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
Intervention Optimization: Introduction to the MOST Mindset.
AbstractGuastaferro, K. (n.d.).Publication year
2023Abstract~Introduction to MOST: An Approach for Building more Effective and Implementable Behavioral Interventions.
AbstractGuastaferro, K., & Pfammatter, A. (n.d.).Publication year
2023Abstract~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 (pMultiphase 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.New York City Transit Workers: An Essential Workforce – Addressing Occupational Resilience through Intervention Optimization.
AbstractMerdjanoff, A. A., Gershon, R., & Guastaferro, K. (n.d.).Publication year
2023Abstract~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.Optimization of Implementation Strategies Using MOST: An Emphasis on the Factorial Design.
AbstractSzeszulski, J., & Guastaferro, K. (n.d.).Publication year
2023Abstract~Optimizing for Dissemination of a Family Navigation Intervention to Improve Pediatric Mental Health Services using MOST.
AbstractGuastaferro, K. (n.d.).Publication year
2023Abstract~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. S., Murphy-Costanzo, A. S., Anderson, A., Melamed, N., & Madden, S. (n.d.).Publication year
2023Journal title
Journal of Child Sexual AbuseVolume
32Issue
8AbstractSocial 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.Raising expectations for D&I science: Intervention optimization as an opportunity to move toward implementability and equitability.
AbstractStrayhorn, J., Collins, L., Guastaferro, K., & Shelley, D. (n.d.).Publication year
2023AbstractThe emerging field of intervention optimization offers implementation science opportunities in several areas. In this session we offer an orientation to intervention optimization via the multiphase optimization strategy (MOST), followed by two presentations highlighting recent methodological developments in the intersection between intervention optimization and implementation science: first, in the optimization of multicomponent implementation strategies, and second, in optimizing to achieve not only effectiveness and implementability but also equitability (and even, we suggest, equitability in implementation). Panel chair Dr. Linda M. Collins and discussant Dr. Donna Shelley will then lead a discussion on implications and next steps for D&I science.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.The Why and How of Intervention Optimization: Examples of Projects using the Multiphase Optimization Strategy (MOST).
AbstractGuastaferro, K. (n.d.).Publication year
2023Abstract~Using implementation science to inform the preparation phase of the multiphase optimization strategy (MOST) framework.
AbstractMerrill, K. G., Silva, J., Sedeno, A., Salgado, S., Vargas, V., Cano, J., Nabor, V., Merrill, J., DeCelles, J., Guastaferro, K., & Donenberg, G. (n.d.).Publication year
2023Abstract~Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to adapt a sexual and reproductive health intervention for Latina teens and female caregivers.
AbstractMerrill, K. G., Silva, J., Fuentes, J., Sedeno, A., Salgado, S., Cano, J., Nabor, V., Merrill, J., DeCelles, J., Guastaferro, K., & Donenberg, G. (n.d.).Publication year
2023Abstract~What is MOST and what does it offer to advance our understanding of techniques and mechanisms that mitigate against stigma?
AbstractGuastaferro, K. (n.d.).Publication year
2023Abstract~American single father homes: A growing public health priority
AbstractShipe, S. L., Ayer, L., & Guastaferro, K. (n.d.).Publication year
2022Journal title
American Journal of Public HealthVolume
112Issue
1Page(s)
21-23Abstract~An (extremely) brief overview of MOST.
AbstractGuastaferro, K. (n.d.).Publication year
2022Abstract~An 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.Building expert-consulted guidance for the selection of research designs for optimizing behavioral interventions.
AbstractMarques, M. M., Pfammatter, A., & Guastaferro, K. (n.d.).Publication year
2022Abstract~How MOST can be used to advance implementation science objectives.
AbstractGuastaferro, K. (n.d.).Publication year
2022Abstract~Human-centered design methods to achieve preparation phase goals in the multiphase optimization strategy framework
AbstractO’Hara, K. L., Knowles, L. M., Guastaferro, K., & Lyon, A. R. (n.d.).Publication year
2022Journal title
Implementation Research & PracticeVolume
3AbstractBackground: The public health impact of behavioral and biobehavioral interventions to prevent and treat mental health and substance use problems hinges on developing methods to strategically maximize their effectiveness, affordability, scalability, and efficiency. Methods: The multiphase optimization strategy (MOST) is an innovative, principled framework that guides the development of multicomponent interventions. Each phase of MOST (Preparation, Optimization, Evaluation) has explicit goals and a range of appropriate research methods to achieve them. Methods for attaining Optimization and Evaluation phase goals are well-developed. However, methods used in the Preparation phase are often highly researcher-specific, and concrete ways to achieve Preparation phase goals are a priority area for further development. Results: We propose that the discover, design, build, and test (DDBT) framework provides a theory-driven and methods-rich roadmap for achieving the goals of the Preparation phase of MOST, including specifying the conceptual model, identifying and testing candidate intervention components, and defining the optimization objective. The DDBT framework capitalizes on strategies from the field of human-centered design and implementation science to drive its data collection methods. Conclusions: MOST and DDBT share many conceptual features, including an explicit focus on implementation determinants, being iterative and flexible, and designing interventions for the greatest public health impact. The proposed synthesized DDBT/MOST approach integrates DDBT into the Preparation phase of MOST thereby providing a framework for rigorous and efficient intervention development research to bolster the success of intervention optimization.Making the #MOST of Implementation Science.
AbstractGuastaferro, K. (n.d.).Publication year
2022Abstract~MOST Designs in Behavioral Research.
AbstractGuastaferro, K. (n.d.).Publication year
2022Abstract~