Academic centers for prevention research. Making prevention a practical reality

The Prevention Centers Grant Program attempts to bridge the gap between the development and the implementation of research findings in public health practice. The program funds practical research on health issues of national and international importance. Grants can be awarded to schools of medicine, schools of osteopathy, or schools of public health. Ongoing programs at the University of North Carolina, the University of Washington, the University of Texas, and the University of Hawaii, as well as programs funded in 1990 at the University of Arizona, the University of Illinois, and Columbia University, are discussed.     

The KiVa antibullying curriculum and outcome: Does fidelity matter?

Research on school-based prevention suggests that the success of prevention programs depends on whether they are implemented as intended. In antibullying program evaluations, however, limited attention has been paid to implementation fidelity. The present study fills in this gap by examining the link between the implementation of the KiVa antibullying program and outcome. With a large sample of 7413 students (7–12 years) from 417 classrooms within 76 elementary schools, we tested whether the degree of implementation of the student lessons in the KiVa curriculum was related to the effectiveness of the program in reducing bullying problems in classrooms. Results of multilevel structural equation modeling revealed that after nine months of implementation, lesson adherence as well as lesson preparation time (but not duration of lessons) were associated with reductions in victimization at the classroom level. No statistically significant effects, however, were found for classroom-level bullying. The different outcomes for victimization and bullying as well as the importance of documenting program fidelity are discussed.     

Implementing a Comprehensive Program for the Prevention of Conduct Problems in Rural Communities: The Fast Track Experience

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.     

Sustainable antibullying program implementation: School profiles and predictors

We examined the sustainability of the KiVa antibullying program in Finland from its nationwide roll-out in 2009 to 2016. Using latent class analyses, we identified four different patterns of implementation. The persistent schools (43%) maintained a high likelihood of participation throughout the study period. The awakened (14%) had a decreasing trend during the first years, but then increased the likelihood of program participation. The tail-offs (20%) decreased in the likelihood of participating after the third year, and the drop-offs (23%) already after the first year. The findings suggest that many schools need support during the initial years to launch and maintain the implementation of evidence-based programs; yet a large proportion of schools manage to sustain the program implementation for several years. The logistic regression analyses showed that large schools persisted more likely than small schools. Lower initial level of victimization was also related to the sustainability of the program. Finally, persistent program participation was predicted by several school-level actions during the initial years of implementing the program. These results imply that the sustainability of evidence-based programs could be enhanced by supporting and guiding schools when setting up the program during the initial implementation.     

Culturally Sensitive Risk Behavior Prevention Programs for African American Adolescents: A Systematic Analysis

The current review conducted a systematic assessment of culturally sensitive risk prevention programs for African American adolescents. Prevention programs meeting the inclusion and exclusion criteria were evaluated across several domains: (1) theoretical orientation and foundation; (2) methodological rigor; (3) level of cultural integration; (4) program target or domain (e.g., schools, communities, families); (5) outcome change level assessed (e.g., addressing change in beliefs/values or behaviors); and (6) program effects on risk behaviors. Thirteen studies (N = 13) with adolescent participants ranging from 10 to 18 years were identified and evaluated. Analyses suggested that more effective culturally sensitive risk prevention programs included the following: (1) a clearly articulated theoretical orientation, which utilized both universal (e.g., behavioral theories) and culturally specific (e.g., Africultural theories) frameworks; (2) a rigorous methodological design (e.g., inclusion of control group, utilization of program manuals, valid and reliable study measures); (3) an integration of culture at multiple levels (e.g., accessibility, delivery, and content) of programming; (4) consideration of the influence of multiple contexts and domains (e.g., family, community, school); (5) multiple behavior change outcomes (e.g., behaviors, relationships, values); and (6) sustained program effects over time. Recommendations for increasing the effectiveness and efficacy of culturally sensitive prevention programs are discussed.     

Understanding Parent Participation in a Going-to-Scale Implementation Trial of the Early Risers Conduct Problems Prevention Program

We examined parent participation in the context of a going-to-scale implementation trial of the evidence-based, multi-component Early Risers conduct problems prevention program. In this study we examine the participation of parents in two parent/family-focused components of Early Risers that were delivered over 2 years across 21 rural school sites with 155 primarily Caucasian families. One component is a standardized “Parent Skills” curriculum delivered at participating schools and the second component delivers “Family Support” via tailored case management services through school and non-school site contacts. The study examines predictors of parent participation for each parent-focused component using multilevel modeling analyses. Previous research is extended by examining parent participation within the context of a going-to-scale trial and by looking at a broader array of child/parent/family and implementation context predictors. Parent participation in Parent Skills is predicted by higher level of parent’s frustration in parent–child relationships, while their participation in Family Support is related to lower family income. Implementers with higher previous work experience with children/families and lower education levels, as well as those manifesting more extroverted and less agreeable personality characteristics, elicit more participation in Parent Skills. Greater participation in Family Support is also predicted by lower levels of implementer neuroticism. Finally, implementers who achieve higher quality of delivery fidelity have greater participation in Parent Skills and a lower level of adherence fidelity predicts more participation in Family Support. The results are discussed within the context of going-to-scale service provision and in terms of implications for future prevention efforts.     

Enhancing school-based prevention and youth development through coordinated social,emotional, and academic learning

A comprehensive mission for schools is to educate students to be knowledgeable, responsible, socially skilled, healthy, caring, and contributing citizens. This mission is supported by the growing number of school-based prevention and youth development programs. Yet, the current impact of these programs is limited because of insufficient coordination with other components of school operations and inattention to implementation and evaluation factors necessary for strong program impact and sustainability. Widespread implementation of beneficial prevention programming requires further development of research-based, comprehensive school reform models that improve social, health, and academic outcomes; educational policies that demand accountability for fostering children's full development; professional development that prepares and supports educators to implement programs effectively; and systematic monitoring and evaluation to guide school improvement.     

Modeling the Bullying Prevention Program Preferences of Educators: A Discrete Choice Conjoint Experiment

We used discrete choice conjoint analysis to model the bullying prevention program preferences of educators. Using themes from computerized decision support lab focus groups (n = 45 educators), we composed 20 three-level bullying prevention program design attributes. Each of 1,176 educators completed 25 choice tasks presenting experimentally varied combinations of the study’s attribute levels. Latent class analysis yielded three segments with different preferences. Decision Sensitive educators (31%) preferred that individual schools select bullying prevention programs. In contrast, Support Sensitive educators (51%) preferred that local school boards chose bullying prevention programs. This segment preferred more logistical and social support at every stage of the adoption, training, implementation, and long term maintenance processes. Cost Sensitive educators (16%) showed a stronger preference for programs minimizing costs, training, and implementation time demands. They felt prevention programs were less effective and that the time and space in the curriculum for bullying prevention was less adequate. They were less likely to believe that bullying prevention was their responsibility and more likely to agree that prevention was the responsibility of parents. All segments preferred programs supported by the anecdotal reports of colleagues from other schools rather than those based on scientific evidence. To ensure that the bullying prevention options available reflect the complex combination of attributes influencing real world adoption decisions, program developers need to accommodate the differing views of the Decision, Support, and Cost Sensitive segments while maximizing the support of parents and students.     

Combining whole-school and targeted programs for the reduction of bullying victimization: A randomized,effectiveness trial

Despite the extensive evaluation of school-based interventions for bullying, victimization remains a significant problem in schools. Bullying victimization is significantly predicted by contextual (school-related) factors. As a consequence whole-school programs have been commonly used to prevent and reduce bullying victimization. Evidence also points to individual risk factors (such as emotional distress) in predicting victimization, yet programs to prevent bullying victimization by changing these individual risks are far less developed. Few studies have approximated “real-world” implementation conditions in their trials. The current effectiveness trial evaluated the combination of a whole-school program designed to prevent bullying perpetration and victimization together with a targeted intervention for at-risk students, teaching them individual and dyadic strategies to reduce their anxiety and manage victimization, allowing schools some latitude to implement programs as they typically would. Students from Grades 3 and 4 (N = 8,732) across 135 schools were randomly assigned to one of four conditions: combined intervention; whole-school intervention only; individual intervention only; and care as usual. Victimization decreased significantly and similarly across all four conditions at 12 and 24 months following baseline. Similar reductions and failure to discriminate conditions were found on other key constructs: anxiety; bullying perpetration; and depression. Possible reasons for the failure to demonstrate victimization prevention differences and lessons learned from this large, effectiveness trial are considered.     

“Signs of Suicide” Shows Promise as a Middle School Suicide Prevention Program

Although the Signs of Suicide (SOS) suicide prevention program has been implemented at both the middle and high school levels, its efficacy has been demonstrated previously only among high school students. The current study evaluated SOS implemented in high military impact middle schools. Compared to controls, SOS participants demonstrated improved knowledge about suicide and suicide prevention, and participants with pretest ideation reported fewer suicidal behaviors at posttest than controls with pretest ideation. These results provide preliminary evidence for SOS's efficacy as a suicide prevention program for middle school students.     

Context Matters for Social-Emotional Learning: Examining Variation in Program Impact by Dimensions of School Climate

This paper examines whether three dimensions of school climate—leadership, accountability, and safety/respect—moderated the impacts of the INSIGHTS program on students’ social‐emotional, behavioral, and academic outcomes. Twenty‐two urban schools and N = 435 low‐income racial/ethnic minority students were enrolled in the study and received intervention services across the course of 2 years, in both kindergarten and first grade. Intervention effects on math and reading achievement were larger for students enrolled in schools with lower overall levels of leadership, accountability, and safety/respect at baseline. Program impacts on disruptive behaviors were greater in schools with lower levels of accountability at baseline; impacts on sustained attention were greater in schools with lower levels of safety/respect at baseline. Implications for Social‐Emotional Learning program implementation, replication, and scale‐up are discussed.     

Testing the feasibility of a briefer school-based preventive intervention with aggressive children: A hybrid intervention with face-to-face and internet components

This study describes the results from a feasibility study of an innovative indicated prevention intervention with hybrid face-to-face and web-based components for preadolescent youth. This intervention includes a considerably briefer set of face-to-face sessions from the evidence-based Coping Power program and a carefully integrated internet component with practice and teaching activities and cartoon videos for children and for parents. The Coping Power – Internet Enhanced (CP-IE) program introduces a set of cognitive-behavioral skills in 12 small group sessions for children delivered during the school day and 7 group sessions for parents. Eight elementary schools were randomly assigned to CP-IE or to Control, and six children at each school were identified each year based on 4th grade teacher ratings of aggressive behavior. Path analyses of teacher-rated disruptive behavior outcomes for 91 fifth grade children, across two annual cohorts, indicated Control children had significantly greater increases in conduct problem behaviors across the 5th grade year than did CP-IE children. This much briefer version of Coping Power provided beneficial preventive effects on children's behavior in the school setting similar to the effects of the longer version of Coping Power. The website materials appeared to successfully engage children, and parents' use of the website predicted children's changes in conduct problems across the year.     

School Mobility and Achievement: Longitudinal Findings From an Urban Cohort

This study investigated the effects of school mobility on reading and math achievement for 1,087 low-income Black children in the Chicago Longitudinal Study. Between kindergarten and seventh grade, 73% of the students changed schools at least once during elementary school and 21% changed schools three or more times. The prospective longitudinal design of the Chicago Longitudinal Study allowed for controlled analyses of both the predictors and the consequences of school mobility. The significant predictors of the number of moves included prior achievement, the number of years of preschool participation in an education intervention program, and parent education. Although the students who changed schools frequently between kindergarten and seventh grade performed approximately one year behind their nonmobile peers on reading and mathematics achievement tests taken at the end of seventh grade, only one half of this difference appears attributable to frequent mobility. The remaining portion is due to the fact that the mobile students were lower achieving even before they started to change schools. The negative consequences of past school mobility are lower for students who moved into better quality schools such as magnets or academic academies. Findings indicate that it is frequent, rather than occasional, mobility that significantly increases the risk of underachievement.     

Consultation and the Introduction of Social Problem-Solving Groups in Schools

Social problem-solving programs for withdrawn and hyperactive children within a school context were developed and implemented in a day care center, a Montessori nursery school, a Catholic elementary school, and a Catholic high school. This article describes the program implementation for each of the four schools and some of the effects on the consultative relationship.     

A six-district study of educational change: direct and mediated effects of the child development project

A comprehensive elementary school program, the Child Development Project, was conducted in two schools in each of six school districts over a three-year period. Two additional schools in each district served as a comparison group. The program attempts to create a 'caring community of learners' in school and classroom through classroom, schoolwide, and parent involvement components. The classroom component includes student collaboration, a literature-based approach to reading, and a student-centered approach to classroom management. Classroom observation, student questionnaire, teacher questionnaire, and test data were collected in a baseline year and in each of the three years of program implementation. Results showed positive student results in the five program schools that made significant progress in implementation. Schools that progressed in implementation showed gains – relative to their comparison schools – in students' personal, social, and ethical attitudes, values, and motives. Significant effects on academic achievement were found only in two schools with a performance-based assessment and a highly consistent local reform mandate. Modeling analyses indicated that student sense of community was an important mediating variable for almost all dependent variables – indicating that the program produced positive effects to the degree that it was successful in establishing a caring community in the school.     

Career education and career maturity

The relationships between career maturity and the career curriculum practices and policies of 38 Melbourne metropolitan secondary schools were investigated in this study. An Australian adaption of the Career Development Inventory was used as the measure of career maturity of random samples of year 9 and year 11 students. Career curriculum practices were ascertained via questionnaires. Questionnaires were completed by the principal, career teacher, and three subject teachers in each of the schools in the study. The questionnaires yielded five factors, one associated with congruence to Super's theory and four assocated with innovation/implementation factors. The results of the study supported the view that schools with career education programs achieved higher gains in the career maturity of their students between years 9 and 11 than schools with no career education programs. The findings also showed a strong relationship between the type of program offered, the support of the school for that program, and the gains in career maturity of the students between years 9 and 11.     

Sustainability of Teacher Implementation of School-Based Mental Health Programs

Evidence-based prevention and intervention programs are increasingly being implemented in schools and it therefore is becoming increasingly important to understand the complexities of program implementation under real-world conditions. Much research has focused on the contextual factors that influence program implementation but less work has attempted to provide an integrated understanding of mechanisms (e.g., teacher-training processes) that affect teachers' program implementation. In this paper, we review literature on factors related to teachers' implementation of school-based prevention and intervention programs, then from this review abstract what we believe are four basic ingredients that characterize potentially sustainable teacher-implemented classroom programs. Finally, we present a sequential model, based on these ingredients, of the naturalistic processes underlying sustainability of teachers' program implementation and describe how this sustainability can be enhanced through provision of teacher training and performance feedback from a classroom consultant.     

Family life education in Chicago schools: a study of programs implemented by nonschool agencies

Although nonschool agencies provide important complementary courses on family life education (FLE) in public and private schools, little is known about the scope and content of such curricula. This paper describes a study documenting the types of school-based family life education programs implemented by nonschool agencies in Chicago. Semistructured telephone interviews were conducted with professionals from 26 health care and social service agencies, identified as offering FLE courses in the metropolitan area. The surveyed organizations provided FLE programs in almost 100 public and private schools in Chicago during the 1982-83 and 1983-84 school years. Most programs were relatively short, utilized few interactive teaching techniques (e.g., role-playing, exercises), covered a wide variety of topics, and were integrated into other curricula units rather than implemented as separate courses. Agency personnel covered topics viewed as important by school administrators and teachers, most notably information on contraception and sexual decision making.     

The Impact of More Fully Implemented Guidance Programs on the School Experiences of High School Students: A Statewide Evaluation Study

Relationships between the statewide implementation of comprehensive guidance programs and the school experiences of high school students were explored. Data from 22,964 students attending 236 Missouri high schools were analyzed by using hierarchical linear modeling. Schools with more fully implemented model guidance programs had students who were more likely to report that (a) they had earned higher grades, (b) their education was better preparing them for their future, (c) their school made more career and college information available to them, and (d) their school had a more positive climate. Positive program effects were found after removing differences due to school enrollment size, socioeconomic status, and percentage of minority students in attendance. Results highlight the important roles school counselors play in promoting the central educational goals of their schools and support a comprehensive guidance program focus for university counseling faculty who train school counselors.