A Framework for Valuing Investments in a Nurturing Society: Opportunities for Prevention Research

Investing in strategies that aim to build a more nurturing society offers tremendous opportunities for the field of prevention science. Yet, scientists struggle to consistently take their research beyond effectiveness evaluations and actually value the impact of preventive strategies. Ultimately, it is clear that convincing policymakers to make meaningful investments in children and youth will require estimates of the fiscal impact of such strategies across public service systems. The framework offered here values such investments. First, we review current public spending on children and families. Then, we describe how to quantify and monetize the impact of preventive interventions. This includes a new measurement strategy for assessing multisystem service utilization and a price list for key service provision from public education, social services, criminal justice, health care and tax systems.     

The promotion of wellness in children and families challenges and opportunities.

This article considers the effects of marital disruption on children and families, using a risk and resilience perspective. The challenges that parental divorce poses for children are widely recognized; however, less attention has been given to strategies for promoting children's resilience and healthy developmental trajectories. The purpose of this article is to redress that imbalance by highlighting the importance of understanding pathways toward risk and resilience in children in the aftermath of divorce and the ways in which this research can be integrated into effective, evidence-based preventive interventions and proactive social policies that foster supportive parent-child relationships and psychological wellness in children and families.     

Rationale and principles for early intervention with young children at risk for anxiety disorders

Anxiety disorders are one of the most prevalent categories of disorder among adults and children. Children of parents with anxiety disorders are known to be at higher risk for anxiety disorders themselves, with manifestations of this risk often appearing in toddlerhood or early childhood. Yet because affected parents are often unskilled in anxiety management, they often have difficulty in helping their young children learn to manage anxiety. Literature on the course of anxiety disorders through childhood and on effective cognitive-behavioral interventions suggests that preventive interventions even with very young children could potentially be of benefit in mitigating the course of these often debilitating disorders. This paper outlines the rationale for offering early or preventive interventions to preschool-age children at risk and their parents and discusses means of identifying children to target for intervention and the importance of parental involvement. Drawing upon the literature on parental factors in childhood anxiety disorders as well as on effective intervention strategies with preschool-age children, it delineates principles for intervention with parents and effective components of intervention with youngsters in this age range.     

Preventive interventions among children exposed to trauma of armed conflict: a literature review

Increasing research is available on the preconditions for child mental health and optimal development in traumatic conditions, whereas less is known how to translate the findings into effective interventions to help traumatized children. This literature review analyses the effectiveness of psychosocial preventive interventions and treatments and their theoretical bases among children traumatized in the context of armed conflicts (war, military violence, terrorism and refugee). The first aim is to evaluate the effectiveness of preventive interventions in preventing emotional distress and impairment and promoting optimal emotional‐cognitive and social development. The second task is to analyze the nature of the underlying mechanisms for the success of preventive interventions, and the theoretical premises of the choice of intervention techniques, procedures and tools. We found 16 relevant published studies, but an examination of them revealed that only four of them had experimental designs strong enough that they could be included in the meta‐analysis. While the subjective reports of the researchers suggested that systematic preventive interventions were effective in decreasing PTSD and depressive symptoms among children traumatized due to armed conflict, the more objective results of the meta‐analysis and the weaknesses in designs uncovered during the meta‐analysis undermine such a conclusion. Additionally, a majority of the reported preventive interventions focused only on children's biased cognitive processes and negative emotions, while only a few aimed at influencing multiple domains of child development and improving developmental functioning on emotional, social and psychophysiological levels. It is concluded that substantial additional work needs to be done in developing effective preventive interventions and treatments for children traumatized by exposure to war and violence. Aggr. Behav. 36:95–116, 2010. © 2009 Wiley‐Liss, Inc.     

PATHS in Croatia: A school‐based randomised‐controlled trial of a social and emotional learning curriculum

This study represents the first rigorous evaluation of a social‐emotional learning curriculum, PATHS (P romoting A lternative Th inking S trategies; Kusché & Greenberg, 1994), in elementary schools in Croatia. This study randomly assigned 29 schools to receive the universal preventive intervention or continue with usual practices. Within those schools, this study included 57 classrooms and 568 children. Teachers rated nine child behaviours in the middle of first grade (pre‐intervention) and near the end of second grade (post‐intervention). Hierarchical linear models, nesting children within classrooms, revealed few changes in behaviour across the sample as a whole or among higher risk children. However, there were changes on eight of the nine behaviours for lower risk children. The findings are considered in the context of the classroom culture and teachers' preparation and readiness to implement a social‐emotional learning curriculum in Croatia. This study highlights the need to supplement universal preventive interventions with selective preventive interventions that can provide more intensive and targeted skill practice for higher risk children. This study also highlights the nuanced effects of a universal preventive intervention in helping different children in different ways.     

Multicultural Issues in the Delivery of Group Interventions

Innovative preventive interventions are increasingly delivered in small group settings to children in school who are at risk for a variety of negative outcomes. In addition to reducing children's risk, these interventions present the possibility of enhancing students' awareness and understanding of cross-ethnic peers. To be effective with children from diverse ethnic backgrounds, these programs must examine their underlying assumptions regarding the definitions of social competence and methods of behavior change, tailor the program for each ethnic group served, and examine the impact of the interventions across different domains of the children's life.     

Conceptualization and Treatment of Social Withdrawal in the Schools

Social withdrawal represents a class of behavior problems that are not as frequently referred by teachers in school settings as are disruptive, acting-out behaviors. Approximately 15% of all children referred to school psychologists and other mental health professionals in the schools are socially withdrawn. This paper provides several definitions of social withdrawal from a social skills perspective and presents a four-fold classification system of children's social skills deficits. Assessment procedures for identifying socially withdrawn children are briefly reviewed. Four social skills training strategies (i.e., modeling, coaching, peer-mediated interventions, and group contingencies) are reviewd and the relative efficacy of each are evaluated. Several commercially-available social skills training curricula designed for school settings are described at the conclusion of this paper.     

Homelessness Among Families, Children, and Adolescents: An Ecological–Developmental Perspective

This paper reviews and evaluates the literatures on children in families that are homeless and on adolescents who are homeless on their own. After presenting several emerging theoretical approaches, we propose a broad ecological-developmental perspective that recognizes that, although persons in these groups often lack resources and experience negative events that can amplify the risk for poor outcomes, they also have resources and adaptive potential. The perspective also recognizes that homelessness may have different meanings and outcomes at different points in development and that we need to consider interactions between individual development and multiple levels of social organization in order to foster new solutions to homelessness. On the basis of this perspective, we discuss directions for treatment and preventive interventions as well as social policy.     

EFFECTS OF SELF-EVALUATION ON PRESCHOOL CHILDREN'S USE OF SOCIAL INTERACTION STRATEGIES WITH THEIR CLASSMATES WITH AUTISM

This study investigated effects of a self-evaluation procedure on preschool children's use of social interaction strategies among their classmates with autism. Three triads of children (comprised of 1 trained normally developing peer, 1 untrained peer, and 1 child with autism) participated. A multiple baseline design across subjects was used to demonstrate that peers who were taught facilitative strategies increased their use of strategies only after the self-evaluation intervention was introduced. Improvements in social behavior of children with autism was associated with peers' increased strategy use. Untrained peers demonstrated little change in their social behavior. Treatment effects were replicated when trained peers were asked to use self-evaluation with other children with autism during other play times. Self-evaluation procedures enhanced the use of social interaction strategies on the part of normally developing peers during social skills interventions.     

The direct way may not be the best way: Children with ADHD and their understanding of self-presentation in social interactions

Knowledge and use of self-presentational tactics is an important social skill. We examined understanding of the function of three different self-presentational tactics (self-promotion, ingratiation and blasting) in 11 8–12-year-old boys with attention-deficit/hyperactivity disorder (ADHD) and 11 matched comparison children. Children were given six different self-presentation stories, two for each one of the three different tactics. After each story, they were asked to evaluate the effects of the self-presentational tactic used. Children with ADHD rated self-promotion and blasting as more positive and more effective—and ingratiation as less positive and less effective—than children in the control group. This implicates that children with ADHD prefer simple and direct self-presentational strategies (like self-promotion), and, therefore, may not as easily understand more subtle strategies (like ingratiation). They also seem to be more inclined to use negatively connoted strategies (like blasting). We suggest that this limited understanding of self-presentational strategies in children with ADHD may explain some of their problems in social interactions. Therefore, social skill interventions in children with ADHD should incorporate elements focusing on use and understanding of different self-presentational strategies.     

Promoting child and family wellness: priorities for psychological and social interventions

In order to foster the well‐being of children and families we propose a shift in the priorities of psychological and social interventions. Following a brief discussion of the concept of wellness, we present a framework for interventions to promote child and family wellness. Psychological and social intervention strategies to promote child and family wellness are then reviewed and interpreted in terms of the framework. Recommendations for changing priorities for programmes and policies are based on the framework and a review of the effectiveness of existing interventions. Copyright © 2000 John Wiley & Sons, Ltd.     

Posttraumatic Stress Following Acute Medical Trauma in Children: A Proposed Model of Bio-Psycho-Social Processes During the Peri-Trauma Period

Millions of children worldwide experience acute medical events. Children’s responses to these events range from transient distress to significant posttraumatic stress disorder symptoms (PTSS). While many models suggest explanations for the development and maintenance of PTSS in adults, very few have focused on children. Current models of child PTSS are primarily restricted to the post-trauma period, thus neglecting the critical peri-trauma period when screening and preventive interventions may be most easily implemented. Research on PTSS in response to pediatric medical trauma typically examines predictors in isolation, often overlooking potentially important interactions. This paper proposes a new model utilizing the bio-psycho-social framework and focusing on peri-trauma processes of acute medical events. Understanding the relationships among bio-psycho-social factors during peri-trauma can inform early identification of at-risk children, preventive interventions and clinical care. Recommendations for future research, including the need to examine PTSS in the context of multiple influences, are discussed.     

Strategies to Engage Underrepresented Parents in Child Intervention Services: A Review of Effectiveness and Co-occurring Use

The purpose of this review was to estimate the impact of parent engagement strategies tested with underrepresented families of young children with social, emotional, or behavioral disorders, and describe the combinations in which these strategies are commonly used together. We conducted a systematic review using the PracticeWise Engagement Coding System to identify which strategies had the strongest empirical support for engaging underrepresented (i.e., minority race or ethnicity, or low income) families receiving psychosocial services for their children. Social network analyses were used to identify the frequency of strategy use and how strategies were combined to engage underrepresented families. Linear regression was used to estimate the impact of each strategy on parent engagement, using attrition as a proxy for non-engagement. Thirty-five studies met inclusion criteria. Parent attrition was predicted by larger sample sizes, lower maternal education, interventions that were more community or home-based, less therapist monitoring, positive reinforcement from therapists, and more pairing families with peers. Social network analyses suggested that more effective strategies were more frequently implemented alone and less effective strategies were commonly combined with each other. Our findings suggest that researchers and practitioners require guidance in selecting engagement strategies to reduce attrition of underrepresented families in treatment. Although we identified promising strategies for improving parent engagement in treatment for underrepresented children with social, emotional, or behavioral disorders, the frequent combining of engagement strategies in research means that there is little data on the independent effects of interventions to increase parent engagement for this population.     

A Review of Technology-Based Youth and Family-Focused Interventions

In the past 10 years, mental and behavioral health has seen a proliferation of technology-based interventions in the form of online and other computer-delivered programs. This paper focuses on technology-based treatment and preventive interventions aimed at benefitting children and adolescents via either involving the parents and families, or only the youth. The review considered only technology-based interventions that had at least one published study with a randomized controlled trial design. Questions being addressed included: (1) What are the technology-based interventions in the mental/behavioral health area that have been systematically evaluated in published studies? (2) What are the common and unique characteristics of these interventions and their application with respect to sample characteristics, target problems, and technology characteristics (platforms, structures, elements, and communication formats)? and (3) Which intervention approaches and strategies have accrued the greatest evidence? The review identified 30 technology-based psychosocial interventions for children and families, 19 of which were parent or family-focused (32 studies) and 11 of which were youth-focused (in 13 studies). For the parent/family-focused interventions, greatest promise was found in those that addressed either youth behavioral problems or depressive/anxious symptoms, as well as more general bolstering of parenting efficacy. The youth-focused interventions showed some promise in reducing depressive/anxious symptoms. Advantages and disadvantages of the technology-based approaches were considered, and areas for future research and development were discussed.     

Early Identification and Intervention for Behavior Problems in Primary Care: A Comparison of Two Abbreviated Versions of Parent-Child Interaction Therapy

Behavioral screening and preventive intervention were implemented for 3- to 6-year-olds in pediatric primary care with subclinical behavior problems. One hundred eleven children were screened with the Eyberg Child Behavior Inventory. Thirty children who scored within one standard deviation of the normative mean whose mothers indicated wanting help for their child's behavior were randomized to one of two abbreviated versions of Parent-Child Interaction Therapy (PCIT) for use in pediatric primary care: (a) a 4-session group preventive intervention called Primary Care PCIT (PC-PCIT); or (b) written materials describing basic steps of PCIT and guidelines for practice, called PCIT Anticipatory Guidance (PCIT-AG). Decreases in child problem behaviors and ineffective parenting strategies, and increases in parental feelings of control were not significantly different between versions at post-intervention or 6-month follow-up. Changes during intervention were significantly larger for both groups than changes during pretreatment baseline, with moderate to large effect sizes. These brief versions of PCIT are both promising primary care preventive interventions that deserve further study.     

Training parents to help their children read: A randomized control trial

Background . Low levels of literacy and high levels of behaviour problems in middle childhood often co‐occur. These persistent difficulties pose a risk to academic and social development, leading to social exclusion in adulthood. Although parent‐training programmes have been shown to be effective in enabling parents to support their children's development, very few parent interventions offer a combination of behavioural and literacy training. Aims . This paper (1) reports on a prevention programme which aimed to tackle behaviour and literacy problems in children at the beginning of school, and (2) presents the effects of the intervention on children's literacy. Sample . One hundred and four 5‐ and 6‐year‐old children selected from eight schools in an inner city disadvantaged community in London participated in the intervention. Methods . This is a randomized control trial with pre‐ and post‐measurements designed to evaluate the effectiveness of an intervention. The behavioural intervention consisted of the ‘Incredible Years’ group parenting programme combined with a new programme designed to train parents to support their children's reading at home. Results . Analyses demonstrated a significant effect of the intervention on children's word reading and writing skills, as well as parents' use of reading strategies with their children. Conclusion . A structured multicomponent preventive package delivered with attention to fidelity can enable parents to support their children's reading at home and increase their literacy skills. Together with the improvement in child behaviour, these changes could improve the life chances of children in disadvantaged communities.     

Complacency, misdirection, and effective prevention of children's injuries.

Injuries are the leading killer of children in the United States, yet most parents, communities, and legislatures remain uncommitted to effective injury prevention. Possible reasons for this complacency are described, and effective methods, likely targets, and useful tactics for prevention are reviewed. The greatest challenges to injury preventionists are to persuade those who remain uninformed concerning the importance of injury prevention, to redirect those efforts currently devoted to ineffective interventions, to continue to evaluate and implement effective preventive interventions, and to search for improved prevention strategies.     

Preschoolers at risk for attention-deficit hyperactivity disorder and oppositional defiant disorder: family,parenting, and behavioral correlates

This community study assigned 129 4-year-olds to groups at risk for attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), both ADHD and ODD, or no problems. Mothers of children at risk for ODD reported more family dysfunction, felt less competent as parents, suggested fewer solutions to child behavior problems, demonstrated a less assertive approach to child management, and reported more child internalizing problems than did mothers of children not elevated on ODD symptoms. Mothers of children at risk for ADHD reported higher personal depression scores than did those of the non-ADHD subgroup. Children at risk for ADHD evidenced the most difficulties in school where teachers reported more social behavior, classroom management, and internalizing problems relative to other children not at risk for ADHD. When solving child management problems, mothers of children in all groups suggested twice as many controlling/negative management strategies as positive/preventive strategies. In addition, faced with oppositional and conduct problems, mothers of children in all groups increased controlling/negative suggestions and decreased positive/preventive suggestions. Mothers of girls at risk for ADHD, ODD, and ADHD/ODD gave more rewards per positive behavior than did mothers of boys.     

Toward a framework for defining and resolving ethical issues in the protection of communities involved in primary prevention projects

Ethical issues flow from and are embedded in contexts of practice. Contexts of practice refer to the diverse social settings where interventions occur. Primary prevention activities require new professional roles in these diverse social settings. These new roles engage the professional in new activities, which in turn allow new ethical issues to arise. This article takes an ecological perspective on ethical issues arising from the enactment of new preventive roles intended to affect groups or communities. Within this perspective, the concepts of context and culture take on special conceptual significance. Four ecological assumptions about preventive interventions intended to affect groups or communities are offered as a means of framing ethical issues in such interventions. Finally, several approaches to developing ecological knowledge about the contexts of practice are presented as ways of furthering our ability to conceptualize and cope with ethical issues in preventive interventions intended to affect groups or communities.     

Vulnerabilities of Academically Gifted Students

Abstract

It is often assumed that gifted students enjoy relatively good social and emotional adjustment, vibrant mental health, and overall well being. Unfortunately, this is not always the case, and a significant number of gifted students experience painful, troubling and often debilitating psychological problems. Gifted children and youth possess a set of personality characteristics that make them uniquely vulnerable. School personnel and parents need to be cognizant of these risk factors so that they can provide coordinated and comprehensive educational and social opportunities to foster resilience and, when needed, provide preventive and therapeutic mental health interventions for those gifted students with actual psychological problems.