The Strengthening Hawaii Families Program
The Coalition for Drug-Free Hawaii has revised SFP to be more culturally appropriate for Hawaiian Asian/Pacific Islanders. The Strengthening Hawaii Families (SHF) Program has a 20-session curriculum that emphasizes awareness of family values, family relationships, and communication skills. A 10-session family and parenting values curriculum precedes the 10-session SFP family management curriculum to increase parental readiness for change. The revised curriculum covers topics such as connecting with one another, using caring words, building generational continuity, appreciating culture, communicating, ensuring honesty, making choices, building trust, expressing anger, and developing problem-solving, decisionmaking, and stress management skills. Audiotapes and videotapes accompany the new curriculum manuals. An independent evaluation was conducted (Kameoka, 1996) using a quasi-experimental, pretest-posttest, nonequivalent control group design to evaluate the effectiveness of hypothesized outcome variables on program objectives. The original 14-session SFP was implemented in 4 sites and compared with the 20-session, culturally revised SHF program implemented in 9 sites. The measurement battery, which was culturally modified by altering words and expressions not common in Hawaii, included several different assessment instruments.
Because of SFP's high attrition (48 percent) and the lack of risk-level equivalence between the SFP and SHF groups, results of the outcome comparisons must be interpreted with caution. The sample size was small, the population was low drug users, and the curriculum was adapted to a value-based versus a social learning/social skills curriculum. The evaluator interpreted the SHF program as an educational program designed for families not in treatment or therapeutic programs. Participants receiving professional mental health services were eliminated from the data analysis to reduce bias due to their clinical status.
The outcome evaluation results indicated that both SFP and SHF programs attained the goal of strengthening family relationships and produced significant improvements in areas such as family conflict, family cohesion, and family organization. Only the original SFP resulted in statistically significant (p<0.01) improvements in attitudes and ability to reward positive behavior. Treatment and nontreatment groups differed significantly on parenting attitudes toward physical punishment. The mean posttest for the nontreatment group was 1.66, compared with 2.39 for the treatment group on this variable. Because of low numbers and high variance, however, this positive result can be reported only as a nonsignificant trend. Similarly, the original SFP resulted in a larger mean decrease from pretest to posttest in parental depression compared with the culturally modified SHF. Because of its larger sample size, which gave more power to the analysis, however, only SHF produced a statistically significant result. Even with a smaller sample size, SFP was more effective in improving children's mental health by reducing their hostility, depression, anxiety, somatization (psychological distress manifested in physical symptoms), interpersonal problems, phobias, and paranoia. The SHF program, in contrast, had a positive impact only on hostility, paranoia, and depression. Substance use decreased for SFP parents, siblings, and children but increased significantly for SHF children and nonsignificantly for SHF parents. It is not clear why the original SFP was more effective than the culturally tailored SHF. The shift from a behavior- to a values-based program may have decreased the emphasis on behavior change.
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