Screening, brief intervention, and referral to treatment for adolescents: Attitudes, perceptions, and practice of New York school-based health center providers.

BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) has been endorsed by the American Academy of Pediatrics as an evidence-based strategy to address risky substance use among adolescents in primary care. However, less than half of pediatricians even screen adolescents for substance use. The purpose of this study was to identify variation in SBIRT practice and explore how program directors' and clinicians' attitudes and perceptions of effectiveness, role responsibility, and self-efficacy impact SBIRT adoption, implementation, and practice in school-based health centers (SBHCs). METHODS: All 162 New York State SBHC program directors and clinicians serving middle and high school students were surveyed between May and June of 2013 (40% response rate). RESULTS: Only 22% of participants reported practicing the SBIRT model. Of the individual SBIRT model components, using a standardized tool to screen students for risky substance use, referring students with substance use problems to specialty treatment, and assessing students' readiness to change were practiced least frequently. Less than 30% of participants felt they could be effective at helping students reduce substance use, 63% did not believe it was their role to use a standardized screening tool, and 20-30% did not feel confident performing specific aspects of intervention and management. Each of these factors was correlated with SBIRT practice frequency (P < .05). CONCLUSIONS: Findings from this study identify an important gap between an evidence-based SBIRT model and its adoption into practice within SBHCs, indicating a need for dissemination strategies targeting role responsibility, self-efficacy, and clinicians' perceptions of SBIRT effectiveness.

The empowerment of low-income parents engaged in a childhood obesity intervention.

Parents influence children's obesity risk factors but are infrequently targeted for interventions. This study targeting low-income parents integrated a community-based participatory research approach with the Family Ecological Model and Empowerment Theory to develop a childhood obesity intervention. This article (1) examines pre- to postintervention changes in parents' empowerment; (2) determines the effects of intervention dose on empowerment, and (3) determines whether changes in parent empowerment mediate previous changes identified in food-, physical activity-, and screen-related parenting. The pre-post quasi-experimental design evaluation demonstrated positive changes in parent empowerment and empowerment predicted improvement in parenting practices. The integrated model applied in this study provides a means to enhance intervention relevance and guide translation to other childhood obesity and health disparities studies.

A childhood obesity intervention developed by families for families: results from a pilot study.

BACKGROUND: Ineffective family interventions for the prevention of childhood obesity have, in part, been attributed to the challenges of reaching and engaging parents. With a particular focus on parent engagement, this study utilized community-based participatory research to develop and pilot test a family-centered intervention for low-income families with preschool-aged children enrolled in Head Start. METHODS: During year 1 (2009-2010), parents played an active and equal role with the research team in planning and conducting a community assessment and using the results to design a family-centered childhood obesity intervention. During year 2 (2010-2011), parents played a leading role in implementing the intervention and worked with the research team to evaluate its results using a pre-post cohort design. Intervention components included: (1) revisions to letters sent home to families reporting child body mass index (BMI); (2) a communication campaign to raise parents' awareness of their child's weight status; (3) the integration of nutrition counseling into Head Start family engagement activities; and (4) a 6-week parent-led program to strengthen parents' communication skills, conflict resolution, resource-related empowerment for healthy lifestyles, social networks, and media literacy. A total of 423 children ages 2-5 years, from five Head Start centers in upstate New York, and their families were exposed to the intervention and 154 families participated in its evaluation. Child outcome measures included BMI z-score, accelerometer-assessed physical activity, and dietary intake assessed using 24-hour recall. Parent outcomes included food-, physical activity- and media-related parenting practices and attitudes. RESULTS: Compared with pre intervention, children at post intervention exhibited significant improvements in their rate of obesity, light physical activity, daily TV viewing, and dietary intake (energy and macronutrient intake). Trends were observed for BMI z-score, sedentary activity and moderate activity. Parents at post intervention reported significantly greater self-efficacy to promote healthy eating in children and increased support for children's physical activity. Dose effects were observed for most outcomes. CONCLUSIONS: Empowering parents to play an equal role in intervention design and implementation is a promising approach to family-centered obesity prevention and merits further testing in a larger trial with a rigorous research design.

Reframing family-centred obesity prevention using the Family Ecological Model.

OBJECTIVE: According to the Family Ecological Model (FEM), parenting behaviours are shaped by the contexts in which families are embedded. In the present study, we utilize the FEM to guide a mixed-methods community assessment and summarize the results. Additionally, we discuss the utility of the FEM and outline possible improvements. DESIGN: Using a cross-sectional design, qualitative and quantitative methods were used to examine the ecologies of parents' cognitions and behaviours specific to children's diet, physical activity and screen-based behaviours. Results were mapped onto constructs outlined in the FEM. SETTING: The study took place in five Head Start centres in a small north-eastern city. The community assessment was part of a larger study to develop and evaluate a family-centred obesity prevention programme for low-income families. SUBJECTS: Participants included eighty-nine low-income parents/caregivers of children enrolled in Head Start. RESULTS: Parents reported a broad range of factors affecting their parenting cognitions and behaviours. Intrafamilial factors included educational and cultural backgrounds, family size and a lack of social support from partners. Organizational factors included staff stability at key organizations, a lack of service integration and differing school routines. Community factors included social connectedness to neighbours/friends, shared norms around parenting and the availability of safe public housing and play spaces. Policy- and media-related factors included requirements of public assistance programmes, back-to-work policies and children's exposure to food advertisements. CONCLUSIONS: Based on these findings, the FEM was refined to create an evidence-based,temporally structured logic model to support and guide family-centred research in childhood obesity prevention.

Engaging low-income parents in childhood obesity prevention from start to finish: a case study.

Prevention of childhood obesity is a national priority. Parents influence young children's healthy lifestyles, so it is paradoxical that obesity interventions focus primarily on children. Evidence and theory suggest that including parents in interventions offers promise for effective childhood obesity prevention. This case study engaged parents' as co-researchers in the design, implementation and evaluation of an intervention for low-income families with a child enrolled in Head Start. Parent engagement mechanisms include: (1) targeted partnership development (2) operationalizing a Community Advisory Board (CAB) that was the key decision making body; (3) a majority of CAB members were parents who were positioned as experts, and (4) addressing structural barriers to parent participation. Lessons learned are provided for future research, and practice.

Family ecological predictors of physical activity parenting in low-income families.

Physical activity (PA) parenting, or strategies parents use to promote PA in children, has been associated with increased PA in children of all ages, including preschool-aged children. However, little is known about the circumstances under which parents adopt such behaviors. This study examined family ecological factors associated with PA parenting. Low-income parents (N = 145) of preschool-aged children (aged 2 to 5 years) were recruited from five Head Start centers in upstate New York. Guided by the family ecological model (FEM), parents completed surveys assessing PA parenting and relevant family and community factors. Hierarchical regression analysis identified independent predictors of PA parenting. Parent depressive symptoms, life pressures that interfere with PA and perceived empowerment to access PA resources were associated with PA parenting. Community factors, including neighborhood play safety and social capital, were not independently associated with PA parenting in the multivariate model. Together, family ecological factors accounted for a large proportion of the variance in PA parenting (R (2) = .37). Findings highlight the need to look beyond cognitive predictors of PA parenting in low-income families and to examine the impact of their broader life circumstances including indicators of stress.

The Family-centered Action Model of Intervention Layout and Implementation (FAMILI): the example of childhood obesity.

Parents play a fundamental role in shaping children's development, including their dietary and physical activity behaviors. Yet family-centered interventions are rarely used in obesity prevention research. Less than half of childhood obesity prevention programs include parents, and those that do include parents or a family component seldom focus on sustainable change at the level of the family. The general absence of a family-centered approach may be explained by persistent challenges in engaging parents and families and the absence of an intervention framework explicitly designed to foster family-centered programs. The Family-centered Action Model of Intervention Layout and Implementation, or FAMILI, was developed to address these needs. FAMILI draws on theories of family development to frame research and intervention design, uses a mixed-methods approach to conduct ecologically valid research, and positions family members as active participants in the development, implementation, and evaluation of family-centered obesity prevention programs. FAMILI is intended to facilitate the development of culturally responsive and sustainable prevention programs with the potential to improve outcomes. Although childhood obesity was used to illustrate the application of FAMILI, this model can be used to address a range of child health problems.

Making sense of it all: consumer providers' theories about factors facilitating and impeding recovery from psychiatric disabilities.

This qualitative study examined the accounts of fifteen adults regarding how they recovered from serious psychiatric disability. Interviews were analyzed using a grounded theory approach within a framework of Symbolic Interactionism. Recovery was identified as a dynamic process of personal growth and transformation. Barriers to recovery included paternalistic and coercive treatment systems, indifferent professionals, side effects from medication, and psychiatric symptoms. The existence of supportive relationships, meaningful activities and effective traditional and alternative treatments were identified as influential in facilitating recovery. The consumer providers who participated in this study provided important findings and fresh understanding about the recovery process.

Co-production dynamics and time dollar programs in community-based child welfare initiatives for hard-to-serve youth and families.

Hard-to-serve youth and families residing in high-poverty communities often have multiple, interlocking needs. These needs necessitate complex service models. The complex model described in this article combines a unique approach to wraparound services with a coproduction framework and related theories. The model aims to improve outcomes for vulnerable youth and their families, simultaneously strengthening communities by employing residents and engaging participants in community service. Examples derived from current pilot projects illustrate co-production's importance for other child welfare initiatives.

Targeting evaluations of youth development-oriented community partnerships.

Community-based partnerships (CBPs) focused on youth development (YD) have the potential to improve public health outcomes. These partnerships also present opportunities for the design and implementation of innovative, community-level change strategies, which ultimately may result in new capacities for positive YD. Evaluation-driven learning and improvement frameworks facilitate the achievement of these partnership-related benefits. Partnerships are complex because they embody multiple levels of intervention (eg, youth-serving programs, youth participation as partners or evaluators, network development for collaborative projects and resource sharing, YD-oriented organizational or community policy change). This inherent complexity transfers to evaluations of CBPs. This article provides resources for meeting evaluation-related challenges. It includes a framework for articulating relevant evaluation questions for YD-oriented CBPs, a summary of relevant types of evaluation studies, and practical solutions to common evaluation problems using targeted evaluation studies. Concrete examples of relevant, small-scale evaluation studies are provided throughout.

An evaluation of child welfare design teams in four states.

Empowerment-oriented design teams were structured in four states to promote collaborative practices among professionals and former clients. These teams were structured to serve as both learning and training systems, and they identified competencies for collaborative practices. Because these design teams represent a new learning and improvement system for child welfare and related service systems, and because these systems need more effective approaches to learning, training, and improvement, outcomes-oriented evaluations are imperative. The outcomes evaluation reported here relied on two evaluation strategies. First, 48 design team members completed follow-up surveys; these surveys explored individuals' perceptions of their design team involvement. Second, 22 design team members were interviewed directly; they were asked questions about the benefits and accomplishments resulting from their design team experience. These data from both evaluation strategies indicate that design teams promoted family-centered practice and interprofessional collaboration; enhanced service delivery and an understanding of co-occurring needs; and fostered personal growth and self-awareness among participants. These commonalties and similarities were surprising and interesting because design teams in the four states proceeded differently. These findings are discussed in relation to emergent theory on collaborative learning processes and products.