Families Actively Improving Relationships (FAIR)

About This Program

Target Population: Parents with parental rights for at least one of their minor children, in utero to age 17, who have been referred to the child welfare system or at-risk for referral to it

For parents/caregivers of children ages: 0 – 17

Program Overview

Using a well-specified behavioral approach, FAIR treatment is individualized to fit the unique circumstances and needs of families presenting with opioid, methamphetamine, and other drugs of abuse. FAIR clinicians coordinate with child welfare staff to ensure that parents are meeting their child welfare treatment plan goals. Parents are incentivized to work toward their treatment goals that increase child safety and permanency. The model allows for service delivery within a flexible environment including meeting times and places (in-home, community, shelter). Sessions occur in the community where clients have the opportunity to practice success, and other places most likely for parenting to occur (e.g., home, school, playground, visitations). With the overall goal of creating safe and sober households, treatment includes a focus on addressing progress in the following areas:

  • Substance abuse
  • Mental health symptoms
  • Parenting deficits
  • Associated social determinants of health

The FAIR team is available 24/7 for on-call support and ongoing engagement strategies.

Program Goals

The goals of Families Actively Improving Relationships (FAIR) are:

  • Reduce likelihood their child would be neglected and increase use of positive parenting
  • Increase likelihood of keeping their child in the home or reunifying with their child
  • Reduce substance use, cravings, and other problem drug behaviors
  • Eliminate intravenous (IV) drug use, if applicable
  • Reduce stress from parenting
  • Reduce depression and anxiety
  • Reduce trauma symptoms
  • Increase likelihood of being in stable housing
  • Increase days employed
  • Increase likelihood of successful child welfare case closure

Essential Components

The essential components of Families Actively Improving Relationships (FAIR) include:

  • Treatment involves four major components, supported by ongoing purposeful engagement:
    • Delivering substance abuse treatment including contingency management and positive reinforcement, frequent urinalysis, relationship building, day planning, healthy environments, peer choices, and refusal skills
    • Delivering mental health treatment including cognitive-behavioral therapy, developing healthy coping skills, emotion regulation strategies, exposure therapy, and referral for medication management. Behavioral strategies are used to support cognitive-behavioral interventions.
    • Teaching and supporting parenting skills including nurturing and attachment, reinforcement, emotion regulation, supervision, structure, nonharsh discipline, and nutrition.
    • Resource building and provision of ancillary supports including assistance with securing housing, education, employment, support with court and child welfare attendance, and other probationary requirements.
  • Sessions:
    • Provided in the community at times and places that are convenient to the parent including support and coaching during:
      • Court
      • Visitations
      • Other child welfare contacts
    • Action-oriented and include skill building under real-world conditions
    • Allow creative approaches to engage clients in structured curricula
    • Always prioritize safety
    • Coordination with child welfare included in target treatment plan goals
    • Use of positive reinforcement included to reinforce all small gains made toward goal attainment
    • Frequent (not random) urinalysis
    • Use of FAIR bucks included for reinforcement that can be traded in at the FAIR store – a program-specific store stocked with donated goods that promote safe, stable, and positive family homes
    • Involvement of an ecological perspective that includes prosocial and family supports as indicated
    • Use of specific FAIR strategies, language, and worksheets
    • Assessment of trauma-related responses included throughout treatment
    • Culturally responsive to the individual needs of parents, children, and other indigenous supports (e.g., Indian Child Welfare Agency [ICWA] cases, religious beliefs, gender identity, and sexual orientation)

Program Delivery

Parent/Caregiver Services

Families Actively Improving Relationships (FAIR) directly provides services to parents/caregivers and addresses the following:

  • Parental substance abuse, parenting deficits, child neglect, depression, anxiety, posttraumatic stress, unemployment, unstable or lack of housing, inappropriate interpersonal relations; parent of child with child welfare involvement, foster care involvement, disruptive behaviors, parentified behaviors, internalizing symptoms, potential difficulty adjusting to new parenting behaviors, potential difficulty adjusting to transitioning back to parental home from out-of-home placement
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Children involved in family sessions and may be present during parent training focused sessions as well (if age appropriate) Immediate family members involved in family sessions Extended family members involved in family sessions Caseworkers/probation officers involved in coordination and collaboration Prosocial peer supports involved in supportive activities Additional community members (e.g., pastor, landlord) as appropriate – typically very limited involvement Teachers and school officials as appropriate to assist parents navigate the education system for their children Coordination with other health care providers and prescribers

Recommended Intensity:

Five to seven days a week for 30 minutes to 2 hours for the first three weeks depending on severity and stability. In the 4th week, the sessions can be 15 minutes to 2 hours long and occur three times a week until the provider reduces them to two times a week. In the final month, it is 1 to 2 hours only once a week.

Recommended Duration:

8 to 9 months

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Community Daily Living Setting
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider

Homework

Families Actively Improving Relationships (FAIR) includes a homework component:

FAIR is action-oriented with an emphasis on skill building. Individually tailored for each client, a small goal is set to practice or execute in-between sessions (e.g., submit an application, clean a section of a room, practice communication skills, use time-out).

Languages

Families Actively Improving Relationships (FAIR) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Services are provided in the community. Staff must have transportation and ability to transport families (either approved use of personal car or agency car).

The FAIR Store is an essential component of the program. Requires dedicated space to create a “store” of donated goods that clients can access. Can range from large closet to dedicated room.

Team office with typical computing resources for documentation. Space for group supervision.

Education and Training

Prerequisite/Minimum Provider Qualifications

Supervisor – Masters degree or above in a behavioral health related field (e.g., psychology, social work, counseling) and licensed.

Counselors – Bachelors degree or above and experience with behavioral interventions preferred.

Resource Builder (stocks and manages the FAIR store and secures other service donations for incentives) – High School or above

Education and Training Resources

There is a manual that describes how to deliver this program, and there is training available for this program.

Saldana, L., Maas-DeSpain, A., & Laws, M. (2019). Families Actively Improving Relationships: A strength-based, behavioral approach to creating safe and stable families. Eugene, Oregon.

The manual is available from the program contact (see bottom of page).

Training Contact:
Training is obtained:

Training is done at the provider organization. Shadow training of supervisor is available at training center but is optional. There also is virtual remote weekly coaching.

Number of days/hours:

Length of training varies by position. For supervisors, it is 5 days. For counselors, it is 4 days. There is then ongoing weekly team monitoring, coaching, and feedback for a minimum of 12 months and three months of meeting fidelity standards, 80% successful graduation rates, and meeting 80% of program capacity.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Families Actively Improving Relationships (FAIR) as listed below:

FAIR implementation follows the Stages of Implementation Completion (SIC) framework and includes the following assessment materials:

  • Feasibility Assessment
  • Needs and Fit Assessment
  • Readiness Checklist
  • Capacity Calculator
  • Cost Calculator

There is an expectation that newly adopting sites will work with the FAIR experts to complete each of the implementation activities outlined on the FAIR-SIC prior to training and service delivery. More information can be found at https://www.oslc.org/sic/.

Formal Support for Implementation

There is formal support available for implementation of Families Actively Improving Relationships (FAIR) as listed below:

  • On-site readiness visit and stakeholder meeting
  • On-site training, three site visits in first year
  • Weekly observation of supervision through virtual conferencing for first 6 months
  • Weekly supervisor consultation
  • Weekly team consultation for 6 months, followed by biweekly
  • Following the first year, biannual site visits until certification

Formal support is conducted until all of the following requirements are met:

  • Minimum of 12 months
  • 3 months of supervisor meeting 80% fidelity threshold
  • 3 months operating at a minimum of 80% program capacity
  • A minimum of 80% successful graduations

Formal support consists of:

  • Intervention Coaching
  • Implementation Coaching
  • Modeling
  • Fidelity Monitoring and Feedback
  • Assessing Program Effectiveness

Fidelity Measures

There are fidelity measures for Families Actively Improving Relationships (FAIR) as listed below:

Fidelity is measured through direct observation using virtual technology and/or video recordings of group supervision sessions by the expert coach. Sessions are coded regarding “content” and “structure.”

A fidelity measure has been used in the clinical trials. The 15-item measure is collected from parents by a research assistant. Use of the measure outside of research conditions has not been evaluated.

Implementation fidelity to the implementation process will be measured using the Stages of Implementation Completion (SIC) web-based monitoring tool found at https://www.oslc.org/sic/. Team fidelity is assessed by FAIR supervisors, once trained to reliability. Implementation fidelity is assessed by FAIR experts providing technical assistance.

Measures of fidelity are recorded and stored in an encrypted web-based system.

Implementation Guides or Manuals

There are implementation guides or manuals for Families Actively Improving Relationships (FAIR) as listed below:

The FAIR implementation approach follows the Stages of Implementation Completion (SIC) framework. The SIC is an evidence-based implementation tool that has been adapted or customized for over 45 programs, and has been used to examine and facilitate the adoption of new programs in child welfare and other public systems. The SIC spans 8 stages of implementation from Engagement through the development of program Competency. Within each stage are a number of implementation activities (e.g., development of recruitment plan, establishment of fidelity monitoring system). Adopting sites are provided technical assistance to follow the FAIR-SIC framework.

Implementation Cost

There have been studies of the costs of implementing Families Actively Improving Relationships (FAIR) which are listed below:

Please see a full description of costing methods and implications for service delivery and catchment areas:

Saldana, L. (2016). Addressing the needs of families referred for neglect: The FAIR efficacy trial. https://www.oslc.org/wp-content/uploads/2016/04/FAIRFinalReport.pdf

Research on How to Implement the Program

Research has not been conducted on how to implement Families Actively Improving Relationships (FAIR).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Saldana, L., Smith, D., & Weber, E. (2013). Adolescent onset of maternal substance abuse: Descriptive findings from a feasibility trial. Journal of Child and Adolescent Substance Abuse, 22, 407–420. https://doi.org/10.1080/1067828X.2013.788885

Type of Study: One-group pretest–posttest
Number of Participants: 16

Population:

  • Age — 21– 48 years (Mean=29.63 years)
  • Race/Ethnicity — 75% White, 12.5% Black, 6.3% Pacific Islander, and 6.3% Native American
  • Gender — 100% Female
  • Status — Participants were mothers involved with child welfare services for child neglect and severe substance use.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of the Families Actively Improving Relationships (FAIR) program. Measures utilized included the Addiction Severity Index (ASI) and the Trauma Symptom Inventory (TSI). Results indicate that age of onset was associated with family history of use. The majority of mothers reported polysubstance abuse starting at an early age and quickly escalating patterns of behavior including intravenous (IV) drug use. Limitations include small sample size, reliance on self-reported measures, and lack of follow-up.

Length of postintervention follow-up: None.

Saldana, L. (2015). An integrated intervention to address the comorbid needs of families referred to child welfare for substance use disorders and child neglect: FAIR Pilot Outcomes. Child Welfare, 94(5e), 167–186. https://www.ncbi.nlm.nih.gov/pubmed/26827470

Type of Study: Randomized controlled trial
Number of Participants: 31

Population:

  • Age — 22–49 years
  • Race/Ethnicity — 27 Caucasian, 2 African American, 1 Native American, and 1 Pacific Islander
  • Gender — 100% Female
  • Status — Participants were mothers involved with the CWS for child neglect and severe substance use.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of the Families Actively Improving Relationships (FAIR) program. Participants were randomized to either FAIR (n=18) or to caseworker-referred treatment as usual (TAU; n=13). Measures utilized included the Parent Daily Report (PDR), the Child Behavior Checklist (CBCL), the Parenting Stress Inventory (PSI), the Brief Child Abuse Potential Inventory (BCAP), the Addiction Severity Index (ASI), the Trauma Symptom Inventory (TSI), the Service Utilization Survey (SUS), and the Beck Depression Inventory (BDI). Results indicate that mothers who received FAIR were likely to engage in and complete their comprehensive treatment program. Results also indicated that at 6 months postbaseline, mothers receiving FAIR showed significant improvements in parenting and subsequent child functioning, as rated by the PDR and CBCL. Mothers randomized to FAIR reported significant improvements as rated by the ASI by 6 months postbaseline. By 12 months, mothers randomized to FAIR were not only more likely to have achieved and maintained sobriety, but reported significant decreases in cravings and problems related to substance use. Mothers randomized to FAIR showed significant improvements in mental health symptoms over time. FAIR mothers also showed increases in days of employment by 6 months. Limitations include because of the developmental nature of this pilot, FAIR components evolved over the course of the study period, small sample size, reliance on self-reported measures, geographically and limited racial and ethnic diversity sample, and length of follow-up.

Length of postintervention follow-up: 4 months.

Additional References

Child Welfare Information Gateway. (2018). Acts of omission: An overview of child neglect. U.S. Department of Health and Human Services, Children’s Bureau. https://www.childwelfare.gov/pubPDFs/acts.pdf

Saldana, L. (2016). Addressing the needs of families referred for neglect: The FAIR efficacy trial. https://www.oslc.org/wp-content/uploads/2016/04/FAIRFinalReport.pdf

Contact Information

Lisa Saldana
Agency/Affiliation: Oregon Social Learning Center
Website: www.oslc.org/projects/fair
Email:
Phone: (541) 485-6207

Date Research Evidence Last Reviewed by CEBC: December 2019

Date Program Content Last Reviewed by Program Staff: June 2020

Date Program Originally Loaded onto CEBC: June 2020