The foundation of PPI curriculums is the most recent research about brain chemistry, life skills education, risk and protective factors, trauma-informed/resilience-building practices, asset development, and community service. 

Adverse Childhood Experiences (ACEs) Study is an ongoing collaborative research between the Centers for Disease Control and Prevention and Kaiser Permanente, Robert F. Anda, MD, MS, and Vincent J. Felitti, MD. Over 17,000 Kaiser patients participating reveal staggering proof of the health, social, and economic risks that result from childhood trauma, including physical, chronic emotional trauma, such as depression, hallucinations and post-traumatic stress disorders in adolescence and in adulthood. ACEs seem to account for one-half to two-thirds of the serious problems with drug use; they increase the likelihood that girls will have sex before reaching 15 years of age; and that boys or young men will be more likely to impregnate a teenage girl. Families with addiction are often dealing with multiple adverse childhood experiences (ACEs): substance use, disorders, neglect, family violence and emotional, physical and sexual abuse.  Commonly there is parental separation or divorce and often one or both parents are dealing with mental illness and incarceration. Their children are among those at highest risk for future physical and mental health problems, having experienced many adverse childhood experiences (ACEs).  ACE authors have specifically noted this relationship:

  • The ACE Study provides population-based clinical evidence that unrecognized adverse childhood experiences are a major, if not the major, determinant of who turns to psychoactive materials and becomes ‘addicted’ (Felitti, 2003).

  • Growing up with alcohol abusing parents is strongly related to the risk of experiencing other categories of ACEs (Anda, 2010).

 

Protective & Risk Factors  Cumulative risks in childhood increase the risk of early alcohol and drug use and the likelihood of addiction. Research-based prevention programs can provide intervention in children's early development to strengthen protective factors and reduce risks long before problems behaviors develop (NIDA, 2014). Some risk factors are particularly potent, such as having a family history of substance use disorders. However, in an environment with no drug abusing peers and strong anti-drug norms, a child is less likely to become a drug or alcohol user. Key risk factors include:

  • lack of attachment/nurturing by parents or caregivers

  • ineffective parenting

  • a chaotic home environment

  • lack of a significant relationship with a caring adult

  • a caregiver who abuses substances, suffers from mental illness, or engages in criminal behavior.

 

An important goal of prevention is to change the balance between risk and protective factors so that protective factors outweigh risk factors (NIDA, 2014). For example, protective factors such as parental support and involvement can mitigate the influence of having substance-using peers. Self-regulation skills, relational skills, and problem-solving skills are related to positive outcomes, such as resiliency, having supportive friends, positive academic performance, improved cognitive functioning, and better social skills (Child Welfare League of America, 2014). Families can serve a protective function when there is:

 

  • a strong bond between children and families

  • supportive parenting  that meets financial, emotional, cognitive and social needs

  • parental involvement in a child's life

  • clear limits and consistent enforcement of discipline.

 

Developmental Assets identified after extensive research, Developmental Assets are critical for young people to thrive (SEARCH Institute, 2006). Many  are similar to Protective Factors, unique is the emphasis on providing

  • Sense of purpose, hope, self-esteem, and a positive view of personal future and power: being of service to others and valued; having high expectations and values of integrity, honesty, restraint, respect

  • Ability to see beauty in the world

  • Connection with caring and religious communities.

 

Family-Based Programs  The most effective prevention programs target the whole family, delaying initiation of substance use, improving youth resistance to peer pressure to use alcohol, reducing affiliation with antisocial peers, improving problem-solving and reducing levels of problem behaviors (UNODC, 2009). When family programs were compared with other prevention approaches, they were found to be the second most effective approach after in-home family support, and approximately 15 times more effective than programs that provided youth only with information (Hawkins, Kosterman, Catalano, Hill & Abbott, 2008; Hiscock, Bayer, Price, Ukoumunne, Rogers, & Wake, 2008). Moreover the effect of family skills training programs was sustained over time with long-term results of programs showing delayed initiation of substance use, improved youth resistance to peer pressure to use alcohol or drugs, reduced affiliation with antisocial peers, improved problem-solving and reduced levels of problem behaviors. With parents, positive results include sustained improvement in family and child management skills (setting standards, monitoring of behavior and consistent discipline). Family skills training programs differ from parent education programs, which focus on providing parents with information about the use of substances (UNODC, 2009).  A research review  concluded that the most effective family skills training programs include active parental involvement, focus on the development of social skills and responsibility among children and adolescents, and address issues related to substance use (Spoth, Redmond, Treadeu and Shin, 2002). Effective interventions also involve youth in family activities and strengthen family bonds. They generally combine: (a) training of parents to strengthen their parenting skills; (b) training of children in personal and social skills; and (c) family practice sessions. A typical session will see parents and children attending their own groups and, coming together as a whole family for some practice time (Spoth, Redmond, Shin & Azevedo, 2004; Spoth, Guyull & Day, 2002; Spoth, et al, 2002).

 

Reviews of Family Treatment Courts (FTCs) show that “manualized, structured, evidence-based family treatments…” are an essential component (Marlowe & Carey 2012).

PPI Curriculums incorporate research recommendations from federal agencies and national organizations:

 

  • National Institute on Drug Abuse's Prevention Principles which recommends programs enhance protective factors; reduce risk factors; target all forms of drug abuse including tobacco, alcohol, marijuana, and inhalants; teach life skills; be interactive; include a parent component and be age specific, developmentally appropriate, culturally sensitive. 

  • National Institute on Alcoholism and Alcohol Abuse's Prevention Principles which recommend that programs have clarity of purpose; address resiliency factors and risk factors; have clear "no drug" messages; teach skill building and refusal skills; offer positive healthy alternatives; include parental risk factors; and start as early as possible offering role models and support groups for specific high risk populations. 

  • US Department of Health and Human Services (DHHS) Substance Abuse and Mental Health Services Administration (SAMHSA) and ACEs Connection Network which focus on identifying and addressing Adverse Childhood Experiences (ACEs) identified by Kaiser and Center on Disease Control & Prevention in one of the largest investigations of childhood abuse and neglect and household challenges and later-life health and well-being.

  • United Nations Office on Drugs and Crime (UNODC) which recognizes that Family Skills Training for the whole family (parents and children - infancy through adolescence) positively change family functioning and parenting practices in enduring ways resulting in healthier and more supportive environments.

  • Asset Development Research, which recommends that programs build internal assets (such as caring, self-esteem, sense of purpose, and positive view of life); build external assets (family support, communication, empowerment); and teach social competencies. 

  • Harvard Center on the Developing Child whose mission is to drive science-based innovation that achieves breakthrough outcomes for children facing adversity with a focus on the early years of life. 

  • ZERO TO THREE which works to ensure that babies and toddlers benefit from the family and community connections critical to their well-being and development.

  • National Association for Children of Addiction and other research on children of addiction (COA) which recommends that programs reduce risk factors; teach communication skills: how to make healthy friends and set boundaries; increase resiliency/protective factors including teaching children that chemical dependency is a disease affecting all members of the family -- their parents love them, but have a disease that makes it difficult for them to express this love.

  • Research on children with learning differences and those exposed in utero to alcohol and other drugs, which recommends programs increase resiliency/protective factors; reduce risk factors; and emphasize areas where they can contribute. These high-risk children need to realize that they are part of something larger than themselves. They need to learn rage/anger management, how to appropriately express feelings/defenses, boundaries, problem solving and decision-making skills, and centering. Lessons need to be age-specific, developmentally appropriate, interactive, multi-modal, repetitive and structured. Self-esteem issues are critical.

RESEARCH

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