Positive Family Support Program (PFS)

The Positive Family Support Program (PFS), formerly known as the Adolescent Transitions Program (ATP), is a multilevel, family-centered intervention targeting children who are at risk for problem behavior or substance use. Designed to address the family dynamics of adolescent problem behavior, it is delivered in the middle school setting to parents and their children. The parent-focused curriculum concentrates on developing family management skills such as making requests, using rewards, monitoring, making rules, providing reasonable consequences for rule violations, problem-solving, and active listening. Strategies targeting parents are based on evidence about the role of coercive parenting strategies in the development of problem behaviors in youth. The curriculum for teens takes a social learning approach to behavior change and concentrates on setting realistic goals for behavior change, defining reasonable steps toward goal achievement, developing and providing peer support for prosocial and abstinent behavior, setting limits, and learning problem-solving.

Program activities are led by group leaders and include parent group meetings, individual family meetings, and teen group sessions, as well as monthly booster sessions for at least 3 months following completion of the group. Meetings and sessions may include discussion and practice of a targeted skill, group exercises (either oral or written, depending on group needs), role-plays, and setting up home practice activities. Many of the skill-building exercises include activities that parents and children do together. Each curriculum also has six accompanying videotapes that demonstrate the program's targeted skills and behaviors.

The long-term goals of the program are to arrest the development of teen antisocial behaviors and drug experimentation. Intermediate goals are to improve parents' family management and communication skills.

Parents had improved feelings toward their children and were less likely to react negatively to their children's behavior and less likely to take a "lax" approach to their children after participating in the program. They also showed improvements in the skill areas of tracking and reinforcing behavior, setting expectations and defining problems, and remaining calm in stressful situations. Antisocial behaviors in their children decreased significantly, measures of child adjustment showed improvement, and total problem behavior decreased. Furthermore, the PFS intervention resulted in significantly less use of tobacco, alcohol, and marijuana.

Researchers conducted a 2-year randomized clinical trial to assess the effectiveness of the parent and teen interventions, both as individual interventions and together. Analysis of the data from the 2-year study found significant improvements in family interactions. Parents and children in the intervention groups showed reductions in negative engagement in family interactions. This effect was the same for the combined parent-teen intervention as it was for either intervention condition alone. In addition, the results of latent growth curve modeling analyses indicated that children's externalizing behavior was significantly reduced after their parents participated in PFS. The researchers conducted additional analyses on a subset of "high attending" families and found that for parents who received four or more sessions of PFS there was a clear and moderate-sized effect of treatment on parent-reported externalizing behavior.

A 4-year randomized trial of the parent-focused PFS component focused on eight small community samples in Oregon. Researchers in the 4-year study used growth curve modeling to identify intervention effects, compare treatment and control groups, and track changes in these groups over time. This analysis revealed several promising effects of the intervention. For example, parents in both treatment and waitlist groups showed significant improvements in positive problem-solving with their teens attributable to treatment and maintained this at future assessment points. In addition, parents in both groups had improved feelings toward their children and were less likely to react negatively to their children's behavior and less likely to take a "lax" approach to their children after participating in the program. Both groups also showed improvements in the skill areas of tracking and reinforcing behavior, setting expectations and defining problems, and remaining calm in stressful situations. Child behavior also showed improvement as a result of participation in the program. Antisocial behaviors decreased significantly, measures of child adjustment showed improvement, and total problem behavior decreased.

One study found that by the first year of high school, PFS was associated with a significant reduction in substance use initiation among at-risk and typically developing students, controlling for previous substance use in middle school. Students in the PFS treatment group reported significantly less substance use in grade nine than students in the control group.

Another study found intervention status was significantly related to all diagnostic outcomes. This means the PFS intervention group reported significantly less use of tobacco, alcohol, and marijuana compared with the control group. In addition, the intervention group exhibited significantly less antisocial behavior compared with the control group. Intervention status was also significantly related to the number of arrests from grades six to eleven. The PFS intervention group had significantly fewer arrests compared with the control group.