Mixed picture of readiness for adoption of evidence-based prevention programs in communities: exploratory surveys of state program delivery systems

Study protocol for a cluster-randomized trial of a bundle of implementation support strategies to improve the fidelity of implementation of schoolwide Positive Behavioral Interventions and Supports in rural schools

Background

Improving the implementation of evidence-based interventions is important for population-level impacts. Positive Behavioral Interventions and Supports (PBIS) is effective for improving school climate and students’ behavioral outcomes, but rural schools often lag behind urban and suburban schools in implementing such initiatives.

Methods/Design

This paper describes a Type 3 hybrid implementation-effectiveness trial of Rural School Support Strategies (RS3), a bundle of implementation support strategies selected to improve implementation outcomes in rural schools. In this two-arm parallel group trial, 40 rural public schools are randomized to receive: 1) a series of trainings about PBIS; or 2) an enhanced condition with training plus RS3. The trial was planned for two years, but due to the pandemic has been extended another year. RS3 draws from the Interactive Systems Framework, with a university-based team (support system) that works with a team at each school (school-based delivery system), increasing engagement through strategies such as: providing technical assistance, facilitating school team functioning, and educating implementers. The primary organizational-level outcome is fidelity of implementation, with additional implementation outcomes of feasibility, acceptability, appropriateness, and cost. Staff-level outcomes include perceived climate and self-reported adoption of PBIS core components. Student-level outcomes include disciplinary referrals, academic achievement, and perceived climate. Mediators being evaluated include organizational readiness, school team functioning, and psychological safety.

Discussion

The study tests implementation strategies, with strengths including a theory-based design, mixed methods data collection, and consideration of mediational mechanisms. Results will yield knowledge about how to improve implementation of universal prevention initiatives in rural schools.

Cooperative Extension professionals' knowledge and attitudes toward the opioid epidemic: Implications for capacity development and outreach

INTRODUCTION

Worsening of the opioid epidemic amplifies calls for involvement of the nationwide Cooperative Extension System (Extension) in addressing this crisis. Understanding knowledge and attitudes among Extension professionals who directly interact with communities is critical given identified needs for increased capacity and substantial federal investments supporting Extension's opioid response. This study explored opioid knowledge and attitudes among Extension professionals in one state to identify attitudes and perceptions that may influence community-level efforts.

METHODS

An online survey including 25 Likert scale questions about attitudes and beliefs related to substance use was administered to Extension professionals. Questions were categorized into five concept areas: treatment and community support, legal and punitive approaches, substance use as an illness, external causes of substance use, and personal causes of substance use. Descriptive statistics and response frequencies for all variables were calculated. One-way ANOVAs were used to calculate geographic differences between the state's three Extension regions.

RESULTS

Survey responses (n = 236) indicated respondents recognized the complexity of the opioid crisis and had favorable attitudes toward treatment and community support approaches. Support for legal and punitive approaches was mixed, as were attitudes toward external and personal causes of substance use. Most indicated needing better resources and more knowledge to engage in work locally.

CONCLUSION

Increased capacity is needed in Extension to adequately support families and communities dealing with substance use disorder. Findings suggest areas of focus and provide insight for others seeking to develop capacity in opioid response by engaging Extension professionals or other community outreach workers in substance use prevention efforts.

Beyond effectiveness of the Strengthening Families Program (10-14): a scoping RE-AIM-based review

A scoping review, based on the RE-AIM framework, was conducted to analyze evidence of reach, effectiveness, adoption, implementation, and maintenance of the Strengthening Families Program (10-14), a preventive family-based substance abuse program for adolescents. Sixty-five articles were included. The results disclosed that effectiveness, implementation, and maintenance at the individual-level were the most evaluated aspects, while reach, maintenance at the setting-level, and adoption were the least investigated aspects. Positive effects on drug abuse prevention and protective parenting factors were found in the U.S. studies. Likewise, Latin American studies have shown the improvement of parenting practices. However, European studies have produced mixed results, with predominantly null effects on substance abuse. The implementation quality was high. There is no available evidence of adoption and maintenance at the setting-level by the organizations that implemented it. New studies must examine the reach, adoption, and sustainability of the program to lay foundations for its future use as an instrument of public policies.

Strengthening the Power of Evidence-Based Prevention in Cooperative Extension: A Capacity-Building Framework for Translation Science-Driven Behavioral Health

Background

Translation science entails application of information gained through scientific research to practices intended to improve prevention and public health. The outreach arm of Land-Grant Universities—the Cooperative Extension System—is uniquely poised to facilitate this translation process and contribute to resolution of current substance misuse and other behavioral health issues.

Objective

This paper summarizes selected literatures that guided the conceptualization of a framework for building Extension’s capacity to enhance the translation process, in order to better address substance misuse and other behavioral health issues.

Method

Peer-reviewed literature was obtained from journals representing varied disciplines including medicine, public health, education, and psychology. Journals for Extension professionals were a prominent source of relevant literature. The literature review informed the identification of relevant practice gaps, barriers in addressing those gaps, and the development of a capacity-building framework.

Results

The framework described highlights opportunities for building Cooperative Extension’s capacity to address goals in four key domains. These goals include (1) catalyzing Extension’s organizational development to support science-driven practices, (2) bolstering prevention and behavioral health-oriented professional development for Extension faculty and staff, (3) creating a stronger culture of behavioral health in Extension, and (4) strengthening Extension’s financing of prevention-oriented behavioral health efforts.

Conclusion

Addressing the capacity-related goals identified in this paper could be a major catalyst for enhancing the power of proven, prevention-oriented behavioral health and, thereby, the well-being of our families, communities and nation.

Transdisciplinary Approaches for the Dissemination of the SWITCH School Wellness Initiative Through a Distributed 4-H/Extension Network

Background

Schools provide an ideal setting for promoting healthy lifestyles in youth, but it has proven difficult to promote the adoption and implementation of evidence-based programming by school leaders. The SWITCH® (School Wellness Integration Targeting Child Health) intervention is a capacity-building process designed to help school leaders learn how to plan, implement, and sustain school wellness programs on their own.

Objective

The present study evaluates the transdisciplinary approaches used in establishing an integrated research-practice partnership with the state-wide 4-H/Extension network to support broader dissemination.

Method

The study used a mixed methods approach to evaluate the degree of engagement and motivation of 4-H leaders (N = 30) for providing ancillary support for local school wellness programming. Engagement from 4-H Staff was logged over a year-long period through tracking completion of training and ongoing engagement with aspects of SWITCH. They completed checkpoint surveys and an interview to provide perceptions of supporting school implementation of SWITCH programming. Data were analysed through Pearson bivariate correlations and constant comparative analysis.

Results

County-level 4-H staff demonstrated high engagement in SWITCH by attending training sessions and hosting structured checkpoint sessions with schools. Interview data revealed that 4-H Staff valued connections with schools and emphasized that training on SWITCH was consistent with their existing roles related to youth programming.

Conclusions

The results demonstrate the value of the sequential capacity-building process used to train 4-H Staff to facilitate school wellness programming. The transdisciplinary approaches built transferable skills and fostered relationships that directly support the broader goals of 4-H.

Effectiveness of Parent-Child Mediation in Improving Family Functioning and Reducing Adolescent Problem Behavior: Results from a Pilot Randomized Controlled Trial

Parent-child mediation programs are intended to resolve or manage disputes and improve family functioning, but rigorous evaluations of their effectiveness are lacking. Families referred to a community-based mediation program (N = 111) were randomized to an intervention or wait-list control group, and completed three surveys over a 12-week period. With the exception of parent-reported child delinquency (which decreased more in the intervention group), this evaluation provides little support for the short-term effectiveness of parent-child mediation for improving family functioning and reducing child problem behaviors in general. Given that this is the first randomized controlled trial of a parent-child mediation program, additional evaluations involving larger samples and longer follow-ups are needed before firm conclusions can be drawn about the effectiveness of this intervention.

Reflections on a Community Psychology Setting and the Future of the Field

The 50th anniversary of the Swampscott Conference offers an opportunity to reflect on a community psychology setting, The Consultation Center at Yale, that was formed in response to the 1963 Community Mental Health Act and the 1965 Swampscott Conference. The Center has flourished as a community psychology setting for practice, research, and training for 39 of the 50 years since Swampscott. Its creation and existence over this period offers an opportunity for reflection on the types of settings needed to sustain the field into the future.

Planning for Sustainability of an Evidence-Based Mental Health Promotion Program in Canadian Elementary Schools

Substantial research illuminates many factors effecting the implementation of evidence-based mental health promotion programs in schools; however, research on how schools plan for sustaining their investments in these programs is limited. In this qualitative study, we elicited descriptions of opportunities and challenges for sustainability. We interviewed 24 individuals from schools involved in a longitudinal, qualitative research project that followed uptake and implementation of the evidence-based WITS Programs across 2 years (Leadbeater et al. 2012). WITS stands for Walk away, Ignore, Talk it out and Seek help and the online WITS Programs focus on preventing peer victimization ( www.witsprograms.ca ). Our findings suggest that sustainability planning in schools is not merely a next step following high quality implementation, but rather involves multiple ongoing processes that need to be anticipated and supported by school leadership and program champions and developers in order to realize investments in evidence-based programs.