Strategies to Avoid Replication Failure With Evidence-Based Prevention Interventions: Case Examples From the Strengthening Families Program.

Research has found disturbing long-term effects of poor parenting on children's behavioral health including addiction, delinquency, depression/anxiety, and poorer health as adults. Poor parenting practices thus contribute substantially to the health crisis in America. However, skilled, nurturing parents, or caretakers can help youth avoid these developmental problems. A number of family and parenting evidence-based interventions (EBIs) that teach parenting skills are now available for dissemination. Unfortunately, replications of EBIs do not always produce the original positive results. Organizations that seek to use family EBIs to improve parenting and family skills need to avoid practices that create replication failure. We examine several possible factors that contribute to replication failure using examples from five replications of the EBI "Iowa Strengthening Families Program for ages 10-14." We then share six strategies conducive to avoid replication failures including (1) choosing the right program and implementation strategy for the population, (2) administering the right "dosage," (3) choosing and properly training implementers, (4) maintaining program integrity and adherence, (5) ensuring cultural sensitivity, and (6) ensuring accurate and complete reporting of evaluation results. These guidelines can advance prevention science to meet the demands of a growing public health agenda.

Formative Evaluation to Build an Online Parenting Skills and Youth Drug Prevention Program: Mixed Methods Study.

BACKGROUND: Family-based drug prevention programs that use group-based formats with trained facilitators, such as the Strengthening Families Program (SFP), are effective in preventing underage drinking and youth drug use. However, these programs are resource-intensive and have high costs and logistical demands. Tailoring them for Web-based delivery is more cost-effective and makes it easier to scale these programs for widespread dissemination. This requires the active involvement of all key stakeholders to determine content and delivery format. OBJECTIVE: The aim was to obtain consumer, agency stakeholder, and expert input into the design of a Web-based parenting skills training and youth drug prevention program. METHODS: We conducted 10 focus groups with 85 adults (range 4-10, average 8 per group), 20 stakeholder interviews with family services agency staff, and discussed critical design considerations with 10 prevention scientists and e-learning experts to determine the optimal program content and technology features for SFP Online. Focus group participants also answered survey questions on perceived barriers to use, desired navigational features, preferred course format, desired content, preferred reward structures, course length, interactive components, computer efficacy, and technology use. Descriptive statistics were used to examine consumer characteristics; linear regression was used to examine relations between SFP exposure and four continuous outcome measures, including desired program content, interactive technology, and concerns that may inhibit future use of SFP Online. Logistic regression was used as a binary measure of whether consumers desired fun games in the SFP Online program. RESULTS: Three broad thematic categories emerged from the qualitative interviews enumerating the importance of (1) lesson content, (2) logistics for program delivery, and (3) multimedia interactivity. Among the many significant relations, parents who viewed more SFP lessons reported more reasons to use an online program (beta=1.48, P=.03) and also wanted more interactivity (6 lessons: beta=3.72, P=.01; >6 lessons: beta=2.39, P=.01), parents with less interest in a mixed delivery format (class and online) reported fewer reasons to use the online program (beta=-3.93, P=.01), comfort using computers was negatively associated with concerns about the program (beta=-1.83, P=.01), having mobile phone access was related to fewer concerns about online programs (beta=-1.63, P=.02), willingness to view an online program using a mobile phone was positively associated with wanting more online components (beta=1.95, P=.02), and parents who wanted fun games wanted more interactivity (beta=2.28, P=.01). CONCLUSIONS: Formative evaluation based on user-centered approaches can provide rich information that fuels development of an online program. The user-centered strategies in this study lay the foundation for improving SFP Online and provide a means to accommodate user interests and ensure the product serves as an effective prevention tool that is attractive to consumers, engaging, and can overcome some of the barriers to recruitment and retention that have previously affected program outcomes in family-based prevention.

Cultural adaptation process for international dissemination of the strengthening families program.

The Strengthening Families Program (SFP) is an evidence-based family skills training intervention developed and found efficacious for substance abuse prevention by U.S researchers in the 1980s. In the 1990s, a cultural adaptation process was developed to transport SFP for effectiveness trials with diverse populations (African, Hispanic, Asian, Pacific Islander, and Native American). Since 2003, SFP has been culturally adapted for use in 17 countries. This article reviews the SFP theory and research and a recommended cultural adaptation process. Challenges in international dissemination of evidence-based programs (EBPs) are discussed based on the results of U.N. and U.S. governmental initiatives to transport EBP family interventions to developing countries. The technology transfer and quality assurance system are described, including the language translation and cultural adaptation process for materials development, staff training, and on-site and online Web-based supervision and technical assistance and evaluation services to assure quality implementation and process evaluation feedback for improvements.

Parenting skills and family support programs for drug-abusing mothers.

Children born to drug-using mothers can suffer from fetal alcohol or drug syndrome (FAS/FDS) or fetal alcohol or drug effect (FAE/FDE). Such children have a greater likelihood of developing acute or chronic physical, cognitive and behavioral problems. In-utero exposure to tobacco, alcohol or drugs impact on the developing fetus and, after birth, the family environment and family system exert effects on the infants and children of substance-abusing parents. Evidence-based prevention and maternal drug treatment programs focus on enhancing parental childcaring abilities, supporting parent-child attachment and encouraging family support systems to improve children's health and cognitive outcomes. FAS/FDS prevention programs, as well as selective and indicated prenatal and postnatal interventions, can improve the support given both to mother and to child, and evidence-based, in-home parenting and family-skills-training approaches are particularly useful.

[Strengthening family interventions for the prevention of substance abuse in children of addicted parents]. / Intervenciones de fortalecimiento familiar para la prevención del consumo de sustancias en hijos de padres adictos.

The scientific literature consistently reports that while children of substance abusers may be at biological, psychological, or environmental risk, the effects of these risks can be abbreviated through the use of effective interventions and treatments. Research has consistently demonstrated reductions in family and child dysfunction when effective family intervention programs are consistently utilized. While a number of effective family-based approaches have been developed and evaluated, only a few have been designed specifically for children of substance abusing parents. Just two have been tested in randomized control trials -The Streghtening Families Program and Focus on the Family. The Streghtening Families Program has demonstrated statistically significant reductions in family and child dysfunctions across several ethnocultural groups when consistently utilized. Clinical and advanced graduate programs should stress training in these evidence-based practices as well as how to adapt these models to be more culturally sensitive and age or gender appropriate in order to serve a growing and needy population of families.

Prevention approaches to enhance resilience among high-risk youth: comments on the papers of Dishion & Connell and Greenberg.

This article synthesizes research on resilience theory and its implications for prevention interventions to increase resilience in high-risk children and adolescents. In addition, this response to both the articles by Drs. Greenberg and Dishion summarizes their key points. Their papers discuss the neuroscience substrate behind two major mediators of antisocial behaviors, namely lack of self-regulation and executive function problems. In addition, we present an overall Resilience Framework that will help the reader organize the aspects of resilience discussed by these two researchers into a transactional process model. This article extends prior researchers' suggestion that resilience is the product of the interaction of genetic, biological, and environmental precursors to a further consideration of higher-level cognitive precursors, such as purpose in life and existential meaning. The relevance of resilience to the prevention of negative outcomes in high-risk children of alcoholics (COAs) and substance abusers is covered. Within this third wave of resilience research on prevention interventions, we present data suggesting that family strengthening approaches have the greatest impact on increasing resilience.

Worksite health promotion programs in college settings.

The purpose of this paper is to describe the multifaceted nature and benefits of worksite health promotion programs (WHPPs), with emphasis on the college setting. An assessment of the peer-reviewed literature was conducted of articles published since 2000. Several search engines were accessed and selected key words were used. Most studies examining WHPPs have focused on return on investment and productivity. Research that targets the softer side-benefits of health promotion programs in the workplace is less available. Although the college setting offers some advantages for implementing health promotion programs. They may also have unique challenges due to their large and diverse employee population. There is little research to show the effectiveness and unique challenges of college-based health promotion programs.

Family-strengthening approaches for the prevention of youth problem behaviors.

Effective parenting is the most powerful way to reduce adolescent problem behaviors. Dissemination of research-based family interventions has been slow, with most practitioners still implementing ineffective programs. This article reviews 2 federal studies that involved national searches for effective family interventions targeting pre-birth to adolescence: Preventing Substance Abuse Among Children and Adolescents: Family-Centered Approaches (Center for Substance Abuse Prevention, 1998) and Strengthening America's Families (R. Alvarado, K. L. Kumpfer, K. Kendall, S. Beesley, & C. Lee-Cavaness, 2000). Results identified 3 effective prevention approaches, 13 principles of effectiveness, and 35 programs. Recommendations include increased dissemination research on training and technical assistance systems, adoption with fidelity and quality, and gender-, age-, and culturally sensitive adaptations.

Prevention that works for children and youth. An introduction.

The widespread implementation of effective prevention programs for children and youth is a sound investment in society's future. The most beneficial preventive interventions for young people involve coordinated, systemic efforts to enhance their social-emotional competence and health. The articles in this special issue propose standards for empirically supported programming worthy of dissemination and steps to integrate prevention science with practice. They highlight key research findings and common principles for effective programming across family, school, community, health care, and policy interventions and discuss their implications for practice. Recent advances in prevention research and growing support for evidence-based practice are encouraging developments that will increase the number of children and youth who succeed and contribute in school and life.

What works in prevention. Principles of effective prevention programs.

The high prevalence of drug abuse, delinquency, youth violence, and other youth problems creates a need to identify and disseminate effective prevention strategies. General principles gleaned from effective interventions may help prevention practitioners select, modify, or create more effective programs. Using a review-of-reviews approach across 4 areas (substance abuse, risky sexual behavior, school failure, and juvenile delinquency and violence), the authors identified 9 characteristics that were consistently associated with effective prevention programs: Programs were comprehensive, included varied teaching methods, provided sufficient dosage, were theory driven, provided opportunities for positive relationships, were appropriately timed, were socioculturally relevant, included outcome evaluation, and involved well-trained staff. This synthesis can inform the planning and implementation of problem-specific prevention interventions, provide a rationale for multi-problem prevention programs, and serve as a basis for further research.

A focus group assessment to determine motivations, barriers and effectiveness of a university-based worksite wellness program.

BACKGROUND: This study explores university employee perceptions and under-standing about its Worksite Health Promotion Program (WHPP). The WHPP included a Health Risk Appraisal (HRA), biometric screening, publicity for on-campus health programs and facilities, and health coaching. METHODS: A qualitative design was used based on a grounded theory ap-proach. Four 90 minutes focus groups with 6-8 participants in each were conducted within a two 2 week period among employees, representing fac-ulty/participants, fac-ulty/nonparticipants, staff/participants, and staff/nonparticipants. Responses to questions about motivations, barriers, and perceived health benefits that impacted participation in the WHPP were digi-tally recorded, transcribed and coded for themes. RESULTS: Incentives effectively motivated participation. Biometric screening had the largest impact on behavior change, followed by the information learned from the HRA. However, despite two-thirds of the employees partici-pating in the pro-gram, lack of a full understanding of WHPP benefits and services lowered partici-pation in follow-up services and supplemental pro-grams. CONCLUSIONS: Biometric screening and HRAs effectively motivate program par-ticipation. Communication of benefits and services are important when providing WHPPs.

Longitudinal outcomes of a comprehensive, incentivized worksite wellness program.

This study evaluated health benefits of long-term participation in an employer-based wellness program, focusing on selected chronic disease risk factors. A repeated measures longitudinal time-series study was conducted of 8 years of existing prospectively collected annual data, including clinical measures of weight, blood pressure, cholesterol, and body fat percent. Participants were divided into their risk levels at baseline. Outcomes were compared to level of participation, for which annual points earned was a surrogate. Participants had lower increases in body mass index (BMI) than the general population had during the same time period. Greatest improvements in BMI, blood pressure, and cholesterol were seen in those at highest risk levels at baseline and in those whose physical activity increased over time. It was found that long-term participation in this program improved BMI, blood pressure, and cholesterol. Most benefits were found for those in high-risk groups. This program should recruit more employees in high health risk categories and emphasize retention and increased levels of participation.

Outcome evaluation of the Veterans Affairs Salt Lake City Integrative Health Clinic for Chronic Nonmalignant Pain.

OBJECTIVES: the purpose of this longitudinal outcome study was to investigate the effectiveness of the Integrative Health Clinic and Program, an innovative outpatient clinical service that provides nonpharmacologic, biopsychosocial interventions using research based mind-body skills and complementary and alternative therapies. The study assessed improvement in chronic nonmalignant pain and related depression, anxiety, and health-related quality of life. METHODS: the study was a retrospective post-hoc quasi-experimental design with a group analysis comparing chronic nonspinal-related pain (CNSP) (eg, joint pain, headache, and fibromyalgia) (n=53) to chronic spinal-related pain (CSP) (eg, back pain and neck pain) (n=88). Data were collected at intake and up to 4 follow-up visits. Hierarchical Linear Modeling was used for statistical analysis. Outcome measures included: Quality of Life (Short Form-36), the Beck Depression Inventory, and Beck Anxiety Inventory. RESULTS: there were statistically significant differences within and between the CNSP and CSP groups across all follow-up visits. For the CNSP group, depression, anxiety, and bodily pain significantly improved with moderate-to-large effect sizes at 6 months (Cohen's d=0.74, 0.53, and 0.66, respectively) and these benefits persisted across all follow-up visits. The CSP group showed an improvement trend in bodily pain (Cohen's d=0.26). DISCUSSION: significant study findings revealed that the greatest improvement after participation in Integrative Health Clinic and Program were seen in the CNSP group with benefits persisting to 24 months in mood and in some health-related quality of life subcategories.

A wakeup call to the prevention field: are prevention programs for substance use effective for girls?

Substance misuse in adolescent girls has increased dramatically since 1992. This article reviews trends in use rates and etiological theories tested by gender that suggest that family protective factors have more influence on girls. Next, a literature review reveals that few prevention programs have published their outcomes by gender or developed gender-specific programs. Nationwide community coalition results found positive effects on boys but increased drug use in young girls. The most effective programs are family focused targeting family bonding, supervision, and communication. Recent gender-specific prevention programs with positive results address stress, depression, social assertiveness, and body image. The authors recommend additional research testing programs by gender and also gender-specific versus generic versions of evidence-based programs to determine how to improve prevention program effectiveness for girls.

Prevention of alcohol and drug abuse: what works?

There is no single "best" prevention program, and no one program or approach will stop all drug use. There are many effective research-based programs; the best approach for any particular population requires selecting the best intervention for the target population on the basis of a knowledge of the risk and protective factors in that population. Unfortunately, the most highly marketed school or family programs are generally not those programs with the best outcomes. The best approach to prevention is to begin early to reduce emerging behavioral and emotional problems in youth. Longer-lasting effects should accrue from changing school, community, and family environmental conditions that promote and maintain drug problems in youth. More and more prevention specialists are considering moving from a focus on the individual to changes in total systems or the environmental contexts that promote or hinder drug use. On the basis of economic considerations, the "whole family" systems-change approach of family skills training classes is becoming popular even in the managed care environment. The greatest challenge facing the drug abuse prevention field is to get information out to practitioners and communities about the best prevention programs, approaches, and principles of effectiveness. Researchers and funding agencies must learn how to effectively market the most successful programs to bridge the gap between research and practice. We must become as effective at marketing drug prevention programs as drug dealers are at promoting and selling drugs. Communities need health care professionals who are knowledgeable about substance abuse prevention and who can advocate the implementation and ongoing improvement of prevention programs with known effectiveness.

Parent/child transactional processes predictive of resilience or vulnerability to "substance abuse disorders".

This article discusses implications of a theoretical model of resilience--the Resilience Framework, including the impact of parent/child transactional processes in moderating or mediating a child's biological or environmental risks and later substance misuse. Research is presented on behavioral and emotional precursors of substance abuse disorders in children of substance users. Detrimental processes within dysfunctional family environments are presented followed by a listing of strategies for increasing resilience in youth by improving family dynamics. The value in elucidating these interactive processes is to increase our understanding of ways to reduce the impact of risk factors. Prevention providers should use these strategies as benchmarks for selecting or developing effective family-focused prevention programs. Resources are presented for finding effective family interventions as well as an example of a family intervention based on resilience principles, namely the Strengthening Families Program. Recommendations are made for future research and better dissemination of evidence-based family interventions.

Family-based interventions for substance use and misuse prevention.

Because "substance abuse" is a "family disease" of lifestyle, including both genetic and family environmental causes, effective family strengthening prevention programs should be included in all comprehensive substance abuse prevention activities. This article presents reviews of causal models of substance use and evidence-based practices. National searches by the authors suggest that there is sufficient research evidence to support broad dissemination of five highly effective family strengthening approaches (e.g., behavioral parent training, family skills training, in-home family support, brief family therapy, and family education). Additionally, family approaches have average effect sizes two to nine time larger than child-only prevention approaches. Comprehensive prevention programs combining both approaches produced much larger effect sizes. The Strengthening Families Program (SFP) is the only one of these programs that has been replicated with positive results by independent researchers with different cultural groups and with different ages of children. Few research-based programs have been adopted by practitioners, partly because of technology transfer issues. Overall, research on ways to improve dissemination, marketing, training, and funding is needed to improve adoption of effective prevention programs.

Cultural sensitivity and adaptation in family-based prevention interventions.

Because of the substantial impact of families on the developmental trajectories of children, family interventions should be a critical ingredient in comprehensive prevention programs. Very few family interventions have been adapted to be culturally sensitive for different ethnic groups. This paper examines the research literature on whether culturally adapting family interventions improves retention and outcome effectiveness. Because of limited research on the topic, the prevention research field is divided on the issue. Factors to consider for cultural adaptations of family-focused prevention are presented. Five research studies testing the effectiveness of the generic version of the Strengthening Families Program (SFP) compared to culturally-adapted versions for African Americans, Hispanic, Asian/Pacific Islander, and American Indian families suggest that cultural adaptations made by practitioners that reduce dosage or eliminate critical core content can increase retention by up to 40%, but reduce positive outcomes. Recommendations include the need for additional research on culturally-sensitive family interventions.

Effectiveness of school-based family and children's skills training for substance abuse prevention among 6-8-year-old rural children.

This research tested the effectiveness of a multicomponent prevention program, Project SAFE (Strengthening America's Families and Environment), with 655 1st graders from 12 rural schools. This sample was randomly assigned to receive the I Can Problem Solve (ICPS) program (M. B. Shure & G. Spivack, 1979), alone or combined with the Strengthening Families (SF) program (K. L. Kumpfer, J. P. DeMarsh, & W. Child, 1989), or SF parent training only. Nine-month change scores revealed significantly larger improvements and effect sizes (0.35 to 1.26) on all outcome variables (school bonding, parenting skills, family relationships, social competency, and behavioral self-regulation) for the combined ICPS and SF program compared with ICPS-only or no-treatment controls. Adding parenting-only improved social competency and self-regulations more but negatively impacted family relationships, whereas adding SF improved family relationships, parenting, and school bonding more.