A Multilevel Approach to Family-Centered Prevention in Schools: Process and Outcome

(Propedéutica en el Campo del Desarrollo Humano y Educativo)

Thomas J. Dishion and Kathryn Kavanagh (University of Oregon)

An ecological perspective on adolescent problem behavior uses a wide-angle lens to study development and to
design effective interventions (Bronfenbrenner, 1989; Dishion, French, & Patterson, 1995). With respect to
development, families have both a direct and indirect effect on the etiology of adolescent problem behavior. The
direct effect is clear, disrupted, and chaotic, and coercive parenting covaries with levels of antisocial behavior in
5 preschool (Gardner, 1989; Shaw, Owens, Vondra, Keenan, & Winslow, 1996) and childhood (Loeber &
Dishion, 1983; McCord, McCord, & Howard, 1960; Patterson, 1982; Patterson, Reid, & Dishion, 1992).
Antisocial behavior in childhood appears to provide a basis for accumulative risk associated with peer rejection,
poor academic skills, and eventual involvement in a deviant peer group (Dishion, Patterson, Stoolmiller, &
Skinner, 1991; Patterson et al., 1992). Because of this process of accumulative risk, we think that youth starting
10 early have a poorer prognosis than those who start late, with respect to persistence and seriousness of future
problem behaviors, such as delinquency and substance use (Dishion, Capaldi, & Yoerger, 1999; Moffitt, 1993;
Patterson, 1993). Parenting seems to have an indirect effect by virtue of the role of family management, in
general, and parent monitoring, in particular, in modulating at-risk youth involvement and exposure to deviant
peers (Dishion & McMahon, 1998; Patterson, Reid, & Dishion, 1992).
15 The literature suggests that multiple risk factors disrupt parental functioning, including poverty (Conger et al.,
1992; Elder, Van Nguyen, & Caspi, 1985), marital discord (Hetherington & Clingempeel, 1992), and parental
substance use (Chassin, Presson, & Sherman, 1990; Dishion, Reid, & Patterson, 1988). Additionally, oppression
and the lack of resources and stigmatization (Duran & Duran, 1995; McLloyd, 1990) undermine the cross-
generation transmission of socialization practices from parent to child, and eventually, from the child to the next
20 generation.
Parenting practices can serve a protective function within a disrupted community (Sampson & Laub, 1994).
Parent supervision, in particular, may protect youth from escalating patterns of problem behavior in high-risk
neighborhoods (Dishion & Mc- Mahon, 1998). Supporting the caregivers’ use of behavior management skills
and building strong parent-child relationships have been shown to reduce early oppositional problems in the
25 preschool years (Webster-Stratton, 1984), antisocial behavior in middle childhood (Patterson, 1974; Patterson,
Dishion, & Chamberlain, 1993), and problem behavior and substance use in early adolescence (Dishion,
Andrews, Kavanagh, & Soberman, 1996; Henggeler, Melton, & Smith, 1992).
An ecological framework is useful for designing interventions that address mental health problems as a public
health issue (Biglan, 1995). A critical problem in child clinical psychology is that interventions designed in
30 university settings are simply not: (a) accessible to the vast majority of families; or (b) replicable with respect to
being effective in community settings. Recently Hoagwood and Koretz (1996) suggested that intervention and
prevention research would benefit policy if interventions were designed to fit in or alter existing service-delivery
systems. This perspective is consistent with the public health perspective: Effective interventions are needed that
reach a large number of individuals, even if the associated effect size is relatively small (Biglan, 1995).
35 Early adolescence is an optimal developmental vantage point for targeting parenting practices to reduce
adolescent problem behavior. First, problem behavior begins to escalate around age 13, as autonomy and
exposure to unsupervised peer groups increases (Dishion et al., 1995; Patterson, 1993). Second, puberty appears
to present a critical period for adolescent parent-child relationships, in that many parents disengage at this age,
leading to premature autonomy (Dishion et al., 1999). Third, there appears to be a gross mismatch that has
40 inadvertently emerged over the century between the needs of adolescents and the form and functioning of major
socialization settings, such as schools and families (Eccles, Lord, & Roeser, 1995).
In the United States, the vast majority of children up to the age of 13–14 attend school. Moreover, schools serve
as convenient meeting places for deviant peer groups (Dishion, Duncan, Eddy, Fagot, & Fetrow, 1994; Kellam,
1990; Rutter, 1985). Attending to the school environment, as well as family dynamics, may be necessary to
45 affect comprehensive reductions in children’s problem behavior (Patterson, 1974). Preventive intervention
programs, therefore, need to “consider schools as potential sites for service delivery, as well as potential objects
of intervention activity” (Trickett & Birman, 1989, p. 361).
 A school-based intervention for parents can be as simple as enhancing communication and cooperation between
parents and school staff. Interventions that clarify expectations, incentives, discipline policies and the like can
50 impact parents’ monitoring, limit-setting, and support of youth academic achievement (Gottfredson, Gottfredson,
& Hybl, 1993; Reid, 1993). Moreover, increasing specific information to parents regarding their child’s
attendance, homework, and class behavior results in improved monitoring and support for at-risk children’s
academic and social success (Blechman, Taylor, & Schrader, 1981; Heller & Fantuzzo, 1993).
Researchers studying the impact of interventions on families generally concur that it is critical to be both
55 comprehensive and responsive to the developmental history of the child and family (Reid, Snyder, & Patterson,
in press). For example, it seems reasonable to expect that interventions for families of adolescents with a
developmental history of antisocial behavior will be more intensive and structured than interventions for a late
starter. This suggests that a comprehensive intervention strategy would have an explicit mechanism for: (a)
titrating the level of support to parents with the level of need; and (b) integrating diverse intervention levels to
60 maximize and support protective parenting practices in a community setting (Dishion & Kavanagh, in press).

Adolescent Transitions Program

The Adolescent Transitions Program (ATP) is a multilevel family-centered intervention delivered in the
middle-school setting (Dishion & Kavanagh, in press). Best described as a “tiered” strategy, each level of
intervention builds on the previous level. Using traditional nomenclature, the three levels represent universal,
selected, and indicated family interventions. Universal reaches all parents within a school setting, selected
65 addresses the needs of at-risk families, and the indicated level is best described as family treatment.

Universal: The Family Resource Room

The first step in establishing family-based services in a school setting is creating a Family Resource Room
(FRR). The goals of the FRR are to: (a) establish an infrastructure for collaboration between school staff and
parents; (b) support norms for protective parenting practices; and (c) disseminate information encouraging
family management practices that promote school success to prevent the development of early-onset alcohol and
70 other drug use. The FRR also provides the vehicle through which a program of multilevel interventions can be
offered during the school year. Several strategies can be used to interact with parents at the universal level.
Others have also found home visiting to be a key strategy for increasing participation in family-centered
interventions (e.g., Szapocznik & Kurtines, 1989). We have found that brief, proactive summer visits increase
parental engagement with intervention services. Summer visits typically last 1 hour and focus on a “plan for
75 success” for each middle-school student in the coming year (Dishion & Kavanagh, in press). We found that a
majority of families (60%) readily agreed to a brief home visit. Of the families within a group in which home
visits were offered, 62% participated in familybased services, compared to 41% of families in a group to which
no home visits were offered during the summer.
Another promising tool, also involving parent self-assessment, uses videotape examples and a simple pencil-
80 and-paper rating form. “Parenting in the Teenage Years” (Dishion & Kavanagh, 1995) was developed to help
parents identify observable risk factors in the context of parent-child interaction. The videotape (designed to be
viewed by parents during the first week of school) presents examples of teen risk behavior. It also focuses on the
use of effective family management skills (positive reinforcement, monitoring, limit-setting, and relationship
skills) to facilitate parents’ evaluation of their own level of risk, as well as their child’s level of risk.