1. The Strengthening Families Program
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
Research Methods
Results
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 parent-child 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).
Study Procedures:
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 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.
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).
The Strengthening Families Program (SFP 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:
parenting efficacy and skills,
family relationships
children’s depression, behavior problems, social skills, grades, etc.
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.
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: 
Design: 2 x 2 Quasi-experimental pre- posttest design with post-hoc, sub-group 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.
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.
Study
Procedures
Needs
Assess-
ment
from Data
Analysis
Engage-
Feasibility
Pilot Test
SFP with
Chinese
Families
References
Strength-ening Families Program
Chinese American families
Substance Abuse Prevention in Chinese youth & families
Spencer, M.S., & Chen, J. (2004). Effect of discrimination on mental health service utilization among Chinese Americans. Am J Public Health.94:
Kumpfer, K.L., Alvarado, R., Smith, P., & Bellamy, N. (2002). Cultural sensitivity in universal family-based prevention interventions. Prevention Science, 3(3),
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),