making a difference with youth, families and communities partnerships in prevention science...
TRANSCRIPT
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Making a Difference withYouth, Families and Communities
Partnerships in Prevention Science InstituteIowa State University
October, 2005
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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/ScientistsK. 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 CoordinatorsE. Berrena, M. Bode, D. Broshar, B. Bumbarger,
K. James, J. Meek, C. Tomaschik
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Funding Agencies
• National Institute on Drug Abuse
• National Institute of Mental Health
• National Institute on Alcohol Abuse and Alcoholism
• Center for Substance Abuse Prevention
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1. Mission and Background
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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.
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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.
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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
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Conceptual Framework and Partnership Model
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External Resource Agents
from Community/State University
Local Linking Agentsfrom Extension
System
Internal Capacity Agents
from Public Schools
Framework for State Public Education Systems Approach to
“Science-with-Practice”
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.
University/Prevention Coordinator Teams
Local Community Team
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PROSPER—Organizational Structure for State Public Education Partnerships
University/State-Level TeamUniversity Researchers, Extension Program Directors
Prevention Coordinator TeamExtension Prevention Coordinators
Local Community TeamsExtension Agent, Public School Staff,
Social Service Agency Representatives, Parent/Youth Representatives
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2. Illustrative Findings: Effectiveness in—
A. Delivery of Community-Level, Evidence-Based Interventions (EBIs)
B. Producing Positive Community-Level Outcomes through Partnership-Delivered EBIs
C. Quality Implementation of Rigorous Intervention Studies
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A.Partnership Effectiveness in Delivery of Community-level EBIs
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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
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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.
91% 90%
0
10
20
30
40
50
60
70
80
90
100
Aver
age
% A
dher
ence
Family Programs
School Programs
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Partnership-Based Delivery Results—Family Program Retention/Participation LevelsStrengthening Families Program Family Session Attendance
95.8% 95.2% 95.2%
91.6%
65.9%
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
3 or moresessions
4 or moresessions
5 or moresessions
6 or 7sessions
All 7sessions
% Enrolled Families Attendin
g
*Enrolled families are those that signed up and attended at least one session.
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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!
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Partnership-Based Delivery Results—Harambee Cultural Adaptation Pilot Study
• 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
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.
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B. Positive Community-Level Outcomes Through
Partnership-Delivered EBIs
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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
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0
0.2
0.4
0.6
0.8
1
0 months
(Pretest)
6 months
(Posttest)
18 months
(Grade 7)
30 months
(Grade 8)
48 months
(Grade 10)
72 months
(Grade 12)
Fir
st
Tim
e P
rop
ort
ion
Trajectory for ISFP Condition
Trajectory for Control Condition
Results—Partnership-Based Outcome StudiesLongitudinal Growth of First-Time Drunkenness
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.
Lifetime Drunkenness Through 6 Years Past Baseline: Logistic Growth Curve
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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.
Lifetime Marijuana Use Through 6 years Past Baseline: Logistic Growth Curve
0
0.05
0.1
0.15
0.2
0.25
0 months(Pretest)
6 months(Posttest)
18 months(Grade 7)
30 months(Grade 8)
48 months(Grade 10)
72 months(Grade 12)
Pro
port
ion
Trajectory for ISFP Condition
Trajectory for Control Condition
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Results—Partnership-Based Outcome Studies
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.
15.3
17.5
15.7
17.9
15.5
17.8
13
14
15
16
17
18
19
10% Lifetime Marijuana Use
50% Lifetime Cigarette Use
50% Lifetime Drunkenness
Control Condition
Partnership-based IowaStrengthening FamiliesProgram Condition
Ag
e
Average Teen Age in School Districts When Stated Prevalence Levels are Reached—From 6-Year Follow-up
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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
38.0
58.8
25.231.5
47.9
8.1
0
10
20
30
40
50
60
70
Pretest 2-5
Years**
Pretest-4 years
Pretest-6 years**
Pe
rce
nta
ge
Control Transition ISFP Transition
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0
1
2
3
4
5
6
7
8
%
Past Year Use Lifetime Use--Past Year Plus Prior Use
ISFP ControlStudy 1 (12th Grade)
SFP+LST ControlStudy 2 (11th Grade)
7.61
2.12
2.633.21
4.59
Results—Partnership-Based Meth Outcomes of Universal Interventions
Source: Spoth, et al. (2005). Two randomized studies of the long-term effects of brief, partnership-based universal preventive interventions on adolescent methamphetamine use
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
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0.2
0.5
0.8
1.1
1.4
0 months(Pretest)
6 months(Posttest)
18 months (7th Grade)
30 months (8th Grade)
48 months(10th Grade)
Ag
gre
ss
ion
-Ho
sti
lity
Ind
ex
--O
bs
erv
er
Ra
ted
ISFP
Control
Results—Partnership-Based Outcome StudiesObserver-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.
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4.1
11.2
4.1
9.9
2
4
6
8
10
12
%
Conduct Disorder Antisocial PersonalityDisorder
ISFP Condition
Control Condition
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.
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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.
Results—Differential Effects on Girls and Boys Internalizing Symptoms
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0 6 12 18 24 30 36 42 48 54 60 66 72
Months from Posttest
An
xio
us/
De
pre
sse
d S
ynd
rom
e
Intervention Girls Control Girls
Intervention Boys Control Boys
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Tested Model Results—Long-Term Effects of Public Education Partnership Program on Academic Success
• 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.eduSpoth, R., Randall, G. K. and others. Building family skills leads to long-term academic success. Manuscript in final preparation.)
Partnership-based Iowa Strengthening Families Program
Enhanced Positive
Parenting Behavior
Reduced Substance-
related Risk
Behaviors
IncreasedStudentSchool
Engagement
IncreasedStudent
AcademicSuccess
6th Grade 8th Grade 12th Grade
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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.
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$9.60
$11.34
$7.86
0123456789
10111213
*Actual Study Conditions 1 more case prevented/100 1 less case prevented/100
Do
llars
Retu
rned
Partnership-Based Strengthening Families Program: Benefit-Cost Ratios Under Different Assumptions
*Study Data indicate $9.60 returned for each dollar invested under actual study conditionsSource: 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.
Results—Delaying Onset of Alcohol Use Leads to Cost Savings
$9.60
$11.34
$7.86
0123456789
10111213
*Actual Study Conditions 1 more case prevented/100 1 less case prevented/100
Do
llars
Retu
rned
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C. Partnership Effectiveness inHigh-Quality Implementation of Rigorous Outcome Research
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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
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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
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3. Future Directions
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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)
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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
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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
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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!
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A Vision for PROSPER
Making a Difference
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Obesity PreventionFramework for Health-Promoting Public Education Partnership Network (HealthPEP Net): Design, Testing and Dissemination
Community-University Partnership Network(PROSPER Prototype)
DI
SS E M I N SOA T I N
SYT
EM
UPLB CI UE
TACDOI
N
Intervention Development Process● Scientifically-rigorous ● Ecological ● Consumer-oriented
Testing/Implementation
Design SustainedDissemination
S
*From “Obesity and Youth” Regional Conference at Iowa State University (R. Spoth)
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Making a Difference with a National Network of
Partnerships
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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
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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
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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)
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