Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Type2TranslationalResearch:Advances,Challenges,IllustrativeStudies,andStrategicNextSteps2016InterdisciplinaryTranslationalScienceRetreatNebraskaCenterforResearchonChildren,Youth,FamiliesandSchools,UniversityofNebraska–LincolnRichardSpothPartnershipsinPreventionScienceInstitute,IowaStateUniversity
PROmotingSchool-community-universityPartnershipstoEnhanceResilience
ReportedresearchhasbeenfundedbygrantsfromtheNationalInstituteonDrugAbuse(DA13709,DA028879),theCentersforDiseaseControlandPrevention(DP002279),andtheAnnieE.CaseyFoundation,withco-fundingfromtheNationalInstituteonAlcoholAbuseandAlcoholism.
Overview
1. Context:Evidence-BasedPreventionAdvancesandTranslationChallenges
2. IllustrativePROSPERDeliverySystemResearch
3. TranslationResearchReviewSummary
4. PrioritiesandStrategicNextSteps
Part1.Context:Advances&Challenges
AdvancesinEvidence-BasedPrevention• NRC-IOM2009Report*reviewsanarrayofevidence-basedpreventiveinterventions(EBIs)– Prenatalthroughadolescentstages– Preventmultiplebehavioralproblems,withlong-termeffects– Manyshowcostbenefit/costeffectiveness
• Highlightsevidenceonfamily-focusedprogramsinparticular
*NationalResearchCouncilandInstituteofMedicine(2009).Preventingmental,emotional,andbehavioraldisordersamongyoungpeople:progressandpossibilities.CommitteeonthePreventionofMentalDisordersandSubstanceAbuseAmongChildren,Youth,andYoungAdults:ResearchAdvancesandPromisingInterventions.MaryEllenO’Connell,ThomasBoat,andKennethE.Warner,Editors.WashingtonDC:TheNationalAcademiesPress.
éCaregiver-childbonding,childmanagement,aswellassocial,emotionalandcognitivecompetencies
ê Substanceuse,delinquency,conductproblems,othermentalhealthproblems
Part1.Context:Advances&Challenges
KeyAdvances:DemonstrationsofCrossoverEffects• Universalinterventionprimarygoal:Delayyoungadolescentinitiationofgatewaysubstanceuse
• Effects– Upto14yearspastbaselineêWide-rangingtypesofsubstanceuseéParentingskillsandfamilyfunctioning,youthskills(e.g.,peerresistance,socialcompetencies),schoolengagementandgrades
êAggressive/destructivebehaviors,conductproblems,mentalhealthproblems(e.g.,depression),health-riskingsexualbehaviors
How? Programsaddresscommonrisk/protectivefactors;impactprimarysocializingenvironments(socialnetworks)Source:Spoth,GlobalImplementationConferencePlenary,2013.
Part1.Context:Advances&Challenges
Advances:UpsidesandDownsides
• Upside – AdvancesnotedinNRC-IOM2009Report,e.g.,EBIsandpositivedevelopmentaltrajectories
• Downside – SlowflowofEBIstopopulationimpact,duetomanybarriers
Part1.Context:Advances&Challenges
InOtherWords,AdvancesNotwithstanding
• Mostinterventionsactuallyimplementedinrealworldareuntested
• Mostlyhaveonlylimited,oftenineffectiveimplementationordeliverysystems,so…– Poorimplementationquality– Limitedsustainability– Slowscaling,resultingfrommanybarriers
• Inotherwords,thereislimitedtranslationofinterventionsciencetopractice.
Part1.Context:Advances&Challenges
ImprovingTranslation:AddressCoreChallengesforEnhanced“Flow”toPractice
#1:Infrastructureandsystemsdevelopmentforenhancedtranslation– buildingnecessarysupportsforpracticeandresearch– includingworkforcedevelopment
#2:Neededscientificadvancesforsystems-orientedT2research
*Source:Spoth,Rohrbach,Greenberg,etal.(2013).AddressingcorechallengesforthenextgenerationofType2translationresearchandsystems:TheTranslationSciencetoPopulationImpact(TSci Impact)framework. PreventionScience,14(4),319-351.
Part2.IllustrativePROSPERResearch
IllustrativeTranslationalResearch:PROSPERPROmoting School-community-universityPartnershipstoEnhanceResilience)
THEPROSPERAPPROACH
Part2.IllustrativePROSPERResearch
PROSPERResearch– BuildingonExistingInterventionInfrastructures/EducationSystems
• USDA – CooperativeExtensionSystem– Largestinformaleducationsystemintheworld– Reachintoeverycountyinthecountry
• DoE – StatePublicSchoolSystems– Universalsystemreachingnearlyallchildren– ExistingrelationshipswithExtensionSystem
• DoD – MilitaryFamilySupportSystems– TiesintoNationalGuardsupportsystems– Couldlinktoexistingmilitarytraininginfrastructures
• Groundworkforlinkageofthesystemsbeganinthelate1980s
Part2.IllustrativePROSPERResearch
TestedCommunityPartnershipSustainabilityModel
LocalCommunityTeams–ExtensionAgent,PublicSchoolStaff,
SocialServiceAgencyRepresentatives,Parent/YouthRepresentatives
University/State-LevelTeam–UniversityResearchers,ExtensionProgramDirectors
PROSPER
PreventionCoordinatorTeam–ExtensionPreventionCoordinators
• PrimaryTask:Sustained,qualityimplementationoffamilyandschoolEBIsselectedfromamenu
CommunityTeams:
• Planandcoordinatefamilyprograms,includingrecruitmentandmonitoringforquality
• Workwiththeschooltocoordinateaschoolprogram,includingmonitoringforquality
Part2.IllustrativePROSPERResearch
Goal1:SustainEvidence-basedInterventionswithHighQuality
• Generateresourcesforongoingprogramming
Part2.IllustrativePROSPERResearch
WhoisInvolvedattheCommunityLevel?
• Small,strategicPROSPERCommunityTeams• Teamsstartwithbetween8-10membersincluding:
– Familyand/oryouthExtension-basedTeamLeader–average10hours/week
– School-basedCo-teamLeader– about1hour/week– Communityvolunteers– about3hours/month
* Localmentalhealth/publichealthrepresentatives* Localsubstanceabuseagencyrepresentative* Parents* Youth
• TeamsandEBIsexpandasteamsmature,guidedbyTA
Part2.IllustrativePROSPERResearch
Goal2:BuildandMaintainaWell-functioning,ProductiveTeamCommunityTeams:
• Internally,theteamfocusesonholdingregular,effectivemeetingsandmaintaininganactivemembership
• Externally,theteamfocuseson:– Buildingconnectionswiththeschoolandcommunityorganizations
– Strategiccommunicationthroughoutthecommunitytopromoteawarenessofitsefforts
– Recognizingandrewardingsupportersandcontributors
Part2.IllustrativePROSPERResearch
PreventionCoordinators(MiddleTier)–TechnicalAssistancetoSupportTeams• Attendteammeetingsintheirassignedcommunity
• ContactTeamLeadersnearlyeveryweektodiscussPROSPERactivitiesandgoals
• InteractwithotherPreventionCoordinatorstosharesuccessfulstrategiesandapproaches
• ActasliaisonbetweentheircommunityteamandtheStateManagementTeamtoproblemsolveissuesbeforetheybecomesevere
Part2.IllustrativePROSPERResearch
OutcomeStudy• CollaborationwithPSU
• Design:RCTof28schooldistricts(14IA,14PA)– Fullpartnershipwithcommunityteams– Delayedintervention
• Participants:Twocohortsof6thgradechildren(≈ 6,000studentspercohort);2nd cohorthas≈1,000intensiveassessmentfamilies
• Multimethod,multi-informantmeasurement(nowat10thwaveofdatacollection–posthighschool)
PROSPERisfundedbyagrantfromtheNationalInstituteonDrugAbuse#DA013709-R.Spoth(PI,IowaStateUniversity),M.Greenberg(PIonsubcontract,PennsylvaniaStateUniversity),C.Redmond(Co-PIatISU),M.Feinberg(Co-PIatPSU),withco-fundingfromtheNationalInstituteonAlcoholAbuseandAlcoholism.
Part2.IllustrativePROSPERResearch
“Snapshot”ofLong-termOutcomes–PositiveTrajectories
Source:Spoth,Redmond,Shin,Greenberg,Feinberg,Schainker(2013).PROSPERcommunity-universitypartnershipsdeliverysystemeffectsonsubstancemisusethrough6½yearspastbaselinefromaclusterrandomizedcontrolledinterventiontrial.PreventiveMedicine,56,190-196.*Sumofsixlifetimeillicitusemeasures(methamphetamines,Ecstasy,inhalants,Vicodin,prescriptiondrugmisuseoverall,otherillicitdruguse).
Long-termImpactonIllicitSubstanceUseIndexThrough6½YearsPastBaseline
Differenceingrowthofuseisstatisticallysignificant,asaredifferencesatmultipletimepoints,including11thand12thgrades.
Strongereffectsforhigher-riskyouth.
Part2.IllustrativePROSPERResearch
SnapshotofFindings─PeerNetworks/NegativePeerInfluences
(Blackdot=substanceuser,Whitedot=non-user)– Indicates thatnon-usernominatedasubstanceuserasafriend
– Morenonuser studentschooseusersasfriends
– Peernetworkfavorsuse
– Moresubstanceuserschoosenon-usersasfriends
– Peernetworkopposesuse
PROSPERshiftspeerinfluencetowardnon-users.Source:Osgood,Feinberg,Gest,Moody,Ragan,Spoth,Greenberg&Redmond(2013).EffectsofPROSPERontheinfluencepotentialofprosocial versusantisocialyouthinadolescentfriendshipnetworks.JournalofAdolescentHealth,53(2),174-179.
PROSPERLowEstimate
PROSPERHighEstimate
EconomistReport
Estimate**
DirectCostsPerFamily $278.56* $348.25* $851.00
Part2.IllustrativePROSPERResearch
SnapshotofFindings– CostEffectiveImplementationofEvidence-basedPrograms
Source:Crowley,Jones,Greenberg,Feinberg&Spoth(2012).Resourceconsumptionofadisseminationmodelforpreventionprograms:ThePROSPERdeliverysystem.JournalofAdolescentHealth,50,256-263.(Seeexplanationof“dayofimplementation”costs.)**SeeWashingtonStateInstituteforpublicPolicyReport,2004.
SFP10-14Implementation:PROSPERteamvs.SFP10-14alone.
*Representsa59-67%reductionincosts.
PROSPERApproachtoTranslationofScienceattheCommunityLevel
Part2.IllustrativePROSPERResearch
BarrierstoTranslationattheCommunityLevelKeyBarrierstoCommunityImplementation:1. Inadequatetechnicalassistanceandsupportsystems
forevidenced-basedprogramdelivery2. Limitedparticipation/activeengagementoftargeted
generalpopulations3. Poorimplementationqualityofevidence-based
programs4. Limitedprogramsustainability(especiallyfunding)5. Limitedintegrationofongoingevaluationforquality
improvement
Part2.IllustrativePROSPERResearch
AddressingImplementationQualityBarrier–OngoingEBIMonitoring
• Educate/trainPROSPERpartnershipmembersabouttheimportanceofqualitymonitoringat:– Statewidemeetings– Learningcommunities– Facilitatorandobservertrainings– “Feedbacksessions”afterprogram(e.g.SFP10-14)sessioniscompleted
– Facilitatorsupervision
Part2.IllustrativePROSPERResearch
SnapshotofFindings– PROSPERStrategiestoImplementationve Findings
90.9 90.8 89.3 92.6 92.0 94.1
0
10
20
30
40
50
60
70
80
90
100
Percen
tage
Cohort1
Cohort2
Cohort3
Cohort4
Cohort5
Cohort6
See:Spothetal.(2007).PROSPERstudyofevidence-basedinterventionimplementationqualitybycommunity-universitypartnerships.JournalofCommunityPsychology,35(8),981-999.AlsoseeSpothetal.(2011).Six-yearsustainabilityofevidence-basedinterventionimplementationqualitybycommunity-universitypartnerships:ThePROSPERstudy.AmericanJournalofCommunityPsychology,48,412-425.
PROSPERLong-TermAdherenceRatings
Part2.IllustrativePROSPERResearch
AddressingSustainabilityBarrier–Benchmarking/TechnicalAssistance• Assessbenchmarkedprogressacrossallphases,withspecialattentiontocorecomponents– Usedtomonitorsustainabilityeffortsreteamandprograms
– Facilitatessustained,long-termdevelopment
InstructionsforCompletingPROSPERModelBenchmarkScoring
ProgramQuality
Management/Planning
Purpose: Improved Child and Family Outcomes
AddressingSustainabilityBarrier– TeamTrainingGuidedbyPROSPERSustainabilityModel
Stra
tegi
es ConductingEffective, Regular Meetings
Planning forRecognitions
and Rewards
Monitoring Team
Structure & Roles &
Participation
StrengtheningPartnerships with Schools/
Other Organizations
StrategicCommunication
PlanningCommunity/
School Positioning
Resource Generation
for Programs
Effective External Relationships
Effective Internal Relationships
Evidence-basedFamily Program
Evidence-basedSchool Program O
bjec
tives
Goal 1:Sustaining Growth &
Quality of Programming
Goal 2: Sustaining Well-
Functioning Teams
Part2.IllustrativePROSPERResearch
SnapshotofFindings– TeamFinancialSustainabilityAverageTotalContributionsReceivedAcrossAllProjectCommunitiesbyAcademicYear
Part3.TranslationResearchReview
Type2TranslationResearchReviewSummary– ThankstoOurCo-authors
Part3.TranslationResearchReview
DefinitionofT2TranslationResearchin“Advances”Paper
• Investigatesthecomplex processesandsystemsthroughwhichsustainableEBIsareintegratedintopracticeonalargescale,acrosstargetedpopulationsandsettings
• Essentialforrealizingthepopulation-levelhealthimpactofEBIs
T2TranslationFunctionstoInvestigateEBIswithPopulationImpact
ImplementationAdoptionPre-Adoption SustainabilityStartResearchCycleforEBIs
TheTranslationSciencetoPopulationImpactFramework─BasicTranslationFunctions
T2TranslationFunctionstoInvestigate
TheTranslationSciencetoPopulationImpactFramework─BasicTranslationFunctionSupportsandContexts
EBIswithPopulationImpact
ImplementationAdoptionPre-Adoption SustainabilityStartResearchCycleforEBIs
InfrastructureSupportsPractice-orientedResearch,Practitioner-Scientist
Partnerships,FinancingStructures
Part3.TranslationResearchReview
CoreChallenge#2:NeededScientificAdvances-KeyResearchQuestionsforEachTranslationPhase
*Source:Spoth,Rohrbach,Greenberg,etal.(2013).AddressingcorechallengesforthenextgenerationofType2translationresearchandsystems:TheTranslationSciencetoPopulationImpact(TSci Impact)framework. PreventionScience,14(4),319-351.
Part3.TranslationResearchReview
Pre-Adoption/AdoptionPhases─IllustrativeFactorstoInvestigate• Consumerpreferences
• Program/providerdecision-making• Economicbenefitanalysis
• Organizationalreadiness• Illustrativequestions:“Howdoprogramadministratorsevaluatedifferenttypesofevidence?
• Howarecostandothereconomicdatausedinthedecision-makingprocess?”(e.g.,Asen etal.studyofschoolboardmembers)
WhichCombinationofProgramFeaturesareMostPreferred?
Question:DoyoupreferProgramA,ProgramB,ordoyouhavenopreference?
1. Meetsweekenddays2. Meetsatachurch3. Taughtbyparents4. Endorsedbyschool
administrators
Doyouslightlypreferthisprogramorstronglypreferthisprogram?SeeSandleretal.,2005.Developingeffectivepreventionservicesfortherealworld:Apreventionservicedevelopmentmodel.AmericanJournalofCommunityPsychology,35(3-4),127-142.Source:Spoth&Redmond,1993. Identifyingprogrampreferencesthroughconjointanalysis:Illustrativeresultsfromaparentsample.AmericanJournalofHealthPromotion,8(2),124-133.
1. Meetsweekdayevenings2. Meetsataschool3. Taughtbychild
developmentspecialist4. Endorsedbyparents
Pre-AdoptionPhase─IllustrativeConsumerPreferenceResearchSnapshot:ConjointAnalysis
A B
Part3.TranslationResearchReview
ImplementationPhase─IllustrativeFactorstoInvestigate• FactorsinparticipantengagementinEBIs
• Provider/organization/teamfactorsaffectingimplementation
• Training/technicalassistance(TA)• Fidelity/adaptation• Forexample:IsonlineEBItrainingaseffectiveasin-persontraining?
Part3.TranslationResearchReview
ImplementationPhase– lllustrative ResearchSnapshot:ParticipantEngagementona4-pointScale
3.6 3.63.5
3.7 3.7 3.73.4 3.5 3.5 3.6 3.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Year1 Year2 Year3 Year4 Year5 Year6
PROSPERFamilyProgram PROSPERSchool-basedProgram
Part3.TranslationResearchReview
SustainabilityPhase─IllustrativeFactorstoInvestigate• Effectivefunding/financingstrategies• Provider/organizationteamfactorsaffectingsustainability
• Interventioncharacteristics/costs• Organizational/communitysystemfactors• Supportivepolicy• Illustrativequestion:“Whatfundingstrategiesaremostconducivetosustainability?”
Part3.TranslationResearchReview
SustainabilityPhase– IllustrativeResearchSnapshot:CommunityTeamFundingSources
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
AY0506 AY0607 AY0708 AY0809 AY0910
Federal
State
Local
School
NGLA
Foundation
Business
Fundraising
Prosper
Extension
Other
Part4.PrioritiesandStrategies
PrioritiesandPossibleStrategicSteps
Question:Allthingsconsidered,whataresomestrategicsteps?Whataretherelatedresearchand*organizationalpriorities?
*ForTranslationalCenterdevelopment
Part4.PrioritiesandStrategies
OverviewofPossibleStrategicStepsfromT2AdvancesArticle*1. PlanningandOrganizationforInfrastructure
DevelopmentandCapacityBuilding– BuildinteragencycollaborationusingNationalPreventionStrategy,focusingonEBIscalingsystems,withacommonconceptualframework
– Buildpreventionworkforce—“buildout”currentlyavailabletraining/certificationsystems;organizenetworkofuniversity-supportedtrainers(e.g.,ICUDDR)
– Strengtheninfrastructurefornetworkedpreventionsystems—buildonexistinginfrastructure;learnfromexistingimplementationsystemsresearch;linkwithACAhealthcarereformefforts(e.g.,CommunityBenefit)
*Updated/supplementedActionStepsfromSpoth,Rohrbach,Greenberg,etal.(2013).AddressingcorechallengesforthenextgenerationofType2translationresearchandsystems.PreventionScience,14(4),319-351
Part4.PrioritiesandStrategies
IncreasingImpact:PossibleStrategicStepsfromT2AdvancesArticle(cont.)2. InnovativeFundingMechanisms
– Supportbraidedfundingapproachesv Acrossserviceandresearchagenciesv Stateagencyfundingtosupportcommunitygrantswithfederalagencysupportforresearch
– Develop state/regionpreventionfinancingteamswithCommunitiesofInterest,tosupportprioritypreventiongoals
– Engageprivate-publicpartnerships(e.g.,foundationsandnon-profithospitals)
– Developpreventionandwellnessfundstosupportnetworkedcommunities
Part4.PrioritiesandStrategies
IncreasingImpact:PossibleStrategicStepsfromT2AdvancesArticle(cont.)3. Develop,test,coordinatescalableEBIdeliverysystems,
withembeddedresearch– Clarifytranslationlessonsfromwide-rangingsuccessfulsystemsv SystemsfordeliveringindividualEBIs,orEBIsonmenusv ConsidersystemsforuniversalEBIswithcrossovereffectsasgatewaystomoretargeted,orintensiveinterventions
– Embedresearchinstateandnationalpreventionsystemstodevelop,test,disseminateEBIs,andusecontinuoussystemsimprovementacrosstranslationphases
IowaStateUniversity PennsylvaniaStateUniversityPartnershipinPreventionScienceInstitute PreventionResearchCenterRichardSpoth,Director MarkGreenberg,Director
PPSIScientists: PRCScientists:CleveRedmond ChungyeolShin MarkFeinberg DanielF.PerkinsLisaSchainker KateRalston ClaudiaMincemoyer JanetWelsh
SarahMeyerChilenski
HumanInteractionResearchInstituteTomBacker,Director
THANKYOUfromPPSIandThePROSPERPartnershipGroup
FundedbyTheCentersforDiseaseControlandPrevention
TheAnnieE.CaseyFoundationTheNationalInstituteonDrugAbuse
Pleasevisitourwebsite…HelpingKidsPROSPER.org