Cady Berkel

Putting the Pieces Together: An Integrated Model of Program Implementation

Considerable evidence indicates that variability in implementation of prevention programs is related to the outcomes achieved by these programs. However, while implementation has been conceptualized as a multidimensional construct, few studies examine more than a single dimension, and no theoretical framework exists to guide research on the effects of implementation. We seek to address this need by proposing a theoretical model of the relations between the dimensions of implementation and outcomes of prevention programs that can serve to guide future implementation research. In this article, we focus on four dimensions of implementation, which we conceptualize as behaviors of program facilitators (fidelity, quality of delivery, and adaptation) and behaviors of participants (responsiveness) and present the evidence supporting these as predictors of program outcomes. We then propose a theoretical model by which facilitator and participant dimensions of implementation influence participant outcomes. Finally, we provide recommendations and directions for future implementation research.

It Takes a Village: Protecting Rural African American Youth in the Context of Racism

Prior research demonstrates negative consequences of racism, however, little is known about community, parenting, and intrapersonal mechanisms that protect youth. Using a mixed-methods approach, this study illuminated linkages between positive and negative contextual influences on rural African American adolescent outcomes. Quantitative results provide support for Structural Ecosystems Theory, in that the influence of discrimination and collective socialization on adolescent outcomes was mediated by racial socialization and positive parenting. Parenting and community influences contributed to adolescent racial identity and self image, which protected against common negative responses to racism; including academic underachievement, succumbing to peer pressure, and aggressive tendencies. Qualitative results indicate that current measures of discrimination may underestimate adolescents’ experiences. Adolescents reported racist experiences in the domains of school, peers, and with the police (males only). Moreover, qualitative findings echoed and expanded quantitative results with respect to the importance of the protective nature of parents and communities.

Linking Parental Socialization to Interpersonal Protective Processes, Academic Self-Presentation, and Expectations among Rural African American Youth

Data obtained from 2 waves of a longitudinal study of 671 rural African American families with an 11-year-old preadolescent were used to examine pathways through which racial and ethnic socialization influence youth self-presentation, academic expectations, and academic anticipation. Structural equation modeling analyses indicated that racial and ethnic socialization were linked with youth expectations for and anticipation of academic success through youth self-pride, which included racial identity and self-esteem, and through academic self-presentation. The results highlight the need to disaggregate racial and ethnic socialization to attain a better understanding of the ways in which these parenting domains uniquely forecast youth self-pride and academic orientation.

Mexican-Origin Early Adolescents’ Ethnic Socialization, Ethnic Identity, and Psychosocial Functioning

This study examined how parental ethnic socialization informed adolescents’ ethnic identity (EI) development and, in turn, youths’ psychosocial functioning (i.e., mental health, social competence, academic efficacy, externalizing behaviors) among 749 Mexican-origin families. In addition, school ethnic composition was examined as a moderator of these associations. Findings indicated that mothers’ and fathers’ ethnic socialization were significant longitudinal predictors of adolescents’ EI, although fathers’ ethnic socialization interacted significantly with youths’ school ethnic composition in fifth grade to influence EI in seventh grade. Furthermore, adolescents’ EI was significantly associated with increased academic self-efficacy and social competence, and decreased depressive symptoms and externalizing behaviors. Findings support theoretical predictions regarding the central role parents play in Mexican-origin adolescents’ normative developmental processes and adjustment and, importantly, underscore the need to consider variability that is introduced into these processes by features of the social context such as school ethnic composition.

A test of the social development model during the transition to junior high with Mexican American adolescents.

Mexican American adolescents have higher rates of externalizing problems than their peers from other ethnic and racial groups. To begin the process of understanding factors related to externalizing problems in this population, this study used the social development model (SDM) and prospective data across the transition to junior high school from 750 diverse Mexican American families. In addition, the authors examined whether familism values provided a protective effect for relations within the model. Results showed that the SDM worked well for this sample. As expected, association with deviant peers was the primary predictor of externalizing behaviors. There was support for a protective effect in that adolescents with higher familism values had slower rates of increase in association with deviant peers from 5th to 7th grades than those with lower familism values. Future research needs to determine whether additional culturally appropriate modifications of the SDM would increase its usefulness for Mexican American adolescents.

Directions for the Advancement of Culturally Adapted Preventive Interventions: Local Adaptations, Engagement, and Sustainability

To advance the implementation and dissemination of culturally adapted interventions to diverse populations, greater attention should be devoted to three underdeveloped topics: (a) local adaptations of interventions when they are implemented in community settings, (b) participant engagement, and (c) the sustainability of adapted interventions. Several typologies have been developed for studying local adaptations, and some research indicates that such adaptations might add to intervention effectiveness. There is suggestive evidence of ethnocultural group disparities in intervention engagement and in the success of efforts to boost engagement. Theory and limited data indicate that interventions’ flexibility and fit with organizational culture and resources can be achieved through cultural adaptations. Furthermore, those adaptations should be associated with sustainability, but research has yet to test that hypothesis adequately. Several recommendations are made for advancing culturally adapted interventions through additional research on local adaptations during implementation, the many facets of participant engagement, and sustainability.

Predictors of Participation in the Family Check-Up Program: a Randomized Trial of Yearly Services from Age 2 to 10 Years

A key challenge of community-based prevention programs is engaging families in the context of services settings involving children and families. The Family Check-Up (FCU) program is designed to engage families in parenting support appropriate to their level of need by use of assessment-enhanced motivational interviewing. This study involved families screened for risk who were seeking services at women, infant, and children’s offices in three geographical regions (N = 731). Families in the randomized intervention group (N = 367) were offered the FCU yearly, from age 2 through 10. The results of multivariate modeling indicated that caregivers reporting high levels of perceived caregiving stress (i.e., depression, low parenting satisfaction, daily hassles) participated at a higher rate in two critical components (feedback and follow-up support interventions) of the FCU program over the 8-year trial period than caregivers reporting lesser degrees of stress. The implications of these findings are discussed in the context of family-centered programs for the prevention of child behavior problems and directions for future research.

Understanding the art and science of implementation in the SAAF efficacy trial

PURPOSE The purpose of this paper is to demonstrate the importance of considering both fidelity and adaptation in assessing the implementation of evidence-based programs. DESIGN/METHODOLOGY/APPROACH The current study employs a multi-method strategy to understand two dimensions of implementation (fidelity and adaptation) in the Strong African American Families (SAAF) program. Data were video recordings of program delivery and pre-test and post-test interviews from the efficacy trial. Multilevel regression in Mplus was used to assess the impact of fidelity to the manual, coded by independent observers, on racial socialization outcomes. One activity on racial socialization, a core component of the program, was selected for an in-depth examination using conversation analysis (a qualitative method of analyzing talk in interactions). FINDINGS Results of the quantitative analyses demonstrated that fidelity of the selected activity was associated with increases in parents use of racial socialization from pre-test to post-test, but only when participant attendance was included in the model. Results of the qualitative analyses demonstrated that facilitators were making adaptations to the session and that these adaptations appeared to be in line with cultural competence. RESEARCH LIMITATIONS/IMPLICATIONS The development of quantitative fidelity measures can be problematic, with many decision points to consider. The current study contributes to the evidence base to develop a quantitative measure of adaptation for family-based parenting programs. ORIGINALITY/VALUE Many researchers examining implementation of evidence-based programs consider fidelity and adaptation to be polar ends of a single spectrum. This paper provides evidence for the importance of examining each independently.

Attendance Trajectory Classes Among Divorced and Separated Mothers and Fathers in the New Beginnings Program

We examined attendance trajectories among mothers and fathers in the effectiveness trial of the New Beginnings Program, a parenting-focused prevention program for divorced and separated parents. We also investigated attendance trajectory class differences on two sets of pretest covariates: one set previously linked to participation in programs not specifically targeting divorced parents (i.e., sociodemographics, perceived parenting skills, child problem behaviors, parent psychological distress) and another that might be particularly salient to participation in the context of divorce (i.e., interparental conflict, level of parent-child contact, previous marital status to the ex-spouse). For mothers and fathers, results supported four attendance trajectory classes: (1) non-attenders (NA), (2) early dropouts (ED), (3) declining attenders (DA), and (4) sustained attenders (SA). In the final model testing multiple covariates simultaneously, mothers who were EDs and DAs were more likely to be Latina than SAs, and EDs reported more interparental conflict than SAs. Mother trajectory groups did not differ on parenting skills, child problem behavior, or mother-child contact in the final or preliminary models. In the final model for fathers, EDs rated their children higher on externalizing than DAs, had less contact with their children than DAs and NAs, and reported less distress than SAs. Father trajectory groups did not differ on fathers’ age, ethnicity, income, perceived parenting skills, or interparental conflict in the final or preliminary models. Results highlight qualitatively distinct latent classes of mothers and fathers who disengage from a parenting intervention at various points. We discuss implications for intervention engagement strategies and translational science.

Participation Patterns Among Mexican–American Parents Enrolled in a Universal Intervention and Their Association with Child Externalizing Outcomes

Abstract This study used growth mixture modeling to examine attendance trajectories among 292 Mexican–American primary female caregivers enrolled in a universal preventive intervention and the effects of health beliefs, participation intentions, cultural influences, and intervention group cohesion on trajectory group membership as well as trajectory group differences on a distal outcome, immediate posttest teacher report of child externalizing (T2). Results supported four trajectory groups—early terminators (ET), mid-program terminators (MPT), low-risk persistent attenders (LRPA), and high-risk persistent attenders (HRPA). Compared with LRPAs, caregivers classified as HRPAs had weaker familism values, less parenting efficacy, and higher externalizing children with lower GPAs. Caregivers in the two persistent attender groups reported strong group cohesion and providers rated these caregivers as having strong participation intentions. Children of caregivers in the LRPA group had the lowest T2 child externalizing. Children of caregivers in the MPT group had lower T2 externalizing than did those of the ET group, suggesting partial intervention dosage can benefit families. Despite high levels of attendance, children of caregivers in the HRPA had the highest T2 externalizing, suggesting this high-risk group needed either more intensive services or a longer period for parents to implement program skills to evidence change in child externalizing.