Navigating Real-World Randomized Clinical Trials: The 'Parents as Teachers' Experience.

The Parents as Teachers Randomized Controlled Trial (PAT RCT) Case Study investigates the multifaceted impact of implementing the PAT RCT in Arizona, U.S.A., shedding light on both the positive and negative effects. There has been a recent focus on improving the implementation of RCTs in community settings, as this issue has not been fully addressed. This research presents a case study examining the implementation of a community-based RCT in home visitation. This study also addresses the strategies that can be employed to mitigate some of the challenges in the implementation of an RCT, offering valuable insights for future RCTs in the domain of home visiting. The PAT program, aimed at providing parent education and family engagement for children from birth to kindergarten, encompasses a range of services, including personal visits, group connections, child screenings, and community resource linkages. The Parents as Teachers Randomized Controlled Trial (PAT RCT) directly promotes health by educating parents about health and wellness as well as providing early child screenings and heath referrals, all of which enhance health outcomes through timely interventions and improved parental practices. Lessons from the study also aim to improve the implementation of future health-related RCTs, ensuring effective delivery and impactful results.

Guy Talk: A Gender-Specific Sexual Education Program to Reduce Sexual Risk Behaviors With High School Males.

PURPOSE: The purpose of this study was to investigate the feasibility and effectiveness of a gender-specific intervention targeted to adolescent males to reduce sexual risks. METHOD: This study used a randomized clinical trial comparing a broad-based male empowerment curriculum with a no-treatment control group. The sample (N = 580) was recruited from schools and was implemented in community-based settings mostly in an after-school context. Assessments were conducted at baseline, postintervention, and 3 months follow-up time periods. RESULTS: There were significant differences between the two groups favoring the intervention group on several of the outcome indicators, including condom technical skills, attitudes toward women, social skills, peer assertiveness, and attitudes toward consent. Quality of implementation was rated high, and qualitative data suggest themes that reflect key lessons emphasized in the curriculum. CONCLUSIONS: Gender-specific programs for adolescent males can help reduce indicators that are related to sexual risk reduction. More long-term follow-up is needed to assess impact on sexual behaviors. Efforts directed at male populations should continue to be researched for potential in reducing sexual risks.

A Randomized Controlled Trial of Healthy Families: 6-Month and 1-Year Follow-Up.

Home visitation research remains on the forefront as policy makers look to evidence for programs they believe are worthy of investment, particularly in terms of child abuse prevention. A randomized controlled trial (N = 245) of the Healthy Families Arizona home visitation program was conducted. Outcomes were assessed across several key domains related to child abuse and neglect: safety and resources, parenting attitudes and behaviors, health and maternal outcomes, and mental health and coping. Findings revealed significant differences between the groups at both 6-month and 1-year follow-up assessments on use of resources, mobilizing resources, home environment, subsequent pregnancy, positive affect, and problem solving favoring the Healthy Families group. A significant difference was also found between the groups on total violence measured at the 1-year follow-up favoring the Healthy Families group. A qualitative linguistic inquiry and word count analysis was conducted of parent's descriptions of their children and their parenting experiences. Results again revealed significant differences between the groups in narrative descriptions that favored the Healthy Families group. Implications of these findings are discussed in light of the existing evidence for home visitation programs.

Go Grrrls: A Randomized Controlled Trial of a Gender-Specific Intervention to Reduce Sexual Risk Factors in Middle School Females.

PURPOSE: Adolescent females continue to face health consequences associated with risky sexual behaviors such as unintended pregnancies and sexually transmitted diseases. The purpose of this study was to investigate the efficacy of a gender-specific intervention targeted to early adolescent females. METHOD: This study used an intent to treat randomized clinical trial comparing a broad-based female empowerment curriculum with a dose-matched science and technology female leadership curriculum. The sample ( N = 801) was recruited from schools and was implemented in community-based settings mostly in an after school context. Assessments were conducted at baseline, postintervention, 6-, and 18-month follow-up time periods. RESULTS: Both groups in the study obtained good implementation and engagement. The average attendance rate was 81% of program sessions. There were significant differences between the two groups favoring the intervention group on measures of sexually transmitted disease knowledge and condom technical skills. On a measure of condom self-efficacy, there was a significant trend. At the postassessment, there was a significant difference on the intentions to reduce sexual risk behaviors. Both the intervention and control groups made gains on the self-assertive behavior scale. CONCLUSIONS: Gender-specific programs for early adolescent females can help reduce indicators that are related to sexual risk reduction. More long-term follow-up is needed to assess impact on sexual behaviors. Efforts directed at a younger population of females should continue to be researched for potential in reducing sexual risks.

Challenges to Breastfeeding Initiation and Duration for Teen Mothers.

PURPOSE: The purpose of this study was to evaluate breastfeeding practices of teen mothers in a pre- and postnatal education and support program. STUDY DESIGN AND METHODS: We studied breastfeeding practices of primarily Hispanic and non-Hispanic White teen mothers who participated in the Teen Outreach Pregnancy Services (TOPS) program, which promoted breastfeeding through prenatal programming and postpartum support. Analyses identified the most common reasons participants had not breastfed and, for those who initiated breastfeeding, the most common reasons they stopped. RESULTS: Participants (g = 314) reported on whether and for how long they breastfed. Nearly all participants reported initiating breastfeeding but few breastfed to 6 months. For the most part, reasons they reported stopping breastfeeding paralleled those previously reported for adult mothers across the first several months of motherhood. CLINICAL IMPLICATIONS: We found that teen mothers can initiate breastfeeding at high rates. Results highlight areas in which teen mothers' knowledge and skills can be supported to promote breastfeeding duration, including pain management and better recognizing infant cues. Our findings expand limited previous research investigating reasons that teen mothers who initiate breastfeeding stop before 6 months.

Assessing risk of recidivism among juvenile offenders: the development and validation of the recidivism risk instrument.

A recidivism risk instrument was developed and validated on a sample of juvenile offenders (N = 1,987) based on the need to classify juveniles by their likelihood of re-offense. Female recidivism (R(2) = 27%) was predicted by younger age at first expulsion from school, history of parent incarceration, gang involvement, felony class offense, and firearm use. Male recidivism (R(2) = 12%) was predicted by younger age at first adjudication, referrals, school suspensions, history of maternal incarceration, firearm use, running away, gang involvement, and destroying property/stealing. Cross-validation analyses indicated that high-risk offenders recidivated at more than five times the rate of low-risk offenders.

Development and initial validation of an outcome measure for home visitation: The healthy families parenting inventory.

The Healthy Families Parenting Inventory (HFPI) is a 63-item outcome measure that was designed to examine change in nine parenting-related domains. The HFPI was developed to respond to the need for an outcome measure for home visitation programs that is relevant to the intervention, sensitive to change, and appropriate with a diverse participant base, and would produce data that are immediately useful in practice. The authors detail the steps in the development and initial validation of the HFPI. The pattern of inter-item and item-to-subscale correlations as well as an exploratory factor analysis and sensitivity to change analysis support the nine-factor model of the HFPI.

The influence of race and ethnicity on substance use and negative activity involvement among monoracial and multiracial adolescents of the southwest.

This study examined predictors of substance use and negative activity involvement among a diverse sample of European American, African American, Hispanic, Native American, and multiracial early adolescents (n = 749) living in a large urban city in the Southwest United States. This study investigated a broad set of predictor variables that tap sociodemographic, peer, family, community, and school influences. Overall, findings from this study confirm that lifetime substance use remains high among youth of color. Of particular concern is this study's finding that multiracial adolescents are at elevated risk to use substances and engage in negative activities. The implications of this study for understanding how risk factors are influenced by race and other variables on different measures of problem behavior are discussed.

The evaluation of Healthy Families Arizona: a multisite home visitation program.

Healthy Families Arizona is a broadly implemented home visitation program aimed at preventing child abuse and neglect, improving child health and development, and promoting positive parent/child interaction. The program began as a pilot in two sites in 1991 and by 2004 had grown to 48 sites located in urban, rural, and tribal regions of the state. The unique administrative structure of the program and collaboration between evaluation and quality assurance have helped overcome many of the problems familiar to home visitation programs. This paper describes how a systematic focus to improve processes and outcomes has positioned the program for a randomized longitudinal study. Key components of the program are described and evaluation results are presented.

The role of community in facilitating service utilization.

Guided by an integrated theory of parent participation, this study examines the role community characteristics play in influencing a parent's decision to use voluntary child abuse prevention programs. Multiple regression techniques were used to determine if different community characteristics, such as neighborhood distress and the community's ratio of caregivers to those in need of care, predict service utilization levels in a widely available home visiting program. Our findings suggest that certain community characteristics are significant predictors of the extent to which families utilize voluntary family supports over and above the proportion of variance explained by personal characteristics and program experiences. Contrary to our initial assumptions, however, new parents living in the most disorganized communities received more home visits than program participants living in more organized communities. The article concludes with recommendations on how community capacity building might be used to improve participant retention.

The implications of ecologically based assessment for primary prevention with indigenous youth populations.

This paper describes a five-stage approach toward conducting an ecologically based assessment with Indigenous youth populations, and the implications of this approach for the development and implementation of culturally grounded prevention interventions. A description of a pilot study funded by the National Institutes of Health/National Institute on Drug Abuse (NIH/NIDA) focused on drug use and American Indian youth is presented as one model for operationalizing ecologically based assessment with Indigenous youth populations, and issues related to translating the pilot study into a prevention intervention are discussed. This paper suggests that ecologically based assessment can serve as a foundation for culturally grounded prevention interventions, promoting the social and ecological validity of those interventions.

Who is Offering and How Often?: Gender Differences in Drug Offers Among American Indian Adolescents of the Southwest.

This exploratory study examines gender differences in the patterns of drug offers among a sample of 71 American Indian middle school students. Participants respond to an inventory of drug-related problem situations specific to the cultural contexts of Southwestern American Indian youth. They are asked to consider the frequency of drug offers from specific groups in their social networks and the difficulty associated with refusing drugs from various offerers. The results indicate that female and male American Indian youth differ in the degree of exposure to drug offers and the degree of perceived difficulty in handling such offers. Even after controlling for differences in age, grade level, socioeconomic status, family structure, and residence on a reservation, girls report significantly more drug offers than boys from friends, cousins, and other peers. Compared to boys, girls also report a significantly higher sense of difficulty in dealing with drug offers from all sources.

Understanding maternal intentions to engage in home visiting programs.

Little is known as to why some parents choose to engage in voluntary home visitation services while others refuse or avoid services. To address this knowledge gap, this study tests several hypotheses about the factors that influence maternal intentions to engage in home visitation services and the link between these intentions and the receipt of a home visit. The sample consists of an ethnically diverse group of mothers identified as at-risk for parenting difficulties (N = 343). These mothers were offered home visitation services from nine home visiting programs located across six states. Regardless of service acceptance or refusal, all mothers were interviewed within 2 weeks of the service offer and 3 months later.The findings suggest that mothers who intend to use services look substantially different from those who do not state an intention to participate in home visitation. The results indicate that lower infant birth weight and greater comfort with a provider in one's home are significant predictors of maternal intentions to utilize home visiting services. The study results also support the connection between intent and behavior as the expressed intention to engage in home visitation services was a key predictor of the receipt of a visit.

Improving the quality of home visitation: an exploratory study of difficult situations.

OBJECTIVE: The primary purpose of this study was to use an ecological assessment model to obtain a better understanding of difficult situations that home visitors confront when implementing home visitation services. METHOD: A mixed method study was used which included conducting focus groups to identify specific situations faced by home visitors who implement the Healthy Families America model of child abuse and neglect prevention. The results of the focus groups were used to design a survey. The survey had 91 Healthy Families home visitors rate situations according to frequency and difficulty. RESULTS: The results revealed that situations that were ranked most difficult included working with families where there are limited resources, where family mental illness is present (e.g., threatening suicide), where there is substance use in the home, and where families are unmotivated. A factor analysis of the situations produced five factors that reflect the difficulty of doing home visitation: having a lack of clinical skill, addressing family difficulties, addressing parenting difficulties, resolving personal difficulties, and having a lack of experience. CONCLUSION: The situations identified in this study can assist in developing the competencies needed by home visitors. The factor analysis results can be conceptualized into an inventory for staff supervision, with workers completing the inventory to identify individual areas of training needs.

Acculturation as a predictor of the onset of sexual intercourse among Hispanic and white teens.

OBJECTIVE: To investigate ethnic differences in onset of sexual intercourse among Hispanic/Mexican American and white adolescents based on acculturation. DESIGN/METHODS: Preprogram survey data from 7270 Hispanic or white teens in 7th to 12th grade involved in the Arizona Abstinence-Only Education Program were used to predict the probability of onset of sexual intercourse based on age, sex, family structure, program location, religiosity, free school lunch, grades, rural residence, acculturation, and ethnicity. Specific attention was given to the influence of acculturation among Hispanic teens. The primary language spoken by the respondents (English, Spanish, or both) was used as a proxy measure for acculturation. RESULTS: Hispanic youth were at a greater risk for experiencing onset of intercourse than white youth, while controlling for all other predictors (odds ratio [OR], 1.40 [95% confidence interval (CI), 1.21-1.63]). This risk was amplified for highly acculturated Hispanic teens (OR, 1.69 [95% CI, 1.43-1.99]). However, less acculturated Hispanic youth were actually less likely to have experienced first intercourse than white youth (OR, 0.59 [95% CI, 0.42-0.82]), English-speaking Hispanic youth (OR, 0.35 [95% CI, 0.25-0.49]), or bilingual Hispanic youth (OR, 0.45 [95% CI, 0.31-0.64]). CONCLUSIONS: Low acculturation emerges as a significant protective factor while controlling for other social and cultural factors, in spite of the increased risk of initiating sexual intercourse for Hispanic teens overall. Hispanic Spanish speakers were least likely to have initiated intercourse, while Hispanic English speakers were the most likely.

The public's perception of social work: is it what we think it is?

This article reports on the public's current perception of the social work profession as examined in a nationally representative, random digit telephone survey of 386 people. The survey asked respondents about their knowledge, beliefs, and attitudes regarding the profession and its practitioners and required respondents to make comparisons between social workers and other helping professionals such as psychiatrists, psychologists, counselors, nurses, and clergy. Results of the survey indicated that for the most part, a majority of the public understands the social work profession and in many ways recognizes its value.

An Ecological Assessment of Drug-Related Problem Situations for American Indian Adolescents of the Southwest.

This study examined difficult situations related to drug and alcohol use as identified by American Indian youth in the South-west. Sixty-two contextually based items were developed from focus group data, and were administered to 71 American Indian youth. The items measured the frequency in which youth experienced specific drug-related situations, as well as the perceived difficulty in resisting drug use offers in those situations: The results indicated that the most frequent and difficult drug and alcohol situations occurred primarily with friends or cousins at their homes or after school. Implications for culturally specific assessment, prevention, and treatment are discussed.

Evaluation of an empowerment program for early adolescent girls.

This article describes and evaluates the Go Grrrls Program, a preventive intervention specifically designed for early adolescent girls. The 12-session curriculum was designed to address developmental tasks considered critical for healthy psychosocial development, such as achieving competent gender role identification, establishing an acceptable body image, developing a positive self-image, forming satisfactory peer relationships, achieving independence, learning to utilize resources, and planning for the future. Middle school students received the intervention and were compared with a no-intervention peer group. Differences were assessed using measures of body image, gender role identification, common beliefs, depression, peer esteem, and help endorsements. Results revealed significant differences between groups on three of the outcome measures (peer esteem, help endorsements, and common beliefs). Implications for the development and implementation of preventive interventions are discussed.