Kate Guastaferro
Kate Guastaferro
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Assistant Professor of Social and Behavioral Sciences
Associate Director of the Center for the Advancement and Dissemination of Intervention Optimization
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Professional overview
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Kate Guastaferro, PhD is an intervention scientist by training, her work is devoted to the development, optimization, implementation and evaluation of effective, efficient, affordable and scalable interventions with high public health impact. She is an expert in the multiphase optimization (MOST) strategy and her expertise is in parent-focused, multicomponent behavioral interventions to prevent child maltreatment. Dr. Guastaferro co-led a statewide trial focused on the coordinated implementation of three evidence-base child sexual abuse prevention programs; included in this trial was the parent-focused child sexual abuse program that she developed, piloted and evaluated. Her current work is focused on the integration of intervention optimization into the prevention of child maltreatment.
Prior to joining NYU, Dr. Guastaferro was an assistant research professor in human development and family studies at the Pennsylvania State University, and an affiliate of its Prevention Research Center and Child Maltreatment Solutions Network. In 2020, she was awarded the Victoria S. Levin Award for Early Career Success in Young Children’s Mental Health Research from the Society for Research in Child Development. She has been published in Child Maltreatment, Translational Behavioral Medicine, and the American Journal of Public Health.
Dr. Guastaferro received her PhD and MPH from Georgia State University’s School of Public Health, and her BA in anthropology from Boston University. She also completed a year of postdoctoral training at the Pennsylvania State University.
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Education
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Postdoctoral Fellow, Prevention and Methodology Training Program (T32 DA017629), The Pennsylvania State UniversityPhD Public Health, Georgia State UniversityMPH Health Promotion, Georgia State UniversityBA Anthropology, Boston University
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Honors and awards
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Victoria S. Levin Award, Society for Research on Child Development (2020)NIH Loan Repayment Program Award: Toward the Optimization of Behavioral Interventions to Prevent Child Maltreatment (201820192020)Public Health Achievement Award, Georgia State University (2016)Scarlet Key Honor Society, Boston University (2008)
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Publications
Publications
Child Maltreatment Types by Age: Implications for Prevention
AbstractGuastaferro, K., & Shipe, S. L. (n.d.).Publication year
2024Journal title
International journal of environmental research and public healthVolume
21Issue
1AbstractChild maltreatment is a global public health issue known to affect an average of 600,000 U.S. children of all ages (0–18 years old) annually. However, a preponderance of preventive programs target children on the younger end of the spectrum, specifically those aged 0–5. Annual reports of the prevalence of maltreatment provide opportunities to analyze trends, but in 2009, these reports stopped reporting the ages of victims for each type of maltreatment (i.e., neglect, physical abuse, emotional abuse, and sexual abuse). This omission limits the ability to match (or design) prevention programs responsive to the ages of those at greatest risk. Using data from the National Child Abuse and Neglect Data System (NCANDS) from 2011–2020, this secondary data analysis describes trends for four types of maltreatment by age from an epidemiological perspective. Implications for practice (i.e., prevention) and policy are presented. The findings of this study offer the first step in what is hoped to be a line of research that seeks to identify, match, and/or develop evidence-based programs to prevent child maltreatment among the populations at highest risk.Firearm screening and secure storage counseling among home visiting providers: a cross-sectional study of SafeCare® providers in the U.S.
AbstractOsborne, M. C., Guastaferro, K., Banks, S., Vedantam, H., & Self-Brown, S. (n.d.).Publication year
2024Journal title
Frontiers in Public HealthVolume
12AbstractBackground: Firearms used in pediatric firearm deaths are most often obtained from the child’s home, making secure firearm storage initiatives imperative in prevention efforts. Evidence-based home visiting (EBHV) programs are implemented with over 277,000 families annually, providing an opportunity for secure firearm storage counseling. The purpose of this study was to assess EBHV providers’ experiences with firearm screening (“assessment”), secure storage counseling, and their perceptions for related training needs. Methods: Providers in the U.S. from SafeCare®, an EBHV program often implemented with families experiencing increased risk of child neglect and physical or emotional abuse, were invited to participate in a survey to examine firearm assessment and attitudes toward and experiences with firearm safety counseling. Survey items were primarily Likert scale ratings to indicate level of agreement, with some open-ended follow-up questions. Descriptive statistics (i.e., frequencies and percentages) were used to report item-level agreement. A post hoc analysis was conducted using Spearman correlation to examine the association between assessment and counseling and provider-level factors. Results: Sixty-three SafeCare providers consented to and completed the survey items. Almost three-quarters (74.6%) agreed/strongly agreed that they assess in-home firearm availability. However, 66.7% agreed/strongly agreed that they have not been adequately trained to discuss firearm safety topics. A substantial proportion (80.6%) indicated they would counsel more if materials and training on this topic were available. Response variability emerged by level of urbanicity. A post hoc analysis found that providers’ self-reported frequency of assessment and counseling were associated with their comfort level discussing firearm safety and whether or not they had worked with families impacted by firearm injury. Conclusion: SafeCare providers report a need for materials and training on secure firearm storage, and a willingness to provide more counseling with proper training to the families they serve. Findings illuminate the need for secure storage initiatives for EBHV programs, which have broad service reach to a substantial number of at-risk U.S. families annually.Piloting an Alternative Implementation Modality for a School-Based Child Sexual Abuse Prevention Curriculum
AbstractMozid, N. E., Espinosa, R. N., Grayson, C., Falode, O., Yang, Y., Glaudin, C., & Guastaferro, K. (n.d.).Publication year
2024Journal title
International journal of environmental research and public healthVolume
21Issue
2AbstractBackground: In the U.S., the most pervasive child sexual abuse (CSA) prevention strategy involves school-based prevention programs; however, the reach of these programs is limited due to implementation constraints, such as budgets or turnover. This is notable as standard delivery of often requires two facilitators in the classroom. Leveraging a natural experiment in the implementation of Safe Touches, the current study sought to explore the feasibility of implementation with a single facilitator using pre-recorded videos compared to the standard in-person delivery. Methods: A six-item CSA-related knowledge questionnaire was delivered to (N = 1480) second-graders post-workshop. An independent-samples t-test was used to compare the mean of CSA-related knowledge item responses for each delivery modality. Student-level data were paired with teacher evaluations and an interview with the facilitator. Results: Across workshops delivered in 25 schools, there was no significant difference in knowledge based on CSA-related questions by workshop modality. Teachers indicated the facilitators responded effectively to the children’s questions and comments in both delivery modalities. Input from the facilitator was positive. Conclusions: Triangulation of student knowledge, teacher input, and facilitator experience indicates the viability and feasibility of this implementation strategy for Safe Touches, and potentially other school-based CSA prevention programs. To ensure equitable access to the CSA prevention program, the empirical examination of, and investment in, alternative implementation options for school-based CSA preventive programs is encouraged.Recruiting and retaining first-year college students in online health research: Implementation considerations
AbstractGuastaferro, K., Tanner, A. E., Rulison, K. L., Miller, A. M., Milroy, J. J., Wyrick, D. L., & Collins, L. M. (n.d.).Publication year
2024Journal title
Journal of American College HealthVolume
72Issue
2Page(s)
623-630AbstractObjective: Decreasing participation in intervention research among college students has implications for the external validity of behavioral intervention research. We describe recruitment and retention strategies used to promote participation in intervention research across a series of four randomized experiments. Method: We report the recruitment and retention rates by school for each experiment and qualitative feedback from students about recommendations for improving research participation. Results: There was considerable variation among schools’ recruitment (4.9% to 64.7%) and retention (12% to 67.8%) rates. Student feedback suggested study timing (e.g., early in the semester), communication strategies (e.g., social media), and incentive structure (e.g., guaranteed incentives) could improve research participation. The highest survey participation rate was observed at the university which mandated students to complete the intervention (but not the survey). Conclusions: Intervention scientists must consider the population and study context to make informed decisions related to recruitment and retention strategies.StandUPTV: Preparation and optimization phases of a mHealth intervention to reduce sedentary screen time in adults
AbstractKeadle, S., Hasanaj, K., Leonard-Corzo, K., Tolas, A., Crosley-Lyons, R., Pfisterer, B., Legato, M., Fernandez, A., Lowell, E., Hollingshead, K., Yu, T. Y., Phelan, S., Phillips, S. M., Watson, N., Hagobian, T., Guastaferro, K., & Buman, M. P. (n.d.).Publication year
2024Journal title
Contemporary Clinical TrialsVolume
136AbstractRecreational sedentary screen time (rSST) is the most prevalent sedentary behavior for adults outside of work, school, and sleep, and is strongly linked to poor health. StandUPTV is a mHealth trial that uses the Multiphase Optimization Strategy (MOST) framework to develop and evaluate the efficacy of three theory-based strategies for reducing rSST among adults. This paper describes the preparation and optimization phases of StandUPTV within the MOST framework. We identified three candidate components based on previous literature: (a) rSST electronic lockout (LOCKOUT), which restricts rSST through electronic means; (b) adaptive prompts (TEXT), which provides adaptive prompts based on rSST behaviors; and (c) earning rSST through increased moderate-vigorous physical activity (MVPA) participation (EARN). We also describe the mHealth iterative design process and the selection of an optimization objective. Finally, we describe the protocol of the optimization randomized controlled trial using a 23 factorial experimental design. We will enroll 240 individuals aged 23–64 y who engage in >3 h/day of rSST. All participants will receive a target to reduce rSST by 50% and be randomized to one of 8 combinations representing all components and component levels: LOCKOUT (yes vs. no), TEXT (yes vs. no), and EARN (yes vs. no). Results will support the selection of the components for the intervention package that meet the optimization objective and are acceptable to participants. The optimized intervention will be tested in a future evaluation randomized trial to examine reductions in rSST on health outcomes among adults.Adapting prevention programs for virtual delivery: A case study in adapting a parent-focused child sexual abuse prevention module
AbstractGuastaferro, K., Melchior, M., Murphy-Costanzo, A., Sunshine, S., Neimeyer, A., Stewart, S., & Noll, J. (n.d.).Publication year
2023Journal title
Journal of Public Health ResearchVolume
12Issue
4AbstractBackground: Evolving and emerging contexts require interventions to respond and adapt. The COVID-19 pandemic necessitated a quick adaptation from in-person to virtual delivery. Not only were there few programs able to transition to virtual delivery, there was a lack of parent-focused CSA-prevention programs. The current study describes the responsive adaptation of a parent-focused child sexual abuse (CSA) prevention module (Smart Parents—Safe and Healthy Kids; SPSHK) for virtual delivery. Design and methods: This two-phase study used mixed-methods to inform and pilot test adaptations to the virtual module. In Phase 1, parenting providers with and without experience delivering SPSHK (N = 110) completed anonymous surveys and a subsample (n = 27) subsequently participated in brief interviews elaborate on challenges and needed adaptations for virtual platforms. Results: Providers indicated the greatest technological difficulties with parents’ access to technology noting the inability to use a screensharing function. Thus, providers recommended no adaptations for the virtual delivery of SPSHK. In Phase 2, the virtual SPSHK module was piloted with nine parents. Results demonstrated virtual SPSHK was acceptable and feasibly implemented. Pre-posttest assessments indicated increases in parents’ CSA-related awareness and use of protective behaviors. Conclusion: The current study suggests the promise of virtual SPSHK implementation and may act as a blueprint for other parent-focused CSA-prevention programs, but also more general parenting programs, considering virtual delivery.Applying an Implementation Framework to the Dissemination of a School-Based Child Sexual Abuse Prevention Program
AbstractGuastaferro, K., Shipe, S. L., Connell, C. M., Zadzora, K. M., & Noll, J. G. (n.d.).Publication year
2023Journal title
Health promotion practiceAbstractSince the 1980s, school-based child sexual abuse (CSA) prevention programs have been the prevailing prevention strategy in the United States. Despite demonstrated effectiveness, there is a lack of infrastructure and educational policy ensuring all students receive these programs. A pragmatic application of the RE-AIM implementation framework, this study provides an overview of a multi-county implementation effort of the school-based CSA prevention program, Safe Touches. Implementation efforts across five counties in a Mid-Atlantic state are described at three levels: organizational (school districts), child, and program facilitator. Children’s CSA-related knowledge was measured at four time points: pre-workshop, immediately post-workshop, and then 6 and 12 months post-workshop. Facilitators completed an anonymous survey post-implementation. Over the course of one and a half academic years, Safe Touches was implemented in 718 public school districts, reaching in total 14,235 second-grade students. Students’ significantly increased knowledge from pre- to post-workshop and gains were maintained at 6 and 12 months (ps <.001). A total of 29 disclosures of maltreatment were made by students to facilitators during or after the workshop. Facilitators generally adopted Safe Touches and attested to the feasibility and benefits of its large-scale implementation as well as the negligible negative impacts for children. When implemented systematically, school-based CSA prevention is able to reach a high number of students, effectively increase CSA-related knowledge, and facilitates disclosures. To maximize the potential public health impact, it is suggested that state funds be allocated to support the implementation of such programs as part of standard education costs.Association Between Child Maltreatment and Substance Use Disorder Across Emerging Adulthood
AbstractGuastaferro, K., Linden-Carmichael, A. N., & Chiang, S. C. (n.d.).Publication year
2023Journal title
Child MaltreatmentVolume
29Issue
2Page(s)
340-349AbstractChild maltreatment is associated with substance use beginning in adolescence and throughout early adulthood. Substance use disorders (SUD) are most likely to develop during emerging adulthood (18–25 years old). Thus, to develop effective substance use prevention strategies, it is useful to know the ages at which associations between maltreatment exposure (prior to age 18) and SUD are most strongly tied. This study examined the age-varying association between child maltreatment and past-year SUD in emerging adulthood by sex and by maltreatment type using time-varying effect models (TVEM). Data were from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). The analytic sample consisted of 5194 emerging adults. The association was strongest at younger ages, with individuals who experienced child maltreatment having three times greater odds of reporting SUD in the past-year. Differential associations were found by sex, racial-ethnic group, and maltreatment type across age. Prevention efforts may be more effective if their development is informed by these important differences and targeted at emerging adults rather than adolescents.Commentary: How Lay Health Workers in a Federally Qualified Community Health Center Filled a Critical Void in a Public Health Crisis
Guastaferro, K., Sheldrick, R. C., Nunez-Pepen, R., Ortiz, M., Much-Hichos, M., Trieu, D., Broder-Fingert, S., & Feinberg, E. (n.d.).Publication year
2023Journal title
Family and Community HealthVolume
46Issue
4Page(s)
259-262Decision support training for advanced cancer family caregivers: Study protocol for the CASCADE factorial trial
AbstractGazaway, S., Wells, R. D., Azuero, A., Pisu, M., Guastaferro, K., Rini, C., Taylor, R., Reed, R. D., Harrell, E. R., Bechthold, A. C., Bratches, R. W., McKie, P., Lowers, J., Williams, G. R., Rosenberg, A. R., Bakitas, M. A., Kavalieratos, D., & Dionne-Odom, J. N. (n.d.).Publication year
2023Journal title
Contemporary Clinical TrialsVolume
131AbstractBackground: Patients with advanced cancer face numerous decisions when diagnosed and often receive decision support from family caregivers. The CASCADE (CAre Supporters Coached to be Adept DEcision partners) factorial trial intervention aims to train caregivers in skills to provide effective decision support to patients and identify most effective intervention components. Methods: This is a 2-site, single-blind, 24 factorial trial to test components of the CASCADE decision support training intervention for family caregivers of patients with newly-diagnosed advanced cancer delivered by specially-trained, telehealth, palliative care lay coaches over 24 weeks. Family caregivers (target N = 352) are randomly assigned to one of 16 combinations of four components with two levels each: 1) psychoeducation on effective decision partnering principles (1 vs. 3 sessions); 2) decision support communication training (1 session vs. none); 3) Ottawa Decision Guide training (1 session vs. none) and 4) monthly follow-up (1 call vs. calls for 24 weeks). The primary outcome is patient-reported decisional conflict at 24 weeks. Secondary outcomes include patient distress, healthcare utilization, caregiver distress, and quality of life. Mediators and moderators (e.g., sociodemographics, decision self-efficacy, social support) will be explored between intervention components and outcomes. Results will be used to build two versions of CASCADE: one with only effective components (d ≥ 0.30) and another optimized for scalability and cost. Discussion: This protocol describes the first factorial trial, informed by the multiphase optimization strategy, of a palliative care decision-support intervention for advanced cancer family caregivers and will address the field's need to identify effective components that support serious illness decision-making.Guidance on selecting a translational framework for intervention development: Optimizing interventions for impact
AbstractGuastaferro, K., & Pfammatter, A. F. (n.d.).Publication year
2023Journal title
Journal of Clinical and Translational ScienceVolume
7Issue
1AbstractIntervention development frameworks offer the behavioral sciences a systematic and rigorous empirical process to guide the translation of basic science into practice in pursuit of desirable public health and clinical outcomes. The multiple frameworks that have emerged share a goal of optimization during intervention development and can increase the likelihood of arriving at an effective and disseminable intervention. Yet, the process of optimizing an intervention differs functionally and conceptually across frameworks, creating confusion and conflicting guidance on when and how to optimize. This paper seeks to facilitate the use of translational intervention development frameworks by providing a blueprint for selecting and using a framework by considering the process of optimization as conceptualized by each. First, we operationalize optimization and contextualize its role in intervention development. Next, we provide brief overviews of three translational intervention development frameworks (ORBIT, MRC, and MOST), identifying areas of overlap and divergence thereby aligning core concepts across the frameworks to improve translation. We offer considerations and concrete use cases for investigators seeking to identify and use a framework in their intervention development research. We push forward an agenda of a norm to use and specify frameworks in behavioral science to support a more rapid translational pipeline.Implementation of a Universal School-Based Child Sexual Abuse Prevention Program: A Longitudinal Cohort Study
AbstractGuastaferro, K., Shipe, S. L., Connell, C. M., Letourneau, E. J., & Noll, J. G. (n.d.).Publication year
2023Journal title
Journal of Interpersonal ViolenceVolume
38Issue
15Page(s)
8785-8802AbstractChild sexual abuse (CSA) is a public health problem of considerable magnitude. The prevailing primary prevention strategies are universal, school-based CSA prevention programs, some of which have been designated as evidence-based, such as Safe Touches. However, to reach their public health impact potential, effective universal school-based CSA prevention programs require effective and efficient dissemination and implementation strategies. The purpose of this study was to demonstrate the reach and effectiveness of a school-based CSA prevention curriculum, Safe Touches, when implemented on a wide scale. Using a longitudinal cohort design, children in second grade classrooms in public elementary schools in five counties received the Safe Touches workshop and completed surveys designed to assess gains in knowledge at four timepoints (one week prior, immediately post-workshop, 6- and 12-months post-workshop). In total, the Safe Touches workshop was delivered in 718 classrooms in 92% of school districts, reaching ~14,235 second graders. Multilevel models (n = 3,673) revealed that Safe Touches significantly increased CSA-related knowledge, and that these gains were maintained 12-months post-workshop (ps <.001). There were some small but significant time-varying effects among participants in schools with a greater percentage of low income and minority students, but these effects largely disappeared 12-months post workshop. This study demonstrates that a single-session, universal school-based CSA prevention program can effectively increase children’s knowledge when implemented and disseminated on a wide scale and knowledge gains can be retained 12-months post intervention.Knowledge Gains from the Implementation of a Child Sexual Abuse Prevention Program and the Future of School-Based Prevention Education
AbstractGuastaferro, K., Shipe, S. L., Connell, C. M., Holloway, J. L., Pulido, M. L., & Noll, J. G. (n.d.).Publication year
2023Journal title
Journal of Child Sexual AbuseVolume
32Issue
7Page(s)
845-859AbstractSchool-based child sexual abuse (CSA) programs effectively increase students’ CSA-related knowledge. This study focuses on an implementation trial of Safe Touches, an empirically supported, school-based CSA prevention program, that was disrupted by the COVID-19 pandemic. We sought to demonstrate gains in CSA-related knowledge following Safe Touches but were limited to a pre-post design. A total of 2,210 students across five counties in a Mid-Atlantic state received the Safe Touches workshop between September 2019 and March 2020. McNemar’s chi-square test was used to assess changes in the proportion of correct responses pre-workshop (Time 1) and one-week post-workshop (Time 2). Students’ CSA-related knowledge increased significantly based on changes in mean CSA knowledge scores and the number of correct item-level responses assessed at Time 1 and Time 2 (p <.000). Leveraging the experience of the facilitators’ who delivered these workshops prior to the disruption of implementation, we gathered facilitators’ perspectives to explore the viability of offering Safe Touches virtually. In July 2020, 16 facilitators completed an electronic survey designed to understand the viability of a virtual Safe Touches workshop. Three themes emerged from facilitator feedback on virtual programming: student engagement concerns, handling disclosures, and technology access to a virtual program. The findings of this study indicate that the Safe Touches workshop significantly increased CSA-related knowledge and, overall, facilitators supported further exploration and development of a virtual Safe Touches workshop. The transition of empirically supported school-based CSA prevention programs to a virtual delivery modality is necessary to maintain an effective means of primary prevention and opportunity for disclosure.Multiphase optimization strategy: How to build more effective, affordable, scalable and efficient social and behavioural oral health interventions
AbstractGuastaferro, K., & Strayhorn, J. C. (n.d.).Publication year
2023Journal title
Community Dentistry and Oral EpidemiologyVolume
51Issue
1Page(s)
103-107AbstractThis commentary introduces the field of social behavioural oral health interventions to the multiphase optimization strategy (MOST). MOST is a principled framework for the development, optimization and evaluation of multicomponent interventions. Drawing from the fields of engineering, behavioural science, economics, decision science and public health, intervention optimization requires a strategic balance of effectiveness with affordability, scalability and efficiency. We argue that interventions developed using MOST are more likely to maximize the public health impact of social behavioural oral health interventions.Operationalizing Primary Outcomes to Achieve Reach, Effectiveness, and Equity in Multilevel Interventions
AbstractGuastaferro, K., Sheldrick, R. C., Strayhorn, J. C., & Feinberg, E. (n.d.).Publication year
2023Journal title
Prevention ScienceAbstractWhen intervention scientists plan a clinical trial of an intervention, they select an outcome metric that operationalizes their definition of intervention success. The outcome metric that is selected has important implications for which interventions are eventually supported for implementation at scale and, therefore, what health benefits (including how much benefit and for whom) are experienced in a population. Particularly when an intervention is to be implemented in a population that experiences a health disparity, the outcome metric that is selected can also have implications for equity. Some outcome metrics risk exacerbating an existing health disparity, while others may decrease disparities for some but have less effect for the larger population. In this study, we use a computer to simulate implementation of a hypothetical multilevel, multicomponent intervention to highlight the tradeoffs that can occur between outcome metrics that reflect different operationalizations of intervention success. In particular, we highlight tradeoffs between overall mean population benefit and the distribution of health benefits in the population, which has direct implications for equity. We suggest that simulations like the one we present can be useful in the planning of a clinical trial for a multilevel and/or multicomponent intervention, since simulated implementation at scale can illustrate potential consequences of candidate operationalization of intervention success, such that unintended consequences for equity can be avoided.Parenting and Mental Health needs of Young, Maltreated parents: implications for Prevention of intergenerational child maltreatment
AbstractAparicio, E. M., Channell Doig, A., Jasczynski, M., Robinson, J. L., Huq, M., Yoo, J. H., Hillig, E., Lee, K., Berkowitz, A., Guastaferro, K., Jones, G., & Bernardi, C. (n.d.).Publication year
2023Journal title
Journal of Family ViolenceVolume
38Issue
4Page(s)
659-672AbstractPurpose: Children of young parents are at elevated risk for child abuse and neglect due to myriad challenges. Despite the dual need for parenting support and mental health support, most literature and programs separate these and do not address maltreated parenting youths’ intergenerational context. The current study explores parenting and mental health needs as intertwined, uplifting experiences of young adult mothers with child maltreatment histories, professionals serving them, and mothers’ own caregivers. Method: Through a community-engaged research process, this grounded theory study was co-conceptualized and conducted through a university-community-based organization partnership. We conducted in-depth interviews with 23 participants: nine young, maltreated mothers aged 18–25 (M = 20.9) years, 14 professionals and two caregivers. Data were collected in the community and analyzed using grounded theory methods. We transcribed each interview and analyzed the transcripts using a structured process of open, focus, axial, and selective/theoretical coding. Rigor was enhanced through several strategies including reflexivity and member checking. Results: Grounded theory analysis produced a detailed model of the process of accessing and receiving mental health and parenting support among young, maltreated mothers, including (1) Reckoning with the Impact of Childhood and Adolescent Trauma on Mental Health and Parenting; (2) Reaching Out; (3) Receiving Parenting Support; (4) Receiving Mental Health Support; and (5) Seeking a Change. Conclusions: Findings support a comprehensive approach for supporting young parents in improving the trajectories of their families through integrated approaches to parenting and mental health intervention.Preventive Education Outreach on Social Media: The Quest to Enroll Community Members in a Child Sexual Prevention Workshop
AbstractGuastaferro, K., Melchior, M., Murphy-Costanzo, A. S., Anderson, A., Melamed, N., & Madden, S. (n.d.).Publication year
2023Journal title
Journal of Child Sexual AbuseVolume
32Issue
8Page(s)
963-978AbstractSocial media is a frequently used tool in health promotion efforts although less so for the prevention of child sexual abuse (CSA). This is due, in part, to the lack of standardized branding guides for community-based efforts in how to craft messages related to CSA prevention. This study examined the use of Twitter (now “X”) as a means of promoting participation in the adult-focused Stewards of Children CSA prevention workshop, prior to and following the implementation of a standardized branding guide. The exposure, reach, and engagement of the top tweets and top media tweets were examined over 24-months pre- and post-implementation of a five-point branding guide. Engagement was descriptively compared to the number of adults who enrolled in the Stewards of Children workshop. As evidenced by the increase in tweet impressions and the number of adults trained, it is likely the implementation of the branding guide was beneficial in promoting participation in the Stewards of Children workshop. Though participation in a program does not inherently suggest behavior change, getting participants to enroll is a crucial first step. The findings emphasize the potential of using social media to ultimately promote behavior change in the field of CSA prevention and beyond.Provider Attitudes and Self-Efficacy When Delivering a Child Sexual Abuse Prevention Module: An Exploratory Study
AbstractGuastaferro, K., Font, S. A., Miyamoto, S., Zadzora, K. M., Walters, K. E., O’Hara, K., Kemner, A., & Noll, J. G. (n.d.).Publication year
2023Journal title
Health Education and BehaviorVolume
50Issue
2Page(s)
172-180AbstractBackground: As constant figures in children’s lives, parents are key in protecting children from sexual abuse. One barrier to reaching parents is that the topic can be difficult to broach and is sensitive in nature. Such barriers can interfere with implementation and fidelity of evidence-based prevention strategies that are focused on reducing rates of childhood sexual abuse (CSA). Aims: In this exploratory study, we examine provider attitudes about delivering CSA-specific content in an evidence-based prevention module and their self-efficacy. Method: Thirty-three providers participated in three surveys: prior to a skills-oriented training on how to deliver the CSA prevention module (pretraining), immediately posttraining, and 6 months posttraining. Changes in self-reported willingness to deliver content, beliefs about parents’ role in CSA prevention, and confidence about their ability to deliver content were assessed over time. Open-ended questions were coded thematically to reinforce quantitative findings. Results: Prior to training, providers were worried that parents would respond negatively to CSA content and were concerned about their comfort level discussing victimization and sexual development. Findings suggest that skill-oriented training and provision scripts effectively supported providers and improved confidence in delivering CSA prevention content. Discussion: Provider self-efficacy is an important element of implementation fidelity. This exploratory study demonstrated that, though providers may approach CSA content with wariness and trepidation, adequate skills-oriented training can reduce negative attitudes and increase perceived efficacy in the actual delivery of CSA content that persists through implementation. Conclusion: Skills-based training can significantly enhance fidelity in the delivery of difficult content included in parent-focused preventative interventions.Systematic braiding of Smoke-Free Home SafeCare to address child maltreatment risk and secondhand smoke exposure: findings from a pilot study
AbstractSelf-Brown, S., Perry, E. W., Recinos, M., Cotner, M. A., Guastaferro, K., Owolabi, S., Spears, C. A., Whitaker, D. J., Huang, J., & Kegler, M. C. (n.d.).Publication year
2023Journal title
Pilot and Feasibility StudiesVolume
9Issue
1AbstractBackground: Exposure to secondhand tobacco smoke (SHS) and child maltreatment are preventable threats to child health. Few evidence-based interventions target both SHS and child maltreatment risk. The purpose of this paper is to describe the systematic braiding process of two evidence-based programs to address child SHS in the home and maltreatment perpetration risk, and present results from the formative work and pilot study. Methods: The first 4 steps of the systematic braiding process were completed, including the following: (1) the identification of core elements of both programs, (2) the development of an initial draft of the braided curriculum (Smoke-Free Home SafeCare — SFH-SC), (3) an acceptability and feasibility pilot of SFH-SC with caregivers of young children who reported a smoker living in the home (N = 8), and (4) feedback collection on the braided curriculum from SafeCare Providers (N = 9). Results: Experts identified common pedagogical and theoretical underpinnings for the two programs and braided Smoke-Free Homes: Some Things Are Better Outside into two SafeCare modules. Caregiver feedback from the pilot demonstrated that participants were engaged with SFH-SC and felt supported and comfortable discussing SHS intervention content with the SFH-SC Provider. Caregiver self-reports indicated a slight increase in smoke-free home rules from baseline to follow-up and a notable reduction in parent stress on the Parent Stress Index of 5.9 points (SD = 10.2). SafeCare Provider feedback following intensive review of the curriculum indicated high feasibility for SFH-SC delivery. Conclusions: Parent and Provider findings suggest SFH-SC is a viable intervention that has potential to reduce the public health impact of SHS and child maltreatment for at-risk families. Protocol: The protocol for the pilot is not published elsewhere; however, the full protocol for the hybrid trial can be found here: https://clinicaltrials.gov/ct2/show/NCT05000632 . Trial registration: NCT, NCT05000632. Registered 14 July 2021, there is not a separate registration number for the pilot.American Single Father Homes: A Growing Public Health Priority
Shipe, S. L., Ayer, L., & Guastaferro, K. (n.d.).Publication year
2022Journal title
American journal of public healthVolume
112Issue
1Page(s)
21-23An Early Palliative Care Telehealth Coaching Intervention to Enhance Advanced Cancer Family Caregivers’ Decision Support Skills: The CASCADE Pilot Factorial Trial
AbstractDionne-Odom, J. N., Wells, R. D., Guastaferro, K., Azuero, A., Hendricks, B. A., Currie, E. R., Bechthold, A., Dosse, C., Taylor, R., Reed, R. D., Harrell, E. R., Gazaway, S., Engler, S., McKie, P., Williams, G. R., Sudore, R., Rini, C., Rosenberg, A. R., & Bakitas, M. A. (n.d.).Publication year
2022Journal title
Journal of Pain and Symptom ManagementVolume
63Issue
1Page(s)
11-22AbstractContext: Patients with advanced cancer often involve family caregivers in health-related decision-making from diagnosis to end-of-life; however, few interventions have been developed to enhance caregiver decision support skills. Objectives: Assess the feasibility, acceptability, and potential efficacy of individual intervention components of CASCADE (CAre Supporters Coached to be Adept DEcision Partners), an early telehealth, palliative care coach-led decision support training intervention for caregivers. Methods: Pilot factorial trial using the multiphase optimization strategy (October 2019-October 2020). Family caregivers and their care recipients with newly-diagnosed advanced cancer (n = 46 dyads) were randomized to1 of 8 experimental conditions that included a combination of one of the following three CASCADE components: 1) effective decision support psychoeducation; 2) decision support communication training; and 3) Ottawa Decision Guide training. Feasibility was assessed by completion of sessions and questionnaires (predefined as ≥80%). Acceptability was determined through postintervention interviews and participants’ ratings of their likelihood to recommend. Measures of effective decision support and caregiver and patient distress were collected at Twelve and Twenty four weeks. Results: Caregiver participants completed 78% of intervention sessions and 81% of questionnaires; patients completed 80% of questionnaires. Across conditions, average caregiver ratings for recommending the program to others was 9.9 on a scale from 1-Not at all likely to 10-Extremely likely. Individual CASCADE components were observed to have potential benefit for effective decision support and caregiver distress. Conclusion: We successfully piloted a factorial trial design to examine components of a novel intervention to enhance the decision support skills of advanced cancer family caregivers. A fully-powered factorial trial is warranted. Key Message: We pilot tested components of CASCADE, an early palliative care decision support training intervention for family caregivers of patients with advanced cancer. CASCADE components were acceptable and the trial design feasible, providing promising future directions for palliative care intervention development and testing. Pilot results will inform a fully-powered trial.Parent-Focused Sexual Abuse Prevention: Results From a Cluster Randomized Trial
AbstractGuastaferro, K., Felt, J. M., Font, S. A., Connell, C. M., Miyamoto, S., Zadzora, K. M., & Noll, J. G. (n.d.).Publication year
2022Journal title
Child MaltreatmentVolume
27Issue
1Page(s)
114-125AbstractThis study tested whether a child sexual abuse (CSA) prevention program, Smart Parents–Safe and Healthy Kids (SPSHK), could be implemented as an additional module in evidence-based parent training and whether the added module might detract from the efficacy of the original program. In a cluster randomized trial, six community-based organizations were randomized to deliver Parents as Teachers (PAT) with SPSHK (PAT+SPSHK) or PAT as usual (PAT-AU). CSA-related awareness and protective behaviors, as well as general parenting behaviors taught by PAT were assessed at baseline, post-PAT, post-SPSHK, and 1-month follow-up. Multilevel analyses revealed significant group by time interactions for both awareness and behaviors (ps <.0001), indicating the PAT+SPSHK group had significantly greater awareness of CSA and used protective behaviors more often (which were maintained at follow-up) compared to the PAT-AU group. No differences were observed in general parenting behaviors taught by PAT suggesting adding SPHSK did not interfere with PAT efficacy as originally designed. Results indicate adding SPHSK to existing parent training can significantly enhance parents’ awareness of and readiness to engage in protective behavioral strategies. Implementing SPHSK as a selective prevention strategy with at-risk parents receiving parent training through child welfare infrastructures is discussed.Taking a School-Based Child Sexual Abuse Prevention Program to Scale: a Cost Analysis
AbstractShipe, S. L., Guastaferro, K., Noll, J. G., Connell, C. M., Morgan, P. L., & Crowley, D. M. (n.d.).Publication year
2022Journal title
Prevention ScienceVolume
23Issue
8Page(s)
1394-1403AbstractCost analyses are used to determine overall costs of implementing evidence-based programming and may help decision makers determine how best to allocate finite resources. Child sexual abuse (CSA), regularly viewed as a human rights violation, is also a public health concern estimated to impact 27% of females and 5% of males by age 18. Universal, school-based CSA programs are one prevailing prevention strategy. However, there are no known cost analyses of school-based CSA prevention programming, thereby limiting potential scalability. Using the ingredients method, this cost analysis presents the findings of implementing Safe Touches, an evidence-based universal prevention program, across four sites (i.e., counties) in one mid-Atlantic state. Reaching a total of 14,235 s grade students, results indicate an average cost of $43 per student, an average classroom cost of $859, an average district cost of $10,637, and an average site cost of $154,243. There was a noted decrease in costs when more students were reached, suggesting a need to focus efforts on bolstering the reach of implementation efforts. Sensitivity analyses explored variations in implementation constraints such as personnel and facilities suggesting a range of per-student costs (lower-bound per-student cost = $34; upper-bound per-student cost = $64). Findings presented herein may be used to inform future universal CSA prevention efforts by providing detailed information about the costs of large-scale implementation of an evidence-based program among elementary-aged children.The preparation phase in the multiphase optimization strategy (MOST): A systematic review and introduction of a reporting checklist
AbstractLandoll, R. R., Vargas, S. E., Samardzic, K. B., Clark, M. F., & Guastaferro, K. (n.d.).Publication year
2022Journal title
Translational Behavioral MedicineVolume
12Issue
2Page(s)
291-303AbstractMulticomponent behavioral interventions developed using the multiphase optimization strategy (MOST) framework offer important advantages over alternative intervention development models by focusing on outcomes within constraints relevant for effective dissemination. MOST consists of three phases: preparation, optimization, and evaluation. The preparation phase is critical to establishing the foundation for the optimization and evaluation phases; thus, detailed reporting is critical to enhancing rigor and reproducibility. A systematic review of published research using the MOST framework was conducted. A structured framework was used to describe and summarize the use of MOST terminology (i.e., preparation phase and optimization objective) and the presentation of preparation work, the conceptual model, and the optimization. Fifty-eight articles were reviewed and the majority focused on either describing the methodology or presenting results of an optimization trial (n = 38, 66%). Although almost all articles identified intervention components (96%), there was considerable variability in the degree to which authors fully described other elements of MOST. In particular, there was less consistency in use of MOST terminology. Reporting on the MOST preparation phase is varied, and there is a need for increased focus on explicit articulation of key design elements and rationale of the preparation phase. The proposed checklist for reporting MOST studies would significantly advance the use of this emerging methodology and improve implementation and dissemination of MOST. Accurate reporting is essential to reproducibility and rigor of scientific trials as it ensures future research fully understands not only the methodology, but the rationale for intervention and optimization decisions.The Prevention of Child Maltreatment: Using SafeCare® to Highlight Successes and Needs for Improvement in Prevention Efforts
AbstractGuastaferro, K., & Lutzker, J. R. (n.d.).Publication year
2022Journal title
International Journal on Child Maltreatment: Research, Policy and PracticeVolume
5Issue
1Page(s)
19-29AbstractChild maltreatment is a public health problem of considerable magnitude. Though substantial progress has been made in the prevention of child maltreatment, one incident of maltreatment is one too many. Intervention and/or prevention efforts must always be dynamic. In this commentary, we highlight recent prevention and policy efforts in the United States, using SafeCare, an evidence-based parent support program with a focus on the prevention of neglect, as an example. We describe broad-scale implementation efforts and offer a vision for what the field must do to realize public heath impact, highlighting recent advances of parent support models in policy, advocacy, and programs. Strategies that might improve current efforts are suggested to ensure the field not become static.