1 advances in prevention controlled studies have identified both ineffective and effective...

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1 Advances in Prevention Advances in Prevention Controlled studies have identified both ineffective and effective prevention and youth development policies and programs.

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Advances in PreventionAdvances in Prevention

Controlled studies have identified both ineffective and effective prevention and youth development policies and programs.

2

Ineffective StrategiesIneffective StrategiesNational Institute of JusticeNational Institute of Justice

o Didactic programs targeted on arousing fear (e.g. Scared Straight).

o D.A.R.E. o Peer counseling programs.o Segregating problem students into separate

groups.o After school activities with limited

supervision and absence of more potent programming.

o Summer jobs programs for at-risk youth.

National Institute of Justice, 1998

3

Effective Programs and Policies Effective Programs and Policies Have Been Identified in a Wide Have Been Identified in a Wide

Range of AreasRange of Areas

1. Prenatal & Infancy Programs

2. Early Childhood Education

3. Parent Training

4. After-school Programming

5. Mentoring with Contingent Reinforcement

6. Youth Employment with Education

7. Organizational Change in Schools

8. Classroom Organization, Management, and Instructional Strategies

9. School Behavior Management Strategies

10. Curricula for Social Competence Promotion

11. Community & School Policies

12. Community Mobilization (Hawkins & Catalano, 2004)

4

Lists of Rigorously Tested and Lists of Rigorously Tested and Effective Prevention ApproachesEffective Prevention Approaches

•Blueprints for Violence Preventionwww.colorado.edu/cspv/blueprints/

•Communities That Care Prevention Strategies Guidehttp://preventionplatform.samhsa.gov

55

Program Examples with Multiple Outcomes

Parenting Programs (Incredible Years, Triple P, Strengthening Families 10-14 Program)

Comprehensive Early Education Family Disruption Interventions (e.g.,

Divorce, Maternal Depression) School-Based Programs, often linked

with parenting (e.g., SSDP, LIFT)

66

School-Based Program Examples

Good Behavior Game PATHS Life Skills Training Linking Interests of Families and

Teachers Fast Track Adolescent Transitions Program

7

Life Skills TrainingLife Skills Training

Description: Curriculum for social competence promotion and drug abuse prevention

Target: Students ages 11 to 14.

Contact: Gilbert Botvin, Ph.D., Director Institute for Prevention Research Cornell University Medical College411 East 69th Street, KB-201New York, NY, 10021 212-746-1270

8

Life Skills TrainingLife Skills TrainingMajor ComponentsMajor Components

• Drug Resistance Skills and Norms

• Self-Management Skills

• General Social Skills

Middle School Program

•15 Class Periods (6th or 7th Grade)

•10 Class Periods (7th or 8th Grade)

•5 Class Periods (8th or 9th Grade)

10

Life Skills TrainingLife Skills Training

Evidence of Effect Evidence of Effect

• Reduces tobacco, alcohol, and marijuana use 50-75%.

• Effects maintained through grade 12.

• Cuts polydrug use up to 66%.

• Reduces pack-a-day smoking by 25%.

• Decreases use of inhalants, narcotics, and hallucinogens 25% to 55%.

11

Strengthening Families Strengthening Families 10-14 Program10-14 Program

Description: Seven two hour weekly sessions for parents and children.

Target: All children aged 10 to 14 and their parents

Contact: Richard L. Spoth Ph.D. Partnerships in Prevention Science Institute Iowa State University

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0

0.2

0.4

0.6

0.8

1

0 months

(Pretest)

6 months

(Posttest)

18 months

(Grade 7)

30 months

(Grade 8)

48 months

(Grade 10)

72 months

(Grade 12)

Fir

st T

ime

Pro

po

rtio

n

Trajectory for ISFP Condition

Trajectory for Control Condition

Strengthening Families 10-14Strengthening Families 10-14 Effects on Getting DrunkEffects on Getting Drunk

Source: Spoth, Redmond, Shin, & Azevedo (2004). Brief family intervention effects on adolescent substance initiation: School-level curvilinear growth curve analyses six years following baseline. Journal of Consulting and Clinical Psychology, 72, 535-542.

Lifetime Drunkenness Through 6 Years Past Baseline: Logistic Growth Curve

13

Guiding Good ChoicesGuiding Good Choices(Preparing for the Drug Free (Preparing for the Drug Free

Years)Years)Description: Series of Five Two Hour Workshops for Parents

Target: Parents of children ages 9 to 14

Contact: J. David Hawkins & Richard Catalano University of Washington

Available from:Channing Bete Company

www.channing-bete.com

14

Guiding Good ChoicesGuiding Good Choices

• Strengthens parents’ skills to:

build family bonding,

establish and reinforce clear and consistent guidelines for children’s behavior,

teach children skills to resist peer influence,

improve family management practices, and

reduce family conflict.

15

Guiding Good ChoicesGuiding Good ChoicesEvidence of EffectsEvidence of Effects

Significantly reduced drug use through age 18.

Significantly reduced growth in delinquency through age 16.

Significantly reduced growth in depression through age 18.

Significantly reduced alcohol abuse among young women at age 22.

1616

 

Seattle Social Development Seattle Social Development ProjectProject(SSDP)(SSDP)

Funded by: National Institute on Drug AbuseNational Institute of Mental HealthNational Institute on Alcohol Abuse and AlcoholismOffice of Juvenile Justice and Delinquency PreventionRobert Wood Johnson Foundation

J. David Hawkins, Principal Investigator

Richard F. Catalano, Ph.D.Investigator

Robert D. Abbott, Ph.D. Investigator

Karl G. Hill, Ph.D.Investigator, Project Director

Rick Kosterman, Ph.D.Investigator, Project Dir. (NIMH)

Todd I. Herrenkohl, Ph.D.Investigator

Sabrina Oesterle, Ph.D.Research Analyst

Jennifer Bailey, Ph.D.Research Analyst

Olivia Lee, Ph.D.Research Analyst

Maria Roper-CaldbeckData Collection Supervisor

Stephen W. Raudenbush, Ph.D.Statistical Consultant

Advisory Board:David P. Farrington, Ph.D.Michael Newcomb, Ph.D.John H. Laub, Ph.D.

17

The Seattle Social The Seattle Social Development Study: A Test Development Study: A Test of Raising Healthy Childrenof Raising Healthy Children

• A theory-driven longitudinal study of the development of prosocial and antisocial behaviors.

• In September 1985, 18 Seattle elementary schools were identified that over-represented students from high crime neighborhoods.

• 808 (76%) of the 5th grade students in these schools and their parents consented to participate in the longitudinal study; they constitute the study sample.

• About 200 of these students had been in an earlier phase of SSDP starting in 1st grade.

18

SSDP Intervention DesignSSDP Intervention Design

• Initiated full intervention and control conditions in 1981 in 8 Seattle elementary schools.

• Expanded in 1985 to 18 Seattle elementary schools to add a late intervention condition, a parent training only condition, and additional control students.

• Quasi-experimental study

Full treatment (grades 1-6) = 149 Late treatment (grades 5-6) = 243 Control = 206

Parent training only (grades 5-6) = 210

19

SSDP: SSDP: Gender, Ethnicity & SESGender, Ethnicity & SES

• SESEligible for free/reduced lunch (5th,6th or 7th) 423 52%

• Ethnic Group European-American 381 47% African-American 207 26% Asian-American 177 22% Native-American 43 5% of these 44 5% were Hispanic

• Gender Female 396 49% Male 412 51%

2020

Seattle Social Development ProjectSeattle Social Development ProjectPanel RetentionPanel Retention

MEANAGE G2 10 11 12 13 14 15 16 (17) 18 21 24 27 30 33

% 87% 69% 81% 96% 97% 95% -- 94% 95% 93% 92% 91% 92%!

Elementary Middle High Adult

SSDP: A theory-driven longitudinal study of the etiology of prosocial and antisocial behaviors.

21

Family

School

Individual/Peer

X

X

X

X

X

X

X

X

X

Risk Factors Addressed By the Risk Factors Addressed By the SSDP InterventionSSDP Intervention

The Social Development ModelThe Social Development Model

( + ) ( - ) ( +, -

PROSOCIAL PATH

ANTISOCIAL PATH

Individual constitutional

factors

Prosocial opportunities

Prosocial involvement

Prosocial rewards

Bonding to prosocial

others

Clear & Healthy

Standards

Antisocial BehaviorPosition in the social structure: race, SES, age,

gender

External constraints:Laws, norms,

family & classroom standards

Skills for interaction

Antisocial values

Bonding to antisocial

others

Antisocial rewards

Antisocial involvement

Antisocial opportunities

Individual CharacteristicsBe Aware of…

The Social Development The Social Development StrategyStrategy

The Goal… Healthy Behaviors …for all children and youth

Healthy Beliefsand

Clear Standards

…in families, schools, and peer groups

Ensure…

Build…Bonding

–Attachment–Commitment

…to families, schools, and peer groups

By providing… Opportunities Skills Recognition …in families, schools, and peer groups

24

Social development in a Social development in a parent child interactionparent child interaction

Parent-Child Interaction Coded for

OpportunitiesInvolvementRewardsBonding, etc.

SSDP Intervention: SSDP Intervention: Raising Healthy Children Raising Healthy Children

Teacher In-Service TrainingTeacher In-Service Training Parent WorkshopsParent Workshops Child Social, Cognitive and Child Social, Cognitive and

Emotional Skills TrainingEmotional Skills Training

Core componentsCore components

26

Proactive classroom management (grades 1-6)• Establish consistent classroom expectations and routines at the beginning

of the year• Give clear, explicit instructions for behavior• Recognize and reward desirable student behavior and efforts to comply• Use methods that keep minor classroom disruptions from interrupting

instruction

Interactive teaching (grades 1-6)• Assess and activate foundation knowledge before teaching• Teach to explicit learning objectives• Model skills to be learned• Frequently monitor student comprehension as material is presented• Re-teach material when necessary

Cooperative learning (grades 1-6)• Involve small teams of students of different ability levels and

backgrounds as learning partners• Provide recognition to teams for academic improvement of

individual members over past performance

SSDP Intervention Component:SSDP Intervention Component: Teacher In-Service Training Teacher In-Service Training

27

Parent WorkshopsParent Workshops

Raising Healthy Children (grades 1-2)• Observe and pinpoint desirable and undesirable child

behaviors Teach expectations for behaviors Provide consistent positive reinforcement for desired behavior Provide consistent and moderate consequences for undesired

behaviors

Supporting School Success (grades 2-3)• Initiate conversation with teachers about children’s learning Help children develop reading and math skills Create a home environment supportive of learning

Guiding Good Choices (grades 5-6)• Establish a family policy on drug use Practice refusal skills with children Use self-control skills to reduce family conflict Create new opportunities in the family for children to contribute

and learn

28

Child Social, Cognitive Child Social, Cognitive and Emotional Skills and Emotional Skills

TrainingTraining• Listening• Following directions• Social awareness (boundaries, taking

perspective of others)• Sharing and working together• Manners and civility (please and thank you)• Compliments and encouragement• Problem solving • Emotional regulation (anger control)• Refusal skills

2929

InterventionIntervention

Prosocial opportunities

Prosocial involvement

Prosocial rewards

Bonding to prosocial

others

Belief in the moral order

Position in the social structure: race, SES, age,

gender

External constraints:Norms

Family & Classroom Management

Individual constitutional

factors

Problem Behavior

Belief in antisocial

values

Bonding to antisocial

others

Antisocial rewards

Antisocial involvement

Antisocial opportunities

Skills for interaction

( + ) ( - ) ( +, -

Positive Behavior

PROSOCIAL PATH

ANTISOCIAL PATH

SSDP Intervention

30

SSDP Intervention Effects SSDP Intervention Effects Compared to ControlsCompared to Controls

1 2 3 4 5 6 7 8 9 10 11 12

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

Control

Full Intervention

Late Tx

Control

Full Intervention

Late Tx

At the end of the 2nd grade• boys less aggressive• girls less self-destructive

By the start of 5th grade, those in the full intervention had• less initiation of alcohol • less initiation of delinquency• better family management• better family communication• better family involvement• higher attachment to family• higher school rewards• higher school bonding

Grade

AgeHawkins, Von Cleve & Catalano (1991)

Hawkins, Catalano et al. (1992)

31

2.70

2.75

2.80

2.85

2.90

2.95

3.00

3.05

3.10

13 14 15 16 17 18Age

Leve

l of Sc

hool

Bon

ding Full Treatment

Late TreatmentControl

Effects of SSDP Intervention on Effects of SSDP Intervention on School Bonding from Age 13 to School Bonding from Age 13 to

1818

Hawkins, Guo, Hill, Battin-Pearson & Abbott (2001)

SSDP Intervention Effects SSDP Intervention Effects Compared to ControlsCompared to Controls

11 22 33 44 55 66 77 88 99 1010 1111 1212

77 88 99 1010 1111 1212 1313 1414 1515 1616 1717 1818 1919 2020 2121 2222 2323 2424 2525 2626 2727

Control

Full Intervention

Late Tx

Control

Full Intervention

Late Tx

By age 18 Youths in the Full Intervention had

less heavy alcohol use: less lifetime violence: less grade repetition

Grade

Age

25.0% Control vs. 15.4% Full59.7% Control vs. 48.3% Full22.8% Control vs. 14.0% Full

SSDP Intervention Effects SSDP Intervention Effects Compared to ControlsCompared to Controls

11 22 33 44 55 66 77 88 99 1010 1111 1212

77 88 99 1010 1111 1212 1313 1414 1515 1616 1717 1818 1919 2020 2121 2222 2323 2424 2525 2626 2727

Control

Full Intervention

Late Tx

Control

Full Intervention

Late Tx

Grade

Age

By age 21, full intervention group had: More high school graduates:

More attending college: Fewer selling drugs:

Fewer with a criminal record:

81% Control vs. 91% Full 6% Control vs. 14% Full13% Control vs. 4% Full53% Control vs. 42% Full

The Raising Healthy The Raising Healthy Children program has had Children program has had long term effects on long term effects on mental health outcomes mental health outcomes at ages 24 and 27.at ages 24 and 27.

SSDP: SSDP: Proportion in 3 Conditions Proportion in 3 Conditions Who Met Criteria for GAD, social Who Met Criteria for GAD, social phobia, MDE, or PTSD diagnosis phobia, MDE, or PTSD diagnosis at ages 24 and 27at ages 24 and 27

27%

21%18%*

26%

22%

15%*

0%

5%

10%

15%

20%

25%

30%

Prev

alen

ce

Age 24 Age 27

Control

Late

Full

*p< .05

The Raising Healthy The Raising Healthy Children Program also Children Program also affected sexual affected sexual behaviorbehavior

37

SSDP Intervention Effects SSDP Intervention Effects Compared to Controls:Compared to Controls: Fewer Lifetime Sexual Fewer Lifetime Sexual

PartnersPartners

1 2 3 4 5 6 7 8 9 10 11 12

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

Control

Full Intervention

Late Tx

Control

Full Intervention

Late Tx

Grade

Age

At age 18

62%50%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

few

er li

feti

me

sexu

al p

artn

ers

Control Full

percent with more than one sexpartner by age 18

Hawkins, et al. (1999)

38

SSDP Intervention Effects SSDP Intervention Effects Compared to Controls:Compared to Controls:

More Condom UseMore Condom Use

1 2 3 4 5 6 7 8 9 10 11 12

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

Control

Full Intervention

Late Tx

Control

Full Intervention

Late Tx

Grade

Age

At age 21

44%60%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

con

do

m u

se a

t m

ost

rec

ent

inte

rco

urs

e

Control Full

Lonczak, et al. (2002)

39

SSDP Intervention Effects SSDP Intervention Effects Compared to Controls:Compared to Controls:

Fewer Pregnancies and Births Fewer Pregnancies and Births Among FemalesAmong Females

1 2 3 4 5 6 7 8 9 10 11 12

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

Control

Full Intervention

Late Tx

Control

Full Intervention

Late Tx

Grade

Age

Among Females At age 21

56%

38%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

lifet

ime

pre

gn

anci

es

Control Full

40%

23%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

lifet

ime

bir

ths

Control Full

Lifetime Pregnancy Lifetime Birth

40

0%

10%

20%

30%

40%

50%

60%

70%

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Age

Cum

ulati

ve O

nset

TxTx

Sig. Tx effect on STI Hazard rate, p < 0.019

Control

Full Tx

Intervention effects on STI onset through age 30

38.8%

26.2%

41

0%

10%

20%

30%

40%

50%

60%

70%

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Age

Cu

mu

lati

ve

ST

I O

ns

et

Differential intervention effects on STI onset by ethnicity

Sig. Tx X Ethnicity Interaction on STI onset, p < 0.0401

African Am.Control

African Am.Full TxTxTx

65%

33%

27%

26%

Caucasian Am.Control

Caucasian Am.Full Tx

42

Mediating Mechanisms of Tx?African Americans

Tx:Full vs Control

Ever STI by age 30

-.37 *

Included as Controls

Gender:(F)

Low SES

Teen Mom

43

Mediating Mechanisms of Tx?African Americans

Tx:Full vs Control

Ever STI by age 30

Prosocial FamilyEnvironment

.29

-.25

Included as Controls

Gender:(F)

Low SES

Teen Mom

-.32 *

*

*

Zero order effect: -.37*

44

Mediating Mechanisms of Tx?African Americans

Tx:Full vs Control

Ever STI by age 30

SchoolBonding

Prosocial FamilyEnvironment

.52

-.31 *

.28

-.22

*

*

.32

-.09

*

Included as Controls

Gender:(F)

Low SES

Teen Mom

Zero order effect: -.37*

45

Mediating Mechanisms of Tx?African Americans

Tx:Full vs Control

Ever STI by age 30

SchoolBonding

Early Sex(< 14yrs)

Prosocial FamilyEnvironment

-.27 *

.28

-.18

*

*

.34

-.10

* -.29

.21

*

*

.52-.16

Included as Controls

Gender:(F)

Low SES

Teen Mom

Zero order effect: -.37*

46

Cost-BenefitCost-BenefitAn independent cost-benefit analysis by Washington State Institute for Public Policy estimated that projected benefits resulting from the SSDP intervention effects observed through age 21 would produce a net positive return per participant.

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

$3.00

$3.50

Investment Return

$1.00

$3.14

Aos, et al., 2004

47

Conclusions from SSDP’s Conclusions from SSDP’s Test Test

of Raising Healthy of Raising Healthy ChildrenChildren

• Increasing opportunities, skills and recognition for ALL children in the elementary grades can put more children on a positive developmental path.

• parents and teachers trained to use the social development strategy can make a demonstrable difference that lasts into adulthood.

• The social development strategy appears to have greatest effects on those at greatest risk

48

Discussion Point Discussion Point

• How could you strengthen How could you strengthen the design of the SSDP the design of the SSDP project to get stronger high project to get stronger high school effects on drug and school effects on drug and alcohol use? alcohol use?

49

Raising Healthy Children: Building Resilience through Families and Schools

J. David Hawkins, Ph.D.

Professor of Prevention

Social Development Research Group

School of Social Work

University of Washington

[email protected]

www.sdrg.org