Family Coaching as a delivery modality for evidence-based prevention programs

Abstract

Family Coaching is proposed as a new delivery format for evidence-based prevention programs (EBPPs). Three recent developments in health promotion support the potential efficacy of Family Coaching: (1) renewed interest in integrated prevention programs for multiple risk factors and behavior changes, (2) broad and long-term impacts of family-based interventions, and (3) popular acceptance of “coaching” as a nonstigmatizing, goal-focused intervention strategy. Family coaches are community members and paraprofessionals trained in common elements of EBPP. Family Coaching has specific goals, is short term, and has definable outcomes. Coaches frame the program’s goals to be consistent with the family’s values, normalize the family’s experience, assess their strengths, and help the family set goals and develop skills and routines to problem solve challenging situations. Broad dissemination of EBPP will be facilitated with delivery formats that are flexible to meet families’ priorities and providers’ desires and capacities to tailor programs to local contexts.

Introduction

While the number of evidence-based prevention programs (EBPPs) has exploded over the last 20 years, there has not been broad diffusion or adoption of the programs nationally or globally (Cochrane Community, 2014). Low utilization of preventive services is one of the top risk factors contributing to excess morbidity and mortality in the United States (Chowdhury et al., 2016) and globally (Strong, Mathers, Leeder, & Beaglehole, 2005). The lack of EBPP penetration has resulted in calls to develop EBPP with strong consumer demand (Valente, 2006), which task-shift prevention from medical professionals to paraprofessionals and community members (World Health Organization (WHO), 2007), and with opportunities for providers to adapt programs to local contexts and priorities (Dworkin, Pinto, Hunter, Rapkin, & Remien, 2008; Rotheram-Borus, Swendeman, & Becker, 2014; Rotheram-Borus, Swendeman, & Chorpita, 2012).

The goal of this article is to describe Family Coaching as a modality for delivering EBPP to children and families, a modality that has potential for strong consumer demand, greater flexibility for provider adaptation and sense of ownership, and broad diffusion of early intervention and prevention. We propose Family Coaching as a generic delivery format for a wide range of EBPP to prevent minor challenges from becoming major problems for a variety of outcomes over the life course. Three recent developments in health promotion and disease prevention support the potential efficacy of Family Coaching: (1) renewed interest in and evidence for the efficacy of multiple risk factor (MRF) interventions, multiple behavior change research, and integrated versus disease-specific prevention programs; (2) the broad and long-term impacts of early childhood and family-based interventions; and (3) the emergence from the marketplace of “coaching” as a goal-focused intervention and support strategy. Following a brief review of these developments, we outline the general framework for Family Coaching and conclude with discussion of implications for research and evidence-based practice.

MRF interventions and multiple behavior change interventions

EBPP typically target a single health outcome and narrow range of behaviors (e.g. eating behaviors for obesity and safer sex for HIV prevention). Yet, many diseases share risk behaviors, which often cluster in individuals and populations (Brandt et al., 2001). For example, over half of all Americans have two or more of the four behavioral risk factors that contribute to half of the morbidity and mortality in the United States: physical inactivity, an unhealthy diet, use tobacco, and misuse alcohol frequently (Fine, Philogene, Gramling, Coups, & Sinha, 2004). Individuals with high levels of emotional distress are twice as likely to have three or four of these risk factors (Fine et al., 2004). Similar trends are well documented for the co-occurrence of sexual risks, substance abuse, medical non-adherence, and emotional distress among people at risk of or living with HIV and co-occurring infections (Jessor & Jessor, 1977; Kalichman, 2008; Tomlinson et al., 2013).

Recognition of the co-occurrence of risk factors for multiple diseases had led to renewed interest in MRF interventions and multiple health behavior change research (Atkins & Clancy, 2004; Prochaska, Spring, & Nigg, 2008). In the global health arena, the limitations of disease-specific programs have led to calls for integrating prevention programs so that multiple risks are addressed concurrently (O’Connell, Boat, & Warner, 2009). For example, one of our programs in South Africa addresses HIV, tuberculosis, alcohol use, and malnutrition among South African pregnant women. Similar integrations have been advocated for increasingly prevalent noninfectious chronic illnesses (Merson, O’Malley, Serwadda, & Apisuk, 2008; Ooms, Van Damme, Baker, Zeitz, & Schrecker, 2008; Rotheram-Borus et al., 2009). These recommendations are supported by research that identifies common elements underlying evidence-based interventions, practice, and theory across health challenges (e.g. Chorpita, Daleiden, & Weisz, 2005; Noar, Chabot, & Zimmerman, 2008; Rotheram-Borus et al., 2009).

Early studies of multiple behavior change interventions (MBCIs) or MRF interventions conducted in the 1970s were highly successful, especially with children (Kendall & Braswell, 1993). There was a long line of studies which identified both the developmental pathways by which children developed self-control and internal verbal instructions and efficacy in problem solving (e.g. Mischel & Patterson, 1976; Spivack, Platt, & Shure, 1976). Researchers designing evidence-based interventions focused on training skills, such as problem solving, emotional self-regulation, or goal setting (Bergin & Garfield, 2004). Training these generic skills in the context of a supportive relationship was efficacious in children of different developmental stages and different presenting complaints (e.g. attention deficit, impulsive behavior, and substance abuse). Yet, over time, the generation of a set of theories related specifically to health behaviors (e.g. Theory of Reasoned Action and the Health Belief Model), concurrent with the rise of a set of funding agencies at the National Institute of Health which were increasingly focused on single health outcomes, resulted in an ever-increasing set of highly specific, single outcome, manualized EBPP being developed. Cognitive-behavioral approaches were designed to shape adaption of new behavioral routines that were inconsistent with the specific risky act. In any one area of health and for every developmental period, there are multiple EBPPs aimed at achieving the same goal. For example, there are 14 EBPPs to improve parenting (Sandler, Schoenfelder, Wolchik, & MacKinnon, 2011). The Centers for Disease Control and Prevention (CDC) have identified more than 120 EBPPs which are being diffused in the United States, each with its own EBPP (CDC, 2014).

Today, this approach is increasingly questioned. A greater impact on public health may be made by integrating approach to shift multiple outcomes concurrently, and with reduced costs, compared to single-behavior interventions (Prochaska et al., 2008). This is most apparent for obesity, cardiovascular disease, cancers, and diabetes (Fine et al., 2004). However, many other EBPP ostensibly targeting a single health outcome, such as HIV transmission, actually target and impact multiple health behaviors and outcomes (e.g. sexual behavior, substance use, coping skills, mental health, and quality of life; Rotheram-Borus et al., 2006). These findings also support the theoretical postulate that successes in changing one behavior may generalize over time to other behaviors and overall lifestyle changes over time through enhanced motivation, self-efficacy, and skills (Eccles & Wigfield, 2002).

Early intervention and prevention for children and families

Early intervention and prevention programs focused on children’s social and emotional development through parent training and family-based interventions have shown wide-ranging and long-term benefits for children and parents (Leslie et al., 2016). For example, nurse home-visitation programs during pregnancy result in significant benefits for children, lasting into late adolescent and early adulthood (Olds et al., 1998; Olds et al., 2002). Early childhood interventions that included behavioral counseling, as well as school-based social development programs that included parent training, have resulted in improvements in multiple outcomes in adolescence and young adulthood including mental health, academic and economic achievement, employment, criminal and antisocial behaviors, sexual health, smoking, and alcohol use (Aronen & Kurkela, 1996; Hawkins, Kosterman, Catalano, Hill, & Abbott, 2008; Reynolds et al., 2007; Schweinhart & Weikart, 1997). Emerging data also suggests that family-based interventions have intergenerational effects. A coping intervention program for mothers with AIDS and their adolescent children found that when the adolescents became parents many years after intervention, they had better parenting outcomes and reduced negative effects of early parentification, their children had fewer internalizing and externalizing mental health symptoms, and they tend toward improved child cognitive development and home environments, compared to families randomized to the control condition (Rotheram-Borus et al., 2006; Stein, Rotheram-Borus, & Lester, 2007).

Coaching: from prevention to the marketplace

There has been an explosion of popular interest and scientific literature on individual coaching in the last 10 years. This type of person-centered coaching was first widely recognized as a process for business executives to help achieve their professional goals without the stigma of attending therapy (Feldman & Lankau, 2005). Coaching is now broadly available to help people improve their performance and balance their professional and personal goals. Although executive and employee coaching are ostensibly focused on work domains, many executive coaches note that their clients often request coaching for personal, family, and parenting challenges (Feldman & Lankau, 2005; Hawksley, 2007). Coaches are now specializing personal and life coaching as an alternative to psychotherapy (L. S. Green, Oades, & Grant, 2006). Coaching practice has gained popular acceptance and an emerging evidence base (L. S. Green et al., 2006; Hawksley, 2007). Most recently, parent coaching has emanated as an area of specialization that responds to parents’ desires and needs for support in managing their children’s behaviors and development (Forehand, Jones, & Parent, 2013; Sanders, Kirby, Tellegen, & Day, 2014; Shepard & Dickstein, 2009).

Coaching has also been used as a strategy for various health professionals to deliver their services: nurses (Huffman, 2007; Lewis & Zahlis, 1997), physicians (Kaplan, 1999), dieticians (Lipscomb, 2006), and occupational therapists (Graham, Rodger, & Ziviani, 2009). Coaching has also been used specifically to support families to:

• Increase healthy eating and exercise (Gorczynski, Morrow, & Irwin, 2008; Heimendinger et al., 2007; Van Zandvoort, Irwin, & Morrow, 2009);

• Enhance patient self-management and improve outcomes (Huffman, 2007);

• Reduce community violence (Kliewer et al., 2006) and domestic violence (Katz & Windecker-Nelson, 2006);

• Provide family therapy when some family members refuse (McGoldrick & Carter, 2001);

• Improve parenting skills around health and behavioral challenges (Mabe, Turner, & Josephson, 2001; Morawska, Stallman, Sanders, & Ralph, 2005).

Now referred to as health coaching, these strategies differ from traditional health education by emphasizing goal setting, problem solving, and skill building (Butterworth, Linden, & McClay, 2007).

Currently, there are no unified standards or definitions for coaching as a practice. The common characteristic across coaching specializations and literatures is that coaching is always goal oriented and solution focused (Simmons & Wolever, 2013; Stober & Grant, 2006). Other common characteristics include collaborative problems solving, practice, and feedback (Baldwin et al., 2012; Simmons & Wolever, 2013). Coaching is aimed at achieving specific outcomes established at an initial contact and modified over time as goals are met and new challenges are prioritized. In general, coaches aim to help individuals and groups recognize, build, and leverage their strengths to achieve a goal and adapt to changes in contexts around the goal.

Although common definitions are lacking, the “coaching” role is broadly understood in society, and there are typically positive associations with the role, most often from sports coaches (Kremer-Sadlik & Kim, 2007; Zaff, Moore, Papillo, & Williams, 2003). Children spend 24% of their non-school time in organized sports activities (Hofferth & Sandberg, 2001), where parents expect children to learn teamwork, fair play, sportsmanship, discipline, commitment, responsibility, self-esteem, and self-confidence from their coaches (Eccles, Barber, Stone, & Hunt, 2003). Sports coaches are expected to know the rules of the game and key strategies to optimize their players’ ability to achieve success during a game, as well as manage children in a group, elicit supportiveness from parents, bring out children’s effort, and train children to acquire new skills. One of the most important aspects of coaching is that sports participation is seen as a metaphor and training for larger life issues (i.e. building character) and a vehicle for socializing children to the family’s values (Kremer-Sadlik & Kim, 2007).

Parents invest their family’s and children’s time, energy, and resources to support their children’s long-term healthy development. Furthermore, a family or child is not stigmatized for having a coach. In Family Coaching, it is anticipated that these positive associations are generalized to other types of coaches and coaching. Thus, the family can conceptualize itself as a team and approach Family Coaching without the underlying stigma that is frequently cited as a barrier to participation in family therapy (Corrigan, 2004). Coaching could also prove to be effective with adolescents because it allows them to participate in developing solutions that evolve with consideration of the youth’s autonomy and through dialogue with a coach (Gorczynski et al., 2008).

Methods/strategies/intervention applications

Family Coaching: a disruptive innovation in prevention

Building on the model of disruptive innovations (Christensen, Baumann, Ruggles, & Sadtler, 2006), we propose that Family Coaching can be applied in every problem situation in which a:

• Pattern of challenges can be anticipated and recognized;

• Set of rules can be generated to help guide adaptation or resolution of the problem situation.

Disruptive innovations provide a new product or service that is “good enough” to address a common problem and results in more accessible services for a broader audience; examples include minute clinics in pharmacies, affordable insurance, community colleges, micro-finance, distance learning, and telemedicine (Christensen et al., 2006). Family Coaching is proposed as a similar disruptive innovation for early intervention and prevention by providing “good enough” services for common family problems instead of over-serving needs with high-cost services and providers such as medical doctors, psychiatrists, psychologists, and other professionals qualified to address serious and acute problems, or alternatively, through highly scripted EBPPs that typically address a single or narrow range of outcomes for a specific population.

There are a variety of settings in which Family Coaching can be implemented: schools, family services organizations, primary health-care settings, private practices, and innovative settings such as minute clinics in pharmacies or Family Coaching centers in retail settings. Across settings, we anticipate that family coach selection, training, and coaching processes are similar. We propose two broad criteria for selecting Family Coaches that will be available in any setting: “positive peer deviant” parents and community paraprofessionals.

Family coaches: positive peer deviants and community paraprofessionals

The theory of positive peer deviants suggests that a desirable deliverer of health promotion services to families is a mother or father from the local community whose children are thriving (Marsh, Schroeder, Dearden, Sternin, & Sternin, 2004). Because they are faced with the same community challenges and with similar resources (financial, educational, and cultural) as their neighbors, parents with thriving children have credibility and the ability to connect with families through empathy and common experiences in local community life, which are needed to mentor other parents (Johnson, Howell, & Molloy, 1993). Thus, we label these family coaches “Mentor Mothers” or “Mentor Fathers.”

Paraprofessional family coaches, such as mentor parents, must have positive social skills; experience with children; and must be good, pragmatic problem solvers. Paraprofessionals have knowledge of the community and can provide families with advice and links to resources without training in psychotherapy (Grimes & McElwain, 2008). Paraprofessional family coaches might be sport coaches, teachers, clergy, health educators, or other community members who have experience working with children and families.

Family coach expertise and skills are based on common elements of EBPP

A family coach is an expert about predictable problems that children and families experience. Most children will disobey their parents, fight with siblings, become anxious or depressed, experience stress at school transitions, and have trouble with academic subjects and peer relationships at some point during childhood. At least 50% of the children will experience a parental divorce or a traumatic injury or loss (Sandler, Tein, Mehta, Wolchik, & Ayers, 2000). At least one in four families will have a parent or child with a chronic illness (Strong et al., 2005). Obesity and diabetes are increasingly common in families and linked to multiple behaviors (purchasing, eating, and exercise), mental health outcomes (depression), and social influences (Epstein, Valoski, Wing, & Mccurley, 1994).

For each of these common developmental and health challenges, prevention researchers have documented the risk and protective factors, how persons of different ages and developmental capacities are likely to cope with the challenges, and have developed EBPP to address them. There are strategies embedded in the EBPPs that can make each challenge easier to experience and less likely to result in negative family outcomes. The last 50years of prevention science can inform family coaches in how to support families coping with these predictable problems. Thus, the coach’s expertise comes from having the best of scientific evidence and EBPP available to inform how to deal with common developmental and health challenges, as well as predictable problem-specific situations (e.g. birth of a child, school transitions, divorce, bereavement, and chronic illness).

We propose that family coaches can be selected, trained, and monitored paraprofessionals and mentor parents with the capacity to learn the common factors, processes, and behavioral principles of EBPP. For example, at the broadest level of abstraction, family coaches would receive training in five common factors of EBPP (Rotheram-Borus et al., 2009): (1) establishing a framework to understand behavior change; (2) conveying issue-specific and population-specific information necessary for healthy actions; (3) building cognitive, affective, and behavioral self-management skills; (4) addressing environmental barriers to implementing healthy behaviors; and (5) providing tools to develop ongoing social and community support for healthy actions.

Like all EBPP, Family Coaching must first set realistic expectations about its goals, content, and outcomes as well as expectations for the coaches’ and family members’ roles. The role of the coach complements the role of the family. Families are presumed to be well intentioned, caring for each other, and competent as the most knowledgeable informants about themselves. A coach’s first job is to help the family remember and focus on its strengths; it is important to help families place their current challenges in the larger perspective of their lifespan. Focusing on a family’s strengths typically helps to relieve the immediate emotional distress that is associated with the presenting problem. It reminds the family of the many happy, loving experiences and their competencies in dealing with earlier challenges. Once a context of positive family caring is reestablished (Stuart, Tripodi, Jayaratne, & Camburn, 1976), the coach assists the family in setting its goals for the intervention. The goal is a realistic, single change that will address a current priority set by the family.

Establishing the targeted outcome for Family Coaching is as important as the change program for the targeted outcome. When seeking wellness or preventive services, all families have their own story or narrative about their current difficulties or concerns. The 5-minute speech sample, for example, is an evidence-based strategy for recording and analyzing a family’s story about itself and any presenting problems (McCarty & Weisz, 2002). The narrative in the sample consistently identifies points to positively leverage the family’s desires for change and guides explanations developed with the coach that reframe the family’s existing conceptualizations of their current situations to facilitate the desired change.

Family coaches must have training in common processes of EBPP, which are highly consistent with cognitive-behavioral and social leaning techniques (i.e. goal setting, problem solving, self-monitoring, modeling, rehearsal, and rewards). In addition, family coaches must have the following competencies from family-based EBPP: (1) behavioral management of children, including key cognitive skills, affective skills, and verbal and nonverbal behavioral skills; (2) clear expectations about the roles of parents and children in a family; (3) an understanding of how to analyze the reinforcement contingencies for family roles around a specific challenge; (4) tools to help the family evaluate the consistency and positivity of their daily routine, the contrast between their values and their actions, and their position and opportunities within their social network; (5) the ability to establish positive bonds and to care for families; and (6) the ability to respect the limits of their role within families.

As an expert about common and predictable challenges, the coach can provide families with key information about their current problem; help them anticipate predictable sources of stress and strategies for coping with their challenge; and help them prioritize, practice, and implement solutions. A coach’s goals are limited to current challenges, not historical issues. Coaches must be clear about the limits of how they will help the family and their role in the change process. The coach is responsible for recognizing when a family needs intensive, professional help and referral to a medical or mental health professional.

Family Coaching session activities: aligning daily routines with values and goals

Almost all changes in a family will require shifts in the family’s daily routine (Weisner, 2002). Preparing for this task, coaches initially facilitate an assessment by asking the family to complete the following measures: (1) identifying and rating the relative importance of a set of family values; (2) retrospectively reporting the activity schedule for each day over the prior week and rating the quality of activities; and (3) keeping a diary for the next 3 days in real time and reporting the activities and interactions. Reviewing this information helps the coach and family realign their routines to more closely support their values and goals. The activities in Table 1 are implemented intensively at the first coaching assessment session and briefly repeated at each subsequent session to provide structural continuity and help families appreciate the value of consistent routines modeled in the session structure.

Table 1.

Activity Sequence for Family Coaching Sessions

Step	Activity	Purpose
1	Share accomplishments, favorite moments, and compliments.	Alternative to focusing on deficits, highlight the family strengths.
2	Normalize family’s experiences of stressors by sharing science-based information.	Family recognizes their experience is not unique; family members are less likely to think the problem one person’s fault.
3	Behavioral analysis of each family member’s roles and actions taken prior to, during, and after the last three times the problem occurred.	Similar family roles and rules occur across situations; leads to understanding of what factors encourage the problem and how the family can solve the problem.
4	Applaud family’s problem solving attempts from the behavioral analysis.	Family strengths are highlighted, encourages problem solving
5	Set a single, achievable goal for family and each member by next appointment.	Change occurs over time through small incremental successes
6	Scheduling additional sessions or referral to specialist services, as appropriate	Meet needs of clients given capacities of family coaches

It typically takes 1–2 hours to review the information above and evaluate whether there appear to be any significant issues that may be better served by therapy or medical treatment, rather than a brief, behaviorally focused coaching intervention. Along with the activities outlined in Table 1, several actions are accomplished during the session: (1) list and review problem incidents since the last meeting, ranking them from the easiest to the most difficult situations to manage; (2) identify a challenge priority and identify a skill to acquire and provide the family with tools to facilitate skill acquisition; (3) practice the skill and coping with stressful situations and incidents by role playing with family members exchanging roles; (4) identify the thoughts, feelings, and actions that were most helpful during the session and share compliments among family members; and (5) set specific goals to accomplish by the next coaching session.

Being different from therapy, coaching is not conducted by meeting only once weekly. It is anticipated that when the problem is first experienced, frequent meetings may facilitate initial behavior change. Time between coaching sessions allows consolidation of new skills. As skills are acquired and successes occur in coping with the problem situation, coaching sessions should be spaced over a longer period. For example, a family might be seen three times within a week or two followed by sessions 1, 2, and 6 months later to ensure that the new skills and routines that the family is practicing are sustained over time. Monitoring and feedback are basic to improving quality over time.

Limits of Family Coaching

Coaches must recognize where more intensive interventions, such as therapy or medical care, are needed and to triage these families. One of the coach’s first jobs is to identify families whose needs for intervention are greater than those that should be provided by a “prevention” program. All coaching services must be supported by a licensed psychologist or physician who can evaluate and refer families requiring more intensive services. Like other service providers, coaches recognize the following problems are beyond their capacity: suicidal and homicidal intentions; serious physical jeopardy; drug use that places the children at serious physical risk, sexual or physical abuse, or neglect situations; and serious medical or psychological disorders.

Family Coaching is also appropriate for supporting ongoing self-management of chronic illnesses. For example, families with a child or parent with diabetes (type I or II) must implement routine exercise and healthy-eating regimens. Coaches can be highly effective in helping families organize their everyday routines to adhere to self-management tasks. However, ongoing medical monitoring, such as chemotherapy or dialysis, is not appropriate to be supported by a family coach. Evidence-based coaching standards are advocated to be implemented to ensure against misuse of the practice (Griffiths & Campbell, 2008). Although paraprofessionals can become experts within a specific illness, a family coach is not intended to be an expert in a broad range of physical conditions.

Discussion

We outline Family Coaching as a delivery format for EBPP. There are multiple family and parenting interventions that are similar to coaching: they are based on cognitive-behavioral and social learning theories and techniques; delivered in fewer than 10 sessions; have an active, supportive facilitator that delivers the program; and builds on family’s strengths (Kaminski, Valle, Filene, & Boyle, 2008). These programs typically target a single outcome, often reflecting funders’ or researchers’ priorities. However, many other outcomes are targeted directly or indirectly, either as mediators (e.g. coping, communication, self-regulation, and behavioral skills) or collateral outcomes (e.g. quality of life, anxiety, and depression) to the stated priority. Family Coaching is conceptualized as a generic delivery format, based on common behavior change principles and techniques found across EBPP, that can be applied to address different developmental and health challenges. We anticipate adapting the content of existing EBPP for a specific problem to the Family Coaching delivery format. The information, skills, and predictable challenges found in the EBPPs will form the Family Coaching content for a specific problem area determined by the family and the coach. Therefore, there will be a broad range of problem domains that can be addressed within the one format, making Family Coaching an example of an MRF or MBCI.

The flexibility of Family Coaching to target multiple risks and behaviors presents both a challenge and an opportunity to broadly diffuse EBPP, by capitalizing on families’ motivation and self-determination to address their prevention and wellness priorities (Ryan & Deci, 2000). We do not propose that Family Coaching addresses multiple behaviors simultaneously, but rather sequentially through a families’ multiple priorities that will change with developmental transitions and emerging health challenges over the life course. Sequential targeting of risks and behaviors builds self-efficacy, skills, and motivation with each successful change that can be bridged or generalized to other challenges (Noar et al., 2008). Eventually, these capacities can be applied and sustained by the family without the support of a coach, as evidenced in the long-term and wide-ranging benefits of early intervention programs for families.

Conclusion

Recommendations and implications for health promotion practice and research

The validation that Family Coaching is a viable and effective delivery format for diffusion of evidence-based prevention will require substantial resources and a programmatic research agenda. For example, after synthesizing and adapting EBPP content to Family Coaching and establishing a systematic training protocol, efficacy and effectiveness must be evaluated. If Family Coaching were to be validated as an EBPP in its own right using traditional standards of evidence and phases of EBPP development and validation (Flay et al., 2005), a series of randomized controlled trials would need to be conducted taking 10 or more years. Yet, the need for locally acceptable prevention programs often leads providers to design and deliver their own programs ahead of evidence for effectiveness (Hallett, White, & Garnett, 2007). By basing Family Coaching on evidence-based practices derived from the past 30years of health promotion and prevention research, it is highly likely to be efficacious and effective. Family Coaching, therefore, is likely to be amenable to alternative standards of evidence and evaluation methods (L. W. Green & Glasgow, 2006) that could be embedded in its dissemination as a continuous quality improvement process (Rapkin & Trickett, 2005).

While multiple researchers have demonstrated that it is possible to improve children’s and families’ adjustment and sustain these changes over time, EBPP are not being broadly utilized by consumers (providers, organizations, and families) and dissemination has been slow. Yet, if we are to broadly disseminate EBPP, we need to provide choices to families of varying strategies for acquiring the information, skills, support, and resources to routinely promote their health. Family Coaching is one option for an alternative delivery format that has the potential to be scaled nationally and globally, at relatively lower costs, and with potentially high demand by families in a nonstigmatizing, strength-based, and individually tailored coaching format.

Biographies

Mary Jane Rotheram-Borus is a licensed clinical psychologist, a professor with the UCLA Department of Psychiatry and Biobehavioral Sciences, and the Director of the Global Center for Children and Families at UCLA. Dr. Rotheram-Borus founded the UCLA Family Commons, a wellness center located in shopping malls and low-income schools, to deliver evidence informed interventions. Her research interests include HIV prevention with adolescents, children and family wellness, and assessment and modification of children’s social skills.

Dallas Swendeman is Associate Professor in the Department of Psychiatry and Biobehavioral Sciences at UCLA. He Co-Directs the UCLA Global Center for Children and Families, and is Co-Director of the Center of Expertise on Women’s Health, Gender and Empowerment for the University of California Global Health Institute. His research focuses on child and family wellbeing for early prevention and intervention, HIV prevention and self-management with youth and sex workers, and empowerment and technology-based intervention modalities.

Erin Rotheram-Fuller is an Associate Professor at Mary Lou Fulton Teachers College at Arizona State University as well as a licensed psychologist. Specializing in autism research, Dr. Erin Rotheram-Fuller studies the school and family environment and support systems around children with social and educational challenges.

Maryann K. Youssef is a Project Director on an NICHD funded adolescent HIV project at UCLA. Ms. Youssef received her Master’s in Public Health at the University of Miami and has experience working on projects in Los Angeles and South Africa on maternal and child health, HIV, drug and alcohol abuse, and family wellness.