# Presentation: 499479

## Moving into Sustaining Intervention Systems: Study of the PROSPER Community-University Partnership Model

- Presentation for
- NIDA’s Intervening Early Workshop
*Richard Spoth*
- September 19, 2007

## Overview of Presentation

**PROSPER** **Context**—Challenges and Opportunities in “Scaling Up”
**PROSPER Background and Design**
**PROSPER Early** **Findings**—Implementation, Outcomes, Sustainability
**PROSPER Future** **Directions**—Long-term               Outcomes, Next (4th) Generation Partnership Network

## PROSPER Context—Challenges and Opportunities in “Scaling Up”  Through  Community-University Partnerships 

## Challenge of General PopulationIntervention—Substance Initiation

- Monitoring the Future Study, 2005—among 8th-12th graders, lifetime use prevalence rates
- 				_8__th__ Grade_	_10__th__ Grade_	_12__th__ Grade_
- Alcohol		    41.0%	    63.2%	    75.1%
- Drunkenness	    19.5%	    42.1%	    57.5%
- Cigarettes		    25.9%	    38.9%	    50.0%
- Marijuana		    16.5%	    34.1%	    44.8%
- Methamphetamines      3.1%	      4.1%	      4.5%
- Escalating rates of use from 8th-12th grades
- Early initiation linked with misuse/high social, health, economic costs

## Two Windows of Opportunity forIntervention with General Populations

- See Spoth, Reyes, Redmond, & Shin (1999). Assessing a public health approach to delay onset and progression of adolescent substance use: Latent transition and log-linear analyses of longitudinal family preventive intervention outcomes. *Journal of Consulting and Clinical Psychology, 67*, 619-630.

## What is Needed?

- Development of an armamentarium of evidence-based interventions (EBIs) to delay initiation/prevent transition
- Scaling up these EBIs for public health impact

## Challenge of Scaling Up

- Evaluated-
- not effective

- EBIs

- Not Evaluated

- ... and rigorously demonstrated, _long-term_
- EBI impact is very rare

## What is essential to scaling up?

- What is essential to scaling up?

- Community-based organizations (_CBOs_) that work with youth and families
- _Collaborators_ with implementation and evaluation science expertise
- _Systems_ to support and sustain quality EBI delivery through CBOs
_**Models**_** for linking these together**
_**Evidence**_** that the “linking” models work (PROSPER Study)**

## Models for Linking with Support Systems...

- Cooperative Extension System
- Largest informal education system in the world
- Over 3,150 agents in nearly every county
- Science with practice orientation
- Public School System
- Universal system reaching nearly all children
- States have networks for programming support
- Increasing emphasis on accountability/empirical orientation

## Models for Linking with Support Systems—First Generation Partnership Design

**State University**
**Prevention Research Team and Extension Specialists**

**School/Community Implementers**
** ****Assisted by Extension**

## Models for Linking with Support Systems—Second Partnership Prevention Trial Design 

**School/Community Implementers**

**State University**
**Prevention Research Team and Extension Specialists**

**Regional Extension Coordinators**

## Illustrative Evidence for                            Partnership-Based Interventions 

- Source: Spoth, Redmond, Shin, & Azevedo (2004). Brief family intervention effects on adolescent substance initiation: School-level curvilinear growth curve analyses six years following baseline. *Journal of Consulting and Clinical Psychology, 72, 535-542.*

## Illustrative Evidence for Partnership-Based Interventions—Economic Benefits

- For one, a test of a model for sustainable, community-based
- EBI delivery...

- So, what more do we need?

## 2. PROSPER Background and Design      (Promoting School-community-university Partnerships        to Enhance Resilience) 

## Third Generation Partnership Trial Design 

- (Sustainability Design)

- University/State-Level Team
- University Researchers, Extension Program Directors

- Prevention Coordinator Team–
- Extension Prevention Coordinators

- Local Community Teams
- Extension Agent, Public School Staff,
- Social Service Agency Representatives, Parent/Youth Representatives

## What are the phases of PROSPER implementation?

- Phase 1: Organization—team formation/planning (6-8 months)
- Phase 2: Initial operations—EBI implementation (6-8 months forward), following EBI selection from menu
- 6th grade family-focused EBI
- 7th grade school-based EBI
- Phase 3: Early sustainability planning (Year 3 forward)
- Phase 4: Ongoing operations/sustainability—institutionalization within Extension (current)

## PROSPER Study Overview*

- Aims
- Evaluate the effectiveness of partnership implementation of EBIs on youth and family outcomes
- Learn what factors are most important in partnership effectiveness, particularly sustained, quality implementation
- Design
- RCT of 28 school districts (14 IA, 14 PA) assigned to full partnership and “delayed intervention” (comparison) conditions
- Participants
- Two cohorts of 6th grade children (approximately 6,000 students per cohort)

- *Funded by NIDA and conducted in collaboration with Pennsylvania State University (Mark Greenberg, Mark Feinberg, Co-PIs)

## PROSPER Partnership Process-to-Outcome Model for Implementation of Evidence-Based Youth and Family Competence-Building Interventions

_**Intervention**__**Process/**__**Outcomes**_

- Source: Spoth & Greenberg, 2005.  Toward a comprehensive strategy for effective practitioner-scientist partnerships and larger-scale community benefits. *American Journal of Community Psychology, 35,* 107-126.

-  **Quality of Partnership/Team Process                                             Partnership/Team Effectiveness**

**Organization         Initial Operations        Early Sustainability           Ongoing Operations &**
**Phase                          Phase                            Phase                            Sustainability Phase**

**Team Member Characteristics**

## 3. Early Findings—     Local team recruitment of families 

- 3. Early Findings—     Local team recruitment of families

- Comparison study rates range from 1%-6%
- 17 % attended at least one session (N = 1,064; est. 2,650 family members)
- High end of researcher –based recruitment
- Intent-to-treat analysis

- Source: Spoth, Clair, Shin, & Redmond (2007). Toward dissemination of evidence-based family interventions: Maintenance of community-based partnership recruitment results and associated factors. *Journal of Family Psychology, 21*, 137-146*.*

## 3. Early Findings—Implementation Study

- Average over 90% adherence with family EBIs
- Average over 90% adherence with school EBIs
- High ratings on other quality indicators
- Quality maintained across cohorts

- Source: Spoth, Guyll, Lillehoj, Redmond, Greenberg (In press). PROSPER study of evidence-based intervention implementation quality by community-university partnerships.  *Journal of Community Psychology.*

## 3. Early Findings—Proximal Outcomes

- 				    Intervention         Control              F-value
- Selected Outcomes 	        LS Mean	        LS Mean               (1,12)
- Parent-Child Activities	3.82		3.68		12.28**
- Family Cohesion		3.53		3.44		16.89**
- Substance Refusal Intentions	4.68		4.64		  5.26*
- Substance Refusal Efficacy	4.41		4.37		  1.00
- Substance Use Expectancies	4.66		4.57		21.00**
- Antisocial Peers		1.67		1.78		14.45**
- Deviant Behaviors		1.26		1.28		  4.80*
- Problem Solving		3.62		3.46		24.08**
- Assertiveness			4.22		4.16		10.04****	**
- 7th Grade Multi-Level ANCOVA Results—Intent-to-Treat Analysis
- *p<0.05; **p<0.01

## Early Findings— Illustrative Substance-Related Outcomesat 11⁄2 Years Past Baseline 

- Source: Spoth, Redmond, Shin, Greenberg, Clair, & Feinberg (2007). Substance use outcomes at 11⁄2 years past baseline from the PROSPER community-university partnership trail. *American Journal of Preventive Medicine, 32*(5), 395-402.

## 3. Early Findings—     Initial Financial Sustainability 

- 100% of PROSPER teams obtained external funding within a year
- Funds obtained from a variety of sources – state, city, business, religious and service organizations, and private individuals.
- Collectively, over $600,000 for sustained EBI, as of last year

## 4. Future Directions

## Next Steps in Evaluating the PROSPER Model (Funded Continuation Phase)

- _Longitudinal follow-up_ of youth through high school to assess substance use
- In-depth _examination of youth at high-risk_ for substance abuse re whether universal interventions impact these youth
- _Evaluation of institutionalization of teams and EBIs_
- Long-term functioning of teams
- Sustainability of original EBIs
- Implementation and sustainability of new EBIs
- Formative studies to evaluate _adaptation to obesity prevention (R21)_

## Key Scaling-up Challengesfor PROSPER Partnership Model*

- The high level of sustained effort required for EBI implementation
- Need for ongoing support from all levels of the organizations involved
- Local preferences for tailor-fitting vs. standardized approaches to programming
- Competing demands on key personnel and on resources required
- Leadership and other team member turnover (maintaining team investment and continuity)
*****Sources: Hallfors et al., 2002; Mihalic et al., 2002; Spoth & Molgaard, 1999

## Addressing Challenges Through aPROSPER Partnership Network

- Addressing Challenges Through aPROSPER Partnership Network

## Fourth Generation Partnership Design—PROSPER Network (Proposal Submitted)

**PROSPER Network Team for Scientific and EBI Technical Assistance**
- Prevention Scientists, PROSPER TA Providers, IT and Research Data Managers/Analysts
- (Overall project management, Scientific and EBI TA management and coordination,
- information and data management and analysis)

**PROSPER State Partnerships**

**State-level PROSPER Management Team**
- Extension-Based Date Coordinator/Evaluators, Project Director, Extension Administrator/Liaison

**State-level Prevention Coordinator Team**
- Extension Prevention Coordinators

**Community Teams in State Site**
- Extension Agent, Public School Staff, Social Service Agency Representatives,
- Parent/Youth Representatives, other Community Stakeholders

## Acknowledgement of 
Our Partners in Research
Investigators/Collaborators 
R. Spoth (Director), C. Redmond  & C. Shin (Associate Directors),
T. Backer, K. Bierman, G. Botvin, G. Brody, S. Clair, 
T. Dishion, M. Greenberg, D. Hawkins, 
K. Kavanagh, K. Kumpfer, C. Mincemoyer, 
V. Molgaard, V. Murry, D. Perkins, J. A. Stout
Associated Faculty/Scientists
K. Azevedo, J. Epstein, M. Feinberg, K. Griffin, 
M. Guyll, K. Haggerty, S. Huck, R. Kosterman, 
C. Lillehoj, S. Madon, A. Mason, J. Melby, M. Michaels, 
T. Nichols, K. Randall, L. Schainker, 
T. Tsushima, L. Trudeau, J. Welsh, S. Yoo
Prevention Coordinators
E. Berrena, M. Bode, B. Bumbarger, E. Hanlon 
K. James, J. Meek, A. Santiago, C. Tomaschik

- Our Partners in Research
- Investigators/Collaborators
- R. Spoth (Director), C. Redmond  & C. Shin (Associate Directors),
- T. Backer, K. Bierman, G. Botvin, G. Brody, S. Clair,
- T. Dishion, M. Greenberg, D. Hawkins,
- K. Kavanagh, K. Kumpfer, C. Mincemoyer,
- V. Molgaard, V. Murry, D. Perkins, J. A. Stout
- Associated Faculty/Scientists
- K. Azevedo, J. Epstein, M. Feinberg, K. Griffin,
- M. Guyll, K. Haggerty, S. Huck, R. Kosterman,
- C. Lillehoj, S. Madon, A. Mason, J. Melby, M. Michaels,
- T. Nichols, K. Randall, L. Schainker,
- T. Tsushima, L. Trudeau, J. Welsh, S. Yoo
- Prevention Coordinators
- E. Berrena, M. Bode, B. Bumbarger, E. Hanlon
- K. James, J. Meek, A. Santiago, C. Tomaschik

## Please visit our website at...