Service Delivery Innovations in Community Prevention

这项拟议的研究旨在促进有关社区实践交付系统的知识，这些系统将提高客户在早起“成功技能”行为问题预防计划中的参与度和留存率。这项研究将考察与参与障碍相关的儿童、父母和家庭特征如何影响中心和外展项目交付系统的参与率和结果。该计划将由皮尔斯伯里联合社区[PUC]实施，这是一个非营利性组织，拥有社区中心，服务于经济困难的城市家庭，其中绝大多数是非裔美国人。儿童在幼儿园、一年级和二年级期间将接受攻击性/破坏性行为的筛查，临市局将在三年内实施该计划。 项目调查员将把这些参与者随机分配到基于中心或外联计划的交付模式。项目调查人员将对机构工作人员的项目实施情况进行保真度评估，并评估客户参与率和保留率、参与和留住的感知障碍以及项目结果。具体目标被设计为一系列层次化的步骤，以反映“适合度”模型，该模型确定了儿童、父母和家庭因素的特定模式，这些因素与每种交付系统模式的心理社会和人口特征、参与率和结果之间的契合度有显著改善，并控制了儿童攻击水平。调查人员还将对两个报销计划(例如大写的)进行探索性成本分析 模式与服务收费模式)，与两种早起计划交付模式未来资金的必要差异有关。

The proposed study seeks to advance knowledge about community practice delivery systems that will enhance client participation and retention in the Early Risers "Skills for Success" conduct problems prevention program. The study will examine ways in which child, parent, and family characteristics associated with barriers to participation affect participation rates and outcomes in both center-based and outreach program delivery systems. The program will be implemented by Pillsbury United Communities [PUC], a nonprofit organization with neighborhood centers that serve economically disadvantaged, urban families, the vast majority of whom are African American. Children will be screened for aggressive/disruptive behavior during the kindergarten, 1st, and 2nd grades and PUC will implement the program over a three-year period. Project investigators will randomize these participants to either the Center-Based or Outreach program delivery models. Project investigators will conduct fidelity assessments of program implementation by agency staff and evaluate rates of client participation and retention, perceived barriers to participation and retention, and program outcomes. The specific aims are designed as a hierarchical series of steps to reflect a "goodness-of-fit" model that identifies specific patterns of child, parent, and family factors associated with significant improvements in the fit between psychosocial and demographic characteristics, rates of participation, and outcomes for each delivery system modality, controlling for levels of child aggression. Investigators will also perform an exploratory cost analysis of two reimbursement schedules (e.g., capitated model vs. fee-for-service model) associated with necessary differences in future funding of the two Early Risers program delivery models.