Effective Family-Based Approaches for Preventing Child and Youth Problem Behavior

Background: Family-based prevention programs targeting youth problem behavior, including substance use, delinquency, violence, and school drop out, have expanded in number and type over the past two decades. Family-based prevention includes: home visiting programs offering prenatal services to new mothers at risk; behavioral parent training programs providing social-emotional skills to parents and their children in groups; and family interventions provided in home or in outpatient settings to families in crises to prevent out of home placement. Across formats, family-based prevention programs offer the benefit of involving parents in improving family functioning as means of buffering youth from problem development. Considering the rapidly increasing body of evidence rigorously evaluating family-based prevention programs, the current study aimed to systematically review the evidence to answer two research questions: 1) How effective are family-based prevention programs in preventing youth problem behavior? and 2) What are characteristics of effective programs?

Methods: Due to the great number of available studies, we limited our systematic review to include existing meta-analyses and systematic reviews of family-based prevention programs addressing child and youth problem behavior.  Using Boolean format, we systematically searched empirical databases (PsycINFO, MEDLINE, ERIC, Wilson Social Science Abstracts, Social Work Abstracts, Social Science Citation Index, and Social Science Abstracts), using the search terms: “family,” “prevention,” and “meta-analysis” or “systematic review” in combination with the four problem behaviors of focus: “substance use,” “delinquency,” “violence,” “school dropout,” and their synonyms. We reviewed all studies meeting inclusion criteria to determine the magnitude of effects and to delineate program characteristics associated with positive outcomes. Our systematic review identified 11 meta-analyses or systematic reviews focused on family-based prevention of child and youth problem behavior.

Results: Overall, family-based prevention programs are associated with preventing problem behavior among children and adolescents; however, the magnitude of these effects varied considerably across studies. The majority of family-based prevention effects ranged from .20-.40, indicating a small to moderate effect. Parent training approaches demonstrated moderate effects (.30-.42) most consistently, while home visiting programs for new families included small effects on youths’ social and emotional (.10) and cognitive development (.18) and more moderate effects (.50) on preventing child abuse. Common characteristics among effective family-based prevention programs were: using an empirically-supported theoretical framework, involving parents and children in programming, including a focus on improving parent-child relationships, including a focus on skill-building, and allowing for interactive practice of new skills.

Conclusions: A number of family-based prevention programs have produced significant impacts on preventing, delaying, and reducing substance use, delinquency, violence, and school dropout. Considering the relatively low cost of prevention programs, even small to modest effects are likely to be very important preventing the onset of problems that may lead to costly treatment alternatives at a later age. Administrators should select programs that are empirically-grounded and help families build relationships while developing skills. Essential in maximizing the effects of these programs is broad dissemination and implementation with fidelity as well as the development of intentionally flexible models that allow for cultural and contextual adaptation to meet the needs of diverse families.