Families on Track Integrated Preventive Intervention Program

About This Program

Target Population: Children with fetal alcohol spectrum disorders (FASD) or prenatal alcohol exposure (PAE) ages 4 to 8 and their parents/caregivers

For children/adolescents ages: 4 – 8

For parents/caregivers of children ages: 4 – 8

Program Overview

The Families on Track Integrated Preventive Intervention Program is based on developmental psychopathology theory and promotes positive developmental trajectories for children with FASD or PAE and their families. It targets important risk and protective factors during the key transition period around school entry (child ages 4 to 8). The 30-week multi-component program integrates two existing programs. Children receive the preschool/kindergarten Promoting Alternative Thinking Strategies (PATHS curriculum in a weekly small group format, including positive peer models. Parents/caregivers receive the Families Moving Forward (FMF) Program every other week, individually, typically within their homes. The FMF Program also includes targeted school and provider consultation. A neuropsychological and diagnostic evaluation is recommended at the start of the program to promote the protective factor of early diagnosis and to characterize the child's individual neuropsychological profile for use in FMF caregiver sessions.

Program Goals

The goals of the Families on Track Integrated Preventive Intervention Program are:

For Parents and Caregivers:

  • Identify protective factors of early diagnosis.
  • Engage appropriate developmental and community services.
  • Create a stable and nurturing home environment.
  • Increase knowledge of FASD and advocacy.
  • Improve attitudes, including an increased parenting sense of efficacy and satisfaction.
  • Improve use of targeted parenting practices.
  • Increase self-care.
  • Meet important family needs through community linkages.

For Children:

  • Increase adaptive behavior and decrease disruptive behavior problems.
  • Increase self-control, emotional understanding, self-esteem, peer relationship, and interpersonal problem-solving skills.

Logic Model

The program representative did not provide information about a Logic Model for Families on Track Integrated Preventive Intervention Program.

Essential Components

The essential components of the Families on Track Integrated Preventive Intervention Program include:

  • Concurrent and integrated implementation of the Families Moving Forward (FMF) Program with caregivers and child skills groups using selected sessions from the Pre-K/K Promoting Alternative Thinking Strategies (PATHS) curriculum.
    • Caregiver component:
      • 15 FMF 90-minute individual sessions
      • Every other week
      • Typically in their homes
    • Child skills groups:
      • Weekly for 30 weeks, usually during the school year
      • Typically 90-minutes in length
      • 6 to 10 children, including children with FASD and typically developing peers
      • The complete overview of the concurrent session order available by request from the program contact (see bottom of the page)
    • An intervention team with appropriate expertise and skills to implement parent/caregiver individual sessions and child skills groups
      • Specialist providing the FMF Program also co-leader of the child skills groups using the PATHS curriculum
      • Regular meetings among intervention staff to:
        • Discuss caregiver and child progress
        • Share observations and effective strategies
        • Align intervention planning
      • Meetings critical to ensuring the caregiver and child components are well integrated.
    • A neuropsychological assessment (and diagnostic, if needed) recommended for each child with FASD or PAE at the start of the program. This can be done by the intervention team (with appropriate expertise) or obtained by referral.
    • Essential components of the FMF Program include:
      • Develops a good working alliance between the FMF Specialist and caregiver(s), using motivational interviewing and cognitive-behavioral techniques, with an emphasis on caregiver support.
      • Delivers a manualized, yet customizable, curriculum in an intervention flow that covers a comprehensive set of topics tailored to families raising children with FASD or PAE.
      • Actively involves caregivers throughout the intervention with discussion, watching videos of children with FASD and their families, reading Fact Sheets, and applying this information to their own child using Worksheets or other activities.
      • Collaborates with caregivers to help them learn user-friendly and creative methods of practical behavior management, using positive behavior support (PBS) principles. These are called brainstorming in the FMF Program. This results in caregivers learning to make behavior plans for specific, troubling problem behaviors.
      • Offers psychoeducation to caregivers on a neurodevelopmental viewpoint, which refers to an understanding of the effects of prenatal alcohol exposure, FASD, and their own child’s functional profile of strengths and challenges across a wide range of developmental domains. This is called reframing in the FMF Program.
      • Collaborates with caregivers to help them learn to understand the value of preventative, proactive, practical strategies for modifying the child’s various environments (including home and school), and caregiver behavior, to head off many problem behaviors. These strategies are called accommodations in the FMF Program.
      • Offers psychoeducation on other important topics, such as advocacy, self-care, anticipatory guidance (i.e., looking forward to the future), and calming strategies for kids. Additional optional topics are also offered, such as sensory processing, social communication, and talking to kids about learning differences and diagnoses.
      • Helps caregivers work through the emotional side of raising a child with invisible disabilities that may not be recognized by schools or society.
      • Provides targeted consultation to schools, including a school visit or school contact done collaboratively with the caregiver.
      • Offers targeted consultation to other providers working with the child. Also works with caregivers to link to needed community services and supports.
      • Focuses on helping caregivers feel more effective, satisfied, positive about their child and the parent-child relationship, and to engage in more self-care and get family needs met.
    • Specific to the implementation of FMF within the Families on Track Program, specialists teach caregivers the skills children are learning in the PATHS skills groups and discuss ways the caregivers can support these skills at home.
    • Essential components of the child skills groups include:
      • Selection of a small group of children ages 4 to 8. Some of the children will have FASD or PAE, and some will be typically developing peers. There should be two group co-leaders. Additional aides or support staff could be considered based on the needs of the children in the group.
      • Delivery of selected lessons from the Preschool/Kindergarten version of the PATHS curriculum (table available through program contact). Lessons involve multi-modal instruction that includes didactics, discussions, role playing, games, stories, puppets, music, art, and skills practice. Each lesson includes objectives, complete scripts, and instructions. The Pre-K/K curriculum kit includes two binders of lessons, an instruction manual, and additional materials needed for delivery (i.e., posters, charts, feelings faces, stickers, puppets, and books).
      • Each 90-minute session uses the following structure:
        • Structured welcome activity selected by the co-leaders that is tailored to the children in the group and consistent with that week’s theme.
        • PATHS lesson
        • Snack with social skills practice
        • 2–3 extension activities to create opportunities to practice the skill taught in the PATHS lesson. These can include optional activities suggested in the PATHS curriculum guide or developed by co-leaders based on the needs of the group.
        • Free play
      • Group leaders look for generalization opportunities and natural teaching moments throughout the 90-minute session.
      • Group-wide positive behavioral support strategies are utilized and individualized behavior plans are created for children who need additional support to participate in the group setting (often in coordination with the FMF Specialist working with the family).
      • Parents are provided with handouts and letters included in the PATHS curriculum kit to keep them informed of the skills their children are learning and promote generalization of skills at home.
    • Note: Other implementation patterns can be discussed with the program contact (see bottom of page) given that the PATHS curriculum is traditionally delivered by teachers during the school day and the FMF Program has been implemented clinically in a variety of settings (e.g., home, clinic, private practice, child development center) and alternate frequency (i.e., weekly 60-minute sessions). Concurrent and integrated implementation is essential.

Program Delivery

Child/Adolescent Services

Families on Track Integrated Preventive Intervention Program directly provides services to children/adolescents and addresses the following:

  • Diagnosed with FASD or PAE

Parent/Caregiver Services

Families on Track Integrated Preventive Intervention Program directly provides services to parents/caregivers and addresses the following:

  • Parent/caregiver(s) of a child with PAE or FASD
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Additional caregivers in the family are encouraged to participate in all or selected FMF sessions, as appropriate. Additionally, many families raising children with FASD include multiple children with prenatal exposure. Content learned in the FMF Program can be applied to multiple children with FASD or PAE in the home. Some families, particularly adoptive or foster families, may also be raising typically developing children in the targeted age range. These siblings may be appropriate to include in the child skills groups. The FMF Program also includes targeted school and provider consultation. The FMF Specialist and caregiver complete a core school planning session together at home and decide on the level, timing, and format of school consultation. They will then meet with the teacher and possibly other school personnel, typically in a face-to-face meeting when possible. The primary goals of the school consultation include: Promote positive home-school involvement with the teacher. Align home and school goals. Identify an advocate for the child/family in the school. Motivate and support school staff to be interested in FASD and outside input. The goals for consultation with other providers are similar. Provider consultation can occur at any time during the program. Consultation may occur in person or over the phone.

Recommended Intensity:

Child small group 90-minute weekly sessions; parent/caregiver sessions 90-minute bi-weekly sessions; may be possible to consider alternate intensity patterns.

Recommended Duration:

30 weeks

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Daily Living Setting
  • Foster / Kinship Care
  • Community-based Agency / Organization / Provider
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)
  • Virtual (Online, Telephone, Video, Zoom, etc.)

Homework

Families on Track Integrated Preventive Intervention Program includes a homework component:

Parents/caregivers and FMF Specialists agree on Action Steps to complete between each session. Given that cognitive-behavioral therapy (CBT) is one of the clinical techniques in the FMF Program, every session has a Fact Sheet and related Worksheet, which is often started in session and completed for homework. Implementation and troubleshooting of the behavior plan is also typically included in the Action Steps starting after about the 4th session. Specialists and caregivers may also include additional personalized tasks. FMF Specialists also review with caregivers what the children are learning in groups and discuss strategies to support theses skills at home and school.

Languages

Families on Track Integrated Preventive Intervention Program 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:

Child groups require:

  • A minimum of 2 trained group leaders (ideally, but not required, the FMF Specialists working with the families of children with FASD or PAE lead the group). Additional assistants are recommended based on the behavioral and support needs of the children
  • PreK/K PATHS curriculum kits/li>
  • Supplemental low-cost materials (e.g., craft supplies, props) are required by the PATHS curriculum for some activities/li>
  • A room with adequate space for a small group of children to interact and play. A carpet or seating area is needed for group discussion. A selection of toys should be available for free play

Parent/Caregiver intervention requires:

  • Trained FMF Specialists, who have taken basic training and done 10 hours of intervention fidelity consultation while carrying initial cases/li>
  • Access to a computer and printer to print off FMF Program materials prior to sessions/li>
  • Access to a method to show video clips from FMF website or DVD/li>
  • Specialist and Family binders, and secure storage to maintain case files

Integration requires:

  • Private and secure meeting space for intervention staff implementing FMF and child skills group to meet, review caregiver and child progress, discuss observations and effective strategies, and align intervention/li>
  • A clinical supervisor who monitors fidelity to program components, facilitates discussions of clinical issues and family progress, and oversees staffing and dynamics/li>
  • Administrative support recommended for facilitating intake and logistics of case assignments, space reservation, scheduling, materials management, etc.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Service Providers: Master’s level training in an appropriate psychosocial field (e.g., clinical psychology, social work, counseling, child development, marriage and family counseling, and similar); appropriate licensure or certification, or be an advanced trainee supervised by a licensed clinician; and completion of the FMF application process with approval from the FMF Central Office prior to training (application can be downloaded from the FMF website).

Supervisors: PhD-level training that includes considerable experience with standardized testing and data interpretation to support providers in using this data with families. Additional requirements include appropriate licensure or certification; at least 2 years of supervision experience; experience in delivering the FMF and PATHS programs; and completion of the separate FMF Supervisor training.

Manual Information

There is not a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Informal consultation is available. Organizations also have to have training in the FMF Program and PATHS.

Number of days/hours:

Varies dependent on agency needs.

Relevant Published, Peer-Reviewed Research

Petrenko, C. L. M., Pandolfino, M. E., & Robinson, L. K. (2017). Findings from the Families on Track preventive intervention pilot trial with children with FASD and their families. Alcoholism: Clinical and Experimental Research, 41(7), 1340–1351. https://doi.org/10.1111/acer.13408

Type of Study: Randomized controlled trial
Number of Participants: 30

Population:

  • Age — Children: 4–8 years (Mean=6.52–6.59 years); Adults: Mean=45.77–48.19 years
  • Race/Ethnicity — Children: 25 White/Caucasian, 7 African American/Black, 4 Hispanic/Latino, 1 Native American, and 1 Asian; Adults: 28 White/Caucasian, 2 Native American, 1 African American/Black, and 1 Hispanic/Latino
  • Gender — Children: 77% Male; Adults: 86% Female
  • Status — Participants were children with fetal alcohol spectrum disorders (FASD) or prenatal alcohol exposure (PAE) and their primary caregivers.

Location/Institution: Two New York study sites

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to pilot Families on Track Integrated Preventive Intervention, a multicomponent intervention designed to prevent secondary conditions in children with fetal alcohol spectrum disorders (FASD) and improve family adaptation. Families were randomized to either the Families on Track Integrated Preventive Intervention (n=16) or an active control of neuropsychological assessment and personalized community referrals (n=14). Measures utilized include the Differential Ability Scales, Second Edition (DAS-II), the Woodcock–Johnson Tests of Achievement, the Third Edition Brief Battery, the NEPSY-II Visuomotor Precision Short Sensory Profile Children’s Communication Checklist, Second Edition, the DAS-II Recognition of Pictures, the DAS-II Recall of Digits Forward, the NEPSY-II Narrative Memory, the DAS-II Recall of Digits Backward, the NEPSY-II Inhibition, the NEPSY-II Word Generation, the Behavior Rating Inventory of Executive Function, the Behavior Assessment System for Children, Second Edition, the Adaptive Behavior Assessment System, Second Edition, the Berkeley Puppet Interview-The Berkeley Puppet Interview (BPI), the Eyberg Child Behavior Inventory (ECBI), the Emotion Regulation Checklist (ERC), the Impairment Rating Scale (IRS), the Knowledge and Advocacy Scale (K&A), the Parenting Practices Interview (PPI), the Family Needs Met, the Parenting Sense of Competence (PSOC), the Parenting Stress Index, Fourth Edition, Short Form (PSI-4-SF), the Perceived Social Support Scale (PSSS), the Baseline Caregiver Interview, the Client Satisfaction Questionnaire (CSQ), and the Parent Evaluation Inventory-FOT (PEI-FOT). Results indicate that families participating in the intervention reported high program satisfaction. Relative to comparison group outcomes, Families on Track Integrated Preventive Intervention was associated with medium-to-large effects for child emotion regulation, self-esteem, and anxiety. Medium-sized improvements in disruptive behavior were observed for both groups. Medium and large effects were seen for important caregiver outcomes: knowledge of FASD and advocacy, attributions of behavior, use of antecedent strategies, parenting efficacy, family needs met, social support, and self-care. Limitations include small sample size; significant cost and time barrier for many clinicians or agencies; and sustaining a 30-week skills group with a single-entry point would be challenging in many community settings (with the exception of schools), and lack of follow-up.

Length of postintervention follow-up: None.

Petrenko, C. L. M., Demeusy, E. M, & Alto, M. E. (2019). Six-month follow-up of the Families on Track Intervention pilot trial for children with fetal alcohol spectrum disorders and their families. Alcoholism: Clinical and Experimental Research, 43, 2242–2254.https://doi.org/10.1111/acer.14180

Type of Study: Randomized controlled trial
Number of Participants: 30

Population:

  • Age — Children: 4–8 years (Mean=6.52–6.59 years); Adults: Mean=45.77–48.19 years
  • Race/Ethnicity — Children: 25 White/Caucasian, 7 African American/Black, 4 Hispanic/Latino, 1 Native American, and 1 Asian; Adults: 28 White/Caucasian, 2 Native American, 1 African American/Black, and 1 Hispanic/Latino
  • Gender — Children: 77% Male; Adults: 86% Female
  • Status — Participants were children with fetal alcohol spectrum disorders (FASD) or prenatal alcohol exposure (PAE) and their primary caregivers.

Location/Institution: Two New York study sites

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the same sample as Petrenko et al. (2017). The purpose of this study was to pilot Families on Track Integrated Preventive Intervention, a multicomponent intervention designed to prevent secondary conditions in children with fetal alcohol spectrum disorders (FASD) and improve family adaptation. Families were randomized to either the Families on Track Integrated Preventive Intervention (n=16) or an active control of neuropsychological assessment and personalized community referrals (n=14). Measures utilized include the Eyberg Child Behavior Inventory (ECBI), the Emotion Regulation Checklist (ERC), the Impairment Rating Scale (IRS), the Knowledge and Advocacy Scale (K&A), the Parenting Practices Interview (PPI), the Family Needs Met, the Parenting Sense of Competence (PSOC), the Parenting Stress Index, Fourth Edition, Short Form (PSI-4-SF), the Perceived Social Support Scale (PSSS), the Baseline Caregiver Interview, the Client Satisfaction Questionnaire (CSQ), and the Parent Evaluation Inventory-FOT (PEI-FOT). Results indicate that relative to the comparison group, Families on Track Integrated Preventive Intervention families showed continued gains in parenting efficacy and maintained prior improvements in FASD knowledge over the follow-up period. Although intervention families reported a decrease in their needs being met over the follow-up period, they continued to report their needs being met to greater extent than those in the comparison group. Consistent with postintervention outcomes, children in both groups exhibited similar decreases in child disruptive behavior 6 months following the intervention. Unfortunately, positive gains seen at postintervention for child self-esteem and emotion regulation were attenuated at follow-up. Limitations include small sample size; certain measures that were available at postintervention were not available at follow-up; generalizability of findings to other types of families raising children with FASD; and the intensive time requirements of the intervention may have resulted in a self-selected sample with greater financial means or higher needs.

Length of postintervention follow-up: 6 months.

Additional References

No reference materials are currently available for Families on Track Integrated Preventive Intervention Program.

Contact Information

Christie Petrenko, PhD
Agency/Affiliation: Mt. Hope Family Center, University of Rochester
Email:
Phone: (585) 275-2991

Date Research Evidence Last Reviewed by CEBC: December 2020

Date Program Content Last Reviewed by Program Staff: February 2021

Date Program Originally Loaded onto CEBC: February 2021