Transcript Style B 36 by 54 wide

Cultural-adaptations for Chinese Families of an Evidence-based Substance Abuse Prevention Program:
The Strengthening Families Program
Karol L. Kumpfer, Ph.D., Department of Health Promotion and Education, University of Utah, Salt Lake City, UT
Keely Cofrin Allen, Ph.D., Director of the Office of Health Care Statistics, Utah Department of Health, UT
Qing-qing Hu & Jing Xie, G.A., Department of Health Promotion and Education, University of Utah, Salt Lake City, UT
Introduction & Background
Intervention Description
Family Harmony in Chinese
Families. Underlying the image of the
harmonious family, immigrant Chinese
families experience a variety of
psychological problems, including
domestic violence, parent-child conflict,
substance abuse, delinquency, and
discrimination (Sue, 2005; Uba, 1994).
Differential generational acculturation is a
major contributor to increased parentchild conflict (Rodnium, 2007).
Mental Health Problems in
Chinese Families. Despite recent
research revealing mental health and
risky health behaviors among Chinese
Americans, their low use of mental health
services is well documented ( Spencer &
Chen, 2004).
Justification for Implementing
the Cultural Adapted SFP. While a
number of effective family-based
programs exist capable of improving
family relationships, mental disorders
and substance abuse (Kumpfer &
Alvarado, 2003), very few have been
culturally adapted to other cultures or for
Chinese families. This study seeks to
develop a culturally adapted version of
the Strengthening Families Program
(SFP) for Chinese families because
cultural adaptation has been found to
improve recruitment and retention by
40% (Kumpfer, et al., 2002; 2008).
Strengthening
Families
Program
Chinese
American
families
Substance
Abuse
Prevention in
Chinese
youth &
families
Research Methods
Study Procedures:
The Strengthening Families Program
(SFP 3 -16 Year) is:
The first evidence-based intervention
for children of drug abusers (Kumpfer
& Johnson, 2007).
SFP is a 14-session family skills
training program including weekly one
hour of:
1. parent training
2. children’s skills training and
3. family practice session.
Incentives to attend include:
• a meal,
• transportation,
• child care for infants and toddlers,
• small rewards for attendance and
homework completion.
RESEARCH RESULTS. Tested on 8
NIDA, NIAAA and NIMH-funded RCTs,
plus 7 CSAP/CSAT studies with
culturally adapted versions, it was
found to significantly improve:
1. parenting efficacy and skills,
2. family relationships
3. children’s depression, behavior
problems, social skills, grades, etc.
4. children’s risk for drug abuse.
The WHO Cochrane Collaboration
Reviews at Oxford University found
SFP to be the most effective program
in reducing adolescent alcohol and
drug abuse (Foxcroft, et al., 2003).
Thousands of family support agencies
nationwide and 17 countries have
implemented SFP with outcomes often
larger than in the RCTs, proving SFP is
a robust evidence-based intervention.
Phase One—Needs Assessment
Compare the SFP Asian family group
data (n = 60) with the SFP norm data
(n= 3,500) to determine risk and
protective factors in Chinese families.
Phase Two—Engagement Feasibility
Assessment from focus groups.
Do a 1 hour focus group and survey to
know what is their need for attending
and graduating from SFP; the barriers
to take SFP and their ideas on how to
engage families in this program.
Phase Three—Implementation of SFP
with Chinese families.
Recruit and complete SFP with 10-15
Chinese families. Cultural adaptation
done weekly in sessions by Chinese
group leaders. Revise the SFP
curriculum manuals and parent
handouts each week based on family’s
suggestions and the group leaders’
experience.
Study
Procedures
Needs
Assessment
from Data
Analysis
Engagement
Feasibility
Assessment
Pilot Test
SFP with
Chinese
Families
Research Aims: To prevent substance
abuse, delinquency, and mental
health problems among Chinese
children and adolescents by
developing a culturally adapted
version of an evidence-based
family skills training program.
We propose specific research aims:
To determine if there are any
significant differences in risk
or protective factors at intake
or pretest for Asian families.
To determine the best methods
for recruiting and engaging
Chinese families. Barriers and
benefits to attendance will also be
assessed.
To determine the effectiveness of
the Chinese SFP by analyzing the
outcomes of the first-cut cultural
adaptation of the SFP 6-11 Years.
Design: 2 x 2 Quasi-experimental preposttest design with post-hoc, subgroup analysis comparing Asian and
non-Asian families participating in
SFP (Cook & Campbell, 1979).
Measures: A parent self-report testing
battery including 5 SFP Parenting
scales (supervision, skills, efficacy,
confidence, involvement), 5 Moos
Family Environment Scales (conflict,
cohesion, organization, resilience,
communication), NIDA 30-day alcohol
and drug use, Kellam POCA for 7
children’s behaviors (concentration,
overt and covert aggression,
depression, hyperactivity, criminality,
social skills). The secondary data
analysis results of the within-S and
between-groups ANOVA were
analyzed using SPSS v.17.0
comparing Asian and non-Asian
families who completed SFP.
Results
Phase I Needs Assessment: An analysis
of pretest differences of Asian families
compared to non-Asian families revealed 5
of 18 outcomes were significantly lower in
Asians: Children’s Covert Aggression (p.
< .03), Social Skills (p <..01), Parents
ATOD Use (p <.01) and Positive
Parenting (p < .03) and Family Cohesion
(p < .05) suggesting that immigrant Asian
families could benefit from a positive
parenting program that includes Social
Skills Training for the children.
Phase I SFP Outcomes: A 2 x 2 ANOVA
comparing Asian to non-Asian families
revealed 3 interaction effects. Asian
families improved more in Positive
Parenting (p.< .03, d = .71 vs .51),
Parenting Skills (p. <.06, d = .52 vs 42),
and Children’s Social Skills (p.<.04, d =
.46 vs. 28). Asian families improved by
posttest in 18 of 21 outcomes or all but
Criminality, Hyperactivity and ATOD use
because of low pretest scores. The Effect
Sizes were larger in Asian families for the
Parent, Family and Child Cluster variables
and largest (d>0.70) for Positive Parenting,
Family Communication, and Family
Organization. The improvement in
“Family Conflict” was more than twice as
large in Asian as in non-Asian families
(d=.44 vs.18).
References
Spencer, M.S., & Chen, J. (2004). Effect of
discrimination on mental health service utilization
among Chinese Americans. Am J Public Health.94:
809-814.
Kumpfer, K.L., Alvarado, R., Smith, P., & Bellamy,
N. (2002). Cultural sensitivity in universal familybased prevention interventions. Prevention Science,
3(3), 241-244.
Kumpfer, K. L., Pinyuchon, M., de Melo, A., &
Whiteside, H. (2008). Cultural adaptation process for
international dissemination of the Strengthening
Families Program (SFP). Evaluation and Health
Professions. 33 (2), 226-239.