Improving Dissemination, Cost/Benefit and Outcomes Using Computer Technology in Family EBIs

Background. Family evidence-based interventions (FEBIs) are the most effective treatments for preventing behavioral health disorders. The Strengthening Families Program (SFP), a family EBI now in 36 countries, has been found in Cochrane meta-analyses to be the most effective intervention for preventing adolescent substance abuse (Foxcroft, et.al, 2008; 2012) and particularly among girls (UNODC, 2016). A longitudinal RCT of an SFP 10-14 version for African-American families reduced by 50% diagnoses of substance abuse disorders, depression/anxiety, and HIV in genetically at-risk youth (Brody, et.al., 2012). Unfortunately, SFP and FEBIs have lower cost/benefit ratios than youth-only group programs because of higher implementation costs with five to seven facilitators per family group session (Miller & Hendrie, 2008, Aos, 2014). Reducing implementation costs using digital delivery from $1,400/family to $5 would increase SFP’s dissemination in the USA and in low resource countries.

Methods: To reduce costs to $5/family, an 11-session Strengthening Families Program (SFP 7-17) video DVD was created by the Strengthening Families Foundation. It has been evaluated in 6^th and 8^th graders (n=140) using a quasi-experimental design comparing DVD to family group+DVD and SFP norms. Also, it is being implemented and evaluated for use in behavioral health primary care organizations, juvenile justice, and schools. Novel dissemination methods include delivery by teachers in Health Education classes, by in-home case workers in primary care settings, small group family discussion groups, and self-guided use mandated in juvenile justice.

Results. The group+DVD produced larger effect sizes than the regular 14-session SFP family group version for age-matched norms. Compared to the group+DVD version, the DVD-only resulted in 18 of 21 significant outcomes and almost as large Cohen’s d effect sizes for parenting (d = .48 vs. 65) and family outcomes (d = .69 vs. .70), but better youth outcomes (d = .54 vs. .48) possibly because teens learn better from visual images. A Communities that Care statewide survey revealed a 50% reduction in 8th grade binge drinking only in school districts implemented it in health classes. Results of other implementations in behavioral health will be presented.

Conclusions. These promising results suggest that the cost/benefit ratios of family EBIs can be improved using digital delivery (e.g., DVD, web, YouTube, and phone apps) to reduce behavioral health disorders in diverse families.