Families and Schools Together - FAST Netherlands

This project is a pilot study to adapt the innovative evidence based intervention Families and Schools Together (FAST) to the Dutch situation. We will furthermore lay the foundations for larger scale Dutch effectiveness studies and at the same time examine the feasibility of future implementation and dissemination of this highly promising approach. FAST is a theory driven multifamily group programme aimed at families of children aged 4 to 12, who are at risk of serious academic, social and mental health problems. It builds protective factors in children and empowers parents to be the primary prevention agents for their children. Several agencies involved with childcare (Schools, Mental Health Services and Social Services) work together with parent representatives to form a team of approximately 6-8 workers to deliver the intervention in a community near setting (usually the child's school). The team sees eight to twelve families together, in one room, at the same time for eight to ten afternoons. The threshold to attend is low, which is why the program has proven to be particularly successful in recruiting and retaining marginalised families such as those on low incomes, those socially isolated or those from ethnic minority backgrounds, who all tend to under use conventional mental health and social services. Several studies including randomised controlled trials (RCTs) have shown FAST to improve social and academic competence and to significantly reduce externalising as well as internalising symptoms in the index children. Family functioning is improved and families connect more amongst each other and with community organisations thus building social capital. FAST is well established, currently runs at over 800 schools, has been awarded numerous prizes and has model program status at the Substance Abuse and Mental Health Service Administration (SAMHSA) in the USA. We would like to make this program available in the Netherlands. METHOD: During the pilot phase we distinguish three phases: preparation, running the programme and evaluation. PREPARATION: This phase has four aims. Firstly formalities need to be finalised (including ethical approval and formal contracts between the agencies involved - letters of intent are already available). Secondly the initial team needs to be put together and trained, bearing in mind that team members should have the potential to become future trainers. Thirdly families likely to benefit from this intervention need to be recruited and fourthly practical arrangements need to be put into place (including translation of any materials necessary for parents). RUNNING FAST GROUPS: For this pilot study three consecutive FAST cycles will be run at two schools. In each of the cycles 8-12 families will be seen as a group by the team of 6-10 multi-agency, multidisciplinary workers. After each cycle the program will be adjusted and the processes smoothed. Certified FAST trainers from abroad will supervise the first two cycles. During the third cycle three national trainers will be trained. Participants: Families of children age 4-7 (boys and girls from multi-ethnic background) who have been identified as being at risk of academic, social or mental health disadvantage. For the first two groups these will be children attending a special primary school for children at risk in Leiden, the third group will be run at a regular primary school in a deprived area of Leiden. With 8-12 families per group we estimate to obtain data on ca. 30 index-children, ca. 30 siblings as well as their parents and families. EVALUATION: 1. ADAPTABILITY of the program to the Dutch situation: FAST itself uses a number of standardised measures in order to assess whether FAST delivered in any given community fulfils the overall FAST standards and whether the program does what it is intended to do. We will furthermore measure satisfaction in parents, teachers, children and the team that delivers the care. 2. FEASIBILITY of future studies and future expansion: Qualitative and quantitative assessments of the implementation process will be used. All three participating agencies (at worker and managerial level) as well as parent representatives will be questioned. We will also be able to estimate costs per cycle and per child for future programmes and make a comparison to other projects in the Netherlands. 3. EFFECTS: Pre- and post group measures will be taken regarding the index children, their siblings and their parents. We will use a number of standardised instruments to measure amongst others child's psychopathology, parental stress, family functioning, families' community involvement, child's school performance and parental and child satisfaction. The pilot data obtained can inform a future randomised controlled trial and help with power calculations as it will enable us to accurately estimate effect sizes and to identify the most appropriate instruments to use for future larger trials.