The first purpose of this review was to assess the impact of implementation on program outcomes, and the second purpose was to identify factors affecting the implementation process. Results from over quantitative 500 studies offered strong empirical support to the conclusion that the level of implementation affects the outcomes obtained in promotion and prevention programs. Findings from 81 additional reports indicate there are at least 23 contextual factors that influence implementation. The implementation process is affected by variables related to communities, providers and innovations, and aspects of the prevention delivery system (i.e., organizational functioning) and the prevention support system (i.e., training and technical assistance). The collection of implementation data is an essential feature of program evaluations, and more information is needed on which and how various factors influence implementation in different community settings.

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Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation

This report builds on a highly valued predecessor, the 1994 Institute of Medicine (IOM) report entitled Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. That report provided the basis for understanding prevention science, elucidating its then-existing research base, and contemplating where it should go in the future. This report documents that an increasing number of mental, emotional, and behavioral problems in young people are in fact preventable. The proverbial ounce of prevention will indeed be worth a pound of cure: effectively applying the evidence-based prevention interventions at hand could potentially save billions of dollars in associated costs by avoiding or tempering these disorders in many individuals. Furthermore, devoting significantly greater resources to research on even more effective prevention and promotion efforts, and then reliably implementing the findings of such research, could substantially diminish the human and economic toll.

Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities

Toward a unified treatment for emotional disorders

This meta-analysis reviewed 82 school-based, universal social and emotional learning (SEL) interventions involving 97,406 kindergarten to high school students (Mage = 11.09 years; mean percent low socioeconomic status = 41.1; mean percent students of color = 45.9). Thirty-eight interventions took place outside the United States. Follow-up outcomes (collected 6 months to 18 years postintervention) demonstrate SEL's enhancement of positive youth development. Participants fared significantly better than controls in social-emotional skills, attitudes, and indicators of well-being. Benefits were similar regardless of students’ race, socioeconomic background, or school location. Postintervention social-emotional skill development was the strongest predictor of well-being at follow-up. Infrequently assessed but notable outcomes (e.g., graduation and safe sexual behaviors) illustrate SEL's improvement of critical aspects of students’ developmental trajectories.

Promoting Positive Youth Development through School-Based Social and Emotional Learning Interventions: A Meta-Analysis of Follow-Up Effects.

There is a pressing need to enhance the availability and quality of mental health services provided to persons from historically disadvantaged racial and ethnic groups. Many previous authors have advocated that traditional mental health treatments be modified to better match clients' cultural contexts. Numerous studies evaluating culturally adapted interventions have appeared, and the present study used meta-analytic methodology to summarize these data. Across 76 studies the resulting random effects weighted average effect size was d = .45, indicating a moderately strong benefit of culturally adapted interventions. Interventions targeted to a specific cultural group were four times more effective than interventions provided to groups consisting of clients from a variety of cultural backgrounds. Interventions conducted in clients' native language (if other than English) were twice as effective as interventions conducted in English. Recommendations are provided for improving the study of outcomes associated with mental health interventions adapted to the cultural context of the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

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Culturally adapted mental health intervention: A meta-analytic review.

According to a recent report of the Surgeon General (U.S. Department of Health and Human Services 1999), a range of treatments exist for most mental disorders, and the efficacy of those treatments is well documented. However, a supplement to that report (U.S. Department of Health and Human Services 2001) notes that minorities are largely missing from the efficacy studies that make up the evidence base for treatments. Because of this omission, questions arise as to whether it is appropriate to advocate for providing evidence-based care for minority populations. Do efficacious treatments generalize to minority populations? Should we adapt care for each cultural group? Does poverty affect outcomes of care? If we were better able to encourage ethnic minorities to enter care, would outcomes be similar to those found for majority patients? New data have become available regarding the impact of mental health interventions on ethnic minorities. Although data are not available to answer each question posed above, we examine what is known about outcomes of mental health treatments for ethnic minorities and begin to answer these important questions about providing care to our growing and diverse ethnic minority populations.

Outcomes of mental health care are obtained through two types of research, efficacy and effectiveness studies. Efficacy studies, or randomized, controlled trials, are useful in identifying the outcomes that are likely to be associated with precisely defined care provided by experts. These studies identify the impact of interventions on outcomes, such as decreases in psychiatric symptoms and remission of syndromes. The goal of efficacy studies is to determine whether or not an intervention works for a specific syndrome. Thus, the populations studied need to meet criteria for that syndrome and be relatively free of comorbid disorders. Furthermore, highly trained, specialized clinicians provide the care under carefully specified conditions. To date, these studies have predominantly been conducted in nonminority populations; well-controlled efficacy studies examining outcomes of mental health care for minorities are rarely available. In fact, in an analysis conducted for the report of the Surgeon General entitled “Mental Health: Culture, Race and Ethnicity” (U.S. Department of Health and Human Services 2001), it was found that of 9266 participants involved in the efficacy studies forming the major treatment guidelines for bipolar disorder, schizophrenia, depression, and attention deficit/hyperactivity disorder (ADHD), only 561 Black, 99 Latino, 11 Asian American/Pacific Islanders, and zero American Indians/Alaskan Natives were included. Few of these studies had the power necessary to examine the impact of care on specific minorities. In this chapter, we examine available data from treatment outcome studies with minorities.

Effectiveness studies are also important when thinking about outcomes of psychosocial interventions because these studies help evaluate outcomes of care given in real-world settings. Once an intervention is found to be efficacious, effectiveness studies then determine how they work within more diverse (both in terms of diagnosis and comorbidities) populations and when given by less-specialized clinicians. Clinicians in effectiveness studies are more likely to be generalists working in clinical settings. Outcomes often include factors such as whether or not care is sought, length of care, and adequacy of interventions. In addition, because of generally larger sample sizes, some of these trials are able to examine outcomes associated with not only symptom reduction, but also with functioning, quality of life, and cost effectiveness of care. Newer studies tend to include more diverse samples and a few have specifically included a minority sample. Again, we examine data available for minorities and compare outcomes with nonminority samples.

State of the science on psychosocial interventions for ethnic minorities.

Psychosocial intervention development for the prevention and treatment of depression: Promoting innovation and increasing access.

In this study we examine the degree to which a manualized cognitive-behavioral therapy intervention can be adapted to be culturally sensitive in treating depressed low-income African American women with multiple stressors. We describe the adaptations we made to an existing intervention, a group treatment developed for depressed low-income medical patients. We also describe our evaluation of the adapted treatment in which outcomes of African American women treated in the culturally adapted group were compared to African American women treated in the non-adapted group. Following treatment, women in the adapted group exhibited a larger drop in average BDI scores. Implications are discussed in terms of challenges related to the development and evaluation of culturally adapted treatment.

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Adapted cognitive behavioral group therapy for depressed low-income African American women

Robustness of psychotherapy for depression

https://psycnet.apa.org/journals/pre/5/1/7r.pdf

How far have we come--where should we go? Representatives of the next generation of prevention researchers respond to Biglan, Eddy, Ialongo, Roosa, and Sandler.

Laura Kohn

Papers

State of the science on psychosocial interventions for ethnic minorities.

Psychosocial intervention development for the prevention and treatment of depression: Promoting innovation and increasing access.

Adapted cognitive behavioral group therapy for depressed low-income African American women

Robustness of psychotherapy for depression

How far have we come--where should we go? Representatives of the next generation of prevention researchers respond to Biglan, Eddy, Ialongo, Roosa, and Sandler.