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Fam Syst Health ; 39(1): 7-18, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34014726


OBJECTIVE: For implementation of an evidence-based program to be effective, efficient, and equitable across diverse populations, we propose that researchers adopt a systems approach that is often absent in efficacy studies. To this end, we describe how a computer-based monitoring system can support the delivery of the New Beginnings Program (NBP), a parent-focused evidence-based prevention program for divorcing parents. METHOD: We present NBP from a novel systems approach that incorporates social system informatics and engineering, both necessary when utilizing feedback loops, ubiquitous in implementation research and practice. Examples of two methodological challenges are presented: how to monitor implementation, and how to provide feedback by evaluating system-level changes due to implementation. RESULTS: We introduce and relate systems concepts to these two methodologic issues that are at the center of implementation methods. We explore how these system-level feedback loops address effectiveness, efficiency, and equity principles. These key principles are provided for designing an automated, low-burden, low-intrusive measurement system to aid fidelity monitoring and feedback that can be used in practice. DISCUSSION: As the COVID-19 pandemic now demands fewer face-to-face delivery systems, their replacement with more virtual systems for parent training interventions requires constructing new implementation measurement systems based on social system informatics approaches. These approaches include the automatic monitoring of quality and fidelity in parent training interventions. Finally, we present parallels of producing generalizable and local knowledge bridging systems science and engineering method. This comparison improves our understanding of system-level changes, facilitates a program's implementation, and produces knowledge for the field. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Informática Aplicada à Saúde dos Consumidores , Divórcio , Implementação de Plano de Saúde/métodos , Poder Familiar , Pais/educação , Adulto , COVID-19 , Criança , Saúde da Criança , Educação Infantil , Feminino , Humanos , Masculino , Relações Pais-Filho , Avaliação de Programas e Projetos de Saúde , SARS-CoV-2
J Prim Prev ; 40(1): 111-127, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30656517


The field of prevention has established the potential to promote child adjustment across a wide array of outcomes. However, when evidence-based prevention programs have been delivered at scale in community settings, declines in implementation and outcomes have resulted. Maintaining high quality implementation is a critical challenge for the field. We describe steps towards the development of a practical system to monitor and support the high-quality implementation of evidence-based prevention programs in community settings. Research on the implementation of an evidence-based parenting program for divorcing families called the "New Beginnings Program" serves as an illustration of the promise of such a system. As a first step, we describe a multidimensional theoretical model of implementation that links aspects of program delivery with improvements in participant outcomes. We then describe research on the measurement of each of these implementation dimensions and test their relations to intended program outcomes. As a third step, we develop approaches to the assessment of these implementation constructs that are feasible to use in community settings and to establish their reliability and validity. We focus on the application of machine learning algorithms and web-based data collection systems to assess implementation and provide support for high quality delivery and positive outcomes. Examples are presented to demonstrate that valid and reliable measures can be collected using these methods. Finally, we envision how these measures can be used to develop an unobtrusive system to monitor implementation and provide feedback and support in real time to maintain high quality implementation and program outcomes.

Divórcio , Ciência da Implementação , Relações Pais-Filho , Melhoria de Qualidade , Adolescente , Adulto , Criança , Currículo , Coleta de Dados/métodos , Prática Clínica Baseada em Evidências , Feminino , Humanos , Aprendizado de Máquina , Masculino , Modelos Teóricos , Avaliação de Programas e Projetos de Saúde
Prev Sci ; 19(6): 782-794, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29243200


This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents' competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.

Comportamento Cooperativo , Promoção da Saúde/normas , Modelos Teóricos , Poder Familiar , Pais/educação , Avaliação de Programas e Projetos de Saúde/métodos , Adolescente , Criança , Feminino , Humanos , Entrevistas como Assunto , Masculino , Transtornos do Neurodesenvolvimento/prevenção & controle , Observação , Pesquisa Qualitativa
Prev Sci ; 19(5): 663-673, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-27933424


An examination of the content and processes of evidence-based programs is critical for empirically evaluating theories about how programs work, the "action theory" of the program (West et al. in American Journal of Community Psychology, 21, 571-605, 1993). The New Beginnings Program (NBP; Wolchik et al., 2007), a parenting-after-divorce preventive intervention, theorizes that program-induced improvements in parenting across three domains: positive relationship quality, effective discipline, and protecting children from interparental conflict, will reduce the negative outcomes that are common among children from divorced families. The process theory is that home practice of program skills related to these parenting domains is the primary mechanism leading to positive change in parenting. This theory was tested using multi-rater data from 477 parents in the intervention condition of an effectiveness trial of the NBP (Sandler et al. 2016a, 2016b). Four research questions were addressed: Does home practice of skills predict change in the associated parenting outcomes targeted by the program? Is the effect above and beyond the influence of attendance at program sessions? What indicators of home practice (i.e., attempts, fidelity, efficacy, and competence) are most predictive of improvements in parenting? Do these indicators predict parenting improvements in underserved subpopulations (i.e., fathers and Latinos)? Structural Equation Modeling analyses indicated that parent-reported efficacy and provider-rated parent competence of home practice predicted improvements in the targeted parenting domains according to both parent and child reports. Moreover, indicators of home practice predicted improvements in parenting for fathers and Latinos, although patterns of effects varied by parenting outcome.

Poder Familiar , Pais/educação , Avaliação de Programas e Projetos de Saúde , Habilidades Sociais , Adolescente , Criança , Pré-Escolar , Divórcio , Feminino , Previsões , Humanos , Masculino , Modelos Teóricos , Desenvolvimento de Programas
J Acquir Immune Defic Syndr ; 63 Suppl 1: S72-84, 2013 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-23673892


African Americans and Hispanics in the United States have much higher rates of HIV than non-minorities. There is now strong evidence that a range of behavioral interventions are efficacious in reducing sexual risk behavior in these populations. Although a handful of these programs are just beginning to be disseminated widely, we still have not implemented effective programs to a level that would reduce the population incidence of HIV for minorities. We proposed that innovative approaches involving computational technologies be explored for their use in both developing new interventions and in supporting wide-scale implementation of effective behavioral interventions. Mobile technologies have a place in both of these activities. First, mobile technologies can be used in sensing contexts and interacting to the unique preferences and needs of individuals at times where intervention to reduce risk would be most impactful. Second, mobile technologies can be used to improve the delivery of interventions by facilitators and their agencies. Systems science methods including social network analysis, agent-based models, computational linguistics, intelligent data analysis, and systems and software engineering all have strategic roles that can bring about advances in HIV prevention in minority communities. Using an existing mobile technology for depression and 3 effective HIV prevention programs, we illustrated how 8 areas in the intervention/implementation process can use innovative computational approaches to advance intervention adoption, fidelity, and sustainability.

Metodologias Computacionais , Infecções por HIV/prevenção & controle , Implementação de Plano de Saúde , Promoção da Saúde/métodos , Grupos Minoritários , Afro-Americanos , Telefone Celular , Previsões , Infecções por HIV/etnologia , Hispano-Americanos , Humanos , Avaliação de Programas e Projetos de Saúde , Comportamento de Redução do Risco , Comportamento Sexual , Estados Unidos
Adm Policy Ment Health ; 39(4): 301-16, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22160786


What progress prevention research has made comes through strategic partnerships with communities and institutions that host this research, as well as professional and practice networks that facilitate the diffusion of knowledge about prevention. We discuss partnership issues related to the design, analysis, and implementation of prevention research and especially how rigorous designs, including random assignment, get resolved through a partnership between community stakeholders, institutions, and researchers. These partnerships shape not only study design, but they determine the data that can be collected and how results and new methods are disseminated. We also examine a second type of partnership to improve the implementation of effective prevention programs into practice. We draw on social networks to studying partnership formation and function. The experience of the Prevention Science and Methodology Group, which itself is a networked partnership between scientists and methodologists, is highlighted.

Pesquisa Participativa Baseada na Comunidade/organização & administração , Disseminação de Informação/métodos , Relações Interprofissionais , Transtornos Mentais/prevenção & controle , Serviços de Saúde Mental/organização & administração , Comportamento Cooperativo , Humanos , Organizações , Avaliação de Programas e Projetos de Saúde , Parcerias Público-Privadas , Projetos de Pesquisa , Pesquisadores , Estados Unidos