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Tolan PH, Harris AR, Burchinal M, Jennings PA. Promoting 21st Century Health and Wellness Skills in Elementary School Children: a Group Randomized Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01717-3. [PMID: 39138816 DOI: 10.1007/s11121-024-01717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
In a group randomized trial of 45 elementary schools, a whole-child health and wellness curriculum introduced as a regular part of the educational programming was compared to education as usual over 2 years with a 2-year follow-up. The curriculum focused on integrating multiple SEL skills-mindfulness, compassion, and physical awareness-with the intent to advantage developmental patterns for these skills, academic engagement, personal well-being, and student behavior. The program design and trial implementation were launched with end-use delivery and long-term sustainability as integral considerations. Effects were shown for several SEL skills and behavioral indicators previously robustly correlated to long-term outcomes. Effects were demonstrated more broadly in schools serving high-poverty communities, suggesting the impact was stronger where the need was greater. Results are interpreted regarding supporting school-based SEL, the potential of applying group randomized trials with end-use conditions of implementation, and the value of fitting innovation efforts to school system operations, mandates, and priorities for promoting sustainability.
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Stewart RE, Cardamone NC, Shen L, Dallard N, Comeau C, Mandell DS, Bowen J, Rothbard A. Effect of Providing Evidence-Based Mental Health Treatment on Retention in Care Among Medicaid-Enrolled Youths. Psychiatr Serv 2024:appips20240066. [PMID: 39091172 DOI: 10.1176/appi.ps.20240066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
OBJECTIVE Youths who start behavioral health treatment often stop before completing a therapeutic course of care. To increase treatment engagement and quality of care, the Evidence-Based Practice and Innovation Center in Philadelphia has incentivized use of evidence-based practices (EBPs) for mental health care of youths. The authors aimed to compare treatment outcomes between youths who received EBP care and those who did not. METHODS Using EBP-specific billing codes and propensity score matching, the authors compared treatment retention among youths who received trauma-focused cognitive-behavioral therapy (TF-CBT; N=413) or parent-child interaction therapy (PCIT; N=90) relative to matched samples of youths in standard outpatient therapy (N=503). RESULTS Youths with a minimum of one session of TF-CBT or PCIT attended a second session at higher rates than did youths in the matched control group (TF-CBT: 96% vs. 68%, p<0.01; PCIT: 94% vs. 69%, respectively, p<0.01). On average, these returning youths attended more sessions in the EBP groups than in the control group (TF-CBT: 15.9 vs. 11.5 sessions, p<0.01; PCIT: 11.2 vs. 6.9 sessions, p<0.01). CONCLUSIONS These findings indicate that, in addition to improving quality of care, EBP implementation helps address the major challenge that most youths who engage with treatment are not retained long enough for care to have therapeutic effects. Future research should examine the mechanisms through which EBPs can improve treatment retention.
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Affiliation(s)
- Rebecca E Stewart
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Nicholas C Cardamone
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Lisa Shen
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Natalie Dallard
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Carrie Comeau
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Jill Bowen
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Aileen Rothbard
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
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Rázuri EB, Yang Y, Tinius E, Knight DK. Adaptation of a trauma-informed intervention to prevent opioid use among youth in the legal system. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209294. [PMID: 38272116 DOI: 10.1016/j.josat.2024.209294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/24/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Youth in the legal system are at high risk for opioid and other substance use problems and exhibit high rates of trauma exposure. Trauma-focused therapeutic approaches to prevent substance use show promise, but few evidence-based interventions are designed with justice-involved youth in mind. Consequently, implementing trauma-informed, evidence-based interventions within juvenile justice systems is challenging. The current paper describes the systematic adaptation of Trust-Based Relational Intervention (TBRI) as a family-centered substance use prevention program for youth transitioning from secure residential facilities. METHODS The study utilized the ADAPT-ITT methodological framework to adapt TBRI Caregiver Training, an evidence-based, trauma-informed intervention designed to help caregivers support children and youth with histories of trauma. Phases of adaptation included (1) Assessment, (2) Decision, (3) Prototype Development, and (4) Testing and Integration. The adaptation process explored contextual factors (e.g., systems, facilities, and staff) and the needs of the new target population (i.e., youth in the legal system and their caregivers). Adaptations were made to both content (e.g., terminology and activities) and structure (e.g., session duration and delivery setting) with input from participants from the target population, key stakeholders, and content experts. RESULTS The systematic adaptation of the intervention model resulted in a two-phase, four-component intervention package that can be implemented in juvenile justice settings as part of youth reentry services. The primary intervention, delivered while youth are in residential facilities, includes the TBRI Caregiver Curriculum, TBRI Youth & Young Adult Curriculum, and TBRI Nurture Groups. The secondary intervention, delivered after youth transition home, includes the TBRI Family Coaching Curriculum. CONCLUSIONS Utilizing a systematic methodological framework to guide adaptation has implications for developing accessible, culturally relevant, and contextually appropriate interventions. Accounting for contextual factors and population needs can improve the fit of evidence-based interventions for youth in the legal system, facilitating uptake and ultimately improving outcomes for youth at risk for substance use problems. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04678960.
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Affiliation(s)
- Erin Becker Rázuri
- Karyn Purvis Institute of Child Development, Texas Christian University, United States.
| | - Yang Yang
- Institute of Behavioral Research, Texas Christian University, United States
| | - Elaine Tinius
- Institute of Behavioral Research, Texas Christian University, United States
| | - Danica Kalling Knight
- Karyn Purvis Institute of Child Development, Texas Christian University, United States; Institute of Behavioral Research, Texas Christian University, United States
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Jones SC, Schlundt D, Williams N, Smalls M, Idrizi K, Alexander L, Anthony M, Selove R. Challenges in Disseminating Evidence-Based Health Promotion Programs in Faith Community Settings: What We Need to Include. Health Promot Pract 2024:15248399241259688. [PMID: 39066625 DOI: 10.1177/15248399241259688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Effective dissemination of information about evidence-based programs (EBPs) is essential for promoting health equity. Faith-based and other community organizations have difficulty locating EBPs for implementation in their settings. A research team engaged in a systematic search to identify a menu of EBPs that could be offered to African American FBOs as part of a community-engaged implementation study. Methods. A four-stage process was developed to search for EBPs meeting seven inclusion criteria for dissemination in faith-based organizations (FBOs). Criteria included relevance to identified health disparity topics, endorsement on a federal website, free access to downloadable program materials, facilitator guidance, no requirements for health care providers, and culturally relevant materials for African American communities. RESULTS Nineteen government websites were searched. Sixty-six potential EBPs were identified. Six EBPs met all inclusion criteria. DISCUSSION The search for EBPs that met seven criteria for implementation in African American FBOs demonstrated challenges that have been described in the literature. Researchers encountered a lack of standardized terminology for identifying EBPs on federal websites, frequent requirement for health care providers or clinics and/or fees for training and materials. FBOs are supportive and safe places to offer EBPs to promote health, and EBPs need to be designed and disseminated to meet the needs and preferences of FBOs. Including members of FBOs and others in the community in EBP development, design, and dissemination, such as searchable health promotion EBP registries, can increase the likelihood that effective programs intended to address health disparities are readily accessible to FBOs for implementation.
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Affiliation(s)
| | | | - Neely Williams
- Tennessee Community Engaged Alliance, Nashville, TN, USA
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Pickard K, R Edmunds S, Wedderburn Q, Wikel K, Buster J, Maye M. We Must Consider Infrastructure when Attempting to Scale up Autism EBIs: A Case Example from Early Intervention Systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01399-7. [PMID: 39046687 DOI: 10.1007/s10488-024-01399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 07/25/2024]
Abstract
In the autism field, there is increasing interest in translating evidence-based interventions (EBIs) into systems that serve young autistic children and their families. Public Early Intervention systems have been a focal point of research-based implementation efforts given that these systems are federally mandated to provide services to children birth to three years of age with developmental delays under Part C of the Individuals with Disabilities Education Act. Although a growing number of research studies are now training Early Intervention providers to deliver autism EBIs, this work has been conducted on a relatively small scale and has only just begun to consider the alignment of these models with Early Intervention systems and whether sufficient infrastructure exists to scale up these training efforts and to sustain their public health impact. This commentary aims to address this gap by reviewing factors that have been found to uniformly impact the scale-up of EBIs across diverse public systems (Fagan 20, 1147-1168, 2019), and to extend this framework to the implementation of EBIs within public Early Intervention systems. These factors include developer and funder capacity, the public's awareness of and support for EBIs, the system's leadership support for EBI use, the capacity for community engagement in implementation efforts, the availability of a skilled workforce capable of delivering EBIs, and the capacity for data monitoring and quality improvement. This commentary discusses how these factors may specifically impact the scale-up of autism EBIs within EI systems to support toddlers and young, autistic children, and implications for autism researchers.
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Affiliation(s)
- Katherine Pickard
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory School of Medicine, 1920 Briarcliff Road, Atlanta, GA, 30329, Georgia.
| | - Sarah R Edmunds
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Quentin Wedderburn
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Kerri Wikel
- Center for Disability Resources, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | | | - Melissa Maye
- Henry Ford Health, Center for Health Policy and Health Services Research, Detroit, MI, USA
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Balis LE, Porter G, Grocke-Dewey M. Demonstration Projects to Test Built Environment Changes: A Systematic Review. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:490-500. [PMID: 37713643 DOI: 10.1097/phh.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
CONTEXT Built environment interventions (pedestrian/bicycle infrastructure and enhanced access) mitigate barriers to physical activity by making the healthy choice the default choice. Demonstration projects (eg, temporary pedestrian lanes or sidewalks marked with tape) are used to test these interventions before making permanent changes. However, it is unknown whether demonstration projects lead to desired built environment changes. OBJECTIVE To systematically review the literature to determine outcomes and overall public health impacts of demonstration projects and whether they lead to permanent changes to the built environment. DESIGN Systematic review, conducted from March to September 2022 by searching PubMed and EBSCOhost for peer-reviewed literature and Google for gray (non-peer-reviewed) literature. Inclusion criteria were policy, systems, or environmental interventions; temporary implementation; and presence of evaluation data. Exclusion criteria were individual/interpersonal-level interventions, permanent implementation, and absence of evaluation data. Two authors coded for inclusion/exclusion and resolved discrepancies, coded a portion of included sources and resolved discrepancies, refined coding guide definitions, and coded remaining sources. MAIN OUTCOME MEASURES Data were extracted based on the expanded RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, which incorporates constructs of the Implementation Outcomes Framework (acceptability, appropriateness, feasibility). RESULTS Gray (N = 23) and peer-reviewed (N = 1) sources describing unique demonstration projects (N = 31) met inclusion criteria. Projects tested built environment interventions including traffic calming measures, crosswalks, bike lanes, intersection design, and trails. Sources primarily reported effectiveness (typically improved safety), maintenance, acceptability, and appropriateness. Most sources did not report projects leading to permanent changes to the built environment. CONCLUSIONS Based on inconsistent reporting of key outcomes (number of community members reached, changes to physical activity levels), overall impacts are unknown. Most demonstration projects captured community members' feedback, which was typically positive, but it is unknown whether feedback led to long-term changes. We recommend providing improved demonstration project guidance for practitioners to facilitate robust data collection, including suggested evaluation methods and tools.
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Affiliation(s)
- Laura E Balis
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska (Dr Balis); University of Nebraska Medical Center, Omaha, Nebraska (Dr Porter); and Montana State University, Bozeman, Montana (Dr Grocke-Dewey)
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Pickard KE, Hendrix NM, Greenfield ES, Yohannes M. Using Causative Methods to Determine System-Level Factors Driving the Uptake and Use of Evidence-Based Practices in a Public Early Intervention System. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:554-566. [PMID: 38431889 DOI: 10.1007/s10488-024-01346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
Part C Early Intervention (EI) systems are an entry point to services for autistic toddlers and can be leveraged to facilitate access to autism evidence-based practices (EBPs). However, EI systems are complex and limited research has examined how an EI system's infrastructure (i.e. system-level factors) impacts the adoption and implementation of EBPs. To address this gap, 36 EI providers and 9 EI administrators completed a semi-structured interview or focus group about factors impacting the implementation of autism EBPs. Qualitative analysis included a combination of grounded theory and causative coding. Analyses were refined by input from providers, administrators, and family stakeholders in the form of round tables and presentations at the state's interagency coordinating council. Primary themes centered on: (1) the costs associated with independent contracting structures; (2) operational demands; (3) workforce stability; (4) communication consistency; and (5) implementation supports for EBP implementation. Causative coding helped to demonstrate the perceived relationships between these factors and underscored the important role of incentivization structures, collaboration opportunities, and championing in supporting the use of EBPs within a system that primarily uses independent contracting structures. The current study extends previous research by demonstrating how several system-level factors are perceived to play a role in the adoption and implementation of EBPs by independently contracted EI providers. These findings underscore the need for implementation strategies, such as incentivization strategies and social network building, to increase providers' implementation of autism EBPs within EI systems.
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Affiliation(s)
- Katherine E Pickard
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA.
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA.
| | - Nicole M Hendrix
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
| | - Elizabeth S Greenfield
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
| | - Millena Yohannes
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
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Oser CB, McGladrey M, Booty M, Surratt H, Knudsen HK, Freeman PR, Stevens-Watkins D, Roberts MF, Staton M, Young A, Draper E, Walsh SL. Rapid jail-based implementation of overdose education and naloxone distribution in response to the COVID-19 pandemic. HEALTH & JUSTICE 2024; 12:27. [PMID: 38935213 PMCID: PMC11212218 DOI: 10.1186/s40352-024-00283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND People incarcerated in jails are highly impacted by the opioid epidemic, and overdose education and naloxone distribution (OEND) is an effective strategy to reduce opioid overdose deaths. This study examines barriers and facilitators of fast-track OEND implementation within the jails in the Wave 1 Kentucky counties of the HEALing Communities Study during the COVID-19 pandemic. METHODS Meeting minutes with jail stakeholders were qualitatively coded using the Practical, Robust Implementation and Sustainability Model (PRISM) as the coding framework. The analysis highlighted the top barriers and facilitators to fast-track OEND implementation within the PRISM framework. RESULTS Space and staffing shortages related to the COVID-19 pandemic, disruptions in interorganizational programming from pandemic-related service suspensions, and a lack of technological solutions (e.g., reliable Internet access) for socially distanced delivery were the top barriers to fast-track OEND implementation. In addition, there were limitations on non-jail staff access to jails during COVID-19. Top facilitators included jail leadership support, the option to prioritize high-risk groups, and the incorporation of OEND processes into existing communications and management software. While the COVID-19 pandemic strained jail infrastructure, jail and partner agency collaboration led to creative implementation strategies for the successful integration of OEND into jail operations. Urban jails were more likely than rural jails to be early adopters of OEND during the public health emergency. CONCLUSIONS Understanding the barriers to and facilitators of OEND within jails will improve implementation efforts seeking to curb opioid overdose deaths. Jail leadership support and interorganizational efforts were key facilitators to implementation; therefore, it is recommended to increase buy-in with multiple agencies to promote success. Challenges brought on by COVID-19 have resulted in a need for innovative solutions for implementation. CLINICAL TRIAL INFORMATION ClinicalTrials.gov, NCT04111939, Submitted 30 September 2019, https://clinicaltrials.gov/study/NCT04111939?titles=HEALing%20Communities%20Study&rank=1 .
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Affiliation(s)
- Carrie B Oser
- Department of Sociology, Center for Health Equity Transformation, Center on Drug & Alcohol Research, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY, 40506, USA.
| | - Margaret McGladrey
- Department of Health Management and Policy, Center for Innovation in Population Health, University of Kentucky, 111 Washington Avenue, Lexington, KY, 40508, USA
| | - Marisa Booty
- Department of Sociology, University of Kentucky, 1515 Patterson Office Tower, Lexington, KY, 40506, USA
| | - Hilary Surratt
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice & Science, Center for the Advance of Pharmacy Practice, University of Kentucky, 789 S. Limestone, Lexington, KY 40508, USA
| | - Danelle Stevens-Watkins
- Department of Educational, School, and Counseling Psychology, Center on Drug & Alcohol Research, University of Kentucky, 103 Dickey Hall, Lexington, KY 40506, USA
| | - Monica F Roberts
- Substance Use Priority Research Area, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Michele Staton
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, 1100 Veterans Drive, Medical Behavioral Science Building, Lexington, KY, 40536, USA
| | - April Young
- Department of Epidemiology and Environmental Health, Center on Drug & Alcohol Research, University of Kentucky, 111 Washington Ave, Lexington, KY 40508, USA
| | - Emma Draper
- Department of Psychology, Williams College, 25 Stetson Ct., Williamstown, MA, 01267, USA
| | - Sharon L Walsh
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA
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de Andrade M. REALITIES in health disparities: Researching Evidence-based Alternatives in Living, Imaginative, Traumatised, Integrated, Embodied Systems. Front Public Health 2024; 12:1391084. [PMID: 38962765 PMCID: PMC11220268 DOI: 10.3389/fpubh.2024.1391084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/10/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Under the backdrop of pervasive health inequalities, public health professionals, researchers and non-academic partners in the United Kingdom are mobilising to understand how and in what ways community assets can address health disparities at scale in complex systems. While there is recognition that cultural, natural and community resources can improve health outcomes, these are unequally dispersed with lack of integration in communities and health and social care systems. Researching Evidence-based Alternatives in Living, Imaginative, Traumatised, Integrated, Embodied Systems (REALITIES) is a participatory action research Scottish consortium of 57 with established community asset hubs in five localities with strong relationships uniting conflicting ways of seeing the world. Our collective of lived and felt experience community members, community-embedded researchers, academics and non-academics draws upon a variety of practices, methods, datasets and philosophies to expand existing approaches to tackling health inequalities. Methods We present conceptual and theoretical underpinnings for our co-produced systems-level model and empirical findings from testing REALITIES across three disadvantaged localities (November 2022, ongoing). After explaining the context that led to the development of the new scalable REALITIES model for integrated public systems to interface with 'assets', we detail philosophical pillars and guiding principles for our model and how we applied these mechanisms to explain how integrated partnership working can lead to improved health outcomes across multiple public systems. Results We present a meta-analysis from co-producing and testing the model, showing how measuring change in complex public systems involves critical investigation of People, Process, Place, Price, Power and Purpose. Our critique reflects on power imbalances and inequities in Research-practice-Policy (RPP) partnerships and suggestions for how to nurture healthy ecosystems: overcoming barriers and enabling participation; reflecting on challenges of scaling up, testability and complexity of RPP partnerships; moving from siloed learning to transdisciplinary collaboration in practice; ensuring knowledge exchange has direct impact on communities and frontline practitioners; embedding relational ethics and safeguarding into daily practice. Discussion We propose the REALITIES model to unite alternative, sometimes conflicting, ways of thinking about public systems and community assets by continuously reflecting on entanglements between different assumptions about knowledge, reality, evidence, and unnecessary binaries between creative methodologies and scientific method.
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Affiliation(s)
- Marisa de Andrade
- School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
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Wandersman A, Scheier LM. Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers. Eval Health Prof 2024; 47:143-153. [PMID: 38790113 DOI: 10.1177/01632787241248768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Hundreds of millions of dollars are spent each year by U.S. federal agencies for training and technical assistance (TTA) to be delivered by training and technical assistance centers (TTACs) to "delivery system organizations" (e.g., federally qualified health centers, state departments of health, substance abuse treatment centers, schools, and healthcare organizations). TTACs are often requested to help delivery system organizations implement evidence-based interventions. Yet, counterintuitively, TTACs are rarely required to use evidence-based approaches when supporting delivery systems (in the use of evidence-based programs). In fact, evaluations of TTAC activities tend to be minimal; evaluation of technical assistance (if conducted at all) often emphasizes outputs (number of encounters), satisfaction, and self-reports of knowledge gained-more substantive outcomes are not evaluated. The gap between (a) the volume of TTA services being funded and provided and (b) the evaluation of those services is immense and has the potential to be costly. The basic question to be answered is: how effective are TTA services? This article introduces the special issue on Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers. The special issue promotes 1) knowledge of the state of the art of evaluation of TTACs and 2) advances in what to evaluate in TTA. A major goal of the issue is to improve the science and practice of implementation support, particularly in the areas of TTA.
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Gayles JG, Chilenski SM, Barragán N, Rhoades Cooper B, Welsh JA, Galinsky M. Unpacking Technical Assistance (TA) Strategies Within a State-Level Prevention Support System: A Mixed-Method Study in Determining Types and Amount of TA. Eval Health Prof 2024; 47:204-218. [PMID: 38790112 PMCID: PMC11127505 DOI: 10.1177/01632787241248769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The research-practice gap between evidence-based intervention efficacy and its uptake in real-world contexts remains a central challenge for prevention and implementation science. Providing technical assistance (TA) is considered a crucial support mechanism that can help narrow the gap. However, empirical measurement of TA strategies and their variation is often lacking. The current study unpacks the black box of TA, highlighting different TA strategies, amounts, and their relation to intervention characteristics. First, we qualitatively categorized interactions between TA providers and implementers. Second, we explored how characteristics of implementing organizations and the intervention related to variations in the amount of TA delivered. Using data spanning six years, we analyzed over 10,000 encounters between TA providers and implementers. Content analysis yielded four distinct strategies: Consultation (27.2%), Coordination Logistics (24.5%), Monitoring (16.5%), and Resource Delivery (28.2%). Organizations with prior experience required less monitoring and resource delivery. Additionally, characteristics of the intervention were significantly associated with the amount of consultation, monitoring, coordination logistics, and resource delivery provided. The specific features of the intervention showed significant variation in their relation to TA strategies. These findings provide initial insights into the implications of intervention characteristics in determining how much of which TA strategies are needed to support implementations in real-world settings.
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Affiliation(s)
- Jochebed G Gayles
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Sarah M Chilenski
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Nataly Barragán
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | | | - Janet Agnes Welsh
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Megan Galinsky
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
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Reho K, Agley J, Gassman R, Roberts J, Heil SKR, Katara J. How do the Substance Abuse and Mental Health Services Administration's Technology Transfer Centers Decide What Evidence-Based Practices to Disseminate and Determine How to Do So? A Cross-Sectional Study of a National Network. Eval Health Prof 2024; 47:167-177. [PMID: 38790109 PMCID: PMC11157975 DOI: 10.1177/01632787231225653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
It is important to use evidence-based programs and practices (EBPs) to address major public health issues. However, those who use EBPs in real-world settings often require support in bridging the research-to-practice gap. In the US, one of the largest systems that provides such support is the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Technology Transfer Center (TTC) Network. As part of a large external evaluation of the Network, this study examined how TTCs determine which EBPs to promote and how to promote them. Using semi-structured interviews and pre-testing, we developed a "Determinants of Technology Transfer" survey that was completed by 100% of TTCs in the Network. Because the study period overlapped with the onset of the COVID-19 pandemic, we also conducted a retrospective pre/post-pandemic comparison of determinants. TTCs reported relying on a broad group of factors when selecting EBPs to disseminate and the methods to do so. Stakeholder and target audience input and needs were consistently the most important determinant (both before and during COVID-19), while some other determinants fluctuated around the pandemic (e.g., public health mandates, instructions in the funding opportunity announcements). We discuss implications of the findings for technology transfer and frame the analyses in terms of the Interactive Systems Framework for Dissemination and Implementation.
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Affiliation(s)
- Kaitlyn Reho
- Prevention Insights, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, USA
| | - Jon Agley
- Prevention Insights, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, USA
| | - Ruth Gassman
- Prevention Insights, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, USA
| | - Jeffrey Roberts
- Prevention Insights, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, USA
| | | | - Jharna Katara
- Biostatistics Consulting Center, Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA
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Kohrman N, Rashid M, Flores R, Blyler C, Barragan NC, Kuo T, Inkelas M, Chen S, Rader F, Cheng S, Albert C, Bello NA, Ebinger J. A qualitative analysis of post-hoc interviews with multilevel participants of a randomized controlled trial of a community-based intervention. PLoS One 2024; 19:e0303075. [PMID: 38723012 PMCID: PMC11081230 DOI: 10.1371/journal.pone.0303075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Community-based health interventions often demonstrate efficacy in clinical trial settings but fail to be implemented in the real-world. We sought to identify the key operational and contextual elements of the Los Angeles Barbershop Blood Pressure Study (LABBPS), an objectively successful community-based health intervention primed for real-world implementation. LABBPS was a cluster randomized control trial that paired the barbers of Black-owned barbershops with clinical pharmacists to manage uncontrolled hypertension in Black male patrons, demonstrating a substantial 21.6 mmHg reduction in systolic blood pressure. Despite this success, the LABBPS intervention has not expanded beyond the original clinical trial setting. The aim of this study was to determine the facilitating and limiting factors to expansion of the LABBPS intervention. METHODS We undertook a qualitative assessment of semi-structured interviews with study participants performed after trial completion. Interviews included a total of 31 participants including 20 (6%) of the 319 LABBPS program participants ("patrons"), 10 (19%) barbers, and one (50%) clinical pharmacist. The semi-structured interviews were focused on perceptions of the medical system, study intervention, and influence of social factors on health. RESULTS Several common themes emerged from thematic analysis of interview responses including: importance of care provided in a convenient and safe environment, individual responsibility for health and health-related behaviors, and engagement of trusted community members. In particular, patrons reported that receiving the intervention from their barber in a familiar environment positively influenced the formation of relationships with clinical pharmacists around shared efforts to improve medication adherence and healthy habits. All interviewee groups identified the trust diad, comprising the familiar environment and respected community member, as instrumental in increasing health-related behaviors to a degree not usually achieved by traditional healthcare providers. DISCUSSION In conclusion, participants of an objectively successful community-based intervention trial consistently identified key features that could facilitate wider implementation and efficacy: social trust relationships, soliciting insights of trust bearers, and consistent engagement in a familiar community setting. These findings can help to inform the design and operations of future community-based studies and programs aiming to achieve a broad and sustainable impact.
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Affiliation(s)
- Nathan Kohrman
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Mohamad Rashid
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Roxana Flores
- Los Angeles County Department of Public Health, Division of Chronic Disease and Injury Prevention, Los Angeles, California, United States of America
| | - Ciantel Blyler
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Noel C. Barragan
- Los Angeles County Department of Public Health, Division of Chronic Disease and Injury Prevention, Los Angeles, California, United States of America
| | - Tony Kuo
- Department of Epidemiology, Los Angeles (UCLA) Fielding School of Public Health, University of California, Los Angeles, California, United States of America
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- UCLA Clinical and Translational Science Institute, Population Health Program, Los Angeles, California, United States of America
| | - Moira Inkelas
- UCLA Clinical and Translational Science Institute, Population Health Program, Los Angeles, California, United States of America
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Steven Chen
- Associate Dean for Clinical Affairs, University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, California, United States of America
| | - Florian Rader
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Christine Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Natalie A. Bello
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Joseph Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
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14
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So M, Dziuban EJ, Pedati CS, Holbrook JR, Claussen AH, O'Masta B, Maher B, Cerles AA, Mahmooth Z, MacMillan L, Kaminski JW, Rush M. Childhood Physical Health and Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Modifiable Factors. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:316-336. [PMID: 35947281 PMCID: PMC10032176 DOI: 10.1007/s11121-022-01398-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 10/15/2022]
Abstract
Although neurobiologic and genetic factors figure prominently in the development of attention deficit/hyperactivity disorder (ADHD), adverse physical health experiences and conditions encountered during childhood may also play a role. Poor health is known to impact the developing brain with potential lifelong implications for behavioral issues. In attempt to better understand the relationship between childhood physical health and the onset and presence of ADHD symptoms, we summarized international peer-reviewed articles documenting relationships between a select group of childhood diseases or health events (e.g., illnesses, injuries, syndromes) and subsequent ADHD outcomes among children ages 0-17 years. Drawing on a larger two-phase systematic review, 57 longitudinal or retrospective observational studies (1978-2021) of childhood allergies, asthma, eczema, head injury, infection, or sleep problems and later ADHD diagnosis or symptomatology were identified and subjected to meta-analysis. Significant associations were documented between childhood head injuries, infections, and sleep problems with both dichotomous and continuous measures of ADHD, and between allergies with dichotomous measures of ADHD. We did not observe significant associations between asthma or eczema with ADHD outcomes. Heterogeneity detected for multiple associations, primarily among continuously measured outcomes, underscores the potential value of future subgroup analyses and individual studies. Collectively, these findings shed light on the importance of physical health in understanding childhood ADHD. Possible etiologic links between physical health factors and ADHD are discussed, as are implications for prevention efforts by providers, systems, and communities.
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Affiliation(s)
- Marvin So
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Eric J Dziuban
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Caitlin S Pedati
- Virginia Beach Department of Public Health, Virginia Beach, VA, USA
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA
| | - Angelika H Claussen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA
| | | | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Jennifer W Kaminski
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA
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15
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Buckley PR, Combs KM, Drewelow KM, Hubler BL, Lain MA. Validity Evidence for an Observational Fidelity Measure to Inform Scale-Up of Evidence-Based Interventions. EVALUATION REVIEW 2024:193841X241248864. [PMID: 38687041 DOI: 10.1177/0193841x241248864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
As evidence-based interventions are scaled, fidelity of implementation, and thus effectiveness, often wanes. Validated fidelity measures can improve researchers' ability to attribute outcomes to the intervention and help practitioners feel more confident in implementing the intervention as intended. We aim to provide a model for the validation of fidelity observation protocols to guide future research studying evidence-based interventions scaled-up under real-world conditions. We describe a process to build evidence of validity for items within the Session Review Form, an observational tool measuring fidelity to interactive drug prevention programs such as the Botvin LifeSkills Training program. Following Kane's (2006) assumptions framework requiring that validity evidence be built across four areas (scoring, generalizability, extrapolation, and decision), confirmatory factor analysis supported the hypothesized two-factor structure measuring quality of delivery (seven items assessing how well the material is implemented) and participant responsiveness (three items evaluating how well the intervention is received), and measurement invariance tests suggested the structure held across grade level and schools serving different student populations. These findings provide some evidence supporting the extrapolation assumption, though additional research is warranted since a more complete overall depiction of the validity argument is needed to evaluate fidelity measures.
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Affiliation(s)
- Pamela R Buckley
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
| | - Katie Massey Combs
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
| | - Karen M Drewelow
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
| | - Brittany L Hubler
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
| | - Marion Amanda Lain
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
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16
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Maldupa I, Innes N, Viduskalne I, Brinkmane A, Senakola E, Krumina K, Uribe SE. Clinical effectiveness/child-patient and parent satisfaction of two topical fluoride treatments for caries: a randomised clinical trial. Sci Rep 2024; 14:8123. [PMID: 38582806 PMCID: PMC10998894 DOI: 10.1038/s41598-024-58850-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/03/2024] [Indexed: 04/08/2024] Open
Abstract
Knowledge gaps exist regarding optimal silver diammine fluoride (SDF) regimens and the efficacy of new products for arresting dental caries in young children. We evaluated the effectiveness of 38%-SDF (SDI-RivaStar), Tiefenfluorid (TF) comparing with Placebo (P), all in conjunction with behavioural modification (BM), in preventing major complications (endodontic/extractions/pain)-a patient-centred outcome-due to early childhood caries over 12 months in children under 71-months. A six-arm, patient/parent-blinded, superiority, placebo-controlled randomised control trial at the university clinic in Riga, Latvia, from 1/9/20-31/8/22 (Protocol registration ISRCTN17005348). The trial tested six protocols, using three compounds (P/SDF/TF) under two regimes: annual and biannual (P1/P2/TF1/TF2/SDF1/SDF2) for major complications. Secondary outcomes included minor complications and parental satisfaction. All groups received BM. 373/427 randomised children (87.3%) completed the study. SDF2 had a significantly lower rate and risk of major (21.5%, OR = 0.28, 95%CI [0.11, 0.72], p < 0.05) and minor complications (OR = 0.16 (95%CI [0.05, 0.50], p = 0.002). Overall satisfaction was 96% (p > 0.05). SDF biannual application with BM effectively prevented major complications of early childhood caries and was well accepted by children and their parents. Trial registration number: ISRCTN17005348, principal investigator: Ilze Maldupa, registration date: 30/06/2021.Clinical trial registration number: ISRCTN registry: ISRCTN17005348, https://doi.org/10.1186/ISRCTN17005348 , registration date: 30/06/2021.
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Affiliation(s)
- Ilze Maldupa
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema str. 20, Riga, 1007, Latvia.
| | - Nicola Innes
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Ilona Viduskalne
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema str. 20, Riga, 1007, Latvia
| | - Anda Brinkmane
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema str. 20, Riga, 1007, Latvia
| | - Egita Senakola
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema str. 20, Riga, 1007, Latvia
| | - Karina Krumina
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema str. 20, Riga, 1007, Latvia
| | - Sergio E Uribe
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema str. 20, Riga, 1007, Latvia
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Riga, Latvia
- Faculty of Dentistry, Universidad de Valparaíso, Valparaíso, Chile
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17
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Weist MD, Garbacz A, Schultz B, Bradshaw CP, Lane KL. Revisiting the Percentage of K-12 Students in Need of Preventive Interventions in Schools in a "Peri-COVID" Era: Implications for the Implementation of Tiered Programming. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:481-487. [PMID: 38007704 DOI: 10.1007/s11121-023-01618-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
As the public health framework has been implemented in schools through multi-tiered systems of support, as in Positive Behavioral Interventions and Supports (PBIS), a prominent interpretation has been that 80% of students will benefit from universal or Tier 1 schoolwide behavior support, around 15% will require added selective or Tier 2 targeted support, and 5% will require the more intensive selective or Tier 3 intervention. The PBIS framework also emphasizes the use of tiered logic, with strengthened efforts at the universal and selective levels when student behavioral or mental health needs exceed expected levels. The prediction that 5% of students will require indicated support was based mostly on students at risk for discipline encounters (i.e., office discipline referral data) and, more recently, systematic screening data, but this percentage remains an interpretation of the public health framework. Further, epidemiologic data over the past decade show that rates of childhood mental health disorders have risen and are even higher now as schools struggle to recover from the COVID-19 pandemic-much higher than 15% and 5% for selective and indicated levels. Thus, we believe it is time to revisit projections of the number of students in need of Tier 2 and Tier 3 support. In this position paper, we review the evidence for escalating youth mental health needs and discuss the implications for the tiered prevention framework in schools. We describe strategies to expand the availability of preventive intervention supports beyond Tier 1 efforts and conclude with recommendations for practice, policy, and research in this peri-COVID recovery era.
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Affiliation(s)
- Mark D Weist
- University of South Carolina, Columbia, SC, 29208, USA.
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18
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Barrett CA, Sleesman DJ, Amin T. A Mixed Methods Examination of Decision-Making During Program Exploration and Implementation in Schools. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:459-469. [PMID: 38416383 DOI: 10.1007/s11121-024-01655-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 02/29/2024]
Abstract
Schools are a critical setting to promote healthy youth development through the provision of evidence-based programs (EBPs), yet preventive EBPs in schools are underutilized. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework highlights numerous factors that may influence program adoption during the Exploration phase and progress monitoring during the Implementation phase. However, no research has systematically and simultaneously identified the factors that influence school administrators' decision-making during these important processes. We conducted semi-structured interviews with 24 school administrators in the Midwestern region of the U.S. to understand how they weigh various considerations that inform their adoption and progress monitoring of prevention programs. Results indicated that school administrators consider five separate factors during the adoption decision, prioritized in the following order: need for the program, school community buy-in, contextual fit, resources, and program characteristics (including the evidence-base). Further, administrators consider five indicators to monitor program performance, prioritized as follows: intervention fidelity, quantitative and qualitative data that determine if the identified need was met, school community buy-in, resource consumption, and program characteristics. Implications for prevention scientists and suggestions for future research are discussed.
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Affiliation(s)
| | | | - Tazkira Amin
- Michigan State University, East Lansing, MI, 48824, USA
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19
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Covell NH, Patel SR, Margolies PJ, Hinds MT, Lopez LO, Dixon LB. Support From Intermediary Organizations for Evidence-Based Practices in Behavioral Health Care. Psychiatr Serv 2024; 75:191-193. [PMID: 37731345 DOI: 10.1176/appi.ps.20230139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Intermediary and purveyor organizations play a key role in disseminating and implementing evidence-based behavioral health best practices (EBPs). The authors provide a case example to describe how state-funded intermediaries can enhance the implementation and sustainment of EBP. Benefits of using state-funded intermediaries include the ability to collaborate with state entities to address barriers to and then incentivize best practices, access to resources to develop a robust infrastructure to support EBP training and implementation, and enhanced capacity to support organizations beyond individual EBPs (e.g., developing an internal quality-improvement process, supporting cross-cutting competencies, and helping organizations to identify synergies across EBP and to prioritize what to implement first).
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Affiliation(s)
- Nancy H Covell
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
| | - Sapana R Patel
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
| | - Paul J Margolies
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
| | - Melissa T Hinds
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
| | - Luis O Lopez
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
| | - Lisa B Dixon
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
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20
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Dopp AR, Hindmarch G, Osilla KC, Meredith LS, Manuel JK, Becker K, Tarhuni L, Schoenbaum M, Komaromy M, Cassells A, Watkins KE. Mis-implementation of evidence-based behavioural health practices in primary care: lessons from randomised trials in Federally Qualified Health Centers. EVIDENCE & POLICY : A JOURNAL OF RESEARCH, DEBATE AND PRACTICE 2024; 20:15-35. [PMID: 38911233 PMCID: PMC11192460 DOI: 10.1332/17442648y2023d000000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Background Implementing evidence-based practices (EBPs) within service systems is critical to population-level health improvements - but also challenging, especially for complex behavioral health interventions in low-resource settings. "Mis-implementation" refers to poor outcomes from an EBP implementation effort; mis-implementation outcomes are an important, but largely untapped, source of information about how to improve knowledge exchange. Aims and objectives We present mis-implementation cases from three pragmatic trials of behavioral health EBPs in U.S. Federally Qualified Health Centers (FQHCs). Methods We adapted the Consolidated Framework for Implementation Research and its Outcomes Addendum into a framework for mis-implementation and used it to structure the case summaries with information about the EBP and trial, mis-implementation outcomes, and associated determinants (barriers and facilitators). We compared the three cases to identify shared and unique mis-implementation factors. Findings Across cases, there was limited adoption and fidelity to the interventions, which led to eventual discontinuation. Barriers contributing to mis-implementation included intervention complexity, low buy-in from overburdened providers, lack of alignment between providers and leadership, and COVID-19-related stressors. Mis-implementation occurred earlier in cases that experienced both patient- and provider-level barriers, and that were conducted during the COVID-19 pandemic. Discussion and conclusion Multi-level determinants contributed to EBP mis-implementation in FQHCs, limiting the ability of these health systems to benefit from knowledge exchange. To minimize mis-implementation, knowledge exchange strategies should be designed around common, core barriers but also flexible enough to address a variety of site-specific contextual factors and should be tailored to relevant audiences such as providers, patients, and/or leadership.
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21
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Aguilera A, Arévalo Avalos MR, Rosales K, Reyes Y, Hernandez-Ramos R, Ramos G, Garcia E, Hoang T, Ochoa-Frongia L, Fortuna LR, Schueller SM. Effectiveness-implementation hybrid trial of Spanish language, digital cognitive-behavioral therapy (dCBT) intervention for depression and anxiety - protocol for the SUPERA (SUpport from PEeRs to expand Access) study. Contemp Clin Trials 2024; 137:107422. [PMID: 38145715 PMCID: PMC11138320 DOI: 10.1016/j.cct.2023.107422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/09/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Limited English Proficiency (LEP) Latinxs experience a longer duration of untreated depression and anxiety. LEP Latinxs have difficulty accessing mental healthcare due to insufficient Spanish-speaking behavioral/mental health clinicians to meet demand. These under-resourced healthcare systems are less likely to be the site for the implementation of innovations. Digital interventions can provide an effective option for overcoming these barriers; yet, when digital evidence-based treatments are available, uptake and engagement is often low. This manuscript presents the protocol for the SUPERA (SUpport from PEeRs to expand Access) study which will evaluate the implementation of an evidence-based, Spanish language, digital cognitive-behavioral therapy (dCBT) intervention (i.e., SilverCloud) in safety-net primary care clinics for LEP Latinx patients with depression or anxiety. METHODS We will conduct an effectiveness-implementation hybrid trial (Type 2) design comparing engagement and clinical outcomes in two modalities of dCBT delivery (peer-supported vs. unsupported). We will also compare provider-level outreach (using a clinic patient registry) versus inreach (traditional provider referral) to compare rates of initiation, completion, and cost. Participants will be 426 LEP Latinx adults ≥18 years of age, PHQ-9 ≥ 10 or GAD-7 ≥ 8, with access to the internet via smartphone, and not currently receiving individual psychotherapy. We will collect baseline, post-intervention (8 weeks), and follow up (3 months) data. CONCLUSION The long-term goal of this research is to aid in the implementation of digital mental health interventions that can be sustainably implemented in low-resourced settings, while reducing the reliance on professionals, overcoming workforce deficits, and increasing relevance for diverse populations.
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Affiliation(s)
- Adrian Aguilera
- School of Social Welfare, University of California Berkeley, Berkeley, CA, United States of America; Department of Psychiatry, University of California-San Francisco, San Francisco, CA, United States of America.
| | - Marvyn R Arévalo Avalos
- School of Social Welfare, University of California Berkeley, Berkeley, CA, United States of America
| | - Karina Rosales
- School of Social Welfare, University of California Berkeley, Berkeley, CA, United States of America
| | - Yazleen Reyes
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States of America
| | - Rosa Hernandez-Ramos
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States of America
| | - Giovanni Ramos
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States of America
| | - Esmeralda Garcia
- School of Social Welfare, University of California Berkeley, Berkeley, CA, United States of America
| | - Tuyen Hoang
- Biostatistics, Epidemiology & Research Design (BERD) Unit, University of California, Irvine, Irvine, CA, United States of America
| | - Lisa Ochoa-Frongia
- School of Medicine, University of California-San Francisco, San Francisco, CA, United States of America
| | - Lisa R Fortuna
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA, United States of America
| | - Stephen M Schueller
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States of America
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22
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Owen A, Owen R, Batz R, Marasco-Wetzel J. Adolescent Perceptions of Adult-Mediated Healthcare Communication. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:400-415. [PMID: 38319709 DOI: 10.1080/19371918.2024.2314022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Adolescence is a time of rapid growth and development and may be accompanied by increased risk-taking behaviors and independence. Youth are particularly at risk for high levels of stress, decreased physical activity, unsafe sexual activity, abuse, depression, and suicide. Considering the unique health risks adolescents face, healthcare service access and utilization can play a pivotal role in promoting positive long term health outcomes throughout adulthood. At the same time, adolescents must often rely on parents/caregivers to mediate their healthcare access. Understanding how adolescents perceive adult interactions within healthcare is important for developing interventions that increase youth access to healthcare. We found that adolescents perceived adult-mediated healthcare experiences as either supportive (Subthemes: Recognition Builds Trust and Validation) or unsupportive (Subthemes: Adult-Focused Communication and Lack of Privacy). Based on our findings, we argue that prevention-focused interventions should include communication-based strategies. We discuss social work and healthcare practice and policy implications of these findings.
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Affiliation(s)
- Aleksa Owen
- School of Social Work, University of Nevada, Reno, NL, USA
| | - Randall Owen
- Special Education, College of Education and Human Development, University of Nevada, Reno, NL, USA
| | - Ruby Batz
- Special Education, College of Education and Human Development, University of Nevada, Reno, NL, USA
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Hobbs T, Santana De Lima E, Bevington D, Preece C, Allen K, Barna P, Berry V, Booker T, Davies K, Davis G, Deighton J, Freeman L, Fuggle P, Goddard E, Greene Barker T, Harris J, Heather A, Jardiel MF, Joshi K, Keenan M, Kennedy L, Malhotra T, March A, Pilling S, Pitt M, Potter K, Rehill N, Shand J, Surtees R, Fonagy P. Kailo: a systemic approach to addressing the social determinants of young people's mental health and wellbeing at the local level. Wellcome Open Res 2023; 8:524. [PMID: 38798997 PMCID: PMC11126905 DOI: 10.12688/wellcomeopenres.20095.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 05/29/2024] Open
Abstract
The mental health and wellbeing of children and young people is deteriorating. It is increasingly recognised that mental health is a systemic issue, with a wide range of contributing and interacting factors. However, the vast majority of attention and resources are focused on the identification and treatment of mental health disorders, with relatively scant attention on the social determinants of mental health and wellbeing and investment in preventative approaches. Furthermore, there is little attention on how the social determinants manifest or may be influenced at the local level, impeding the design of contextually nuanced preventative approaches. This paper describes a major research and design initiative called Kailo that aims to support the design and implementation of local and contextually nuanced preventative strategies to improve children's and young people's mental health and wellbeing. The Kailo Framework involves structured engagement with a wide range of local partners and stakeholders - including young people, community partners, practitioners and local system leaders - to better understand local systemic influences and support programmes of youth-centred and evidence-informed co-design, prototyping and testing. It is hypothesised that integrating different sources of knowledge, experience, insight and evidence will result in better embedded, more sustainable and more impactful strategies that address the social determinants of young people's mental health and wellbeing at the local level.
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Affiliation(s)
- Tim Hobbs
- Dartington Service Design Lab, Buckfastleigh, England, TQ11 0EE, UK
| | | | | | - Cristina Preece
- Dartington Service Design Lab, Buckfastleigh, England, TQ11 0EE, UK
| | - Kate Allen
- University of Exeter, Exeter, England, EX4 4PY, UK
| | | | - Vashti Berry
- University of Exeter, Exeter, England, EX4 4PY, UK
| | - Thomas Booker
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England, WC1E 6BT, UK
| | - Karuna Davies
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England, WC1E 6BT, UK
| | - George Davis
- Dartington Service Design Lab, Buckfastleigh, England, TQ11 0EE, UK
| | | | - Leanne Freeman
- Dartington Service Design Lab, Buckfastleigh, England, TQ11 0EE, UK
| | | | - Ellen Goddard
- Dartington Service Design Lab, Buckfastleigh, England, TQ11 0EE, UK
| | - Tamsin Greene Barker
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England, WC1E 6BT, UK
| | - Julie Harris
- Dartington Service Design Lab, Buckfastleigh, England, TQ11 0EE, UK
| | - Amy Heather
- University of Exeter, Exeter, England, EX4 4PY, UK
| | | | | | - Megan Keenan
- Dartington Service Design Lab, Buckfastleigh, England, TQ11 0EE, UK
| | - Laura Kennedy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England, WC1E 6BT, UK
| | | | - Anna March
- University of Exeter, Exeter, England, EX4 4PY, UK
| | - Steve Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England, WC1E 6BT, UK
| | - Martin Pitt
- University of Exeter, Exeter, England, EX4 4PY, UK
| | - Katie Potter
- Dartington Service Design Lab, Buckfastleigh, England, TQ11 0EE, UK
| | | | | | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England, WC1E 6BT, UK
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24
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Houghtaling B, Balis L, Pradhananga N, Cater M, Holston D. Healthy eating and active living policy, systems, and environmental changes in rural Louisiana: a contextual inquiry to inform implementation strategies. Int J Behav Nutr Phys Act 2023; 20:132. [PMID: 37957692 PMCID: PMC10644669 DOI: 10.1186/s12966-023-01527-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/08/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Healthy eating and active living policy, systems, and environmental (PSE) changes are implemented across the United States through Cooperative Extension. However, translating multisector PSE changes to practice in community settings is challenging and there is a lack of knowledge about barriers and facilitators to PSE changes among state Extension systems using standardized frameworks. Therefore, a research-to-practice partnership effort aimed to identify Louisiana Cooperative Extension Service Family and Consumer Science (LFCS) practitioners' barriers and facilitators to implementing PSE changes in rural Louisiana communities. METHODS A qualitative approach using the 2022 Consolidated Framework for Implementation Research (2022 CFIR) was used. Focus group discussions were conducted at five LFCS regional trainings between February and May 2022. All LFCS practitioners with any level of experience implementing healthy eating and active living PSE changes were eligible to participate, with emphasis on understanding efforts within more rural communities. Focus group discussions were audio-recorded and transcribed verbatim. Researchers analyzed qualitative data using the constant comparison method and 2022 CFIR domains and constructs including Inner Setting (LFCS organization), Outer Setting (rural Louisiana communities), Innovation (PSE changes), and Individuals (PSE change implementation actors/partners). RESULTS Across the five regions, LFCS practitioners (n = 40) described more barriers (n = 210) than facilitators (n = 100); findings were often coded with multiple 2022 CFIR domains. Reported Inner Setting barriers were lack of formal or informal information sharing and lack of access to knowledge and information. Outer Setting barriers included sustaining and initiating community partnerships and local environmental or political conditions. Individual barriers included a lack of time and expertise, and Innovation barriers included the complex nature of rural PSE changes. Facilitators were mentioned at multiple levels and included community partner buy-in and practitioners' motivation to implement PSE changes. CONCLUSIONS Implementation strategies are needed to build on organizational strengths and to overcome multi-level barriers to PSE change implementation among LFCS practitioners. The results from the in-depth contextual inquiry used could serve as a guide for future pragmatic assessment efforts among other state Extension systems or as a model for identifying barriers and facilitators and associated implementation strategies among other public health systems in the U.S. and abroad.
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Affiliation(s)
- Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA, 70803, USA.
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, USA.
- Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA.
| | - Laura Balis
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, USA
- Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA
| | - Nila Pradhananga
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA, 70803, USA
| | - Melissa Cater
- Agricultural and Extension Education and Evaluation, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA, 70803, USA
| | - Denise Holston
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA, 70803, USA
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Johnston B, Ruffalo L, Nelson D, O'Connor S, Young S. Foundations of Community Engagement: A Series for Effective Community-Engaged Research. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11350. [PMID: 37822302 PMCID: PMC10562524 DOI: 10.15766/mep_2374-8265.11350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/22/2023] [Indexed: 10/13/2023]
Abstract
Introduction Medical students lack systematic exposure to community engagement. Community-engaged research (CEnR) is an effective approach to improve community health, and community-engaged physicians are better attuned to the community context of their patients' health and well-being. The Medical College of Wisconsin (MCW) Office of Community Engagement began offering the educational series Foundations of Community Engagement in 2021 to meet this need. Methods We developed and implemented a four-session series for medical students at MCW and the University of Nebraska Medical Center. A 1-hour session on the foundations of CEnR was held for all learners. Three 1-hour sessions dove deeper into CEnR principles for a self-selected cohort. These small-group sessions involved discussion between faculty and community partners and facilitated small-group discussion. Students completed evaluations after each session. Results A total of 160 students participated in the introductory session; 36 took part in the follow-up series. Survey response rates varied from 38% to 67% for each session. Overall, 87% of students in all sessions felt their session was worthwhile, with 85% of large-group and 96% of small-group respondents reporting they learned something they would use in their practice or profession. Qualitative responses included appreciation for addressing a curricular gap and desire for more time and more sessions to continue discussions. Discussion The program was effective at stimulating medical student self-reported gains in skills, attitudes, and future intentions regarding CEnR in an efficient manner. Effective programs that transfer positive CEnR skills and attitudes to future physicians can promote CEnR within academic medicine.
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Affiliation(s)
- Bryan Johnston
- Assistant Professor, Department of Family and Community Medicine, Medical College of Wisconsin
| | - Leslie Ruffalo
- Associate Professor, Department of Family and Community Medicine, Medical College of Wisconsin
| | - David Nelson
- Professor, Department of Family and Community Medicine, Medical College of Wisconsin
| | - Sarah O'Connor
- Program Director, Office of Community Engagement, Medical College of Wisconsin
| | - Staci Young
- Professor, Department of Family and Community Medicine, Director, Office of Community Engagement, and Senior Associate Dean for Community Engagement, Medical College of Wisconsin
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26
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Goldstein AB, Oudekerk BA, Blanco C. HEAL Preventing Opioid Use Disorder: a Vision for Research to Increase Access to Prevention Services. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:8-15. [PMID: 37603259 DOI: 10.1007/s11121-023-01547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 08/22/2023]
Abstract
Launched in 2018, the National Institutes of Health (NIH) Helping to End Addiction Long-term Initiative®, or NIH HEAL Initiative, is an aggressive effort to speed scientific solutions to stem this national public health crisis. Investments in new strategies to prevent opioid misuse are a key component of this comprehensive response to the opioid epidemic. In 2019, funded through the NIH HEAL Initiative® and administered by the National Institute on Drug Abuse (NIDA), HEAL Preventing Opioid Use Disorder (HEAL Preventing OUD) research program began, filling the gap of needed upstream prevention interventions. The vision for HEAL Preventing OUD is that: Healthcare organizations and public systems will be able to make evidence-based preventive intervention services accessible to all persons who experience risk for opioid and other substance misuse or use disorder. Realizing this vision will require research investments in four strategic areas: (1) risk identification; (2) intervention development; (3) social determinants, health equity, and policy; and (4) dissemination, implementation, scale up, and sustainment. There exists tremendous potential for prevention to be a viable solution for the ongoing opioid crisis, particularly through investments in upstream, equitable, and sustainable prevention services.
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Affiliation(s)
- Amy B Goldstein
- National Institute On Drug Abuse, National Institutes of Health, 3 WFN RM08D06, MSC 6020, 301 North Stonestreet Ave, Rockville, MD, 20850, USA.
| | - Barbara A Oudekerk
- National Institute On Drug Abuse, National Institutes of Health, 3 WFN RM08D06, MSC 6020, 301 North Stonestreet Ave, Rockville, MD, 20850, USA
| | - Carlos Blanco
- National Institute On Drug Abuse, National Institutes of Health, 3 WFN RM08D06, MSC 6020, 301 North Stonestreet Ave, Rockville, MD, 20850, USA
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Bailey JA, Pandika D, Le VT, Epstein M, Steeger CM, Hawkins JD. Testing Cross-Generational Effects of the Raising Healthy Children Intervention on Young Adult Offspring of Intervention Participants. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1376-1385. [PMID: 37733189 PMCID: PMC10948000 DOI: 10.1007/s11121-023-01583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Abstract
This study tested whether effects of a preventive intervention delivered in elementary school showed benefits for the young adult offspring of intervention recipients over 20 years later. The Raising Healthy Children (RHC) intervention, trialed in 18 public schools in Seattle, Washington, from 1980-1986 (grades 1-6), sought to build strong bonds to family and school to promote school success and avoidance of substance use and illegal behavior. Four intervention groups were constituted: full, late, parent training only, and control. Participants were followed through 2014 (age 39 years). Those who became parents were enrolled in an intergenerational study along with their oldest offspring (10 assessments between 2002 and 2018). This study includes young adult offspring (ages 18-25 years; n = 169; 52% female; 4% Asian, 25% Black, 40% multiracial, 4% Native American, 2% Native Hawaiian/Pacific Islander, 25% White, and 14% Hispanic/Latinx) of participants in the original RHC trial. Offspring outcome measures included high school noncompletion, financial functioning, alcohol misuse, cannabis misuse, cigarette use, criminal behavior, internalizing behavior, social skills, and social bonding. A global test across all young adult outcome measures showed that offspring of parents who received the full RHC intervention reported better overall functioning compared to offspring of control group parents. Analyses of individual outcomes showed that offspring of full intervention group parents reported better financial functioning than offspring of control group parents. Findings show the potential of universal preventive interventions to provide long-term benefits that reach into the next generation. ClinicalTrials.gov Identifier: NCT04075019; retrospectively registered in 2019.
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Affiliation(s)
- Jennifer A Bailey
- Social Development Research Group, University of Washington, 9725 3rd Avenue NE, Suite 401, 98115, Seattle, WA, USA.
| | - Danielle Pandika
- Social Development Research Group, University of Washington, 9725 3rd Avenue NE, Suite 401, 98115, Seattle, WA, USA
| | - Vi T Le
- Social Development Research Group, University of Washington, 9725 3rd Avenue NE, Suite 401, 98115, Seattle, WA, USA
| | - Marina Epstein
- Social Development Research Group, University of Washington, 9725 3rd Avenue NE, Suite 401, 98115, Seattle, WA, USA
| | | | - J David Hawkins
- Social Development Research Group, University of Washington, 9725 3rd Avenue NE, Suite 401, 98115, Seattle, WA, USA
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Calvert HG, McQuilkin M, Havlicak A, Lewis T, Turner L. Acceptability, appropriateness, and feasibility of Rural School Support Strategies for behavioral interventions: a mixed methods evaluation over two years of a hybrid type 3 implementation-effectiveness trial. Implement Sci Commun 2023; 4:92. [PMID: 37568206 PMCID: PMC10416374 DOI: 10.1186/s43058-023-00478-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Positive Behavioral Interventions and Supports (PBIS) is a framework for implementing evidence-based interventions for preventing behavioral issues and improving climate in schools. The implementation of school-wide PBIS with fidelity is complex, requiring leadership commitment, teaming, and coordination of systems for tracking behaviors and consequences. Putting these components in place while ensuring alignment with the values and needs of the school community can be difficult for schools with fewer resources, such as rural schools. Implementation supports are needed, including strategies such as technical assistance, but it is unclear whether lower-cost modalities such as virtual support are acceptable, appropriate, and feasible and whether perceptions vary throughout the implementation process. METHODS A type 3 hybrid implementation-effectiveness trial is taking place in 40 Idaho schools, testing a bundle of implementation supports selected to meet the needs of schools in rural areas. Supports include technical assistance from an implementation support practitioner (ISP), didactic trainings, virtual learning sessions, and an online resource portal. Surveys and interviews in the first 2 years of implementation (fall 2019 to spring 2021) explored outcomes of acceptability, appropriateness, and feasibility regarding the implementation supports among more than 150 school stakeholders. RESULTS Evaluations showed high acceptability and appropriateness of the PBIS concepts and training. The 20 schools receiving additional implementation support rated the technical assistance and support from the project's ISPs as the most acceptable and appropriate resource. Reasons for acceptability were the relationship built with the ISP, the ISP's expertise, and being a "neutral party." Although in-person support from the ISP was preferred, remote support was acceptable and increased feasibility of attendance. Virtual learning sessions were acceptable for learning and collaboration, particularly in the second year of implementation, once ISPs had developed closer relationships with school teams. CONCLUSIONS School staff found training, technical assistance, and virtual learning sessions to be acceptable and appropriate. Virtual formats of training and technical assistance decreased in acceptability but increased feasibility of attendance. In-person support was preferred during initial implementation, and virtual support was more acceptable thereafter. TRIAL REGISTRATION This trial was prospectively registered on ClinicalTrials.gov ( NCT03736395 ), on November 9, 2018.
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Affiliation(s)
- Hannah G Calvert
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA.
| | - Michaela McQuilkin
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA
| | - Ashley Havlicak
- School of Public and Population Health, College of Health Sciences, Boise State University, 1910 W University Dr, Boise, ID, 83725-1742, USA
| | - Teri Lewis
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA
| | - Lindsey Turner
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA
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29
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Sloboda Z, Johnson KA, Fishbein DH, Brown CH, Coatsworth JD, Fixsen DL, Kandel D, Paschall MJ, Silva FS, Sumnall H, Vanyukov M. Normalization of Prevention Principles and Practices to Reduce Substance Use Disorders Through an Integrated Dissemination and Implementation Framework. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1078-1090. [PMID: 37052866 PMCID: PMC10476513 DOI: 10.1007/s11121-023-01532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
Major research breakthroughs over the past 30 years in the field of substance use prevention have served to: (1) enhance understanding of pharmacological effects on the central and peripheral nervous systems and the health and social consequences of use of psychoactive substances, particularly for children and adolescents; (2) delineate the processes that increase vulnerability to or protect from initiation of substance use and progression to substance use disorders (SUDs) and, based on this understanding, (3) develop effective strategies and practices to prevent the initiation and escalation of substance use. The challenge we now face as a field is to "normalize" what we have learned from this research so that it is incorporated into the work of those involved in supporting, planning, and delivering prevention programming to populations around the world, is integrated into health and social service systems, and helps to shape public policies. But we wish to go further, to incorporate these effective prevention practices into everyday life and the mind-sets of the public, particularly parents and educators. This paper reviews the advances that have been made in the field of prevention and presents a framework and recommendations to achieve these objectives generated during several meetings of prevention and implementation science researchers sponsored by the International Consortium of Universities for Drug Demand Reduction (ICUDDR) that guides a roadmap to achieve "normalization."
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Affiliation(s)
- Zili Sloboda
- Applied Prevention Science International, Ontario, OH, USA.
| | - Kimberly A Johnson
- Department of Mental Health Law and Policy, College of Community and Behavioral Sciences, University of South Florida, Tampa, FL, USA
- International Consortium of Universities of Drug Demand Reduction, Tampa, FL, USA
| | - Diana H Fishbein
- Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- National Prevention Science, The Pennsylvania State University, State College, Harrisburg, PA, USA
| | | | | | - Dean L Fixsen
- Active Implementation Research Network, Inc, Chapel Hill, NC, USA
| | - Denise Kandel
- Department of Psychiatry and School of Public Health, Columbia University, New York, NY, USA
| | - Mallie J Paschall
- Prevention Research Center (PRC), Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | | | - Harry Sumnall
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Michael Vanyukov
- Departments of Pharmaceutical Sciences, Psychiatry, and Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
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30
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Wiedermann CJ, Barbieri V, Plagg B, Marino P, Piccoliori G, Engl A. Fortifying the Foundations: A Comprehensive Approach to Enhancing Mental Health Support in Educational Policies Amidst Crises. Healthcare (Basel) 2023; 11:healthcare11101423. [PMID: 37239709 DOI: 10.3390/healthcare11101423] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
In recent times, global crises such as the COVID-19 pandemic, climate change, and geopolitical conflicts have significantly impacted pupils' mental health. This opinion article presents evidence-based recommendations to bolster mental health support within educational systems, aiming to alleviate the psychological burden faced by students during these challenging times. This article argues that a proactive, holistic approach to mental health is essential for building a resilient educational infrastructure. More than ever, we support the call for the integration of mental health education into the core curriculum, equipping students with vital coping skills and fostering emotional intelligence. Additionally, we emphasize the importance of training educators and staff to identify and address mental health issues. Furthermore, this article highlights the need for interdisciplinary collaboration involving general practitioners, mental health professionals, community organizations, and policymakers in crafting and implementing support strategies. Educational institutions can effectively leverage the expertise of diverse stakeholders to create targeted interventions by cultivating partnerships. Finally, the significance of continuously evaluating and refining mental health support policies to ensure their efficacy and adaptability in the face of evolving crises is emphasized. Through these comprehensive recommendations, this opinion article seeks to catalyze a transformation in educational policies, prioritize mental health support, and empower pupils to thrive during tumultuous times.
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Affiliation(s)
- Christian J Wiedermann
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
- Department of Public Health, Medical Decision Making and Health Technology Assessment, University of Health Sciences, Medical Informatics and Technology, 6060 Hall, Tyrol, Austria
| | - Verena Barbieri
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
| | - Barbara Plagg
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
- Faculty of Education, Free University of Bolzano, 39100 Bolzano, Italy
| | - Pasqualina Marino
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
| | - Adolf Engl
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
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31
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Zhang Y, Cook C, Fallon L, Corbin C, Ehrhart M, Brown E, Locke J, Lyon A. The Interaction Between General and Strategic Leadership and Climate on Their Multilevel Associations with Implementer Attitudes Toward Universal Prevention Programs for Youth Mental Health: A Cross-Sectional Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:427-449. [PMID: 36585557 DOI: 10.1007/s10488-022-01248-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
Emerging literature has highlighted the importance of discerning general and strategic organizational context (OC) factors (e.g., leadership and climate) and their interaction effect on individual implementation behaviors (e.g., attitudes toward evidence-based practices; EBPs) in youth mental healthcare. This study aimed to examine how leadership and climate (general and strategic) are associated with implementer attitudes toward EBPs across the individual and organizational levels and their interaction effect in schools. A series of multilevel models (MLMs) were fitted on a diverse sample of schools actively implementing universal prevention programs for youth mental health (441 implementers from 52 schools). The organization-level aggregates and individual educators' perceptions of general and strategic leadership and climate, and their interaction terms, were entered as level-2 and level-1 predictors of four attitudinal dimensions (Requirement, Openness, Appeal, and Divergence) based on their level of measurement. At the organizational level, higher levels of strategic leadership and climate, but not their general counterparts, were consistently associated with more favorable attitudes in all four dimensions. At the individual/within-school level, higher levels of perceived general and strategic leadership and climate were associated with more favorable attitudes of Requirement and Openness. At the organizational/between-school level, general climate moderated the positive effect of strategic climate on implementers' perception of appeal and divergence of EBPs. Our findings indicate that leaders should make data-based decisions to allocate resources on strategic and/or general leadership and climate to foster favorable staff attitudes toward EBPs based on the level of measurement, implementation-specificity, and attitudinal dimensions.
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Affiliation(s)
- Yanchen Zhang
- Department of Psychological & Quantitative Foundations, The University of Iowa, 361 Lindquist Center, Iowa City, IA, 52242, USA.
| | - Clay Cook
- Department of Educational Psychology, University of Minnesota, 341 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Lindsay Fallon
- Department of Counseling and School Psychology, University of Massachusetts-Boston, 100 William T. Morrissey Blvd., Boston, MA, 02125, USA
| | - Catherine Corbin
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
| | - Mark Ehrhart
- Department of Industrial/Organizational Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, USA
| | - Eric Brown
- Department of Public Health Sciences, University of Miami, Coral Gables, FL, 33124, USA
| | - Jill Locke
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
| | - Aaron Lyon
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
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Lee-Easton MJ, Magura S, Maranda MJ, Landsverk J, Rolls-Royce J, Green B, DeCamp W, Abu-Obaid R. A Scoping Review of the Influence of Evidence-Based Program Resources (EBPR) Websites for Behavioral Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:379-391. [PMID: 36564667 PMCID: PMC10191876 DOI: 10.1007/s10488-022-01245-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
Evidence-based program resources (EBPR) websites evaluate behavioral health programs, practices or policies (i.e., interventions) according to a predetermined set of research criteria and standards, usually resulting in a summary rating of the strength of an intervention's evidence base. This study is a mixed-methods analysis of the peer-reviewed academic literature relating to the influence of EBPRs on clinical practice and policy in the behavioral health field. Using an existing framework for a scoping review, we searched for research articles in PubMed, Web of Science, SCOPUS, and ProQuest that were published between January 2002 and March 2022, referenced an EBPR or multiple EBPRs, and presented data showing the influence of one or more EBPRs on behavioral health. A total of 210 articles met the inclusion criteria and were classified into five distinct categories of influence, the most important of which was showing the direct impact of one or more EBPRs on behavioral health (8.1% of articles), defined as documenting observable changes in interventions or organizations that are at least partly due to information obtained from EBPR(s). These included impacts at the state legislative and policy-making level, at the community intervention level, provider agency level, and individual practitioner level. The majority of influences identified in the study were indirect demonstrations of how EBPRs are used in various ways. However, more studies are needed to learn about the direct impact of information from EBPRs on the behavioral health field, including impact on clinician practice and treatment outcomes for consumers.
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Affiliation(s)
- Miranda J Lee-Easton
- The Evaluation Center, Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo, MI, 49008, USA
| | - Stephen Magura
- The Evaluation Center, Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo, MI, 49008, USA.
| | - Michael J Maranda
- The Evaluation Center, Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo, MI, 49008, USA
| | - John Landsverk
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR, 97401, USA
| | - Jennifer Rolls-Royce
- Chadwick Center, Rady Children's Hospital, 3020 Children's Way-Mailcode 5131, San Diego, CA, 92123, USA
| | - Brandn Green
- Development Services Group Inc, 7315 Wisconsin Ave #800E, Bethesda, MD, 20814, USA
| | - Whitney DeCamp
- Department of Sociology, Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo, MI, 49008, USA
| | - Ruqayyah Abu-Obaid
- The Evaluation Center, Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo, MI, 49008, USA
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Mustanski B, Saber R, Jones JP, Macapagal K, Benbow N, Li DH, Brown CH, Janulis P, Smith JD, Marsh E, Schackman BR, Linas BP, Madkins K, Swann G, Dean A, Bettin E, Savinkina A. Keep It Up! 3.0: Study protocol for a type III hybrid implementation-effectiveness cluster-randomized trial. Contemp Clin Trials 2023; 127:107134. [PMID: 36842763 PMCID: PMC10249332 DOI: 10.1016/j.cct.2023.107134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Despite evidence that eHealth approaches can be effective in reducing HIV risk, their implementation requirements for public health scale up are not well established, and effective strategies to bring these programs into practice are still unknown. Keep It Up! (KIU!) is an online program proven to reduce HIV risk among young men who have sex with men (YMSM) and ideal candidate to develop and evaluate novel strategies for implementing eHealth HIV prevention programs. KIU! 3.0 is a Type III Hybrid Effectiveness-Implementation cluster randomized trial designed to 1) compare two strategies for implementing KIU!: community-based organizations (CBO) versus centralized direct-to-consumer (DTC) recruitment; 2) examine the effect of strategies and determinants on variability in implementation success; and 3) develop materials for sustainment of KIU! after the trial concludes. In this article, we describe the approaches used to achieve these aims. METHODS Using county-level population estimates of YMSM, 66 counties were selected and randomized 2:1 to the CBO and DTC approaches. The RE-AIM model was used to drive outcome measurements, which were collected from CBO staff, YMSM, and technology providers. Mixed-methods research mapped onto the domains of the Consolidated Framework for Implementation Research will examine determinants and their relationship with implementation outcomes. DISCUSSION In comparing our implementation recruitment models, we are examining two strategies which have shown effectiveness in delivering health technology interventions in the past, yet little is known about their comparative advantages and disadvantages in implementation. The results of the trial will further the understanding of eHealth prevention intervention implementation.
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Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America.
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Justin Patrick Jones
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Nanette Benbow
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Patrick Janulis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, 295 Chipeta Way, Williams Building, Salt Lake City, UT 84108, United States of America
| | - Elizabeth Marsh
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
| | - Benjamin P Linas
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
| | - Krystal Madkins
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Gregory Swann
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Abigael Dean
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Emily Bettin
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Alexandra Savinkina
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
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Fishbein DH, Sloboda Z. A National Strategy for Preventing Substance and Opioid Use Disorders Through Evidence-Based Prevention Programming that Fosters Healthy Outcomes in Our Youth. Clin Child Fam Psychol Rev 2023; 26:1-16. [PMID: 36542196 PMCID: PMC9768412 DOI: 10.1007/s10567-022-00420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
The recently released National Drug Control Strategy (2022) from the White House Office of National Drug Control Policy (ONDCP) lays out a comprehensive plan to, not only enhance access to treatment and increase harm reduction strategies, but also increase implementation of evidence-based prevention programming at the community level. Furthermore, the Strategy provides a framework for enhancing our national data systems to inform policy and to evaluate all components of the plan. However, not only are there several missing components to the Strategy that would assure its success, but there is a lack of structure to support a national comprehensive service delivery system that is informed by epidemiological data, and trains and credentials those delivering evidence-based prevention, treatment, and harm reduction/public health interventions within community settings. This paper provides recommendations for the establishment of such a structure with an emphasis on prevention. Systematically addressing conditions known to increase liability for behavioral problems among vulnerable populations and building supportive environments are strategies consistently found to avert trajectories away from substance use in general and substance use disorders (SUD) in particular. Investments in this approach are expected to result in significantly lower rates of SUD in current and subsequent generations of youth and, therefore, will reduce the burden on our communities in terms of lowered social and health systems involvement, treatment needs, and productivity. A national strategy, based on strong scientific evidence, is presented to implement public health policies and prevention services. These strategies work by improving child development, supporting families, enhancing school experiences, and cultivating positive environmental conditions.
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Affiliation(s)
- Diana H Fishbein
- Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, 105 Smith Level Road, Chapel Hill, NC, 27599, USA.
- The Pennsylvania State University, State College, PA, USA.
- National Prevention Science Coalition to Improve Lives, Oakland, CA, USA.
| | - Zili Sloboda
- National Prevention Science Coalition to Improve Lives, Oakland, CA, USA
- Applied Prevention Science International, Ontario, OH, USA
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Razuri EB, Yang Y, Tinius E, Knight DK. Adaptation of a trauma-informed intervention for youth involved in the legal system. RESEARCH SQUARE 2023:rs.3.rs-2596631. [PMID: 36909596 PMCID: PMC10002807 DOI: 10.21203/rs.3.rs-2596631/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Background Youth in the legal system (YILS) have high rates of trauma exposure, which are associated with increased risk of behavioral health needs (e.g., substance-use problems) and recidivism. Research suggests that a trauma-focused therapeutic approach can improve outcomes for YILS, but few evidence-based interventions (EBIs) are designed with justice-involved youth in mind. Consequently, implementing trauma-informed EBIs within juvenile justice (JJ) systems is challenging. The current paper describes the systematic adaptation of Trust-based Relational Intervention (TBRI) as a substance use prevention intervention for YILS and their caregivers. Methods The current study utilized a methodology based on the ADAPT-ITT framework to adapt TBRI Caregiver Training, an evidence-based, trauma-informed intervention program. Phases of adaptation included (1) Assessment, (2) Decision, (3) Prototype Development, and (4) Testing and Integration. The adaptation process explored contextual factors (e.g., systems, facilities, and staff) and the needs of the new target population (i.e., YILS and their caregivers). Adaptations were made to both content (e.g., terminology and activities) and structure (e.g., session duration and delivery setting) in an iterative process with input from participants from the target population, key stakeholders, and content experts. Results The systematic adaptation of the intervention model resulted in a two-phase, four-component intervention package that can be implemented in juvenile justice settings as part of youth reentry services. The primary intervention, delivered while youth are in residential facilities, includes the TBRI Caregiver Curriculum, TBRI Youth & Young Adult Curriculum, and TBRI Nurture Groups. The secondary intervention, delivered after youth transition home, includes the TBRI Family Coaching Curriculum. Conclusions Utilizing an implementation science framework to guide adaptation has implications for developing accessible, culturally relevant, and contextually-appropriate interventions. Accounting for contextual factors and population needs can improve the fit of EBIs in juvenile justice, facilitating uptake and ultimately improving outcomes for youth. Trial registration ClinicalTrials.gov Identifier: NCT04678960.
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Barrett CA, Sleesman DJ, Spear SE, Clinkscales A, Amin T. Sticking with Programs That Do Not Work: The Role of Escalation of Commitment in Schools. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:567-576. [PMID: 36809497 PMCID: PMC9942045 DOI: 10.1007/s11121-023-01510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/23/2023]
Abstract
Schools are the most common site to implement evidence-based prevention programs and practices (EBPs) to improve behavioral and mental health outcomes among children and adolescents. Research has highlighted the critical role of school administrators in the adoption, implementation, and evaluation of such EBPs, focusing on the factors they should consider during the adoption decision and the behaviors needed for successful implementation. However, scholars have only recently begun to focus on the de-adoption or de-implementation of low-value programs and practices to make room for evidence-based alternatives. This study introduces escalation of commitment as a theoretical framework for understanding why school administrators may stick with ineffective programs and practices. Escalation of commitment is a robust decision-making bias in which people feel compelled to continue with a course of action even when performance indicators suggest it is not going well. Using grounded theory methodology, we conducted semi-structured interviews with 24 building- and district-level school administrators in the Midwestern United States. Results suggested that escalation of commitment occurs when administrators attribute the underlying causes of poor program performance not to the program itself but instead to issues related to implementation, leadership, or the limitations of the performance indicators themselves. We also identified a variety of psychological, organizational, and external determinants that accentuate administrators' continuance of ineffective prevention programs. Based on our findings, we highlight several contributions to theory and practice.
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Biglan A, Prinz RJ, Fishbein D. Prevention Science and Health Equity: A Comprehensive Framework for Preventing Health Inequities and Disparities Associated with Race, Ethnicity, and Social Class. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:602-612. [PMID: 36757658 DOI: 10.1007/s11121-022-01482-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 02/10/2023]
Abstract
The ultimate goal of our public health system is to reduce the incidence of disability and premature death. Evidence suggests that, by this standard, the USA falls behind most other developed countries largely as a function of disparities in health outcomes among significant portions of the US population. We present a framework for addressing these disparities that attributes them, not simply to differences in the behavioral and physical risk factors, but to social, environmental, and structural inequities such as poverty, discrimination, toxic physical setting, and the marketing of harmful products. These inequities result from de facto and instituted public policies. An analysis of the NIH research portfolio indicates a relative lack of investment in experimental evaluations of preventive interventions-especially studies targeting disadvantaged populations. Moreover, experimental research on reducing social inequities is almost entirely lacking. A line of research focusing on the drivers of inequities and their dissolution must include experimental evaluation of strategies for getting policies adopted that will reduce inequities. In conclusion, a summary is provided of the types of research that are needed and the challenges involved in conducting the experimental research that is essential for reducing inequities and disparities and, in turn, prolonging life.
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Affiliation(s)
- Anthony Biglan
- Oregon Research Institute, 2324 West 28th Avenue, Eugene, Eugene, OR, 97405, USA. .,National Prevention Science Coalition to Improve Lives, Pennsylvania, USA.
| | - Ronald J Prinz
- University of South Carolina, Columbia, USA.,National Prevention Science Coalition to Improve Lives, Pennsylvania, USA
| | - Diana Fishbein
- University of North Carolina, Chapel Hill, USA.,The Pennsylvania State University, Pennsylvania, USA.,National Prevention Science Coalition to Improve Lives, Pennsylvania, USA
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Pina AA, Stoll RD, Holly LE, Wynne H, Chiapa A, Parker J, Caterino L, Tracy SJ, Gonzales NA, Valdivieso A. Streamlined pediatric anxiety program for school mental health services. J Anxiety Disord 2023; 93:102655. [PMID: 36517320 PMCID: PMC9844125 DOI: 10.1016/j.janxdis.2022.102655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/10/2022]
Abstract
There needs to be serious transformation of evidence-based interventions (EBIs) into real-world solutions; otherwise, EBIs will never achieve the intended public health impact. In a randomized trial, we reported effects of a redesigned anxiety program. Herein, we described the redesign process that led to the program. Survey data revealed provider preferences for school mental health anxiety services. Focus groups and prototype feedback sessions revealed service barriers to uptake, implementation, and sustainability along with corresponding enabling strategies. Prototype feedback sessions also focused on refinement and fine-tuning of the redesign. In the end, traditional EBI strategies were transformed and packaged into six lessons, lasting 20-30 minutes each, and amenable to delivery in small-group format. The redesign achieved the intended purpose of retaining elements from cognitive and behavior therapy and social skills training for the target population of the intervention (e.g., 3rd to 5th graders with heterogeneous anxiety problems - identified and referred). The streamlined EBI is accessible from PBS LearningMedia™ - a service that hosts public, research-based, and school-ready materials.
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Affiliation(s)
- Armando A Pina
- Department of Psychology, Arizona State University, Tempe, AZ, USA.
| | - Ryan D Stoll
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Lindsay E Holly
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Henry Wynne
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Amanda Chiapa
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Julia Parker
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Linda Caterino
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Sarah J Tracy
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Nancy A Gonzales
- Department of Psychology, Arizona State University, Tempe, AZ, USA
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Lyons MD, Taylor JV, Zeanah KL, Downey SK, Zabek FA. Supporting School Mental Health Providers: Evidence from a Short-Term Telementoring Model. CHILD & YOUTH CARE FORUM 2023; 52:65-84. [PMID: 35125853 PMCID: PMC8804076 DOI: 10.1007/s10566-022-09673-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 01/28/2023]
Abstract
Background To support student mental health, school staff must have knowledge of evidence-based practices and the capacity to implement them. One approach used to address this challenge is a group-based telementoring model called Extension for Community Healthcare Outcomes (ECHO). In other applications (e.g., healthcare settings), ECHO has been shown to increase healthcare professionals' self-efficacy and knowledge of evidence-based practices leading to improved patient outcomes. Objectives This study examined the potential for ECHO to be used as a method for increasing school staff engagement and knowledge of evidence-based school mental health practices. Methods Using a quasi-experimental design, this study compared outcomes across two professional development experiences aimed at promoting school staff ability to provide evidence-based mental health services. School staff from four school districts participated in a school mental health training initiative. All participants (N = 57) had access to asynchronous, online mental health modules. A sub-sample (n = 33) was also offered monthly ECHO sessions. Results Tests of group difference in outcomes revealed significant increases in engagement with online learning (d = 0.58) and satisfaction (d = 0.82) for those who participated in ECHO as compared to those who did not. Knowledge about evidence-based practices was not significantly different between groups. Conclusions Results suggest that group-based telementoring may be a promising approach for improving engagement and satisfaction with training initiatives aimed at promoting evidence-based school mental health practices. However, further study of ProjectECHO using experimental designs is needed to make causal inferences about its effect on provider outcomes.
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Affiliation(s)
- Michael D. Lyons
- School of Education and Human Development, University of Virginia, Charlottesville, VA USA
- Department of Health, and Human Sciences, University of Virginia, Charlottesville, VA USA
| | - Julia V. Taylor
- School of Education and Human Development, University of Virginia, Charlottesville, VA USA
| | - Kathryn L. Zeanah
- School of Education and Human Development, University of Virginia, Charlottesville, VA USA
| | - Sarah K. Downey
- School of Education and Human Development, University of Virginia, Charlottesville, VA USA
| | - Faith A. Zabek
- School of Education and Human Development, University of Virginia, Charlottesville, VA USA
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Boyd RC, Castro FG, Finigan-Carr N, Okamoto SK, Barlow A, Kim BKE, Lambert S, Lloyd J, Zhang X, Barksdale CL, Crowley DM, Maldonado-Molina M, Obasi EM, Kenney A. Strategic Directions in Preventive Intervention Research to Advance Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:577-596. [PMID: 36469162 PMCID: PMC9734404 DOI: 10.1007/s11121-022-01462-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/09/2022]
Abstract
As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.
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Affiliation(s)
- Rhonda C Boyd
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Allison Barlow
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
| | | | | | - Jacqueline Lloyd
- Office of Disease Prevention, National Institutes of Health, Rockville, MD, USA
| | - Xinzhi Zhang
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Barksdale
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Anne Kenney
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
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Boudreaux ED, Larkin C, Sefair AV, Mick E, Clements K, Pelletier L, Yang C, Kiefe C. Studying the implementation of Zero Suicide in a large health system: Challenges, adaptations, and lessons learned. Contemp Clin Trials Commun 2022; 30:100999. [PMID: 36237289 PMCID: PMC9551075 DOI: 10.1016/j.conctc.2022.100999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/12/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Suicide remains the 10th leading cause of death in the United States. Many patients presenting to healthcare settings with suicide risk are not identified and their risk mitigated during routine care. Our aim is to describe the planned methodology for studying the implementation of the Zero Suicide framework, a systems-based model designed to improve suicide risk detection and treatment, within a large healthcare system. Methods We planned to use a stepped wedge design to roll-out the Zero Suicide framework over 4 years with a total of 39 clinical units, spanning emergency department, inpatient, and outpatient settings, involving ∼310,000 patients. We used Lean, a widely adopted a continuous quality improvement (CQI) model, to implement improvements using a centralize "hub" working with smaller "spoke" teams comprising CQI personnel, unit managers, and frontline staff. Results Over the course of the study, five major disruptions impacted our research methods, including a change in The Joint Commission's safety standards for suicide risk mitigation yielding massive system-wide changes and the COVID-19 pandemic. What had been an ambitious program at onset became increasingly challenging because of the disruptions, requiring significant adaptations to our implementation approach and our study methods. Conclusions Real-life obstacles interfered markedly with our plans. While we were ultimately successful in implementing Zero Suicide, these obstacles led to adaptations to our approach and timeline and required substantial changes in our study methodology. Future studies of quality improvement efforts that cut across multiple units and settings within a given health system should avoid using a stepped-wedge design with randomization at the unit level if there is the potential for sentinel, system-wide events.
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Affiliation(s)
- Edwin D. Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Celine Larkin
- Departments of Emergency Medicine and Psychiatry, UMass Chan Medical School, Worcester, MA, USA
| | - Ana Vallejo Sefair
- Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Eric Mick
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Karen Clements
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | | | - Chengwu Yang
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Catarina Kiefe
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
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Kroon D, van Dulmen SA, Westert GP, Jeurissen PPT, Kool RB. Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study. BMJ Open 2022; 12:e062902. [PMID: 36343997 PMCID: PMC9644331 DOI: 10.1136/bmjopen-2022-062902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE We aimed to increase the understanding of the scaling of de-implementation strategies by identifying the determinants of the process and developing a determinant framework. DESIGN AND METHODS This study has a mixed-methods design. First, we performed an integrative review to build a literature-based framework describing the determinants of the scaling of healthcare innovations and interventions. PubMed and EMBASE were searched for relevant studies from 1995 to December 2020. We systematically extracted the determinants of the scaling of interventions and developed a literature-based framework. Subsequently, this framework was discussed in four focus groups with national and international de-implementation experts. The literature-based framework was complemented by the findings of the focus group meetings and adapted for the scaling of de-implementation strategies. RESULTS The literature search resulted in 42 articles that discussed the determinants of the scaling of innovations and interventions. No articles described determinants specifically for de-implementation strategies. During the focus groups, all participants agreed on the relevance of the extracted determinants for the scaling of de-implementation strategies. The experts emphasised that while the determinants are relevant for various countries, the implications differ due to different contexts, cultures and histories. The analyses of the focus groups resulted in additional topics and determinants, namely, medical training, professional networks, interests of stakeholders, clinical guidelines and patients' perspectives. The results of the focus group meetings were combined with the literature framework, which together formed the supporting the scaling of de-implementation strategies (SPREAD) framework. The SPREAD framework includes determinants from four domains: (1) scaling plan, (2) external context, (3) de-implementation strategy and (4) adopters. CONCLUSIONS The SPREAD framework describes the determinants of the scaling of de-implementation strategies. These determinants are potential targets for various parties to facilitate the scaling of de-implementation strategies. Future research should validate these determinants of the scaling of de-implementation strategies.
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Affiliation(s)
| | | | | | | | - Rudolf B Kool
- IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
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Studts CR, Jacobs JA, Bush ML, Lowman J, Westgate PM, Creel LM. Behavioral Parent Training for Families With Young Deaf or Hard of Hearing Children Followed in Hearing Health Care. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3646-3660. [PMID: 35985319 PMCID: PMC9802658 DOI: 10.1044/2022_jslhr-22-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE It is well established that individuals with a communication disability, including being deaf or hard of hearing (DHH), experience inequities in health services and outcomes. These inequities extend to DHH children's access to psychosocial evidence-based interventions (EBIs). Behavioral parent training is an EBI that can be used to improve caregiver and child outcomes. Despite being supported by decades of effectiveness research, this EBI is rarely accessed by, or studied with, caregivers of DHH children. The purpose of this article is to describe a program of stakeholder-engaged research adapting and assessing behavioral parent training with caregivers of young DHH children followed in hearing health care, aimed at reducing inequities in access to this EBI. METHOD The first section briefly summarizes the literature on disruptive behavior problems in young children, with a focus on preschool-age DHH children. The evidence base for behavioral parent training is described. Next, the gaps in knowledge and practice regarding disruptive behaviors among DHH children are highlighted, and the potential integration of behavioral parent training into the standard of care for this population is proposed. CONCLUSIONS Young DHH children who use hearing aids and/or cochlear implants experience disruptive behavior problems at rates at least as high as typically hearing children, but their access to EBIs is limited, and behavioral parent training programs tailored to this population have not been rigorously tested. Caregivers and hearing health care service providers affirm the potential benefits of behavioral parent training and were partners in adapting this EBI. This research highlights several principles and approaches essential for reducing inequities and improving the quality of life not only for DHH children and their families but also for individuals with communication disabilities more broadly: engagement of key stakeholders in research, collaboration across disciplines, and using implementation science methods and models to design for implementation, dissemination, and sustainment. Presentation Video: https://doi.org/10.23641/asha.21215900.
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Affiliation(s)
- Christina R. Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Julie A. Jacobs
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington
| | - Matthew L. Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington
| | - Joneen Lowman
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | | | - Liza M. Creel
- Department of Health Management and Systems Sciences, University of Louisville, KY
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Phelps A, Lawrence-Wood E, Couineau AL, Hinton M, Dolan P, Smith P, Notarianni M, Forbes D, Hosseiny F. Mental Health Reform: Design and Implementation of a System to Optimize Outcomes for Veterans and Their Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12681. [PMID: 36231981 PMCID: PMC9565186 DOI: 10.3390/ijerph191912681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
The social, health, and economic burden of mental health problems in the veteran community is heavy. Internationally, the array of services and support available to veterans and their families are extensive but vary in quality, are often disconnected, complex to navigate, and lack clear coordination. This paper describes a conceptual framework to guide the design and implementation of a system of services and supports to optimize the mental health and wellbeing of all veterans and their families. The framework recognizes the diversity of veterans across intersecting identities that uniquely shape experiences of posttraumatic mental health and wellbeing. It brings together several strands of research: the values and principles that should underpin the system; the needs of diverse veterans and their families; challenges in the current services and supports; evidence-based interventions; and principles of effective implementation. Central to the future system design is a next generation stepped model of care that organizes best and next practice interventions in a coherent system, matches service provision to level of need and addresses access and navigation. Practical guidance on implementation provides an aspirational and flexible structure for system evolution, and a template for all stakeholders-individuals, groups, agencies and organizations-to effect system change.
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Affiliation(s)
- Andrea Phelps
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Ellie Lawrence-Wood
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Anne-Laure Couineau
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Mark Hinton
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Paul Dolan
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Patrick Smith
- Atlas Institute for Veterans and Families, Ottawa, ON K1Z 7K4, Canada
| | | | - David Forbes
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Fardous Hosseiny
- Atlas Institute for Veterans and Families, Ottawa, ON K1Z 7K4, Canada
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Grunin L, Yu G, Cohen S. Combined Race and Gender Trend Disparities in Depressive Symptoms among U.S. High School Students: 1999-2019. Issues Ment Health Nurs 2022; 43:824-834. [PMID: 35468031 DOI: 10.1080/01612840.2022.2067274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In 2019, over 3.2 million adolescents in the U.S. reported depressive symptoms-a number that continues to increase annually. Not only can depression negatively impact an adolescent's academic performance, social development, and cognitive function, but it is also the most common condition associated with suicide. Previous studies have reported prevalence rates and statistical trends by either gender or race. We conducted an in-depth analysis of the current racial and gender trend disparities in adolescent depressive symptoms by examining linear and quadratic trends from the Youth Behavior Risk Survey (N = 158,601) over two decades (1999-2019), stratified by gender and race subgroups, both separately and combined. This novel quantitative method allows for a more nuanced approach when exploring social and cultural influences on adolescent depressive symptoms. We found a significant difference in the prevalence of depressive symptoms between males and females among Black, Hispanic, and multiracial adolescents in each separate year of pooled data. However, an increased prevalence trend over the 20-year period was only seen among the females of these three racial categories. White and Asian female adolescents also exhibited a statistical increase in prevalence of depressive symptoms over time. The only group of males with a significant trend increase over time were White adolescents. Understanding the intersection of gender and race in adolescent depressive symptoms trends enhances evidence for nurses and other healthcare professionals when developing and implementing targeted, effective prevention and intervention measures.
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Affiliation(s)
- Laura Grunin
- NYU Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Gary Yu
- NYU Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Sally Cohen
- NYU Rory Meyers College of Nursing, New York University, New York, New York, USA
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Lee-Easton MJ, Magura S, Abu-Obaid RN, Landsverk J, DeCamp W, Rolls-Reutz J, Moore K, Firpo-Triplett R, Buckley PR, Stout ER, Perkins DF. Visitors' Assessment and Utilization of Evidence-Based Program Resources (EBPR) Websites. Subst Use Misuse 2022; 57:1688-1697. [PMID: 35968844 PMCID: PMC9552282 DOI: 10.1080/10826084.2022.2107675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Background: Evidence-based program resources (EBPR) websites for behavioral health are a potentially useful tool to assist decision-makers and practitioners in deciding which behavioral health interventions to implement. EBPR websites apply rigorous research standards to assess the effectiveness of behavioral healthcare programs, models, and clinical practices. Method: Visitors to a convenience sample of six EBPR websites (N=369, excluding students) were recruited for telephone interviews primarily by means of a pop-up invitation on the sites. Results: The visitors view the EBPR sites as important sources of information to support the identification and adoption of evidence-based programs/practices (EBPs) in behavioral healthcare, which aligns with the primary mission of EBPRs. For repeat visitors, there was some indication that the information obtained helped effect certain changes in their agencies' programs and policies. However, increased or improved guidance on EBP implementation was also requested. Conclusion: EBPR websites should be better publicized to the behavioral healthcare field.
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Affiliation(s)
| | - Stephen Magura
- Evaluation Center, Western Michigan University, Kalamazoo, MI
| | | | | | - Whitney DeCamp
- Department of Sociology, Western Michigan University, Kalamazoo, MI
| | | | | | | | - Pamela R. Buckley
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO
| | - Ellyson R. Stout
- Suicide Prevention Resource Center, Education Development Center, Waltham, MA
| | - Daniel F. Perkins
- Clearinghouse for Military Family Readiness, Pennsylvania State University, University Park, PA
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Scott JT, Prendergast S, Demeusy E, McGuire K, Crowley M. Trends and Opportunities for Bridging Prevention Science and US Federal Policy. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1333-1342. [PMID: 35930099 DOI: 10.1007/s11121-022-01403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
Prevention science sheds light on complex social policy problems, yet its social impact cannot reach full potential without the uptake of research evidence by policymakers. This mixed-methods study examined the US federal legislation pertaining to justice-involved youth to reveal opportunities for strengthening the use of prevention science in legislation. The results indicated that research language, particularly references to the type of study (e.g., longitudinal) or methodology (e.g., data mining), within bills predicted bill progression out of committee and enactment. Rigorous scientific methods may either lend credence to a bill during its progression in the legislative process or may be infused in language during mark-up and negotiation of bills that successfully progress in Congress. In-depth bill coding illustrated the ways that research has been used in legislation to define problems, reinforce effective practice, generate knowledge through research and evaluation, and disseminate findings. A prominent implication of these findings is that policies could be used to improve data monitoring and evaluation capacity in ways that enhance the implementation of evidence-based interventions. The comprehensive use of research in legislation increases the likelihood that policies reach their intended outcomes and benefit those they are designed to serve.
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Affiliation(s)
- J Taylor Scott
- The Pennsylvania State University, University Park, PA, USA
| | | | | | | | - Max Crowley
- The Pennsylvania State University, University Park, PA, USA.
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Maranda MJ, Lee-Easton MJ, Magura S. Variations in Definitions of Evidence-Based Interventions for Behavioral Health in Eight Selected U.S. States. EVALUATION REVIEW 2022; 46:363-390. [PMID: 35544762 DOI: 10.1177/0193841x221100356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND U.S. state legislatures fill a vital role in supporting the use of evidence-based interventions (EBIs) through statutes and regulations (mandates). OBJECTIVE The study determined the terms used by selected states to describe EBIs and how those terms are defined in mandates. RESEARCH METHODS The mandates of eight purposely selected states were accessed and coded using the Westlaw Legal Research Database. RESULTS Considerable variation was found in the terms used by states to describe EBIs. Although "evidence-based" was the most frequently utilized term (60% of mandates), an additional 29 alternative terms appeared with varying frequencies. Most terms were simply mentioned, with no further definition or elaboration. When terms were further defined or elaborated, the majority were defined using numerous and different types of external sources or references. Three approaches were found in the mandates defining EBIs: "single definition," "hierarchies of evidence levels," and "best available evidence"; the states differed considerably in the approaches used in their mandates. CONCLUSIONS The variations in EBI-related terminology across states and within states, coupled with a lack of elaboration on the meaning of important terms and the predominant use of external rather than internal guidelines, may be a source of confusion for behavioral health provider agencies that seek direction about what constitutes an EBI. Prior studies indicate that many agencies may lack staff with the technical ability to adequately evaluate what constitutes an EBI. Thus, lack of clear guidance from official state government mandates may impede the implementation of EBIs within states.
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Long EC, Scott JT, Craig LE, Prendergast S, Pugel J, Crowley DM. How substance use prevention research gets used in United States federal policy. Addiction 2022; 117:2235-2241. [PMID: 35293062 DOI: 10.1111/add.15874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS The growing body of research evidence on substance use and substance use disorder (SU/SUD) prevention could be leveraged to strengthen the intended impact of policies that address SU/SUD. The aim of the present study was to explore how research was used in United States federal legislation that emphasized SU/SUD prevention. DESIGN Using a mixed-methods approach, we assessed whether the use of research predicted a bill's legislative progress. We randomly sampled 10 bills that represented different types of research keywords to examine how research was used in these bills, applying content analysis. SETTING United States Congress. PARTICIPANTS/CASES Federal legislation introduced between the 101st and the 114th Congresses (1989-2017; n = 1866). MEASUREMENTS The quantitative outcome measures were bills' likelihood of passing out of committee and being enacted. Qualitative outcomes included the ways research was used in legislation. FINDINGS Bills that used any research language were 2.2 times more likely to pass out of committee (OR = 2.18; 95% CI, 1.75, 2.72) and 82% more likely to be enacted (OR = 1.82; 95% CI, 1.23, 2.69) than bills not using research language. Bills using dissemination words were 57% more likely to pass out of committee (OR = 1.57; CI, 1.08, 2.28) and analysis words were 93% more likely (OR = 1.93; 95% CI, 1.51, 2.47) than bills not using dissemination or analysis words. Research was used to (i) define the problem to justify legislative action, (ii) address the problem by providing funding, and (iii) address the problem through industry regulations. However, there was a lack of research use that targets underlying risk and protective factors. CONCLUSIONS In the US Congress, substance use and substance use disorder prevention bills that use research language appear to be more likely to progress in the legislative cycle than bills that do not, suggesting that legislation using research may be viewed as more credible.
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Affiliation(s)
- Elizabeth C Long
- Evidence-to-Impact Collaborative, Pennsylvania State University, University Park, PA, USA
| | - Jennifer Taylor Scott
- Evidence-to-Impact Collaborative, Pennsylvania State University, University Park, PA, USA
| | - Logan E Craig
- The Well-Being Lab, George Mason University, Fairfax, VA, USA
| | - Sarah Prendergast
- Center on Labor, Human Services, and Population, Urban Institute, Washington, DC, USA
| | - Jessica Pugel
- Evidence-to-Impact Collaborative, Pennsylvania State University, University Park, PA, USA
| | - Daniel Max Crowley
- Evidence-to-Impact Collaborative, Pennsylvania State University, University Park, PA, USA
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Mayo-Wilson E, Grant S, Supplee LH. Clearinghouse Standards of Evidence on the Transparency, Openness, and Reproducibility of Intervention Evaluations. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022. [PMID: 34357509 DOI: 10.1007/s11121-021-01284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Clearinghouses are influential repositories of information on the effectiveness of social interventions. To identify which interventions are "evidence-based," clearinghouses review intervention evaluations using published standards of evidence that focus primarily on internal validity and causal inferences. Open science practices can improve trust in evidence from evaluations on the effectiveness of social interventions. Including open science practices in clearinghouse standards of evidence is one of many efforts that could increase confidence in designations of interventions as "evidence-based." In this study, we examined the policies, procedures, and practices of 10 federal evidence clearinghouses that review preventive interventions-an important and influential subset of all evidence clearinghouses. We found that seven consider at least one open science practice when evaluating interventions: replication (6 of 10 clearinghouses), public availability of results (6), investigator conflicts of interest (3), design and analysis transparency (3), study registration (2), and protocol sharing (1). We did not identify any policies, procedures, or practices related to analysis plan registration, data sharing, code sharing, material sharing, and citation standards. We provide a framework with specific recommendations to help federal and other evidence clearinghouses implement the Transparency and Openness Promotion (TOP) Guidelines. Our proposed "TOP Guidelines for Clearinghouses" includes reporting whether evaluations used open science practices, incorporating open science practices in their standards for receiving "evidence-based" designations, and verifying that evaluations used open science practices. Doing so could increase the trustworthiness of evidence used for policy making and support improvements throughout the evidence ecosystem.
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Affiliation(s)
- Evan Mayo-Wilson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, 47405, USA. .,Department of Social & Behavioral Sciences, Fairbanks School of Public Health, Indiana University Richard M, Indianapolis, IN, USA.
| | - Sean Grant
- Department of Social & Behavioral Sciences, Fairbanks School of Public Health, Indiana University Richard M, Indianapolis, IN, USA
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