An argument for online family-based prevention program's adaption in response to COVID-19

Following the COVID-19 outbreak, clients served by child protection agencies found themselves isolated due to physical distancing measures that limited direct service provision. Despite the inherent benefits of these measures in controlling the spread of COVID-19, they created significant strains on professional and community support systems. As a result, many service providers found themselves altering their social services delivery from in-person to online platforms. Even with the advent of more advanced telehealth technologies, the implementation of behavioral programming falls mainly on the caregivers of the clients that are served. In this summary, we present Cohen and Tisch's (2020) article that describes the retooling and online adaptation of the Celebrating Families! (CF!) Intervention.

CF! is a 3- to 4-month manualized intervention developed primarily by professionals with expertise in recovery from substance use disorders for families with at least one parent identified with substance use problems and either implicated in an adjudicated child abuse or neglect incident or suspected of putting the family at risk for future incidents. CF! is designed to improve parenting skills, family functioning, and family relationships to break the cycle of intergenerational adverse experiences and substance use problems. Throughout 14 sessions, this intervention uses in-person group meetings to focus on parenting skills, family relationships, problem-solving, emotional regulation, psychoeducation, and future orientation, among other components. A retooling and adaptation of the CF! to become online was implemented because of COVID.

This quasi-experimental mixed-methods study reports on the implementation using a two-group design to compare CF! outcomes of online and in-person treatment groups. The online group was comprised of a sample of 41 participants in four cohorts between March and May 2020, while the in-person group included 58 participants who received services in five cohorts from January 2017 through June 2018. An ANOVA was used to test the within-group improvement over time in both the in-person and online groups and between-group similarity of the in-person and online groups' outcomes. The qualitative content analysis provided a depth of information from families' voices and their intervention's satisfaction.

Study results indicate that both groups showed improvement in outcomes, with moderate effect sizes. More precisely, both interventions moderately improved parenting skills, family relationships, and parent self-efficacy over time. However, the average scores of the online groups were generally lower than the in-person scores. One explanation may be that online classes occurred during the early weeks of the COVID -19 pandemic, while the in-person intervention occurred pre-pandemic. COVID – 19 resulted in additional stress through "lock-down" policies; the social and economic sequelae of such measures may be contributing factors affecting families and, in turn, influencing their scores in the CF! scales. With the onset of pandemic-related stressors and the uncertainty about returning to normal social and economic patterns, such stress becomes more and more chronic over time. It may affect psychotherapeutic interventions' ability to have the same successes as obtained during pre-COVID times.

The qualitative method addressed participants' accounts of improvements in parenting behaviors, family relationships, coping skills, and knowledge insights using open-ended questions instruments. They also revealed high satisfaction from participants in both groups. Interestingly, online CF! participants had a better completion rate than the in-person mode.

Reasons for higher completion of the program may be related to the constraints imposed in the early days of the shelter-in-place policies—more family members were at home during this time with fewer options to distract them from the classes. Indeed, the convenience of online delivery may have increased participation, regardless of the pandemic.

This research shows promise in delivering online programs, even those that are highly relational interactive family group intervention. The similarity of responses from both the in-person and online participants to the Satisfaction Questionnaire shows that both options can meet this population's needs. This study confirms that in person social work services can be retooled for online delivery. CF! Intervention can positively affect changes in family relationships, parenting behaviors, and coping skills, all of which are required to break the cycle of substance use problems and adverse family experiences.