Dissemination and Implementation of U.S.-Based Youth and Family-Focused Behavioral Interventions in International Contexts: Innovations and Lessons Learned

The past two decades of prevention science have led to the development of numerous evidence-based intervention programs designed to promote better health and education outcomes among vulnerable populations. With a growing body of efficacy evidence from longitudinal randomized controlled trials, scientists and practitioners now have a much better sense of what works in terms of improving outcomes for at-risk children and families. Despite the emergence of this strong empirical evidence base for promising interventions, many questions remain in the field about how to move prevention programs, most of which are developed in highly controlled settings, into diverse sociocultural and structural contexts. Dissemination of evidence based practices within international contexts raises particular challenges given even broader variation in social structural characteristics, historical contexts, and the operations of various systems of care. Drawing from our experience in the integration, cultural adaptation, and dissemination of five U.S.-developed evidence-based programs in Mexico, Costa Rica, and the Central American region, we propose a roundtable to discuss innovations and lessons learned from the dissemination and implementation of Keepin’ It Real (Marsiglia, PI); Familias Unidas (Pantin, PI); and Miles de Manos, a program adapted from Nuestras Familias (Martinez, PI), Linking the Interests of Families and Teachers (LIFT; Eddy, PI), and Positive Behavior Interventions and Supports (PBIS).

Implementation of evidence based prevention programs in international settings is far more than a technical matter. Many more fundamental challenges are at the center of international implementation including the need to understand how sociohistorical factors influence current practices, to learn how social and service systems operate and who in those systems have power to act, to identify what promising practices are already underway within these contexts, and to identify how the integration of newer intervention approaches might enhance efforts already underway. While the need for intervention accommodation is a consideration, the more central effort in implementation science is focused on community readiness and uptake. On the other hand, the cultural adaptation approach tends to emphasize how to transform the intervention model to be more ecologically valid within particular contexts by modifying elements of the intervention, without compromising its effectiveness, in order to enhance the fit between the intervention and community cultural values, preferences, and norms. In this roundtable, we propose to compare and contrast our models that bring together in diverse ways the major emphases of both implementation science and cultural adaptation, and share innovations and lessons learned from these distinct projects.