Joie D. Acosta

Intervening with practitioners to improve the quality of prevention: One year findings from a randomized trial of Assets-Getting To Outcomes

There continues to be a gap in prevention outcomes achieved in research trials versus those achieved in “real-world” practice. This article reports interim findings from a randomized controlled trial evaluating Assets-Getting To Outcomes (AGTO), a two-year intervention designed to build prevention practitioners’ capacity to implement positive youth development–oriented practices in 12 community coalitions in Maine. A survey of coalition members was used to assess change on individual practitioners’ prevention capacity between baseline and one year later. Structured interviews with 32 program directors (16 in the intervention group and 16 in the control group) were used to assess changes in programs’ prevention practices during the same time period. Change in prevention capacity over time did not differ significantly between the intervention and control groups. However, in secondary analyses of only those assigned to the AGTO intervention, users showed greater improvement in their self-efficacy to conduct Assets–based programming and increases in the frequency with which they engaged in AGTO behaviors, whereas among non-users, self-efficacy to conduct Assets–based programming declined. Interview ratings showed improvement in several key areas of performance among intervention programs. Improvement was associated with the number of technical assistance hours received. These results suggest that, after one year, AGTO is beginning to improve the capacity of community practitioners who make use of it.

An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes

BackgroundStudies have shown that communities have not always been able to implement evidence-based prevention programs with quality and achieve outcomes demonstrated by prevention science. Implementation support interventions are needed to bridge this gap between science and practice. The purpose of this article is to present two-year outcomes from an evaluation of the Assets Getting To Outcomes (AGTO) intervention in 12 Maine communities engaged in promoting Developmental Assets, a positive youth development approach to prevention. AGTO is an implementation support intervention that consists of: a manual of text and tools; face-to-face training, and onsite technical assistance, focused on activities shown to be associated with obtaining positive results across any prevention program.MethodsThis study uses a nested and cross-sectional, cluster randomized controlled design. Participants were coalition members and program staff from 12 communities in Maine. Each coalition nominated up to five prevention programs to participate. At random, six coalitions and their respective 30 programs received the two-year AGTO intervention and the other six maintained routine operations. The study assessed prevention practitioner capacity (efficacy and behaviors), practitioner exposure to and use of AGTO, practitioner perceptions of AGTO, and prevention program performance. Capacity of coalition members and performance of their programs were compared between the two groups across the baseline, one-, and two-year time points.ResultsWe found no significant differences between AGTO and control group’s prevention capacity. However, within the AGTO group, significant differences were found between those with greater exposure to and use of AGTO. Programs that received the highest number of technical assistance hours showed the most program improvement.ConclusionsThis study is the first of its kind to show that use of an implementation support intervention-AGTO -yielded improvements in practitioner capacity and consequently in program performance on a large sample of practitioners and programs using a randomized controlled design.ClinicalTrials.gov identifierNCT00780338

Citizen preparedness for disasters: are current assumptions valid?

US government programs and communications regarding citizen preparedness for disasters rest on several untested, and therefore unverified, assumptions. We explore the assumptions related to citizen preparedness promotion and argue that in spite of extensive messaging about the importance of citizen preparedness and countless household surveys purporting to track the preparedness activities of individuals and households, the role individual Americans are being asked to play is largely based on conventional wisdom. Recommendations for conceptualizing and measuring citizen preparedness are discussed.

A novel test of the GTO implementation support intervention in low resource settings: Year 1 findings and challenges

Implementation research is expanding because Evidence-Based Programs (EBPs) are not adopted in many medical domains. However, rigorous implementation research is needed in nonclinical, community-based settings, which often have low capacity that undermines implementation quality and outcomes. This presentation describes Enhancing Quality Interventions Promoting Healthy Sexuality, a 5-year, cluster Hybrid Implementation RCT (Type II) testing how well a community-based setting (Boys & Girls Clubs, BGCs) conducts an EBP called Making Proud Choices (MPC) that aims to prevent teen pregnancy and sexually transmitted infections, with and without an implementation support intervention called Getting To Outcomes (GTO). GTO is a 10-step model of program operation grounded in implementation theory and an intervention of written tools, training and bi-weekly onsite technical assistance.

Household preparedness is not enough: the challenges and opportunities in assessing community readiness for disasters

The public health community faces numerous challenges in measuring community preparedness and resilience. This study aimed to identify existing measures of partnership, self-sufficiency, and social connectedness, as well as gaps and opportunities in the measurement of community preparedness and resilience. To accomplish these aims, the study team conducted a broad environmental scan to identify a list of possible measures in these areas and then assessed these measures using a set of standard criteria and feedback from key informants. Results suggest that while there is great interest in quantifying community preparedness, existing data have major limitations. There is a need for more measures of organizational and network activity and measures in the area of community engagement and empowerment.

An examination of measures related to children's exposure to violence for use by both practitioners and researchers

Millions of children each year are exposed to violence in their homes, schools, and communities as both witnesses and victims. As a result, evidence-based programs for children and adolescents who have been exposed to traumatic events (CEV-EBPs) have been widely disseminated but rarely evaluated in their real-world applications. One crucial aspect of conducting such evaluations is finding appropriate measures that can be of use both to the practitioner and to the researcher. This review aims to provide guidance to the field by first identifying any gaps in the availability of psychometrically tested measures for certain outcome domains and age ranges and then recommending the measures that are most appropriate for use by both researchers and practitioners. Interviews with content experts in the measurement of trauma symptoms and parent–child relationships were conducted to identify the key outcome domains for measurement that are critical to the evaluation of CEV-EBPs and the criteria for dual-use measures, defined as measures that are useful to both researchers and practitioners. A database of 46 relevant measures was created by compiling measures from existing repositories and conducting a focused literature review. Our review of these measures found that existing repositories had few measures of depression, a major gap that should be addressed. Further, there were few measures for young children ages 0–3 years (n = 15) and only a handful of measures (n = 9) had both a child and parent version of the measure. Overall, although the different repositories that currently exist are helpful, researchers and practitioners would benefit from having a single reputable source (e.g., a centralized repository or item bank) to access when searching for measures to use in evaluating CEV-EBPs. Such a tool would hold promising to narrow the current gap between research and practice in the field of children’s exposure to violence.

An Agenda to Advance Integrative Resilience Research and Practice: Key Themes From a Resilience Roundtable

People are facing an increasing variety and number of stressors, ranging from interpersonal difficulties to environmental hazards and societal forces. Resilience is the process of, capacity for, or outcome of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress. The science of resilience has advanced greatly since 2000, but there is an increasing recognition of the need for researchers and practitioners from different disciplines and sectors to work better together on this topic and for a shared agenda for promoting transdisciplinary resilience research. The study provides a path forward, primarily built on proceedings from a Resilience Roundtable, held in June 2016, and supplemented with relevant literature review. The Resilience Roundtable brought together researchers, practitioners, and policymakers, across disciplines and sectors for a daylong discussion of where and how we can move to a more integrated and cohesive resilience agenda, with attention to critical factors that would motivate more collaborative work. The roundtable identified priorities for advancing a shared resilience agenda and made ten recommendations for implementing it.

Harnessing a community for sustainable disaster response and recovery: An operational model for integrating nongovernmental organizations

OBJECTIVE Nongovernmental organizations (NGOs) are important to a community during times of disaster and routine operations. However, their effectiveness is reduced without an operational framework that integrates response and recovery efforts. Without integration, coordination among NGOs is challenging and use of government resources is inefficient. We developed an operational model to specify NGO roles and responsibilities before, during, and after a disaster. METHODS We conducted an analysis of peer-reviewed literature, relevant policy, and federal guidance to characterize the capabilities of NGOs, contextual factors that determine their involvement in disaster operations, and key services they provide during disaster response and recovery. We also identified research questions that should be prioritized to improve coordination and communication between NGOs and government. RESULTS Our review showed that federal policy stresses the importance of partnerships between NGOs and government agencies and among other NGOs. Such partnerships can build deep local networks and broad systems that reach from local communities to the federal government. Understanding what capacities NGOs need and what factors influence their ability to perform during a disaster informs an operational model that could optimize NGO performance. CONCLUSIONS Although the operational model needs to be applied and tested in community planning and disaster response, it holds promise as a unifying framework across new national preparedness and recovery policy, and provides structure to community planning, resource allocation, and metrics on which to evaluate NGO disaster involvement.

The Promise and Pitfalls of Community Resilience

An important shift in terminology has occurred in emergency preparedness, and the concept of community resilience has become ubiquitous. Although enhancing community resilience is broader than preparedness, and emphasizes a distinct set of activities and participants, the terms are often used interchangeably. The implications of this shift have not been fully explored. This commentary describes the potential promise and pitfalls of the concept of community resilience and recommends strategies to overcome its limitations. We believe that resilience has the power to dramatically change this field in immense, positive ways, but some important challenges such as confusion about definitions and lack of accountability must first be overcome. (Disaster Med Public Health Preparedness. 2013;7:603-606).

A Cluster-Randomized Trial of Restorative Practices: An Illustration to Spur High-Quality Research and Evaluation

ABSTRACT Restorative practices in schools lack rigorous evaluation studies. As an example of rigorous school-based research, this article describes the first randomized control trial of restorative practices to date, the Study of Restorative Practices. It is a 5-year, cluster-randomized controlled trial (RCT) of the Restorative Practices Intervention (RPI) in 14 middle schools in Maine to assess whether RPI affects both positive developmental outcomes and problem behaviors and whether the effects persist during the transition from middle to high school. The 2-year RPI began in the 2014–2015 school year. The study’s rationale and theoretical concerns are discussed along with methodological concerns including teacher professional development. The theoretical rationale and description of the methods from this study may be useful to others conducting rigorous research and evaluation in this area.