Intervention Summary

Celebrating Families!

Celebrating Families! (CF!) is a parenting skills training program designed for families in which one or both parents are in early stages of recovery from substance addiction and in which there is a high risk for domestic violence and/or child abuse. The CF! program uses a cognitive behavioral theory (CBT) model to achieve three primary goals:

Break the cycle of substance abuse and dependency within families,
Decrease substance use and reduce substance use relapse, and
Facilitate successful family reunification.

The CBT model defines substance use as a learned social behavior that is acquired through modeling or imitation of the observed behavior in others with whom one has some type of social relationship. In this model, addiction is considered a disease. The CF! program provides weekly instruction focusing on a healthy lifestyle free from drugs and alcohol, addressing risk and protective factors as well as developmental assets of family members. Following a family dinner, parents and children participate in separate 90-minute instructional group sessions devoted to a particular theme. Parents then reunite with their children for a 30-minute activity to practice what has been presented and learned and to receive feedback on their performance. Themes include (1) healthy living, (2) nutrition, (3) communication, (4) feelings and defenses, (5) anger management, (6) facts about alcohol, tobacco, and other drugs, (7) chemical dependency as a disease, (8) the effects of chemical dependency on the whole family, (9) goal setting, (10) making healthy choices, (11) healthy boundaries, (12) healthy friendships and relationships, and (13) individual uniqueness. Originally designed for the Family Treatment Drug Court (FTDC) system, CF! is currently used by drug courts, dependency courts, faith-based organizations, residential and outpatient treatment services, and social service agencies serving parents and children ages 4-17. The FTDC is the most recent and the fastest growing type of drug court in the United States. It provides a setting for all the participants in the child protection system to come together to determine the individual treatment needs of substance-abusing parents whose children are wards of the court. The goal of the FTDC is to rehabilitate the parents as competent caretakers so that their children can be safely returned to their parents' care.

Descriptive Information

Areas of Interest	Mental health promotion Mental health treatment Substance use disorder prevention
Outcomes	1: Parenting skills 2: Parent tobacco and substance use 3: Parent depressive symptoms 4: Family environment 5: Child behaviors 6: Family reunification
Outcome Categories	Alcohol Drugs Family/relationships Mental health Social functioning Tobacco
Ages	6-12 (Childhood) 13-17 (Adolescent) 18-25 (Young adult) 26-55 (Adult)
Genders	Male Female
Races/Ethnicities	American Indian or Alaska Native Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	Residential Outpatient Other community settings
Geographic Locations	Urban Suburban
Implementation History	CF! was implemented in Santa Clara County, California, at the request of Judge P. Leonard Edwards II, Supervising Judge of the county's juvenile dependency court, as one of a series of social services funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). CF! has been implemented in 20 States (Arizona, California, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Kentucky, Maryland, Minnesota, Montana, Nebraska, New Mexico, New York, North Carolina, Ohio, Oklahoma, Texas, and Virginia) and in Ontario, Canada. At least 7,000 parents and their children have participated in the program.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: No Evaluated in comparative effectiveness research studies: Yes
Adaptations	A Spanish-language version of the program is being piloted in Santa Clara County.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Selective Indicated

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Lutra Group. Year One (FY 05-06) evaluation report for the Celebrating Families! grant. Unpublished report. Salt Lake City, UT: Author.

Study 2

Quittan, G. A.. An evaluation of the impact of the Celebrating Families Program and Family Drug Treatment Court on parents receiving Family Reunification Services. Unpublished master's thesis, San Jose State University, San Jose, California.

Outcomes

Outcome 1: Parenting skills
Description of Measures	Parenting skills were measured by the Kumpfer Parenting Skills scale, a 40-item instrument with questions such as "I praise my child when he/she has behaved well," "I use clear directions with my child," and "We talk as a family about issues/problems or we hold family meetings." Responses are given on 5-point rating scale ranging from 1 (never) to 5 (almost always).
Key Findings	Staff in two community-based organizations and one women's residential treatment facility were trained to administer CF! to parents in early recovery from substance dependence and their children. The CF! group met once weekly for 16 weeks in addition to receiving the standard substance abuse treatment(s) offered by the facility. Following participation in CF!, parents reported more positive parenting (p < .0001), greater involvement with their children (p < .0001), better parenting skills (p < .009), more effective parenting (p < .0001), and increased supervision of their children (p < .0001). These parenting improvements were associated with a range of large effect sizes (Cohen's d = 0.95 to 2.81). Self-reports from parents in the CF! evaluation described above were compared with self-reports from an independent sample of parents in the Strengthening Families Program (SFP), a nationally administered program measuring the same outcomes. Parents who participated in CF! reported more positive parenting (p < .001) and greater involvement with their children (p < .001) compared with parents who participated in SFP. These group differences were associated with small effect sizes (Cohen's d = 0.21 and 0.24, respectively).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.3 (0.0-4.0 scale)

Outcome 2: Parent tobacco and substance use
Description of Measures	Self-reported use of tobacco and other substances was measured using the 6-item Center for Substance Abuse Prevention (CSAP) Government Performance and Results Act (GPRA) scale. Parents were asked "In the past 30 days, on how many days have you used the following?" for each of the following substances: alcohol (both in general and used to the point of intoxication), tobacco, marijuana/hashish/pot, other illegal drugs, and prescription drugs not prescribed by a doctor. For illegal and prescription drugs, parents were asked to specify the type of drug used.
Key Findings	Staff in two community-based organizations and one women's residential treatment facility were trained to administer CF! to parents in early recovery from substance dependence and their children. The CF! group met once weekly for 16 weeks in addition to receiving the standard substance abuse treatment(s) offered by the facility. Following participation in CF!, parents reported less alcohol and drug use (p < .0001), a finding that was associated with a large effect size (Cohen's d = 2.00).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.4 (0.0-4.0 scale)

Outcome 3: Parent depressive symptoms
Description of Measures	Parent depression was measured using the Beck Depression Inventory (BDI). The BDI is a 21-item self-report instrument for measuring depressive symptoms in the past week. Total scores range from 0 to 63 and indicate whether depression is minimal (0-13), mild (14-19), moderate (20-28), or severe (29-63).
Key Findings	Staff in two community-based organizations and one women's residential treatment facility were trained to administer CF! to parents in early recovery from substance dependence and their children. The CF! group met once weekly for 16 weeks in addition to receiving the standard substance abuse treatment(s) offered by the facility. Following participation in CF!, parents reported less depression (p < .0001), a finding that was associated with a large effect size (Cohen's d = 1.50).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.6 (0.0-4.0 scale)

Outcome 4: Family environment
Description of Measures	Family environment was measured by the Family Strengths Assessment, a parent-completed 12-item questionnaire that gauges the strength of 12 family factors: supportiveness, communication, parenting, discipline style, family organization, family unity, positive mental health, physical health, emotional strength, knowledge and education, social network, and spiritual strength. Responses are given on a scale from 1 (none) to 5 (very strong). In addition, family conflict, organization, communication, and cohesion were measured by four modified subscales (3 to 5 items each) of the Moos Family Environment Scale (FES). The FES consists of 10 subscales that measure the social and environmental characteristics of family systems: family cohesion, expressiveness, conflict, organization, control, independence, achievement orientation, intellectual-cultural orientation, active-recreational orientation, and moral-religious emphasis.
Key Findings	Staff in two community-based organizations and one women's residential treatment facility were trained to administer CF! to parents in early recovery from substance dependence and their children. The CF! group met once weekly for 16 weeks in addition to receiving the standard substance abuse treatment(s) offered by the facility. Following participation in CF!, parents reported better family organization (p < .0001), cohesion (p < .0001), and communication (p < .0001) with greater family strengths/resilience overall (p < .00001). These improvements in family environment were associated with a range of large effect sizes (Cohen's d = 2.27 to 3.12). Self-reports from parents in the CF! evaluation described above were compared with self-reports from an independent sample of parents in the Strengthening Families Program (SFP), a nationally administered program measuring the same outcomes. Parents who participated in CF! reported greater family cohesion (p < .001), better communication (p < .001), less family conflict (p < .001), and greater overall family strengths/resilience (p < .001) compared with parents who participated in SFP. These group differences were associated with a range of small effect sizes (Cohen's d = 0.20 to 0.33).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.1 (0.0-4.0 scale)

Outcome 5: Child behaviors
Description of Measures	Child aggression, conduct disorders, and depression were measured by parent report on 62 items from the revised Kellam Parent Observation of Children's Activities (POCA-R), such as "runs away from home overnight," "starts physical fights," "has lots of friends," "loses temper," "fidgets or moves a lot," "gets distracted easily," and "lies to parents or teachers." Responses were given on a 5-point scale ranging from 1 (never) to 5 (always).
Key Findings	Staff in two community-based organizations and one women's residential treatment facility were trained to administer CF! to parents in early recovery from substance dependence and their children. The CF! group met once weekly for 16 weeks in addition to receiving the standard substance abuse treatment(s) offered by the facility. Following participation in CF!, parents reported more overt aggression or acting out behavior (p < .04) and hyperactivity (p < .004) in their children, despite a significant improvement in concentration (p < .0001). The effect sizes for acting out behavior, hyperactivity, and concentration ranged from medium to large (Cohen's d = 0.74 to 2.49). The increase in acting out behavior was limited to the children of parents in the women's residential facility, while the increase in hyperactivity was limited to the children of parents who were either recently released from prison or to children of families with an incarcerated family member. Parents in the women's residential facility reported significantly less depressive symptoms in their children (p < .001) following participation in CF!, a finding that was associated with a large effect size (Cohen's d = 3.22). Self-reports from parents in the CF! evaluation described above were compared with self-reports from an independent sample of parents in the Strengthening Families Program (SFP), a nationally administered program measuring the same outcomes. Parents who participated in CF! reported more acting out behavior (p < .001) and hyperactivity (p < .001) in their children compared with parents participating in SFP. These group differences were associated with small and medium effect sizes (Cohen's d = 0.53 and 0.23, respectively). Parents who participated in CF! reported less depression in their children compared with parents participating in SFP (p < .001); this group difference was associated with a small effect size (Cohen's d = 0.31).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.1 (0.0-4.0 scale)

Outcome 6: Family reunification
Description of Measures	Family reunification was measured as the time between the date of a court-issued order for parent-child reunification and actual reunification of a parent with at least 50 percent of his or her children previously in child welfare services. This amount of time was also calculated as a rate over a 24-month follow-up period (corresponding with four successive 6-month case review hearings for juvenile dependency as mandated by the Adoption and Safe Families Act).
Key Findings	Data on parents with a history of participation in one of three treatment programs--CF!, Family Treatment Drug Court (FTDC), or the Traditional Child Welfare Case Plan--were obtained from the Santa Clara County, California, child welfare system database. Each record included 18 to 24 months of follow-up data and was selected based on a one-to-one match across treatment programs by gender (all female), age, ethnicity, number of children in the child welfare system, type of abuse, removal date, and reunification date. Family reunification occurred sooner for parents participating in CF! and FTDC compared with parents participating in the Traditional Child Welfare Case Plan program (in months 7-12 and 13-18, respectively, vs. in months 19-24; p = .01). CF! and FTDC parents also had higher family reunification rates compared with parents in the Traditional Child Welfare Case Plan program (73% and 72%, respectively, vs. 37%; p = .01).
Studies Measuring Outcome	Study 2
Study Designs	Preexperimental
Quality of Research Rating	2.1 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	6-12 (Childhood) 13-17 (Adolescent) 26-55 (Adult)	85.7% Female 14.3% Male	42.9% White 37.1% Hispanic or Latino 20% Race/ethnicity unspecified
Study 2	18-25 (Young adult) 26-55 (Adult)	100% Female	44.9% Hispanic or Latino 39.7% White 7.7% Black or African American 6.4% Race/ethnicity unspecified 1.3% American Indian or Alaska Native

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Parenting skills	3.0	2.5	3.0	1.0	2.0	2.5	2.3
2: Parent tobacco and substance use	3.5	2.5	3.0	1.0	2.0	2.5	2.4
3: Parent depressive symptoms	3.5	3.5	3.0	1.0	2.0	2.5	2.6
4: Family environment	2.0	2.0	3.0	1.0	2.0	2.5	2.1
5: Child behaviors	2.0	2.0	3.0	1.0	2.0	2.5	2.1
6: Family reunification	1.0	1.5	1.5	4.0	1.5	3.0	2.1

Study Strengths

The Beck Depression Inventory is a gold standard instrument. Adequate to good reliability is present for some measures. Considerable attention was paid to intervention fidelity, and fidelity checklists were used by two observers during randomly selected sessions.

Study Weaknesses

Too little information is available to assess most of the measures used; the measures represent selected items from larger scales or were developed by the principal evaluator without any independent testing of validity and reliability. Assessment instruments were changed to a retrospective pre/post assessment due to a lack of confidence in the truthful response rate of the pretest data. While fidelity checks were in place, the authors acknowledged that not all content was delivered; it is unclear what content was not delivered as planned and why. Both studies had weak designs with multiple threats to internal validity. The sample size in one study was small, and the authors were aware that cases had missing values, yet no analytic strategies were used to address missing data. The retrospective chart review, which was conducted for one gender only, also reflected a small sample size with a limited matching scheme for group assignment.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Celebrating Families! audio CD

Celebrating Families! curriculum handouts

Celebrating Families! evaluation tools:

Adult Cognitive Questionnaire
Adult Satisfaction Questionnaire
Child Cognitive & School Questionnaires
Children's Satisfaction Questionnaire
Evaluation Instruments and Procedures
General Fidelity Site Visit Form--Session 1
General Fidelity Site Visit Form--Session 2
General Fidelity Site Visit Form--Session 3
Group Leader Parenting Skills Observation Record
Group Leader Youth (3-17) Skills Observation Record
Instructions for the General Fidelity Site Forms
Parent Retro/Post Questionnaire
Site Coordinator Information Survey
Youth Cognitive & School Questionnaires
Youth Retro/Post Questionnaire
Youth Satisfaction Questionnaire

Celebrating Families! pamphlet

Celebrating Families! training materials:

Celebrating Families Pre-Training [PowerPoint presentation]
Celebrating Families Training [PowerPoint presentation]
Effects of Chemical Dependency on Early Childhood Development [handout]
Fetal Alcohol Spectrum Disorders [PowerPoint presentation]
Practice Teaching Instructions [handout]
Training Evaluation Form
Two-Day Training Agenda
What's It Like To Have a Learning Difference? [PowerPoint presentation]

Center for Substance Abuse Prevention. Recovering hope: Mothers speak out about fetal alcohol spectrum disorders [DHHS Publication No. SMA 3979]. Rockville, MD: Substance Abuse and Mental Health Services Administration.

National Association for Children of Alcoholics. Celebrating Families! group leader/facilitator guide: Volume 1. Rockville, MD: Author.

National Association for Children of Alcoholics. Celebrating Families! group leader/facilitator guide: Volume 2. Rockville, MD: Author.

National Association for Children of Alcoholics. Celebrating Families! group leader/facilitator guide: Volume 3. Rockville, MD: Author.

National Association for Children of Alcoholics. Celebrating Families! group leader/facilitator guide: Volume 4. Rockville, MD: Author.

National Association for Children of Alcoholics. Celebrating Families! early childhood component group leader/facilitator guide: Volume 5. Rockville, MD: Author.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
4.0	3.8	3.0	3.6

Dissemination Strengths

Facilitator guides are thorough, well organized, and engaging. Helpful notes, prompts, and illustrative examples are included throughout the implementation materials. Developers offer optional training and technical assistance to implementers. A range of evaluation tools, including process and outcome measures, is provided to support quality assurance.

Dissemination Weaknesses

Although site leaders need some formal implementation training from the program developers to use the fidelity tools correctly, training is not required at any level. Very little guidance is provided to implementers on how data derived from quality assurance instruments are used to improve program delivery.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Program materials set	$215 each	Yes
Recommended site implementation package (includes 10 sets of the Facilitator Guides)	$1,350	No
Additional Facilitator Guide sets	$135 each	No
Additional CDs	$8 each	No
Additional DVDs	Free	No
Celebrating Families! brochures	Free	No
2-day, on-site training workshop with two trainers	$4,000 per site plus travel expenses	No
Phone or online technical support	$100 per hour	No
Fidelity forms	Free	No

Additional Information

The projected program operating budget for a 16-session program with 2 weeks allotted for planning and organizing is about $694 per participant, assuming 40 participants per program cycle. The cost can be significantly reduced to as little as $360 per participant with the use of staff flex time, trained interns, and volunteers to administer the program and in-kind donations of food, space, and transportation. The developer can provide sample operating budgets and information on potential funding sources upon request.