Intervention Summary

Families and Schools Together (FAST)

Families and Schools Together (FAST) is a 2-year, multifamily group intervention based on social ecological theory, family systems theory, and family stress theory. FAST is designed to build relationships between and within families, schools, and communities (particularly in low-income areas) to increase all children's well-being, especially as they transition into elementary school. The objectives of the intervention are to:

Enhance parent–child bonding and family functioning while reducing family conflict and isolation and child neglect;
Enhance school success through more parent involvement and family engagement at school, improved school climate, and reduced school mobility;
Prevent substance use by both adults and children by building protective factors and referring appropriately for treatment; and
Reduce the stress that children and parents experience in daily life situations in their communities by empowering parents, building social capital, and increasing social inclusion.

The intervention consists of an active outreach phase to engage and recruit families; 8 weeks of multifamily group meetings, each about 2.5 hours long; and 2 years of monthly, parent-led group meetings. The 8 weekly sessions follow a preset schedule and include activities such as family communication and bonding games, parent-directed family meals, parent social support groups, between-family bonding activities, one-on-one child-directed play therapy, and opening and closing routines modeling family rituals. These experiential learning activities are adapted for each participating community to be culturally and linguistically representative. Respect for parents as the head of the family and as partners is required at every level in FAST. Sessions are led by a trained team that includes at least one member of the school staff in addition to parents and professionals from local social service agencies in the community. FAST teams must be culturally representative of the families served.

Collaborative FAST teams are first trained and then supervised by trainers over three on-site visits. These site visits provide an opportunity for the implementation team to learn how to modify the program to fit local cultural priorities and how to monitor program integrity.

Descriptive Information

Areas of Interest	Mental health promotion Substance use disorder prevention
Outcomes	1: School mobility 1: Child problem behaviors 2: Child social skills and academic competencies
Outcome Categories	Education Family/relationships Mental health Social functioning Physical aggression and violence-related behavior
Ages	0-5 (Early childhood) 6-12 (Childhood)
Genders	Male Female
Races/Ethnicities	American Indian or Alaska Native Asian Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	School Other community settings
Geographic Locations	Urban Suburban Rural and/or frontier Tribal
Implementation History	FAST was developed by Dr. Lynn McDonald, Professor of Social Work, at a community-based, nonprofit family service agency in Madison, Wisconsin. Since then, FAST has been implemented in about 2,500 schools and 450,000 participants in 48 States. Other countries using the program include Australia, Austria, Brazil, Canada, Germany, Iran, Kazakhstan, Kyrgyzstan, Malaysia, the Netherlands, Northern Ireland, the Philippines, Russia, Scotland, Tajikistan, Turkmenistan, the United Kingdom, Uzbekistan, and Wales. Six large randomized controlled trials (RCTs) of FAST have been completed since the first small RCT was conducted. Several State, county, and city governments have used their funds to support scale-ups of FAST programs in their areas. These efforts include investing in training of local certified FAST trainers, national FAST trainers, and certified supervisors. The developer, Families and Schools Together, Inc., maintains an ongoing monitoring and feedback system to track these and other community-based implementations and evaluations of the intervention.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes
Adaptations	Manualized adaptations are available for families of young children (ages 0–3), preschool children (ages 3–5), youth (ages 11–14), and teens (ages 14–18). FAST group processes have been adapted for a number of low-income, socially marginalized cultural groups in the United States, including Latino immigrants, Southeast Asian refugees, African Americans living in inner cities, and American Indians in rural and urban communities. In Australia, FAST was adapted for rural Aborigine families. In Canada, the First Nation people adapted FAST to fit their tribal values. In Brazil, FAST was adapted for the families of preschool-age children living in favelas (slums). The FAST team manual, Training of Trainer materials, program integrity checklist, site visit reports, and evaluation questionnaires have been translated into Dutch, German, Portuguese, Russian, and Spanish.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Universal Selective Indicated

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

Fiel, J. E., Haskins, A. R., & Turley R. Reducing school mobility: A randomized trial of a relationship-building intervention. American Educational Research Journal, 50(6), 1188–1218.

Program Integrity Checklist Scores

Supplemental Tables

Supplementary Materials

Morales, J. R., & Guerra, N. G. Effects of multiple context and cumulative stress on urban children's adjustment in elementary school development. Child Development, 77(4), 907–923.

Program Integrity Checklist

Outcomes

Outcome 1: School mobility
Description of Measures	School mobility was assessed by calculating the percentage of children who changed schools between the first and third year of the study. Students who attended a different school in grade 3 than they did in grade 1 were identified as having made a school move. Data were obtained through rosters provided by schools at the beginning of year 1 and year 3. Students who were retained in grade (i.e., not advanced to the next grade at the end of a school year) were also identified so as not to be incorrectly labeled as movers.
Key Findings	Fifty-two elementary schools in two cities were randomly assigned to the intervention condition (receiving FAST) or control condition (continuing existing school practices without the intervention). Randomization produced two comparable groups of schools that were statistically similar at baseline in demographic and academic performance characteristics. Students in the intervention schools were generally less likely to change schools over the 3-year study period compared with students in the control schools, but this difference was not statistically significant. However, additional analyses found a substantial intervention effect for one subgroup of students. Specifically, Black students in schools implementing FAST were less likely to move to a different school compared with Black students in the control schools (p < .05).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.7 (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)	50% Female 50% Male	70% Hispanic or Latino 15% White 10% Black or African American 5% Race/ethnicity unspecified

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: School mobility	4.0	3.5	3.8	3.5	3.3	4.0	3.7

Study Strengths

School mobility was measured using school rosters, an existing data source with acceptable reliability. The instruments used to measure intervention fidelity included well-defined constructs matching the intervention's core components. Fidelity was supported through the manualization of the program, the use of a trained implementation team, the systematic collection of data, and the use of a program integrity checklist, direct observation, and dosage monitoring. The study used intent-to-treat analyses with multiple imputation procedures for missing data. Random assignment controlled for some confounding variables. The analytical techniques used in the study were strong.

Study Weaknesses

Some potential confounding variables were not completely addressed. For example, the investigators were unable to differentiate between the two types of noncompulsory school moves (strategic and reactive), limiting conclusions about how the intervention may have influenced potentially harmful versus beneficial types of school mobility.

Documents Reviewed

Study 1

Kratochwill, T. R., McDonald, L., Levin, J. R., Bear-Tibbetts, H. Y., & Demaray, M. K.. Families and Schools Together: An experimental analysis of a parent-mediated multi-family group program for American Indian children. Journal of School Psychology, 42, 359-383.

Study 2

McDonald, L., Moberg, D. P., Brown, R., Rodriguez-Espiricueta, I., Flores, N. I., Burke, M. P., et al. After-school multifamily groups: A randomized controlled trial involving low-income, urban, Latino children. Children and Schools, 28(1), 25-34.

Study 3

Kratochwill, T. R., McDonald, L., Levin, J. R., Scalia, P. A., & Coover, G. Families and Schools Together: An experimental study of multi-family support groups for children at risk. Manuscript in preparation.

Outcomes

Outcome 1: Child problem behaviors
Description of Measures	Child problem behaviors were measured using the following instruments: Child Behavior Checklist (CBCL). The externalizing subscale measures delinquent and aggressive behaviors, and the internalizing subscale measures withdrawal, somatic complaints, and anxiety/depression. Using a 3-point rating scale from 0 (not true) to 2 (very true or often true), parents and teachers indicate the extent to which each item describes a child's behavior at home and/or at school within the past 6 months. Social Skills Rating System (SSRS), parent and teacher versions. The problem behavior subscale measures internalizing and externalizing behaviors. Parents and teachers rate how often a child exhibits certain behaviors using a 3-point rating scale from 0 (never) to 2 (often).
Key Findings	One study compared students in FAST families with students in an assessment-only control group. At posttest, FAST students had significant improvements in teacher-reported externalizing behaviors, teacher-reported aggressive behaviors, and parent-reported withdrawal (all p values < .05) compared with control group students. The effect sizes were small (Cohen's d = 0.36 for externalizing behaviors) and large (Cohen's d = 1.20 for aggressive behaviors and Cohen's d = 0.87 for withdrawal). At 1-year follow-up, FAST participants sustained their improvement in withdrawal compared with control students (p < .05), a finding associated with a large effect size (Cohen's d = 1.92). FAST participants also showed significant improvement compared with control students in the following teacher-reported measures at 1-year follow-up: internalizing behaviors, anxious/depressed behaviors, attention problems, aggressive behaviors, and problem behaviors (all p values < .05). The effect sizes were medium (Cohen's d = 0.51 for internalizing behaviors, Cohen's d = 0.78 for anxious/depressed behaviors, Cohen's d = 0.70 for aggressive behaviors, and Cohen's d = 0.61 for problem behaviors) and large (Cohen's d = 0.92 for attention problems). Another study compared students in FAST families with those in families receiving eight behavioral parenting pamphlets and family education. At 2-year follow-up, FAST students had significant improvement in teacher-reported externalizing behaviors compared with students in the control group (p < .001). No significant difference was found between groups on internalizing behaviors. A third study compared students in FAST families with students receiving their school's usual services. At 1-year follow-up, FAST students had significant improvements in parent-reported externalizing behaviors and somatic complaints compared with control group students (all p values < .05). The effect sizes for these findings were small (Cohen's d = 0.42) and medium (Cohen's d = 0.53), respectively.
Studies Measuring Outcome	Study 1, Study 2, Study 3
Study Designs	Experimental
Quality of Research Rating	3.7 (0.0-4.0 scale)

Outcome 2: Child social skills and academic competencies
Description of Measures	Child social skills and academic competencies were assessed using the following instruments: CBCL. The academic performance scale, completed by the teacher, measures the child's specific academic skills, including reading, writing, and math, relative to the skills of other children at the same grade level. SSRS, parent and teacher versions. The social skills subscale measures cooperation, assertion, and self-control. The academic competence subscale (in the teacher version only) measures overall academic performance, reading, mathematics, motivation, parental encouragement, intellectual functioning, and classroom behavior. Parents and teachers rate how often a child exhibits certain behaviors using a 3-point scale from 0 (never) to 2 (often).
Key Findings	One study compared students in FAST families with students in an assessment-only control group. At 1-year follow-up, teachers assessed FAST students as having greater academic competence than control students (p < .05), a finding associated with a medium effect size (Cohen's d = 0.77). No significant difference was found between groups on social skills. Another study compared students in FAST families with those in families receiving eight behavioral parenting pamphlets and family education. At 2-year follow-up, FAST students had significant improvements in social skills and academic performance compared with students in the control group (all p values < .05). A third study compared students in FAST families with students receiving their school's usual services. No significant difference was found between groups on social skills or academic performance.
Studies Measuring Outcome	Study 1, Study 2, Study 3
Study Designs	Experimental
Quality of Research Rating	3.7 (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	0-5 (Early childhood) 6-12 (Childhood)	Data not reported/available	100% American Indian or Alaska Native
Study 2	0-5 (Early childhood) 6-12 (Childhood)	59% Female 41% Male	100% Hispanic or Latino
Study 3	0-5 (Early childhood) 6-12 (Childhood)	57% Female 43% Male	40% White 35% Black or African American 13% Asian 12% Hispanic or Latino

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: Child problem behaviors	4.0	4.0	3.5	3.5	3.5	3.5	3.7
2: Child social skills and academic competencies	4.0	4.0	3.5	3.5	3.5	3.5	3.7

Study Strengths

All the studies used standardized data collection instruments with well-established psychometric properties. The authors addressed the majority of methodological concerns related to fidelity, attrition, missing data, confounding variables, and analysis.

Study Weaknesses

One study implemented an adaptation of the intervention, making it difficult to monitor intervention fidelity. While the ability to modify the intervention is viewed as an important benefit, adaptations are nevertheless problematic in evaluating overall effectiveness.

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.

Families and Schools Together, Inc. FASTWORKS manual. Madison, WI: Author.

Families and Schools Together, Inc.. FAST PCS training manual. Madison, WI: Author.

Families and Schools Together, Inc.. Middle school FAST: Trainer's resource kit. Madison, WI: Author.

Families and Schools Together, Inc. Baby FAST program guide. Madison, WI: Author.

Families and Schools Together, Inc. FAST program guide. Madison, WI: Author.

Families and Schools Together, Inc. FAST research background [DVD]. Madison, WI: Author.

Families and Schools Together, Inc. FAST training presentations [CD-ROM]. Madison, WI: Author.

FAST Web site

McDonald, L.. Baby FAST program manual. Madison, WI: Families and Schools Together, Inc.

McDonald, L. High school FAST program manual. Madison, WI: Families and Schools Together, Inc.

McDonald, L., Morgan, A., Billingham, S., Kiser-Billingham, B., Coe-Braddish, D., Payton, E., et al. Middle school FAST program manual. Madison, WI: Families and Schools Together, Inc.

McDonald, L., & Scalia, P. Families & Schools Together (FAST): Interactive CD-ROM. Madison, WI: University of Wisconsin Board of Regents.

McDonald, L., & Scalia, P. FAST babies: Trainer resource kit. Madison, WI: Families and Schools Together, Inc.

Scott, D., McDonald, L., Roessler, J., & Scalia, P. Multi-site replication manual: Taking FAST to scale. Madison, WI: Families and Schools Together, Inc.

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
4.0	4.0	4.0	4.0

Dissemination Strengths

Excellent materials and a strong implementation model support the implementation of this program. Detailed information on funding and sustaining the program is available to administrators. Robust training, consultation, and trainer certification are provided by developers. Training includes comprehensive information for both planning and implementation. Evaluation is seen as an integral part of program implementation and is addressed during training. Numerous evaluation tools and clear instructions for their use support a comprehensive quality assurance package.

Dissemination Weaknesses

No weaknesses were identified by reviewers.

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
Licensing fee	$550 per site	Yes
Training package	$4,295 per site, plus travel expenses	Yes
Ongoing technical assistance	$200 per site	Yes
Evaluation package	$1,100 per site	Yes

Additional Information

A sample budget for implementing FAST is available from the developer. The training and evaluation costs given above are for 1 site serving 10 families. Training and evaluation costs are higher for "multihub" implementation involving a larger number of families across multiple sites. In developing countries, on average, 40 families are served per implementation cycle, requiring a site team of 20 team members. In the United Kingdom, on average, 20 families are served per cycle, requiring a site team of 10. Universal FAST for all kindergartners with special outreach to stressed families is the current recommended model, serving 40 families at a time, with a site team of 20. Costs for scaling up FAST for wide-scale implementation are negotiated individually.