Positive Family Support
Blueprints Program Rating: Promising
A family-based, 3-tiered intervention that aims to reduce problem behavior and risk for substance abuse and depression and improve family management practices and communication skills, as well as adolescents' self-regulation skills and prosocial behaviors.
- Sexual Risk Behaviors
- Family Therapy
- Parent Training
- School - Individual Strategies
Continuum of Intervention
- Universal Prevention (Entire Population)
- Selective Prevention (Elevated Risk)
- Indicated Prevention (Early Symptoms of Problem)
- Early Adolescence (12-14) - Middle School
- Male and Female
- All Race/Ethnicity
- : Promising
- : Effective
- : Effective
Program Information Contact
Marianne Fillhouer, M.A., Ed.S.
Arizona State University
P.O. Box 876005
Tempe, AZ 85287-6005
Phone: (480) 727-6141
Fax: (480) 965-5430
- Tom Dishion, Ph.D.
- REACH Institute
Brief Description of the Program
Positive Family Support-Family Check-Up (formerly Adolescent Transitions Program) is a three-tiered, multi-staged program that is administered through the middle school setting. The first, universal level involves the creation of a Family Resource Center (FRC), operated by a Parent Consultant. A 6-week universal prevention program called SHAPe (Success, Health, and Peace) is implemented at this level in participating children's homeroom school classes. The FRC provides a structured place for school staff and parents to collaborate. Norms of protective, prosocial parenting behaviors are set and information on prosocial family management is distributed. Weekly homework assignments require parent and child to interact to practice family management techniques. The second, selected level provides early, brief interventions in which schools collaborate with parents to effect positive behavior change in students where concerns around their school success (i.e., attendance and completion of work) are beginning to emerge. Home incentive-driven monitoring tools are used to engage parents in the behavior change process. The third, indicated level is called Family Check-Up. Here, families participate in an interview and assessment session that is followed by a motivational feedback session in which parents collaborate with therapists or trained school staff to select available intervention programs the family can receive. This level addresses indicated problems through a brief treatment program, academic and social behavior monitoring, parent groups, and behavioral family therapy sessions. The FCU can also be implemented with students at Level Two. Positive Family Support is designed to be embedded within schools that have an existing Positive Behavioral Interventions and Supports (PBIS) infrastructure.
See: Full Description
Significant program outcomes among intervention youth compared to the control group include:
- Reductions in substance use (cigarettes and alcohol) by ninth grade (Connell, Dishion, & Deater-Deckard, 2006; Dishion, Nelson & Kavanagh, 2003).
- Reductions in depression by ninth grade among high-risk youth, with significant differences in the number of youths scoring in the clinical range, both for youth and mother reports (Connell & Dishion, 2008).
- Improvements in overall youth self-regulation, with small to medium effect sizes in associations between seventh grade self-regulation and youth depressive symptoms from sixth to eighth grade (Stormshak, Fosco, & Dishion, 2010).
- Reduced growth in school absenteeism and reduced decline in GPA from grades 6 to 9 among high-risk youth (Stormshak, Connell, & Dishion, 2009).
- Reduced antisocial behavior by age 18 and parent conflict through adolescence (Connell et al., 2007; Van Ryzin & Dishion, 2012).
- Reduced arrests for adolescent onset offenders (Connell et al., 2011).
- Increases in effortful control (self-regulation), which in turn has significant associations with less growth in antisocial behavior, deviant friendships, and substance use over time (Fosco et al., 2013).
- Indirect program effects on high risk sexual behavior by age 22 (Caruthers et al., 2014), mediated by family relationship quality.
Significant Program Effects on Risk and Protective Factors:
- Increased parent monitoring (Connell, Dishion, & Deater-Deckard, 2006; Dishion, Nelson & Kavanagh, 2003).
Compared to the control group, Connell et al. (2017) found no significant intervention effects at ages 28-30 on past-year or lifetime major depressive disorder diagnoses.
The sample was roughly half female, 40% African American and 60% European American. In Cohort 1 studies, there were no gender or ethnicity differences.
Risk and Protective Factors
- Individual: Early initiation of antisocial behavior, Favorable attitudes towards antisocial behavior, Favorable attitudes towards drug use, Rebelliousness, Stress, Substance use
- Peer: Interaction with antisocial peers, Peer substance use
- Family: Family conflict/violence, Parental attitudes favorable to antisocial behavior, Parental attitudes favorable to drug use, Poor family management*
- School: Low school commitment and attachment
- Individual: Coping Skills, Problem solving skills
- Peer: Interaction with prosocial peers
- Family: Attachment to parents, Opportunities for prosocial involvement with parents, Parent social support, Parental involvement in education, Rewards for prosocial involvement with parents
- School: Opportunities for prosocial involvement in education, Rewards for prosocial involvement in school
*Risk/Protective Factor was significantly impacted by the program.
Training and Technical Assistance
Training includes a readiness assessment and meeting (virtual or in-person) with school administrators and key school personnel. Follow-up PFS trainings range from 2-3 days total and involve various school staff. The Tier 1 (Universal) training session includes as many school staff as possible, including teachers, administrators, and support staff. Subsequent trainings (Tier 2: Selected and Tier 3: Individualized) include school participants that are going to be implementing more targeted interventions, including a modified version of Family Check-Up for schools. The training format includes didactic presentation of the model with digital taped and live role-modeled examples of the specific clinical components, strategies and techniques, as well as small-group activities and planning time for school teams. Role-plays are used to give experiential practice and assist participants in gaining clinical feedback and support to begin to gain mastery of the skills involved. The training content is the same if the training is directly for a particular school but may be broken up differently depending on the resources such as current fiscal and logistic contingencies in any particular school.
Brief Evaluation Methodology
The initial program development study randomized 119 youth to two components of the indicated level of the ATP, a peer group and parent group intervention. This study revealed that the family component was the most effective for reducing risk for delinquency and drug use. The peer component led to iatrogenic effects on delinquency and drug use over a three year period. Following the initial component study, the ATP was rendered as a three-tiered family-centered program. A large-scale study conducted with random assignment and multiple outcome measures and one replication study of the Adolescent Transitions Program have been evaluated. The main study, Project Alliance 1, conducted in three public middle schools in the Pacific Northwest, evaluated two cohorts of adolescents (672 students in cohort 1 and 998 adolescents in the combined cohort 1 and 2 studies) who were randomly assigned at the individual level to either ATP (intervention condition) or school as usual (comparison condition). Youth were assessed each year beginning in sixth grade, with the long-term follow-up surveying youth at age 22, for a total of 7 waves of data collection. Several outcome measures were assessed, including self-reported alcohol, tobacco, and marijuana use, antisocial behavior, depression, and academic achievement and school attendance. Youth self-reported on deviant peer involvement, parental monitoring, and family conflict as variables predicting initial involvement in problem behavior and engagement in treatment. Both intent-to-treat and complier average causal effect (CACE) analyses were conducted on outcome measures. A second replication study, Project Alliance 2, took place in three urban middle schools with 377 6th-9th grade adolescents and their families and used intent-to-treat analysis.
Connell et al. (2017) randomized 6th grade students in three schools to intervention and control groups and studied the long-term outcomes of the combined cohort sample (n = 998) in early adulthood (ages 28-30). The outcomes included past-year and lifetime depression diagnoses.
Caruthers, A. S., Van Ryzin, M. J., & Dishion, T. J. (2014). Preventing high-risk sexual behavior in early adulthood with family interventions in adolescence: Outcomes and developmental processes. Prevention Science, 15 (Supplement 1), S59-S69.
Connell, A. M., Dishion, T. J., & Deater-Deckard, K. (2006). Variable- and person-centered approaches to the analysis of early adolescent substance use: Linking peer, family, and intervention effects with developmental trajectories. Merrill-Palmer Quarterly, 52, 421-448.
Connell, A. M., Dishion, T. J., Yasui, M., & Kavanagh, K. (2007). An adaptive approach to family intervention: Linking engagement in family-centered intervention to reductions in adolescent problem behavior. Journal of Consulting and Clinical Psychology, 75, 568-579.
Connell, A. M., & Dishion, T. J. (2008). Reducing depression among at-risk early adolescents: Three-year effects of a family-centered intervention embedded within schools. Journal of Family Psychology, 22, 574-585.
Connell, A. (2009). Employing complier average causal effect analytic methods to examine effects of randomized encouragement trials. The American Journal of Drug and Alcohol Abuse, 35, 253-259.
Connell, A., M., Dishion, T. J., & Klostermann, S. (2011). Family Check Up effects on adolescent arrest trajectories: Variation by developmental subtype. Journal of Research on Adolescence, 22(2), 367-380.
Dishion, T. J., Kavanagh, K., Schneiger, A., Nelson, S., & Kaufman, N. K. (2002). Preventing early adolescent substance use: A family-centered strategy for the public middle school. Prevention Science, 3(3), 191-201.
Dishion, T. J., Nelson, S. E., & Kavanagh, K. (2003). The family check-up with high-risk young adolescents: Preventing early-onset substance use by parent monitoring. Behavior Therapy, 34, 553-571.
Fosco, G. M., Frank, J. L., Stormshak, E. A., & Dishion, T. J. (2013). Opening the "Black Box": Family Check-Up intervention effects on self-regulation that prevents growth in problem behavior and substance use. Journal of School Psychology, 51, 455-468.
Stormshak, E. A., Connell, A., & Dishion, T. J. (2009). An adaptive approach to family-centered intervention in schools: Linking intervention engagement to academic outcomes in middle and high school. Prevention Science, 10, 221-235.
Stormshak, E. A., Fosco, G. M., & Dishion, T. J. (2010). Implementing intervention with families in schools to increase youth school engagement: the Family Check-up model. School Mental Health, 2, 82-92.
Van Ryzin, M. J., & Dishion, T. J. (2012). The impact of a family-centered intervention on the ecology of adolescent antisocial behavior: Modeling developmental sequelae and trajectories during adolescence. Development and Psychopathology, 24(3), 1139-1155.