Gang involvement moderates the effectiveness of evidence-based intervention for justice-involved youth

There are no validated, evidence-based intervention approaches to helping youth who are involved in gang activity. The goal of this study was to evaluate the impact of gang involvement on the effectiveness of evidence-based intervention services for problem behavior delivered to youth referred by the justice system. We analyzed data drawn from 421 youth (69% male; M age = 15.08 years, SD = 1.32; 38% Black/African-American, 18% Latino/a, 34% White, 10% other) referred consecutively over a 13-month period for Multisystemic Therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009) across clinical service sites in 7 different Eastern states of the US. Outcomes were indicated by successful or unsuccessful case closures, and gang involvement was indicated by a validated multi-factored classification scheme. We conducted analyses of outcomes related to gang involvement for the whole sample as well as a propensity score-matched (PSM) reduced sample. Analyses of treatment success rates indicate that gang involvement significantly and substantially reduces the effectiveness of MST in this population.     

The effectiveness of intervention for adolescents exposed to domestic violence

The purpose of this study is to evaluate the effectiveness of a 10-week group intervention for adolescents who were exposed to domestic violence in their home, and compare behavioral and emotional symptoms between adolescents with direct or indirect exposure to domestic violence. Participants of the group intervention (N = 32) reported an increase in knowledge of domestic violence based on quiz scores of pre- and post-tests. Compared to those without direct exposure to domestic violence, the participants that were directly exposed to domestic violence presented greater symptoms in the subscales of the Child Behavioral Checklist and the Revised Children's Anxiety and Depression Scale. Such findings are discussed along with previous literature. The study also discusses limitations related to internal and external validity threats and suggestions for future replication of the group intervention toward adolescents who were exposed to domestic violence and the related program evaluation.     

Physical activity and nutrition program for adults with metabolic syndrome: Process evaluation

IntroductionThe Vietnam Physical Activity and Nutrition (VPAN) program aimed to improve physical activity and nutrition for adults aged 50–65 years with Metabolic Syndrome in Vietnam. The VPAN program consisted of a range of resources and strategies, including an information booklet, resistance band, face-to-face education sessions, and walking groups. This process evaluation assessed the participation, fidelity, satisfaction, and reasons for completing and not-completing the VPAN.MethodsData were collected by mixed-methods from a sample of 214 intervention participants. Quantitative data were collected via surveys (n = 163); qualitative data via face-to-face exit interviews with intervention program completers (n = 10) and non-completers (n = 10), and brief post education session discussions.ResultsMost participants (87%–96%) reported the program resources and strategies useful, assisting them to increase their physical activity level and improving their diet. The education sessions were the most preferred strategy (97%) with high attendance (>78% of participants). The main reasons for withdrawal were work commitments and being too busy.ConclusionThe evaluation indicated that the program reached and engaged the majority of participants throughout the six-month intervention. The combination of printed resources and face-to-face intervention components was a suitable approach to support lifestyle behavioural change in the Vietnamese population.     

Diabetes education program for people with type 2 diabetes: An international perspective

BackgroundIn the Palestinian community, lifestyle changes, rapid urbanization and socioeconomic development, stress, smoking, and changes in food habits has increased the risk of non-communicable diseases especially diabetes mellitus. Diabetes complications can be prevented if the glycemic status of patients with diabetes is maintained within a nearly normal range. Therefore, patient education is critical in controlling blood glucose levels within the normal range.ObjectiveThis study aimed at measuring the effect of diabetes educational intervention program for patients suffering from type 2 diabetes attending the Diabetes Clinic in Tulkarim Directorate of Health.MethodsA short duration observational study involving pre- and post-test educational intervention program was carried out on a relatively small number of type 2 diabetes patients at the Diabetes Clinic in Tulkarim Directorate of Health. In total, 215 patients attended a group-based 4 h educational intervention session about diabetes. The program included explaining diabetes mellitus-symptoms, risk factors, types, treatment and complications and main aspects of self-care of the disease (foot care, eye care, and blood glucose monitoring), main aspects of dietary management, weight reduction, blood pressure, smoking cessation, periodic investigations, home monitoring and importance of physical activity. Knowledge evaluation questionnaire were evaluated pre- and post-study. Anthropometric measurements such as body weight (WT), body mass index (BMI) and laboratory tests such as fasting blood glucose (FBG), hemoglobin A1C (HbA1c), cholesterol (Chol), and triglycerides (TG) were measured both at the beginning and at the end of the study. Significance of the results was assessed by paired t-test at 95% confidence interval.ResultsThe participant’s mean age was 51.07 that ranged between 31 and 70 years. For a total of 215 participants, 41.4% were males and 58.6% were females. The mean weight before educational intervention was 80.81 ± 14.95 kg (82.6 kg for males and 79.5 kg for females) that decreased to 78.9 ± 14.33 kg (81.1 kg for males and 77.3 kg for females) after educational intervention program. The BMI also decreased significantly after educational intervention. The mean fasting blood sugar was 188.65 ± 71.45 mg/dL before educational intervention that decreased to 177.7 ± 66.11 mg/dL after the educational intervention (p = 0.049). The mean glycosylated hemoglobin was 8.57 ± 1.21 before educational intervention that decreased to 7.95 ± 1.42 after educational intervention. The mean value of cholesterol before educational intervention was 183.27 ± 37.74 mg/dL that decreased to 169.57 ± 34.23 mg/dL after educational intervention. The mean triglycerides value decreased after educational intervention from 209.85 ± 171.04 mg/dL to 183.28 ± 152.4 mg/dL (p = 0.025). The mean score of knowledge questionnaire before educational intervention was 60.6 ± 20.65 that increased to 78.1 ± 13.4 after conducting educational intervention.ConclusionsDiabetes education was found to be effective on BMI, FBG, HbA1c, Chol, TG, and knowledge.RecommendationsDiabetes education is a cornerstone in the management and care of diabetes and should be an integral part of health planning involving patient’s family, diabetes care team, community, and decision makers in the education process.     

The effectiveness of a parenting education program based on respected parents & respected children for mothers of preschool-aged children

The purpose of this study was to evaluate the effectiveness of the Respected Parents & Respected Children (RPRC) parenting education program for mothers of preschool-aged children in South Korea. A total of 99 mothers were assigned to an intervention group (n = 54) or a control group (n = 45). Mothers in the intervention group received 16 weekly sessions of the parenting education program and then were compared with mothers who did not take part in the program. Questionnaires were used to assess parenting characteristics (i.e., maternal depression and anger, parenting behavior, co-parenting, parenting efficacy, and parenting stress) at baseline (pre-test), immediately after the termination of the program (post-test), and 8 months after the end of the program (follow-up test). Maternal rejection/restrictions, dissatisfaction, and parental distress of the intervention group decreased and efficacy as parents improved after taking part in the program, and these effects were sustained at follow-up. Our findings support the effectiveness of the RPRC parenting education program in changing parenting strategies and satisfaction and emphasize the need for preventive interventions for parents with young children.     

Organizational and health promotion benefits of diaper bank and community-based organization partnerships

The Diaper Bank of North Carolina provides a supplemental supply of free disposable diapers, baby wipes, and diaper rash cream to low-income families. Rather than providing the diapers directly to families in need, the diaper bank formed partnerships with service-providing community-based organizations (CBOs) that distribute the diapers to their own clients. During a multi-phase mixed methods evaluation, we conducted qualitative key informant interviews with staff members (n = 9) of CBOs that distribute diapers. Analysis of the interviews informed development of an electronic survey distributed to CBO staff members (n = 42) who did not participate in key informant interviews. Key findings demonstrate the provision of diaper bank diapers allowed CBOs to assist families in meeting a basic need while: (1) positively impacting their organization and program budgets, (2) enhancing communication with clients, (3) improving program retention, (4) teaching problem solving and critical thinking skills, and (5) connecting families with other services.     

‘Reach Out,Rise Up’: The efficacy of text messaging in an intervention package for anxiety and depression severity in young people

BackgroundDepression and anxiety are among the most commonly experienced mental health issues faced by young people in Aotearoa, New Zealand. Considerable barriers exist that prevent young people from engaging with face-to-face mental health services. Young people's preference for technology-based counselling mediums such as text messaging opens up new pathways for intervention.ObjectiveA pilot text message-based intervention package was trialled for use by young people to evaluate the potential efficacy of the text package as an intervention for depression and anxiety symptoms.MethodThe text package was piloted using a 10-week longitudinal cohort pilot with 21 young participants (12–24 years) who demonstrated mild to moderate anxiety and/or depression symptoms.ResultsParticipants' post-package scores were significantly lower than their pre-package scores for both anxiety (Z = − 2.83, p = .005, r = − 0.65) and depression (Z = − 2.49, p = .013, r = −.056). ‘Feeling encouraged and supported’ increased as a result of receiving support from a trained supporter (Z = − 2.06, p = .039, r = − 0.45), but not from friends/family (Z = − 1.72, p = .130, r = − 0.37). Anxiety and depression scores did not change as a result of support from either trained supporters or friends/family.ConclusionsFindings support the potential efficacy of the text package, justify wider trials of the text package, and support the use of text message-based interventions as potentially effective therapies for young people.     

Development of an innovative process evaluation approach for the Families Improving Together (FIT) for weight loss trial in African American adolescents

This study demonstrates how a multi-theoretical, multilevel process evaluation was used to assess implementation of the Families Improving Together (FIT) for weight loss intervention. FIT is a randomized controlled trial evaluating a culturally tailored, motivational plus family-based program on weight loss in African American adolescents and their parents. Social Cognitive, Self Determination, Family Systems theories and cultural tailoring principles guided the conceptualization of essential elements across individual/family, facilitator, and group levels. Data collection included an observational rating tool, attendance records, and a validated psychosocial measure.ResultsAttendance records (0 = absent, 1 = present, criteria = ≥70%) indicated that 71.5% of families attended each session. The survey (1 = false, 6 = true, criteria = ≥4.5) indicated that participants perceived a positive group climate (M = 5.16, SD = 0.69). A trained evaluator reported that facilitator dose delivered (0 = no, 1 = yes, criteria = ≥75%) was high (99.6%), and fidelity (1 = none to 4 = all, criteria = ≥3) was adequate at facilitator (M = 3.63, SD = 0.41) and group levels (M = 3.35, SD = 0.49). Five cultural topics were raised by participants related to eating (n = 3) and physical activity (n = 2) behaviors and were integrated as part of the final curriculum.DiscussionResults identify areas for program improvement related to delivery of multi-theoretical and cultural tailoring elements. Findings may inform future strategies for implementing effective weight loss programs for ethnic minority families.     

Mortality among a national population sentenced to compulsory care for substance use disorders in Sweden: Descriptive study

Sweden's compulsory addiction system treats individuals with severe alcohol and narcotics use disorders. Merging data from three national level register databases of those sentenced to compulsory care from 2001 to 2009 (n = 4515), the aims of this study were to: (1) compute mortality rates to compare to the general Swedish population; (2) identify leading cause of mortality by alcohol or narcotics use; and (3) identify individual level characteristics associated with mortality among alcohol and narcotics users. In this population, 24% were deceased by 2011. The most common cause of death for alcohol users was physical ailments linked to alcohol use, while narcotics users commonly died of drug poisoning or suicide. Average age of death differed significantly between alcohol users (55.0) and narcotics users (32.5). Multivariable logistic regression analysis identified the same three factors predicting mortality: older age (alcohol users OR = 1.28, narcotic users OR = 1.16), gender [males were nearly 3 times more likely to die among narcotics users (p < .000) and 1.6 times more likely to die among alcohol users (p < .01)] and reporting serious health problems (for alcohol users p < .000, for narcotics users p < .05). Enhanced program and government efforts are needed to implement overdose-prevention efforts and different treatment modalities for both narcotic and alcohol users.     

Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.     

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.     

Barriers and facilitators to evaluation of health policies and programs: Policymaker and researcher perspectives

Our research sought to identify the barriers and facilitators experienced by policymakers and evaluation researchers in the critical early stages of establishing an evaluation of a policy or program. We sought to determine the immediate barriers experienced at the point of initiating or commissioning evaluations and how these relate to broader system factors previously identified in the literature.We undertook 17 semi-structured interviews with a purposive sample of senior policymakers (n = 9) and senior evaluation researchers (n = 8) in Australia.Six themes were consistently raised by participants: political influence, funding, timeframes, a ‘culture of evaluation’, caution over anticipated results, and skills of policy agency staff. Participants also reflected on the dynamics of policy-researcher relationships including different motivations, physical and conceptual separation of the policy and researcher worlds, intellectual property concerns, and trust.We found that political and system factors act as macro level barriers to good evaluation practice that are manifested as time and funding constraints and contribute to organisational cultures that can come to fear evaluation. These factors then fed into meso and micro level factors. The dynamics of policy-researcher relationship provide a further challenge to evaluating government policies and programs.     

Feasibility of bidirectional text messages in evaluating a text-based nutrition education program for low-income parents: Results from the Text2BHealthy program

Text messages are increasingly used in the delivery of health education programs. One appealing aspect of this approach is the possibility of remotely collecting participant data to use in program tailoring or evaluation. The purpose of the present study is to test the feasibility of using text messages to collect participant data. Using data from 33 texted evaluation questions sent through the Text2BHealthy nutrition education program for low-income parents (n = 108−1521) response rates under different incentive and prompting strategies were examined. Response rates are generally low across a pilot year and three program years, ranging from 10–55%. While incentives seemed to be ineffective at improving response rates, results indicate that prompting participants to respond may increase response rates. Individuals who respond to an initial question are highly likely to respond to a follow-up question (88–99%) and to report positive behaviors (68–100%). Responses received through text may be unrepresentative and positively biased. Text messages may be a supplemental data collection strategy in nutrition education programs, but low response rates and response bias undermine data quality.     

How an intervention project contributes to social inclusion of adolescents and young people of foreign origin

This article presents the results of the impact study of the Nightingale Project, a social mentoring project, whose aim is to support the welcoming and social inclusion processes of adolescent students of foreign origin who recently arrived in Catalonia and who are currently enrolled in the country's schools. The more than one hundred mentoring pairs (mentor and mentee) that took part in the intervention project were administered a questionnaire (N = 58). This same questionnaire was also given to a group of adolescents with the same profile but who did not participate in the project (N = 128) and who were treated as a control group.After six months of intervention (which corresponds to the duration of the Nightingale Project), results show that students who participate in mentoring learn the language faster, create broader and more diverse networks of friends in school, develop higher educational aspirations and expectations, are better acquainted with the reception context (municipality they live in), and improve standards of self-confidence and self-esteem, among other characteristics. The research also demonstrates that mentoring aimed at adolescents, as is the case of the Nightingale Project, plays a key role in avoiding development of an oppositional identity and, conversely, helps facilitate a process of resilience in adolescents in the new context of reception.     

Programmatic effects to modify sources of financial support among Hispanic teenage mothers

This study evaluates whether a randomized school-based intervention for adolescent teenage mothers successfully helped participants achieve better financial independence and economic prospects. Project Mothers and Schools (PMAS) is an initiative intended to modify attitudes and beliefs related to self-sufficiency, parenting, educational goals and achievement, career goals, health behaviors, and interpersonal relationships with family members. PMAS participants were surveyed at baseline and 12 months after intervention enrollment to evaluate the receipt of financial support from 11 sources. The 48 “core group” participants received a basic level of services, whereas the 43 “core-plus group” participants received the same basic services and additional enhanced services. Wilcoxon signed-rank tests were used to identify statistically significant changes in participant responses from baseline to 12 months post-intervention. Both groups reported higher levels of employment 12 months post-intervention compared to baseline (z = − 3.162, p = 0.002 and z = − 2.646, p = 0.008, respectively). The core-plus group used more Food Stamps (z = − 2.673, p = 0.008) and reported receiving more child support (z = 2.236, p = 0.025) 12 months post-intervention versus baseline. PMAS benefited all participants by promoting employment 12 months post-intervention versus baseline. The enhanced services offered to the core-plus group appeared to also increase participant access to Food Stamps and child support, sources which assist participants down the path toward eventual financial independence.     

Effectiveness of an empowerment program for adolescent second generation migrants: A cluster randomized controlled trial

Dutch adolescent second generation migrants are at increased risk of becoming marginalized and developing problem behavior. We tested the effectiveness of the Dutch multi-component empowerment program POWER that aims to prevent such problems. We hypothesized a positive intervention effect on participants' sense of mastery, coping skills, activities, conduct problems, and prosocial behavior. We conducted a cluster randomized controlled trial including a pretest and posttest with an intervention condition (n = 132) and a waitlist control condition (n = 116). Analyses showed that POWER was only effective in influencing the youngsters' participation in activities like sport, hobbies, and casual work. When implemented with high fidelity, POWER also influenced the level of conduct problems as well as their coping style. However, a more accurate registration of the implementation process would have been helpful and the program can potentially be further improved by clearly specifying which components of the program can be adapted and which must be delivered as intended.     

A randomized controlled trial of the effectiveness of the youth crime prevention program ‘New Perspectives’ (NP): Post-treatment changes and moderator effects

ObjectivesNew Perspectives (NP) aims to prevent that youth at onset of a criminal career will develop a more persistent criminal behavior pattern. The study aim was to examine whether NP was effective relative to care as usual in preventing and reducing (persistent) delinquency. Moreover, we examined improvements in secondary outcomes (e.g., peer and parent relationships and cognitive distortions) and other outcomes (e.g., substance use and self-esteem).MethodsAt-risk youth (N = 101) aged 12 to 19 years were randomly assigned to the intervention group (NP, n = 47) or control group (‘care as usual’, n = 54). The effects of the NP intensive phase (3 months after program start) and aftercare phase (6 months after program start) were analyzed.ResultsNP and care as usual did not differ on any of the outcome measures at both post-test occasions. The effects of NP were the same for boys and girls, different age groups, and ethnic groups.ConclusionsThe overall null-effects are discussed, including implications for further research, policy, and practice.     

Quality improvement learning collaborative to examine foster care guidelines

Learning collaboratives (LC) are an important method of implementing quality improvement by serving as laboratories to translate research into practice and sharing knowledge. We created a Foster Care Learning Collaborative (FCLC) of 11 foster care health sites to share best practices on providing health services for children in foster care. Using a collaborative approach involving monthly conference calls, we invited each health site to present specific health care delivery issues for the purpose of developing collaborative quality improvement projects regarding the delivery of healthcare to children placed into foster care. For health sites providing primary care (n = 8 of 11 sites), we examined adherence to two American Academy of Pediatrics (AAP) guidelines for children entering foster care: a) the initial health screen, and b) the comprehensive medical evaluations. At least four distinct types of health care models that provide either direct primary care or administrative oversight for children in foster care were identified: 1) medical home sites (n = 3); 2) foster care evaluation/intake sites (n = 2); 3) specialized primary care sites (n = 1); and, 4) state administrative programs (n = 2). Data from the six direct primary care sites (n = 586 children) and two state administrative models (n = 3855 children) was collected. The time-frame for the initial health screen was adjusted to 7 days after entry and adherence (31%) was comparable among primary care sites. Adherence to AAP guidelines regarding completion of a comprehensive medical evaluation within 30 days of intake varied among medical homes (30%–86%), intake models (23%–33%), specialized primary care site (43%), and state models (43%–73%). No site was fully compliant with the AAP guideline for universal comprehensive medical evaluation within 30 days, and there is variation within and among care models. A foster care learning collaborative identified significant variability in adherence to a commonly accepted guideline for timely access to healthcare for children placed into foster care. The LC c model offers the opportunity to evaluate best practices, identify barriers to care, and provide objective feedback for improvement.     

Measurement and evaluation practices of factors that contribute to effective health promotion collaboration functioning: A scoping review

The purpose of this scoping review was to identify promising factors that underpin effective health promotion collaborations, measurement approaches, and evaluation practices. Measurement approaches and evaluation practices employed in 14 English-language articles published between January 2001 and October 2015 were considered. Data extraction included research design, health focus of the collaboration, factors being evaluated, how factors were conceptualized and measured, and outcome measures. Studies were methodologically diverse employing either quantitative methods (n = 9), mixed methods (n = 4), or qualitative methods (n = 1).In total, these 14 studies examined 113 factors, 88 of which were only measured once. Leadership was the most commonly studied factor but was conceptualized differently across studies. Six factors were significantly associated with outcome measures across studies; leadership (n = 3), gender (n = 2), trust (n = 2), length of the collaboration (n = 2), budget (n = 2) and changes in organizational model (n = 2). Since factors were often conceptualized differently, drawing conclusions about their impact on collaborative functioning remains difficult. The use of reliable and validated tools would strengthen evaluation of health promotion collaborations and would support and enhance the effectiveness of collaboration.     

Program records as a source for program implementation assessment and youth outcomes predictors during residential care

This study used point card information from a residential program to generate treatment fidelity metrics and determine if the metrics predicted youth outcomes after six months in care. Youth outcomes included staff (n = 52) and youth (n = 143) ratings, youth conduct records kept by the residential program's teaching-family homes and school records. Treatment fidelity metrics included the program components: (a) percentage of positive interactions, (b) number of privileges earned, and (c) a skills taught to interactions ratio. The percentage of positive interactions averaged 90% per youth; 76% of the point cards indicated that privileges were earned; and a variety of life skills were typically taught to the youth (skills ratio = .61). The data from the treatment fidelity metrics supported that the program was implemented consistent with program expectations. The range of implementation quality for each measured component was then used to predict youth outcomes. Increased percent of positive interactions predicted significantly decreased externalizing behaviors as reported by staff (β = − 0.31, p < .001) and youth (β = − 0.30, p < .001), and significantly fewer incidents of non-compliance (Exp(b) = 0.93, p < .001) and school problems (Exp(b) = 0.91, p < .001) as indicated on the program records. The skills ratio indicated similar trends across outcomes, although non-significant at the p < .01 level. Permanent products may be helpful to develop program treatment fidelity metrics, which may be useful for monitoring implementation and may be associated with improved youth outcomes.