National Academies Press: OpenBook
« Previous: 7 Meeting Scale-Up Challenges
Suggested Citation:"8 Sum Up and Way Forward." Institute of Medicine and National Research Council. 2014. Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18808.
×

8

Sum Up and Way Forward

At the end of the workshop, those who moderated the panels as well as Lauren Supplee summarized important take-home points from the presentations and discussions that suggest a way forward in scaling up child prevention programs. David Hawkins began this session by noting the importance of creating organizational capacity, desire, and the infrastructure necessary for dissemination and implementation. He reiterated the need to create demand for programs by creating motivating stories about them and prompting what Joe McCannon called a pull for them rather than a push. Hawkins also emphasized monitoring implementation, but at the same time not being excessively rigorous and focusing more on achieving objectives than strictly adhering to protocols. He suggested being more forthcoming about revealing what was tried and did not work, rather than only highlighting successes.

Pat Shea from the National Association of State Mental Health Program Directors emphasized the importance of cross-sector collaboration at the federal level and supporting programs focused on very early childhood development because they are wise investments. She was also encouraged to hear about intermediary organizations that support adoption and implementation of programs and “act as a bridge between the research base and the real world,” attending to all of the local factors that affect successful scaling up of a program. “I wished I had a cloning machine to enable more states to have access to these types of intermediary support organizations,” Shea said. “The key takeaway for policy makers and funders is the importance not only of investing in programs but also investing in the process of implementation,” she added.

Suggested Citation:"8 Sum Up and Way Forward." Institute of Medicine and National Research Council. 2014. Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18808.
×

Mary Ann McCabe from the George Washington University School of Medicine noted the importance of recognizing the need to deliver evidence-based programs in doctors’ offices, schools, and other settings where children and families are served. She said, “There is some appetite for family-focused prevention programs in innovative settings, especially because they are nonstigmatizing, and that is something we can really capitalize on going forward.” She added that designing programs for the funding streams that can support them in these emerging settings will help spread programs there, and suggested informing implementers of health care reform about how to fund prevention programs in health care settings as well as fund the workforce and training for them. She also emphasized the opportunity to capitalize on new digital technologies, and suggested mitigating against the risks of increasing disparities with increasing use of technology.

Ruth Perou of the Centers for Disease Control and Prevention noted the importance of bringing multiple sectors to the table, including business leaders and key stakeholders, to move forward with scale-up. She also encouraged the sharing of tools, strategies, and technologies for scale-up, as well as cost–benefit analyses that motivate legislators to fund such scale-up. “We need to start to learn from each other and from others outside our field. We need to throw a much wider net if we are going to be innovative,” she said.

William Beardslee stated that he agreed with Norway’s dissemination strategy of training master trainers rather than developing a systems-wide approach for all training, and suggested considering this as an option in programs disseminated in the United States. He noted the attention that must be paid to cultural humility and competence. “Interventions typically are devised in one culture and one language, but offered to people in many different cultures. We need to understand that process more fully as that has been a part of these successful systems-wide approaches,” he said. Beardslee added, “Along with equal access and equity and narrowing disparities, we want to achieve genuine partnerships with families. That’s what characterizes interventions that last—families come together to learn skills, partner with their coaches and teachers, and then they carry them on. Paying attention to how to develop respectful partnerships is really important.”

Supplee noted the diversity of stakeholders, who all have different goals and roles in the system. All are needed for success, but they are not all working together. “How do we start working together?” she asked. She emphasized that not only do public officials need to be more accountable for the investment of public dollars in evidence-based programs, but there needs to be equal accountability for outcomes. “We’re going for public health outcomes, not scaling evidence-based programs. We want to pick careful outcomes that we can measure, because it can go really wrong very

Suggested Citation:"8 Sum Up and Way Forward." Institute of Medicine and National Research Council. 2014. Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18808.
×

quickly,” Supplee emphasized. She also pointed out the importance of differentiating between scaling programs, scaling infrastructure, and scaling fiscal capacity and workforce.

Supplee noted the broad educational spectrum of workers delivering programs, from paraprofessionals with a high school diploma to clinicians with Ph.D.s, and what might be successful with those with the highest level of education may not be so successful with those at the lower end of the educational spectrum. She encouraged building capacity in provider organizations and called for “leaving no community behind. Some of our neediest communities with our neediest families don’t have that capacity and infrastructure necessary to support quality implementation of evidence-based programs. We need to think about how we can build that capacity so we can get these evidence-based programs into these communities.” Supplee also called for holding technical assistance providers to the same standards as that for evidence-based programs. “We know a lot about adult learning. Let’s use it,” she said.

In addition, Supplee suggested models, such as described by Collins and colleagues (Collins, 2013; Collins et al., 2005), calling for “designing efficient, effective programs to get the outcomes we want, rather than throwing the entire kitchen sink at everything. The reason why this is really critical is because I see on-the-ground programs put so much time and effort into trying to achieve fidelity on things that might not even draw outcomes.” Identifying gaps and trying to fill them with the help of intermediary agencies is also important, she said, but those are not available in every state or discipline. She emphasized the importance of doing implementation science and studying programs at scale, and added that randomized controlled trials may not be the best method to use when conducting this research; there are other rigorous methods that researchers can apply in their studies as well as real-time pivotal program evaluations that can provide the answers needed.

In brief, individual workshop participants described the following strategies to facilitate the scale-up of family-focused preventive programs:

  • Create organizational capacity, demand, and infrastructure necessary for dissemination and implementation. (Hawkins)
  • Monitor implementation while allowing some flexibility to achieve objectives, rather than strictly adhering to implementation protocols. (Hawkins)
  • Utilize cross-sector collaboration as well as intermediary organizations that support adoption and implementation of programs. (Shea)
  • Support programs focused on very early childhood because of potential for greater return on investment. (Shea)
Suggested Citation:"8 Sum Up and Way Forward." Institute of Medicine and National Research Council. 2014. Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18808.
×
  • Deliver evidence-based programs in a range of settings where children and families receive services, and design programs for the funding streams that can support them in these settings. (McCabe)
  • Share tools, strategies, and technologies for scale-up, as well as cost–benefit analyses that motivate legislators to fund scale-up. (Perou)
  • Capitalize on new digital technologies while mitigating the risks of increasing disparities with increasing use of technology. (McCabe)
  • Design programs that are culturally relevant and that involve partnerships with families. (Beardslee)
  • Hold public officials accountable for investment of public dollars in evidence-based programs as well as for program outcomes, and select program outcomes that can be measured. (Supplee)
  • Build capacity for quality implementation of programs in provider organizations that serve families who are most in need of such programs. (Supplee)
  • Evaluate programs at scale. (Supplee)

REFERENCES

Collins, L. M. 2013. Optimizing family interventions: The Multiphase Optimization Strategy (MOST). In S. McHale, P. Amato, and A. Booth (Eds.). Emerging methods in family research. New York: Springer.

Collins, L. M., S. A. Murphy, V. N. Nair, and V. J. Strecher. 2005. A strategy for optimizing and evaluating behavioral interventions. Annals of Behavioral Medicine 30(1):65-73.

Suggested Citation:"8 Sum Up and Way Forward." Institute of Medicine and National Research Council. 2014. Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18808.
×
Page79
Suggested Citation:"8 Sum Up and Way Forward." Institute of Medicine and National Research Council. 2014. Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18808.
×
Page80
Suggested Citation:"8 Sum Up and Way Forward." Institute of Medicine and National Research Council. 2014. Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18808.
×
Page81
Suggested Citation:"8 Sum Up and Way Forward." Institute of Medicine and National Research Council. 2014. Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18808.
×
Page82
Next: Appendix A: Workshop Agenda »
Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health: Workshop Summary Get This Book
×
Buy Paperback | $40.00 Buy Ebook | $32.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Over the last three decades, researchers have made remarkable progress in creating and testing family-focused programs aimed at fostering the cognitive, affective, and behavioral health of children. These programs include universal interventions, such as those for expecting or new parents, and workshops for families whose children are entering adolescence, as well as programs targeted to especially challenged parents, such as low-income single teens about to have their first babies, or the parents of children with autism. Some family-focused programs have been shown to foster significantly better outcomes in children, including enhanced educational performance, and reduced rates of teen pregnancy, substance abuse, and child conduct and delinquency, as well as reduced child abuse. The favorable cost-benefit ratios of some of these programs are due, in part, to the multiple and far-ranging effects that family-focused prevention programs targeting children can have. Other family-focused programs have shown success in smaller academic studies but have not been widely applied, or have not worked as effectively or failed when applied to more diverse real-world settings.

Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health is the summary of a workshop convened by the Institute of Medicine Forum on Promoting Children's Cognitive, Affective, and Behavioral Health to explore effective preventive interventions for youth that can modify risk and promote protective factors that are linked to mental, emotional, and behavioral health, and how to apply this existing knowledge. Based on the 2009 report Preventing Mental, Emotional, and Behavioral Disorders Among Young People, this report considers how to build a stronger research and practice base around the development and implementation of programs, practices, and policies that foster children's health and well-being across the country, while engaging multi-sectorial stakeholders. While research has advanced understanding of risk, promotive, and protective factors in families that influence the health and well-being of youth, a challenge remains to provide family-focused interventions across child and adolescent development at sufficient scale and reach to significantly reduce the incidence and prevalence of negative cognitive, affective, and behavioral outcomes in children and adolescents nationwide, as well as to develop widespread demand for effective programs by end users. This report explores new and innovative ways to broaden the reach and demand for effective programs and to generate alternative paradigms for strengthening families.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!