BC Council for Families

by Rosanne Farnden Lyster

Examining the benefits of family prevention programs.

On the surface at least, prevention makes sense to most people. Our folklore is full of sayings that reflect this logic: "A stitch in time saves nine"; "An ounce of prevention is worth a pound of cure"; "Give me a fish, I eat for a day, teach me to fish and I eat for a lifetime"; "Don't put the cart before the horse"; and even the Scout/Guide motto, "Be prepared."

Prevention strategies with families follow these adages. Family prevention programs build individual and family competence and empower people. It sounds a lot like a motherhood issue - something we can all believe in. However, when you look at resource allocations this belief doesn't seem to be reflected. At present, services are often more "oriented to `mopping up the flood' while paying little attention to `turn(ing) off the taps'" (Blair, 1992).

One criticism often made is that prevention takes money away from treatment (Blair, 1992). This statement bears some truth, depending on where one's priorities are placed. However, if we only focus on treatment, we will quickly run out of resources for the long term, because the flood waters will only continue to rise.

Of course, prevention isn't free of costs. Identifying risks, developing sound strategies and conducting sound effectiveness studies are all time consuming and require a significant allocation of finances. However, their cost is trivial compared to the social costs of drug abuse, school dropout, depression or delinquency.

Indeed, treatment strategies are costly and have definite limitations -one of which is effectiveness. Markman (1992) suggests that in many cases, "therapy is undertaken too late to repair the damage of years of destructive conflict" (p.70). He estimates that the negative effects of divorce, martial distress and destructive conflict on spouses and children constitute major social problems, and cost an estimated billions of dollars in North America each year.

But perhaps even more important than the logic of cost-effectiveness is the role that prevention plays in recognizing human potential. Prevention "helps to work against human deprivation" (McFadden, 1981 p.55). In essence, prevention programs are all about improving quality of life. In other words, why wait until the suffering begins?

Compassionate people will say, "But we can't just let the people who are hurting keep on hurting; we have to do something." This is true. We will always need treatment. Just the same, we can't keep opening more and more treatment programs to deal with problems. To be truly compassionate, we need to prevent as many of the problems as we can from even happening in the first place.

Does Prevention Work?

A final criticism of prevention is the question of effectiveness. Does it work? Yes, prevention does work. We can strengthen relationships, facilitate healthy parenting, and increase family and individual well-being. Research indicates time and time again that prevention efforts which are well designed and effectively carried out have significant positive results. To illustrate this, the following is a very brief review of the research into two aspects of family life: parent-child and couple relationships.

Parent-Child Relationships

Brock, Oertwein and Coufal (1994) suggest that three themes emerge in the study of parent-child interaction: nurturance, structuring and patterns of interaction. Most parenting education programs have been developed to enhance one or more of these themes. One assumption behind these activities is the belief that the childrearing milieu is one of the key determinants of lifetime health (Cowen, 1979) and that this milieu can, in fact, be enhanced. A review of parenting education outcomes indicates that the following effects have been reported: increase in child's IQ; increased infant responsiveness to parental behaviour; improvement in child's school performance; increased parental competency in reading infant cues; increased use of positive and facilitative language interactions with child; open and flexible childrearing attitudes; increased parental awareness of self as educator of child; and increase in parents' feelings of control over their own lives (Powell, 1986). Furthermore, Powell (1986) found that parents who had participated in parenting education were more likely to discuss childrearing matters with friends, relatives and acquaintances.

One of the most studied parenting programs is Systematic Training for Effective Parenting (STEP). This method of parenting education encourages parents to understand the goals of their child's misbehaviour (attention-getting, power, revenge and expression of inadequacy) and then to respond in a way that will facilitate more positive behaviours and interactions. The most significant results have been "positive changes in parent-child interactions (7 of 8 studies), parental attitude (10 of 13 studies), child behaviours (9 of 10 studies) and parent perception of child behaviours (11 of 13 studies)" (Brock et al., 1994). Barber (1992) developed a study to examine the impact of parent education on parents' feelings of competence and isolation. He found that parent education programs can have an immediate impact on the participants' sense of competence as parents. At the three-month follow-up, a sense of social isolation had declined, competence was sustained, and a significant decline in global child difficulty was noted.

In an application of Relationship Enhancement to parent education, Guerney (1976) found that parents "manifested significant changes in all the skills they were expected to learn: reflection of feelings, allowing self-direction, and involvement with the child. The children showed highly significant improvement on all measures of adjustment studied" (cited in Guerney, 1988, p.115). A further application resulted in the following outcome. In a study of father-son pairs, the treatment group showed significantly more improvement in empathic acceptance, and in the expression of views deemed to show greater self-awareness, sensitivity to feelings, and to be less threatening to others, overall improvement in general communication and improvement in self-concepts of fathers and sons (Ginsberg, 1977 cited in Guerney, 1988). A final application with mother-daughter pairs found that there was improvement in empathic and expressive communication skills, general patterns of communication, and the quality of their general relationship." At the six-month follow-up, the gains were not just stable, but continued to increase!

Coopersmith, (1967; cited in Hinkle et al., 1979) found that children with high self-esteem tended to come from a democratic family atmosphere characterized by warmth, acceptance, consistency, firm limits and participation in family decision-making. His study sought to determine if these traits could be developed through parenting education. Through an Adlerian parent education program, he found that parents did indeed develop more democratic attitudes and behaviours. Further, after five weeks in the program, parents noted changes in their children's behaviour and increases in children's levels of self-esteem were noted from the pre-test to the eight-week point of the program. Overall, there was an improvement in family atmosphere and parents reported the necessary confidence to be firm and consistent as well as warm and friendly.

Many fathers find themselves unprepared to assume an active parental role. This lack of preparation has been noted in such areas as knowledge of normal child development, developmentally appropriate parenting skills and sensitivity to their children's needs. Research has indicated that programs for fathers can be effective in increasing fathers' perceptions of parental competence and some forms of paternal involvement (McBride, 1990), in increasing fathers' communication skills with their children (Levant and Doyle, 1989), and in decreasing the amount of stress fathers experience in parental roles (McBride, 1991). The conclusion is that parent education and support programs designed specifically for fathers can have a positive impact on various aspects of family life. Treatment-group fathers showed increased responsibility forms of involvement (such as planning and scheduling required parenting tasks), non-workday interaction, non-workday accessibility, and knowledge about parenting. Fathers indicated that they were more comfortable with the parenting role and that they were moved beyond traditional ways of thinking about their roles to more active models (McBride, 1991).

Couple Relationships

Not only does marital discord, separation and divorce put children at risk, it is not healthy for the adults involved. "Marital distress and destructive marital arguing are major risk factors for many forms of dysfunction and psychopathology....marital distress has been linked to higher rates of depression in adults (especially women) and to conduct disorders in children (Renick et al., 1992, p.141).

The work of Howard Markman and his associates at the University of Denver provides a strong case example for primary prevention. This team has developed a program for couples called "The PREP Model: Helping Couples Fight FOR Their Marriage." The program was developed through years of research into the predictors of marital success and studying ways to help alleviate marital discord and maintain satisfying relationships. 150 couples who took the program have now been tracked over a ten-year period.

The results indicate that the PREP couples in the study have a significantly lower divorce rate (50% lower) than those without the PREP training. Further, the couples aren't just staying together, they report significantly higher levels of marital satisfaction than the control group. This holds true even during the childrearing years, a time when couples traditionally experience lower satisfaction levels. These couples have 2 - 3 times lower levels of violence in their relationship. PREP couples employ more constructive arguing techniques, and less destructive ones, even years later.

A very promising outcome is that parents who have taken PREP training seem to have children with higher levels of self-esteem. This finding is exciting in that it supports a basic premise of the B.C. Council for the Family that healthy marriages and healthy children are connected. A known predictor of resilience in children is a stable parental marriage. This study suggests that we can promote resilience and/or health in children by working to strengthen the marriages of their parents. This is true primary prevention. Bader and his associates (1980), in a Canadian study of a marriage preparation program found that even five years after the program, participant couples were more able than couples in the control group to resolve conflicts and seek professional help earlier, when it is likely to be more effective.

Rappaport (1976) found that participants in a Relationship Enhancement group became more empathic, were more aware of their own feelings, and were less likely to engage in arguments with their partners than those in the control group. They showed greater improvement in marital adjustment, marital harmony, marital communication, trust and intimacy than the control group.

Participants in a pre-marital program showed greater improvement in the general quality of their relationships, in handling problems, in self-perception of warmth, in genuineness, and in satisfaction with their relationship than a control group (Ginsberg&Vogelsong, 1977, cited in Guerney, 1988). Based on an assumption that educational programs for couples can "serve a primary prevention function, enabling participants to deal with future developments and crisis-related conflicts"(1974, p. 386), D'Augelli, Deyss, Guerney, Hershenberg and Sborofsky set out to study the effects of a program for dating couples. They found that even after a training program of a relatively short duration, the couples "improved significantly in the quality of helping relationship skills...in comparison with the control groups, experimental couples demonstrated improved listener-acceptance and feeling awareness and viewed their relationship as improved. On self-report measures, they showed more improvement than did the control group in their ability to handle relationship problems and in their self-perceived empathy, warmth, genuineness, trust and intimacy" (p.388).

Conclusion

What is definitely clear from this brief review of the literature is that prevention programs are effective. It is now past the time to put to rest the requests for proof. We have the proof. Primary prevention works. Family life education and other primary prevention approaches are valid components of the family service continuum. Just as there is a place for other modes of treatment, there is a valid place for prevention. Our next quest is to secure a more equitable distribution of resources to further the goals of the field.

This article first appeared in Family Connections (Fall, 1995), published by the BC Council for Families.