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This introduction to a special issue of the American Journal of Community Psychiatry is the result of a symposium at the Annual Meeting of the Society for Applied Anthropology, 2006, that brought together anthropologists and psychologists involved in community based collaborative intervention studies to examine critically the assumptions, processes and results of their multilevel interventions in local communities with local partners. The papers were an effort to examine context by offering a theoretical framework for the concept of “level” in intervention science, and advocating for “multi-level” approaches to social/behavioral change. They presented examples of ways in which interventions targeted social “levels” either simultaneously or sequentially by working together with communities across levels, and drawing on and co-constructing elements of local culture as components of the intervention. The papers raised a number of important issues, for example: (1) How are levels defined and how should collaborators be chosen; (2) does it matter at which level multilevel interventions begin; (3) do multilevel interventions have a greater effect on desired outcomes than level-specific interventions; (4) are multilevel interventions more sustainable; (5) are multilevel interventions cost effective to run, and evaluate; (6) how can theories of intervention be generated and adapted to each level of a multilevel intervention; (7) how should intervention activities at each level coordinate to facilitate community resident or target population empowerment? Many of these questions were only partially addressed in the papers presented at that time, and are more fully addressed in the theoretical papers, case studies and approach to evaluation included in this collection. [ABSTRACT FROM AUTHOR]

This paper informs practice in community‐based home visiting workforce development by describing the development and evaluation of a university‐based training certificate program for home visitors and supervisors. The Interactive Systems Framework for Dissemination and Implementation (ISF; Wandersman et al., 2008) guides our conceptualization and paper organization. The ISF describes the components involved in translating research findings into effective implementation of prevention programs. We describe implementation and lessons learned from seven development activities: (a) review of the literature, (b) survey of other training initiatives across the country, (c) focus groups with home visitors and supervisors, (d) consultation with individual home visitors, (e) creation of a state advisory board of home visiting providers and stakeholders, (f) evaluation of two pilot trainings, and (g) video development. We then present evaluation data from 49 home visitors and 23 supervisors who completed the training certificate program after the pilot trainings. Both home visitors and supervisors rated training satisfaction highly, reported significant increases in self‐efficacy related to the training topics, and reported extensive use of motivational communication techniques, which are the foundational skills of the training content. These and other favorable results reflect the benefits of building on advances in theory and science‐based practice and of involving providers and stakeholders repeatedly throughout the development process. Highlights: We developed a state‐wide training center for infant home visitors. Training content was developed through an iterative process of community partner feedback. Home visitors reported increases in self‐confidence following training in most competency areas. Participant evaluations of training are consistent with positive results from an RCT of training. [ABSTRACT FROM AUTHOR]

This paper applies concepts and methods developed in management to translate efficacious prevention programs into effective prevention services. The paper describes Quality Function Deployment (QFD) as a method for structured planning and development that connects the needs and wants of the consumer with the design of the product or service. The paper describes basic tools used in quality management, and discusses how they might be applied to prepare a prevention program for implementation by community agencies. Prevention programs are conceptualized as having multiple consumers (i.e., stakeholders), including the participants who receive the service, the service providers, the organizations that deliver the program, and the researchers who evaluate the programs. As an illustration of one step in the application of QFD to translate efficacious prevention programs into effective prevention services, analysis of the needs and preferences of Family Courts for the implementation of an the New Beginnings Program is presented. [ABSTRACT FROM AUTHOR]

Population studies indicate that trauma exposure is ubiquitous and has a significant impact on health. Trauma‐informed practice seeks to address the health consequences of trauma through integrative responses that incorporate an understanding of the effects of trauma, the multiple pathways to recovery, and the potential for re‐traumatization. Current trauma‐informed practice considers trauma exposure an individual clinical problem rather than a societal problem with population health consequences. Population health refers to the aggregated health status of individuals who share some characteristic, such as trauma exposure, and includes the study of determinants that shape the distribution of health outcomes in specific populations. In this paper, we describe a population health perspective for trauma‐informed practice that complements the current clinical perspective, and then discuss implications of that perspective for programs, systems, and policies. We summarize essential concepts about trauma over the life course and describe principles of population health science relevant to trauma‐informed practice. We then discuss implications of these principles by identifying four priorities for trauma‐informed practice from a population health perspective: (a) adopting trauma‐informed policies to prevent trauma exposure and to foster resilience in the aftermath of trauma; (b) infusing trauma‐informed practice into everyday activities so it is a routine part of interpersonal transactions; (c) incorporating trauma‐informed practices into existing service systems; and (d) adapting existing treatments to incorporate trauma‐informed principles for population health impact. Highlights: Trauma exposure is ubiquitous in the population and has a significant impact on health.Trauma‐informed practice seeks to address the clinical health consequences of trauma.A population health perspective can complement a clinical perspective to trauma‐informed practice.We describe principles of a population health perspective to address trauma and its impact on health.We conclude discussing implications of a population health perspective on trauma‐informed practice. [ABSTRACT FROM AUTHOR]

Community interventions that use social network analysis to identify and involve influential individuals are promising for behavior change. However, youth friendships are often unstable. The current study examined the stability of the youth selected as influential in a friendship social network, that is, the degree to which youth selected at one time point were also selected at subsequent time points. Influential youth, also called popular opinion leaders (POLs), were selected to be part of a community‐wide sexual violence prevention initiative. POLs were selected based on high in‐degree (number of times an individual was nominated as a best friend by another student). We found that POLs were unstable: only 29.81%–41.01% of POLs were stable across time. The percentage of POLs who were stable decreased across time. No factors (social identities, behavioral, attitudinal) consistently predicted POL stability. Although these findings are in need of replications, social network interventions for youth may need to repeatedly select new POLs to account for instability. Highlights: The influential youth selected by social network analysis are unstable over time.Social network interventions should select new youth at least every six months.We did not identify any consistent predictors of the stability of influential youth. [ABSTRACT FROM AUTHOR]

Coalition-based efforts that use a science-based approach to prevention can improve the wellbeing of community youth. This study measured several coalition capacities that are hypothesized to facilitate the adoption of a science-based approach to prevention in communities. Using data from 12 coalitions participating in a community-randomized trial of the prevention strategy Communities That Care (CTC), this paper describes select measurement properties of five salient coalition capacities (member substantive knowledge of prevention, member acquisition of new skills, member attitudes toward CTC, organizational linkages, and influence on organizations), as reported by coalition members, and examines the degree to which these capacities facilitated the community leader reports of the community-wide adoption of a science-based approach to prevention. Findings indicated that the five coalition capacities could be reliably measured using coalition member reports. Meta-regression analyses found that CTC had a greater impact on the adoption of a science-based prevention approach in 12 matched pairs of control and CTC communities where the CTC coalition had greater member (new skill acquisition) and organizational capacities (organizational linkages). [ABSTRACT FROM AUTHOR]

This special issue of the American Journal of Community Psychology is the result of a 18-year partnership with Alaska Native communities using collaborative field based research methods. Its goal is to provide a case study fulfilling the spirit of ecological inquiry, offering a detailed and nuanced description of a community intervention. The articles describe the nature of our work, including some of our successes, as well as challenges, dilemmas, and even disappointments we experienced along the way. Our primary aim was to develop and assess the feasibility of a complex, multi-level intervention to increase protective factors hypothesized to reduce suicide and alcohol abuse among rural Yup'ik Alaska Native youth ages 12-18. The articles that follow include descriptions of the cultural context, relevant literature and project history, our methods of community engagement in measurement development strategies, an empirical test of the prevention model that guided the intervention, the development and implementation of the intervention, a feasibility and impact assessment, and an evaluation of community engagement. A final article summarizes what is generalizable from the work in field based intervention research with rural and culturally distinct populations, and future prospects for decolonizing community intervention research methods. These papers raise important issues, including (1) need for deep, contextual ecological descriptions, (2) reconceptualization of time in the research relationship, (3) distinctions between populations and communities, and (4) the conflict between values of communities and intervention science. [ABSTRACT FROM AUTHOR]

This paper describes the processes we engaged into develop a measurement protocol used to assess the outcomes in a community based suicide and alcohol abuse prevention project with two Alaska Native communities. While the literature on community-based participatory research (CBPR) is substantial regarding the importance of collaborations, few studies have reported on this collaboration in the process of developing measures to assess CBPR projects. We first tell a story of the processes around the standard issues of doing cross-cultural work on measurement development related to areas of equivalence. A second story is provided that highlights how community differences within the same cultural group can affect both the process and content of culturally relevant measurement selection, adaptation, and development. [ABSTRACT FROM AUTHOR]

This paper reports on the development and piloting of the Madres a Madres (Mothers to Mothers) program, a new, community-based parent training program designed for immigrant Latina mothers and their children. Promotoras, or female community health workers of Latina background, delivered the program in a home visitation format. A total of 194 mothers and 194 focal children (87 male, 107 female) ages 7-12 were randomized to the intervention (113 mother-child dyads) or wait-list control condition (81 mother-child dyads) over the study period. Outcomes of interest were mother-reported parenting skills, broad family functioning, and child externalizing and internalizing behaviors. Data collection occurred at pretest, 3-month posttest, and 9-month follow-up periods. Multilevel growth models revealed increases in intervention mothers' reported parenting skills, family support, and family organization, and reductions in child internalizing behavior from pretest to follow-up, relative to the control condition. Outcomes did not vary by focal child age, gender, nativity status, or mother acculturative status (years in the United States). Findings are discussed in the context of future directions for research on the Madres a Madres program and on the implementation and dissemination of empirically-supported parent training practices to culturally diverse families. [ABSTRACT FROM AUTHOR]

Community research and action projects undertaken by community-university partnerships can lead to contextually appropriate and sustainable community improvements in rural and urban localities. However, effective implementation is challenging and prone to failure when poorly executed. The current paper seeks to inform rural community-university partnership practice through consideration of first-person accounts from five stakeholders in the Rural Embedded Assistants for Community Health (REACH) Network. The REACH Network is a unique community-university partnership aimed at improving rural health services by identifying, implementing, and evaluating innovative health interventions delivered by local caregivers. The first-person accounts provide an insider's perspective on the nature of collaboration. The unique perspectives identify three critical challenges facing the REACH Network: trust, coordination, and sustainability. Through consideration of the challenges, we identified several strategies for success. We hope readers can learn their own lessons when considering the details of our partnership's efforts to improve the delivery infrastructure for rural healthcare. [ABSTRACT FROM AUTHOR]

The Interactive Systems Framework for Dissemination and Implementation (ISF) was introduced as a heuristic systems level model to help bridge the gap between research and practice (Wandersman et al., in Am J Commun Psychol 41:171-181, ). This model describes three interacting systems with distinct functions that (1) distill knowledge to develop innovations; (2) provide supportive training and technical assistance for dissemination to; (3) a prevention delivery system responsible for implementation in the field. The Strategic Prevention Framework (SPF) is a major prevention innovation launched by the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Administration (SAMHSA). The SPF offers a structured, sequential, data-driven approach that explicitly targets environmental conditions in the community and aims for change in substance use and problems at the population level. This paper describes how the ISF was applied to the challenges of implementing the SPF in 14 Rhode Island communities, with a focus on the development of a new Training and Technical Assistance Resources Center to support SPF efforts. More specifically, we (1) describe each of the three ISF interacting systems as they evolved in Rhode Island; (2) articulate the lines of communication between the three systems; and (3) examine selected evaluation data to understand relationships between training and technical assistance and SPF implementation and outcomes. [ABSTRACT FROM AUTHOR]

The ultimate success of preventive interventions relies on their ability to engage and influence the growing presence of subcultural groups. To encourage and guide the development of effective preventive intervention for subcultural groups, four approaches are described, illustrated, and critiqued with respect to their considerations of cultural fit, reach, efficacy and adoption. Those approaches are (a) the prevention research cycle, (b) cultural adaptations of evidence-based interventions, (c) investigator-initiated culturally-grounded approaches, and (d) community-initiated indigenous approaches. Special attention is given to recent advances in the specification of stages in the cultural adaptation of interventions. The paper closes with some conclusions and topics in need of greater attention. [ABSTRACT FROM AUTHOR]

“Xperience” is an innovative alcohol and drug prevention program that has adopted a multilevel, community-based strategy to promote drug-and-alcohol free social activities, venues and norms among urban youth ages 14–20. The intervention aims to strengthen protective factors and reduce risk factors for alcohol and other substance use among high school age youth by addressing multiple factors at the individual, peer, community and city level. The purpose of this paper is to discuss the process of building the different levels of this intervention during the 3-year formative phase. We will explain: (1) Why we chose to adopt a multilevel and participatory strategy, (2) Formative research leading to the intervention model, (3) The theoretical framework underlying the methodology, (4) Pilot intervention development (Years One and Two), (5) Current program methods and outcome goals, and lastly, (6) Some of the lessons learned, goals achieved, and plans for the future. This descriptive account of building a multilevel intervention aims to serve as a useful guide for others wishing to develop similar approaches, and for theorizing about some of the common challenges involved in this process. [ABSTRACT FROM AUTHOR]

This paper describes the development, application, and results of an implementation monitoring component of the Communities That Care (CTC) prevention framework used in the Community Youth Development Study (CYDS) to ensure high-fidelity prevention program implementation. This system was created based on research that community-based implementation of evidence-based prevention programs often includes adaptations in program design, content, or manner of delivery (Gottfredson and Gottfredson, Journal of research in crime and delinquency, 39, 3–35, 2002; Hallfors and Godette, Health Education Research, 17, 461–470, 2002; Wandersman and Florin, American Psychologist, 58, 441–448, 2003). A lack of fidelity to the implementation standards delineated by program designers is one indicator of a gap between prevention science and practice which can lessen the likelihood that communities will realize the positive participant effects demonstrated in research trials. By using the CTC model to select and monitor the quality of prevention activities, the 12 CYDS communities replicated 13 prevention programs with high rates of adherence to the programs’ core components and in accordance with dosage requirements regarding the number, length, and frequency of sessions. This success indicates the potential of the CTC program implementation monitoring system to enhance community Prevention Delivery Systems (Wandersman et al. American Journal of Community Psychology, this issue) and improve the likelihood of desired participant changes. [ABSTRACT FROM AUTHOR]

A central question in adolescent reproductive health circles is how to effectively disseminate research to practitioners in a way that supports them in using the most scientifically sound and effective programming. In 2002, the Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC) tackled this question by funding three national-level and five state-level organizations focused on adolescent pregnancy prevention to promote the use of science-based programs and approaches. Healthy Teen Network (HTN) and Education, Training and Research Associates (ETR), two national organizations, have partnered under this CDC funding to implement an effective model for capacity building. This paper provides an overview of the approaches used by HTN and ETR in capacity building using a seven-step process. We describe how we modified the Interactive Systems Framework for Dissemination and Implementation (ISF) for science-based innovations to apply to capacity-building for adolescent reproductive health (ARH) programs, and how we developed relevant, sustainable training and technical support. We conclude by reviewing some of the results of this training, and discuss the future work that will likely continue to advance the science behind effective dissemination of ARH research to practice. [ABSTRACT FROM AUTHOR]

Building on theory and past research, in early 2000 scientists in the Division of Reproductive Health developed a prevention innovation for CDC’s Global AIDS Program for use in countries severely affected by the HIV/AIDS epidemic. This innovative program model is called MARCH: Modeling and Reinforcement to Combat HIV/AIDS (Galavotti et al. Am J Public Health 91:1602–1607, ). MARCH promotes behavioral changes that reduce the risk of HIV infection and creates normative environments that sustain these changes through two key program components: entertainment-education using mass media, particularly long-running radio serial dramas, and reinforcement activities at the community level. Using the framework developed by Wandersman et al. (Am J Commun Psychol, 41(3–4), 2008), we describe the key elements of the MARCH prevention innovation and outline how we support its adaptation and implementation. We focus on the following questions: How do we get from an innovative model to effective program implementation in the field? How do we support implementation with fidelity when adaptation is required? And, once implemented, can we demonstrate fidelity of the adaptation to the original program model? Because our program model requires local adaptation for every instance of implementation, we suggest a potential enhancement to the Interactive Systems Framework—support for adaptation of the innovation—as part of the Prevention Support System. In this paper we describe how we supported adaptation of the radio serial drama component for unique contexts in several African countries. We focus attention on the tools and trainings we developed to build innovation specific capacity for implementation, including capacities for adaptation. We then present results of a qualitative analysis of scripts from the MARCH radio serial drama in Zimbabwe to assess the adapted program’s fidelity to the original design of the innovation. Finally, we discuss lessons learned and explore implications for the field. [ABSTRACT FROM AUTHOR]

This paper provides the opportunity to consider local challenges to implementing science-based programs. Wandersman et al. (American Journal of Community Psychology 2008) define three systems necessary to effectively implement science-based programming. These systems include the Prevention Support System, which is responsible for assisting communities in implementing effective practices; the Prevention Research System, which is responsible for developing and packaging prevention programming; and the Prevention Delivery System, which is responsible for delivering services. The authors conduct a content analysis related to six county level efforts to implement science-based programs in Ohio. These counties are part of a larger Ohio initiative referred to as Partnerships for Success. The authors suggest that local officials are quite skilled at accessing the Prevention Research System and providers at the local level represent an effective service delivery system. The authors contend that the Prevention Support System in these counties is capable of enhancing several functions related to local infrastructure but is deficient in other important elements. [ABSTRACT FROM AUTHOR]

In this paper, we argue that attempts to change social settings have been hindered by lack of theoretical advances in understanding key aspects of social settings and how they work in a dynamic system. We present a systems framework for understanding youths’ social settings. We focus on three aspects of settings that represent intervention targets: social processes (i.e., patterns of transactions between two or more people or groups of people), resources (i.e., human, economic, physical, temporal resources), and organization of resources (i.e., how resources are arranged and allocated). We postulate that these setting aspects are in dynamic transaction with each other, resulting in setting outcomes. Discussion focuses on the implications of our theoretical framework for setting intervention. [ABSTRACT FROM AUTHOR]

This article articulates joint priorities for the fields of prevention science and community psychology. These priorities are intended to address issues raised by the frequent observation of natural tensions between community practitioners and scientists. Thefirstpriority is to expand the knowledge base on practitioner-scientist partnerships, particularly on factors associated with positive outcomes within communities. To further articulate this priority, the paper first discusses the rapid growth in community-based partnerships and the emergent research on them. Next described is an illustrative research project on a partnership model that links state university extension and public school delivery systems. The article then turns to thesecond, related priority of future capacity-building for diffusion of effective partnership-based interventions to achieve larger-scale health and well-being across communities. It outlines two salient tasks: clarification of a conceptual framework and the formulation of a comprehensive capacity-building strategy for diffusion. The comprehensive strategy would require careful attention to the expansion of networks of effective partnerships, partnership-based research agendas, and requisite policy-making. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to examine the diffusion effects of a youth‐led sexual violence prevention program (i.e., Youth Voices in Prevention [Youth VIP]). Specifically, social network analysis was used to measure the extent to which Youth VIP changed behaviors for 1172 middle and high school youth who did not attend program events but were friends with Youth VIP participants and completed the first and final survey (approximately 2 years apart). Findings suggest that there was considerable interpersonal communication about Youth VIP among the students generated by program participation. Specifically, youth with friends who participated in Youth VIP were more likely to report hearing their friends talk about Youth VIP and reported talking to their friends about Youth VIP compared with those not connected to Youth VIP participants. However, there were no diffusion effects found for behavioral outcomes (i.e., bystander intervention behavior, violence victimization, and perpetration). Given the mixed findings, further research is needed to determine the extent to which youth‐led sexual violence prevention initiatives lead to changes in broader community‐wide changes in youths' behaviors. Highlights: Sexual violence is a public health crisis in the United States among youth.Youth‐led sexual violence prevention programs have promise in preventing sexual violence.Youth who were part of a sexual violence initiative talked to their friends about the initiative.Friends of friends in the program did not demonstrate changes in their own attitudes and behaviors. [ABSTRACT FROM AUTHOR]

This special section addresses a gap area of resilience and LGBT well-being. Although comprehensive global diversity regarding LGBT resilience was challenging to find, the special section includes representation from outside the US (Israel and Hong Kong), ethnic/racially diverse domestic populations, immigration, and one population for which LGBT identities might be considered marginalized-Christians in the US. The full range of LGBT identities are represented in the issue along with persons identifying as queer or questioning, although transgendered people were less well represented than lesbian, gay or bisexual identities. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to examine the impact of exposure to Bringing in the Bystander—High School Curriculum (BITB‐HSC) on school personnel, which included a seven session classroom curriculum for ninth through twelfth graders (student curriculum), a bystander training workshop for school personnel (school personnel workshop), and reading materials (handout). We examined how exposure to these various BITB‐HSC intervention components was associated with school personnel's knowledge and bystander efficacy, intentions, and barriers specific to student relationship abuse (RA) and sexual assault (SA). Participants were 488 school personnel from 12 high schools in upper New England who completed the 4‐month follow‐up survey that assessed for intervention exposure (284 participants completed both the baseline and follow‐up survey). Whereas 53% of participants were exposed to no intervention components, the other half of the sample were exposed to a combination of intervention components. Higher baseline knowledge and reactive bystander intentions were associated with subsequent exposure to both the student curriculum and the handout, and fewer barriers to bystander action predicted exposure to the school personnel workshop. Exposure to the school personnel workshop, student curriculum, and handout was associated with subsequent greater knowledge, exposure to the student curriculum predicted reactive bystander intentions, and exposure to the handout predicted higher reactive bystander intentions and bystander efficacy. Findings suggest that despite challenges with engagement, exposure to the BITB‐HSC components may be a useful tool in improving school personnel's responses to RA and SA among high school students. Highlights: We examined the impact of a violence prevention program on school personnel outcomes.53% of participants were exposed to no intervention components.Exposure to intervention components led to increases in knowledge.Exposure to the student curriculum predicted reactive bystander intentions, and exposure to the handout predicted higher reactive bystander intentions and bystander efficacy.Despite challenges with engagement, exposure to the BITB‐HSC components may be a useful tool in improving school personnel's responses to RA and SA among high school students. [ABSTRACT FROM AUTHOR]

Highlights: We review research on interventions for pediatric medical trauma using a developmental framework.Most interventions integrated caregivers and cognitive behavioral therapy (CBT), consistent with best practices. Interventions with the most promising findings were online, self‐guided, or time‐limited.Many interventions lacked developmental specificity, despite the importance of this framework. Pediatric medical traumatic stress (PMTS) is common among injured/ill children and is associated with elevated distress, treatment non‐adherence, and poor health outcomes. As survivorship of life‐threatening pediatric injury and illness continues to increase alongside rapid medical advancements, rates of PMTS and negative sequelae are expected to grow; however, research on prevention and treatment of PMTS is limited. The current study sought to systematically review the literature using a developmental framework to highlight research gaps. Sixteen peer‐reviewed studies were identified via a systematic literature search. Consistent with best practices for treatment of childhood trauma, caregiver involvement and CBT principles served as the foundation for most interventions. All studies reported improvements in PMTS; however, among the most methodologically rigorous, few found statistically superior reductions in PMTS between intervention and control groups. While many studies focused on a specific developmental stage and discussed developmental considerations, others took a "one‐size‐fits" approach. Interventions that demonstrated the most promising findings were online, self‐guided, or time‐limited. Future research would benefit from expanding diversity of participants, continuing to evaluate novel delivery methods, and integrating developmental considerations along with trauma‐informed care (TIC) approaches, given their useful framework for understanding child traumatic stress responses and avenues for prevention and treatment. [ABSTRACT FROM AUTHOR]

Highlights: This study focused on implementation processes, and facilitators and barriers to ACEs screenings.There was high feasibility and acceptability of ACEs screenings at infants' pediatric visits.Almost half of families at well‐child pediatric visits indicated positive for ACEs.A majority of families with ACEs accepted prevention services in the pediatric setting.Wellness navigators provided a cultural bridge and service access in integrated behavioral health. Adverse childhood experiences (ACEs) have demonstrable negative effects on long‐term physical and mental health. Low‐income and ethnic minority communities face significant disparities in exposure to ACEs. Pediatric settings offer an opportune context to identify and address ACEs, with the potential to reduce barriers in access to resources and services. The current study examined the feasibility and acceptability of screening infants and their parents for ACEs at a community medical clinic. Feasibility data indicated that 151 (92%) of the 164 unique patients that presented for well‐child visits for infants (4‐ to 12‐months) across a 13‐month period were screened for infant and parent ACEs. Of these 151 patients, 47% met eligibility (infants with 1 + ACEs, parents with 2 + ACEs) deemed intermediate risk and indicated referral to prevention services. The majority of referred families (77%) accepted prevention services, including appointments with bilingual and bicultural wellness navigators who provided a cultural bridge and access to resources that could address patients' social determinants of health. Qualitative interviews with providers expand upon screening acceptability. Implications for integrated behavioral health, ACEs screening, and trauma‐responsive prevention in a pediatric setting are discussed. [ABSTRACT FROM AUTHOR]

The Place of Strength (PoS) project represents an effort to Indigenize program evaluation with Indigenous communities by melding art with prevention science. We propose that Native artists as evaluators: (a) opens avenues of communication for Indigenous perspectives; (b) provides opportunities to capture spiritual, relational, and emotional impacts of prevention programming; and (c) maintains Indigenous processes, language, and values at the center of knowledge production. The New Mexico Tribal Prevention Project (NMTPP) funded seven Southwestern tribes to develop substance abuse prevention programs. In response to their expressed negative experiences with evaluation of prevention strategies, NMTPP piloted PoS. PoS shifted systematic knowledge paradigms to Tribal thought, values, and perspectives embodied in art. Art exists in Native communities as a way of documenting lifeways and historical experiences through various cultural forms. We share the process of collaborating with Native artists to document the impact of substance abuse prevention initiatives through their art within a community context. We offer concepts derived from this project as a community psychology model for re‐conceptualizing evaluation utilizing Indigenous knowledge. Highlights: The Place of Strength project Indigenizes program evaluation with Native artists as evaluators.Art is an example of Indigenous knowledge production that can be applied to program evaluation.We share about a collaboration with Native artists to document substance abuse prevention efforts.Native artist‐evaluators enhanced community engagement, program fidelity, and program outcomes.Evaluation using Indigenous knowledge kept the process, outcomes and impact within the community. [ABSTRACT FROM AUTHOR]

Rigorous research and program evaluation are needed to understand the experience of dating and sexual violence among youth and the impact of prevention and intervention efforts. Our dilemma in doing this work occurred when youth disclosed dating and sexual violence on a research survey. What responsibility do researchers have to protect survivors' confidentiality as a research participant versus taking steps to ensure the student has the opportunity to access help? In our evaluation of a pilot dating violence prevention program, our protocols employed widely used procedures for providing resources to participants upon their completion of the survey and de-identifying survey data. Upon reviewing preliminary survey results, we became concerned that these established procedures were not sufficient to support research participants who were adolescent survivors of dating and sexual violence. We followed a structured ethical decision-making process to examine legal and ethical considerations, consult with colleagues, consider impacts and alternative solutions, and ultimately find a solution. Through this process, we developed procedures that balance participant confidentiality and the desire to support the welfare of survivors, which other researchers may want to employ when conducting youth sexual and dating violence research in school and community settings. [ABSTRACT FROM AUTHOR]

The TRACK- II program is a multi-site, community-based randomized controlled trial evaluating an intervention to assist mothers living with HIV ( MLH) in disclosing their HIV status to their young children. Many participants-both mothers and children-reported significant depression and/or suicidal ideation, a phenomenon that presented ethical challenges. This article focuses on participants at one site (Atlanta). Through the vignette of 'Jordan,' we describe ethical challenges that may arise when faced with the responsibility of maximizing participants' safety while maintaining the boundaries of the researcher role. Guided by community psychology values, our team has taken measures within our role as researchers to empower and protect children and mothers endorsing suicidal ideation. For example, we have relied on relationships with community-based organizations and AIDS service organizations to connect HIV-affected families to mental health services. Furthermore, we have expanded our system of documentation to follow-up adequately with families at risk, and we track family resources to promote a strengths-based framework. We have solicited families' feedback about their supports and needs to understand how we may best serve them by connecting them to the resources they report needing most and empowering them to care for themselves. [ABSTRACT FROM AUTHOR]

The program Edúcame Primero (Educate Me First) is an evidence-based practice for eradicating child labor that has been applied with positive results in Colombia, Peru, and several Central American countries. In this article, we describe the difficulties of implementing the program in two poor areas of Lima (Peru) between 2014 and 2016. Specifically, we discuss three ethical challenges faced during the implementation of the program: (a) the existence of a movement of working children that defends the right of children to work; (b) the polarization of some community-based associations and government institutions on how to deal with the problems of working children; and (c) the use of network indicators in the evaluation of the community's level of cohesion. Taking the Code of Ethics of the General Council of Associations of Psychologists in Spain as a guide, we adopted a consensus approach in planning and research design, combining different criteria of value with the participation of different stakeholders. The implementation of the program in Peru gave preference to developing skills in children over changing attitudes in relation to child protection, although the intervention openly declared its aims when engaging institutions and families. Finally, we address how social network research places special ethical demands on conventional ethical standards. Our experience with this project shows the importance of acting as a bridge between different stakeholders and assessing how all of them benefit from the intervention. [ABSTRACT FROM AUTHOR]

Reduction of cancer-related disparities requires strategies that link medically underserved communities to preventive care. In this community-based participatory research project, a public library system brought together stakeholders to plan and undertake programs to address cancer screening and risk behavior. This study was implemented over 48 months in 20 large urban neighborhoods, selected to reach diverse communities disconnected from care. In each neighborhood, Cancer Action Councils were organized to conduct a comprehensive dynamic trial, an iterative process of program planning, implementation and evaluation. This process was phased into neighborhoods in random, stepped-wedge sequence. Population-level outcomes included self-reported screening adherence and smoking cessation, based on street intercept interviews. Event-history regressions ( n = 9374) demonstrated that adherence outcomes were associated with program implementation, as were mediators such as awareness of screening programs and cancer information seeking. Findings varied by ethnicity, and were strongest among respondents born outside the U.S. or least engaged in care. This intervention impacted health behavior in diverse, underserved and vulnerable neighborhoods. It has been sustained as a routine library system program for several years after conclusion of grant support. In sum, participatory research with the public library system offers a flexible, scalable approach to reduce cancer health disparities. [ABSTRACT FROM AUTHOR]

Sexual assault is a pervasive problem in the U.S. military, especially against women. Bystander intervention is increasingly promoted as important for reducing sexual violence, and it may be particularly helpful in contexts with high rates of sexual violence. Bystander training encourages and enables people to intervene safely and stop sexual violence. In this study, we drew from an ecological model to investigate intrapersonal, microsystem, and exosystem factors that predicted Service members' assumption of personal responsibility to intervene in an alcohol-involved sexual assault. Moreover, we examined how these predictors played a role in decisions about how to intervene: confronting the perpetrator, assisting the victim, or finding someone to help. We analyzed data from 24,610 active duty personnel collected by the Department of Defense. Several factors significantly related to Service members' bystander intentions: gender, rank, morale, attitudes about sexual assault, training, and trust in the military sexual assault system predicted the likelihood and method of bystander intervention. These findings help identify how and why people intervene (or fail to intervene) when they witness situations that could develop into sexual violence. [ABSTRACT FROM AUTHOR]

The Strategic Prevention Framework ( SPF) is a conceptual model that supports coalition-driven efforts to address underage drinking and related consequences. Although the SPF has been promoted by the U.S. Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention and implemented in multiple U.S. states and territories, there is limited research on the SPF's effectiveness on improving targeted outcomes and associated influencing factors. The present quasi-experimental study examines the effects of SPF implementation on binge drinking and enforcement of existing underage drinking laws as an influencing factor. The intervention group encompassed 11 school districts that were implementing the SPF with local prevention coalitions across eight Kansas communities. The comparison group consisted of 14 school districts that were matched based on demographic variables. The intervention districts collectively facilitated 137 community-level changes, including new or modified programs, policies, and practices. SPF implementation supported significant improvements in binge drinking and enforcement outcomes over time ( p < .001), although there were no significant differences in improvements between the intervention and matched comparison groups ( p > .05). Overall, the findings provide a basis for guiding future research and community-based prevention practice in implementing and evaluating the SPF. [ABSTRACT FROM AUTHOR]

This study tested sustained effects of the Communities That Care (CTC) prevention system on health-risking behaviors 9 years after baseline in a community-randomized trial involving 24 towns in seven states. Earlier analyses found sustained effects on abstinence from drug use and delinquency through Grade 12 in a panel of fifth graders. At age 19, 91 % (n = 3986) of the living panel completed the survey. Data were analyzed using generalized linear mixed models. The prevalence of lifetime and current substance use and delinquency were the primary outcomes. Secondary outcomes included substance use disorders, major depression, suicidality, educational attainment, and sexual risk behaviors. CTC had a significant overall effect across lifetime measures of the primary outcomes for males, but not for females or the full sample, although lifetime abstinence from delinquency in the full sample was significantly higher in CTC communities (ARR = 1.16). Males in CTC communities also continued to show greater lifetime abstinence from cigarette smoking (ARR = 1.22). CTC did not have a sustained effect on current substance use and delinquency nor did it improve the secondary outcomes at age 19 for either gender. Communities using CTC may need to extend their prevention planning to include the high school years to sustain effects on drug use and delinquency beyond high school for both genders. Trial Registration: ClinicalTrials.gov identifier: NCT01088542. [ABSTRACT FROM AUTHOR]

Selective prevention programs hold the promise of alleviating child anxiety symptoms, decreasing the risk for emotional problems across the lifespan. Such programs have particular public health import for young children of poor, underserved communities. Identifying factors related to parent engagement, and methods to improve engagement, are paramount in the effort to develop anxiety-focused, community prevention programs. This feasibility study investigated the effect of an enhanced recruitment strategy to maximize parent engagement, as well as factors related to attendance in a single session focused on anxiety prevention. Participants were poor, ethnic minority parents of children aged 11-71 months (n = 256) who completed a survey that assessed anxiety risk according to trauma exposure, child anxiety, or parent anxiety, as well as preferences for preventive services (phase 1). Those meeting risk criteria (n = 101) were invited to a preventive group session (phase 2). Half of parents received enhanced recruitment (ER), which included personalized outreach, matching parent preferences, and community endorsement. Other parents were invited by mail. Chi square analyses indicated that ER was associated with planning to attend (49 vs. 6 % of control). Parents receiving ER were 3.5 times more likely to attend. Higher sociodemographic risk was correlated with higher child anxiety symptoms but not attendance. Results highlight the need for improved strategies for engaging parents in preventive, community-based interventions. [ABSTRACT FROM AUTHOR]

This article describes the use of interactive theater, audience response assessment, and peer educators to create community-generated approaches for bystander interventions (i.e., actions taken by people who become aware of controlling, abusive and violent behavior of others) to prevent intimate partner violence (IPV) and to foster change in community norms. We include a case example of an ongoing university-community partnership, which mobilizes community members to develop and implement socioculturally relevant IPV prevention programs in multiple Asian communities. We used interactive theater at a community event-a walk to raise awareness about IPV in South Asian communities-and examined how the enacted bystander interventions reflect specific community contexts. We detail the challenges and limitations we have encountered in our attempts to implement this approach in collaboration with our community partners. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The current study employs a grounded theory approach to examine West African immigrants' resolution of parent-child conflict and intimate partner conflict. Data from 59 participants present an interactive social ecological framework, where a lack of resolution at one level results in attempts to resolve problems at higher levels. Four levels are identified within West African immigrants' problem solving ecology, each with specific actors in positions of authority: individual/dyadic (parents and spouses), extended family (which includes distant relatives and relatives living in home countries), community leadership (non-family elders and religious leaders), and state authorities. From participants' descriptions of family challenges emerged a picture of a social ecology in flux, with traditional, socially conservative modes of resolving family conflict transposed across migration into the more liberal and state-oriented familial context of the United States. This transposition results in a loss spiral for the traditional social ecology, differentially affecting individual actors within families. Implications for helping professionals working with new immigrant communities include identifying variability in openness to adapting structures that are not working well (e.g., patriarchal protection of abusive husbands) and supporting structures known to be associated with well being (e.g., collective monitoring of youth). [ABSTRACT FROM AUTHOR]

This study examined implications of the economic downturn that began in December 2007 for the Community Youth Development Study (CYDS), a longitudinal randomized controlled trial of the Communities That Care (CTC) prevention system. The downturn had the potential to affect the internal validity of the CYDS research design and implementation of science-based prevention in study communities. We used archival economic indicators and community key leader reports of economic conditions to assess the extent of the economic downturn in CYDS communities and potential internal validity threats. We also examined whether stronger economic downturn effects were associated with a decline in science-based prevention implementation. Economic indicators suggested the downturn affected CYDS communities to different degrees. We found no evidence of systematic differences in downturn effects in CTC compared to control communities that would threaten internal validity of the randomized trial. The Community Economic Problems scale was a reliable measure of community economic conditions, and it showed criterion validity in relation to several objective economic indicators. CTC coalitions continued to implement science-based prevention to a significantly greater degree than control coalitions 2 years after the downturn began. However, CTC implementation levels declined to some extent as unemployment, the percentage of students qualifying for free lunch, and community economic problems worsened. Control coalition implementation levels were not related to economic conditions before or after the downturn, but mean implementation levels of science-based prevention were also relatively low in both periods. [ABSTRACT FROM AUTHOR]

Coalitions are the most common platform for implementing community-level environmental strategies (ES), such as media, policy, or enforcement for substance use prevention. The current study examines the associations between two types of coalition capacity (general and innovation-specific) and ES implementation efforts and outputs within 14 intervention communities over a three-year period. Efforts refer to the amount of energy exerted to implement an ES while outputs refer to the materials produced through these efforts. Quantitative measures of capacity were provided by coalition key informants and expert-raters. Additionally, Training and Technical Assistance (TTA) provided proactively to improve the implementation of ES was also examined. Greater general capacity, as rated by a coalition informant, was associated with more ES policy effort. Both expert-rated general and innovation-specific capacity, however, were associated with greater ES outputs. Study results also found that community coalitions that endorsed weaker mobilization, structure and task leadership, (measures of general capacity), utilized more TTA compared to those who perceived their coalition as having greater capacity. Moreover, communities that utilized more TTA resources reported a greater number of successful policy changes. The study supports the need to consider both general and innovation-specific capacity for ES implementation and offers promising preliminary findings regarding the role of TTA for improving coalitions' capacity to facilitate policy change. [ABSTRACT FROM AUTHOR]

Although numerous evidence-based programs (EBPs) have been proven effective in research trials and are being widely promoted through federal, state, and philanthropic dollars, few have been 'scaled up' in a manner likely to have a measurable impact on today's critical social problems. The Interactive Systems Framework for Dissemination and Implementation (ISF) explicates three systems that are critical in addressing the barriers that prevent these programs from having their intended public health impact. In this article we describe the relevance of these systems in a real-world context with a specific focus on the Prevention Support System (PSS). We expand on the ISF model by presenting funders and policy-makers as active and engaged stakeholders, and demonstrate how a state-level PSS has used empirical evidence to inform general and program-specific capacity-building and support interactions among researchers, funders, and practitioners in Pennsylvania. By embracing this expanded ISF framework as a conceptual model for the wide-scale dissemination and support of EBPs, and recognizing the need for a distinct state-level PSS, Pennsylvania has created an infrastructure to effectively address the primary barriers to moving from lists of EBPs to achieving population-level public health improvement. [ABSTRACT FROM AUTHOR]

Community practitioners can face difficulty in achieving outcomes demonstrated by prevention science. Building a community practitioner's prevention capacity-the knowledge and skills needed to conduct critical prevention practices-could improve the quality of prevention and its outcomes. The purpose of this article is to: (1) describe how an intervention called Assets-Getting To Outcomes (AGTO) was used to establish the key functions of the ISF and present early lessons learned from that intervention's first 6 months and (2) examine whether there is an empirical relationship between practitioner capacity at the individual level and the performance of prevention at the program level-a relationship predicted by the ISF but untested. The article describes an operationalization of the ISF in the context of a five-year randomized controlled efficacy trial that combines two complementary models designed to build capacity: Getting To Outcomes (GTO) and Developmental Assets. The trial compares programs and individual practitioners from six community-based coalitions using AGTO with programs and practitioners from six similar coalitions that are not. In this article, we primarily focus on what the ISF calls innovation specific capacity and discuss how the combined AGTO innovation structures and uses feedback about its capacity-building activities, which can serve as a model for implementing the ISF. Focus group discussions used to gather lessons learned from the first 6 months of the AGTO intervention suggest that while the ISF may have been conceptualized as three distinct systems, in practice they are less distinct. Findings from the baseline wave of data collection of individual capacity and program performance suggest that practitioner capacity predicts, in part, performance of prevention programs. Empirically linking practitioner capacity and performance of prevention provides empirical support for both the ISF and AGTO. [ABSTRACT FROM AUTHOR]

Analyses of program engagement can provide critical insight into how program involvement leads to outcomes. This study examines the relation between participant engagement and program outcomes in Family Foundations (FF), a universal preventive intervention designed to help couples manage the transition to parenthood by improving coparenting relationship quality. Previous intent-to-treat outcome analyses from a randomized trial indicate FF improves parental adjustment, interparental relationships, and parenting. Analyses for the current study use the same sample, and yield statistically reliable relations between participant engagement and interparental relationships but not parental adjustment or parenting. Discussion considers implications for FF and the difficulties researchers face when examining the relation between engagement and outcomes in preventive interventions. [ABSTRACT FROM AUTHOR]

Over the prior decade, structural change efforts have become an important component of community-based HIV prevention initiatives. However, these efforts may not succeed when structural change initiatives encounter political resistance or invoke conflicting values, which may be likely when changes are intended to benefit a stigmatized population. The current study sought to examine the impact of target population stigma on the ability of 13 community coalitions to achieve structural change objectives. Results indicated that coalitions working on behalf of highly stigmatized populations had to abandon objectives more often than did coalitions working for less stigmatized populations because of external opposition to coalition objectives and resultant internal conflict over goals. Those coalitions that were most successful in meeting external challenges used opposition and conflict as transformative occasions by targeting conflicts directly and attempting to neutralize oppositional groups or turn them into strategic allies; less successful coalitions working on behalf of stigmatized groups struggled to determine an appropriate response to opposition. The role of conflict transformation as a success strategy for working on behalf of stigmatized groups is discussed. [ABSTRACT FROM AUTHOR]

This study examined the long-term effects of the Better Beginnings, Better Futures project, a community-based early childhood development program, on 18-19 year-old youths' narratives about turning points in their lives. The sample consisted of youth who participated in Better Beginnings from ages 4-8 ( n = 62) and youth from a comparison community who did not participate in Better Beginnings ( n = 34). Controlling for covariates, significant differences favoring youth from the Better Beginnings sites were found on several dimensions of the turning point stories: ending resolution, personal growth, meaning-making, coherence, and affect transformation. Effect sizes ranged from .45 to .76 for these outcome dimensions, indicating moderate to large effects. Also, turning point story dimensions were found to be significantly correlated with two standardized measures of well-being: youths' self-esteem and community involvement. Youths' self-esteem was directly related to story ending resolution, personal growth, and meaning making, and youths' community involvement was directly related to story specificity, meaning making, and coherence. Family functioning was also examined in relation to these narrative dimensions but was not found to be significantly related to them. The findings suggest the utility of a narrative approach for the evaluation of the long-term outcomes of early childhood development programs. [ABSTRACT FROM AUTHOR]