The 4 Rs and 2 Ss is a curriculum-based practice designed to strengthen families, decrease child behavioral problems, and increase engagement in care. It is a 16 week multiple family group model that focuses on parts of family life that have been empirically linked to youth conduct difficulties:
Rules
Responsibilities
Respectful Communication
Relationships
Stress
Social Support
Last reviewed: 2025
Intended Outcomes:
- Increased family cohesion
- Increased family communication
- Decreased reports of oppositional defiant behaviors
- Decreased child inattention
- Decreased problematic parent-child interactions
- Families stay in treatment longer
- Decreased parenting stress
Continuum of Care:
Treatment
Topic Areas:
Behavioral Health/Mental Health, Disruptive Behaviors
Ages:
Childhood (4-12)
Geographic Locations:
Rural, Urban
Delivery Settings:
Community-Based, School-Based
Cultural Considerations:
A balanced amount of the research involved diverse populations
Audience:
Parents and families of children ages 4-11 years old who show defiant behavior.
Credentials:
This program is implemented by clinicians.
Manuals:
Yes
Is Training Required?
Yes, see developer info
Who can provide the required training?
Unknown.
Program Costs (materials, training, etc.):
Yes, refer to program website
Program/Practice Website:
https://mcsilver.nyu.edu/4rs-2ss/
Relevant Published, Peer-Reviewed Research:
Acri, M., Hamovitch, E., Mini, M., Garay, E., Connolly, C., & McKay, M. (2017). Testing the 4Rs and 2Ss Multiple Family Group intervention: study protocol for a randomized controlled trial. Trials, 18(1), 588. https://doi.org/10.1186/
Acri, M., Falek, I., Hamovitch, E., Gopalan, G., Bornheimer, L., & McKay, M. (2022). An Examination of the 4 Rs 2 Ss for Problem Behaviors: A Preventive Approach. Families in Society. https://doi.org/10.1177/
Bahar, O. S., Byansi, W., Kivumbi, A., Namatovu, P., Kiyingi, J., Ssewamala, F. M., McKay, M. M., & Nyoni, T. (2020). From “4Rs and 2Ss” to “Amaka Amasanyufu” (Happy Families): Adapting a U.S.-based Evidence-Based Intervention to the Uganda Context. Family Process, 59(4), 1928-1945. https://doi.org/10.1111/famp.
Gopalan, G. (2016). Feasibility of improving child behavioral health using task-shifting to implement the 4Rs and 2Ss program for strengthening families in child welfare. Pilot Feasibility Stud 2, 21. https://doi.org/10.1186/
Small et al. (2015). Meeting the complex needs of urban youth and their families through the 4Rs 2Ss Family Strengthening Program: The “real world” meets evidence-informed care. Res Soc Work Pract. 2015 July 1; 25(4): 433–445. doi:10.1177/1049731514537900.
Ssewamala, F. M., McKay, M. M., Sensoy Bahar, O., Nabunya, P., Neilands, T., Kiyingi, J., Namatovu, P., Guo, S., Nakasujja, N., & Mwebembezi, A. (2022). Suubi4StrongerFamilies: A study protocol for a clustered randomized clinical trial addressing child behavioral health by strengthening financial stability and parenting among families in Uganda. Frontiers in Psychiatry, 13, 949156. https://doi.org/10.3389/fpsyt.
Additional Sources:
WV Rating:
Promising
»WV Ratings Info
Rationale for Rating:
The program shows promising results for reducing child conduct difficulties and improved social skills. It has shown to work best with children who have a diagnosis of Oppositional Defiant Disorder, and the results have been strongest with increased severity of the symptoms of ODD. The positive results that have been shown in the research have typically stayed with the participants over time, also showing promise. It would be recommended that further study be conducted, as many adaptations have occurred throughout the progression and history of research. It is hard to determine which adaptation or program version/foundation/theory is strongest. In some cases, parental stress has shown to increase, and further research could determine what settings and adaptations show best results for all of these aspects of the research history.
Contraindications or Concerns:
Parenting stress has been shown to increase in some instances.
Other Registries/Ratings
The California Evidence-Based Clearinghouse for Child Welfare:
Not On Registry
Blueprints for Healthy Youth Development:
Not On Registry
Clearinghouse for Military Family Readiness:
Not On Registry
Office of Juvenile Justice and Delinquency Prevention Model Programs Guide:
Washington State Institute for Public Policy:
Not On Registry