Making a Difference withYouth, Families and Communities

Partnerships in Prevention Science InstituteIowa State University

October, 2005

Investigators/Collaborators R. Spoth (Director), C. Redmond & C. Shin (Associate Directors),

T. Backer, K. Bierman, G. Botvin, G. Brody, S. Clair, T. Dishion, M. Greenberg, D. Hawkins,

K. Kavanagh, K. Kumpfer, C. Mincemoyer, V. Molgaard, V. Murry, D. Perkins, J. A. Stout

Associated Faculty/ScientistsK. Azevedo, J. Epstein, M. Feinberg, K. Griffin, M. Guyll, K. Haggerty, S. Huck, R. Kosterman,

C. Lillehoj, S. Madon, A. Mason, J. Melby, M. Michaels, T. Nichols, K. Randall, D. Ryu, L. Schainker,

T. Tsushima, L. Trudeau, J. Welsh, S. Yoo

Prevention CoordinatorsE. Berrena, M. Bode, D. Broshar, B. Bumbarger,

K. James, J. Meek, C. Tomaschik

Funding Agencies

• National Institute on Drug Abuse

• National Institute of Mental Health

• National Institute on Alcohol Abuse and Alcoholism

• Center for Substance Abuse Prevention

1. Mission and Background

Institute Mission: Public Health and Well-Being Through Science-with-Practice

To promote healthy and capable youth, adults, families, and communities through prevention and health promotion science with practice.

Why is it important to pursue the mission?

• High prevalence rates of various public health problems (youth problem behaviors, unhealthy lifestyles)

• Benefits of positive youth and family development, particularly among those at risk

• Need to move toward a more comprehensive strategic plan for prevention/positive youth development/ health promotion

• Limited diffusion of high-fidelity, evidence-based interventions—one estimate of effective prevention “market penetration” is 1%

Sources: Spoth, R., Greenberg, M., Bierman, K., & Redmond, C. (2004). PROSPER Community-university partnership model for public education systems: Capacity-building for evidence-based, competence-building prevention. Prevention Science, 5(1), 31-39; Spoth, R. & Greenberg, M. (in press). Toward effective practitioner-scientist partnerships and larger-scale community benefits, American Journal of Community Psychology.

Advantages of Focus on Evidence-Based Interventions (EBIs)

• Positive outcomes and economic benefits more likely for youth, families, others

• Better accountability—resources not used for ineffective programs

• Funding increasingly targeted for evidence-based interventions

• Materials, training and technical assistance typically are available

Conceptual Framework and Partnership Model

External Resource Agents

from Community/State University

Local Linking Agentsfrom Extension

System

Internal Capacity Agents

from Public Schools

Framework for State Public Education Systems Approach to

“Science-with-Practice”

Source: Spoth, R., Greenberg, M., Bierman, K., & Redmond, C. (2004). PROSPER partnership model for state public education systems: Capacity-building for evidence-based competence-building prevention. Prevention Science (special issue), 5(1), 31-39.

University/Prevention Coordinator Teams

Local Community Team

PROSPER—Organizational Structure for State Public Education Partnerships

University/State-Level TeamUniversity Researchers, Extension Program Directors

Prevention Coordinator TeamExtension Prevention Coordinators

Local Community TeamsExtension Agent, Public School Staff,

Social Service Agency Representatives, Parent/Youth Representatives

2. Illustrative Findings: Effectiveness in—

A. Delivery of Community-Level, Evidence-Based Interventions (EBIs)

B. Producing Positive Community-Level Outcomes through Partnership-Delivered EBIs

C. Quality Implementation of Rigorous Intervention Studies

A.Partnership Effectiveness in Delivery of Community-level EBIs

Types of Indicators of EffectiveCommunity-Level EBI Delivery

• Consistently high implementation quality/adherence

• High intervention recruitment rates

• High intervention retention rates

• Involvement of youth and families across the risk spectrum

• Successfully implemented cultural adaptations

• Initial evidence of partnership sustainability

Partnership-Based Delivery Results—Implementation Adherence*

*Rates presented are from PROSPER study. Also see: Spoth, R., Guyll, G., Trudeau, T., & Lillehoj-Goldberg, C. (2002). Two studies of proximal outcomes and implementation quality of universal preventive interventions in a community-university collaboration context. Journal of Community Psychology, 30, 499-518.

91% 90%

0

10

20

30

40

50

60

70

80

90

100

Aver

age

% A

dher

ence

Family Programs

School Programs

Partnership-Based Delivery Results—Family Program Retention/Participation LevelsStrengthening Families Program Family Session Attendance

95.8% 95.2% 95.2%

91.6%

65.9%

0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

85

90

95

100

3 or moresessions

4 or moresessions

5 or moresessions

6 or 7sessions

All 7sessions

% Enrolled Families Attendin

g

*Enrolled families are those that signed up and attended at least one session.

Partnership-Based Delivery Results—Sustainability

Early in first sustainability phase of ongoing partnership study—11 of 13 local teams have raised their own sustainability funds!

Partnership-Based Delivery Results—Harambee Cultural Adaptation Pilot Study

• Urban African-American families

• Recruitment is 70% of families assessed

• High retention rate

• High level of implementation quality

• Positive attitude re program• Mix of posttest results—

guide next steps

Source: Spoth, R. Guyll, M., Chao, W., & Molgaard, V. (2003). Exploratory study of a preventive intervention with general population African American families. Journal of Early Adolescence, 13(3), 301-328.

B. Positive Community-Level Outcomes Through

Partnership-Delivered EBIs

Wide Range of Positive Community-Level Outcomes

• Positive youth protective factor and skills-building outcomes (e.g., significant improvements in relationships with parents, refusals with peers offering alcohol)

• Long-term effects on school engagement and academic success (e.g., increased grade point average)

• Long-term reductions in substance use (up to six years past baseline—e.g., 40% reduced likelihood of having been drunk by 10th grade)

• Long-term conduct/behavior problem reduction (e.g., 40% fewer aggressive and destructive behaviors by10th grade)

• Economic benefits (e.g., $9.60 return on the dollar invested)• Comparable longitudinal benefits for lower- and higher-risk groups

0

0.2

0.4

0.6

0.8

1

0 months

(Pretest)

6 months

(Posttest)

18 months

(Grade 7)

30 months

(Grade 8)

48 months

(Grade 10)

72 months

(Grade 12)

Fir

st

Tim

e P

rop

ort

ion

Trajectory for ISFP Condition

Trajectory for Control Condition

Results—Partnership-Based Outcome StudiesLongitudinal Growth of First-Time Drunkenness

Source: Spoth, R., Redmond, C., Shin, C., & Azevedo, K. (2004). Brief family intervention effects on adolescent substance initiation: School-level curvilinear growth curve analyses six years following baseline. Journal of Consulting and Clinical Psychology, 72(3), 535-542.

Lifetime Drunkenness Through 6 Years Past Baseline: Logistic Growth Curve

Results—Partnership-Based Outcome StudiesLongitudinal Growth of Marijuana Use

See Spoth, Redmond, Shin, & Azevedo (2004). Brief family intervention effects on adolescent substance initiation: School-level curvilinear growth curve analyses six years following baseline, Journal of Consulting and Clinical Psychology, 72(3), 535-542. Also see Spoth & Greenberg (in press). Toward a comprehensive strategy for effective practitioner-scientist partnerships and larger-scale community benefits, American Journal of Community Psychology.

Lifetime Marijuana Use Through 6 years Past Baseline: Logistic Growth Curve

0

0.05

0.1

0.15

0.2

0.25

0 months(Pretest)

6 months(Posttest)

18 months(Grade 7)

30 months(Grade 8)

48 months(Grade 10)

72 months(Grade 12)

Pro

port

ion

Trajectory for ISFP Condition

Trajectory for Control Condition

Results—Partnership-Based Outcome Studies

See Spoth, Redmond, Shin, & Azevedo  (2004). Brief family intervention effects on adolescent substance initiation: School-level curvilinear growth curve analyses six years following baseline, Journal of Consulting and Clinical Psychology, 72(3), 535-542. Also see Spoth & Greenberg (in press). Toward a comprehensive strategy for effective practitioner-scientist partnerships and larger-scale community benefits, American Journal of Community Psychology.

15.3

17.5

15.7

17.9

15.5

17.8

13

14

15

16

17

18

19

10% Lifetime Marijuana Use

50% Lifetime Cigarette Use

50% Lifetime Drunkenness

Control Condition

Partnership-based IowaStrengthening FamiliesProgram Condition

Ag

e

Average Teen Age in School Districts When Stated Prevalence Levels are Reached—From 6-Year Follow-up

Results—Transition from Non-Advanced Use to Advanced Use*

Source: Spoth, R. (2004, September). Slower and fewer transitions to use: Results from a community-university partnership approach. Presentation at the Conference on Blending Clinical Practice and Research: Forging Partnerships, sponsored by NIDA in Detroit, MI.

* Advanced use means use of legal substances on regular basis or use of illicit drugs at least once: Reports one or more of the following—past month alcohol use (> 4 times), past month binge, past month one or more cigs/day, ever use of marijuana, inhalants, or other illicit drugs.

*p < .05

38.0

58.8

25.231.5

47.9

8.1

0

10

20

30

40

50

60

70

Pretest 2-5

Years**

Pretest-4 years

Pretest-6 years**

Pe

rce

nta

ge

Control Transition ISFP Transition

0

1

2

3

4

5

6

7

8

%

Past Year Use Lifetime Use--Past Year Plus Prior Use

ISFP ControlStudy 1 (12th Grade)

SFP+LST ControlStudy 2 (11th Grade)

7.61

2.12

2.633.21

4.59

Results—Partnership-Based Meth Outcomes of Universal Interventions

Source: Spoth, et al. (2005). Two randomized studies of the long-term effects of brief, partnership-based universal preventive interventions on adolescent methamphetamine use

Lifetime and Past-Year Meth Use at 4½-6½ Years Past Baseline

ISFP = Iowa Strengthening Families Program SFP + LST = Strengthening Families Program: For Parents and Youth 10-14 and Life Skills Training

0.2

0.5

0.8

1.1

1.4

0 months(Pretest)

6 months(Posttest)

18 months (7th Grade)

30 months (8th Grade)

48 months(10th Grade)

Ag

gre

ss

ion

-Ho

sti

lity

Ind

ex

--O

bs

erv

er

Ra

ted

ISFP

Control

Results—Partnership-Based Outcome StudiesObserver-Rated Aggressive/Hostile Behaviors

Source: Spoth, R., Redmond, C., & Shin, C. (2000). Reducing adolescents' aggressive and hostile behaviors: Randomized trial effects of a brief family intervention four years past baseline. Archives of Pediatrics and Adolescent Medicine, 154, 1248‑1257.

4.1

11.2

4.1

9.9

2

4

6

8

10

12

%

Conduct Disorder Antisocial PersonalityDisorder

ISFP Condition

Control Condition

Results—Diagnosable Disorders 10 Years Past Baseline

Source: Spoth, R., Redmond, C., Mason, A., Kosterman, R., Haggerty, K., & Hawkins, J. D. (2005, May). Ten-year follow-up assessment of brief, family-focused interventions effects on lifetime conduct and antisocial personality disorders: Preliminary results. Poster presented at the Society for Prevention Research 13th Annual Meeting, Washington, D.C.

Source: Trudeau, Azevedo, Spoth, & Randall (2005). Effects of a universal family-focused intervention on associated growth patterns of adolescent internalizing symptoms and alcohol use. Manuscript under review.

Results—Differential Effects on Girls and Boys Internalizing Symptoms

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0 6 12 18 24 30 36 42 48 54 60 66 72

Months from Posttest

An

xio

us/

De

pre

sse

d S

ynd

rom

e

Intervention Girls Control Girls

Intervention Boys Control Boys

Tested Model Results—Long-Term Effects of Public Education Partnership Program on Academic Success

• Partnership (School-Community-University) program in 6th grade significantly impacts student academic success (parent-reported grades) in 12th grade:-Through enhanced positive parenting behavior effects on school engagement-Through reduced substance-related risk behavior effects on school engagement

• Results from a randomized, controlled study with 33 Iowa school districts (see Project family Trial II at www.ppsi.iastate.eduSpoth, R., Randall, G. K. and others. Building family skills leads to long-term academic success. Manuscript in final preparation.)

Partnership-based Iowa Strengthening Families Program

Enhanced Positive

Parenting Behavior

Reduced Substance-

related Risk

Behaviors

IncreasedStudentSchool

Engagement

IncreasedStudent

AcademicSuccess

6th Grade 8th Grade 12th Grade

Results—Benefits to Higher-Risk Subgroups

• Successfully recruited and retained both higher- and lower-risk participants

• Benefit comparable across higher- and lower-risk subgroups

• When risk moderation effects observed, mostly stronger effects for those at higher risk

Source: Spoth, R., & Redmond, C. (2002). Project Family prevention trials based in community-university partnerships: toward scaled-up preventive interventions. Prevention Science, 3(3), 203-221.

$9.60

$11.34

$7.86

0123456789

10111213

*Actual Study Conditions 1 more case prevented/100 1 less case prevented/100

Do

llars

Retu

rned

Partnership-Based Strengthening Families Program: Benefit-Cost Ratios Under Different Assumptions

*Study Data indicate $9.60 returned for each dollar invested under actual study conditionsSource: Spoth, R., Guyll, M., & Day, S. X. (2002). Universal family-focused interventions in alcohol-use disorder prevention: Cost-effectiveness and cost-benefit analyses of two interventions. Journal of Studies on Alcohol, 63(2), 219-228.

Results—Delaying Onset of Alcohol Use Leads to Cost Savings

$9.60

$11.34

$7.86

0123456789

10111213

*Actual Study Conditions 1 more case prevented/100 1 less case prevented/100

Do

llars

Retu

rned

C. Partnership Effectiveness inHigh-Quality Implementation of Rigorous Outcome Research

Types of Evidence of Successful Partnership-Based Outcome Study

• School recruitment/retention across studies• Sample quality across studies—representative of

general population samples• Intervention validity across studies• About 30,000 individuals assessed across studies• Methodological innovations/multilevel designs

and analyses

Results—Study Recruitment and Retention of Public Schools• Six randomized controlled studies

conducted, 11 supplemental studies

• 106 public schools involved in randomized controlled studies

• 90% of all schools attempted were successfully recruited

• 98% of school districts retained long-term—in two studies, 100% retained through end of HS

3. Future Directions

Overview of PROSPER Collaborative Study with PSU*• Design

• Random assignment of 28 school districts (14 IA, 14 PA) to full partnership and “delayed intervention” (comparison) conditions

• Participants• Two successive cohorts of 6th grade children and

their families (N 5,750 students in each cohort)• Random selection of 1,100 families from Cohort

II for more intensive assessments (in-home, teacher, school archival data)

*PROSPER = PROmoting School-community-university Partnerships to Enhance Resilience. In collaboration with the Prevention Research Center at Pennsylvania State University (Mark Greenberg, Director; Karen Bierman, Co-Director)

PROSPER Local Team Activities• Recruit team members and

building local team cohesion• Consider local needs &

resources for program implementation

• Select from a menu of evidence-based programs• Family-focused program• School-based program

Key Focus on Building Local Team Sustainability

• Emphasis on ongoing technical assistance through Extension-prevention staff

• Ongoing partnership evaluation & feedback

• TA focus on expansion of resources

• Strategies to accommodate team membership/leadership change

What PROSPER Has AccomplishedThird Year

• High family recruitment rates across 2 cohorts, compared with other “real world” community-based efforts

• Consistently high levels of implementation quality, for both family and school programs

• All of 13 local teams have raised their own sustainability funds!

A Vision for PROSPER

Making a Difference

Obesity PreventionFramework for Health-Promoting Public Education Partnership Network (HealthPEP Net): Design, Testing and Dissemination

Community-University Partnership Network(PROSPER Prototype)

DI

SS E M I N SOA T I N

SYT

EM

UPLB CI UE

TACDOI

N

Intervention Development Process● Scientifically-rigorous ● Ecological ● Consumer-oriented

Testing/Implementation

Design SustainedDissemination

S

*From “Obesity and Youth” Regional Conference at Iowa State University (R. Spoth)

Making a Difference with a National Network of

Partnerships

Partnership Network Development

• Developing a partnership network to support community participatory research

• Goal is to achieve larger-scale public health and well-being through broader implementation of a science-with-practice approach

• Partnership network intended to: Effectively deliver evidence-based interventions

on a larger scale Evaluate the public health impact of EBIs Support development and evaluation of

interventions with promise of positive outcomes

Future Directions

Toward a National Network of Partnerships—Early-Adopter States

•Meet with Extension and research leadership in other early-adopter states

•Conduct initial readiness and resource assessments

•Organize state-level steering committee State partnership team Pilot study Grant-driven approach

Future Directions

Toward a National Network of Partnerships—National-Level Efforts

•Build awareness among national leaders and potential stakeholders

•Organize a research network steering committee•Develop infrastructure for national-level technical assistance and multistate/multisite research (e.g., readiness assessment tools, network analyses of opinion leaders, information management system)

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