Thursday’s plenary session focused on education and early childhood.  Arthur Reynolds described the mechanisms through which early cognitive gains can feed through into later social and emotional learning.  He discussed the predominance of efficacy studies over those which replicated or ‘scaled up’ intervention, and stressed the need to think about feasibility, sustainability and generalizability.  Talking about the Child-Parent Center Program, he made the point that it could save $5000 per child, and pay for the cost of itself, when compared with 1.2 years of special education.  Hirokazu Yoshikawa presented key findings from an evaluation of a programme which addressed teachers’ professional development and the classroom environment, including classroom coaching and a focus on language.  The study found moderate effects on classroom quality, but only impacts on child-level outcomes for those children who were low attendees.  He posed the question as to whether scaling up a programme can increase effectiveness.  Finally, David Willis emphasised the importance which early childhood experiences make the longer term outcomes. 

Influences on Patterns of Parents’ Engagement and Participation Behaviors in Family Prevention Programs

Some very interesting papers in this session.  Ankie Menting presented research from a study examining engagement in a parent training intervention for mothers released from incarceration.  The study looked at reasons for consent and retention, which these were associated with the extent of data provided by participants.  Monetary compensation was found not to be that important – overall parents’ desire to learn new parenting skills and to contribute to science were the key reasons for consenting, though a number of other reasons were also described.  For intervention group families, learning was most important for retention in the programme, and for control group families, contribution to science was linked to the provision of interview data during the trial. 

Anne Mauricio suggested that whilst participation in parenting programmes was influenced by family characteristics and implementation aspects, there had been less research on programme and provider effects.  In this study, group composition was linked to attendance, and there were also some links between participant characteristics and attendance.  Overall higher fidelity was linked to lower levels of attendance, though this differed slightly according to the language which the programme had been delivered in.  ‘Early terminators’ had mixed profiles, including those with a lower GPA and less externalising behavioural problems, but also those more educated and less depressed.  Sessions staffed by providers who were skilled and experienced but least like participants (in terms of ethnicity) were linked to mid programme termination

Katy Bamberger’s paper looked at how parental engagement in programmes changed over time (during attendance).  I was particularly interested in this work, since it addressed these issues in the context of SFP10-14.  Her paper looked at the relationship between parent engagement and family conflict during the sessions.  She suggested that engagement was a dynamic construct, which could be a target for enhancing programmes.  Engagement could be thought to include the interaction of the participants with the curriculum/new skills/programme content, and also with staff and other participants.  Engagement might include multiple forms of engagement – e.g. speaking, thinking and listening.  Katy’s research sought to address whether engagement was as important, or more important than, attendance.  This study used group leaders’ observation of parent sessions.  Engagement was conceptualised as including participation, interest, positive affect to leaders and other parents, and a score was created.  Over time there were differences in engagement levels between parents, and across time points.  Family conflict was used as a predictor of engagement, and was observed in the family hour – it included family tension overall and session specific tension.  Overall engagement increased over weeks 1-7, but tended to level off.  Parents with high tension engaged less and vice versa.  But both groups of parents maintained similar strategies (I think this referred to the skills and techniques they are asked to use at home between the sessions).  There was also an interaction between chronic and session specific tension.  In some sessions families with low stress overall have more engagement in sessions in with they have high stress levels (compared with families who had high stress overall).  One of the issues raised by the talk concerned which aspects of engagement programme leaders were most likely to pick up on.

Early Childhood Prevention Strategies to Promote Health and Reduce Risk for Obesity

This session discussed the emotional health consequences of weight status, and the fact that patterns of eating develop early during childhood, making this an important time to intervene, as early childhood weight status tracks into adulthood.  The first paper, by Kirsten Davison, discussed early childhood risk factors obesity.  She pointed out that there were important mechanisms linking screen time and obesity, including curtailed sleep, sedentary activity, and food consumed.  She also asked whether obesity issues could be linked to other constructs, such as family functioning.  The second paper, by Julie Lumeng made the important point that addressing obesity was far more complex than simply telling people to eat less and exercise more, and that most parents are doing the best they can, and do not want their children to be obese.  Her paper looked at ‘veracious’ eating by children in the Headstart scheme, the links between anxiety and hunger, and those between stress, cortisol and eating – stress increases emotional eating and can lead to obesity.  She suggested that when children were suffering high levels of stress, the only substance which they can use to self-regulate this stress is food (whereas adults may use alcohol or other substances).  Stress can produce abnormal cortisol levels which create changed dietary patterns.  But over time continually high levels of stress may blunt cortisol and self-regulation, reducing satiety responsiveness, which may lead to overweight.  The third paper, by Alexandra Adams looked at the prevention of obesity in tribal communities, and the importance of working with them and considering their health belief constructs.

Implementing Large Scale Interventions in Schools: Promoting Parent Engagement and School Support for Family-Centre Interventions

Andy Garbacz argued that meaningful family engagement in tiered service delivery frameworks in schools is feasible, and described the use of a ‘family zone’ or room in schools (what he described as antecedent/context building).  Carl Sumi presented results from a programme called First Steps to Success, which is designed to reinforce good behaviour in the classroom.  He stressed the need for interventions to make sure they address schools’ goals and missions – a point I heard being made at various points during the conference.  Karen Bierman described a scheme to extend and enrich head start home visits with EBI components, specifically the REDI Parent programme.  She argued that at the pre-school age stage, both cognitive skills and social readiness are important.  In the research which she presented, changes in child outcomes were achieved, but without changes in general aspects of parenting.  Skilled parents appeared to benefit children the most, but less skilled parents gained a lot (in terms of skills, etc.).  The implication appeared to be that it was not always necessary to change global parenting to bring about changes via parents.  

Friday

Friday morning I chaired a session on ‘Promoting Positive Mental Health in Children and Young People’.  It was interesting to note during Mia Köster’s session that depression scores for children increased (as measured by peers I think), possibly due to increased more awareness of depression issues. 

The morning plenary focused on the prevention of HIV/AIDS, and the use of ‘treatment as prevention’.  During the session the point was made that often the focus is on the prescription of anti-viral drugs, but it is important to remember the context in which these are delivered and received.  Biomedical technologies often eventually ‘morph’ into behaviours (e.g. condoms).  

The Effectiveness of Family Strengthening Programs for Prevention and Treatment

The first paper in this session reported on the effectiveness of the Strong African American Families Programme.  Steve Kogan suggested that the programme – adapted from SFP10-14, had as its underlying theoretical basis the goal of enhancing self-regulation.  The aim of the current study was to test the programme in ‘real world’ conditions.  Challenges in such effectiveness evaluations include: achieving delivery as intended; recruitment, especially for normative universal prevention interventions; and attention to the needs of ethnic minority groups.  This implementation used the Cooperative Extension system.  Steve made the point that prevention programmes often borrow mechanisms from more ‘treatment’ focused interventions.  SAAF was implemented in eight rural counties in Georgia through the Extension systems.  State level specialists were involved in providing technical assistance.  Adherence (delivery of the intervention) was high – at 86%.  Intermediate outcomes for the intervention group were as predicted by the programme’s logic model. 

David Collins described the cultural adaptation of a Family Strengthening Programme, targeted at parents who had been incarcerated.  

 

Terje Gunnar Ogden presented findings from a study of Parent Management Training (PMTO) – based on the Oregon Model, focusing on the issue of treatment alliance.  He distinguished between common factors (e.g. the characteristics of the therapist, and their alliance with participants)) and programme factors and their relative influence in shaping programme outcomes.  Fidelity and alliance were not empirically correlated (even though they were theoretically), but both fidelity and alliance predicted outcomes.  Fidelity predicted positive changes in outcomes, but alliance had the opposite effects.  The more ‘difficult’ the children’s behaviour at T1, the poorer the fidelity at T1.  There was no transfer from parent ratings to teacher ratings of child behaviour.  One of the questions asked at the end of this paper was whether fidelity and alliance were truly independent.

Schools and Wellbeing: Social and Emotional learning Programs

Neil Humphrey presented findings from a trial of PATHS in the UK – a universal SEL curriculum programme for children aged 7-9.  Overall, and using ITT, there were not many effects for the programme.  In implementation there were issues of low dosage, with some classes behind where they should have been in relation to delivery.  Fidelity and quality of delivery were high, but not that well correlated.  There was a strong correlation between quality of delivery and participant responsiveness.  The more SEL work that schools were doing (i.e. other programmes, etc.), the poorer the effects of PATHS, but where these other programmes comprised ‘targeted’ work, there was some positive moderation.  Higher dosage either made no difference, or possibly had a negative effect on outcomes, and the same was true for pupil reports of fidelity.  There were associations between quality of delivery and outcomes.  I think the paper also suggested that where the programme had higher reach there were better outcomes.  When sub group analyses were conducted it was identified that there were some treatment effects for some groups in relation to emotional symptoms, peer problems and pro –social behaviour (for those with initially higher levels of problems I think).  For conduct problems there was some indication of iatrogenic effects, but it was possible that this was due to positive changes in the control group (linked to new interventions delivered in those schools).  

The second paper in this session – by Michael Wigelsworth, reported findings from a meta-analysis, which compared effects (and their size) between: efficacy and effectiveness studies; those led by/involving/or not involving programme developers; and ‘home grown’ v ‘imported’ programmes.  The findings appeared to be quite complex and mixed.  Except for emotional competence, efficacy studies had bigger effects than effectiveness studies.  In terms of programmes being culturally transferred between countries, it was sometimes the case that they were more effective when adapted for a new setting, but the small numbers of programmes involved made it more difficult to identify clear patterns.  Some programmes might have a greater need for the involvement of the original developers – for instance where teachers needed to acquire new sets of skills.  There was also an important temporal aspect in the involvement of developers – that is, they might be more likely to be involved in early (feasibility or efficacy trials) when programmes were still being ‘tweaked’.  

Presidential Address and Plenary Session

This morning’s opening plenary session focused on the new Affordable Care Act which has come into force in the United States, and its impacts and challenges for the health care system in the US.  It’s interesting to listen to the talks as an outsider, and just how much the health and social care system here differs from the one which I’m familiar with in the UK.  The Presidential Address by Dr Howard Koh, Assistant Secretary of the US Department of Health and Human Services really impressed me, particularly the clear vision he set out, and his emphasis upon the need to link health and non health agencies if we are really to address the social determinants of health. 

Some key themes ran through the four papers which formed the opening plenary – the heightened role which the Affordable Care Act gives to prevention in general, the greater quality or care and the access to it, and the need for different agencies and sectors to work together.  Systems and structures matter.  Dr Koh’s talk suggested that around 9 million Americans had moved from having no health insurance to having some insurance, and how the this and the changes in restrictions on upper limits of care provision, had addressed the problem of ‘medical bankruptcy’ – not a term that I’ve heard used in discussions of the UK health system.

Special Interest Group (SIG) Meeting: Implementation and Adaptation in Prevention Research

This was a really good discussion, which tried to identify key issues which the science of implementation needs to address.  It seemed to me that a key theme running through much of the conference sessions I attended today were concerned with fidelity and adaptation, as well as the development of implementation systems.

Some of the key issues which were discussed in this SIG meeting were:

·         How important are fidelity and adaptation, and how do these two concepts interrelate – for instance, adaptations can enhance fidelity, as well as reduce it

·         Does quality of implementation matter as well as, or even more than, fidelity of implementation (the ‘how’ as well as the ‘what’)?

·         How do you ‘go to scale’ with interventions, and is more helpful to conceptualise this question as ‘how to you build intervention sustainability?’?

·         What kinds of adaptations do people make?

Implementing Prevention Programs, Policies, And Practices: Context, Culture and Fidelity

Three really interesting papers, and some good points about fidelity and context.  Jose Ruben Parra-Cordanna described her team’s contribution to moving the debate about adaptation forward, from ‘whether we should adapt’ to ‘how can we adapt’, and talked about their adaptation of a parenting programme for Latino immigrants – the very high rates of father engagement seemed impressive – at about 85% of those approached I think. 

Joy Lanwehr’s talk looked at a programme comprising visits by mentors to schools, and the important role played by school and district context in supporting or in some cases undermining the intervention.  For instance, how class teachers interacted with the mentor during their visits could be highly influential.

Finally Phillip Graham raised some important questions about the implementation of evidence-based interventions in urban, culturally diverse areas.  Some of the key questions I noted were:

·         How do we know when an intervention needs updating (either because out theories change, or because the problems or contexts we’re studying change)

·         The importance of understanding how an intervention is designed to be delivered, and the intended mechanisms of change, and not only whether the programme manual is followed to ‘the letter’ or the language/terms changed/kept the same.

21st Century Family-Based Prevention: Connecting Theory to Etiology, To Intervention Content

Mark Van Ryzin presented results from a meta analysis of family-based prevention programmes.  He noted that

·         there are now many efficacious programmes, which are becoming more diverse over time

·         that the move to use web based interventions is an important trend, as is the adaptation of existing interventions

·         there is increasing attention being paid to fidelity, including the use of manuals and manualisation.

 

The paper presented the results of the meta-analyses which code programme components (e.g. content on behaviour management, affective relationships, etc), but there did not appear to be any main effects according to these components.  One of the questions at the end asked about whether it would be helpful to look at styles/methods of delivery, which seemed a useful point.

Nancy Gonzales described her work around engaging families in school-based programmes, and the difficulties of achieving this.  She asked whether an effective programme that is long can be sustained, and described her team’s work in determining how interventions could be ‘streamlined’ and shortened, whilst retaining the core components and mechanisms.  Self-regulation was identified as the basis of the intervention being discussed, which allowed decisions to be made about what needed to be kept.  She made the point that ‘hardened’ manuals don’t necessarily fit with current day demands on parents’ time, and linked this to the rise of social media.

Finally, Gene Brody gave a fascinating talk about the potential of parenting/family programmes to reduce the risk of physical health problems (such as cardiovascular disease).  The theory underlying this was that high quality parenting can buffer the health effects in adulthood of having grown up in a low SES area.  That is, that family-centred interventions can ameliorate social and ethnic inequalities in health.

Following the three paper, Thomas Dishon provide a summary and discussion of the three papers.  Some key points which I noted were:

·         The important role of NIDA funding in family-based prevention work

·         Levels of engagement at the outset of a trial affect how we interpret the results down the line (e.g. from 5% of the families that were originally engaged?)

·         The value of moving from thinking about programs to thinking about principles – we need to integrate evidence-based principles into the everyday work of agencies.  We need to think about systems, and how the service setting affects our ability to deliver effective interventions.

·         That it is becoming harder to engage parents in interventions due to time constraints, etc.

Parenting Factors and the Prevention of Unhealthy Outcomes among Youth

Melissa Lippold’s paper examined the links between parental knowledge of youth activities and its association with substance use.  Her research focus on whether lability (fluctuations) in knowledge could have links to problem behaviour –  through processes linked to unclear standards; impacts on self esteem, depression, and internalisation of norms.  The findings of the research were pretty striking – variation in knowledge was mainly explained by lability (85%) compared to expected developmental trends (15%).  Lability appeared to be associated with substance use, with some moderation with gender (greater associations between lability and delinquency and internaliazing problems for girls).  She discussed the possible explanations for these results, reflecting that it may be normative for families to experience ‘ups and downs’ in knowledge from year to year, and may reflect the renegotiation of relationships as young people enter adolescence.  The influences on these processes could be either parent or child driven.

Stephanie Ayers used an ecodevelopmental model to look at the relationships between family, peer, school and neighbourhood factors and rates of substance use among American Indian Youth.  There were some interesting relationships here – while family communication as a whole didn’t appear to differ across users/non users of alcohol and other substances, for specific aspects of parenting such as rule and norm setting (I think) there were some quite strong associations.

Finally Dexter Thomas looked at whether parent-child relationships mediated the association between family low income and worse diabetic outcomes (for young people with Type 1 diabetes, which is not caused by diet/lifestyle factors).  This association was based on the economic stress which low socio-economic status could create on parenting styles, and the fact that parents with greater resources may invest more in their children.  The analysis found that lower income was indirectly associated with poorer adherence to diabetes reigimens, and that  poorer adherence and gylcemic control was influenced by parenting constructs.

SPR 2014 kicked off today, this year in Washington DC.  The opening day comprises ‘pre-conference’ workshops during the day, followed by a welcome reception and the NIDA International Poster Session in the evening.

Today is also the day when the SPR’s International Task Force organises its annual Networking Forum, preceded by the Task Force’s Advisory Board, of which I am a member.

The Networking Forum provides a way in which delegates from around the world can meet, and it also helps generate ideas and discussion about how SPR can promote international collaboration (at a research project level) and develop links between the society and other organisations with similar goals and interests.  Personally, I think it’s a great initiative which really helps make the conference feels open and welcoming to international delegates, and allows you to meet people at the very start of the conference, with the following days providing opportunities to build on those new connections.

A key focus of this year’s Networking Forum was to discuss the development of a guide for developing and sustaining international collaboration.  Group discussions covered three main areas which are likely to be included in the guidance: developing research questions and identifying stakeholders; the impact of cultural influences on working relationships; and strategies for analysis, writing and dissemination.  A key theme for me was the issue of when researchers should be flexible (say in relation to intervention implementation, research designs and writing strategies), and when to insist on certain standards or ways of working to ensure rigour.

The forum also provided the opportunity to hear about the work of agencies and networks with links to SPR.  This year, these included funding opportunities offered by NIDA and NIAAA, the work of UNODC in working with national governments, and updates from Mentor International on the Prevention Hub and Registry, and the new European Quality Standards for Prevention. 

Following the pre-conference workshops and the networking forum, it was time for the NIDA International Poster session, at which I was presenting a poster, with fellow attendee Sarah-Morgan Trimmer, on behalf of the Project SFP Cymru research team.  This poster session is done as part of a reception for all conference delegates, which seems to make it well attended.  Although traditionally the oral presentation might be seen as ‘high status’ than a poster presentation, I think I’d share the view that poster sessions can be a really good way of sharing research.  Whereas with traditional oral sessions the time for discussion and questions can be limited, the session tonight created lots of opportunities for people to ask us questions about the results we presented, and for us to ask delegates what they thought about the findings in our poster.

All in all I think the format of the day – with an inclusive forum in the afternoon (and other subject specific workshops) followed by a poster session and reception is a good way to welcome people, especially those attending for the first time, and to ’kick start’ some of the networking and new connections which make conferences an important part of academic life.


The full programme schedule can be found here.

My conference diary blog piece is now live on the DECIPHer Centre website.

A while back I told a colleague at work about a new coffee shop which had just opened close to our office.  'That place? It's been open for months', she replied.  And so it seems  with technology and computers - I am rarely a pioneer, and learn about labour saving devices and tricks long after other colleagues have integrated them into the daily practice.

I'm not that old (comments below are closed on that), but I have been using MS Word for most of my adult life, and it's so much a part of my daily life and work that I hardly ever give it a second thought.  Maybe I should.  A few years back I worked on a report with a colleague (not the same one who knew about the ancient coffee shop) who seemed to know how to do all kinds of things with MS Word, all of which were automated, accurate, and saved lots of time, but none of which I quite seemed to be able to get the hang of.  So, being brutally honest, I have carried on doing things manually when sometimes there has been an easier and better way.

A few weeks ago I was pulling together a large report, which included many tables and figures, and which needed to have a comprehensive and accurate contents page.  I realised that I probably needed to invest a small amount of time in finding out how to work with Word's headings system, and its ability to create titles for tables and headings, all of which can then automatically create (and update) tables of contents.  I wish I'd done this many years ago, and I'll always use the system from now on.  

Here are the main things I worked out how to do properly.  Many (most?) of you are probably doing this, and it is very likely that there are even better ways of doing some of the following, but here goes:

1. Use the Headings function (labelled Styles in the 'Home' view), and highlighting the heading text in your document, choose the relevant style from style box.  So for instance, 'Chapter 1' is a 'Heading 1', 'Introduction' is a 'Heading 2', and sub sections of the introductions are 'Heading 3', and so on.  
2. Doing this for each heading means that you can then create a table of contents with just a few clicks.  Under the 'References' tab click 'Table of contents'.  At any point you can ask Word to update the table, and any changes to the wording, order or page number of your heading will automatically be updated.
3. When you include a table in your document, right click on the table (with your cursor over the box in the top left of the table) and click 'Insert caption'.  Word gives the table a number, and includes it in the table 'legend' which you can add to with a description - e.g. Table 1: the proportion of dogs in Cardiff who wear glasses'.
4. You can do the same thing for figures.  And for both tables and figures, Word will always place the legend in the correct place (and you can change where this should be).
5. If you insert a new table/figure into to your document, change their order, or delete a table, Word will automatically update the table numbers in the legends.  So, for instance, if you have Tables 1, 2, 3, 4, and 5, and you remove Table 2, Tables 3, 4 and 5 will automatically change to 2, 3 and 4.
6. Just like for your section headings, Word can create (and, with one click, update) an index of tables, and the same for figures.  This is particularly helpful if you have a lot of tables/figures in your document.
7. If you want to refer to a table or figure in the main text of your report, you can insert a 'cross reference' to it from the 'References' option.  Say you want to include the statement 'Table 1 shows the proportion of dogs that wear glasses in Cardiff'.  Word inserts the text 'Table 1' (though you can alter what text is displayed).  Word doesn't always seem to update the table numbers in the cross references, but a tip I picked up is that if you click 'Print' and then 'Print Preview' this does make all the revisions.  Don't ask me why!
8. Right-clicking on a table and selecting 'auto fit' gives you the option to fit the table to its contents, and/or the width of the page.  I found these options good for making the tables tidier, and much better than trying to do it manually.
9. Right clicking on a table and selecting 'Table properties' allows you to choose if you want text to be able to 'wrap around' it.  For example, you may have a relatively narrow table, around which the text can continue to flow (like the photo in this blog piece).  Or you may prefer to have text, then the table, with no text by the side of it, and then more text.