Dissemination of an evidence-based parenting program: Clinician perspectives on training and implementation

The present study used a qualitative approach to examine clinicians' experiences as trainees of an evidence-based parenting program, parent–Child interaction therapy (PCIT). In order to explore factors related to successful implementation and maintenance of the PCIT program in a community setting, twenty-nine community clinicians completed phone interviews six months to four years after an initial forty-hour PCIT training workshop. Clinicians reported positive experiences with the training, but also described barriers related to agency, client, program, and training factors. Findings suggest that (1) trainees view the core components of PCIT as acceptable and valuable, (2) training costs and problems with third-party reimbursement can impede implementation, (3) clinicians may benefit from training that includes skills in motivation enhancement, and (4) ongoing consultation is valuable to clinicians, although trainees differ in their preferences regarding the manner of delivery (e.g., teleconference, live). This study brings clinicians into the conversation regarding barriers to and facilitators of evidence-based training and implementation.     

Risk factors for teenage childbirths among child welfare clients: Findings from Sweden

This study contributes to the literature on preventing teenage childbirths by asking whether the pattern and strength of risk factors is the same for high-risk child welfare clients, as for their peers in the majority population. Longitudinal register data on more than 700,000 Swedish females, including around 29,000 child welfare clients, were analyzed by means of linear probability models and calculations of population attributable fractions. Comparisons of effect sizes suggest that the differences in pattern were marginal, but there were notable differences in strength. The girls' school failure was the most prominent risk factor across all groups, also when prevalence was taken into account. In the majority population, the hypothetical reduction of teenage childbirths is on the scale of 30% if this risk factor could be eliminated. In the child welfare subgroups, however, the hypothetical improvement was even larger, around 40%. Reducing the high rate of school failure could thus yield a profound reduction in teenage childbirths in child welfare subgroups, where the incidence of teenage childbirth is substantially higher compared to other peers.     

A comprehensive program for pregnant adolescents: parenting and prevention

Beginning in 1981 as an effort to reduce mortality rates of at-risk infants, the Teen Pregnancy Project of this agency has grown steadily into a multiservice program with many approaches, yet all services for its help-resistant population depend upon an outreach, home-visiting initiative to establish useful relationships with its clients.     

Alternative methods for handling attrition: an illustration using data from the Fast Track evaluation

Using data from the evaluation of the Fast Track intervention, this article illustrates three methods for handling attrition. Multiple imputation and ignorable maximum likelihood estimation produce estimates that are similar to those based on listwise-deleted data. A panel selection model that allows for selective dropout reveals that highly aggressive boys accumulate in the treatment group over time and produces a larger estimate of treatment effect. In contrast, this model produces a smaller treatment effect for girls. The article's conclusion discusses the strengths and weaknesses of the alternative approaches and outlines ways in which researchers might improve their handling of attrition.     

Recruiting fathers to parenting programs: Advice from dads and fatherhood program providers

The benefits of high-quality father–child relationships for fathers and children alike are well documented. While evidence suggests parenting programs can improve the quality of father–child relationships, few fathers participate in such programs. This qualitative study aims to fill the gap in knowledge on best practices for recruiting urban African American fathers, a group of fathers with unique parenting challenges, to parenting programs. Focus groups were conducted with 29 fathers to gain their perspectives on recruitment strategies. Semi-structured interviews were also conducted with a nationwide sample of 19 fatherhood program providers to learn about their most successful recruitment strategies. Recruitment strategies based on emergent themes from the focus groups and interviews are presented here. Themes included using word-of-mouth recruitment, increasing advertising, targeting advertising specifically to urban African American fathers, providing transportation and incentives, recruiting through the courts, collaborating with other community agencies, and offering parenting programming along with other programming valued by fathers such as employment assistance. Implications for developing strategies for recruiting urban African American fathers to parenting programs are discussed.     

An evaluation of the nutrition education and training program : Findings from Nebraska

This paper summarizes methods and findings from a classical randomized experiment used to evaluate the Nutrition Education and Training (NET) Program that was developed and implemented in Nebraska. The evaluation focused on assessing how well the program was implemented and the impact it had on children's nutrition-related knowledge, attitudes, preferences, and habits. Data were collected from over 2,300 children in 96 classrooms distributed across grades 1–6 in 20 schools spanning the state of Nebraska. The 20 participating schools were selected from 98 volunteers and were assigned to treatment or control status using a modified random assignment procedure that resulted in equivalent pretest means on outcome measures. Pretest data and two waves of posttest data were collected. The evaluation found strong positive effects in all grades on several measures of nutrition knowledge, positive effects on reported food preference and willingness to select new foods in the school lunch line in grades 1–3, positive effects on willingness to taste previously rejected foods in grades 4–6, and no consistent effects on food attitudes, reported food habits, or plate waste.     

Examining the need for cultural adaptations to an evidence-based parent training program targeting the prevention of child maltreatment

Evidence-based behavioral parent training programs (BPTs) have been recommended as a primary prevention strategy for child maltreatment, and use of BPTs is increasing. As these programs are implemented in new contexts and among new populations, the cultural relevance of these programs and need for adaptations or modifications must be considered. The purpose of this study was to assess the types of cultural adaptations that are being made to a widely implemented BPT, SafeCare, by providers working with families involved in the child welfare system, and to explore the need for more systematic adaptations. Eleven SafeCare providers, from six states, participated in individual, semi-structured interviews. Overall, the providers did not recommend systematic adaptations of the model for specific ethnic groups. However, they provided general and specific information regarding SafeCare components that require adaptation on a case-by-case basis, which is likely to be applicable to many BPTs. More research is needed to develop clear guidance about when and how to assess the need for cultural adaptations and how to institute adaptations that improve rather than weaken evidence-based programs. By sharing data and experiences, purveyors can contribute to the body of knowledge about adaptation.     

Telephone support for parenting: an evaluation of Parentline Plus

Recent Government policy has advocated universal support services for parents, including a national telephone helpline (for example, Department for Education and Skills, 2003). The Home Office funded just such a helpline—Parentline Plus—as part of the Supporting Families initiative. The efficiency and effectiveness of this service in supporting parents were evaluated through secondary analysis of call data, assessment of taped calls, and interviews with callers. The helpline offers anonymous non‐stigmatising support to a growing number of callers, and most callers interviewed valued highly the service they received. Many had significant support needs that were not met by other forms of service provision.     

Exploration of factors predictive of at-risk fathers' participation in a pilot study of an augmented evidence-based parent training program: A mixed methods approach

There has been burgeoning parenting intervention research specifically addressing fathers in recent decades. Corresponding research examining their participation and engagement in evidence-based parent training programs, which have almost exclusively targeted mothers, is just emerging. The current study used mixed methods to examine factors that influenced completion of an augmented version of an evidence-based child maltreatment prevention program developed for male caregivers called SafeCare Dad to Kids (Dad2K) in a pilot study. The current sample comprised 50 male caregivers (M_age = 29.42 years, SD = 8.18) of a child between the ages of 2 and 5 years. Fathers participated in a baseline assessment and were considered program completers (n = 27) if they participated in the program's six home visiting sessions. A subsample of completers (n = 11) was recruited to participate in qualitative interviews that provided in-depth information about fathers' experiences in Dad2K. Logistic regression indicated that, in the context of other demographic predictors, fathers with an education beyond high school were over 5 times more likely to complete Dad2K program compared to fathers with a high school education or less. Qualitative analyses revealed that interviewed father completers were motivated to enroll and participate in a fathering program because of an interest to learn and obtain skills to make them a better parent. Fathers with a high school education or less may require additional engagement strategies to help proactively encourage their enrollment and completion of parent training programs.     

Evaluating the effectiveness of combining Home-Start and Triple P parenting support in the Netherlands

The effects of Home-Start compared to Home-Start extended with Triple P group training were studied. The underlying theoretical models of change of both programs complement each other and therefore it was assumed that combined support leads to increased positive outcomes. Outcomes related to parental wellbeing, parenting behaviour and child behaviour were included. One hundred forty four parents, all mothers, were randomly assigned to either the Home-Start program or the combined support of Home-Start and Triple P group level 4. Parents reported on wellbeing, parenting behaviour, and child behaviour at baseline, post-program and at 6-month follow-up. Based on intention to treat analyses, families in the combined intervention condition showed similar effects on the majority of primary and secondary outcomes as the only receiving Home-Start condition. A negative effect on parental depression and on two subscales of the Child Behavioral Checklist (anxiety and oppositional defiant behaviour) was found for families in the combined Home Start and Triple-P condition. The hypothesized stronger positive effect of combining Home-Start and Triple P support on selected outcome measures was not confirmed. Combining promising evidence-based parenting programs with complementary underlying theoretical frameworks does not necessarily lead to better results.     

A large-scale initiative to disseminate an evidence-based drug abuse prevention program in Italy: Lessons learned for practitioners and researchers

Across developed countries, experimentation with alcohol, tobacco, and other drugs often begins in the early adolescent years. Several evidence-based programs have been developed to prevent adolescent substance use. Many of the most rigorously tested and empirically supported prevention programs were initially developed and tested in the United States. Increasingly, these interventions are being adopted for use in Europe and throughout the world. This paper reports on a large-scale comprehensive initiative designed to select, adapt, implement, and sustain an evidence-based drug abuse prevention program in Italy. As part of a large-scale regionally funded collaboration in the Lombardy region of Italy, we report on processes through which a team of stakeholders selected, translated and culturally adapted, planned, implemented and evaluated the Life Skills Training (LST) school-based drug abuse prevention program, an evidence-based intervention developed in the United States. We discuss several challenges and lessons learned and implications for prevention practitioners and researchers attempting to undertake similar international dissemination projects. We review several published conceptual models designed to promote the replication and widespread dissemination of effective programs, and discuss their strengths and limitations in the context of planning and implementing a complex, large-scale real-world dissemination effort.     

A multi-site study of the ACT Raising Safe Kids program: Predictors of outcomes and attrition

The present study examined the factors related to attrition and treatment outcomes in the ACT-Raising Safe Kids (ACT-RSK) program. ACT-RSK is a family violence and child abuse prevention program for parents and caregivers of young children. Sixty parents or caregivers of children aged 9 years or younger completed the ACT-RSK group program and the research measures. The study took place at 7 community-based sites in the midwestern United States. Program completers were significantly older than noncompleters, suggesting that parent age relates to attrition from this program. Pre/post comparisons indicated increased nurturing behavior, decreased harsh parenting, and decreased negative discipline, as well as decreased child behavior problems following completion of the ACT-RSK program. Parent age predicted children's outcomes, indicating better results for the children of older parents/caregivers. In addition, pre-test harsh parenting scores predicted children's outcomes, suggesting that families with relatively higher initial levels of parental psychological aggression and corporal punishment had more robust child outcomes following completion of the program.     

Distress,Need for Help,and Positive Feelings Derived from Participation in Sex Research: Findings of a Population Study in the Netherlands

To inform cost-benefit analyses of potential harms and benefits for participants in sex research, the current study investigated potential effects of completing a self-report sex survey. The data stem from a sexual health study in a population sample in the Netherlands (N = 8,064; 15 to 70 years old). Three measures assessed potential effects of participation: distress, need for help, and positive feelings related to research participation. Analyses showed that levels of experienced distress and need for help resulting from participation in a self-report sex survey were low, while participants reported positive feelings to a considerable extent. Only few participants reported levels of positive experiences that were lower than the levels of distress (4.8%) or need for help (1.7%) they experienced. Although differences were found according to sociodemographic characteristics and sexual experiences, the proportion of variance explained by these variables was generally small. While the findings of this study show that the balance between potential harm and positive outcomes seems disturbed for few participants, researchers should provide participants with the details of care providers in case they experience any distress or need for help.     

Evolutionary Evaluation: Implications for evaluators,researchers, practitioners,funders and the evidence-based program mandate

Evolutionary theory, developmental systems theory, and evolutionary epistemology provide deep theoretical foundations for understanding programs, their development over time, and the role of evaluation. This paper relates core concepts from these powerful bodies of theory to program evaluation. Evolutionary Evaluation is operationalized in terms of program and evaluation evolutionary phases, which are in turn aligned with multiple types of validity. The model of Evolutionary Evaluation incorporates Chen's conceptualization of bottom-up versus top-down program development. The resulting framework has important implications for many program management and evaluation issues. The paper illustrates how an Evolutionary Evaluation perspective can illuminate important controversies in evaluation using the example of the appropriate role of randomized controlled trials that encourages a rethinking of “evidence-based programs”. From an Evolutionary Evaluation perspective, prevailing interpretations of rigor and mandates for evidence-based programs pose significant challenges to program evolution. This perspective also illuminates the consequences of misalignment between program and evaluation phases; the importance of supporting both researcher-derived and practitioner-derived programs; and the need for variation and evolutionary phase diversity within portfolios of programs.     

Parents' beliefs about the cause of parenting problems and relevance of parenting support: Understanding low participation of ethnic minority and low socioeconomic status families in the Netherlands

ObjectivesTo provide in-depth understanding of parents' beliefs about the causes of parenting problems, and the perceived relevance of parenting support in a sample of ethnic minority and low socioeconomic status (SES) families.MethodsCross-comparative analyses were performed on qualitative data from 61 parents (age child: 0–15 years) of two ethnic minority groups (Antillean-Dutch and Moroccan-Dutch) and one ethnic majority group (native Dutch) in the Netherlands. Methodology included in-depth qualitative interviews followed by focus groups. Atlas.ti software was used to manage and analyse data inductively.ResultsParenting support was perceived to be less relevant if parents related the cause of parenting problems to stress and external factors. Low-SES and ethnic minority parents more often emphasised unfavourable living conditions and living in two cultures as causes for parenting problems. Parents considered parenting support most relevant during periods of rapid change in their children, or in their parenting role.ConclusionResults indicate that beliefs regarding the cause and controllability of problems are important to understand parents' motivation to participate in parenting support. Notable differences were found regarding the period during the child's life that parenting support was perceived as most relevant. Motivation to participate was higher during various stages of transition, which ranged from the transition to parenthood, to toddlerhood, the age of seven, and adolescence.     

An overview of evidence-based program registers (EBPRs) for behavioral health

Evaluations of behavioral health interventions have identified many that are potentially effective. However, clinicians and other decision makers typically lack the time and ability to effectively search and synthesize the relevant research literature. In response to this opportunity, and to increasing policy and funding pressures for the use of evidence-based practices, a number of “what works” websites have emerged to assist decision makers in selecting interventions with the highest probability of benefit. However, these registers as a whole are not well understood. This article, which represents phase one of a concurrent mixed methods study, presents a review of the scopes, structures, dissemination strategies, uses, and challenges faced by evidence-based registers in the behavioral health disciplines. The major findings of this study show that in general, registers of evidence-based practices are able, to a degree, to identify the most effective practices meet this need to a degree. However, much needs to be done to improve the ability of the registers to fully realize their purpose.