There is strong research support for the effectiveness and feasibility of family-centered, evidence-based programs (EBPs) to prevent the developmental and negative effects of youth problem behaviors. Despite this support, there is a relatively low rate of disseminating existing EBPs to diverse nations and cultures, and there is even less research being conducted to evaluate the existing efforts towards dissemination and uptake. Youth problem behavior prevention is a burgeoning area of psychological study in Spain, yet Spanish psychologists do not currently utilize evidence-based prevention approaches. This study aimed to fill gaps in the research related to understanding best practices in disseminating and evaluating the dissemination of EBPs to international settings and to evaluating the uptake of a family-centered EBPs for use in Spain to prevent problem behavior in adolescence and adulthood. The current study utilized a pretest/posttest with a follow-up, randomized control design to conduct a pilot feasibility and effectiveness trial of a family-centered EBP proven to effectively prevent problem behavior during adolescence. Seventeen pre-adolescents (ages 9-12) and their parents from the Seville metropolitan area in Spain were randomly assigned to receive the Family Check-Up intervention (FCU) or waitlist-control condition. This study used a multimodal, multi-agent approach to (1) examine intervention feasibility and uptake, (2) measure trends in youth adjustment and family management practices in the study sample, (3) examine differences in youth behavior and internalizing problems, and positive parenting, limit setting, and monitoring based on intervention group assignment, and (4) measure motivation to change based on random assignment to the intervention condition. Results from mixed effects repeated analysis of variance analyses indicated that the intervention group made significant improvements in conduct and internalizing problems and in parental limit setting, positive parenting, and family problem solving. These quantitative findings coupled with confirmatory qualitative themes suggest that the intervention was both effective in reducing youth adjustment problems and enhancing parenting skills and feasible when applied within the Spanish cultural context. Implications of culturally sensitive, community-based methods of intervention dissemination are discussed.

abstract: The present study applied latent class analysis to a family-centered prevention trial in early childhood to identify subgroups of families with differential responsiveness to the Family Check-up (FCU) intervention. The sample included 731 families of 2-year- olds randomized to the FCU or control and followed through age five with yearly follow up assessments (Dishion et al., 2014; Shaw et al., 2015). A two-step mixture model was used to examine whether specific constellations of family characteristics at age 2 (baseline) were related to intervention response at age 3, 4, and 5. The first step empirically identified latent classes of families based on a variety of demographic and adjustment variables selected on the basis of previous research on predictors of response to the FCU and parent training in general, as well as on the clinical observations of FCU implementers. The second step modeled the effect of the FCU on longitudinal change in children's problem behavior in each of the empirically derived latent classes. Results suggested a five-class solution, where a significant intervention effect of moderate-to- large size was observed in one of the five classes. The families within the responsive class were characterized by child neglect, legal problems, and mental health issues. Pairwise comparisons revealed that the intervention effect was significantly greater in this class of families than in two other classes that were generally less at risk for the development of disruptive behavior problems, and post hoc analyses partially supported these results. Thus, results indicated that the FCU was most successful in reducing child problem behavior in the highly distressed group of families. We conclude by discussing the potential practical utility of these results and emphasizing the need for future research to evaluate this approach's predictive accuracy. / Dissertation/Thesis / Masters Thesis Psychology 2016

This article describes a case study in the use of the Family Check-Up (FCU), a family-based and ecological preventive intervention for children at risk for problem behavior. The FCU is an assessment-driven intervention that utilizes a health maintenance model; emphasizes motivation for change; and offers an adaptive, tailored approach to intervention. This case study follows one Caucasian family through their initial assessment and subsequent treatment for their toddler daughter's conduct problems over a 2-year period. Clinically meaningful improvements in child and family functioning were found despite the presence of child, parent, and neighborhood risk factors. The case is discussed with respect to the findings from a current multisite randomized control trial of the FCU and its application to other populations.

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Research has shown that children who exhibit problem behaviors in early childhood will oftentimes continue to experience these issues into adolescence, leading to an increase in negative social and health outcomes such as substance abuse and delinquency. The Family Check Up (FCU) is a proven, targeted intervention that seeks to address these problems at a young age in order to reduce the risk of these negative behaviors continuing into adolescence. The intervention consists of 3 components: 1) an initial interview in which the behavioral health consultant gets to know the family; 2) an assessment that consists of questionnaires and videotaped family interactions; and 3) a feedback session during which the family is provided with feedback unique to their particular situation, as well as appropriate solutions to these issues. The FCU has been shown to be effective in school-based settings in past studies; this study represents the first to test the feasibility of offering the FCU in a pediatric primary care practice. The aims of the study are based upon the RE-AIM framework (Reach; Effectiveness; Adoption; Implementation; and Maintenance), a Decision and Implementation (DamdI) science model that will assist in the evaluation of the utility of the FCU in the pediatric primary care setting. This particular project is focusing on two elements of the framework, Reach and Adoption. The FCU was implemented at East Tennessee State University’s (ETSU) Pediatrics Clinic beginning on January 19th, 2015. The parents of patients between the ages of 4 and 5 years old are given the Pediatric Symptom Checklist (PSC-17), a screener which helps to identify children who may be at risk for emotional and behavioral problems. If a child scores 15 or higher on the PSC-17, they are invited to participate in the components of the FCU. Research is ongoing, with 23 out of 31 patients (74.2%) completing the PSC-17 at their well-child visit. The results of the screeners thus far show that with the average score on the PSC-17 is 6.57, with the lowest score being 0 and the highest score being 19. Only 1 patient scored ≥ 15 on the PSC-17 thus far, possibly indicating the need for an expansion of the inclusion criteria for the remainder of the study. The final results of the project will indicate the rate of Reach and Adoption within the ETSU Pediatrics Clinic as well as provide evidence as to the most successful way to reach a specific population with an evidence-based intervention.

xiii, 101 p. / Ensuring that psychological interventions are well received and effective among ethnically and culturally diverse groups is at the forefront of psychological research. This study is a nonexperimental, posttest evaluation of differences between European American and ethnocultural group parents' perceptions of the Family Check-Up (FCU), a family-centered, ecologically and community-based intervention that provides family assessment, support, and motivation to change for families coming to counseling. Research has demonstrated the effectiveness of the FCU but has yet to evaluate parent perceptions of the FCU. This study examines features of intervention implementation that lead to treatment satisfaction and adherence by evaluating parent perceptions of (a) the FCU intervention, (b) therapist interpersonal qualities, and (c) therapist multicultural competence. Both parent and observational coder ratings of the intervention were assessed along these dimensions. In the first year of a longitudinal study of the FCU, data were collected from parents of children who attended three public middle schools in a metropolitan area of the Pacific Northwest. Within-subjects analyses were conducted to assure measurement validation and treatment fidelity. A between-subjects multivariate analysis of variance was utilized to examine ethnocultural group differences. Results revealed that all measures demonstrated high internal consistency reliability, high interscale correlations, and good construct validity. Results revealed high interrater agreement between parent ratings of treatment receipt and coder ratings of treatment delivery, indicating treatment fidelity. Results revealed no statistically significant differences in parent perceptions of the FCU intervention, regardless of parent ethnocultural group. Additional analyses demonstrated that observational coders rated family consultants who worked with ethnocultural group parents higher in multicultural competence than those who worked with European American parents. In summary, study results suggest (a) that the measures developed and adapted for this investigation were reliable and valid, and (b) that we found no evidence of perceived differences in the FCU intervention across ethnocultural group and European American parents. The FCU continues to be an intervention that can be successfully implemented among ethnically and culturally diverse families. / Committee in charge: Dr. Benedict McWhirter, Chair; Dr. Elizabeth Stormshak, Member; Dr. Joseph Stevens, Member; Dr. Thomas Dishion, Outside Member

Emerging adulthood is a unique developmental stage during which significant transitions in living environment, social networks, personal responsibilities, and identity development occur. Stress resulting from such transitions relates to increases in health risk behaviors. As such, emerging adults (EAs) have a high prevalence of substance use disorders and sexually transmitted infections. However, EAs are less likely to seek treatment. Therefore, brief methods of intervention, such as Motivational Interviewing (MI) and the Family Check-up (FCU), might be useful approaches for working with this unique population. MI and the FCU are linked with decreases in health risk behaviors. The FCU comprises three sessions: an initial interview, an ecological assessment, and a feedback session. MI techniques are used during the feedback session. Only a few studies have investigated treatment fidelity of the FCU and no studies have examined the use of MI techniques within the FCU. The current study aims to assess treatment fidelity of the FCU, specifically measuring the extent to which therapists adhere to principles of MI during FCU feedback sessions. The current study also aims to determine if a positive relationship exists between therapists’ MI-adherence and client change talk (CT), and to determine if MI-adherence and client CT predict post-intervention health risk behaviors among the 134 EAs who participated in the FCU. Measures of health risk behaviors were collected pre- and post-intervention. MI-adherence was measured with the Motivational Interviewing Treatment Integrity (MITI 4) and client change language was measured using the Client Language Easy Rating Scale (CLEAR) and the Motivational Interviewing Skills Code 2.1 (MISC 2.1) self-exploration code. Four therapists were assessed for treatment fidelity. Results indicate overall fair treatment fidelity. Significant differences between therapists were observed. MI-adherence was positively related to client CT, but not client self-exploration. Several indicators of MI-adherence predicted decreases in EA post-intervention health risk behaviors. Client CT predicted a decrease in EA post-intervention marijuana quantity and client self-exploration predicted increases in marijuana quantity and number of sexual partners. These results have important implications for FCU training and implementation, and indicate that MI-adherence might be a mechanism of change within the FCU intervention.

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