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Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children’s Cognitive, Affective, and Behavioral Health WOR K SHOP SUMM ARY Margie Patlak, Rapporteur Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health Board on Children, Youth, and Families

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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 ap- proved 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 Preven- tion (200-2011-38807, TO #16); the Department of Justice Office of Juvenile Jus- tice and Delinquency Prevention (2013-MU-MU-0002); the National Institutes of Health (HHSN26300035); the Robert Wood Johnson Foundation (71071); the Sub- stance 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 Associa- tion, 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. International Standard Book Number-13:  978-0-309-30544-0 International Standard Book Number-10:  0-309-30544-6 Additional copies of this workshop summary are available for sale from the Na- tional 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 ad- opted 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 sum- mary. Washington, DC: The National Academies Press.

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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 Acad- emy 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 en- gineers. 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 engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is presi- dent 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 Insti- tute 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 Sci- ences 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

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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), 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, George Washington University School of Medicine, 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 and Director, Miami Clinical Translational Science Institute and Center for Family Studies, University of Miami 1  Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published work- shop rests with the workshop rapporteur and the institution. v

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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 and 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, 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 1  Institute of Medicine 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. vii

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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 MARY ANN McCABE, Society for Child and Family Policy and Practice, Society of Pediatric Psychology, Associate Clinical Professor of Pediatrics, George Washington University School of Medicine 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, University of Southern California School of Social Work 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 and Director, Global Center for Children and Families, 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 and Director, Miami Clinical Translational Science Institute and Center for Family Studies, University of Miami viii

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VERA FRANCES TAIT, Associate Executive Director and 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 TARA MAINERO, Research Associate STACEY SMIT, Senior Program Assistant AMANDA PASCAVIS, Program Assistant REBECCA JONES, Christine Mirzayan Fellow (January-April 2014) KIMBER BOGARD, Director, Board on Children, Youth, and Families ix

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Reviewers T his workshop summary has been reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent re- view is to provide candid and critical comments that will assist the institu- tion 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 the Institute of Medicine, she was respon- xi

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xii REVIEWERS sible 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 rapporteur and the institution.

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Contents 1 INTRODUCTION 1 Selection of Family-Focused Preventive Programs, 3 Organization of the Workshop Summary, 4 References, 5 2 SCALED-UP, EVIDENCE-BASED FAMILY-FOCUSED PREVENTIVE PROGRAMS 7 Nurse–Family Partnership, 7 The Incredible Years®, 10 Triple P-Positive Parenting Program, 11 Keeping Foster and Kin Parents Supported and Trained (KEEP), 15 References, 16 3 EMERGING SETTINGS FOR IMPLEMENTING FAMILY-FOCUSED PREVENTIVE PROGRAMS 19 Pediatric Settings, 19 School and Home Settings, 25 Online Programs, 28 References, 32 4 INTERMEDIARY ORGANIZATIONS AND SCALE-UP 35 Invest in Kids, 35 Evidence-Based Prevention and Intervention Support (EPIS) Center, 37 xiii

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xiv CONTENTS Substance Abuse and Mental Health Services Administration Strategic Prevention Framework, 38 Project LAUNCH, 39 PROSPER, 39 New York State Office of Mental Health Clinic Technical Assistance Center, 41 REACH Institute, 42 Washington State Institute for Public Policy, 42 Summary of Intermediary Strategies to Aid Scale-Up, 44 References, 46 5 EXPANDING PROGRAMS INTERNATIONALLY 47 References, 49 6 SCALE-UP CHALLENGES 51 Lack of Demand, 52 Insufficient Organizational Capacity, 53 Lack of Sustainable Funding, 54 Factors Influencing Decision Making, 56 Other Challenges, 57 References, 58 7 MEETING SCALE-UP CHALLENGES 59 Building Demand, 59 Building Capacity, 62 Providing a Supportive Infrastructure, 64 Adapting and Improving Programs, 65 Monitoring Programs, 69 Building Sustainable Funding, 70 Overcoming Organizational Silos, 72 Other Scale-Up Strategies, 74 Researching Implementation Strategies, 75 References, 76 8 SUM UP AND WAY FORWARD 79 References, 82 APPENDIXES A WORKSHOP AGENDA 83 B SPEAKER BIOSKETCHES 91

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Boxes, Figures, and Table BOXES 1-1 Programs Presented at the Workshop, 4 2-1 Consistent Results Across Nurse–Family Partnership Trials, 9 FIGURES 2-1 Nurse–Family Partnership scale-up approach, 10 2-2 The Incredible Years® provider locations in the United States, 12 2-3 Scaling up delivery of The Incredible Years®: Countries where training occurs, 13 2-4 Triple P: Multi-level system, 14 3-1 Overview of Family Check-Up team’s systemic implementation model, 26 3-2  by 16: Gestures commonly observed in children, by age in 16 months, 29 3-3 Autism Navigator®: Free tools for the public, 30 4-1 PROSPER evolving community partnership sustainability model, 40 7-1 Family Check-Up model: An iterative translational research strategy, 67 7-2 Stages of implementation completion, 76 xv

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xvi BOXES, FIGURES, AND TABLE TABLE 4-1 Summary Table of Intermediary Strategies to Aid Scale-Up of Evidence-Based Family-Focused Prevention Programs, 44