YOUTH WITH MULTIPLE PROBLEM BEHAVIORS: WHAT HAVE WE LEARNED ABOUT THEM, HOW SUCCESSFUL HAVE WE BEEN IN INTERVENING WITH THEM, AND WHERE TO GO FROM HERE?. Eve Reider1, Anthony Biglan2, Deborah Capaldi3, Thomas Dishion4, Kenneth Dodge5, David Olds6, Mary Jane Rotheram-Borus7, 1National Institutes of Health, Bethesda, MD United States; 2Oregon Research Institute, Eugene, OR United States; 3Oregon Social Learning Center, Eugene, OR United States; 4University of Oregon, Eugene, OR United States; 5Duke University, Durham, NC United States; 6University of Colorado Health Sciences Center, Denver, CO United States; 7University of California, Los Angeles, Los Angeles, CA United States
Youth with multiple problem behaviors constitute a small proportion of the youth population but present major current and future costs to society in health services, lost productivity and victim costs. They have been the focus of intensive research for the past thirty years in the areas of basic science, etiology, epidemiology, prevention, treatment, services, and dissemination. This roundtable is an opportunity to take stock with experts in the field regarding knowledge gained, major gap areas, and next steps in the research agenda. At a time when federal dollars are limited, it is important to be clear in determining the most fruitful direction for next steps and how to do it in a judicious, integrated and efficient fashion that produces synergistic effects. This roundtable of experts include: Anthony Biglan, Oregon Research Institute; Deborah Capaldi, Oregon Social Learning Center; Thomas Dishion, University of Oregon; Mary Jane Rotheram-Borus, University of California, Los Angeles, David Olds, University of Colorado, and Kenneth Dodge, Duke University. Types of questions that will be examined include: 1) what novel etiological findings can be used to inform the development of new interventions with this population?; 2) what evidence is there regarding what interventions work, for whom, and under what conditions?; 3) what are the barriers to taking effective interventions for this population to scale?; and 4) what are next steps in developing a research agenda?
CONCURRENT 2, EFFICACY TRIALS, Organized Symposia
MODIFYING PEER INFLUENCE IN A LONGITUDINAL PREVENTIVE INTERVENTION FOR AGGRESSIVE CHILDREN
Chair: Joel Hektner
MODIFYING PEER INFLUENCE IN A LONGITUDINAL PREVENTIVE INTERVENTION FOR AGGRESSIVE CHILDREN. Joel Hektner1, John Lochman2, 1North Dakota State University, Fargo, ND United States; 2University of Alabama, Tuscaloosa, AL United States
Association with deviant peers has been regarded as a critical component linking early aggressive behavior to later delinquency and drug use (e.g. Vitaro, et al., 1997). Because aggressive children´s attempts to develop friendships with prosocial children are often not reciprocated (Hektner, et al., 2000), and because, as they age, aggressive children become attracted to similarly aggressive children (Cairns, et al., 1988), they come under the influence of deviant peers who shape their behavior through social reinforcement and modeling (Cairns & Cairns, 1994). For this reason, one of the key goals of the Early Risers preventive intervention has been to modify peer affiliation patterns, and thus peer influence, such that aggressive children would increasingly affiliate with normative peers.
The papers in this symposium examine the efficacy of this intervention strategy at different levels of analyses that increasingly narrow in on the specific peer-related mechanisms driving that efficacy. In the first paper, the programs and practices employed in the intervention to modify peer influence are described, and the overall six-year longitudinal results of the intervention are examined. The second paper then addresses the question of whether changes in peer affiliation patterns mediated the intervention´s effects on reducing disruptive behavior. The third paper examines how initial changes in peer affiliation patterns established in the context of a summer intervention program became generalized to the children´s regular classroom peer context. Finally, John Lochman will serve as discussant.
Data for these studies were collected as part of a longitudinal study using a randomized, control group design that assessed the preventive effects of the Early Risers “Skills for Success” program aimed at aggressive children (N = 245). The program design included an integrated set of child and parent/family intervention components that had as a major focus the promotion of prosocial peer influence through social skills training, strategic peer affiliation activities and peer involvement. The program began following the kindergarten year and included a three-year intervention phase followed by a two-year booster phase. Methods of assessment included parent, teacher and peer report instruments assessing multiple constructs over multiple timepoints. Taken together, the papers presented in this symposium have implications for both theories of peer influence and prevention efforts based on those theories
CHARACTERISTICS OF FRIENDS AS A MEDIATOR OF INTERVENTION EFFECTIVENESS ON REDUCING DISRUPTIVE BEHAVIORS. Debra Bernat1, Joel Hektner2, Gerald August1, 1University of Minnesota, Minneapolis, MN United States; 2North Dakota State University, Fargo, ND United States
The goal of this paper is to examine potential mediators of the Early Risers “Skills for Success” program outcomes. Preliminary analyses suggest that the Early Risers program lowered rates of disruptive behaviors among children who participated in the intervention compared to children in the control condition. One of the mechanisms thought to account for this result is the program´s effort to change patterns of peer affiliations. Previous analyses on these data show that the intervention was effective in leading aggressive children to acquire less aggressive friends (August, Egan, Realmuto, and Hektner, 2003). In this paper, we examine if the intervention´s effect on peer affiliations explains the reduction in rates of disruptive behaviors. Specifically, we examine whether reduced rates of conduct disorder and oppositional defiant disorder in sixth grade are due to changes in peer affiliations in 4th grade.
Data for this study were collected as part of an ongoing 6-year longitudinal study designed to evaluate the preventive effects of the Early Risers “Skills for Success” program. Following the 4th intervention year (during the 4th grade), an assessment of peer influence variables was conducted. Peer reputation and sociometric data were collected from 75 aggressive program children, 50 aggressive control children and their 1489 classmates. Following completion of the program (during the 6th grade), an outcomes assessment was conducted that yielded information regarding mental health status, antisocial behaviors, use and abuse of drugs, as well as teacher-rated school adjustment.
A series of regression models is used to assess the direct and indirect effects of the Early Risers program on disruptive behaviors. First, we examine the direct effects of the Early Risers Program on peer affiliations in fourth grade and disruptive behaviors in sixth grade. Next, we examine the relationship between peer affiliations and disruptive behaviors to assess that there is a relationship between the potential mediator and the outcome. Finally, mediation is assessed by examining the change in the model coefficient for the intervention when the mediator (peer affiliation) is included in the model and when it is not. A reduction in the estimate for the intervention when peer affiliation is included in the model indicates a significant mediation effect. This mediational analysis delineates the processes that lead to reductions in disruptive behaviors in the Early Risers program.
AGGRESSIVE CHILDREN´S PEER AFFILIATION PATTERNS OVER 4 YEARS IN PROGRAM AND REGULAR CLASSROOM CONTEXTS. Joel Hektner1, Susanne Lee2, Debra Bernat2, 1North Dakota State University, Fargo, ND United States; 2University of Minnesota, Minneapolis, MN United States
The role of deviant peer group membership is thought to be most consequential during adolescence (Moffitt, 1993), and theories of aggressive peer affiliation focus on adolescence (e.g. Cairns, et al., 1988; Dishion, et al., 1994). However, Snyder, et al. (1997) presented evidence suggesting that the origins of selective affiliation can be traced back to the preschool years. What remains to be examined is the degree of stability of these peer affiliation patterns through the middle childhood years. Could aggressive children participating in an intervention be lead to develop new peer affiliations with nonaggressive children, and if so, would this new tendency to affiliate with nonaggressive children generalize beyond the intervention program itself to the children´s regular school classroom? These are the questions the current study seeks to address.
Participants were 120 children who, as one component of the Early Risers preventive intervention, attended three consecutive summer programs and were then also assessed in their regular classrooms the following year. They aged from 7 to 10 years old during the study. Throughout each summer program the aggressive children were paired with nonaggressive peer mentors in a buddy system. Friendship nominations and sociometric assessments of peer reputation were collected each year. Results from the first summer (Hektner, et al., 2000) showed that by the end of the summer, the children had more nonaggressive mutual friends within the program than they did at the beginning. Results from the regular classroom assessment three years later (August, et al., 2003) also showed that program children, as compared to controls, had less aggressive mutual friends.
The current study provides the link between these two findings by examining whether those children who developed mutual friendships with nonaggressive children within the summer programs also generalized this friendship selection pattern to their regular school classroom which did not necessarily contain the friends gained during the summer program. Results show that children who chose nonaggressive friends during the summer programs also chose nonaggressive friends one year later in their regular school classroom. The most aggressive children in the summer programs showed the strongest tendency to chose the same type of mutual friends in the regular classroom as they did in the previous summers (stability correlation r = .55), and those friends were, on average, nonaggressive.
SIX-YEAR OUTCOMES OF AN EARLY-AGE PREVENTIVE INTERVENTION TARGETING PEER INFLUENCE IN AGGRESSIVE CHILDREN. Gerald August1, George Realmuto1, Michael Bloomquist1, 1University of Minnesota, Minneapolis, MN United States
There is general consensus that multicomponent, high-intensity preventive intervention designs are required to address the complex, cumulative, and multidetermined nature of childhood conduct disorder (e.g., Conduct Problems Prevention Research Group, 1999; 2002). The Early Risers “Skills for Success” program is an example of this prevention genre. The intervention design includes two complementary components, CHILD and FAMILY, that are delivered in tandem over a multiyear period. CHILD features social and academic skill development programs supported by a structured behavioral modification system. CHILD interventions are delivered via an annual Summer program, a School Year “Circle of Friends” program and a school-based Monitoring and Mentoring program. FAMILY consists of a parent education and skills training program fused with a family support and empowerment program.
A major focus of Early Risers is to interrupt the mediational chain that links early childhood aggression to peer rejection. The social development (bonding) model (Catalano & Hawkins, 1996) provides an empirically grounded theoretical base for the design of CHILD intervention actions. The social development model translates into several behavioral change strategies that are built into the Early Risers CHILD component. Included are (1) formal education and training in emotional regulation skills and social problem solving skills reinforced by behavioral rehearsal, modeling, coaching, and role play techniques, (2) strategic peer involvement via cooperative activities that pair aggressive children with prosocial peer mentors “buddy system”, and (3) a contingency point system administered on a minute-to-minute basis across program activities to reinforce prosocial behavior.
Beneficial short-term effects have been observed among aggressive children participating in the Early Risers program. These included gains in academic achievement as measured by standardized achievement tests, social competence as measured by teacher and parent rating instruments, and peer status as measured by peer nominations and sociometric assessment (August, Egan, Realmuto, & Hektner, 2003). The present study is the first assessment of long-term outcomes at a time when children were entering the middle school years. Preliminary analyses show lower rates of Oppositional Defiant and Conduct Disorder symptoms for program children. We will also present data comparing program and control children on rates of alcohol, tobacco, and other drug use, on youth attitudes and expectancies about drug use, attitudes toward antisocial behavior, and school adjustment variables.
CONCURRENT 3, DISSEMINATION, Poster Forum
STATE AND COMMUNITY SYSTEMS
Chair: Peter Mulhall
COMMUNITY READINESS AS A PREDICTOR OF LATER COALITION FUNCTIONING USING MULTIPLE INFORMANTS. Richard Puddy1, Mark Feinberg1, Brendan Gomez1, Mark Greenberg2, 1Pennsylvania State University, University Park, PA United States
The concept of exploring community readiness to engage in prevention programming has recently received increasing scholarly attention. It has been established that community readiness is one factor that shows predictive relationships to indices of functioning of community-based coalitions organized to implement prevention programs (author and year citation here). A noted weakness in previous literature on this topic is a single method approach to ratings of community readiness and coalition functioning, therefore limiting the generalizability of results beyond individual communities. A multiple informant and multiple methods approach utilizing community coalition members as well as outside observers would serve to validate recent findings on the relationship of community readiness to coalition functioning or perceived effectiveness.
This paper is based on the evaluation of Pennsylvania´s statewide Communities That Care initiative and examines the predictive relationship of community readiness to coalition functioning. A unique feature of this evaluation is that it incorporates multiple informant´s reports of both community readiness and coalition functioning. That is, a total of 244 local team members comprising 28 local prevention boards across the state completed questionnaires about their community´s readiness to implement prevention programs at an initial time point, as well as a web-based questionnaire measuring factors such as coalition functioning at a later time point. Technical Assistance (TA) consultants to those teams rated individual communities on measures of observed meeting effectiveness and coalition functioning.
Results suggest strength of the relationship at a multidimensional level. Community readiness as reported by board members and TA consultants is strongly correlated with coalition functioning as reported by board members and TA consultants. For example, team member report of community readiness in terms of support for prevention was associated with consultant-reported coalition functioning concerning funding issues. Moreover, consultant-reported readiness of the team in terms of early model execution at the mobilization phase was related to team member report of team directiveness. These findings support previous research suggesting that community readiness does indeed impact later coalition functioning, and expands this knowledge base by incorporating multiple informants and multiple methods as well as an illustration of how technology (using an innovative web-based survey) can be used to increase participant responsiveness.
COMMUNITIES THAT CARE: THE EFFECT OF A STRUCTURED TRAINING PROGRAM ON THE EFFICACY OF COMMUNITY SUBSTANCE ABUSE PREVENTION COALITIONS. Koren Hanson1, Monica Williams1, Michael Arthur1, Rose Quinby1, J. David Hawkins1, 1University of Washington, Seattle, WA United States
The use of community coalitions to promote healthy youth development has become a popular strategy over the past few decades and, as such, researchers have been increasingly interested in assessing the factors that make these coalitions both effective and sustainable (Greenberg, Feinberg, Gomes, Riggs, & Osgood, 2002; Greenberg, Osgood, Babinski, & Anderson, 1999; Harachi, Ayers, Hawkins, & Catalano, 1996). While there is little evidence to date suggesting community-based coalitions produce positive outcomes, various experts have suggested methods which may assist these groups in achieving their goals (Wolff, 2001; Berkowitz, 2001; Hallfors et al., 2002). One recommendation is to offer coalitions a standardized structure, including a training and technical assistance package designed to help them outline their goals and define their outcomes (Wolff, 2001; Hallfors et al., 2002). The purpose of this paper is to investigate the effect of a structured training program called Communities That Care (CTC) on community substance abuse prevention coalitions involved in the Community Youth Development Study (CYDS), a randomized controlled trial of CTC.
As part of CYDS, twelve experimental communities across the U.S. are implementing the Communities That Care prevention planning system. CTC mobilizes communities to form coalitions and provides a strategic planning framework using prevention science to select and implement prevention activities aimed at reducing prioritized risk factors while strengthening protective factors in the community. During this process, members of the CTC coalitions were invited to attend a set of five formalized training sessions designed to provide instruction and technical assistance in assessing levels of risk and protection, inventorying existing prevention resources, and selecting and implementing tested, effective programs based on their risk and protective factor data. Following the first four CYDS CTC training sessions, a random sample of members from each community´s CTC coalition was surveyed about their knowledge, attitudes, understanding and perceptions of the CTC process as well as about the efficacy, accomplishments and barriers specific to their coalition. Using the data collected from these telephone interviews of 218 coalition members, this paper addresses the effect of the first four CTC training sessions on indicators of coalition functioning (e.g. accomplishment of specified benchmarks in the CTC process, internal coalition conflict, perceived benefits from involvement, and barriers to coalition success). The paper investigates the degree to which participation in CTC trainings influenced the perceived functioning of the coalitions during the first year of the Community Youth Development Study.
IMPLEMENTING BEST PRACTICE PROGRAMS IN REAL WORLD SETTINGS: THE MISSOURI SPIRIT PROJECT. Liz Sale1, Carol Evans1, 1Missouri Institute of Mental Health, St. Louis, MO United States
With the development of SAMHSA's National Registry of Effective Programs, there has been a rapid increase in the number of "best practice" substance abuse prevention programs implemented nationwide. While the dissemination of best practice programs promises to advance the prevention field by incorporating prevention theory into current programming, the use of a best practice model does not necessarily guarantee program success due to the realities of field settings. Resistance to new programming, lack of understanding of prevention principles, lack of teacher and staff training, lack of buy-in by local administrators (principals, program administrators, etc.), and other local factors all impede the effective implementation of "proven" programs. Furthermore, cultural/ethnic, age, gender, and socio-economic factors also affect the effectiveness of "proven" programs.
The Missouri SPIRIT project, funded in 2002, is a Missouri Department of Mental Health initiative aimed at strengthening prevention programming through the dissemination of SAMHSA best practice programs statewide. Five school districts across the state, with different ethnic/racial compositions, age groups, and socioeconomic levels were selected to receive several of the more prominent model programs, including Life Skills Training, Positive Action, PeaceBuilders, Second Step, and Reconnecting Youth. Program goals included increasing protective factors (school bonding, school climate, social competence, social skills, etc.) and reducing risk factors, including substance use. The sample size for this study is approximately 3,000, with youth ranging in age from Kindergarten through 12th grade. This presentation discusses the challenges faced by local school districts in implementing these programs, with data from site visits, focus groups of teachers, administrators, and staff, and longitudinal data on changes in protective and risk factors and substance use. The lessons learned from this study can help to inform future decision makers in effectively disseminating "proven" programs to their communities.
COMMUNITIES THAT CARE® IN AN URBAN SCHOOL DISTRICT: THE EFFECT OF EARLY ADOPTION OF PREVENTION STRATEGIES ON IMPLEMENTATION AND SUSTAINABILITY. Koren Hanson1, Susan Haws1, Michael Arthur1, Monica Williams1, 1University of Washington, Seattle, WA United States
The promotion of healthy youth development by community coalitions has become a popular strategy over the past few decades, prompting researchers to investigate factors that make these coalitions both effective and sustainable (Wolff, 2001; Berkowitz, 2001; Hallfors et al., 2002; Arthur, Ayers, Graham, & Hawkins, 2002; Greenberg, Feinberg, Gomes, Riggs, & Osgood, 2002; Greenberg, Osgood, Babinski, & Anderson, 1999; Harachi, Ayers, Hawkins, & Catalano, 1996). In 2002, the Seattle School District received a grant from the Safe Schools Healthy Students (SSHS) Initiative to implement a coalition-based prevention planning system in twenty-six middle and high schools across the District with the goal of reducing risky behaviors and promoting positive youth development. Over the past two years, school-based coalitions have utilized the Communities That Care® (CTC) framework, developed by Drs. Hawkins and Catalano, to mobilize school teams, examine student risk and protective factor data, and implement tested, effective prevention programs that meet the needs of their students. As the SSHS funding period comes to a close, it is relevant to investigate factors which have influenced the implementation of CTC within individual schools.
In a previous presentation to the Society for Prevention Research, Lafazia and Hanson (2003) discussed characteristics of schools and school-based CTC teams which were associated with faster adoption of the CTC strategic prevention planning process. This work divided the school teams into three groupings (Early Adopters, Early Majority Adopters, and Late Adopters) depending on their stage of implementation after the first year of the SSHS grant. Additional analyses were later completed by Hanson and Steinman (2004) to look at the barriers to the successful implementation of CTC reported by both CTC team members and key informants from school buildings, the school district and outside service providing agencies. This presentation will serve as a follow-up to the prior research, specifically in terms of assessing how these three groups of adopters continued with the CTC process over the course of the SSHS grant and how their initial levels of adoption were predictive of continued implementation. Analysis is based on qualitative and quantitative data from two waves of interviews with CTC team leaders, key informants, and school CTC mobilizers. This presentation will also discuss the role of early adoption in sustainability of both tested, effective prevention programs and the CTC process as a whole within an urban school district.