The evidence base for many prevention and intervention programs designed to improve a variety of children’s outcomes is growing. There are programs that improve children’s behavior, others that successfully promote social-emotional learning and others that are able to prevent and reduce substance abuse. Whilst they are effective in controlled environments, the benefits associated with many of these programs are found to be variable when implemented in real-world settings.

The ability to disseminate evidence-based programs effectively on a large scale and within community settings is a significant challenge facing the field of prevention science. A recent research study conducted in the US suggests that the intensity of the training and the quality of the technical assistance provided to implementers has a bearing on the effectiveness of one evidence based intervention - Coping Power - when implemented under real-world conditions.

Coping Power is a two-year prevention and intervention program for aggressive children. It comprises a child component and a parent component, both of which are delivered in the school setting. Children attend sessions during lesson time in which they develop emotional awareness, anger management and social problem solving skills. Parents receive fewer sessions (34 versus 16) and the focus is on rewarding appropriate behaviors and setting age-appropriate limits and expectations. The program is delivered by school counselors.

Professor John Lochman and colleagues at Duke University, found that service providers who expected to receive prompt feedback from their trainers about their performance delivered Coping Power with greater care and enthusiasm, developed more high quality engagement with students who in turn displayed improved behavioral and social outcomes after completing the program.

The trial, reported in the Journal of Consulting and Clinical Psychology, involved 57 schools in North Alabama, US. Program deliverers (school counselors) were randomly allocated to one of three conditions. Coping Power plus feedback (CP-TF), Coping Power basic training (CP-BF) and a non-intervention control condition. Both CP-TF and CP-BF counselors attended three initial workshop training days prior to the start of the intervention and monthly training sessions. The monthly sessions each lasted two hours and focused on training for forthcoming sessions, debriefing from previous sessions and delivery-related problem solving.

Counselors in the CP-TF condition also had access to a comprehensive package of technical assistance. This included an email account and telephone hotline through which they could reach the trainers for individual consultation on implementation concerns. They also received supervisory feedback - trainers reviewed audiotapes of program sessions every week and provided comments on the participants’ engagement with the program and the counselor’s ability to deliver the material, engage students and generally manage the groups.

Lochman reports that counselors in the CP-BF condition failed to achieve any significant improvements in behavior when compared to the non-intervention control conditions. In contrast, counselors who received regular technical assistance with a strong supervisory element (CP-TF) achieved reductions children’s externalizing behavior as reported by both parents and teachers.

The researchers estimate that the costs associated with the review of audiotapes and regular feedback requires an additional 20 to 30 hours of technical assistance for each trainee. This in effect doubles the cost of provider training, but is essential if benefits to participants are to be delivered. Lochman recommends that ‘sufficient funding should be provided to ensure intensive levels of training for evidence-based programs in community settings, and training procedures should require participants to engage in some level of performance feedback’.

Reference:
Lochman JE, Boxmeyer C, Powell N, Qu L, Wells K, Windle, M (2009) Dissemination of the Coping Power Program: Importance of Intensity of Counselor Training, Journal of Consulting and Clinical psychology, 77, 3, p.397-409