Intervention Summary

Strong African American Families (SAAF)

Strong African American Families (SAAF) is a culturally tailored, family-centered intervention for 10- to 14-year-old African American youths and their primary caregivers. The goal of SAAF is to prevent substance use and behavior problems among youth by strengthening positive family interactions, preparing youths for their teen years, and enhancing primary caregivers' efforts to help youths reach positive goals.

Facilitators administer SAAF through seven 2-hour sessions using separate skill-building curricula for youths and primary caregivers. Sessions can be implemented at any time during the week, including weekends. During the first hour of each session, youths and primary caregivers meet separately with facilitators. Topics addressed in the youth sessions include the importance of following house rules; adaptive ways of responding to racism; the formation of goals for the future and plans to attain them; and skills for resisting early sexual involvement, substance use, and other risk behaviors. The primary caregiver sessions address ways in which the caregivers can monitor their children's behavior; encourage adaptive strategies for their children to respond to racism; and develop adaptive communication skills for discussing sex, substance use, and other risk behaviors. During the second hour of each session, youths and primary caregivers meet as a family with the facilitator and build on what was learned in the separate sessions. In the family sessions, facilitators work with families to build family-based strengths for supporting the youth's goals, enhancing racial pride, and improving communication and support.

SAAF is usually offered at schools and community facilities, and it should be implemented by trained facilitators who have experience working with families and youths. In the study reviewed for this summary, the intervention was provided to 5th-grade students and their primary caregivers.

Descriptive Information

Areas of Interest	Mental health promotion Substance use disorder prevention
Outcomes	1: Alcohol use 2: Conduct problems
Outcome Categories	Alcohol Social functioning
Ages	6-12 (Childhood)
Genders	Male Female
Races/Ethnicities	Black or African American
Settings	School Other community settings
Geographic Locations	Rural and/or frontier
Implementation History	SAAF was initially implemented in a 2-year randomized prevention trial with more than 600 African American families in rural counties in Georgia. Since then, organizations in Colorado, Georgia, Iowa, and Pennsylvania have used SAAF with approximately 115 additional families.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Universal

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Brody, G. H., Chen, Y.-F., Kogan, S. M., Murry, V. M., & Brown, A. C. Long-term effects of the Strong African American Families program on youths' alcohol use. Journal of Consulting and Clinical Psychology, 78(2), 281-285.

Brody, G. H., Kogan, S. M., Chen, Y., & Murry, V. M. Long-term effects of the Strong African American Families program on youths' conduct problems. Journal of Adolescent Health, 43(5), 474-481.

Brody, G. H., Murry, V. M., Gerrard, M., Gibbons, F. X., Molgaard, V., McNair, L., et al.. The Strong African American Families program: Translating research into prevention programming. Child Development, 75(3), 900-917.

Brody, G. H., Murry, V. M., Kogan, S. M., Gerrard, M., Gibbons, F. X., Molgaard, V., et al. The Strong African American Families program: A cluster-randomized prevention trial of long-term effects and a mediational model. Journal of Consulting and Clinical Psychology, 74(2), 356-366.

Outcomes

Outcome 1: Alcohol use
Description of Measures	Alcohol use was measured using: Two self-report items from the Monitoring the Future (MTF) survey. The items assessed each youth's initiation of alcohol use and frequency of past-month alcohol use. Youths were asked if they had ever drunk beer, wine, wine coolers, whiskey, gin, or other liquors; they also were asked how many times during the past month they had drunk any of these beverages. The Alcohol Composite Index, a self-report instrument modeled after the Alcohol Initiation Index. Youths responded with "yes" (1 point) or "no" (0 points) to 3 items that asked if they had ever in their lives consumed an entire alcoholic drink, if they had consumed an entire alcoholic drink during the past month, and if they had ever drunk three or more alcoholic drinks at one time (binge drinking). Points for all responses were summed, yielding a total score ranging from 0 to 3, with higher scores indicating greater alcohol use.
Key Findings	Participating 5th graders and their primary caregivers were randomly assigned to the intervention group, which received SAAF, or the comparison group, which received three informational leaflets via postal mail regarding development in early adolescence, stress management, and suggestions to encourage children to exercise, respectively. Results indicated that: From pretest to the 29-month follow-up, fewer youths in the intervention group initiated alcohol use (Alcohol Composite Index) relative to youths in the comparison group (mean scores of 0.19 and 0.29, respectively; p < .05). From pretest to the 29-month follow-up, youths in the intervention group had 17.4% less growth in alcohol use (Alcohol Composite Index) relative to youths in the comparison group (p < .05). At the 5-year follow-up, youths in the intervention group drank a fewer number of times during the past month (items from the MTF survey) relative to youths in the comparison group (average of 0.68 and 1.41 times, respectively; p < .05).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.6 (0.0-4.0 scale)

Outcome 2: Conduct problems
Description of Measures	Conduct problems were assessed using 5 self-report items from the National Youth Survey. Each youth answered 5 questions concerning the frequency with which, during the past year, he or she engaged in disruptive behaviors involving theft, truancy, and suspension from school. The number of conduct problems that the youth endorsed constituted the conduct problems score.
Key Findings	Participating 5th graders and their primary caregivers were randomly assigned to the intervention group, which received SAAF, or the comparison group, which received three informational leaflets via postal mail regarding development in early adolescence, stress management, and suggestions to encourage children to exercise, respectively. Results indicated that from pretest to the 29-month follow-up, youths in the intervention group had fewer conduct problems relative to youths in the comparison group (p < .025).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.8 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	6-12 (Childhood)	54% Female 46% Male	100% Black or African American

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Alcohol use	3.4	3.4	3.3	4.0	3.8	4.0	3.6
2: Conduct problems	4.0	4.0	3.3	4.0	3.8	4.0	3.8

Study Strengths

The study used instruments with documented psychometric properties. Fidelity of implementation was addressed through the training and monitoring of facilitators. Interrater reliability checks were conducted on 23% of the fidelity assessments, and intraclass correlations exceeded .80 for each of the three types of sessions. Further, mean coverage of the components that composed the curricula was 90%, and no significant differences were found in coverage among youth, primary caregiver, or family sessions. The attrition rate was low. The potential effects of differential attrition were assessed in a systematic manner. The study had a large sample of youths and their primary caregivers, who were randomly assigned to the intervention or comparison condition. Analyses were thorough and highly appropriate.

Study Weaknesses

The Alcohol Composite Index was slightly modified from another instrument and not considered standardized. On average, families attended fewer than five of the seven weekly sessions.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Center for Family Research. Strong African American Families program: Caregiver sessions 1-7 [DVD]. Athens: University of Georgia.

Center for Family Research. Strong African American Families program: Family session 5 [DVD]. Athens: University of Georgia.

Center for Family Research. Strong African American Families program: Program CD. Athens: University of Georgia.

Center for Family Research. Strong African American Families program: Promotional DVD. Athens: University of Georgia.

Center for Family Research. Strong African American Families program: Youth sessions 3-5 [DVD]. Athens: University of Georgia.

Center for Family Research. Strong African American Families program binder. Athens: University of Georgia.

Center for Family Research. SAAF site resource manual. Athens: University of Georgia.

Center for Family Research. Strong African American Families: Fidelity manual. Athens: University of Georgia.

Center for Family Research. Strong African American Families: Master trainer manual. Athens: University of Georgia.

Center for Family Research, University of Georgia. Strong African American Families: Informational folder:

Estimated Costs for Adopting SAAF
SAAF Activities and Targeted Outcomes Summaries
SAAF Frequently Asked Questions
SAAF Training Frequently Asked Questions
Sample Program Session, "Youth Session 3: Dealing With Temptation for Early Sex"
Supporting research articles

Center for Family Research, University of Georgia. Strong African American Families: Training folder:

General Training Feedback Form
Participant Evaluation of Trainer Form
Program Brochure
Sample Training Agenda
Tips for Successful Recruitment and Retention Flyer

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
3.2	2.9	3.0	3.0

Dissemination Strengths

Implementation instructions are practical and include clear guidance on preparing for program sessions and dealing with problems that may arise. The session-by-session program binder is extensive and coherent. It provides clear direction on how to implement the program, including information on who should implement each part of the program, as well as the optimal facilitator-to-participant ratio. Key program activities are related to specific outcomes, which helps implementers to understand the rationale for the procedural aspects of the program. The 3-day facilitator training is required, and the expectations and goals of the training are clear and logical. Technical assistance and consultation are available both during and after the training. The fidelity manual includes adherence checklists for each of the seven sessions, and the developer conducts a quality assurance site visit to assess each implementer's adherence to the program.

Dissemination Weaknesses

Tools for assessing organizational readiness and for determining whether the program fits with the implementer's existing organizational activities are limited. Implementation and training are logistically complex and require extensive operational and staff resources, which may limit the program's availability to rural sites. A standardized written training curriculum is not available to support consistent training and program delivery. Little information is offered on what sites should do with the data they collect through the use of adherence checklists. Information is limited on how the fidelity materials can be used for improving, modifying, or updating the program.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
SAAF Program Pack (includes program materials on CD-ROM, training materials, and promotional video and session-specific information on DVDs)	$7,000 each	Yes
3-day, on-site facilitator training for up to 30 participants	Included in the cost of the SAAF Program Pack	Yes
Technical assistance and consultation	Included in the cost of the SAAF Program Pack	No

Additional Information

Other implementation costs can range from approximately $3,600 to $9,500, depending on whether the implementer provides meals, child care, transportation, and incentives for participants and whether facilitators are compensated. This estimate is based on program implementation with a group of 24 participants (i.e., 12 youths and 12 primary caregivers).