Fortalezas Familiares Program: Building Sociocultural and Family Strengths in Latina Women with Depression and Their Families

The purpose of this article is to describe Fortalezas Familiares (FF; Family Strengths), a community‐based prevention program designed to address relational family processes and promote well‐being among Latino families when a mother has depression. Although depression in Latina women is becoming increasingly recognized, risk and protective mechanisms associated with children's outcomes when a mother has depression are not well understood for Latino families. We begin by reviewing the literature on risk and protective psychosocial mechanisms by which maternal depression may affect Latino youth, using family systems theory and a developmental psychopathology framework with an emphasis on sociocultural factors shaping family processes. Next, we describe the theoretical basis and development of the FF program, a community‐based 12‐week intervention for Latina immigrant women with depression, other caregivers, and their children. Throughout this article, we use a case study to illustrate a Latina mother's vulnerability to depression and the family's response to the FF program. Recommendations for future research and practice include consideration of sociocultural processes in shaping both outcomes of Latino families and their response to interventions.     

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.     

Effectiveness of a trauma/grief-focused group intervention: a qualitative study with war-exposed Bosnian adolescents

The effectiveness and impacts of a school-based, trauma/grief-focused group treatment program for war-exposed youth in Bosnia and Herzegovina were investigated using semistructured focus groups, conducted separately for students and their school counselor group leaders. Overall, students' and leaders' evaluations of the groups were generally positive. General themes of outcomes and impacts perceived by students and group leaders include: acquisition of coping skills and attitudes, willingness to advocate for peers, improved interpersonal relationships, negative impacts, general positive impacts, impacts in the schools, impacts on the group and logistics of the program, and broader impacts on the perception of mental health in the community. The broad positive impacts of this program suggest that trauma/grief-focused group treatment intervention programs targeting trauma-exposed youth may be effective on multiple levels with war-exposed youth and their communities.     

Diverse community contexts and community resources for sexual and gender minority youth: A mixed‐methods study

Sexual and gender minority (SGM) youth face marginalization and oppression on the basis of their SGM identity, and they often lack traditional support systems to deal with these minority stressors. SGM community resources may alleviate the impact of the stressors that SGM youth face, but these have not been studied in relation to the size and climate of SGM youth's communities. This mixed‐methods study examined the relationship between community size and the climate toward SGM individuals and the availability and utilization of SGM community resources. Survey findings indicate that nonmetropolitan communities were associated with less availability and utilization; hostile communities were associated with lower availability only. Interview findings reveal nuanced complexities on the relationship between community and resource provision. Implications for future research and community practice are discussed.     

Reducing the Risk of Internalizing Symptoms among High‐risk Hispanic Youth through a Family Intervention: A Randomized Controlled Trial

Familias Unidas is an intervention that has been found to be efficacious in preventing and reducing substance use, sexual risk, and problem behaviors among Hispanic youth. While it does not specifically target youth internalizing symptoms, the intervention works to strengthen parenting and family factors associated with reduced risk of internalizing symptoms (i.e., depression, anxiety symptoms). This study examines the effects of Familias Unidas on internalizing symptoms among high‐risk youth, as well as the role of family level factors in the intervention's effects. A total of 242 12–17‐year‐old Hispanic youth with a history of delinquency and their primary caregivers were recruited from the school and juvenile justice systems, and randomly assigned to the Familias Unidas intervention or community practice control. A linear latent growth model was used to examine intervention effects on the trajectory of adolescent internalizing symptoms from baseline to 6 and 12 months post‐baseline. Results show that the Familias Unidas intervention was more efficacious than control in reducing youth internalizing symptoms. Baseline youth externalizing and internalizing symptoms did not moderate the intervention's effects on the trajectory of youth internalizing symptoms. While parent – adolescent communication did not significantly moderate the intervention's effects, changes in parent – adolescent communication mediated the intervention's effects on internalizing symptoms, showing stronger intervention effects for youth starting with poorer communication. Findings indicate that the Familias Unidas intervention can reduce internalizing symptoms among high‐risk Hispanic youth, and that improving parent – youth communication, a protective family factor, may be one of the mechanisms by which the intervention influences youth internalizing symptoms.     

The Better Beginnings,Better Futures Project: Long‐term Parent,Family, and Community Outcomes of a Universal,Comprehensive, Community‐Based Prevention Approach for Primary School Children and their Families

Better Beginnings, Better Futures is a large‐scale, multi‐year, longitudinal research‐demonstration project designed to reduce children's problems, promote healthy child development, and enhance family and community environments in three economically disadvantaged communities in the province of Ontario, Canada. The initial intervention was implemented from 1993 to 1997 and focused on families with children from 4 to 8 years of age in their first 4 years of schooling (from Junior Kindergarten to Grade 2). This study examined the long‐term parent, family and community programme outcomes, 15 years after the start of the intervention, when the young people who had participated in the intervention as young children were 18 to 19 years of age. Comparison of intervention communities with matched non‐intervention communities showed a mix of outcomes. Although few significant differences between intervention and comparison communities were found with regard to parents' health and family outcomes, there was evidence that parents in the intervention communities were engaging in fewer risk behaviours, had lower levels of depression and had more community involvement than parents in the comparison communities. These results suggest that the intervention did have some positive long‐term effects on youths' parents and on their community environments. Results are discussed with respect to the importance of considering family and neighbourhood contexts in the development and evaluation of prevention programmes. Copyright © 2012 John Wiley & Sons, Ltd.     

The Importance of the Community Context in the Epidemiology of Early Adolescent Substance Use and Delinquency in a Rural Sample

Considerable research has demonstrated that substance use and delinquency during early adolescence can have long-term negative health consequences. As the correlates of these behaviors cross levels and contexts, it is likely that a social ecological approach will provide insight to inform community prevention. This approach informs the present study, which focuses on developing a multiple-method measurement strategy to examine associations among community risks, resources, and rates of early adolescent substance use and delinquency in 28 rural and small town communities. Measures include five domains of community risk, four domains of community resources, and population rates of early adolescent substance use and delinquency. Results demonstrated that several measures of context were significantly associated with community rates of adolescent substance use and delinquency, and different risks and resources appear important for different outcomes. Multiple associations were curvilinear, and interactions may also be important. Findings suggest that it may be worthwhile to create and test new intervention strategies that target community factors in the pursuit of prevention.     

Indigenizing CBPR: Evaluation of a Community-Based and Participatory Research Process Implementation of the Elluam Tungiinun (Towards Wellness) Program in Alaska

The process that community based participatory research (CBPR) implementation takes in indigenous community contexts has serious implications for health intervention outcomes and sustainability. An evaluation of the Elluam Tungiinun (Towards Wellness) Project aimed to explore the experience of a Yup'ik Alaska Native community engaged within a CBPR process and describe the effects of CBPR process implementation from an indigenous community member perspective. CBPR is acknowledged as an effective strategy for engaging American Indian and Alaska Native communities in research process, but we still know very little about the experience from a local, community member perspective. What are the perceived outcomes of participation in CBPR from a local, community member perspective? Qualitative methods were used to elicit community member perspectives of participation in a CBPR process engaged with one Yup'ik community in southwest Alaska. Results focus on community member perceptions of CBPR implementation, involvement in the process and partnership, ownership of the project with outcomes observed and perceived at the community, family and individual levels, and challenges. A discussion of findings demonstrates how ownership of the intervention arose from a translational and indigenizing process initiated by the community that was supported and enhanced through the implementation of CBPR. Community member perspectives of their participation in the research reveal important process points that stand to contribute meaningfully to implementation science for interventions developed by and for indigenous and other minority and culturally diverse peoples.     

Context-Dependent Pathways of the Transmission of Risk from Communities to Individuals

Research has consistently documented the role of environmental risk factors in the onset of delinquent behavior among youth. Less is known about the processes through which these contextual risks are translated to individual youth behavior. The aim of the current study is to examine the role of family risk factors in the transmission of community risk. Data was obtained from a nationally representative sample of over 30,000 middle school youth and community key informants (CKI). A multilevel, moderated mediation model was estimated with family risk as the moderator of the effect of CKI ratings of community risk on youth perceptions of risk. Results showed that when youth came from low risk families (measured by parental use of positive family management strategies), youth perceptions of risk mediated the effects of community risk on youth delinquency; however, there was no evidence of a significant mediated effect under conditions of high risk (measured by poor family management). This appears to be because youth from high-risk families perceived their neighborhoods as high-risk, regardless of actual levels of risk (as reported by CKI). This study finds that the relationship between communities and adolescent behavior is complex and interacts with the family environment.     

An Evidence‐Based Approach to Reducing Recidivism in Court‐Referred Youth

The authors obtained recidivism data on a predominantly Latino/a sample of juvenile offenders within a 24‐month period following their participation in a community‐based psychoeducational counseling program emphasizing life skills development. The treatment group was compared with a sample of youth derived from the same database who had participated in community probationary programs. Youth in the treatment group had statistically significant less recidivism in a 24‐month period subsequent to completing the program than did youth in the control group.     

The Youth Public Arts Program: Interpersonal and Intrapersonal Outcomes for At-Risk Youth

This article provides the findings of a program evaluation of the Youth Public Arts Program, a long-standing community-based art program that serves at-risk youth in eastern North Carolina. The program evaluation was undertaken to examine the art skills, social and interpersonal skills, and community involvement of the participants. The study included four focus groups and telephone surveys with a total of 38 stakeholders (program participants, parents of participants, program staff, and referral sources). Results indicated that the at-risk youth had gains in both interpersonal and intrapersonal skills, including family relationships, peer relationships, community interaction, increased art skills, confidence, and self-regulation. This article adds to the very limited literature on community-based art programs for youth.     

The relationship between out-of-school activities and positive youth development: an investigation of the influences of communities and family

There is growing evidence that participation in constructive leisure activities facilitates positive youth development. Empirical evidence also supports the influence of families and communities on positive developmental outcomes for adolescents. This study examined the relationship among attitudes toward family and community, participation in structured out-of-school activities, and pro-social behavior. As predicted, community aspects such as opportunities available and the attitudes the youth held toward the community, as well as their attitude toward family were predictive of activity involvement. Activity involvement, in turn, was predictive of pro-social behavior. Attitude toward family was also predictive of attitude toward the community. Attitude toward community was a direct predictor of the positive developmental outcome of pro-social behavior, although contrary to the original hypothesis, family influences did not have a direct effect on pro-social behavior. Implications for continued practice and change for a variety of sectors in the positive youth development field such as educators and educational institutions, youth-serving organizations, families, and policy makers are discussed, along with recommendations for continued research in this field.     

Impact of a Kentucky Maternal, Infant, and Early Childhood Home-Visitation Program on Parental Risk Factors

As public health organizations continue to implement maternal and child health home-visitation programs, more evaluation of these efforts is needed, particularly as it relates to improving parental behaviors. The purpose of our study was to assess the impact of families’ participation in a home-visitation program offered by a central Kentucky health department on parental risk factors. A family social worker or nurse interviewed parents pre-intervention, completing a Parent Survey which assessed multiple parental risk factors associated with negative health and well-being and to calculate a total risk score. Upon exiting the program, parents are re-interviewed to document improvements, review progress and accomplished goals, plan for transitional services, and calculate a new risk score. As of December 2010, 64 families had completed the home-visitation program and had pre- and post-risk scores available for analysis. Based on paired-sample t tests, there was a statistically significant difference in total mean risk scores among both mothers and fathers from pre to post. The McNemar–Bowker test also revealed statistically different scores for four of the six risk factors for mothers and fathers pre- and post-home-visitation: lifestyle behaviors and mental health, coping skills and support systems, stresses, and anger management skills. Findings suggest that families who were deemed at-risk for adverse pregnancy and child health outcomes benefit from participation in the home-visitation program. Programs designed to promote positive pregnancy outcomes and child development may benefit from providing social support, fostering parental knowledge, skill development and problem solving, insuring proper medical care, and connecting parents with community resources.     

Effectiveness of a Group Therapy Program for Children with Psychosocial Deficits: Benefits of Concurrent Participation in Organized Activities

Prior research suggests children’s involvement in organized activities predicts positive outcomes, although benefits for youth with psychosocial deficits remain unclear. This study examines if activity participation predicts response to a group therapy program for children with psychosocial deficits and if improvements depend on children’s functioning within the organized activity context. Participants were 178 children (M age?=?9.6 years) enrolled in a group therapy program. Greater activity participation significantly predicted improvements in family functioning and social skills, suggesting the value of participation in organized activities for youth with psychosocial deficits.     

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.     

Issues in Professional Training to Implement Evidence‐based Parenting Programs: The Preferences of Indigenous Practitioners

Indigenous children have elevated risk for poor health, behavioural, emotional, and social outcomes. Significant evidence exists that parenting programs can reduce family risk factors and improve outcomes for children and families; however, mainstream programs have had slower uptake in Indigenous communities than other communities. Culturally sensitive delivery of evidence‐based programs can enhance engagement of parents, yet the development of a workforce to deliver programs to Indigenous parents faces many obstacles. This project seeks to identify professional training processes that enhance Indigenous practitioners’ skills and confidence in delivering an evidence‐based parenting program. A survey of trained parenting practitioners via an online practitioner network assessed their views of the training and post‐training support processes they had experienced. Respondents were 57 Indigenous and 720 non‐Indigenous practitioners from 15 countries. Most training processes were rated equally helpful by Indigenous and non‐Indigenous practitioners. However, several training processes were identified as important for the delivery of culturally competent training, such as tailoring the pace of training and simplifying the language in teaching resources. Practitioners with higher ratings of the helpfulness of peer support following training reported higher program uptake and implementation. Qualitative themes also focused on the helpfulness of program resources, and having a peer support network and mentoring. Increasing access to appropriate, flexibly delivered training and post‐training support for Indigenous professionals will support the development of a skilled workforce with local knowledge and connections, and further increase the reach of evidence‐based services in Indigenous communities.     

Strengthening parent well‐being at the work—family interface: A German trial on workplace Triple P

This study examines the efficacy of a parenting training (Workplace Triple P (WPTP)) especially designed for the needs of employed parents. The program aims to reduce stress at the work–parenting interface by targeting family risk and protective factors and assisting parents to manage competing work and family demands. Ninety‐seven part‐ and full‐time working parents (74 mothers and 23 fathers; intervention group: n = 42 parents; waitlist‐control group n = 55 parents) from multiple organizations and multiple occupations with children between 2 and 10 years were randomly assigned to an intervention and a waitlist‐control condition. After the training, parents from the intervention condition, compared to those from the waitlist‐control condition, reported a significant reduction in individual and work‐related stress. Additionally, they reported a significant reduction in dysfunctional parenting and significant higher levels of parental and occupational self‐efficacy. Within the intervention condition all effects were maintained at the 3‐ and 6‐month follow‐up examinations. The findings support the notion that WPTP promotes parental well‐being and reduces stress at the work–parenting interface. Given that strengthening parenting skills has the potential to strengthen work, strategies to implement WPTP in organizational resources and community‐based services are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Structural and Community Change Outcomes of the Connect‐to‐Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention,Testing, and Medical Care

Connect to Protect (C2P), a 10‐year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV‐related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions’ context and operation that facilitated and undermined their ability to achieve structural change and build communities’ capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS‐competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV‐risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions’ ability to successfully implement HIV‐related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS‐competent community.     

Supporting Out‐of‐School Time Staff in Low Resource Communities: A Professional Development Approach

Federally funded out‐of‐school time (OST) programs provide academic support, enrichment, and safety for students and families in low‐resource communities. However, programs struggle to meet these aims, in part because of the lack of program structure and limited training and support for staff. This observational case study documents the training and technical assistance (TA) delivered to OST frontline staff and program leadership to implement Positive Behavior in Out‐of‐School Time (Positive BOOST), an adaptation of positive behavior interventions and supports conducted in multiple settings. Findings across three programs indicate that varied levels of TA (i.e., business as usual, performance feedback, coaching) are associated with different levels of staff‐ and program‐level implementation. Taken together with previous research, these findings suggest that targeted investment in developing the skills of OST staff and improving program‐wide outcomes is critical for supporting youth in low‐resource communities.     

Promoting Social Nurturance and Positive Social Environments to Reduce Obesity in High-Risk Youth

Nurturing environments within the context of families, schools, and communities all play an important role in enhancing youth’s behavioral choices and health outcomes. The increasing prevalence rates of obesity among youth, especially among low income and ethnic minorities, highlight the need to develop effective and innovative intervention approaches that promote positive supportive environments across different contexts for at-risk youth. We propose that the integration of Social Cognitive Theory, Family Systems Theory, and Self-Determination Theory offers a useful framework for understanding how individual, family, and social-environmental-level factors contribute to the development of nurturing environments. In this paper, we summarize evidence-based randomized controlled trials that integrate positive parenting, motivational, and behavioral skills strategies in different contexts, including primary care, home, community, and school-based settings. Taken together, these studies suggest that youth and parents are most likely to benefit when youth receive individual-level behavioral skills, family-level support and communication, and autonomous motivational support from the broader social environment. Future investigators and healthcare providers should consider integrating these evidence-based approaches that support the effects of positive social climate-based interventions on promoting healthy eating, physical activity, and weight management in youth.