Advances in Prevention

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

2. Ineffective StrategiesNational Institute of Justice • Didactic programs targeted on arousing fear (e.g. Scared Straight). • D.A.R.E. • Peer counseling programs. • Segregating problem students into separate groups. • After school activities with limited supervision and absence of more potent programming. • Summer jobs programs for at-risk youth. NationalInstitute of Justice, 1998

3. Prenatal & Infancy Programs Early Childhood Education Parent Training After-school Programming Mentoring with Contingent Reinforcement Youth Employment with Education Organizational Change in Schools Classroom Organization, Management, and Instructional Strategies School Behavior Management Strategies Curricula for Social Competence Promotion Community & School Policies Community Mobilization Effective Programs and Policies Have Been Identified in a Wide Range of Areas (Hawkins & Catalano, 2004)

4. 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

5. 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) 5

6. School-Based Program Examples Good Behavior Game PATHS Life Skills Training Linking Interests of Families and Teachers Fast Track Adolescent Transitions Program 6

7. 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

8. Life Skills TrainingMajor Components • Drug Resistance Skills and Norms • Self-Management Skills • General Social Skills

9. 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 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%.

11. 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

12. Strengthening Families 10-14 Effects on Getting Drunk Lifetime Drunkenness Through 6 Years Past Baseline: Logistic Growth Curve 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.

13. 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

14. 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.

15. Guiding Good ChoicesEvidence 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.

16. Seattle Social Development Project(SSDP) 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. • 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

17. 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.

18. 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

19. SSDP: Gender, Ethnicity & SES • Gender • Female 396 49% Male 412 51% • Ethnic Group • European-American 381 47% • African-American 207 26% • Asian-American 177 22% • Native-American 43 5% of these 44 5% were Hispanic • SES • Eligible for free/reduced lunch (5th,6th or 7th) 423 52%

20. Seattle Social Development ProjectPanel Retention Middle High Elementary Adult SSDP: A theory-driven longitudinal study of the etiology of prosocial and antisocial behaviors. MEANAGE G210 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%!

21. Risk Factors Addressed By the SSDP Intervention X X X X X X X X X Family School Individual/Peer

22. Prosocial involvement Prosocial rewards Bonding to prosocial others Clear & Healthy Standards External constraints:Laws, norms, family & classroom standards Antisocial Behavior Skills for interaction Position in the social structure: race, SES, age, gender Individual constitutional factors Antisocial opportunities Antisocial involvement Antisocial rewards Bonding to antisocial others Antisocial values The Social Development Model PROSOCIAL PATH Prosocial opportunities ANTISOCIAL PATH ( +, - ( - ) ( + )

23. Healthy Behaviors The Goal… …for all children and youth Healthy Beliefs and Clear Standards …in families, schools, and peer groups Ensure… Bonding –Attachment –Commitment …to families, schools, and peer groups Build… By providing… Opportunities Skills Recognition …in families, schools, and peer groups Be Aware of… Individual Characteristics The Social Development Strategy

24. Social development in a parent child interaction Parent-Child Interaction Coded for OpportunitiesInvolvementRewardsBonding, etc.

25. SSDP Intervention: Raising Healthy Children Core components • Teacher In-Service Training • Parent Workshops • Child Social, Cognitive and Emotional Skills Training

26. 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 members over past performance

27. 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

28. Child Social, Cognitive and Emotional Skills Training • 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

29. Intervention SSDP Intervention ( +, - ( - ) ( + ) PROSOCIAL PATH Prosocial opportunities Prosocial involvement Prosocial rewards Bonding to prosocial others Belief in the moral order External constraints:Norms Family & Classroom Management Positive Behavior Skills for interaction Position in the social structure: race, SES, age, gender Problem Behavior Individual constitutional factors Antisocial opportunities Antisocial involvement Antisocial rewards Bonding to antisocial others Belief in antisocial values ANTISOCIAL PATH

30. Late Tx Full Intervention Full Intervention Control Control 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 Grade Age Hawkins, Catalano et al. (1992) Hawkins, Von Cleve & Catalano (1991)

31. Effects of SSDP Intervention on School Bonding from Age 13 to 18 Hawkins, Guo, Hill, Battin-Pearson & Abbott (2001)

32. Late Tx Full Intervention Full Intervention Control Control SSDP Intervention Effects Compared to Controls 25.0% Control vs. 15.4% Full 59.7% Control vs. 48.3% Full 22.8% Control vs. 14.0% Full By age 18 Youths in the Full Intervention had less heavy alcohol use: less lifetime violence: less grade repetition Late Tx Grade Age

33. Late Tx Full Intervention Full Intervention Control Control SSDP Intervention Effects Compared to Controls 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% Full 13% Control vs. 4% Full 53% Control vs. 42% Full Late Tx Grade Age

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

35. SSDP: Proportion in 3 Conditions Who Met Criteria for GAD, social phobia, MDE, or PTSD diagnosis at ages 24 and 27 *p< .05

36. The Raising Healthy Children Program also affected sexual behavior

37. Late Tx Full Intervention Full Intervention Control Control SSDP Intervention Effects Compared to Controls:Fewer Lifetime Sexual Partners Hawkins, et al. (1999) percent with more than one sexpartner by age 18 At age 18 Late Tx Grade Age

38. Late Tx Full Intervention Full Intervention Control Control SSDP Intervention Effects Compared to Controls:More Condom Use Lonczak, et al. (2002) At age 21 Late Tx Grade Age

39. Late Tx Full Intervention Full Intervention Control Control SSDP Intervention Effects Compared to Controls:Fewer Pregnancies and Births Among Females Among Females At age 21 Lifetime Pregnancy Lifetime Birth Late Tx Grade Age

40. Intervention effects on STI onset through age 30 Control 38.8% 26.2% Sig. Tx effect on STI Hazard rate, p < 0.019 Tx Full Tx

41. Differential intervention effects on STI onset by ethnicity 65% African Am.Control Sig. Tx X Ethnicity Interaction on STI onset, p < 0.0401 Caucasian Am.Control 33% 27% 26% African Am.Full Tx Caucasian Am.Full Tx Tx

42. Tx:Full vs Control -.37 * Included as Controls Gender:(F) Ever STI by age 30 Low SES Teen Mom Mediating Mechanisms of Tx?African Americans

43. Prosocial FamilyEnvironment .29 -.25 -.32 * Included as Controls Gender:(F) Zero order effect: -.37 * Low SES Teen Mom Mediating Mechanisms of Tx?African Americans * Tx:Full vs Control * Ever STI by age 30

44. Prosocial FamilyEnvironment SchoolBonding .52 .28 * .32 * -.09 -.22 * -.31 * Included as Controls Gender:(F) Zero order effect: -.37 * Low SES Teen Mom Mediating Mechanisms of Tx?African Americans Tx:Full vs Control Ever STI by age 30

45. -.16 Prosocial FamilyEnvironment SchoolBonding Early Sex(< 14yrs) .52 -.29 * .28 * .34 * .21 * -.10 -.18 * -.27 * Included as Controls Gender:(F) Zero order effect: -.37 * Low SES Teen Mom Mediating Mechanisms of Tx?African Americans Tx:Full vs Control Ever STI by age 30

46. $3.14 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. $1.00 Aos, et al., 2004

47. 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

48. Discussion Point How could you strengthen the design of the SSDP project to get stronger high school effects on drug and 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 jdh@u.washington.edu www.sdrg.org