This study evaluated institutional sustainability of the Early Risers “Skills for Success” conduct problems prevention program. In a previous early-stage effectiveness trial Early Risers had been successfully implemented by a nonprofit community agency with guidance, supervision, technical assistance and fiscal support/oversight provided by program developers. The current advanced-stage effectiveness trial applied a randomized, control group design to determine whether this community agency could replicate earlier positive findings with a new cohort of participants, but with less direct involvement of program developers. An intent-to-intervene strategy was used to compare children randomly assigned to Early Risers or a no-intervention comparison group. Compared to results obtained in an early-stage effectiveness trial, program attendance rates were much lower and only one positive outcome was replicated. Failure to replicate program effects was not attributed to poor program implementation, because data collected pertaining to exposure, adherence and quality of delivery were acceptable, and a participation analysis showed that families who attended at higher levels did benefit. It was difficulties that the community agency experienced in engaging families in program components at recommended levels that primarily accounted for the results. Possible organizational barriers that impeded sustainability included unreliable transportation, poor collaboration between the agency and the local public school system, high staff turnover, agency downsizing, and fiduciary responsibility and accountability. It was concluded that both program developers and program providers need to be proactive in planning for sustainability.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
The original study design included three experimental conditions, each with a projected sample size of 100. Two conditions represented delivery variants of the Early Riser program and the third was an assessment-only control condition. Following recruitment, administrative downsizing in the service agency precluded implementation of one program delivery model leaving a design that compared the Early Risers prototype model with the control. As a consequence, students recruited for either of the original two program conditions were collapsed into one condition. This resulted in a program-control enrollment ratio that approximated 2:1.
Required exposure for the Family Skills program was adapted before the start of the trial in light of the serious participation problems experienced in ET1 trial (August et al., 2003b, 2004). The originally validated intervention model required a total of 12 biweekly parent sessions in year 1 and 11 sessions in year 2 (August et al., 2001). This was modified in the present study to 6 sessions in year 1 and 6 sessions in year 2.
REFERENCES
August, G. J., Egan, E. A., Hektner, J. M., & Realmuto, G. M. (2003a). Parceling component effects of a multifaceted prevention program for disruptive elementary school children. Journal Of Abnormal Child Psychology, 31, 515–527.
August, G. J., Hektner, J. M., Egan, E. A., Realmuto, G. M., & Bloomquist, M. L. (2002). The early risers longitudinal prevention trial: Examination of 3-year outcomes in aggressive children with intent-to-treat and as-intended analyses. Psychology of Addictive Behaviors, 16, 27–39.
August, G. J., Lee, S. S., Bloomquist, M. L., Realmuto, G. M., & Hektner, J. M. (2003b). Dissemination of an evidence-based preventive innovation for aggressive children living in diverse, urban neighborhoods. Prevention Science, 4, 271–286.
August, G. J., Lee, S. S., Bloomquist, M. L., Realmuto, G. M., & Hektner, J. M. (2004). Maintenance effects of an evidence-based prevention innovation for aggressive children living in culturally diverse urban neighborhoods: The Early Risers effectiveness study. Journal of Emotional and Behavioral Disorders, 12, 194–205.
August, G. J., Realmuto, G. M., Hektner, J. M., & Bloomquist, M. L. (2001). An integrated components preventive intervention for aggressive elementary school children: The Early Risers program. Journal of Consulting and Clinical Psychology, 69, 614–626.
Bamberger, M., & Cheema, S. (1990). Case studies of project sustainability: Implications for policy and operations from Asian experience. Washington, DC: The World Bank.
Bavolek, S. J., & Keene, R. G. (1999). Adult-adolescent parenting inventory AAPI-2. Park City, UT: Family Development Resources, Inc.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory manual (2nd ed.). San Antonio, TX: Psychological Corp.
Bloomquist, M. L., August, G. J., Lee, S. S., Berquist, B. E., & Mathy, R. M. (2005). Targeted prevention of antisocial behavior in children: The Early Risers “Skills for Success” Program. In R. G. Steele & M. C. Roberts (Eds.), Handbook of mental health services for children, adolescents, and families (pp. 201–214). New York: Kluwer.
Conduct Problems Prevention Research Group. (1999). Initial impact of the Fast Track Prevention Trial for conduct problems. I. The high-risk sample. Journal of Consulting and Clinical Psychology, 67, 631–647.
Dane, A. V., & Schneider, B. H. (1998). Program integrity in primary and early secondary prevention: Are implementation effects out of control? Clinical Psychology Review, 18, 23–45.
Eddy, J. M., Reid, J., Stoolmiller, M., & Fetrow, R. A. (2003). Outcomes during middle school for an elementary school-based preventive intervention for conduct problems: Follow-up results from a randomize trial. Behavioral Therapy, 34, 535–552.
Glasgow, R. F., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89, 1322–1327.
Goodman, R. M., & Stechler, A. B. (1988). The life and death of a health promotion program: An Institutionalization case study. International Quarterly of Community Health Education, 8, 5–21.
Gresham, F. M., & Elliott, S. N. (1990). Social skills rating system manual. Circle Pines, MN: American Guidance Service.
Hollingshead, A. (1975). Four-factor index of social status. Unpublished manuscript, Yale University, New Haven, CT.
Kellam, S. G., & Langevin, D. J. (2003). A framework for understanding “evidence” in prevention research and programs. Prevention Science, 4, 137–153.
Lee, S. S., August, G. J., Bloomquist, M. L., Mathy, R. M., & Realmuto, G. M. (2005). Implementing an evidence-based preventive intervention in neighborhood family centers: Examination of perceived barriers to program participation. Manuscript submitted for publication.
Lochman, J. E., & Wells, K. C. (2004). The Coping Power Program for preadolescent aggressive boys and their parents: Outcome effects at the 1-year follow-up. Journal of Consulting and Clinical Psychology, 72, 571–578.
Mancini, J. A., & Marek, L. I. (2004). Sustaining community-based programs for families: Conceptualization and Measurement. Family Relations, 53, 339–347.
Moffitt, T. E. (1993). Adolescent-limited and life—Course persistent antisocial behavior: A developmental taxonomy. Psychological Bulletin, 100, 674–701.
O’Loughlin, J., Renaud, L., Richard, L., Gomez, L. S., & Paradis, G. (1998). Correlates of the sustainability of community-based heart health promotion interventions. Preventive Medicine, 27, 702–717.
Patterson, G. E., DeBaryshe, B. D., & Ramsey, E. (1989). A developmental perspective of antisocial behavior. American Psychology, 44, 329–333.
Peters, R., & Petrunka, K. (2005, May). What happens after the demonstration phase? Examining the sustainability of a prevention project. Paper presented at the annual conference of the Society for Prevention Research, Washington, DC.
Reid, M. J., Webster-Stratton, C., & Hammond, M. (2003). Follow-up of children who received the Incredible Years intervention for oppositional-defiant disorder: Maintenance and prediction of 2-year outcome. Behavior Therapy, 34, 471–491.
Rosenthal, R. (1994). Parametric measures of effect size. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (pp. 231–244). New York: Russell Sage Foundation.
SAS Institute (2000). SAS/STAT user's guide, Version 8. Cary, NC: Author.
Shediac-Rizkallah, M. C., & Bone, L. R. (1998). Planning for sustainability of community based health programs: conceptual frameworks and future directions for research, practice, and policy. Health Education Research: Theory and Practice, 13, 87–108.
Smolkowski, K., Biglan, A., Barrera, M., Taylor, T., Black, C., & Blair, J. (2005). Schools and Homes in Partnership (SHIP): Long-term effects of a preventive intervention focused on social behavior and reading skill in Early Elementary School. Prevention Science, 6, 113–125.
Tarter, R. E., Sambrano, S., & Dunn, M. G. (2002). Predictor variables by developmental stages: A Center for Substance Abuse prevention multisite study. Psychology of Addictive Behaviors, 16, S1–S10.
Wells, K. B., Manning, W. G., & Benjamin, B. (1986). Use of outpatient mental health services in HMO and fee-for-service plans: Results from a randomized controlled trial. Health Services Research, 21, 453–474.
Werthamer-Larsson, L., Kellam, S. G., & Wheeler, L. (1991). Effect of first-grade classroom environment on child shy behavior, aggressive behavior, and concentration problems. American Journal of Community Psychology, 19, 585–602.
Woodcock, R. W., McGrew, K. S., & Mather, N. (2001). Woodcock-Johnson III Tests of Achievement. Itasca, IL: Riverside.
ACKNOWLEDGMENT
This study was supported by an Award from the National Institute of Mental Health (MH 63328).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
August, G.J., Bloomquist, M.L., Lee, S.S. et al. Can Evidence-Based Prevention Programs be Sustained in Community Practice Settings? The Early Risers’ Advanced-Stage Effectiveness Trial. Prev Sci 7, 151–165 (2006). https://doi.org/10.1007/s11121-005-0024-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-005-0024-z