: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

162 AKTAN, KUMPFER, AND TURNER

In addition to the process and outcome evaluation noted above, a cultur- ally-specific evaluation component is also conducted which includes observa- tions of the program in process from a cultural perspective. Information is obtained by the cultural specificity evaluator from the trainers and the partici- pant families through interviews and observation concerning the specificity of the program for African-American families. Information obtained from this evaluation is incorporated in program revisions.

RESULTS

The results presented herein are comprised of selected pretest and posttest data on three cohorts of families. In the first 16 months of the program (March 1991 to June 1992), information was obtained on 88 individual parents (both substance-using and nonusing). The 88 “targeted” children participating in the program, 49 males and 39 females, ranged from six to twelve years old with a mean age of 7.6 years. About 41% of the children were in the fourth grade or higher; 27% in the second or third grade; and 32% in first grade or kin- dergarten ( N = 75). Approximately half of the children ( N = 45) had expe- rienced significant school failure in terms of repeating at least one year in school. Tables la and l b present the demographic characteristics of the Safe Haven Program participants during this time period. Table l a presents the characteristics of the parents only; Table l b presents the characteristics of the “targeted” child only.

Process Evaluation

The results of the process evaluation, which included frequent observations of training, staff meetings, and the family groups by the program originator and trainer, demonstrated that the Safe Haven Program staff were successful in recruiting families, implementing the program, and collecting data necessary for the evaluation component of the project. Trainer ratings on session fidel- ity checklists, suggested by project staff, were true to the intent of the program. Although participant involvement was rated for each session by the trainers, it was not found to predict outcomes. A similar result was found for the fami- lies in a study in Alabama (Kumpfer, 1991).

When barriers were encountered, the staff did not compromise on the recruitment of African-American parents with substance use problems. The staff was particularly successful in recruiting African-American substance-us- ing fathers. Given the low percentage of fathers of any racelethnicity attend- ing parenting programs, this was a major success. Qualitative data collected from the participants and staff revealed that one male staff member was pri-

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Page 7: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

EFFECTIVENESS OF A FAMILY SKILLS TRAINING PROGRAM 163

Table la.

Selected Demographic Characteristics of Safe Haven Program Participants (parents only) ~ ~~

Sample size (n) Percent sample

Ethnicity, n = 88 Education, n = 88

Religion, n = 88

Employment status, I1 = 88

Household income, n = 76

Source of income n = 76

Number of children (under age 18) in household, n = 88

African-American Elementary Junior high graduate High school graduate Some college College graduate Baptist Fundamentalist Catholic Protestant Other Employed 30 or more hours/week Employed < 30 hourdweek Unemployed < $5,000 $5,000-$14,999 $15,0OO-$I9,999 $20,000-$24,999 > $24,999 Welfare Wages Pension Rents Other One child 2-3 children 4-6 children 6-10 children

88 2

31 31 18 6

55 6 6 6

1s 8

16 64 26 26 11 7 6

44 22 6 3 1

11 50 22 5

100 2

35 35 21

7 62 7 7 I

22 9

18 73 34 34 14 9 9.

58 29 8 4 1

12 57 25 6

marily responsible for the success in involving African-American males. His approach, that fathers’ involvement in the rearing of their children is neces- sary and desirable, was effective.

Approximately half of all families participating in the program completed the 12-week program in the first few months of implementation. This figure rapidly rose to 80% and has remained at that level.

Outcome Evaluation

A nonequivalent comparison, repeated measures, quasi-experimental design was employed to evaluate the effectiveness of the Safe Haven Program. Both

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Page 8: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

164 AKTAN, KUMPFER, AND TURNER

Table lb .

Selected Demographic Characteristic Safe Haven Program Participants (“targeted” child only)

~~

Sample size (n) Percent sample

Ethnicity, n = 88 African-American 88 100 Sex, n = 88 Male 49 56

Female 39 44 Age, n = 88 6-1 years 40 46

8-9 23 26 10-12 25 28

Grade, n = 15 Kindergarten or first 24 32 Second or third 20 21 Fourth or higher 31 41

Repeated grade 2 years 21 60 n = 45 1 year 18 40

between-S design comparisons using an analysis of variance (ANOVA) with independent t-tests of correlated means were made of the pre- and posttest data from three cohorts of families ( N = 88) as well as matched subject within-S design comparisons ( N = 56). A Pearson Product Moment Correlation matrix analysis was conducted to determine the intercorrelations among the different variables. The results of this analysis verified the interrelatedness of the Child Behavior Checklist Internalizing and Externalizing Scales.

The effectiveness of the Safe Haven Program with families reporting “high” substance use was compared with families reporting “low” substance use. A determination of “high” versus “low” substance use was based on parental reports of quantity, frequency, and category of substance use by mosr adults in the child’s family (not self-reports). Respondents who reported “heavy” daily use of alcohol (on a five-point scale which also included only daily use) or use of illicit drugs four or more times per month by most adults in the child’s family were assigned to the “high” use category. The rationale was that “high” use in the child’s family could indicate more impairment than in ‘‘low’’ use families; thus, a differential likelihood to benefit from the pro- gram could exist. A within-S matched subjects analysis of variance (ANOVA) was conducted to compare a group of “high” substance use ( N = 27) with a group of “low” substance use ( N = 29). The null hypothesis of equal effec- tiveness for both groups was predicted.

The results show that the program had significant positive effects on the parents, the children, and the families combined; however, more improvements in the children’s risk and protective factors were noted in the children of the

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Page 9: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

EFFECTIVENESS OF A FAMILY SKILLS TRAINING PROGRAM 165

high drug-using parents. Each of these domains will be discussed below be- ginning with the parents’ results, followed by the childrens’ results, and finally, the families’ results.

Parent Parenting Improvements and Drug Use Reductions

The parents in both groups reported a significant drop in illegal drug use in the family (paired t = 3.32, p < .002), and significant reductions in their own drug use (paired t = 5.56, p < .OOO). As at least one of the parents is simultaneously in drug user treatment, these improvements are expected to occur; however, the parenting program may have contributed to reduced drug use because the parents in other Strengthening Families Programs not in drug treatment also reported significantly reduced substance use. The Safe Haven parents also reported significant decreases in their depression in the total sample (paired t = 2.39, p < .024) and in the “high” drug use group only (paired t = 2.87, p < .006). Reported significant improvement in their perceived effi- cacy as parents occurred in the high drug use parents (paired t = 3.20, p < .002) and the total sample (paired t = 3.20, p < .002), but not the “low” drug-using group even though they were nearly equal on the pretest. These results are presented in Table 2.

Table 2.

Measures of ParentlAdult Functioninga

Low drug use High drug use Total sample

Measure Pretest Posttest Pretest Posttest Pretest Posttest

Parent efficacy: Mean S.D.

Mean S.D.

Mean S.D.

Mean S.D.

Parent depression:

Parent’s own drug use:

Family illegal drug use:

2.320, (.539)

1.496, (.376)

2.033, (.635)

1.66, (.47)

2.166 (.499)

1.367 (.276)

1.735*** (.428)

2.357, (.681)

1.789, (.604)

3.222, ( ,944)

1.968*** (.469)

1.505** (. 295)

2.303*** (. 840)

1.77** (.54)

2.339 (.609)

1.645 (SIO)

2.617 (. 995)

1.86 (37)

2.067*** (.490)

1.437*** (.292)

2.014*** (.717)

1.61*** (.47)

“Comparison between low and high drug use pretest means are statistically significant at the .05 level (t-tests) if the means do not have the same subscript. Comparisons are to be made only within a single dependent variable. Pre to post changes in the low, high, or total sample are statistically significant if the posttest means contains superscript asterisk@. *p > .05, **p < .05, ***p < .01.

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Page 10: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

166 AKTAN, KUMPFER, AND TURNER

The high drug-using parents also reported significant increases in the amount of time they spent with their children, whereas the low drug-using parents did not. No significant reductions in their use of corporal punishment (paired t = 1.61, p < ,115) were found in the combined sample or for the separate groups. It is of interest that the low drug-using parents had higher rates of corporal punishment on the pretest than did the high drug-using par- ents while both groups had reduced their corporal punishment at about the same rate by the posttest. The program improved the level of inappropriately high developmental expectations found in these families in earlier research (Kumpfer, 1987), but not significantly.

Children’s Problems Decreased

On the Achenbach and Eldelbrock Child Behavior Checklist, a number of significant changes were measured which suggest improvements in the child- ren’s externalizing problem behaviors, namely aggression (paired t = 2.88, p < .006) and hyperactivity (paired t = 3.11, p < .003). A marginally sig- nificant reduction occurred for conduct disorders or delinquent behaviors (paired t = 1.77, p < .082). The composite externalizing scale also showed significant reductions (paired t = 2.86, p < .006). These effects occurred pri- marily in the high drug-using samples, since changes were significant on all of these measures in the high drug-using group ( p < .05), but the changes were not significant in the low drug-using group ( p > .05). These results are presented in Table 3.

Similar results were obtained for the internalizing scales. A significant reduction for the total sample was found on the composite internalizing scale (paired t = 2.27, p < .027) as well as for schizoid scores (paired t = 2.23, p < .030), depression (paired t = 3.29, p < .001), uncommunicati.veness (paired t = 2.20, p < .032), and obsessive/compulsive behavior (paired t = 2.44, p < .018). Marginally significant effects were noted for the mea- sure of social withdrawal (paired t = 1.89, p < .064). The measure of so- matic complaints was not significant (paired t = 0.35, p < .726). These re- sults are presented in Table 4.

The changes in the internalizing measures are attributed primarily to the high drug-using families since these families changed significantly on the com- posite index ( p < .001), while the low drug-using group did not change sig- nificantly ( p < . lo). The high drug-using group also changed significantly on measures of schizoid behavior, depression, uncommunicative behavior, obses- sive/compulsive behavior, and social withdrawal ( p < .05). The low drug- using group did not change significantly on any of these measures.

In addition, the children were also reported by their parents to have sig- nificant reductions in school problems (paired t = 3.50, p < .001), although

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Page 11: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

EFFECTIVENESS OF A FAMILY SKILLS TRAINING PROGRAM 167

Table 3.

Children's Externalizing Behaviors (CBCL) a

Low drug use High drug use Total sample

Measure Pretest Posttest Pretest Posttest Pretest Posttest

Externalizing: Mean S.D.

Mean S.D.

Delinquency: Mean S.D.

Hyperactivity: Mean S.D.

Aggression:

,511, (.205)

,607, (.282)

.273, (.167)

,652, (.278)

,490 (.251)

,584 (.288)

,299 (.297)

,586 (.242)

-635, (.305)

,754, (-333)

.398, (. 330)

,756, (. 322)

.445*** (.205)

.525*** (.264)

.221*** (.187)

,593 ** * (.212)

.573 (.265)

,681 (.317)

,335 (267)

,704 (.303)

.468*** (.228)

.555*** (.272)

.260* (.249)

.589*** (.225)

acornparison between low and high drug use pretest means are statistically significant at the .05 level (f-tests) if the means do not have the same subscript. Comparisons are to be made only within a single dependent variable. Pre to post changes in the low, high, or total sample are statistically significant if the posttest means contains superscript asterisk(s). *p > .05, **p < .05, ***p < .01.

the effect was significant only in the low drug use group ( p < .001). The par- ents reported increased school bonding (paired t = 4.63, p < .OOl) which was significant for both the high and low drug-using groups ( p < .002). The to- tal sample reported increased time spent on homework (paired t = 2.22, p < .032). This effect did not differentially impact the high or low drug use group. These results are presented in Table 5 .

Most of these improvements occurred in the children of the high drug users. These children have more problems on the pretest and showed more improvement on the posttest on the Child Behavior Checklist as rated by their parents. It is possible that these changes reflect solely changes in the percep- tual system of the parents. Nevertheless, these positive results lend support to the findings of several earlier studies in Alabama (Kumpfer, 1991) and Utah (Harrison, 1994), which indicated that the Strengthening Families Program was having positive effects on the children and their families.

Family Environment Improved

The effects of the program on the family were the weakest, with only the family cohesion scale of the Family Environment Scale (Moos, 1974) meeting

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Page 12: Effectiveness of a Family Skills Training Program for Substance Use Prevention with Inner City African-American Families

168 AKTAN. KUMPFER, AND TURNER

Table 4.

Children's lnternalizing Behaviors (C/3CL)a

Low drug use High drug use Total sample

Measure Pretest Posttest Pretest Posttest Pretest Posttest

Internalizing composite: Mean S.D.

Schizoid: Mean S.D.

Mean S.D.

Mean S.D.

Child depression:

Uncommunicative:

,422, (.215)

,345, (.228)

,409, (.217)

.469, (.342)

,416 (.308)

,339 (.337)

.373 (.283)

,485 ( ,345)

,571, (.255)

,525, (.297)

,596, (.308)

,652, (.301)

.404* * * (.162)

.327*** (.182)

.383*** (. 195)

.453*** (.211)

,496 (.245)

,435 (.278)

SO3 (.281)

,560 (.332)

.410** (.243)

.333** (.268)

.378*** (.241)

.469** (.284)

Obsessive/conipulsive: Mean ,492, .450 ,587, .433*** ,539 .441** S.D. (.280) (.304) (.310) (.214) (.297) (.261)

Mean ,299, .355 ,460, ,385 ,380 ,360 S.D. (.206) (.385) (.325) (.246) (.281) (.321)

Mean ,518, .511 ,603, .442*** 561 .477* S.D. (.289) (.330) (.309) (.193) (.299) (.270)

Somatic complaints:

Social withdrawal:

"Comparison between low and high drug use pretest means are statistically significant at the .05 level (t-tests) if the means do not have the same subscript. Comparisons are to be made only within a single dependent variable. Pre to post changes in the low, high, or total sample are statistically significant if the posttest means contains superscript asterisk(s). * p > .05, * * p < .05, ***p < .01.

the significance level (paired t = 2.24, p < .029). Other measures of fam- ily environment which approached but did not reach significance were family conflict (paired t = 1.89, p < .064), faniily relationship (paired t = 1.80. p < .077), and family organization (paired t = 1.95, p < .056). These re- sults are presented in Table 6.

Family organization is one of the two major scales hypothesized to im- prove significantly, based on prior findings in Alabama (Kumpfer, 1991) and Utah (Harrison, 1994). It is a new finding that family cohesion improved. This was not found in the Alabama study (Kumpfer, 1991) possibly due to the Safe Haven Program putting increased emphasis on reuniting mothers and fathers as a total family. The research provides provisional evidence that family re-

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EFFECTIVENESS OF A FAMILY SKILLS TRAINING PROGRAM 169

Table 5.

Other Measures of ParentlChild Functioninga

Low drug use High drug use Total sample

Measure Pretest Posttest Pretest Posttest Pretest Posttest

School problem: Mean S.D.

School bonding: Mean S.D.

Mean S.D.

Mean S.D.

Time on homework:

Corporal punishment:

2.875, (.504)

2.314, (.506)

2.275, (.888)

2.344, (.729)

2.503*** (.417)

2.027*** (.437)

1.912* (.718)

2.055 (.704)

2.705, (.630)

2.334, (.751)

2.375, (. 996)

2.136, (. 800)

2.446* (.462)

1.956*** (. 409)

2.053 (.707)

2.037 (.694)

2.786 (.574)

2.324 (.634)

2.327 (.936)

2.240 (.765)

2.473 *** (.438)

1.991*** (.421)

1.986** (. 707)

2.046 (.692)

Parent-child activity: Mean 2.746, 2.386 2.865, 2.327*** 2.805 2.356*** S.D. (.956) (.583) (1.108) (.570) (1.026) (S71)

acornparison between low and high drug use pretest means are statistically significant at the .05 level (&tests) if the means do not have the same subscript. Comparisons are to be made only within a single dependent variable. Pre to post changes in the low. high, or total sample are statistically significant if the posttest means contains superscript asterisk(s). *p > .05, **p < .05, ***p < .01.

lationships improved. The program brings all the family together for at least one evening a week; therefore, the family possibly spent more time together. The parents reported that parent and child activities increased (paired t = 3.04, p < .004), as well as parent and child time together (paired t = 3.28, p < .004).

There were no significant unintended effects of the program; hence, the Safe Haven Program appears to have a beneficial effect in supporting treatment reductions in the parent and family illegal drug use, improving parent efficacy and behaviors toward children, improving the children’s risk and protective factors and behaviors, and strengthening families.

DISCUSSION

The results obtained from the evaluation of the Safe Haven Program in Detroit, Michigan, are valid and match clinician’s reports on the differences between high drug-using and low drug-using families. “Heavily” drug-involved

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170 AKTAN, KUMPFER, AND TURNER

Table 6.

Family Environment Sca/ea

Low drug use High drug use Total sample

Measure Pretest Posttest Pretest Posttest Pretest Posttest

Family cohesion: Mean S . D .

Family conflict: Mean S . D .

Mean S.D.

Mean S.D.

Family relationships:

Family organization:

2.330, (.760)

2.932, (.822)

2.434, (.462)

2.701, ( ,906)

1.960* (.586)

2.611** (.632)

2.610 (.397)

2.340 (. 790)

2.363, (.959)

3.105,, (.838)

2.304, (.680)

2.666, ( ,767)

2.107 (. 796)

2.992 (.680)

2.430 (.501)

2.432 (1.003)

2.346 (.854)

3.017 (. 827)

2.370 (.578)

2.684 (.835)

2.031** (.693)

2.798* (.677)

2.522* (.456)

2.384* (.892)

”Comparison between low and high drug use pretest means are statistically significant at the .05 level (r-tests) if the means do not have the same subscript. Comparisons are to be made only within a single dependent variable. Pre to post changes in the low, high, or total sample are statistically significant if the posttest means contains superscript asterisk(s). *p > .05, **p < .05, ***p < .01.

families have been reported by Wolin et al. (1979) to be deficit in family rituals and organization. This study supports that finding. In addition, another primary family environment problem in heavily drug-involved families is family con- flict (Kumpfer and DeMarsh, 1985; Kumpfer, 1991). This study supports those findings as well.

The behavioral and emotional problems in the children of the high drug- using parents were significant. Increased effectiveness with the children of the high drug users is possibly due to the greater number of behavioral external- izing and internalizing problems at the beginning of the program.

This quasi-experimental design did not involve a dismantling design with a group of youth receiving only the children’s programs. As such, it is impos- sible to determine if solely the parents’ component, as opposed to solely the children’s component, is requisite for these significant improvements. In ear- lier research (DeMarsh and Kumpfer, 1986), the children’s skills training com- ponent did not make as significant a difference on children’s problem behav- iors as did the parenting program. The children’s skills training component mainly improved prosocial skills, while the parent training program alone made most of the difference in negative problem behaviors. It would be useful to implement solely a childrens’ program to determine if this remains the case.

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EFFECTIVENESS OF A FAMILY SKILLS TRAINING PROGRAM 171

The results of the Safe Haven Program show that it is possible to involve high risk drug-using parents in relatively lengthy parenting and family pro- grams and to keep them involved until graduation.

FUTURE RESEARCH

A major feature of the Safe Haven Program is an adaptation of the pro- gram curriculum and supporting audiovisual materials to be more meaningful to the targeted African-American population. This revision is based on a cul- tural sensitivity and specificity evaluation conducted in the second year of the Safe Haven Program. The revision of the program manuals includes culturally- specific content and art work while the program videos feature African-Ameri- can families in typical family situations encountered by the families of local substance users. An evaluation will be conducted in the fourth year to deter- mine what impact, if any, the African-American cultural orientation has on the effectiveness of the program, The revised culturally-specific program (Aktan et al., 1994a, 1994b, 1994c) and evaluation of its effectiveness will be the subject of a future paper.

Whether the results obtained from these families over the 12-week period will be achieved or maintained over a longer period of time, such as the six and twelve month follow-up, remains to be seen. Investigation of more longer term effects of the program will be the focus of additional analyses of the third through the fifth years.

ACKNOWLEDGMENTS

The Safe Haven Program for the Prevention of Substance Abuse was fund- ed by Grant H86 SP01793 from the US Government, Center for Substance Abuse Prevention., Substance Abuse Mental Health Services Administration. The program was implemented by the City of Detroit Department of Health, Bureau of Substance Abuse, Detroit, Michigan 48202. The opinions stated here are those of the authors and do not necessarily reflect the views of the US Government, Center for Substance Abuse Prevention, the Detroit Department of Health, or the University of Utah.

REFERENCES

AKTAN, G. B. (1995). Organizational frameworks of a substance use prevention program. Int. J . Addict. 30(2): 185-201.

AKTAN, G. B. , BRIDGES, S. D . , and KUMPFER, K. L. (1994a). The Safe Haven Program: Strengthening African-American Families. Parent Training Manual. Detroit Department of Health, Bureau of Substance Abuse.

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172 AKTAN, KUMPFER, AND TURNER

AKTAN, G. B., BRIDGES, S. D., and KUMPFER, K. L. (1994b). The Safe Haven Program: Strengthening African-American Families. Children 's Training Manual. Detroit Department of Health, Bureau of Substance Abuse.

AKTAN, G. B., BRIDGES, S. D., and KUMPFER, K . L. (1994~). The Safe Haven Program: Strengthening African-American Families. Family Training Manual. Detroit Department of Health, Bureau of Substance Abuse.

BRY, B. H. (1983). Predicting drug abuse: Review and reformulation. fnt. J . Addict. lS(2):

CLONINGER, C . R., BOHMAN, M., SIGVARDSSON, S . , and VON KNORRING, A. L. (1985). Psychopathology in adopted-out children of alcoholics: The Stockholm Adoption Study. Rec. Dev. Alcohol. 3: 37-51.

COTTON, N. S . (1979). The familial incidence of alcoholism: A review. J . Stud. Alcohol

DEMARSH, J. P., and KUMPFER, K. L. (1986). Family-orinted interventions for the prevention of chemical dependency in children and adolescents. In S . Ezekoye, K. Kumpher, and W. Bukoski (Eds.), Childhood and Chemical Abuse: Prevention and Intervention. New York: Haworth Press.

DINKMEYER, D., and McKAY, G. D. (1976). Systematic Training for Egective Parenting. Circle Pines, MN: American Guidance Service.

DISHION, T. J., KAVANAGH, K., and REID, J. B. (1989, November). Child-rearing vs. Peer Interventiow in the Reduction of Risk for Adolescent Substance Use and A&rtment Problem. A Secondary Prevention Strategy. Paper presented at the Conference for the Advancement of Applied Behavior Therapy, Washington, D.C.

FINN, P. R., and PIHL, R. 0. (1988). Risk for alcoholism: A comparison between two differ- ent groups of sons of alcoholics on cardiovascular reactivity and sensitivity to alcohol. Al- coholism: Clin. Exp. Res. 12: 142-147.

FOREHAND, R. L., and McMAHON, R. J. (1981). Helping the Noncompliant Child. A Clin- ician T Guide to Parent Training. New York: Guilford Press.

GOODWIN, D. W. (1985). Alcoholism and genetics: The sins of the father. Arch. Gen. Psychiatry

GORDON, T. (1970). Parent Effectiveness Training. New York: P. H. Wyden. GUERNEY, B., JR. (1964). Filial therapy: Description and rationale. J. Consult. Psychol. 28(4):

HARRISON, R. S . (1994). Final Evaluation of the Utah Communiry Youth Activity Project. Sub- mitted to the Utah State Division of Substance Abuse. Social Research Institute, Graduate School of Social Work, University of Utah, Salt Lake City, UT.

JOHNSON, G. M.. SCHOUTZ, F. C., and LOCKE. T. P. (1984). Relationships between ado- lescent drug use and parental drug behaviors. Adolescence 19: 295-299.

KANDEL, D. B., KESSLER, R. C., and MARGULIES, R. Z. (1978). Antecedents of adoles- cent initiation into stages of drug use. In D. B. Kandel (Ed.), Longitudinal Research on Drug Use: Empirical Findings and Methodological Issues. New York: Wiley.

KUMPFER, K. L. (1987). Special populations: Etiology and prevention of vulnerability to chemical dependency in children of substance abusers. In B. S . Brown and A. R. Mills (Eds.), Youth at High Risk for Substance Abuse (pp. 1-71). Rockville, MD: NIDA.

KUMPFER, K. L., and DEMARSH, J. P. (1985). Genetic and family environmental influences on children of drug abusers. J . Child Contemp. SOC. 3(4): 49-91.

KUMPFER, K. L. (1991, November). YCOSA Black Parenting Project: Final Evaluation Report. Submitted to the Alabama Department of Mental Health and Mental Retardation.

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EFFECTIVENESS OF A FAMILY SKILLS TRAINING PROGRAM 173

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RESUMEN

La efectividad del Safe Haven Program (“Programa Refugio Seguro”) para la prevencibn del us0 de alcohol o drogas, un programa didactic0 sobre hab- ilidades de relaciones familiares para familias de ascendencia africana-amer- icana, fue evaluada usando un diseiio cuasi-experimental con medidas multiples de grupos comparativos no-equivalentes que incluyo entrevistas con padres y niiios antes y despuCs de participacibn en el programa, utilizando el Moos Family Environment Scale (“La Escala para Describir el Medio Ambiente Familiar desarrolada por Moos”), y el Achenbock and Edelbrock Child Behav- ior Check List (“Lista de Tipos de Conducta de Niiios desarrollada por Achen- bock and Edelbrock”). Los resultados indican que el Safe Haven Program parece tener un efecto beneficioso en incrementar la eficacia de padres en su rol de padres y sus conductas hacia sus niiios, mejorar 10s factores y conductas de 10s nifios en cuanto a1 riesgo y proteccibn, y apoyar reducciones en el us0 de drogas ilegales en padres y miembros de la familia a consecuencia de tra- tamiento.

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I74 AKTAN, KUMPFER, AND TURNER

RESUME

L’efficacitk du programme “Safe Haven” ax6 sur la prkvention de I’utilisation des drogues chez les familles amkricaines noires, a CtC Cvalde d’une manitre non Cquivaltene. Pour ce faire, on a fait passer diffkrentes Cpreuves expCr- imentales qui comprennent entre autres des tests prkliminaires et des tests suhskquents et des rencontres parents et enfants. Parmi ces Cpreuves, on re- trouve le Moos Family Environment Scale et le Achenbock and Edelbrock Child Behavior Checklist. Les rCsultats obtenus indiquent que le programme “Safe Haven” semble avoir un effet favorable sur les relations parents-enfants et sur le comportement des parents; amkliorant ainsi les facteurs de protection, de risques et de comportement. I1 aide aussi rkduire les traiternents des par- ents et des enfants qui consomment des drogues illCgales.

THE AUTHORS

Georgia B. Aktan, Ph.D., is the Principal Investigator of the Safe Ha- ven Program in the City of Detroit Department of Health, Bureau of Sub- stance Abuse, Detroit, Michigan. Dr. Aktan received her doctorate from the University of Michigan and has been active in social science research for 13 years, including 5 years in sub- stance abuse prevention and treatment. Dr. Aktan is also Research Coordina- tor for the Michigan Department of Public Health, Center for Substance

Abuse Services, Lansing, Michigan, where she oversees the conduct of the Michigan Family of Needs Assessment Studies funded by the Center for Sub- stance Abuse Treatment, Substance Abuse Mental Health Services Administra- tion. Su

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EFFECTIVENESS OF A FAMILY SKILLS TRAINING PROGRAM 175

school age children and is currently Strengthening Families Program fo

Karol L. Kumpfer, Ph.D., is a psy- chologist with over 20 years of re- search experience in alcohol and other drug use prevention and treatment. Dr. Kumpfer is currently an Associate Professor of Health Education at the University of Utah where she has conducted extensive federally-funded research on family, school, and com- munity approaches to drug preven- tion. Dr. Kumpfer has developed sev- eral family skills training programs focusing on elementary and middle

involved in research on applications of the Nr different ethnic youth and their families.

Charles W. Turner, Ph.D.. received is doctorate in Psychology from the University of Wisconsin and is cur- rently Professor of Psychology at the University of Utah were he has ad- junct appointments in the Educational Psychology and Health Education Departments. In addition to collabora- tive research on substance use preven- tion and treatment, Dr. Turner con- ducts research on the role of personality and social psychological variables in the management of chronic disease processes.

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