Families Matter
9th Australian Institute of Family Studies Conference
Melbourne, 9-11 February 2005

Resilient Families: A program to promote health and wellbeing in 
adolescents and their families.  

Alison L. Shortt & John W. Toumbourou
Centre for Adolescent Health

Summary
This paper describes Resilient Families – a program designed to improve adolescent health and wellbeing by building positive relationships between young people, their parents, and other adults in the first two years of secondary school.  A randomised controlled trial of this program is currently being conducted in partnership with twenty-four secondary schools in Melbourne and surrounding areas. Throughout this paper, the term parent/carer is used to identify the individual, couple or group of individuals with the main child-rearing responsibility. 

Background
Early adolescence is a developmental period in which a range of health-compromising behaviours such as tobacco use, alcohol use, illicit drug use, unprotected sexual intercourse, depression, suicidal behaviour, and violence first emerge or increase in prevalence (Bond, Thomas, Toumbourou, Patton, & Catalano, 2000). These health- compromising behaviours are influenced by interplay of risk and protective factors at the individual (e.g., temperament, social skills) and social-environmental (e.g., family, school) level (Bond et al, 2000; Hawkins Catalano & Miller, 1992). Our area of interest has been family-level factors. There is a growing body of research from large-scale longitudinal studies that attests to the relatively large influence of family-level factors on children and adolescents’ health and wellbeing (e.g., Prior, Sanson, Smart & Oberklaid, 2000; Resnick, Bearman & Blum, 1999). 

Over the last decade, there have been increasing efforts to develop and evaluate prevention programs that enhance protective factors and reverse or reduce risk factors (Hawkins, Catalano & Arthur, 2002). Family-focused prevention and treatment interventions targeting parents have been shown to reduce problem behaviours in children (Sanders, Gooley, & Nicholson, 2000; Woolfendeen, Williams & Peat, 2002). There is increasing interest in parenting interventions that address risk and protective factors at the family level during the adolescent period, and in turn promote health and wellbeing in adolescents.  

A strong bond or connection between parents and youth is the foundation for any intervention work.  Research indicates that parent-adolescent bonding can be strengthened through training parents to be supportive and involved (Kosterman, Hawkins, Spoth, Haggerty, & Zhu, 1997; Spoth, Redmond, Hockaday, & Yoo, 1996).  Parenting interventions can also increase proactive communication between parents and adolescents (Kosterman et al.).  Family management practices including clear family rules and standards prohibiting adolescent alcohol and other drug use, and parents/carers’ monitoring and supervision have been found to reduce youth substance use (Toumbourou & Gregg, 2001).  Parents can be taught techniques for monitoring activities, to praise appropriate behaviour and to apply moderate and consistent discipline that enforces defined family rules (Kosterman et al.).  In addition to impacting on these family-level risk and protective factors, parenting interventions have demonstrated success in preventing early adolescent involvement in alcohol use (Spoth, Redmond & Shin, 1998), tobacco use and conduct problems (Dishion et al., 1996).  Benefits following exposure to parent education and family interventions in early adolescence have been demonstrated to persist to two-years (Spoth, Redmond, & Lepper, 1999) and four-years (Spoth et al., 2000) post-intervention.

Toumbourou and Gregg (2002) conducted an evaluation of a universal family intervention called Parenting Adolescents: A Creative Experience (PACE; Jenkin & Bretherton, 1994). PACE is a parent-education group program with a focus on parent-adolescent communication, conflict resolution and adolescent development. It uses an adult-learning model to empower parents to use problem-solving techniques to support one another. Across Australia over 3000 parents attended PACE groups conducted in schools and community venues. To evaluate the program, parents and Year 8 adolescents (N=577) in 14 intervention schools and 14 matched control schools completed surveys pre-intervention and at 3-months post-intervention. At follow-up, parents and adolescents in the intervention group reported a reduction in family conflict. Adolescents reported increased maternal care, less delinquency, and less poly-drug use (the odds of transition to poly drug use were halved). Analysis of PACE participants within the schools revealed a greater likelihood for sole-parents and families with poly drug using youth to participate in the program.

Guided by the Social Development Model of youth development (Catalano & Hawkins, 1996) and their experiences evaluating PACE, Toumbourou and colleagues developed a school-based family intervention called Resilient Families.  The transition to secondary school can be a time of substantial change in developmental pathways (Smart et al., 2003; Vassallo et al., 2002). Previous research suggests that prevention programs timed to coincide with key transition points, such as the transition to secondary school, can produce beneficial effects (National Crime Prevention, 2001; National Institute of Drug Abuse, 2004). In keeping with this, Resilient Families targets students and their families in the first two years of secondary school. Because all Year 7 students and their families are invited to participate, Resilient Families reduces labelling because individuals and families “at risk” are not singled out (Dishion, Kavanah, Schneiger, Nelson & Kaufman, 2002).

In Year 7 the Resilient Families program consists of five key components: (1) A 10-week Student Curriculum delivered to all students, (2) A 2-hour educational quiz night for parents/carers called Parenting Adolescents: What are the questions and what are the answers, (3) An 8-week PACE program for parents/carers, (4) A referral for family counselling which is available upon request, and (5) The building of a community of parents in the school.  Program activities were designed to link together to reinforce consistent messages and strategies.  The National Health and Medical Research Council has funded a trial of the Resilient Families Program in 24 secondary schools in Melbourne and surrounding areas. All five of the components are being implemented in intervention schools during 2004 with parenting activities continuing during 2005 into Year 8. 

Evaluating Resilient Families: Randomised Controlled Trial

Response Rates

Government and Catholic secondary schools in Melbourne and surrounding areas were selected. Schools were chosen to be at least 5 kilometres away from each of the other intervention schools because it was expected that effects of the intervention (e.g. building a closer community of parents) could infiltrate into the community and effect populations attending comparison schools.  Overall, 39 schools were approached and 24 schools agreed to participate (62% school participation rate). There was no significant difference in refusal rates between the intervention or comparison condition.  

In order to evaluate the program, all families of a Year 7 student were approached to complete an annual survey. Participation involved students completing a survey during school time, and/or their parent/carer completing a mail out survey once in 2004, 2005 and 2006.  In the intervention schools, 86% of students returned consent forms and 14% did not return consent forms. In total, 56% of parents consented and 30% refused consent for their adolescent to participate in a student survey. In the comparison schools, 85% of families returned consent forms. A total of 53% of parents consented and 32% refused consent. Given these low response rates, further Analyses are planned to determine the extent of possible bias in the responding sample by comparing it to the state-wide representative sample of Victorian youth participating in the International Youth Development Study (www.rch.org.au/iyds; Hemphill, Toumbourou, Catalano, & Maters, 2004).

Sociodemographic characteristics of respondents

The mean age for student participants (N=2337) in Year 7 was 12.3 years.  Ten percent of students were born outside of Australia and almost 2% identified themselves as Aboriginal or Torres Strait Islander decent. Students reported that 40% of their mothers and 44% of their father were born outside.  The majority of these parents were born in Vietnam, Italy or England.  Sixty-eight percent of students reported speaking only English at home, 29% spoke English and another language, and the remainder spoke only a language other than English.

Seventy-five percent of students reported that their parents were either married or living together.  Twenty-two percent reported that their parents were separated or divorced, and 2% reported that one or both of their parents had died. Students reported that they had an average of two siblings.  Thirty-eight percent of the students’ mothers or stepmothers (who they live with) were in full-time paid employment and 37% were in part-time paid employment.  Seventy-nine percent of fathers or stepfathers (who they live with) were in full-time paid employment and 13% were in part-time paid employment. 

Resilient Families: Components and Implementation

The Resilient Families Student Curriculum consists of ten, 45-minute sessions that are administered by class teachers to students in their first year of secondary school.  A two-hour training session is recommended for teachers prior to implementing the curriculum.  The curriculum focuses on communication, emotional awareness, peer resistance skills, conflict resolution, and problem solving.  Each session incorporates a homework activity that is to be completed by the student and a parent/carer.  This provides an opportunity for teachers to identify students without a significant adult in their life and establish a mentor program to support these students throughout the high school years.  Students are asked to discuss issues about families using scenarios rather than disclose personal information about their own family.  

Parent education and support activities make up the second and third components of Resilient Families.  Recruiting and engaging parents/carers is a major challenge.  In the trial of the PACE described earlier, only 10% of parents participated in the program.  Similar difficulties are well documented by other research groups in Australia (Ralph et al., 2003) and overseas (Spoth et al., 1998; Spoth et al., 1999).  In order to increase schools ownership of the activities, Resilient Families staff met with school staff (representatives from teaching, leadership and welfare teams) and a nominated parent (Year 7 parent, parent involved in parenting group or on school council) to plan the parenting activities at each school.  At this meeting the format for the quiz night (whether students and parents should be invited for a meal prior to the quiz or whether the event should be parents only), the provision of childcare, transport to and from the events, and the need for translation services, were discussed.
 
The quiz night for parents/carers uses an interactive question and multiple choice answer format.  It opens with a series of questions about youth culture with parents asked to identify popular singers and actors.  In the parent-adolescent communication section, parents are encouraged to think about the communication style they use with their adolescent/s.  In the conflict resolution section, parents are informed of the WINK (Wait – “I message” – Negotiate an outcome that is safe and fair- and Keep cool) strategy that their adolescents were taught in the student curriculum.  Alcohol and substance use, adolescent development, sibling rivalry, and depression are some of the other topics covered.  In 2004, all parents/carers with an adolescent in Year 7 were invited to attend this evening. Approximately 10% of parents attended and another quiz night will be held with parents/carers of Year 8 students in 2005 in order to increase the number of parents participating in the program.  

The third component of the Resilient Families program, PACE, consists of 8 x 2 hour group sessions for parents/carers.  Sessions are conducted once a week during school terms and the topics include listening, assertion, adolescent development, conflict resolution, resilience, drugs and alcohol, and family.  Recruitment for the PACE program comes at the end of the quiz night when PACE is described and parents/carers are invited to join a group conducted at their school. In addition, schools are asked to advertise PACE in their school newsletter and with a flyer sent home with students. Approximately 5% of parents/carers with a Year 7 attended a PACE group in 2004. Each intervention school will conduct another PACE group in 2005. Resilient Families parenting activities are offered to all parents regardless of risk status. If a parent attending the quiz night or PACE group requests assistance for a problem, a referral is offered.

The final component of the program, building a community of parents, aims to facilitate relationships amongst parents with Year 7 students within each school. Many schools have established processes to build connections between families new to secondary school (e.g., new parents evenings).  Building on these initiatives, Resilient Families staff negotiated with participating schools to investigate opportunities for parents with Year 7s to exchange contact details with other parents. The rationale for this was that parents could then inform other parents of parenting activities and social events at the school through a telephone or email tree system.  Consistent with National Privacy Legislation, schools approached parents with an invitation to provide contact information to other parents with a student in Year 7, and/or to nominate themselves as a parent representative who would directly contact other parents to invite them to parenting events. 

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