Sixsmith and D’Eath (2011)1 were commissioned by the Western Region Drugs Task Force to evaluate the roll-out of the Strengthening Families Programme (SFP) in five centres in the region. The SFP was developed in the USA to build resilience and reduce risk factors for poor health and social outcomes, including substance misuse and related behaviours, in at-risk families. This article describes the main findings of the evaluation as they relate to seven specific questions posed by the evaluators.
Was the SFP implemented as planned; what, if any, were the deviations from the plan; and what were the reasons for the deviations?
Steering committees comprising multi-agency representation were convened in all five centres as planned. However, levels of participation varied across committees, with several experiencing non-involvement of individuals and agencies. In one of the centres, plans to implement the SFP were abandoned because of inadequate levels of participation on the committee. For some steering committees, the referral system did not work as planned. Referral processes varied across the centres and some did not receive any referrals from the committees.
The steering committees, for the most part, decided the criteria for referral to the SFP. However, these decisions exhibited a lack of clarity and consensus as to the appropriate target groups. Steering groups reported inconsistencies around understanding which risk factors were relevant to determining eligibility for the SFP. For example, groups differed on whether substance use was a risk factor, and, if it was, how the nature and extent of the risk was to be assessed. These inconsistent views were at variance with the overall aim of the SFP, which, according to the task force, was to reduce substance misuse by both parents and teenagers.
What were the perspectives of participating parents and teenagers on the SFP content and delivery?
The delivery of the SFP by a facilitator was valued by participants and the variety of activities, including role play, games and art, contributed to an unexpected fun experience; it was this experience that appeared to engage and sustain involvement. Teenagers seemed to learn more from specific modules, such as substance misuse, sexuality, communication and resolving conflict. On the other hand, parents tended to speak about their learning in general terms.
Was the mealtime an important element of the SFP for participants?
Parents, teenagers and service providers considered the mealtime an important component of the SFP. The mealtime preceded each of the 14 weekly sessions and was seen to act as an ice-breaker, providing an opportunity for less formal communication between families and providers and within families. Some families expressed the desire to incorporate this experience into family living.
Was the training adequate for facilitators to deliver the SFP, overall and in this setting?
An information seminar and a two-day training session were delivered in each of the four sites. Overall, there were mixed views on the adequacy of training, with several facilitators saying that the training was only adequate because of the range of skills they already possessed and that essential skills were neither provided nor tested during the training provided.
What alterations to the process and programme (implementation and content) are necessary to ensure successful outcomes in future delivery?
Changes to the referral process and greater clarity about the role of the referral agencies were identified as necessary improvements. In addition, improved clarity in identifying relevant target groups and in recruitment processes were perceived as necessary changes that could improve implementation and impact. Service providers suggested that future programmes could focus on families with children who were younger than the 12–16-year age group stipulated by the current SFP. This suggestion was based on the view that younger children were more amenable to behaviour change, and that some teenager participants in the current SFP exhibited challenging behaviours.
Did the SFP impact on participants, and if so what was the impact?
Families were assessed before and after their participation in the SFP, using three domains in the Family Environment Scale (FES): family cohesion, expressiveness and conflict. According to the authors, the small sample size and poor response rate to some questions interfered with the analysis that was planned; the limited data generated meant that no significant differences between pre and post intervention were detected.
Interviews with family members suggested that some benefits from participation in the SFP were achieved, such as improved communication within the family unit and enhanced parenting skills.
Did the SFP reduce drug and alcohol use among participants?
Parents were invited to answer questions drawn from the SLAN questionnaire about their alcohol intake and related behaviours, before and after their participation in the SFP. The authors report that too few participants answered some questions, which interfered with meaningful analysis. From the limited number of questions answered, no measurable impact on alcohol intake or related behaviours was detected.
Teenagers were invited to answer questions drawn from the Health Behaviour in School-aged Children (HBSC) questionnaire about their substance use and related behaviours, before and after their participation in the SFP. The authors report that the amount and consistency of data generated from responses was inadequate to allow a meaningful statistical analysis. From the data generated, no differences in substance use can be credited to participation in the SFP.
Interviews with parents (n=10), teenagers (n=7) and service providers (n=9) revealed that, for most of the families taking part in the SFP, substance use was not perceived to be a major problem.
The lack of consensus on appropriate target groups and on what constitutes an at-risk family could have been overcome by a thorough needs assessment of potential participants. The lack of clarity between participants and service providers regarding the main objectives of the programme could have been resolved by setting short-term objectives, such as the reduction of identified risk factors, rather than focusing on long-term and perhaps unrealistic outcomes such as the reduction or cessation of substance use. The inclusion of alternative outcomes would have necessitated the selection of alternative data collection instruments. Instead of using modified versions of the SLAN and HBSC surveys, alternative instruments could have been used to assess the impact of the SFP on participants.
1. Sixsmith J and D’Eath D (2011) An independent evaluation of the Strengthening Families Programme in the WRDTF Region. Galway: Western Region Drugs Task Force. www.drugsandalcohol.ie/16657