Speakers
Description
Authors: Margaret Kuklinski (University of Washington, Social Development Research Group), Dalene Beaulieu (University of Washington), Nicole Eisenberg (University of Washington), Eva-Lotta Björk (Prevention Sverige), Rivka Schwartz (SAR High School), Mats Glans (Swedish Institute for Applied Prevention Science), Birgitta Mansson (Swedish Institute for Applied Prevention Science), Sara Heide (Swedish Institute for Applied Prevention Science), Romina Veas (San Carlos de Maipo Foundation), Raul Perry (San Carlos de Maipo Foundation), Marcelo Sanchez (San Carlos de Maipo Foundation), Crisitian Meneses (San Carlos de Maipo Foundation), Jim Leighty (University of Washington)
Chair: Margaret Kuklinski
Cross-cultural research studies affirm that warm, nurturing relationships between parents and their children, along with clear guidelines for children’s behavior, promote healthy development across a variety of contexts and cultures. Guiding Good Choices (GGC) is an evidence-based universal prevention program for parents of children ages 9-14, that reduces risk factors for substance use and other behavioral health concerns, and enhances protective factors by teaching parents strategies and skills that promote bonding and enable clear guidelines. Research trials have demonstrated that GGC strengthens connection between parents and children, increases parenting skills, reduces family conflict, and improves substance use, depression symptoms, and delinquent behavior. GGC is currently available for in-person or virtually delivery to groups of parents in English, Spanish, and Swedish.
This symposium features four presentations. The first describes GGC, including its theoretical underpinnings, target audience, evidence base, outcomes, and recommendations for successful implementation. The second provides international examples of GGC implementation in two very different countries, Sweden and Chile, including describing adjustments made to align with local context. The third presentation reports on GGC implementation in a school setting, illustrating the process from program selection, to adaptation, implementation, and saturation among families in the school. The final presentation highlights the program’s acceptability and utility across diverse settings (e.g., schools, pediatrics clinics), modes (in-person, virtual), and populations (universal, selective, indicated).
These presentations reveal that GGC can be an effective tool for supporting parents and fostering adolescent health across diverse contexts and settings. Acceptability in multiple countries and cultures holds promise for extending reach of effective parenting supports globally. Implementing virtually and in diverse settings points to opportunities for reducing attendance barriers and further extending reach. The GGC program has the potential to support families and adolescents globally by equipping them with strategies aimed at preventing behavioral health problems and promoting wellbeing.
Abstract 1
What is Guiding Good Choices?
Margaret Kuklinski (University of Washington, Social Development Research Group), Dalene Beaulieu (University of Washington), Nicole Eisenberg (University of Washington)
Background: Over the last decade, behavioral health problems have risen dramatically among youth worldwide. Broader dissemination of effective family-focused prevention programs could reduce these concerns, promote health and wellbeing, and support parents and families, with positive effects on global public health. Guiding Good Choices (GGC) is an evidence-based family-focused prevention program for parents with children ages 9 to 14. It has been shown in two randomized controlled trials to sustainably reduce substance use, depression symptoms, and delinquent behavior, and to support positive, nurturing family relationships. This presentation describes GGC’s theoretical foundation; the goals of each GGC session; the tools, training, and technical assistance available to support high quality implementation; and overviews the feasibility of GGC implementation and impact in diverse countries, cultures, and context.
Method: GGC is theoretically grounded in the Social Development Strategy, which underscores the importance of strong positive bonds, which are broadly protective, and clear guidelines, which serve as guardrails against health risking behaviors. Each of GGC’s 5 sessions offers parents tools, skills, and strategies (e.g., setting consistent guidelines, conflict management, dealing with peer pressure) that promote family bonding and increase the likelihood of healthy behavior in adolescence. Information, opportunities for discussion, skills demonstration, and ample time to practice facilitate the use of tools, skills, and strategies in the home environment.
Results: In addition to evidence of positive impact on families and adolescent health, recent evaluations have demonstrated the feasibility, acceptability, and preliminary effectiveness of implementing the program in multiple settings (e.g., community-based organizations, healthcare settings), languages (e.g., Spanish, Swedish), and when delivered virtually.
Discussion: GGC is a universal anticipatory guidance curriculum with high potential for equipping families across the globe with skills to prepare for the teenage years. Training and technical assistance are routinely available to facilitators and agencies wishing to implement the program.
Abstract 2
International implementation of Guiding Good Choices: Lessons learned from Sweden and Chile
Eva-Lotta Björk (Prevention Sverige), Nicole Eisenberg (University of Washington), Sara Heide (Swedish Institute for Applied Prevention Science), Birgitta Mansson (Swedish Institute for Applied Prevention Science), Mats Glans (Swedish Institute for Applied Prevention Science), Romina Veas (San Carlos de Maipo Foundation), Crisitian Meneses (San Carlos de Maipo Foundation), Raul Perry (San Carlos de Maipo Foundation), Marcelo Sanchez (San Carlos de Maipo Foundation), Dalene Beaulieu (University of Washington)
Background: While there is a strong need for preventive interventions worldwide, there is a dearth of evidence-based programs that are linguistically and culturally relevant for use across multiple countries, especially in underserved areas (e.g., Latin America), where prevention needs are high, or in countries that lack interventions in the desired language. We share results from the implementation of Guiding Good Choices—a universal preventive parenting intervention—across two very different countries: Chile and Sweden.
Method: GGC was developed in the U.S. as a bilingual program; all materials and trainings are available in English and Spanish. In Chile, the Spanish-language version was piloted in 2021-2 as part of a feasibility study that examined implementation fidelity and participant satisfaction using surveys and observer ratings. Recruitment was tailored to the local context and Chilean substance use data were included in the curriculum, but the program was not adapted any further. In Sweden, all program materials and trainings were translated into Swedish, including creating new videos used in the curriculum. GGC implementation began in 2021 as part of city-wide community prevention efforts in two Swedish cities.
Results: In Chile, trained facilitators delivered the program to 46 parents in 4 groups. Self-report and observational data indicated that implementation fidelity and parent satisfaction were very high. Focus groups also pointed out some areas for improvement. In Sweden, 24 facilitators were trained, and to date, they have delivered GGC to 150 families. GGC has been very well accepted and has played an important role in the city's prevention efforts.
Discussion: Findings indicate it is possible to deliver GGC with high fidelity and acceptability in a new country. Despite significant cultural and political differences, GGC showed a good fit to the new settings. Families reported relating to the concepts and benefiting from the program.
Abstract 3
From early considerations to reaching saturation in Guiding Good Choices implementation
Dalene Beaulieu (University of Washington), Rivka Schwartz (SAR High School)
Background: Despite evidence that parenting programs can improve behavioral health outcomes, achieving high levels of parent participation and attendance has traditionally been challenging. This presentation highlights an effective approach to engaging parents and families in a Modern Orthodox Jewish high school community in Guiding Good Choices, an evidence-based program for parents with children ages 9 to 14, in a large urban area. The school’s thoughtful stepwise approach, supported by coaching from a GGC Specialist, resulted in high levels of exposure among families in the school.
Method: In 2019 SAR high school engaged the University of Washington’s Center for Communities that Care (Center) when staff sensed there were some significant behavioral health concerns among in students. The Center and SAR collaborated to (a) collect student self-report data to understand strengths, problem behaviors, risk factors, and protective factors, (b) select GGC in response to high levels of alcohol use revealed in the data, (c) tailor GGC to meet the population’s unique needs, and (d) implement it with fidelity and reach.
Results: Adaptations focused on increasing cultural resonance (e.g., aligning images with Orthodox teachings) prior to implementation. A small initial pilot helped build support within the school and among rabbis and parents, and provided the foundation for broader implementation within SAR. Data from parents propelled further adjustments (e.g., scheduling, Shabbat-specific examples). The community’s positive response undergirded SAR leaders’ decision to adopt a policy of mandatory participation in GGC for all incoming 9th grade parents, which has led to over 90% of parents completing the program.
Discussion: By working stepwise through a process that included close collaboration among school leadership, the SAR community, and GGC experts, SAR achieved high-fidelity implementation and optimized saturation and engagement among parents. SAR’s replicable process can be tailored to help future GGC implementers achieve their reach goals.
Abstract 4
Extending the reach of Guiding Good Choices across settings and across the prevention continuum
Nicole Eisenberg (University of Washington), Margaret Kuklinski (University of Washington, Social Development Research Group), Jim Leighty (University of Washington)
Background: Many parent-focused preventive interventions have had limited uptake even though they have demonstrated health impact, and participants who attend report high degrees of satisfaction. In this paper we highlight multiple pathways to greater reach of an evidence-based parenting intervention, Guiding Good Choices (GGC), in new contexts and populations across the prevention continuum.
Method: GGC was developed in the U.S. for in-person community or school-based delivery. We describe several innovations and strategies aimed at increasing GGC’s reach, implementation feasibility, and acceptability. They include adapting GGC for synchronous virtual delivery, broadening implementation to include healthcare settings, and increasing access among caregivers in recovery from opioid use disorder. We share results from surveys and interviews documenting fidelity, parent engagement and satisfaction and preliminary effectiveness.
Results: (a) GGC was adapted for synchronous virtual group delivery during the COVID-19 pandemic (b) and delivered to ~300 caregivers from pediatrics clinics in 3 U.S. states, who were recruited via pediatrician invitation. Implementation was satisfying to parents. Fidelity was high. Pretest-posttest comparisons showed statistically significant improvements in parenting attitudes and knowledge. (c) In one U.S. state, GGC was integrated into settings serving families in recovery from opioid use disorder; ~75 caregivers in recovery participated in GGC. Surveys and interviews revealed parents were highly satisfied, learned new skills, and observed positive impacts on their children.
Discussion: Innovations showcase the flexibility and acceptability of GGC in varied settings serving children and families. They demonstrate that GGC can be implemented virtually with high fidelity, with related gains in parent knowledge and attitudes. Finally, they show GGC’s relevance as a universal intervention and also when offered selectively to populations in which children are at higher risk for behavioral health concerns. Collectively innovations suggest GGC’s potential for stronger public health impact through broader dissemination and implementation.
| Conflict of interest | no conflicts of interest |
|---|
