Service Delivery Innovations in Community Prevention

拟议的研究旨在促进社区实践交付系统的知识，这将提高客户的参与和保留在早起的“成功的技能”进行问题预防计划。该研究将探讨儿童，父母和家庭特征与参与障碍相关的方式，这些障碍影响了基于中心和外展计划交付系统的参与率和结果。该计划将由Pillsbury United Communities（PUC）实施，这是一个非营利组织，拥有社区中心，为经济弱势的城市家庭提供服务，其中绝大多数是非洲裔美国人。儿童将在幼儿园、一年级和二年级接受攻击性/破坏性行为的筛查，PUC将在三年内实施该方案。 项目调查人员将这些参与者随机分配到基于中心或外展计划交付模式。项目调查人员将对机构工作人员的项目实施情况进行忠诚度评估，并评估客户参与率和保留率、参与和保留的感知障碍以及项目成果。具体目标的设计作为一个层次的一系列的步骤，以反映一个“适合度”的模型，确定与显着改善的心理社会和人口特征，参与率，和结果之间的配合的儿童，父母和家庭因素的具体模式，为每个交付系统模式，控制儿童攻击的水平。研究者还将对两个报销计划进行探索性成本分析（例如，有头的 模式与收费服务模式），这与两种早期崛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.