Strengthening Families for Parents and Youth

2. Strengthening Families for Parents and Youth Building Resiliency in At-Risk Youth in Ontario Addictions Ontario Conference May 31, 2011 Marriott Toronto Airport Hotel

3. Presenters Diane Buhler, Parent Action on Drugs, SFPY Lead Agency Barbara Steep, Centre for Addiction and Mental Health, SFPY Partner and SFF Lead

4. Thanks to our partners: Toronto Drug Strategy Health Canada, DSCIF Toronto Public Health Centre for Addiction and Mental Health Griffin Centre Hospital for Sick Kids, Adolescent Medicine Division Toronto Catholic District School Board YMCA of Greater Toronto Youthlink Jean Tweed Centre

5. Learning Objectives Participants will Be familiar with the SFPY project Understand the key concepts of the SFPY program Understand how the SFPY program supports resiliency Understand how the program model and concepts can be adapted in diverse clinical and community settings including addictions, treatment and youth serving

6. Agenda Introductions SFP and the SFPY project Building Resiliency At-Risk Youth SFPY learning models and examples Applications within addictions programs, treatment settings and youth serving agencies Program outcomes and learnings

7. Introductions

8. Strengthening Families Program Program model was developed as a 4 year NIDA grant in 1983 specifically to increase resiliency among children of alcohol and drug-abusing parents by Dr. Karol Kumpfer, University of Utah Results demonstrated that combining the parenting, children�s skills training and family relationship enhancement program strengthened many factors against drug-abuse

9. Cited as one of the best interventions of its kind by Cochrane Collaboration, the US National Institute on Drug Abuse, the Office of Juvenile Justice and Delinquency Prevention and the Substance Abuse and Mental Health Service Administration Recognized as �best practice� program by CCSA Strengthening Families Program

10. Strengthening Families Program Goal: Improve parent-child relationships and family functioning Outcomes: Reduce environmental risk factors among children/youth Improve protective factors among children/youth Increasing personal resilience among children/youth Reduced involvement in high risk behaviours (e.g. drug use, unsafe sexual behaviours etc)

11. The SFF program is unique because it was designed specifically to decrease several risk factors and enhance family protective factors that together, BUILD RESILIENCY IN CHILDREN and prevent children from developing substance use, depression, violence and other problems. Resiliency is the ability to bounce back or adapt to difficulties in one�s life. The graphic is adapted from from Parent Session 9 � handout 9A that you will find in the handout section of the parent manual Risk factors ( which are the lightning bolts on the graphic) are in handout 8A in the parent manual � some examples are: Family chaos, lack of routines, rituals Lack of involvement/time together Isolation Stress Parental and sibling abuse Lack of supervision Harsh discipline Negative interactions with children (not playful, controlling) Unrealistic expectations for developmental age Poor parental mental health � depression and irritability Marginalization �families may have experienced various forms of opression based on their social location (race, ethnicity, language, socioeconomic status, family composition, religion etc.) Some families may have experienced multiple forms of oppression. Give some examples of how the program reduces some of these risk factors. For example: in SFF parents learn communication skills � they also practice giving effective directions, and learn about using choices and consequences with their children � these new parenting skills help reduce more negative practices like harsh punishment. OR � parents learn about children�s growth and development in order to decrease unrealistic expectations Protective factors are illustrated on the outside layer of the graphic and can be found on Parent 8B handout. Some examples are: One caring adult in children's lives Positive parenting � the use of praise, consistent discipline, realistic developmental objectives Involvement of parents in the lives of their children � spending positive time together Strong extended family and support structures Support in critical decision making Parental rules and standards around the use of alcohol, tobacco and other drugs Family routines, rituals and traditions Give some examples of how SFF aims to enhance protective factors within the child�s family. For example, in session 13 families work together to develop a family shield which helps them talk about and identify their values and special traditions As facilitators it is important to be respectful of people�s life circumstances (as naturally we would be with any of our clients). The SFF program offers participants practical skills they can use to improve and strengthen family relationships. This is done in a non-judgemental way and does not offer opinions regarding the choices families have made. (provide and example about how this distinction is made�I.e. between demonstrating communication or the importance of routine, rituals, traditions versus a judgment/opinion) SFF aims to provide an inclusive, welcoming environment for all families and to provide opportunities for families to make meaningful connections with service providers and other families in their community as a step in reducing isolation and building confidence and self �esteem. The SFF program is unique because it was designed specifically to decrease several risk factors and enhance family protective factors that together, BUILD RESILIENCY IN CHILDREN and prevent children from developing substance use, depression, violence and other problems. Resiliency is the ability to bounce back or adapt to difficulties in one�s life. The graphic is adapted from from Parent Session 9 � handout 9A that you will find in the handout section of the parent manual Risk factors ( which are the lightning bolts on the graphic) are in handout 8A in the parent manual � some examples are: Family chaos, lack of routines, rituals Lack of involvement/time together Isolation Stress Parental and sibling abuse Lack of supervision Harsh discipline Negative interactions with children (not playful, controlling) Unrealistic expectations for developmental age Poor parental mental health � depression and irritability Marginalization �families may have experienced various forms of opression based on their social location (race, ethnicity, language, socioeconomic status, family composition, religion etc.) Some families may have experienced multiple forms of oppression. Give some examples of how the program reduces some of these risk factors. For example: in SFF parents learn communication skills � they also practice giving effective directions, and learn about using choices and consequences with their children � these new parenting skills help reduce more negative practices like harsh punishment. OR � parents learn about children�s growth and development in order to decrease unrealistic expectations Protective factors are illustrated on the outside layer of the graphic and can be found on Parent 8B handout. Some examples are: One caring adult in children's lives Positive parenting � the use of praise, consistent discipline, realistic developmental objectives Involvement of parents in the lives of their children � spending positive time together Strong extended family and support structures Support in critical decision making Parental rules and standards around the use of alcohol, tobacco and other drugs Family routines, rituals and traditions Give some examples of how SFF aims to enhance protective factors within the child�s family. For example, in session 13 families work together to develop a family shield which helps them talk about and identify their values and special traditions As facilitators it is important to be respectful of people�s life circumstances (as naturally we would be with any of our clients). The SFF program offers participants practical skills they can use to improve and strengthen family relationships. This is done in a non-judgemental way and does not offer opinions regarding the choices families have made. (provide and example about how this distinction is made�I.e. between demonstrating communication or the importance of routine, rituals, traditions versus a judgment/opinion) SFF aims to provide an inclusive, welcoming environment for all families and to provide opportunities for families to make meaningful connections with service providers and other families in their community as a step in reducing isolation and building confidence and self �esteem.

12. SFP Adaptations Many initiatives throughout the world, with a global data base maintained Canadian Ontario: Strengthening Families for the Future (for parents and children 7-11) accessed through CAMH Used for more than 10 years, underwent a 5 year evaluation Also rural British Columbia and French-speaking and English-speaking Black Canadians in Quebec American African-American, Latino, American-Indian, Asian/Pacific Islander, Rural (Iowa)

13. SFPY Project Background The Toronto Drug Strategy (TDS) identified the need for family-based early intervention initiatives SFF is currently used by diverse agencies in Toronto as well as in rural and urban communities throughout Ontario Program for youth using the SFP model was identified as filling a gap

14. SFPY Project Description Strengthening Families for Parents and Youth 12-16: A Community Initiative to Adapt an Evidence Based Model for Implementation with Families of At-Risk Youth Funded by the Drug Strategy Community Initiatives Fund of Health Canada Produce an evidence based program model appropriate for families and communities with at risk-youth in Toronto and applicable to communities throughout Ontario

15. SFPY Adaptations Shorten from 14 - 8 sessions Factors: Youth tolerance; implementation practicalities, family commitment Addition of a new module on youth and drug use Re-write of materials for Ontario audiences 4 youth forums/workshops provided input on content, activities and materials: Initial review (e.g. youth�s views on family, drugs etc.) Feedback on processes and material design from pilot session

16. Project Status Initial adaptation followed by 2 revisions of the 8-week curriculum 5 trials completed with YMCA, TCDSB, Griffin and CAMH partners 3 trials completing this spring + 1 in fall Lessons learned: parents love it, youth CAN enjoy it, incentives count, and food is important to everyone!

17. Project Evaluation Extremely important � to ascertain impact of adapted curriculum on standardized measures of resiliency Parent evaluation of family functioning and perception of child behaviour Retro pre/post test from K. Kumpfer Input and analysis from Kumpfer along with multitude of international trials of all ages and adaptations Parent/youth open ended satisfaction questionnaire Youth perception of family functioning � a challenge Process evaluation from facilitators and coordinators

18. SFPY Curriculum Overview 8 weeks covers all topics of original 14 week curriculum, except sexuality Parent and youth sessions cover matching topics Builds from initial positive attention and praise to problem solving 9th week is evaluation and celebration

19. SFPY Format/Implementation Family meal + parent/youth sessions (70 minutes) followed by family session (50 minutes) Childcare provided Site arrangements for rooms, meals, childcare and other logistics of delivery Facilitator preparation and debriefing PAD management with site coordinator

20. Building Resiliency What do we mean by resiliency? Building youth resiliency via parent responses Significant where parents are overwhelmed by Personal issues Teen�s challenging behaviours Family risk factors Environmental risk factors

21. At-Risk Youth Youth identified by: Behaviours at school Difficult home environments Parent�s inability to support child Substance use/abuse Parent-child conflict

22. SFPY Parents Learning Model: Ownership of need and capacity for change to improve family functioning Skills- building and practice, practice, practice! Emphasis on praise, positive communication, positive discipline, and problem solving Recognition of youths� stressors, needs and voice

23. SFPY Youth Learning Model

24. SFPY Family Learning Model Positive family interaction � parent and youth (e.g. Parent-Teen Game) Appreciate teens (e.g. Teen Time & Teen Goals) Intergenerational teams (e.g. Communication Squares activity) Dialogue on challenging subjects (e.g. 4 corners activity) Increase family commitment (e.g. Family Mobile/Pie) Empower youth (e.g. Message to Our Parents)

25. Adapting SFPY to Addictions and Other Settings Make minor changes to represent culture and service philosophy without compromising model Support treatment goals/recovery maintenance Facilitators representative of cultures/ milieu Encourage parents who have experienced trauma, disorders but who are stable in terms of diagnoses

26. SFPY Lessons Learned Appreciate diversity Acknowledge possible family/youth discomfort Focus on family strengths Concentrate on skill acquisition and practice (parents) Invite parents to try new methods Cannot resolve issues of teen problem behaviour � can improve parent-teen interaction

27. SFPY Outcomes and Impact Initial trials: meeting outcome objectives Youth Empowerment: Message to our parents Parent Commitment to applying new skills Family Commitment to Change Families re-engaged and open to pursuing further help Reduced substance use

31. For more information: Strengthening Families for Parents and Youth, contact: Diane Buhler, Parent Action on Drugs pad@sympatico.ca Strengthening Families for the Future, contact: Barbara Steep, CAMH barbara_steep@camh.net