The purpose of the proposed research is to advance the dissemination of evidence-based interventions (EBIs) targeting youth health-risking behaviors, through a network of state partnerships. Toward this end, the proposed research will evaluate EBI implementation support strategies designed to facilitate broader dissemination of an empirically-validated state partnership model that effectively links existing EBI delivery systems. The need for the proposed research is indicated by epidemiological data on substance use and other health-risking problem behaviors among adolescents and by the dearth of sustained, quality implementation of EBIs designed to prevent such problems. Successful and sustained EBI implementation necessitates sustained partnerships among families, schools, and communities with a proactive technical assistance model to support them. Our PROSPER partnership model links the public school system with the land grant university dissemination system called the Cooperative Extension System and other resources in states for prevention programming. It has evolved through two decades of NIH-funded, randomized-controlled prevention trials, and has demonstrated a range of positive, long-term public health impacts. Because prevention activities offered through public schools and other youth program dissemination systems often do not utilize EBIs, particularly ones that are implemented with quality and in a sustainable way, there is a need to reach more states and communities with our model. Further development and testing of partnership adoption and implementation support components is required. We propose to conduct web-based surveys of key informants representing the land grant university Cooperative Extension, Public School, and Public Health systems from all 50 states, to assess social network and readiness factors potentially influencing the adoption of the PROSPER partnership model and to rank states on level of readiness as early adopters (Aim 1). Using information from the state survey data to select four states, we will conduct an evaluation of a partnership adoption decision-making team support strategy that incorporates motivational coaching (Aim 2). Finally, we will conduct a controlled pilot study with rural community sites in a selected partnership-ready state (Aim 3). This will involve the provision of PROSPER model training and implementation support components, along with a newly-developed web-based implementation process and outcome evaluation system. This pilot work will allow us to evaluate a range of system and organizational factors influencing the quality of EBIs implemented and EBI outcomes. It also will reveal whether PROSPER community sites show higher quality implementation of EBIs and stronger outcomes, as compared with community sites in the same states conducting usual prevention activities supported by state and federal funding, absent our partnership model.
There has been limited randomized, longitudinal study evaluating how to optimally sustain quality implementation of evidence-based interventions (EBIs) for general populations, in order to achieve population- level effects on youth smoking, other substance use, and other problem behaviors, such as aggression. Community-university partnership-based prevention trials conducted by the investigations over the past two decades have resulted in an empirically-validated model that supports high-quality, sustained implementation of general population EBIs. Past pilot work suggests the promise of specific adoption and implementation supports for broader dissemination of the model (called the PROSPER Network Model) in multiple state sites, to be further developed and tested through the proposed research.
