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Each year hundreds of thousands of children and families receive behavioral interventions designed to prevent child maltreatment; yet rates of maltreatment have not declined in over a decade. To reduce the prevalence and prevent the life-long negative consequences of child maltreatment, behavioral interventions must not only be effective, but also...
Citations
... (accessed on 15 December 2023)). Research is needed to enhance the evidence of existing programs and, as has been indicated, future research must improve the effectiveness and implementability of these programs [20] to ensure they reach the targeted population. ...
Child maltreatment is a global public health issue known to affect an average of 600,000 U.S. children of all ages (0–18 years old) annually. However, a preponderance of preventive programs target children on the younger end of the spectrum, specifically those aged 0–5. Annual reports of the prevalence of maltreatment provide opportunities to analyze trends, but in 2009, these reports stopped reporting the ages of victims for each type of maltreatment (i.e., neglect, physical abuse, emotional abuse, and sexual abuse). This omission limits the ability to match (or design) prevention programs responsive to the ages of those at greatest risk. Using data from the National Child Abuse and Neglect Data System (NCANDS) from 2011–2020, this secondary data analysis describes trends for four types of maltreatment by age from an epidemiological perspective. Implications for practice (i.e., prevention) and policy are presented. The findings of this study offer the first step in what is hoped to be a line of research that seeks to identify, match, and/or develop evidence-based programs to prevent child maltreatment among the populations at highest risk.
... Lastly, the potential scalability and public health impact of SFH-SC, if found to be effective, are a major goal for this research,thus, the grant funding does not support substantial changes to the time for delivery of SFH braided into SafeCare as part of child protective system implementations. Future research could expand on this work to explore adaptations to further optimize the delivery of SFH-SC [32]. ...
Background
Exposure to secondhand tobacco smoke (SHS) and child maltreatment are preventable threats to child health. Few evidence-based interventions target both SHS and child maltreatment risk. The purpose of this paper is to describe the systematic braiding process of two evidence-based programs to address child SHS in the home and maltreatment perpetration risk, and present results from the formative work and pilot study.
Methods
The first 4 steps of the systematic braiding process were completed, including the following: (1) the identification of core elements of both programs, (2) the development of an initial draft of the braided curriculum (Smoke-Free Home SafeCare — SFH-SC), (3) an acceptability and feasibility pilot of SFH-SC with caregivers of young children who reported a smoker living in the home (N = 8), and (4) feedback collection on the braided curriculum from SafeCare Providers (N = 9).
Results
Experts identified common pedagogical and theoretical underpinnings for the two programs and braided Smoke-Free Homes: Some Things Are Better Outside into two SafeCare modules. Caregiver feedback from the pilot demonstrated that participants were engaged with SFH-SC and felt supported and comfortable discussing SHS intervention content with the SFH-SC Provider. Caregiver self-reports indicated a slight increase in smoke-free home rules from baseline to follow-up and a notable reduction in parent stress on the Parent Stress Index of 5.9 points (SD = 10.2). SafeCare Provider feedback following intensive review of the curriculum indicated high feasibility for SFH-SC delivery.
Conclusions
Parent and Provider findings suggest SFH-SC is a viable intervention that has potential to reduce the public health impact of SHS and child maltreatment for at-risk families.
Protocol
The protocol for the pilot is not published elsewhere; however, the full protocol for the hybrid trial can be found here: https://clinicaltrials.gov/ct2/show/NCT05000632.
Trial registration
NCT, NCT05000632. Registered 14 July 2021, there is not a separate registration number for the pilot.
... MOST integrates insights from engineering, statistics, and behavioral intervention science, for the "development, optimization, and evaluation of behavioral, biobehavioral, and biomedical interventions" (52). Numerous, comprehensive explanations of MOST methodology exist elsewhere [e.g., (60)]. ...
Although US tobacco use trends show overall improvement, social disadvantage continues to drive significant disparities. Traditional tobacco cessation interventions and public policy initiatives have failed to equitably benefit socially-disadvantaged populations. Advancements in mobile digital technologies have created new opportunities to develop resource-efficient mobile health (mHealth) interventions that, relative to traditional approaches, have greater reach while still maintaining comparable or greater efficacy. Their potential for affordability, scalability, and efficiency gives mHealth tobacco cessation interventions potential as tools to help redress tobacco use disparities. We discuss our perspectives on the state of the science surrounding mHealth tobacco cessation interventions for use by socially-disadvantaged populations. In doing so, we outline existing models of health disparities and social determinants of health (SDOH) and discuss potential ways that mHealth interventions might be optimized to offset or address the impact of social determinants of tobacco use. Because smokers from socially-disadvantaged backgrounds face multi-level barriers that can dynamically heighten the risks of tobacco use, we discuss cutting-edge mHealth interventions that adapt dynamically based on context. We also consider complications and pitfalls that could emerge when designing, evaluating, and implementing mHealth tobacco cessation interventions for socially-disadvantaged populations. Altogether, this perspective article provides a conceptual foundation for optimizing mHealth tobacco cessation interventions for the socially-disadvantaged populations in greatest need.
... Related, there needs to be examinations of ways to make programs and models more affordable to implement such that a greater number of children and families in need can be accessed. Incorporation of innovative methods such as the engineering-inspired multiphase optimization strategy (MOST) framework could maximize the effectiveness, efficiency, affordability, and scalability of parent education programs (Guastaferro & Collins, 2019;Guastaferro et al., 2021). It remains as urgent as it was in 1983 that as a field, we not become static. ...
Child maltreatment is a public health problem of considerable magnitude. Though substantial progress has been made in the prevention of child maltreatment, one incident of maltreatment is one too many. Intervention and/or prevention efforts must always be dynamic. In this commentary, we highlight recent prevention and policy efforts in the United States, using SafeCare, an evidence-based parent support program with a focus on the prevention of neglect, as an example. We describe broad-scale implementation efforts and offer a vision for what the field must do to realize public heath impact, highlighting recent advances of parent support models in policy, advocacy, and programs. Strategies that might improve current efforts are suggested to ensure the field not become static.
Background
Newly arrived Chinese Americans face difficulties engaging in advance care planning (ACP) discussions with their family caregivers. Avoiding such discussions and failing to complete advance directives can delay palliative and hospice care. Yet, timely palliative care is essential to maintaining the quality of life at the end of life. Currently, there is a lack of interventions to help Chinese Americans diagnosed with cancer or heart disease overcome the barriers to engaging in ACP discussions via effective use of resilience.
Objective
This study aims to develop a culturally tailored, resilience-building intervention for Chinese Americans with cancer or heart disease.
Methods
The development of this intervention will be guided by the 3-phase multiphase optimization strategy. In the first phase of preparation, we will examine the prespecified components of the intervention through pilot studies to understand the necessity of each component. First, a qualitative study will be conducted to understand the experiences of 10 religious or spiritual leaders who have provided pastoral or spiritual care to Chinese Americans in Chicago, United States. The interview findings will be categorized as facilitators and barriers and integrated into the development of the intervention’s resilience-building guide. Second, a cross-sectional study will be conducted to assess the readiness of Chinese Americans to engage in ACP discussions with their family using surveys. Third, think-aloud interviews will be conducted to understand the experiences of 18 pairs of Chinese Americans and their family caregivers regarding the prototype of the culturally tailored, resilience-building intervention. Finally, we will examine the feasibility and acceptability of the intervention prototype along with issues related to the study’s implementation process.
Results
Recruitment for the qualitative study began in November 2023. As of October 2024, a total of 7 participants have been recruited, enabling a preliminary qualitative analysis to evaluate the analytical framework developed from the literature. Recruitment for the cross-sectional study began in April 2024, and as of October 2024, a total of 63 Chinese Americans have participated. The potential participant recruitment lists for the think-aloud interviews have been received, enabling recruitment to begin after the preliminary qualitative analysis is completed.
Conclusions
The proposed culturally tailored, resilience-building intervention is an innovative way to facilitate ACP discussions among Chinese Americans, particularly those diagnosed with serious chronic diseases. The findings from all 3 study methods will inform the development of the proposed intervention and identify effective recruitment strategies for this underserved and hard-to-reach population to be used in future research.
International Registered Report Identifier (IRRID)
DERR1-10.2196/59343
Preventing and treating mental health and substance use problems requires effective, affordable, scalable, and efficient interventions. The multiphase optimization strategy (MOST) framework guides researchers through a phased and systematic process of developing optimized interventions. However, new methods of systematically incorporating information about implementation constraints across MOST phases are needed. We propose that early and sustained integration of community-engaged methods within MOST is a promising strategy for enhancing an optimized intervention's potential for implementation. In this article, we outline the advantages of using community-engaged methods throughout the intervention optimization process, with a focus on the Preparation and Optimization Phases of MOST. We discuss the role of experimental designs in optimization research and highlight potential challenges in conducting rigorous experiments in community settings. We then demonstrate how relying on the resource management principle to select experimental designs across MOST phases is a promising strategy for maintaining both experimental rigor and community responsiveness. We end with an applied example illustrating a community-engaged approach to optimize an intervention to reduce the risk for mental health problems and substance use problems among children with incarcerated parents.
The prevailing strategy in the prevention of child maltreatment is early childhood home visiting. However, the effects of these programs vary among populations, there are high rates of attrition over time, and, in general, it is likely that families at greatest risk do not receive these services. To realize the full public health impact of this federally supported prevention strategy, home visiting models must consider ways to improve the effectiveness, parental engagement, and implementation of the program. This chapter introduces the engineering-inspired Multiphase Optimization Strategy (MOST) to the field of child maltreatment prevention. The objective of the MOST framework is to arrive at an intervention that strategically balances effectiveness against qualities of affordability, scalability, and efficiency. An overview of MOST is provided and then highlighted through three applied examples of how MOST may be used to improve the effectiveness, engagement, and implementation of home visiting programs. It is no longer sufficient to merely demonstrate effectiveness of home visiting programs—we must ensure these programs benefit and reach those who need it most.KeywordsIntervention optimizationMOSTIntervention scienceChild maltreatmentPreventionEngagementImplementation scienceFactorial experimentHome visitingParentingBehavioral scienceTranslational sciencePublic healthClinical trialResource constraints
