One of the most challenging aspects of implementing an evidence-based program is balancing fidelity and adaptation. In this interview, Rachel Ferrara, MSW and Dr. Allison Minugh discuss overcoming challenges in the implementation of the Family Matters program for Providence’s Partnerships for Success grant by prioritizing cultural responsiveness and community collaboration. Read the full Family Matters Results Summary Report here.
Could you please start by introducing yourselves and sharing about your experience in substance use prevention and your current prevention work.
Rachel Ferrara, MSW, currently serves as the Human Services Division Director for the City of Providence’s Department of Housing & Human Services (HHS). The Human Services Division serves as the coordinating body for the City’s health living policies and initiatives by implementing policy, environmental, and system changes to support community health in Providence’s neighborhoods. The Division focuses on closing the health gap through increased access to healthy food, physical activity, maternal health services, behavioral health supports, and other health-related programming. In this role, Ferrara advises the Mayor and senior policy staff on youth health, overall wellness, and chronic disease prevention, with a strong focus on substance use and overdose prevention. Her background reflects a strong commitment to substance use prevention and community health, blending strategic oversight, data-driven evaluation, and hands-on program management.
Allison Minugh, Ph.D. is president and CEO of Datacorp, a small, woman-owned business. Dr. Minugh is a trained research methodologist in behavioral health psychology and distinguished senior data scientist with specialized expertise in data governance, data handling policies and procedures, and the creation of transparent data infrastructures. As a committed life-long learner, Dr. Minugh has collaborated with leading researchers nationwide to enhance her research methodology skills. She is widely respected for her work in the prevention and treatment fields and for her exceptional abilities in needs assessment, evaluation, social indicators, data management, and analytic protocols.
Rachel Ferrara and Dr. Minugh currently work together on the City of Providence’s Municipal Strategic Prevention Framework Partnerships for Success (PFS) Grant. The City of Providence’s Department of Housing & Human Services (HHS) was awarded 5 years of funding through the Substance Abuse and Mental Health Services Agency (SAMHSA) of the United States Department of Health and Human Services for the Partnerships for Success grant in August 2020. The PFS program focuses on city-wide alcohol and tobacco/nicotine use by youths aged twelve to seventeen years, particularly in out-of-school settings.
Could you tell us about the Family Matters program? How and why did you select Family Matters as the evidence-based practice to implement?
Family Matters was originally selected as part of our Regional Substance Use Prevention Taskforce strategic plan to support our strategy for intervening with parents/families. We needed a no-cost evidence-based practice, with known effectiveness. For our Partnerships for Success grant, Family Matters was largely selected for its fit and feasibility, which suggested it would be a good candidate for adaptation.
Family Matters can be implemented by a variety of organizations and individuals, such as health promotion practitioners in health departments, school health educators, parent-teacher groups, community-based organizations, non-profits, and volunteers. The program addresses parenting techniques related to substance use prevention for a wide age range and can be applied to all genders, multiple races and ethnicities, and geographic locations. The program has been implemented since 1996 and has a solid evidence base supporting its use. It is a universal prevention program that has shown no adverse effects, concerns, or unintended consequences.
The program addresses local conditions and activities, including:
- Provides caregivers with accurate information about substance use
- Impacts attitudes towards tobacco and alcohol use
- Reduces tobacco and alcohol use in youth and adolescents
- Increases family bonding
- Increases parenting skills
What challenges did you encounter in the implementation of the program? How did you address and overcome these challenges, particularly in balancing adaptation and fidelity to the program?
Key challenges arose when scheduling the sessions and deciding between group versus individual formats. We addressed these challenges by allowing the implementation to be scheduled on a cohort-by-cohort basis. Early on we experienced a lot of apprehension from participants due to cultural norms and stigma surrounding substance use.
Some participants perceived the program funder (City of Providence) as a government threat and worried that disclosing certain information in program discussions would lead to their prosecution. This issue was addressed through further discussion of the program using culturally familiar terms and reassurance from facilitators communicating in the participant’s native language. Facilitating language seemed to be a big help.
Your implementation of the second cohort of Family Matters focused on being collaborative and community-driven. Could you tell us about the collaborative nature of this program and the people and organizations involved? What was the impetus to engage community members and organizations like the Center for Southeast Asians (CSEA)? How has this engagement enriched your work and the impact of the program?
Providence is extremely multilingual, with more than double the statewide percentage of foreign-born residents and households that speak a language other than English (over 35 different languages) at 31.6% and 48.4%, respectively. It was critical to partner with organizations that were already connected with and providing services to these populations.
CSEA uses an outreach approach to recruitment. Facilitators head into the community to local shops, neighborhoods, and community events that they know have a high population/attendance of Southeast Asian (SEA) individuals. Facilitators advocate for the program by using fliers and personally engaging with potential participants. On the spot, they provide potential participants with the recruitment flier as well as any additional information to help answer questions regarding substance use or the program curriculum.
Likewise, the Refugee Dream Center supplies information to individuals within the organization and uses more of an in-reach approach for recruitment.
With both community partners, we work closely throughout each implementation to ensure it is truly collaborative effort.
How did the program prioritize cultural sensitivity and responsiveness? How did implementation integrate and address cultural values?
The PFS program prioritized cultural responsiveness by using culturally familiar terms as well as facilitators who could communicate in the participant’s native language, which truly reassured participants. Facilitation in the participants’ native language had a big impact.
What was the process like to develop resources in Lao and Cambodian? Who was involved?
CSEA staff translated the materials into written languages. There are some strictly spoken languages used at CSEA; in these cases, staff translate on the spot.
What has been the most rewarding aspect of this experience?
Frankly, the most rewarding aspect of this experience has been seeing the participant results and sharing the outcomes in various different forums. There seems to be a great deal of interest in this adaptation that has been rewarding.
How do you envision the program evolving? What are some of the broader goals of this work?
In the future, we envision this program potentially expanding to different family members based on cultural considerations. For instance, both SEA and Refugee families tend to have more than one generation living within the household. CSEA inquired about adding grandparents as participants in future implementation. The program could also be expanded to school parents.
What advice would you give to prevention providers who encounter challenges in program implementation, particularly in balancing adaptation and fidelity?
It is truly important to perform qualitative interviews and work closely with implementation staff. You have to really dig into the issues you face while sticking to the intended delivery format. For prevention providers, it’s important to remember that it’s a real-world situation and you have to be able to adapt to unforeseen issues that will invariably arise.
