Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health Workshop Summary (2014) / Chapter Skim
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7 Meeting Scale-Up Challenges
7 Meeting Scale-Up Challenges
Pages 59-78
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From page 59... ...
BUILDING DEMAND Several participants noted programs tend to be more successful if there is consumer support for them; local, agency, or political champions of them; and if the right program is matched to the right organization. Consumer Demand Families are the ultimate consumers of family-centered programs, which will not be successful unless family support is engendered, Ron Prinz said.
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From page 60... ...
program in their communities, they are asked to complete an Incredible Years Agency Readiness Questionnaire, which helps them prioritize their needs and identify their target population to assess if the program is a good match, and if not, other evidence-based programs are suggested. The Readiness Questionnaire also suggests organizations develop parent recruitment and referral strategies.
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From page 61... ...
. Rotheram-Borus suggested building demand for programs for families by offering the programs along with or part of other community programs already in demand, such as martial arts or as part of summer camp or afterschool club offerings.
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From page 62... ...
Prado agreed, noting the importance of building relationships with those that can be champions for a program "not only from the top down but from the bottom up and to engage at all levels in between." Because the average tenure of school superintendents in the country is about 2 to 3 years, Familias Unidas tried to find champions for their school-based programs not just with school superintendents and directors of mental health counseling for the district, but with the associate superintendents of curriculum and education, and the mental health counselors, social workers and school counselors delivering the services the program offered. "We had a lot of champions so it was an easy sell when a new person came on board," he noted.
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From page 63... ...
RotheramBorus suggested organizations have not adequately tapped "the many armies of potential prevention promoters -- every soccer coach, school safety officer, child classroom aide, swim teacher, music teacher -- these could be armies of paraprofessional prevention promoters but I haven't seen any of our intervention programs go towards them." Kaplan-Sanoff said that in Healthy Steps it is preferred that everyone from the receptionists to the physicians attend the training sessions. The IY program suggests that at least two group leaders or clinicians per group be provided with authorized accredited training to support each other and the next person hired if one of the leaders is replaced.
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A field operation that assesses and understands the needs of the organizations that adopt programs and their barriers is the hallmark of these initiatives that really succeed," he said. PROVIDING A SUPPORTIVE INFRASTRUCTURE Several speakers indicated the need for a supportive infrastructure in order to ensure successful implementation of evidence-based prevention programs.
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From page 65... ...
Nonetheless, some experts in the field believe adopters might have to tailor even well-suited programs to fit their budget and priorities. Webster-Stratton emphasized the importance of adopters following program protocols, but she recognized that programs also need ongoing remodeling based on feedback, research, and the setting in which they are delivered.
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From page 66... ...
The more we have contact with our clients, which are the communities, the more they're going to shape us, in terms of the kinds of interventions we'll be developing." He noted the general strategy of a translational process is that interventions be revised for public health service settings, and after they have been tested and tailored for real-world conditions, the developmental model the intervention is based on may be revised. Dishion said this strategy has worked for the Family Check-Up program, whose application in American Indian communities prompted its developers to add historical trauma to the original model's list of factors influencing families (see Figure 7-1)
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model, it adapted it substantially, Ogden reported. This program was originally designed to have 20 to 50 parent sessions and is usually delivered to individual families, but it also has modules for school con
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In addition, the Norway implementation developed training and intervention manuals and a description of the core intervention components. Six months after receiving the brief parent training, a study found the beneficial outcomes were sustained on most child and parent variables as they are for the more extensive PMTO (Kjøbli and Bjørnebekk, 2013)
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From page 69... ...
"We can give a consultation using the clips of the videos, and in years to come we're going to find that we're going to be more able to use this mechanism to help us have better implemented interventions," she said. Prado seconded that notion, pointing out that to provide feedback to the social workers or school counselors who conduct parent sessions in the Familias Unidas program, sessions are videotaped by a rater who watches these 2-hour sessions two or three times.
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She noted that encouragingly, there has been a gradual increase in grants that are allowing and paying for planning periods of 6 months to 1 year and then requiring implementation plans that have to be approved before the services can be provided, as well as funding that can be spent on data systems, continuous quality improvement, and infrastructure costs, which some research suggests is about 30 percent of ongoing costs. "This is not a one-time investment -- 30 percent of the grant might have to go to infrastructure," she stated.
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From page 71... ...
She noted that 10 percent of children who receive Medicaid are using behavioral health services and/or psychotropic medication. Given that 20 percent of children in the United States are reported to need behavioral health services, there probably is an underuse of that service in children supported by Medicaid, she said.
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From page 72... ...
Rotherham-Borus recommended designing programs to fit existing funding streams. OVERCOMING ORGANIZATIONAL SILOS Several participants noted that many prevention interventions for children or families have results that spill over into a number of different domains because, as Spoth pointed out, they target similar, common risk and preventive factors.
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From page 73... ...
"We want to get examples of where communities might want to integrate services, such as marrying a substance abuse program with an education program and workforce program to get better results in a particular population," Stack said. She added, "We are trying to build partnerships and infrastructure to support a completely different way of doing business -- it is really an opportunity to find a target population and test this notion that we can provide a much more holistic set of services to achieve greater impact." Convincing economic analyses can also prompt agencies to overcome siloing, Lee reported.
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From page 74... ...
"You can continue to toggle and tweak these as you expand all these different dimensions," McCannon said. Finally, McCannon suggested giving people the opportunity to try and fail and to waste no will, which means "anytime someone comes with an idea you say ‘yes' and you work with them on adapting it to make it work in their setting," McCannon said.
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From page 75... ...
An example of implementation research Chamberlain presented at the workshop found an organization's pre-implementation behavior before adopting a foster care treatment program predicted successful startup of the programs as well as its sustainability over time. Such pre-implementation behavior included measures of how long it took organizations to achieve
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From page 76... ...
Supplee gave another example of ground-breaking research on implementation called MIHOPE. This study, which stands for Mother and Infant Home Visiting Program Evaluation, is a large-scale random assignment evaluation of home visiting programs funded by MIECHV.
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:113-121. MIHOPE (Mother and Infant Home Visiting Program Evaluation)
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