CD09-001 Abstracts

1 R18 CE001705-01 -- Translating Effective Maltreatment Intervention into the Community

BAGGETT, KATHLEEN M

The current proposal seeks to develop and test the translatability of an evidence-based parenting intervention into a community-based program aimed at reducing child maltreatment. Specifically, we propose to translate the Play and Learning Strategies program (PALS; Landry & Smith, 1996; Smith, et al 2000; Landry, et al, 2001), an evidence-based program demonstrated to increase responsive parenting and thereby promote healthy infant social emotional development. The PALS program has been demonstrated to operate with fidelity and effectiveness within an in-person, one-to-one, mother-coach relationship. However, within this effectiveness evidence, the role of coach has remained within the research context. Attempts to more broadly disseminate this program into the community have met with many barriers to effectiveness; particularly those related to the provision of training and support necessary for community-based coaches to serve families at the level that research coaches have previously demonstrated (Glasgow, Marcus, Bull, & Wilson, 2004). Through our prior work (Infant Net; Feil, Baggett, Davis, et al, 2008), we have developed an internet-based delivery system for the PALS program, one that harnesses the power of the internet to facilitate efficient connections between the community parents and trained PALS coaches. By utilizing the Infant Net delivery platform, we have the opportunity to address critical dissemination barriers through linking home visitors within community service organizations directly to professionally-trained PALS program consultants in order to provide the necessary training and ongoing support required for effective community-based program implementation. It is within this context, consistent with Healthy People 2010 goals pertaining to Healthy Infants and toddlers, that we will pursue the following: Objective 1) In preparation of community implementation, we will conduct a 6-month development phase in which we will adapt existing Infant Net PALS materials into the necessary context to translate program implementation into diverse communities by: a) adapting existing training and coaching materials to better reflect a community home visitor-program consultant support relationship; and b) overlaying the existing Spanish translation of the PALS program onto the computer-delivery platform to increase program reach to linguistically diverse communities; and Objective 2) Following our provision of laptops with "eye-ball" cameras to community agency home visiting staff and installation of wireless Internet access in each community agency who does not already have it, we will proceed with implementation of our community-adapted intervention, Infant Net for Home Visitors (Infant Net-HV), within nine Healthy Families (HF) programs spanning a 13-county region in the state of Kansas. Our implementation approach will take the form of a 3-wave, iterative implementation design in which each wave will provide feedback to inform subsequent wave implementations. Across the 3 waves, we will implement with nine HF sites, 18 home visitors, and 270 at-risk families. Translatability of the community-adapted, evidence-based program will be assessed relative to the impact of known barriers to dissemination on program reach, uptake, feasibility, fidelity and, by virtue, secondary mother and infant health outcomes. An initial cost analysis of the program will also be performed in order to provide this information to community sites for viewing relative to their own operating budgets and prior intervention efforts. All project information will be presented to Healthy Families leadership and assessed as to its potential for subsequent policy support related to maintenance and sustainability of the Infant Net-HV program. In further support of maintenance and sustainability efforts, iterative community feedback from each wave of implementation, including the documentation of things that "didn't work", will be summarized and placed into a Community Implementation Manual to accompany project results.

1 R18 CE001714-01 -- Translating Child-Parent Psychotherapy into the Juvenile and Family Court System

FRASER, JENIFER GOLDMAN

This study focuses on the translation of child-parent psychotherapy, an evidence-based intervention shown to improve the mental health and behavioral outcomes of infants and toddlers exposed to maltreatment, into the juvenile court system. The Infant Mental Health-Court Team Program (IMH-CTP) is an innovative, systems-changing model in which the child and family court becomes the platform for assuring timely referrals to child-parent psychotherapy, monitoring treatment, and ensuring that the child's emotional well- being is at the center of judicial decision-making and permanency planning. The model was developed and implemented in the Dependency Division of the Miami-Dade Juvenile Court (11th Judicial Circuit). The research study will examine the implementation process and outcomes associated with dissemination of child-parent psychotherapy via the IMH-CTP model in two new community settings: Leon County in Tallahassee, Florida (2nd Judicial Circuit Court) and Wayne County in Detroit, Michigan (3rd Judicial Circuit Court). The dissemination sites will receive intensive technical assistance in the form of periodic on-site annual trainings/workshops and peer-to-peer judicial mentoring, participation in a Webinar Learning Collaborative, and regular frequent communication with the "expert" Miami court team. We will take a mixed- methods (quantitative/qualitative) approach to study implementation, collecting (a) semi-structured interview data on adoption and implementation processes from community stakeholders at the dissemination sites, (b) semi-structured interview data on implementation and maintenance at the originating Miami site, (c) court and clinical observational fidelity assessments at the dissemination sites, (d) structured and naturalistic documentation of dissemination and implementation activities, and (e) in-depth interviews with a subset of mothers who complete child-parent psychotherapy on satisfaction with treatment, the IMH-CTP experience, and facilitators/barriers to engagement in treatment. For the outcomes component of the study, 90 mother- infant dyads (30 at each of the three study sites) will be followed and mother/infant assessment data collected pre- and post-treatment and at 6-month follow-up. We will examine the relationship between fidelity of implementation and effectiveness, comparing the new dissemination sites (Tallahassee and Detroit) to the original site (Miami). Comparisons will be made in maltreatment recurrence, injuries, permanency outcomes, changes in the quality of the mother-child relationship, child development and behavioral health, and maternal depression and stress. The study findings will contribute to the translation research field with an evidence-based dissemination strategy for the IMH-CTP and represents an important step towards the institutionalization of child-parent psychotherapy in judicial practice to prevent recurrence of maltreatment and promote the health and well-being of maltreated infants and toddlers.

1 R18 TP000320-01 -- A Health Security Card for Disasters and Public Health Emergencies

JAMES, JAMES J

The American Medical Association (AMA) seeks to promote the health, safety, and resilience of internally displaced populations in a disaster or public health emergency by establishing and promoting a standardized health security card, which contains essential data elements necessary for healthcare providers, and local, tribal, and state health departments to identify individuals, meet their immediate health needs, better access critical data, and better obtain surveillance and situational awareness, thereby minimizing morbidity and mortality in at- risk populations. An overarching participatory management methodology will be utilized to reach this goal. Specific aims include: 1) To utilize a multidisciplinary private-public stakeholder team to achieve consensus on the essential data elements necessary for a health security card for use in disasters and public health emergencies. 2) To establish consensus on the technological vehicle and platform for the card. 3) To refine and validate the vehicle and platform for the card through a series of focus groups targeting at-risk populations. 4) To disseminate the health security card to a nationally representative sample (n=1000), with an oversampling of at-risk populations, through selected training centers of the National Disaster Life SupportTM (NDLSTM) Program and in conjunction with local, tribal, and state public health departments, representing all FEMA regions. 5) To conduct a 6-week and 6-month follow-up evaluation and reliability test of the health security card and public health systems platform against the In Case of Emergency Prescription History Service (ICERx.org), a national medication record and pharmaceutical database. Analysis will include frequency of logins by the 6-week and 6-month time intervals, as well as completeness and accuracy of medication information compared with the ICERx medication database. A follow-up 6-month telephone survey will be conducted of all participants to determine subjective usability and portability of the health security card. The AMA is very capable of achieving success by virtue of its experience in building systems-level relationships and programs, and through its ability to leverage these networks to assist affected populations in a disaster or public health emergency. Building on past efforts, a primary goal of this project is to move the dissemination and utilization of an enhanced personal health information card from the clinician-patient model to a caregiver- population model to enable the deployment of the card across state-lines, especially for those most vulnerable and at greatest risk in a disaster or public health emergency. The AMA seeks to promote the health, safety, and resilience of populations affected by a disaster or public health emergency by establishing and promoting a standardized health security card, which contains essential information to identify individuals and meet their immediate health needs. Building on past efforts, the proposed project will move the dissemination and utilization of an enhanced card from a clinician-patient model to a caregiver- population model to enable the deployment of the card across state-lines at the population level, especially for those most vulnerable and at greatest risk. It is believed that the health security card can have a dual function by raising awareness and health literacy of at-risk populations thereby impacting and benefiting day-to-day clinical care, reducing overall healthcare costs, and improving individual and community resilience.

1 R18 EH000537-01 -- Medicaid Asthma Home Visit Project- Improving Health and Reducing Costs of Health

KRIEGER, JAMES W

Seattle-King County Healthy Homes is an evidence-based approach for controlling asthma among low-income children. The first aim of our proposal is to translate the research-based model into practice, assess the impact of translation on the asthma-related outcomes included in evaluation of the original model, and describe the translation process. Our second aim is to assess the cost-effectiveness and return on investment (ROI) of the translated model. We hope to demonstrate that Healthy Homes is a replicable and cost-effective model that can be provided to all children with uncontrolled asthma insured by Medicaid. Background: Asthma remains the most common chronic condition of childhood, affecting 9.1% of all American children. The rate of asthma has doubled since 1980 and remains at historically high levels. Asthma education is effective in reducing asthma morbidity and urgent health services utilization. The National Institutes of Health has identified it as a core asthma control strategy. However, many children with asthma and their caretakers do not participate in asthma education because of access barriers. Offering education in the home may increase participation. Recent research shows that providing asthma education through home visits results in reductions in asthma symptoms and urgent health care utilization. The CDC Guide to Community Preventive Services recently recommended home visits as an effective intervention. A major barrier to wider implementation of the home visit approach is lack of reimbursement for this service by health care payers, who need evidence of the ROI of this intervention. Intervention: A community health workers (CHW) will visit 200 Medicaid-insured children with uncontrolled asthma in their homes over a year. A CHW is a peer educator who provides tailored, culturally-appropriate asthma education. She will assess current asthma control status, self-management practices and the presence of asthma triggers in the home and help children and their caretakers use medications more effectively, prevent and manage exacerbations, facilitate access health services and communication with providers, and reduce exposure to asthma triggers. They will provide participants with tools to reduce exposure to triggers (e.g. a vacuum). Another important role will be provision of instrumental, informational and emotional support. Evaluation: We will use the RE-AIM framework and community-based participatory research methods to assess the translation process. We will complete a quasi-experimental study to assess the cost-effectiveness and ROI of the intervention using administrative claims and self-reported asthma control data.

1 R18 CE001723-01 -- Translating and Implementing Fall Prevention Research through Clinical Practice

LI, FUZHONG

Falls are a major threat to the lives, health, and independence of older adults. An expected increase in falls corresponding to a growing aging population threatens to burden an already strained healthcare system. However, falls are preventable. Increasing evidence supports the effectiveness of exercise-based prevention programs such as Tai Chi to improve strength, balance, and mobility, which reduce the risk of falling. Tai Chi: Moving for Better Balance is an evidence-based fall prevention program that targets older adults at risk of falling. The program has also undergone community evaluation with good potential for widespread adoption. However, the extent to which such an evidence-based program can be disseminated via healthcare providers is unknown. While patients are often being counseled on measures to reduce the risk of falling, including physical activity, healthcare professionals often lack adequate information regarding interventions demonstrated to be effective; others might have the information but do not use it in their work with patients. This proposed study addresses this research-to-clinical-practice issue in healthcare settings. On the basis of our prior work, we propose a dissemination project to assess the potential public health impact of delivering the Tai Chi: Moving for Better Balance program through local healthcare providers: primary care physicians, nurse practitioners, and physical therapists. Utilizing a twice weekly (90 minutes per session), 4-month, single-group design, we will conduct an initiation, process, and outcome evaluation of our program with respect to Reach (participation rate of patients), Effectiveness (improvement in functional ability and quality of life, reductions in fall incidence), Adoption (participation rates of healthcare providers), Implementation (degree to which intervention components are delivered as intended), and Maintenance (sustainability of the program among providers who make referrals to the program and among patients who receive the program). To better understand the translational process, we will also address issues such as program fidelity evaluation and facilitators/barriers. It is expected that outcomes from this dissemination study will increase understanding of the impact of community-wide diffusion of an evidence-based, community-evaluated Tai Chi fall prevention program on providers and older adult patients, with the ultimate objective of implementing and sustaining community-based exercise programs to meet Healthy People 2010 goals for preventing and reducing injuries and enhancing life independence among older adults.

1 R18 DP002138-01 - A translation study of the Academia da Cidade program (ACP): an evidence based, professionally supervised community physical activity program for Latino adults

MARSHALL, SIMON JOSEPH

The purpose of this study is to translate, implement, and evaluate the Academia da Cidade Program (ACP), an evidence-based, professionally supervised physical activity intervention conducted in Recife, Brazil, for use with Latino communities in North America. The translated program will involve group-based physical activity classes that are free or offered for a nominal charge ($1/person) to community members. Classes will be taught in urban recreation centers and parks by promotores who are trained as nationally-certified Group Fitness Instructors (GFI) as part of a newly-established Academia, a program of the San Diego Prevention Research Center (SDPRC) and the American Council of Exercise (ACE(R)). This overall purpose will be accomplished by four main research activities. Specifically, we will: (1) develop a Community Action Plan (CAP) to transadapt the ACP intervention for use with Latino adults; (2) conduct a scientific trial of its public health impact using a two-group staggered enrollment trial design; (3) evaluate the public health impact of the program using the RE-AIM framework to quantify its Reach, Effectiveness, Adoption, Implementation and Maintenance; (4) evaluate the sustainability and cost-effectiveness of the program using a program logic model to identify inputs, activities, and outputs that contribute to successful program implementation and the building of community capacity to support long-term program maintenance; and (5) disseminate project findings to appropriate public health partners and relevant stakeholders.

1 R18 TP000316-01 -- Extending Emergency Response Skills to Limited English Proficiency Communities

MEISCHKE, HENDRIKA

The objective of this proposal is to extend emergency response skills to communities with limited English proficiency (LEP) by investigating strategies for effective dissemination of bystander CPR (Cardio- pulmonary resuscitation) skills to LEP communities. Bystander CPR has been proven to reduce mortality from cardiac arrest. Unfortunately, individuals from different ethnic communities are less likely to receive bystander CPR, possibly due to insufficient dissemination of CPR training to these populations. A recent survey showed that Latino and Asian participants were less likely to report CPR training than other ethnic groups in one large metropolitan community. In addition, research shows that CPR instructions provided by 9-1-1 dispatch operators during a cardiac emergency are less likely to be accepted and performed by LEP callers compared to non-LEP callers. Where bystanders do perform CPR, the time-interval between onset of the emergency call and onset of bystander CPR is more than a minute longer for LEP callers than non-LEP callers. Telephone- assisted CPR has been shown to reduce mortality from cardiac arrest and as such the lack of understanding of CPR instructions or significant delays in communication of instructions may negatively affect health outcomes. Proposed primary research activities include 1) focus group research with Asian and Latino LEP individuals to investigate awareness and acceptability of bystander CPR and preferred channels for dissemination of basic CPR skills training, 2) experimental research to test linguistically adapted 9-1-1 operator-assisted CPR instructions on understanding and performance of CPR among LEP and non-LEP individuals during a simulated cardiac arrest, and 3) observational research activities including 9-1-1 tape abstraction to evaluate the implementation of linguistically adapted dispatch-assisted CPR instructions in two large call centers in the Pacific Northwest over a 9-month period. Secondary aims are to investigate the feasibility of video-based dissemination strategies for reaching Asian and Latino communities with basic CPR training and dissemination of research results to other communities. All study activities are designed to involve community partners as well as representatives of LEP populations in Asian and Latino communities. Although CPR is only one of many emergency preparedness and response techniques, both the evidence for benefit from bystander CPR as well as the health disparities that exist in rates of bystander CPR justify this focus. The results of the proposed research activities will lead to immediate changes at the "system- level" as new dispatch telephone instructions will become standard policy at the participating call centers after evaluation. In addition, the results will illuminate potential communication and dissemination strategies for reaching LEP communities with other types of emergency preparedness and response information. Extending Emergency Response Skills to Limited English Proficiency Communities The objective of this proposal is to investigate effective communication strategies for dissemination of CPR training and instructions to limited English proficiency (LEP) communities by 1) evaluating linguistically adapted 9-1-1 dispatch-assisted CPR instructions (T-CPR) on understanding and performance of CPR among LEP communities and 2) investigating the feasibility of video-based dissemination strategies for reaching Asian and Latino communities with basic CPR training. The results of the proposed research activities will lead to immediate changes at the "system-level" (i.e., new dispatch telephone instructions that will become standard policy after evaluation)and will shed light on potential communication and dissemination strategies for reaching LEP communities with other types of emergency preparedness and response information.

1 R18 DP002144-01 -- StrongWomen-Healthy Hearts: A Community-Based Program for Midlife and Older Women

NELSON, MIRIAM E

Cardiovascular disease (CVD) is the leading cause of death for women in the United States and disproportionately affects underserved populations. The Strong Women - Healthy Hearts Program has the potential for positive impact on this public health issue. The 12-week intervention has demonstrated effectiveness in increasing physical activity, improving diet quality, and decreasing body weight in a controlled, randomized trial in two states. This application seeks to evaluate the dissemination of the Strong Woman - Healthy Hearts Program through two approaches in partnership with the Cooperative State Research, Education, and Extension Service (CSREES), our partner in the effectiveness trial. The proposed dissemination plan leverages a successful, five-year collaboration between Tufts University and CSREES, which has an extensive network of 2,900 county and regional offices nationwide. First, we will work with the Pennsylvania State Cooperative Extension to conduct an in-depth evaluation in Pennsylvania according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework using quantitative and qualitative methods. Second, in partnership with the National Extension Association of Family and Consumer Sciences, we will evaluate the first wave of national dissemination with a larger number of CSREES educators to quantitatively assess the RE-AIM components. The central objective of this application is to rigorously evaluate dissemination of the Strong Women - Healthy Hearts Program using the RE-AIM framework in order to achieve maximal public health impact. The results will help to reach Healthy People 2010 Goal 1, Objectives 12, 19, and 22. This study is also designed to provide data on best practices for reaching priority subpopulations, especially low-income and rural women. In this way it will contribute to Healthy People 2010 Goal 2, the reduction of health disparities.

1 R18 CE001730-01 -- Translating an effective teen driving program for parents to primary care

SHOPE, JEAN THATCHER

The study will translate an evidence-based approach to improve adolescent motor vehicle safety. Motor vehicle crashes are the leading cause of death among 16-19-year olds, and a major threat to teens' well being, yet are seldom addressed by Primary Care Providers (PCPs) as they advise families about health issues. This study's purpose is to evaluate the translation of Checkpoints, an evidence-based, parent program to set limits on and monitor teen driving, for delivery via a brief intervention by primary care providers (PCPs) of teens. Checkpoints can enhance adherence to Graduated Driver Licensing restrictions, and has been shown to increase the use of a parent/teen driving agreement, and to reduce teens' risky driving, violations, and crashes. The proposed brief PCP intervention will refer parents of teens to the Checkpoints Web Program, a sustainable and appealing delivery mode that could be widely adopted and institutionalized. There are four study aims. Aim 1: Adapt Checkpoints for dissemination by PCPs and over the Internet, and examine the PCP/Checkpoints Web Program's adaptability and fidelity. Checkpoints' effectiveness in reaching families through PCPs and over the Web has not been examined. The content of the effective Checkpoints program delivered previously to parents in driver education classes will be adapted, with part of it delivered by the PCPs in a brief intervention with parents and a more extensive part provided by the Checkpoints Web Program to which parents will be referred. Adaptation and fidelity will be evaluated. Aim 2: Distribute the PCP/Checkpoints Web Program through pediatric and family medicine offices. In collaboration with the American Academy of Pediatrics, practices will be recruited through two national networks, Pediatric Research in Office Settings (PROS) and the Electronic Primary Care Research Network (ePCRN), a "network of networks" group of family medicine practitioners. Participating practice staff and PCPs will be trained to identify eligible families, deliver the brief intervention, assist families to access the Checkpoints Web Program on-line, and implement specific promotional and reminder activities. Aim 3: Identify practice, PCP, and parental factors related to the dissemination, implementation, institutionalization, adoption, and health outcomes of the PCP/Checkpoints Web Program. Variation in adoption, implementation, and institutionalization of the PCP/Checkpoints Web Program will be measured at three levels (practices, individual PCPs, and individual parents) for their association with parents' frequency of accessing the website, downloading materials, and using the program. Aim 4: Measure the feasibility and sustainability of the PCP/Checkpoints Web Program in terms of the economic costs associated with dissemination, implementation, institutionalization, and health outcomes. Feasibility of the approach taken to disseminate and implement the program will be evaluated, both in terms of monetary and opportunity costs. Costs related to website maintenance, as well as costs to PCPs, their practices, and parents will be assessed.

1 R18 DP002279-01 -- Adoption and Implementation Support Innovations for PROSPER Partnership-Based EBI

SPOTH, RICHARD L

The purpose of the proposed research is to advance the dissemination of evidence-based interventions (EBIs) targeting youth health-risking behaviors, through a network of state partnerships. Toward this end, the proposed research will evaluate EBI implementation support strategies designed to facilitate broader dissemination of an empirically-validated state partnership model that effectively links existing EBI delivery systems. The need for the proposed research is indicated by epidemiological data on substance use and other health-risking problem behaviors among adolescents and by the dearth of sustained, quality implementation of EBIs designed to prevent such problems. Successful and sustained EBI implementation necessitates sustained partnerships among families, schools, and communities²with a proactive technical assistance model to support them. Our PROSPER partnership model links the public school system with the land grant university dissemination system²called the Cooperative Extension System²and other resources in states for prevention programming. It has evolved through two decades of NIH-funded, randomized-controlled prevention trials, and has demonstrated a range of positive, long-term public health impacts. Because prevention activities offered through public schools and other youth program dissemination systems often do not utilize EBIs, particularly ones that are implemented with quality and in a sustainable way, there is a need to reach more states and communities with our model. Further development and testing of partnership adoption and implementation support components is required. We propose to conduct web-based surveys of key informants representing the land grant university Cooperative Extension, Public School, and Public Health systems from all 50 states, to assess social network and readiness factors potentially influencing the adoption of the PROSPER partnership model and to rank states on level of readiness as early adopters (Aim 1). Using information from the state survey data to select four states, we will conduct an evaluation of a partnership adoption decision-making team support strategy that incorporates motivational coaching (Aim 2). Finally, we will conduct a controlled pilot study with rural community sites in a selected ³partnership-ready´ state (Aim 3). This will involve the provision of PROSPER model training and implementation support components, along with a newly-developed web-based implementation process and outcome evaluation system. This pilot work will allow us to evaluate a range of system and organizational factors influencing the quality of EBIs implemented and EBI outcomes. It also will reveal whether PROSPER community sites show higher quality implementation of EBIs and stronger outcomes, as compared with community sites in the same states conducting usual prevention activities supported by state and federal funding, absent our partnership model. There has been limited randomized, longitudinal study evaluating how to optimally sustain quality implementation of evidence-based interventions (EBIs) for general populations, in order to achieve population- level effects on youth smoking, other substance use, and other problem behaviors, such as aggression. Community-university partnership-based prevention trials conducted by the investigations over the past two decades have resulted in an empirically-validated model that supports high-quality, sustained implementation of general population EBIs. Past pilot work suggests the promise of specific adoption and implementation supports for broader dissemination of the model (called the PROSPER Network Model) in multiple state sites, to be further developed and tested through the proposed research.

1 R18 CE001745-01 -- Healthy Futures for Children in Foster Care: Translating Evidence into Practice

SZILAGYI, MOIRA

Children and adolescents in foster care are a high-risk special needs population with an extremely high rate of developmental, behavioral, and mental health problems attributable to multiple childhood traumas. Although isolated evidence-based interventions have been found to improve comprehensive assessment and treatment of mental health problems, to improve parenting skills of foster and birth parents, and to enhance the critical visitation process, no community has translated these individual interventions into a comprehensive, coordinated, and sustainable program. The goal of Healthy Futures is to implement such a model program. Specific Aims: The specific aims are to 1) Develop and implement a training program for health professionals who care for the foster care population on using validated assessments, and on coaching parenting skills and visitation; 2) Implement validated assessments of family needs/strengths and child development/mental health problems; 3) Implement a promising coached visitation model for birth parents and their children, including a mental health intervention for extremely high risk families; 4) Implement evidence-based mental health treatments for Children in Foster Care, including Trauma-Focused Cognitive Behavioral Therapy (all ages) and Inter-Personal Psychotherapy (adolescents); 5) Implement evidence-based parenting programs for foster and birth parents; and, 6) Disseminate and diffuse findings via child welfare, public health, and professional organizations (including on a national website with toolkits for professionals). Methods: We will convene an oversight group to plan each stage of the integration, while a local agency will assess and measure each stage of this three-year process. We will train Visitation Specialists, child welfare caseworkers and administrators, and mental health and pediatric professionals on the use of a secure web- based system that will be used for inter-disciplinary communication. Children entering foster care and their parents will receive assessments that will be scored, analyzed and shared through this secure web-based system (COMET). Based on these assessments, professionals will triage families into an appropriate level of visitation (coached or supervised), mental health intervention (child parent psychotherapy) and/or parent skills training. We will also train professionals on coaching parents using the principles of a specific evidence-based parenting skills program (Incredible Years). Professionals will periodically re-assess how children and families are faring and use re-assessments to re-assign families to interventions. We will also increase the access to mental health care for children in foster care by offering on-site evidence-based mental health services. Organization: We have more than 20 years of experience locally and nationally in foster care, a rich history of collaboration, and a receptive community.

1 R18 CE001733-01 -- Effectiveness and cost-effectiveness of coaching models to promote implementation

WHITAKER, DANIEL JAMES

Child neglect is the dominant problem in the child welfare system, accounting for over 64% of cases annually. Neglect is also the most serious form of maltreatment, leading to an array of negative outcome that are biological, social, emotional, and behavioral in nature. The SafeCare(R) model is one of the few evidenced-based practices that focus on child neglect by teaching parents skills that address proximal antecedents of neglect (safety, health, and parent- child interactions). The National SafeCare Training and Research Center conducts training and research on the SafeCare model. To achieve optimal implementation, practitioners conducted SafeCare (or any new practice) must be "coached" live as the implement a practice. The proposed study will examine three different models of coaching, one in which NSTRC coaches providers directly (purveyor coaching), and the other two in coaching is conducted by the local implementation team and supported either by the NSTRC, or by an intermediary organization whose staff has become certified SafeCare trainers. Thus we will examine how implementation is affected by coaching when the purveyor group (NSTRC) is a various levels of closeness to the actual implementation. We will randomly assign 90 providers at 30 agencies to receive one of the three forms of coaching, and will examine implementation related variables (provider fidelity and competence, and family skill acquisition) as the primary outcomes. We will also conduct a rigorous cost effectiveness analysis of the coaching models to understand costs with respect to return on fidelity.

1 R18 DP002106-01 -- A Multi-State Asian-Language Quitline for Smokers

ZHU, SHU-HONG

This study addresses a significant gap in the implementation of effective tobacco cessation services as recommended by the Community Guide to Preventive Services. The Guide recommends telephone counseling, or "quitlines," as a key population-based tobacco control strategy. Currently, all 50 U.S. states have established quitlines. However, only one quitline offers direct counseling in Asian languages. Justifications for the absence of Asian-language services range from the lack of proven protocols for this population to the practical difficulty of staffing a program in multiple Asian languages. The project will translate an experimentally validated, Asian-language, smoking cessation telephone counseling protocol into a multi-state quitline operation. State health departments in California, Hawaii and Colorado will work with the researchers who developed and tested the protocol to create a practical dissemination model. The project aims to demonstrate that collaboration between researchers and policy makers will help to translate research results quickly into real world public health practice. The project involves both dissemination and implementation and has two overlapping phases. In the first phase, researchers will work with three states that are ready to adopt an Asian quitline. Together they will: (1) evaluate the dissemination success of a multi-state model for an Asian quitline in which each state promotes the quitline individually, but a centralized operation provides the counseling service; (2) examine the natural variation in implementation of promotional strategies by comparing smokers' responses to advertising messages in the context of state-specific cessation policies; and (3) test implementation fidelity by comparing the number and length of counseling sessions with those in California's original Asian trial, and with those of participating states' English and Spanish quitlines. In the second phase, researchers will work with the health departments in other states to encourage further dissemination. Specifically, they will: (1) examine the organizational readiness of other state health departments to adopt either the multi-state Asian quitline or to start their own Asian quitlines, and to assess their change in readiness from year 1 to year 3; (2) conduct in-depth interviews with representatives from selected state health departments, state quitline operators, and community organizations to determine their perceptions of barriers to adoption of Asian-language quitlines; and (3) set in motion a process for further dissemination by recruiting at least one additional state to join the multi-state Asian quitline by year 3 of the project. The proposed multi-state quitline project, if implemented successfully, can serve as a model for other states in providing behavioral cessation services to Asian-language smokers, helping to reduce disparities in access to effective treatment for these populations.

 

* Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.

Please note: Some of these publications are available for download only as *.pdf files. These files require Adobe Acrobat Reader in order to be viewed. Please review the information on downloading and using Acrobat Reader software.