What Happens After the Demonstration Phase? The Sustainability of Canada's At Home/Chez Soi Housing First Programs for Homeless Persons with Mental Illness

This research examined the sustainability of Canada's At Home/Chez Soi Housing First (HF) programs for homeless persons with mental illness 2 years after the end of the demonstration phase of a large (more than 2000 participants enrolled), five‐site, randomized controlled trial. Qualitative interviews were conducted with 142 participants (key informants, HF staff, and persons with lived experience) to understand sustainability outcomes and factors that influenced those outcomes. Also, a self‐report HF fidelity measure was completed for nine HF programs that continued after the demonstration project. A cross‐site analysis was performed, using the five sites as case studies. The findings revealed that nine of the 12 HF programs (75%) were sustained, and that seven of the nine programs reported a high level of fidelity (achieving an overall score of 3.5 or higher on a 4‐point scale). The sites varied in terms of the level of systems integration and expansion of HF that were achieved. Factors that promoted or impeded sustainability were observed at multiple ecological levels: broad contextual (i.e., dissemination of research evidence, the policy context), community (i.e., partnerships, the presence of HF champions), organizational (i.e., leadership, ongoing training, and technical assistance), and individual (i.e., staff turnover, changes, and capacity). The findings are discussed in terms of the implementation science literature and their implications for how evidence‐based programs like HF can be sustained.     

Sustainability of Teacher Implementation of School-Based Mental Health Programs

Evidence-based prevention and intervention programs are increasingly being implemented in schools and it therefore is becoming increasingly important to understand the complexities of program implementation under real-world conditions. Much research has focused on the contextual factors that influence program implementation but less work has attempted to provide an integrated understanding of mechanisms (e.g., teacher-training processes) that affect teachers' program implementation. In this paper, we review literature on factors related to teachers' implementation of school-based prevention and intervention programs, then from this review abstract what we believe are four basic ingredients that characterize potentially sustainable teacher-implemented classroom programs. Finally, we present a sequential model, based on these ingredients, of the naturalistic processes underlying sustainability of teachers' program implementation and describe how this sustainability can be enhanced through provision of teacher training and performance feedback from a classroom consultant.     

Trauma‐Informed Programs Based in Schools: Linking Concepts to Practices and Assessing the Evidence

When children experience stress and adversity in their homes and communities, schools become a critically important setting in which to intervene and foster their resilience. Changing practices within schools so that vulnerable and traumatized children are better understood and more compassionately served is a goal shared by many school professionals, yet schools remain poorly equipped to address the needs of these children. Any number of school‐based programs have the potential to benefit children with an elevated risk for academic difficulties and mental health disorders, although questions remain as to which programs are most promising, effective, and sustainable. Questions also remain about which programs best serve diverse populations and which have potential to reach the largest number of children, including those who do not outwardly manifest behaviors consistent with an underlying disorder but nonetheless require support. In this review, we take stock of existing programs used in schools to address the social, emotional, and academic needs of children with trauma histories. We summarize components of a various trauma‐focused programs, categorized as: (a) individual and group‐based approaches, (b) classroom‐based approaches, and (c) school‐wide approaches. For each category, we review and comment on the state and quality of research findings and provide illustrative examples from the literature to show how programs address trauma in the school context. Findings of the review suggest that empirical evidence currently favors individual and group‐based approaches, although classroom‐based and school‐wide programs may be better positioned for integration, access to services, and sustainability. Implications and recommendations center on future research, practice, and policy.     

Ready, Willing, and Able: Developing a Support System to Promote Implementation of School-Based Prevention Programs

While the number and scope of evidence‐based health, education, and mental health services continues to grow, the movement of these practices into schools and other practice settings remains a complex and haphazard process. The purpose of this paper is to describe and present initial support for a prevention support system designed to promote high‐quality implementation of whole school prevention initiatives in elementary and middle schools. The function and strategies of a school‐based prevention support system are discussed, including key structures and activities undertaken to identify, select, and provide technical assistance to school personnel. Data collected over a 5 year period are presented, including evidence of successful implementation support for 5 different evidence‐based programs implemented with fidelity at 12 schools and preliminary evidence of goal attainment. Findings suggest the ongoing collection of information related to organizational readiness assists in the adoption and implementation of effective practices and initiatives and provide valuable insight into the development of results‐oriented approaches to prevention service delivery. Problems, progress, and lessons learned through this process are discussed to frame future research and action steps for this school‐based prevention support system. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

Workforce Support for Urban After‐School Programs: Turning Obstacles into Opportunities

Organized after‐school programs can mitigate risk and build resilience for youth in urban communities. Benefits rely on high‐quality developmental experiences characterized by a supportive environment, structured youth–adult interactions, and opportunities for reflective engagement. Programs in historically disenfranchised communities are underfunded; staff are transient, underpaid, and undertrained; and youth exhibit significant mental health problems which staff are variably equipped to address. Historically, after‐school research has focused on behavior management and social‐emotional learning, relying on traditional evidence‐based interventions designed for and tested in schools. However, after‐school workforce and resource limitations interfere with adoption of empirically supported strategies and youth health promotion. We have engaged in practice‐based research with urban after‐school programs in economically vulnerable communities for nearly two decades, toward building a resource‐efficient, empirically informed multitiered model of workforce support. In this paper, we offer first‐person accounts of four academic–community partnerships to illustrate common challenges, variability across programs, and recommendations that prioritize core skills underlying risk and resilience, align with individual program goals, and leverage without overextending natural routines and resources. Reframing obstacles as opportunities has revealed the application of mental health kernels to the after‐school program workforce support and inspired lessons regarding sustainability of partnerships and practice.     

School Climate and Implementation of a Preventive Intervention

Although there has been wide dissemination of research-based psychosocial prevention programs, a similarly strong research base to guide program implementation has been lacking. Program implementation has been particularly difficult for schools, due partly to insufficient understanding of how school ecologies interact with these programs. This study examined the effects of multiple dimensions of school climate on level and rate of change in implementation of a violence prevention intervention across three school years. Using multi-level modeling, the study found that teacher-reported support between staff and among teachers and students predicted higher average levels of implementation. Teacher-reported administrative leadership predicted greater growth in implementation across 3 years. Findings offer implications for an ecological model of program implementation that considers school-level contextual effects on adoption and sustainability of new programs in schools. The Metropolitan Area Child Study Research Group is a collaboration of (in alphabetical order) Leonard Eron, University of Michigan; Nancy Guerra, University of California, Riverside; David Henry, University of Illinois at Chicago; L. Rowell Huesmann, University of Michigan; Patrick Tolan, University of Illinois at Chicago; and Richard VanAcker, University of Illinois at Chicago.     

Sustainable antibullying program implementation: School profiles and predictors

We examined the sustainability of the KiVa antibullying program in Finland from its nationwide roll-out in 2009 to 2016. Using latent class analyses, we identified four different patterns of implementation. The persistent schools (43%) maintained a high likelihood of participation throughout the study period. The awakened (14%) had a decreasing trend during the first years, but then increased the likelihood of program participation. The tail-offs (20%) decreased in the likelihood of participating after the third year, and the drop-offs (23%) already after the first year. The findings suggest that many schools need support during the initial years to launch and maintain the implementation of evidence-based programs; yet a large proportion of schools manage to sustain the program implementation for several years. The logistic regression analyses showed that large schools persisted more likely than small schools. Lower initial level of victimization was also related to the sustainability of the program. Finally, persistent program participation was predicted by several school-level actions during the initial years of implementing the program. These results imply that the sustainability of evidence-based programs could be enhanced by supporting and guiding schools when setting up the program during the initial implementation.     

Essential Elements for Community Engagement in Evidence-Based Youth Violence Prevention

In the field of youth violence prevention, there has been increasing emphasis on “evidence based” programs and principles shown through scientific research as reaching their intended outcomes. Community mobilization and engagement play a critical role in many evidence‐based programs and strategies, as it takes a concerted effort among a wide range of people within a community to alter behavior and maintain behavioral change. How do concerned individuals and groups within a community engage others within and outside of that community to effectively plan, develop and implement appropriate EB programs as well as evaluate the outcomes and impacts of locally developed programs yet to be proven? The authors discuss five elements essential for community engagement in evidence‐based youth violence prevention based on their work in a university‐community partnership through the Asian/Pacific Islander Youth Violence Prevention Center (API Center), a National Academic Center for Excellence on Youth Violence Prevention Center supported by the Centers for Disease Control and Prevention. They include: (a) aligning EBPs with a community's shared vision and values; (b) establishing an inclusive environment for the planning, implementation and evaluation of EBPs; (c) nurturing collaboration for increased effectiveness and efficacy of EBPs; (d) building adequate leadership and community capacity to develop and sustain EBPs; and (e) building a learning community for evaluation and self‐reflection. The authors propose placing greater emphasis on “evaluative thinking” and organizational capacity for evaluation as we pursue evidence‐based practices for youth violence prevention. This is especially important for ethnic groups for which an evidence base is not well established.     

Strengthening the Child‐ and Youth‐Serving Workforce: Surveying the Landscape,Overcoming Challenges

This special issue addresses a neglected but important topic in our field: strengthening the child‐ and youth‐serving workforce. Investing in this workforce should be a national priority because considerable evidence has shown that investments in early childhood education and development, particularly in low‐resource contexts, that are reinforced through skills‐based programs in adolescence and adulthood, have beneficial impacts throughout life. Investing in quality child‐ and youth‐serving programs also has the additional benefit of creating a productive and capable future workforce. The editors and authors of the special issue should be commended for producing the first special issue on this topic in our field or in related fields, one that is long overdue. Articles in this issue survey the landscape of an amorphous and complex area of practice and research and describe key challenges for the field. In this commentary, I offer organizing frameworks to characterize the child‐ and youth‐serving workforce, note emerging issues when addressing specific challenges, and identify areas for future research.     

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.     

Sustained Implementation of Evidence‐based Programs in Disadvantaged Communities: A Conceptual Framework of Supporting Factors

This paper presents a review of the empirical literature for studies evaluating factors that facilitate and create barriers to sustained program implementation in disadvantaged communities. It outlines study methodology and sustainment outcomes and proposes a conceptual model that involves implementation sustainment support for providers delivering evidence‐based health and family services in disadvantaged communities. Sustained program implementation in the community setting is a significant issue as only 43% of studies reported successfully sustained programs. The review identified 18 factors that facilitate success and create barriers to program sustainment. The factors are synthesized into three themes; program characteristics, workplace capacity, and process and interaction factors. The majority of factors map onto commonly cited sustainability influences in implementation science. However, there was an additional focus for studies included in this review on the importance of factors such as program burden, program familiarity and perceived competence in program skills, workplace support for the program, staff mobility and turnover, supervision and peer support, and ongoing technical assistance. The need to use a conceptual framework and develop measures to guide and evaluate capacity building in EBP implementation and sustainment in low‐resource community settings is highlighted.     

L’évaluation du risque de récidive et l’intervention basée sur les données probantes : les conditions nécessaires à l’implantation de méthodes structurées d’évaluation et d’intervention efficaces

The results of different studies on the best practices of the prevention of recidivism are clear: it is possible to reduce the risk of recidivism of offenders through efficient intervention. Structured risk assessment combined with practices based on risk, need and responsivity principals may reduce the risk of recidivism by up to 30%. These programs, developed primarily in Canada, require adaptations to better suit a French context. The present article proposes to revise the main stages essential to the introduction of a new evaluation and intervention strategy based on evidence, namely, the exploration, the preparation of the establishment, the creation and implementation themselves, the sustainability approach and the introduction of evaluative research studies. The advantages of considering such an implementation strategy are discussed.     

Enhancing school-based prevention and youth development through coordinated social,emotional, and academic learning

A comprehensive mission for schools is to educate students to be knowledgeable, responsible, socially skilled, healthy, caring, and contributing citizens. This mission is supported by the growing number of school-based prevention and youth development programs. Yet, the current impact of these programs is limited because of insufficient coordination with other components of school operations and inattention to implementation and evaluation factors necessary for strong program impact and sustainability. Widespread implementation of beneficial prevention programming requires further development of research-based, comprehensive school reform models that improve social, health, and academic outcomes; educational policies that demand accountability for fostering children's full development; professional development that prepares and supports educators to implement programs effectively; and systematic monitoring and evaluation to guide school improvement.     

A public health approach to preventing child abuse in low‐ and middle‐income countries: A call for action

Violence against children is prevalent across all countries and cultures, with the burden of child injury and violence heaviest in low‐ and middle‐income (LAMI) settings. There are several types of program to prevent child abuse, with family‐based approaches to prevention being the most comprehensively researched and successful interventions in high‐income settings. In LAMI countries, however, there is very little research evidence for the prevention of child abuse. We conducted a systematic search of relevant databases for studies published between 1995 and 2011 and the search revealed only one relevant study. There is thus a need for research into child maltreatment prevention in LAMI settings, taking account of local resources and contexts. In the light of the lack of evidence, we focus on two case studies that document the use of home visiting by community health workers perinatally to improve maternal and child outcomes. We propose four areas for action moving forward, including increased investment in early intervention and prevention programs, development of a research agenda that prioritizes prevention research, integration of implementation research into efforts to scale up interventions, and improving systematically collected information on child maltreatment.     

Participatory Action Research (PAR) in Middle School: Opportunities, Constraints, and Key Processes

Late childhood and early adolescence represent a critical transition in the developmental and academic trajectory of youth, a time in which there is an upsurge in academic disengagement and psychopathology. PAR projects that can promote youth's sense of meaningful engagement in school and a sense of efficacy and mattering can be particularly powerful given the challenges of this developmental stage. In the present study, we draw on data from our own collaborative implementation of PAR projects in secondary schools to consider two central questions: (1) How do features of middle school settings and the developmental characteristics of the youth promote or inhibit the processes, outcomes, and sustainability of the PAR endeavor? and (2) How can the broad principles and concepts of PAR be effectively translated into specific intervention activities in schools, both within and outside of the classroom? In particular, we discuss a participatory research project conducted with 6th and 7th graders at an urban middle school as a means of highlighting the opportunities, constraints, and lessons learned in our efforts to contribute to the high‐quality implementation and evaluation of PAR in diverse urban public schools.     

Early Childhood Teachers' Perspectives on Social-Emotional Competence and Learning in Urban Classrooms

The promotion of social-emotional competence and implementation of social-emotional learning programs have increased substantially in schools; however, little is known about teachers' perceptions of such programs. This qualitative study explored early childhood (3 to 8 years old) teachers' perceptions of classroom-based social-emotional learning programs for young, urban-dwelling children. A focus of the study included learning what teachers believe were the critical components and challenges of such programs. Five themes emerged from the content analysis: responsibility, curricula/program design, contextual relevance, support, and barriers. The findings from this study are discussed with regard to educational policy implications about social-emotional learning curricula and programs, especially those implemented in urban schools.     

Sustaining the Utilization and High Quality Implementation of Tested and Effective Prevention Programs Using the Communities That Care Prevention System

This paper describes the extent to which communities implementing the Communities That Care (CTC) prevention system adopt, replicate with fidelity, and sustain programs shown to be effective in reducing adolescent drug use, delinquency, and other problem behaviors. Data were collected from directors of community‐based agencies and coalitions, school principals, service providers, and teachers, all of whom participated in a randomized, controlled evaluation of CTC in 24 communities. The results indicated significantly increased use and sustainability of tested, effective prevention programs in the 12 CTC intervention communities compared to the 12 control communities, during the active phase of the research project when training, technical assistance, and funding were provided to intervention sites, and 2 years following provision of such resources. At both time points, intervention communities also delivered prevention services to a significantly greater number of children and parents. The quality of implementation was high in both conditions, with only one significant difference: CTC sites were significantly more likely than control sites to monitor the quality of implementation during the sustainability phase of the project.     

Letting Go: Conceptualizing Intervention De‐implementation in Public Health and Social Service Settings

The discontinuation of interventions that should be stopped, or de‐implementation, has emerged as a novel line of inquiry within dissemination and implementation science. As this area grows in human services research, like public health and social work, theory is needed to help guide scientific endeavors. Given the infancy of de‐implementation, this conceptual narrative provides a definition and criteria for determining if an intervention should be de‐implemented. We identify three criteria for identifying interventions appropriate for de‐implementation: (a) interventions that are not effective or harmful, (b) interventions that are not the most effective or efficient to provide, and (c) interventions that are no longer necessary. Detailed, well‐documented examples illustrate each of the criteria. We describe de‐implementation frameworks, but also demonstrate how other existing implementation frameworks might be applied to de‐implementation research as a supplement. Finally, we conclude with a discussion of de‐implementation in the context of other stages of implementation, like sustainability and adoption; next steps for de‐implementation research, especially identifying interventions appropriate for de‐implementation in a systematic manner; and highlight special ethical considerations to advance the field of de‐implementation research.     

Navigating Complex Implementation Contexts: Overcoming Barriers and Achieving Outcomes in a National Initiative to Scale Out Housing First in Canada

The scaling out of Housing First (HF) programs was examined in six Canadian communities, in which a multi‐component HF training and technical assistance (TTA) was provided. Three research questions were addressed: (a) What were the outcomes of the TTA in terms of the development of new, sustained, or enhanced programs, and fidelity to the HF model? (b) How did the TTA contribute to implementation and fidelity? and (c) What contextual factors facilitated or challenged implementation and fidelity? A total of 14 new HF programs were created, and nine HF programs were sustained or enhanced. Fidelity assessments for 10 HF programs revealed an average score of 3.3/4, which compares favorably with other HF programs during early implementation. The TTA influenced fidelity by addressing misconceptions about the model, encouraging team‐based practice, and facilitating case‐based dialogue on site specific implementation challenges. The findings were discussed in terms of the importance of TTA for enhancing the capacities of the HF service delivery system—practitioners, teams, and communities—while respecting complex community contexts, including differences in policy climate across sites. Policy climate surrounding accessibility of housing subsidies, and use of Assertive Community Treatment teams (vs. Intensive Case Management) were two key implementation issues.     

Using a Training-of-Trainers Approach and Proactive Technical Assistance to Bring Evidence Based Programs to Scale: An Operationalization of the Interactive Systems Framework’s Support System

Bringing evidence based programs to scale was a major initial impetus for the development of the Interactive Systems Framework for Dissemination and Implementation (ISF). The ISF demonstrates the importance of the Support System in facilitating the uptake of innovations in the community (the Delivery System). Two strategies that members of the Support System commonly use are training‐of‐trainers (TOT) models and technical assistance (TA). In this article, we focus on the role of the Support System in bringing evidence‐based programs (EBPs) to scale in the Delivery System using a case example, with special attention on two strategies employed by Support Systems—training‐of‐trainers (TOT) and proactive technical assistance. We then report on findings from a case example from the Promoting Science Based Approaches to Teen Pregnancy Prevention project that furthers our conceptualization of these strategies and the evidence base for them. We also report on the limitations in the literature regarding research on TOTs and proactive TA and provide suggestions for future research on TOTs and proactive TA that will enhance the science and practice of support in the ISF. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith