Meeting the Complex Needs of Urban Youth and Their Families Through the 4Rs 2Ss Family Strengthening Program

Abstract

Youth living in poverty face compounding familial and environmental challenges in utilizing effective community mental health services. They have ongoing stressors that increase their dropout rate in mental health service use. Difficulties also exist in staying engaged in services when they are involved with the child welfare system. This study examines the 4Rs 2Ss Family Strengthening Program, developed across four broad conceptual categories related to parenting skills and family processes that form a multiple family group service delivery approach. A total of 321 families were enrolled in this randomized intervention study, assigned to either the 4Rs 2Ss Family Strengthening Program or standard care services. Caregivers and their children randomly assigned to the experimental condition received a 16 week multiple family group intervention through their respective outpatient community mental health clinic. Data was collected at baseline, midtest (8 weeks), posttest (16 weeks), and 6 month follow-up. Major findings include high engagement in the 4Rs 2Ss Family Strengthening Program, 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 the 4Rs 2Ss Family Strengthening Program resulted in improved effects for child behaviors. Lastly, no evidence of moderation effects on family stress, child welfare involvement, or parental needs were found. The 4Rs 2Ss Family Strengthening Program appeared able to engage families with more complex “real world” needs.

Addressing Barriers to Recruitment and Retention in the Implementation of Parenting Programs: Lessons Learned for Effective Program Delivery in Rural and Urban Areas

“…Less than half of participating families (43%) completed all sessions, but all families completed at least one session. Although the completion rate is low, it is consistent with prior research with urban families, which documented retention rates between 30% and 65% (Finigan-Carr et al 2014; Small et al 2015).…”

“…Even when families chose that option initially, they frequently required in-home support to continue engagement in the sessions. Of note, however, is the fact that this support did not increase retention and engagement above and beyond that observed in prior research but rates of retention remain comparable to rates observed in other research with urban families (Finigan-Carr et al 2014; Small et al 2015). Although the VCU Clark-Hill site had family consultants available to implement the programs individually in families’ homes, the family consultants reported encountering scheduling difficulties.…”

Stages of change and engagement in a family intervention

“…As recommended in some studies, it may be useful to discuss any possible external obstacles (timetables and journeys) and internal obstacles (fear of being criticized or questioned) with the family and also expectations of change, as this would clarify the sense of the intervention and its benefits for the family (Gopalan et al, 2010;Small et al, 2015;Sterrett, Jones, Zalot, & Shook, 2010). As recommended in some studies, it may be useful to discuss any possible external obstacles (timetables and journeys) and internal obstacles (fear of being criticized or questioned) with the family and also expectations of change, as this would clarify the sense of the intervention and its benefits for the family (Gopalan et al, 2010;Small et al, 2015;Sterrett, Jones, Zalot, & Shook, 2010).…”

“…Given the impact of psychosocial interventions on families, it is necessary to consider how to promote the transition from the precontemplation to contemplation stages. As recommended in some studies, it may be useful to discuss any possible external obstacles (timetables and journeys) and internal obstacles (fear of being criticized or questioned) with the family and also expectations of change, as this would clarify the sense of the intervention and its benefits for the family (Gopalan et al, ; Small et al, ; Sterrett, Jones, Zalot, & Shook, ). Encouraging participation by all family members would also reduce the dropout risk.…”

“…that are present in family conflicts (Benbassat & Priel, 2015;Fonagy & Target, 1997;Lebow & Rekart, 2007). As will be seen later, it is essential that the family members understand that their difficulties and conflicts have a relational basis and that change will be a result of modifying or regulating their relationships in order to reduce guilt, repair fractures, and promote the experience of synchrony and of sharing the meaning of what they are going through (Fearon et al, 2006;Molinari, Everri, & Fruggeri, 2010;Small, Jackson, Gopalan, & McKay, 2015;Tuttle, Knudson-Martin, & Kim, 2012).…”