Developing a family intervention to reduce substance use and HIV risk among a community sample of children and their African-American mothers who use crack cocaine: The importance of cultural adaptations

Family-level approaches can be more effective in increasing protective behaviors compared to those that focus on the parent or child alone. Evidence-based family interventions, however, require cultural adaptations to be effective with diverse populations. Research demonstrates that parenting is a culturally embedded construct; strict or ‘harsh' parenting is protective for some African-American families in resource-poor environments, whereas other ethnic groups may thrive on other parenting styles. Thus, it is critical that family interventions for African-American mothers who abuse crack cocaine be adapted to their cultural and socio-contextual environments. The NIDA-funded Families Overcoming Risk Together (FORT) study seeks to adapt and pilot test a family skills intervention for children of African-American mothers who use crack but are not in treatment. A formative, community participatory approach was used to develop strategies to reach African-American mothers, and to tailor an intervention to reduce substance use and HIV risks. Target mothers, children, and service providers participated in focus groups and an intervention advisory panel to gain a better understanding of the issues and contexts of this targeted population. Following a randomized pilot intervention trial, process focus groups helped to identify additional modifications to improve recruitment, engagement, and evaluation procedures. This presentation will present lessons learned from these formative and pilot phases about issues including recruitment, parenting practices, and next steps. Adaptation and tailoring activities with community input have been critical to understanding the familial strengths of these mothers and children and how to best build upon them to foster their resiliency in future interventions.