Thinking systematically for enduring family change

The family-centered prevention programs described in the previous chapters underscore (1) the importance of family systems and other theories for guiding the development of family-centered preventive programs; (2) the efficacy of such well-designed and theoretically informed programs for significantly improving outcomes for both children and parents; and (3) the robust, population-level public health benefits that can accrue from disseminating family-based programs that can simultaneously effect a wide range of risk outcomes by improving core aspects of family functioning. In addition to carefully considering change at the individual and family systems levels, the previous chapters demonstrate that there are important macro-and systems-level challenges to overcome before these types of programs can achieve their optimal reach and impact-to improve outcomes for whole populations over generations. The programs described in this volume have been uniquely successful at addressing many of these barriers, especially regarding dissemination, and in a few cases have achieved impressive scale. In many respects, the programs described in previous chapters can be viewed as the first generation of evidence-based family-centered prevention programs; they can serve as a guidepost for the development of the next generation of programs that will achieve even greater impact and scale, and do so more quickly and efficiently, and with larger effect sizes.