EBP Exchange – UMB School of Social Work

In what sometimes seems like another life, I developed a program called Reducing The Risk (RTR) in the early 1980s, which turned out to be an effective curriculum for reducing the rates of unprotected sexual intercourse among youth.  As a developer of RTR, I’m now working with ETR Associates and the CDC to help them develop adaptation tools, because many users want to use an evidence based curriculum but adapt it to the cultural and developmental context (sound familiar?).  I accepted the challenge of working with the ETR/CDC team because I wanted to learn more about methods of adaptation, because everyone wants what Phillip Kendall calls “flexible fidelity”. This ETR/CDC process is intended to systematize the way you go about adapting ESIs to your local circumstances–i.e., to improve transportability.  Their work is based on prior work at SAMHSA and CDC’s Division of HIV/AIDS Prevention (DHAP).  I’ve attached the description of the adaptation tools, for anyone who is thinking about this process. I very much like what they have done. Kendall says that you need to keep the program’s “strategy” in mind when you adapt it, but is pretty vague about what strategy is. In the attached, they break they start with a very clear logic model for the intervention and then break the strategy down into (1) a description of core content components; (2) a description of core instructional components; and (3) a description of core implementation components. They also have categories of adaptations (green, yellow, red) which are clearly allowable, need consultation, and are clearly not allowable, respectively.  I hope you find this as interesting as I did.  Altuough RTR is a school-based prevention curriculum, I think it has relevance to other manualized treatments. I’ll keep you posted as this process proceeds. (CDC welcomes the dissemination of this information, so there are no copyright issues.)

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This post describes a promising approach to reducing alcohol effected pregancies (AEP)among young women who are at risk, via a four session counseling intervention, one contraception counseling visit,  and one visit to health services.  The counseled group had half the likelihood of a AEP as the control group. That is considerable and worth considering with regard to providing more basis for adding this form of intervention to our child welfare and maternal and child health work.  Olds has shown–in his Nurse-Family Partnership work–that birth spacing adds a considerable amount to the many and long-term benefits of being in the treatment group. If this brief an intervention could achieve that level of impact, this would be big news indeed.

Brief Interventions Can Prevent Drinking During Pregnancy, Study Says
January 16, 2007

Research Summary

Researchers report that a series of five brief counseling sessions was effective in getting high-risk women to quit drinking during pregnancy and start using birth control, Reuters reported Jan. 12.A study from the U.S. Centers for Disease Control and Prevention (CDC) found that women who took part in the counseling sessions and were interviewed nine months later were twice as likely to avoid risky drinking, use contraception, or both. “What we were able to do was to help the women become aware that they were at risk, and subsequently they made decisions to change their risk behavior,” said CDC researcher R. Louise Floyd.Prior to the study, the 830 women who took part in the study did not use reliable birth control and reported binge drinking or consumed eight or more alcoholic drinks per week. More than half were considered alcohol-dependent, more than 90 percent used illicit drugs, and more than 70 percent smoked.The study was published in the January 2007 issue of the American Journal of Preventive Medicine.

Reference:
Floyd, R.L., et. al. (2007) Preventing Alcohol-Exposed Pregnancies: A Randomized Controlled Trial. American Journal of Preventive Medicine, 32(1): 1-10.