Channels of change: contrasting network mechanisms in the use of interventions

Predictors of champion behaviors in an evidence-based parenting program: A structural equation modeling approach

The importance of champions in the implementation of evidence-based public health programs has been well established. Champions perform a range of behaviors which can have significant influence on the adoption and sustainability of interventions. This study investigates champion behaviors in parenting practitioners with the aim to provide insight into the range and extent that practitioners engage in champion behaviors and to examine predictors of practitioners' champion behaviors using structural equation modeling. Data were collected during a large international implementation survey of 1606 practitioners trained to deliver an evidence-based parenting program, the triple P-Positive Parenting Program. We developed a 13-item Champion Behaviors Scale which was administered alongside other measures of predictors of implementation outcomes. Perceived usefulness of the program was the most important facilitator of both public and personal champion behaviors. Certain desirable features of the program tended to not only be positively associated with the perceived usefulness of the program, but also had a unique impact on practitioners' personal champion behaviors. Higher positions within organizations were linked with more public champion behaviors. Although organizational support was found to be unrelated to champion behaviors in the structural model, it facilitated other predictors of champion behaviors.

Scaling and Disseminating Brief Bullying Prevention Programming: Strengths, Challenges, & Considerations

Peer bullying occurs frequently among middle school youth, negatively impacting students and the broader school climate. However, during these years there is a gap in translating empirically supported prevention science into school-based practices. This paper describes how the evidence-based Free2B bullying prevention multi-media assembly was disseminated by a team of educators, researchers, and technologists to over 14,000 students in 40 middle schools across the state. This dissemination and scaling effort was conducted in partnership with the state's government officials and Office of Safe Schools in order to ensure that each school and district across the state had equal access in applying for the programming. Over half of participating students expressed concerns about school bullying, with 36% reporting victimization and 17% reporting perpetration of bullying in the past month. Significant improvements were found in problem-solving knowledge, confidence in being a positive bystander, and sympathy for peer victims. We discuss gender and community setting differences (urban, suburban, rural) in the findings, implications for dissemination and implementation science, and school psychologists' role in disseminating bullying prevention practices.

The effect of caregiver key opinion leaders on increasing caregiver demand for evidence-based practices to treat youth anxiety: protocol for a randomized control trial

Background

Research has identified cognitive behavioral therapy with exposures (CBT) as an effective treatment for youth anxiety. Despite implementation efforts, few anxious youth receive CBT. Direct-to-consumer marketing offers a different approach to address the unmet need for youth receiving effective treatments. Involving a local caregiver key opinion leader in direct-to-consumer initiatives may be an effective strategy to increase caregiver demand for CBT. Research indicates that key opinion leaders improve health promotion campaigns, but key opinion leaders have not been studied in the context of increasing caregiver demand for evidence-based treatments.

Method

Project CHAT (Caregivers Hearing about Anxiety Treatments) will test the role of key opinion leader participation in conducting outreach presentations to increase caregiver desire to seek CBT for their youth’s anxiety. Caregiver attendees (N = 180) will be cluster randomized by school to receive one of two different approaches for presentations on CBT for youth anxiety. Both approaches will involve community outreach presentations providing information on recognizing youth anxiety, strategies caregivers can use to decrease youth anxiety, and how to seek CBT for youth anxiety. The researcher-only condition will be co-facilitated by two researchers. In the key opinion leader condition, a caregiver key opinion leader from each local community will be involved in tailoring the content of the presentation to the context of the community, co-facilitating the presentation with a researcher, and endorsing strategies in the presentation that they have found to be helpful. In line with the theory of planned behavior, caregiver attendees will complete measures assessing their knowledge of, attitudes towards, perceived subjective norms about, and intention to seek CBT pre- and post-presentation; they will indicate whether they sought CBT for their youth at 3-month follow-up. Results will be analyzed using a mixed method approach to assess the effectiveness of a key opinion leader to increase caregiver demand for CBT.

Discussion

This study will be the first to examine the potential of key opinion leaders to increase caregiver demand for CBT. If proven effective, the use of key opinion leaders could serve as a scalable dissemination strategy to increase the reach of evidence-based treatments.

Trial registration

This trial was registered on clinicaltrials.gov (NCT04929262) on June 18, 2021. At the time of trial registration, pre/post-presentation data had been collected from 17 participants; thus, it was retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-021-00213-x.

Dissemination Science in School Mental Health: A Framework for Future Research

There has been an increase in school mental health research aimed at producing generalizable knowledge to address longstanding science-to-practice gaps to increase children's access to evidence-based mental health services. Successful dissemination and implementation are both important pieces to address science-to-practice gaps, but there is conceptual and semantic imprecision that creates confusion regarding where dissemination ends and implementation begins, as well as an imbalanced focus in research on implementation relative to dissemination. In this paper, we provide an enhanced operational definition of dissemination; offer a conceptual model that outlines elements of effective dissemination that can produce changes in awareness, knowledge, perceptions, and motivation across different stakeholder groups; and delineate guiding principles that can inform dissemination science and practice. The overarching goal of this paper is to stimulate future research that aims to advance dissemination science and practice in school mental health.

A Social Network Analysis of Friendship and Spiritual Support in a Religious Congregation

Religious congregations are social settings where people gather together in community to pursue the sacred (Pargament, 2008). Such settings are important to understand as they provide a context for individuals to develop relationships, share ideas and resources, and connect individuals to larger society (Todd, 2017a). Yet, research to date has not deeply examined the inherently relational nature of religious congregations. Thus, in this study, we used social settings theory (Seidman, 2012; Tseng & Seidman, 2007) to develop and test hypotheses about relationships within one Christian religious congregation. In particular, we used social network analysis to test hypotheses about relational activity, popularity, and homophily for friendship and spiritual support types of relational links. Our findings demonstrate how relational patterns may be linked to participation in congregational activities, occupying a leadership role, a sense of community and spiritual satisfaction, stratification, socialization, and spiritual support. Overall, this advances theory and research on the relational aspects of religious congregations, and more broadly to the literature on social settings. Limitations, directions for future research, and implications for theory and religious congregations also are discussed.

Implementation capital: merging frameworks of implementation outcomes and social capital to support the use of evidence-based practices

BACKGROUND

Although there is growing recognition that the implementation of evidence-based practices is a social process, the conceptualization of social capital in implementation frameworks often conflates bonding and bridging social capital. This conflation makes it difficult to concretely operationalize social capital and limits the concept's utility for explaining implementation outcomes.

DISCUSSION

We propose a new framework of implementation capital that merges an existing conceptual framework of implementation outcomes with an existing operational framework of social capital. First, we review a conceptual framework of implementation outcomes, which includes the acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, and sustainability of evidence-based practices. Second, we describe an operational framework of social capital that grounds bonding and bridging social capital in the structure of implementers' social networks. Third, we bring these two frameworks together to create a merged framework of implementation capital that shows how specific aspects of social capital can support specific implementation outcomes. Implementation outcomes of acceptability, appropriateness, and adoption are linked to bonding social capital through mechanisms of trust and norm enforcement, while outcomes of feasibility and fidelity are linked to bridging social capital through mechanisms of increased access to information and resources. Additionally, setting-level implementation outcomes of cost, penetration, and sustainability are associated with small worldliness at the setting level, which simultaneously optimizes both bonding and bridging social capital in a setting.

CONCLUSION

The implementation capital framework is helpful because it separates two distinct forms of social capital-bonding and bridging-that are often conflated in the implementation literature, and offers concrete ways to operationalize them by examining the structure of implementers' social networks and the networks of their settings. This framework offers specific guidance about how individual and setting networks might be shifted to support implementation outcomes.

Teacher Job Stress and Satisfaction in Urban Schools: Disentangling Individual-, Classroom-, and Organizational-Level Influences

Schools remain among the most frequent providers of children's mental health services, particularly in low-income urban settings. Several decades of research have focused on training teachers to implement evidence-based interventions for minimizing disruptive behavior. Studies consistently demonstrate robust improvements in student behavior and learning; however, the impact on teachers' work-related stress or satisfaction is not well understood. Six urban, high-poverty elementary schools were randomly assigned to a school mental health services model (Links to Learning; L2L) for referred, disruptive students or to services and professional development as usual (SAU). Teachers (n = 71, K-4 general education teachers) in L2L schools participated in professional development and consultation in two universal and two targeted interventions to reduce disruptive behaviors and promote learning. Teachers (n = 65) in SAU schools participated in professional development as usual. Multiple regression models examined teacher reports of individual-level self-efficacy, classroom-level student functioning, and school-level organizational health as predictors of stress and satisfaction. Findings revealed no significant difference between conditions on teacher work-related stress or satisfaction. Organizational health was the strongest predictor of stress and satisfaction. Training on and implementation of evidence-based classroom interventions did not appear to significantly impact teachers' work-related stress or satisfaction. Instead, findings point to organizational climate and teacher connectedness as potential levers for change, supporting prior work on teacher stress and satisfaction in schools. The significance of targeting organizational factors may be particularly significant in urban school districts.

Network Analysis in Community Psychology: Looking Back, Looking Forward

Network analysis holds promise for community psychology given the field's aim to understand the interplay between individuals and their social contexts. Indeed, because network analysis focuses explicitly on patterns of relationships between actors, its theories and methods are inherently extra-individual in nature and particularly well suited to characterizing social contexts. But, to what extent has community psychology taken advantage of this network analysis as a tool for capturing context? To answer these questions, this study provides a review of the use network analysis in articles published in American Journal of Community Psychology. Looking back, we describe and summarize the ways that network analysis has been employed in community psychology research to understand the range of ways community psychologists have found the technique helpful. Looking forward and paying particular attention to analytic issues identified in past applications, we provide some recommendations drawn from the network analysis literature to facilitate future applications of network analysis in community psychology.

Schooling and Children's Mental Health: Realigning Resources to Reduce Disparities and Advance Public Health

Schools have long been the primary setting for children's mental health services but have neither the resources nor the expertise to manage these services independently. The critical importance of school success for children's adjustment provides a strong rationale for schooling as an essential component of children's mental health services. In this article, we review evidence for how schooling and mental health coalesce, suggesting an alignment of school and community mental health resources that prioritizes successful schooling as a key mental health outcome. We describe collaborative principles and ecological practices that advance a public health focus on children's mental health while also reducing the burden on schools to maintain mental health services. We close with a model of mental health services illustrating these principles and practices in high-poverty urban schools and propose future directions for research and practice to promote positive mental health for all children and youth.

Scaling-Up Youth-Led Social Justice Efforts through an Online School-Based Social Network

The exploration of social networking sites (SNS) in promoting social change efforts offers great potential within the field of community psychology. Online communities on SNS provide opportunities for bridging across groups, thus fostering the exchange of novel ideas and practices. Currently, there have only been limited efforts to examine SNS within the context of youth-led efforts. To explore the potential of SNS to facilitate the diffusion of social justice efforts between distinct youth groups, we linked three school-based youth-led participatory action research projects involving 54 high school students through a SNS. This study offers an innovative methodological approach and framework, utilizing social network analysis and strategic sampling of key student informants to investigate what individual behaviors and online network features predict student adoption of social change efforts. Findings highlight prospective facilitators and barriers to diffusion processes within a youth-led online network, as well as key constructs that may inform future research. We conclude by providing suggestions for scholars and practitioners interested in examining how SNS can be used to enhance the diffusion of social justice strategies, youth-led engagement efforts, and large-scale civic organizing.

Enhancing dissemination and implementation research using systems science methods

BACKGROUND

Dissemination and implementation (D&I) research seeks to understand and overcome barriers to adoption of behavioral interventions that address complex problems, specifically interventions that arise from multiple interacting influences crossing socio-ecological levels. It is often difficult for research to accurately represent and address the complexities of the real world, and traditional methodological approaches are generally inadequate for this task. Systems science methods, expressly designed to study complex systems, can be effectively employed for an improved understanding about dissemination and implementation of evidence-based interventions.

PURPOSE

The aims of this study were to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity.

METHOD

Case examples of three systems science methods-system dynamics modeling, agent-based modeling, and network analysis-are used to illustrate how each method can be used to address D&I challenges.

RESULTS

The case studies feature relevant behavioral topical areas: chronic disease prevention, community violence prevention, and educational intervention. To emphasize consistency with D&I priorities, the discussion of the value of each method is framed around the elements of the established Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework.

CONCLUSION

Systems science methods can help researchers, public health decision makers, and program implementers to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity.

Redesigning community mental health services for urban children: Supporting schooling to promote mental health

OBJECTIVE

This study examined a school- and home-based mental health service model, Links to Learning, focused on empirical predictors of learning as primary goals for services in high-poverty urban communities.

METHOD

Teacher key opinion leaders were identified through sociometric surveys and trained, with mental health providers and parent advocates, on evidence-based practices to enhance children's learning. Teacher key opinion leaders and mental health providers cofacilitated professional development sessions for classroom teachers to disseminate 2 universal (Good Behavior Game, peer-assisted learning) and 2 targeted (Good News Notes, Daily Report Card) interventions. Group-based and home-based family education and support were delivered by mental health providers and parent advocates for children in kindergarten through 4th grade diagnosed with 1 or more disruptive behavior disorders. Services were Medicaid-funded through 4 social service agencies (N = 17 providers) in 7 schools (N = 136 teachers, 171 children) in a 2 (Links to Learning vs. services as usual) × 6 (pre- and posttests for 3 years) longitudinal design with random assignment of schools to conditions. Services as usual consisted of supported referral to a nearby social service agency.

RESULTS

Mixed effects regression models indicated significant positive effects of Links to Learning on mental health service use, classroom observations of academic engagement, teacher report of academic competence and social skills, and parent report of social skills. Nonsignificant between-groups effects were found on teacher and parent report of problem behaviors, daily hassles, and curriculum-based measures. Effects were strongest for young children, girls, and children with fewer symptoms.

CONCLUSION

Community mental health services targeting empirical predictors of learning can improve school and home behavior for children living in high-poverty urban communities.

Future Directions for Dissemination and Implementation Science: Aligning Ecological Theory and Public Health to Close the Research to Practice Gap

Dissemination and implementation science (DI) has evolved as a major research model for children's mental health in response to a long-standing call to integrate science and practice and bridge the elusive research to practice gap. However, to address the complex and urgent needs of the most vulnerable children and families, future directions for DI require a new alignment of ecological theory and public health to provide effective, sustainable, and accessible mental health services. We present core principles of ecological theory to emphasize how contextual factors impact behavior and allow for the reciprocal impact individuals have on the settings they occupy, and an alignment of these principles with a public health model to ensure that services span the prevention to intervention continuum. We provide exemplars from our ongoing work in urban schools and a new direction for research to address the mental health needs of immigrant Latino families. Through these examples we illustrate how DI can expand its reach by embedding within natural settings to build on local capacity and indigenous resources, incorporating the local knowledge necessary to more substantively address long-standing mental health disparities. This paradigm shift for DI, away from an overemphasis on promoting program adoption, calls for fitting interventions within settings that matter most to children's healthy development and for utilizing and strengthening available community resources. In this way, we can meet the challenge of addressing our nation's mental health burden by supporting the needs and values of families and communities within their own unique social ecologies.

Top-down, bottom-up, and around the jungle gym: a social exchange and networks approach to engaging afterschool programs in implementing evidence-based practices

This paper uses concepts from social networks and social exchange theories to describe the implementation of evidence-based practices in afterschool programs. The members of the LEGACY Together Afterschool Project team have been involved in conducting collaborative research to migrate a behavioral strategy that has been documented to reduce disruptive behaviors in classroom settings to a new setting-that of afterschool programs. We adapted the Paxis Institute's version of the Good Behavior Game to afterschool settings which differ from in-school settings, including more fluid attendance, multiple age groupings, diverse activities that may take place simultaneously, and differences in staff training and experience (Barrish et al. in J Appl Behav Anal 2(2):119-124, 1969; Embry et al. in The Pax Good Behavior Game. Hazelden, Center City, 2003; Hynes et al. in J Child Serv 4(3):4-20, 2009; Kellam et al. in Drug Alcohol Depend 95:S5-S28, 2008; Tingstrom et al. in Behav Modif 30(2):225-253, 2006). This paper presents the experiences of the three adult groups involved in the implementation process who give first-person accounts of implementation: (1) university-based scientist-practitioners, (2) community partners who trained and provided technical assistance/coaching, and (3) an afterschool program administrator. We introduce here the AIMS model used to frame the implementation process conceptualized by this town-gown collaborative team. AIMS builds upon previous work in implementation science using four phases in which the three collaborators have overlapping roles: approach/engagement, implementation, monitoring, and sustainability. Within all four phases principles of Social Exchange Theory and Social Network Theory are highlighted.

A call to address complexity in prevention science research

The problems targeted by preventive interventions are often complex, embedded in multiple levels of social and environmental context, and span the developmental lifespan. Despite this appreciation for multiple levels and systems of influence, prevention science has yet to apply analytic approaches that can satisfactorily address the complexities with which it is faced. In this article, we introduce a systems science approach to problem solving and methods especially equipped to handle complex relationships and their evolution over time. Progress in prevention science may be significantly enhanced by applying approaches that can examine a wide array of complex systems interactions among biology, behavior, and environment that jointly yield unique combinations of developmental risk and protective factors and outcomes. To illustrate the potential utility of a systems science approach, we present examples of current prevention research challenges, and propose how to complement traditional methods and augment research objectives by applying systems science methodologies.

Reinventing Mpowerment for black men: long-term community implementation of an evidence-based program

Although research on the dissemination of evidence-based programs to community providers has rapidly grown, research describing implementation of evidence-based efforts remains a central need. Insight on implementation may aid in developing approaches to assisting organizations to use a variety of evidence-based practices effectively and to improve the design of programs that can and will be used faithfully. This mixed-method case study provides a descriptive account of the implementation of an evidence-based program designed principally for white gay and bisexual young men, the Mpowerment Project, in the 4th and 5th years after its initial adoption by an organization serving black gay and bisexual men. We identify factors that have shaped how the program has evolved and is currently operated. The case study results highlight how the dynamic interaction of practice-based experiences, skills, relationships, local context, and practitioner judgments about the relevance and credibility of evidence for specific actions propel the reinvention of evidence-based program procedures. Implications for research and practice are provided.

Teachers Supporting Teachers in Urban Schools: What Iterative Research Designs Can Teach Us

Despite alarming rates and negative consequences associated with urban teacher attrition, mentoring programs often fail to target the strongest predictors of attrition: effectiveness around classroom management and engaging learners; and connectedness to colleagues. Using a mixed-method iterative development framework, we highlight the process of developing and evaluating the feasibility of a multi-component professional development model for urban early career teachers. The model includes linking novices with peer-nominated key opinion leader teachers and an external coach who work together to (1) provide intensive support in evidence-based practices for classroom management and engaging learners, and (2) connect new teachers with their larger network of colleagues. Fidelity measures and focus group data illustrated varying attendance rates throughout the school year and that although seminars and professional learning communities were delivered as intended, adaptations to enhance the relevance, authenticity, level, and type of instrumental support were needed. Implications for science and practice are discussed.