This study evaluated institutional sustainability of the Early Risers “Skills for Success” conduct problems prevention program. In a previous early-stage effectiveness trial Early Risers had been successfully implemented by a nonprofit community agency with guidance, supervision, technical assistance and fiscal support/oversight provided by program developers. The current advanced-stage effectiveness trial applied a randomized, control group design to determine whether this community agency could replicate earlier positive findings with a new cohort of participants, but with less direct involvement of program developers. An intent-to-intervene strategy was used to compare children randomly assigned to Early Risers or a no-intervention comparison group. Compared to results obtained in an early-stage effectiveness trial, program attendance rates were much lower and only one positive outcome was replicated. Failure to replicate program effects was not attributed to poor program implementation, because data collected pertaining to exposure, adherence and quality of delivery were acceptable, and a participation analysis showed that families who attended at higher levels did benefit. It was difficulties that the community agency experienced in engaging families in program components at recommended levels that primarily accounted for the results. Possible organizational barriers that impeded sustainability included unreliable transportation, poor collaboration between the agency and the local public school system, high staff turnover, agency downsizing, and fiduciary responsibility and accountability. It was concluded that both program developers and program providers need to be proactive in planning for sustainability.
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Notes
The original study design included three experimental conditions, each with a projected sample size of 100. Two conditions represented delivery variants of the Early Riser program and the third was an assessment-only control condition. Following recruitment, administrative downsizing in the service agency precluded implementation of one program delivery model leaving a design that compared the Early Risers prototype model with the control. As a consequence, students recruited for either of the original two program conditions were collapsed into one condition. This resulted in a program-control enrollment ratio that approximated 2:1.
Required exposure for the Family Skills program was adapted before the start of the trial in light of the serious participation problems experienced in ET1 trial (August et al., 2003b, 2004). The originally validated intervention model required a total of 12 biweekly parent sessions in year 1 and 11 sessions in year 2 (August et al., 2001). This was modified in the present study to 6 sessions in year 1 and 6 sessions in year 2.
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ACKNOWLEDGMENT
This study was supported by an Award from the National Institute of Mental Health (MH 63328).
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August, G.J., Bloomquist, M.L., Lee, S.S. et al. Can Evidence-Based Prevention Programs be Sustained in Community Practice Settings? The Early Risers’ Advanced-Stage Effectiveness Trial. Prev Sci 7, 151–165 (2006). https://doi.org/10.1007/s11121-005-0024-z
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DOI: https://doi.org/10.1007/s11121-005-0024-z