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’.  

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 Day 2 highlight from the conference was the excellent parallel session on school health.  Chris Bonell gave a paper on the results of a systematic review of school effects on pupils’ health.  One key finding was that ‘valued added’ schools (which had higher attainment and lower truancy levels than might be expected) had better health outcomes.  He suggested that this might be because these ‘authoritative’ schools provide support and control which engage pupils in school-based identities.  

In the same session Yoland Anyon discussed the differing levels of school-based service utilisation among different ethnic groups.  One conclusion was that students from Asian backgrounds had lower levels of service use, perhaps because staff were less likely to pick up their internalising behaviours, as opposed to more externalising behaviours which were more prevalent among other groups.  This seemed to match very closely some of the key findings I identified whilst recently reviewing the literature on school-based mental health services. Jamie Dowdy presented the third paper in the session, which examined differing levels of engagement with extra-curricular activities in school.


At lunchtime I led a ‘brown bag’ discussion group (though there were no brown bags) on developing and evaluating complex interventions.  A key issue that we discussed concerned the challenges around selecting which prevention interventions to adopt, when many share overlapping content.  Should we be thinking about sharing and replicating programmes, or the principles that form their basis?

As well as the plenary and parallel sessions in the afternoon, there was also another poster session in the evening.  These sessions always seem to be well attended, and with authors standing by their poster are a great way to ask questions about people’s work, and more generally promote knowledge exchange.

Finally on Day 2 there was the conference dance, with music provided by the Mothers of Prevention band (all conference delegates).  Great music, and all the more impressive given that they only get to practice together a couple of times a year.  And as with other aspects of the conference, a very inclusive feeling, with the opportunity to meet new people.

And so to Friday.  I started off in a session looking at how prevention interventions aimed at preventing substance misuse in adolescents can have longer term impacts on the health and wellbeing of young adults.  The presentations by Richard Spoth, Mark Eddy and Marie-Héléne Verénneau examined three different interventions – Strengthening Families Programme 10-14, LIFT and Family Check-up.  Given the challenges of retaining participants in trials, the follow-up data presented – some of which was around 10 years after initial recruitment, was impressive.  I also learnt more in Hélène’s presentation of how CACE analysis is undertaken to look at the outcome of participants who engaged (or would have engaged with) the intervention being evaluated.

Friday morning’s plenary had three quite different presentations.  Megan Gunnar discussed how early adversity in childhood can affect neurological and physiological development, but that nurturing and attachment can act as a buffer.  Irwin Sandler examined the effects of the NBP parenting intervention.  Whilst this had positive effects only on parenting and externalising behaviours at 6 months, there were a much larger number of effects at long term follow-up, and better impacts for high risk families. Next came what for me was probably one of the best talks of the whole conference.  Carl Castro gave an overview of the US army’s attempts to improve the psychological health of soldiers returning from deployment. 

After lunch I headed to a session which comprised four short papers on different aspects of the development and evaluation of Familias Unidas a parenting intervention for Latino families in the US.  One of the key take home messages from this session was that interventions which attempt to change/impact one behaviour or outcome have the potential to influence others which they never intended to modify.  In this case, there appeared to be some increase in physical activity among youth from families with low parental involvement at baseline.  It was also interesting to see not only mediation and moderation being incorporated into analyses, but also moderated mediation.

For the final session of the day, and the conference, I chaired a session of three papers concerned with different aspects of alcohol consumption.  The first by Kerry Lippy examined how alcohol policies around alcohol consumption or social norms/social disorganisation have the potential to reduce alcohol-related sexual violence.  The second paper by Kate Karriker-Jaffee was concerned with how neighbourhoods socio economic characteristics might affect negative consequences of drinking, and using a moderated mediation analysis looked at the role of economic distress, affluence, and drinking norms.  Finally, Eileen Pitpitan reported the findings of a survey of clients of female sex workers in Mexico, which examined whether place of sex moderated the association between alcohol consumption and condom use.  The key finding was that sex in bars/clubs was more likely to take place without condom use.

And then it was time to head to the airport.  I got a lot out of the four days of the conference.  Key highlights and things I learnt were perhaps the following:

• International collaboration (or at least dissemination or knowledge exchange?) has a key role to play in enhancing our understanding of what works, where, and how it works.
  
• We need to embrace the complexity of prevention interventions.  They can have a range of intended (and sometimes unintended) outcomes, and these may differ between different groups.
  
• We sometimes need to move beyond trying to change one behaviour or a narrow aspect of health/wellbeing and embrace connections and systems.  At the very least we need to understand how something like parenting, school attachment, or physical activity, sits within a broader network of causal pathways.
  
• What works in one place doesn't necessarily work in another place, but sometimes it can do.
  

So that’s me done.  I hope to go back next year – it was worth the journey and the jetlag to come away with new ideas and connections.  Now the challenge is to try and harness them in my own work.

So writing a conference diary each day seemed like a good idea.  But it didn’t prove to be as easy as I thought, maybe because I was too busy ... well, doing the conference. 

My pre-conference day was spent doing all things international.  In the morning I attended my first meeting of the Advisory Group for the Society for Prevention Research’s International Task Force.  It was good to hear about what the Task Force is doing to help facilitate and promote international collaboration. 

The afternoon was taken up with the International Networking Forum (organised by the International Taskforce).  It’s a great idea, as it helps connect prevention researchers from different countries, and is an excellent way to make people feel welcome.  This meeting included an overview of what the International Task Force would be working on during the coming year, the four priorities being:

1. Contributing to the development of a prevention hub which includes a registry of prevention researchers around the world
2. Work on defining what we mean by prevention science – both in different countries and in different areas of research which might constitute it
3. Drawing together information on links to websites which summarise effective interventions and strategies
4. Developing the structures and strategies of the efforts to build international collaboration through and beyond the International task force.
   

Some highlights for me were the discussions we had about the challenges of international collaboration, potential sources of help (such as the International Association of Addiction Journals mentorship scheme), the work of the UN ODC which tries to ensure prevention is based on research and evidence, and the plans for the future development of the EU SPR.

Then it was time for the international poster session, at which I was presenting our work on an exploratory trial of the Kids, Adults Together Programme.

So, then to Wednesday – day 1 of the main conference.

A fantastic start, with some really good plenary papers on the crucial role of the social and environmental determinants of health.  Leonard Syme argued that social class is often controlled for in studies, but rarely studied.  His key point was that we have to move away from a narrow focus on individual behaviours and risk factors.  Sandro Galea described the need to avoid allowing the 'urgent' crowd out the 'important', and suggested that focusing on individual behaviour interventions (rather than looking at social determinants) was a form of 'riveting distraction'.  He made the point that unless we address social determinants we will always have social gradients.

Then was a parallel session on engaging high risk youth and their families into preventive interventions.  The papers in this session and the interesting summary at the end highlighted the importance of understanding what we mean by engagement, and how best to promote it.  

After lunch there was an excellent session on the transportability and adaptation of parenting interventions.  Frances Gardner from Oxford University presented the results of a systematic review which examined the effectiveness of interventions in new countries (i.e. countries to which they had been transported from their original place of development).  The take home message was that the four interventions included in the studies reviewed indicated that they were at least as effective in the new country - sometimes more so, with stronger effects in non Western countries.  Helen Baker Henningham described the adaptation of Incredible Years for Jamaican schools, and highlighted the importance of understanding the environments in which teachers worked, and how to optimise the intervention so that they could implement it fully.

In the last parallel session of the day I attended, Jonathan Pettigrew gave an interesting paper on the relationship between implementation quality and the outcomes in a trial of Keepin It Real - a school-based substance misuse prevention intervention.  His results indicated that the quality of intervention delivery mattered as much (if not more so) than levels of adherence (the extent to which all programme activities were delivered).  

So what have I learnt so far? It's striking just how much research at the conference has been about parenting and family relationships, and it brings home for me the real impact which processes like parental communication can have on young people's health and wellbeing.  Secondly, sometimes our research findings can surprise us and raise questions as well as answers.  Why for instance, should programmes which are adapted for new countries be more effective than in their original country of development?  Thirdly, studying implementation is crucial - it tells us so much about how our interventions work, the contexts they operate within.

So less of a conference diary, and a more a rather random set of thoughts.  I think the best thing about this conference is the willingness of people to talk to others - to share,and to ask questions.

Arrived in San Francisco this evening for the annual conference of the Society for Prevention Research.  I'll be blogging my conference diary here.  Spent the flight over from the UK doing some writing, and watched a documentary - Dust Bowl, on the depression and drought that hit the Mid West of the USA in the 1930s. A powerful account of how desperate life became for people, and the resilience of both the families who stayed to try and make a living in what had become a desert, and those who left for other parts of the country.

Just back from the annual Public Health Centres of Excellence Conference at the Fuse Centre in Durham, I've been reflecting on what I learnt, both from the talks themselves, and from meeting people working in the field.  Conferences are full of etiquette, rituals and socially learned ways of 'operating', and some of these take time to learn.

One art which I am still mastering is that moment at the end of a talk, when the chair gets up and announces 'OK, we'll open it up for questions and discussion'.  Some people's hands immediately shoot up, and they make their point with confidence in relaxed style. 

For me, putting my hand up can be a nerve-wracking affair.  You have to wait until it's your turn, rehearsing the question over and over again in your mind.  And the thought process is often 'What if this question sounds daft?', 'Maybe they covered the point I'm asking about and I missed it?', or 'Maybe they explained X clearly, and I'm the only one still left thinking about it.'

And then, even more frustratingly, sometimes you have your question, go through the thought process above, conclude it's not worth asking, and then somebody two rows in front asks the very same question.  'But that was my question' you think.

So now, if I have a question, I'll usually ask it.  The more I ask, the more confortable it gets.  If the talk is on a topic I know very well I might make a comment, but most times, I prefer to ask a question when the presentation itself raises a question that I want an answer to.  And if at all possible, I keep my question succint.  As Eugene Delacroix said, "Artists who seek perfection in everything are those who cannot attain it in anything."