Sexual Abuse Prevention Concept Knowledge: Low Income Children Are Learning but Still Lagging

School-based child sexual abuse (CSA) prevention programs have proliferated since beginning over 30 years ago. Research on program effectiveness has emphasized summative outcomes while under-reporting implementation and process fidelity, limiting reliable comparisons across programs and populations. External validity is further limited by racially and economically homogenous samples, or a failure to report such demographics. This article presents data from a CSA prevention program delivered to 2nd and 3rd grade public school children. A formative concept and item level analysis on the Children’s Knowledge of Abuse Questionnaire at baseline and four week follow-up, as well as fidelity and implementation data, are reported. Results show that children learn and retain certain concepts, but vary widely in knowledge across items. This sample of low-income, minority children also show lower baseline and “learned” abuse prevention knowledge compared to published norms, which is not attributed to implementation variability. These data give critical insight into workshop effectiveness that is masked in summative reporting, yet essential to adapting and strengthening school-based CSA programs. Knowing the long-term consequences of adverse childhood experiences and disparate health outcomes linked to race and socioeconomic status, it is imperative to adequately assess CSA prevention program impact across diverse populations.     

Methodological strategies for evaluating youth gang prevention programs

This article reflects on common challenges and lessons learned during the evaluation of gang prevention programs based on case studies of three federally funded Canadian programs. Elements of evaluation design, implementation, data analysis and reporting of results are discussed. More specifically, the article highlights issues that occur when evaluating community projects focused on preventing extreme risks for violence and the complexity of working in potentially dangerous and/or unstable work environments. Topics covered include the problem with quasi-experimental designs, model fidelity adherence, program documentation, client recruitment and retention, and data collection. Recommendations are provided to improve evaluations of youth gang prevention programs and similar community-based interventions that focus on the prevention of youth violence.     

Do student social background and school context affect implementation of a school-based physical activity program?

This study examined the relationship between student- and school- characteristics and different implementation parameters of “Active All Year Round”, a nationwide Danish school-based physical activity program. The study is based on data from multiple sources: questionnaire data from students from 16 fifth-grade school classes (n = 276) and their teachers (n = 16), in-class observations (n = 15) and register data. Predictors included the student-level characteristics of gender, family affluence, immigration background, and perception of school connectedness as well as the school-level characteristics of school size, school parental education level, school physical activity policy and school’s prioritization of health promotion. Implementation was assessed by creating an implementation score from data on program psychological reach, dose delivered, dose received and fidelity. Data were analyzed by multilevel linear regression analysis. Findings indicated that the program was more easily implemented for students with higher school connectedness. To conclude, school-based health promotion programs can be improved by knowing, before the program is implemented, which factors increase the odds of better implementation.     

Implementation and process evaluation of a school-based drug abuse prevention program: Project Towards No Drug Abuse

The present study provides an implementation, process, and immediate outcomes evaluation of the classroom component of Project Towards No Drug Abuse (TND). This project involves development and evaluation of a school-based drug abuse prevention curriculum for continuation high school youth, who are at relatively high risk for drug abuse. Three randomized conditions were evaluated: a standard care, classroom only, and classroom plus school-as-community. The latter condition was an enhanced school-based condition which involved outside-of-classroom meetings and activities. Implementation was high in both program conditions even though this was a higher risk context. Process evaluation data were favorable and did not vary between the two program conditions. Immediate outcomes data (knowledge) was higher in the two program conditions than in the standard care condition. Regarding the classroom program, addition of extra-classroom activities does not appear to alter the quality of delivery of the program.     

Formative evaluation on a physical activity health promotion program for the group home setting

Physical inactivity and high rates of chronic conditions is a public health concern for adults with intellectual disability. Few health promotion programs target the group home setting which is the pre-dominant form of residential accommodation for persons with intellectual disability. A process evaluation of a physical activity health promotion program, Menu-Choice, was conducted with five group home sites for adults with intellectual and developmental disabilities. Menu-Choice assists group home staff in including physical activity goals within resident schedules. The physical activity program was designed based on theoretical frameworks, community-based participatory approaches, and established health promotion guidelines for adults with disabilities. Fourteen program coordinators (age M 39; 77% females), 22 staff (age M 39; 82% females), and 18 residents (age M 59; 72% females; 56% ambulatory) participated. Results from the fidelity survey and program completion highlight potential challenges with implementation. Findings will assist with the refinement of the program for continued implementation trials in the group home community.     

Effects as a function of implementation fidelity of a transdiagnostic prevention program in young school-aged children

Super Skills for Life (SSL) is a transdiagnostic prevention program for school-aged children with internalizing problems. The current study aimed to examine the short- and long-term (12-month follow-up) effectiveness of SSL, depending on implementation fidelity. Participants were 123 Spanish-speaking children aged 6–8 years with internalizing symptoms and their parents. High (n = 41) and low fidelity (n = 26) groups were established and compared with a control group (CG) (n = 56). Compared to CG, the high-fidelity group (HFG) achieved better outcomes than the low-fidelity group (LFG) at short and long term, including symptoms of anxiety, depression, and internalizing problems, and also externalizing problems at long-term. The LFG improved key symptoms at short term (depression) and long term (anxiety and depression). Findings suggest that SSL is beneficial even if not delivered at maximum fidelity, although considering the influence of implementation fidelity is critical because the high-fidelity implementation yielded the greatest effects when compared to the CG. This research provides valuable data, analyzing for the first time the influence of fidelity on SSL outcomes in young school-aged children exhibiting internalizing symptoms, while there is still a lack of studies of these characteristics concerning transdiagnostic prevention programs targeting childhood anxiety and depression.     

Using process data to explain outcomes. An illustration from the Child and Adolescent Trial for Cardiovascular Health (CATCH)

The purpose of this article is to illustrate the use of process evaluation for understanding study outcomes. Data from the Child and Adolescent Trial for Cardiovascular Health (CATCH), a large school-based field trial, are used. Teacher characteristics, measures of classroom curriculum implementation, and competing influences are linked to changes in dietary knowledge, intentions, and self-efficacy of students in the intervention schools. Multiple regression analyses indicate that teacher characteristics did not predict program implementation. Teacher characteristics and program fidelity, or the number of modifications made to the classroom curriculum during implementation, had direct and independent effects on student outcomes.     

The outlook is G.R.E.A.T.: What educators say about school-based prevention and the Gang Resistance Education and Training (G.R.E.A.T.) program

This article reports on a survey of administrators, counselors, and teachers from middle schools involved in the National Evaluation of the Gang Resistance Education and Training (G.R.E.A.T.) program. This survey was part of a multisite evaluation that also elicited the responses of students, parents, and officers teaching the G.R.E.A.T. program. School personnel provide their views about important current issues, including their perceptions of school safety, the role of law enforcement officers in schools, and the role and effectiveness of school-based prevention programs in general and the G.R.E.A.T. program in particular. Results from this survey have important implications for the plethora of prevention programs currently located in American schools.     

The context of program implementation and evaluation: A pilot study of interorganizational differences to improve child welfare reform efforts

This article contributes to the growing literature on evaluation and implementation science by examining the interaction between staff perceptions of organizational strength with perceptions and indicators of program fidelity. As part of a pilot project related to the evaluation of the Family to Family initiative, a survey was distributed to employees within two urban child welfare agencies with a total of 410 respondents across both sites, for a combined response rate of 72.2%. Survey results were analyzed both in terms or respondents' perception of their agency as well as in relation to measures of program performance and workload. Multivariate models show that organizational indicators are the most significant and positive predictors of perceived program implementation. Specifically, staff who positively perceived the availability of information within their agency also believed that the programs were well implemented in their agency. These findings suggest that as the value of program changes are articulated within an organization, the implementation of the initiative is perceived to improve.     

Principals' perceptions of benefits and barriers to school-based suicide prevention programs

Suicidal behavior among children and adolescents is a national problem and schools can be an effective context for suicide prevention and intervention efforts. School-wide screening programs are viewed as most effective from a public health standpoint, although they garner the least support from school administrators. The purpose of this article is to examine administrators' perceptions of three school-based suicide prevention models while also capturing opinions on barriers and benefits to implementation. Data were gathered through interviews with seven principals from one Midwestern state. Findings reveal agreement among principals that schools play a key role in suicide prevention, but they differ on which type of prevention approach is most appropriate. School principals believed the school-wide screening program included more barriers to implementation than either the in-service or the curriculum-based program, largely due to the likelihood of parental disapproval. Limitations of the study and implications for improving suicide prevention efforts are discussed.     

Great minds don't always think alike: the challenges of conducting substance abuse prevention research in public schools

Prevention researchers and school personnel lack a common understanding concerning the opportunities and burdens of school-based drug prevention research. In this article, we review issues related to researching substance abuse prevention programs in school settings, and assess challenges related to recruitment, communication, research design, surveying, and ensuring program fidelity. We conclude that before any school is enrolled, there must be a mutual understanding as to the nature and extent of the study's requirements and what adjustments a school will have to make to support a successful collaboration. Further, researchers must understand that schools' responsibilities for preparing students to perform well on academic and standardized tests will always overshadow the value they place on participating in studies to evaluate the effectiveness of prevention curricula.     

Cultivating Compassion for Self and Others: A School-Based Pilot Study for Peer-Nominated Caring Adolescents

Many have called for school-based student programs that teach skills related to self-care and caring for others. Here, such a program for peer-nominated adolescents was developed and piloted virtually at one high school during the COVID-19 pandemic. Results of a longitudinal, quasi-experimental evaluation of the program showed high-quality program implementation and promising program impacts. Effect sizes indicated moderate to large program impacts on improvements in adolescents' self-compassion, sense of interdependence, and perspective-taking, and female adolescents' interoceptive awareness, compared to controls. No group differences in compassion for others were found. The need for more research on programs that help adolescents balance compassion for the self and for others is discussed.     

Implementation of evidence-based interventions: analyzing critical components for sustainability in community mental health services

This study analyses the implementation and sustainability of evidence-based community mental health services in the form of publicly financed Individual Placement and Support programs. Critical implementation components and program fidelity were assessed after one year. After two years, program fidelity was assessed once again. After three years, the programs’ sustainability was assessed and semi-structured interviews performed, in order to deepen the understanding of implementation. Interviews and documents provided the quantitative and qualitative data, which were analyzed by the use of the Supported Employment Fidelity Scale, the Sustainable Implementation Scale (which was developed in a connecting study), and qualitative content analysis. Despite promising fidelity results after one year, eight out of 14 programs were terminated within three years. Implementation of integrated evidence-based programs in community-based settings is a delicate undertaking. Implementing agencies can benefit from rigorous preparation before program start, especially concerning the circumstances at the organizational level, such as making plans for collaboration, financing and assessments of program fidelity.     

Examining the link between program implementation and behavior outcomes in the lifestyle education for activity program (LEAP)

Lifestyle Education for Activity Program (LEAP) was a comprehensive, school-based intervention designed to promote physical activity in high school girls. The intervention focused on changes in instructional practices and the school environment to affect personal, social, and environmental factors related to physical activity. Multiple process evaluation tools and an organizational assessment tool were developed to monitor program implementation from a framework called the LEAP essential elements, which characterized complete and acceptable intervention delivery; secular trends were also monitored. Using process data, LEAP intervention schools were categorized into low- and high-implementing groups and compared with control schools on nine essential elements assessed at the organizational level. The Wilcoxon scores test revealed that low- and high-implementing intervention, and control schools differed significantly on two of nine administrator-reported organizational-level components: having a physical activity team and having a faculty-staff health promotion program. A mixed-model analysis of covariance indicated that, compared to control schools, a greater percentage of girls in high-implementing schools reported engaging in vigorous physical activity. Process evaluation can be used to understand the relationship between level of implementation and successful program outcome.     

Evaluation of the implementation of a socio-educational program with immigrant families: a case study

There exist an increasing number of studies that demonstrate the necessity to evaluate the processes which characterize a program and guarantee its implementation and evaluation. This paper deals with the implementation of a program designed to improve the acculturation of immigrant families in Spain (EU). Implementation followed a process that has proved successful in other settings, but is being applied here for the first time. Qualitative and quantitative measures are employed to assess each stage of implementation, with a particular emphasis on fidelity to program design. The intent was to guide effective revision of the program, and to establish it in a form that can be implemented on a larger scale.     

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.     

An evaluation of immediate outcomes and fidelity of a drug abuse prevention program in continuation high schools: project towards no drug abuse (TND)

The present study provides an implementation fidelity, process, and immediate outcomes evaluation of Project Towards No Drug Abuse (TND), a drug prevention program targeting continuation high school youth (n=1426) at risk for drug abuse. A total of 24 schools participated in three randomized conditions: TND Only, TND and motivational interviewing follow-up, and no treatment control. Fidelity was high: across program schools the curriculum was implemented as intended and was received favorably by students. Relative to controls, intervention conditions produced effects on hypothesized mediators, including greater gains in program related knowledge, greater reductions in drug use intentions, and positive changes in motivation. However, few generalizations to attitudes and intentions regarding risky sexual behavior were found. The pattern of results suggests that the experimental manipulations worked as intended.     

The irrelevance of evidence in the development of school-based drug prevention policy, 1986-1996

This article examines development in school-based drug prevention policy and programming since the Anti-Drug Abuse Act of 1986. Using data from national surveys and evaluations of school-based programs, it argues, first, that there was really no need for a massive infusion of money into school-based drug prevention in the late 1980s, and, second, that there was little or no evidence to indicate that a "new generation" of effective programs, based on the so-called social influence model, was emerging at this time. Despite the infusion of resources into school-based prevention efforts, adolescent drug use has risen in recent years. Moreover, evaluations continue to show that the effectiveness of social influence programs is very much in the eye of the beholder. Fundamental questions need to be asked of school-based drug prevention--just as they should be asked of other key components of our current drug control policy.     

An evaluation of the fidelity of implementation of a school-based drug abuse prevention program: project toward no drug abuse (TND)

This article provides an implementation fidelity evaluation of the fourth experimental trial of Project Towards No Drug Abuse (TND). Two theoretical content components of the curriculum were examined to increase our understanding of the active ingredients of successful drug abuse prevention programs. A total of 18 senior high schools were randomly assigned by block to receive one of three conditions: cognitive perception information curriculum, cognitive perception information + behavioral skills curriculum, or standard care (control). These curricula were delivered to both regular and continuation high schools students (n=2331) by trained project health educators and regular classroom teachers. Across all program schools, the two different curricula were implemented as intended, were received favorably by students, and showed significant improvements in knowledge specific to the theoretical content being delivered. This pattern of results suggests that the experimental manipulations worked as intended, and thus, permit the attribution of future behavioral outcome differences between conditions to differences in content of Project TND material provided rather than to differences in the fidelity of delivery. Further, our findings indicate that Project TND can be implemented effectively with low and high risk youth in a general environment as well as with high risk youth in a more specialized environment.