Intervention research: Integrating practice guidelines with dissemination strategies-A rejoinder to Paul, Stuve, and Cross

Paul, Stuve, and Cross (this issue) misunderstood the importance of the token economy described by Morisse et al. (1996) because they evaluated it solely from a clinical research perspective. Intervention research is a broader paradigm that describes the development of effective interventions via a series of research activities including basic psychological research, clinical research, and dissemination research. Given the wisdom of intervention research, we address three points made by our colleagues: (a) mental health staff should not adapt empirically validated practice guidelines to meet the needs of their program; (b) total-quality-management strategies like Interactive Staff Training should not drive dissemination efforts because they have little empirical support; and (c) user-friendly programs are inappropriate and unethical because they ignore consumer interests.     

An Ecological Analysis of Batterer Intervention Program Standards

Summary

Many states and local jurisdictions have drafted and implemented standards for batterer intervention programs. This article first presents a review of the arguments for and against the current standards. The author argues that the extant empirical research on batterer intervention is, at best, a limited source of knowledge for setting standards. The author then uses Bronfenbrenner's (1972, 1975) ecological framework to analyze existing standards, and to guide recommendations for future research on batterer intervention.     

Developing Guidelines for Domestic Violence Offender Programs

Summary

This article reviews research on domestic violence that can help inform the development of guidelines for programs for men who batter. It also illustrates some successes and problems in other fields that might be instructive for the domestic violence field. Firm conclusions about “best practice” guidelines for intervention seem to be premature because of flaws in evaluation studies. In addition, there is growing evidence of variability among men who batter on dimensions such as severity of violence, childhood traumas, generality of violence and personality traits. Programs also need to be able to respond to motivational and cultural difference among abusers. Existence of variability implies the need for multiple forms of interventions.     

Primary Prevention Mental Health Programs for Children and Adolescents: A Meta-Analytic Review

Used meta-analysis to review 177 primary prevention programs designed to prevent behavioral and social problems in children and adolescents. Findings provide empirical support for further research and practice in primary prevention. Most categories of programs produced outcomes similar to or higher in magnitude than those obtained by many other established preventive and treatment interventions in the social sciences and medicine. Programs modifying the school environment, individually focused mental health promotion efforts, and attempts to help children negotiate stressful transitions yield significant mean effects ranging from 0.24 to 0.93. In practical terms, the average participant in a primary prevention program surpasses the performance of between 59% to 82% of those in a control group, and outcomes reflect an 8% to 46% difference in success rates favoring prevention groups. Most categories of programs had the dual benefit of significantly reducing problems and significantly increasing competencies. Priorities for future research include clearer specification of intervention procedures and program goals, assessment of program implementation, more follow-up studies, and determining how characteristics of the intervention and participants relate to different outcomes.     

Future Directions in Mandated Standards for Domestic Violence Offenders

Summary

Over the past decade, states have been enacting domestic violence legislation, which often empowers judges to mandate batterers into intervention programs. To insure that these programs meet reasonable standards and that there is some homogeneity among programs, collateral laws mandating the development of batterer treatment standards are also common. The standards that have emerged have become a source of controversy. The current volume was developed in order to examine the issues and evidence, and to suggest some guidelines, if not for the standards themselves, then for the process that states might use in developing rational, useful standards, or in reevaluating and revising existing standards. To that end, this article offers a synthesis of the selections in this special volume and a suggested set of recommendations that committees might consider as they engage in the difficult processes of standard development or revision.     

The Impact of Legislative Standards on Batterer Intervention Program Practices and Characteristics

Changes in social policy are often pursued with the goal of reducing a social problem by improving prevention efforts, intervention program practices, or participant outcomes. State legislative standards for intimate partner violence intervention programs have been adopted nearly universally across the US, however, we do not know whether such standards actually achieve the intended goal of affecting programs’ policies and practices. To assess the effect that batterer intervention program (BIP) standards have on policies and practices of programs, this study used longitudinal surveys collected as part of an ongoing evaluation conducted from 2001 to the present to compare intervention program (N = 74) characteristics and practices at three time points before and after the adoption of standards in Oregon. Analyses were conducted to examine all BIPs in Oregon at each time point, as well as change among a subset of programs in existence at all survey assessments. Results indicate that across all programs, the use of mixed gender group co-facilitation increased by 14 % between 2004 and 2008, while program length increased by approximately 12 weeks. However, other practices such as programs’ coordination with community partners were unchanged. Analyses of within-program change revealed fewer differences, with only program length increasing significantly over the three assessments. These and other findings indicate that while standards affected program length as intended, other practices commonly addressed by legislative standards remained unchanged. The findings provide needed information regarding programs’ compliance with components of the standards, the potential need for compliance monitoring, and the potential impact of state standards on program effectiveness and on the prevalence of intimate partner violence.     

Addressing Cultural Factors in Development of System Interventions

SUMMARY

The purpose of this article is to address various issues concerning multicultural interventions at a system level. Diversity is presented through a different conceptual approach and specific implications for school psychological practice are addressed. In this theoretical context an alternative model of school psychological services that was developed in the Greek educational system is presented and a primary intervention program is described as a paradigm of multicultural system/community intervention. Finally, the components of a transnational approach to multicultural system/community interventions that provides the basic procedural guidelines to developing effective, culturally sensitive interventions in the school environment is proposed.     

Enhancing Social Responsibility and Prosocial Leadership to Prevent Aggression,Peer Victimization,and Emotional Problems in Elementary School Children

Testing the theories that form the basis of prevention programs can enhance our understanding of behavioral change and inform the development, coordination, and adaptation of prevention programs. However, theories of change showing the linkages from intervention program components to risk or protective factors to desired outcomes across time are rarely specified or tested. In this 2‐year longitudinal study, we test the theory that increases in two protective factors (i.e., children's prosocial leadership and their teachers’ expectations of social responsibility) targeted by the WITS Programs (Walk Away, Ignore, Talk it Out, and Seek Help) would be associated with declines in peer victimization, aggression, and emotional problems. Participants included Canadian students, in grades 1–4 at baseline (n = 1329) and their parents and teachers. Consistent with our theory of change, variability in program implementation (adherence and integration) and in children's use of program skills (child responsiveness) are related to increases in both protective factors. Increases in these protective factors are associated with subsequent declines in children's aggression, victimization, and emotional problems. We discuss how enhancement of these protective factors may operate to improve child outcomes and the need for theory‐based research to refine and improve the effectiveness of intervention strategies and to improve program scale‐up.     

Theological Distance Education

SUMMARY

Theological institutions accredited by the Association of Theological Schools with distance education courses or programs continue to increase. Theological librarians, although often overlooked, play a significant role in their use of technology to meet the needs of distance students with the support of national library guidelines and accreditation standards. The current state of support to seminary distance programs includes traditional interlibrary loans, consortium relationships, proprietary full text journals, and free Internet resources. Distance learning for graduate theological education is here to stay. The continuing efforts of pioneering distance seminary librarians will guarantee quality, passionate service to students of tomorrow.     

Evaluation of an integrated fluency and Acceptance and Commitment Therapy intervention for adolescents and adults who stutter: Participant perspectives

PurposeChildhood-onset stuttering is a neurodevelopmental disorder that may cause pervasive negative consequences for adults who stutter. In addition to significant challenges in personal, social, and emotional domains, stuttering has been shown to impose an economic burden on adults who stutter. Intervention for adults who stutter has historically addressed speech fluency more so than the covert psychosocial aspects of the disorder. There is an identified clinical need for holistic, efficacious, and cost-effective stuttering interventions that meet consumer needs. The purpose of the present study is to evaluate a novel, integrated intervention that combined traditional fluency techniques with Acceptance and Commitment Therapy, from the perspective of the adults who stutter who participated in the intervention.MethodTwenty-eight adults who stutter completed the intervention program. Participants were invited to complete an online post-program written survey (including qualitative comments) and a semi-structured interview to explore their evaluations of the program with respect to its authenticity, acceptability, and social validity.ResultsParticipants perceived positive psychosocial changes as a result of the program, and were satisfied with the program overall. Qualitative thematic analyses of the written survey comments and the semi-structured interviews identified two major themes: factors specific to the intervention and factors specific to the therapeutic process. Several important sub-themes were also identified.ConclusionFindings support the authenticity, acceptability, and social validity of an integrated fluency and psychosocial intervention for stuttering. Findings also highlight the need for consideration of the consumer voice in the management of stuttering disorders, in keeping with person-centred care.     

Randomized controlled trial evaluating the effectiveness of a web-based stress management program among community college students

Background and Objectives: This study evaluated the effectiveness of a web-based stress management program among community college students that focused on increasing perceived control over stressful events. Design: Students (N = 257) were randomly assigned to a Present Control Intervention or a Stress-information only comparison group. Methods: Primary outcomes were perceived stress and stress symptoms; secondary outcomes were depression and anxiety. Self-report measures were completed online at preintervention, postintervention, and three-week follow-up. Intervention effects were estimated using linear mixed models. Seventy-five percent of the sample (n = 194) completed the pretest and comprised the intent-to-treat sample. Results: Participants in the intervention group reported significant increases in present control, and significant decreases in all four primary and secondary outcome measures from baseline to postintervention and follow-up. Within-group effect sizes were small to medium at postintervention (mean d = –.34) and follow-up (mean d = –.49). The mean between-group effect size on the four outcome measures was d = .35 at postintervention but d = .12 at follow-up, due to unexpected decreases in distress in the comparison group. Conclusions: Our online program is a cost-effective mental health program for college students. Limitations and future direction are discussed.     

An Emergent Theory of Gatekeeping Practices in Counselor Education

This article summarizes findings from a qualitative study involving 8 counselor educators who taught in master's programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP). Data analysis revealed an emergent theory of gatekeeping practices that includes 4 phases: preadmission, postadmission, remediation plan, and remediation outcome. The authors detail each phase and relate this process to counselor education. They outline implications of the findings for standards proposed by CACREP (2009) and American Counseling Association (2005) guidelines and offer suggestions for future research.     

Dreams,Memories, Reflections by C. G. Jung

Abstract

Group interventions have assumed a growing role in primary prevention and supportive care for cancer and HIV disease. Earlier sections of this Special Report examined empirical findings for these interventions and provided recommendations for future research. The current section offers brief recommendations for service providers, policymakers, and stakeholders.

Group services now occupy an increasingly prominent place in primary prevention programs and medical settings. In previous sections of this Special Report (Sherman, Leszcz et al., 2004; Sherman, Mosier et al., 2004a, 2004b) we examined the efficacy of different group interventions at different phases of cancer or HIV disease, considered characteristics of the intervention and the participants that might influence outcomes, and discussed mechanisms of action. Methodological challenges and priorities for future research were highlighted. In this, the final section, we offer brief recommendations for service providers, policymakers, and other stakeholders. We consider some of the barriers that constrain use of empirically-based group interventions and note how these programs might be implemented more widely and effectively.     

Substance Abuse Prevention:

Components of a successful substance abuse prevention program are discussed. Substance use and abuse trends in school-aged populations are briefly reviewed. Prevention program strategies deemed desirable through recent research efforts are incorporated in describing a model program. Educational approaches and substance abuse intervention strategies are differentiated. Program planning guideliens are presented and discussed. These guidelines are designed to establish and maintain school and community support for prevention programs.     

Addiction‐Specific CACREP Standards in Clinical Mental Health Counseling Programs: How Are They Met?

In 2009, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) included training standards specific to addiction for clinical mental health counseling programs. This study surveyed CACREP‐accredited program coordinators to determine how addiction‐specific standards were addressed.     

A Prime Time for Marital/Relational Intervention: A Review of the Transition to Parenthood Literature with Treatment Recommendations

The transition to parenthood is a near universal experience for individuals and families, yet there is a severe lack of applied research and clinical treatment guidelines. Justification for a greater clinical emphasis on this transition is made through a review of the common changes experienced by new parents. Intervention guidelines are offered in the areas of client/participant recruitment, assessment, and clinical areas of focus. Specific topics that should be addressed in treatment include the parents' family-of-origin influences and individual personality characteristics, changes experienced in the couple relationship, and important contextual issues.     

Moderators and predictors of response to eating disorder risk factor reduction programs in collegiate female athletes

ObjectiveThe primary aim of this paper was to investigate moderators and predictors of response to two programs designed to reduce eating disorder risk factors in collegiate female athletes. This study served as an ancillary study to a parent trial that investigated the feasibility of an athlete modified cognitive dissonance-based program (AM-DBP) and an athlete modified healthy weight intervention program (AM-HWI).Design157 female collegiate athletes were randomized to either the AM-DBP or the AM-HWI program. Participants completed surveys at baseline, post-intervention, 6 weeks, and 1 year.MethodsAfter classifying sports as either lean or non-lean, we investigated if sport type acted as a moderator of program response to AM-DBP and AM-HWI using ANOVAs. Next, we examined whether baseline thin-ideal internalization, weight concern, shape concern, bulimic pathology, dietary restraint, and negative affect acted as predictors of changes in bulimic pathology using linear regression models.ResultsAthletes in non-lean sports who received AM-DBP showed more improvement in negative affect versus non-lean sport athletes in AM-HWI. Higher baseline scores of bulimic pathology predicted greater response in bulimic pathology to both programs at 6-weeks. In contrast, athletes with higher dietary restraint and negative affect baseline scores showed decreased response to both interventions at 6-weeks. Finally, athletes with higher baseline shape concern showed a decreased response to the AM-HWI intervention at the post intervention time point.ConclusionResults from the present study indicate that lean/non-lean sport may not play a strong role in determining response to efficacious programs. Further, factors such as pre-existing bulimic pathology, dietary restraint, negative affect, and shape concern may affect general response to intervention versus specific responses to specific interventions.     

Eating disorder prevention on college campuses: Recruitment challenges

IntroductionUniversities are believed to present rich opportunities for eating disorder prevention research. However, the widespread recruitment from psychology subject pools and the attractive compensation offered widens the gap between efficacy trials and effectiveness studies, and raises concerns about the possibility of wide-scale dissemination.ObjectiveTo encourage thinking about how to disseminate prevention programs broadly.MethodWe provide a real-world example of the implementation of two prevention programs.ResultsThis paper illustrates the difficulties of recruiting for a disordered eating prevention intervention when offering minimal compensation despite the use of comprehensive and creative advertising.ConclusionsThese difficulties speak to the challenges in conducting widespread eating disorder prevention in university settings and highlight the need to develop strategies to help overcome challenges in prevention research and dissemination.     

Effects of an early reading intervention based on grapho-syllabic decoding and fluency training in French elementary schools

IntroductionStudies conducted in recent decades have led to the development of instructional interventions to help prevent or eliminate a large proportion of reading difficulties. However, few experiments have been conducted in French schools.ObjectiveAims for this research were to create, implement and evaluate a remediation program for French students with reading difficulties up to the end of elementary school.MethodThis paper examines the effects of a decoding-skills and fluency-based intervention on 133 struggling readers in second- to fifth-grade. Depending on the nature of their reading difficulties, students were given a year-long training based either on grapho-syllabic conversion — focusing on syllable units, rather than phonemic units, is considered a promising way of helping French-speaking beginning readers — or on repeated reading techniques, used to improve fluency.ResultsIncreases in written-word identification scores were greater for students who followed the program than they were for a control group of 184 students with reading difficulties who did not follow the program.ConclusionThe results show that programs combining early evaluation of written-word identification abilities followed by a year-long series of remediation sessions focusing on specific difficulties can help students progress in written-word identification. However, further research is needed to examine why our program was less effective with children from disadvantaged (“éducation prioritaire”) areas.     

Mandated Reporting Among School Personnel

Summary

An empirical review and critique of existing state standards for batterer programs in the domestic violence field appeared timely, given the current debate about their status and utility. Although there has been a considerable amount of polemic discussion of the topic, relatively limited data have been reported. The present article surveyed the content of standards developed in 30 states within the United States. Five categories of interest were examined including: (1) the minimum length of treatment specified; (2) specification of treatment orientation, methods, and content; (3) preferred or allowable modalities of treatment; (4) whether research findings were mentioned or endorsed as a basis for development of treatment standards; and (5) methods for developing and revising standards. A related area, the minimum education required for providers, was also included as an area of interest to further describe the current pool of practitioners targeted for regulation. An analysis of the content of these standards was then performed with regard to existing peer-reviewed research in the field. The results are discussed in terms of the strengths and weaknesses of current standards, the areas in which further research is needed, and specific recommendations regarding steps that might be taken to improve existing efforts.