Streamlined Prevention and Early Intervention for Pediatric Anxiety Disorders: A Randomized Controlled Trial.

There is a need to optimize the fit between psychosocial interventions with known efficacy and the demands of real-word service delivery settings. However, adaptation of evidence-based interventions (EBI) raises questions about whether effectiveness can be retained. This randomized controlled trial (RCT) evaluated a streamlined package of cognitive, behavior, and social skills training strategies known to prevent and reduce anxiety symptom and disorder escalation in youth. A total of 109 youth (Mage = 9.72; 68% girls; 54% Latinx) at risk based on high anxiety were randomized to the streamlined prevention and early intervention (SPEI) (n = 59) or control (n = 50) and were assessed at pretest, posttest, and 12-month follow-up. A main objective was to determine whether our redesign could be delivered by community providers, with acceptable levels of fidelity, quality, and impact. In terms of process evaluation results, there was high protocol fidelity, excellent clinical process skills, few protocol adaptations, and high satisfaction with the SPEI. In terms of outcomes, there were no significant main or moderated effects of the SPEI at the immediate posttest. However, at the follow-up, youth in the SPEI reported greater self-efficacy for managing anxiety-provoking situations, greater social skills, and fewer negative cognitive errors relative to controls. Collectively, findings suggest that the redesigned SPEI might be an attractive and efficient solution for service delivery settings.

"Home Practice Is the Program": Parents' Practice of Program Skills as Predictors of Outcomes in the New Beginnings Program Effectiveness Trial.

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.

Predictors of externalizing behavior problems in early elementary-aged children: the role of family and home environments.

As children enter elementary school they display behavioral orientations that reveal potential developmental trajectories. Developmental transitions offer unique opportunities for examining developmental pathways and the factors that influence emerging pathways. The primary goal of this investigation was to examine characteristics of family and home contexts in predicting externalizing behavior problems among children transitioning into elementary school. Dimensions of the family and home environments of maltreated and nonmaltreated children (N = 177) were examined and used to predict externalizing behavior problems. Maltreatment was assessed using case file information, characteristics of the family and home environment were rated by interviewers, and externalizing behavior was assessed by mother's ratings on the Child Behavior Checklist. Relative to nonmaltreated children, the family environments of physically abused children were characterized by higher levels of negative social interactions. Also, in comparison to nonmaltreated children, the home environments of children who experienced neglect were characterized as less organized and clean. Hierarchical regression analyses revealed that physical abuse was the strongest predictor of externalizing behavior. After controlling for the contribution of physical abuse, mother's negative behavior toward the focal child, aggression between siblings, and the lack of an organized and clean home were each predictive of externalizing behavior.

Streamlined pediatric anxiety program for school mental health services.

There needs to be serious transformation of evidence-based interventions (EBIs) into real-world solutions; otherwise, EBIs will never achieve the intended public health impact. In a randomized trial, we reported effects of a redesigned anxiety program. Herein, we described the redesign process that led to the program. Survey data revealed provider preferences for school mental health anxiety services. Focus groups and prototype feedback sessions revealed service barriers to uptake, implementation, and sustainability along with corresponding enabling strategies. Prototype feedback sessions also focused on refinement and fine-tuning of the redesign. In the end, traditional EBI strategies were transformed and packaged into six lessons, lasting 20-30 minutes each, and amenable to delivery in small-group format. The redesign achieved the intended purpose of retaining elements from cognitive and behavior therapy and social skills training for the target population of the intervention (e.g., 3rd to 5th graders with heterogeneous anxiety problems - identified and referred). The streamlined EBI is accessible from PBS LearningMedia™ - a service that hosts public, research-based, and school-ready materials.

The Family Check-Up 4 Health (FCU4Health): Applying Implementation Science Frameworks to the Process of Adapting an Evidence-Based Parenting Program for Prevention of Pediatric Obesity and Excess Weight Gain in Primary Care.

Implementation experts have recently argued for a process of "scaling out" evidence-based interventions, programs, and practices (EBPs) to improve reach to new populations and new service delivery systems. A process of planned adaptation is typically required to integrate EBPs into new service delivery systems and address the needs of targeted populations while simultaneously maintaining fidelity to core components. This process-oriented paper describes the application of an implementation science framework and coding system to the adaptation of the Family Check-Up (FCU), for a new clinical target and service delivery system-prevention of obesity and excess weight game in primary care. The original FCU has demonstrated both short- and long-term effects on obesity with underserved families across a wide age range. The advantage of adapting such a program is the existing empirical evidence that the intervention improves the primary mediator of effects on the new target outcome. We offer a guide for determining the levels of evidence to undertake the adaptation of an existing EBP for a new clinical target. In this paper, adaptation included shifting the frame of the intervention from one of risk reduction to health promotion; adding health-specific assessments in the areas of nutrition, physical activity, sleep, and media parenting behaviors; family interaction tasks related to goals for health and health behaviors; and coordinating with community resources for physical health. We discuss the multi-year process of adaptation that began by engaging the FCU developer, community stakeholders, and families, which was then followed by a pilot feasibility study, and continues in an ongoing randomized effectiveness-implementation hybrid trial. The adapted program is called the Family Check-Up 4 Health (FCU4Health). We apply a comprehensive coding system for the adaptation of EBPs to our process and also provide a side-by-side comparison of behavior change techniques for obesity prevention and management used in the original FCU and in the FCU4Health. These provide a rigorous means of classification as well as a common language that can be used when adapting other EBPs for context, content, population, or clinical target. Limitations of such an approach to adaptation and future directions of this work are discussed.

Translational research on parenting of adolescents: Linking theory to valid observation measures for family centered prevention and treatment.

Parental monitoring and family problem solving are key parenting practices targeted in evidence-based interventions targeting adolescents and families, yet the constructs have yet to be validated across ethnic groups. The study's objective was to promote translational research by evaluating convergent, discriminant, and predictive validity of the two constructs at age 16-17 years through the use of multiple observation indicators and methods and as a function of ethnic status. Videotaped parent-adolescent family interactions were coded for monitoring and problem solving in a sample of 714 European American (EA; 59.2 %) and African American (AA; 40.8 %) males (53.8 %) and females (46.2 %). Structural equation models established convergent and discriminant validity of parental monitoring and problem solving among parent, youth, and observation measures for AA and EA families. Low levels of parent monitoring was highly predictive of antisocial behavior in EA and in AA youths (p < 0.001) and moderately predicted future drug use (p < 0.001) for both groups at age 18-19. Poorer family problem solving was also moderately predictive of antisocial behavior (p < 0.001 for EA; p < 0.05 for AA) and drug use (p < 0.01 for EA; p < 0.05 for AA) at age 18-19. These findings suggest that interventions targeting parental monitoring and family problem solving can be reliably evaluated through various measurement methods and that such interventions are of value in efforts to prevent and treat problem behavior in adolescence. These family processes are readily observable in videotaped family interaction tasks in both EA and AA families.

The trajectory of fidelity in a multiyear trial of the family check-up predicts change in child problem behavior.

OBJECTIVE: Therapist fidelity to evidence-based family interventions has consistently been linked to child and family outcomes. However, few studies have evaluated the potential ebb and flow of fidelity of therapists over time. We examined therapist drift in fidelity over 4 years in the context of a Family Check-Up prevention services in early childhood (ages 2-5 years). METHOD: At age 2, families engaging in Women, Infants, and Children Nutritional Supplement Program services were randomized and offered annual Family Check-Ups. Seventy-nine families with a child in the clinical range of problem behaviors at age 2 years were included in this analysis. RESULTS: Latent growth modeling revealed a significant linear decline in fidelity over time (M = -0.35, SD = 0.35) and that steeper declines were related to less improvement in caregiver-reported problem behaviors assessed at ages 7.5/8.5 years (b = -.69, p = .003; ß = -.95, 95% CI [-2.11, -0.22]). CONCLUSION: These findings add to the literature concerning the need to continually monitor therapist fidelity to an evidence-based practice over time to optimize family benefits. Limitations and directions for future research are discussed.