Advances in Prevention
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Transcript of Advances in Prevention
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Advances in PreventionAdvances in Prevention
Controlled studies have identified both ineffective and effective prevention and youth development policies and programs.
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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
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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)
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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
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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)
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School-Based Program Examples
Good Behavior Game PATHS Life Skills Training Linking Interests of Families and
Teachers Fast Track Adolescent Transitions Program
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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
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Life Skills TrainingLife Skills TrainingMajor ComponentsMajor 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)
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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%.
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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
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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
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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.
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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.
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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.
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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.
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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
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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%
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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.
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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
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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
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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
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Social development in a Social development in a parent child interactionparent child interaction
Parent-Child Interaction Coded for
OpportunitiesInvolvementRewardsBonding, etc.
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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
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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
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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
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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
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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
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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)
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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)
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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
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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
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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.
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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
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The Raising Healthy The Raising Healthy Children Program also Children Program also affected sexual affected sexual behaviorbehavior
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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)
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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)
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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
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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%
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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
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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
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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*
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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*
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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*
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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
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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
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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?
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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
www.sdrg.org