AbstractParent–child violence is a public health problem that affects the lives of millions of children and families annually. It is associated with many negative short‐ and long‐term outcomes (e.g., anxiety disorders, depression, suicidal ideation, and substance abuse) and also contributes significantly to the costs associated with health and medical care, special education, criminal justice, child welfare, and losses in productivity. In this chapter, nonbehavioral and behavioral interventions to prevent the reoccurrence of abusive behavior are discussed. The nonbehavioral interventions include kinship care, foster care, and adoption and termination of parental rights. The behavioral interventions discussed include Nurse–Family Partnership, SafeCare, Parent–Child Interaction Therapy, and Incredible Years. While the field has come a long way in recognizing the prevalence of parent–child violence, how it affects the lives of children, and treatments that work, much work remains to be done to ensure that impacted families have access to and benefit from programs that have evidence of effectiveness.

Russia has one of the fastest rising rates of HIV among women in the world. This study sought to identify key factors in HIV transmission among women in Russia. Data were collected as part of a larger clinical trial to prevent alcohol-exposed pregnancies (AEP). Women at risk for an AEP were recruited at women's clinics; 708 women, aged 18-44 (M = 29.04 years), completed HIV risk surveys. Structural Equation Modeling was used to test the relationships between alcohol use and sex behavior constructs with HIV/STI risk. While the model indicated that multiple factors are involved in women's HIV/STI risk, the independent alcohol use variable explains 20 % of the variance in women's HIV/STI risk. The findings suggest that alcohol use directly and indirectly predicts HIV/STI risk among women, and its effect is mediated by alcohol use before sex.

Early home visitation (EHV) for child maltreatment prevention is widely adopted but has received inconsistent empirical support. Supplementation with interactive software may facilitate attention to major risk factors and use of evidence-based approaches. We developed eight 20-min computer-delivered modules for use by mothers during the course of EHV. These modules were tested in a randomized trial in which 413 mothers were assigned to software-supplemented e-Parenting Program (ePP), services as usual (SAU), or community referral conditions, with evaluation at 6 and 12 months. Outcomes included satisfaction, working alliance, EHV retention, child maltreatment, and child maltreatment risk factors. The software was well-received overall. At the 6-month follow-up, working alliance ratings were higher in the ePP condition relative to the SAU condition (Cohen's d = .36, p < .01), with no differences at 12 months. There were no between-group differences in maltreatment or major risk factors at either time point. Despite good acceptability and feasibility, these findings provide limited support for use of this software within EHV. These findings contribute to the mixed results seen across different models of EHV for child maltreatment prevention.

This chapter describes the Hart and Risley research, applications of their work, and its role with SafeCare, an evidence-based parent training programme that has a footprint in 25 US states, the United Kingdom, Israel, Canada, Australia, Spain and Belarus. It discusses the historical development of the SafeCare model, reviews its evidence base and describes the Parent-Infant Interaction (PII) training module. With the discovery and understanding of the 'word gap' identified by Hart and Risley's research, the city of Providence, Rhode Island, US found that two-thirds of their prospective kindergarteners arrived at school with below national academic reading levels. To address this problem, the City of Providence launched 'Providence Talks', the first municipality-driven intervention programme aiming to close the 'word gap' and increase childhood literacy. Families referred to Project 12-Ways had significantly more child maltreatment reports to child protective services prior to any intervention than the comparison families did, suggesting that the Project 12-Ways families were more 'difficult' to begin with.

The number of HIV cases attributed to heterosexual contact and the proportion of women among HIV positive individuals has increased worldwide. Russia is a country with the highest rates of newly diagnosed HIV infections in the region, and the infection spreads beyond traditional risk groups. While young women are affected disproportionately, knowledge of HIV risk behaviors in women in the general population remains limited. The objectives of this study were to identify patterns of behaviors that place women of childbearing age at high risk for HIV transmission and determine whether socio-demographic characteristics and alcohol use are predictive of the risk pattern. A total of 708 non-pregnant women, aged between 18 and 44 years, who were at risk for an alcohol-exposed pregnancy were enrolled in two regions in Russia. Participants completed a structured interview focused on HIV risk behaviors, including risky sexual behavior and alcohol and drug use. Latent class analysis was utilized to examine associations between HIV risk and other demographic and alcohol use characteristics and to identify patterns of risk among women. Three classes were identified. 34.93% of participants were at high risk, combining their risk behaviors, e.g., having multiple sexual partners, with high partner’s risk associated with partner’s drug use (class I). Despite reporting self-perceived risk for HIV/STI, this class of participants was unlikely to utilize adequate protection (i.e., condom use). The second high risk class included 13.19% of participants who combined their risky sexual behaviors, i.e., multiple sexual partners and having STDs, with partner’s risk that included partner’s imprisonment and partner’s sex with other women (class II). Participants in this class were likely to utilize protection/condoms. Finally, 51.88% of participants were at lower risk, which was associated primarily with their partners’ risk, and these participants utilized protection (class III). The odds of being in class I compared with class III were 3.3 (95% CI [1.06, 10.38]) times higher for those women who had Alcohol Use Disorders Identification Test scores ≥ 8 than those who had lower scores, and were 3.9 (95% CI [1.69, 8.97]) times higher for those who used alcohol before sex than those who did not. In addition, women who drank more days per week were 1.36 times more likely to be in class II than in class III. The study informs prevention by identifying specific population groups and targets for interventions. Alcohol use is a significant predictor and an overarching factor of HIV risk in women. Since at-risk drinking is common among young Russian women, alcohol risk reduction should be an essential component of HIV prevention efforts.

Families living in poverty are significantly more likely to become involved with child welfare services, and consequently, referred to interventions that target abusive and neglectful parenting practices. Program engagement and retention are difficult to achieve, possibly because of the concrete resource insufficiencies that may have contributed to a family's involvement with services in the first place. Various strategies have been used to enhance program completion, such as motivational interventions, monetary incentives, and financial assistance with concrete needs. This study examines the influence of adjunctive concrete support provided by home visitors on families' (N = 1754) engagement, retention, and satisfaction with services as well as parenting outcomes. Using propensity stratification, mixed modeling procedures revealed that increasing concrete support predicted greater engagement, satisfaction, goal attainment, and lower short-term recidivism. Results suggest that adjunctive concrete support is a potentially beneficial strategy for promoting service engagement and satisfaction and increasing short-term child safety.

An estimated 10% to 20% of youth in primary care exhibit behavioral symptoms and may go underdetected. Most screeners identify risk base of symptoms alone, irrespective of functional impairment. To address this issue, the Pediatric Symptom Checklist-17 (PSC-17), a widely used symptom screener, was combined with functional impairment and current behavioral services enrollment items to form the Pediatric Behavioral Health Screen (PBHS) and assessed compared to the full Child Behavior Checklist (CBCL). A total of 267 youth between 6 and 16 years of age were administered the screener and the CBCL. Areas under the receiver operating curves approached or exceeded 0.90 in all analyses, reflecting excellent classification accuracy. Almost no false negatives were observed among currently untreated cases with functional impairment. No differential item functioning was found. Performance of the PSC-17 as a pediatric primary care behavioral health screener supported previous research, and additional functional impairment items to form the PBHS appeared useful, particularly for interpreting borderline range scores.

Objective of this study is to identify background infant and maternal characteristics that predict child maltreatment (CM) incidence reporting among Neonatal Intensive Care Unit (NICU) graduates by health care providers versus community sentinels with the goal of identifying ways to improve CM risk surveillance. Demographic, medical data including diagnoses and caregiving needs at discharge for infants treated in a NICU during 2005 to 2008 were obtained from the neonatology databases. CM outcome data was obtained from child welfare databases. Latent class analysis procedures were used to identify observable infant and maternal characteristics that define unobserved groups (latent classes) that predict NICU graduates CM incidence reporting among health care providers versus community sentinels. Medical surveillance (reports made by health care providers) accounted for only 37% of the CM reports made to child welfare. Infant health was more predictive of medical surveillance than maternal characteristics suggesting that health providers may assess risk differently than community sentinels. Based on a simple, two latent class model, the latent class with high infant health indicator membership probabilities was a better predictor of health care provider related reports than the class with lower membership probabilities (odds ratio = 2.72; 95% confidence interval [1.76, 4.20]). Health care providers may be keyed more to an infant's medical frailty than to caregiver (maternal) contextual characteristics and thus may miss an opportunity to identify and intervene to prevent CM among children with medical problems. Findings raise the question of whether increased attention to contextual factors can aid or increase early identification of infants at risk of child maltreatment in NICU settings.

BACKGROUND:Drinking patterns among Russian women indicate substantial risk for alcohol-exposed pregnancies. Data about women's knowledge and attitudes related to alcohol consumption during pregnancy and the extent to which women's knowledge and attitudes affect their alcohol use remain limited.OBJECTIVES:To describe Russian women's knowledge and attitudes and assess whether women's knowledge and attitudes were associated with their risky drinking.METHODS:A cross-sectional survey was administered to women of childbearing age (n = 648). Participants were recruited at women's health clinics and asked about their alcohol consumption, pregnancy status, attitudes, and knowledge about effects of alcohol and Fetal Alcohol Syndrome (FAS).RESULTS:40% of the women surveyed believed or were uncertain whether alcohol consumption during pregnancy was acceptable. Although 34% had heard of FAS, only 8% possessed accurate knowledge. Correct knowledge was associated with decreased alcohol consumption among pregnant women, but there was no association between knowledge and risky drinking in nonpregnant women, including those who were at risk for an unplanned pregnancy or were trying to conceive. However attitudes were strongly associated with risky drinking by nonpregnant women across levels of knowledge about FAS and any alcohol use by pregnant women.CONCLUSIONS:Russian women had limited knowledge and several misconceptions about the effects of alcohol on the fetus, and risky alcohol consumption was strongly associated with women's attitudes and knowledge. The study provides strong evidence to support continuing public health education about effects of alcohol use during pregnancy. Correcting specific misconceptions and targeting the preconceptional period in health communications are necessary to reduce at-risk drinking and the risk for alcohol-exposed pregnancies.

Evidence-based treatments (EBTs) are available for treating childhood behavioral health challenges. Despite EBTs’ potential to help children and families, they have primarily remained in university settings. Little empirical evidence exists regarding how specific, commonly used training and quality control models are effective in changing practice, achieving full implementation, and supporting positive client outcomes.

Background Alcohol consumption levels in Russia are among the highest in the world [1]. Fetal Alcohol Spectrum Disorders in children are completely preventable by avoiding alcohol use during pregnancy [2]; yet, substantial numbers of women around the world consume alcohol during pregnancy mostly prior to pregnancy recognition [3-5]. A U.S. prevention model, Project CHOICES, utilized a pre-conceptional approach consisting of four counseling sessions and a family planning clinic visit [6]. A brief intervention protocol [7] and the CHOICES were adapted by the research team to design a brief intervention for implementation in public OB/GYN clinics in two regions in Russia. The objective of this study was to evaluate impact of the adapted protocol in reducing the risk for alcohol-exposed pregnancies (AEP) and alcohol consumption in general.

Background: Current evidence suggests that screening and brief intervention (SBI) programs can be effective at reducing risky alcohol consumption. While validity and reliability have been demonstrated for existing screening instruments, little is known about how the diagnostic properties of an instrument influence the cost-effectiveness of SBI. We develop a decision theoretic framework to model this issue, and to measure the potential improvement in cost-effectiveness that could result from changes in screening instrument properties and other factors associated with SBI. Material and methods: To make use of our decision theoretic model, we obtain estimates of the input parameters by conducting a comprehensive review of the literature. In particular, we review the literature on the sensitivity and specificity of the Alcohol Use Disorders Identification Test (AUDIT), and then synthesize this evidence using meta-analytic methods. We also compile evidence on the cost of SBI, the QALY gains of SBI, and the prevalence of risky drinking among primary care patients. We assess uncertainty via Monte Carlo analysis. Finally, we conduct expected value of perfect information (EVPI) analyses to investigate the sources of decision uncertainty. Results: When QALYs are valued at a conservative $1,000/QALY our decision theory indicates an optimal AUDIT threshold score of 5. Our model indicates that employing the recommended threshold score of 8 results in about $4.50 per patient in foregone benefits. This suggests large aggregate foregone benefits with even modest sized patient populations. Gender-specific results are qualitatively similar, but reveal that the optimal SBI program is dramatically different across genders. Conclusions: Despite the relatively sound psychometric properties of the AUDIT, small differences in the sensitivity and specificity can have large impacts on the cost-effectiveness of SBI. Differences in the AUDIT ’s performance across males and females, as well as differences in the prevalence of risky drinking across genders, contribute heavily to the costeffectiveness of SBI as well.

The Interdisciplinary Collaborative Team (ICT) strategy uses front-line providers as adaptation, training and quality control agents for multi-agency EBT implementation. This study tests whether an ICT transmits fidelity to subsequent provider cohorts. SafeCare was implemented by home visitors from multiple community-based agencies contracting with child welfare. Client-reported fidelity trajectories for 5,769 visits, 957 clients and 45 providers were compared using three-level growth models. Provider cohorts trained and live-coached by the ICT attained benchmark fidelity after 12 weeks, and this was sustained. Hispanic clients reported high cultural competency, supporting a cultural adaptation crafted by the ICT.

Posttraining expert case consultation is a key component of transporting and scaling up evidence-based treatments, and hopefully retaining their efficacy. Live practice observation and in vivo coaching is a strategy used in academic training environments, but is rarely feasible in field settings. Post hoc telephone consultation is a substitute strategy but does not approximate many aspects of live coaching. Live video technology offers a closer approximation but has not yet been sufficiently tested. Using a roll-out experimental design, this study compared client outcomes across doses of two posttraining expert consultation strategies-standard telephone consultation and live video coaching. The study was conducted during a two-state, 30-agency implementation involving 80 therapists and 330 cases receiving Parent-Child Interaction Therapy (PCIT). Child behavior problems fell from well above to below clinical cutoff values, with about a 1 standard deviation improvement in 14 sessions, which is within the range reported in laboratory efficacy trials. Symptom improvement was augmented by increased therapist dose of live video consultations. Phone consultation dose had no association with client level outcomes. PCIT benefits appear to be retained when the model is transported at scale into the field, and live video consultation appeared to offer small but significant advantages over telephone consultation as one element of an overall transport strategy.

AIMS:This study obtained data to inform the development of programs for prevention of Fetal Alcohol Spectrum Disorders (FASD) by examining Russian women's perceptions about the determinants of their decisions regarding alcohol consumption during pregnancy; the importance of educating professionals and community about FASD; and the credibility of various sources of information.DESIGN:Cross-sectional survey.SETTING:Seven women's clinics in St. Petersburg and the Nizhny Novgorod region in Russia.PARTICIPANTS:Six hundred and forty-eight pregnant and non-pregnant women of childbearing age.MEASURES:A face-to-face structured interview assessed demographic characteristics, pregnancy status, alcohol consumption, and level of trust in and receptivity to FASD prevention messages.FINDINGS:The most influential contributor to women's decisions regarding alcohol consumption during pregnancy was their own knowledge, followed by information from an obstetrician/gynecologist or nurse. It was most important to women that obstetrics and gynecology professionals and husbands or partners were knowledgeable about the effects of drinking during pregnancy. Physicians' recommendations and research data were regarded by the women as the most credible sources of information. There were significant variations in responses by socio-demographic characteristics and alcohol consumption levels. Younger women were more likely to report the contributions of husbands, mothers, and friends or coworkers to their decisions about alcohol consumption and indicated the importance of educating these people. Women at risk for alcohol use during pregnancy reported greater influence of husbands or partners and warning labels on containers on their alcohol consumption.CONCLUSIONS:This study emphasizes the importance of broadly disseminating information about FASD, particularly research data, through education of health professionals and the general public in Russia. Women's socio-demographic characteristics and alcohol consumption levels should be considered in designing prevention programs.

Parent training programs are the most common type of service prescribed for parents in the child welfare system. Parent-Child Interaction Therapy (PCIT), an evidence-based model originally developed as a parent-mediated treatment for disruptive behavior problems in preschool-age children, has been adapted as an intervention for maltreating parents of preschool- and school-age children. PCIT uses behavioral principles to: (a) increase positive parenting skills; (b) enhance the parent-child relationship; (c) establish effective and consistent behavior management strategies; and (d) decrease child behavior problems. The adapted version of PCIT for child welfare populations includes a motivational enhancement component which has been found necessary for reducing child welfare recidivism. Additional PCIT research findings indicate significant improvements in mental health and behavior among children in the child welfare system. The PCIT model is flexible and has been extended to home-based services and foster care settings. The fact that PCIT robustly delivers two types of benefits (i.e. reduced recidivism risk among abusive parents and improved wellbeing and behavior among children) in one compact and focused intervention makes it particularly appealing for child welfare service systems. This chapter describes PCIT and the adaptations that have been made for use in child welfare. The chapter also addresses cross-cultural adaptations of PCIT and summarizes some barriers and related implementation strategies.

Implementation and scale-up of evidence-based practices (EBPs) is often portrayed as involving multiple stakeholders collaborating harmoniously in the service of a shared vision. In practice, however, collaboration is a more complex process that may involve shared and competing interests and agendas, and negotiation. The present study examined the scale-up of an EBP across an entire service system using the Interagency Collaborative Team approach. Participants were key stakeholders in a large-scale county-wide implementation of an EBP to reduce child neglect, SafeCare®. Semistructured interviews and/or focus groups were conducted with 54 individuals representing diverse constituents in the service system, followed by an iterative approach to coding and analysis of transcripts. The study was conceptualized using the Exploration, Preparation, Implementation, and Sustainment framework. Although community stakeholders eventually coalesced around implementation of SafeCare, several challenges affected the implementation process. These challenges included differing organizational cultures, strategies, and approaches to collaboration; competing priorities across levels of leadership; power struggles; and role ambiguity. Each of the factors identified influenced how stakeholders approached the EBP implementation process. System-wide scale-up of EBPs involves multiple stakeholders operating in a nexus of differing agendas, priorities, leadership styles, and negotiation strategies. The term collaboration may oversimplify the multifaceted nature of the scale-up process. Implementation efforts should openly acknowledge and consider this nexus when individual stakeholders and organizations enter into EBP implementation through collaborative processes.