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Making a Difference with Youth, Families and Communities

Making a Difference with Youth, Families and Communities. Partnerships in Prevention Science Institute Iowa State University October, 2005. Investigators/Collaborators R. Spoth (Director), C. Redmond & C. Shin (Associate Directors), T. Backer, K. Bierman, G. Botvin, G. Brody, S. Clair,

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Making a Difference with Youth, Families and Communities

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  1. Making a Difference withYouth, Families and Communities Partnerships in Prevention Science Institute Iowa State University October, 2005

  2. Investigators/Collaborators R. Spoth (Director), C. Redmond & C. Shin (Associate Directors), T. Backer, K. Bierman, G. Botvin, G. Brody, S. Clair, T. Dishion, M. Greenberg, D. Hawkins, K. Kavanagh, K. Kumpfer, C. Mincemoyer, V. Molgaard, V. Murry, D. Perkins, J. A. Stout Associated Faculty/Scientists K. Azevedo, J. Epstein, M. Feinberg, K. Griffin, M. Guyll, K. Haggerty, S. Huck, R. Kosterman, C. Lillehoj, S. Madon, A. Mason, J. Melby, M. Michaels, T. Nichols, K. Randall, D. Ryu, L. Schainker, T. Tsushima, L. Trudeau, J. Welsh, S. Yoo Prevention Coordinators E. Berrena, M. Bode, D. Broshar, B. Bumbarger, K. James, J. Meek, C. Tomaschik

  3. Funding Agencies • National Institute on Drug Abuse • National Institute of Mental Health • National Institute on Alcohol Abuse and Alcoholism • Center for Substance Abuse Prevention

  4. 1. Mission and Background

  5. Institute Mission: Public Health and Well-Being Through Science-with-Practice To promote healthy and capable youth, adults, families, and communities through prevention and health promotion science with practice.

  6. Why is it important to pursue the mission? • High prevalence rates of various public health problems (youth problem behaviors, unhealthy lifestyles) • Benefits of positive youth and family development, particularly among those at risk • Need to move toward a more comprehensive strategic plan for prevention/positive youth development/ health promotion • Limited diffusion of high-fidelity, evidence-based interventions—one estimate of effective prevention “market penetration” is 1% Sources: Spoth, R., Greenberg, M., Bierman, K., & Redmond, C. (2004). PROSPER Community-university partnership model for public education systems: Capacity-building for evidence-based, competence-building prevention. Prevention Science, 5(1), 31-39; Spoth, R. & Greenberg, M. (in press). Toward effective practitioner-scientist partnerships and larger-scale community benefits, American Journal of Community Psychology.

  7. Advantages of Focus on Evidence-Based Interventions (EBIs) • Positive outcomes and economic benefits more likely for youth, families, others • Better accountability—resources not used for ineffective programs • Funding increasingly targeted for evidence-based interventions • Materials, training and technical assistance typically are available

  8. Conceptual Framework and Partnership Model

  9. Framework for State Public Education Systems Approach to “Science-with-Practice” Local Community Team Internal Capacity Agents from Public Schools External Resource Agents from Community/State University Local Linking Agents from Extension System University/Prevention Coordinator Teams Source: Spoth, R., Greenberg, M., Bierman, K., & Redmond, C. (2004). PROSPER partnership model for state public education systems: Capacity-building for evidence-based competence-building prevention. Prevention Science (special issue), 5(1), 31-39.

  10. PROSPER—Organizational Structure for State Public Education Partnerships Local Community Teams Extension Agent, Public School Staff, Social Service Agency Representatives, Parent/Youth Representatives Prevention Coordinator Team Extension Prevention Coordinators University/State-Level Team University Researchers, Extension Program Directors

  11. 2. Illustrative Findings: Effectiveness in— • Delivery of Community-Level, Evidence-Based Interventions (EBIs) • Producing Positive Community-Level Outcomes through Partnership-Delivered EBIs • Quality Implementation of Rigorous Intervention Studies

  12. Partnership Effectiveness in Delivery of Community-level EBIs

  13. Types of Indicators of EffectiveCommunity-Level EBI Delivery • Consistently high implementation quality/adherence • High intervention recruitment rates • High intervention retention rates • Involvement of youth and families across the risk spectrum • Successfully implemented cultural adaptations • Initial evidence of partnership sustainability

  14. Partnership-Based Delivery Results—Implementation Adherence* *Rates presented are from PROSPER study. Also see: Spoth, R., Guyll, G., Trudeau, T., & Lillehoj-Goldberg, C. (2002). Two studies of proximal outcomes and implementation quality of universal preventive interventions in a community-university collaboration context. Journal of Community Psychology, 30, 499-518.

  15. Partnership-Based Delivery Results—Family Program Retention/Participation LevelsStrengthening Families Program Family Session Attendance % Enrolled Families Attending *Enrolled families are those that signed up and attended at least one session.

  16. Partnership-Based Delivery Results—Sustainability Early in first sustainability phase of ongoing partnership study—11 of 13 local teams have raised their own sustainability funds!

  17. Urban African-American families Recruitment is 70% of families assessed High retention rate High level of implementation quality Positive attitude re program Mix of posttest results—guide next steps Partnership-Based Delivery Results—Harambee Cultural Adaptation Pilot Study Source: Spoth, R. Guyll, M., Chao, W., & Molgaard, V. (2003). Exploratory study of a preventive intervention with general population African American families. Journal of Early Adolescence,13(3), 301-328.

  18. B. Positive Community-Level Outcomes Through Partnership-Delivered EBIs

  19. Wide Range of Positive Community-Level Outcomes • Positive youth protective factor and skills-building outcomes (e.g., significant improvements in relationships with parents, refusals with peers offering alcohol) • Long-term effects on school engagement and academic success (e.g., increased grade point average) • Long-term reductions in substance use (up to six years past baseline—e.g., 40% reduced likelihood of having been drunk by 10th grade) • Long-term conduct/behavior problem reduction (e.g., 40% fewer aggressive and destructive behaviors by10th grade) • Economic benefits (e.g., $9.60 return on the dollar invested) • Comparable longitudinal benefits for lower- and higher-risk groups

  20. Results—Partnership-Based Outcome Studies Longitudinal Growth of First-Time Drunkenness Lifetime Drunkenness Through 6 Years Past Baseline: Logistic Growth Curve Source: Spoth, R., Redmond, C., Shin, C., & Azevedo, K. (2004). Brief family intervention effects on adolescent substance initiation: School-level curvilinear growth curve analyses six years following baseline. Journal of Consulting and Clinical Psychology, 72(3), 535-542.

  21. Results—Partnership-Based Outcome StudiesLongitudinal Growth of Marijuana Use See Spoth, Redmond, Shin, & Azevedo (2004). Brief family intervention effects on adolescent substance initiation: School-level curvilinear growth curve analyses six years following baseline, Journal of Consulting and Clinical Psychology, 72(3), 535-542.Also see Spoth & Greenberg (in press). Toward a comprehensive strategy for effective practitioner-scientist partnerships and larger-scale community benefits, American Journal of Community Psychology.

  22. Results—Partnership-Based Outcome Studies Average Teen Age in School Districts When Stated Prevalence Levels are Reached—From 6-Year Follow-up See Spoth, Redmond, Shin, & Azevedo  (2004). Brief family intervention effects on adolescent substance initiation: School-level curvilinear growth curve analyses six years following baseline, Journal of Consulting and Clinical Psychology, 72(3), 535-542. Also see Spoth & Greenberg (in press). Toward a comprehensive strategy for effective practitioner-scientist partnerships and larger-scale community benefits, American Journal of Community Psychology.

  23. Results—Transition from Non-Advanced Use to Advanced Use* Source: Spoth, R. (2004, September). Slower and fewer transitions to use: Results from a community-university partnership approach. Presentation at the Conference on Blending Clinical Practice and Research: Forging Partnerships, sponsored by NIDA in Detroit, MI. * Advanced use means use of legal substances on regular basis or use of illicit drugs at least once: Reports one or more of the following—past month alcohol use (> 4 times), past month binge, past month one or more cigs/day, ever use of marijuana, inhalants, or other illicit drugs. *p < .05

  24. Results— Partnership-Based Meth Outcomes of Universal Interventions Lifetime and Past-Year Meth Use at 4½-6½ Years Past Baseline ISFP = Iowa Strengthening Families Program SFP + LST = Strengthening Families Program: For Parents and Youth 10-14 and Life Skills Training Source: Spoth, et al. (2005). Two randomized studies of the long-term effects of brief, partnership-based universal preventive interventions on adolescent methamphetamine use

  25. Results— Partnership-Based Outcome Studies Observer-Rated Aggressive/Hostile Behaviors Source: Spoth, R., Redmond, C., & Shin, C. (2000). Reducing adolescents' aggressive and hostile behaviors: Randomized trial effects of a brief family intervention four years past baseline. Archives of Pediatrics and Adolescent Medicine, 154, 1248‑1257.

  26. Results— Diagnosable Disorders 10 Years Past Baseline Source: Spoth, R., Redmond, C., Mason, A., Kosterman, R., Haggerty, K., & Hawkins, J. D. (2005, May). Ten-year follow-up assessment of brief, family-focused interventions effects on lifetime conduct and antisocial personality disorders: Preliminary results. Poster presented at the Society for Prevention Research 13th Annual Meeting, Washington, D.C.

  27. Results— Differential Effects on Girls and Boys Internalizing Symptoms Source: Trudeau, Azevedo, Spoth, & Randall (2005). Effects of a universal family-focused intervention on associated growth patterns of adolescent internalizing symptoms and alcohol use. Manuscript under review.

  28. Tested Model Results—Long-Term Effects of Public Education Partnership Program on Academic Success 6th Grade 12th Grade 8th Grade • Partnership (School-Community-University) program in 6th grade significantly impacts student academic success (parent-reported grades) in 12th grade: -Through enhanced positive parenting behavior effects on school engagement -Through reduced substance-related risk behavior effects on school engagement • Results from a randomized, controlled study with 33 Iowa school districts (see Project family Trial II at www.ppsi.iastate.eduSpoth, R., Randall, G. K. and others. Building family skills leads to long-term academic success. Manuscript in final preparation.) Enhanced Positive Parenting Behavior Increased Student School Engagement Increased Student Academic Success Partnership-based Iowa Strengthening Families Program Reduced Substance-related Risk Behaviors

  29. Results—Benefits to Higher-Risk Subgroups • Successfully recruited and retained both higher- and lower-risk participants • Benefit comparable across higher- and lower-risk subgroups • When risk moderation effects observed, mostly stronger effects for those at higher risk Source: Spoth, R., & Redmond, C. (2002). Project Family prevention trials based in community-university partnerships: toward scaled-up preventive interventions. Prevention Science,3(3), 203-221.

  30. Results— Delaying Onset of Alcohol Use Leads to Cost Savings Partnership-Based Strengthening Families Program: Benefit-Cost Ratios Under Different Assumptions *Study Data indicate $9.60 returned for each dollar invested under actual study conditions Source: Spoth, R., Guyll, M., & Day, S. X. (2002). Universal family-focused interventions in alcohol-use disorder prevention: Cost-effectiveness and cost-benefit analyses of two interventions. Journal of Studies on Alcohol, 63(2), 219-228.

  31. Partnership Effectiveness inHigh-Quality Implementation of Rigorous Outcome Research

  32. Types of Evidence of Successful Partnership-Based Outcome Study • School recruitment/retention across studies • Sample quality across studies—representative of general population samples • Intervention validity across studies • About 30,000 individuals assessed across studies • Methodological innovations/multilevel designs and analyses

  33. Results—Study Recruitment and Retention of Public Schools • Six randomized controlled studies conducted, 11 supplemental studies • 106 public schools involved in randomized controlled studies • 90% of all schools attempted were successfully recruited • 98% of school districts retained long-term—in two studies, 100% retained through end of HS

  34. 3. Future Directions

  35. Overview of PROSPER Collaborative Study with PSU* • Design • Random assignment of 28 school districts (14 IA, 14 PA) to full partnership and “delayed intervention” (comparison) conditions • Participants • Two successive cohorts of 6th grade children and their families (N 5,750 students in each cohort) • Random selection of  1,100 families from Cohort II for more intensive assessments (in-home, teacher, school archival data) *PROSPER = PROmoting School-community-university Partnerships to Enhance Resilience. In collaboration with the Prevention Research Center at Pennsylvania State University (Mark Greenberg, Director; Karen Bierman, Co-Director)

  36. PROSPER Local Team Activities • Recruit team members and building local team cohesion • Consider local needs & resources for program implementation • Select from a menu of evidence-based programs • Family-focused program • School-based program

  37. Key Focus on Building Local Team Sustainability • Emphasis on ongoing technical assistance through Extension-prevention staff • Ongoing partnership evaluation & feedback • TA focus on expansion of resources • Strategies to accommodate team membership/leadership change

  38. What PROSPER Has AccomplishedThird Year • High family recruitment rates across 2 cohorts, compared with other “real world” community-based efforts • Consistently high levels of implementation quality, for both family and school programs • All of 13 local teams have raised their own sustainability funds!

  39. A Vision for PROSPERMaking a Difference

  40. Obesity Prevention Framework for Health-Promoting Public Education Partnership Network (HealthPEP Net): Design, Testing and Dissemination E D C U I C L A B T U I P O N Intervention Development Process ● Scientifically-rigorous ● Ecological ● Consumer-oriented Testing/ Implementation Sustained Dissemination Design Community-University Partnership Network (PROSPER Prototype) S D M I S E S T E S M Y I S N A N T O I *From “Obesity and Youth” Regional Conference at Iowa State University (R. Spoth)

  41. Making a Difference with a National Network of Partnerships

  42. Partnership Network Development • Developing a partnership network to support community participatory research • Goal is to achieve larger-scale public health and well-being through broader implementation of a science-with-practice approach • Partnership network intended to: • Effectively deliver evidence-based interventions on a larger scale • Evaluate the public health impact of EBIs • Support development and evaluation of interventions with promise of positive outcomes

  43. Future Directions • Toward a National Network of Partnerships— • Early-Adopter States • Meet with Extension and research leadership in other early-adopter states • Conduct initial readiness and resource assessments • Organize state-level steering committee • State partnership team • Pilot study • Grant-driven approach

  44. Future Directions • Toward a National Network of Partnerships— • National-Level Efforts • Build awareness among national leaders and potential stakeholders • Organize a research network steering committee • Develop infrastructure for national-level technical assistance and multistate/multisite research (e.g., readiness assessment tools, network analyses of opinion leaders, information management system)

  45. Please visit our website at... • Or visit us in Ames, Iowa... www.ppsi.iastate.edu

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