Families and Communities Research Group

>> FCRG Projects - SAFE Children

SAFE Children I

Investigators: Patrick N. Tolan, Ph.D., Deborah Gorman-Smith, Ph.D., and David B. Henry Ph.D.
Funded by: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration

The primary aim of this study is to test a family-based comprehensive preventive intervention with children, living in inner-city Chicago and entering first grade, for effects on key risk markers for later drug and other substance use. Over a 9 month period, this intervention combined components focused on 1) enhancing parent and child orientation to and involvement with school; 2) academic tutoring; 3) social competence and peer relations of the child; and 4) parent and family functioning to enhance the child's academic performance, the parental investment in the child's well-being and development, and the social competence and self-control of the child. Throughout the intervention, the unique impact of the social ecology of urban-poor and inner-city neighborhoods were considered (Gorman-Smith, Tolan & Henry, 1998; Tolan & Gorman-Smith, 1997). These components were integrated through a 20-session multiple-family group intervention and twice weekly individual tutoring in reading for each child in the intervention. A key consideration driving this approach is that a family-focused intervention is critical for parental investment in the prevention activities which is a requisite to obtain sufficient impact, lasting effects, and transfer of skills across settings and situations (Nye, Zucker, & Fitzgerald, 1995; Tolan & Gorman-Smith, 1997; Tremblay et al., 1990; Szapocznik et al., 1986).

422 (84% of those targeted) families participated in the prevention program (SAFE Children; Schools and Families Educating Children). Data were obtained through individual interviews conducted with the primary caregiver(s) and target child five times over the course an 24 month period (two pre-test, one mid-test, post-test, follow-up). 401 families participated in all five waves of data collection (95%). Data were also obtained through teacher assessments and school records. Following the first wave of interviews, families were randomly assigned to treatment or control. Of the 217 families assigned to treatment, 82% completed the intervention.

Initial analyses suggest that the intervention has had positive effects on reading achievement (as measured through the Woodcock Johnson Reading Abilities), parental involvement in school, parenting practices (i.e., discipline effectiveness and positive parenting) and family relationship characteristics (i.e., communication, beliefs).

SAFE Children I Intervention

There were two components of the intervention. All children and families randomly assigned to the intervention group participated in both parts of the intervention.

(a) Multiple-Family Groups. The family-focused intervention was comprised of weekly multiple family group meetings (e.g. 4-6 families per group) and addressed issues of parenting, family relations, and parental involvement and investment in their child's schooling (Tolan, Gorman-Smith & Quintana, 1997). All family members were invited to attend these meetings. Multiple family groups were used because previous research suggests that they are efficient forms for service delivery, building social support among participants, and improving parent-child interactions directly (McKay et al., in press; Webster-Stratton, 1984).

The intervention was comprised of 20 weekly sessions. The first sessions focused on the family's role in their child's schooling and helping the family to affirm and express the importance of their identity and responsibility to each other. The following sessions focused on the relation of home to school and the structure needed in the home to help children succeed in school. After this, the focus was on family relations with communication, problem-solving and maintaining support as the primary foci. The following table outlines the family portion of the preventive intervention of SAFE Children:

1. General Introduction - Setting a Fun and Positive Atmosphere
2. Learning is it's Own Reward
3. Helping Kids Do Their Best in School
4. Parents as Teachers and Advocates
5. Developmental Expectations
6. Why Play is Important
7. Identifying Family Strengths (Family Image and Heritage)
8. Making Family Goals - Identifying Family Strengths and Problems
9. Communication with Children
10. Communication with Adults
11. Discipline
12. Identifying and Defining Family Rules and Consequences
13. Adjusting Ineffective Family Rules and Consequences
14. Consistent Follow-through with Reasonable Consequences (Limit Setting)
15. Anger and Self-Control
16. Conflict Resolution/Listening Skills with Peers/School Staff
17. Helping Children with Social Relationships
18. Family Support - Identifying the Need/Where to Go
19. Maximizing Learning Opportunities/ Using the Community as a Resource
20. Being Part of the Community

(b) Tutoring One-on-one tutoring was provided to all children assigned to the treatment group of SAFE Children. The tutoring program was based on that used by FAST-Track and uses the Wallach program (Wallach & Wallach, 1976) and modified to meet the needs of this population (Leventhal & Gorman-Smith, 1997). The program is heavily phonics-based, teaching the basic skills of reading such as understanding letter-sound relationships, blending sounds into words, identifying letter combinations that correspond to regular combinations of phonemes, reading strings of words, and understanding the thought expressed by a sentence as it is read. Whole language strategies are also incorporated into the program activities through games and reading time. This program also complements the reading program used by the Chicago Public Schools which is phonics-based rather than whole-word approach. We worked with the reading coordinator and the first grade teachers in each school to maximize the consistency of our tutoring with the primary work in the class.

The second component of the tutorial program was literacy education. The purpose of this component was to increase children's opportunities to apply reading skills, to reinforce the skills, values and beliefs taught as part of the family-based intervention and to use this opportunity to address issues of ethnic identity (Otto, 1993). Tutors spent a portion of each session reading with the child. A series of books were written and illustrated by a member of our staff. A new book was introduced each week and children will given copies to add to their library, so that by the end of the intervention they had 15 to 20 books of their own. will spend one half-hour a week reading stories with students.

The program was taught by trained undergraduate students. Tutors received approximately 20 hours of training before beginning the intervention. They received weekly group supervision by the Tutoring Coordinator (a post-doctoral student under the supervision of the PIs).

Each child was tutored by a trained adult twice a week for 30 sessions. Each session was 30 minutes in length and was divided into three, ten minute segments: (1) phonics, (2) sound and word activities, and (3) reading books. The activities and reading time provided opportunities to apply and reinforce the reading skills.

SAFE Children II

The primary purpose of this study is to evaluate, for families living in inner-city Chicago, the benefits of a family-based, comprehensive, preventive-intervention targeting key risk markers for later drug and other substance use of their child. Specifically, this study was designed to test for additional benefits from a second-phase of intervention delivered during the latter part of the elementary school years for families that participated in a CSAP funded prevention trial during 1997-1998. That first phase intervention (called SAFE Children) was delivered at the transition to and during first grade and showed proximal effects on the targeted domains. This continuation provides much needed additional understanding of early prevention for substance abuse among a high-risk and understudied population (inner-city families). This study was designed to determine the magnitude and persistence of benefits accumulated from both phases of preventive intervention and differentiate the effects specifically due to a second-phase intervention (a “booster”) from those from the first-phase intervention. This study has an unprecedented capability to differentiate these preventive effects due to the measurement strategy (9 assessments over the two phases) and use of a developmental modeling approach to intervention evaluation. This approach can incorporate normal developmental patterns, whether one of stability or growth and whether that growth is linear or non-linear. Because intervention effects are modeled as interaction with developmental trajectories, this study can reliably differentiate benefits of the second-phase intervention from long-term impact of the first-phase intervention and each of these from normal development. Thus, this evaluation will provide needed information about substance abuse prevention for an ethnically diverse, high-risk population and advance understanding about the importance of a “booster” or second-phase of intervention.

SAFE Effectiveness

SAFE Children Effectiveness Trial: The aims of the ACE are 1) to apply developmental-ecological understanding to violence prevention in communities, and 2) to use evidence-based interventions and evaluation tools in community violence prevention. The SAFE Children Effectiveness Trial furthers both aims by applying an evidence-based intervention at a critical time in affecting the development of aggression, the entry into school. Specifically, this study will help establish the utility of an efficacious program for preventing violence in inner-city communities. This research has three specific aims.

The first aim of this study is to test, for families living in inner-city Chicago with children entering first grade, the effectiveness of an efficacious family-based preventive-intervention targeting key risk markers for later aggression and related problem behaviors called Schools and Families Educating Children, or SAFE Children. This intervention combines components focused on: 1) enhancing parent and child orientation to school; 2) academic tutoring; 3) promoting self-control in the child; 4) promoting the child’s social competence; 5) reducing aggression, and 6) improving parenting and family functioning. The intent is to make the first year of school one of helping families enhance ability to manage development within the inner-city community and children to succeed at school and socially. In doing so, the risk for aggression and school failure is reduced and the risk for later violence should be reduced. In this trial we will apply strong scientific methods including random assignment and careful measurement of growth patterns over several years to test for replication of these effects but under conditions more approximating those of service provision typically. To do so, we will collaborate with community mental health providers and participating schools to test the effectiveness of SAFE Children when delivered by community mental health providers and student-tutors. Instead of using undergraduate tutors and graduate student family interventionists, as in the SAFE Children efficacy trial, the proposed study will implement SAFE Children with 8th grade tutors recruited from the schools the first grade subjects attend, and with family interventionists drawn from the staff of mental health centers serving the targeted communities.

The second aim of the study is to demonstrate that this intervention can be implemented with fidelity in conditions that are common for service to inner-city families. The goal is to show that with strong training and a good collaborative relationship between the center and the community schools and agencies we can have effective implementation. To that end we will study variation in implementation and how that relates to impact of the program. This information can be important for advancing knowledge about the use of efficacious programs in larger scale attempts to reduce youth violence.

The third aim is to understand how intervention effects are influenced by variations in characteristics among the population and neighborhood conditions. This focus will help inform prevention efforts to ensure they are ecologically sensitive.