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Strategies for Scaling Effective Family- Focused Preventive Interventions to Promote Children’s Cognitive, Affective, and Behavioral Health Workshop Summary Margie Patlak, Rapporteur Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health Board on Children, Youth, and Families PREPUBLICATION COPY: UNCORRECTED PROOFS

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by contracts between the National Academy of Sciences and the American Academy of Pediatrics (Unnumbered Award); the American Board of Pediatrics (Unnumbered Award); the Annie E. Casey Foundation (213.0427); Autism Speaks (Unnumbered Award); the Centers for Disease Control and Prevention (200-2011-38807, TO #16); the National Institutes of Health (HHSN26300035); the Department of Justice-Office of Juvenile Justice and Delinquency Prevention (2013-MU-MU-0002); the Robert Wood Johnson Foundation (71071); the Substance Abuse and Mental Health Services Administration (HHSP233201300244P); and the William T. Grant Foundation (182528). Additional support came from the American Orthopsychiatric Association, the American Psychological Association, the Hogg Foundation for Mental Health, the Society for Child and Family Policy and Practice, the Society of Clinical Child and Adolescent Psychology, and the Society of Pediatric Psychology. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. Library of Congress Cataloging-in-Publication Data or International Standard Book Number 0-309-0XXXX-X Library of Congress Catalog Card Number 97-XXXXX Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu/. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: Institute of Medicine (IOM) and National Research Council (NRC). 2014. Strategies for scaling effective family-focused preventive interventions to promote children’s cognitive, affective, and behavioral health: Workshop summary. Washington, DC: The National Academies Press. PREPUBLICATION COPY: UNCORRECTED PROOFS

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org PREPUBLICATION COPY: UNCORRECTED PROOFS

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MEMBERS OF THE PLANNING COMMITTEE FOR THE WORKSHOP ON STRATEGIES FOR SCALING TESTED AND EFFECTIVE FAMILY-FOCUSED PREVENTIVE INTERVENTIONS TO PROMOTE CHILDREN’S COGNITIVE, AFFECTIVE, AND BEHAVIORAL HEALTH1 J. DAVID HAWKINS (Chair), Director, Social Development Research Group, Social Work Endowed Professor of Prevention, University of Washington School of Social Work WILLIAM R. BEARDSLEE, Director, Baer Prevention Initiatives, Chairman Emeritus, Department of Psychiatry, Boston Children’s Hospital, and Gardner/Monks Professor of Child Psychiatry, Harvard Medical School DARA BLACHMAN-DEMNER, Social Science Analyst, Crime, Violence, and Victimization Research Division, National Institute of Justice UMA KOTAGAL, Senior Vice President for Quality, Safety and Transformation, and Executive Director, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center MARY ANN MCCABE, Society for Child and Family Policy and Practice, Society of Pediatric Psychology, Associate Clinical Professor of Pediatrics, School of Medicine George Washington University, and Affiliate Faculty in Psychology, George Mason University RUTH PEROU, Acting Mental Health Coordinator, Program Performance and Evaluation Office, Centers for Disease Control and Prevention EVE REIDER, Health Scientist Administrator, Prevention Research Branch, National Institute on Drug Abuse PAT SHEA, Deputy Director, Technical Assistance and Prevention, National Association of State Mental Health Program Directors ANDY SHIH, Senior Vice President of Scientific Affairs, Autism Speaks LAUREN SUPPLEE, Director, Division of Family Strengthening, and Social Science Research Analyst, Office of Planning, Research, and Evaluation, Administration for Children and Families, Department of Health and Human Services JOSÉ SZAPOCZNIK, Professor and Chair, Department of Public Health Sciences, Director, Miami Clinical Translational Science Institute, and Director, Center for Family Studies, University of Miami 1 IOM planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop rests with the workshop rapporteur and the institution. v PREPUBLICATION COPY: UNCORRECTED PROOFS

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FORUM ON PROMOTING CHILDREN’S COGNITIVE, AFFECTIVE, AND BEHAVIORAL HEALTH1 WILLIAM R. BEARDSLEE (Co-Chair), Director, Baer Prevention Initiatives, Chairman Emeritus, Department of Psychiatry, Boston Children’s Hospital, and Gardner/Monks Professor of Child Psychiatry, Harvard Medical School C. HENDRICKS BROWN (Co-Chair), Professor, Departments of Psychiatry, Behavioral Sciences, and Preventive Medicine, Northwestern University DARA BLACHMAN-DEMNER, Social Science Analyst, Crime, Violence, and Victimization Research Division, National Institute of Justice THOMAS F. BOAT, Christian R. Holmes Professor, Dean, College of Medicine, and Vice President for Health Affairs, University of Cincinnati FELESIA R. BOWEN, Assistant Professor, and Director, Center for Urban Youth, Rutgers College of Nursing DAVID A. BRENT, Academic Chief, Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, and Professor of Psychiatry, Pediatrics, and Epidemiology, School of Medicine, University of Pittsburgh DAVID A. CHAMBERS, Associate Director, Dissemination and Implementation Research, and Chief, Services Research and Clinical Epidemiology Branch, Division of Services and Intervention Research, National Institute of Mental Health WILMA PETERMAN CROSS, Senior Public Health Advisor, Office of Disease Prevention, National Institutes of Health LAUREN FASIG, Director, Children, Youth, and Families Office, and Public Interest Directorate, American Psychological Association COSTELLA GREEN, Branch Chief, Division of Community Programs, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Service Administration J. DAVID HAWKINS, Director, Social Development Research Group, Social Work Endowed Professor of Prevention, University of Washington School of Social Work KIMBERLY E. HOAGWOOD, Society of Clinical Child and Adolescent Psychology, American Psychological Association, and Professor and Vice Chair for Research, Department of Child and Adolescent Psychiatry, New York University School of Medicine COLLEEN HORTON, Policy Program Officer, Hogg Foundation for Mental Health, University of Texas, Austin UMA KOTAGAL, Senior Vice President for Quality, Safety and Transformation, and Executive Director, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center LAUREL K. LESLIE, Board of Directors, American Board of Pediatrics, Professor of Medicine and Pediatrics, Tufts University School of Medicine, and Director, Center for Aligning Researchers and Communities for Health, Tufts Clinical and Translational Science Institute 1 IOM forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. vi PREPUBLICATION COPY: UNCORRECTED PROOFS

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MARY ANN MCCABE, Society for Child and Family Policy and Practice, Society of Pediatric Psychology, Associate Clinical Professor of Pediatrics, School of Medicine, George Washington University, and Affiliate Faculty in Psychology, George Mason University JUSTIN MILNER, Senior Research Associate, Urban Institute WILLIAM MODZELESKI, Senior Consultant, SIGMA Threat Management Associates JENNIFER NG’ANDU, Program Officer, Robert Wood Johnson Foundation JENNIFER OPPENHEIM, Public Health Advisor, and Director, Project LAUNCH, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration LAWRENCE A. PALINKAS, Albert G. and Frances Lomas Feldman Professor of Social Policy and Health, and Director, Behavior, Health, and Society Research Cluster, School of Social Work, University of Southern California RUTH PEROU, Acting Mental Health Coordinator, Program Performance and Evaluation Office, Centers for Disease Control and Prevention EVE REIDER, Health Scientist Administrator, Prevention Research Branch, National Institute on Drug Abuse MARY JANE ROTHERAM-BORUS, Bat-Yaacov Professor of Child Psychiatry and Biobehavioral Sciences, Director, Global Center for Children and Families, and Director, Center for HIV Identification Prevention & Treatment Services (CHIPTS), Department of Psychiatry, University of California, Los Angeles PAT SHEA, Deputy Director, Technical Assistance and Prevention, National Association of State Mental Health Program Directors ANDY SHIH, Senior Vice President of Scientific Affairs, Autism Speaks JOSÉ SZAPOCZNIK, Professor and Chair, Department of Public Health Sciences, Director, Miami Clinical Translational Science Institute, and Director, Center for Family Studies, University of Miami VERA FRANCES TAIT, Associate Executive Director, Director, Department of Child Health and Wellness, American Academy of Pediatrics VIVIAN TSENG, Vice President of Programs, William T. Grant Foundation JENNIFER TYSON, Social Science Analyst, Office of Juvenile Justice and Delinquency Prevention, Department of Justice DONALD WERTLIEB, Professor Emeritus, Eliot-Pearson Department of Child Development, Tufts University Project Staff MORGAN A. FORD, Senior Program Officer KIMBER BOGARD, Board Director TARA MAINERO, Research Associate STACEY SMIT, Senior Program Assistant AMANDA PASCAVIS, Program Assistant REBECCA JONES, Christine Mirzayan Fellow (January-April 2014) vii PREPUBLICATION COPY: UNCORRECTED PROOFS

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REVIEWERS This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: Felesia R. Bowen, Rutgers College of Nursing Jennifer Wyatt Kaminski, Centers for Disease Control and Prevention Irwin Sandler, Arizona State University José Szapocznik, University of Miami Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Jeanne Brooks-Gunn, Columbia University. Appointed by the National Research Council and Institute of Medicine, she was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the author(s) and the institution. ix PREPUBLICATION COPY: UNCORRECTED PROOFS

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Contents 1 INTRODUCTION 1 Selection of Family-Focused Preventive Programs, 3 Organization of the Workshop Summary, 3 References, 5 2 SCALED-UP, EVIDENCE-BASED FAMILY-FOCUSED PREVENTIVE 7 PROGRAMS Nurse–Family Partnership, 7 The Incredible Years, 10 Triple P – Positive Parenting Program, 12 Keeping Foster and Kin Parents Supported and Trained (KEEP), 13 References, 14 3 EMERGING SETTINGS FOR IMPLEMENTING FAMILY-FOCUSED 17 PREVENTIVE PROGRAMS Pediatric Settings, 17 School and Home Settings, 22 Online Programs, 24 References, 28 4 INTERMEDIARY ORGANIZATIONS AND SCALE-UP 31 Invest in Kids, 31 Evidence-Based Prevention and Intervention Support (EPIS) Center, 32 Substance Abuse and Mental Health Service Administration Strategic Prevention Framework, 33 Project LAUNCH, 34 PROSPER, 35 New York State Office of Mental Health Clinic Technical Assistance Center, 36 REACH Institute, 36 Washington State Institute for Public Policy, 37 Summary of Intermediary Strategies to Aid Scale-Up, 38 References, 40 xi PREPUBLICATION COPY: UNCORRECTED PROOFS

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xii Contents 5 EXPANDING PROGRAMS INTERNATIONALLY 43 References, 45 6 SCALE-UP CHALLENGES 47 Lack of Demand, 47 Insufficient Organizational Capacity, 49 Lack of Sustainable Funding, 49 Factors Influencing Decision Making, 51 Other Challenges, 52 References, 53 7 MEETING SCALE-UP CHALLENGES 55 Building Demand, 55 Building Capacity, 58 Providing a Supportive Infrastructure, 59 Adapting and Improving Programs, 60 Monitoring Programs, 63 Building Sustainable Funding, 64 Overcome Organizational Silos, 66 Other Scale-Up Strategies, 67 Researching Implementation Strategies, 68 References, 69 8 SUM UP AND WAY FORWARD 71 References, 73 APPENDIXES A WORKSHOP AGENDA 75 B SPEAKER BIOSKETCHES 81 PREPUBLICATION COPY: UNCORRECTED PROOFS

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Tables, Figures, and Boxes TABLES 2-1 Consistent Results Across Nurse–Family Partnership Trials, 8 4-1 Summary Table of Intermediary Strategies to Aid Scale-Up of Evidence-based Family-Focused Prevention Programs, 38 FIGURES 2-1 Nurse–Family Partnership scale-up approach, 9 2-2 The Incredible Years® provider locations in the United States, 11 2-3 Scaling up delivery of The Incredible Years®: Countries where training occurs, 11 2-4 Triple P: Multi-level system, 13 3-1 Overview of Family Check-Up team’s systemic implementation model, 23 3-2 16 by16: Gestures commonly observed in children, by age in months, 26 3-3 Autism Navigator®: Free tools for the public, 27 4-1 PROSPER evolving community partnership sustainability model, 35 7-1 Family Check-Up model: An iterative translational research strategy, 61 7-2 Stages of implementation completion, 69 BOXES 1-1 Programs Presented at the Workshop, 4 xiii PREPUBLICATION COPY: UNCORRECTED PROOFS

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