Promoting Positive Adolescent Health Behaviors and Outcomes Thriving in the 21st Century (2020) / Chapter Skim
Currently Skimming:
4 Core Components of Programs Focused on Optimal Health
4 Core Components of Programs Focused on Optimal Health
Pages 101-142
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From page 101... ...
Female, age 171 As described in Chapter 1, the committee was charged with identifying the key elements or core components of programs that may be successful in preventing risk behaviors and improving outcomes for youth using an optimal health lens. In particular, the sponsor was interested in using a core components methodology to align with work on other current federal research and evaluation initiatives (Blase and Fixsen, 2013)
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These programs typically receive the "evidence-based" designation as a result of at least one experimental or quasi-experimental study that demonstrates a statistically significant positive impact on an outcome of interest. Registries such as Blueprints for Healthy Youth Development2 review the research on candidate programs and provide listings of those that meet their evidence standards.
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. Other approaches to identifying core components involve systematic reviews of evidence, meta-analyses, or reviews of systematic reviews or meta-analyses (Boustani et al., 2015; Lipsey, 2018; Peters et al., 2009)
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find any additional core components not previously identified. Eligibility Criteria To identify the most relevant systematic reviews and meta-analyses for our review, stay within the scope of the charge in our statement of task, and ensure that the articles we reviewed met minimum quality standards for systematic reviews and meta-analyses, we used a set of eligibility criteria to determine which documents would be eligible for this review.
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A meta-analysis or systematic review must have included interventions targeting mindfulness, character education, or moral or spiritual development. 3 The five dimensions of optimal health are broad and cover many aspects of adolescent health and development.
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A meta-analysis or systematic review must have reported effect sizes that represent the magnitude of the treatment effect. Combining effect sizes.
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, one block describing the optimal adolescent health domain or subdomain of interest (e.g., sexual risk behavior, pregnancy) , and one block identifying meta-analyses and systematic reviews.
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The remaining articles considered a variety of behaviors and outcomes that mapped onto multiple optimal health domains (n = 6)
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Multiple Optimal Health Areas (n = 6) • Ciocanel et al.
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Second, the interdependence and interaction among the dimensions can make them difficult to disentangle. Accordingly, many programs incorporating social or spiritual health are categorized under "multiple optimal health domains." Organizing Framework The committee's methodological approach for extracting information from each article drew on the methods used by other core components researchers and was guided by the organizing framework illustrated in Figure 4-2.
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Included in primary prevention are vaccination and behavior change programs, both of which can prevent the onset or impact of the disease or condition (Centers for Disease Control and Prevention [CDC]
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• Social worker/counselor • Demonstration • Other • Other • Primary care provider • Service provision • Mental health provider • Role play/practice Method Location • Researchers • Lecture • In-person • School • Graduate students • Videos • Phone • Home/ housing • Community health workers • Discussion • Online/computer • Faith-based • Mentors • Test/quiz • Video • Community • Faith-based • Homework/workbooks • Slides • Residential facility • Other • Other • Other • Online/computer • Phone Training • Primary care clinic Dosage • Trained/untrained • Mental health clinic • Number of sessions • Number of hours • Other • Length of sessions Optimal Health Domain–Based Content Physical Social Intellectual Sexual behavior Substance use • Communication skills • School engagement/attendance • Abstinence • Type • Conflict resolution/social • Vocational/skills training • Risk reduction -- Alcohol problem solving • College preparation • Risk discontinuation -- Tobacco • Refusal skills • School restructuring • Anatomy/physiology -- Other drugs • Social influence/actual vs. • Supplemental academic services • Puberty/development • Abstinence perceived social norms • Alternative schooling • Pregnancy/reproductive • Cessation • Social support • Other health • Risk reduction • Social capital • Healthy relationships • Consent • Social competence • Personal safety/consent • Brain development • Other Multiple domains/Other: • LGBTQ • Positive youth development • Contraception Emotional Spiritual • Contracting -- Condoms • Cognitive-behavioral • Morals/values • Rewards -- Hormonal methods therapy (CBT)
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Staffing Program staffing referred to the person or people who delivered the program or intervention. The committee identified teachers, parents or family members, peers, social workers or counselors, primary care providers, mental health providers, researchers, graduate students, community health workers, mentors, and faith-based staff in the initial list.
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The committee identified a number of different types of content, which were further categorized by optimal health domain and, in the case of physical health, the behavior of interest. Again, understanding that this list was not exhaustive, we included space to identify any other content that was not on the initial list.
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, and were further categorized as social-emotional, refusal, prosocial behavior, mindfulness, attention, and cognitive flexibility. Targets The targets of programs were the behaviors and outcomes that each program sought to prevent or promote, and were categorized by optimal health domain (see Figure 4-6)
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Figure 4-6 Targets 116 Behaviors Outcomes Physical Emotional Social Physical Sexual behavior Internalizing • Communication Sexual behavior Externalizing • Ever had sex • Self-harm • Conflict resolution • Romantic • Arrest -- Vaginal • Suicidal ideation • Creating relationships relationships • Intentional injury -- Oral • Suicide attempt • Bullying • Intimacy • Unintentional injury -- Anal • Depressive • Other • STI/STD/HIV • Other • Frequency symptoms • Pregnancy • Current activity • Anxiety symptoms • Sexual assault/abuse • Partners • Stress Spiritual • Relationship based Social • Protection • Emotional distress • Mindfulness violence • Relationships -- Condom use • Psychosomatization • Meditation • Other • Isolation -- Contraception use • Self-esteem • Civic engagement • Other • Goal-setting Substance use -- Dual method use • Psychological • Abuse • STI/HIV testing adjustment • Religious attendance • Other • Addiction Spiritual • Other • Other • Unintentional injury • Identity • Disease/disability • Morals/values Substance use Externalizing Intellectual • Death • Other • Ever used • Delinquency • Enrollment • Other • Frequency • Violence • Attendance • Current use • Conduct problems • Academic adjustment/ • Binge/excessive use • Other school bonding Emotional Intellectual • Other • Other Internalizing • Grades • Anxiety disorder • Academic • Depression disorder achievement • Panic attack • School completion • Suicide • Other • Other FIGURE 4-6 Components included in targets.
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Associated outcomes included grades, academic achievements, and school completion. RESULTS OF THE COMMITTEE'S SYSTEMATIC REVIEW The committee examined several types of information from the eligible systematic reviews and meta-analyses, including the findings reported and any core components of the programs and interventions that were recorded
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The results of our systematic review of reviews and meta-analyses are summarized below by optimal health domain. Physical Health Substance Use The committee reviewed 10 systematic reviews and meta-analyses that examined programs and interventions focused on prevention or reduction of youth substance use, including alcohol, tobacco, marijuana, and other drugs, or a combination of two or more of these substances.
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. The committee's review of systematic reviews and meta-analyses of programs targeting substance use revealed several promising components, including the utility of school-based programs for universal prevention, programs that begin in childhood, and those that combine social competence and social influence approaches by incorporating skill development with social norm education.
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Rather, it represents an opportunity for future research to evaluate the effectiveness of identifiable core components of programs and practices that may be generalizable across different settings and target populations. Sexual Behavior Eight different systematic reviews and meta-analyses focused on sexual health.
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. As was found for the substance use studies, the sexual health studies included in the committee's review generally were not designed to identify program components that were more effective than others.
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. All six systematic reviews and meta-analyses included programs focused on universal prevention of emotional health problems, while most also included programs targeted to adolescents considered at risk based on family history or symptoms (Calear and Christensen, 2010; Clarke, Kuosmanen, and Barry, 2015; 7 Articles that focused only on samples of adolescents with diagnosed mental health disorders (e.g., depression, anxiety, attention deficit-hyperactivity disorder)
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techniques were shown to be effective in improving emotional health across all the systematic reviews and meta-analyses. The goal of CBT is to change the automatic negative thoughts that contribute to emotional distress and related behavior problems, and such therapies have strong evidence of effectiveness for a variety of internalizing and externalizing problems across ages and demographic subgroups (Hofmann et al., 2012)
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Studies that include social health among the domains covered are discussed in greater detail in the section below on multiple optimal health domains. Spiritual Health As with social health, no studies in our review focused exclusively on spiritual health.
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Therefore, actions to create supportive school culture and promote equitable access to resources can have major impacts on adolescents' overall health and well-being. Multiple Optimal Health Domains Given the interrelatedness of the dimensions of optimal health, it is not surprising that six of the systematic reviews and meta-analyses considered the effects of programs on outcomes in multiple optimal health domains 8 An additional 15 programs for teen mothers were included in the review but were analyzed separately given these participants' specialized needs.
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. This finding provides further support for the findings described earlier, suggesting that schools are particularly well suited for providing programs that have positive effects on multiple optimal health-related outcomes.
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More specifically, the positive effects of social-motional e learning and positive youth development programs were statistically equivalent for students of different racial/ethnic backgrounds and socioeconomic levels. Such findings indicate the value of these programs in achieving equitable, positive outcomes for all youth, regardless of background.
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6) Summary In summary, the committee's ability to identify specific and discrete core program components was limited by the scope of the systematic reviews and meta-analyses currently available in the literature.
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CORE COMPONENTS OF PROGRAMS FOCUSED ON OPTIMAL HEALTH 129 BOX 4-1 Promising Components Identified in the Systematic Review, by Optimal Health Domain Physical Health Substance use: Universal programs • Being school based • Beginning in childhood • Combining social competence and social influence approaches • Sexual behavior: • Beginning in childhood • Creating a supportive and inclusive culture in program settings • Including diverse youth and their communities in program development, imple mentation, and evaluation efforts • Promoting skills based on social-emotional learning and positive youth devel opment as a complement to inclusive sex education and sexual health services Emotional Health Universal programs • Being school based • Including in-person meetings • Multiple sessions over longer periods of time • Incorporating cognitive-behavioral therapy techniques • Intellectual Health • Providing programs in schools or a combination of schools and other settings • Promoting supportive school culture and access to resources Multiple Optimal Health Domains Promoting competencies based on social-emotional learning and positive • youth development Starting interventions in childhood • Being sequenced, active, focused, and explicit • RESULTS OF CORE COMPONENTS PAPER REVIEW In addition to the systematic review of systematic reviews and meta- analyses reported above, the committee identified a selected group of papers that were clearly focused on core components of effective practice for improving outcomes in each of the optimal health domains. These papers used methodologies of systematic reviews or meta-analyses (Boustani et al., 2015)
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identified common elements that exist across evidence-based prevention programs for multiple health behaviors and outcomes, including substance use, life skills, sexual health, violence, and depression/anxiety. To this end, they used a distillation and matching approach, which entails systematically reviewing EBPs to aggregate the core components that are most common to these programs and are thus likely to be the most effective (Chorpita et al., 2005)
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FIGURE 4-7 Common components of adolescent prevention programs. SOURCE: Boustani et al.
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took a broad and integrative approach to understanding a range of factors that might influence positive youth development. They compared four interrelated frameworks: social competence (SC)
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suggests that this efficiency is enhanced if the elements of change are similar across all of the targeted behaviors and outcomes. These authors conducted a systematic review of the effectiveness of school-based health promotion programs targeting substance use, sexual behavior, and nutrition.9 The 55 reviews included in their analysis yielded five core components deemed effective across all three targeted behaviors: being theory-based; addressing social influences (especially social norms)
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CONCLUSIONS With respect to core components of programs that are effective in promoting positive adolescent health behaviors and outcomes, the committee drew the following conclusions. CONCLUSION 4-1: Most current research is not designed to identify which components of adolescent risk behavior programs or interventions are more effective than others.
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(2009) All programs: • Being theory-based • Addressing social influences (especially social norms)
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CONCLUSION 4-4: Programs that incorporate approaches based on behavioral theory, social-emotional learning, and positive youth development are more successful in promoting positive adolescent health behaviors and outcomes across multiple optimal health domains relative to those that do not use these approaches to inform programmatic efforts. CONCLUSION 4-5: Multicomponent, multisession programs focused on social-emotional learning and positive youth development that emphasize knowledge, attitudes, and skills are more successful in supporting healthy adolescent development than programs focused on individual risk behaviors.
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Memo to the Committee on Applying Lessons of Opti m mal Adolescent Health to Improve Behavioral Outcomes for Youth. Baltimore City, MD: Baltimore City Health Department.
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. Interventions for adolescent mental health: An overview of systematic reviews.
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Cochrane Database of Systematic Reviews(10)
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. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
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Campbell Systematic Reviews, 8, 61.
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