Effects of Topper Training on psychosocial problems, self-esteem, and peer victimisation in Dutch children: A randomised trial

Expert consensus on multilevel implementation hypotheses to promote the uptake of youth care guidelines: a Delphi study

BACKGROUND

The implementation of youth care guidelines remains a complex process. Several evidence-based frameworks aid the identification and specification of implementation determinants and strategies. However, the influence of specific strategies on certain determinants remains unclear. Therefore, we need to clarify which active ingredients of strategies, known as behaviour change techniques (BCTs), elicit behaviour change and improve implementation outcomes. With this knowledge, we are able to formulate evidence-based implementation hypotheses. An implementation hypothesis details how determinants and in turn, implementation outcomes might be influenced by specific implementation strategies and their BCTs. We aimed to identify (1) determinants relevant to the implementation of youth care guidelines and (2) feasible and potentially effective implementation hypotheses.

METHODS

A four-round online modified Delphi study was conducted. In the first round, experts rated the implementation determinants based on their relevance. Next, experts formulated implementation hypotheses by connecting BCTs and implementation strategies to determinants and were asked to provide a rationale for their choices. In round three, the experts reconsidered and finalised their hypotheses based on an anonymous overview of all formulated hypotheses, including rationales. Finally, the experts rated the implementation hypotheses based on their potential effectiveness and feasibility.

RESULTS

Fourteen experts completed the first, second, and third rounds, with 11 completed the final round. Guideline promotion, mandatory education, presence of an implementation leader, poor management support, knowledge regarding guideline use, and a lack of communication skills were reported as most relevant determinants. In total, 46 hypotheses were formulated, ranging from 6 to 9 per determinant. For each determinant, we provide an overview of the implementation hypotheses that were most commonly deemed feasible and potentially effective.

CONCLUSION

This study offers valuable insights into youth care guideline implementation by systematically identifying relevant determinants and formulating hypotheses based on expert input. Determinants related to engagement and to knowledge and skills were found to be relevant to youth care guideline implementation. This study offers a set of hypotheses that could help organisations, policymakers, and professionals guide the implementation process of youth care guidelines to ultimately improve implementation outcomes. The effectiveness of these hypotheses in practice remains to be assessed.

Does affirming children's autonomy and prosocial intentions help? A microtrial into intervention component effects to improve psychosocial behavior

Prior research has related children's prosocial behavior to overall well-being, and stimulating prosocial behavior is the aim of many social-emotional skills interventions. This study assessed if affirming children's autonomy stimulates their psychosocial behavior. We conducted a three-arm microtrial with four repeated measures to assess if a social-emotional skills intervention with an autonomy affirmation component had an additive effect on children's behavior as compared to a "regular" intervention focused exclusively on teaching social-emotional skills and a no-treatment control condition. Our sample consisted of 779 children in Grades 4-6 (M_age = 10.61, SD = 0.93). Findings from latent change modeling demonstrated that the social-emotional skills intervention with an autonomy affirmation component yielded superior effects as compared to the "regular" intervention and the no-treatment control condition on the improvement of internalizing and externalizing problem behavior in the three-month period after the intervention. The intervention with autonomy affirmation did not yield superior effects on prosociality and social skills, self-efficacy, and self-esteem or self-perceived competence. The absence of these effects may be attributed to the dosage of the interventions implemented-the affirmation of children's autonomy may require more than four sessions to sort observable effects. Overall, however, the findings of this study provide an initial suggestion that it may be beneficial to affirm children's autonomy and prosocial intentions when enhancing children's behavior.