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The 4 Rs and 2 Ss for Strengthening Families Program

Topic Areas
Scientific Rating
Child Welfare Relevance
Disruptive Behavior Treatment (Child & Adolescent)
2  — Supported by Research Evidence
High
Motivation and Engagement Programs
NR  — Not able to be Rated
High

About This Program

Target Population: For children, ages 7-11, and their family members (ages 0-99)

For children/adolescents ages: 7 – 11

For parents/caregivers of children ages: 7 – 11

Program Overview

The 4 Rs and 2 Ss for Strengthening Families Program is a program where families who have children with behavioral difficulties can participate in a group treatment to help improve family communication, family relationships, and satisfaction with services. Participating families have a child between 7-11 years old with behavioral difficulties and at least one primary caregiver who will participate in the group with the child.

The group topics focus on Rules, Relationships, Respectful Communication, and Responsibilities (4 Rs) and Stress and Social Support (2 Ss). Each session follows a similar format and focuses on the R or S of the day. There are discussions and activities to help caregivers, and their child learn how to use each R or S. Each week, there is also “Roadwork” (i.e., some activities to try at home).

The 4 Rs and 2 Ss has been adapted to be used with individual families, but that version has not been reviewed by the CEBC.

Program Goals

The goals for The 4 Rs and 2 Ss for Strengthening Families Program are:

For children:

  • Decrease behavioral difficulties
  • Increase social skills
  • Reduce impairment with playmates
  • Reduce overall impairment
  • Reduce need for services

For caregivers:

  • Decrease parenting stress
  • Improved relationship with family members
  • Increase in parenting self-efficacy
  • Reduce need for services

Logic Model

View the Logic Model for The 4 Rs and 2 Ss for Strengthening Families Program.

Essential Components

The essential components of The 4 Rs and 2 Ss for Strengthening Families Program include:

  • Pre-Group logistics include:
    • Identify families in need of services with children who have behavioral difficulties
    • Identify space and support to facilitate a multiple family group in a clinic or community setting including:
      • Date
      • Time
      • Refreshments, if possible
      • Other information to share with families
    • Determine the number of families for group (recommended 5-7)
  • Group Sessions include:
    • A 16-week curriculum-based practice designed to:
      • Strengthen families especially highly stressed minority families who are poverty impacted
      • Decrease child behavioral problems
      • Increase engagement in care
    • Emphasis on six core dimensions:
      • Rules
      • Responsibilities
      • Respectful communication
      • Relationships
      • Stress management
      • Social Support
    • Highly trained (about 10 hours of training) facilitators (a clinical provider ideally co-led with a parent advocate) to facilitate the multiple family groups
    • Treatment and techniques used include:
      • Common elements of evidence-based behavioral parent training and family therapy treatments to address behavioral difficulties in youth
      • Established engagement techniques and address any potential barriers to attendance
      • A strength-based approach
    • Each session includes:
      • Time for families to practice togetherness and communication
      • A safe space for shared experiences and mutual support
      • Group facilitation skills including group cohesion
      • Emphasis on building family relationships and functioning
      • Emphasis on reducing stigma associated with raising a child with mental health issues by normalizing families’ experiences
      • Emphasis on “Roadwork” which promotes continued learning outside the group

Program Delivery

Child/Adolescent Services

The 4 Rs and 2 Ss for Strengthening Families Program directly provides services to children/adolescents and addresses the following:

  • Disruptive behavior disorders, specifically oppositional defiant disorder and/or conduct disorder

Parent/Caregiver Services

The 4 Rs and 2 Ss for Strengthening Families Program directly provides services to parents/caregivers and addresses the following:

  • Parents/caregivers of children with behavioral challenges; parental stress, discipline challenges, dysfunctional family relationships
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Other family members are encouraged to attend as well. Multiple caregivers are also encouraged to attend especially if they are overseeing rules or responsibilities for the child.

Recommended Intensity:

Once a week for 1-1.5 hours

Recommended Duration:

16 weeks

Delivery Settings

This program is typically conducted in a(n):

  • Community Daily Living Setting
  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • Shelter (Domestic Violence, Homeless, etc.)

Homework

The 4 Rs and 2 Ss for Strengthening Families Program includes a homework component:

There is ‘Roadwork’ assigned after each session which is practice for youth and families to do in between sessions.

Languages

The 4 Rs and 2 Ss for Strengthening Families 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:

Space for family members to gather and a table to sit around is preferrable.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Treatment program is facilitated by both a mental health provider (e.g., LMSW, MSW, LMFT, etc.) and a Family Peer Advocate (FPA) who have participated in the training. Interns can also facilitate if trained. Group experience is helpful.

Manual Information

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

Program Manual(s)

Manual details:

There is a Spanish version and Facilitator Guide available at https://mcsilver.nyu.edu/4rs-2ss/.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training materials and resources are available upon request. The developers are also available to provide direct training and technical assistance in supporting agencies in their implementation through the Clinic Technical Assistance Center (CTAC) for sites in New York or through McSilver Institute for Poverty Policy and Research (McSilver) for sites nationwide. Virtual, hybrid, and in-person training sessions are available.

Training is provided in various ways. Most often, the training consists of 3 parts:

  • Participate in an online training module
  • Participate in a half-day training to learn about the model and pro-family engagement techniques
  • Participate in a half-day practice with feedback

Consultation is encouraged once the group has begun.

Number of days/hours:

Approximately 10 hours of training

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for The 4 Rs and 2 Ss for Strengthening Families Program as listed below:

A meeting with developers and trainers is required to assess feasibility and implementation barriers. There are also online learning modules (Part 1 of the training).

Formal Support for Implementation

There is formal support available for implementation of The 4 Rs and 2 Ss for Strengthening Families Program as listed below:

Formal support includes virtual meetings, consultation, and email. Support is available during the facilitation of the 16 weeks or as needed. Fidelity monitoring and coaching is also available.

Fidelity Measures

There are fidelity measures for The 4 Rs and 2 Ss for Strengthening Families Program as listed below:

Fidelity is only required if participating in a Training of the Trainer program. Fidelity observations and instruments help determine that the practice is being implemented as intended. Ideally, the person observing is a supervisor who has participated in the program training. The observer can also be a colleague who has participated in the program training. The observer and facilitator prepare together before the observation. The observer completes a fidelity form.

Implementation Guides or Manuals

There are no implementation guides or manuals for The 4 Rs and 2 Ss for Strengthening Families Program.

Implementation Cost

There are no studies of the costs of The 4 Rs and 2 Ss for Strengthening Families Program.

Research on How to Implement the Program

Research has not been conducted on how to implement The 4 Rs and 2 Ss for Strengthening Families Program.

Relevant Published, Peer-Reviewed Research

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

McKay, M. M., Gopalan, G., Franco, L., Dean-Assael, K., Chacko, A., Jackson, J. M., & Fuss, A. (2011). A collaboratively designed child mental health service model: Multiple family groups for urban children with conduct difficulties. Research on Social Work Practice, 21(6), 664–674. https://doi.org/10.1177/1049731511406740

Type of Study: Randomized controlled trial
Number of Participants: 321 families

Population:

  • Age — Caregivers: Mean=36 years; Children: Mean=9 years
  • Race/Ethnicity — Caregivers: 169 Hispanic/Latino, 96 Black/African Amer., 30 White/Cauc., 13 Other, 3 Native Amer., & 2 Asian/Pacific Islander; Children: 157 Hispanic/Latino, 95 Black/African Amer., 21 Other, 25 White/Cauc., 8 Native Amer., & 1 Asian/Pacific Islander
  • Gender — Not specified
  • Status — Participants were youth meeting diagnostic criteria for oppositional defiant (ODD) or conduct disorders (CD), and their families nested within child outpatient mental health clinics that serve low income African American and Latino children.

Location/Institution: Thirteen outpatient mental health clinics in low-income communities throughout the New York City metropolitan area

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to present preliminary outcomes associated with an experimental, longitudinal study of a Multiple Family Group (MFG) service delivery approach [now called The 4 Rs and 2 Ss for Strengthening Families Program] on two outcomes: 1) youth oppositional behavior and 2) parent stress over time. Participants were randomly assigned within clinics to one of two study conditions: MFG or standard care. Measures utilized include the Parenting Stress Index (PSI) and the IOWA Connors Rating Scale (IOWA-CRS). Results indicate that at baseline, there are no statistically significant differences between treatment groups. Participants in the MFG condition improved in terms of child oppositional behavior at a significantly different rate than those in the comparison condition. At the 6-month follow-up (approximately 10 months from baseline), there is little, if any, change in ODD symptoms for participants in the comparison condition, while there is a substantial decrease for MFG group participants. Post-hoc analyses of overall means confirms that there is little change in ODD symptoms from baseline to follow-up for control group participants, while there is a substantial drop in ODD symptoms from baseline to follow-up. Results also indicate that at baseline, the amount of caregiver-reported parenting stress is not significantly different between the treatment groups. There is a significant difference in the rate at which parenting stress decreases between treatment groups over time. At the 6-month follow-up (approximately 10 months from baseline), participants in the MFG group manifest a greater decrease in parenting stress over time than comparison group participants. Post-hoc analyses of overall means further indicates a greater decrease in parenting stress from baseline to follow-up for MFG group participants than the decrease from baseline to follow-up for comparison group participants. Limitations include lack of randomization and reliance on self-reported measures.

Length of controlled postintervention follow-up: 2 and 14 months.

Chacko, A., Gopalan, G., Franco, L., Dean-Assael, K., Jackson, J., Marcus, S., Hoagwood, K., & McKay, M. (2015). Multiple family group service model for children with disruptive behavior disorders: Child outcomes at post-treatment. Journal of Emotional and Behavioral Disorders, 23(2), 67–77. https://doi.org/10.1177/1063426614532690

Type of Study: Randomized controlled trial
Number of Participants: 320 families

Population:

  • Age — Caregivers: Not specified; Children: 7–11 years
  • Race/Ethnicity — Caregivers: 53% Latino and 30% Black/African American; Children: 112 Hispanic/Latino, 66 Black/African American, 16 White/Caucasian, 15 Other, and 3 Native American
  • Gender — Caregivers: Not specified; Children: 68% Male
  • Status — Participants were inner-city children meeting diagnostic criteria for oppositional defiant (ODD) or conduct disorders (CD) and their families.

Location/Institution: One outpatient mental health clinic serving youth and their families from socioeconomically disadvantaged communities in the New York City area

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as McKay et al. (2011). The purpose of the study was to determine the benefits of a multiple family group (MFG) service delivery model [now called The 4 Rs and 2 Ss for Strengthening Families Program] compared with services as usual (SAU) in improving the functioning of youth with oppositional defiant/conduct disorder in families residing in socioeconomically disadvantaged communities. Participants were allocated to either receive MFG or clinical SAU conditions. Measures utilized include the Iowa Connors Rating Scale-Oppositional/Defiant Subscale (IOWA CRS OD), the Social Skills Rating System: Social Skills Subscale (SSRS-SSS), and the Impairment Rating Scale (IRS). Results indicate that caregivers of youth in the MFG service delivery model condition reported significant improvement in youth oppositional behavior and social competence compared with youth in the SAU condition. Impairment improved over time for both groups with no difference between treatment conditions. The MFG service delivery model led to a greater percentage of youth with clinically significant improvements in oppositional behavior. Attendance to the MFG service delivery model was high, given the high-risk nature of the study population. Limitations include lack of randomization, the dosage of treatment and attendance to treatment were difficult to obtain for youth enrolled in the SAU condition, and the exclusive use of parent report measures of outcome.

Length of controlled postintervention follow-up: None.

Gopalan, G., Chacko, A., Franco, L., Dean-Assael, K. M., Rotko, L. E., Marcus, S. M., Hoagwood, K. E., & McKay, M. M. (2015). Multiple family groups for children with disruptive behavior disorders: Child outcomes at 6-month follow-up. Journal of Child and Family Studies, 24(9), 2721–2733. https://doi.org/10.1007/s10826-014-0074-6

Type of Study: Randomized controlled trial
Number of Participants: 320 families

Population:

  • Age — Caregivers: Not specified; Children: 7–11 years
  • Race/Ethnicity — Caregivers: 53% Latino and 30% Black/African American; Children: 112 Hispanic/Latino, 66 Black/African American, 16 White/Caucasian, 15 Other, and 3 Native American
  • Gender — Caregivers: Not specified; Children: 68% Male
  • Status — Participants were inner-city children meeting diagnostic criteria for oppositional defiant (ODD) or conduct disorders (CD) and their families

Location/Institution: Thirteen community-based outpatient mental health clinics that serve youth and their families residing in socioeconomically disadvantaged communities across the New York City metropolitan area

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as McKay et al. (2011). The purpose of the study was to report on the 6-month follow-up outcomes of an effectiveness study testing a multiple family group (MFG) intervention [now called The 4 Rs and 2 Ss for Strengthening Families Program] for clinic-referred youth with disruptive behavior disorders (DBDs) and their families, in socioeconomically disadvantaged families compared to services-as-usual (SAU) using a block comparison design. Participants were allocated to either receive MFG or SAU treatment conditions. Measures utilized include the Iowa Connors Rating Scale-Oppositional/Defiant Subscale (IOWA CRS OD), the Social Skills Rating System: Social Skills Subscale (SSRS-SSS), and the Impairment Rating Scale (IRS). Results indicate that compared to SAU participants, MFG participants reported significant improvement at 6-month follow-up in child behavior, impact of behavior on relationship with peers, and overall impairment/need for services. Limitations include lack of randomization, significant differential attrition by treatment conditions at 6-month follow-up, and the exclusive use of parent report measures of outcome.

Length of controlled postintervention follow-up: 6 months.

Gopalan, G., Small, L., Fuss, A., Bowman, M., Jackson, J., Marcus, S., & Chacko, A. (2015). Multiple family groups to reduce child disruptive behavior difficulties: Moderating effects of child welfare status on child outcomes. Child Abuse & Neglect, 46, 207–219. https://doi.org/10.1016/j.chiabu.2015.06.006

Type of Study: Randomized controlled trial
Number of Participants: 320 families

Population:

  • Age — Caregivers: Not specified; Children: 7–11 years
  • Race/Ethnicity — Caregivers: 53% Latino and 30% Black/African American; Children: 112 Hispanic/Latino, 66 Black/African American, 16 White/Caucasian, 15 Other, and 3 Native American
  • Gender — Caregivers: Not specified; Children: 68% Male
  • Status — Participants were inner-city children meeting diagnostic criteria for oppositional defiant (ODD) or conduct disorders (CD) and their families.

Location/Institution: Thirteen community-based outpatient mental health clinics that serve youth and their families residing in socioeconomically disadvantaged communities across the New York City metropolitan area

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as McKay et al. (2011). The purpose of the study was to examine whether child behavioral outcomes for a multiple family group (MFG) service delivery model [now called The 4 Rs and 2 Ss for Strengthening Families Program] differ for families with self-reported lifetime involvement in child welfare (CW) services compared to other families. Participants were assigned to MFG or services as usual (SAU) using a block comparison design. Measures utilized include the IOWA Connors Rating Scale (IOWA-CRS), the Social Skills Rating System: Social Skills Subscale (SSRS-SSS), and the Impairment Rating Scale (IRS). Results indicate that among CW-involved families, MFG participants reported significantly reduced child oppositional defiant disorder symptoms at 6-month follow-up compared with SAU participants. No other differences were found in the effect of MFG treatment between CW and non-CW-involved families. Limitations include lack of randomization, the broad definition of lifetime CW involvement obtained through provider self-report, significant differential attrition at 6-month follow-up by treatment condition, and the exclusive use of parent-report measures of outcomes.

Length of controlled postintervention follow-up: 6 months.

Small, L. A., Jackson, J., Gopalan, G., & McKay, M. M. (2015) Meeting the complex needs of urban youth and their families through the 4Rs 2Ss family strengthening program: The “real world” meets evidence-informed care. Research on Social Work Practice, 25(4), 433–445. https://doi.org/10.1177/1049731514537900

Type of Study: Randomized controlled trial
Number of Participants: 321 families

Population:

  • Age — Caregivers: Mean=36 years; Children: Mean=9 years
  • Race/Ethnicity — Caregivers: 169 Hispanic/Latino, 96 Black/African American, 30 White/Caucasian, 13 Other, 3 Native American, and 2 Asian/Pacific Islander; Children: 157 Hispanic/Latino, 95 Black/African American, 25 White/Caucasian, 21 Other, 8 Native American, and 1 Asi
  • Gender — Not specified
  • Status — Participants were youth meeting diagnostic criteria for oppositional defiant (ODD) or conduct disorders (CD), and their families nested within child outpatient mental health clinics that serve low income, African American and Latino children.

Location/Institution: Thirteen community-based outpatient mental health clinics in low-income communities throughout the New York City metropolitan area

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as McKay et al. (2011). The purpose of the study was to examine The 4 Rs and 2 Ss for Strengthening Families Program (4R2S), developed across four broad conceptual categories related to parenting skills and family processes that form a multiple family group service delivery approach. Participants were randomly assigned to 4R2S or clinical services as usual treatment conditions. Measures utilized include the Parenting Stress Index (PSI), the Center for Epidemiologic Studies Depression Scale (CES-D), the IOWA Connors Rating Scale (IOWA-CRS), the Social Skills Rating System: Social Skills Subscale (SSRS), the REACH attendance tracking log, and child welfare involvement was measured by a single item asked of adult caregivers at baseline and follow-up. Results indicate that there was high engagement in 4R2S compared to standard services. Although child welfare status is not related to attendance, family stress and parental depression are also related to participant engagement in this multiple family group intervention. Involvement in 4R2S resulted in improved effects for child behaviors. Lastly, no evidence of moderation effects on family stress, child welfare involvement, or parental needs was found. Limitations include lack of randomization and reliance on self-reported measures.

Length of controlled postintervention follow-up: 2 months.

Acri, M., Bornheimer, L. A., Jessell, L., Flaherty, H. B., & McKay, M. M. (2016). The impact of caregiver treatment satisfaction upon child and parent outcomes. Child and Adolescent Mental Health, 21(4), 201–208. https://doi.org/10.1111/camh.12165

Type of Study: Randomized controlled trial
Number of Participants: 320 families

Population:

  • Age — Caregivers: Not specified; Children: 7–11 years
  • Race/Ethnicity — Caregivers: 53% Latino and 30% Black/African American; Children: 51% Latino and 31% Black/African American
  • Gender — Caregivers: Not specified; Children: 70% Male
  • Status — Participants were inner-city children meeting diagnostic criteria for oppositional defiant (ODD) or conduct disorders (CD) and their families.

Location/Institution: Thirteen community-based outpatient mental health clinics in low-income communities throughout the New York City metropolitan area

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as McKay et al. (2011). The purpose of the study was to examine caregiver treatment satisfaction. Participants were assigned to The 4 Rs and 2 Ss for Strengthening Families Program Multiple Family Group (MFG)experimental condition or services as usual (SAU) control condition. Measures utilized include the IOWA Connors Rating Scale (IOWA-CRS), the Parenting Stress Index-Short Form (PSI), and satisfaction with treatment was measured using the Metropolitan Area Child Study (MACS) process measures program satisfaction subscale. Results indicate that the two main effects models that focused on satisfaction with treatment were predictive of parental stress and child oppositional defiant behaviors independently. Satisfaction with treatment accounted for 31% of the variance in child oppositional behavior and 24% of parental stress improvements across time, holding all covariates constant. Limitations include the assignment to treatment condition was not randomized, treatment satisfaction was only collected from caregivers who completed treatment, and child satisfaction with services was not assessed.

Length of controlled postintervention follow-up: None.

Gopalan, G., Bornheimer, L. A., Acri, M., Winters, A., O’Brien, K. H., & Chacko, A. (2018). Multiple family group service delivery model for children with disruptive behavior disorders: Impact on caregiver stress and depressive symptoms. Journal of Emotional and Behavioral Disorders, 26(3), 182–192. https://doi.org/10.1177/1063426617717721

Type of Study: Randomized controlled trial
Number of Participants: 320 families

Population:

  • Age — Caregivers: Not specified; Children: 7–11 years
  • Race/Ethnicity — Caregivers: 53% Latino and 30% Black/African American; Children: 112 Hispanic/Latino, 66 Black/African American, 16 White/Caucasian, 15 Other, and 3 Native American
  • Gender — Caregivers: Not specified; Children: 68% Male
  • Status — Participants were inner-city children meeting diagnostic criteria for oppositional defiant (ODD) or conduct disorders (CD) and their families.

Location/Institution: Thirteen community-based outpatient mental health clinics that serve youth and their families residing in socioeconomically disadvantaged communities across the New York City metropolitan area

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as McKay et al. (2011). The purpose of the study was to examine the effects of a behavioral parent training program called The 4 Rs and 2 Ss for Strengthening Families Program (4R2S) on caregiver stress and depressive symptoms. Participants were assigned to 4R2S or clinical services as usual (SAU) treatment conditions. Measures utilized include the Center for Epidemiologic Studies Depression Scale (CESD) and the Parenting Stress Index-Short Form (PSI). Results indicate that among caregivers with clinically significant scores at baseline, 4R2S participants manifested significantly reduced scores on the stress and depressive symptom scores to SAU participants at the 6-month follow-up. Limitations include lack of randomization; 4R2S participants responded less at the 6-month follow-up assessment compared to SAU participants; and the study findings may not generalize to younger and older children, as well as those youths with sub-threshold levels of disruptive behavior disorders (DBD) symptoms.

Length of controlled postintervention follow-up: 6 months.

Bornheimer, L. A., Acri, M., Li Verdugo, J., & McKay, M. M. (2021). Family processes and mental health among children and caregivers in a family strengthening program. Journal of Child and Family Studies, 30(11), 2903–2912. https://doi.org/10.1007/s10826-021-02035-w

Type of Study: Randomized controlled trial
Number of Participants: 30 agencies (287 caregiver/child dyads)

Population:

  • Age — Caregivers: Average=41.09 years; Youth: Average=8.87 years
  • Race/Ethnicity — Caregivers: 140 Non-Hispanic/Latino, 100 Black/African American, and 77 White; Youth: 141 Hispanic/Latino, 111 Black/African American, and 68 White
  • Gender — Caregivers: 172 Female; Youth=213 Male
  • Status — Participants were inner-city children meeting diagnostic criteria for oppositional defiant (ODD) or conduct disorders (CD) and their families.

Location/Institution: All licensed outpatient child mental health agencies located within the five boroughs that was provided by the New York State Office of Mental Health (Manhattan, Brooklyn, Queens, Bronx, Staten Island)

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the specific relationship between the family process variables and mental health outcomes of children and caregivers who participated in a NIMH-funded Type II hybrid effectiveness-implementation study in New York City. Clinics were randomized to services as usual (SAU; COND0), the comparison condition, or one of two active intervention arms: the standard The 4 Rs and 2 Ss for Strengthening Families Program (COND1) or an augmented 4 Rs and 2 Ss that included Clinic Implementation Teams (CIT; COND2), which oversaw a structured adaptation of the intervention to facilitate uptake. Measures utilized include the Center for Epidemiologic Studies Depression Scale (CESD), the Iowa Conners Rating Scale-Inattention and Oppositional Defiant Disorder Subscales, the Alabama Parenting Questionnaire, the Family Assessment Device, the Parenting Stress Index-Short Form (PSI), and the Multidimensional Scale of Perceived Social Support family subscale. Results indicate that two of the six family process variables related to one or more child and caregiver mental health outcome. Caregiver stress significantly related to child inattention, child ODD, and caregiver depression. Family rules significantly related to caregiver depression over time. Limitations include that constructs in measurement and modeling were too limiting or did not capture the construct completely, reliance on self-reported measures, and the sample of clinics recruited into the study were mostly homogenous.

Length of controlled postintervention follow-up: None.

Additional References

Acri, M. C., Hamovitch, E. K., Lambert, K., Galler, M., Parchment, T. M., & Bornheimer, L. A. (2019). Perceived benefits of a multiple family group for children with behavior problems and their families. Social Work with Groups, 42(3), 197–212. https://doi.org/10.1080/01609513.2019.1567437

Gopalan, G., Franco, L. M., Dean-Assael, K., McGuire-Schwartz, M., Chacko, A., & McKay, M. (2014). Statewide implementation of The 4 Rs and 2 Ss for Strengthening Families. Journal of Evidence-Based Social Work, 11(1-2), 84–96. https://doi.org/10.1080/15433714.2013.842440

McKay, M. M., & Acri, M. (2018). A conversation on building resilience and protecting children: An evidence-based family strengthening approach. Washington University Journal of Law and Policy, 57, 133.

Contact Information

Kara Marie Dean-Assael, DSW
Agency/Affiliation: Project Director
Website: mcsilver.nyu.edu/4rs-2ss
Email:
Phone: (917) 215-9395

Date Research Evidence Last Reviewed by CEBC: December 2024

Date Program Content Last Reviewed by Program Staff: May 2025

Date Program Originally Loaded onto CEBC: May 2025