Kate Guastaferro
Kate Guastaferro
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Assistant Professor of Social and Behavioral Sciences
Co-Director of the Center for the Advancement and Dissemination of Intervention Optimization
Director of the Doctor of Public Health (DrPH) Program
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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
The Smart Parents Study
AbstractAbuchaibe, V., Abourjaily, E., & Guastaferro, K. (n.d.).Publication year
2025Abstract~The Smart Parents Study: Providers
AbstractAbjourjaily, E., Abuchaibe, V., & Guastaferro, K. (n.d.).Publication year
2025Abstract~Theatre testing a sexual and reproductive health program for Latina teens and their female caregivers: A mixed methods study.
AbstractMerrill, K. G., Silva, J., Atadero, J., Hung, I. L., Salgado, S., Cano, J. K., Nabor, V., Merrill, J., DeCelles, J., Guastaferro, K., Baumann, A., Fuentes, J., Rodriguez, L., & Donenberg, G. (n.d.).Publication year
2025Journal title
BMC Public HealthVolume
25AbstractBackground Floreciendo is a sexual and reproductive health program for Latina teens (14–18 years) and their female caregivers adapted from the evidence-based IMARA intervention. We report on our experience theater testing Floreciendo during the preparation phase of the multiphase optimization strategy (MOST) framework. Floreciendo includes four two-hour sessions (i.e., intervention components). Our aims were to: (1) examine the preliminary acceptability, appropriateness, and feasibility of the intervention components, including the acceptability of the implementation plan (i.e., logistics, strategies), and (2) systematically report on curriculum modifications made based on findings. Methods Using a community-based participatory research approach, we theater tested the program at a community organization over one weekend with three teen-caregiver dyads (n = 6) using mixed methods. Immediately following the delivery of each intervention component, teens and caregivers completed surveys and engaged in feedback sessions. Observers (n = 8) and facilitators (n = 2) completed surveys, recorded activity start and end times, and participated in a post-program discussion. Survey item ratings were on four-point Likert scales, with higher scores indicating more favorable results. Feedback informed subsequent curriculum modifications, which were documented using the FRAME. Results We found high satisfaction with the intervention components among all surveyed (n = 16) and with the implementation plan among teens and caregivers (n = 6) (≥ 3.7/4.0). Teens and caregivers described sessions as “educational,” “motivating,” “interactive,” and “fun”; all (100%; n = 6) reported that they would recommend the program to others. Teens and caregivers rated the appropriateness of the material and language/wording highly (4.0/4.0; n = 6), although caregivers expressed difficulty understanding “passive communication” given translation difficulties. Feasibility was also rated highly across groups (≥ 3.8/4.0; n = 16); 18% of activities were 10 + minutes longer than planned based on observer reports but the sessions overall remained within 2 min of the allotted time. We modified the intervention components based on the feedback received. For example, we moved discussions about sex to come later in the foundational session to increase participant comfort. Conclusions Findings offer preliminary evidence of Floreciendo’s acceptability, appropriateness, and feasibility. Theater testing is a valuable tool for intervention adaptation and FRAME is useful for tracking curriculum modifications over time. MOST researchers could consider theater testing while carrying out preparation-phase activities.Universal parent-focused child sexual abuse prevention : A quasi-experimental protocol
AbstractAbourjaily, E. L., Guastaferro, K., McElwee, K., & Connell, C. M. (n.d.).Publication year
2025Journal title
PloS oneVolume
20Issue
1AbstractBackground Child sexual abuse (CSA) is a significant public health concern, and there is a lack of universal, evidence-based primary prevention interventions that extend beyond a focus solely on children. Parents remain a consistently underutilized target for primary prevention efforts aimed at mitigating CSA despite their unique relationship and close proximity to their children. CSA risk is not confined to any specific demographic, and its effects on affected children are well-documented, significantly impacting numerous dimensions of their wellbeing. Thus, there is a clear and urgent need to address this gap in prevention strategies. Methods This study will use a quasi-experimental design (target N = 412) to examine potential gains in CSA-related awareness and intentions to use protective behaviors among parents who participate in a universal parent-focused CSA prevention workshop, Smarter Parents. Safer Kids., compared to those who do not. Participants in both the control (n = 206) and experimental group (n = 206) will complete 3 survey assessments: Survey 0 (baseline), Survey 1 (1-month), and Survey 2 (3-month follow-up). The experimental group will participate in a Smarter Parents. Safer Kids. workshop between the Surveys 0 and 1. We will use data collected from the baseline to measure potential mediators of CSA-related awareness and intention to use protective and preventive behaviors. In adjacent efforts to enhance the curriculum’s reach with future dissemination and implementation, we will also explore the impact of recruitment materials and strategies on parental engagement. Conclusion Results of this study will advance efforts to implement parent-focused CSA prevention with a universal audience.Validation of a new tool to assess parents' practical implementation of behavioral strategies for child sexual abuse prevention
AbstractAbourjaily, E., Self-Brown, S. R., & Guastaferro, K. (n.d.).Publication year
2025Abstract~A to Z and not just “K:” Considerations for Applying the Multiphase Optimization Strategy in Your Career Development Award.
AbstractWells, R. D., Gazaway, S., Merrill, K. G., & Guastaferro, K. (n.d.).Publication year
2024Abstract~Adapting a selective parent-focused child sexual abuse prevention curriculum for a universal audience: A pilot study
AbstractGuastaferro, K., Abuchaibe, V., McCormick, K., Bhoja, A., Abourjaily, E., Melchior, M., Grayson, C., Welikson, P., Dan, C., & Zeleke, M. B. (n.d.).Publication year
2024Journal title
PLOS ONEPage(s)
1-16AbstractParents are an obvious, but underutilized player in the prevention of child sexual abuse (CSA). A handful of universal parent-focused prevention programs have emerged, however, the evidence for these programs is mixed and the programs suffer ubiquitously from barriers to implementation (e.g., poor engagement, low participation) thereby limiting public health impact. To combat these barriers and improve evidence, researchers previously developed and tested a selective parent-focused CSA prevention program. While promising, the selective approach still leaves a gap in the prevention landscape – parents from the universal audience. However, there appear to be no standardized methods to inform this type of adaptation— interventions designed as universal or selective have primarily been delivered as such. This study sought to adapt the selective curriculum for a universal audience and examined the acceptability and feasibility of the program for evaluation in a future trial. Using mixed methods, N=31 parents (i.e., primary caregiver for a child under 13) completed pre- and post-workshop surveys followed by a brief individual interview conducted via Zoom. Interviews, coded using content analysis methods, focused on three themes: parents as agents of prevention (e.g., prior action, confidence), curriculum (e.g., content, design), and engagement (e.g., future marketing and promotion). Overall participants’ mean score on CSA-related awareness and intention to use protective behavioral strategies increased. The participants found the curriculum highly acceptable noting strengths in the content and design. All told, the results of this pilot study suggest the acceptability and feasibility of examining the efficacy of the universal parent-focused curriculum in a larger trial. Procedural challenges, such as bots in recruitment, identify areas of caution in design of the larger trial and a roadmap for others seeking to adapt selective programs for universal audiences.Adaptive Interventions: Innovations in Intervention and Experimental Design.
AbstractNahum-Shani, I., Almirall, D., & Guastaferro, K. (n.d.).Publication year
2024Abstract~An Innovative Approach to Reducing Second Hand Smoke Exposure and Child Maltreatment Risk: The Smoke-Free Home SafeCare Curriculum.
AbstractGuastaferro, K., Recinos, M., Perry, E., Kegler, M., & Self-Brown, S. (n.d.).Publication year
2024Abstract~Applying the resource management principle to achieve community engagement and experimental rigor in the multiphase optimization streategy framework
AbstractO’Hara, K. L., Guastaferro, K., Hita, L., Rhodes, A., Thomas, N., Wolchik, S., & Berkel, C. (n.d.).Publication year
2024Journal title
Implementation Research & PracticeVolume
5Page(s)
1-12AbstractPreventing and treating mental health and substance use problems requires interventions that are effective, affordable, scalable, and efficient. The MOST framework guides researchers through a phased and systematic process of developing optimized interventions. However, new methods of systematically incorporating information about implementation constraints across MOST phases are needed. We propose that early and sustained integration of community-engaged methods within MOST is a promising strategy for enhancing an optimized intervention’s potential for implementation. In this paper, we outline the advantages of using community-engaged methods throughout the intervention optimization process, with a focus on the Preparation and Optimization Phases of MOST. We discuss the role of experimental designs in optimization research and highlight potential challenges in conducting rigorous experiments in community settings. We then demonstrate how relying on the resource management principle to select experimental designs across MOST phases is a promising strategy for maintaining both experimental rigor and community responsiveness. We end with an applied example that illustrates a community-engaged approach to optimize an intervention to reduce the risk for mental health problems and substance use problems among children with incarcerated parents.Association between child maltreatment and substance use disorder across emerging adulthood
AbstractGuastaferro, K., Linden-Carmichael, A. N., & Chiang, S. C. (n.d.).Publication year
2024Journal 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.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.Cultural and Family Influences on Parents’ Child Sexual Abuse-Related Awareness and Protective Behaviors.
AbstractBhoja, A., Abourjaily, E., McCormick, K., Zeleke, M., & Guastaferro, K. (n.d.).Publication year
2024Abstract~Enhancing Assessment of Child Maltreatment Risk in Research: Integrating Measures of Food Insecurity.
AbstractAbuchaibe, V., Ott, K., Dan, C., & Guastaferro, K. (n.d.).Publication year
2024Abstract~Family structure and children's risk of child protective services re-reports
AbstractShipe, S. L., Guastaferro, K., Ayer, L., Lee, J. Y., & Connell, C. M. (n.d.).Publication year
2024Journal title
Child Abuse and NeglectVolume
154AbstractBackground: Single parent families are at higher risk of re-report to Child Protective Services (CPS) than two-parent families. Yet, how single-family homes differ in risk from two-parent families remains under researched. Objective: To identify heterogenous patterns of child and caregiver factors among CPS-involved families and the subsequent risk for CPS re-report based on child and family characteristics (i.e., sociodemographic information, family structure, and risk indicators). Participants and setting: Data were from the 2017 National Child Abuse and Neglect Data System Child File (N = 249,026). Methods: We conducted latent class analysis (LCA) to identify discrete patterns (i.e., classes) based on child and caregiver risk indicators (e.g., substance use, behavioral health). We then used logistic regression to examine family structure and other family characteristics and CPS indicators predicted CPS re-report for each class. Results: Results yielded five distinct classes: 1) Financial Stressors (25 % of the sample); 2) Caregiver Substance Use (16 %); 3) Complex Household Stressors (3 %); 4) Child Disabilities (4 %); and 5) Minimal Household Stressors (53 %). Family structure was significantly associated with CPS re-reports for Classes 1, 2, and 5. For Class 1, single father families had increased odds of CPS re-report compared to other family structures. For Classes 2 and 5, single father families' odds of CPS re-reports were greater than those of married families, but lower than single mother families. Conclusions: Children growing up in single father families have different likelihoods of repeat CPS involvement compared to those in single mother and married families. Financial stressors and parental substance use within single father families should be addressed.Firearm screening and secure storage counseling among home visiting providers: A cross-sectional survey 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
12Abstract~HIV Prevention in Foster Care Youths: Time for a Refocus
AbstractAdrian, C. W., Shipe, S. L., & Guastaferro, K. (n.d.).Publication year
2024Journal title
American Journal of Public HealthVolume
114Issue
11Page(s)
1179-1183Abstract~Household family type and children’s risk of child protective services re-reports
AbstractShipe, S. L., Guastaferro, K., Ayer, L., Lee, J. Y., & Connell, C. M. (n.d.).Publication year
2024Journal title
Child Abuse & NeglectVolume
154AbstractBackground: Single parent families are at higher risk of re-report to Child Protective Services (CPS) than two-parent families. Yet, how single-family homes differ in risk from two-parent families remains under researched. Objective: To identify heterogenous patterns of child and caregiver factors among CPS-involved families and the subsequent risk for CPS re-report based on child and family characteristics (i.e., sociodemographic information, household family type, and risk indicators).Participants and Setting: Data were from the 2017 National Child Abuse and Neglect DataSystem Child File (N = 249,026). Methods: We conducted latent class analysis (LCA) to identify discrete patterns (i.e., classes) based on child and caregiver risk indicators (e.g., substance use, behavioral health). We then used logistic regression to examine household family type and other family characteristics and CPS indicators predicted CPS re-report for each class.Results: Results yielded five distinct classes: 1) Financial Stressors (25% of the sample); 2) Caregiver Substance Use (16%); 3) Complex Household Stressors (3%); 4) Child Disabilities (4%); and 5) Minimal Household Stressors (53%). Family type was significantly associated with CPS re-reports for Classes 1, 2, and 5. For Class 1, single father families had increased odds of CPS re-report compared to other family types. For Classes 2 and 5, single father families’ odds of CPS re-reports were greater than those of married families, but lower than single mother families. Conclusions: Children growing up in single father families have different likelihoods of repeat CPS involvement compared to those in single mother and married families. Financial stressors and parental substance use within single father families should be addressed.Implementing a Sexual and Reproductive Health Workshop for Latina Teens and their Female Caregivers: Findings from Theater Testing and Piloting.
AbstractMerrill, K. G., Silva, J., Atadero, J., Hung, I. L., Salgado, S., Cano, J., Nabor, V., Sedeno, A., Vargas, V., Romero, G., Perez, C., Fuentes, J., Florence, K., Merrill, J., DeCelles, J., Guastaferro, K., & Donenberg, G. (n.d.).Publication year
2024Abstract~Increasing pre-exposure prophylaxis (PrEP) in primary care: A study protocol for a multi-level intervention using the Multiphase Optimization Strategy (MOST) framework
AbstractLockhart, E., Turner, D., Guastaferro, K., Szalacha, L. A., Alzate, H. T., Marhefka, S., Pittiglio, B., Dekker, M., Yeh, H.-H., Toney, J., Manogue, S., & Ahmedani, B. K. (n.d.).Publication year
2024Journal title
Contemporary Clinical TrialsVolume
143AbstractBackground In the United States, over 1.2 million people are living with HIV. This disease disproportionately affects men who have sex with men (MSM), people of color, youth and young adults, and transgender individuals. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention medication. Barriers exist for both primary care providers (PCPs) to prescribe PrEP and prevent patients from initiating PrEP. Methods The research design for this study, MOST: PrEP, follows the multiphase optimization strategy (MOST) framework. The purpose is to identify a multi-level intervention among patients and PCPs to increase PrEP prescriptions in primary care. First, feedback will be obtained from providers and patients via focus groups, then suggestions related to the context-specific (provider and individual level) factors of intervention component delivery will be incorporated. Subsequently, a rigorous experiment will be conducted using a 24 factorial design focusing on priority populations for PrEP initiation. Provider components include a computer-based simulation training and a best practice alert. Patient components include a tailored PrEP educational video and HIV risk assessment. Finally, the facilitators and barriers to implementing the intervention components will be examined. Conclusion In this protocol paper, we describe the first known multilevel MOST optimization trial in healthcare. Intervention components are to be delivered to patients and providers in a large healthcare system, based in an Ending the Epidemic priority jurisdiction. If effective, this multi-level approach could be disseminated to providers and patients in other large healthcare systems to make a significant impact on HIV prevention.Integrating implementaiton science and intervention optimization
AbstractGuastaferro, K., Moucheraud, C., Purtle, J., Collins, L., & Shelley, D. (n.d.).Publication year
2024Journal title
Implementation ScienceVolume
20Issue
41Page(s)
1-10AbstractBackground: Implementation scientists increasingly recognize the value of multiple strategies to improve the adoption, fidelity, and scale up of an evidence-based intervention (EBI). However, with this recognition comes the need for alternative and innovative methods to ensure that the package of implementation strategies work well within constraints imposed by the need for affordability, scalability, and/or efficiency. The aim of this article is to illustrate that this can be accomplished by integrating principles of intervention optimization into implementation science. Method: We use a hypothetical example to illustrate the application of the multiphase optimization strategy (MOST) to develop and optimize a package of implementation strategies designed to improve clinic-level adoption of an EBI for smoking cessation. Results: We describe the steps an investigative team would take using MOST for an implementation science study. For each of the three phases of MOST (preparation, optimization, and evaluation), we describe the selection, optimization, and evaluation of four candidate implementation strategies (e.g., training, treatment guide, workflow redesign, and supervision). We provide practical considerations and discuss key methodological points. Conclusion: Our intention in this methodological article is to inspire implementation scientists to integrate principles of intervention optimization in their studies, and to encourage the continued advancement of this integration.Intervention optimization: A paradigm shift and its potential implications for clinical psychology
AbstractCollins, L. M., Nahum-Shani, I., Guastaferro, K., Strayhorn, J. C., Vanness, D., & Murphy, S. (n.d.).Publication year
2024Journal title
Annual Review of Clinical PsychologyVolume
20Page(s)
10.1-10.27AbstractTo build a coherent knowledge base about what psychological intervention strategies work, develop interventions that have positive societal impact, and maintain and increase this impact over time, it is necessary to replace the classical treatment package research paradigm. The multiphase optimization strategy (MOST) is an alternative paradigm that integrates ideas from behavioral science, engineering, implementation science, economics, and decision science. MOST enables optimization of interventions to strategically balance effectiveness, affordability, scalability, and efficiency. In this review we provide an overview of MOST, discuss several experimental designs that can be used in intervention optimization, consider how the investigator can use experimental results to select components for inclusion in the optimized intervention, discuss the application of MOST in implementation science, and list future issues in this rapidly evolving field. We highlight the feasibility of adopting this new research paradigm as well as its potential to hasten the progress of psychological intervention science.Intervention Optimization: A Paradigm Shift and Its Potential Implications for Clinical Psychology
AbstractCollins, L., Nahum-Shani, I., Guastaferro, K., Strayhorn, J. C., Vanness, D. J., & Murphy, S. A. (n.d.).Publication year
2024Journal title
Annual Review of Clinical PsychologyVolume
20Issue
1Page(s)
21-47AbstractTo build a coherent knowledge base about what psychological intervention strategies work, develop interventions that have positive societal impact, and maintain and increase this impact over time, it is necessary to replace the classical treatment package research paradigm. The multiphase optimization strategy (MOST) is an alternative paradigm that integrates ideas from behavioral science, engineering, implementation science, economics, and decision science. MOST enables optimization of interventions to strategically balance effectiveness, affordability, scalability, and efficiency. In this review we provide an overview of MOST, discuss several experimental designs that can be used in intervention optimization, consider how the investigator can use experimental results to select components for inclusion in the optimized intervention, discuss the application of MOST in implementation science, and list future issues in this rapidly evolving field. We highlight the feasibility of adopting this new research paradigm as well as its potential to hasten the progress of psychological intervention science.Maximizing Impact: Expanding the Reach of Child Maltreatment Prevention Interventions
AbstractGuastaferro, K. (n.d.).Publication year
2024Abstract~Maximizing the reach of universal child sexual abuse prevention: Protocol for an equivalence trial
AbstractGuastaferro, K., Melchior, M. S., Heng, S., Trudeau, J., & Holloway, J. L. (n.d.).Publication year
2024Journal title
Contemporary Clinical Trials CommunicationsVolume
41AbstractBackground: Child sexual abuse (CSA) affects 1 in 5 girls and 1 in 12 boys before age 18. Universal school-based prevention programs are an effective and cost-efficient method of teaching students an array of personal safety skills. However, the programmatic reach of universal school-based programs is limited by the inherent reliance on the school infrastructure and a dearth of available alternative delivery modalities. Methods: The design for this study will use a rigorous cluster randomized design (N = 180 classrooms) to determine the equivalence of two delivery modalities of Safe Touches: as usual vs. modified. The as usual workshop will be delivered by two facilitators with live puppet skits (n = 90). Whereas, the modified workshop will be delivered by one facilitator using prerecorded skit videos (n = 90). We will determine the equivalence by measuring concept learning acquisition preworkshop to immediate postworkshop (Aim 1) and retention at 3-months postworkshop (Aim 2) among students in classrooms that receive the as usual or modified workshops. To conclude equivalence, it is imperative to also examine factors that may impact future dissemination and implementation, specifically program adoption among school personnel and implementation fidelity between the two modalities (Aim 3). Conclusion: Study findings will inform the ongoing development of effective CSA prevention programs and policy decisions regarding the sustainable integration of such programs within schools. Clinical trial registration: NCT06195852.