A Family-Based, Developmental-Ecological Preventive Intervention for High-Risk Adolescents

By Liddle, Howard A.; Hogue, Aaron | Journal of Marital and Family Therapy, July 2000 | Go to article overview

A Family-Based, Developmental-Ecological Preventive Intervention for High-Risk Adolescents


Liddle, Howard A., Hogue, Aaron, Journal of Marital and Family Therapy


Family-based preventive intervention has emerged as a promising modality for preventing antisocial behavior problems in youth. This article introduces an intensive, family-based preventive intervention for high-risk adolescents: Multidimensional Family Prevention. Multidimensional Family Prevention combines the advantages of standard prevention models (curriculum based and protection focused) with those of psychosocial treatment models (assessment based and problem focused). The model's main features are described: theoretical foundations (risk and protection theory, developmental psychopathology, ecological theory), guidelines for constructing a multidomain prevention program (family and peer relationships, school and prosocial activities, drug use and health issues, cultural themes), and strategies for tailoring and implementing five flexible intervention modules (adolescent, parent, interactional, extended family, extrafamilial). Implemented in the family's home, the intervention works to create a resilient family environment that supports the basic adolescent developmental goals of renegotiated attachment bonds within the family and durable connections with prosocial institutions.

INTRODUCTION

Prevention has become a major programmatic and investigative force in the child and adolescent mental health specialty (Coie et al., 1993). Preventive interventions aim to prevent or delay psychosocial problems in youth by strengthening health and coping mechanisms and ameliorating early-onset symptoms before they mature into psychological disorders (Mrazek & Haggerty, 1994). Currently, antisocial behavior problems such as aggression, drug use, delinquency, and violence have received the majority of attention in the prevention field. National estimates indicate that adolescent drug use (Substance Abuse and Mental Health Services Administration ([SAMHSA] 1995) and delinquency and violence rates (Osofsky, 1997) remain alarmingly high. These problems exact a great toll on the families and communities in which troubled youth reside, and the financial burden of interdiction and institutionalization for legal offenses associated with adolescent antisocial behavior is substantial. Also, once these problems develop in childhood and adolescence, they can be extremely resistant to remission and to treatment efforts (Reid, 1993). With such high stakes, the identification and dissemination of effective preventive interventions for antisocial behavior in early adolescence has become a top priority in the prevention field, indeed in our country (Elias, 1997).

Family-based prevention has emerged as a promising intervention modality for addressing the complex web of ecological influences that gives rise to the initiation of severe behavior problems (Hogue & Liddle, 1999). The impact of family-related factors on the development of antisocial behavior is now well documented. Disruptions in family management practices (Patterson, 1986), high rates of conflict and low rates of communication and involvement (Baumrind, 1991), and lack of parental investment in and attachment to their children (Brook, Nomura, & Cohen, 1989) all create vulnerability to various problems in youth. In contrast, positive parenting practices such as supportiveness and behavioral monitoring foster psychological well-being and insulate children against negative environmental influences (Steinberg, 1990). Family-based intervention models have considerable empirical support for treating existing childhood disruptive and antisocial behavior (Center for Substance Abuse Prevention [CSAP], 1996) and adolescent substance abuse (Liddle & Dakof, 1995), and preventive interventions have also demonstrated success in preventing adolescent drug use (Bry, Catalano, Kumpfer, Lochman, & Szapocznik, 1998) and violence (Borduin et al., 1995). For these reasons, interventions aimed at strengthening family coping mechanisms offer considerable promise for creating stable gains in therapy with problem youths (McMahon, Slough, & Conduct Problems Prevention Research Group, 1996). …

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