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     

A Business Model for Managing System Change Through Strategic Financing and Performance Indicators: A Case Study

This article describes how a system of care operated by a county government agency used a fiscal crisis as the opportunity to reform its children's system. A cross-system response to the crisis is outlined that includes a system of care framework coupled with a business model, inter-departmental collaboration and leadership, the use of strategic reinvestment strategies, and a quality improvement system that focuses on key indicators. Implementation of the system change is described with a specific focus on cross-system entry points, financing strategies that re-allocate funds from deep-end programs to community-based services, and management oversight through the use of performance indicators to monitor and support effectiveness. This article examines the results of the system change, including the diversion of youth from system penetration, the reduction in residential treatment bed days, the re-allocation of these savings to community-based services, and the outcomes of children who were diverted from residential care and served in the community. The article offers a number of recommendations for other communities contemplating system change.     

Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial

This study further evaluates the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). A diagnostically heterogeneous clinical sample of 37 patients with a principal anxiety disorder diagnosis was enrolled in a randomized controlled trial (RCT) involving up to 18 sessions of treatment and a 6-month follow-up period. Patients were randomly assigned to receive either immediate treatment with the UP (n=26) or delayed treatment, following a 16-week wait-list control period (WLC; n=11). The UP resulted in significant improvement on measures of clinical severity, general symptoms of depression and anxiety, levels of negative and positive affect, and a measure of symptom interference in daily functioning across diagnoses. In comparison, participants in the WLC condition exhibited little to no change following the 16-week wait-list period. The effects of UP treatment were maintained over the 6-month follow-up period. Results from this RCT provide additional evidence for the efficacy of the UP in the treatment of anxiety and comorbid depressive disorders, and provide additional support for a transdiagnostic approach to the treatment of emotional disorders.     

The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the unified protocol for the transdiagnostic treatment of emotional disorders

The present study aimed to understand the contributions of both the trait tendency to experience negative emotions and how one relates to such experience in predicting symptom change during participation in the Unified Protocol (UP), a transdiagnostic treatment for emotional disorders. Data were derived from a randomized controlled trial comparing the UP to a waitlist control/delayed-treatment condition. First, effect sizes of pre- to post-treatment change for frequency of negative emotions and several variables measuring reactivity to emotional experience (emotional awareness and acceptance, fear of emotions, and anxiety sensitivity) were examined. Second, the relative contributions of change in negative emotions and emotional reactivity in predicting symptom (clinician-rated anxiety, depression, and severity of principal diagnosis) reductions were investigated. Results suggested that decreases in the frequency of negative emotions and reactivity to emotions following participation in the UP were both large in magnitude. Further, two emotional reactivity variables (fear of emotions and anxiety sensitivity) remained significantly related to symptom outcomes when controlling for negative emotions, and accounted for significant incremental variance in their prediction. These findings lend support to the notion that psychological health depends less on the frequency of negative emotions and more on how one relates to these emotions when they occur.     

Control networks and neuromodulators of early development

In adults, most cognitive and emotional self-regulation is carried out by a network of brain regions, including the anterior cingulate, insula, and areas of the basal ganglia, related to executive attention. We propose that during infancy, control systems depend primarily upon a brain network involved in orienting to sensory events that includes areas of the parietal lobe and frontal eye fields. Studies of human adults and alert monkeys have shown that the brain network involved in orienting to sensory events is moderated primarily by the nicotinic cholinergic system arising in the nucleus basalis. The executive attention network is primarily moderated by dopaminergic input from the ventral tegmental area. A change from cholinergic to dopaminergic modulation would be a consequence of this switch of control networks and may be important in understanding early development. We trace the attentional, emotional, and behavioral changes in early development related to this developmental change in regulative networks and their modulators.     

Examining process constructs of narrative career counselling: an exploratory case study

The present article examines how the five process constructs of reflection, connectedness, meaning making, learning and agency are operationalised in a constructivist approach to career counselling, specifically a storytelling approach. This article reports on an exploratory case study of a Black South African female university student. The case study provides examples of how a career counsellor enacts these constructs and facilitates their development in a client, as well as examples of how they are evident in client dialogue and action. Insight into the process of a storytelling approach to narrative career counselling is demonstrated, from which tentative suggestions are made about how to facilitate the process constructs of reflection, connectedness, meaning making, learning and agency.     

Mark Graves <Emphasis Type="Italic">Mind,Brain and the Elusive Soul: Human Systems of Cognitive Science and Religion</Emphasis>

This article explores the use of Graves’ theory of the soul as an interdisciplinary tool to facilitate a holistic approach to healing. Graves’ discussion is applied to the use of therapeutic interventions to facilitate the emergent processes of healing and spiritual growth in traumatized persons.     

Spiritual Autobiography and Older Adults

Spiritual autobiography groups constitute a form of ministry that can potentially enrich the lives of older adults, their families, and their congregations. Such groups, when competently led, provide participants with an environment in which they can make meaning out of their lives, grieve their losses, and give and receive support. The actions and interactions involved in composing, telling, and hearing life stories are salutary exercises that can increase participants’ experiences of clarity, coherence, and connection to God and to each other. The spiritual wisdom that emerges from such life stories, when shared within congregations, can enhance intergenerational relationships and lead to spiritual growth for members of diverse ages.     

Viewing time through the lens of the self: The fit effect of self‐construal and temporal distance on task perception

This paper describes how different self‐construals influence people's perception of temporal distance and in turn their task evaluation. We hypothesize that people with a more accessible interdependent (vs. independent) self‐construal perceive future events as temporally more proximal, and that people's reaction toward a task is intensified when the temporal distance to the task matches (vs. mismatches) their self‐construal. Across four studies, we showed that individuals with a more accessible interdependent self‐construal (Study 1) and East Asians (Study 2) perceived future events as more proximal than those with a more accessible independent self‐construal and European Americans. Further, when considering a task at a temporal distance that fits their self‐construal, individuals perceived a pleasant task as more motivating (Study 3) and an unpleasant task as less motivating (Study 4).

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