Adapting and Pilot Testing a Parenting Intervention for Homeless Families in Transitional Housing

• Date: 01 December 2018
• DOI: http://doi.org/10.1111/famp.12341
• Author: Jamila E. Holcomb,Kendal Holtrop
• Published date: 01 December 2018

Adapting and Pilot Testing a Parenting Intervention

for Homeless Families in Transitional Housing

KENDAL HOLTROP*

JAMILA E. HOLCOMB

†

Intervention adaptation is a promising approach for extending the reach of evidence-

based interventions to underserved families. One highly relevant popul ation in need of

services are homeless families. In particular, homeless families with children constitute

more than one third of the total homeless population in the United States and face several

unique challenges to parenting. The purpose of this study was to adapt and pilot test a

parenting intervention for homeless families in transitional housing. An established

adaptation model was used to guide this process. The systematic adaptation efforts

included: (a) examining the theory of change in the original intervention, (b) identifying

population differences relevant to homeless families in transitional housing, (c) adapting

the content of the intervention, and (d) adapting the evaluation strategy. Next, a pilot test

of the adapted intervention was conducted to examine implementation feasibility and

acceptability. Feasibility data indicate an intervention spanning several weeks may be

difficult to implement in the context of transitional housing. Yet, acceptability of the

adapted intervention among participants was consistently high. The findings of this pilot

work suggest several implications for informing continued parenting intervention rese arch

and practice with homeless families in transitional housing.

Keywords: Parenting/Parenthood; Intervention Adaptation; Evidence-Based Parenting

Intervention; Transitional Housing; Family Homelessness; Homeless Parents

Fam Proc 57:884–900, 2018

Evidence-based interventions have been developed to prevent and treat a variety of

public health problems; yet, their impact has been constrained by challenges in

disseminating and implementing these programs among diverse target populations. A

promising method for extending the reach of evidence-based interventions is through

intervention adaptation (Krivitsky et al., 2012; McKleroy, Galbraith, Cummings, & Jones,

2006). Intervention adaptation is defined as, “the process of altering a program to reduce

mismatches between its characteristics and those of the new context in which it is to be

implemented” (Card, Solomon, & Cunningham, 2011, p. 25). This may include addin g or

*Department of Human Development and Family Studies, Michigan State University, East Lansing, MI.

†

Children’s Home Society, Tallahassee, FL.

Correspondence concerning this article should be addressed to Kendal Holtrop, Department of Human

Development and Family Studies, Michigan State University, 552 W. Circle Drive, 1D Human Ecology,

East Lansing, MI 48824. E-mail: holtropk@msu.edu

Portions of this work were performed while the authors were at the Department of Family and Child

Sciences, Florida State University.

This study was funded by a grant from the Florida State University Council on Research and Creativity.

The authors would like to thank the parents, service providers, and administrators at the transitional

housing community for making this study possible. We would also like to thank Dr. Lenore McWey and

the other research team members who have contributed to this program of research.

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Family Process, Vol. 57, No. 4, 2018 ©2018 Family Process Institute

doi: 10.1111/famp.12341

omitting components, changing content to match a cultural context, or adjusting delivery

in response to the capacity of a service agency; however, the core components essential for

intervention effectiveness must be preserved (Backer, 2001; McKleroy et al., 2006). Recent

studies confirm the value of intervention adaptation by demonstrating favorable engage-

ment and retention (Domenech Rodr

ıguez, Baumann, & Schwartz, 2011; Wieling et al.,

2015), high acceptability from the target population (Holtrop et al., in press; Wieling et al.,

2015), and evidence of effectiveness (van Mourik, Crone, de Wolff, & Reis, 2017; Parra-

Cardona et al., 2017) when targeting diverse cultural groups. Overall, program s of inter-

vention adaptation research offer a critical opportunity for family therapists to combat

existing mental health and service disparities by increasing access to evidence-based

interventions among underserved families (Parra-Cardona et al., 2014).

The Current Context: Homeless Families in Transitional Housing

Families with children represent 35% of the U.S. homeless population (U.S. Depart-

ment of Housing and Urban Development [HUD], 2016), with as many as 2.5 million chil-

dren experiencing homelessness each year (Bassuk, DeCandia, Beach, & Berman, 2014).

This places them at risk for a number of negative outcomes. Homeless children often expe-

rience negative life events (e.g., parental imprisonment, separation from parents, witness-

ing violence), which have been associated with symptoms of traumatic stress and

emotional/behavioral problems (Herbers, Cutuli, Monn, Narayan, & Masten, 2014). Com-

pared to low-income housed children, school-aged homeless children are significantly more

likely to have mental health problems (Bassuk, Richard, & Tsertsvadze, 2015). Homeless

mothers report high rates of physical and sexual assault (Arangua, Andersen, & Gelberg,

2005) and depression (Bassuk & Beardslee, 2014). Homeless families are also at an

increased risk for child welfare involvement (Park, Metraux, Broadbar, & Culhane, 2004).

Adapting effective parenting programs for homeless families is an important component

of providing necessary services to this population (Bassuk, DeCandia, & Richard, 2015).

As many as 90% of homeless people in families stay in shelter settings (HUD 2016), so par-

enting programs must be responsive to this context. Although shelters provide important

supports and stability, they also pose unique challenges to parenting. These cha llenges

include interfering with family rules and routines, increased scrutiny aimed at parenting

practices, undermining parental authority, limiting available discipline strategies, and

exposing children to deviant peers (Holtrop, McNeil, & McWey, 2015; Mayberry, Shinn,

Benton, & Wise, 2014; Schultz-Krohn, 2004). Even once families enter supportive housing,

parenting needs remain. Lee et al. (2010) surveyed 134 families in supportive housing and

found that self-reported parenting practices were below normative means for attachment,

communication, involvement, and parenting confidence. These families also evidenced

increased risk for child socioemotional, behavioral, and academic problems (Lee et al.,

2010). In response, scholars have called for continued efforts to conduc t intervention

research with homeless families, particularly utilizing evidence-based parenting prog rams

in shelter settings (Gewirtz, Burkhart, Loehman, & Haukebo, 2014; Haskett, Loehman, &

Burkhart, 2016).

Parenting Intervention Efforts with Homeless Families

Recent reviews of parenting interventions for families exposed to homelessness con-

clude this body of research is underdeveloped and further work is needed (Gewirtz et al.,

2014; Haskett et al., 2016). Initial efforts to develop and pilot such programs have been

reported (e.g., Burns et al., 2013; Davey, 2004), although further evaluation is needed. An

example of more developed work in this area is reported by Melley et al. (2010) in their

study evaluating a therapeutic nursery program for families with young children (ages

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