Browsing by Subject "Implementation science"

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American Identity Measure: CAPAS (Spanish version)
(2015) Parra-Cardona, Ruben
Latinx populations in the United States (US) continue to be seriously impacted by persistent health disparities. According to the 2018 Monitoring the Future Study, Latinx adolescents had the highest rates of use of most illicit drugs compared to other ethnic groups. When considering differential risks among Latinxs, US-born youth in low-income first-generation families are at high risk for experiencing poverty, discrimination, and barriers to access services. These adolescents can also be exposed to deleterious parent-youth cultural conflicts, which may increase their risk for behavioral problems, including the use of alcohol and other drugs. Contextual stressors also have a negative impact the quality of parenting practices of immigrant parents, with associated deleterious consequences for their adolescent children. Although parent training (PT) interventions constitute the gold standard for strengthening parenting practices that are effective protective factors in the lives of adolescents, the availability of efficacious culturally adapted PT interventions in underserved Latinx communities remains scarce throughout the US. Thus, there is an urgent need in the implementation science (IS) field to identify implementation strategies aimed at addressing service gaps affecting Latinx populations. The research aims of this R34 investigation are: (a) To implement a pilot study aimed at refining a culturally adapted version of the evidence-based intervention known as GenerationPMTO© (i.e., CAPAS-Youth), adapted for Latinx immigrant families with adolescent children, (b) to implement a randomized controlled trial, aimed at empirically testing the efficacy of the CAPAS-Youth intervention with first-generation low-income Latinx families in Travis County, (c) to measure barriers and facilitators associated with the implementation of the CAPAS-Youth prevention intervention in the target context, and (d) to measure relevant implementation outcomes to inform a future R01 effectiveness trial. Implementing efficacious prevention initiatives in faith-based organizations constitutes a key alternative to address service barriers experienced by underserved populations. We also propose that by training lay members of target communities as prevention interventionists, the sustainment of prevention programs can be greatly enhanced. This investigation has relevance as we focus on a population that remains understudied in the IS field. The investigation has high public health relevance as it is responsive to Goals 2 and 4 of NIDA’s strategic plan, aimed at “addressing health disparities experienced by populations not adequately served by existing systems of care.”
Capturing fidelity to understand implementation of Trauma-focused Cognitive Behavioral Therapy in juvenile justice correctional facilities
(2019-02-08) Heier, Julie E.; Carlson, Cindy I., 1949-; Lopez, Molly; Whittaker, Tiffany A; Stark, Kevin D
The primary objective of this study examined the relationship between therapist treatment fidelity to Trauma-focused Cognitive- Behavioral Therapy (TF-CBT) and youth self-reported post session symptom severity. TF-CBT was provided to 21 incarcerated youth by 8 therapists employed in 3 juvenile correctional facilities. This study used observational coding measurement of 53 TF-CBT therapy audiotapes to measure therapist fidelity components: adherence to TF-CBT specific strategies, technical competence, nonspecific competence, and patient engagement across three treatment phases (1=psychoeducation phase, 2= skills building phase, and 3= trauma narrative and processing). Results found treatment fidelity did not relate to improved youth self -reported symptom severity across treatment. Higher pretreatment symptom severity was the only positive predictor of TF-CBT effectiveness and it related to a worsening of post-session symptoms. The second aim examined treatment adherence reliability of therapist self-report and observational coder ratings. Therapists and trained observational coders provided adherence ratings on 49 TF-CBT treatment sessions. Correspondence between therapists and observational coders was low, with 8 of 11 of the codes having a Kappa value of .4 or lower. Results indicate therapists overreport treatment adherence in comparison to observational coders. Overall, the study’s findings suggest that therapist treatment fidelity to a protocol may not be the key mechanism related to EBT effectiveness in unique settings with complex populations. Substantial research is still needed to corroborate the relationship between treatment fidelity and outcomes across settings, treatments, and informants. Implications for implementation science and effectiveness research with juvenile justice youth are also discussed.