What works in prevention. Principles of effective prevention programs

The high prevalence of drug abuse, delinquency, youth violence, and other youth problems creates a need to identify and disseminate effective prevention strategies. General principles gleaned from effective interventions may help prevention practitioners select, modify, or create more effective programs. Using a review-of-reviews approach across 4 areas (substance abuse, risky sexual behavior, school failure, and juvenile delinquency and violence), the authors identified 9 characteristics that were consistently associated with effective prevention programs: Programs were comprehensive, included varied teaching methods, provided sufficient dosage, were theory driven, provided opportunities for positive relationships, were appropriately timed, were socioculturally relevant, included outcome evaluation, and involved well-trained staff. This synthesis can inform the planning and implementation of problem-specific prevention interventions, provide a rationale for multi-problem prevention programs, and serve as a basis for further research.     

Future Directions for Health Promotion Program Development in Schools

Many schools will develop health promotion and disease prevention programs during this decade. Because of the rapidly changing nature of these programs, it is helpful to consider the major issues that will have an impact on health promotion program development. These issues include: (1) increased wellness focus; (2) improved database for planning; (3) computerized assessment procedures; (4) prioritized market segments; (5) standardization of service protocols; (6) confluent appraoches; (7) role delination for the school health team; (8) staff development programs; and (9) program evaluation.     

Ecological interventions and the process of change for prevention: Wedding theory and research to implementation in real world settings

Considers a preventive intervention effort designed to modify the characteristics and regularities of the school environment so as to enhance the expectations conveyed to high risk students. Employing this case effort (Weinstein et al., 1991) as a base, several issues are highlighted that deserve greater attention in the design, implementation, assessment, and reporting of other preventively-focused social interventions. These issues include: (1) the degree of program implementation fidelity, (2) the impact a lack of attainment of program fidelity may have on arriving at erroneous evaluation conclusions about social programs, (3) the ways in which the theory and basic research employed in the program rationale is appropriate to and reflected in the program as designed, (4) issues of program potency and dosage, (5) the ways in which quantitative and qualitative evaluation data can enhance each other, and (6) the import of evaluability assessments of programs prior to moving to outcome evaluations. In addressing these issues, the importance of developmentally- and ecologically-informed program formulations is underscored. Finally, the critical role that program reports such as the Weinstein paper, with its careful discussion of both the process of implementation and outcome assessments, can play in the development of more effective prevention program implementation efforts is highlighted.     

Ready, Willing, and Able: Developing a Support System to Promote Implementation of School-Based Prevention Programs

While the number and scope of evidence‐based health, education, and mental health services continues to grow, the movement of these practices into schools and other practice settings remains a complex and haphazard process. The purpose of this paper is to describe and present initial support for a prevention support system designed to promote high‐quality implementation of whole school prevention initiatives in elementary and middle schools. The function and strategies of a school‐based prevention support system are discussed, including key structures and activities undertaken to identify, select, and provide technical assistance to school personnel. Data collected over a 5 year period are presented, including evidence of successful implementation support for 5 different evidence‐based programs implemented with fidelity at 12 schools and preliminary evidence of goal attainment. Findings suggest the ongoing collection of information related to organizational readiness assists in the adoption and implementation of effective practices and initiatives and provide valuable insight into the development of results‐oriented approaches to prevention service delivery. Problems, progress, and lessons learned through this process are discussed to frame future research and action steps for this school‐based prevention support system. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

School Climate and Implementation of a Preventive Intervention

Although there has been wide dissemination of research-based psychosocial prevention programs, a similarly strong research base to guide program implementation has been lacking. Program implementation has been particularly difficult for schools, due partly to insufficient understanding of how school ecologies interact with these programs. This study examined the effects of multiple dimensions of school climate on level and rate of change in implementation of a violence prevention intervention across three school years. Using multi-level modeling, the study found that teacher-reported support between staff and among teachers and students predicted higher average levels of implementation. Teacher-reported administrative leadership predicted greater growth in implementation across 3 years. Findings offer implications for an ecological model of program implementation that considers school-level contextual effects on adoption and sustainability of new programs in schools. The Metropolitan Area Child Study Research Group is a collaboration of (in alphabetical order) Leonard Eron, University of Michigan; Nancy Guerra, University of California, Riverside; David Henry, University of Illinois at Chicago; L. Rowell Huesmann, University of Michigan; Patrick Tolan, University of Illinois at Chicago; and Richard VanAcker, University of Illinois at Chicago.     

Approaches to Adolescent Smoking Cessation and Education

The role of the school in the control of smoking among adolescents is explored. Incidence and trends of smoking among youth are discussed and health consequences of smoking are explored. The role of the school in smoking prevention, cessation, and regulation also is described. Innovative educational strategies to prevent smoking are reviewed and model programs are described. School-based smoking cessation programs are reviewed and suggstions are made for the development of local programs. School policies on smoking are given. Recommendations are given for a comprehensive school program to control smoking.     

The Evaluation of Arkansas Act 1220 of 2003 to Reduce Childhood Obesity: Conceptualization, Design, and Special Challenges

This article describes the evaluation of the Arkansas Act 1220 of 2003, a comprehensive legislative proposal to address the growing epidemic of childhood obesity through changes in the school environment. In addition, the article discusses specific components of the evaluation that may be applicable to other childhood obesity policy evaluation efforts. The conceptual framework for the evaluation, research questions, and evaluation design are described, along with data collection methods and analysis strategies. A mixed methods approach, including both quantitative (surveys, telephone interviews) and qualitative (key informant interviews, records reviews) approaches, was utilized to collect data from a range of informant groups including parents, adolescents, school principals, school district superintendents, and other stakeholders. Challenges encountered with the evaluation are discussed, as are strategies to overcome those challenges. Now in its 9th year, this evaluation has documented substantial changes to school policies and environments but fewer changes to student and family behaviors. The evaluation may inform the methods of other evaluations of childhood obesity prevention policies, as well as inform policymakers about how quickly they might expect implementation of such policies in their own states and localities and anticipate both positive and adverse outcomes.     

Entwicklungsbezogene Pr?vention von Gewalt und Kriminalit?t

This article provides an overview of concepts and empirical evaluations of developmental prevention of delinquency, violence and other forms of antisocial behavior in childhood and youth. At first basic terms and arguments are discussed; then a selection of family, child school and community-oriented programs are briefly presented. There follows an integrative evaluation of the field that is mainly based on systematic reviews and meta-analyses. An integrative model shows that preventive effects depend on many characteristics of the programs, contexts, participants and evaluation methods. In total effect sizes are positive and small but show practical relevance. There is a strong need for more well controlled outcome evaluations with long-term follow-up and more process evaluations of implementation and quality assurance. Future research and practice should be integrated within a long-term and cross-departmental prevention policy.     

Employee fitness and wellness programs in the workplace

Worksite fitness and health promotion programs have grown exponentially in the past 15 years. To examine the impact of these programs, the literature through 1988 was reviewed. In general, fitness and wellness programs result in increased levels of fitness and a reduction in the risk factors for coronary heart disease. Recent research using control groups has found relations between reduction in health care costs, absenteeism, and turnover and implementation of comprehensive health promotion programs. Issues related to participation rates, program implementation, and evaluation are also addressed.     

Developing a Culturally Appropriate Depression Prevention Program: Opportunities and Challenges

This paper describes the experiences of the first author and his colleagues in the development and implementation of a depression prevention program that specifically targets Latina mothers. Building on the earlier papers that highlight the underutilization of mental health services by Latinos in general, this paper will make the case that the situation is particularly concerning with regards to depression. In addition to the fact that depression is a highly prevalent disorder among Latino adults, the potential consequences for children of parents with depression are significant. Thus, the underutilization of formal mental health services by Latinos makes depression a critical public health problem that calls for creative solutions. One possible solution is the careful development and implementation of prevention programs. Depression prevention programs have some advantages over formal mental health treatment in that they can be offered at a relatively low cost, can be packaged in ways that make them less stigmatizing, and if effective, can reduce the incidence of cases that develop into clinical depression.This paper will describe the process of developing a novel depression prevention program, with a particular focus on the attention paid to cultural sensitivity. We describe the complexity inherent in defining cultural sensitivity and illustrate in concrete ways its implementation in the development and evaluation of the prevention program. In addition, we explore some of the challenges that emerge when attempting to balance the creation of a program that is culturally sensitive with the demands of rigorous quantitative evaluation.     

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.     

The Role of Families and Care Givers as Risk and Protective Factors in Preventing Youth Violence

This paper reviews research which discusses the risk and protective functions that families and other caregivers provide in influencing the development of aggressive behavior in youth. Currently, there is an emphasis on providing violence prevention programs in the school environment, typically with little parental or caregiver involvement. By enhancing the role of families and caregivers in youth violence prevention programs, we assert that an unique opportunity exists to both address specific risk factors for violence while enhancing the protective features of the family. Relatedly, the risk literature on youth violence indicates that the most influential risk factors (i.e., the family, community, and peers) have their principle impact on youth aggression outside the school. We suggest a shift in the focus of violence prevention programming that is more inclusive of families as both a risk and protective agent. In support of this position, relevant theory and reviews of exemplary family-involved programs are offered. Challenges to involving youth caregivers are identified and recommendations for overcoming those challenges suggested. Last, recommendations for future research and public policy in the prevention of youth violence are offered.     

The Role of Lay Health Advisors in Cardiovascular Risk Reduction: A Review

Interventions are needed to reduce the negative impact of cardiovascular disease. The combination of health risks for disease, disability, and mortality, particularly among underserved populations, might be best addressed with programs designed to enhance awareness and development of resources within a context of community support. The objectives of this review were to: (1) provide a comprehensive review and evaluation of the roles, evaluation, and effectiveness of LHA in community-based programs with an emphasis on cardiovascular risk reduction; and (2) provide recommendations for future research involving LHA in such programs. Computer and manual searches were conducted of articles in the English-language literature from 1980 to 2007. Twenty articles were evaluated, which emphasized the role of the LHA in cardiovascular risk reduction. A review of research literature provides a starting point for determining salient approaches for intervention and evaluation, issues related to program implementation and sustainability, and strengths and limitations of existing approaches.     

The EARLY ALLIANCE Prevention Trial: An Integrated Set of Interventions to Promote Competence and Reduce Risk for Conduct Disorder, Substance Abuse, and School Failure

Describes the EARLY ALLIANCE interventions, an integrated set of four programs designed to promote competence and reduce risk for early-onset conduct disorder, substance abuse, and school failure. These interventions are evaluated as part of a prevention trial that begins at school entry and targets child functioning and socializing practices across multiple contexts (school, peer group, family) and multiple domains (affective, social, and achievement coping-competence). The paper presents the conceptual foundation of the four interventions, including a synopsis of the risk and protective factors associated with conduct disorder and related outcomes, and of the coping-competence model driving EARLY ALLIANCE. The developmental rationale, intended impact, and procedures are described for each intervention: a universally administered classroom program and indicated, peer, reading-mentoring, and family programs. Interventions are currently being tested in a prevention trial, which is briefly summarized.     

Dropping out of school: A review of intervention programs

This article reviews the literature on dropout prevention for school-aged children. A review of dropout prevention programs identified in the literature highlights methodological concerns, with a discussion of design, sampling, statistical analysis, and implementation issues. The interventions employed with greatest frequency in the studies reviewed emphasized academic enhancement, psychosocial skill development, mentoring, and parent/teacher behavior management training. Programs that were academically oriented or those that were multi-component programs emerged with the most promising empirical base. However, at the present time, there is a lack of consistent and persuasive outcome evidence that meet Kratochwill and Stoiber's [Sch. Psychol. Q. 15 (2001) 233] criteria for empirically supported interventions. This deficiency leads to the conclusion that there is no one particular best practice or beneficial treatment currently available to address the problem of school dropout even though a number of intervention programs appear to hold promise. Implications for school psychologists include both practice and research applications.     

Toward a Community Career System Program Evaluation Framework

This article presents a framework to guide evaluation activities for school and community programs that attempt to improve career development outcomes for students K‐16. Three essential components to this framework are discussed: (a) a comprehensive career development model for students K‐16, (b) a framework to identify post‐high school outcomes for students, and (c) a program evaluation strategy to address the diverse needs of local communities. The authors hope to engage counselors, career development researchers, and policymakers in a collaborative effort to implement practices and policies that effectively meet the post‐high school transition needs of all students.     

Preschool children's development in classic Montessori, supplemented Montessori, and conventional programs

Research on the outcomes of Montessori education is scarce and results are inconsistent. One possible reason for the inconsistency is variations in Montessori implementation fidelity. To test whether outcomes vary according to implementation fidelity, we examined preschool children enrolled in high fidelity classic Montessori programs, lower fidelity Montessori programs that supplemented the program with conventional school activities, and, for comparison, conventional programs. Children were tested at the start and end of the school year on a range of social and academic skills. Although they performed no better in the fall, children in Classic Montessori programs, as compared with children in Supplemented Montessori and Conventional programs, showed significantly greater school-year gains on outcome measures of executive function, reading, math, vocabulary, and social problem-solving, suggesting that high fidelity Montessori implementation is associated with better outcomes than lower fidelity Montessori programs or conventional programs.