Partnership Intervention Research Articles

Experiencing success: an occupational therapy partnership programme. Gymnastics for children with attention deficit hyperactivity disorder

Purpose This paper aims to outline and evaluate a pilot partnership programme – an Occupational Therapy–led gymnastics group intervention for children aged eight to twelve with a diagnosis of attention deficit hyperactivity disorder (ADHD). Design/methodology/approach The overall aim of this programme was to increase participation in a valued leisure occupation. Based on the needs of the children, a physical-activity-based intervention was chosen that was challenging, novel and motivating. The intervention was then developed to target executive functioning and processing skills; enhance motor coordination skills; develop social skills; and primarily provide a positive experience. Seventeen children attended 75-minute sessions weekly for eight weeks. The programme was evaluated using non-standardised qualitative measures – parent, child and coach evaluation questionnaires were developed by the occupational therapist for this purpose. Findings Children engaged well in the programme with results showing increased participation and enjoyment of a new leisure occupation; improvement in social interaction levels and a sense of belonging; and development of motor and process skills. The results demonstrate the benefit of a partnership approach and suggest sustainability of the programme as well as the gains made. Originality/value The results of this evaluation suggest that the programme met its aims and supports further research into the efficacy of this type of partnership approach and intervention in supporting children with ADHD attending Child and Adolescent Mental Health Services.

Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation.

Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation.

Effects of a family dyadic partnership program for people with hypertension in a rural community: A pilot randomised controlled trial.

To evaluate the feasibility, acceptability and preliminary effectiveness of a theory-based patient-family carer partnership intervention for people with hypertension in a Chinese rural community. A pilot randomised controlled trial using pretest and post-test design. Rural China PARTICIPANTS: Forty-four hypertensive patients and their family carers (family dyads) were randomly recruited from a village clinic located in China between November 2019 and January 2020. Participants were randomised to either an intervention group receiving a five-session patient-family carer partnership intervention over 10weeks or a control group receiving usual care. The feasibility and acceptability of patient-family carer partnership intervention and the changes in patients' systolic blood pressure, diastolic blood pressure and percentage of normal controlled blood pressure. The patient-family carer partnership intervention was a feasible and acceptable program with high recruitment (81.5%) and completion rates (95.5%) and positive feedback from participants. Greater improvement in the percentage of normal controlled blood pressure was identified in the intervention group tested by the χ2 tests, with P=.03. Two-way ANOVA results indicated its interaction (Group×Time) effects on patients' systolic blood pressure (P<.001), diastolic blood pressure (P<.001), dyadic partnership quality (P=.002), self-care (P<.001), self-efficacy (P=.02), antihypertensive drug treatment rate (P=.02), prescription adjustment (P=.03), perceived anxiety (P<.001) and health-related quality of life (EuroQol five-dimensional five-level: P=.02; EuroQol visual analogue scale: P<.001); family carers' dyadic partnership quality (P=.002), perceived depression (P=.04) and health-related quality of life (P=.02) were significant. Our findings support the feasibility and acceptability of the patient-family carer partnership intervention and indicate benefits in improving patients' blood pressure control, dyadic relationship and psychological well-being of family dyads in rural area. Further research to test the longer-term effect in a large-sized population is recommended.

Stakeholder perspectives on the effectiveness of the Victorian Salt Reduction Partnership: a qualitative study

BackgroundInterventions to reduce population salt intake are feasible and cost-effective. The Victorian Salt Reduction Partnership implemented a complex, multi-faceted salt reduction intervention between 2014 and 2020 in the Australian state of Victoria. This study aimed to understand stakeholder perspectives on the effectiveness of the Victorian Salt Reduction Partnership.MethodsSemi-structured interviews were conducted with Partnership and food industry stakeholders. The Consolidated Framework for Implementation Research was adapted for the Partnership intervention and used to guide the qualitative analysis.ResultsFourteen Partnership and seven food industry stakeholders were interviewed. The Partnership was viewed as essential for intervention planning and decision-making and an enabler for intervention delivery. The goals of capacity building and collaborative action were perceived to have been achieved. The implementation team executed intended intervention activities and outputs, with some adaptations to strategy. Barriers and enablers to implementation were identified by interviewees, such as compatibility of individual, organisational and Partnership values and building positive relationships between the Partnership and food industry, respectively. Legal, political, social, environmental, technological and economic factors affecting intervention design, delivery and outcomes were identified.ConclusionsEstablishing a Partnership with diverse skills and experience facilitated collaborative action, capacity building and execution of the intervention. Monitoring and evaluating implementation informed strategy adaptations, which allowed optimisation of Partnership strategy. The importance of developing strong communication networks between strategic and implementation-levels was a key lesson.

Differential impacts of COVID-19 across racial-ethnic identities in persons with opioid use disorder

ObjectiveThe COVID-19 pandemic has exacerbated health disparities, particularly among at-risk people with opioid use disorder (OUD). We sought to characterize the direct and indirect impacts of COVID-19 on this group to understand how the pandemic has affected this group, this group's public health response to COVID-19, and whether there were differences by race/ethnicity. MethodsThis study recruited its sample from a drug treatment setting in the northeast region of the United States. We surveyed 110 individuals on methadone as treatment for OUD and assessed COVID-19-related impacts on their health behaviors and other indices of social, physical, and mental well-being, including sexual health behaviors, substance use, mental health status, health care access, income, and employment. ResultsOur findings highlight overall increases in depression, anxiety, loneliness, and frustration among the sample of people with OUD; the study also observed decreases in financial stability. Significant differences between groups indicated a greater financial burden among racial-ethnic minorities; this subgroup also reported greater direct adverse effects of COVID-19, including being more concerned about contracting COVID-19, not being able to get a COVID-19 test, and knowing someone who had died from COVID-19. A greater proportion of Whites indicated increases in alcohol consumption and non–prescription drug use than did racial-ethnic minorities. ConclusionsTreatment providers must be vigilant in managing direct and indirect outcomes of COVID-19 among people with OUD. Findings highlight the need to develop culturally competent, differentiated interventions in partnership with community-based organizations to meet the unique challenges that the COVID-19 pandemic presents for people in treatment for OUD.

Social Profit of Legal Metrology in the Brazilian Electricity Sector

In Brazil, despite of the undeniable importance of metrology in society, there is still no consensus as to the most effective way to “quantify” this statement. The aims of this study is to present a method to quantify the social impact caused by legal metrological control, focusing on voluntary verification and legal metrology expertise in electrical energy meter . In this sense, this article presents a model, developed exclusively for the public sector, with the objective of quantifying the return or economy in favor of society through National Legal Metrology System direct and indirect actions in the Brazilian electricity sector, considering the 2017 year. This model is an adaptation of Social Profit mode the “Brazilian Agricultural Research Corporation – Embrapa”. . Only laboratories under the control of the Legal Metrology Board, through their delegated bodies, which perform or supervise voluntary checks and metrological examinations performed by the technicians of the Brazilian Network of Legal Metrology and Quality – RBMLQ, were considered. Next step, performance indicators were proposed and validated to obtain social profit. The data show that Inmetro’s actions enable a return to society of US$ 32 million for each US$ 1 million of investment in this activity, pointing to the effectiveness of the model in quantifying the social profit of the agency. In a more detailed analysis it was possible to evaluate a potential revenue recovery for the states, throughTaxes, of the order of US$ 400 million, if the actions of expertise and verification are intensified, pointing to a promising horizon of revenue increase for the Brazilian government through the fight against fraud. Preliminary analyzes show both the massive presence and extreme remoteness of the state are not the best management models to be adopted for the electricity sector. The study suggests, at first, a direct correlation of Inmetro intervention and participation actions in partnership with the private sector in the electricity sector and revenue recovery with reduction in the increase of electric bills. Thus, we infer that the presence of the state as regulator in this case can be effective if adapted to reality. Further studies, however, need to be done. Social profit proved to be effective for use in actions to improve public governance, another point to be explored further on.

Accelerating Early Language and Literacy Skills Through a Preschool-Home Partnership Using Dialogic Reading: a Randomized Trial

This study tested a preschool-home partnership intervention, in which early childhood teachers encouraged the parents/caregivers of preschoolers to engage in dialogic reading at home. This was an experimental test of Bronfenbrenner’s hypothesis that parental involvement in early care and education programs should promote child development, as well as a test of a train-the-trainer approach to the dialogic reading intervention. The current study focuses on testing the causality of parent involvement: (1) homework assigned to parents/caregivers will improve the early language and literacy skills of their 2 ~ 3-year-old children; (2) gains by children in the intervention group with low pre-test language and literacy score, low family literacy score, and high parents/caregivers’ extent of using dialogic reading strategies at home will show larger gains in literacy scores than their counterparts. A sample of 12 early care and education programs, 18 early childhood teachers, 87 two–to three-year-old children and their parents/caregivers were followed for 18 ~ 20 weeks after assignment to the intervention group or the control group. The impacts of the six-week parent involvement intervention continued to grow during the six-week follow-up phase, and represented substantial gains of the intervention group in four aspects of early language and literacy skills. This study provides evidence that a simple homework assignment intervention can be an effective tool to promote child development when parents/caregivers are engaged. The intervention also had ongoing influence on children’s early language and literacy skills, even after the intervention period had ended.

Dementia and Falls Management in Underserved Populations: The Cognition and Mobility Care Management Program.

Cognitive and mobility impairments are common and underdiagnosed chronic conditions that afflict community-dwelling older adults. This study describes the organization, implementation, and evaluation of an intervention for underserved and ethnically diverse older patients with dementia and/or falls risk. Observation, baseline and 1 year after intervention. Community-based primary care county clinics in inland southern California. A total of 272 persons, aged 70 years and older, who screened positive for falls and/or dementia and enrolled in the Cognition and Mobility Care Management program during the study period. A nurse care manager performed a patient and caregiver evaluation and created and implemented a care plan with medical, behavioral, and psychosocial interventions in partnership with patients and their primary care providers. Process outcomes included rates of positive screening for dementia and fall risk, referral, enrollment, and visit completion. Patient outcomes included fall history, mobility and cognitive assessments, and depression scales. Patients and/or caregivers completed questionnaires rating perceived benefits of enrollment after 1 year in the program. Medical assistants screened 573 patients aged 70 years and older during the study period; 78% screened positive for dementia and/or fall risk. Of the patients who screened positive, 94% were referred; 91% of contacted patients elected to enroll, and 272 patients completed an intake visit (meanage = 77 years; 65% female; 75% Latino; 10% African American). The patients and caregivers who completed satisfaction questionnaires 1 year after enrollment rated the program highly, and 92% would recommend the program to others. A primary care-based screening and comanagement program to identify and manage dementia and falls risk in primarily Latino and African American older adult patients living in an underserved area was well received, with high satisfaction and perceived benefit from patients and caregivers.

Implementing Play Streets in Low-Income Rural Communities in the United States.

Play streets involve the temporary closure of streets that for a specified time create a safe place for active play. Play streets have been implemented primarily in cities; it is unknown if they could be adapted and implemented in rural areas. To learn about implementation, core components of play streets and inform adaptation, we conducted systematic peer-reviewed and grey literature searches and interviews with a purposive sample of key informants. Data were analyzed by theme and used to inform implementation of play streets by four community organizations in low-income rural areas of Maryland, North Carolina, Oklahoma, and Texas from June to September 2017. Core elements of play streets in urban areas were present in rural settings-the content (e.g., activities offered), delivery of the intervention in partnership with community members and local organizations, and reoccurrence of play streets at a single location. There were three key adaptations relating to delivery and context to consider uniquely when implementing play streets in rural areas (1) using locations other than streets, (2) varying locations to account for geographic dispersion, and (3) maximizing participation and resources by coupling play streets with community events. Play streets can be successfully implemented in rural settings with these modifications, which support feasibility, reach, and access. Play streets in rural areas should include activities for active play that are age-appropriate and fun, without necessarily tailoring content for rural areas.

Os cuidados em parceria com a pessoa idosa/familiar cuidador para prevenção da desnutrição após gastrectomia

Introduction: In the process of nursing care for the elderly undergoing gastrectomy, the intervention in partnership, based on a personalized plan is crucial to avoid complications, namely in preventing malnutrition in the elderly and the preparation of their return home to prevent readmissions. Objetives:Prevent malnutrition in the elderly undergoing gastrectomy and prepare for their return home. Methods: Intervention project using the project methodology, carried out in a Central Hospital in Lisbon. It involved 8 elderly people who underwent gastrectomy, family caregivers and 39 nurses. Data were collected through document analysis, observation of practices and interviews, and were analyzed using descriptive statistics and content analysis. Results: New practices were introduced in the nursing team, ensured to all clients: detailed and individualized record of the information collected in the initial assessment, assessment of the malnutrition status, initial and final weighing and articulation with other professionals of the multiprofessional team. The nutritional assessment (with MNA scale) of the elderly revealed that five were at risk of malnutrition and one was already in a state of malnutrition. The weight assessment started to be carried out on the 1st day of hospitalization and at the end of hospitalization, revealing a negative variation of 1.81 kg. Conclusions: The partnership intervention allowed care centered on the elderly. There was a restructuring of care that allowed nurses to get to know the elderly better and to detect cases of malnutrition and prepare the transition process for home.

Promoting Parent Partnership in Developmentally Supportive Care for Infants in the Pediatric Cardiac Intensive Care Unit.

Limited opportunities for parents to care for their critically ill infant after cardiac surgery can lead to parental unpreparedness and distress. This project aimed to create and test a bedside visual tool to increase parent partnership in developmentally supportive infant care after cardiac surgery. The Care Partnership Pyramid was created by a multidisciplinary team and incorporated feedback from nurses and parents. Three Plan-Do-Study-Act (PDSA) cycles tested its impact on parent partnership in care. Information about developmentally supportive care provided by parents during each 12-hour shift was extracted from nursing documentation. A staff survey evaluated perceptions of the tool and informed modifications. Changes in parent partnership during PDSA 1 did not reach statistical significance. Staff perceived that the tool was generally useful for the patient/family but was sometimes overlooked, prompting its inclusion in the daily goals checklist. For PDSA 2 and 3, parents were more often observed participating in rounds, asking appropriate questions, providing environmental comfort, assisting with the daily care routine, and changing diapers. Use of a bedside visual tool may lead to increased parent partnership in care for infants after cardiac surgery. Future projects are needed to examine the impact of bedside care partnership interventions on parent preparedness, family well-being, and infant outcomes.

Assessing the impact of a family nurse-led intervention on young mothers' references to internal states.

ABSTRACTA mother's propensity to refer to internal states during mother–child interactions is important for her child's developing social understanding. However, adolescent mothers are less likely to reference internal states when interacting with their children. We investigated whether young mothers’ references to internal states are promoted by the Family Nurse Partnership (FNP) intervention, an intensive home‐visiting programme designed to support adolescent mothers in England. We also investigated family, maternal, and child factors associated with young mothers’ references to inner states during interactions with their children. Adolescent mothers (n = 483, aged ≤ 19 years when recruited in pregnancy) and their children participated in an observational substudy of a randomized controlled trial investigating the impact of FNP compared to usual care. Mother–child dyads were video‐recorded during free play, and mothers’ speech was coded for use of internal state language (references to cognitions, desires, emotions, intentions, preferences, physiology, and perception). We found no differences in mothers’ use of internal state language between the FNP and usual care groups. A sample‐wide investigation identified that other features of mothers’ language and relationship status with the child's father were associated with internal state language use. Findings are discussed with reference to targeted interventions and implications for future research.

A developmental evaluation of an intraprofessional Pharmacy Communication Partnership (PROMPT) to improve transitions in care from hospital to community: A mixed-methods study

BackgroundPeople transitioning from hospital- to community-based care are at increased risk of experiencing medication problems that can lead to adverse drug events and poor health outcomes. Community pharmacists provide medication expertise and support during care transitions yet are not routinely included in communications between hospitals and other primary health care providers. The PhaRmacy COMmunication ParTnership (PROMPT) intervention facilitates medication management by optimizing information sharing between pharmacists across care settings. This developmental evaluation sought to assess the feasibility and acceptability of implementing the PROMPT intervention, and to explore how contextual factors influenced its implementation.MethodsPROMPT was implemented for 14 weeks (January–April, 2018) in the general internal medicine units at two teaching hospitals in Toronto, Canada. PROMPT featured two contact points between hospital and community pharmacists around patient discharge: (1) faxing an enhanced discharge prescription and discharge summary to a patient’s community pharmacy and (2) a follow-up phone call from the hospital pharmacist to the community pharmacist. Our mixed-method evaluation involved electronic patient records, process measures using tracking forms, telephone surveys and semi-structured interviews with participating community and hospital pharmacists.ResultsThe intervention involved 45 patients with communication between 12 hospital and 45 community pharmacists. Overall, the intervention had challenges with feasibility. Issues with fidelity included challenges with the medical discharge summary being available at the time of faxing and hospital pharmacists’ difficulties with incorporating novel elements of the program into their existing practices. However, both community and hospital pharmacists recognized the potential benefits to patient care that PROMPT offered, and both groups proposed recommendations for further improvements. Suggestions included enhancing hospital staffing and resources.ConclusionImproving intraprofessional collaboration, through interventions such as PROMPT, positions pharmacists as leaders of medication management services across care settings and has the potential to improve patient care; however, more co-design work is needed to enhance the intervention and its fidelity.

The impact of a Stress Control course delivered in partnership with a sports organisation on mental health outcomes in a general population

Abstract Mental health problems have a significant impact globally in terms of social and economic costs. Increasing access to and uptake of mental health interventions (particularly by men) remains a challenge for service providers. The current study sought to examine the efficacy of a delivering a Stress Control intervention in partnership with a community sporting organisation (the Gaelic Athletic Assocaition, GAA) in ameliorating mental health difficulties in a general population. Measures of anxiety, depression and quality of life were administered before and after the delivery of the 6-week programme. A focus group was conducted afterwards to gather qualitative data on participants’ experiences of the intervention. Statistically significant decreases in depression scores were found following attendance at the course: t (94) = 3.14, p = .002, with a large effect size (0.5) (n = 95). There was an increase in the number of male attendees compared with clinic-based courses. Thematic analysis of the focus group data revealed a number of key themes including increased accessibility in terms of the scale and context of the delivery of the course. Delivering large-scale psychoeducational courses like Stress Control in partnership with the GAA represents a promising avenue for increasing access (for males in particular) to an effective intervention for improving mental health outcomes Key learning aims (1) To gain an understanding of the impact of delivering a large-scale psychological intervention in partnership with a community sports organisation on accessibility and stigma reduction for participants. (2) To become aware of the potential benefits of considering non-clinic-based locations in running public mental health interventions. (3) To understand the key role of the normalisation of the experience of common mental health problems and the impact on intervention uptake.

The Effects of Family-School Partnership Interventions on Academic and Social-Emotional Functioning: a Meta-Analysis Exploring What Works for Whom

Family-school partnership (FSP) interventions capitalize on connections between families and schools, as parents and teachers jointly promote child development through activities that bridge both settings. The current meta-analysis assessed the effects of FSP interventions on children’s academic and social-emotional competencies. From initial comprehensive search procedures (i.e., online reference databases, hand searches of relevant journals, and cited references) yielding over 19,000 abstracts, our study sample included 77 FSP intervention studies with 438 effect sizes. Studies including the following comprised our final sample: (1) an FSP intervention, (2) school-aged children, (3) academic and/or social-emotional outcomes, (4) a naturalistic setting, and (5) an experimental or quasi-experimental group design. Utilizing robust variance estimation (RVE), results revealed that FSP interventions significantly and positively impacted children’s academic achievement (δ = .25 ) and behaviors (δ = .30), social-behavioral competence (δ = .32), and mental health (δ = .34). Additionally, particular structural (i.e., home-based involvement) and relational (i.e., school to home communication, collaboration, bi-directional communication) components significantly contributed to FSP intervention effects. Mixed-effects meta-regression analyses were used to assess if effects of FSP intervention components were moderated by children’s grade or race/ethnicity. Results indicated that certain FSP intervention components (i.e., bi-directional communication, behavioral support) were more effective for older students. No significant moderation effects were found race/ethnicity, indicating that FSP intervention components were effective across participants. Overall, findings provide further support for the use of FSP interventions to support youth outcomes. Future meta-analyses should include single-case design studies and explore unique combinations of FSP intervention components.

Conjoint Behavioral Consultation for Students Exhibiting Symptoms of ADHD: Effects at Post-treatment and One-Year Follow-Up

Both behavioral and pharmacological interventions have short-term efficacy for reducing symptomology of attention-deficit/hyperactivity disorder (ADHD). However, intervention effects typically dissipate once interventions are removed. Scholars have advocated for a life-course model of intervention to sustain outcomes for students with ADHD. This model of service delivery is collaborative, individually tailored, and responsive to the culture and context of the student. Conjoint behavioral consultation (CBC) is a family–school partnership intervention that is consistent with a life-course model and has demonstrated efficacy in the short- and long-term reductions of problem behaviors; however, little is known about the efficacy of CBC for students with ADHD specifically. The present study sought to evaluate the efficacy of CBC for students exhibiting symptoms of ADHD immediately following treatment and 12 month later using data from a larger randomized controlled trial. Results indicated that students in the CBC condition (n = 29) had significantly lower parent ratings of hyperactivity and behavioral symptoms at post-treatment relative to students in the “business as usual” control condition (n = 16). However, at follow-up, differences were no longer statistically significant. Additionally, although both groups demonstrated significant improvements in teacher-reported attention problems at post-treatment, students in the control group had significantly lower scores at follow-up. Implications for the use of CBC for students with ADHD symptomology and future research directions are discussed.

Challenges of Youths Involved in Fish Farming in the Federal Capital Territory, Abuja, Nigeria

This study determined the challenges of youths involved in fish farming in the Federal Capital Territory, Abuja, Nigeria. Multi-stage sampling procedure was used to select and interview a total of 54 youth fish farmers’from18 villages in three area councils of the FCT, Abuja. Results of the analysis were presented using percentage, frequency counts, and mean scores. Results reveal that majority (57.4%) of the respondents had fish farming as their major occupation. The majority (87%) of respondents adopted the monoculture system of fish production. However, the major challenges faced by the youths were high cost of feed ( =2.76) and poor access to credit facilities ( =2.17). The farmers’ perceived solutions to the challenges were access to loans and grants, provision of feed subsidy, access to affordable land, provision of infrastructure (such as good roads, better markets, and better power supply), proper training of fish farmers on management practices, increased research and extension services. The study points to the need for public-private partnership intervention geared towards improving the entrepreneurial drive of the youths through focused training and other empowerment activities to enable them address the challenges facing fish farmers in the area.Keyword: Youth fish farming, federal capital territory Abuja

The holistic assessment and care planning in partnership intervention study (HAPPI): A protocol for a feasibility, cluster randomized controlled trial

During an initial phase of this research, an e-Delphi survey was conducted to gain consensus among stakeholders on the components of a nurse-led assessment and care planning intervention for older people who live with frailty in primary care. This feasibility randomized controlled trial (fRCT) will test the proposed intervention and its implementation and determine methods for the design of a conclusive randomized controlled trial. The fRCT, with embedded qualitative study, aims to recruit 60 participants. Moderately and severely frail older people will be identified using the electronic frailty index (eFI) and the intervention will be delivered by senior community nurses. The control participants will receive usual primary care for frailty. The study is funded by the National Institute of Health Research (NIHR; funding granted in May 2016, ref: ICA-CDRF-2016-02-018) and received NHS and University Research Ethics Committee approval in 2018. There is evidence that the delivery of complex interventions for community-dwelling older people can reduce care home and hospital admissions and falls, there is less evidence for the benefit of any specific type or intensity of intervention or the additional benefits of targeting the frail population. This trial will determine feasibility of the intervention, define recruitment and retention parameters and trial logistics, and decide outcome measures. This study aims to address the limitations of current research by using a systematic method of frailty diagnosis and participant identification, trialling implementation of a person-centred intervention, and testing of feasibility parameters. ISRCTN: 74345449.

Addressing county lines: praxis for community safety practitioners

PurposeCounty lines involving the exploitation of vulnerable children and young people by gangs have been described as a bigger threat than the exploitation exposed by the Rotherham scandal (The Times, 27 November 2017). The purpose of this paper is to explain the contingencies and drivers informing gang identities in the irregular economy of drugs and make some suggestions to address these.Design/methodology/approachThe paper discusses the social reality (ontology) of UK gangs in the UK and the different theories of knowledge about gangs (epistemologies) that can both help and hamper gangs’ policy and practices. The paper is based on recent research and sets out strategic ideas for good community safety practice in order to develop multi-modal partnership interventions in gang-affected neighbourhoods. Recent policies are located within the broader political economy of crime, which raises questions of current policy direction to achieve safer neighbourhoods.FindingsA critical realist approach to gangs (Pitts, 2016) assumes that unobservable structures (patterns of relations and roles) cause observable events (gang behaviour). This suggests a reality of gangs independent of theories about them. In this paradigm, the author’s theories about the world are historically, socially and culturally situated and always partial. Not only do gangs change in space and time, but also so do the author’s representations of them.Research limitations/implicationsArguably, at this moment, the authors’ best ideas about the underlying causal forces which precipitate gangs involve social structures which have push and pull factors acting in conjunction with culturally enmeshed individuals with limited choices. The pushes of social exclusionary factors such as institutional racism and unemployment act in consort with pull factors of excessive consumerism. However, the author’s ideas about gangs are partial and fallible, and this demands a methodological pluralism that involves a range of stakeholders when researching and formulating appropriate interventions.Practical implicationsTo address the impact of gang violence at the micro or neighbourhood level, Andell and Pitts (2009, 2013, 2017) developed an interactive model of action research which is inclusive of the experiences and knowledge of stakeholders. This knowledge can be valuable not only to build multi-modal strategies in gang-affected neighbourhoods, but can also be useful as a reflexive spur to provide feedback and direction on what works to reduce community harms. Earlier research experience (Andell and Pitts 2009, 2013, 2017) informs ideas that that single agency or “siloed” approaches to problems associated with gangs and drug markets can cause confusion and mistrust for other stakeholders and that more integrated approaches are needed.Social implicationsIn order to assist young people to attain their potential with the assistance of institutions, both micro and macro changes need to take place. The social capital of community networks needs to be enhanced and the redistributive potential of economic policy needs to be enacted. Therefore, policy is needed which is founded on the belief that research is capable of understanding the mechanisms that produce material and cultural domination, and this analysis, in conjunction with stakeholder knowledge, could lead to a realistic program for collective actions in both the micro and macro spheres that reduce relative deprivation and curb the cultural mores for excess.Originality/valueThe paper suggests a critical realist approach to gangs (Pitts, 2016) and assumes that unobservable structures (patterns of relations and roles) cause observable events (gang behaviour). This imputes a reality of gangs independent of theories about them. In this paradigm, the author’s theories about the world are historical, socially and culturally situated and always partial. Not only do gangs change in space and time, but also so do the author’s representations of them.

Conjoint behavioral consultation in rural schools: Do student effects maintain after 1 year?

Challenging behavior problems are common in early childhood and, if left untreated, may escalate into more severe and intractable problems in adolescence and early adulthood. This trajectory is of particular importance in rural schools, where disruptive behaviors are more prominent than in urban and suburban schools. Conjoint behavioral consultation (CBC) is a family-school partnership intervention with documented efficacy in producing immediate decreases in child problem behaviors and increases in child adaptive behaviors and social skills. The purpose of the present study was to determine whether the immediate effects of CBC maintain over a 1-year follow-up period. Participants at study enrollment were students (N = 267) and their parents, as well as both the students' original (N = 152) and subsequent (N = 135) teachers in 45 Midwest rural schools. At the time of initial study enrollment, students were assigned randomly to an active CBC intervention or "business as usual" control condition. Results demonstrated that immediate effects of parent-rated adaptive and social skills and teacher-rated school problems were maintained at the 1-year follow-up. Additionally, for parent-rated adaptive skills and teacher-rated school problems, improvements during the maintenance phase were statistically equivalent to gains in the control group. However, increases in parent-rated social skills for the control group during the follow-up phase significantly outpaced increases among the CBC group. Implications for use of CBC in rural communities, as well as future research directions, are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).