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How Do Family-Focused Prevention Programs Work? A Review of Mediating Mechanisms Associated with Reductions in Youth Antisocial Behaviors

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Abstract

The development and evaluation of family-focused preventive interventions has grown significantly in recent decades, but the degree to which these interventions produce anticipated improvements in the family environment, and the extent to which such changes are associated with reductions in youth antisocial behaviors (ASB), is unclear. This article seeks to answer these questions by reviewing evidence from tests of mediation conducted in evaluations of family-focused interventions. Interventions are drawn from family-focused interventions rated as Model Plus, Model, or Promising on the Blueprints for Healthy Youth Development Web site (http://www.colorado.edu/cspv/blueprints/) based on evidence of their effectiveness in reducing child externalizing behaviors, substance use, and/or delinquency. Of the 19 such interventions listed on Blueprints, seven programs (37 %) were evaluated using mediation analyses which met study criteria. Two-thirds (67 %) of these analyses indicated significant improvements in the targeted family processes for intervention versus control group participants. Over half (62 %) of all tests of mediation were statistically significant and indicated that improvements in the family environment were associated with reductions in ASB. The results support prior theoretical and empirical literature identifying the family as an important context for preventing ASB and promoting healthy youth development. The findings also provide information that can be used to refine current family-focused interventions in order to increase their efficiency and potency, and to develop new interventions in order to expand the number and types of families who can benefit from such services.

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Notes

  1. For example, Sanders et al. (2014)) note that 42 additional evaluations of the Triple P program were available for their meta-analysis compared to a meta-analysis published only five years previously (Nowak and Heinrichs 2008).

  2. For a comparison of the review processes and standards used by different behavioral health registries, see Means et al. (2015).

  3. Early childhood education interventions may include services for parents, but since the child is the main focus of the intervention, this type of program was excluded from the review.

  4. It should be noted that Baron and Kenny (1986) do discuss techniques for testing the significance of the indirect effect, primarily the Sobel method. Although the Sobel method has been endorsed (e.g., MacKinnon et al. 2002), it has also been critiqued as having low statistical power because the coefficients produced using this technique are unlikely to be randomly distributed.

  5. We also indicate whether or not evaluations assessed mediation using latent growth curve models. Such models require at least three data points, but if they examine mediation by analyzing the impact of changes in the mediator from baseline to a follow-up period on changes in the outcome from baseline to the same follow-up period, temporal ordering is not ensured. Nonetheless, because they involve multiple measurement periods and a longer-term follow-up, causal interpretations can be made with more confidence using this method compared to studies with only two assessments (Cheong et al. 2003).

  6. See Table 3 (in the Appendix) for a list of all the excluded studies and reasons for exclusion.

  7. Table 4 in the Appendix provides more specific information on the number of statistical tests evaluating changes in parenting practices and demonstration of mediation.

  8. This figure is based on the mediation tests actually performed. Following the Baron and Kenny (1986) approach, some studies did not evaluate mediation if the targeted parenting practice(s) was not affected by the intervention, the parenting practice was not related to the outcome, or the main effect of the intervention on the outcome was not statistically significant. In these cases, we did not assume that mediation was not present but rather do not count the test as having been performed (see Table 4).

  9. It is also possible, however, that some outcomes will only be evidenced in the long term, given the developmental progression of ASB (Farrington and Welsh 2013).

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  1. Department of Sociology and Criminology & Law, University of Florida, 3219 Turlington Hall, P.O. Box 117330, Gainesville, FL, 32611-7330, USA

    Abigail A. Fagan & Kristen M. Benedini

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Appendix

Appendix

See Tables 3 and 4.

Table 3 Evaluation studies which examined mediation but did not meet inclusion criteria
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Table 4 Results of mediation analyses, by type of parenting practice, in evaluations of family-focused prevention programs identified as effective in Reducing Children’s ASB by Blueprints for Health Youth Development
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Fagan, A.A., Benedini, K.M. How Do Family-Focused Prevention Programs Work? A Review of Mediating Mechanisms Associated with Reductions in Youth Antisocial Behaviors. Clin Child Fam Psychol Rev 19, 285–309 (2016). https://doi.org/10.1007/s10567-016-0207-0

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