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Conversations with the Director: Greta Massetti

May 30, 2013

Greta Massetti Discusses Scalable Interventions

Greta Massetti

Photo by Luis Luque

Greta Massetti, PhD, chief, Research and Evaluation Branch, Division of Violence Prevention at the National Center for Injury Prevention and Control talked with CDC Director Thomas Frieden, MD, MPH, about violence prevention on April 29 in a Conversation with the Director.

After a few minutes of polite, getting-to-know-you questions, Frieden starts taking notes, interested in specifics from Massetti about Triple-P, the Positive Parenting Program, an intervention that helps build healthy family relationships.

Massetti discusses the evidence that has built up around Triple-P since its creation some 30 years ago in Australia. Studies have found that the program reduces child behavior problems and teaches parents more effective ways to discipline their children, but more importantly, to bond more closely with them. A CDC-funded trial also found that communities that applied Triple-P had fewer cases of child abuse, child abuse injuries, and out-of-home placements. But taking Triple-P from homes into entire communities is complicated.

“There are some cost limitations for communities to do the full-scale Triple-P, Massetti says, “but the evidence is strong [that Triple-P works well].”

Frieden is quick with questions. “So, Triple-P, how would you go about peeling out the different components and making them widely available?”

Massetti reports that the Division of Violence Prevention is developing a CDC-branded strategy to promote positive parenting. The point is to allow communities to get information online and engage in child maltreatment prevention efforts—but without the price tag of a proprietary program.

Frieden also wants to know more about prevention programs tailored to suicide, teen dating violence, rape prevention, and child maltreatment. He even wonders if studies suggest whether breastfeeding affects child maltreatment. The discussion is wide-ranging, but wherever it leads, Frieden keeps returning to two main points: What works? And how do you scale it up? And yet, neither he nor Massetti is naive about the political and economic realities of trying to expand any government program, no matter how effective. Cost is one reason many violence prevention programs are school-based.

“With schools and the Triple-P equivalent,” Frieden says, “what you essentially want is the minimum effective dose. How can you get it scaled by saying, ‘If you do this much, you’ll get a reasonably good impact’?”’

“That’s a good question,” Massetti responds. “I don’t know that there’s a lot of research on that, because I think there’s a confound between dose and content. There are programs that have many more sessions that probably have better content, and so they have better effects, but is it the content, or is it the dose?”

In some areas of violence prevention, most programs only consist of one session, Massetti continues. “When it comes to rape prevention, schools may only have a single assembly where they [try to teach] all the kids about preventing sexual violence…and we have lots of research that shows that’s not effective.” But Massetti is enthusiastic about increasing the prevention dose. “We’re trying to push the envelope a little, and how do we take what’s already happening and—”

“Or how do you go to text, and YouTube?” Frieden asks.

“Right! How do you reach them in other ways?” Massetti ponders. “Because the other major barrier in schools is that teachers are not comfortable talking about those topics.”

Controversial topics are nothing new to Massetti and her team. Teen dating violence is another priority. Their program—Dating Matters™: Strategies to Promote Healthy Teen Relationships—is CDC’s comprehensive teen dating violence prevention initiative based on the current evidence about what works in prevention. It includes a social media and technology strategy to reach youth, with CDC’s first direct-to-youth text campaign. Rather than merely lecturing students during school-wide assemblies, Dating Matters is also at the forefront of social messaging.

“For youth, if you’re not getting to them through text messaging, there’s just no way to reach their eyeballs that will have that potential for impact,” Massetti says. “So, we’re really excited to see that. And then, because of Facebook and other social media components, students have an opportunity to take ownership of those messages, and not just receive them, but also put them back out into their community. I think youth are engaged in a different way than they were by, say, bus ads 20 years ago.”

Massetti knows she faces a difficult challenge in violence prevention. Every day it seems the media uncovers new horrors—the Aurora and Newtown shootings, Chicago gang violence, the Boston Marathon bombings, the Cleveland abductions. But violence prevention is possible. The evidence is there. The question remains, is our society willing to fund the programs? As Frieden would ask next: What would it take to scale up successful violence prevention programs and take them to every community?

This Snapshot by Luis Luque

CDC Connects Story Manager: Kathy Chastney