Making a Difference with Youth, Families and Communities

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Making a Difference withYouth, Families and
Communities

• Partnerships in Prevention Science Institute
• Iowa 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/Scientists
• K. 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 Coordinators
• E. 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 interventionsone 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-scientis
t 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 accountabilityresources 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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Framework for State Public Education Systems
Approach to Science-with-Practice
Local Community Team
Internal Capacity Agents from Public Schools
External Resource Agents from Community/State
University
Local Linking Agents from Extension System
University/Prevention Coordinator Teams
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.
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PROSPEROrganizational Structure for State Public
Education Partnerships
Local Community Teams Extension Agent, Public
School Staff, Social Service Agency
Representatives, Parent/Youth Representatives
Prevention Coordinator Team Extension Prevention
Coordinators
University/State-Level Team University
Researchers, Extension Program Directors
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2. Illustrative Findings Effectiveness in

• Delivery of Community-Level, Evidence-Based
  Interventions (EBIs)
• Producing Positive Community-Level Outcomes
  through Partnership-Delivered EBIs
• Quality Implementation of Rigorous Intervention
  Studies

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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 ResultsImplementatio
n 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.
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Partnership-Based Delivery ResultsFamily
Program Retention/Participation
LevelsStrengthening Families Program Family
Session Attendance
Enrolled Families Attending
Enrolled families are those that signed up and
attended at least one session.
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Partnership-Based Delivery ResultsSustainability

Early in first sustainability phase of ongoing
partnership study11 of 13 local teams have
raised their own sustainability funds!
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Partnership-Based Delivery ResultsHarambee
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 resultsguide 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 baselinee.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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ResultsPartnership-Based Outcome
Studies Longitudinal Growth of First-Time
Drunkenness
Lifetime Drunkenness Through 6 Years Past
Baseline Logistic Growth Curve
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.
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ResultsPartnership-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.

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ResultsPartnership-Based Outcome Studies
Average Teen Age in School Districts When Stated
Prevalence Levels are ReachedFrom 6-Year
Follow-up

• 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.

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ResultsTransition 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 followingpast
month alcohol use (gt 4 times), past month binge,
past month one or more cigs/day, ever use of
marijuana, inhalants, or other illicit drugs. p
lt .05
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Results Partnership-Based Meth Outcomes of
Universal Interventions
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
Source Spoth, et al. (2005). Two randomized
studies of the long-term effects of brief,
partnership-based universal preventive
interventions on adolescent methamphetamine use
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Results Partnership-Based Outcome
Studies Observer-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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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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Results Differential Effects on Girls and Boys
Internalizing Symptoms
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.
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Tested Model ResultsLong-Term Effects of Public
Education Partnership Program on Academic Success
6th Grade
12th Grade
8th Grade
Enhanced Positive Parenting Behavior
Increased Student School Engagement
Increased Student Academic Success
Partnership-based Iowa Strengthening Families
Program
Reduced Substance-related Risk Behaviors

• 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.edu?Spoth, R.,
  Randall, G. K. and others. Building family skills
  leads to long-term academic success. Manuscript
  in final preparation.)

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ResultsBenefits 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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Results Delaying Onset of Alcohol Use Leads to
Cost Savings
Partnership-Based Strengthening Families Program
Benefit-Cost Ratios Under Different Assumptions
Study Data indicate 9.60 returned for each
dollar invested under actual study
conditions Source 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.
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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 studiesrepresentative 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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ResultsStudy 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-termin 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/leadersh
  ip 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 PROSPERMaking a Difference
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Obesity Prevention Framework for Health-Promoting
Public Education Partnership Network (HealthPEP
Net) Design, Testing and Dissemination
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Intervention Development Process ?
Scientifically-rigorous ? Ecological ?
Consumer-oriented
Testing/ Implementation
Sustained Dissemination
Design
Community-University Partnership Network (PROSPER
Prototype)
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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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www.ppsi.iastate.edu