A Longitudinal Analysis of Trajectories and Predictors of Fidelity Using the SafeCare Parenting Model.

Evidence-based practice (EBP) fidelity, understood as the extent to which a program is implemented as the developers intended, is a key implementation variable which likely relates to consumer outcomes. However, studies that track fidelity longitudinally and at large scale are uncommon, and finding reliable predictors of fidelity has proven to be a complex challenge. Further, attitudes toward EBP are a potentially important predictor of fidelity, but results across the literature have been mixed. The purpose of the present study is to use data from the ongoing implementation and dissemination of the SafeCare model to better understand (1) the characteristics of SafeCare implementation fidelity trajectories, and (2) whether individual level factors predict differences in fidelity and fidelity trajectories, especially provider attitudes toward EBP. The analyses reported here include 14,778 observed fidelity sessions by 868 providers in 172 agencies. We use multilevel modeling to examine fidelity, fidelity trajectories over time, and several potential individual-level predictors of fidelity, including demographics, work history, and attitudes toward EBP. We found: (1) that SafeCare fidelity begins high at baseline (93.85% on average); (2) that SafeCare fidelity displays a statistically significant trend of positive linear growth, even among those with less positive attitudes; and (3) that positive attitudes are associated with slightly higher fidelity on average and at baseline, while negative attitudes are associated with slightly lower fidelity on average and at baseline. To our knowledge, this is the largest longitudinal analysis of EBP fidelity in a child welfare program to date, and our findings support the notion that intensive coaching supports which are titrated over time can be sufficient to ensure sustained high fidelity, at least in some cases. Further, these findings indicate that robust training and coaching processes can ensure high fidelity and fidelity growth even among providers with less positive attitudes toward EBP.

Highly compressible glass-like supramolecular polymer networks.

Supramolecular polymer networks are non-covalently crosslinked soft materials that exhibit unique mechanical features such as self-healing, high toughness and stretchability. Previous studies have focused on optimizing such properties using fast-dissociative crosslinks (that is, for an aqueous system, dissociation rate constant kd > 10 s-1). Herein, we describe non-covalent crosslinkers with slow, tuneable dissociation kinetics (kd < 1 s-1) that enable high compressibility to supramolecular polymer networks. The resultant glass-like supramolecular networks have compressive strengths up to 100 MPa with no fracture, even when compressed at 93% strain over 12 cycles of compression and relaxation. Notably, these networks show a fast, room-temperature self-recovery (< 120 s), which may be useful for the design of high-performance soft materials. Retarding the dissociation kinetics of non-covalent crosslinks through structural control enables access of such glass-like supramolecular materials, holding substantial promise in applications including soft robotics, tissue engineering and wearable bioelectronics.

Barriers and facilitators to implementing evidence-based interventions in the context of a randomized clinical trial in the United States: a qualitative study.

BACKGROUND: Evidence-based interventions, which are typically supported by data from randomized controlled trials (RCTs), are highly valued by providers of human services like child welfare. However, implementing such interventions in the context of a randomized clinical trial is a complex process, as conducting an RCT adds extra tasks for providers and complicating factors for provider organizations. Utilizing the Exploration, Preparation, Implementation, and Sustainment Framework, this study examines factors that facilitate or impede success in the implementation of evidence-based interventions in the context of a largescale trial of SafeCare,® a child maltreatment intervention. METHODS: Qualitative data were obtained as part of a larger mixed-methods study involving a cluster randomized trial comparing SafeCare to usual services for caregivers within nine child welfare agencies across four states. Between May and October 2017, individual interviews were conducted with a purposive sample of 21 child welfare administrators and 24 supervisors, and 19 focus groups were conducted with 84 providers. Data were coded iteratively and grouped into themes. RESULTS: Several interconnected themes centered on facilitators and barriers to SafeCare implementation in the context of a randomized clinical trial. Facilitators included: (1) Benefits afforded through RCT participation; (2) Shared vision and sustained buy-in across system and organizational levels; and (3) Ongoing leadership support for SafeCare and the RCT. Barriers that hindered SafeCare were: (1) Insufficient preparation to incorporate SafeCare into services; (2) Perceived lack of fit, leading to mixed support for SafeCare and the RCT; and (3) Requirements of RCT participation at the provider level. CONCLUSIONS: These data yield insight into an array of stakeholder perspectives on the experience of implementing a new intervention in the context of a largescale trial. This research also sheds light on how the dynamics of conducting an RCT may affect efforts to implement interventions in complex and high-pressure contexts. Findings highlight the importance of aligning knowledge and expectations among researchers, administrators of organizations, and supervisors and providers. Researchers should work to alleviate the burdens of study involvement and promote buy-in among frontline staff not only for the program but also for the research itself.

Prebiotic Catalytic Peptide Ligation Yields Proteinogenic Peptides by Intramolecular Amide Catalyzed Hydrolysis Facilitating Regioselective Lysine Ligation in Neutral Water.

The prebiotic origin of catalyst-controlled peptide synthesis is fundamental to understanding the emergence of life. Building on our recent discovery that thiols catalyze the ligation of amino acids, amides, and peptides with amidonitriles in neutral water, we demonstrate the outcome of ligation depends on pH and that high pKa primary thiols are the ideal catalysts. While the most rapid thiol catalyzed peptide ligation occurs at pH 8.5-9, the most selective peptide ligation, that tolerates all proteinogenic side chains, occurs at pH 7. We have also identified the highly selective mechanism by which the intermediate peptidyl amidines undergo hydrolysis to α-peptides while demonstrating that the hydrolysis of amidines with nonproteinogenic structures, such as ß- and γ-peptides, displays poor selectivity. Notably, this discovery enables the highly α-selective protecting-group-free ligation of lysine peptides at neutral pH while leaving the functional ε-amine side chain intact.

Thrombocytopenia: Evaluation and Management.

Thrombocytopenia is a platelet count of less than 150 × 103 per µL and can occur from decreased platelet production, increased destruction, splenic sequestration, or dilution or clumping. Patients with a platelet count greater than 50 × 103 per µL are generally asymptomatic. Patients with platelet counts between 20 and 50 × 103 per µL may have mild skin manifestations such as petechiae, purpura, or ecchymosis. Patients with platelet counts of less than 10 × 103 per µL have a high risk of serious bleeding. Although thrombocytopenia is classically associated with bleeding, there are conditions in which bleeding and thrombosis can occur, such as antiphospholipid syndrome, heparin-induced thrombocytopenia, and thrombotic microangiopathies. Patients with isolated thrombocytopenia in the absence of systemic illness most likely have immune thrombocytopenia or drug-induced thrombocytopenia. In stable patients being evaluated as outpatients, the first step is to exclude pseudothrombocytopenia by collecting blood in a tube containing heparin or sodium citrate and repeating the platelet count. If thrombocytopenia is confirmed, the next step is to distinguish acute from chronic thrombocytopenia by obtaining or reviewing previous platelet counts. Patients with acute thrombocytopenia may require hospitalization. Common causes that require emergency hospitalization are heparin-induced thrombocytopenia, thrombotic microangiopathies, and the hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Common nonemergency causes of thrombocytopenia include drug-induced thrombocytopenia, immune thrombocytopenia, and hepatic disease. Transfusion of platelets is recommended when patients have active hemorrhage or when platelet counts are less than 10 × 103 per µL, in addition to treatment (when possible) of underlying causative conditions. It is important to ensure adequate platelet counts to decrease bleeding risk before invasive procedures; this may also require a platelet transfusion. Patients with platelet counts of less than 50 × 103 per µL should adhere to activity restrictions to avoid trauma-associated bleeding.

Evaluating child maltreatment and family violence risk during the COVID-19 Pandemic: Using a telehealth home visiting program as a conduit to families.

The COVID-19 pandemic has affected many child maltreatment risk factors and may have affected maltreatment among vulnerable families. We surveyed 258 certified providers of an evidence-based home visiting program, SafeCare, about their perception of the impact of the pandemic on the families they serve. We examined if the providers perceived an overall change in child maltreatment and family violence risk among the families with young children they served and factors that may have contributed to changes. Regressions estimated the relationship between providers' assessment of families' ability to social distance, emotional struggles, and access to public resources/services with providers' perception of child maltreatment and family violence risk in the home. Findings indicate that 87% of providers believed maltreatment risk had increased during the pandemic. Providers serving families who were unable to social distance due to employment were more likely to report increased supervisory neglect and material neglect among the families they serve. Providers reporting that families were struggling with elevated frustration levels also reported more family conflict and material neglect among the families they serve. Results from this research can inform strategic decision-making for policies and programs that address the challenges low-income families with young children face in emergency situations.

La pandemia del COVID-19 ha afectado muchos factores de riesgo de maltrato del niño y pudiera haber afectado el maltrato en familias vulnerables. Les preguntamos en una encuesta a 258 proveedores certificados de un programa de visitas a casa con base en la evidencia, SafeCare®, acerca de sus percepciones del impacto de la pandemia en las familias a quienes les ofrecían el servicio. Examinamos si los proveedores percibían un cambio general en el maltrato del niño y el riesgo de violencia familiar en familias con niños pequeños a las que les servían y los factores que pudieran haber contribuido a los cambios. Las regresiones calcularon la relación entre la evaluación de los proveedores acerca de la habilidad de la familia para mantener la distancia social física, los problemas emocionales, así como el acceso a recursos y servicios públicos, con la percepción de los proveedores acerca del maltrato infantil y el riesgo de violencia familiar en la casa. Los resultados indican que el 87 por ciento de los proveedores creía que el riesgo de maltrato había aumentado durante la pandemia. Aquellos proveedores que les servían a familias que no podían mantener la distancia social física debido al empleo, estuvieron más propensas a reportar el aumento en la negligencia de supervisión y la negación de material en las familias a quienes les servían. Los proveedores que reportaron que las familias estaban luchando con elevados niveles de frustración también reportaron más conflicto familiar y negación de material en las familias a las que les servían. Los resultados de esta investigación pueden apoyar la toma de decisiones estratégica para políticas y programas que se enfoquen en los retos que enfrentan las familias de bajos recursos con niños pequeños en situaciones de emergencia.

La pandémie du COVID-19 a affecté bien des facteurs de risque de la maltraitance de l'enfant et peut avoir affecté la maltraitance chez les familles vulnérables. Nous avons questionné 258 prestataires certifiés d'un programme de visite à domicile fondé sur des données probantes, SafeCare®, sur leur perception de l'impact de la pandémie sur les familles qu'ils servent. Nous avons examiné si les prestataires ont perçu un changement général de la maltraitance de l'enfant et dans le risque de violence familiale au sein des familles avec les jeunes enfants qu'ils servaient et les facteurs qui ont pu contribuer à ces changements. Des régressions ont estimé la relation entre l'évaluation qu'ont fait les prestataires de la capacité des familles à assurer la distanciation sociale, des difficutés émotionnelles et de l'accès aux resources/services publiques avec la perception des prestataires de la maltraitance de l'enfant et du risque de violence familiale à la maison. Les résultats indiquent que 87 pourcent des prestataires pensaient que le risque de maltraitance avait augmenté durant la pandémie. Les prestataires servant les familles qui ne pouvaient pas assurer la distanciation sociale à cause de leur emploi étaient plus à même de faire état d'une négligence acrue de la supervision et de négligence matérielle chez les familles qu'ils servent. Les prestataires indiquant que les familles faisaient face à des difficultés avec des niveaux de frustration élevés ont aussi fait état de plus de conflit familial et de néglicence matérielle chez les familles qu'ils servent. Les résultats de ces recherches peuvent aider les prises de décision stratégiques pour les politiques et les programmes qui répondent aux défis des familles défavorisées avec de jeunes enfants dans des situations d'urgence.

Formulation of Metal-Organic Framework-Based Drug Carriers by Controlled Coordination of Methoxy PEG Phosphate: Boosting Colloidal Stability and Redispersibility.

Metal-organic framework nanoparticles (nanoMOFs) have been widely studied in biomedical applications. Although substantial efforts have been devoted to the development of biocompatible approaches, the requirement of tedious synthetic steps, toxic reagents, and limitations on the shelf life of nanoparticles in solution are still significant barriers to their translation to clinical use. In this work, we propose a new postsynthetic modification of nanoMOFs with phosphate-functionalized methoxy polyethylene glycol (mPEG-PO3) groups which, when combined with lyophilization, leads to the formation of redispersible solid materials. This approach can serve as a facile and general formulation method for the storage of bare or drug-loaded nanoMOFs. The obtained PEGylated nanoMOFs show stable hydrodynamic diameters, improved colloidal stability, and delayed drug-release kinetics compared to their parent nanoMOFs. Ex situ characterization and computational studies reveal that PEGylation of PCN-222 proceeds in a two-step fashion. Most importantly, the lyophilized, PEGylated nanoMOFs can be completely redispersed in water, avoiding common aggregation issues that have limited the use of MOFs in the biomedical field to the wet form-a critical limitation for their translation to clinical use as these materials can now be stored as dried samples. The in vitro performance of the addition of mPEG-PO3 was confirmed by the improved intracellular stability and delayed drug-release capability, including lower cytotoxicity compared with that of the bare nanoMOFs. Furthermore, z-stack confocal microscopy images reveal the colocalization of bare and PEGylated nanoMOFs. This research highlights a facile PEGylation method with mPEG-PO3, providing new insights into the design of promising nanocarriers for drug delivery.

Adaptation and implementation of a parenting curriculum in a refugee/immigrant community using a task-shifting approach: a study protocol.

BACKGROUND: Delivering evidence-based interventions to refugee and immigrant families is difficult for several reasons, including language and cultural issues, and access and trust issues that can lead to an unwillingness to engage with the typical intervention delivery systems. Adapting both the intervention and the delivery system for evidence-based interventions can make those interventions more appropriate and palatable for the targeted population, increasing uptake and effectiveness. This study focuses on the adaptation of the SafeCare© parenting model, and its delivery through either standard implementation methods via community-based organizations (CBO) and a task-shifted implementation in which members of the Afghans, Burmese, Congolese community will be trained to deliver SafeCare. METHOD: An adaptation team consisting of community members, members of CBO, and SafeCare experts will engage a structured process to adapt the SafeCare curriculum for each targeted community. Adaptations will focus on both the model and the delivery of it. Data collection of the adaptation process will focus on documenting adaptations and team member's engagement and satisfaction with the process. SafeCare will be implemented in each community in two ways: standard implementation and task-shifted implementation. Standard implementation will be delivered by CBOs (n = 120), and task-shifted implementation will be delivered by community members (n = 120). All interventionists will be trained in a standard format, and will receive post-training support. Both implementation metrics and family outcomes will be assessed. Implementation metrics will include ongoing adaptations, delivery of services, fidelity, skill uptake by families, engagement/completion, and satisfaction with services. Family outcomes will include assessments at three time points (pre, post, and 6 months) of positive parenting, parent-child relationship, parenting stress, and child behavioral health. DISCUSSION: The need for adapting of evidence-based programs and delivery methods for specific populations continues to be an important research question in implementation science. The goal of this study is to better understand an adaptation process and delivery method for three unique populations. We hope the study will inform other efforts to deliver health intervention to refugee communities and ultimately improve refugee health.

Evaluation of the Child Safety Matters Curriculum for Improving Knowledge about Victimization among Elementary School Children: A Randomized Trial.

This project employed a randomized-control design to evaluate the effectiveness of the MBF Child Safety Matters® (CSM) curriculum. Six Georgia schools across 3 counties agreed to participate, and 136 K - 5th grade classrooms were randomized to either receive the CSM curriculum or be a wait-list control and to receive the curriculum after the evaluation. In total, 2,414 students participated at pretest (1195 CSM and 1219 control) and 2,260 participated at posttest (1159 CSM and 1101 control). Pre/posttests were collected from all students prior to the delivery of the CSM curriculum and again approximately a month later to measure knowledge gains related to child safety. Intervention students displayed a greater increase in knowledge for the information taught in the CSM program as compared to students who did not receive the intervention (d = .29).

Host-Enhanced Phenyl-Perfluorophenyl Polar-π Interactions.

Phenyl-perfluorophenyl polar-π interactions have been revisited for the design and fabrication of functional supramolecular systems. The relatively weak associative interactions (ΔG ≈ -1.0 kcal/mol) have limited their use in aqueous self-assembly to date. Herein, we propose a strategy to strengthen phenyl-perfluorophenyl polar-π interactions by encapsulation within a synthetic host, thus increasing the binding affinity to ΔG= -15.5 kcal/mol upon formation of heteroternary complexes through social self-sorting. These heteroternary complexes were used as dynamic, yet strong, cross-linkers in the fabrication of supramolecular gels, which exhibited excellent viscoelasticity, stretchability, self-recovery, self-healing, and energy dissipation. This work unveils a general approach to exploit host-enhanced polar-π interactions in the design of robust aqueous supramolecular systems.

Effect of the SafeCare© intervention on parenting outcomes among parents in child welfare systems: A cluster randomized trial.

Child maltreatment has long-lasting negative impacts, and interventions are needed to improve caregiver's parenting skills to prevent maltreatment. This paper reports on a randomized trial comparing the SafeCare© model to services as usual (SAU) for child-welfare referred caregivers. SafeCare is an 18-session behavioral parenting program that teaches skills in positive parent-child interactions, home safety, and child health. SAU is generally unstructured and includes support, crisis management, referrals for need, and parenting education. Teams of providers at nine sites were randomized to implement SafeCare (19 teams; 119 providers) or continue SAU (17 teams; 118 providers). Two-hundred eighty eight caregivers (193 SafeCare; 95 SAU) with children aged 0-5 who were receiving services agreed to complete a baseline and 6-month assessment. Assessments measured positive parenting behaviors, parenting stress, protective factors, and neglectful behaviors using validated scales. Participants were primarily white (74.6%), female (87.0%), and low-income (68.6%), and had a mean age of 29. Latent change score models (LCSM) using a sandwich estimator consistent with the trial design were used to examine changes in 13 outcomes. Results indicated that SafeCare had small to medium effects for improving several parenting outcomes including supporting positive child behaviors (d = 0.46), proactive parenting (d = 0.25), and two aspects of parenting stress (d = 0.28 and .30). No differential change between groups was found for other indicators, including all indicators of neglect. Parenting programs such as SafeCare offer a promising mode of intervention for child welfare systems. Scale-up of parenting programs can improve parenting, improve child outcomes, and potentially reduce maltreatment. CLINICALTRIAL.GOV REGISTRATION NUMBER: NCT02549287.

Drug Court as an Intervention Point to Affect the Well-Being of Families of Parents with Substance Use Disorders.

Background: A high proportion of justice-involved individuals have a substance use disorder and many of those individuals serve in a caregiving role to a child under 18. Given the negative impact of substance use and justice-involvement on the wellbeing of children, the criminal justice system may offer a unique intervention point with high public health impact. This study describes characteristics of adult drug court participants (DCP) that affect the wellbeing of their children and families and compares the DCP parenting and mental health characteristics to their child's other caregiver in order to understand how parenting differs within drug court families. Method: Data were collected from a sample of 100 DCP; 58 had a matched other caregiver. Drug court data regarding substance use and criminogenic risk/need were collected. Analyses differentiated the parenting behaviors and mental health needs of DCP from other caregivers. Results: The DCP were at moderate to high risk for recidivism and presented with multiple and significant criminogenic and psychosocial functioning needs. Risk for potential maltreatment and poor parenting behaviors were elevated, and significantly higher compared to other caregivers. DCP demonstrated clinically elevated mental health needs, and were significantly different across all indicators of mental health compared to other caregivers. Conclusions: Adult drug courts address the occurrence of substance use disorders but there are additional needs to be intervened upon. Adult drug courts may be a viable intervention point to address issues of parenting and mental health to improve the wellbeing of criminal justice-involved individuals, their children, and families.

Does adoption of an evidence-based practice lead to job turnover? Results from a randomized trial.

It is important to understand the impact of implementation of evidence-based practices (EBPs) on the workforce. EBP implementation can increase job demands, stress, and burnout, and may thereby exacerbate turnover. This study examined the effects of implementation of an EBP on turnover among staff at nine child welfare agencies. A total of 102 providers were randomized to either adopt an EBP, SafeCare© , or continue providing services as usual. Participants completed a baseline survey assessing demographics, attitudes toward EBPs, and organizational functioning, and provider turnover was recorded for up to 18 months following implementation. The overall turnover rate was 35%, but did not differ by EBP assignment (odds ratio [OR] = 1.27; 95% confidence interval [0.66, 2.45]). Variables associated with turnover included age (OR = 0.92), years since degree completion (OR = 0.94), prior exposure to EBP (OR = 3.91), believing that adopting an EBP was burdensome (OR = 0.52), and motivation for change (OR = 0.89). EBP assignment moderated two aspects of negative attitudes toward EBP (divergence and monitoring) to predict turnover; those attitudes were only positively related to turnover for individuals assigned to the EBP (OR = 1.46, 1.16). Implications of the findings for implementation are discussed.

Acid-Triggered, Acid-Generating, and Self-Amplifying Degradable Polymers.

We describe the 3-iodopropyl acetal moiety as a simple cleavable unit that undergoes acid catalyzed hydrolysis to liberate HI (p Ka ∼ -10) and acrolein stoichiometrically. Integrating this unit into linear and network polymers gives a class of macromolecules that undergo a new mechanism of degradation with an acid amplified, sigmoidal rate. This trigger-responsive self-amplified degradable polymer undergoes accelerated rate of degradation and agent release.

A Direct Arylation-Cyclisation Reaction for the Construction of Medium-Sized Rings.

A strategy for assembling biaryls linked through a medium-sized ring is herein presented. π-Complexation of fluoroarenes to chromium tricarbonyl activates the molecule towards both C-H activation and nucleophilic aromatic substitution without covalently altering the molecular connectivity of the arene. The construction of bridged biaryl molecules with 6-10-membered core rings is achieved through a one-pot C-H arylation/nucleophilic aromatic substitution sequence. The methodology is applicable to the synthesis of heterocyclic as well as fully carbocyclic rings.

Systematic Braiding of 2 Evidence-Based Parent Training Programs: Qualitative Results From the Pilot Phase.

An effective approach in early intervention for children and families, including child maltreatment prevention, is home-based services. Although several evidence-based programs exist, they are often grouped or delivered together, despite having different foci and approaches. This article describes the development and pilot phases of a trial evaluating the systematic braiding of 2 evidence-based home-based models, SafeCare and Parents as Teachers. We describe the methodology for braiding model implementation and curriculum, specifically focusing on how structured qualitative feedback from pilot families and providers was used to create the braided curriculum and implementation. Systematic braiding of 2 models at the implementation and curriculum levels is a mechanism that has the potential to meet the more comprehensive needs of families at risk for maltreatment.

Ag(I)-Catalyzed C-H Activation: The Role of the Ag(I) Salt in Pd/Ag-Mediated C-H Arylation of Electron-Deficient Arenes.

The use of stoichiometric Ag(I)-salts as additives in Pd-catalyzed C-H functionalization reactions is widespread. It is commonly proposed that this additive acts as an oxidant or as a halide scavenger promoting Pd-catalyst turnover. We demonstrate that, contrary to current proposals, phosphine ligated Ag(I)-carboxylates can efficiently carry out C-H activation on electron-deficient arenes. We show through a combination of stoichiometric and kinetic studies that a (PPh3)Ag-carboxylate is responsible for the C-H activation step in the Pd-catalyzed arylation of Cr(CO)3-complexed fluorobenzene. Furthermore, the reaction rate is controlled by the rate of Ag(I)-C-H activation, leading to an order zero on the Pd-catalyst. H/D scrambling studies indicate that this Ag(I) complex can carry out C-H activation on a variety of aromatic compounds traditionally used in Pd/Ag-mediated C-H functionalization methodologies.

Addendum to "Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial".

A previous article published several years ago (Prinz et al. Prevention Science, 10, 1-12, 2009) described the main results of a place-randomized-design study focused on the prevention of child-maltreatment-related outcomes at a population level through the implementation of a multilevel system of parenting and family support (the Triple P-Positive Parenting Program). The current report, prepared at the encouragement of the journal, provides additional details about procedures, measures, and design-related decisions, presents an additional analysis of the main outcome variables, and poses questions about the study and its implications. We also offer guidance about how the field can move forward to build on this line of research. From the outset, the three designated primary child maltreatment outcomes were county-wide rates for substantiated child maltreatment cases, out-of-home placements, and hospital-treated child maltreatment injuries, derived from independent data sources available through administrative archival records. Baseline equivalence between the two intervention conditions was reaffirmed. The additional analysis, which made use of a 5-year baseline (replacing a 1-year baseline) and ANCOVA, yielded large effect sizes for all three outcomes that converged with those from the original analyses. Overall, the study underscored the potential for community-wide parenting and family support to produce population-level preventive impact on child maltreatment. Issues addressed included (1) the need for replication of population-oriented maltreatment prevention strategies like the one tested in this randomized experiment, (2) the need to demonstrate that a parenting-based population approach to maltreatment prevention can also impact children's adjustment apart from child abuse, and (3) the role of implementation science for achieving greater population reach and maintenance over time.

Erratum to: An Analysis of Training, Generalization, and Maintenance Effects of Primary Care Triple P for Parents of Preschool-Aged Children with Disruptive Behavior.

CONFLICT OF INTEREST: The Triple P-Positive Parenting Program is owned by the University of Queensland (UQ). The University through its main technology transfer company UniQuest Pty Limited has licensed Triple P International Pty Ltd to disseminate the program worldwide. Royalties stemming from this dissemination activity are distributed to the Parenting and Family Support Centre, School of Psychology, UQ; Faculty of Health and Behavioural Sciences at UQ; and contributory authors. No author has any share or ownership in Triple P International Pty Ltd. Matthew Sanders is the founder and an author on various Triple P programs and a consultant to Triple P International. Karen Turner is an author of various Triple P programs. Ronald Prinz is a consultant to Triple P International. Cheri Shapiro is a consultant to Triple P America.