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Home > > Science Meeting Summaries & Special Reports > Intervening Early: Progress and Opportunities in Child Service Settings > Moving Interventions into Sustaining Systems


Header - Frontiers in Addiction Research

MOVING INTERVENTIONS INTO SUSTAINING SYSTEMS

SUMMARY

This session was chaired by Dara Blachman (OBSSR). Karen Bierman (Pennsylvania State University), and Cathy Kipp and Lynda Sheffer (Head Start of York County) presented on implementing research-based interventions in Head Start classrooms; Mary Dozier (University of Delaware) and Carole Shauffer (Youth Law Center) spoke about implementing and integrating specialized mental health services into child welfare settings with a focus on infants; Richard Spoth (Iowa State University) discussed moving interventions into sustaining systems using partnerships between the university, the cooperative extension service, and the public school system; and Marion Forgatch (Oregon Social Learning Center) talked about implementing evidence-based practice on a nationwide scale in Norway. Highlights of the discussion, moderated by Janice Cooper (Columbia University), included the need for high levels of fidelity to the core intervention when "scaling up," while still recognizing the need for adapting to community needs. To achieve this goal, multiple factors must be considered: race, ethnicity, language proficiency, policy as well as the family/caregiver, and the need for support by family and the community.

Implementing and Integrating Research-Based Supports into Existing Head Start Classrooms
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Implementing and Integrating Research-Based Supports into Existing Head Start Classrooms
Karen Bierman, Ph.D., Cathy Kipp, and Lynda Sheffer

Whereas efficacy trials can identify efficacious intervention strategies, effectiveness research that bridges the gap to service delivery in real-world systems is critical for improving practice. The Head Start research project called REDI (Research-based, Developmentally Informed) uses developmental theory and prior efficacy trials to identify research-based instructional strategies that target social-emotional skills and language-emergent literacy skills. In a randomized, controlled effectiveness trial, Head Start teachers in three counties integrated the REDI curricula and coaching strategies into their traditional curricula (High Scope or Creative Curriculum). A well-specified curriculum and mentored professional development helped teachers to implement the intervention. During the first 3 years of the current funding, the research design followed 2 cohorts of 4-year-old children (N = 356: 19 percent Hispanic, 26 percent African-American; 54 percent girls) in 44 Head Start classrooms; classrooms were randomly assigned to intervention or "usual practice" comparison groups. Multimethod assessments revealed significant differences favoring children in the enriched intervention classrooms on measures of vocabulary, emergent literacy, emotional understanding, social problem solving, social behavior, and learning engagement. During the final 2 years of the current funding, the project is focusing on identifying and coping with the challenges of supporting long-term sustainability for the REDI practices within the partnering Head Start programs. The REDI program is described, outcome findings are reviewed, and "lessons learned" are discussed in terms of the importance of researcher-practitioner collaborations that extend from program design through sustainable program accommodation and ownership.

Implementing and Integrating Specialized Mental Health Services into Child Welfare Settings
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Implementing and Integrating Specialized Mental Health Services into Child Welfare Settings
Mary Dozier, Ph.D., and Carole Shauffer, M.Ed., J.D.

The child welfare system is an important arena for evidence-based practice. There have been relatively few evidence-based interventions developed specifically for children in this system. Administrators and staff at all levels have heard the call to use evidence-based practice but are often confused about how to begin.

In this presentation, a model of intervention for the youngest children in the child welfare system is described. Over the last 15 years, key challenges confronting infants and toddlers in the system have been identified, and intervention components that target these issues have been developed. The intervention has been shown to be effective in helping children develop more secure attachments to caregivers and better ability to regulate behavior and physiology.

Issues involved in implementing and disseminating the intervention are discussed. Essential to effective implementation is educating child welfare officials about the specific developmental challenges facing infants and toddlers. All decisionmakers, both formal and informal, should be educated to ensure that the intervention is embedded in the culture of the agency.

Moving Interventions into Sustaining Systems: Study of the PROSPER Community-University Partnership Model
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Moving Interventions into Sustaining Systems: Study of the PROSPER Community-University Partnership Model
Richard Spoth, Ph.D.

During the past 3 decades, the field of prevention science has confronted two major challenges: the development of evidence-based interventions (EBIs) and effective strategies for scaling up EBIs to achieve public health impact. The Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER) Project builds on a program of translational research that addresses the second of these challenges by using a network of partnerships that link the Land Grant University Extension System and public school system for intervention delivery.

A summary of key challenges and opportunities encountered as the field moves toward sustaining intervention systems for scaling up EBIs is presented, and a community-university partnership approach to address those challenges and opportunities is described. Next, the PROSPER project background, starting with a description of the project's partnership model and design—a sequential cohort, randomized, controlled study of 28 school districts in Iowa and Pennsylvania—is presented. Early findings are summarized, including results on EBI recruitment from general populations, quality of EBI implementation, proximal family and youth competency outcomes, and local sustainability of interventions. Substance use outcomes at a follow-up assessment conducted 1½ years past baseline are also presented.

Finally, an overview of future directions for testing and evaluating the sustainability of community implementation teams and EBIs is presented. A design for an expanded network of partnerships is outlined along with anticipated barriers to surmount in this planned work.

Implementing Evidence-Based Practice on a Large Scale
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Implementing Evidence-Based Practice on a Large Scale
Marion Forgatch, Ph.D.

The transplant of an efficacious intervention from a controlled environment to a community is a delicate operation. This operation requires sensitive instruments capable of assessing competent adherence to methods that predict changes in mechanisms and outcomes. Data were presented on the transfer of Parent Management Training–the Oregon Model (PMTO), an evidence-based method from the United States to Norway in a nationwide implementation. Measures were created using direct observations from two separate settings. Fidelity of Implementation (FIMP), a measure used to evaluate competent adherence to PMTO principles and procedures, is based on data from DVD recordings of intervention sessions. PMTO parenting practices were measured by observation of video recordings of family interaction tasks. Several studies have shown that intervention-induced changes in parenting practices produce benefits to youth outcomes, including delinquency, externalizing, internalizing, and academic functioning. This study examined fidelity in relation to change over training, drift across successive generations of professionals trained in Norway, and as a measure with predictive validity to parenting practices. Fidelity decayed from Generation 1 (G1) to G2 but returned to G1 levels by G3. Norwegian findings from a treatment population replicate U.S. findings with a prevention sample. Structural equation modeling was used in both studies to show that therapists' FIMP scores (measured during intervention) predict improvements in maternal and paternal parenting, which were measured before and following intervention.


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