FRONTIER aligns with a six-stage translational prevention model that aims to elicit sustainable population level reductions in mental and behavioral health disorders, as well as the disparities and inequities that contribute to them. This translational process is neither linear nor circular; rather, each translational type, while primarily occurring as a stage in a progression (T0 – T5), also informs all the other types.
T5 – Reform universal social systems
T4 – Target entire communities: institutionalization and policy reform
T3 – Comparative effectiveness trials: personalized vs. standard
T2 – Adaptive interventions evaluations & subtyping
T1 – Blueprint for program development & optimization
T0 – Basic science: heterogeneity & mechanisms
T0 Basic science: heterogeneity & mechanisms
The fundamental process of discovery where findings from the social, behavioral, and biomedical sciences (preclinical and clinical) are translated into research with human subjects. The study of analogous processes and phenomena via field or lab-based investigation that can then be applied to the design of more precisely targeted preventive intervention. Also, a phase where Type 2 research is back-translated to understand inevitable etiological heterogeneity in intervention outcomes and can reveal malleable mechanisms in the emergence of clinical subgroups.
Example: Parallel study with forward- and back-translation to understand the impact of early environmental adversity on brain development and mechanisms that subsequently confer risk.
T1 Blueprint for program development & optimization
Moving the research from bench to bedside involves the translation of applied theory to methods (measures, analysis) and program development. Applies mechanistic information as a blueprint to develop (a) screening tools to distinguish risk groups and (b) adaptive intervention strategies to map onto these diverse mechanisms. Optimizing identifies components that more potently and efficiently move the needle to alter the outcome.
Example: Development of measures, methodologies, and interventions that focus on self-regulatory processes subserved by prefrontal-limbic connections, such as the initial development of Good Behavior Game, Promoting Alternative THinking Strategies (PATHS) and other social emotional learning (SEL) approaches.
T2 Adaptive interventions evaluations and sub-typing
Moving from bedside to practice settings involves translation of program development to implementation; i.e., efficacy trials with emphasis on internal validity and effectiveness trials with emphasis on internal and external validity. Validates and refines the various resultant adaptive intervention strategies via creative designs such as SMART and Multi-phase Optimization Strategies (MOST). Also, identifies subgroups with differential levels of responsivity for translation back to T0 stage to characterize them on the basis of mechanisms that portend variable outcomes.
Example: Randomized clinical trials of preventive interventions to establish the size of outcomes that can be attributed to the programs (controlling for alternative influences) and then rigorous testing with well-defined populations.
T3 Comparative effectiveness trials: personalized vs. standard
Positive results from T2 then launches into T3, the practice-oriented phase involving research to test the degree to which efficacy and effectiveness trial outcomes can be replicated under real world settings, focused on adoption, adaptation, and dissemination. Comparative effectiveness (confirmatory) trials are often used to pit personalized intervention models against standard “one-size-fits-all” models in real-world settings to determine whether personalized models are feasible, acceptable, and produce effects equal to or better than standard models.
Example: Study parameters of adaptation models with highly replicated programs and interventions exerting strong positive effects, across time and context.
T4 Target entire communities: institutionalization and policy reform
Research focused on scaling-up. Wide-scale implementation, adoption, and institutionalization of new guidelines, practices, and policies that emerge as the outcome of T4 research. Targets entire communities by modifying service delivery systems and services, optimizing transmission through social networks, or instituting targeted policy or macro-environmental changes that are different between communities.
Example: Research on scaling of the evidence-based programs in multiple school districts within and across countries.
T5 Reform universal social systems
Translation to global communities, which involves fundamental and universal change in attitudes, policies, and social systems. Can also involve reform of universal social systems to become more responsive to individual needs based on sound and well-tested scientific evidence, accounting for global political, economic, and cultural variations.
Example: Acceptance of science-based health prevention practices, reform of the juvenile justice system, wide-scale educational innovations, supportive systems for families, normative practices conducive to healthy child development and the reduction of trauma.