Is the Strengthening Families Programme feasible in Europe?
| Pages | 133-150 |
| Date | 15 June 2015 |
| DOI | https://doi.org/10.1108/JCS-02-2014-0009 |
| Published date | 15 June 2015 |
| Author | Gregor Burkhart |
| Subject Matter | Health & social care,Vulnerable groups,Children's services |
Is the Strengthening Families Programme
feasible in Europe?
Gregor Burkhart
Dr Gregor Burkhart is Principal
Scientific Analyst at European
Monitoring Centre for Drugs
and Drug Addiction,
Interventions, Policies and Best
Practice Unit, Lisbon, Portugal.
Abstract
Purpose –The purpose of this paper is to provide insights into the potential of technology transfer in
prevention interventions. It argues that contextual factors are more identifiable and more malleable than the
cliché of “culture”as a barrier to implementation might suggest. The key question is how various contextual
factors impact on programme implementation and effectiveness in the different cultures of a multifaceted
continent such as Europe, and how successful programmes adapt to various contexts.
Design/methodology/approach –Using a questionnaire survey, input was collected from people
involved in the adaptation and implementation of the Strengthening Families Programme (SFP) in several
European countries.
Findings –The publications and experiences of the SFP implementers and evaluators in most of the
European countries where it was introduced suggest that the programme is both feasible and effective
(where outcomes are available). To achieve this, however, the implementers spent a considerable amount of
time and effort to prepare, pre-test and consult with their target populations in order to adjust SFP to culture
and context. This paper suggests restricting the use of “culture”to a set of norms and values, and to
distinguish this from “context”which describes social and political organisation. Even though both condition
each other, it is helpful to address culture and context separately when adapting prevention programmes.
Research limitations/implications –Outcome data were not available for all implementations of SFP and
some very recent ones in Austria, France and Italy could not be included in the questionnaire survey.
Practical implications –An examination of social capital might help implementers to anticipate resistance
from the targetpopulation that seems to emanate from history,culture and context. The level of trustof others
and institutions and the willingness to co-operate with them can heavily influence the readiness of drug
prevention service planners, commissioners and providers, as well as the target population, to adopt
interventionsand other behaviours.Programmes seem to havekey principles that make themeffective and that
should notbe modified in an adaptation: a particular example is theprogramme protocol. Otheraspects, such
as wording,pictures and the content of examplesused to illustrate some issuesdo have to be modified and are
essentialfor an intervention to be well-acceptedand understood. Insome programmes, the effectiveprinciples
–so-called “kernels”–are identifiable although, overall, prevention research still strives to identify them.
Social implications –Implementing complex programmes that require the cooperation of many
stakeholders might increase social capital in the communities involved.
Originality/value –The paper examinesthe common belief among many Europeanprevention professionals
that programmes fromabroad, particularly from North America,cannot be implemented in Europe.
Keywords Family-based prevention, Programmes
Paper type Technical paper
Introduction
Some commentators[1] argue that programmes developed in one cultural context, such
asNorthAmerica(CanadaandtheUSA),areunlikelytoworkinEuropebecausemostof
the evidence for their effectiveness is from North America. Many reviews question
whether this evidence is applicable to Europe (e.g. Cuijpers, 2003; Faggiano et al., 2008;
McGrath et al., 2006).
Received 12 February 2014
Revised 28 June 2014
Accepted 7 May 2015
DOI 10.1108/JCS-02-2014-0009 VOL. 10 NO. 2 2015, pp. 133-150, © Emerald Group Publishing Limited, ISSN 1746-6660
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The Strengthening Families Programme (SFP), originally a selective family-based intervention first
developed by Karol Kumpfer and associates in 1983 in Utah in the USA, was revised in 1992 into
a shorter (and more universal) version (the Iowa SFP) by Virginia Molgaard. Versions of the SFP
are currently being implemented in Germany, Ireland, Greece, Spain, the Netherlands, Poland,
Portugal, Slovenia, Sweden and the UK.
This paper aims to provide insights into the potential of know-how transfer in prevention
interventions. It argues that contextual factors are more identifiable and more malleable than the
cliché of “culture”as a barrier to implementation might suggest. The key question is how various
contextual factors impact on programme implementation and effectiveness in the different
cultures of a multifaceted continent such as Europe, and how successful programmes adapt to
various contexts. Furthermore, the experiences gained during the adaptation and implementation
of SFP in Europe may help other practitioners to prepare for the main challenges when
implementing allochthonous[2] programmes, especially those concerning:
■the cultural characteristics of the target groups, such as differing beliefs and values, but also
levels of education;
■the determinants of context, such as organisational differences in health, social and
education systems and the degree of community organisation and civic involvement; and
■aspects relevant for the implementation process, such as parenting cultures, professional
cultures, and the training level and educational background of the professionals involved in
the implementation.
Using a questionnaire survey in the summer of 2011, information was collected from people
involved in the adaptation and implementation of SFP in eight European countries. Respondents
were in Germany: Julian Stappenbeck, Universitätsklinikum Hamburg-Eppendorf; in Greece:
Dina Kyritsi, 1st Department of Pediatrics, Agia Sofia Hospital for Children, Athens; in Ireland:
Robert O’Driscoll, Arbour House, St. Finbarrs Hospital, Cork; in Spain: Carmen Orte, Universitat
Illes Balears, Palma de Mallorca; in the Netherlands: Martijn Bool, MOVISIE, Knowledge centre for
social development, Utrecht; in Poland: Katarzyna Okulicz-Kozaryn, Institute of Psychiatry and
Neurology, Warsaw; in Portugal: Catia Magalhaes, IREFREA, Coimbra; in Sweden: Eva
Skärstrand, STAD, Stockholm Centre for Psychiatric Research and Education; and in UK: Debby
Allen, School of Health and Social Care, Oxford Brookes University.
The items of the questionnaire were all related to implementation aspects (delivery, training,
problems encountered and ways to solve them, protocol changes, adaptations and lessons
learnt), and less to aspects of evaluation, since this paper’s main focus is on the various
implementation and adaptation aspects of SFP, and less on whether it is effective in all sites.
The implementation of the more sophisticated drug prevention interventions is more likely to be
set out in a manual (i.e. manualised) to assure accuracy of implementation. Such programmes are
also more likely to have been pre-tested in order to confirm the validity of their theory base and to
have been evaluated (at best with several replications) to avoid unintentional (iatrogenic) effects
and to prove positive outcomes. Such interventions could be considered “high-tech prevention”
as their development and implementation requires specific know-how, research, repeated
refinement procedures, quality control, proof of effectiveness, replication studies and some
certainty that they do not harm. In medicine, most people would naturally expect such a level of
“technology assessment”, especially from medications, before they are allowed to be distributed
to the population.
Broadly speaking, high-tech programmes are a more common approach to prevention in
North America, and thereis much research and other investment in order to improve them and to
assure their effectiveness in replication trials. There is also important marketcompetition between
specific programmes and their developers,as they are offered to service planners,commissioners
and providers for a price. This might be due to structural differences:whereas in the EU, services
such as healthcare and education are generally of high quality and available for all, this is not the
case in the USA, so the need for complementary programmes is higher there. In Europe, such
programmes are rare, especially outside classrooms. Rather, prevention strategies consist of
varying (by country)combinations of local policies forvulnerable populations; isolatedor combined
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