Transcript 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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Ineffective Strategies
National 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.
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National Institute of Justice, 1998
Effective Programs and Policies Have Been
Identified in a Wide Range of Areas
1.
Prenatal & Infancy
Programs
2.
3.
4.
5.
Early Childhood Education
6.
Youth Employment with
Education
7.
Organizational Change in
Schools
Parent Training
After-school Programming
Mentoring with Contingent
Reinforcement
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
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(Hawkins & Catalano, 2004)
Lists of Rigorously Tested and Effective
Prevention Approaches
• Blueprints for Violence Prevention
www.colorado.edu/cspv/blueprints/
• Communities That Care Prevention
Strategies Guide
http://preventionplatform.samhsa.gov
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Program Examples with Multiple
Outcomes
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
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
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)
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School-Based Program Examples


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
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
Good Behavior Game
PATHS
Life Skills Training
Linking Interests of Families and
Teachers
Fast Track
Adolescent Transitions Program
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Life 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 College
411 East 69th Street, KB-201
New York, NY, 10021
212-746-1270
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Life Skills Training
Major Components
• Drug Resistance
Skills and Norms
• Self-Management
Skills
• General Social
Skills
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Middle School Program
•
•
•
15 Class Periods (6th or 7th
Grade)
10 Class Periods (7th or 8th
Grade)
5 Class Periods (8th or 9th
Grade)
Life Skills Training
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%.
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Strengthening Families 10-14
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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Strengthening Families 10-14
Effects on Getting Drunk
Lifetime Drunkenness Through 6 Years Past Baseline:
Logistic Growth Curve
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First Time Proportion
Trajectory for ISFP Condition
Trajectory for Control Condition
0.8
0.6
0.4
0.2
0
0 mont hs
6 mont hs
18 mont hs
30 mont hs
48 mont hs
72 mont hs
(Pret est )
(Post t est )
(Grade 7)
(Grade 8)
(Grade 10)
(Grade 12)
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.
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Guiding Good Choices
(Preparing for the Drug Free 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
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Guiding 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.
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Guiding Good Choices
Evidence 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.
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Seattle Social Development Project
(SSDP)
J. David Hawkins,
Principal Investigator
Jennifer Bailey, Ph.D.
Research Analyst
Richard F. Catalano, Ph.D.
Investigator
Olivia Lee, Ph.D.
Research Analyst
Robert D. Abbott, Ph.D.
Investigator
Maria Roper-Caldbeck
Data Collection Supervisor
Karl G. Hill, Ph.D.
Investigator, Project Director
Stephen W. Raudenbush, Ph.D.
Statistical Consultant
Rick Kosterman, Ph.D.
Investigator, Project Dir. (NIMH)
Advisory Board:
David P. Farrington, Ph.D.
Michael Newcomb, Ph.D.
John H. Laub, Ph.D.
Todd I. Herrenkohl, Ph.D.
Investigator
Sabrina Oesterle, Ph.D.
Research Analyst
Funded by: National Institute on Drug Abuse
National Institute of Mental Health
National Institute on Alcohol Abuse and Alcoholism
Office of Juvenile Justice and Delinquency Prevention
Robert Wood Johnson Foundation
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The Seattle Social Development
Study: A Test of 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.
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SSDP 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
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SSDP:
Gender, Ethnicity & SES
• Gender
Female 396
Male
412
49%
51%
• Ethnic Group
European-American
African-American
Asian-American
Native-American
of these
were Hispanic
• SES
Eligible for free/reduced lunch (5th,6th or 7th)
381
207
177
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44
423
47%
26%
22%
5%
5%
52%
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Seattle Social Development Project
Panel Retention
SSDP: A theory-driven longitudinal
study of the etiology of prosocial
and antisocial behaviors.
Elementary
MEAN
AGE G2
10
%
11
12
Middle
13
14
High
15
16
87% 69% 81% 96% 97% 95%
Adult
(17) 18
--
21 24 27 30 33
94% 95% 93% 92% 91%2092%!
Risk Factors Addressed By the SSDP
Intervention
Family
School
X
X
X
X
X
X
Individual/Peer
X
X
X
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The Social Development Model
PROSOCIAL PATH
Prosocial
opportunities
External constraints:
Laws, norms,
family & classroom
standards
Prosocial
involvement
Prosocial
rewards
Bonding to
prosocial
others
Skills for
interaction
Position in the
social structure:
race, SES, age,
gender
Individual
constitutional
factors
Antisocial
opportunities
Antisocial
involvement
Clear &
Healthy
Standards
Antisocial Behavior
Antisocial
rewards
Bonding to
antisocial
others
Antisocial
values
ANTISOCIAL PATH
(+)
(-)
( +, -
The Social Development Strategy
The Goal…
Healthy Behaviors
Ensure…
Healthy Beliefs
and
Clear Standards
By providing…
…in families, schools,
and peer groups
Bonding
Build…
…to families, schools,
and peer groups
–Attachment
–Commitment
Opportunities
Skills
…for all children and youth
Recognition
…in families, schools,
and peer groups
Be Aware of…
Individual Characteristics
Social development in a
parent child interaction
Parent-Child
Interaction
Coded for
Opportunities
Involvement
Rewards
Bonding, etc.
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SSDP Intervention:
Raising Healthy Children
Core components
 Teacher
In-Service
Training
 Parent Workshops
 Child Social, Cognitive
and Emotional Skills
SSDP Intervention Component:
Teacher In-Service Training
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
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members over past performance
Parent 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
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Child Social, Cognitive and
Emotional Skills Training
• Listening
• Following directions
• Social awareness (boundaries, taking perspectiv
of others)
• Sharing and working together
• Manners and civility (please and thank you)
• Compliments and encouragement
• Problem solving
• Emotional regulation (anger control)
• Refusal skills
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Intervention
SSDP Intervention
PROSOCIAL PATH
External constraints:
Norms
Family & Classroom
Management
Prosocial
opportunities
Prosocial
rewards
Bonding to
prosocial
others
Antisocial
opportunities
Antisocial
involvement
(+)
(-)
Belief in the
moral order
Positive Behavior
Skills for
interaction
Position in the
social structure:
race, SES, age,
gender
Individual
constitutional
factors
Prosocial
involvement
Problem Behavior
Antisocial
rewards
( +, -
Bonding to
antisocial
others
Belief in
antisocial
values
ANTISOCIAL PATH
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SSDP Intervention Effects Compared to
Controls
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
At the end of the 2nd grade
• boys less aggressive
• girls less self-destructive
Late Tx
Late Tx
Full Intervention
Full Intervention
Control
Control
Grade
1
2
3
4
5
6
7
8
9
10
11
12
Age
7
8
9
10
11
12
13
14
15
16
17
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Hawkins, Von Cleve & Catalano (1991)
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21
22
23
24
25
26
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Hawkins, Catalano et al. (1992)
Effects of SSDP Intervention on School
Bonding from Age 13 to 18
Level of School Bonding
3.10
Full Treatment
Late Treatment
Control
3.05
3.00
2.95
2.90
2.85
2.80
2.75
2.70
13
14
15
Age
16
17
18
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Hawkins, Guo, Hill, Battin-Pearson & Abbott (2001)
SSDP Intervention Effects
Compared to Controls
By age 18 Youths in the
Full Intervention had
less heavy alcohol use: 25.0% Control vs. 15.4% Full
less lifetime violence: 59.7% Control vs. 48.3% Full
less grade repetition 22.8% Control vs. 14.0% Full
Late Tx
Late Tx
Full Intervention
Full Intervention
Control
Control
Grade
1
2
3
4
5
6
7
8
9
10
11
12
Age
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
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SSDP Intervention Effects
Compared to Controls
By age 21, full intervention
group had:
More high school graduates: 81% Control vs. 91% Full
More attending college: 6% Control vs. 14% Full
Fewer selling drugs: 13% Control vs. 4% Full
Fewer with a criminal record: 53% Control vs. 42% Full
Late Tx
Late Tx
Full Intervention
Full Intervention
Control
Control
Grade
1
2
3
4
5
6
7
8
9
10
11
12
Age
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
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The Raising Healthy
Children program has had
long term effects on mental
health outcomes at ages 24
and 27.
SSDP: Proportion in 3 Conditions
Who Met Criteria for GAD, social
phobia, MDE, or PTSD diagnosis at
ages 24 and 27
30%
Prevalence
25%
20%
Control
27%
26%
22%
21%
18%*
Late
15%*
15%
10%
5%
0%
Age 24
*p< .05
Age 27
Full
The Raising Healthy
Children Program also
affected sexual
behavior
SSDP Intervention Effects
Compared to Controls:
Fewer Lifetime Sexual Partners
Hawkins, et al. (1999)
percent with more than one sex
partner by age 18
62%
fewer lifetime
sexual partners
100%
At
age
18
90%
50%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Full
Control
Late Tx
Grade
1
Age
7
Late Tx
Full Intervention
Full Intervention
Control
Control
2
3
4
5
6
7
8
9
10
11
12
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8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
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SSDP Intervention Effects
Compared to Controls:
More Condom Use
Lonczak, et al. (2002)
condom use at
most recent
intercourse
100%
At
age
21
60%
90%
44%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Control
Late Tx
Grade
1
Age
7
Full
Late Tx
Full Intervention
Full Intervention
Control
Control
2
3
4
5
6
7
8
9
10
11
12
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8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
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SSDP Intervention Effects
Compared to Controls:
Fewer Pregnancies and Births Among
Females
Among Females At age 21
100%
100%
56%
90%
lifetime births
lifetime
pregnancies
90%
80%
38%
70%
60%
50%
40%
30%
20%
10%
0%
Control
80%
40%
70%
23%
60%
50%
40%
30%
20%
10%
0%
Full
Control
Lifetime Pregnancy
Lifetime Birth
Late Tx
Grade
1
Age
7
Late Tx
Full Intervention
Full Intervention
Control
Control
2
3
4
5
6
Full
7
8
9
10
11
12
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8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Intervention effects on STI onset
through age 30
70%
60%
Cumulative Onset
50%
Control
38.8%
40%
30%
20%
26.2%
Sig. Tx effect on STI
Hazard rate, p < 0.019
10%
Full Tx
Tx
0%
11 12
13 14 15 16 17
18 19 20 21 22
Age
23 24 25 26 27
28 29 30
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Differential intervention effects
on STI onset by ethnicity
70%
60%
Cumulative STI Onset
50%
40%
65%
African Am.
Control
Sig. Tx X Ethnicity
Interaction on STI
onset, p < 0.0401
Caucasian Am.
Control
33%
27%
30%
26%
20%
African
Caucasian
Am.Am.
Full Tx
Full Tx
10%
Tx
0%
11
12
13
14
15
16
17
18
19
20
21
Age
22
23
24
25
26
27
28
29
30
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Mediating Mechanisms of Tx?
African Americans
Tx:
Full vs Control
-.37 *
Gender:
(F)
Ever STI
by age 30
Low SES
Teen Mom
Included as Controls
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Mediating Mechanisms of Tx?
African Americans
Prosocial Family
Environment
.29*
Tx:
Full vs Control
-.32 *
Gender:
(F)
Zero order effect:
-.37*
-.25*
Ever STI
by age 30
Low SES
Teen Mom
Included as Controls
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Mediating Mechanisms of Tx?
African Americans
.52
Prosocial Family
Environment
School
Bonding
.28 * .32 *
Tx:
Full vs Control
-.31 *
Gender:
(F)
Zero order effect:
-.37*
-.22*
-.09
Ever STI
by age 30
Low SES
Teen Mom
Included as Controls
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Mediating Mechanisms of Tx?
African Americans
-.16
.52
Prosocial Family
Environment
School
Bonding
-.29 *
.28 * .34 *
Tx:
Full vs Control
-.27 *
Gender:
(F)
Zero order effect:
Early Sex
(< 14yrs)
-.37*
-.18*
-.10
.21*
Ever STI
by age 30
Low SES
Teen Mom
Included as Controls
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Cost-Benefit
An 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.
$3.50
$3.14
$3.00
$2.50
$2.00
$1.50
$1.00
$1.00
$0.50
$0.00
Investment
Return
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Aos, et al., 2004
Conclusions from SSDP’s Test
of Raising Healthy Children
• 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
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Discussion Point
• How could you strengthen the
design of the SSDP project to get
stronger high school effects on drug
and alcohol use?
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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
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