Disproportionate Minority Confinement Conference

1. Disproportionate Minority Confinement Conference • Des Moines, Iowa • Dec.2, 2004 • National Resource Center for Family Centered Practice,University of Iowa, School of Social Work • Presenter: Lynn McDonald, MSW, PhD, University of Wisconsin-Madison

2. Goals of Presentation • Overview of the Families and Schools Together FAST Program: an evidence based prevention model (SAMHSA, OJJDP) • History of successful engagement of low-income, minority parents into multi-family groups to build protective factors • Recommended principles of cultural adaptation of an evidence-based model

3. Multi-Family Groups: FAST • Community based, school based, family based, prevention process • 8 weekly MFG sessions • 5-25 whole families attend • Team led activities, no didactics • 2 years of monthly MFG • 10-150 whole families attend • Parent led activities

4. Non traditional strategies engage minority parents • Cultural representation of parents at every level of the process: planning, training, multi-family groups, evaluation, • Outreach to invite voluntary involvement • Shift of power to ongoing parent run MFG for two year, including a budget for parents • Experiential learning: adult education • Family stress reduced, social capital built

5. Relationship Based vs. Curriculum Based Program • Each child needs a caring, long-term relationship to learn, love and be resilient • Parents need support from adults to parent • A community needs trusting, respectful, reciprocal relationships: social capital ties • FAST offers a structure with opportunities to build relationships with respect, laughter, time, and interaction, through repetitive, weekly, participatory, fun, activities

6. Based on Theory of Social Ecology of Child Development(Bronfenbrenner, 1979)

7. Family Support, Family Systems and Family Stress • Hill’s Family Stress Theory: stress is buffered by support and perception; family support • Minuchin’s Family systems: increase hierarchy, cohesion, reduce unresolved conflict • Family assets and strengths enhanced • Whole families included to build community

8. M F T K B Bonding & Bridging Family Dyad Peers Dyad Family Community

9. Learning through Repeated Experiences • Children practice respectful behaviors towards their parents (300X in 8 weekly MFG sessions) • Children practice taking turns, waiting for a turn • Children practice talking about their drawing, their feelings, and their play with their own parents • Parents practice taking charge, making requests • Parents practice listening to their children • Parents practice playing with their child • Parents practice asking for social support

10. FAST uses Experiential Learning  20% 30% 50% 70% 90%

11. Research Based • Each FAST activity applies mental health research • Each implementation requires outcome and process evaluations, with quantitative and qualitative data • Teams self-assess process; parent graduates give feedback; trainers oversee implementation of core components for site certification • Experimental design studies with randomization and 1-2 year follow-up show positive impact on FAST compared to control children which holds over time

12. 80% Retention Rates • 80% of all low-income parents graduate • Of those who attend one MFG session, 80% parents come back and attend six+ of eight MFG sessions to graduate from FAST • National FAST average: 20% drop out vs. outpatient clinic average: 40-60% drop out • Rates maintain across low income African American, Latino, Native American, Asian

13. Outcomes • Parents increase involvement at schools • Children improve at school • Reduced aggression and bullying • Reduced anxiety and depression • Reduced attention span problems • Increased social skills • Increased academic performance

14. Outcomes • Parents network with other parents • Friendships built of parents of child friends • Family conflict reduces • Family communication increases • Trusting relationships increase within the family and across families and with the schools and community agencies

15. QA and Local Adaptation • Six days of team training in 6 months • Pre and post questionnaires to show impact • By teacher and by parent • Site report: outcome evaluation • Certified FAST Trainer does five site visits • Direct observation with feedback • Local adaptations encouraged and reviewed • Program integrity checklists

16. Core Components for Cultural Adaptation • Cultural representation • Relationship based • Shared governance • Room for adaptation at local level • Monitor program fidelity • Need to have room to make mistakes • Consumer representation

17. Cultural Representation • Value: Nothing about us, without us • Consider the ethnicity, language, culture of the families you wish to serve in the MFG • Create a team of planners which accurately represents those cultures to plan the MFG • Each partner on the team has an equal voice in creating the local adaptations • FAST trusts this process will work locally

18. Relationship Based MFG • Relationship based vs. curriculum based • Trainer assigned to each site-personal • Time for team building-personal • Home visits to recruit parents-personal • Multi-family groups structured to build relationships: dyads, small groups, • Geographically dense, centers or schools • Monthly MFGs sustain relationships

19. Shared Governance • Team is created with a parent, youth, and grandparent, and several professionals • Each team partner has a voice and a vote • The team co-creates local adaptations • Initial weekly MFG sessions---8 weeks----the team transfers its leadership and power to the graduates of the program • Consumer-facilitated monthly MFG--2 years

20. Local Adaptations • 15 years if replications has increased our commitment to focus on local adaptations • Review of the program shows 60% can be locally adapted without loss of impact • Trainers encourage teams to adapt process • Trainers support protection of core program components and review adaptations for possible “drift” away from core values

21. Monitoring Fidelity • Quality assurance systems in place • Certified FAST Trainers make 5 site visits • Direct observation of MFG implementation • Program integrity checklists w/ team review • Pre and post evaluation of every MFG cycle • Consumers provide feedback to team • Team provides feedback to trainer

22. Cultural Representation • Core Component: no exceptions • Each team make-up must be reported • Ethnic make-up of families must be reported to FAST National on a form • Percentages are calculated and compared • There are minimums for compliance • If over 50% of an ethnic group must have a team with over 50% of that ethnicity

23. Compliance Rules • Limit access to FAST Training materials • FAST Trainers are instructed to inquire about anticipated family ethnic make-up • If the team does not look like the families being served, this must be addressed • The team must change, or the families being invited must change, to match • If not resolved at the time, the Trainer is required to leave with the FAST manuals

24. Training for Success • Pre Certification training for Trainers includes role plays on cultural representation as a core component • Role plays on ways to manage conflict • Role plays on talking about race • Role plays on enforcing core components • Role plays on data collection and evaluation

25. Monitoring Cultural Match • 51 most recent FAST evaluations reviewed • % ethnicity of families and teams compared • If over 50% families are of one culture, over 50% of the team should look the same Over 50% Families Teams African American 22 22 Latino 14 12 European Am. 8 15 !!!

26. Does It Matter?? • Preliminary data analyses: Yes, it does • Monitoring matters: compliance increases • Cultural representation matters for: • Retention rates: Under 80% Over 80% • African Amer 6 16 !!!! • Latino Amer 7 7 • European Amer 5 3

27. Evidence Based AND Values Based Model • Evidence based means experimental studies demonstrate outcomes 1 year later • Values based means cultural representation • Nothing about us, without us! • Preliminary data suggest 80%+ retention rates with cultural representation on teams • Cultural adaptation of an evidence based model is a process which is locally created

28. www.fastprogram.org • 800 replication sites • 48 states • 5 countries outside US • Predictable retention rates of 80% • Predictable drop out rates of 20% • Training and TA through FAST National, a non-profit organization, Madison, WI