Better work for the family begins at home?

Maya Angelou wrote, "At our best level of existence, we are parts of a family, and at our highest level of achievement, we work to keep the family alive”.

It was the whole “human family” she was meaning to celebrate, rather than any tidy nuclear ideal, but in the US, where it is estimated that only around 10% of family-based practitioners employ evidence-based family prevention programs, the grandeur of the aspiration has still to be translated into social policy at the vitally important domestic level.

To support the cause, Stephen Small and colleagues at the University of Wisconsin have identified 11 principles of effective prevention program design from an in-depth examination of what is on the market.

Starkly superior to much of the impact evaluation being done elsewhere, the Wisconsin principles fall into four categories: what a family-based prevention program does, how it does it, whom it reaches and how it is monitored and evaluated. The categories cross four aspects: design and content, relevance, implementation and quality assurance.

Principle 1 in the program design and content category insists that evidence-based programs should be theory-driven and have an explicit logic model setting out the program activities and linking them to measurable outcomes.

Principle 2 is about dosage and intensity. What participants get out of a program must have the potential to create durable change and be of an intensity in keeping with the severity of the problem.

Principle 3 states that programs should be comprehensive in their capacity to address multiple risk and protective factors. Comprehensiveness can also be linked to level of engagement. Family-based programs that engage children and parents rather than parents alone are known to be more likely to be succeed.

The fourth principle relates to how participants are engaged. The Wisconsin team say effective programs utilize active learning techniques and permit new skills to be absorbed and practiced.

In the program relevance category they identify three principles: developmental appropriateness, appropriate timing, and socio-cultural relevance.

Effective programs acknowledge developmental differences that characterize children and youth at different ages, and they are introduced when families are most receptive to change. Socio-cultural relevance is about the exigencies of family life and how far programs are in tune with ordinary domestic experience.

Concern about program implementation focuses on delivery – whether by well-qualified and supported staff who know the value of building good relationships.

Colleagues from the Blueprints for Violence Prevention project have found that effectiveness is directly related to staff's experience, confidence, training, and commitment.

Similarly, in his work on Nurse Family Partnerships, David Olds has found compelling evidence for the value of a well qualified and continuously learning staff group.

Two principles emerged from the examination of program assessment and quality assurance: good documentation and commitment to evaluation and refinement.

Principle 11 addresses how well a program is working and being implemented, as well as identifying areas for improvement.

To make the connection between analysis and better practice, Small and Co. have published an Evidence-Informed Program Improvement Manual [1] for practitioners. It contains a freely available assessment tool to benchmark a program against their eleven principles.

See: Small S A, Cooney S M and O'Connor C (2009), “Evidence-informed program improvement: Using principles of effectiveness to enhance the quality and impact of family-based prevention programs,” Family Relations, 58, pp 1-13.