The Participatory Intervention Model - Nastasi Et Al 2000

School Psychology Quarterly, Vol. 15, No. 2, 2000, pp.
207-232
The Participatory Intervention Model: A Framework for Conceptualizing and Promoting Intervention Acceptability
Bonnie K. Nastasi, Kristen Varjas, Stephen L. Schensul, K. Tudor Silva, Jean J. Schensul, and Priyani Ratnayake We propose a participatory approach for conceptualizing and implementing research-based interventions that has as its primary aim the development of acceptable and sustainable change efforts. The Participatory Intervention Model (PIM), rooted in participatory action research, provides a mechanism for integrating theory, research, and practice and for promoting involvement of stakeholders in intervention efforts. We present evidence of PIM's capacity for promoting intervention acceptability, drawing on our research experiences in international sexual-risk prevention work. We conclude with a discussion of PIM's potential for bridging the gap between research and practice, addressing cultural diversity, fostering partnerships, promoting disciplined reflective practice, and integrating the multiple roles of the school psychologist. In recent years, researchers and practitioners in the field of school psychology have recognized the need for a broad conception of intervention development and evaluation that addresses intervention acceptability and integrity, in addition to efficacy (Elliott, Witt, & Kratochwill, 1991; Hiralall & Martens, 1998; Nastasi, 1998; Nastasi, Varjas, Bernstein, & Pluymert, 1998a, 1998b; Schill, Kratochwill, & Elliott, 1998). In particular, designing interventions that consumers (e.g., teachers, parents, students) find acceptable is recognized as critical to the effective implementation and the subsequent effectiveness of interventions. Within traditional approaches to school-based consultation and intervention design, school
B. K. Nastasi, K. Varjas, and J. J. Schensul are from the Institute for Community Research, Hartford, CT. S. L. Schensul is from the Center for International Community Health Studies, University of Connecticut. K. T. Silva is from the Department of Sociology, and P. Ratnayake is from the Department of Psychiatry, University of Peradeniya, Sri Lanka. An earlier version of this manuscript was presented at the 105th annual convention of the American Psychological Association, August 1997, Chicago, IL. The authors thank the editor and the anonymous reviewers for their comments on earlier versions of this manuscript. Address correspondence to Bonnie K. Nastasi, PhD, Associate Director of Interventions, The Institute for Community Research, 2 Hartford Square West, Suite 100, Hartford, CT 06106-5128; E-mail: bonnastasi @ yahoo .com.
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psychologists (as interventionists or researchers) are concerned with designing interventions that consumers (a) will find consistent with their professional or personal perspectives; (b) view as sound, functional and potentially effective; and (c) will likely use (Gutkin & Curtis, 1999). The schism between use and availability of theoretically and empirically sound interventions has been cited as evidence for the importance of involving key stakeholders (consumers) in creating more acceptable interventions (Nastasi et al., 1998a, 1998b) and has caused us to rethink how we conceptualize intervention acceptability. We propose a model for conceptualizing and promoting acceptability as an outcome of a participatory approach to conducting psychological interventions, what we call the Participatory Intervention Model (PIM). The value of PIM lies in its capacity to engender acceptable interventions, empower stakeholders, and sustain social change (Anderson, 1989; Meyers & Nastasi, 1998; Nastasi, Varjas, Sarkar, & Jayasena, 1998; J. J. Schensul, 1998; Serrano-Garcia, 1990). Furthermore, PIM extends current conceptions of school psychologists as scientists-practitioners (Barlow, Hayes, & Nelson, 1984; Edwards, 1987; Stoner & Green, 1992) and as partners in collaborative approaches to practice (Adelman, 1995; Christenson & Conoley, 1992; Rosenfield & Gravois, 1996; Sheridan, Kratochwill, & Bergan, 1996). In this article, we articulate PIM using examples from an interdisciplinary action research project conducted in Sri Lanka, the Sri Lanka Sexual-Risk Prevention Project (Nastasi et al., 1998-1999; Silva et al., 1997). Strategies for promoting acceptability and evidence of acceptability from the project are presented. We conclude with a discussion of the challenges and opportunities that PIM poses for practitioners and applied researchers in school psychology. THE PARTICIPATORY INTERVENTION MODEL PIM is a nonlinear and iterative process that fosters the social construction of interventions and empowerment of participants (similar to the notion of "intervention within research"; Serrano-Garcia, 1990, p. 172). The goals of PIM are to integrate theory and research in the development of culture- or context-specific (i.e., socially or ecologically valid) interventions and to promote ownership and empowerment among stakeholders who are responsible for sustaining and institutionalizing the intervention after the support provided by interventionists or consultants has ceased. Most important to our current discussion is the centrality of culture specificity. Culture-specific interventions focus on competencies that are relevant to the target culture, make use of the language of the population in terms of meaning and vocabulary, and reflect the values and beliefs of the members of the culture (Nastasi, 1998). Culture refers to shared language, ideas, beliefs, values, and behavioral norms. Understanding the culture as shared by its members is considered critical to the development of culture-specific interventions and to acceptability by its members.
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PIM and Intervention Acceptability Using PIM, we extend the definition of intervention acceptability in several important ways. First, we conceptualize social or ecological validity as the culture- or context-specificity of interventions. Second, we go beyond the notion of acceptability as the consumers' perception of the intervention as useful, feasible, effective and consistent with their worldviews, to include involvement, ownership and empowerment of stakeholders. Stakeholders come to view the intervention as their own creation and take responsibility and control over the intervention process. Third, the goals of acceptability are extended beyond integrity and efficacy to include institutionalization and sustainability of intervention efforts. As a result of ownership and empowerment, stakeholders take responsibility for continuing the intervention without support from the interventionist (i.e., sustaining intervention efforts) and for integrating intervention efforts into existing organizations (i.e., institutionalizing intervention efforts). Origins of PIM PIM has its roots in applied anthropology, specifically participatory action research (PAR; Greenwood, Whyte, & Harkavy, 1993; Nastasi, 1998; J. J. Schensul, 1985, 1998; Schensul & Schensul, 1992; S. L. Schensul, 1985). Participatory action research (PAR) is characterized by full involvement of key stakeholders (i.e., those with vested interests and/or needed resources) in a recursive process linking theory, research, and practice. The process begins with formative research, possibly informed by existing theory, to provide a generative basis for designing culture- or context-specific (local) theory. The local theory then guides development of interventions (action or practice). Evaluation of the intervention (further research) informs the modification of intervention design (subsequent practice) and the development of general and culture-specific theory. Inherent in PIM is an approach to disciplined research known as qualitative or naturalistic inquiry (Lincoln & Guba, 1985; also referred to as ethnographic, post-positivistic, phenomenological, etc.). There are several characteristics of naturalistic inquiry that make it particularly suitable for engaging in participatory intervention in a disciplined manner. Consistent with an ecological approach to research and intervention (Bronfenbrenner, 1989; Nastasi, 1998), naturalistic inquiry is conducted in real-life contexts based on the belief that phenomena are highly context bound. The focus of inquiry is to understand and describe phenomena from the perspective of the population one is studying, thus facilitating the development of culture-specific theory and intervention. The methods for inquiry are qualitative and systematic. They include participant observation, key-informant and in-depth interviews, artifacts, ethnographic surveys for data collection, and systematic data analysis techniques. Trustworthiness of data (the parallel of reliability, validity, and objectivity) is ensured through (a) long-term and in-depth engagement with the population and context; (b) the use of multiple sources, methods, and perspectives (similar to a multimethod, multisource, and
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multidisciplinary approach to assessment in school psychology); (c) steps to confirm the veracity of data and interpretations with the stakeholders; and (d) dissemination of methods and findings in a detailed manner that permits replication and judgments about transferability (cf. generalizability). (A full articulation of naturalistic or qualitative inquiry is beyond the scope of this article. For a comprehensive discussion of naturalistic inquiry see Lincoln & Guba [1985]. For the use of qualitative methods for developing, enhancing and evaluating interventions, see Nastasi& Berg [1999].)
THE SRI LANKA SEXUAL-RISK PREVENTION PROJECT
To illustrate the concept of acceptability within PEVI, we draw on our international experiences in developing culture-specific interventions. Working with youth and other stakeholders in a culture that was recognizably different from our own enhanced our sensitivity to key aspects of intervention acceptability. In this section, we briefly describe the interdisciplinary action research project from which we later draw examples of strategies for promoting acceptability and evidence of acceptability. The Sri Lanka Sexual-Risk Prevention Project2 (Nastasi et al., 1998-1999; Silva et al., 1997) was a peer-facilitated intervention program for 89 unmarried female and male youth, ages 17 to 27, residing in a low-income urban area in the central highlands of Sri Lanka. Critical features of the intervention were (a) the focus on sexual knowledge, attitudes, risk perception, decision making, and behavior; (b) cultural specificity of content and language; (c) peer facilitation; (d) use of a social construction model of intervention (i.e., use of group process to foster cognitive and behavior change); and (e) use of a collaborative consultation model for training of peer educators. The intervention consisted of twelve 90-minute sessions, conducted in a small-group format (5-10 members each, facilitated by 2 peer educators) over 4 weeks with 3 sessions per week; the first and last sessions were devoted to evaluation activities. All but one of the sessions were implemented in
1. Other recommended sources on naturalistic/qualitative inquiry include the seven-volume Ethnographer's Toolkit, edited by Schensul and LeCompte (1999), and texts by Bernard (1995), Cres well (1997), Miles & Huberman (1994), Spradley (1979, 1980), and Strauss & Corbin (1990). 2. This project was conducted as part of the Women and AIDS Research Program of the International Center for Research on Women, Washington, DC, as a joint effort of the Center for International Community Health Studies-Connecticut, the Centre for Intersectoral Community Health Studies-Peradeniya (Sri Lanka), and the Institute for Community Research of Hartford, CT. Principal investigators were Stephen Schensul (U.S., Principal Investigator), Jean J. Schensul (U.S., co-Principal Investigator), K. Tudor Silva (Sri Lanka, co-Principal Investigator), Priyani Ratnayake (Sri Lanka, co-Principal Investigator). Other members of the research team included Herbert Aponso (Sri Lanka), M. W. Amarasiri de Silva (Sri Lanka), Merrill Eisenberg (U.S.), Judy Lewis (U.S.), Bonnie Nastasi (U.S.), Chelliah Sivajoganathan (Sri Lanka), and Piyaseeli Wedsinghe (Sri Lanka). Kristen Varjas (U.S.) was a research assistant for the intervention phase of the project. For detailed reports of the project, see Nastasi et al., 1998-99; Silva etal., 1997.
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Participatory
Generation
Partnership
Essential Changes
Natural Adaptation
FIGURE 1 . The Participatory Intervention Model.

Adapted from Nastasi, Varjas, Sarkar and Jayasena (1998), and reproduced with permission.
same-gender groups cofacilitated by same-gender peer educators; the last session was conducted in mixed-gender groups, cofacilitated by male and female peer educators. Peer educators received 30 hours of training and regular on-site consultation. Detailed reports of the project have been published elsewhere (Nastasi et al., 1998-1999; Silva et al., 1997). IMPLEMENTING PIM As depicted in Figure 1 (adapted from Nastasi et al., 1998), the process of intervention involves three phases: participatory generation (or intervention design), natural adaptation (implementation), and essential changes (evaluation of effectiveness). Throughout these three phases, interventionists (consultants) in partnership with stakeholders are continually engaged in data collection and analysis to ensure acceptability and cultural specificity of the intervention, to facilitate adaptation of the intervention to the demands of the context, and to monitor change in the direction of program goals. In this manner, there is continual attention to issues of acceptability, integrity, and effectiveness. This evolving partnership is considered essential to promoting involvement, ownership, and empowerment of
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stakeholders, in addition to sustainability and institutionalization of intervention efforts. In subsequent sections, we describe each component of PIM as depicted in Figure 1, giving particular attention to the use of PIM to foster intervention acceptability and exemplifying its use in the Sri Lanka Sexual-Risk Prevention Project. In a later section, we present the evidence of acceptability from the project. Partnership The Concept of Partnership. Partners in PIM are stakeholders with vested interests or necessary resources relevant to the proposed focus of the intervention. For example, in school-based interventions, partners are likely to include teachers, school administrators, parents, students, school mental health staff (including school psychologists), community mental health agency staff, community leaders, and policy makers. We contend that involvement, ownership, empowerment, and partnership are inextricably linked. As stakeholders come to view themselves as partners and become involved in designing and implementing the intervention, their sense of ownership and empowerment increase and, thus, acceptability of the intervention is enhanced. Building upon a sense of partnership, the key players (stakeholders and the interventionist or consultant) together design the intervention, monitor its implementation, and evaluate its effectiveness. Upon completion of the project, the stakeholders are expected to assume responsibility for continuing and institutionalizing intervention efforts. Interventionists (or consultants) can take differing roles in working with consumers as they develop interventions (Graham, 1998; Greenwood et al., 1993; Gutkin, 1999; Serrano-Garcia, 1990; Wickstrom, Jones, LaFleur, & Witt, 1998). Within the school psychology literature, for example, debate has focused on the distinctions between expert (directive, prescriptive) and collaborative approaches (Graham, 1998; Gutkin, 1999; Wickstrom et al., 1998). In an expert model, the professional consultant or interventionist has full authority and control over all aspects of the intervention process. Stakeholders are viewed as passive consumers rather than partners; consultants are concerned with developing interventions that consumers will find acceptable. The consultant/interventionist takes a prescriptive role, providing direction and advice to consumers. In a collaborative model, the consultant/interventionist and the stakeholders engage as partners in developing, implementing, and evaluating the intervention (Graham, 1998; Gutkin, 1999; Wickstrom et al., 1998). Consultants take a facilitative role, engaging in joint problem solving with stakeholders and eliciting their input and participation in decision making. Interventionists are concerned with empowering stakeholders and developing programs together for which stakeholders take ownership. For partnership to occur, the interventionist must be willing to step out of the expert role and stakeholders must be willing to take on responsibilities typically deemed to the interventionist. In reality, the distinction between expert and collaborative approaches is not necessarily so clear-cut. Instead, the degree of participation by the consultant/interven-
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tionist more likely reflects some position along an expert-collaborative continuum, with full collaboration as an ideal (Greenwood et al., 1993). Alternatively, as Gutkin's (1999) work suggests, collaboration does not preclude the use of directive strategies. Furthermore, the degree of participation by the consultant is not necessarily static. That is, the respective levels of involvement by consultants (interventionists/researchers) and consul tees (recipients) may vary throughout the process. At times, interventionists may need to assume more of a leadership role and provide the other partners with opportunities for knowledge acquisition and skill development. As stakeholders gain expertise and assume an increasing sense of ownership and empowerment, they incrementally move toward an equal partner status with interventionists. For example, the participatory researcher may take full responsibility for development or selection of data gathering measures, giving recipients the opportunity to choose from among alternatives. Once data are gathered, participants and researchers might work as partners in analyzing data and interpreting results (Serrano-Garcia, 1990). The expertise and willingness of the interventionist to build collaborative relationships and transfer knowledge and skills are considered critical to the establishment of partnership within PIM. Similarly, the motivation and receptivity of the stakeholders to assume responsibility as partners and develop expertise are crucial. The dynamic nature of the partnership must be addressed in initial negotiations and revisited throughout the process of working together. Such negotiations are consistent with the interactions that occur during entry into a system and contract negotiation in establishing consulting relationships (Christenson & Conoley, 1992; Curtis & Stollar, 1996; Rosenfield & Gravois, 1996; Sheridan et al., 1996). With regard to the issue of partnership, there are several key questions for interventionists: "Who are the key stakeholders? How do we engage stakeholders as partners? How do we bring about transfer of necessary knowledge and skills? How do we redefine the perceived role of the interventionist in order to promote partnership?" Successfully addressing these questions can foster a partnership in which stakeholders and interventionists together can (a) generate interventions, (b) adapt them to the context and individuals they serve, and (c) document and monitor essential changes toward intended outcomes. In the subsequent sections, we examine these three phases of the intervention process. Illustration: The Sri Lanka Sexual-Risk Prevention Project. In the sexual-risk prevention project, partners included medical (physicians and psychiatrists specializing in sexuality and sexually transmitted diseases [STDs]) and social science professionals (anthropologists, sociologists, psychologists), public health workers (community health worker/midwife, community health educator for local STD clinic), university students in medicine and sociology (who served as peer researchers and educators), community members, community peer educators, and program recipients (Nastasietal., 1998-1999; Silvaetal., 1997). The partnership began with the links between social science and medical professionals from the United States and Sri Lanka. The Sri Lanka partners then identified and invited other key partners to the table, including community/public health workers, community (peer) mem-
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bers, and university students. The partners were involved in some capacity in all activities: formative research; decision making about the program design; implementing the program; monitoring and modifying the program during implementation; gathering, analyzing, and interpreting evaluation data; and disseminating findings. All project activities were held at community locations, such as the offices of the Centre for Intersectoral Community Health Studies (situated adjacent to the target community), the local maternal and child health care center, and a local Buddhist temple. Peer researchers and educators were paid for their participation and program recipients were given nominal stipends to acknowledge the time they devoted to the project. As is the custom in Sri Lanka, refreshments (e.g., tea and snacks) were provided at every activity or meeting. The critical strategies for promoting partnership in the project included (a) securing the involvement of key professionals, community health workers, university students, and community members; (b) structuring and facilitating the involvement of key stakeholders in project activities; (c) forging links among stakeholders; (d) ensuring that nonprofessional partners gained the necessary knowledge and skills for full participation and sustainability (e.g., providing or arranging initial and ongoing training); (e) providing compensation consistent with cultural practices so that the value of contributions was acknowledged (e.g., peer researchers and educators viewed their participation as a "job" for which they received training and compensation); (f) holding meetings and activities at convenient times and locations; (g) attending to local cultural practices and norms (e.g., in guiding the content and process of the intervention); and (h) providing ongoing consultation to peer educators during program activities (e.g., interventionists/consultants were available on-site for all sessions). Perhaps most important were efforts to convey a sense of partnership, which was highly dependent on our willingness and capacity to relinquish control over the intervention process. Throughout the process, we assumed the role of collaborative/participatory consultants, providing structure and support for designing, implementing, and evaluating the intervention. We operated behind the scenes allowing stakeholders to take primary responsibility for the front line work. In addition, we engaged in ongoing dialogue with representatives of all stakeholder groups, including professionals, community health workers, peer researchers and educators, community members and program recipients. Participatory Generation The Concept of Participatory Generation. Designing interventions within PIM is best characterized by a process of participatory generation, in which the partners together create interventions (i.e., generate or foster social construction of interventions; see Serrano-Garcia, 1990) to facilitate individual and cultural change. This first component corresponds to the initial design stage of traditional approaches to intervention, during which goals are identified and the specific features (e.g., curriculum content, intervention techniques, staffing) of the intervention are developed. The generation process begins with formative research (cf. the participatory
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action research process) to identify and examine individual and cultural variables relevant to the change process (e.g., individual competencies and behaviors, and cultural practices, norms, and resources). These data are used by the partners to generate culture-specific (local) theory, to identify culture-specific goals and intervention strategies, and to design a culture-specific intervention. In the process of participatory generation, acceptability of an intervention is not posed as an explicit question to stakeholders. The interventionist does not present an intervention for acceptance. Instead, through dialogue and negotiation, the partners create an intervention. If the generation process is truly participatory, then acceptability evolves as a by-product of the process. The focus of acceptability and the goal of the participatory approach are not limited to satisfaction with and/or adherence to the intervention plan. Instead, the focus is extended to include involvement, ownership and empowerment of stakeholders. Illustration: The Sri Lanka Sexual-Risk Prevention Project. In the sexual-risk prevention project (Nastasi et al., 1998-1999), the strategies of the participatory generation phase included (a) an in-depth formative research stage; (b) the use of ethnographic research methods to investigate the cultural and personal or individual factors relevant to the target phenomenon; (c) the involvement of key stakeholders in the formative research phase; (d) the use of formative research findings to inform the development of intervention content and techniques; and (e) the active involvement of key stakeholders, particularly the target population of youth, in the design of the intervention. Formative research was conducted over a 2-year period to identify personal competencies and cultural factors related to sexual risk among Sri Lankan youth. Research methods included the ethnographic techniques of key-informant interviewing (i.e., unstructured interviews with representatives of stakeholder groups), participant observation (i.e., observations in natural settings by peer researchers), in-depth semistructured interviews (with 156 youth), and ethnographic (i.e., culture-specific) surveys administered by peer researchers to a sample of 615 youth from the target age group and geographic region. Most relevant to the design of the intervention were findings regarding culture-specific sexual knowledge, attitudes, and practices; sexual-risk perception; peer relationships (e.g., friendship, love, and sexual relationships); sexual decision making; and self-efficacy. (A detailed report of formative research methods and findings is presented in Silva et al., 1997.) The intervention, based in social construction theory (Guissinger & Blatt, 1994; Rogoff, 1990; Vygotsky, 1978; Wertsch, 1991), involved the use of group process to facilitate negotiated interpretation of existing norms and values regarding relationships and sexuality. In the context of this negotiation, participants acquire information and skills to support healthy sexual decision making. (For a detailed description of the intervention see Nastasi et al., 1998-1999.) Working together, key players (U.S. and Sri Lankan professionals, community health workers, peer researchers and educators, and program recipients) used formative research findings to make decisions about the content and process of the intervention. Stakeholders in collaboration with researchers chose content
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to reflect the experiences of youth. For example, sexual-risk dilemmas used for discussion and decision making were drawn from formative data. Discussion among stakeholders and researchers led to the following decision about the intervention process: In light of cultural taboos about discussion of sexuality in mixed-gender groups, all but the last session were conducted in same-gender groups with same-gender peer educators. Consistent with the iterative process of PIM, participatory generation continued as the program was implemented. Natural Adaptation The Concept of Natural Adaptation. We refer to the second component of PIMthe process of implementationas natural adaptation. In traditional approaches to intervention, the implementation phase involves strict adherence to a planned intervention to maintain integrity of the intervention. In PIM, intervention implementation involves the modification or adaptation of a predesigned (based on research with the target population) intervention to fit the needs and resources of specific participants (target sample) in the natural context (consistent with concepts of mutual adaptation [McLaughlin, 1976,1990];proadaptation [Weissberg, 1990]; and reinvention [Blakely et al., 1987]). The aim of natural adaptation is to create an ecological niche (Bronfenbrenner, 1989) in which intervention goals can be realized. Thus, throughout the process of implementation, alterations are made to achieve an optimal fit of the intervention to the context and the recipients. Consistent with the participatory emphasis of PIM, this phase is conducted in partnership with program participants. The value of natural adaptation is supported by research on organizational change and social program innovations (McLaughlin, 1976, 1990). Based on findings of the Rand Change Agent study conducted in the 1970s (a 4-year study of 293 local school-based projects directed toward educational change), McLaughlin concluded, "successful implementation [of educational interventions or change projects] is characterized by a process of mutual adaptation" (1976, p. 340). Mutual adaptation, like natural adaptation, involves the continual monitoring and modification of project plans or design in addition to changes in participants (e.g., professional staff development) and context (e.g., changes in classroom structure or practices). Particularly critical is the need for replication of the adaptation process each time the program is implemented in another setting (e.g., in a different classroom). Necessary to natural adaptation is continual monitoring of intervention integrity. In PIM, we conceive of integrity as the preservation of key or critical elements of the intervention (e.g., specific strategies that are consistent with existing theory and research), while allowing variation in noncritical elements (e.g., presentation of content in oral vs. written form) (Blakely et al., 1987; McLaughlin, 1976, 1990; Weissberg, 1990). In this manner, we aim to promote acceptability while not relinquishing integrity. A crucial consideration in natural adaptation is the identification
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of elements that are critical (i.e., those related to program outcomes) and noncritical (i.e., those that can vary without interfering with program effectiveness, but are important to acceptability). This is accomplished through in-depth documentation of the implementation process and examination of the relationship between program elements and the development of target skills. The question for interventionists becomes, "What changes are needed in the intervention design to achieve an ecological niche for participants while preserving critical program elements?" In practice, answering that question requires interventionists and participants to identify the elements of the intervention that are necessary for achieving program goals, and the modifications necessary for implementation within the specific local context. Natural adaptation thus requires a continuation or reiteration of the participatory generation phase during which additional data are gathered about the needs, resources and culture of the specific target group as they participate in the intervention. The new data are subjected to ongoing analysis and interpretation, and used to modify program content and process to better meet the needs of specific participants. The goals of natural adaptation are to facilitate change in the direction of program goals and to promote sustainability and institutionalization of the intervention. Illustration: The Sri Lanka Sexual-Risk Prevention Project. In the sexual-risk prevention project (Nastasi et al., 1998-1999), natural adaptation was accomplished through several activities, including the initial training of peer educators, during which we also piloted the intervention; continual on-site consultation; and weekly follow-up peer educator training sessions. These activities provided the context for gathering data on an ongoing basis, through participant observation of sessions, key informant interviewing of peer educators during training and consultation, and collection of artifacts from sessions (e.g., activity logs completed by peer educators, group process evaluations completed by participants, worksheets and narrative session notes completed as part of session activities). These data were analyzed on an ongoing basis and used to modify program content and process to meet the needs of program participants. The following examples help to illustrate this process. Changes in program content resulted from observations and feedback from peer educators. Formative research suggested that virginity was an important factor in sexual decision making among youth; however, we were not aware of the degree of importance until piloting the program with peer educators. The social importance of virginity for young women permeated discussions about sexuality and sexual decision making, and led us to develop a specific session addressing biological and social aspects of virginity and to include loss of virginity as a sexual risk. In another instance, we modified the process of delivering factual information based on ongoing data collection. Observations of sessions, feedback from peer educators, and examination of worksheets during the module on STDs indicated limitations in the peer educators' knowledge and consequent difficulties in responding to participants' questions (thus threatening intervention integrity). In response, we
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secured the services of local health educators, who cofacilitated an additional session on the topic of STDs and helped to ensure that program participants received accurate information. Close monitoring of program implementation revealed necessary considerations for both current and subsequent intervention efforts. For example, peer educators voluntarily scheduled additional sessions if they were unable to complete activities within the specified time, alerting us to the need for extending sessions to meet individual needs. In addition, we observed that holding parallel same-gender sessions in a common location provided opportunities to facilitate supervised interactions across gender. The common meeting place became a context for participants to meet each other informally before we introduced a formal mixed-gender session. Our observations of this phenomenon raised questions about the potential role of informal interactions in building rapport and overcoming initial apprehension about mixed-gender discussions of sexuality. The process of monitoring implementation also facilitated staff development. On-site consultation provided opportunities to monitor peer educator competencies, address their immediate concerns about implementation, identify the need for further peer training, and respond to teachable moments. Weekly training sessions provided further opportunities to review implementation efforts, address the collective training needs of peer educators, and prepare for subsequent intervention sessions. On-site consultation and follow-up training sessions were therefore regarded as critical not only for insuring integrity, but also for fostering skill development, ownership, and empowerment among peer educators. Consultation and training activities involved a participatory process as peer educators and interventionists engaged in mutual decision making or collaborative problem solving. Consultants assumed a facilitative, rather than directive, role in interacting with peer educators to build confidence and foster empowerment. Consultants encouraged peer educators to identify solutions to intervention difficulties. At times, peer educators only needed confirmation of their own competencies. For example, during an early session, one peer educator sought our consultation about uncooperative, off-task behavior of a few members in his group. We engaged immediately in a collaborative problem-solving exchange and discovered that the peer educator had already identified the source and solution to the problem but wanted validation of his decision. Another critical strategy for facilitating empowerment and ownership was the reliance on peer researchers (university students in same age range as the peer educators and participants) as research assistants and front-line consultants. Peer researchers played a key role in the initial data collection prior to the enlistment of the participants for the intervention project and thus in some cases were involved in the project for 2 years before the intervention phase. The peer researchers participated in the training and implementation along with peer educators. Each peer researcher was responsible for monitoring the activities of a certain number of groups
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(each of which were cofacilitated by two community peer educators) and providing immediate assistance when difficulties arose (e.g., modeling appropriate techniques, prompting the peer educator, providing additional information, seeking help from a consultant). The community health worker (midwife) also served in this capacity. As a result, the peer researchers and midwife became participant-consultants. They also served an important role as interpreters of the culture, facilitating communication and understanding between community members and interventionists/researchers. Furthermore, the use of the frontline consultants was considered critical to fostering sustainability and institutionalization of program efforts, especially given their permanence within the cultural context (e.g., university students are viewed as the country's future leaders in business, government, health care and education). Ongoing data collection also served an important research function, that of identifying critical and noncritical elements of the intervention. For example, written documentation of group discussions provided the basis for examining the relationship of the consensus building process of group discourse (proposed as a critical element) to the evolution of new peer norms and the extension of the repertoire of responses to sexual risk (proposed outcomes). In a mixed-gender group discussion of a sexual-risk scenario, male and female participants acknowledged differing perspectives of the boyfriend and girlfriend depicted in the scenario, and agreed that the two characters should "come to a settlement through a dialogue" (a strategy promoted through the intervention). The final solution reached by one group reflected integration of alternative ideas proposed by men and women. Initially the men suggested avoiding penetrative sex and staying with one sex partner. Women agreed with avoiding penetration and choosing a single partner, but also suggested negotiation and marriage. The final group solution reflected an integration of male and female views: nonpenetrative sex, negotiation with the partner, and marriage (i.e., having one partner). Essential Changes The Concept of Essential Changes. The third component of PIM involves the documentation of essential change or the examination of impact of the intervention on targeted outcomes (i.e., effectiveness or efficacy). This component addresses the question, "What progress has been made toward achieving the goals of the intervention?" Answering this question requires assessment at multiple points throughout and after the intervention. Performance at each point is compared with targeted competence level to determine if adequate progress is being made or if essential changes are occurring. In addition, changes in target competencies can be linked to the components of the intervention to determine which components are essential for achieving the desired goals (i.e., to distinguish critical vs. noncritical elements). Follow-up evaluation addresses questions about sustainability and
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institutionalization of intervention efforts. Furthermore, these evaluation data can be used to make modifications to enhance future success of the intervention and to inform the more general theory of behavior change. Both traditional and participatory intervention models call for evaluation to assess transfer and maintenance of the desired effects of the intervention, although with different foci. In traditional models, the focus is generalization of outcomes to other settings (transfer) and over time (maintenance): Did participants exhibit target skills (outcomes) in contexts external to the intervention (e.g., transfer from classroom to playground)? Were changes in skills maintained (e.g., exhibited in the classroom the following year)? In the case of consultation, did the service provider continue to implement the intervention with the target client and other clients? Thus, the focus is change within the individual client (e.g., student) or consultee (e.g., teacher). In PIM, the focus is change within the culture or context that includes the participants in terms of institutionalization and sustainability: To what extent have change efforts persisted? Have key stakeholders or key institutions developed strategies for extending the intervention to a broader population and to similar issues? These questions are related to the issue of ownership for the change process by individuals, organizations, or community systems (versus change within individual participants). The assumption is that generalization of individual change does not occur separately from contextual or cultural change. Theoretically, sustainability and institutionalization require ownership by and empowerment of key stakeholders. Thus, evaluation of the generalization of program outcomes requires attention to continued involvement, ownership, and empowerment of stakeholders in addition to institutionalization and sustainability of change efforts, which are all critical indicators of intervention acceptability in PIM. In the process of monitoring the essential changes, interventionists also attend to the links among acceptability, implementation, and effectiveness. As we monitor essential change, we continue our efforts to foster empowerment and ownership among stakeholders and to facilitate natural adaptation of the intervention. Thus, the iterative process of generation, adaptation, and monitoring change continues throughout the intervention program, with a focus on continued refinement to enhance acceptability, integrity, and effectiveness. At the conclusion of the intervention, stakeholders and researchers collectively make recommendations for future application. In subsequent applications, the iterative process repeats itself at the local level (potentially directed by stakeholders without researcher/interventionist support), thus contributing to sustainability and institutionalization. Such continued application of the iterative process and sustainable social change are dependent on the development of skills for conducting participatory intervention among stakeholders. Illustration: The Sri Lanka Sexual-Risk Prevention Project. In the sexual-risk prevention project (Nastasi et al., 1998-1999), we used both formative and summative evaluation techniques to document essential changes in the targeted competencies of
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sexual knowledge, attitudes, practices, risk perception, and decision making skills. Formative evaluation techniques included participant worksheets and narrative session notes. A program-specific pre-post measure was developed for the purpose of documenting program outcome (adapted from the ethnographic self-report survey used to collect formative research data). The pre-post measure included an open-ended item in which a dilemma about sexual risk was presented and respondents indicated what risks they perceived and how they would approach decision making. Responses were coded (inductively) for sexual-risk perception and decision making. Evaluation of the sexual-risk intervention revealed statistically significant improvement (from pretest to posttest) in women's knowledge of condoms and sexual terminology (r[32] = 2.92, p < .01; f[32] = 6.57, p < .001; respectively) (for a full discussion of findings, see Nastasi et al., 1998-1999). In addition, examination of the proposed solutions for sexual-risk protection indicated qualitative changes from pretest to posttest. Respondents at posttest were less likely to use vague (e.g., "must not act in wrong ways"), inaccurate (e.g., "only have sex with virgins"), or improbable ("by withdrawing one can avoid pregnancy") solutions. Responses at posttest were more likely to include specific strategies that reflected the range of effective alternatives discussed during the intervention, such as condoms, abstinence, nonpenetrative sex, and negotiation with one's partner. Content of discussions (from session notes) also permitted examination of changes in target competencies (e.g., improvement in scope and accuracy of risk perception), thus documenting the process of essential change toward target outcomes. Furthermore, session notes permitted the identification of critical elements of the intervention and documentation of integrity. As illustrated in an earlier section, documentation of discussions among participants suggested that the social construction (group) process facilitated perspective taking and consensus building (essential elements of the intervention process) and fostered the development of decision making and negotiation skills relevant to sexual-risk prevention (targeted outcome). Systematic evaluation of intervention acceptability occurred during the final intervention session. Participants and peer educators responded to a paper-and-pencil, Likert-type, self-report questionnaire specifically designed to assess acceptability (see items in Table 1). In addition, peer educators conducted a focus group discussion with participants to explore lessons learned, issues of satisfaction with program content and process, shortcomings of the intervention, and recommendations for the future. These and other findings regarding acceptability are presented in the next section.
DOES PIM FOSTER INTERVENTION ACCEPTABILITY?
In addressing the validity of PIM for promoting acceptability, we draw on our experiences from the Sri Lanka Sexual-Risk Prevention Project. As indicated in Table 1, participants' (program recipients) responses to the acceptability questionnaire in-
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TABLE 1. Descriptive Statistics for Posttest Acceptability Questionnaire (n = 65)

Question Mean Standard Deviation
The program was effective in providing me with information on the following topics: Relationships with the opposite sex 1.74 Reproductive health 1.45 STDs 1.28 HIV/AIDS 1.29 Preventing STDs 1.23 Preventing AIDS 1.38 Personal decision making 1.46 The information provided will guide my future behavior regarding the following: Relationships with the opposite sex 1.57 Reproductive health 1.37 STDs 1.31 HIV/AIDS 1.28 Preventing STDs 1.38 Preventing HIV/AIDS 1.37 Personal decision making 1.49 I attended all sessions 1.45 I participated in all activities 1.20 I was comfortable participating in the activities 1.26 I would participate in a similar program in the future 1.25
1.15 .69 .65 .68 .52 .80 .77 1.00 .65 .58 .57 .90 .74 .90 .95 .44 .64 .64
Note. Respondents were instructed to indicate level of agreement with each statement, using the following scale: 1 = strongly agree; 2 = agree; 3 = no opinion; 4 = disagree; 5 = strongly disagree.
dicated a high level of satisfaction with most aspects of the program. Responses to open-ended questions also indicated general satisfaction with the program and interest in continuation of this program and similar programs on other topics. They noted, in particular, the need to make the program available to other community members. Participants indicated that their primary motivation was to gain knowledge about sexual risk. They indicated that the stipends for participation were an initial motivation but became less significant over time as they became involved in the program. When asked how the program helped them, both participants and peer educators indicated perceived enhancement of program-specific knowledge, attitudes, and skills. They noted, in particular, the opportunity to overcome myths about reproductive health and sexuality (e.g., myths about virginity), to talk openly with peers about sexuality, to acquire information about how to avoid risky sexual interactions, and to prepare themselves to share information with other community members. A similar set of questions directed to peer educators indicated that they also felt prepared to inform others about sexual risk and to convey the information they had learned to others in the community.
3. Although it is possible that participants' posttest responses to acceptability survey items reflect a bias toward "pleasing the researchers," evidence from multiple data sources collected throughout the project corroborates the favorable responses given at the conclusion of the project.
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Participants also commented on the value of the intervention process. They reflected on the value of the social construction process and noted that their ideas had changed as a result of hearing the perspective of others; for example, recognizing the importance of negotiation with a sexual partner about risk-prevention practices. The participants wholeheartedly supported mixed-gender discussion about sexual-risk decision making and suggested that more sessions be devoted to mixed-gender interactions in the future. This finding was particularly noteworthy given the initial apprehension of stakeholders and the initial awkwardness of peer educators and participants about publicly discussing sexuality even within same-gender groups. To further document acceptability, we present evidence of (a) the culture-specificity of the intervention; (b) key stakeholders' involvement, ownership, and empowerment; and (c) the sustainability and institutionalization of related intervention and research efforts. This documentation is based on data gathered throughout the process of building partnerships, participatory generation (design), natural adaptation (implementation), and documenting of essential changes (evaluation). As articulated in earlier sections, we used a combination of data collection methods, including participant observation, key-informant and in-depth interviews, collection of artifacts, and ethnographic surveys. Analysis of qualitative data involved an inductive and recursive process of reviewing data for themes, generating key constructs and categories, coding data using the inductively derived categories, interpreting data, and verifying interpretations with stakeholders. This recursive process was applied across data sets to identify confirming and disconfirming evidence, both during and subsequent to the intervention process. (For information on qualitative data analysis techniques, see Lincoln & Guba, 1985; Miles & Huberman, 1994; Schensul & LeCompte, 1999; Spradley, 1979, 1980; Strauss & Corbin, 1990.) Culture Specificity We sought to ensure culture specificity in the design of intervention content and process. We provide a few examples of culture-specific features, noting links between formative data and intervention design. The Use of a Peer-Education Model. The decision to involve same-age peers as educators for implementation of the intervention was based in part on formative data indicating that peers were preferred sources of sexual information (over parents, teachers, or other older adults). In addition, cultural practices and norms influenced how we implemented the peer-education model. Cultural taboos about public discussion of sexuality made us cautious about how sessions were conducted. In consultation with project partners (adult and youth), we decided that sessions should be conducted separately for men and women (at least initially) and that group dynamics needed to be monitored closely to ensure that discussions were productive. Recognizing the limited vocabulary about sexuality (e.g.,
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young men relied primarily on colloquial language gathered from "blue [pornographic] films") and the potential difficulty for participants to verbalize sexual terms (young women admitted having difficulty discussing sexuality even with same-age female peers), we used a numbered list of the culture-specific sexual behaviors so that participants could identify terms by number until they became comfortable using the terminology. Definition of Sexual Risk. Based on formative data, we expanded our definition of sexual risk to include multiple factors in addition to HIV and AIDS (the primary intervention target from the perspective of funders), adding to the definition pregnancy, loss of virginity (for women), loss of marriageability (for women), social stigma (for women), loss of relationship, and other STDs. These additional risks were more salient to the participants than the threat of HIV and AIDS, so their inclusion became important to defining the cultural-specificity of the intervention. For example, using the culture-specific list of sexual behaviors, participants considered levels of respective risk (i.e., at which point in the typical sequence of sexual interaction does one become at-risk for loss of virginity, pregnancy, HIV and AIDS, other STDs, etc.) and relevant risk-avoidance techniques (e.g., condoms, nonpenetrative sex). Involvement, Ownership, and Empowerment Recruitment and retention of program recipients were highly successful (Nastasi et al., 1998-1999). Peer educators, with the assistance of the community health worker, recruited participants through social networks in the community. Each community peer educator (n = 15) was asked to recruit 5 participants; our target was 75 participants. A total of 89 individuals attended at least one session (41 female and 54 male); 74% (39 females, 27 males) of those participants attended at least half of the sessions (the criterion for consideration as a regular attendee). Thus, our recruitment efforts yielded a sample of 66 participants; 83% of those participants attended at least 9 sessions and 68% attended 11 to 12 sessions. There was a discrepancy in the retention of male and female members. Whereas almost 100% of the females were retained (39 of 41), only 50% of the males were retained (27 of 54). We attributed this discrepancy to a number of factors. First, the involvement of the community health worker proved crucial to retaining the females. Second, many of the females were unemployed, living at home, and had few opportunities for community participation. The males, in contrast, were more likely to be working or involved in sports teams, had less time to devote to our study, and greater opportunities for other community involvements. Third, there may have been a difference in how participation was initially described to males and females, given that a number of males who initially attended quickly dropped out when the level of commitment became apparent. Key stakeholders showed a high level of ownership or commitment to the project, through their availability and active participation, their willingness to increase involvement as needed, and their interest in the outcome. Empowerment
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was particularly evident among the nonprofessional partnersthe community health worker, peer researchers, and peer educatorswho developed the expertise and confidence necessary to implement the intervention successfully and to extend the educational efforts to the community. The perception of the peer educators as local experts in sexual risk and their willingness to assume that role exemplify their capacity and confidence for continued work within the community. Furthermore, both the professional and nonprofessional partners continued to conduct work in sexual risk prevention, in addition to other areas of community health and education, 2 to 3 years after the initial project was completed. The involvement of key stakeholders also proved critical to promoting cultural specificity and ultimately cultural institutionalization and sustainability. To illustrate, we use examples of representatives from the community health sector. STD Clinic Director and Staff. A member of the research team who was director of a local STD clinic provided important insights about sexual and risk-prevention practices, access to information, and factors that facilitated and inhibited seeking of health care for STDs. These insights were critical in the design, implementation and evaluation of the project. For example, the STD clinic director alerted us to common nonpenetrative sexual practices (also confirmed in formal data collection) that represented strategies for disease prevention that were potentially more acceptable to youth than securing and using condoms. In addition, staff from the STD clinic served as ongoing consultants to provide expert consultation to the peer educators and to co-facilitate the training sessions. Community Health Worker. The community health worker (midwife) provided child and maternal health care to families and was a trusted member of the local community. She played a key role in gaining parental approval for young unmarried women to participate in the program. Young women typically live with their parents until marriage and parents are highly protective. Although parental consent was not required for adult participants, parents could still prevent young women from attending. The community health worker's endorsement and participation in the project, which extended to attending all sessions and assisting peer educators in implementation, alleviated parental concern. In addition, the community health worker escorted female participants to and from the intervention sites. The community health worker's participation helped to ensure that she developed the expertise to facilitate subsequent intervention efforts and to institutionalize the provision of sexual risk prevention services. Given her ongoing interactions with families in the community, the midwife held a key position to advise and disseminate information to youth. Sustainability and Institutionalization After the conclusion of the intervention project, peer educators and program recipients participated in a series of follow-up activities, including a regional dissemination workshop, interviews, training in research techniques, and participatory generation of future projects. These activities provided additional
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opportunities to assess program outcomes and to evaluate actual and potential sustainability of program efforts. Several months after the conclusion of the intervention, a day-long workshop was conducted for professional and nonprofessional community health service providers and community leaders throughout the region. The purpose of the workshop was to disseminate project findings, discuss implications for community health practice, and plan future efforts by government and nongovernment agencies. Both peer educators and participants (program recipients) were involved in the workshop activities. They demonstrated program activities (modeling intervention strategies) and participated in discussions with other key stakeholders (e.g., community agency staff, civic leaders) to generate plans for future intervention efforts. The sense of ownership and empowerment that had developed among peer educators and program recipients was evident during their participation in dissemination activities. They demonstrated activities with confidence and participated eagerly in discussion groups with key stakeholders. In the discussions, they presented themselves as knowledgeable representatives of their peer group who were actively engaged in dialogue about the needs and plans for future interventions. The confidence and skill demonstrated by the peer educators and program recipients were especially noteworthy, given their limited previous interactions with other key stakeholders. For some of these youth, this was their first experience in presenting and interacting with service providers and community leaders. Although we provided the structure for their participation in the workshop, they collaboratively prepared their formal presentations with minimal guidance from consultants and engaged in group discussions without the aid of project staff. Subsequently, several of the peer educators have continued their involvement with the researchers-interventionists in ongoing research and development activities around sexual risk, mental health, and child and maternal health care. In addition, they organized a community action group focused on solving community health-related problems (e.g., organizing an educational program and clean-up activity in their own community focused on prevention of dengue fever). Such involvement in research and generation of new projects brings the participatory process full circle to "participatory generation" (see Figure 1). These examples of sustainability and institutionalization attest to the success of the program in promoting ownership and empowerment among stakeholders.
IMPLICATIONS FOR SCHOOL PSYCHOLOGY INTERVENTION RESEARCH AND PRACTICE
We have presented evidence that the participatory intervention model provides an alternative approach for conceptualizing and promoting intervention acceptability. The use of PIM poses both challenges and opportunities for individual interventionists (as researchers and/or practitioners) and more generally for the field of pro-
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fessional school psychology. These challenges and opportunities have important implications for future research and practice. Based on our experiences, we reflect on these challenges and opportunities. Challenges In PIM, acceptable interventions are defined as those that are (a) culture specific; (b) promote involvement, ownership, and empowerment of key stakeholders; and (c) foster sustainable and institutionalized social change. This takes us far beyond the notion of designing interventions that consumers will view as logical, useful, feasible, and effective, and thus will likely use. The effective use of PIM challenges not only how we think about acceptability, but also how we think about the respective roles of school psychologists and key stakeholders. Moreover, the use of PIM raises questions about the methods we use for conducting psychological interventions. The Roles of School Psychologists and Stakeholders. The significance of partnership in PIM raises questions about the respective roles of school psychologists and stakeholders and potentially engenders redefinition and flexibility of roles. Developing partnerships may require overcoming existing hierarchical power structures within an organization, community, or culture. The school psychologist, as consultant or interventionist, can play a critical role in facilitating partnerships by helping to prepare community members to participate fully in the process, mediating the negotiation of roles and responsibilities, and modeling the partnership process for other professionals. In addition, the respective roles and levels of involvement by different stakeholders may vary across the history of the project. Thus, it behooves school psychologists to be flexible as they negotiate with stakeholders through different phases of the project. By definition, sustainability and institutionalization depend on the capacity of the stakeholders to assume responsibility for intervention efforts once support from interventionists has ceased. The school psychologist can facilitate the transition to institutionalization by helping stakeholders develop necessary skills and confidence, access needed resources, and create an infrastructure for maintaining the process. As stakeholders assume more responsibility for program efforts, interventionists may find it necessary to prepare themselves for relinquishing ownership and control of the process. Theoretically, the interventionist becomes an unnecessary player in program continuation. Within a participatory model, continuation of the process in the absence of the interventionist (school psychologist) and stakeholders' assumption of responsibility for the success or failure of change efforts are considered to be key indicators of acceptability. Methods for Conducting Psychological Intervention. Successfully executing PIM requires consideration of alternative methods for intervention design, implementation, and evaluation. PIM involves the integration of research and practice through the use of participatory action research and naturalistic inquiry methods. Although not incompatible with current conceptions of the scientific practice of school psychology (e.g., data-based problem solving, use of ecologically valid
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methods, collaborative consultation, and systems change), these methods are not likely to be in the repertoire of most school psychologists. Furthermore, the success of both naturalistic inquiry and participatory intervention lies in the capacity for long-term investment and commitment. Much time and effort are necessary to develop effective partnerships, engage in formative research, document the intervention process, conduct a comprehensive evaluation, and plan for institutionalization. Researchers and interventionists should not enter such an endeavor without full realization of its depth and scope. Engaging in PIM challenges how we think about acceptability and how we conduct professional research and practice related to interventions. At the same time, PIM can offer opportunities for promoting acceptability and enhancing school psychology research and practice. Opportunities We contend that PIM can assist school psychologists in creating acceptable and effective interventions, and sustainable social change. Moreover, we argue that PIM can assist us in our efforts to address current challenges in school psychology, including addressing diversity, building school-family-community partnerships, providing comprehensive and integrated psychological services, broadening the role of the school psychologist, promoting disciplined reflective practice, and bridging the gap between research and practice. Addressing Diversity. The process and procedures of PIM hold promise as ways to enhance our understanding of cultural diversity and developing culture-specific services. Specifically, PIM has the potential to help us rethink how we define multiculturalism, develop new strategies for understanding and meeting the needs of a multicultural society, and develop interventions that are acceptable and sustainable for a diverse population. Building School-Family-Community Partnerships. PIM has potential application in the development of effective partnerships with key stakeholders such as school personnel, parents, community agencies, and community members. For example, PIM has the potential for fostering partnerships and coordination among interagency providers and programs and for facilitating the involvement of parents, teachers, and community members in the intervention process. Providing Comprehensive and Integrated Psychological Services. Participatory intervention involves the integration of assessment, consultation, intervention, and evaluation and research activities in the development and delivery of psychological services. Thus, PIM can provide a mechanism for comprehensive service delivery. Furthermore, PIM has the potential for integrating the varied services and seemingly disparate roles of school psychologists. Broadening the Role of School Psychologists. In addition to its potential for role integration, the participatory intervention model can serve as a blueprint for school
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psychologists as change agents, preventionists, applied researchers, and organizational consultants. Through partnerships with community stakeholders, we can extend our role to that of social change agent and community advocate, thereby addressing our responsibilities to society (Prilleltensky, 1991). Promoting Reflective Practice. 'The school psychologist as reflective practitioner engages in a continual process of explicating and evaluating his/her application of theory and research to service delivery" (Nastasi, 1998; p. 168). PIM can serve as a model for disciplined reflective practice, strengthening our conception of the scientist-practitioner as one who engages in the recursive theory-research-practice cycle. Bridging the Gap Between Research and Practice. Perhaps the most important opportunity afforded by participatory intervention is the potential for bridging the schism between use and availability of theoretically and empirically sound psychological interventions. School psychologists with expertise in participatory intervention can play a key role in establishing partnerships with stakeholders to create acceptable theoretically and empirically sound interventions, thus reducing the gap between research and practice. Future Research and Practice The extent to which the challenges of participatory intervention can be overcome and the opportunities can be realized depends on future research and practice within school psychology. Research is needed to examine and establish effective strategies for implementing the participatory intervention model within schools. In particular, strategies for establishing successful partnerships, facilitating the participatory process among stakeholders, and promoting institutionalization need to be examined. Using naturalistic inquiry to address these issues is likely to yield detailed descriptions of successful participatory endeavors from which practitioners can draw. Realizing the practice opportunities afforded by the participatory intervention model requires examination of current practices in professional preparation. The proposed model builds on the skills of professional school psychologists, but also requires development of new competencies. A critical question is whether school psychologists are prepared to engage in naturalistic inquiry, and the extent to which graduate programs in school psychology provide the opportunity to learn naturalistic or qualitative research methods. FINAL WORDS We have argued that the concept of acceptability in traditional models of intervention reflects a perception of teachers, parents, students, and administrators as consumers of the products of school psychology (i.e., the intervention programs we have to offer). From this viewpoint, the interventionist (school psychologist) must change the product (offer an alternative product) or convince the consumer
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of its value to ensure its use. Such efforts to design or identify acceptable interventions are likely to fall short of attempts to understand the beliefs, motivations, practices, language, and culture of our consumers. Furthermore, we contend that such practices may limit opportunities for empowerment of stakeholders and for strengthening the capacity of school psychologists to serve diverse populations. By contrast, the concept of acceptability in the participatory intervention model reflects a perception of stakeholders as partners in identifying and developing the product (i.e., the intervention that evolves from a process of inquiry as to the particulars of the context). We contend that partnership in intervention programming and consequent ownership of the problem and its solutions necessitate a process of inquiry focused on understanding the complexity of the problem, the stakeholders, and the opportunities for solution within the natural setting. As partners, stakeholders are likely to be unwilling to accept solutions without a full understanding of both the problem and the range of possible solutions, thus providing an impetus for interventionists to engage in disciplined inquiry and reflective practice. Furthermore, we have proposed that as stakeholders engage in the construction of solutions, they are likely to become empowered towards effecting and sustaining change. We have provided evidence of the power of PIM to effect change in program recipients and other stakeholders (e.g., peer educators, community health workers, peer researchers). Moreover, we contend that engaging in the participatory process also has the potential for changing current conceptions of school psychologists as consultants and researchers, and for compelling school psychologists to develop new methods for engaging in practice and research. Such challenges provide opportunities to strengthen the field of school psychology and to extend our contributions to a diverse society.
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Action Editor: Terry B. Gutkin Acceptance Date: February 4, 2000

The Participatory Intervention Model - Nastasi Et Al 2000

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The Participatory Intervention Model - Nastasi Et Al 2000

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School Psychology Quarterly, Vol. 15, No. 2, 2000, pp.

PARTICIPATORY INTERVENTION MODEL

PARTICIPATORY INTERVENTION MODEL

FIGURE 1 . The Participatory Intervention Model.

PARTICIPATORY INTERVENTION MODEL

PARTICIPATORY INTERVENTION MODEL

PARTICIPATORY INTERVENTION MODEL

PARTICIPATORY INTERVENTION MODEL

PARTICIPATORY INTERVENTION MODEL

TABLE 1. Descriptive Statistics for Posttest Acceptability Questionnaire (n = 65)

PARTICIPATORY INTERVENTION MODEL

PARTICIPATORY INTERVENTION MODEL

PARTICIPATORY INTERVENTION MODEL

PARTICIPATORY INTERVENTION MODEL

PARTICIPATORY INTERVENTION MODEL

Action Editor: Terry B. Gutkin Acceptance Date: February 4, 2000

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