Families Facing the Future

Parents receiving methadone treatment and their children ages 5-14

The Families Facing the Future parent training curriculum consists of one five-hour family retreat and 32 hour-and-a-half parent training sessions. Sessions are conducted twice a week over a 16-week period. Children attend 12 of these sessions to practice the skills with their parents.

Parent sessions are conducted with groups of six to eight families. It is necessary to provide practice opportunities as well as skill components that address recurring problem behaviors specific to the needs of the parents. The parent training format combines a peer support and skill training model. The training curriculum teaches skills using the "guided participant modeling." Skills are modeled by trainers and other group members, then discussed by participants. Skills steps are reviewed and then parents practice the steps. Video-tape is frequently used in modeling the skills or during practice of the skills. The training focuses on affective and cognitive as well as behavioral aspects of performance.

Kevin Haggerty, MSW

• Agency/Affiliation: University of Washington
• Department: Social Development Research Group
• Website: http://www.sdrg.org/fffsummary.asp
• Email: haggerty@u.washington.edu
• Phone: (206) 543-3188

The goals of Families Facing the Future are:

• Reduce parents' use of illegal drugs
• Reduce risk factors for their children's future drug use while enhancing protective factors

The essential components of Families Facing the Future include:

• Groups consist of 6 to 8 families per group
• Session topics are targeted at specific risk and protective factors and include:
• Family Goal Setting: This five-hour session focuses on bringing a variety of families together to share a common, trust-building experience. Families work together to develop goals for their participation.
• Relapse Prevention: These four sessions include identification of relapse signals or triggers, anger and stress control, and creating and practicing a relapse plan in the event of relapse. The primary focus during these sessions is the impact of relapse on the client's children and skills to prevent and cope with relapse situations.
• Family Communication Skills: The skills of Paraphrasing, Open Questions, "I" Messages are taught during these sessions. Families practice using the skills during two practice sessions. Families also practice and use Family Involvement Skills to develop family expectations and plans for regular family meetings or family play and fun time. All subsequent groups reinforce the use of the communication skills taught in these early sessions. Families are asked to conduct weekly family meetings to practice the skills learned in the training.
• Family Management Skills: Parents learn and practice setting clear and specific expectations, monitoring expectations, rewarding for positive behaviors, and instilling consequences for negative behaviors. Parents practice implementing "the law of least intervention," using the smallest intervention to get the desired behavior from their child. A variety of discipline practices are learned and practiced by parents. These include, praise, ignoring, expressing feelings, if-then messages, time-outs, and privilege restrictions.
• Creating Family Expectations about Drugs and Alcohol: Families work together to define and clarify expectations about drugs and alcohol in their families.
• Teaching Children Skills: Parents learn how to teach their children two important skills, Refusal Skills and Problem Solving Skills, using a five-step process.
• Helping Children Succeed In School: Parents build on the previously learned skills to create, monitor, and consequence a home learning routine for their children.
• The curriculum allows for participant practice in situations they currently face with their own children. Parents complete home extension exercises after each session to generalize the skills from the training setting to the home setting. After parents learn and practice skills, family sessions are conducted where parents and children practice using their new skills together.
• The Families Facing the Future case management intervention comprehensively addresses important aspects of family life. The case management intervention is designed to test the effectiveness of:
• Helping families to identify their goals and empowering them to work toward those goals
• Building on families' strengths to stabilize their household through providing tangible services and skills
• Working directly with clients and their families to reduce post-treatment relapse factors and risk factors for later drug abuse by children
• Motivating and encouraging continuation with the parenting skills training
• Further reinforcing, practicing, and generalizing parenting skills to the home environment
• Case managers approach these tasks by providing families with a pro-social model, offering them opportunities for involvement in pro-social activities, networking them into needed services, and changing their reward structure through coaching and reinforcement of their new skills. Case managers also work with families to accomplish the family goals established in the initial parent training session.

Child/Adolescent Services

Families Facing the Future directly provides services to children and addresses the following:

• Parents with drug abuse and dependence problems

Parent/Caregiver Services

Families Facing the Future directly provides services to parents/caregivers and addresses the following:

• Drug abuse and dependence

Recommended Intensity

Parents: 1.5 hour sessions, twice a week; Children: 1.5 hour session, approximately once a week

Recommended Duration

Parents: One 5-hour session, then 32 sessions (16 weeks); Children: 12 sessions (12 weeks)

Delivery Settings

This program is typically conducted in a(n):

• Outpatient Clinic

Homework

This program does include a homework component.

Short family activities to be completed

Resources Needed to Run Program

The typical resources for implementing the program are:

• 1 meeting room
• Cost of two full to half-time staff are needed for group work and home visits
• Childcare
• DVD or VHS player
• TV

Prerequisite/Minimum Provider Qualifications

Training in chemical dependency and parenting, Master's level education

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Onsite; travel expenses must be reimbursed

Number of days/hours:

3 days at 8 hours per day

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Families Facing the Future as listed below.

Members of the Families Facing the Future staff work with the treatment agency to ensure they are tracking the patients at intake and collecting information on children's ages. This information is used to evaluate whether or not the agency has the patient base necessary to launch the Families Facing the Future program.

Formal Support for Implementation

There is formal support available for implementation of Families Facing the Future as listed below:

On-site training is available. Consultation is available via phone and email to answer questions related to implementation and evaluation.

Fidelity Measures

There are no fidelity measures for Families Facing the Future.

Implementation Guides or Manuals

There are no implementation guides or manuals for Families Facing the Future.

Research on How to Implement the Program

Research has not been conducted on how to implement Families Facing the Future.

Child Welfare Outcome: Child/Family Well-Being

"What is included in the Relevant Published, Peer-Reviewed Research section?"

• Catalano, R. F., Haggerty, K. P., Gainey, R. R., & Hoppe, M. J. (1997). Reducing parental risk factors for children's substance misuse: Preliminary outcomes with opiate-addicted parents. Substance Use & Misuse, 32(6), 699–721. https://doi.org/10.3109/10826089709039371

  Type of Study: Randomized controlled trial

  Participants: 178 children and 144 parents

  Sample / Population:

  • Age — Children: 9–14 years; Adults: Mean=35 years
  • Race/Ethnicity — Children: 62% European American, 25% African American, and 13% Mixed Race/Other; Adults: 77% White and 18% African American
  • Gender — Children: 54% Male and 46% Female; Adults: 77% Female
  • Status —

    Participants were parents being treated in a methadone clinic and their children.

  Location/Institution: Seattle, WA

  Summary:

  The purpose of the study was to examine whether Focus on Families (FOF) [now called Families Facing the Future] could reduce parent’s drug use and prevent children’s initiation of drug use. Participants were randomly assigned to receive standard methadone treatment plus FOF, or standard methadone treatment alone. Measures utilized include the Problem Situation Inventory (PSI) and the Moos Family Cohesion Scale. Results indicate that experimental participants held more family meetings to discuss family fun, displayed stronger refusal/relapse coping skills, demonstrated stronger sense of self-efficacy in role play situations, and had lower levels of opiate use than control subjects. No significant differences in family bonding, family conflict, or other measures of drug use were found. Limitations include small sample size, low generalizability to other populations due to ethnicity, and lack of follow-up.

  Length of controlled postintervention follow-up: None.

• Catalano, R. F., Gainey, R. R., Fleming, C. B., Haggerty, K. P., & Johnson, N. O. (1999). An experimental intervention with families of substance abusers: One-year follow-up of the focus on families project. Addiction, 94(2), 241–254. https://doi.org/10.1046/j.1360-0443.1999.9422418.x

  Type of Study: Randomized controlled trial

  Participants: 178 children and 144 parents

  Sample / Population:

  • Age — Children: Mean=10.4 years; Adults: Mean=35.3 years
  • Race/Ethnicity — Children: Not specified; Adults: 77% White, 18% African American, and 5% Other
  • Gender — Children: Not specified; Adults: 100% Female
  • Status —

    Participants were parents being treated in a methadone clinic and their children.

  Location/Institution: Seattle, WA

  Summary:

  The study used the same sample as Catalano et al. (1997). The purpose of the study was to examine whether the Focus on Families (FOF) [now called Families Facing the Future] could reduce parent’s drug use and prevent children’s initiation of drug use. Participants were randomly assigned to receive standard methadone treatment plus the FOF program, or standard methadone treatment alone. Measures utilized include the parents and children were interviewed using questions designed for this study covering the topics of parent and child substance use, family interaction and conflict, parenting, and peers. In addition, random urine samples were collected (for urinalysis). Results indicate that there was some improvement in parents’ ability to avoid drug use, use of household rules, and reduction in domestic conflict. Parents also reported significantly less cocaine use. Significant differences were not found between the intervention and comparison group on children’s behaviors by the end of the follow-up period. Limitations include small sample size and lack of generalizability due to the ethnic composition of the participants.

  Length of controlled postintervention follow-up: 6 and 12 months.

• Gainey, R. R., Haggerty, K. P., Fleming, C. B., & Catalano, R. F. (2007). Teaching parenting skills in a methadone treatment setting. Social Work Research, 31(3), 185–190. https://doi.org/10.1093/swr/31.3.185

  Type of Study: Randomized controlled trial

  Participants: 63 Intervention and 49 Methadone-only

  Sample / Population:

  • Age — Mean=35 years
  • Race/Ethnicity — 77% White
  • Gender — 73% Female
  • Status —

    Participants were clients recruited from methadone clinics.

  Location/Institution: Seattle, WA

  Summary:

  The study used the same sample as Catalano et al. (1997). The purpose of the study was to test the effectiveness of the Focus on Families (FOF) program [now called Families Facing the Future] in increasing parenting skills knowledge. Participants were randomly assigned to receive standard methadone treatment plus FOF or to a standard treatment only comparison group. Measures utilized include the Parenting Skills Knowledge Scale (PSKS). Results indicate that parents in the experimental condition were rated higher on parenting skills, with those who attended more sessions showing a stronger effect. Limitations include small sample size, low generalizability to other populations due to ethnicity, and length of follow-up.

  Length of controlled postintervention follow-up: 1 month.

• Haggerty, K. P., Skinner, M., Fleming, C. B., Gainey, R. R., & Catalano, R. F. (2008). Long‐term effects of the Focus on Families project on substance use disorders among children of parents in methadone treatment. Addiction, 103(12), 2008–2016. https://doi.org/10.1111/j.1360-0443.2008.02360.x

  Type of Study: Randomized controlled trial

  Participants: 177

  Sample / Population:

  • Age — 15–29 years
  • Race/Ethnicity — 58% Caucasian
  • Gender — 57% Male
  • Status —

    Participants were children of parents undergoing methadone treatment at the time of the intervention.

  Location/Institution: Two methadone clinics in the Pacific Northwest

  Summary:

  The study used the same sample as Catalano et al. (1997). The purpose of the study was to examine the development of substance use disorders among children involved in the Focus on Families project [now called Families Facing the Future]. Participants were randomly assigned to receive standard methadone treatment plus FOF or to a standard treatment only comparison group. Measures utilized include the Composite International Diagnostic Interview (CIDI). Results indicate that intervention and control participants did not differ significantly in risk of developing substance use disorders. However, there was evidence of a significant difference in intervention effect by gender. There was a significant reduction in the risk of developing a substance use disorder for intervention group males compared to control group males, while intervention versus control differences among females were nonsignificant and favored the control condition. Limitations include small sample size, difference in mortality by experimental condition, and long period between follow-up assessments.

  Length of controlled postintervention follow-up: 12–15 years.

• Skinner, M. L., Haggerty, K. P., Fleming, C. B., & Catalano, R. F. (2009). Predicting functional resilience among young-adult children of opiate-dependent parents. Journal of Adolescent Health, 44(3), 283–290. https://doi.org/10.1016/j.jadohealth.2008.07.020

  Type of Study: Randomized controlled trial

  Participants: 151 (children of adults in previous sample)

  Sample / Population:

  • Age — Children: Mean=23.15 years at follow-up; Adults: Not specified
  • Race/Ethnicity — Children: 59% Caucasian; Adults: Not specified
  • Gender — Children: 57% Male; Adults: 73% Female
  • Status —

    Participants were children of parents undergoing methadone treatment at the time of the intervention.

  Location/Institution: Two methadone clinics in the Pacific Northwest

  Summary:

  The study used the same sample as Catalano et al. (1997). The purpose of the study was to describe the adversities experienced by a sample of children of opiate-dependent parents in the Focus on Families project (FOF) [now called Families Facing the Future], examine criteria for young adulthood functional resilience, and test parent, child, and school predictors of resilience. Participant parents were randomly assigned to receive either standard methadone treatment or treatment plus FOF. Measures utilized include the Composite International Diagnostic Interview (CIDI). Results indicate that although all participants had an opiate-dependent parent, 70% experienced two or more additional types of childhood adversity and 20% experienced four or more types. A total of 24% met the following three criteria for functional resilience at the time of their young-adult interview: (1) working or being enrolled in school, (2) no history of substance abuse or dependence, and (3) no adult criminal charges in the prior 5 years. The FOF intervention did not significantly predict functional resilience. Girls were approximately four times more likely to exhibit resilience than boys. Experiencing a wider range of adversities in addition to having an opiate-dependent parent did not reduce the likelihood of functional resilience. Of the five child, family, and school predictors tested, only externalizing or internalizing problems in childhood were significantly associated with the likelihood of functional resilience as a young adult. Limitations include resilience was measured at only one time point, reliance on self-reported measures, analyses on only a subset of the original sample, and small sample size.

  Length of controlled postintervention follow-up: None.

• Catalano, R. F., Haggerty, K. P., Fleming, C. B., & Skinner, M. L. (2007). Focus on Families: Integration of relapse prevention and child drug abuse prevention training with parents in methadone treatment. In K. A. Witkiewitz & G. A. Marlatt (Eds.), Therapist's guide to evidence-based relapse prevention (pp. 237-257). Elsevier.

• Gainey, R. R., Haggerty, K. P., Fleming, C. B., & Catalano, R. F. (2007). Teaching parenting skills in a methadone treatment setting. Social Work Research, 31(3), 185–190. https://doi.org/10.1093/swr/31.3.185

• Haggerty, K. P., Skinner, M. L., Fleming, C. B., Gainey, R. R., & Catalano, R. F. (2008). Long-term effects of the Focus on Families project on substance use disorders among children of parents in methadone treatment. Addiction, 103, 2008-2016. https://doi.org/10.1111/j.1360-0443.2008.02360.x