Commentary on Scaling-Up Evidence-Based Interventions in Public Systems.

This commentary reviews the findings and recommendations from the Society for Prevention Research (SPR) Mapping Advances in Prevention Science (MAPS) IV Task Force as detailed in the article by Fagan et al. (Prevention Science, 2019). In addition to highlighting similarities and differences with the prior MAPS II Task Force findings, discussion focuses on four extension recommendations: the importance of attending to equitable implementation as a pathway to evidence-based intervention (EBI) uptake by communities, the value of broadening conceptualization of data monitoring and evaluation capacity beyond EBI-specific data, the opportunity to more precisely guide EBI-referrals from public systems, and the importance of EBI developers and purveyors proactively and deliberately operationalizing fidelity measurement using actionable constructs.

Three Critical Elements for Real-Time Monitoring of Implementation and Adaptation of Prevention Programs.

We are at a place in history where the prevention science literature has established a cadre of evidence-based programs and practices (EBPPs) that have been proven, under controlled efficacy and effectiveness trials, to significantly improve the well-being of those served. Research in implementation science has also repeatedly demonstrated the importance of fidelity for realizing the benefits of these EBPPs when applied in real-world contexts. However, as a field, while we have ever-increasing evidence of 'what' systems and supports are needed to take EBPPs to scale, we continue to struggle with 'how' to successfully bring them to scale with quality in real-world service settings. The articles in this special issue of The Journal of Primary Prevention (JPP) further our understanding of the dimensions that need to be considered when scaling EBPPs and help inform what a scalable implementation support system would entail. The following commentary discusses implications for such a system and presents an example of using technology to support scaling up EBPPs while maintaining program fidelity and quality.

Career Development Institute with Enhanced Mentoring: A Revisit.

OBJECTIVE: The need for innovative methods to promote training, advancement, and retention of clinical and translational investigators in order to build a pipeline of trainees to focus on mental health-relevant research careers is pressing. The specific aim of the Career Development Institute for Psychiatry is to provide the necessary skill set and support to a nationally selected broad-based group of young psychiatrists and PhD researchers to launch and maintain successful research careers in academic psychiatry. The program targets such career skills as writing, negotiating, time management, juggling multiple demanding responsibilities, networking, project management, responsible conduct of research, and career goal setting. The current program builds on the previous program by adding a longitudinal, long-distance, virtual mentoring, and training program, seen as integral components to sustaining these career skills. METHODS: Career development activities occur in four phases over a 24-month period for each annual class of up to 18 participants: online baseline career and skills self-assessment and goal setting, preparations for 4-day in-person workshop, long-distance structured mentoring and online continued learning, peer-mentoring activities, and post-program career progress and process evaluation. Program instructors and mentors consist of faculty from the University of Pittsburgh and Stanford University as well as successful past program graduates from other universities as peer mentors. A comprehensive website facilitates long-distance activities to occur online. Continued training occurs via webinars every other month by experts discussing topics selected for the needs of each particular class. Personally assigned mentors meet individually bimonthly with participants via a secure web-based "mentor center" that allows mentor dyads to collaborate, share, review, and discuss career goals and research activities. RESULTS: Preliminary results after the first 24 months are favorable. Almost uniformly, participants felt the program was very helpful. They had regular contact with their long-distance mentor at least every 2 months over the 2-year period. At the end of the 2-year period, the majority of participants had full-time faculty appointments with K-award support and very few were doing primarily clinical work. CONCLUSIONS: The longitudinal program of education, training, mentoring, peer support, and communications for individuals making the transition to academic research should increase the number of scientists committed to research careers in mental health.

Celebrating the strengths of black youth: increasing self-esteem and implications for prevention.

The purpose of this study was to test the impact of a preventive intervention program, celebrating the strengths of black youth (CSBY), on African American children's self-esteem, racial identity, and parental racial socialization messages. CSBY consisted of 10 in-person group sessions in which small groups of middle school students met two trained group leaders. Parents were invited to attend three of the 10 group sessions. African American children between the ages of 7 and 10 were randomly assigned to either a treatment (TX; n = 33) or waitlist control (WLC; n = 40) group. Pre- and post-measures were completed to capture treatment effects. Analyses revealed that treatment group participants had higher levels of self-esteem post intervention than WLC group participants. In addition, treatment group parents were more likely to communicate egalitarian messages to their children post intervention than WLC parents. The advantages of a cultural heritage, strengths-based preventive intervention for African American youth and suggestions for future research are discussed.

Career progress in online and blended learning environments.

OBJECTIVE: The authors examined the career achievement of early- and mid-career researchers in social, behavioral, and mental health who participated in a career-development conference. METHOD: Trainees participated in a career-development conference either through attending a live conference supplemented with an online version of the conference (Combined: N=46) or through the online version of the conference alone (Web-Only: N=60). An objective measure tracked the trainees' publications, involvement in research projects, honors and grant awards, collaborations, and scientific presentations before and 9 months after participation in the career-development conference. RESULTS: Statistical analysis showed that trainees improved for each category measured, with no significant differences across the Combined and Web-Only groups. The strongest variable affecting improvement was Time, and the most significant time effect was seen in the production of presentations and publications. A significant Gender difference was present, with women showing greater total career progress than men. CONCLUSION: Career-development conferences can support career growth for trainees. Online training provides a cost-effective and time-efficient alternative to in-person methods, while still enhancing key markers of career progress.

The Development and Preliminary Impact of CAMP Air: A Web-based Asthma Intervention to Improve Asthma Among Adolescents.

OBJECTIVE: Describe the development and preliminary impact of CAMP Air, a web-based intervention for adolescents with uncontrolled asthma. MATERIALS AND METHODS: CAMP Air was developed using an iterative process with input from stakeholders and incorporating usability testing results (n = 14 adolescents). To test CAMP Air's initial impact, 61 adolescents from two New York City public high schools (n = 37) and from clinics, community-based organizations, and third-party recruitment services (i.e., community sample; n = 24) were enrolled in a randomized pilot trial. Participants were randomized to CAMP Air (n = 30) or information-and-referral control intervention (n = 31). A point-person worked with school participants to complete CAMP Air. RESULTS: CAMP Air participants were satisfied with the intervention and its value for supporting self-management, completing on average 6 of 7 modules. Relative to controls, CAMP Air participants demonstrated significantly improved asthma knowledge, asthma control, night wakening and school absences, and less risk for urgent care visits. Adolescents enrolled in schools completed more modules and had significantly fewer nights woken and school absences than community enrollees. CONCLUSION: CAMP Air improves asthma outcomes among adolescents with uncontrolled asthma. PRACTICE IMPLICATIONS: A web-based intervention CAMP Air is a promising intervention. When a point-person works with adolescents, CAMP Air's access and impact are improved.

Improving Children's Mental Health with a Digital Social Skills Development Game: A Randomized Controlled Efficacy Trial of Adventures aboard the S.S. GRIN.

OBJECTIVE: The purpose of this study was to investigate whether a computer-based game to improve social skills and mental health in children with social skills deficits would be efficacious. The program, Adventures aboard the S.S. GRIN, translates a proven in-person intervention into a nine-episode interactive online adventure game that provides opportunity for knowledge acquisition and skill practice. MATERIALS AND METHODS: Participants (children aged 7-11 years with social skills challenges) were randomly assigned to immediate treatment group (n = 33) or waitlist control group (n = 36). Children in the immediate treatment condition completed the game at home over the course of 9 weeks. Before playing the game and again within 1 week of game completion, children completed surveys about social literacy, social anxiety, bullying, social self-efficacy, and social satisfaction. RESULTS: Children who played Adventures improved significantly more from pretest to posttest than children who did not play the game in social literacy, social anxiety, bullying victimization, and social satisfaction. CONCLUSION: Online interactive games can be effective in improving mental health for children who struggle with social skills. For children who can access them, serious games have the potential to increase the reach of effective programs by overcoming the logistical and implementation barriers (such as cost, travel, and accessibility) that limit traditionally delivered mental health interventions.

Differences Between Japanese and U.S. Children's Performance on "Zoo U": A Game-Based Social Skills Assessment.

OBJECTIVE: The purpose of this study was to test whether and how performance on a digital game-based social skills assessment tool, "Zoo U" (3C Institute, Durham, NC), differed for children in the United States and Japan across six core social skills. MATERIALS AND METHODS: "Zoo U" was administered to 497 third and fourth grade children from the United States and Japan (46 percent Japanese) by teachers and researchers, respectively. U.S. children received the original version of "Zoo U," and Japanese children received a fully translated Japanese version of the program. Scoring of each of the six social skills is built into the "Zoo U" software, with specific scoring algorithms for each grade level that provide both a continuous scale score and cutoffs for three distinct performance categories: high, average, and low. RESULTS: A multivariate analysis of variance (MANOVA) was conducted to assess differences by cultural group on each of the six continuous social skill scores, controlling for gender and grade level. Results revealed significant differences on four of the six skills in expected directions. Chi-squared and odds ratios analyses were then conducted on the assignment of children into each of the performance categories by cultural group, revealing additional nuance to the cultural differences identified in the MANOVA consistent with existing literature. CONCLUSIONS: We were able to replicate known cultural differences between U.S. and Japanese children with a simple direct translation of a Web-based social skills assessment game, "Zoo U." Our results provide preliminary support for the potential of game-based assessment methods to provide efficient and valid social skill assessments to children around the world.

Implementing a Web-Based Intervention to Train Community Clinicians in an Evidence-Based Psychotherapy: A Pilot Study.

OBJECTIVE: The authors conducted a feasibility assessment of online training plus an online learning collaborative to support implementation of an evidence-based psychosocial treatment in a community mental health system. METHODS: Two mental health centers were randomly allocated to in-person training with local supervision, and three were assigned to online training plus an online learning collaborative supported by expert clinicians. Participants (N=36) were clinicians interested in interpersonal and social rhythm therapy (IPSRT), an evidence-based psychotherapy for bipolar disorder. After training, 136 patients reported monthly on the extent to which clinicians used 19 IPSRT techniques. RESULTS: Clinicians from both training groups increased use of IPSRT techniques. Patients of clinicians receiving Internet-supported e-learning and of those receiving in-person training reported comparable clinician use of IPSRT techniques. CONCLUSIONS: Internet-supported e-learning by community clinicians was found to be feasible and led to uptake of an evidence-based psychotherapy comparable to that by clinicians who received face-to-face training.

Effect of children's perceived rejection on physical aggression.

This study investigated whether the perception of self as socially rejected might contribute to increased physical aggression among elementary-school children. It was hypothesized that physically aggressive children would become more physically aggressive over time if they perceived that they were rejected and tended to blame peers for social failure experiences. Third-grade boys and girls (n = 941) were assessed in the Fall and Spring of the school year. Peer-report data on physical aggression and social preference were collected, along with self-report data on perceived rejection and attributions for social failure experiences. Results for boys were consistent with hypotheses, whereas the results for girls revealed a different pattern of relations. These results constitute prospective evidence that children's self-perceptions of social rejection can uniquely influence externalizing behavior. Results are discussed in terms of mechanisms that might mediate the relation between perceived rejection and physical aggression.

A web-based platform to support an evidence-based mental health intervention: lessons from the CBITS web site.

OBJECTIVE: To explore the role of Web-based platforms in behavioral health, the study examined usage of a Web site for supporting training and implementation of an evidence-based intervention. METHODS: Using data from an online registration survey and Google Analytics, the investigators examined user characteristics and Web site utilization. RESULTS: Site engagement was substantial across user groups. Visit duration differed by registrants' characteristics. Less experienced clinicians spent more time on the Web site. The training section accounted for most page views across user groups. Individuals previously trained in the Cognitive-Behavioral Intervention for Trauma in Schools intervention viewed more implementation assistance and online community pages than did other user groups. CONCLUSIONS: Web-based platforms have the potential to support training and implementation of evidence-based interventions for clinicians of varying levels of experience and may facilitate more rapid dissemination. Web-based platforms may be promising for trauma-related interventions, because training and implementation support should be readily available after a traumatic event.

The Impact of Children's Social Adjustment on Academic Outcomes.

This study tested whether social adjustment added to the prediction of academic outcomes above and beyond prior academic functioning. School records and peer-, teacher-, and self-report measures were collected for 1,255 third grade children in the fall and spring of the school year. Social acceptance by and aggression with peers were included as measures of social adjustment. Academic outcomes included math and reading GPA, classroom behavior, academic self-esteem, and absenteeism. As expected, support for the causal model was found where both forms of social adjustment contributed independently to the prediction of each area of academic adjustment. Gender differences in the patterns of results were present, particularly for the impact of aggression on academic adjustment. Discussion focuses on the implications for social-emotional literacy programs to prevent negative academic outcomes.

The efficacy of a Social Skills Group Intervention for improving social behaviors in children with High Functioning Autism Spectrum disorders.

This study tested the efficacy of a new social skills intervention, S ocial S kills GR oup IN tervention-High Functioning Autism (S.S.GRIN-HFA), designed to improve social behaviors in children with high functioning autism spectrum disorders. Fifty-five children were randomly assigned to S.S.GRIN-HFA treatment (n = 27) or control (i.e., traditional S.S.GRIN intervention; n = 28). Examination of the direction and magnitude of change in functioning revealed that children who participated in S.S.GRIN-HFA exhibited significantly greater mastery of social skill concepts compared to children in the control group. Parents of S.S.GRIN-HFA group participants reported an improved sense of social self-efficacy, whereas parents of control participants reported a decline. The advantages of a specialized intervention such as S.S.GRIN-HFA, designed specifically for children with high functioning autism spectrum disorders, are discussed.

Predicting change in children's aggression and victimization using classroom-level descriptive norms of aggression and pro-social behavior.

This study examined aggressive and pro-social classroom descriptive norms as predictors of change in aggression and victimization during middle childhood. Participants included 948 children in third through fifth grade. Measures of teacher-reported aggressive and peer-reported pro-social descriptive norms were completed at the onset of the study. Children completed self-report measures of aggression and victimization on three occasions during one academic year. Multilevel growth models were analyzed to determine the amount of student-reported change in aggression and victimization attributable to the classroom norm variables. Results indicated that students in classrooms with higher initial mean levels of aggression reported larger increases in aggression and victimization over the school year. In contrast, boys with higher initial levels of aggression reported smaller increases in aggression than boys with lower initial levels of aggression, and both boys and girls with higher initial aggression reported declining victimization over the school year. Pro-social classroom norms were unrelated to change in aggression and victimization. The implications of the findings for future studies on the influence of classroom social norms as well as interventions for aggression and victimization are discussed.

Teacher preference, peer rejection, and student aggression: a prospective study of transactional influence and independent contributions to emotional adjustment and grades.

This study assessed the importance of teacher preference of individual students, relative to peer rejection and student aggression, as an independent predictor of children's emotional adjustment and grades. First, a longitudinal, cross-lagged path analysis was conducted to determine the patterns of influence among teacher preference, peer rejection, and student aggression. Then, parallel growth analyses were examined to test whether lower initial and declining teacher preference, beyond the influence of initial level and change in peer rejection and student aggression, predicted change in loneliness, depression, social anxiety, and grades. Social adjustment, emotional adjustment, and academic adjustment were assessed in the fall and spring of two consecutive school years with 1193 third-grade students via peer-, teacher-, and self-report instruments as well as school records. In the cross-lagged path analysis, reciprocal influence over time between teacher preference and peer rejection was found, and student aggression predicted lower teacher preference and higher peer rejection. In the growth analyses, initial and declining teacher preference were independent predictors of increasing loneliness and declining grades. Discussion focuses on the relevance of the results within a transactional model of school adaptation.

Building friendships and combating bullying: effectiveness of S.S.GRIN at one-year follow-up.

This study tested the long-term effectiveness of a social-skills program for peer-rejected, victimized, and socially anxious children. Third-grade children with peer problems were randomly assigned to treatment (TX; n=187) or no-treatment control (CO; n=194) groups. One year after the intervention, the pattern of findings was similar to that at postintervention; however, several new group differences emerged. Additional positive treatment effects were found, including higher social acceptance and self-esteem and lower depression and anxiety. Lower aggressive behavior was found, particularly for initially more aggressive children. Several gender differences emerged where treatment effects were present for girls but not boys. The demonstrated value of teaching social skills to children experiencing peer problems is discussed and suggestions for future research are offered.

Building relationships and combating bullying: effectiveness of a school-based social skills group intervention.

This study tested the efficacy of a generic social skills intervention, Social Skills GRoup INtervention (S.S.GRIN), for children experiencing peer dislike, bullying, or social anxiety. Third-grade children were randomly assigned to treatment (n = 187) or no-treatment control (CO; n = 194) groups. Examination of the direction and magnitude of change in functioning revealed that S.S.GRIN increased peer liking, enhanced self-esteem and self-efficacy, and decreased social anxiety compared to controls. S.S.GRIN was equally efficacious for all subtypes of peer problems targeted. Particular benefits were found for aggressive children who showed greater declines in aggression and bullying behavior and fewer antisocial affiliations than aggressive control participants. Discussion focuses on the benefits of heterogeneous versus homogeneous groups of participants and the potential value of utilizing generic social skills training protocols.

Strengthening sociometric prediction: scientific advances in the assessment of children's peer relations.

This study assessed the strength of sociometric classification in the prediction of concurrent sociobehavioral adjustment. Differential adjustment for subgroups of unclassified children were also examined. Participants were 881 fifth graders (ages 9 to 12). Classification strength (CS) and unclassified subgroups were determined through newly developed algorithms. CS added significantly to the prediction of all areas of adjustment. For example, highly rejected children were at extreme risk for victimization whereas highly controversial children were most likely to be bullies and relationally aggressive. Unclassified subgroups were found to exhibit adjustment problems mirroring those of their extreme status group counterparts. Findings support that increasing the sensitivity of sociometric measurement results in both greater predictive strength and enhanced understanding of underlying social processes.