- Choose something that’sclearly
relevant to child psychology(i.e., try not to pick something obscure that's barely mentioned in the assigned reading) &
Context Matters in Child and Family Policy Context Matters in Child and Family Policy Kenneth A. Dodge Duke University The traditional model of translation from basic laboratory science to efficacy trials to effectiveness trials to community dissemination has flaws that arise from false assumptions that context changes little or matters lit- tle. One of the most important findings in developmental science is that context matters, but this fact is not sufficiently taken into account in many translation efforts. Studies reported in this special issue highlight both the potential of systematic interventions in parenting, peer relations, and social-cognitive skills training, and the problems that will be encountered in trying to bring these interventions to a community context. It is advocated that developmental scientists start from within the community context itself so that translation to policy is only a small step. It is also advocated that this research be conducted through rigorous community randomized controlled trials. Kudos to the editors! In crafting this special issue, they have implemented a process that did not merely attract existing developmental science, it also pushed scholars to think in new ways and to stretch their science. The articles in this special issue represent the best of contemporary translation science in child development, and they set new standards for rigor and ecological validity in the field. At the same time, crucial questions must still be addressed before the translation to practice and policy is complete. I conclude that the field must adopt a very different approach from the tradi- tional linear, basic-research-to-policy path; instead, we must recognize that contextual differences between the laboratory and the policy setting are so great that we need to embed our research within the community policy context itself. On paper, the path followed in the translation science of child development is straight and logical. It has been adopted from the National Institutes of Health roadmap (Zerhouni, 2003), articulated in models of prevention of mental disorders (Coie et al., 1992; Mrazek & Haggerty, 1994), and is well represented in several of the articles in this special issue. The goal of the field of translational develop- mental science is to use ‘‘basic science’’ to cause population-level impact on raising healthy children, that is, to improve the overall rates of healthy out- comes and to decrease the overall rates of problem outcomes for the population of children in society. This is the standard to which citizens and policy makers, who fund the science, can and should hold the field accountable. So, is there any movement in population measures across secular trends? Unfortunately, the field has not yet demon- strated success in the goal of population impact. Secular trends are not encouraging. Collishaw, Maughan, Goodman, and Pickles (2004) have reported that rates of adolescent mental health problems, especially conduct disorder and depres- sion, have actually increased across time in Western societies. Twenge et al. (2010) have reported that indicators of young adult psychopathology reveal a large, 1 SD increase in most problem scores across the past 70 years. A secondary goal of translational science is to reduce the gaps between the rich and poor, between the haves and the have-nots, in important outcomes for children. Has the gap been reduced? Costello (in press) argues that the gap has not been reduced across time and newer technolo- gies and interventions might actually inadvertently increase the gap. Although numerous developmental-science- based interventions, including some reported in this volume, have been found to have favorable impact on the narrow group of children that have been targeted for these interventions, it is a long step to go from those findings to population impact, and few of these interventions have demonstrated a positive effect on the entire population of children in a community, as indicated by population-level The author acknowledges the support of K05DA15226 from the National Institute on Drug Abuse. Correspondence concerning this article should be addressed to Kenneth A. Dodge, Center for Child and Family Policy, Duke University, Durham, NC 27708. Electronic mail may be sent to
[email protected]. Child Development, January/February 2011, Volume 82, Number 1, Pages 433–442 � 2011 The Author Child Development � 2011 Society for Research in Child Development, Inc. All rights reserved. 0009-3920/2011/8201-0027 DOI: 10.1111/j.1467-8624.2010.01565.x effects. Herrera, Grossman, Kauh, and McMaken (this issue) report that a well-known, evidence- based intervention, Big Brothers Big Sisters School- Based Mentoring, has no positive effects after 1½ years when implemented on a large scale. What is wrong here? I conclude that we need a fundamen- tal shift in how translation research is conducted in order for the goal of population impact to be achieved. The translation model on which most research has been based begins with identification of a human behavioral problem through empirical doc- umentation and epidemiology. The model then brings the phenomenon out of the community and into the laboratory so that ‘‘basic science’’ can reveal the ‘‘truths’’ of human behavior. These truths document human problems, the develop- mental processes that lead to them, and the way out of them. The third step is to translate these truths into intervention strategies that are evaluated experimentally through rigorous trials. The transla- tion includes identifying populations, ages, and tar- geted social and intrapersonal processes in development that mediate ecologically important outcomes for children. This step also involves engi- neering of human development and the art and genius of intervention. The emphasis at this step is on rigorous evaluation of efficacy of the interven- tion to achieve its stated goals, at the admitted cost of ecological validity. The pristine conditions of an ideal efficacy trial (and the goal in these trials is indeed to be as pristine as possible) rarely match the community context of the problem being addressed. In fact, the goal of an efficacy trial is to test whether behavioral change can be engineered, not whether the population is actually changed. They are more a test of developmental theory than an application to practice and policy. Indeed, I argue that the contribution of these studies is more to developmental science than to policy, because the context differences between an efficacy trial and community-based intervention policy are so great that the translation is minimal. The fourth step of translation models moves closer to community impact through effectiveness trials, in which an intervention that has undergone efficacy trials is implemented and tested in real-world conditions. A trade-off is acknowledged that sacrifices scientific rigor for community embeddedness. Finally, the last step is a dissemination effort. Here, a random- ized experiment is rarely attempted, and instead, the focus is on whether the intervention can be implemented with fidelity, sometimes at scale. Models of translation also suggest that the path should be two-way, that is, when the outcomes of intervention require theories of human develop- ment to be modified or highlight areas where future truths should be unearthed by basic science. This translation model has been an apparent suc- cess according to the scientists, as demonstrated by the many articles in this special issue. But it has fallen short of leading to population-level change in raising healthy children for the citizenry, as Shon- koff and Bales (this issue) note. I argue that three errors are made in the assumptions in the transla- tion model that reduce its impact on population outcomes. The first false assumption is that findings readily generalize across contexts, particularly from the laboratory context to the community context. They do not. The lack of generalization should not come as a surprise, given that one of the most important findings from basic science is that context matters, and many studies of children occur in uni- versity communities and Institutional Review Board research contexts that differ from the contexts of policy and community-level intervention. A second false assumption is that the conclusions of labora- tory studies are free from context factors that would constrain the conclusions made by the scientist. Every behavior is embedded in a context. Finally, it is falsely assumed that the rigors that are required for randomized experiments must be sacrificed in research in a community context. This last assump- tion leads to relatively little high-quality research on community processes and population outcomes for children. I argue that a paradigm shift is necessary in real- izing that all behavior is embedded in a context. Behavior is to context as figure is to ground. No one context is more or less ‘‘real’’ than any other context, but some contexts are more ecologically important than others. ‘‘Pulling’’ a phenomenon out of its natural context into the laboratory context for purer scrutiny runs the risk of losing the phe- nomenon altogether because it gets divorced from the contextual circumstances that define the phe- nomenon. The common framing of translation mod- els assumes that there must be a trade-off between scientific rigor and real-world conditions. ‘‘Basic’’ science brings a phenomenon into the laboratory in order to achieve the greatest rigor possible in the least ecologically valid conditions possible. The far- ther one moves down the translation path, the less pristinely rigorous is the science being conducted, but the presumed gain is an increased focus on the community context. Translation science supposedly moves from the rigor and purity of basic science to the messy reality of the community context. 434 Dodge The problem with this model is that it just does not work. When a phenomenon is taken out of its context, it becomes a different phenomenon. Trans- lation often fails. A related problem is that the care- fully constructed, basic-science-based, intervention programs and efficacy studies that establish the potential of these interventions have rarely, if ever, led to population-level changes when implemented at larger scale in the context of a community. I will illustrate reasons for this gap in translation below, describe ways in which the studies in this issue set a new standard for rigor for research within community settings (as well as ways in which some studies still fall short), and then offer a different model for future inquiry, in which rigor- ous science is conducted within the contexts that have the most meaning. Some of the Successes of Translation Science . . . and the Challenges That Remain Context Matters in How Children Develop The studies in this special issue highlight the important but complicated roles that various con- texts play in children’s development. Fiese, Winter, and Botti (this issue) peek into family homes to observe that the family mealtime context is related to a child’s asthma symptom severity. The findings are sensible. Garber, Ciesla, McCauley, Diamond, and Schloredt (this issue) find that a parent’s changing level of depressive symptoms predict a child’s level of depressive symptoms, a family con- text effect that is likely mediated by specific parent- ing behaviors. Guerra, Williams, and Sadek (this issue) find that a negative school context (e.g., nonsupport for social relationships, norms for high aggression) predicts a child’s bullying behaviors. Farrell, Henry, Mays, and Schoeny (this issue) also