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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


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.


Advances:UpsidesandDownsides

• Upside – AdvancesnotedinNRC-IOM2009Report,e.g.,EBIsandpositivedevelopmentaltrajectories

• Downside – SlowflowofEBIstopopulationimpact,duetomanybarriers


InOtherWords,AdvancesNotwithstanding

• Mostinterventionsactuallyimplementedinrealworldareuntested

• Mostlyhaveonlylimited,oftenineffectiveimplementationordeliverysystems,so…– Poorimplementationquality– Limitedsustainability– Slowscaling,resultingfrommanybarriers

• Inotherwords,thereislimitedtranslationofinterventionsciencetopractice.


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


PROSPERResearch– BuildingonExistingInterventionInfrastructures/EducationSystems

• USDA – CooperativeExtensionSystem– Largestinformaleducationsystemintheworld– Reachintoeverycountyinthecountry

• DoE – StatePublicSchoolSystems– Universalsystemreachingnearlyallchildren– ExistingrelationshipswithExtensionSystem

• DoD – MilitaryFamilySupportSystems– TiesintoNationalGuardsupportsystems– Couldlinktoexistingmilitarytraininginfrastructures

• Groundworkforlinkageofthesystemsbeganinthelate1980s


TestedCommunityPartnershipSustainabilityModel

LocalCommunityTeams–ExtensionAgent,PublicSchoolStaff,

SocialServiceAgencyRepresentatives,Parent/YouthRepresentatives

University/State-LevelTeam–UniversityResearchers,ExtensionProgramDirectors

PROSPER

PreventionCoordinatorTeam–ExtensionPreventionCoordinators

• PrimaryTask:Sustained,qualityimplementationoffamilyandschoolEBIsselectedfromamenu

CommunityTeams:

• Planandcoordinatefamilyprograms,includingrecruitmentandmonitoringforquality

• Workwiththeschooltocoordinateaschoolprogram,includingmonitoringforquality


Goal1:SustainEvidence-basedInterventionswithHighQuality

• Generateresourcesforongoingprogramming


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


Goal2:BuildandMaintainaWell-functioning,ProductiveTeamCommunityTeams:

• Internally,theteamfocusesonholdingregular,effectivemeetingsandmaintaininganactivemembership

• Externally,theteamfocuseson:– Buildingconnectionswiththeschoolandcommunityorganizations

– Strategiccommunicationthroughoutthecommunitytopromoteawarenessofitsefforts

– Recognizingandrewardingsupportersandcontributors


PreventionCoordinators(MiddleTier)–TechnicalAssistancetoSupportTeams• Attendteammeetingsintheirassignedcommunity

• ContactTeamLeadersnearlyeveryweektodiscussPROSPERactivitiesandgoals

• InteractwithotherPreventionCoordinatorstosharesuccessfulstrategiesandapproaches

• ActasliaisonbetweentheircommunityteamandtheStateManagementTeamtoproblemsolveissuesbeforetheybecomesevere


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.


“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.


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


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


BarrierstoTranslationattheCommunityLevelKeyBarrierstoCommunityImplementation:1. Inadequatetechnicalassistanceandsupportsystems

forevidenced-basedprogramdelivery2. Limitedparticipation/activeengagementoftargeted

generalpopulations3. Poorimplementationqualityofevidence-based

programs4. Limitedprogramsustainability(especiallyfunding)5. Limitedintegrationofongoingevaluationforquality

improvement


AddressingImplementationQualityBarrier–OngoingEBIMonitoring

• Educate/trainPROSPERpartnershipmembersabouttheimportanceofqualitymonitoringat:– Statewidemeetings– Learningcommunities– Facilitatorandobservertrainings– “Feedbacksessions”afterprogram(e.g.SFP10-14)sessioniscompleted

– Facilitatorsupervision


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


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


SnapshotofFindings– TeamFinancialSustainabilityAverageTotalContributionsReceivedAcrossAllProjectCommunitiesbyAcademicYear

Part3.TranslationResearchReview

Type2TranslationResearchReviewSummary– ThankstoOurCo-authors


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


CoreChallenge#2:NeededScientificAdvances-KeyResearchQuestionsforEachTranslationPhase

*Source:Spoth,Rohrbach,Greenberg,etal.(2013).AddressingcorechallengesforthenextgenerationofType2translationresearchandsystems:TheTranslationSciencetoPopulationImpact(TSci Impact)framework. PreventionScience,14(4),319-351.


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


ImplementationPhase─IllustrativeFactorstoInvestigate• FactorsinparticipantengagementinEBIs

• Provider/organization/teamfactorsaffectingimplementation

• Training/technicalassistance(TA)• Fidelity/adaptation• Forexample:IsonlineEBItrainingaseffectiveasin-persontraining?


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


SustainabilityPhase─IllustrativeFactorstoInvestigate• Effectivefunding/financingstrategies• Provider/organizationteamfactorsaffectingsustainability

• Interventioncharacteristics/costs• Organizational/communitysystemfactors• Supportivepolicy• Illustrativequestion:“Whatfundingstrategiesaremostconducivetosustainability?”


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


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


IncreasingImpact:PossibleStrategicStepsfromT2AdvancesArticle(cont.)2. InnovativeFundingMechanisms

– Supportbraidedfundingapproachesv Acrossserviceandresearchagenciesv Stateagencyfundingtosupportcommunitygrantswithfederalagencysupportforresearch

– Develop state/regionpreventionfinancingteamswithCommunitiesofInterest,tosupportprioritypreventiongoals

– Engageprivate-publicpartnerships(e.g.,foundationsandnon-profithospitals)

– Developpreventionandwellnessfundstosupportnetworkedcommunities


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