Transcript PROSPER - Iowa State University

Making a Difference with
Youth, Families and Communities
Partnerships in Prevention Science Institute
Iowa State University
October, 2005
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
Funding Agencies
• National Institute on Drug Abuse
• National Institute of Mental Health
• National Institute on Alcohol
Abuse and Alcoholism
• Center for Substance Abuse
Prevention
1. Mission and Background
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.
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
interventions—one 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-scientist partnerships and larger-scale community
benefits, American Journal of Community Psychology.
Advantages of Focus on
Evidence-Based Interventions (EBIs)
• Positive outcomes and economic benefits
more likely for youth, families, others
• Better accountability—resources not used
for ineffective programs
• Funding increasingly targeted for
evidence-based interventions
• Materials, training and technical assistance
typically are available
Conceptual Framework and
Partnership Model
Framework for State Public Education Systems Approach to
“Science-with-Practice”
Local Community Team
Internal Capacity
Agents
from Public Schools
Local
Linking Agents
from Extension
System
External Resource
Agents
from Community/State
University
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.
PROSPER—Organizational 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
2. Illustrative Findings:
Effectiveness in—
A. Delivery of Community-Level,
Evidence-Based Interventions
(EBIs)
B. Producing Positive
Community-Level Outcomes
through Partnership-Delivered
EBIs
C. Quality Implementation of
Rigorous Intervention Studies
A. Partnership Effectiveness in
Delivery of Community-level EBIs
Types of Indicators of Effective
Community-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
Average % Adherence
Partnership-Based Delivery Results—
Implementation Adherence*
100
90
80
70
60
50
40
30
20
10
0
91%
90%
Family Programs
School Programs
*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.
Partnership-Based Delivery Results—
Family Program Retention/Participation Levels
Strengthening Families Program Family Session Attendance
%
Enrolled
Families
Attending
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
95.8%
95.2%
95.2%
91.6%
65.9%
3 or more
sessions
4 or more
sessions
5 or more
sessions
6 or 7
sessions
All 7
sessions
*Enrolled families are those that signed up and attended at least one session.
Partnership-Based Delivery
Results—Sustainability
Early in first
sustainability phase of
ongoing partnership
study—11 of 13 local
teams have raised their
own sustainability
funds!
Partnership-Based Delivery Results—
Harambee 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 results—
guide 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.
B. Positive Community-Level
Outcomes Through
Partnership-Delivered EBIs
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
baseline—e.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
Results—Partnership-Based Outcome Studies
Longitudinal Growth of First-Time Drunkenness
1
Lifetime Drunkenness Through 6 Years Past Baseline:
Logistic Growth Curve
First Time Proportion
Trajectory for ISFP Condition
Trajectory for Control Condition
0.8
0.6
0.4
0.2
0
0 mont hs
6 mont hs
18 mont hs
30 mont hs
48 mont hs
72 mont hs
(Pret est )
(Post t est )
(Grade 7)
(Grade 8)
(Grade 10)
(Grade 12)
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.
Results—Partnership-Based Outcome Studies
Longitudinal Growth of Marijuana Use
Lifetime Marijuana Use Through 6 years Past Baseline:
Logistic Growth Curve
0.25
Trajectory for ISFP Condition
Trajectory for Control Condition
Proportion
0.2
0.15
0.1
0.05
0
0 months
(Pretest)
6 months
(Posttest)
18 months
(Grade 7)
30 months
(Grade 8)
48 months
(Grade 10)
72 months
(Grade 12)
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.
Results—Partnership-Based Outcome Studies
Average Teen Age in School Districts When Stated
Prevalence Levels are Reached—From 6-Year Follow-up
19
17.9
18
17.8
17.5
Partnership-based Iowa
Strengthening Families
Program Condition
Age
17
16
Control Condition
15.7
15.3
15.5
15
14
13
10% Lifetime
Marijuana Use
50% Lifetime
Cigarette Use
50% Lifetime
Drunkenness
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.
Results—Transition from
Non-Advanced Use to Advanced Use*
70
58.8
Percentage
60
47.9
50
38.0
40
30
31.5
25.2
20
10
8.1
0
Pretest
2-5
Years**
Pretest4 years
Control Transition
Pretest6 years**
ISFP Transition
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 following—past month alcohol use (> 4 times), past month binge, past month one or more cigs/day, ever use of
marijuana, inhalants, or other illicit drugs.
*p < .05
Results—
Partnership-Based Meth Outcomes
of Universal Interventions
Lifetime and Past-Year Meth Use at 4½-6½ Years Past Baseline
8
7.61
7
6
5
4.59
% 4
3
3.21
2.63
2
2.12
1
0
ISFP Control
Study 1 (12th Grade)
Past Year Use
SFP+LST Control
Study 2 (11th Grade)
Lifetime Use--Past Year Plus Prior Use
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, partnershipbased universal preventive interventions on adolescent methamphetamine use
Results—
Partnership-Based Outcome Studies
Observer-Rated Aggressive/Hostile
Behaviors
1.4
Aggression-Hostility Index--Observer Rated
ISFP
Control
1.1
0.8
0.5
0.2
0 months
(Pretest)
6 months
(Posttest)
18 months
(7th Grade)
30 months
(8th Grade)
48 months
(10th Grade)
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.
Results—
Diagnosable Disorders 10 Years Past Baseline
11.2
12
9.9
10
ISFP Condition
8
Control Condition
%
6
4.1
4.1
4
2
Conduct Disorder
Antisocial Personality
Disorder
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.
Results—
Differential Effects on Girls and Boys
Internalizing Symptoms
0.7
Anxious/Depressed Syndrome
0.6
Intervention Girls
Control Girls
Intervention Boys
Control Boys
0.5
0.4
0.3
0.2
0.1
0
0
6
12
18
24
30
36
42
48
54
60
66
72
Months from Posttest
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.
Tested Model Results—Long-Term Effects of Public
Education Partnership Program on Academic Success
6th Grade
8th Grade
12th Grade
Enhanced
Positive
Parenting
Behavior
Increased
Student
School
Engagement
Partnership-based
Iowa Strengthening
Families Program
Increased
Student
Academic
Success
Reduced
Substancerelated
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.)
Results—Benefits 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.
Results—
Delaying Onset of Alcohol Use Leads to Cost Savings
Partnership-Based Strengthening Families Program:
Benefit-Cost Ratios Under Different Assumptions
$11.34
$9.60
Dollars Returned
13
12
11
10
9
8
7
6
5
4
3
2
1
0
$7.86
*Actual Study Conditions
1 more case prevented/100
1 less case prevented/100
*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.
C. Partnership Effectiveness in
High-Quality Implementation of
Rigorous Outcome Research
Types of Evidence of Successful
Partnership-Based Outcome Study
• School recruitment/retention across studies
• Sample quality across studies—representative
of general population samples
• Intervention validity across studies
• About 30,000 individuals assessed across
studies
• Methodological innovations/multilevel designs
and analyses
Results—Study 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-term—in two studies, 100%
retained through end of HS
3. Future Directions
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)
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
Key Focus on
Building Local Team Sustainability
• Emphasis on ongoing technical
assistance through Extensionprevention staff
• Ongoing partnership evaluation &
feedback
• TA focus on expansion of resources
• Strategies to accommodate team
membership/leadership change
What PROSPER Has Accomplished
Third 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!
A Vision for PROSPER
Making a Difference
Obesity Prevention
Framework for Health-Promoting Public Education Partnership
Network (HealthPEP Net): Design, Testing and Dissemination
E DUCA
C
I
L
B
TI
PU
ON
Intervention Development Process
● Scientifically-rigorous
● Ecological
● Consumer-oriented
Design
D
Testing/
Implementation
Sustained
Dissemination
Community-University Partnership Network S
(PROSPER Prototype)
M
I
S
E
S E
T
S
M I
Y
S
N A T I O N
*From “Obesity and Youth” Regional Conference at Iowa State University (R. Spoth)
Making a Difference with a
National Network of Partnerships
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
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
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)
• Please visit our website at...
www.ppsi.iastate.edu
• Or visit us in Ames, Iowa...