Preventing Mental, Emotional, and Behavioral Disorders Among Young People Progress and Possibilities (2009) / Chapter Skim
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11 Implementation and Dissemination of Prevention Programs
11 Implementation and Dissemination of Prevention Programs
Pages 297-336
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From page 297... ...
. While sustained, high-quality implementation by communities is essential to achieving greater public health impact from the available tested and effective preventive interventions (Elliott and Mihalic, 2004; Glasgow, Klesges, et al., 2004; Spoth and Greenberg, 2005)
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From page 298... ...
Adoption of an Existing Evidence-Based Program A community's adoption of a specific prevention program involves delivering the program with high fidelity, increasing the likelihood that its impact will be similar to that found in the original studies. Typically, programs have met a specific standard of evidence, often articulated by federal, state, or other external funding sources (Halfors, Pankratz, and Hartman, 2007)
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From page 299... ...
IMPLEMENTATION AND DISSEMINATION 299 TABLE 11-1 Comparison of Three Implementation Approaches Model Advantages Disadvantages Implementation High program fidelity Program may not fit community of an existing needs, strengths, or capacities evidence-based Relatively high likelihood of program achieving intended impact Real-world implementation may differ dramatically from the way Known resources and originally tested requirements for effective implementation Lack of ownership in the program Likely continued funding under Few evidence-based programs have federal and state supported the capacity to provide technical evidence-based prevention assistance and training An evidence-based program may not target outcomes relevant to community Adaptation of an Ownership and high support Key program components may be existing program from community and potentially modified, thereby reducing to meet high adoption outcomes community needs Program more relevant to ethnic, Essential program components not racial, or linguistic characteristics always evident of community Reasonably likely to achieve impact Community- Can develop high community Lengthy period to develop driven acceptance and ownership community awareness, common implementation vision, and program Potential for broader implementation across different Potential for ineffectiveness or organizations and institutions iatrogenic effects within the community Challenges in obtaining funding for Opportunity to empirically sustaining a unique program evaluate the outcomes of programs accepted by the community and use quality improvement methods to enhance outcomes over time
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From page 300... ...
, a prevention system designed to reduce ado lescent delinquency and substance use, was built as part of the Center for Sub stance Abuse Prevention approach to effective implementation (see http://ncadi. samhsa.gov/features/ctc/resources.aspx)
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From page 301... ...
Because the prevention programs in PROSPER are delivered by local practitioners, it focuses on building strong support of the school–local community team, which chooses interventions and is responsible for their implementation. At the state level, researchers work with regional Extension Service prevention coordinators and coordinators from the SDFS Program.
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From page 302... ...
There is long-standing consensus that health promotion and prevention programs should be culturally sensitive, along with concerns about whether a given prevention intervention is generic enough to be efficacious and effective with diverse cultures (Resnicow, Baranowski, et al., 1999; Seto, 2001; Woods, Montgomery, and Herring, 2004; Weeks, Schensul, et al., 1995; Hutchinson and Cooney, 1998)
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From page 303... ...
. AILS was found to have a positive impact on American Indian high school students' feelings of hopelessness, suicidal ideation, and ability to intervene in a peer suicidal crisis situation (LaFromboise and Howard-Pitney, 1993)
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From page 304... ...
In general, there has been a dearth of research on cultural, racial, and ethnic issues involved in interventions aimed at preventing mental, emotional, and behavioral (MEB) disorders (U.S.
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From page 305... ...
Community-Driven Implementation Community-driven implementation builds heavily on the decision making of community leaders, often in partnership with researchers, with a focus on improving the community relevance and sustainability of a program. Implementation is guided by a community-driven agenda and staged implementation of a prevention program, in some cases including development, implementation, and testing of a locally developed intervention.
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From page 306... ...
In addition to providing factual program information, they are also able to share personal, firsthand program experience. Community members also play a role in delivering the intervention, helping to address issues of cultural sensitivity and addressing research concerns of efficacy and effectiveness while preparing the community for dissemination.
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From page 307... ...
building in continuous quality improvement, and (4) balancing program adaptation with fidelity (Baptiste, Blachman, et al., 2007)
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From page 308... ...
. Levels of implementation of preventive interventions are rarely measured; however, more information is available on implementation of substance abuse prevention in schools than on other prevention interventions.
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From page 309... ...
Department of Justice, was institutionalized as an effort to facilitate community-level adoption of specific violence prevention interventions. Similarly, the Safe Schools Healthy Students Initiative, a joint program of three federal agencies, encourages the use of evidence-based programs.
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From page 310... ...
of the parents dropped out within the first year and participating families received fewer home visits than intended; the paraprofessional staff may not have had sufficient skills to identify high-risk situations and engage parents in the process of reducing risks associated with abusive parenting; and a shift away from an emphasis on recognizing and addressing risks for abusive parenting toward an early intervention philosophy of parentdriven goal setting, which was caused by funding requirements, may have compromised its effectiveness. A recent evaluation of an augmented HFA program, with a sharper focus on using cognitive appraisal theory to reduce risks for abuse and neglect, as well as better implementation practices, yielded considerably more favorable results compared with both the unenhanced HFA program and a control group that did not receive any home visiting services (Bugental, Ellerson, et al., 2002)
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From page 311... ...
. Some form of curriculaoriented prevention programs for substance abuse is in a large number of the nation's middle schools.
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From page 312... ...
. Implementation of Prevention in Primary Care Settings Few preventive interventions have been tested in primary care settings, although collaborative treatment models involving primary care and behavioral health staff have begun to emerge (Forrest, Glade, et al., 1999; G uevara, Rothbard, et al., 2007)
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From page 313... ...
However, these groups often have vastly different world views and priorities and are often reluctant to learn about each others' perspectives. The previous sections have described some key challenges to the implementation of preventive interventions, including the need to balance cultural adaptation and fidelity, the difficulty of forming essential c ommunity-research partnerships, and the time lag between documentation that an implementation is effective and its successful adoption.
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From page 314... ...
A report on Nevada's implementation of school-based substance abuse and violence prevention programs concluded that funding was inadequate in most school districts to implement the type of prevention program needed (Nevada State Department of Education, 1998)
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From page 315... ...
As the process of school reform grows, researchers and practitioners will need to work together to develop pre-K-12 guidelines and consider how all the elements of evidence-based programs and policies fit together in the context of an overall schoolwide or school district effort, how they increase students' school success, and how to ensure that coordinated, multiyear programs will be implemented effectively (Adelman and Taylor, 2000; Osher, Dwyer, and Jackson, 2002)
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From page 316... ...
The primary health care system has also generally been overlooked as a setting for preventive interventions. Finally, the bulk of child care–based interventions have occurred in center-based settings, with family day care settings rarely targeted for quality improvement or implementation of specific preventive curricula.
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From page 317... ...
. The Blueprints project has a rigorous system for identifying violence prevention programs with a very high level of evidence, facilitates tests of replication of promising programs, disseminates knowledge of these programs to communities, and provides technical support for community implementation, with the direct involvement of the program's developers.
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From page 318... ...
are providing assistance in implementing prevention programs, particularly substance abuse and violence prevention programs. In addition, programs are being encouraged to provide manuals and other materials to assist in the implementation of programs.
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From page 319... ...
Lack of cultural relevance may contribute to low participation. However, universal family prevention programs designed specifically for specific minority groups (Brody, Murry, 2006b; Prado, Pantin, et al., 2007)
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From page 320... ...
. Many agencies that lack academic or other affiliations often need technical assistance, staff support, and implementation resources to implement preventive interventions (Spoth, Kavanagh, and Dishion, 2002)
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From page 321... ...
STRATEGIES THAT COMPLEMENT THE IMPLEMENTATION OF EVIDENCE-BASED INTERVENTIONS Despite the potential for preventing MEB disorders through the implementation of evidence-based programs, there are limitations to relying exclusively on this approach. First, as noted above, evidence remains limited about the ability of existing evidence-based programs to be effective for populations other than those that participated in the original evaluations of these programs.
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From page 322... ...
Dissemination and adoption of these principles can contribute to the healthy development of the nation's young people and the prevention of MEB disorders. Specifically: • Effective preventive interventions reduce young people's exposure to biologically and psychologically toxic events, such as harsh dis cipline, abuse, and neglect.
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From page 323... ...
Principles such as these can be adopted in home, school, and community environments and need not be attached to specific prevention programs. Communication of the importance of these principles can reinforce desirable behavior, minimize aversiveness, contribute to healthy development, and help promote a societal norm supportive of positive development.
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From page 324... ...
. Expanding implementation of relevant public policies should be part of a national implementation strategy to support prevention of MEB disorders and promotion of mental health.
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From page 325... ...
present a conceptual framework for scaling up preventive interventions and moving from effectiveness to
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From page 326... ...
attaining sufficient levels of intervention utilization in diverse general populations, requiring study of recruitment/retention strategies, cultural sensitivity, and economic viability; and (3) achieving implementation quality, involving investigation of adherence and dosage effects, along with theory-driven, intervention quality improvement" (p.
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From page 327... ...
First, the dearth of generalizable knowledge is a product of the lack of significant investment in scientific studies of the implementation and dissemination process. Second, while the specific factors regarding successful program implementation may vary from case to case, there are many commonalities in why organizations have difficulties adopting and sustaining prevention programs.
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From page 328... ...
They compared a standard implementation model in which the LST curriculum stood apart from the day-to-day teaching activities with an infusion model that integrated the curriculum into traditional courses. Three rural school districts were randomly assigned to the traditional LST condition, the infused LST condition, and a control condition.
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From page 329... ...
The trial was driven by a California mandate to use evidence-based practices and interest in identifying ways to facilitate statewide implementation. Although this particular trial involves multidimensional treatment foster care (Chamberlain, Saldana, et al., in press)
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From page 330... ...
In the years since publication of Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research (Institute of Medicine, 1994) , a modest number of experimental tests have aimed at increasing individual- or family-level participation rates for a preventive intervention.
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From page 331... ...
Many developing countries have skipped the stage of land-line phones and moved directly to cell phones. As is the case for other venues, Internet interventions will not be effective in preventing all types of MEB disorders.
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From page 332... ...
Use of Opinion Leaders More recently, the same principles underlying research on diffusion of interventions and social influence have been used proactively to increase the adoption of prevention programs and test adoption strategies in group-based randomized trials. One approach used early in HIV prevention is to target opinion leaders in a community who would themselves deliver peer-to-peer messages to promote increased program adoption.
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From page 333... ...
Although effect size may be the most appropriate metric for studies of indicated interventions in which all participants begin with a substantial rate of symptoms, it may be a poor m etric for universal interventions. In universal interventions, it is usually the case that a large percentage of the population begins with low levels of symptoms, and thus it is unlikely (at least in the short term)
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From page 334... ...
However, the levels of effective implementation are much lower than the availability of tested interventions suggests. Conclusion: Implementation of effective preventive interventions is hampered by lack of ongoing resources and competing priorities of the service systems or communities that could implement them.
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From page 335... ...
Recommendation 11-2: Research funders should fund research on state- or community-wide implementation of interventions to promote mental, emotional, or behavioral health or prevent MEB disorders that meet established scientific standards of effectiveness. Although there are many evidence-based models, it is not clear how generalizable they are to groups other than the ones with which they were tested.
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From page 336... ...
On a practical level, for tested preventive interventions to become widespread, the available research suggests that successful interventions should include at least the availability of published material, such as handbooks, curriculum, and manuals describing the intervention and prescribing actions to be taken; certification of trainers or an electronic training system; high-quality, data-driven technical assistance; implementation fidelity measures; dissemination efforts that are organized around marketing and delivery; an information management system; and community demand for systems that work. In addition to development and implementation of effective programs, the nation needs to support implementation of policies and broad prevention principles in order to create a comprehensive, sustained approach to prevention.
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