Heterogeneity in Risk and Protection Among Alaska Native/American Indian and Non-Native Children Abstract Currently, little is known about patterns of co-occurring risk and protective factors among young children. Understanding variations in co-occurring risk and protective factors among children in Alaska is important as experiences of collective trauma may contribute to differences in the intersection of risk and protective factors between Alaska Native/American Indian (AN/AI) and non-Native children. Using data from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a linkage of the 2009–2011 Alaska Pregnancy Risk Assessment Monitoring System survey and administrative data sources, and the 2012–2014 Childhood Understanding Behaviors Survey, we conducted latent class analysis to identify classes of AN/AI (N = 593) and non-Native (N = 1018) children in terms of seven risk factors (poverty, maternal depression, maternal binge drinking, parental incarceration, intimate partner violence exposure, other violence exposure, child maltreatment) and four protective factors (father figure involvement, reading by adults, family meals, peer interactions) experienced prior to age 3 years. We identified two classes among AN/AI children: (1) high risk-moderate protection (29.1%) and (2) low socioeconomic status-high protection (70.9%). We identified two classes among non-Native children: (1) moderate risk-high protection (32.9%) and (2) low risk-high protection (67.1%). A test of invariance revealed that risk and protective factor probabilities differed significantly for corresponding classes of AN/AI and non-Native children. Overall, results demonstrate heterogeneity within and between AN/AI and non-Native children in early experiences of risk and protection and suggest that interventions will be more effective if tailored to the experiences and developmental needs of specific groups of Alaska children.

How Early Is Too Early? Identification of Elevated, Persistent Problem Behavior in Childhood Abstract We inquire how early in childhood children most at risk for problematic patterns of internalizing and externalizing behaviors can be accurately classified. Yearly measures of anxiety/depressive symptoms and aggressive behaviors (ages 6–13; n = 334), respectively, are used to identify behavioral trajectories. We then assess the degree to which limited spans of yearly information allow for the correct classification into the elevated, persistent pattern of the problem behavior, identified theoretically and empirically as high-risk and most in need of intervention. The true positive rate (sensitivity) is below 70% for anxiety/depressive symptoms and aggressive behaviors using behavioral information through ages 6 and 7. Conversely, by age 9, over 90% of the high-risk individuals are correctly classified (i.e., sensitivity) for anxiety/depressive symptoms, but this threshold is not met until age 12 for aggressive behaviors. Notably, the false positive rate of classification for both high-risk problem behaviors is consistently low using each limited age span of data (< 5%). These results suggest that correct classification into highest risk groups of childhood problem behavior is limited using behavioral information observed at early ages. Prevention programming targeting those who will display persistent, elevated levels of problem behavior should be cognizant of the degree of misclassification and how this varies with the accumulation of behavioral information. Continuous assessment of problem behaviors is needed throughout childhood in order to continually identify high-risk individuals most in need of intervention as behavior patterns are sufficiently realized.

Randomized Controlled Trial of the Promoting First Relationships® Preventive Intervention for Primary Caregivers and Toddlers in an American Indian Community Abstract Preventive intervention programs that address parenting practices and children’s developmental needs early in life have led to positive changes in caregiving behavior and children’s developmental outcomes. However, little is known about the efficacy of such programs among American Indian families. This study tested the efficacy of the strengths-based Promoting First Relationships® (PFR) program in American Indian families living on a rural reservation. Participants were 34 toddlers (10–30 months old) and their primary caregivers. Families were randomized to an Immediate (n = 17) or Waitlist (n = 17) group after a home visit for baseline data collection, which included assessment of observed caregiver-child interactions, caregiver perceptions, and child behavior. After randomization, we delivered the PFR intervention in 10 visits to the Immediate group, with some adaptations based on focus groups with community members and staff input. We analyzed follow-up assessments by implementing multiple regression analyses, controlling for baseline scores and using multiple imputation to handle missing data. Results supported our primary hypotheses: the Immediate group, compared with Waitlist, had significantly higher scores on the quality (p = .011, d = 1.02) and contingent responsiveness (p = .013, d = 1.21) of caregiver-child interactions, as well as on caregiver knowledge of toddlers’ social and emotional needs and level of developmentally appropriate expectations (p = .000, d = 0.58). Caregiver stress and caregivers’ reports of child behavior did not differ significantly. Our results hold promise for additional PFR research in other Native communities.

Can Machine Learning Improve Screening for Targeted Delinquency Prevention Programs? Abstract The cost-effectiveness of targeted delinquency prevention programs for children depends on the accuracy of the screening process. Screening accuracy is often poor, resulting in wasted resources and missed opportunities to avert negative outcomes. This study examined whether screening approaches based on logistic regression or machine learning algorithms could improve accuracy relative to traditional sum-score approaches when identifying boys in the 5th grade (N = 1012) who would be repeatedly arrested for violent and serious crimes from ages 13 to 30. Screening algorithms were developed that incorporated facets of teacher-reported externalizing problems and other known risk factors (e.g., peer rejection). The predictive performance of these algorithms was evaluated and compared in holdout (i.e., test) data using the area under the receiver operating curve (AUROC) and Brier score. Both the logistic and machine learning methods yielded AUROC superior to traditional sum-score screening approaches when a broad set of risk factors for future delinquency was considered. However, this improvement was modest and was not present when using item-level information from a composite scale assessing externalizing problems. Contrary to expectations, machine learning algorithms performed no better than simple logistic models. There was a large apparent advantage of machine learning that disappeared after appropriate cross-validation, underscoring the importance of careful evaluation of these methods. Results suggest that screening using logistic regression could improve the cost-effectiveness of targeted delinquency prevention programs in some cases, but screening using machine learning would confer no marginal benefit under currently realistic conditions.

Controlling Gun Violence: Assessing the Impact of Australia’s Gun Buyback Program Using a Synthetic Control Group Experiment Abstract Gun Buyback programs have been implemented in various forms in countries such as the UK, USA, Brazil, Australia, and Argentina. Whether or not these programs are an effective approach for reducing national violent crime and homicides, however, remains unclear. Much of the uncertainty is due to the different ways in which Gun Buyback programs have been implemented. The Australian Gun Buyback program is distinguished from Gun Buyback programs in other countries by its abrupt implementation, its narrow focus on a particular class of firearms, and its broad application across the entire population. We assess the impact of Australia’s 1996 Gun Buyback program on national homicide rates using a synthetic control group quasi-experimental design, comparing the results to suicide and motor vehicle fatality trends to test for plausible alternative hypotheses. Results suggest that the Gun Buyback program significantly reduced Australia’s homicide rate in the decade following the intervention (1997–2007).

Does the Fast Track Intervention Prevent Later Psychosis Symptoms? Abstract The Fast Track (FT) intervention was a multimodal preventive intervention addressing antisocial development across 10 years of childhood and early adolescence. The intervention included parent management training, child social-cognitive skills training, peer coaching and mentoring, academic skills tutoring, and a classroom social-emotional learning program. While not specifically designed to target psychosis symptoms (e.g., social withdrawal, thought abnormalities), the present study aimed to examine whether the FT intervention prevented psychosis symptoms through childhood and adolescence and into adulthood. Participants included the FT intervention and high-risk control samples (N = 891; 69% male; M age = 6.58 years, SD = .48). Psychosis symptoms were assessed using the “thought problems” subscale of the parent-report Child Behavior Checklist during grades 1, 2, 4, 5, and 7, and the self-report Adult Behavior Checklist at age 25 years, in line with prior research using this measure. Growth models included the FT condition and covariates (i.e., initial risk screen score, cohort, socioeconomic status, rural/urban status, race, and sex) as predictors; and child, adolescent, and adult psychosis symptoms as outcomes. Intervention status was not significantly associated with the slope of psychosis symptoms; however, after controlling for concurrent cannabis use, intervention participants reported lower levels of psychosis symptoms over time. Findings suggest that interventions targeting antisocial behavior may prevent psychosis symptoms in the long term.

Informing Precision Home Visiting: Identifying Meaningful Subgroups of Families Who Benefit Most from Family Spirit Abstract The Maternal, Infant, and Early Childhood Home Visiting Program was reauthorized February 8, 2018, and invests $2 billion over 5 years to improve mothers’ and children’s outcomes across the life course. Along with this investment, the home-visiting field is striving for implementation innovations to deliver the greatest impact to the most families at the most efficient cost through a focus on precision home visiting. Consistent with the precision home-visiting approach to identify meaningful subgroups to guide content tailoring, the purpose of this paper is to answer (1) how and to what degree an evidence-based home-visiting model benefits mothers and children with substance use or depression and (2) what baseline characteristics indicate who can benefit most. We completed a secondary data analysis of the most recently completed randomized controlled trial (RCT) of Family Spirit (N = 322), a federally endorsed home-visiting intervention designed for young Native American mothers and their children. We examined how baseline differences in mothers’ substance use, depression, and demographic characteristics (household mobility, education, parity, and premature birth) moderated mothers’ and children’s intervention-related outcomes. Children born to mothers with past substance use histories benefited more from the intervention than children born to abstinent mothers (p < 0.01). Unstable housing, parity, and low educational attainment emerged as moderators of intervention effectiveness. Results from this investigation will serve as a basis for designing and evaluating a precision approach to Family Spirit and may provide lessons for other models to explore tailoring variables for optimal impact and efficiency. Trial Registry: NCT00373750

An Analysis of Response Shifts in Teacher Reports Associated with the Use of a Universal School-Based Intervention to Reduce Externalising Behaviour Abstract School-based psychosocial interventions are a widely used approach to prevent or reduce externalising behaviour. However, evaluating the effects of such interventions is complicated by the fact that the interventions may not only change the target behaviour, but also the way that informants report on that behaviour. For example, teachers may become more aware of bullying behaviour after delivering lessons on the topic, resulting in increased teacher reports of the behaviour. In this study, we used multi-group confirmatory factor analysis to evaluate whether teachers exposed to the Promoting Alternative Thinking Strategies (PATHS) intervention changed the way they reported on child externalising behaviour. Using data from the z-proso study (802 participants; 51% male; 69 teachers), teacher reports of aggressive behaviour, attention deficit hyperactivity disorder and non-aggressive conduct disorder symptoms were compared pre- and post- intervention and across the intervention and control conditions. There was no evidence that teacher reporting was affected by exposure to the intervention. This helps bolster the interpretation of intervention effects as reflecting changes in child behaviour, rather than in the manner of informant reporting.

Influence of an Implementation Support Intervention on Barriers and Facilitators to Delivery of a Substance Use Prevention Program Abstract Implementation support interventions have helped organizations implement programs with quality and obtain intended outcomes. For example, a recent randomized controlled trial called Preparing to Run Effective Programs (PREP) showed that an implementation support intervention called Getting To Outcomes (GTO) improved implementation of an evidence-based substance use prevention program (CHOICE) run in community-based settings. However, more information is needed on how these interventions affect organizational barriers and facilitators of implementation. This paper aims to identify differences in implementation facilitators and barriers in sites conducting a substance use prevention program with and without GTO. PREP is a cluster-randomized controlled trial testing GTO, a two-year implementation support intervention, in Boys & Girls Clubs. The trial compares 15 Boys & Girls Club sites implementing CHOICE (control group), a five-session evidence-based alcohol and drug prevention program, with 14 Boys & Girls Club sites implementing CHOICE supported by GTO (intervention group). All sites received CHOICE training. Intervention sites also received GTO manuals, training, and onsite technical assistance to help practitioners complete implementation best practices specified by GTO (i.e., GTO steps). During the first year, technical assistance providers helped the intervention group adopt, plan, and deliver CHOICE, and then evaluate and make quality improvements to CHOICE implementation using feedback reports summarizing their data. Following the second year of CHOICE and GTO implementation, all sites participated in semi-structured interviews to identify barriers and facilitators to CHOICE implementation using the Consolidated Framework for Implementation Research (CFIR). This paper assesses the extent to which these facilitators and barriers differed between intervention and control group. Intervention sites had significantly higher average ratings than control sites for two constructs from the CFIR process domain: planning and reflecting and evaluating. At the same time, intervention sites had significantly lower ratings on the culture and available resources constructs. Findings suggest that strong planning, evaluation, and reflection—likely improved with GTO support—can facilitate implementation even in the face of perceptions of a less desirable implementation climate. These findings highlight that implementation support, such as GTO, is likely to help low-resourced community-based organizations improve program delivery through a focus on implementation processes. Trial Registration This project is registered at ClinicalTrials.gov with number NCT02135991 (URL: https://clinicaltrials.gov/show/NCT02135991). The trial was first registered May 12, 2014.

Scaling up Evidence-Based Interventions Within the US Public Health Market Abstract The Mapping Advances in Prevention Science IV (MAPS-IV) Translation Research Task Force report provides an important enumeration of challenges and potential opportunities for improving extent of implementation of evidenced based interventions. The aspiration is for scientifically based prevention to be implemented widely enough to show population level shifts in incidence and prevalence. The MAPS-IV Task Force report by Fagan and colleagues (2019) provides a thoughtful and informative report that notes important exemplars towards that goal as well as key challenges and suggests strategies for greater impact across five publicly funded systems affecting human development. Comments are offered that center around the value of embedding prevention science within often larger and more sustained social and political forces as well as embracing scaling up within the complex funding streams in which prevention will be sustainable at scale. These include increasing attention to practical considerations that can affect how prevention is viewed, appreciated, and likely utilized as well as the ongoing challenge of how to relate evidenced based programs with the more prevalent and often preferred approaches of those deciding what is funded and what is actually implemented. This valuable contribution to Society for Prevention Research and prevention science is characterized as an important step toward strategies that might plausibly move prevention from primarily demonstration efforts to sustainable public health strategies integrated into the major systems of influence on human development.