Preventing Mental, Emotional, and Behavioral Disorders Among Young People Progress and Possibilities (2009) / Chapter Skim
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6 Family, School, and Community Interventions
6 Family, School, and Community Interventions
Pages 157-190
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From page 157... ...
Chapter 7 reviews preventive interventions that target specific MEB disorders, as well as those aimed at mental health promotion. The discussion in that chapter includes school and community interventions that specifically target substance abuse.
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From page 158... ...
Home visiting programs that start during pregnancy have demonstrated: • Improved pregnancy outcomes, maternal caregiving, and maternal life course • Prevention of the development of antisocial behavior • Reduced physical abuse, aggression, and harsh parenting Comprehensive Early Education Programs (examples: Perry Preschool P rogram, Carolina Abecedarian Project, Child-Parent Centers) • Less child maltreatment • Less use of special education services, less grade retention, higher grade completion • Higher rates of high school graduation and college attendance • Fewer arrests by age 19, higher rates of employment, and higher monthly earnings Family Disruption Interventions New Beginnings Program, an intervention for families undergoing divorce: • Reduced odds of the child reaching diagnostic criteria for any mental disorder • Increased grade point average for adolescents • Reduced number of sexual partners reported by adolescents School-Based Programs Good Behavior Game, a first grade classroom management intervention: • Reduced disruptive behavior and increased academic engaged time • Reduced likelihood that initially aggressive students would receive a diagnosis of conduct disorder by sixth grade • Significantly reduced likelihood that persistently highly aggressive males would receive a diagnosis of antisocial personality disorder as a young adult
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FAMILY, SCHOOL, AND COMMUNITY INTERVENTIONS 159 • Prevention of suicidal ideation and suicide attempts • Significantly reduced risk of illicit drug abuse or dependence disorder at ages 19-21 Life Skills Training, a school-based substance use prevention program: • Significantly reduced drug and polydrug (tobacco, alcohol, and marijuana) use three years after the program • Strongest effects when delivered with fidelity -- 44 percent fewer drug users; 66 percent fewer polydrug users • Significantly reduced methamphetamine use up to 4.5 years later when com bined with the Strengthening Families Program Linking Interests of Families and Teachers, a combined family–school interven tion focused on skills and communication: • Reduced levels of aggressive behavior, less involvement with deviant peers and lower arrest rates, less use of alcohol and marijuana • For fifth graders, continued preventive effects three years later Fast Track, a multicomponent intervention in grades K-10: • Reduced self-reported antisocial behavior and significantly reduced incidence of conduct disorder for children at highest initial risk • Significantly reduced incidence of a diagnosis of attention deficit hyperactivity disorder for children at highest initial risk Seattle Social Development Project, a combined elementary grade parent– teacher training intervention: • Reduced diagnosable mental health disorders by age 24 and heavy alcohol use and violence by age 18 • Effects particularly strong for African Americans Adolescent Transitions Program, a parenting intervention delivered in schools: • Reduced rates of growth in tobacco, alcohol, and marijuana use between ages 11 and 17 and lowered likelihood of being diagnosed with a substance use disorder • Reduced rates of arrest
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From page 160... ...
This section begins with a review of the available evidence regarding family-focused prevention at each developmental phase. It then moves to discussion of interventions that can affect family functioning and mental, emotional, and behavioral outcomes regardless of developmental phase.
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. Reducing preterm births remains a significant opportunity for prevention of MEB disorders in childhood.
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From page 162... ...
Home Visiting Home visiting is an intensive intervention that targets successful pregnancies and infant development. In these highly variable programs, a nurse or paraprofessional begins visiting the mother during the pregnancy or just after birth and continues to do so through the first few years of the child's life.
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The home visiting program with the best experimental evaluations and strongest results to date is the Nurse-Family Partnership (NFP) , which has been evaluated in three randomized controlled trials.
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. There is now extensive evidence on interventions designed to help families develop practices that prevent the development of aggressive and antisocial behavior and its associated problems.
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. �������� In addition, several meta-analyses report positive effects of such interventions across a range of child and parent outcomes for parents of young children (Barlow, Coren, and Stewart-Brown, 2002; Lundahl, Nimer, and Parsons, 2006; Serketich and Dumas, 1996; Kaminski, Valle, et al., 2008)
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evaluated the Incredible Years p arenting program as one component of an intervention designed to prevent read ing failure and the development of aggressive behavior problems among high-risk elementary schoolchildren. Children who received the intervention displayed less negative social behavior than controls.
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recently reported a randomized trial of Triple P in 18 South Carolina counties that was accompanied by a media campaign. This study is noteworthy for being the first to show signifi cant positive effects of a parenting intervention in an entire population.
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. Boxes 6-4 and 6-5 describe two parenting interventions using the parenting skills techniques discussed above that have been developed and evaluated in multiple randomized controlled trials.
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, a video-based adaptation of the original SFP program, help families develop the skills, values, goals, and interaction patterns needed to avoid substance use and other problem behaviors. Spoth and colleagues evaluated SFP 10-14 in two randomized controlled trials involving white, rural families of sixth grade students.
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. The first randomized controlled trial of the original ATP compared the impact of four alternative approaches.
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Some treatment interventions show positive effects for families with adolescents displaying considerable antisocial behavior or substance use. For example, multisystemic therapy (e.g., Henggeler, Clingempeel, et al., 2002)
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From page 172... ...
. A randomized controlled trial of the PTC program demonstrated reductions in coercive parenting, antisocial behavior, and internalizing behavior at 30-month follow-up and reductions in delinquency at 36-month follow-up (DeGarmo, Patterson, and Forgatch, 2004; Martinez and Forgatch, 2001; Patterson, DeGarmo, and Forgatch,
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. One randomized controlled trial of a program for noncustodial fathers, Dads for Life, has shown positive effects.
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Examples included home visiting; community-based, multicomponent interventions (providing services such as family support, preschool education or child care, and community development) ; media interventions; and intensive family preservation services (in-home support programs for families in which maltreatment had already occurred)
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. A quasi-experimental trial of another enhanced foster care program, the Casey Family Program, showed positive effects (Kessler, Heeringa, et al., 2008)
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Morris, Duncan, and ClarkKauffman (2005) analyzed two approaches with the potential to affect family well-being based on seven randomized controlled trials.
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Four years into a longitudinal study of a representative sample of 1,420 children ages 9-13, 350 of whom were American Indian, a casino was opened on the Indian reservation. Income from the casino significantly reduced the percentage of American Indian families in poverty, but did not affect the poverty rate among non-Indian families.
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. The impact of these policies and programs on family economic wellbeing, family functioning, and mental, emotional, and behavioral outcomes could be evaluated in randomized controlled trials.
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preschool prevention programs -- many of which included home visiting, parent training, or preschool education components -- found significant program effects on children's cognitive functioning (when assessed during preschool years) , children's social-emotional functioning (during elementary school)
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review the benefits of three comprehensive early education programs: the Perry Preschool Program and the Carolina Abecedarian project, both evaluated in randomized controlled trials, and the Child-Parent Centers (CPC) , which employed a comparison condition.
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However, none of the studies examined effects on the prevalence of abuse, and it is difficult to draw conclusions about potential downstream effects of these programs on the risk for MEB disorders. Targeting Problem Behaviors, Aggression, Violence, and Substance Abuse Many of the target risk factors of preventive interventions are interrelated.
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report on a randomized controlled trial in which four elementary schools and 14 special education classrooms were randomly assigned to deliver or not deliver the curriculum to students in grades 2 and 3. The school-year curriculum consisted of 60 lessons on emotional and interpersonal understanding, including identifying and appreciating various affec tive states, and how to control emotions.
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and selective/indicated interventions show positive effects, effect sizes tend to be greatest for high-risk groups (Wilson and Lipsey, 2006b, 2007; Beelman and Losel, 2006; Mytton, DiGuiseppi, et al., 2006; Wilson, Lipsey, and Derzon, 2003; Wilson, Gottfredson, and Najaka, 2001) , and greater for improvements in social competence and antisocial behavior than in substance abuse.
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evaluated the long-term impact of the GBG in a randomized controlled trial with 19 Baltimore schools that compared the program with a test of mastery learning among first graders (Block, 1984) and usual practice.
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Most have demonstrated positive effects on multiple problem outcomes. Combined School and Family Interventions in Elementary School A number of interventions that combine multiple types of programs (e.g., parenting and schools)
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It is likely that providing this intervention only to high-risk children would have a favorable benefit-to-cost ratio. intervention that has already demonstrated positive effects separately.
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Both the social skills curriculum and the school/community intervention significantly reduced the rate of increase in violent behavior, provoking behavior, school delinquency, drug use, and recent sexual intercourse and condom use among boys compared with the control condition. The school/community interventions were significantly more effective than the social skills intervention on a combined behavioral measure.
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From page 188... ...
on other health-related behaviors have also found positive effects in such areas as cognitive-behavioral mood management skills (Muñoz, Glish, et al., 1982) , mental health interventions (Marks, Cavanagh, and Gega, 2007; Barak, Hen, et al., 2008)
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CONCLUDING COMMENTS Meta-analyses and numerous randomized controlled trials have demonstrated strong empirical support for interventions aimed at improving parenting and family functioning. Interventions focused on reducing aggressive behavior, avoiding substance use, reducing HIV risk, securing permanent foster care placement, and dealing with difficult family situations such as divorce have all produced beneficial effects.
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From page 190... ...
Similarly, the evidence of positive effects from school-based interventions points to the considerable potential -- with the support of continued evaluation and implementation research in collaboration with educators -- of prevention practices in schools aimed at increasing the resilience of children and reducing the risk for MEB disorders. Also promising are interventions at the level of communities, including local community interventions, as well as mass media and Internet interventions, and approaches targeting policies, which warrant continued and rigorous research.
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