Cascading Pathways to the Long-Term Effects of the Family Bereavement Program

Theoretically, preventive interventions can have long-term effects by creating a positive cascade of effects across development. In a developmental cascading model, more proximal effects of a preventive intervention lead to later improvements in outcomes, which in turn lead to improvements in later developmental outcomes. The cascading effects of preventive interventions can be tested through multi-linkage mediation models (Taylor, Mackinnon, &Tein, 2008). The current study presents evidence of the cascading effects from a randomized trial of the Family Bereavement Program (FBP) over four waves of assessment: pre-test, post-test, 11-month, and 6-year follow-up. The FBP is a 12-session group administered preventive intervention for parentally-bereaved children and adolescents. The intervention includes a component for parents (which targets positive parenting, parental mental health problems and parental grief) and a component for youth (which targets positive coping, grief and building positive relations with caregivers). Two hundred and forty-four youth, ages 8 – 16, from 156 families were involved in the trial, 135 of whom were randomly assigned to the FBP and 109 to a literature control condition. At the pre-test youth were ages 8 – 16, and they were ages 16 – 25 at the six-year follow-up. Participants were randomly assigned to the FBP vs. literature comparison conditions. Data were obtained on 218 youth at the six-year follow-up, 89% of the original sample, and attrition was not differential across the program and literature control conditions. Prior studies have found significant effects of the FBP on parenting and on mental health and substance use problems up to six years following the program. The current study uses structural equation modeling to test the mediating pathways at post-test to effects 11 months later on internalizing and externalizing problems to effects at six-year follow-up on measures of mental health and substance use problems and disorder, and high risk sexual behavior. The results indicated that FBP strengthened positive parenting at post-test, which in turn were associated with lower internalizing problems and externalizing problems at the 11-month follow-up. Internalizing problems at 11-month follow-up were associated with higher levels of internalizing problems and internalizing disorder but with lower levels of substance use six years later. Externalizing problems at 11-month follow-up were associated with higher levels of externalizing problems and externalizing disorder diagnosis, higher levels of substance use, and more sexual partners. The mediation effects of the internalizing and externalizing multi-linkage pathways were significant using the joint significance test (Taylor et al., 2008).