Co-Regulation as a Support for Older Youth in the Context of Foster Care: a Scoping Review of the Literature.

Co-regulation is a relatively new theoretical framework for interventions that connects developmental science to adolescent needs and provides strategies that can be applied across contexts. It also has value in shifting the focus of interventions to the role of relationships and interactions with caring adults, as well as supportive environments. This framework may be particularly salient for older youth with foster care experience whose relationships with adults and availability of developmental supports are disrupted. To understand how co-regulation aligns with current understanding of needs and supports for this population, we conducted a scoping review that involved systematically searching four databases, coding and charting relevant information, and actively engaging expert consultants and other stakeholders. Across 46 primarily descriptive articles, co-regulation was discussed most often in relation to relationships, as expected (89% of articles). Despite theoretical and empirical evidence of the benefits of supportive environments and intentional day-to-day interactions in promoting developmental skills and competencies, these two domains of co-regulation were referenced much less (39% and 28%, respectively). Results highlight opportunities for co-regulation supports that can be provided to older youth with foster care experience by caring adults and near-aged peers in a wide range of roles. Notable limitations in the literature were identified in applying co-regulation within the context of employment and career readiness, healthy relationships, and teen parenting. Also under-researched is the role of adult self-regulation skills and co-regulation approaches for youth from diverse backgrounds, including those who identify as LGBTQ or have disabilities. Considerations for practice and future research are provided.

Commentary on Scaling-up Evidence-based Interventions in US Public Systems to Prevent Behavioral Health Problems.

As evidence-based interventions (EBIs) to prevent mental, emotional, and behavioral health problems continue to become available, approaches for implementation in systems and settings, at scale, are needed. The article, Scaling-up Evidence-based Interventions in U.S. Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities (Fagan et al. 2019) examines five large, complex public systems (behavioral health, child welfare, education, juvenile justice, and public health) that have adopted and implemented EBIs in various ways and presents common factors that support scale-up in these systems. This commentary builds on the authors' strategic approach to offer a few additional considerations-issues of sustainability, ways of thinking about knowledge creation, and use of systems science/modeling approaches-to address scale-up in public systems. Moreover, the focus on public systems provides an opportunity to consider how the implementation and sustainment of EBIs might more directly address social determinants of health that are relevant across policy areas and public systems.

An Applied Contextual Model for Promoting Self-Regulation Enactment Across Development: Implications for Prevention, Public Health and Future Research.

This theoretical paper presents a public health approach for promoting self-regulation across development that is based in cross-disciplinary theory and research. The self-regulation promotion model includes three key approaches that are each dependent on the relationship that children and youth have with caregivers: teaching self-regulation skills, building supportive environments, and providing co-regulation. This model extends the science of self-regulation insofar as it: (1) focuses on promoting wellbeing (not only reducing risks) across domains of functioning, (2) addresses self-regulation intervention across childhood and through young adulthood, (3) integrates multiple theories and applies them to intervention in meaningful ways, and (4) identifies specific strategies that can be used in natural developmental contexts and that address the social ecological environment as well as the individual child. We describe seven key principles that support the model including a description of self-regulation processes and implications for promoting self-regulation at each developmental stage. We end with broad implications for intervention, highlighting the relevance of the self-regulation promotion model for practitioners, policy makers, and prevention researchers.

USING SINGLE-CASE DESIGNS TO EVALUATE COMPONENTS OF TRIBAL HOME-VISITATION PROGRAMS.

Single-case designs are typically used in classroom and clinical settings to assess the behavioral impacts of an intervention with an individual child. Using two illustrative case studies, this article describes the extension of this model to home-visitation programs serving tribal communities and examines the lessons learned throughout the process of adapting this approach. Our experience suggests that the benefits of using this design outweigh the associated challenges and allows researchers to expand the use of single-case designs to previously unexplored settings. Specifically, some of the benefits discussed include allowing for evaluative rigor in contexts with small samples, allowing everyone who qualifies to immediately participate, providing visual representations of the outcome-making the results more tangible and accessible to a broader audience, and allowing for a deep level of cultural sensitivity. The article also provides some general guidelines to address the practical challenges one may face when attempting to use single-case designs in novel ways within nonschool settings.

CONTEXTUAL ISSUES FOR IMPLEMENTATION AND EVALUATION OF HOME-VISITATION PROGRAMS FOR AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES: AN INTRODUCTION TO THE TRIBAL MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAM.

Home-visiting programs have become a key component of evidence-based services for pregnant women, new mothers, their infants, and their families. When Congress authorized the Maternal Infant and Early Childhood Home Visiting Program (MIECHV) in 2010, it set aside 3% of the $1.5 billion in funding to support home-visiting programs operated by tribes, Tribal MIECHV programs have been funded in 14 states and have served over 3,100 families, providing nearly 55,000 home visits to families at risk for poor child, maternal, and family outcomes. In this Introduction to the Special Issue of the Infant Mental Health Journal on the Tribal MIECHV initiative, we provide some key contexts of the work of the Tribal MIECHV grantees as well as an overview of the issues covered in the other articles.

APPROACHES TO THE EVALUATION OF CULTURAL ADAPTATIONS OF HOME VISITING IN TRIBAL COMMUNITIES.

The research that underlies evidence-based practices is often based on relatively homogenous study samples, thus limiting our ability to understand how the study findings apply in new situations as well as our understanding of what might need to be adapted. In a preliminary effort to address those gaps, the requirements for the Tribal Maternal Infant and Early Childhood Home Visiting Program (MIECHV) included the expectation that grantees design and implement rigorous evaluations to address local priorities and to help build the knowledge base regarding the use of evidence-based home-visiting programs in tribal communities. A priority that emerged across many Tribal MIECHV grantees was to determine the added benefit of the cultural adaptations that they were making to their home-visiting programs. While there is literature to describe recommended processes for making cultural adaptations to evidence-based programs themselves, there are very few guidelines for evaluating these adaptations. In this article, we review the varied evaluation approaches utilized by Tribal MIECHV grantees and provide three case examples of how evaluators and tribal communities worked together to articulate evaluation questions and choose appropriate and feasible evaluation designs. The lessons derived from these Tribal MIECHV evaluation experiences have implications for the role of the evaluator in diverse communities across the country evaluating home visiting and other evidence-based practices in settings characterized by unique cultural contexts.

The Intersection Between Prevention Science and Evidence-Based Policy: How the SPR Evidence Standards Support Human Services Prevention Programs.

The revised Society for Prevention Research (SPR) standards of evidence are an exciting advance in the field of prevention science. We appreciate the committee's vision that the standards represent goals to aspire to rather than a set of benchmarks for where prevention science is currently. The discussion about the standards highlights how much has changed in the field over the last 10 years and as knowledge, theory, and methods continue to advance, the new standards push the field toward increasing rigor and relevance. This commentary discusses how the revised standards support work of translating high-quality evaluations to support evidence-based policy and work supporting evidence-based programs' ability to implement at scale. The commentary ends by raising two areas, generating evidence at scale and transparency of research, as additional areas for consideration in future standards.

A school-based expressive writing intervention for at-risk urban adolescents' aggressive behavior and emotional lability.

This school-based randomized controlled trial tested the efficacy of 2 expressive writing interventions among youth living in high-violence urban neighborhoods. Seventeen classrooms (n = 258 seventh graders; 55% female; 91% African American/Black) from 3 public schools were randomized to 3 conditions in which they wrote 8 times about a nonemotional topic (control condition) or about experiencing and witnessing violence following either a standard or an enhanced expressive writing protocol. Outcomes were assessed 1 month prior and 2 and 6 months postintervention and included teacher-rated emotional lability and aggressive behavior and child-rated physical aggression. Intent-to-treat, mixed-model analyses controlled for preintervention measures of outcomes, sex, race, and family structure. At 2 months postintervention, relative to controls, students in the standard expressive writing condition had lower levels of teacher-rated aggression and lability (d = -.48). The beneficial effects of the writing interventions on aggression and lability were stronger at higher levels of community violence exposure.

Results of a rural school-based peer-led intervention for youth: goals for health.

BACKGROUND: School-based interventions are critical for enhancing the health of youth. The Goals for Health (GFH) school-based project was a goal-setting and life-skills intervention conducted in rural areas to increase self-efficacy, knowledge, and positive behaviors related to healthy eating. The intervention was peer-led with high school students teaching health and life skills to sixth-grade students. The purpose of this study was to examine the impact of the GFH school-based program on healthy eating outcomes related to self-efficacy, attitudes, knowledge, and behavior, and to examine the impact of quality of program implementation on the above outcomes. METHODS: Twenty-three rural schools in Virginia (15) and New York (8) participated in the study. Twelve of the schools were intervention schools that received the 12-week GFH program. The remaining 11 were wait-list control schools. Sixth graders (n = 2120 baseline) from all schools were surveyed at 4 time points (preintervention, postintervention, 1 and 2 year follow-up). RESULTS: Results included significant change patterns across the 4 assessment points in the predicted direction for healthy eating-related self-efficacy and fat and fiber knowledge. No significant change patterns were found at follow-up for fat, fiber, or fruit and vegetable intake. Results also indicated differences across gender and ethnicity and significant findings related to quality of implementation. CONCLUSIONS: Future interventions need to provide opportunities to practice healthy living skills over an extended period of time, include components that focus on contextual change in the school and the family, and monitor program implementation.

Individual factors influencing effective nonviolent behavior and fighting in peer situations: a qualitative study with urban African American adolescents.

This qualitative study examined individual-level factors that influence adolescents' responses to problem situations involving peers. Interviews were conducted with 106 middle school students (97% African American) from an urban school system. Participants described factors that would make it easier and those that would make it more difficult for adolescents to make specific responses to problem situations. Responses included effective nonviolent responses and fighting. Qualitative analysis identified 17 individual-level themes representing personal resources, beliefs and values, perceived consequences, and appraisal of the situation. The identification of factors that influence fighting and nonviolent behavior has important implications for efforts to reduce aggression and promote effective nonviolent responses to problem situations.

Developing a comprehensive approach to youth violence prevention in a small city.

A Center for Academic Excellence in Youth Violence Prevention was established in 1999 at Virginia Commonwealth University, in the small city of Richmond, Virginia. The social context of Richmond provides many challenges and assets for preventing youth violence, including high levels of youth exposure to violence and exemplary role models for resiliency. In this paper, the conceptual framework used to guide Center activities is explained first, followed by an accounting of the initial activities for developing a community mobilization process. Next, examples are presented of how the core theme of "Strengthening the Voices of Stakeholders" was implemented at the levels of grassroots/taxpayer, organizations, and systems/policy. A university policy strategy for involving more sectors of the University in community partnerships to prevent youth violence and promote positive early childhood development is then described. The paper closes with an assessment of the mobilization efforts to date and a sketch of new plans for the future.

Public health training on the prevention of youth violence and suicide: an overview.

Although injury is the leading cause of death for Americans aged 40 and under, curricula in U.S. Schools of Public Health rarely include training on injury prevention or control. Domestically and internationally, when the topic of injury is addressed, the focus is often on unintentional injuries. Yet intentional injuries from violence and self-harm (apart from acts of war and terrorism) and the acute and chronic health problems associated with them take a large and often hidden toll on individuals, families, and communities worldwide. Adequate education on the prevention of violence and suicide by teenagers remains missing from public health and medical training. Public health and medical practitioners are confronted by violence-related injury but are provided little formal education on youth violence or suicide, effective responses, or prevention. Adolescents' involvement in violence remains a serious public health problem. Involvement in aggression and self-harm by adolescents leaves them at immediate risk of injury and often has ongoing and negative effects on future development, involvement in community and family life, and risk of morbidity and mortality for self and others. Public health practitioners are at the nexus of health care and service provision at local, state, federal, and multinational levels, and are well suited to provide training and technical assistance on youth violence prevention across disciplines and settings. In this article, training resources, opportunities, and strategies for prevention of the high prevalence of youth violence and suicide in the U.S. are discussed and recommendations for a new public health training initiative are outlined.

A youth violence prevention curriculum for public health students.

A six-module curriculum on youth violence prevention, The Epidemiology and Prevention of Intentional Injury, was developed for inclusion in a Virginia Commonwealth University Department of Epidemiology and Community Health graduate course for public health students. The content of the curriculum was determined by reviewing key literature and the consensus group reports of experts in the area of youth violence prevention and prevention research more generally. A rationale of course content related to youth violence prevention and an overview of course content, objectives, required reading, and assignments are provided. Suggestions are made for possible adaptation of this youth violence prevention curriculum into public health courses other than intentional injury.

Use of an audit in violence prevention research.

Auditing is an effective tool for articulating the trustworthiness and credibility of qualitative research. However, little information exists on how to conduct an audit. In this article, the authors illustrate their use of an audit team to explore the methods and preliminary findings of a study aimed at identifying the relevant and challenging problems experienced by urban teenagers. This study was the first in a series of studies to improve the ecological validity of violence prevention programs for high-risk urban teenagers, titled Identifying Essential Skills for Violence Prevention. The five phases of this audit were engaging the auditor, becoming familiar with the study, discussing methods and determining strengths and limitations, articulating audit findings, and planning subsequent research. Positioning the audit before producing final results allows researchers to address many study limitations, uncover potential sources of bias in the thematic structure, and systematically plan subsequent steps in an emerging design.

Choosing to be violence free in middle school: the student component of the GREAT Schools and Families Universal Program.

This paper describes the theoretical basis and content of the universal student component of the Guiding Responsibility and Expectations for Adolescents for Today and Tomorrow (GREAT) Schools and Families' middle school violence prevention program for changing school climate. The GREAT Student Program builds on and extends the content of the sixth grade Responding In Peaceful and Positive Ways (RIPP-6) social-cognitive violence prevention program through an expanded conceptual framework that focuses on changing school norms and explicitly incorporates cultural and contextual goals. The program consists of twenty 40-minute lessons taught by a trained facilitator on a weekly basis during the school day.