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Implementation of adolescent family-based substance use prevention programmes in health care settings

Objective: To examine factors that influence the effectiveness and quality of implementation of evidence-based family-focused adolescent substance use prevention programmes delivered in health care settings and to assess the effects of programme choice versus programme assignment on programme delivery. Design: Strengthening Families Program: For Parents and Youth 10–14 (SFP) and Family Matters (FM) were delivered as part of a randomized longitudinal prevention study designed to assess the influence of programme choice versus assignment to programme on study recruitment, retention and adolescent substance use outcomes. Families were initially randomized to a choice (FM or SFP) or assigned study condition (FM, SFP or control group). Setting: Families with an 11-year-old child were randomly selected from health plan membership databases of four large managed care medical centres in the San Francisco California Bay area; 494 ethnically diverse families enrolled in study programmes. Method: A mixed-method case study was conducted to assess procedures used to maximize implementation quality and fidelity. Programme monitoring was conducted to assess differences in programme delivery for families in the choice versus assigned study condition. Results: Programme fidelity improved over time. Families who chose FM (versus being assigned to the programme) completed the programme in a shorter period and spent more time implementing programme activities. SFP ‘choice’ families (versus assigned) attended more programme sessions. Conclusion: Fidelity assessment data can be successfully utilized for ongoing quality improvement of programme delivery. Programme choice appears to increase family engagement in programmes. Future effectiveness trials should assess approaches to integrate evidence-based family prevention programmes with adolescent health services.