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The Adolescent Transitions Program (ATP) is a multilevel, family-centered intervention targeting children who are at risk for problem behavior or substance use. Designed to address the family dynamics of adolescent problem behavior, it is delivered in the middle school setting to parents and their children. The parent-focused curriculum concentrates on developing family management skills such as making requests, using rewards, monitoring, making rules, providing reasonable consequences for rule violations, problem-solving, and active listening. Strategies targeting parents are based on evidence about the role of coercive parenting strategies in the development of problem behaviors in youth. The curriculum for teens takes a social learning approach to behavior change and concentrates on setting realistic goals for behavior change, defining reasonable steps toward goal achievement, developing and providing peer support for prosocial and abstinent behavior, setting limits, and learning problem-solving.
The long-term goals of the program are to arrest the development of teen antisocial behaviors and drug experimentation. Intermediate goals are to improve parents’ family management and communication skills. To accomplish these goals, the intervention uses a “tiered” strategy with each level (universal, selective, and indicated) building on the previous level. The universal level is directed to the parents of all students in a school. Program goals at this level include engaging parents, establishing norms for parenting practices, and disseminating information about risks for problem behavior and substance use. At the selective level of intervention, the Family Check-Up, assessment, and support are provided to identify those families at risk for problem behavior and substance use. At the indicated level, direct professional support is provided to parents based on the results of the Family Check-Up through services including behavioral family therapy, parenting groups, or case management services.
Program activities are led by group leaders and include parent group meetings, individual family meetings, and teen group sessions, as well as monthly booster sessions for at least 3 months following completion of the group. Meetings and sessions may include discussion and practice of a targeted skill, group exercises (either oral or written, depending on group needs), role-plays, and setting up home practice activities. Many of the skill-building exercises include activities that parents and children do together. Each curriculum also has six accompanying videotapes that demonstrate the program’s targeted skills and behaviors.
Researchers conducted a 2-year randomized clinical trial to assess the effectiveness of the parent and teen interventions, both as individual interventions and together. Group leaders were mental health professionals. Participating families were self-referred through recruitment advertisements and screened for risk factors (closeness to parents, emotional adjustment, academic engagement, involvement in positive activities, experience seeking, problem behaviors, stressful life events, and child, peer, and family substance use). Those with four or more risk factors were eligible and randomly assigned to one of four groups: parent focus only, teen focus only, both parent and teen focus, and self-directed change (using program videos only). Random assignment was accomplished using cluster sampling to preestablish the order of assignment. After assignment, the sample included four cohorts of about 30 families each. Boys and girls were assigned separately to ensure equal gender distribution. The sample was composed of 158 families, including 83 boys and 75 girls. The children ranged in age from 10 to 14 and were in grades 6, 7, and 8. The sample was 95 percent European-American. A group of 39 families (22 girls, 17 boys) was also recruited as the control group.
Assessments of family interaction, family conflict, behavior problems, and substance use were done at baseline, program termination, and 1 year following termination. Family interaction was assessed using videotapes of parent–child interaction during problem-solving tasks. The interactions were coded and analyzed using the Family Process Code. Internal family conflict and external family stressors were measured using the Family Events Checklist. For behavior problems, the Child Behavior Checklist was used to assess changes in youth behavior through the intervention. Finally, all youths were asked to report on the frequency of their tobacco or other drug use in the past 3 months. In addition, expired-air carbon monoxide levels were assessed to corroborate self-reported smoking behavior.
The most recent evaluation was a 4-year randomized trial of the parent-focused ATP component with eight small community samples in Oregon. In contrast to the prior evaluation, the group leaders in this trial were not professional mental health workers. Subjects were students referred by schools or service agencies based on teacher or social service agency staff assessments, using the Teacher Risk Screening Instrument. The parents of students whose assessments revealed three or more risk factors were contacted and invited to participate in the parenting program. Interested families were randomly assigned to the immediate treatment intervention group or a waitlist control that would receive classes 3 months after the immediate treatment group finished the program. The sample consisted of 303 families, with 151 in the immediate treatment group and 152 assigned to control. The target children were 61 percent male and 39 percent female. The average age of the target children was 12.2 years, and 87.5 percent of the subjects were white. There were no significant differences in demographic characteristics of the immediate treatment and waitlist groups.
Intervention group participants were assessed using measures of parent behavior, parental feelings about the child, parental depression, and children’s behavior at baseline, both after the completion of the final session and 6 months following the final session. The Parent Report of Problematic Interactions was used to assess coercive elements in parent–child interactions. Parents’ reports of their reactions to their child were assessed using the Parenting Scale—Adolescent Version. In addition, the Taped Situations Test was used to measure parents’ ability to handle common parenting situations in positive, effective ways. Parents’ feelings about their children were measured using the Inventory of Family Feelings. The instrument used to assess parental depression was the Beck Depression Inventory. Finally, the extent to which the child exhibited problematic behavior was assessed through the Parental Daily Reports and the Child Behavior Checklist.
Analysis of the data from the 2-year study found significant improvements in family interactions. Parents and children in the intervention groups showed reductions in negative engagement in family interactions. This effect was the same for the combined parent–teen intervention as it was for either intervention condition alone. In addition, the results of latent growth curve modeling analyses indicated that children’s externalizing behavior was significantly reduced after their parents participated in ATP. The researchers conducted additional analyses on a subset of “high attending” families and found that for parents who received four or more sessions of ATP there was a clear and moderate-sized effect of treatment on parent-reported externalizing behavior.
Researchers in the 4-year study used growth curve modeling to identify intervention effects, compare treatment and control groups, and track changes in these groups over time. This analysis revealed several promising effects of the intervention. For example, parents in both treatment and waitlist groups showed significant improvements in positive problem-solving with their teens attributable to treatment and maintained this at future assessment points. In addition, parents in both groups had improved feelings toward their children and were less likely to react negatively to their children’s behavior and less likely to take a “lax” approach to their children after participating in the program. Both groups also showed improvements in the skill areas of tracking and reinforcing behavior, setting expectations and defining problems, and remaining calm in stressful situations. Child behavior also showed improvement as a result of participation in the program. Antisocial behaviors decreased significantly, measures of child adjustment showed improvement, and total problem behavior decreased.
Dishion, Thomas J., and David W. Andrews. 1995. “Preventing Escalation in Problem Behaviors With High-Risk Young Adolescents: Immediate and 1-Year Outcomes.” Journal of Consulting and Clinical Psychology 63(4):538–48.
Dishion, Thomas J., David W. Andrews, Kate Kavanagh, and L.H. Soberman. 1996. “Preventive Interventions for High-Risk Youth: The Adolescent Transitions Program.” In Ray D. Peters and Robert J. McMahon (eds.).Preventing Childhood Disorders, Substance Abuse, and Delinquency. Thousand Oaks, Calif.: Sage, 184–214.
Irvine, A. Blair, Anthony Biglan, Keith Smolkowsk, Carol W. Metzler, and Dennis V. Ary. 1999. “The Effectiveness of a Parenting Skills Program for Parents of Middle School Students in Small Communities.” Journal of Consulting and Clinical Psychology 67(6):811–25.
Kate Kavanaugh
Child and Family Center
195 West 12th Avenue
University of Oregon
Eugene, OR 97401–3408
Phone: (503) 282-3662
Fax: (503) 282-3808
E-mail: katek@hevanet.com
Web site: http://cfc.uoregon.edu/atp.htm
