Shannon Self-Brown

Dynamic adaptation process to implement an evidence-based child maltreatment intervention

BackgroundAdaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The degree to which core elements of an EBP can be maintained while allowing for local adaptation is unclear. In addition, adaptations may also be needed at the system, policy, or organizational levels to facilitate EBP implementation and sustainment. This paper describes a study of the feasibility and acceptability of an implementation approach, the Dynamic Adaptation Process (DAP), designed to allow for EBP adaptation and system and organizational adaptations in a planned and considered, rather than ad hoc, way. The DAP involves identifying core elements and adaptable characteristics of an EBP, then supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. In addition, this study addresses a secondary concern, that of improving EBP model fidelity assessment and feedback in real-world settings.MethodsThis project examines the feasibility, acceptability, and utility of the DAP; tests the degree to which fidelity can be maintained using the DAP compared to implementation as usual (IAU); and examines the feasibility of using automated phone or internet-enabled, computer-based technology to assess intervention fidelity and client satisfaction. The study design incorporates mixed methods in order to describe processes and factors associated with variations in both how the DAP itself is implemented and how the DAP impacts fidelity, drift, and adaptation. The DAP model is to be examined by assigning six regions in California (USA) to either the DAP (n = 3) or IAU (n = 3) to implement an EBP to prevent child neglect.DiscussionThe DAP represents a data-informed, collaborative, multiple stakeholder approach to maintain intervention fidelity during the implementation of EBPs in the field by providing support for intervention, system, and organizational adaptation and intervention fidelity to meet local needs. This study is designed to address the real-world implications of EBP implementation in public sector service systems and is relevant for national, state, and local service systems and organizations.

Relations Among Gender, Violence Exposure, and Mental Health: The National Survey of Adolescents

Using a nationally representative sample of 4,008 adolescents, this study examines gender differences in violence exposure, major depressive episode (MDE) and posttraumatic stress disorder (PTSD), and characteristics of violence incidents. It was hypothesized that there would be gender differences in the types of violence exposure reported and in the prevalence of MDE and PTSD and that gender would moderate the relationship between violence exposure and mental health outcomes. Results indicated significant gender differences in rates of violence exposure, PTSD, and MDE. Additionally, gender was a moderating variable in the relation between sexual assault and PTSD, but not in the other violence exposure?mental health relations examined. It thus appears that the pathways for developing PTSD may be different for male and female victims of sexual abuse. Implications for interventions and future research are discussed.

The relations between family environment and violence exposure among youth: findings from the National Survey of Adolescents.

A national household probability sample of 4,023 adolescents (ages 12 to 17) completed telephone interviews assessing demographics, adverse family environment, and violence exposure. Logistic regressions examined relations among family environment and each violence exposure type, controlling for demographics and other violence exposures. Relationships between family environment and violence exposure varied, depending on type of violence reported, most notably between intrafamilial versus extrafamilial violence. After controlling for family environment, exposure to one violence type significantly increased the likelihood of other violence exposures. Family substance use and not always living with a natural parent were significantly associated with all three types of violence exposure. Findings indicate that clinical assessments should include a thorough evaluation of family environment and violence exposure and also highlight the need for treatment to focus on the adolescent and broader family unit. Future research is needed to further examine these complex interrelationships and their associations with adolescent outcomes.

Predicting posttraumatic stress symptoms in children following Hurricane Katrina: a prospective analysis of the effect of parental distress and parenting practices.

Research exhibits a robust relation between child hurricane exposure, parent distress, and child posttraumatic stress disorder (PTSD). This study explored parenting practices that could further explicate this association. Participants were 381 mothers and their children exposed to Hurricane Katrina. It was hypothesized that 3-7 months (T1) and 14-17 months (T2) post-Katrina: (a) hurricane exposure would predict child PTSD symptoms after controlling for history of violence exposure and (b) hurricane exposure would predict parent distress and negative parenting practices, which, in turn, would predict increased child PTSD symptoms. Hypotheses were partially supported. Hurricane exposure directly predicted child PTSD at T1 and indirectly at T2. Additionally, several significant paths emerged from hurricane exposure to parent distress and parenting practices, which were predictive of child PTSD.

Posttraumatic stress disorder symptom trajectories in Hurricane Katrina affected youth

OBJECTIVE This study examined trajectories of posttraumatic stress disorder symptoms in Hurricane Katrina affected youth. METHOD A total of 426 youth (51% female; 8-16 years old; mean age=11 years; 75% minorities) completed assessments at 4 time points post-disaster. Measures included Hurricane impact variables (initial loss/disruption and perceived life threat); history of family and community violence exposure, parent and peer social support, and post-disaster posttraumatic stress symptoms. RESULTS Latent class growth analysis demonstrated that there were three distinct trajectories of posttraumatic stress disorder symptoms identified for this sample of youth (resilient, recovering, and chronic, respectively). Youth trajectories were associated with Hurricane-related initial loss/disruption, community violence, and peer social support. CONCLUSIONS The results suggest that youth exposed to Hurricane Katrina have variable posttraumatic stress disorder symptom trajectories. Significant risk and protective factors were identified. Specifically, youth Hurricane and community violence exposure increased risk for a more problematic posttraumatic stress disorder symptom trajectory, while peer social support served as a protective factor for these youth. Identification of these factors suggests directions for future research as well as potential target areas for screening and intervention with disaster exposed youth. LIMITATIONS The convenience sample limits the external validity of the findings to other disaster exposed youth, and the self-report data is susceptible to response bias.

Effects of community violence exposure and parental mental health on the internalizing problems of urban adolescents.

Previous research has documented an association between adolescent community violence exposure (CVE) and poor psychological functioning. The purpose of this study is to delineate the relations of CVE, parental mental health, and adolescent PTSD and depression. Participants consisted of 121 pairs of junior high and high school students and their parents. Adolescents completed measures to assess their history of violence exposure and current psychological functioning. Parents completed a demographic questionnaire and measures assessing their psychological functioning. Hierarchical regression analyses were conducted, and results indicated that, after controlling for demographic variables and family violence exposure, parental mental health emerged as a moderating variable in the relation between CVE and adolescent-rated PTSD, but not in the association between adolescent CVE and depression. Clinical implications of this study and directions for future research are discussed.

Prevention of Child Sexual Abuse: Evaluation of a Community Media Campaign

Given that mass media techniques have been an effective tool within the public health field for affecting behavioral change, these strategies may prove successful for the primary prevention of child sexual abuse (CSA). This study was an independent evaluation of a CSA media campaign. Two hundred parents were recruited from eight sites across the United States. Results indicated that the combined mass media campaign affected knowledge about CSA at the time of intervention compared to no intervention. No significant differences were found in regards to CSA attitudes. A significant positive impact on primary prevention response behaviors assessed using hypothetical vignettes was found; however, no significant findings were noted for several other behavioral responses. Knowledge and behavioral gains were not maintained at the one-month follow-up. Small sample size at follow-up may have affected findings. Results of this study imply that media campaigns alone may not significantly affect primary prevention of CSA.

Initial Implementation Indicators From a Statewide Rollout of SafeCare Within a Child Welfare System

There is a strong movement toward implementation of evidence-based practices (EBP) in child welfare systems. The SafeCare parenting model is one of few parent-training models that addresses child neglect, the most common form of maltreatment. Here, the authors describe initial findings from a statewide effort to implement the EBP, SafeCare®, into a state child welfare system. A total of 50 agencies participated in training, with 295 individuals entering training to implement SafeCare. Analyses were conducted to describe the trainee sample, describe initial training and implementation indicators, and to examine correlates of initial training performance and implementation indicators. The quality of SafeCare uptake during training and implementation was high with trainees performing very well on training quizzes and role-plays, and demonstrating high fidelity when implementing SafeCare in the field (performing over 90% of expected behaviors). However, the quantity of implementation was generally low, with relatively few providers (only about 25%) implementing the model following workshop training. There were no significant predictors of training or implementation performance, once corrections for multiple comparisons were applied. The Discussion focuses on challenges to large-scale system-wide implementation of EBP.

Disseminating Child Maltreatment Interventions: Research on Implementing Evidence-Based Programs

Evidence-based practices (EBPs) have the promise to reduce child maltreatment and improve the lives of countless families and children, but effective implementation entails many challenges. Efficacious interventions now exist for parents at risk for or who have perpetrated maltreatment (i.e., Chaffin et al., 2004; Chaffin, Hecht, Bard, Silovsky, & Beasley, in press; Kolko, Iselin, & Gully, 2011; Prinz, Sanders, Shapiro, Whitaker, & Lutzker 2009; Webster-Stratton, 2010) and for youth victimized by maltreatment (Cohen, Mannarino, Berliner, & Deblinger, 2000; Deblinger & Heflin, 1996). Despite the development of such programs, many families involved in the child welfare and foster care systems are not provided interventions or services with strong empirical support (Barth et al., 2005; Hurlburt, Barth, Leslie, Landsverk, & McCrae. 2007). For example, while parenting interventions are virtually de rigueur on service plans, extant parenting services often consist of didactic classroom-centered parent training or mix systems therapy and case management that bear little resemblance to the evidence-based parent behavior management programs that are proven effective (Barth et al., 2005; Casanueva, Martin, Runyan, Barth, & Bradley, 2007). The child maltreatment field is in the nascent stage with regard to transporting EBPs into relevant public sector services systems. Fortunately, research is advancing our understanding of the critical contextual factors at the client, therapist, organization, training, and sociopolitical levels that can increase the likelihood of effective EBP implementation (e.g., Addis, 1997, 2002; Beidas & Kendall, 2010; Berwick, 2003; Chamberlain et al., 2008; Elliott & Mihalic, 2004; Herschell et al., 2003; Sanders & Turner, 2005; Saul et al., 2008; Schoenwald, 2003; Turner & Sanders, 2006; Wandersman et al., 2008; Weisz & Gray, 2008). The purpose of this special issue is to advance implementation science in the field of child maltreatment prevention and intervention by presenting data-based articles that highlight recent efforts to conduct rigorous research on EBP dissemination and implementation. For purposes of this special issue, we use definitions of implementation and stages of implementation provided by National Implementation Research Network (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005). Specifically, implementation is defined as “a specified set of activities designed to put into practice an activity or program of known dimensions.” As implementation is a process, and not an event, Fixsen and colleagues identified the following discernible stages as critical to effective implementation of EBPs: (1) Exploration/Adoption, (2) Program Installation, (3) Initial Implementation, (4) Full Operation, (5) Innovation, and (6) Sustainability (for further description, please refer to Fixsen et al., 2005). The articles published in this issue address all of the implementation stages, with the exception of the innovation stage. Implementation stages relevant to this issue are presented below, along with a brief review of the current state of the literature, and a discussion of how the special issue articles advance current knowledge.

Effects of exposure to community violence and family violence on school functioning problems among urban youth: the potential mediating role of posttraumatic stress symptoms

Adolescents who are exposed to violence during childhood are at an increased risk for developing posttraumatic stress (PTS) symptoms. The literature suggests that violence exposure might also have negative effects on school functioning, and that PTS might serve as a potential mediator in this association. The purpose of the current study was to replicate and extend prior research by examining PTS symptoms as a mediator of the relationship between two types of violence exposure and school functioning problems among adolescent youth from an urban setting. Participants included a sample of 121 junior high and high school students (M = 15 years; range = 13–16 years; 60 males, 61 females) within high-crime neighborhoods. Consistent with our hypotheses, community violence and family violence were associated with PTS symptoms and school functioning problems. Our data suggest that community and family violence were indirectly related to school functioning problems through PTS symptoms. Findings from this study demonstrate that PTS symptoms potentially mediate the relationship between violence exposure and school functioning problems across two settings (community and home). Future research should further examine protective factors that can prevent youth violence exposure as well as negative outcomes related to violence.