October 29-November 2, 2001
Introducing the Presenter:
Lynn McDonald, MSW, PhD
FAST Program Founder, Senior Scientist
The FAST Project: Building Relationships
University of Wisconsin, Wisconsin Center for Education Research
1025 West Johnson Street, Suite 753
Madison, WI 53706
PH: (608) 263-9476 FAX: (608) 263-6448
Email: mrmcdona@facstaff.wisc.edu
Website: www.wcer.wisc.edu/FAST
Lynn McDonald has formal education and family education which has helped to shape her professional work. She says she learned to think about things as a philosophy major at Oberlin College in the 1960’s; she got a Master’s Degree in Social Work from University of Maryland-Baltimore where she learned traditional casework, family systems work, group work, and community organizing skills; each of these is a distinct approach to social change; and finally, she was awarded a PhD in Psychology from the School of Social Sciences, a unique cross-disciplinary approach to research, in 1976 from University of California-Irvine.
Lynn was raised in Europe, the Middle East, and Washington DC as the daughter of a US Diplomat; she attended 12 schools in five countries before going to college, thus speaking several languages, and knowing the stress of high mobility, and the need for continuous family and social networks. She says she learned first hand that ALL parents across all cultures, religions and social class, want the best for their children. Finally, she raised two wonderful children, (now ages 20 and 24), including 5 years as a single parent, and 10 years working half-time in order to be the primary parent for her children. Despite these challenges, she made sure that the children were raised their whole lives in one school district and one house. She learned personally how important informal and formal social supports are to the important role of mothering; with support, nurturing and being consistent are enormously easier to achieve. She applauds the work of parenting in our society, and sees our nation offering meager structural supports for our often stressed and isolated parents.
She has been a family therapist, a child therapist and a community worker. She has been a social work faculty member (University of Wisconsin-Madison, 1975-87), a family therapy professor (Edgewood College, 1996-ongoing), and a Senior Scientist at University of Wisconsin-Madison in the School of Education (1996-ongoing). In a local community mental health agency for 10 years (1986-96), Dr. McDonald developed, piloted, evaluated, researched and disseminated several non-traditional, community-based, family systems based, approaches to mental health service delivery for young children (ages 3-14). One of these was a prevention-early intervention program she developed in 1988, at Family Service, Madison, WI, and it has since become internationally recognized. This is what she will present today: an early intervention, multi-family group approach, called Families and Schools Together: FAST. See Mpeg-1 video or Real Media video for introduction of FAST.
The FAST program has been recognized by several federal agencies and non-governmental entities as both innovative and effective. See FAST/Awards/ In addition, the statewide dissemination initiative of FAST in Wisconsin (for $1 million annually in the state budget, AB 122) received one of 25 Finalist recognitions from Harvard-Kennedy School of Government and Ford Foundation, Innovations in American Government in 1994, while Secretary Tommy Thompson was the governor of Wisconsin (www.ksg.harvard.edu/innovat/finalists/1994/94) There have now been six state initiatives to replicate FAST, and over the past 12 years, the program has been systematically replicated in over 600 communities in 40 states and five countries. FAST has been researched with over $6 million federal research dollars in school-community-family-collaboratives in urban, suburban, and rural communities, and with families of many social class, language and racial backgrounds.
Families
and Schools Together (FAST)
FAST is a research based, early intervention model in which a collaborative team of parents and professionals do outreach to parents, engage them into 8 weekly multi-family group meetings, and then support them as they reconvene monthly over the next two years. FAST has been widely replicated with predictable outcomes on improving all children’s mental health. Multi-family FAST groups offer a non-traditional, mental health screening for all children, provide early intervention by building relationships within and across families, and facilitating supported referrals, as appropriate, to treatment. FAST has been successful in engaging children from stressed families in low-income, culturally diverse communities.
In my presentation, I will help the audience
1). Develop awareness of the urgent need for non-traditional mental health approaches that can increase access to mental health services for all children, while also increasing family involvement. Cultural representation of the child and families being served is a key concept to offering programs at local levels.
2). Learn about FAST as a research based, culturally competent, nationally recognized, widely disseminated, multi-family group strategy for early intervention with children ages 3-14. I will describe the outreach and engagement process, as well as the steps one needs to take to start FAST in your community. We will review steps for start up, as well as steps for quality assurance to get those predictable results in improving children’s mental health in your community. Finally,
3). Understand the policy implications of our recent, federally funded experimental research studies with results based on using multi-family groups in several communities.
The Urgent Need for Non-Traditional, Research-Based, Mental Health Approaches for Children and Families
Recently US Surgeon General Satcher called upon the national mental health and drug treatment community to systematically address economic and cultural disparities in service access. He pointed out that we know what works, however, only one of six children receives the mental health services needed. Mental health symptoms in children often manifest themselves in early bullying, violence, aggressiveness, as well as early drug use initiation and addiction of adolescents. There is a documented need for early screening and early intervention. Dr. Satcher describes this as a major public health problem and urged action. (www.mentalhealth.org/cre)
In addition, since the September 11 attacks and the widespread anxiety about the terrorists, there is an even more urgent reason to consider large scale, multi-family group approaches to early intervention of children’s mental health. Structured opportunities for families to gather together with support from one another to focus on their own children’s need for security and calm communication, and their need to have fun with play and laughter with their own parents could definitely help our children in this national time of fear. I would love to work with communities at this time to adapt some of what we have learned, based on theories of family stress and trauma, to reduce impacts of terrorism in our daily lives with our children.
Since it is evident that the current delivery systems are not and CANNOT possibly be responsive to the documented needs of children in the US for mental health services, non-traditional approaches to delivery of children’s mental health and drug prevention services should be considered in order to increase access. Are there service strategies which could be mass delivered, versus individually delivered, with documented outcomes showing improved child functioning? Is one-to-one screening, early intervention and treatment the only model we can use? If so, the challenge should be to train more mental health professionals and subsidize more training structures. I propose instead that communities seriously consider an alternative: use community partnerships with parents to run multi-family groups. Consider funding a pilot of a well researched, non-traditional method of delivering mental health screening and early intervention services to children, using multi-family groups and trained culturally representative, parent-professional school partnerships trained in new techniques.
Another reason for the disparities in cultural and social class utilization of mental health and drug treatment services may the lack of use by some populations of available mental health resources. Rather than not enough professionals, perhaps they are underutilized because of an underlying issue of local community distrust towards professionals. Perhaps we have over-relied on the traditional medical model of one professional expert providing services to one client, patient or family. This traditional model is based on the dyadic relationship of a trusted healer providing help. However, it assumes a social context of historical trust in the relationship with the “healer”. The respected professional must functions within a context of community relationships which have over time shown that individual to be wise. Trust underlies traditional, effective healing and is an unarticulated factor in the doctor-patient context, or mental health therapist-client relationship.
However, within a social community context of disrupted relationships, community dislocation, high mobility, low social capital, and structural racism, there may not be enough “trust.” If there is community distrust, these traditional “therapeutic” dyadic relationships may not feel safe. If there is not enough “community trust” to build upon, and experts might actually manifest the lack of respect, the judgmental attitudes, the disregard inherent in distorted power relationships in a community. If the teacher who has never met the parent, blames the parent of a student for being the reason the child is unable to learn, why would the parent want to spend any time getting to know that teacher? If the healer assumes a person is “diseased” because of his or her own immoral acts, or thinks that a person is somehow deserving of the condition of being poor and homeless because of in-born features of their race, the healing process will be seriously compromised. If we can build more communities with respectful connections and strong interpersonal relationships, rather than unequal power relationships, then the traditional, dyadic relationship based, forms of mental health screening and intervention can be effective (www.21learn.org/acti/treconomics)
Meanwhile, today we face a major disparity in access to mental health services for low-income, minority families and their children. The dyadic form of mental health services at a clinic may not feel sufficiently respectful, without the context of a long-term, trusting relationship. Through this AIR-CECP Virtual Conference you will learn about research based early-intervention prevention approaches, including FAST which is non-traditional, culturally competent, and increases family involvement. You will see that FAST can effectively screen and serve large numbers of children’s mental health needs, address power imbalances of low-income families with professionals, and help to build trusting relation-ships with parents, schools, and mental health professionals which last for a long time.
Multi-family groups as an alternative service delivery approach at the local community level for children’s mental health and drug prevention is particularly relevant at this time, since September 11, because multi-family groups offered over 8 weekly sessions, could be used universally in schools to address the urgent need for families and schools and communities to come together and resist the feelings of helplessness and social isolation which terrorism creates. There will be some children who will need referrals for more trauma treatment, understandably, and these can be facilitated by the collaborative partnerships with community agencies. Every American child today needs the comfort of fun and laughter within the family, family meals, structures for positive, authentic communication with their own parent, and being in a safe community with other families in a safe public space.
FAST is based on several theories relevant to helping a child be resilient and succeed despite stresses of everyday life. (theory) These important theories are never taught explicitly, but rather were applied in the creation of the program structure. For example, FAST applies Bronfenbrenner’s theory of social ecology which basically says that the relationships which surround the child as he develops over time are critical for his optimal growth, and these include the intimate relationships of mother and family, as well as extended family, neighbors, community, schools, and church; and in addition, at the macro level, the larger social, historical context in which the family is situated as they raise the child, and the policies of the country, will also affect the child’s development. In FAST we work to address multiple levels of the child’s social ecology, rather than only one level. This means that we collaborate with families, schools and community agencies by creating and training FAST teams to implement the preventive process, and those teams must be representative of the social ecology of the child. . Each FAST team is made up of a partnership of parent representatives, school representatives, community mental health and drug treatment agency representatives, in case more than family support is needed. In addition, FAST invites the whole family to attend, and the family defines itself by who is important in that child’s life, i.e. in that child’s social ecology, so it can be multiple generations, with legal relationships or live-in partners, etc. Finally, the families of other children attending that school of the same age are invited to participate, because these are the families of the child’s potential friendship network.
Recently these notions about the importance of interpersonal relationships are being further developed by another theory: social capital theory. Social capital refers not to child development and social ecology, but rather to how society works in general. This theory was developed by a sociologist, James Coleman, and further developed by a political scientist from Harvard, Robert Putnam (2000). The theory of social capital is being researched in many major studies; the results show that personal friendships, connections, and relationships matter significantly to our economy, to crime levels in our neighborhoods, and to our health as individuals. For example, people with strong, caring relationships, live three to five years longer, than do socially isolated people. The results of this research are clearly showing the importance of being connected to another caring person (people), preferably family, extended family, friends, neighbors, churchgoers, club members, work-colleagues, grocery clerks, etc. (vs. a paid therapist or counselor or teacher). Unfortunately, at the same time, studies show that Americans are dropping out of clubs, PTA’s, teams and groups, and are becoming more and more socially disconnected from neighbors and friends, and even from their own families.
This theory of social capital supports the important notion that institutional structures in our society might need to expand their roles in non-traditional ways. Government may need to assume some leadership in creating opportunities for people to build informal social networks, and social capital, in order to maintain health, well-being, and economic success.
Another important theory which underpins the FAST program is
family stress theory. Reuben Hill,
sociologist, studied families over time who were struggling with economic
hardship during the great depression.
He then developed a theory about the factors which differentiated the
families which were resilient despite the stresses of joblessness and poverty,
from those families who lurched into crises and breakdown. The protective factors which he identified
were social connections and positive perceptions. Hill’s
Stress Theory
Another theory which
contributes to the structure of the FAST program is that of risk and protective
factors as they relate to prevention. FAST takes a proactive approach to
prevention. FAST builds assets in the
community for the sake of the child. In
the prevention field, one can focus either on reducing risk factors or building
protective factors. Current research
has shown that protective factors are more predictive of resilience over time
than are risk factors; that is, even one or two strong, supportive, caring,
life long, relationships can actually over-ride and overwhelm the negative
impact on the child’s development of multiple risk factors. In FAST, we assume that all families and
children are under stress and that each family can benefit from protective factor
enhancement. FAST works systematically
to build and enhance relationships through several domains of the social
ecology of the child; specifically,
FAST creates a structure in which multiple levels of relationships are
strengthened, and each of these is an asset and can be considered to be a
protective factor.
The positive, empathic, mutual bond between the mother and the child is correlated with many positive outcomes for a developing child. In FAST, we apply the researched strategy for enhancing this bond, based on the clinical research from the Department of Child Psychiatry, UW-Seattle, of Dr. Kate Kogan. (Kogan, Gordon, and Wimberger (1972), Kogan (1978, 1980) and Webster-Stratton (1986; 1996)). Their protocols, which resulted in an enhanced mother-child bond and improved functioning of child mental health, involved observing and coaching mothers through one way mirrors. A parent was instructed to follow their child's lead without bossing, teaching, or criticizing during several fifteen minute one-to-one sessions, over an 8 week period. Improvements were dramatic across a range of psychological symptoms. The application of this research in FAST "Special Play" is structured so that each week of the eight to ten week program, the participating mothers (or primary caretakers) spend fifteen minutes of quality time with their at-risk child, while trained FAST team members observe the dyad. The team gives support, and coaches the mother toward success. Homework assignments are made for mothers to continue this "special play" for fifteen minutes a day over the next two years.
Protective Factor II: Intimate Support Network: Parent to
Parent Bond
Every parent raising a small child, needs intimate support for themselves. With that daily support, the parent can set aside their own needs and focus on the child’s needs. A marriage which is a healthy partnership is characterized by clear communication, effective conflict resolution, and freedom to express range of emotions. Such a parent-to-parent bond is correlated with many positive child outcomes (Minuchin, 1986) while chronic conflict is damaging for the child (Hetherington, 1989). For low income, depressed parents, having an intimate supportive adult with whom one can converse on a daily basis reduces the likelihood of the daily stresses of life being taken out on the child (Belle, 1980). The FAST program builds the support potential of a parenting team through strengthening marital bonds or bonds between two single parents. For fifteen minutes of each multi-family meeting, the parents pair up into teams of two and are requested to listen to each other review the hassles of the day. Instructions are to not give advice, interrupt, fix the problem, or change the subject, but rather give feedback showing that one is listening.
When families are strong and cohesive, trust one another, share emotions together, communicate openly, and resolve conflicts easily, they can survive many hardships (Lewis, Beavers, Gossett, & Phillips, 1976; Sayger, 1992). Family therapists suggest that families are dysfunctional if: (a) the parents are not in charge of the family; (b) the family cannot resolve conflict through communication; (e) there is low family cohesiveness and members are disengaged from one another (Alexander, 1973; Minuchin, 1979). A disengaged, conflicted, disorganized family is considered to be a causal factor to violence and delinquency, substance abuse, and school failure. There is growing evidence that systemic (i.e., family systems-centered) drug interventions are effective in helping family members with their addictions (Lewis, Piercy, Sprenkle, & Trepper, 1990).
Family Cohesion is considered the central protective factor in the FAST framework and is achieved by strengthening family communication and their ability to resolve conflict. The FAST parents are put in charge of their own family using several strategies: the collaborative team helps children serve a meal to their parents, parents are given instructions (rather than the children) and direct their child's actions, and staff support the parent in order to maximize their experience of success with their own children.
New behavioral
interaction sequences are practiced in family units throughout each of the FAST
program elements: (1) families sit together for one hour at a family table
which they decorate with a family-constructed flag; (meal) 2) parents direct
two, fun family games which specifically include communications exercises and
adhere to the interactional rules for conflict resolution in the family (i.e.,
put parents in charge of their family, take turns speaking, listen to each
family members' perspective, do not criticize) (Alexander & Parsons, 1973).
One game involves acting out feelings, guessing the emotion, and talking about
them in the family. The other game involves drawing something and talking about
it within the family. The two exercises build positive, affectionate,
sustaining familial bonds. Each of these exercises addresses family issues
which have been shown to be correlated with adolescent substance abuse,
alcohol-related aggression (Elkin, 1984) and juvenile delinquency (Kumpfer,
1994).(feeling charades) and (scribbles game)
Many researchers have studied support networks to identify the most salient components of an effective social network and the distinctions made between informal and formal support networks (Crnic, Greenberg, Robinson, & Ragozin, 1984). The mistake of many social interventions is the over reliance on formal networks (i.e., professionals and institutions) and the lack of respect for informal support networks (i.e., peers). Research shows that informal support networks are more reliable and constant over time and people feel more comfortable using them. The informal networks are more flexible and individuated to the specific needs of the family under stress, more culturally sensitive, and less expensive to society. The FAST Program builds informal support networks. The effective elements for recruiting families into voluntary participation in the multi-family program include: (1) home visits made by members of the collaborative team which includes a parent graduate of FAST; (2) training in recruitment language so that the recruiter matches the language used by the parent when they express concern about their child; (3) recruiting the whole family through a shared concern about the child; (4) removing obstacles for participation (e.g., transportation, child care); (5) providing both consistent and intermittent multiple incentives for participation; and (6) respite from the children in an adult-only discussion group.
Parent involvement in the school system is integral to the academic achievement and psychosocial functioning of the child and Stevenson and Baker (1987) noted that mothers' involvement in their children's school activities affects the children's school performance independent of maternal educational status. Historically, parents of at-risk children have experienced a strained and, many times, overwhelmingly negative relationship with their child's school. Few parents of at-risk children will report incidents of being notified by their child's school because of a positive event, even though many positive events may have occurred (McDonald, 1993). The FAST program addresses the parent-school affiliation by helping parents to become more actively involved in their child's school activities. Children and families are referred to FAST via school personnel, each FAST group includes parents with children from the same school, many FAST groups meet in their child's school, and school personnel act as support staff during the FAST program. These activities set the stage for an environment in which school personnel and families can share positive activities without judging, parents meet other parents with similar concerns and develop a supportive cohort, and many positive activities become associated with the school setting, thus opening the doors for mutually respectful, cooperative and friendly communication between parent and school.
As with schools, community agencies can be perceived as the enemy.
Friesen (1993) noted that family-centered services should: (1) be individualized and flexible with emphasis placed on the needs, values, and preferences of the families; (2) be administered by professionals who work collaboratively with families, in settings of the families' choice, sharing information, responsibility, and power; (3) be structured as true inter-professional collaboration involving coordinated planning, with family members as full members of the team; and (4) place resources into flexible, community-based alternatives. The empowerment of families means helping families and children gain accurate information, access to resources, respite care, coping skills for managing problems, and social supports (Johnson, 1993). The FAST program works to empower access to formal support networks. The program includes active participation from parent graduates of FAST, provides self-help activities, offers information on community services, assists with transportation and respite care, and allows for discussion of ways to cope with stressful life events. Professional staff attend all multi-family meetings in the role of a supportive, respectful person (i.e., without a professional agenda).
Protective Factor VII: Empowerment of Parent Positive
Attitude
There is increasing support for the idea that successful
parenting is correlated with high parental self-esteem, having a feeling of
power within one's family unit, and a sense of self-efficacy within society
(Gaudin et al., 1993). Change is dependent on experiential learning, which
includes experiences of succeeding in parenting, of talking about and sharing
one's successes as a parent with other parents, of being respected as a parent,
and of being efficacious with people from different walks of life in getting
things done. Positive social feedback within daily ecology are essential for
maintenance of positive parenting and contributes to the parent's personal
feelings of empowerment (Febrarro, 1994). FAST works to build feelings of
empowerment in parents. Program activities include: (a) making respectful home
visits at the family's convenience to invite families to voluntarily
participate in the program; (b) making sure each family experiences winning the
lottery; (c) building in the principle of reciprocity (Dunst, Trivette, &
Deal, 1988), (i.e., the week after winning the lottery, the family is expected
to give back to the program—for example, by cooking a meal for the whole FAST
group with money provided by the program); thus, each family is singled out in
two positive interpersonal experiences; (d) making personal achievement
announcements to the whole FAST group at the end of each meeting in a large
circle; and (e) training facilitators in role playing exercises on how to
empower parents in micro-event transactions (see an MPEG-1
or RealMedia
video of this).
Having a theory and research based approach is only useful to a community concerned about screening and early intervention of children’s mental health, if parents actually participate. Once a family has attended one session, eighty percent (80%) of families will graduate from the eight weekly meetings, regardless of geography, race and culture, or class backgrounds. This is a consistent rate across hundreds of communities and thousands of FAST cycles implemented over the past 12 years. With training, and if the core components are implemented, you can expect 4 out of 5 whole families who attend once, to graduate after the eight weekly multi-family group sessions.
How do we engage and retain 80% of the parents of children in schools and communities, when so many other good efforts have failed? First, we engage the parents as part of the solution. This is a critical part of the success of FAST. All parents want the best for their children and love their children. It is stress and social isolation and “busy”ness, as well as depression, substance abuse, and domestic violence, which can interfere with the behavioral expression of this. These are the values of FAST. (values) We assume that parents want to know about an approach which will enhance their child’s resilience, if we can help overcome the obstacles which might get in their way. The key here is approaching the parent with respect, with non-judgmental attitudes, and with actual support. Many parent education approaches have the value that parents need to be educated by the experts; this is not appealing to any of us, and attendance is poor. Instead, FAST uses the approach of shared governance, and makes certain that these take place by imbedding the parent-partnership structure into the required core components of FAST which cannot be changed (60% of FAST curriculum can be locally adapted, while 40% cannot be):
FAST engages the parents as partners in the screening and early intervention process by
a) Inviting 2 parents to be on planning, training, outreach and implementation team; FAST training cannot take place without a parent partner present.
b) Insuring that the FAST team has consumer representation, which includes the parent(s) on the team, but also the team must match the participating families in culture, language, ethnicity and race. FAST certification cannot take place without cultural representation of the families on the team.
c) Training of the FAST team on how to show parents respect, with multiple role plays; and discussions during the training of the value base of FAST and signed commitments to the values by the team. These signed value statements are sent to FAST National Training and Evaluation Center in order for the site to be certified.
d) Requiring outreach and home visiting for each FAST parent to invite them in face to face contact, to try attending one multi-family group session.
e) Encouraging parent networking time without any imposed agenda for 45 minutes during each FAST multi-family group meeting. The experience of parents is that they, the parents, have their own knowledge, which as they share and express it, will help them develop a united, confident voice.
f) Inviting FAST parent graduates to give their consumer feedback formally to their FAST team; this is required for certification, and is systematically on the multi-family group process to the implementation team in public;
g) Supporting FAST graduate parent leaders to run monthly multi-family group meetings; allocating a budget for parent determination. FAST is not just an 8 week program and then it is gone; it shifts to a parent-run community development process with local leaders, called FASTWORKS.
h) Maintaining relationships with other parents and the school over time, enabling parent advocacy and systems change to emerge; and
i) Supporting relationships to develop between parents and mental health professionals and drug specialists, facilitating appropriate self-referrals over time (approximately 1/3 of FAST parents self-refer within 2 years).
FAST promotes the resilience of the child to withstand stresses over time by strengthening their relationships with their parent(s), their family unit, other families in the community, and their school. The outreach and multi-family group process promotes social capital at the school and community, in that adults with children the same ages claim friendships with one another after the eight weeks of multi-family groups. Eighty-six percent of participating FAST parents report four years later that they made new friends during FAST. The building of social support networks is organized around the developmental stage of a child. These networks are apparently maintained over time and shift in their functions. FAST parents who initially met while their children were in elementary school, continue to help each other as they monitor their adolescents, and learn to be patient in their communications with children during their teen years.
The multi-family FAST groups are a non-traditional approach which integrates well-researched mental health strategies of child therapy, family therapy, group work, as well as principles of community organizing and adult education, into a replicable package. Non-clinicians can be trained to implement FAST, and with the visiting Certified FAST trainer, can adapt FAST to fit local needs. The documented national retention rate with underserved populations is consistently 80%: If a family attends one session, 80% will complete the eight weekly meetings. Retention rates have remained fairly stable across six statewide initiatives, school districts, and counties.
Multi-family FAST groups have been successfully replicated with site visits by Certified FAST Trainers in over 600 local communities. Collaborative FAST teams in 40 states have engaged thousands of families into multi-family group experiences, and often these have been low-income, stressed families who have been underserved by traditional mental health services (McDonald, et al, 1997, 1998, 1999, 2000, 2001). About half of the families served by FAST have been European American (51%). The impacts on the child’s mental health functioning have been measured by teachers and by parents, pre and post FAST groups, using the Revised Behavior Problem Checklist (RBPC), by Quay Peterson (1987) which is a standardized instrument with established validity and reliability. The RBPC was used to measure changes in domains of mental health functioning of FAST children, for ten years of replications of FAST, to give feedback to each local community about the impact of their work on the children’s mental health functioning. The average amount of improvement for the FAST child in just eight weeks has been 25% as reported by parents, and 20% as reported by teachers. We have checked to determine whether this level of change is consistent across cultural groups, and FAST has also been extremely effective is doing outreach to low-income communities which are predominantly African American, Latino, Asian American and Native American. (American evaluation). We used data from the Center for Substance Abuse Prevention (CSAP) longitudinal follow-up study to measure change over time. The population of the CSAP study in Madison, WI was primarily low income, 90% single parent, and 80% African American. Those data suggested that the gains would hold over time, rather than relapse to pre-FAST levels (csapfollowup.htm).
With these suggestive data in hand, we applied for federal funds to invest in expensive experimental design studies with follow-up one and two years after FAST had been implemented. (www.wcer.wisc.edu/FAST/research/research2.html). These studies were conducted over the past five years, and the results have been recently submitted in federal reports or presented at national meetings, but have not yet been submitted to journals. Although nationally 51% of FAST families have been European American, the FAST experimental studies are specifically on children and families of diverse backgrounds. The resulting outcome data are showing statistically significant decreases in FAST children’s mental health problems, compared to the control group children who seem to be getting worse in some areas of functioning. Similar trends seems to be characteristic of three distinct studies, with three specific, low-income, minority populations. In each study, we are using another standardized instrument on children’s mental health, called the Child Behavior Checklist (CBCL-by Achenbach):
American Indian children in rural settings, (Native American, OERI study)
Latino children in a Midwest urban setting; (NIDA study) and
African American children in a Southern urban setting (Abt study) .
One and two year follow-up reports by teachers and parents showed the improvement of these FAST children’s mental health functioning increased over time, rather than regressing to pre-FAST levels of problems. In contrast, there was documented deterioration of the control children’s mental health indicators over time, as they were still functioning in the toxic social environments without protective factors. FAST children’s mental health symptoms, specifically aggression and anxiety, were reduced immediately and these changes were maintained over time one year later. The results of these research studies will be included on the FAST website. The studies are with culturally diverse, typically underserved child and family populations in both rural and urban settings. These FAST experimental study results are based on systematically addressing positive protective factors in the child’s social ecology with building multiple levels of strong relationships in multi-family groups.
(program features, including Abt study)
a) creating parent-professional, culturally representative teams and having the team trained to do outreach and recruit families voluntarily into multi-family groups;
b) piloting a FAST multi-family group session with supervision by a Certified FAST Trainer involving three direct observation site visits and trainings to adapt FAST locally to fit the unique issues presented in your community with the trainer, and receiving both process and outcome evaluation reports on the pilot;
c) learning how to certify a local FAST trainer to train future parent-professional teams to implement multi-family groups in multiple sites;
d) planning long term sustainable investment of local resources for early intervention (see How To Get Started).
Culturally representative, parent-professional partnerships are trained on these four functions in a cost-effective way, using universal recruitment in their local, possibly low-income communities. In addition, multi-family groups systematically build informal social relationships and multiple protective factors, by reducing social isolation, and re-building our nation’s social capital.
Basic first steps include creation of parent-professional partnerships, reflecting the local community. The parent partnerships should include local mental health and drug treatment professionals as well as with local child-focused structures (e.g. schools, HeadStart, day-care, after-school clubs, churches). Then, with training from the FAST National Training and Evaluation Center, a non-profit organization committed to only one goal: The quality assurance of FAST replication, those local partnership teams can do respectful peer-outreach to other local parents to invite their voluntary participation in multi-family groups, and then also facilitate eight weekly sessions of multi-family groups (see our Training and Evaluation Services).
The activities of the multi-family groups are research based strategies for supporting relationship building at each level of the child’s social ecology. (Research Background of each FAST activity) These sequenced, activities which are repeated each week in dyads and family units and small groups, have been studied using experimental designs (funded by NIDA, OSERS, ADYF, and OERI), with one and two year follow-up data analyzed. These studies show improvement for FAST Participants vs. control children which increases over time. Two of these studies used universal invitations of child populations or communities considered at increased risk for behavioral problems, and we tracked the pre and post teacher and parent evaluations of their mental health indicators. These evaluations included scales on attention span, aggression, anxiety and depression; if these scales show elevations in young children, they have been shown in other research to be correlated with later delinquency, school failure and special education needs, and substance abuse. Of all of the children, including FAST and control group, who were universally recruited with home visits and outreach, over half scored at borderline or clinical levels at pre-tests, on standardized mental health instruments (CBCL-Achenbach).
The parent partner and school partner support the community leadership development of parents in order for them to maintain the ongoing informal social support networks developed during the multi-family groups. In the Abt experimental study on FAST in New Orleans, LA, funded by ACYF, the parent leadership in the community of the FAST parents on one year follow-up was statistically significantly higher than the control parents. In longer term follow-up, without control groups, FAST parents showed unanticipated outcomes: returning for further adult education (44%), finding employment, participating in community activities, increased involvement in schools and PTAs. In addition, self-referrals for further mental health or drug treatment services are facilitated through trusting relationships built at FAST. In four-year longitudinal data, (see the CSAP study), the parents responded to a follow-up survey indicating that one-third of graduated parents reported further involvement in counseling for mental health needs (27%) or treatment services for addictions (8%). If one goes to our website (http://www.wcer.wisc.edu/FAST), there is a video and a powerpoint presentation one can access, to actually see the multi-family group activities. There one will also find a great deal of further information on FAST.
Investing in FAST training and quality assurance structures enables the replication initiative to achieve predictable outcomes. Of the large dissemination initiatives, those who have worked closely with the standards and with the program developer, have achieved excellent improvement in children’s function. Australia is a good example of this. Australian Data
Policy
Implications
Recent research on using universal invitations to whole classrooms into multi-family groups, (provided that every parent is home visited to personally invite them), indicates that about half of the children who attend FAST are at borderline or clinical levels on standardized instruments. This universal recruitment approach is preferable to targeting “at risk” children directly because of three reasons:
1) The documented problems of labeling and self-fulfilling prophecy research within classrooms
2) The research which shows that groups of youth will routinely norm around deviant norms, if the only members of a group are deviants or “at-risk” children
3) It screens all kindergarten, first, second grade children, or all early childhood, or all middle school youth early for behavioral symptoms of mental health/violence/addiction problems in the child and their family.
Thus, universal invitations to FAST guarantee an inclusive approach to screening for mental health problems. This process screens without targeting or publicly naming a child as “different,” and meanwhile also stabilizes families who are stressed and socially isolated, and builds social capital at the school in which families get to know one another. At the same time, the universal screening for mental health indicators facilitates a respectful process of further referral, assessment and treatment as needed. The relationships with the other parents, the school personnel, and the treatment community are already in place to increase the effectiveness of appropriate referrals.
As previously indicated, FAST provides early intervention for the participating children at a school. Within eight weeks of meeting in multi-family groups, the families report that the FAST child’s behavior at home improves an average of 25% on standardized instruments, and these hold across ethnic groups. This means that the child improves enough for his peers and community to notice the changes. This also becomes self-reinforcing for the parents, because they brought the child to FAST themselves. In addition, teachers report 20% reduction in the child’s current problem behaviors at school reported by teachers and parents on Child Behavior Checklist (CBCL-by Achenbach), Social Skills Survey (SSRS-by Gresham & Elliott), and/or the Revised Behavior Problem Checklist (RBPC-by Quay & Peterson), and these gains are maintained over time (McDonald et al., 1997, 1998, 1999, 2000, 2001). For those children who need more treatment, the structure is familiar to the parent and the referral process is smooth.
At this time, there are seven states which have instituted statewide dissemination of this process. All of these are however for only a small proportion of the children at any one of the 600 schools in the US which have run FAST programs.
There is only one school in the US which decided to offer FAST to every single entering kindergarten child. They decided that FAST was a right for every child and family as a part of the transition into the school system. This is a charter school in Chicago which was recently created by Dr. Tony Bryk who wanted to institute only research based, Best Practices, and selected FAST as the parent involvement strategy for the school. They have done this over the last three years, and recommend this universal availability to all schools.
This is the policy which we are recommending at this time: Universally available outreach and multi-family groups at transitions in schools (entering pre-school/Headstart; entering elementary school, middle and high school). We speculate that the impact of FAST on children, families, schools and communities could be significantly increased with instituting the process for every child at the transition stage of school entry. We speculate that this result would essentially be a non-traditional solution to the disparities challenge presented to us by the Surgeon General. This non-traditional policy would accomplish four things:
1) universal screening of all children for mental health needs;
2) universal stabilizing of all families by reducing stress and building social support, and because of trusting relationships, and social capital, the
3) successful referral of children with mental health needs into appropriate treatment services.
4) build social capital in our communities, which reduces problems in mental health.
FAST could be seen as a polio vaccination again polio, or rather a modern society vaccination against stress of busy, isolated families. This is our policy recommendation.
Acknowledgements:
The presentation for this Virtual Conference was prepared by a FAST team which included Phyllis Scalia, Mary Tedeschi, and Lynn McDonald.
Contact for Replication:
FAST National Training Center, pat_FAST@tds.net
2801 International Lane, Suite 107
Madison, WI 53704
608-663-2382
Contact for more information about FAST
Lynn McDonald, MSW, PhD;
FAST Program Founder, Senior Scientist
University of Wisconsin, Wisconsin Center for Education Research
1025 West Johnson Street
Madison, WI 53706
PH: (608) 263-9476 FAX: (608) 263-6448
Email: mrmcdona@facstaff.wisc.edu
FAST Parent Graduate, National Parent Leader:
Cathy Couture, Madison, WI,
Email: McSee@aol.com
FAST Program Director, Administrator-CEO
Pat Davenport, Madison, WI
Email: Pat_FAST@tds.net
FAST School Principal
Jerry Johnson, Madison, WI
Email: Jerry_FAST@tds.net
For further information, click on the web links below:
Parent Involvement as a Protective Factors