Primary Prevention Mental Health Programs: The Future is Exciting

Current outcome research on primary prevention mental health programs is encouraging and the future is exciting. Data continue to accumulate regarding the efficacy of preventive intervention. Exemplary programs can prevent multiple problems across different outcome domains suggesting the need for collaboration among preventionists across disciplines and research areas. The commentators on our review (Durlak and Wells, 1997) offered many useful suggestions to improve the next generation of research. Most recommendations fall broadly under the rubric of increasing the precision of theory, design, and program evaluation. If current recommendations for improving future research are followed, the next reviewers of primary prevention mental health programs for children and adolescents will have a more complete and useful database for analysis.     

Evaluation of Indicated Preventive Intervention (Secondary Prevention) Mental Health Programs for Children and Adolescents

Evaluated the outcomes of 130 indicated preventive interventions (secondary prevention) mental health programs for children and adolescents that seek to identify early signs of maladjustment and to intervene before full-blown disorders develop. Results indicate such programs significantly reduce problems and significantly increase competencies. In particular, behavioral and cognitive-behavior programs for children with subclinical disorders (mean ESs in the 0.50s) appear as effective as psychotherapy for children with established problems and more effective than attempts to prevent adolescent smoking, alcohol use, and delinquency. In practical terms, the average participant receiving behavioral or cognitive-behavior intervention surpasses the performance of approximately 70% of those in a control group. Of particular interest was the high mean effect (0.72) achieved by programs targeting incipient externalizing problems which are customarily the least amenable to change via traditional psychotherapeutic efforts when they reach clinical levels. Priorities for future research include greater specification of intervention procedures, assessment of treatment implementation, more follow-up studies, and identifying how different participants respond to early intervention.     

Enhancing Social Responsibility and Prosocial Leadership to Prevent Aggression,Peer Victimization,and Emotional Problems in Elementary School Children

Testing the theories that form the basis of prevention programs can enhance our understanding of behavioral change and inform the development, coordination, and adaptation of prevention programs. However, theories of change showing the linkages from intervention program components to risk or protective factors to desired outcomes across time are rarely specified or tested. In this 2‐year longitudinal study, we test the theory that increases in two protective factors (i.e., children's prosocial leadership and their teachers’ expectations of social responsibility) targeted by the WITS Programs (Walk Away, Ignore, Talk it Out, and Seek Help) would be associated with declines in peer victimization, aggression, and emotional problems. Participants included Canadian students, in grades 1–4 at baseline (n = 1329) and their parents and teachers. Consistent with our theory of change, variability in program implementation (adherence and integration) and in children's use of program skills (child responsiveness) are related to increases in both protective factors. Increases in these protective factors are associated with subsequent declines in children's aggression, victimization, and emotional problems. We discuss how enhancement of these protective factors may operate to improve child outcomes and the need for theory‐based research to refine and improve the effectiveness of intervention strategies and to improve program scale‐up.     

A Meta-Analysis of Universal School-Based Prevention Programs for Anxiety and Depression in Children

Anxiety and depression are among the most common mental health issues experienced in childhood. Implementing school-based prevention programs during childhood, rather than adolescence, is thought to provide better mental health outcomes. The present meta-analysis aimed to investigate the efficacy of universal school-based prevention programs that target both anxiety and depression in children (aged 13 years or below), and examine three moderators (i.e., program type, primary target of program, and number of sessions) on prevention effects. PsycINFO, PubMED, and Google Scholar were systematically searched for relevant articles published up to and including January 2018. Fourteen randomised controlled trials, consisting of 5970 children, met eligibility criteria. Prevention programs led to significantly fewer depressive symptoms at post-program (g?=?0.172) and at long-term follow-up periods (g?=?0.180), but not at short-term follow-up. Programs were not found to prevent anxiety symptoms across any time point. Considerable heterogeneity was observed for all effects. Program type and length were found to moderate the relationship between prevention program and outcomes. Prevention programs were effective in preventing depressive symptoms at post-program and long-term follow-up, while no significant preventative effect on anxiety symptoms was observed. The FRIENDS Program and programs which contained a greater number of sessions showed beneficial effects on anxiety and depressive symptoms. Universal programs aimed at preventing both anxiety and depression in children are limited. Future research should investigate the long-term evaluation of school-based prevention programs for anxiety and depression in children.     

Evaluation of a Community-Based Peer-to-Peer Support Program for Parents of At-Risk Youth with Emotional and Behavioral Difficulties

Parents of children with emotional and behavioral needs frequently experience difficulty navigating community-based services for their child, as well as experience increased stress and parental strain. Peer-to-peer support programs are an emerging approach to assist these parents, and evidence suggests that they are effective in increasing parents’ perceptions of social support, self-efficacy, and well-being. However, these programs often focus on parents of youth with diagnosed mental health disorders, despite the potential benefit for parents of youth who are at-risk for significant emotional and behavioral problems. In the current study, we used a pre-post design to evaluate a community-based, peer-to-peer support prevention program delivered via telephone to parents (N = 139) of youth with emerging behavioral and emotional difficulties. We evaluated (1) whether the intervention was delivered as designed, (2) the pre- and post-intervention gains in social support and concrete support, and (3) whether parents’ level of participation in the intervention and program adherence predicted outcomes. Results indicated that the intervention was delivered as intended and resulted in increased parental perceived social support and concrete support over time. Furthermore, higher levels of parental participation and intervention adherence were associated with increases in perceived social support. Thus, findings suggest that it may be beneficial for parents of at-risk youth with significant emotional and behavioral difficulties to engage in a peer-to-peer phone support prevention program.     

Challenges of Evaluating Multilevel Interventions

This article uses the Comprehensive Mixed-Methods Participatory Evaluation (CMMPE; Nastasi and Hitchcock Transforming school mental health services: Population-based approaches to promoting the competency and wellness of children, Thousand Oaks, CA: Corwin Press with National Association of School Psychologists 2008; Nastasi et al. School-based mental health services: creating comprehensive and culturally specific programs. Washington, DC: American Psychological Association 2004) model as a framework for addressing the multiplicity of evaluation decisions and complex nature of questions related to program success in multilevel interventions. CMMPE defines program success in terms of acceptability, integrity, social or cultural validity, outcomes (impact), sustainability and institutionalization, thus broadening the traditional notions of program outcomes. The authors use CMMPE and an example of a community-based multilevel sexual risk prevention program with multiple outcomes to discuss challenges of evaluating multilevel interventions. The sexual risk program exemplifies what Schensul and Tricket (this issue) characterize as multilevel intervention–multilevel evaluation (M–M), with both intervention and evaluation at community, health practitioner, and patient levels. The illustration provides the context for considering several challenges related to M–M designs: feasibility of randomized controlled trials within community-based multilevel intervention; acceptability and social or cultural validity of evaluation procedures; implementer, recipient, and contextual variations in program success; interactions among levels of the intervention; unanticipated changes or conditions; multiple indicators of program success; engaging multiple stakeholders in a participatory process; and evaluating sustainability and institutionalization. The complexity of multilevel intervention and evaluation designs challenges traditional notions of evaluation research and experimental designs. Overcoming these challenges is critical to effective translation of research to practice in psychology and related disciplines.     

A Meta-Analysis of Program Characteristics for Youth with Disruptive Behavior Problems: The Moderating Role of Program Format and Youth Gender

There is high variability in efficacy for interventions for youth with disruptive behavior problems (DBP). Despite evidence of the unique correlates and critical consequences of girls’ DBP, there is a dearth of research examining treatment efficacy for girls. This meta-analysis of 167 unique effect sizes from 29 studies (28,483 youth, 50% female; median age: 14) suggests that existing treatments have a medium positive effect on DBP (g = .33). For both boys and girls, the most effective interventions included (a) multimodal or group format, (b) cognitive skills or family systems interventions, and (c) length-intensive programs for (d) younger children. Boys demonstrated significantly greater treatment gains from group format interventions compared to girls, which is particularly important given that the group program format was the most prevalent format for boys and girls, with 14 studies involving 10,433 youth encompassing this category. This is the first meta-analysis to examine the effect of program characteristics in a sample of programs selected to be specifically inclusive of girls. Given that girls are underrepresented in intervention research on DBP, findings are discussed in terms of gender-responsive considerations and elucidating how key aspects of program structure can support more effective intervention outcomes for youth.     

‘Play skills’ for shy children: development of a Social Skills Facilitated Play early intervention program for extremely inhibited preschoolers

The aim of the present study was to develop and provide a preliminary evaluation of a social‐skills‐based early intervention program specifically designed to assist extremely inhibited preschoolers. Participants were a sample of n=22 extremely inhibited preschool‐aged children, who were randomly assigned to either the Social Skills Facilitated Play (SST) or Waitlist Control (WLC) condition. As compared to wait‐list controls, extremely inhibited children who participated in the SST‐facilitated play program sessions demonstrated a significantly greater post‐intervention decrease in observed socially wary behaviours and a significantly greater increase in social and socially competent behaviours at preschool. Results are discussed in terms of the importance of developing and refining early intervention programs for extremely inhibited young children. Copyright © 2010 John Wiley & Sons, Ltd.     

Family Conflict, Emotional Security, and Child Development: Translating Research Findings into a Prevention Program for Community Families

The social problem posed by family conflict to the physical and psychological health and well-being of children, parents, and underlying family relationships is a cause for concern. Inter-parental and parent–child conflict are linked with children’s behavioral, emotional, social, academic, and health problems, with children’s risk particularly elevated in distressed marriages. Supported by the promise of brief psycho-educational programs (e.g., Halford et al. in Journal of Family Psychology 22:497–505, 2008; Sanders in Journal of Family Psychology 22:506–517, 2008), the present paper presents the development and evaluation of a prevention program for community families with children, concerned with family-wide conflict and relationships, and building on Emotional Security Theory (Davies and Cummings in Psychological Bulletin 116:387–411, 1994). This program uniquely focuses on translating research and theory in this area into brief, engaging programs for community families to improve conflict and emotional security for the sake of the children. Evaluation is based on multi-domain and multi-method assessments of family-wide and child outcomes in the context of a randomized control design. A series of studies are briefly described in the programmatic development of a prevention program for conflict and emotional security for community families, culminating in a program for family-wide conflict and emotional security for families with adolescents. With regard to this ongoing program, evidence is presented at the post-test for improvements in family-wide functioning, consideration of the relative benefits for different groups within the community, and preliminary support for the theoretical bases for program outcomes.     

Evaluation of the First 3 Years of the Fast Track Prevention Trial with Children at High Risk for Adolescent Conduct Problems

Fast Track is a conduct-problem prevention trial that derives its intervention from longitudinal research on how serious and chronic adolescent problem behaviors develop. Over 9,000 kindergarten children at 4 sites in 3 cohorts were screened, and 891 were identified as high risk and then randomly assigned to intervention or control groups. Beginning in Grade 1, high-risk children and their parents were asked to participate in a combination of social skills and anger-control training, academic tutoring, parent training, and home visiting. A multiyear universal classroom program was delivered to the core schools attended by these high-risk children. By the end of third grade, 37% of the intervention group was determined to be free of serious conduct-problem dysfunction, in contrast with 27% of the control group. Teacher ratings of conduct problems and official records of use of special education resources gave modest effect-size evidence that the intervention was preventing conduct problem behavior at school. Parent ratings provided additional support for prevention of conduct problems at home. Parenting behavior and children's social cognitive skills that had previously emerged as proximal outcomes at the end of the 1st year of intervention continued to show positive effects of the intervention at the end of third grade.     

On the Semantics and Operations of Primary Prevention and Wellness Enhancement (Or Will the Real Primary Prevention Please Stand Up?)

Compared two recent, major reviews of primary prevention program evaluation research (i.e., Durlak and Wells' meta-analysis of 177 such studies and the Institute of Medicine (IOM) Report's summary of research studies of preventive intervention programs) with respect to specific studies included and input sources used. Whereas the IOM Report defined the goal of primary prevention as reducing the occurrence of new cases of mental disorder, Durlak and Wells' broader definition included both that goal and the promotion of psychological wellness. Overlap in journal sources used by the two reviews was modest and overlap in the actual primary prevention program evaluation studies included was minimal (7%). These findings bespeak somewhat different views of primary prevention and suggest a need for the complementary development of both the above approaches as alternatives, individually and collectively, to mental health's past established restorative ways.     

Friendship Intimacy Exchange Buffers the Relation between ADHD Symptoms and Later Social Problems among Children Attending an After-School Care Program

The friendships of children displaying symptoms of attention-deficit/hyperactivity disorder (ADHD) have been understudied, particularly in comparison to the domain of peer rejection. This study tested whether friendship intimacy exchange buffers the prospective relation between ADHD symptoms and social problems 1 year later in a sample of children attending a community-based after-school program. Children (N?=?131; 53 % boys; 66 % African American) ranging from 5 to 13 years of age participated in this study. At baseline, children reported on friendship intimacy exchange with their identified best friend, and program staff rated children on ADHD symptoms and social problems. Staff ratings of children’s social problems were collected again 1 year later. Multiple regression analyses indicated that, after controlling for demographic variables and baseline social problems, friendship intimacy exchange significantly moderated the association between ADHD symptoms and social problems at the one-year follow-up. Specifically, the relation between ADHD and social problems was no longer significant for children reporting high levels of friendship intimacy exchange. This moderation was not further qualified by either child age or sex, although boys were more likely than girls to report low rates of friendship intimacy exchange. These findings indicate the importance of friendship intimacy for children displaying ADHD symptoms, who often experience significant peer problems. Friendship quality may be a promising target for prevention and intervention efforts in mitigating some of the long-term social problems associated with ADHD symptomatology, and future research is needed to extend these findings to other domains of friendship quality and clinical samples of children with ADHD.     

Evaluation of the effects of a childhood depression prevention program

The study aimed to design and evaluate a program for the prevention of childhood depression (“Pozik-Bizi” [in English, “Live-Happily”]), comparing its effects with a socio-emotional intervention program based on cooperative play. The sample comprised 420 students aged 7 to 10?years from the Basque Country, 51.9% were randomly assigned to the experimental condition (“Pozik-Bizi”) program and 48.1% to the control group (“Play program”). Using a pretest-posttest repeated measures experimental design, 7 evaluation instruments were administered. When comparing the two interventions, it was confirmed that those who participated in the “Pozik-Bizi” program significantly decreased their level of clinical maladjustment, school maladjustment, emotional, and behavioral problems, and they increased positive behaviors that inhibit depression. However, the cooperative play program improved self-concept and social skills significantly more than the “Pozik-Bizi” program. The effect size in all the variables was small. The discussion analyzes the effectiveness of specific programs of prevention of childhood depression versus global programs of social-emotional development. This work provides a program to prevent childhood depression that has been shown to be effective in the reduction of clinical variables. In addition, this study confirms the positive potential of programs of cooperative play, to increase self-concept and social skills.     

The Impact of Legislative Standards on Batterer Intervention Program Practices and Characteristics

Changes in social policy are often pursued with the goal of reducing a social problem by improving prevention efforts, intervention program practices, or participant outcomes. State legislative standards for intimate partner violence intervention programs have been adopted nearly universally across the US, however, we do not know whether such standards actually achieve the intended goal of affecting programs’ policies and practices. To assess the effect that batterer intervention program (BIP) standards have on policies and practices of programs, this study used longitudinal surveys collected as part of an ongoing evaluation conducted from 2001 to the present to compare intervention program (N = 74) characteristics and practices at three time points before and after the adoption of standards in Oregon. Analyses were conducted to examine all BIPs in Oregon at each time point, as well as change among a subset of programs in existence at all survey assessments. Results indicate that across all programs, the use of mixed gender group co-facilitation increased by 14 % between 2004 and 2008, while program length increased by approximately 12 weeks. However, other practices such as programs’ coordination with community partners were unchanged. Analyses of within-program change revealed fewer differences, with only program length increasing significantly over the three assessments. These and other findings indicate that while standards affected program length as intended, other practices commonly addressed by legislative standards remained unchanged. The findings provide needed information regarding programs’ compliance with components of the standards, the potential need for compliance monitoring, and the potential impact of state standards on program effectiveness and on the prevalence of intimate partner violence.     

What We Know—and Don't Know—About Preventing Child Maltreatment

Abstract

Although child maltreatment is routinely acknowledged as a serious social problem, it remains widespread, raising questions about how prevention efforts can be improved. Following a review of theory and research relevant to prevention programming, the two dominant models of child abuse prevention-child empowerment and parent education-are examined, emphasizing both those factors that appear to contribute to program success (e.g., early intervention, sufficient time commitments, cultural sensitivity) and weaknesses in current efforts (e.g., poor implementation). Although underutilized, broader social and system-level reforms, including social policy and media initiatives, hold promise for prevention. Ways in which to leverage these tools are explored. Additional research is urged to explore assumptions on which programs are based, as well as to conduct more rigorous evaluation of current programs. The article concludes that a sustained commitment to prevention efforts aimed at child abuse and neglect is required.     

Pilot Evaluation of the ACT Raising Safe Kids Program on Children’s Bullying Behavior

Research documents that parents play a critical role in the development and maintenance of behavior problems in children. Few bullying prevention programs, however, target children in early childhood or include a parenting component in spite of experts recommending that parent training in behavior management be addressed. Based upon these recommendations, the present study examines the relationship among parent characteristics (hostility, depression, and overall parenting skills) and child bullying and the effects of the American Psychological Association’s ACT Raising Safe Kids program on reducing early childhood bullying. The ACT-RSK program is a primary family violence and child physical abuse prevention program for parents of young children. Fifty-two parents/caregivers, representing children ages 4–10, completed the Brief Symptom Inventory, the ACT Parents Raising Safe Kids Scale, and Early Childhood Bullying Questionnaire (derived from the Child Behavior Checklist and Strengths and Difficulties Questionnaire). Twenty-five of these parents/caregivers were trained in effective parenting including nonviolent discipline, child development, anger management, social problem-solving skills, effects of violent media on children, and methods to protect children from exposure to violence through the ACT-RSK program. The remaining 27 parents/caregivers received treatment as usual. Results indicate decreased bullying in children whose parents completed the ACT-RSK program. Furthermore, of the parent characteristics assessed, parental hostility is the only significant parent predictor for child bullying. These findings suggest the efficacy of this brief intervention for preventing bullying.     

Triple P-Positive Parenting Program: Towards an Empirically Validated Multilevel Parenting and Family Support Strategy for the Prevention of Behavior and Emotional Problems in Children

This paper outlines the theoretical and empirical foundations of a unique multilevel parenting and family support strategy designed to reduce the prevalence of behavioral and emotional problems in preadolescent children. The program known as Triple P-Positive Parenting Program is a multilevel system of family intervention, which provides five levels of intervention of increasing strength. These interventions include a universal population-level media information campaign targeting all parents, two levels of brief primary care consultations targeting mild behavior problems, and two more intensive parent training and family intervention programs for children at risk for more severe behavioral problems. The program aims to determine the minimally sufficient intervention a parent requires in order to deflect a child away from a trajectory towards more serious problems. The self-regulation of parental skill is a central construct in the program. The program uses flexible delivery modalities (including individual face-to-face, group, telephone assisted, and self-directed programs) to tailor the strength of the intervention to the requirements of individual families. Its multidisciplinary, preventive and community-wide focus gives the program wide reach, permitting the targeting of destigmatized access points through primary care services for families who are reluctant to participate in parenting skills programs. The available empirical evidence supporting the efficacy of the program is discussed and its implications for research on dissemination are discussed.     

Smoking Prevention and the Concept of Risk1

Sixth-grade children in 22 schools received either a social-influences smoking-prevention program or routine health education. The social-influences program was designed to teach youth about peer, parent, and media influences affecting smoking onset and to provide them with skills in resisting these influences. Comparison schools were given no program, but were permitted to continue their usual provision of health education. Program impact was evaluated as a function of pretreatment risk of future smoking. Risk was defined with respect to both (a) the prevalence of social models who smoked and (b) previous smoking experience. Two-and-a-half-year results show program impact to vary with both kinds of risk. Smoking-experience risk interacted such that, at first, there was greater impact on children with experience, but on later follow-up the pattern reversed, with the greater treatment effects seen for those initially with limited experience. Social-models risk showed a direct relationship, with greater risk being associated with greater program impact. Implications both for evaluation research and prevention programs are discussed.     

The Early Risers Preventive Intervention: Testing for Six-year Outcomes and Mediational Processes

We examined effects of the Early Risers “Skills for Success” early-age-targeted prevention program on serious conduct problems following 5 years of continuous intervention and one year of follow-up. We also examined if intervention effects on proximally-targeted variables found after 3 years mediated intervention effects on conduct problems found after 6 years. Participants included 151 at-risk children (106 males and 45 females) followed from first through sixth-grade, from 23 semi-rural schools in Minnesota. After 6 years, program children showed fewer oppositional defiant disorder (ODD) symptoms than control children. Program children did not significantly differ from controls on number of conduct disorder (CD) symptoms, DSM-IV diagnoses of ODD and CD, or drug use involvement. Results of the mediation analysis indicated that fewer ODD symptoms among program youth after 6 years were partially mediated by social skills and effective discipline. The study provides support for the early-starter model of conduct problems development that provides the framework for the Early Risers intervention. The study’s implications for prevention and limitations are discussed.     

An evaluation of Headsprout early reading as an online parent-mediated intervention for primary school children

Due to the Coronavirus pandemic and lengthy absences from the classroom, there is a need for large-scale remedial programs to support young children to “catch-up” on literacy and numeracy skills. A stratified randomized controlled trial was used to evaluate the Headsprout Early Reading (HER) program as a parent-mediated digital literacy intervention. A between-groups design compared differences in reading-dependent outcome measures for 36 children assigned to one of three intervention groups: with support, without support, and waitlist-control. Children completed significantly more episodes when parents received implementation support from the researcher compared to the without support group. Children receiving Headsprout instructions demonstrated marginally greater gains than the waitlist-control group in posttest outcome measures; however, differences in reading outcomes were not significant between groups at posttesting. The current research provides tentative support for HER and importantly, highlights the importance of providing support for parents implementing interventions at home.