Prevention, Intervention, and Social Policy H607: Ethnicity, Context, and Family Dynamics

The Plan Levels of prevention/intervention Prevention research cycle With 2 examples Issues to consider in prevention research

Prevention & Intervention What is prevention/intervention? Public Health & Community Psychology Prevention: avoiding all or part of an etiological chain before it arises Intervention: stopping, slowing, or reversing a process that is already underway What is prevention/intervention research? Identifying links in the causal chain (etiology and process) Developing a small theory or theory of change Intervention vs. Treatment

Levels of Intervention Categories of Prevention Tertiary/ Indicated Secondary/Selected Primary/Universal

Prevention Research Cycle Cost/Benefits Analysis Generative Research: Small Theory Dissemination To Public Design Program to change mediators Field Prevention Trial Controlled Prevention Trial

Generative Research Base rates, prevalence, and incidence Sources of the developmental outcome Characteristics of Individual/family Characteristics of the environment Particular combinations of individual and environment Etiologies Moderator or risk factors Mediating processes Develop a “Small Theory” or “Theory of Change”

Develop a “Small Theory:” Advantages A limited number of important and modifiable processes Forces the investigator to specify central processes that underlie the developmental outcome Guides program design and evaluation Offers guidelines for the design of the intervention Guides the design of the efficacy trials With efficacy research, offers guidance for program redesign Empirical tests of the Small Theory adds to our understanding of basic developmental processes

2 Examples: New Beginnings (NB) & Early Alliance (EA) Select an Outcome NB: Conduct Problems, Depression, & other mental health problems EA: Substance Abuse, Conduct Problems, & School Failure

Develop a “Small Theory:” Generative Research New Beginnings: Divorce is a risk factor—results in a secondary intervention. WHY? Why divorce? Disruption of Family Process Divorce Stress Mental Health Problems

Develop a “Small Theory” Early Alliance: 2 Levels Level 1: All children are at some risk results in a ________ intervention. WHY? Teacher- Student Interactions School Failure Conduct Problems Substance Abuse Disconnected from school Negative school experience Small Theory

Develop a “Small Theory” Early Alliance: 2 Levels Level 2: Some are aggressive and oppositional already resulting in a _________ intervention. WHY? Parenting Difficulties Poor Coping Strategies Outcomes Peer Difficulties Small Theory

Both Programs target conduct problems: Different Small Theories Different Interventions

Prevention Research Cycle Cost/Benefits Analysis Generative Research: Small Theory Dissemination To Public Design Program to change mediators Field Prevention Trial Controlled Prevention Trial

The Programs: New Beginnings “Selected/Secondary” Program, 12 Weekly Sessions on topics Topics: Quality of Mother-Child Relationship Disciplinary strategies Negative Divorce Related Events Contact with Noncustodial Father Contact with Nonparental Adults

The Programs: Early Alliance Target students: All 1st & 2nd graders (universal/primary) Those who are aggressive/oppositional (indicated/tertiary) Universal/Primary (SEE TABLE 1) Classroom component Reading—mentoring Indicated/Tertiary Peer Intervention Family Intervention

Prevention Research Cycle Cost/Benefits Analysis Generative Research: Small Theory Dissemination To Public Design Program to change mediators Field Prevention Trial Controlled Prevention Trial

Controlled Trial Why a controlled trial? Under the absolute best circumstances does the intervention…. Change mediators Change outcomes Are these changes correlated

Prevention Research Cycle Cost/Benefits Analysis Generative Research: Small Theory Dissemination To Public Design Program to change mediators Field Prevention Trial Controlled Prevention Trial

Evaluation!! New Beginnings: Early Alliance 6 years post divorce, compared to control group Change in outcomes Few conduct problems & depressive symptoms Change in mediators Better communication between parents, better parenting practices, less conflict around visits Early Alliance 3 years post program, compared to control group Changes in outcomes Lower in aggression , higher academic performance Changes in mediators Higher in coping competence Higher engagement in school

Issues to Consider Iatrogenic Effects Attrition and Dosage Unintended Modifications

Coming up Next Views on intervention targets and strategies Program/Policy team project