Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health: Workshop Summary (2014)

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Introduction¹

Over the past three decades, researchers have made remarkable progress in creating and testing family-focused programs aimed at fostering the cognitive, affective, and behavioral health of children. These programs include universal interventions, such as those for expecting or new parents and workshops for families whose children are entering adolescence, as well as programs targeted to especially challenged parents, such as low-income single teens about to have their first babies, or the parents of children with autism. Some family-focused programs have been shown to foster significantly better outcomes in children, including enhanced educational performance and reduced rates of teen pregnancy, substance abuse, and delinquency, as well as reduce child abuse (Eckenrode et al., 2010; Gavin et al., 2010; Haggerty et al., 2013; Kitzman et al., 2010; Menting et al., 2013; Perrino et al., 2014; Prado et al., 2012; Spoth et al., 2009; Webster-Stratton and Reid, 2010). The favorable cost–benefit ratios of some of these programs (Lee et al., 2012) are due, in part, to the multiple and far-ranging effects that family-focused prevention programs targeting children can have. Other family-focused programs have shown success in smaller academic studies but have not been widely applied, have

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¹The planning committee’s role was limited to planning the workshop. The workshop summary has been prepared by the rapporteur (with acknowledgment of the assistance of staff as appropriate) as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the Institute of Medicine. They should not be construed as reflecting any group consensus.

not worked as effectively or failed when applied to more diverse real-world settings.

The Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health was established in the fall of 2013, partially in response to the 2009 National Research Council and Institute of Medicine (NRC and IOM) report Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities, which noted that there are a number of effective preventive interventions for youth that can modify risk and promote protective factors that are linked to mental, emotional, and behavioral health, but that more work is needed to apply this existing knowledge (NRC and IOM, 2009). The creation of the forum at this time is a critical next step to exploring how to build a stronger research and practice base around the development and implementation of programs, practices, and policies that foster children’s health and well-being across the country, while engaging multi-sectorial stakeholders.

The forum chose to focus its first workshop on strategies for scaling effective family-focused preventive interventions because, as described above, research has advanced understanding of risk, promotive, and protective factors in families that influence the health and well-being of youth. However, despite the potential for widespread economic and social benefits, a challenge remains to provide family-focused interventions across child and adolescent development at sufficient scale and reach to significantly reduce the incidence and prevalence of negative cognitive, affective, and behavioral outcomes in children and adolescents nationwide, as well as to develop widespread demand for effective programs by end users. The forum’s workshop, titled Strategies for Scaling Tested and Effective Family-Focused Preventive Interventions to Promote Children’s Cognitive, Affective, and Behavioral Health, was held in Washington, DC, on April 1-2, 2014.

The workshop topics and speakers were selected by the workshop planning committee. The agenda was organized around the following topics:

• Successes and challenges in scaling family-focused interventions, as described by developers and implementers of four family-focused interventions that have been successfully brought to scale;
• State and federal perspectives of successes and challenges in scaling family-focused interventions;
• Lessons learned from developers of select family-focused interventions implemented in settings (e.g., pediatric primary care, schools, home visiting) that are emerging as important points of intervention;
• Financing and infrastructure to support the scaling of interventions, including potential opportunities afforded by Medicaid and the Patient Protection and Affordable Care Act; and
• Innovative models in scaling family-focused interventions.

The workshop also featured two keynote presentations on strategies for moving evidence-based practice to real-world outcomes, and engaging families of children with developmental disabilities in early detection, intervention, and prevention (see Appendix A for the full workshop agenda). At the end of the workshop, panel moderators presented themes discussed in their panels and discussed potential ways forward. The full webcast of the workshop and speaker presentation slides are available on the meeting webpage.²

During the course of the 2-day workshop, it was not possible to cover all potential topics or perspectives, and speakers could not exhaustively cover all relevant programs, policies, or research for each topic. Consequently, some relevant topics and programs could not be included in the workshop and, by extension, are not included in this workshop summary. This document is not intended to be a comprehensive review of family-focused research and programs to promote children’s cognitive, affective, and behavioral health. Rather, the contents of this workshop summary reflect the research presented at the workshop and the discussions that followed.

SELECTION OF FAMILY-FOCUSED PREVENTIVE PROGRAMS

The family-focused programs discussed at the workshop, and links to more information about the programs, are provided in Box 1-1. The planning committee selected to include programs that have been implemented across a range of settings (e.g., homes, child welfare settings, schools, etc.) and that target different time periods during development spanning prenatal development to adolescence. The planning committee chose to highlight Nurse–Family Partnership, The Incredible Years^®, the Triple P-Positive Parenting Program, and Keeping Foster and Kin Parents Trained and Supported (KEEP) as examples of effective programs that have shown success in being scaled because (1) the approach, curriculum, and training for these programs have been well specified; (2) randomized evaluations of efficacy have been conducted and published; (3) replication of the original program has been conducted and its efficacy reported; (4) recruitment procedures were specified, and the population to which results may be generalized; and (5) developers have had some experience in rolling out the program beyond the controlled trials.

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²The full webcast and speaker presentations are available online: http://www.iom.edu/Activities/Children/ChildrensHealthForum/2014-APR-01.aspx.

ORGANIZATION OF THE WORKSHOP SUMMARY

The workshop summary is organized into eight chapters, including this introduction. Chapter 2 describes four family-focused interventions (named above) that have demonstrated effectiveness in practice and that have been brought to scale. Chapter 3 describes select family-focused interventions that have been implemented in emerging settings and discusses opportunities and challenges to implementation in those settings. Chapter 4 describes several entities that have aided in the scale-up and implementation of family-focused interventions. Chapter 5 describes the experience of scaling

a family-focused intervention developed in the United States (the Parent Management Training Oregon Model) internationally. Chapter 6 discusses challenges that should be considered when scaling up evidence-based programs, including lack of demand, insufficient organizational capacity, lack of sustainable funding, and the various factors that go into decision making about whether or not to implement a program. Chapter 7 offers strategies for meeting such challenges, including building demand, building capacity, providing supportive infrastructure, and adapting and improving programs to meet the needs of the entities that adopt them. Chapter 8 summarizes themes that emerged during the workshop and identifies potential steps for moving forward.

REFERENCES

Eckenrode, J., M. Campa, D. W. Luckey, C. R. Henderson, R. Cole, H. Kitzman, E. Anson, K. Sidora-Arcoleo, J. Powers, and D. Olds. 2010. Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial. Archives of Pediatrics & Adolescent Medicine 164(1):9-15.

Gavin, L. E., R. F. Catalano, C. David-Ferdon, K. M. Gloppen, and C. M. Markham. 2010. A review of positive youth development programs that promote adolescent sexual and reproductive health. Journal of Adolescent Health 46(3 Suppl):S75-S91.

Haggerty, K. P., A. McGlynn-Wright, and T. Klima. 2013. Promising parenting programmes for reducing adolescent problem behaviors. Journal of Children’s Services 8(4):229-243.

Kitzman, H. J., D. L. Olds, R. E. Cole, C. A. Hanks, E. A. Anson, K. J. Arcoleo, D. W. Luckey, M. D. Knudtson, C. R. Henderson, and J. R. Holmberg. 2010. Enduring effects of prenatal and infancy home visiting by nurses on children: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatric & Adolescent Medicine 164(5):412-418.

Lee, S., S. Aos, E. Drake, A. Pennucci, M. Miller, and L. Anderson. 2012. Return on investment: Evidence-based options to improve statewide outcomes, April 2012 (Document No. 12-04-1201). Olympia: Washington State Institute for Public Policy.

Menting, A. T., B. Orobio de Castro, and W. Matthys. 2013. Effectiveness of The Incredible Years parent training to modify disruptive and prosocial child behavior: A meta-analytic review. Clinical Psychology Review 33(8):901-913.

NRC and IOM (National Research Council and Institute of Medicine). 2009. Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: The National Academies Press.

Perrino, T., H. Pantin, G. Prado, S. Huang, A. Brinks, G. Howe, W. Beardslee, I. Sandler, and C. H. Brown. Preventing internalizing symptoms among Hispanic adolescents: A synthesis across Familias Unidas trials. 2014. Prevention Science [Epub ahead of print].

Prado, G., D. Cordova, S. Huang, Y. Estrada, A. Rosen, G. A. Bacio, G. Leon Jimenez, H. Pantin, C. H. Brown, M. R. Velazquez, J. Villamar, D. Freitas, M. I. Tapia, and K. McCollister. 2012. The efficacy of Familias Unidas on drug and alcohol outcomes for Hispanic delinquent youth: Main effects and interaction effects by parental stress and social support. Drug and Alcohol Dependence 125(Suppl 1):S18-S25.

Spoth, R., L. Trudeau, M. Guyll, C. Shin, and C. Redmond. 2009. Universal intervention effects on substance use among adults mediated by delayed adolescent substance initiation. Journal of Consulting and Clinical Psychology 77(4):620-632.

Webster-Stratton, C., and M. J. Reid. 2010. The Incredible Years parents, teachers and children training series: A multifaceted treatment approach for young children with conduct problems. In Evidence-based psychotherapies for children and adolescents, 2nd ed., edited by J. Weisz and A. Kazdin. New York: Guilford Press. Pp. 194-210.