Mixed-method study of a conceptual model of evidence-based intervention sustainment across multiple public-sector service settings.

BackgroundThis study examines sustainment of an EBI implemented in 11 United States service systems across two states, and delivered in 87 counties. The aims are to 1) determine the impact of state and county policies and contracting on EBI provision and sustainment; 2) investigate the role of public, private, and academic relationships and collaboration in long-term EBI sustainment; 3) assess organizational and provider factors that affect EBI reach/penetration, fidelity, and organizational sustainment climate; and 4) integrate findings through a collaborative process involving the investigative team, consultants, and system and community-based organization (CBO) stakeholders in order to further develop and refine a conceptual model of sustainment to guide future research and provide a resource for service systems to prepare for sustainment as the ultimate goal of the implementation process.MethodsA mixed-method prospective and retrospective design will be used. Semi-structured individual and group interviews will be used to collect information regarding influences on EBI sustainment including policies, attitudes, and practices; organizational factors and external policies affecting model implementation; involvement of or collaboration with other stakeholders; and outer- and inner-contextual supports that facilitate ongoing EBI sustainment. Document review (e.g., legislation, executive orders, regulations, monitoring data, annual reports, agendas and meeting minutes) will be used to examine the roles of state, county, and local policies in EBI sustainment. Quantitative measures will be collected via administrative data and web surveys to assess EBI reach/penetration, staff turnover, EBI model fidelity, organizational culture and climate, work attitudes, implementation leadership, sustainment climate, attitudes toward EBIs, program sustainment, and level of institutionalization. Hierarchical linear modeling will be used for quantitative analyses. Qualitative analyses will be tailored to each of the qualitative methods (e.g., document review, interviews). Qualitative and quantitative approaches will be integrated through an inclusive process that values stakeholder perspectives.DiscussionThe study of sustainment is critical to capitalizing on and benefiting from the time and fiscal investments in EBI implementation. Sustainment is also critical to realizing broad public health impact of EBI implementation. The present study takes a comprehensive mixed-method approach to understanding sustainment and refining a conceptual model of sustainment

Dynamic Adaptation Process to Implement an Evidence-based Child Maltreatment Intervention

Background: Adaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The degree to which core elements of an EBP can be maintained while allowing for local adaptation is unclear. In addition, adaptations may also be needed at the system, policy, or organizational levels to facilitate EBP implementation and sustainment. This paper describes a study of the feasibility and acceptability of an implementation approach, the Dynamic Adaptation Process (DAP), designed to allow for EBP adaptation and system and organizational adaptations in a planned and considered, rather than ad hoc, way. The DAP involves identifying core elements and adaptable characteristics of an EBP, then supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. In addition, this study addresses a secondary concern, that of improving EBP model fidelity assessment and feedback in real-world settings. Methods: This project examines the feasibility, acceptability, and utility of the DAP; tests the degree to which fidelity can be maintained using the DAP compared to implementation as usual (IAU); and examines the feasibility of using automated phone or internet-enabled, computer-based technology to assess intervention fidelity and client satisfaction. The study design incorporates mixed methods in order to describe processes and factors associated with variations in both how the DAP itself is implemented and how the DAP impacts fidelity, drift, and adaptation. The DAP model is to be examined by assigning six regions in California (USA) to either the DAP (n = 3) or IAU (n = 3) to implement an EBP to prevent child neglect. Discussion: The DAP represents a data-informed, collaborative, multiple stakeholder approach to maintain intervention fidelity during the implementation of EBPs in the field by providing support for intervention, system, and organizational adaptation and intervention fidelity to meet local needs. This study is designed to address the real-world implications of EBP implementation in public sector service systems and is relevant for national, state, and local service systems and organizations

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

The environment of child maltreatment: contextual factors and the development of psychopathology

Some professionals have hypothesized that the observed problems in children who have been maltreated may actually be a result of the combination of risk factors surrounding the child, including but not limited to direct results of the abuse itself. This article examines the complexity of hypothesized pathways to poor adjustment after physical and sexual abuse. The literature on the impact of major risk factors associated with maltreatment is reviewed in an attempt to clarify the potential contributions of these contextual variables on the development of psychopathology in physically and sexually abused children. The implications this analysis may yield for prevention, intervention, and research in this field are also discussed

Adolescent Victims and Intergenerational Issues in Sexual Abuse

The transitional period of adolescence is characterized by a number of changes and challenges that occur both within and outside the individual. Many developmental events occur during adolescence that have a significant impact on an adolescent’s functioning, including a variety of physical, cognitive, emotional, behavioral, and social changes. In addition, adolescents may experience a variety of other important events, such as peer group changes, school moves, changes in family structure or functioning, and alterations in societal and community expectations (Hansen, Giacoletti, & Nangle, 1995; Peterson & Hamburg, 1986). Unfortunately, many adolescents are further challenged by being a victim of sexual abuse. The widespread prevalence of sexual abuse and the numerous problems and consequences associated with it have been increasingly recognized in recent decades (e.g., Browne & Finkelhor, 1986; Faller, 1993; V. V. Wolfe & Wolfe, 1988). In addition, much has been learned about the treatment of sexually abused children and adolescents during that time (e.g., Hansen, Hecht, & Futa, 1998; O’Donohue & Elliot, 1992). Given that victims of sexual abuse are at risk to develop sexualized behaviors, and that adolescents, for a variety of reasons (e.g., puberty, peer influences) are likely to begin engaging in sexual acts, this population needs special attention to help prevent the intergenerational transmission of abuse. This chapter addresses sexual abuse of adolescent victims and intergenerational issues in sexual abuse. The problem of sexual abuse is described, including historical background and epidemiological information. The potential impact and correlates of sexual abuse are discussed, including characteristics of adolescent victims and their families. The assessment and treatment of sexually abused adolescents is described, with attention to issues of prognosis and clinical management

The Environment of Child Maltreatment: Contextual Factors and the Development of Psychopathology

Some professionals have hypothesized that the observed problems in children who have been maltreated may actually be a result of the combination of risk factors surrounding the child, including but not limited to direct results of the abuse itself. This article examines the complexity of hypothesized pathways to poor adjustment after physical and sexual abuse. The literature on the impact of major risk factors associated with maltreatment is reviewed in an attempt to clarify the potential contributions of these contextual variables on the development of psychopathology in physically and sexually abused children. The implications this analysis may yield for prevention, intervention, and research in this field are also discussed

The role of family support in child adjustment and response to treatment after sexual abuse

This dissertation examines the impact that family support has on the symptoms reported by children after experiencing sexual abuse, as well as the implications for treatment. Family support has been identified as one of the most important predictors of child adjustment following the disclosure of abuse. Participants were all part of a larger treatment study. Global measures of family support did not predict global symptoms of depression or anxiety in the children. After treatment, children reported less sexual anxiety, and parents reported less internalizing symptoms in their children. No significant increases in family support were seen after treatment. Significant relationships were found when examining trauma-specific symptoms, rather than global areas of functioning. Implications for assessment and treatment are discussed

Contracting and Procurement for Evidence-Based Interventions in Public-Sector Human Services: A Case Study

Sustainment of evidence-based interventions (EBIs) in human services depends on the inner context of community-based organizations (CBOs) that provide services and the outer context of their broader environment. Increasingly, public officials are experimenting with contracting models from for-profit industries to procure human services. In this case study, we conducted qualitative interviews with key government and CBO stakeholders to examine implementation of the Best Value-Performance Information Procurement System to contract for EBIs in a child welfare system. Findings suggest that stakeholder relationships may be compromised when procurement disregards local knowledge, communication, collaboration, and other factors supporting EBIs and public health initiatives