Unpacking Technical Assistance (TA) Strategies Within a State-Level Prevention Support System: A Mixed-Method Study in Determining Types and Amount of TA.

The research-practice gap between evidence-based intervention efficacy and its uptake in real-world contexts remains a central challenge for prevention and implementation science. Providing technical assistance (TA) is considered a crucial support mechanism that can help narrow the gap. However, empirical measurement of TA strategies and their variation is often lacking. The current study unpacks the black box of TA, highlighting different TA strategies, amounts, and their relation to intervention characteristics. First, we qualitatively categorized interactions between TA providers and implementers. Second, we explored how characteristics of implementing organizations and the intervention related to variations in the amount of TA delivered. Using data spanning six years, we analyzed over 10,000 encounters between TA providers and implementers. Content analysis yielded four distinct strategies: Consultation (27.2%), Coordination Logistics (24.5%), Monitoring (16.5%), and Resource Delivery (28.2%). Organizations with prior experience required less monitoring and resource delivery. Additionally, characteristics of the intervention were significantly associated with the amount of consultation, monitoring, coordination logistics, and resource delivery provided. The specific features of the intervention showed significant variation in their relation to TA strategies. These findings provide initial insights into the implications of intervention characteristics in determining how much of which TA strategies are needed to support implementations in real-world settings.

Protocol for a hybrid type 3 cluster randomized trial of a technical assistance system supporting coalitions and evidence-based drug prevention programs.

BACKGROUND: Over 5000 community anti-drug coalitions operating in the USA serve as a cornerstone of federal drug prevention. These coalitions, however, have demonstrated effectiveness in preventing substance use only when they use technical assistance (TA) and implement evidence-based programs (EBPs). The absence of TA and EBP implementation by coalitions is a key research-to-practice gap. The Coalition Check-Up TA system is designed to fill this gap by supporting community coalition implementation of EBPs. Existing TA models for evidence-based coalition approaches are resource intensive and coalition model specific. The Coalition Check-Up is a lower cost strategy that works with a variety of types of coalitions to support sustainable implementation of EBPs. This study protocol describes a hybrid type 3 effectiveness-implementation trial applying Wandersman's Interactive Systems Framework to test the effects of the Coalition Check-Up on coalition EBP implementation capacity and outcomes. The Interactive Systems Framework outlines how the prevention support system-especially TA-bolsters EBP dissemination and implementation. METHODS: Using a cluster randomized controlled design, this trial will test the overall effectiveness of the Coalition Check-Up, including how it contributes to EBP implementation and prevention of youth substance use. The first aim is to estimate the impact of the Coalition Check-Up on coalitions' capacity to do their work. We will recruit 68 anti-drug coalitions for random assignment to the Coalition Check-Up or "TA as usual" condition. We will evaluate whether the Coalition Check-Up improves coalition capacity using measures of coalition member responses about team processes, coalition network composition, and collaborative structure. Our second aim is to estimate the impact of the Coalition Check-Up on implementation of EBPs, and our third aim is to estimate the impact of the Coalition Check-Up on youth substance use. DISCUSSION: This project will clarify how the Coalition Check-Up, a scalable approach to TA due to its low cost, affects coalition capacity to support EBP implementation. Analyses also provide insight into causal pathways from the prevention support system to the prevention delivery system outlined by the Interactive Systems Framework. Results will build the evidence-base for how to support community coalitions' sustainable implementation of evidence-based prevention programs and policies. TRIAL REGISTRATION: Clinicaltrials.gov registration number NCT04592120 . Registered on October 19, 2020.

Cultural Orientation Gaps within a Family Systems Perspective.

The intersection of a family's heritage culture and new mainstream cultural norms results in person-to-person differences in values, beliefs, and behaviors, particularly among immigrant families. These differences often lead to divergent cultural views and patterns of behavior both within and between family members. According to the acculturation gap distress hypothesis, these cultural orientation gaps between family members have consequences for family functioning, and, in particular, adolescents' adjustment. Studies supporting this notion have primarily focused on processes in parent-adolescent dyads. Although scholarship on family cultural gaps emerged from a systems perspective, application of key systems tenets are notably limited in existing work. In this paper, we review the background and current state of research on family cultural gaps, provide an overview of key principles of systems perspectives, and then, integrate the cultural gap literature with key systems principles to identify future directions in research and theory.

Cytokine Patterns in Healthy Adolescent Girls: Heterogeneity Captured by Variable and Person-Centered Statistical Strategies.

BACKGROUND: Little is known about variation in individual cytokines/cytokine profiles for a large healthy, pediatric population. When cytokines in a healthy group are not abnormally high as in a disease state, it is challenging to determine appropriate statistical strategies. The aims of the study were (1) to describe variation among cytokine concentrations and profiles in healthy adolescent girls, (2) to illustrate utility of data reduction approaches novel to cytokine research, (variable-centered [principal factor analysis, PFA], person-centered [latent profile analysis, LPA]), and (3) to demonstrate utility of such methods in linking cytokine profiles to health outcomes (e.g., depressive, anxiety symptoms). METHOD: Serum was analyzed for 13 cytokines representing adaptive and innate immune responses in 262 girls (age = 11, 13, 15, and 17 years). RESULTS: There was great variation in cytokine concentrations. PFA revealed a four-factor solution explaining 73.13% of the shared variance among 13 cytokines (e.g., factor 1 included interleukin [IL]-4, IL-13, IL-5, interferon gamma; 26.65% of the shared variance). The LPA supported classifying girls into subgroups characterized by "high overall" (7.3% of sample), "high adaptive" (26.7%), "high innate" (21%), or "low overall" (45%) cytokine levels. Factors and profiles were useful in describing individual differences in depressive/anxiety symptoms (e.g., factor 1 positively associated with depressive symptoms but negatively with trait anxiety; increased depressive symptoms or trait anxiety was associated with greater likelihood of being in the "high adaptive" group). CONCLUSIONS: Healthy girls showed differences in cytokine levels and patterns of variation and important associations with psychological variables. PFA and LPA offer novel approaches useful for examining cytokine panels in healthy populations.

Can mindful parenting be observed? Relations between observational ratings of mother-youth interactions and mothers' self-report of mindful parenting.

Research on mindful parenting, an extension of mindfulness to the interpersonal domain of parent-child relationships, has been limited by its reliance on self-report assessment. The current study is the first to examine whether observational indices of parent-youth interactions differentiate between high and low levels of self-reported mindful parenting. The Iowa Family Interaction Rating Scales (IFIRS) were used to code interactions between mothers and their 7th grade youth. Mothers drawn from the top and bottom quartiles (n = 375) of a larger distribution of self-reported interpersonal mindfulness in parenting (N = 804) represented clearly defined high- and low-mindful parenting groups. Discriminant function analysis (DFA) was used to analyze how well 6 composite IFIRS observational rating variables (e.g., parental warmth, consistent discipline) discriminated between high and low self-reports of mindful parenting. DFA results were cross-validated, with statistically significant canonical correlations found for both subsamples (p < .05). Subsequent independent samples t tests revealed that group means were significantly different on all 6 IFIRS composite ratings. Confirmation of the relations between self-report mindful parenting and the observational ratings was also provided through hierarchical regression analyses conducted with a continuous predictor of mindful parenting using the full sample. Thus, the present study provides preliminary evidence for a link between self-reported mindful parenting and observed interactions between parents and youth.

Integrating mindfulness with parent training: effects of the Mindfulness-Enhanced Strengthening Families Program.

There is growing support for the efficacy of mindfulness training with parents as an intervention technique to improve parenting skills and reduce risk for youth problem behaviors. The evidence, however, has been limited to small scale studies, many with methodological shortcomings. This study sought to integrate mindfulness training with parents into the Strengthening Families Program: For Parents and Youth 10-14 (SFP 10-14), an empirically-validated family-based preventive intervention. It used a randomized-controlled comparative effectiveness study design (N = 432 families, 31% racial/ethnic minority) to test the efficacy of the Mindfulness-Enhanced Strengthening Families Program (MSFP), compared to standard SFP 10-14 and a minimal-treatment home study control condition. Results indicated that, in general, MSFP was as effective as SFP 10-14 in improving multiple dimensions of parenting, including interpersonal mindfulness in parenting, parent-youth relationship quality, youth behavior management, and parent well-being, according to both parent and youth reports at both postintervention and 1-year follow-up. This study also found that in some areas MSFP boosted and better sustained the effects of SFP 10-14, especially for fathers. Although the pattern of effects was not as uniform as hypothesized, this study provides intriguing evidence for the unique contribution of mindfulness activities to standard parent training.

A developmental-contextual model of depressive symptoms in Mexican-origin female adolescents.

The current study tested a developmental-contextual model of depressive symptomatology among Mexican-origin, female early and middle adolescents and their mothers. The final sample comprised 271 dyads. We examined the interrelations among cultural (i.e., acculturation dissonance), developmental (i.e., pubertal development and autonomy expectation discrepancies), and interpersonal (i.e., mother-daughter conflict and maternal supportive parenting) factors in predicting adolescents' depressive symptoms. For both early and middle adolescents, maternal support was negatively associated with mother-daughter conflict and depressive symptoms. Mother-daughter autonomy expectation discrepancies were positively associated with mother-daughter conflict, but this association was found only among early adolescents. Further, mother-daughter acculturation dissonance was positively associated with mother-daughter conflict but only among middle adolescents. Findings call for concurrently examining the interface of developmental, relational, and cultural factors in predicting female adolescents' depressive symptomatology and the potential differences by developmental stage (e.g., early vs. middle adolescence).

Family Correlates of Adjustment Profiles in Mexican-Origin Female Adolescents.

This study used a person-centered approach to examine patterns of adjustment along psychological (i.e., depression, self-esteem, anxiety) and academic (i.e., academic motivation) domains in a sample (N = 338) of Mexican-origin female adolescents. Four adjustment profiles were identified. A High Functioning (n = 173) group, which exhibited high positive adjustment and academic functioning, an Average Functioning (n = 83) group, who exhibited average psychological and academic functioning, an Academically Oriented and Stressed (n = 19) group, who exhibited high academic motivation, but poor psychological functioning in anxiety and negative affect, and a Low Functioning" (n = 25) group, who exhibited poor adjustment overall. Further, paternal and maternal parenting characteristics (i.e., autonomy granting, parent-adolescent conflict, and supportive parenting) were differentially related to Mexican-origin female adolescents' profiles, providing further evidence for the existence of the profiles. Results contribute to the current literature on Latino adolescents and highlight the importance of examining psychological and academic domains concurrently to determine how these two domains of adjustment are linked among this population.

Variable-centered and person-centered approaches to studying Mexican-origin mother-daughter cultural orientation dissonance.

The overall aim of the current study was to identify the methodological approach and corresponding analytic procedure that best elucidated the associations among Mexican-origin mother-daughter cultural orientation dissonance, family functioning, and adolescent adjustment. To do so, we employed, and compared, two methodological approaches (i.e., variable-centered and person-centered) via four analytic procedures (i.e., difference score, interactive, matched/mismatched grouping, and latent profiles). The sample consisted of 319 girls in the 7th or 10th grade and their mother or mother figure from a large Southwestern, metropolitan area in the US. Family factors were found to be important predictors of adolescent adjustment in all models. Although some findings were similar across all models, overall, findings suggested that the latent profile procedure best elucidated the associations among the variables examined in this study. In addition, associations were present across early and middle adolescents, with a few findings being only present for one group. Implications for using these analytic procedures in studying cultural and family processes are discussed.

Profiles of protection from substance use among adolescents.

The purpose of this study was to explore whether adolescents (N = 10,287) could be classified into homogeneous subgroups based on their protective factors and, if so, whether these constellations of protection differentially relate to adolescents' lifetime and 30-day alcohol and tobacco use. Latent class analysis with eight protective factors--four internal and four external--were used to identify the underlying latent class structure. Five profiles of protection emerged: Adequate Protection (54%), Adequate External Protection (9%), Adequate Protection with Low Adult Communication (16%), Adequate Protection with Risky Friends (9%), and Inadequate Protection (12%). Lifetime alcohol use was associated with only a modest increase in odds of belonging to the Adequate External or Low Adult Communication latent classes, but an enormous increase in odds of having Inadequate Protection or Risky Friends. Similar effects were found for past month alcohol use. Unlike alcohol use, which was related most strongly with membership in the Risky Friends latent class (relative to Adequate Protection), cigarette use was most strongly related to membership in the Inadequate Protection latent class. Findings can be used to inform prevention programs as they illustrate the relationships that exist between adolescents' profiles of protection and substance use.