Implementation Of Evidence-based Prevention Programs Research Articles

Protocol for a hybrid type 3 cluster randomized trial of a technical assistance system supporting coalitions and evidence-based drug prevention programs

BackgroundOver 5000 community anti-drug coalitions operating in the USA serve as a cornerstone of federal drug prevention. These coalitions, however, have demonstrated effectiveness in preventing substance use only when they use technical assistance (TA) and implement evidence-based programs (EBPs). The absence of TA and EBP implementation by coalitions is a key research-to-practice gap. The Coalition Check-Up TA system is designed to fill this gap by supporting community coalition implementation of EBPs. Existing TA models for evidence-based coalition approaches are resource intensive and coalition model specific. The Coalition Check-Up is a lower cost strategy that works with a variety of types of coalitions to support sustainable implementation of EBPs. This study protocol describes a hybrid type 3 effectiveness-implementation trial applying Wandersman’s Interactive Systems Framework to test the effects of the Coalition Check-Up on coalition EBP implementation capacity and outcomes. The Interactive Systems Framework outlines how the prevention support system—especially TA—bolsters EBP dissemination and implementation.MethodsUsing a cluster randomized controlled design, this trial will test the overall effectiveness of the Coalition Check-Up, including how it contributes to EBP implementation and prevention of youth substance use. The first aim is to estimate the impact of the Coalition Check-Up on coalitions’ capacity to do their work. We will recruit 68 anti-drug coalitions for random assignment to the Coalition Check-Up or “TA as usual” condition. We will evaluate whether the Coalition Check-Up improves coalition capacity using measures of coalition member responses about team processes, coalition network composition, and collaborative structure. Our second aim is to estimate the impact of the Coalition Check-Up on implementation of EBPs, and our third aim is to estimate the impact of the Coalition Check-Up on youth substance use.DiscussionThis project will clarify how the Coalition Check-Up, a scalable approach to TA due to its low cost, affects coalition capacity to support EBP implementation. Analyses also provide insight into causal pathways from the prevention support system to the prevention delivery system outlined by the Interactive Systems Framework. Results will build the evidence-base for how to support community coalitions’ sustainable implementation of evidence-based prevention programs and policies.Trial registrationClinicaltrials.gov registration number NCT04592120. Registered on October 19, 2020.

An Implementation Evaluation of A Comprehensive Sex Education Program in a Rural Indiana County

Background and Objective: Rural teen pregnancy is a significant public health problem, yet there are no evidence-based prevention programs (EBPs) developed for rural communities. Little is known about the process of implementing and adapting EBPs for rural communities. An implementation science framework is a useful way to methodologically examine EBPs replicated in new contexts. Specifically, the Evaluation, Preparation, Implementation, Sustainment (EPIS) framework was utilized for this project. The purpose of this study is to describe the challenges and sucesses in the implementation of EBPs in a rural community. 
 Project Methods: Youth RISE! is a federally funded, evidence based, community-wide sex education program implemented in Clinton County, Indiana. Qualitative interviews were conducted with key stakeholders involved in implementing the program (n=22). Participants fulfilled diverse roles such as school administrators, teachers, local program partners, and the grantor. These interviews, conducted in-person or via telephone in 2018 and via Zoom in 2020, were subsequently transcribed, coded and analyzed using thematic analysis. Codes were developed from the EPIS implementation framework and an initial review of transcripts and field notes. 
 Results: Participants described the Youth RISE! Program as overwhelmingly successful. Qualitative analysis revealed three central themes of Community Readiness, Transparency, and Buy-In. Community readiness included timing, involvement of trusted community partners, and framing teen pregnancy as a public health issue rather than a values issue. Transparency included frequent communication between all parties, positive messaging, and a strong presence in the community. Buy-in included parent, teacher, and school administration support as well as maintaining equal partnerships between the community, school, and partner agencies. 
 Conclusion and Potential Impact: Contrary to popular beliefs, this rural community was willing to implement comprehensive sex education programs in its schools. This data may be used to inform future implementation of EBPs in rural communities.

The Child Maltreatment Prevention Landscape: Where Are We Now, and Where Should We Go?

Child maltreatment calls for a broad range of preventative policies and practices, but limited governmental funding and leadership has been devoted to the problem. Effective strategies to prevent maltreatment exist, but they have had limited uptake in the child welfare system. In this article, we trace how government responsibility for the prevention of child maltreatment became centered within the nation’s child protection response. Further, we discuss developments in prevention science, review the existing literature on the effectiveness of a range of prevention strategies, and present a public health approach to prevention. The article concludes with a set of recommendations to inform future efforts to prevent child maltreatment through approaches that seek to expand capacity for the implementation of evidence-based prevention programs, while addressing the adverse community experiences that exacerbate risk for child maltreatment.

Redesigning Implementation Measurement for Monitoring and Quality Improvement in Community Delivery Settings.

The field of prevention has established the potential to promote child adjustment across a wide array of outcomes. However, when evidence-based prevention programs have been delivered at scale in community settings, declines in implementation and outcomes have resulted. Maintaining high quality implementation is a critical challenge for the field. We describe steps towards the development of a practical system to monitor and support the high-quality implementation of evidence-based prevention programs in community settings. Research on the implementation of an evidence-based parenting program for divorcing families called the "New Beginnings Program" serves as an illustration of the promise of such a system. As a first step, we describe a multidimensional theoretical model of implementation that links aspects of program delivery with improvements in participant outcomes. We then describe research on the measurement of each of these implementation dimensions and test their relations to intended program outcomes. As a third step, we develop approaches to the assessment of these implementation constructs that are feasible to use in community settings and to establish their reliability and validity. We focus on the application of machine learning algorithms and web-based data collection systems to assess implementation and provide support for high quality delivery and positive outcomes. Examples are presented to demonstrate that valid and reliable measures can be collected using these methods. Finally, we envision how these measures can be used to develop an unobtrusive system to monitor implementation and provide feedback and support in real time to maintain high quality implementation and program outcomes.

Implementation of Evidence-Based Prevention Programs for Eating Disorders: PriMa and Torera in Daily School Life

Prevalence rates for eating disorders remained stable over the years despite the implementation of numerous prevention strategies. This may be due to discrepancies between research and practice and scientific findings are not fully applied to the care of risk groups. The school-based programs PriMa and Torera for primary prevention of eating disorders have been delivered in Thuringian schools since 2004. A current survey provides information on barriers and facilitators for a long-term implementation in the school routine. Using the "Consolidated Framework for Implementation Research", factors which impact the implementation process are discussed. Impeding factors for a long-term implementation are missing framework conditions, staff turnover and a lack of financial support from politicians. Possible solutions could be the establishment of extra time in the curriculum, the employment of individuals responsible for prevention and a close network between all people involved. According to the Society for Prevention Research, discussing implementation factors builds the last part of comprehensive program evaluations. We illustrate the barriers for the integration of evidence-based prevention programs in daily school life. It is important to implement new structures prior to the implementation of resource-intensive new prevention programs in order to increase the effectiveness of said programs and enable long-term implementation.

Optimizing Implementation of Obesity Prevention Programs: A Qualitative Investigation Within a Large-Scale Randomized Controlled Trial.

The prevalence of obesity in rural and remote areas is elevated in comparison to urban populations, highlighting the need for interventions targeting obesity prevention in these settings. Implementing evidence-based obesity prevention programs is challenging. This study aimed to investigate factors influencing the implementation of obesity prevention programs, including adoption, program delivery, community uptake, and continuation, specifically within rural settings. Nested within a large-scale randomized controlled trial, a qualitative exploratory approach was adopted, with purposive sampling techniques utilized, to recruit stakeholders from 41 small rural towns in Australia. In-depth semistructured interviews were conducted with clinical health professionals, health service managers, and local government employees. Open coding was completed independently by 2 investigators and thematic analysis undertaken. In-depth interviews revealed that obesity prevention programs were valued by the rural workforce. Program implementation is influenced by interrelated factors across: (1) contextual factors and (2) organizational capacity. Key recommendations to manage the challenges of implementing evidence-based programs focused on reducing program delivery costs, aided by the provision of a suite of implementation and evaluation resources. Informing the scale-up of future prevention programs, stakeholders highlighted the need to build local rural capacity through developing supportive university partnerships, generating local program ownership and promoting active feedback to all program partners. We demonstrate that the rural workforce places a high value on obesity prevention programs. Our results inform the future scale-up of obesity prevention programs, providing an improved understanding of strategies to optimize implementation of evidence-based prevention programs.

Factors influencing implementation dose and fidelity thereof and related student outcomes of an evidence-based national HIV prevention program.

BackgroundTeachers’ implementation of evidence-based prevention programs in schools is inconsistent. Using data gathered from the national implementation among grade six students in The Bahamas of an evidence-based HIV intervention [Focus on Youth in the Caribbean (FOYC)], this study examines differences in the degree of implementation (“dose”) and adherence to the core activities (“fidelity of implementation”) by teachers according to theoretically and historically relevant teachers’ characteristics, attitudes, and experiences pre-intervention and post-intervention. The relationship of implementation dose and implementation fidelity is assessed according to student outcomes.MethodsBeginning in 2008, the Bahamian Ministry of Education (MOE) included FOYC in the grade six curriculum nationwide. Consistent with standard practice, teachers were offered MOE training workshops in FOYC prior to delivery. The MOE conducted an anonymous curricular assessment among the grade six students at the beginning and end of the school year. Teachers agreeing to participate in the research component were asked to complete a pre-implementation and post-implementation assessment of attitudes and prior experiences.ResultsTeachers taught 15.6 out of 30 core activities, 24 out of the 46 total activities, and 4.6 out of 8 sessions on average. Three teachers’ implementation groups were identified: 1) High Implementation Group (31.7% of the teachers), characterized by high levels of implementation dose and fidelity of implementation; 2) Moderate Implementation Group (52.8%), showing moderate levels of implementation dose but high levels of fidelity of implementation; and 3) Low Implementation Group (15.6%), with low levels of implementation dose and fidelity of implementation. Low Implementation Group teachers compared to teachers in the two higher performing groups had less training in interactive teaching, limited prior exposure to the FOYC curriculum, incomplete attendance at FOYC training workshops, and low levels of comfort in teaching FOYC lessons. Students taught by teachers in the Low Implementation Group demonstrated poorer outcomes relevant to the four student outcomes (HIV/AIDS knowledge, preventive reproductive health skills, self-efficacy, and intention to use protection if they were to have sex).ConclusionsBoth implementation dose and implementation fidelity are related to student outcomes. Teachers at risk for limited implementation can be identified pre-intervention, thus opening the possibility for focused pre-intervention training.

Temporal and geographic trends in homicide and suicide rates in Mexico, from 1998 through 2012

We analyze and discuss the temporal and geographic trends in the officially registered violence-related deaths (216,462 homicides and 77,334 suicides) that occurred between 1998 and 2012 on Mexican territory. Mixed-effects logistic regression models were fitted, separately for men and women and different age groups, where (a) the evolution of the log-odds of the homicide and suicide rates over time was assumed to follow a piecewise linear function and (b) the geographic variation in the latter function was accounted for by random effects associated with the 2,456 municipalities in the country. The homicide analyses show that, although the absolute homicide rates strongly differ between men and women (with a factor of about 10), the overall temporal trends for women between 16 and 49 years and men between 16 and 60 years of age are remarkably similar, in that the rates decrease until 2007 and strongly increase afterwards. In absolute terms, men between 20 and 49 years form the most vulnerable group with an averaged homicide rate in 2012 of over 40 per 100,000. Geographically, homicide rates in 2012 are found to be the highest in the states known for the drugs-related violence, which are also the states where the increase between 2007 and 2010 was the strongest. As to the suicide rates, a steady increase was found over the 15-year study period in females between 12 and 39 years and in men between 12 and 49 years of age, while in the other age groups, the rates remained relatively constant. On average, a completed suicide is about eight times more likely in adult men than in adult women (although important interactions with age should be considered); men between 20 and 49 years of age, together with those over 75, are most vulnerable, with an average suicide rate of over 10 per 100,000 in 2012. In order to decrease the levels of violence in Mexico, moving beyond the political rhetoric and the implementation of evidence-based prevention programs are imperative.

Reciprocal Relations between Coalition Functioning and the Provision of Implementation Support

Community coalitions have been promoted as a strategy to help overcome challenges to the dissemination and implementation of evidence-based prevention programs. This paper explores the characteristics of coalitions that enable the provision of implementation support for prevention programs in general and for the implementation of evidence-based prevention programs with fidelity. Longitudinal cross-lagged panel models were used to study 74 Communities That Care (CTC) coalitions in Pennsylvania. These analyses provide evidence of a unidirectional influence of coalition functioning on the provision of implementation support. Coalition member knowledge of the CTC model best predicted the coalition's provision of support for evidence-based program implementation with fidelity. Implications for developing and testing innovative methods for delivering training and technical assistance to enhance coalition member knowledge are discussed.

Bridging Science to Practice: Achieving Prevention Program Implementation Fidelity in the Community Youth Development Study

This paper describes the development, application, and results of an implementation monitoring component of the Communities That Care (CTC) prevention framework used in the Community Youth Development Study (CYDS) to ensure high-fidelity prevention program implementation. This system was created based on research that community-based implementation of evidence-based prevention programs often includes adaptations in program design, content, or manner of delivery (Gottfredson and Gottfredson, Journal of research in crime and delinquency, 39, 3-35, 2002; Hallfors and Godette, Health Education Research, 17, 461-470, 2002; Wandersman and Florin, American Psychologist, 58, 441-448, 2003). A lack of fidelity to the implementation standards delineated by program designers is one indicator of a gap between prevention science and practice which can lessen the likelihood that communities will realize the positive participant effects demonstrated in research trials. By using the CTC model to select and monitor the quality of prevention activities, the 12 CYDS communities replicated 13 prevention programs with high rates of adherence to the programs' core components and in accordance with dosage requirements regarding the number, length, and frequency of sessions. This success indicates the potential of the CTC program implementation monitoring system to enhance community Prevention Delivery Systems (Wandersman et al. American Journal of Community Psychology, this issue) and improve the likelihood of desired participant changes.