FAIR (Families Actively Improving Relationships)

Based on Research Conducted at OSLC

FAIR IS AN INTENSIVE TREATMENT FOR PARENTS REFERRED TO CHILD WELFARE SERVICES FOR CHALLENGES RELATED TO SUBSTANCE USE, MENTAL HEALTH SYMPTOMS, PARENTING, AND ANCILLARY NEEDS. THE TREATMENT AIMS TO BUILD PARENTS’ SKILLS IN PARENTING AND ADDRESS THEIR SUBSTANCE USE AND MENTAL HEALTH NEEDS, WHILE PROMOTING STABILITY THROUGH HOUSING, EMPLOYMENT, AND OTHER SUPPORTS.

Project Overview

FAIR (Families Actively Improving Relationships) was designed to address the needs of parents referred to child welfare services for substance use, parenting deficits, mental health symptoms, and ancillary support.

FAIR is an intensive community-based treatment model that integrates components of evidence-based behavioral interventions including Parent Management Training (PMT; Patterson & Forgatch, 2010) developed at the Oregon Social Learning Center (OSLC) and Reinforcement Based Therapy (RBT; Jones et al., 2005), a community reinforcement approach of contingency management to address substance use. Behavioral principles from these evidence-based interventions are integrated across four treatment targets. The FAIR team meets clients in the environments in which they exist and provide hands on support to parents to help them gain healthy skills. FAIR has been rigorously evaluated in clinical trials with positive clinical outcomes.

The community-based, outpatient, intensive behavioral treatment involves five major components: 1) Teaching and supporting parenting skills including nurturing and attachment, reinforcement, emotion regulation, supervision, non-harsh discipline, and nutrition; 2) Delivering substance abuse treatment including contingency management, relationship building, day planning, healthy environments and peer choices, and refusal skills; 3) Resource building and provision of ancillary supports including help navigating housing, employment, support with court and child welfare attendance; 4) Use of incentives (FAIR bucks to spend in the FAIR store) for success with all treatment components; and 5) Ongoing engagement strategies. To implement and integrate these 5 components into one model, the FAIR team includes counselors, coaches, a resource builder, and a clinical supervisor. An overview of implementation support for FAIR and approximate annual costs is available here.

In 2019, OSLC was awarded funding to expand the Families Actively Improving Relationships (FAIR) treatment model for the prevention of opioid and methamphetamine use disorders among young parents with public system involvement. This study is part of National Institutes of Health (NIH)’s Helping to End Addiction Long-term (HEAL) Initiative. Currently, this preventive PRE-FAIR model is being implemented in five counties in Oregon and being evaluated for effectiveness. Read the project announcement here.

FAIR References

Cruden, G., Crawford, S., & Saldana, L*. (2021). Prevention adaptation of an evidence-based treatment for parents involved with child welfare who use substances. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2021.689432

Cruden, G., Campbell, M., & Saldana, L.* (2021). The impact of COVID-19 on service delivery for an evidence-based behavioral treatment for families in the child welfare system. Journal of Substance Abuse Treatment, 129, 108388. https://doi.org/10.1016/j.jsat.2021.108388

Saldana, L., Chapman, J. E., Campbell, M., Alley, Z., Schaper, H., & Padgett, C. (2021). Meeting the needs of families involved in the child welfare system for parental substance abuse: Outcomes from an effectiveness trial of the Families Actively Improving Relationships program. Frontiers in Psychology, 12, 2592. https://doi.org/10.3389/FPSYG.2021.689483

Saldana, L. (2015). An integrated intervention to address the comorbid needs of families referred to child welfare for substance use disorders and child neglect: FAIR pilot outcomes. Child Welfare Journal, 94(5), 167-168.

Saldana, L., Smith, D.K., & Weber, E. (2013). Adolescent onset of maternal substance abuse: Descriptive findings from a feasibility trial. Journal of Child and Adolescent Substance Abuse, 22, 407-420.

Principal Investigator

Lisa Saldana, Ph.D.

Active Research Projects

Primary Research and Clinical Interests

Lisa joined OSLC in 2007. She received her doctorate in clinical psychology from the University of Missouri-Columbia in 2003 with a research and clinical emphasis in child maltreatment and evidence-based practice (EBP). She has been active in the development, evaluation, and implementation of EBPs, with a particular emphasis in services for child welfare populations.

Lisa currently is the PI of a number of federally funded projects related to implementation in child serving systems. Building on her previous work with the Stages of Implementation Completion (SIC) ®, she and the SIC team are extending the SIC into the Sustainment Phase of the implementation process. Moreover, they are conducting a randomized trial of the SIC-Coaching strategy as a method for integrating implementation fidelity with intervention fidelity to increase rates of successful implementation among adolescent substance use treatment EBPs. Lisa and the SIC team have collaborated with a number of EBP developers in different service sectors, serving different populations to operationalize and monitor real-world implementation efforts. Similarly, the SIC team has developed the Cost of Implementing New Strategies (COINS) tool for assessing implementation costs across the three phases of implementation.

Lisa also is the primary developer and evaluator the R3 Supervisor Strategy. Developed in collaboration with child welfare leaders, R3 aims to bring evidence-based strategies into child welfare worker-family interactions. The model has been implemented and evaluated across both state and county driven child welfare systems. R3 has received strong endorsement from supervisors trained in the model and consistently has produced positive organizational change.

Lisa is the developer of the Families Actively Improving Relationships (FAIR) model, an integrative intervention for families referred to the child welfare system for parental substance abuse. FAIR integrates evidence-based techniques targeting four key treatment components including parental substance use, maladaptive parenting, and mental health symptoms as well as their correlated contextual problems such as housing and employment. Families referred to FAIR receive services in their natural environments (e.g., home, school, court) and receive incentives related to healthy households for meeting individualized treatment goals. Currently, Lisa and her team are implementing FAIR, and its adaptation PRE-FAIR, in five Oregon counties, as part of a NIDA-funded HEAL prevention study. FAIR is recognized by the California Evidence-Based Clearinghouse. Lisa oversees FAIR services provided to Lane and Douglas County residents through the ODI Clinic; for more information, visit odiclinic.org/fair.