Dissemination of Family-Centered Prevention for Military and Veteran Families: Adaptations and Adoption within Community and Military Systems of Care

In response to the needs of military families confronting the challenges of prolonged war, we developed Families OverComing Under Stress (FOCUS), a multi-session intervention for families facing multiple deployments and combat stress injuries adapted from existing evidence-based family prevention interventions (Lester et al. in Mil Med 176(1): 19–25, 2011). In an implementation of this intervention contracted by the US Navy Bureau of Medicine and Surgery (BUMED), FOCUS teams were deployed to military bases in the United States and the Pacific Rim to deliver a suite of family-centered preventive services based on the FOCUS model (Beardslee et al. in Prev Sci 12(4): 339–348, 2011). Given the number of families affected by wartime service and the changing circumstances they faced in active duty and veteran settings, it rapidly became evident that adaptations of this approach for families in other contexts were needed. We identified the core elements of FOCUS that are essential across all adaptations: (1) Family Psychological Health Check-in; (2) family-specific psychoeducation; (3) family narrative timeline; and (4) family-level resilience skills (e.g., problem solving). In this report, we describe the iterative process of adapting the intervention for different groups of families: wounded, ill, and injured warriors, families with young children, couples, and parents. We also describe the process of adopting this intervention for use in different ecological contexts to serve National Guard, Reserve and veterans, and utilization of technology-enhanced platforms to reach geographically dispersed families. We highlight the lessons learned when faced with the need to rapidly deploy interventions, adapt them to the changing, growing needs of families under real-world circumstances, and conduct rigorous evaluation procedures when long-term, randomized trial designs are not feasible to meet an emergent public health need.     

A Protective Factors Model for Alcohol Abuse and Suicide Prevention Among Alaska Native Youth

This study provides an empirical test of a culturally grounded theoretical model for prevention of alcohol abuse and suicide risk with Alaska Native youth, using a promising set of culturally appropriate measures for the study of the process of change and outcome. This model is derived from qualitative work that generated an heuristic model of protective factors from alcohol (Allen et al. in J Prev Interv Commun 32:41–59, 2006; Mohatt et al. in Am J Commun Psychol 33:263–273, 2004a; Harm Reduct 1, 2004b). Participants included 413 rural Alaska Native youth ages 12–18 who assisted in testing a predictive model of Reasons for Life and Reflective Processes about alcohol abuse consequences as co-occurring outcomes. Specific individual, family, peer, and community level protective factor variables predicted these outcomes. Results suggest prominent roles for these predictor variables as intermediate prevention strategy target variables in a theoretical model for a multilevel intervention. The model guides understanding of underlying change processes in an intervention to increase the ultimate outcome variables of Reasons for Life and Reflective Processes regarding the consequences of alcohol abuse.     

Implementation Quality and Positive Experiences in After-School Programs

Data collected during an evaluation of a multi-site trial of an enhanced after-school program were used to relate quality of program implementation to student experiences after school. The enhanced after-school program incorporated a drug use and violence prevention component that was shown to be effective in previous research. Building on Durlak and Dupre’s (Am J Community Psychol 41:327–350, 2008) dimensions of implementation, we assessed the level of dosage, quality of management and climate, participant responsiveness, and staffing quality achieved at the five program sites. We evaluated how these characteristics co-varied with self-reported positive experiences after-school. The study illustrates how multiple dimensions of program implementation can be measured, and shows that some but not all dimensions of implementation are related to the quality of student after-school experiences. Measures of quality of management and climate, participant responsiveness, and staffing stability were most clearly associated with youth experiences. The importance of measuring multiple dimensions of program implementation in intervention research is discussed.     

The Exchange Boundary Framework: Understanding the Evolution of Power within Collaborative Decision-Making Settings

Many community decision-making bodies encounter challenges in creating conditions where stakeholders from disadvantaged populations can authentically participate in ways that give them actual influence over decisions affecting their lives (Foster-Fishman et al., Lessons for the journey: Strategies and suggestions for guiding planning, governance, and sustainability in comprehensive community initiatives. W.K. Kellogg Foundation, Battle Creek, MI, 2004). These challenges are often rooted in asymmetrical power dynamics operating within the settings (Prilleltensky, J Commun Psychol 36:116–136, 2008). In response, this paper presents the Exchange Boundary Framework, a new approach for understanding and promoting authentic, empowered participation within collaborative decision-making settings. The framework expands upon theories currently used in the field of community psychology by focusing on the underlying processes through which power operates in relationships and examining the evolution of power dynamics over time. By integrating concepts from social exchange theory (Emerson, Am Soc Rev 27:31–41, 1962) and social boundaries theory (Hayward, Polity 31(1):1–22, 1998), the framework situates power within parallel processes of resources exchange and social regulation. The framework can be used to understand the conditions leading to power asymmetries within collaborative decisionmaking processes, and guide efforts to promote more equitable and authentic participation by all stakeholders within these settings. In this paper we describe the Exchange Boundary Framework, apply it to three distinct case studies, and discuss key considerations for its application within collaborative community settings.     

Top-Down,Bottom-Up,and Around the Jungle Gym: A Social Exchange and Networks Approach to Engaging Afterschool Programs in Implementing Evidence-Based Practices

This paper uses concepts from social networks and social exchange theories to describe the implementation of evidence-based practices in afterschool programs. The members of the LEGACY Together Afterschool Project team have been involved in conducting collaborative research to migrate a behavioral strategy that has been documented to reduce disruptive behaviors in classroom settings to a new setting—that of afterschool programs. We adapted the Paxis Institute’s version of the Good Behavior Game to afterschool settings which differ from in-school settings, including more fluid attendance, multiple age groupings, diverse activities that may take place simultaneously, and differences in staff training and experience (Barrish et al. in J Appl Behav Anal 2(2):119–124, 1969; Embry et al. in The Pax Good Behavior Game. Hazelden, Center City, 2003; Hynes et al. in J Child Serv 4(3):4–20, 2009; Kellam et al. in Drug Alcohol Depend 95:S5–S28, 2008; Tingstrom et al. in Behav Modif 30(2):225–253, 2006). This paper presents the experiences of the three adult groups involved in the implementation process who give first-person accounts of implementation: (1) university-based scientist-practitioners, (2) community partners who trained and provided technical assistance/coaching, and (3) an afterschool program administrator. We introduce here the AIMS model used to frame the implementation process conceptualized by this town–gown collaborative team. AIMS builds upon previous work in implementation science using four phases in which the three collaborators have overlapping roles: approach/engagement, implementation, monitoring, and sustainability. Within all four phases principles of Social Exchange Theory and Social Network Theory are highlighted.     

Application of a CBPR Framework to Inform a Multi-level Tobacco Cessation Intervention in Public Housing Neighborhoods

African American women in urban, high poverty neighborhoods have high rates of smoking, difficulties with quitting, and disproportionate tobacco-related health disparities. Prior research utilizing conventional "outsider driven" interventions targeted to individuals has failed to show effective cessation outcomes. This paper describes the application of a community-based participatory research (CBPR) framework to inform a culturally situated, ecological based, multi-level tobacco cessation intervention in public housing neighborhoods. The CBPR framework encompasses problem identification, planning and feasibility/pilot testing, implementation, evaluation, and dissemination. There have been multiple partners in this process including public housing residents, housing authority administrators, community health workers, tenant associations, and academic investigators. The advisory process has evolved from an initial small steering group to our current institutional community advisory boards. Our decade-long CBPR journey produced design innovations, promising preliminary outcomes, and a full-scaled implementation study in two states. Challenges include sustaining engagement with evolving study partners, maintaining equity and power in the partnerships, and long-term sustainability of the intervention. Implications include applicability of the framework with other CBPR partnerships, especially scaling up evolutionary grassroots involvement to multi-regional partnerships.     

Disagreement and Dispute

In this paper, I will trace a distinction between two different ways of thinking about doxastic conflicts. The first way emphasises what is going on at the level of semantics, when two subjects disagree by uttering certain sentences or accepting certain contents. The second way emphasises some aspects that are epistemic in kind, which concern what subjects are rationally required to do whenever they disagree with someone. The semantics-oriented and epistemically-oriented notions will serve for the purpose of assessing some aspects of the debate that revolves around the notions of disagreement on matters of inclination. These aspects include: (i) the idea that disagreements in areas of inclination are somehow defective (Egan 2010); (ii) the idea that Relativism makes disagreement epistemically insignificant (Carter 2013); (iii) the idea that there can be faultless disagreements in which faultlessness is epistemic in kind (Schafer 2011).     

Evaluation of a Brief Mindfulness Program for People with Multiple Sclerosis Delivered in the Community Over Five Years

This study evaluated the effectiveness, change mechanisms, and sustainability of a brief mindfulness intervention for people with multiple sclerosis (PwMS) delivered in the community through a frontline service over five years. Participants were 126 PwMS. A single intervention condition design was used with pre-intervention, post-intervention and 2-month follow-up assessments. The primary outcome was distress. Secondary outcomes were perceived stress, quality of life (QoL) and fatigue, and the proposed change mechanisms: mindfulness, self-compassion, psychological inflexibility. Intention-to-treat analyses showed the primary outcome, distress (Cohen’s d = .25), and all secondary outcomes improved: perceived stress (d = .38), mental health QoL (d = .39), physical health QoL (d = .47), fatigue (d = .30), mindfulness (d = .29), self-compassion (d = .37), psychological flexibility (d = .44). Distress, stress and perceived stress continued to improve post-intervention to follow-up. Mindfulness emerged as a temporal mediator of perceived stress (BCa 95% CI). Self-compassion mediated concurrent improvements in distress, perceived stress, fatigue and physical health QoL, while greater psychological flexibility mediated concurrent reductions in distress (BCa 95% CI). Mindfulness home practice was unrelated to improvements on all outcomes except a marginal association with mindfulness. Of the socio-demographic and illness factors, lower disease severity predicted improvements in physical health QoL (p = .046). Improvements in outcomes were supported by qualitative feedback and participant satisfaction ratings. Twenty-one groups were offered with good participant engagement and wide geographical reach, suggesting sustained feasibility of the Mindfulness for MS program over five years. Findings support the delivery of the Mindfulness for MS program through a community-based service in partnership with a local university.

     

MorePower 6.0 for ANOVA with relational confidence intervals and Bayesian analysis

MorePower 6.0 is a flexible freeware statistical calculator that computes sample size, effect size, and power statistics for factorial ANOVA designs. It also calculates relational confidence intervals for ANOVA effects based on formulas from Jarmasz and Hollands (Canadian Journal of Experimental Psychology 63:124–138, 2009), as well as Bayesian posterior probabilities for the null and alternative hypotheses based on formulas in Masson (Behavior Research Methods 43:679–690, 2011). The program is unique in affording direct comparison of these three approaches to the interpretation of ANOVA tests. Its high numerical precision and ability to work with complex ANOVA designs could facilitate researchers’ attention to issues of statistical power, Bayesian analysis, and the use of confidence intervals for data interpretation. MorePower 6.0 is available at https://wiki.usask.ca/pages/viewpageattachments.action?pageId=420413544.     

Building a Self-Directed Process for the Development of Internationally Trained Professional Profiles in Canada

More and more internationally trained professionals (ITP) coming to Canada face challenges in getting credentials recognized by regulatory bodies and employers (Forum of Labour Market Ministers 2009; Ontario Office of the Fairness Commissioner 2011b). This leads to a high level of brain waste that recently has been estimated to cost Canada up to $3.4 billion per year (Evans, CGA Magazine 45(4): 26, 2011). This paper looks at some of the challenges regarding prior learning assessments and portfolio-building processes toward credential evaluation, and explains some of the reasons why the current system and tools are not meeting the needs of ITPs. In particular, postsecondary institutions and regulatory bodies’ processes toward preparing individuals for evaluation are compared, leading to a number of conclusions on commonality and future directions. The authors conclude with the proposal of a new generic online and modular professional profile model to better prepare ITPs for credential assessment. Such a model would be particularly useful for credentialing bodies with fewer resources available. It would also provide a common set of information to front-line agencies that support ITPs.     

The Role of Lay Health Advisors in Cardiovascular Risk Reduction: A Review

Interventions are needed to reduce the negative impact of cardiovascular disease. The combination of health risks for disease, disability, and mortality, particularly among underserved populations, might be best addressed with programs designed to enhance awareness and development of resources within a context of community support. The objectives of this review were to: (1) provide a comprehensive review and evaluation of the roles, evaluation, and effectiveness of LHA in community-based programs with an emphasis on cardiovascular risk reduction; and (2) provide recommendations for future research involving LHA in such programs. Computer and manual searches were conducted of articles in the English-language literature from 1980 to 2007. Twenty articles were evaluated, which emphasized the role of the LHA in cardiovascular risk reduction. A review of research literature provides a starting point for determining salient approaches for intervention and evaluation, issues related to program implementation and sustainability, and strengths and limitations of existing approaches.     

Chicago Urban Resiliency Building (CURB): An Internet-Based Depression-Prevention Intervention for Urban African-American and Latino Adolescents

Early preventive interventions for depressive disorders in racial/ethnic minorities may help to reduce lifetime depression outcome disparities by improving developmental trajectories and social outcomes. We describe the development process, intervention and evaluation plan for a culturally adapted, low-cost, primary care/Internet-based depression-prevention intervention (CURB, Chicago Urban Resiliency Building). CURB is culturally adapted for socio-economically disadvantaged African-American and Latino adolescents according to the PEN-3 model of health promotion programs (Airhihenbuwa in Health and culture: beyond the Western paradigm, Sage Publishers, Thousand Oaks, 1995). Based on the idea that health behavior is rooted in culture, the PEN-3 model contains three interdependent dimensions that influence health beliefs and behaviors. Within each dimension are factors (using the acronym PEN) that must be considered about the target culture. Application of the PEN-3 model occurred in 3 phases. In each phase, a dimension of the model was explored and subsequent changes were made to the intervention so as to be more culturally suitable. In the CURB clinical trial, adolescents ages 13–17 will be recruited from wait-lists for mental health services at community health care provider organizations and screened for risk of future depressive disorder in the primary care sites. Adolescents screening positive for persistent depressed mood will be randomly assigned to either the CURB intervention group or the wait-list control group. The study aims are to determine if participants in the CURB intervention group will have lower levels of depressive symptoms and/or a lower cumulative incidence of depressive episodes.     

Resources for health: a primary-care-based diet and physical activity intervention targeting urban Latinos with multiple chronic conditions.

OBJECTIVE: The Resources for Health trial evaluates a social-ecologically based lifestyle (physical activity and diet) intervention targeting low-income, largely Spanish-speaking patients with multiple chronic conditions. DESIGN: A randomized controlled trial was conducted with 200 patients recruited from an urban community health center and assigned to intervention and usual care conditions. Intervention involved 2 face-to-face, self-management support and community linkage sessions with a health educator, 3 follow-up phone calls, and 3 tailored newsletters. MAIN OUTCOME MEASURES: Primary outcomes measured at 6-months were changes in dietary behavior and physical activity. Changes in multilevel support for healthy living were evaluated as a secondary outcome. RESULTS: After adjustment for age, sex, language, and number of chronic conditions, significant intervention effects were observed for dietary behavior and multilevel support for healthy lifestyles but not for physical activity. CONCLUSION: The Resources for Health intervention provides an effective and practical model for improving health behavior among low-income, Spanish-speaking patients with multiple chronic conditions.     

Inconsistency and scientific realism

I erect a framework within the semantic view of theories for explaining the empirical success of internally inconsistent models and theories, with scientific realism in mind. The framework is an instance of the ‘content-driven’ approach to inconsistency, advocated by both Norton (Philos Sci 54:327–350, 1987) and Smith (Stud Hist Philos Sci 19:429–445, 1988a, In: Fine A, Leplin J (eds) PSA1988, 1988b), whose ideas my analysis aims to clarify and substantiate.     

Traduction et adaptation du TEI-SF afin de documenter l’acceptabilité sociale de l’intervention comportementale intensive

Early intensive behavioral intervention is more widely used in large-scale community-based services in Autism Spectrum Disorder. There is an increased need to evaluate the social acceptability of these programs. The present study used a measure of social acceptability as part of a social validation procedure to evaluate a community-based EIBI offered in inclusive childcare, as well as two focused interventions associated with this program. To do so, the Treatment Evaluation Inventory Short-form (TEI-SF) questionnaire was adapted and translated to French. The validation results for the TEI-SF, as well as for the social acceptability of the EIBI programs and procedures, are presented. The results are the first evidence of the validity of the TEI-SF (adapted and translated to French), presenting scores of validity of intervention and a favourable perspective related to the early intensive behavioral intervention and opening the door to further research.     

Evaluating a novel intervention to reduce trauma symptoms and sexual risk taking: qualitative exit interviews with sexual minority men with childhood sexual abuse

Childhood sexual abuse (CSA) continues to affect sexual minority men (SMM) at disproportionate levels and contributes to multiple negative health outcomes, including sexual-risk taking and HIV acquisition. This paper presents qualitative evaluative feedback from SMM (N = 9) who participated in a 10-session Cognitive Behavioral Therapy-Trauma and Sexual Health (CBT-TSH) intervention to reduce CSA-related posttraumatic stress reaction and distress. The treatment was designed to increase accurate sexual risk appraisals and to improve self-care health behaviors related to HIV/STI acquisition. The researchers identified four emerging themes: (1) motivation to participate, (2) response to cognitive therapy, (3) process of change, and (4) considerations for intervention improvement. These qualitative findings provide useful feedback on the acceptability of an innovative program that integrates CBT for trauma related to CSA with sexual risk-reduction counseling.     

The Moderating Effects of Congregational and Denominational Support on the Impact of Stress on Clerical Emotional and Physical Health Status

This research is the third component of a three-part series that explores the relationship between stress and health in the clerical profession. The first article (Wells J Relig Health 51:215–230, 2012) determined that there is an association between two different sources of stress in the clerical profession (work-related stress and boundary-related stress). The second article (Wells Pastor Psychol 62:101–114, 2013) determined that there is an association between the two sources of stress and two differing measures of health (emotional health and physical health). This third and final article establishes congregational and denominational support as possible moderators of the effects of both sources of stress on emotional and physical health. The same dataset utilized in the two previous studies is used in this research. Simple and multiple regression are utilized. This research determined that support from both the congregation and the denomination moderates or lessens the negative effects of stress on clerical health status.     

Promoting Healthy Behavior from the Pulpit: Clergy Share Their Perspectives on Effective Health Communication in the African American Church

African Americans continue to suffer disproportionately from health disparities when compared to other ethnicities (ACS 2010; CDC 2007). Research indicates that the church and the pastor in the African American community could be enlisted to increase effectiveness of health programs (Campbell et al. in Health Edu Behav 34(6):864–880, 2007; DeHaven et al. in Am J Public Health 94(6):1030–1036, 2004). The objective of this study was to investigate African American pastors’ perceptions about health promotion in the church and how these perceptions could serve as a guide for improving health communication targeting African Americans. Semi-structured interviews with African American clergy revealed that pastors feel strongly about the intersection of health, religion and spirituality; they also believe that discussing health screening and other health issues more frequently from the pulpit and their own personal experiences will ultimately impact health behavior among congregants. This study suggests that African American clergy see themselves as health promoters in the church and believe this communication (i.e., pastor-endorsed health information materials) will impact health behavior among underserved and minority populations.