An ecological assessment of community-based interventions for prevention and health promotion: Approaches to measuring community coalitions

Presented an ecological assessment of a community coalition to prevent alcohol, tobacco, and other drug abuse, and related risks. Ecological assessment is defined as occurring at multiple social levels and along a continuum of stages of coalition readiness. The assessment is aided by the triangulation, or combining of assessment methods and strategies. Measures used to assess the coalition's formation, implementation of community initiatives, and production of community impacts are described, along with the triangulation strategies used to enhance the assessment findings. We thank our evaluation team members including Erica Adams, Simon Choi, Cindy Crusto, Katie Davino, David delaCruz, Pamela Goodman, Maury Nation, and Diana Seybolt. We also thank the members of the community coalitions for substance abuse prevention and especially the project directors: James Bown, Dian Crain, Johneta Davis, Kelli Kenninson, Paul Pittman, Greg Sparkman, Sheryl Taylor, and Kenneth Wright.     

Triple P-Positive Parenting Program: Towards an Empirically Validated Multilevel Parenting and Family Support Strategy for the Prevention of Behavior and Emotional Problems in Children

This paper outlines the theoretical and empirical foundations of a unique multilevel parenting and family support strategy designed to reduce the prevalence of behavioral and emotional problems in preadolescent children. The program known as Triple P-Positive Parenting Program is a multilevel system of family intervention, which provides five levels of intervention of increasing strength. These interventions include a universal population-level media information campaign targeting all parents, two levels of brief primary care consultations targeting mild behavior problems, and two more intensive parent training and family intervention programs for children at risk for more severe behavioral problems. The program aims to determine the minimally sufficient intervention a parent requires in order to deflect a child away from a trajectory towards more serious problems. The self-regulation of parental skill is a central construct in the program. The program uses flexible delivery modalities (including individual face-to-face, group, telephone assisted, and self-directed programs) to tailor the strength of the intervention to the requirements of individual families. Its multidisciplinary, preventive and community-wide focus gives the program wide reach, permitting the targeting of destigmatized access points through primary care services for families who are reluctant to participate in parenting skills programs. The available empirical evidence supporting the efficacy of the program is discussed and its implications for research on dissemination are discussed.     

Evaluation of an islandwide screening,assessment and treatment program

This article reports on the effectiveness of the Islandwide Screening, Assessment, and Treatment Program of the Child Development Project in Bermuda. From 1982 to 1984, approximately 1100 families with 2-year-old children were screened for children's cognitive and language delay, for behaviour management problems and for other home characteristics that put children at risk for later school failure. Children who failed the screening and subsequent assessment procedures (of whom random samples received treatment) and samples of others who passed screening and assessment were evaluated from 1984 to 1986 at 4 years of age. This article focuses on the results of the cognitive and language programs; the more problematic behaviour management analyses were reported elsewhere (Miller and Scarr, 1988). The screening procedures and assessment measures developed for this project were themselves evaluated and adjusted to maximize efficiency and costeffectiveness. The screening and assessment procedures proved effective in bringing to the attention of the Child Development Project those families and children who need developmental services, and in not overidentifying normal children as potentially delayed in development. Two kinds of treatment services were compared: The Mother-Child Home Program (MCHP), administered by paraprofessional toy demonstrators, and other interventions tailored by professionals to the language and cognitive problems of the child (called ‘tailored programs’). Children who were not extremely delayed or disturbed were randomly assigned either to the MCHP or to a tailored program. Neither intervention program was preferable to the other. Even though improved, the 4-year-olds identified as developmentally delayed at 24 months still lagged behind children who passed all parts of screening and those who failed screening but passed assessment 2 years earlier. The screening and assessment procedures were very effective in the early identification of children with developmental problems, but the treatment programs failed to bring most children to normal levels of cognitive and language functioning.     

Psychological impact of breast cancer on the patient and the family: A clinical perspective

Breast cancer is the most frequently occurring cancer in women, with 182,000 new cases diagnosed in 1993. Breast cancer will strike a sizable percentage of women during the child-rearing years impacting, therefore, not only on the woman, but on the significant others in her life. This article explores the impact of breast cancer for the patient's life partner, parents, and children. A model intervention program for cancer patients with young children, piloted at the Derner Institute and developed in conjunction with the American Cancer Society, is also discussed.     

A university-based incentive program to increase safety belt use: Toward cost-effective institutionalization

A cost-effective incentive program to increase safety belt use was implemented by the campus police of a large university. For each of the 3-week intervention periods during three consecutive academic quarters, the 22 campus police officers recorded the license plate numbers of vehicles with drivers wearing a shoulder belt. From these numbers, 10 raffle winners were drawn who received gift certificates donated by community merchants. Faculty and staff increased their belt usage markedly as a result of the "Seatbelt Sweepstakes," whereas students increased their belt use only slightly. A cost-effectiveness analysis indicated that the sweepstakes cost an average of $0.98 per each newly buckled driver. During each sweepstakes intervention, officers' belt usage increased significantly, but diminished to initial baseline levels after the final withdrawal of the program. Surveys of officers' opinions indicated that the police would accept the program demands as a regular task requirement. This result and the fact that program promotion and coordination were eventually taken over by two student organizations suggest that institutionalization of the "Seatbelt Sweepstakes" is feasible.     

Activity settings as the unit of analysis: A theoretical basis for community intervention and development

Theory, methods, and action develop within context, one of which is the intellectual climate of an era. Community psychology is directly and indirectly interactive with many intellectual currents, such as postmodernism, semiotics, hermeneutics, and dialogism. These ideas are discussed as they impact on community psychology, with an emphasis on the reemergence of meaning as a central condition of psychology and community. Meaning is of key importance to the unifying concept in the transactional theoretical model which is presented. How this model might serve as a conceptual framework for an asset approach to community intervention and development is discussed. Increasingly, it is recognized that the development of theory to guide community research and action is necessary to advance intervention and to realize the potential of community psychology. It is argued that community psychology is positioned by concepts and practice squarely at the point of emerging thought, and can make fuondational contributions to general social science. The next article in this special section illustrates concepts of this model in an early education program and the remaining article illustrates the influence of ecocultural factors.     

Early education as community intervention: Assisting an ethnic minority to be ready for school

An early education program designed for an ethnic minority of Native Hawaiians implemented at the community rather than the individual child level of intervention is described. The program development effort is theory driven and provides an opportunity to investigate the application of neo-Vygotskian theory to an applied community educational problem. Though not specifically derived from the work of O'Donnell, Tharp, and Wilson (1993), the project reported here shares a common intellectual heritage. This paper demonstrates the parallels between the early education program developed for Hawaiian children and the applicability of the theory presented in the work of O'Donnell et al. Portions of this research were supported by Grant #40212121 and Grant #MCJ495051 from the Bureau of Maternal and Child Health and Resource Management, U.S. Department of Health and Human Services awarded to the Center of Development of Early Education, Kamehameha School, Honolulu, Hawaii 96817, and to the Early Intervention Research Institute, Center for Persons with Disabilities, Utah State University, respectively.     

Teaching communicative alternatives to socially withdrawn behavior: An investigation in maintaining treatment effects

This study examined the effectiveness of a contextual intervention strategy paired with an existing packaged intervention on the ability to produce increased and durable social involvement among children who displayed socially withdrawn behavior and their peers. Using a multiple baseline design across three socially withdrawn subjects, results indicated that the combination intervention effectively increased social interactions. Results also indicated that the effects of the intervention maintained two months after intervention termination. General implications for the use of the contextual intervention strategy to produce durable treatment outcomes are discussed.     

Development of child autonomy in eating and toilet training: One- to three-year-old Japanese and French children

This study analyses the interface between children's culture and their development as they learn to perform the daily activities of eating and toileting in culturally appropriate ways. Thirty-three Japanese and 36 French children 12-31 months of age and adults' interventions were observed in public day care centres in Tokyo and in Paris. Within the same time frame, a survey was conducted among the adults (parents and nursery staff) to examine their developmental expectations for children. Observations reveal differences between children's learning in the two countries. Toilet training begins at a later age in Japan and is learned more quickly, whereas learning to eat alone begins earlier than in France but is acquired at a slower pace. The analysis of the surveys shows some discrepancy between adults' conceptions and actual interactions. In both countries, the developmental decrease in physical intervention corresponded with the progress of the child, but adult interventions and strategies varied according to the different cultures. The presence of Japanese adults is greater than those in France, but this does not mean that they intervene physically more often. Finally, instrumental independence begins slightly earlier in Japan.