Blurring the boundaries between synthesis and evaluation. A customized realist evaluative synthesis into adolescent risk behavior prevention

Realist methodologies have been increasingly advocated for the investigation of complex social issues. Public health programs, such as those designed to prevent adolescent risk behavior, are typically considered complex. In conducting a realist review of the empirical literature relating to such programs, we encountered several challenges, including (a) an overabundance of empirical evidence, (b) a problematic level of heterogeneity within and between methodological approaches, (c) discrepancies between theoretical underpinnings and program operationalization, (d) homogeneity of program outcomes, with very little variation in program effectiveness, and (d) a paucity of description relating to content and process. To overcome these challenges, we developed a customized approach to realist evidence synthesis, drawing on the VICTORE (Volition, Implementation, Contexts, Time, Outcomes, Rivalry, and Emergence) complexity checklist and incorporating stakeholder engagement as primary data to achieve greater depth of understanding relating to contextual and mechanistic factors, and the complex interactions between them. Here we discuss the benefits of this adapted methodology alongside an overview of the research through which the methodology was developed. A key finding from this research was that combining the complexity checklist with primary data from stakeholder engagement enabled us to systematically interrogate the data across data sources, uncovering and evidencing mechanisms which may otherwise have remained hidden, giving greater ontological depth to our research findings. This paper builds on key methodological developments in realist research, demonstrating how realist methodologies can be customized to overcome challenges in developing and refining program theory from the literature, and contributes to the broader literature of innovative approaches to realist research

Intervention strategies for children and adolescent with disorders: from intrapsychic to transactional perspective

A large amount of studies and clinical evidence document the importance of infancy and early childhood influences on long term developmental trajectories toward mental health or psychopathology (Sameroff, 2000, 2010). Without healthy, productive adults no culture could continue to be successful. This concern is the main motivation for society to support child development research. Although the academic interests of contemporary developmental researchers range widely in cognitive and socialemotional domains, the political justification for supporting such studies is that they will lead to the understanding and ultimate prevention of behavioural problems that are costly to society. With these motivations and support, there have been major advances in our understanding of the intellectual, emotional, and social behaviour of children, adolescents and adults. This progress has forced conceptual reorientations from a unidirectionalunderstanding of development (e.g., parents affect children and not vice versa) toward a bidirectional conceptualization of development. Childrenare now assumed to affect and even select their environments as much as their environments affect their behaviour. Indeed, key among many of the most influential developmental theories in the past several decades is the assumption that children have bidirectional, or reciprocal, relationships with their environments (Bandura, 1977; Bronfenbrenner, 1979). To date, it is widely accepted that children’s healthy development is shaped by complex transactional processes among a variety of risk and protective factors, with cumulative risk factors increasing the prediction of emotional and behavioural problems (Anda et al., 2007; Rutter & Sroufe, 2000; Sameroff, 2000). Risk and protective factors include individual child characteristics such as genetic and constitutional propensities and cognitive strengths and vulnerabilities; parent characteristics such as mental health, education level, sense of efficacy, and resourcefulness; family factors such as quality of the parent-child relationship, emotional climate, and marital quality; community connectedness factors such as parental social support, social resources, and children’s peer relationships; and neighbourhood factors such as availability of resources, adequacy of housing, and levels of crime and violence (Sameroff & Fiese, 2000). The predictive value of these factors across many studies led to the development of transactional-bioecological models that attempt to conceptualize the relative contributions of proximal and distal risk and protective factors to children’s developmental outcome (Bronfenbrenner & Morris, 2006). In 1975, Sameroff and Chandler proposed the transactional model. This theoretical framework has become central to understanding the interplay between nature and nurture in explaining the development of positive and negative outcomes for children. The transactional model is a model of qualitative change. Sameroff asserted that the transactional model concerned qualitative rather than incremental change and that the underlying process was dialectical rather mechanistic in nature. The aim of this chapter is to explore this theoretical framework and its intervention strategies. In the first part, the transactional model will be described after a brief summary that will illustrate the transition from intrapsychic to transactional perspective. In the second part, intervention strategies for children and adolescent will be described. The attention of research on environmental risk and protective factors has fostered a more comprehensive understanding of what is necessary to improve the cognitive and social-emotional welfare of children and adolescents

Timing of poverty in childhood and adolescent health: Evidence from the US and UK

Childhood poverty is associated with poorer adolescent health and health behaviours, but the importance of the timing of poverty remains unclear. There may be critical or sensitive periods in early life or early adolescence, or poverty may have cumulative effects throughout childhood. Understanding when poverty is most important can support efficient timing of interventions to raise family income or buffer against the effects of low income, but answers may vary across social contexts. The US and the UK are a useful comparison with similar liberal approaches to cash transfers, but very different approaches to healthcare provision. Utilising data from large population studies in the US (n = 9408; born 1979–1996) and UK (n = 1204; born 1991–1997), this study employs a structured life course approach to compare competing hypotheses about the importance of the timing or pattern of childhood exposure to poverty in predicting adolescent health limitations, symptoms of psychiatric distress, and smoking at age 16 (age 15/16 in US). Household income histories identified experience of poverty (measured as <60% of the national median equivalised income for a given year) in early life (ages 0–5), mid-childhood (ages 6–10) and early adolescence (ages 11–15). The Bayesian Information Criterion (BIC) compared fit across models with variables representing different life course patterns of exposure to poverty. Adolescent distress was not associated with poverty in either country. In both countries, however, variables representing cumulative or persistent experiences of poverty exhibited optimal fit of all poverty exposure variables in predicting adolescent smoking and health limitations. There was also evidence of an early life sensitive period for smoking in the US. Poverty was more persistent in the US, but associations between poverty and outcomes were consistent across countries. Although poverty can have cumulative effects on health and behaviour, early interventions may offer the best long-term protection

Investing in Well-being: An Analytical Framework

The NZ Treasury is currently engaged in a project to identify cost-effective interventions to improve outcomes for children and young adults in order to maximise the value of government expenditures across the social sector. The central aim of this paper is to provide an empirically-robust framework to compare intervention across a range of social sectors. There are two key components to the framework. The first is a life-course view of child development that emphasises that experiences and influences in childhood can affect well-being throughout life. The second component involves viewing social expenditures as investments addressed at achieving particular outcomes, typically directed at enhancing well-being. The paper presents evidence from a review of the literature on how the process and experiences of childhood have a later impact on wellbeing; how child development and outcomes are influenced by individual, family and communal factors and how risk and resilience can be used to indicate that an individual is at increased or decreased risk of negative outcomes. Case studies of youth suicide, teenage pregnancy, educational underachievement and youth inactivity provide evidence about what interventions work using key empirical findings from the literature.Well-being; social investment; life-course; child development; child and adult outcomes; portfolio; intervention

Informative experimentation in intuitive science: Children select and learn from their own causal interventions.

We investigated whether children preferentially select informative actions and make accurate inferences from the outcome of their own interventions in a causal learning task. Four- to six-year-olds were presented with a novel system composed of gears that could operate according to two possible causal structures (single or multiple cause). Given the choice between interventions (i.e., removing one of the two gears to observe the remaining gear in isolation), children demonstrated a clear preference for the action that revealed the true causal structure, and made subsequent causal judgments that were consistent with the outcome observed. Experiment 2 addressed the possibility that performance was driven by children's tendency to select an intervention that would produce a desirable effect (i.e., spinning gears), rather than to disambiguate the causal structure. These results replicate our initial findings in a context in which the informative action was less likely to produce a positive outcome than the uninformative one. Experiment 3 serves as a control demonstrating that children's success in the previous experiments is not due to their use of low-level strategies. We discuss these findings in terms of their significance for understanding the development of scientific reasoning and the role of self-directed actions in early causal learning