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Harris A, Jordan N, Carroll AJ, Graham AK, Wilson C, Wilson FA, Berkel C, Smith JD. A budget impact analysis of cost to implement a whole child health focused, family-based intervention in primary care for children with elevated BMI. Implement Sci Commun 2023; 4:59. [PMID: 37277878 DOI: 10.1186/s43058-023-00429-z] [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: 08/16/2022] [Accepted: 04/16/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Although the cost of implementing evidence-based interventions (EBIs) is a key determinant of adoption, lack of cost information is widespread. We previously evaluated the cost of preparing to implement Family Check-Up 4 Health (FCU4Health), an individually tailored, evidence-based parenting program that takes a whole child approach, with effects on both behavioral health and health behavior outcomes, in primary care settings. This study estimates the cost of implementation, including preparation. METHODS We assessed the cost of FCU4Health across the preparation and implementation phases spanning 32 months and 1 week (October 1, 2016-June 13, 2019) in a type 2 hybrid effectiveness-implementation study. This family-level randomized controlled trial took place in Arizona with n = 113 predominantly low-income, Latino families with children ages > 5.5 to < 13 years. Using electronic cost capture and time-based activity-driven methods, budget impact analysis from the perspective of a future FCU4Health adopting entity-namely, ambulatory pediatric care clinicians-was used to estimate the cost of implementation. Labor costs were based on 2021 Bureau of Labor Statistics Occupational Employment Statistics, NIH-directed salary cap levels or known salaries, plus fringe benefits at a standard rate of 30%. Non-labor costs were based on actual amounts spent from receipts and invoices. RESULTS The cost of FCU4Health implementation to 113 families was $268,886 ($2380 per family). Actual per family cost varied widely, as individual tailoring resulted in families receiving a range of 1-15 sessions. The estimated cost of replicating implementation for future sites ranged from $37,636-$72,372 ($333-$641 per family). Using our previously reported preparation costs (i.e., $174,489; $1544 per family), with estimated replication costs of $18,524-$21,836 ($164-$193 per family), the total cost of delivering FCU4Health was $443,375 ($3924 per family), with total estimated replication costs of $56,160-$94,208 ($497-$834 per family). CONCLUSIONS This study provides a baseline for costs associated with implementation of an individually tailored parenting program. Results provide critical information for decision makers and a model for future economic analysis and can be used to inform optimization thresholds for implementation and, when necessary, benchmarks for program adaptation to promote scale-up. TRIAL REGISTRATION This trial was prospectively registered on January 6, 2017, at ClinicalTrials.gov (NCT03013309).
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Affiliation(s)
- Alexandra Harris
- Health Sciences Integrated PhD Program, Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allison J Carroll
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Fernando A Wilson
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, Spencer Fox Eccles School of Medicine, College of Social and Behavioral Science Department of Economics, Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, USA
| | - Cady Berkel
- Population Health & Integrated Behavioral Health, College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, UT, USA.
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When Is It Time to Revise or Adapt Our Prevention Programs? Introduction to Special Issue on Using Baseline Target Moderation to Assess Variation in Prevention Impact. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:199-203. [PMID: 36378392 DOI: 10.1007/s11121-022-01456-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/16/2022]
Abstract
Adaptation of preventive interventions to increase their impact can be advanced by identifying subgroups or specific contexts where program effects appear stronger or weaker. But how do we know where to look for effect heterogeneity in ways that will inform successful adaptation? This paper introduces a special issue that brings together research across prevention science sub-disciplines that adopted baseline target moderated mediation (BTMM) designs to search for effect heterogeneity and guide adaptation of established prevention programs. For this special issue intervention scientists analyzed data from randomized trials using BTM and BTMM models, evaluating evidence for variation in intervention impact for trials spanning different health outcomes, different developmental periods, and different social units. This introduction provides a brief summary of the various patterns of effect reported in these papers, noting that the most common pattern involved compensatory effects (those beginning the trial with greater risk or fewer protective factors benefit the most), but other patterns including rich-get-richer and partially iatrogenic effects were also detected. This paper ends with a discussion of methodological and substantive implications of these findings for future prevention research, including next-generation prevention trials.
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Baseline Target Moderation and Baseline Target Moderation Mediation Approaches: Reflections on Cultural Adaptation and Social Justice. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:304-308. [PMID: 36279077 DOI: 10.1007/s11121-022-01457-2] [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: 10/14/2022] [Indexed: 10/31/2022]
Abstract
Baseline target moderation (BTM) and baseline target moderated mediation (BTMM) constitute critical methodological and analytical approaches for the future of prevention science. However, the continuing refinement and utilization of these approaches carry important challenges when considering equity challenges that remain present in the prevention science field. Accordingly, this commentary is focused on examining cultural and contextual considerations associated with the set of articles included in this study, as well as directions for enhancing future research by embracing a solid grounding on equity perspectives. For example, to which extent do BTM and BTMM approaches include variables of relevance such as perceived discrimination, economic adversity, and other cultural and contextual domains that impact the lives of underserved diverse populations? In addition to providing a review of the articles included in this issue, recommendations are included for informing future prevention research according to equity perspectives.
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Rojas LM, Brincks A, Brown EC, Bahamon M, Estrada Y, Lee TK, Prado G, Pantin H. Family Functioning in Hispanic Parents of Adolescents: Who Benefits Most from a Family-Based HIV and Substance Use Preventive Intervention? PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:249-258. [PMID: 36626022 DOI: 10.1007/s11121-022-01489-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
To understand which families are likely to benefit most from resource-intensive family-based, evidence-based interventions (EBIs), we must examine the key, modifiable determinant of family functioning. The purpose of this study was to (1) identify whether there are subgroups of Hispanic parents that differ meaningfully based on their family functioning at baseline, (2) test whether the Familias Unidas preventive intervention was differentially effective across the baseline family functioning subgroups, and (3) understand the mechanisms of intervention effectiveness within each baseline family functioning subgroup. On a pooled data set of 4 completed efficacy and effectiveness trials of Familias Unidas (n = 1445 low-income, Hispanic immigrant origin, parents and their adolescent between the ages of 12-17), we conducted a series of secondary data analyses. Latent profile analyses revealed four significantly different profiles: (1) low family functioning (n = 210, 14.55%), (2) low-to-moderate family functioning (n = 554, 38.39%), (3) moderate-to-high family functioning (n = 490, 33.96%), and (4) high family functioning (n = 189, 13.10%). A structural equation modeling approach found there were significant differences in intervention effectiveness between the subgroups. The low family functioning subgroup experienced gains in family functioning, and in turn, lower levels of adolescent substance use, internalizing, and externalizing symptoms. The high family functioning subgroup showed significant direct effects of the intervention on adolescent substance use, internalizing, and externalizing symptoms, but no indirect effects through improvements in family functioning. Implications for screening, targeting, and adapting interventions are discussed.
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Affiliation(s)
- Lourdes M Rojas
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, USA. .,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.
| | - Ahnalee Brincks
- Department of Human Development and Family Studies, Michigan State University, East Lansing, USA
| | - Eric C Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Monica Bahamon
- Emergency Department, Jackson Memorial Hospital, Miami, USA
| | - Yannine Estrada
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Hilda Pantin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
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Berkel C, Knox DC, Flemotomos N, Martinez VR, Atkins DC, Narayanan SS, Rodriguez LA, Gallo CG, Smith JD. A machine learning approach to improve implementation monitoring of family-based preventive interventions in primary care. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231187906. [PMID: 37790171 PMCID: PMC10375039 DOI: 10.1177/26334895231187906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background Evidence-based parenting programs effectively prevent the onset and escalation of child and adolescent behavioral health problems. When programs have been taken to scale, declines in the quality of implementation diminish intervention effects. Gold-standard methods of implementation monitoring are cost-prohibitive and impractical in resource-scarce delivery systems. Technological developments using computational linguistics and machine learning offer an opportunity to assess fidelity in a low burden, timely, and comprehensive manner. Methods In this study, we test two natural language processing (NLP) methods [i.e., Term Frequency-Inverse Document Frequency (TF-IDF) and Bidirectional Encoder Representations from Transformers (BERT)] to assess the delivery of the Family Check-Up 4 Health (FCU4Health) program in a type 2 hybrid effectiveness-implementation trial conducted in primary care settings that serve primarily Latino families. We trained and evaluated models using 116 English and 81 Spanish-language transcripts from the 113 families who initiated FCU4Health services. We evaluated the concurrent validity of the TF-IDF and BERT models using observer ratings of program sessions using the COACH measure of competent adherence. Following the Implementation Cascade model, we assessed predictive validity using multiple indicators of parent engagement, which have been demonstrated to predict improvements in parenting and child outcomes. Results Both TF-IDF and BERT ratings were significantly associated with observer ratings and engagement outcomes. Using mean squared error, results demonstrated improvement over baseline for observer ratings from a range of 0.83-1.02 to 0.62-0.76, resulting in an average improvement of 24%. Similarly, results demonstrated improvement over baseline for parent engagement indicators from a range of 0.81-27.3 to 0.62-19.50, resulting in an approximate average improvement of 18%. Conclusions These results demonstrate the potential for NLP methods to assess implementation in evidence-based parenting programs delivered at scale. Future directions are presented. Trial registration NCT03013309 ClinicalTrials.gov.
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Affiliation(s)
- Cady Berkel
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
- Ming Hsieh Department of Electrical Engineering, USC Viterbi School of Engineering, REACH Institute, Arizona State University, Tempe, AZ, USA
| | - Dillon C. Knox
- Signal Analysis and Interpretation Laboratory, University of Southern California, Los Angeles, CA, USA
| | - Nikolaos Flemotomos
- Signal Analysis and Interpretation Laboratory, University of Southern California, Los Angeles, CA, USA
| | - Victor R. Martinez
- Signal Analysis and Interpretation Laboratory, University of Southern California, Los Angeles, CA, USA
| | - David C. Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Shrikanth S. Narayanan
- Signal Analysis and Interpretation Laboratory, University of Southern California, Los Angeles, CA, USA
| | - Lizeth Alonso Rodriguez
- Ming Hsieh Department of Electrical Engineering, USC Viterbi School of Engineering, REACH Institute, Arizona State University, Tempe, AZ, USA
| | - Carlos G. Gallo
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Justin D. Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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Pas ET, Bradshaw CP. Introduction to the Special Issue on Optimizing the Implementation and Effectiveness of Preventive Interventions Through Motivational Interviewing. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:683-688. [PMID: 34283376 DOI: 10.1007/s11121-021-01278-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Elise T Pas
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 415 N. Washington Street, Baltimore, MD, 21231, USA.
| | - Catherine P Bradshaw
- School of Education and Human Development, University of Virginia, 405 Emmet St S, Charlottesville, VA, 22904, USA
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Shaw DS, Wilson MN. Taking a Motivational Interviewing Approach to Prevention Science: Progress and Extensions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:826-830. [PMID: 34173134 PMCID: PMC8231738 DOI: 10.1007/s11121-021-01269-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 01/06/2023]
Abstract
This commentary reviews advances gleaned from the current set of papers to Motivational Interviewing (MI) in prevention science. We begin by acknowledging the pioneering work of Miller and Rollnick to develop the construct of MI, then Dishion's use of MI principles to adapt applications of MI for the field of prevention science. We then highlight some of the contributions provided by the current set of papers and other recent extensions of MI. These novel applications are directed to parents, teachers, and older youth in the service of facilitating behavior change to promote youth development.
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