Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth A National Agenda (2019) / Chapter Skim
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8 Effective Implementation: Core Components, Adaptation, and Strategies
8 Effective Implementation: Core Components, Adaptation, and Strategies
Pages 221-254
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. This chapter focuses on three elements of sound program design that support effective implementation: 1C.
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health–related programs. BOX 8-1 Dimensions of Implementation Fidelity Primary dimensions of fidelity in the implementation of a program or intervention include adherence, quality, participant engagement, and dosage: Adherence refers to whether core intervention components are being delivered as designed or written (i.e., to the appropriate population; by staff trained appropriately in the logic models through which these core components effect the desired outcome; using the right protocols, techniques, and materials; and in the locations or contexts prescribed)
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The sections below describe this process in greater detail. Studying Mediating Factors Researchers studying mediating factors in family- and school-based interventions have explored a variety of child and adolescent intervention outcomes, including effects on child conduct problems and externalizing behaviors, school engagement and achievement, depression and anxiety symptoms, initiation of and growth in substance use, and delinquency and arrests (Carreras et al., 2016)
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The intervention focused on proximal intervention targets -- strengthening positive relationships between young people and their parents and peers -- because of evidence that these relationships have a protective effect with respect to antisocial behavior and early substance use. Intervention components included parent training, training for children in social and problemsolving skills, a recess intervention game (the Good Behavior Game 3)
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The five mediators they examined are core components of CTC's theory of change with respect to reductions in risk and problem behaviors: (1) community adoption of science-based approaches to prevention, (2)
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. Increasing the connections among clearly identified core intervention components, fidelity assessments, and intended intervention outcomes, as well as ensuring much more rigorous monitoring of core intervention components in both research and
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BOX 8-2 Ways to Support Fidelity Monitoring Researchers: Identify, measure, and test the efficacy of core program components. Funders: Include the specification of core components among project deliverables to support both demonstration or pilot testing and quality assurance and improvement efforts.
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302) , and that adapting programs for cultural groups while maintaining their core components has yielded significant benefits.
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. A recent review of parent training interventions found that parents' ethnicity did not appear to moderate the effects of the interventions, and that cultural adaptation did not appear to improve outcomes compared with nonadapted programs (Ortiz and Del Vecchio, 2013)
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. The CBPR approach has shown particularly strong results in programs designed to promote MEB health in Native American populations.
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. This section reviews in turn discrete and blended implementation strategies, providing three examples of the latter, and then examines the evidence on ways of supporting implementation efforts.
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The CTC process emphasizes community and collaboration for prevention activities and strengthening of community norms against adolescent drug use, and has defined a social development strategy to protect youth beginning at birth; refer to Box 8-4 (see also Brown et al., 2014)
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Define clear, measurable outcomes using assessment data. Select and expand tested and effective policies and programs using the Blueprints for Healthy Youth Development website.
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Social Development Strategy [Using] the Social Development Strategy in daily interactions with young people…helps keep them on track for healthy development.
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In the PROSPER model, extension agents from land grant universities serve as prevention coordinators on local community prevention teams. Representatives from public schools co-lead the teams, and a state management team consisting of university officials and prevention researchers provides oversight and supports evaluation activities.
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. Among the program's documented benefits are small to moderate increases in rates of family recruitment in prevention programs; improvement in child and family risk and protective factors that predict adolescent substance use; reduced rates of prescription drug and opioid misuse; and reductions in youth misconduct, such as stealing, skipping school, and carrying a weapon (Spoth et al., 2015)
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GTO is both a model and a support intervention. The 10 steps are intended to serve as a guide for communities in identifying and implementing prevention programs on their own.
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Each of these blended implementation strategies includes the provision of external support in the form of training and technical assistance for facilitators, as well as change agents. This type of support is found in most implementation frameworks; it is generally both proactive and responsive in nature and usually involves a combination of implementation science and skills training, facilitation, and supportive behavioral coaching for individuals, groups, and organizations (Meyers, Durlak, and Wandersman, 2012)
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A handful of discrete strategies have been studied in detail, but research is needed to improve understanding of optimal ways of selecting such strategies and the potential impact of tailoring them to address the barriers to their implementation in particular contexts. CONCLUSION 8-4: Evidence indicates that blended implementation strategies that involve external support to practitioners in such forms as providing training, technical assistance, or facilitators play a key role in in optimizing local implementation outcomes.
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. Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial.
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In Life skills training: Handbook of drug abuse prevention research, intervention strategies, and practice (pp.
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. Mediating factors of a school-based multi-component smoking prevention intervention: The LDP cluster randomized controlled trial.
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. Prevalence and implementation fidelity of research-based prevention programs in public schools.
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. Effects of communities that care on the adoption and implementation fidelity of evidence-based prevention programs in communities: Results from a randomized controlled trial.
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. Sustainability of the Communities That Care prevention system by coalitions participating in the community youth development study.
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. Feasibility, acceptability, and initial findings from a community-based cultural mental health intervention for American Indian youth and their families.
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: A systematic review. Implementation Science, 10(1)
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American Journal of Community Psychology, 50(3–4)
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. The family spirit trial for American Indian teen mothers and their children: CBPR rationale, design, methods and baseline characteristics.
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. Installing the Communities That Care prevention system: Implementation progress and fidelity in a randomized controlled trial.
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American Journal of Community Psychology, 55(1–2)
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. Longitudinal effects of universal preventive intervention on prescription drug misuse: Three randomized controlled trials with late adolescents and young adults.
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American Journal of Community Psychology, 50(3–4)
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