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Preventing Severe Conduct Problems in School-Aged Youth: Findings from the Fast Track Project

Bob McMahon Department of Psychology University of Washington November 25, 2009. Preventing Severe Conduct Problems in School-Aged Youth: Findings from the Fast Track Project. FAST TRACK. Developmental Model Research Design Intervention Model Findings.

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Preventing Severe Conduct Problems in School-Aged Youth: Findings from the Fast Track Project

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  1. Bob McMahon Department of Psychology University of Washington November 25, 2009 Preventing Severe Conduct Problems in School-Aged Youth: Findings from the Fast Track Project

  2. FAST TRACK • Developmental Model • Research Design • Intervention Model • Findings

  3. “EARLY STARTER”DEVELOPMENTAL PATHWAY • Preschool/Early School-Age Onset • Overt and Covert Behaviors • High Degree of Continuity • Poor Prognosis • Enormous Societal Cost “Career Criminal” = $1.3 million (Cohen, 1998)

  4. “EARLY STARTER” PATHWAY TO ANTISOCIAL BEHAVIOR Preschool Years School Entry Early Education Years Early Adolescence • Early child, family, and community risk factors • Poor school readiness in cognitive, social, and emotional domains • Academic failure • Peer rejection • Social coping deficits • Adult support/ • supervision • Deviant peers • Poor adult monitoring • Alienation/ • depression Increased and Diversified Antisocial Behavior

  5. Preschool Years Elementary and Middle School Years Adulthood DEVELOPMENTAL MODEL Adolescence • Serious antisocial activity • School drop-out and failure • Substance use • Early/risky sexual activity • Comorbid psychiatric disorders

  6. Preschool Years Elementary and Middle School Years Adolescence DEVELOPMENTAL MODEL Adulthood • Psychological problems • Criminal behavior • Poor educ/occup adjustment • Marital disruption • Increased mortality

  7. IMPLICATIONS OF THE DEVELOPMENTAL MODEL FOR INTERVENTION DESIGN • Multiple Skill Domains • Multiple Socialization Support Systems • Sustained, Well-Integrated • Developmentally and Culturally Informed

  8. FAST TRACK • Developmental Model • Research Design • Intervention Model • Findings

  9. Robert J. McMahon University of Washington Karen L. Bierman Mark T. Greenberg Pennsylvania State University Kenneth A. Dodge John D. Coie Duke University Ellen E. Pinderhughes Tufts University The Fast Track ProjectConduct Problems Prevention Research Group John E. Lochman University of Alabama

  10. FAST TRACK FUNDING • Fast Track is funded by: • National Institute of Mental Health • With additional support from: • National Institute on Drug Abuse • Department of Education • Center for Substance Abuse Prevention

  11. FAST TRACK SITES Seattle, WA Rural, PA Durham, NC Nashville, TN

  12. FAST TRACK TIMELINE Current Age of Sample YEAR (1991-1993) (2005-2007) AGE ASSESSMENT Screening Implementation Outcome/Mediators INTERVENTION School-Entry Transition Continuing Support Middle School Transition Continuing Support

  13. SCREENING AND SELECTION Teacher Screen 9,594 (54 schools, 3 years)  Eligible - Parent Screen 3,600 (Top 38%)  Parent Screen 3,267 (91%) Total Screen Score (T+P) 1,027  Grade 1 at Core School 968 (94%)  High Risk Sample 891 (92%) Control 446 Intervention 445

  14. SAMPLE (4 SITES AND 3 COHORTS) • High-Risk (n = 891) • 445 Intervention/446 Control • Random Assignment by School • 47% Caucasian, 51% African-American, 3% Other • 69% Boys, 31% Girls • Normative Community Comparisons (n = 387)

  15. MULTIPROBLEM ASPECTS OF HIGH-RISK SAMPLE • Family Context • Single Parent/Inappropriate Partner • Family Conflict/Violence • Substance Abuse • Personal Adjustment Problems • “Insular” • Economically Disadvantaged • Neighborhood Context • High-Risk, Unsafe Neighborhoods

  16. Annual Assessments Multiple Informants Parent, Teacher, Youth, Peers Multiple Methods Ratings, Direct Observations, Achievement Tests, Psychiatric Interviews, Sociometrics, School Records, Court Records Standard Measures Shared with Other National Studies CBC/TRF/YSR, National Youth Survey, C-DISC-4, SACA ASSESSMENT MODEL

  17. FAST TRACK • Developmental Model • Research Design • Intervention Model • Findings

  18. PHASES OF INTERVENTION • Elementary-School Phase • School-Entry Transition (Grades 1 - 2) • Maintenance and Support (Grades 3 - 5) • Adolescent Phase • Middle School Transition (Grades 5 - 7) • Maintenance and Support (Grades 8 - 10)

  19. Academic Achievement AREAS OF INTERVENTION(Elementary School Phase) Child Coping/ Problem Solving Peer Relations Home-School Partnership Parenting & Socialization Classroom Atmosphere

  20. INTERVENTION COMPONENTS(Elementary School Phase) Family School Enrichment Program

  21. INTERVENTION COMPONENTS(Elementary School Phase) Family School PATHS Enrichment Program

  22. INTERVENTION COMPONENTS(Elementary School Phase) Family Home Visiting School PATHS Tutoring Peer Pairing Enrichment Program Parent Groups Friendship Groups Parent-Child Sharing Time

  23. STAFFING RESPONSIBILITIES(Elementary School Phase) • FAMILY COORDINATOR (FC) • Conducts Parent Groups, Parent-Child Sharing Time, Home Visits • EDUCATIONAL COORDINATOR (EC) • Conducts Friendship Groups • Consults with Teachers • Supervises Tutors • CLASSROOM TEACHER • Teaches PATHS Lessons • TUTOR • Conducts Reading Tutoring and Peer Pairing

  24. IMPLEMENTATION ISSUES(Elementary School Phase) • Attendance • Flexible Group Times • Familiar Location • Transportation • Child Care • Parents Are Paid Staff Members • Ethnically-Matched Staff • Social Support Among Group Members

  25. STRUCTURE OF ADOLESCENTPREVENTIVE INTERVENTIONS • Standard Interventions (Grades 5-8) • Individualized Interventions (Grades 5-10)

  26. STRUCTURE OF ADOLESCENT PREVENTIVE INTERVENTIONS • Standard Interventions (Grades 5-8) • All Youth/Families • Monthly Curriculum-Based Parent/Youth Groups • Normative Challenges of Adolescence • Middle/H.S. Transition Support • Individualized Interventions (Grades 5-10)

  27. STRUCTURE OF ADOLESCENT PREVENTIVE INTERVENTIONS • Standard Interventions (Grades 5-8) • Individualized Interventions (Grades 5-10) • Assessment of Risk/Protective Factors • Individualized Skill-Building and Support Services

  28. STAFFING RESPONSIBILITIES(Adolescent Phase) • YOUTH COORDINATOR (YC) • Individualized, Criterion-Based Prevention Services • Curriculum-Based Youth and Parent Groups • Home Visits • VOCATIONAL COORDINATOR • Arrange Workshops/Field Trips/Job Shadows • MENTOR • One-on-One Recreational Activities with Youth • TUTOR • Conducts Academic Tutoring

  29. FAST TRACK • Developmental Model • Research Design • Intervention Model • Findings

  30. RESEARCH PARTICIPATION -SAMPLE x SITE (% IN YEAR 11)

  31. DID STRATEGIES WORK?PARTICIPATION IN PARENT AND CHILD GROUP

  32. INTERVENTION EFFECTSData Analytic Strategy • “Intent To Intervene” Model • “Once Randomized, Always Analyzed” • Regardless of Extent to Which Families Participated in Intervention, Considered Part of Intervention Sample for Analyses

  33. KEY QUESTIONS Does Fast Track Work? How Does It Work? Does It Work Equally Well for Everyone? How Much Does It Cost?

  34. DOES FAST TRACK WORK?Elementary School (Grades 1-5) • Modest Intervention Effects in Multiple Domains Through Elementary School • Both high-risk (and universal) samples • Effect sizes strongest following initial intensive prevention efforts • Small to moderate effect sizes maintained with sustained prevention support

  35. DOES FAST TRACK WORK?Middle School Do Not Find the Broad Effects on Aggressive and Externalizing Behavior Seen in Elementary School Lower Levels of Hyperactive Behaviors (Behavioral Inhibition) at Grade 7 More Deviant Peer Involvement in Grades 7 and 8 CPPRG (in press)

  36. Classroom-level Analyses Peer Sociometrics Aggression, activity-disruption Classroom Atmosphere Prediction of Outcome Quality of teacher implementation Dosage (# of lessons) not strong predictor DOES FAST TRACK WORK? PATHS Universal InterventionEnd of Grade 1 CPPRG (1999b)

  37. Youth present throughout Grades 1,2, and 3 Aggression (T,P), Academic Engagement (T), Social Competence (T), Hyperactive/ disruptive (P) Teacher Ratings Moderated by School Environment Stronger in less disadvantaged schools ↑ baseline aggression – ↑ effects on aggression Peer Ratings Moderated by Gender Effects limited to boys DOES FAST TRACK WORK? PATHS Universal InterventionEnd of Grade 3 CPPRG (in press)

  38. KEY QUESTIONS Does Fast Track Work? How Does It Work? Does It Work Equally Well for Everyone? How Much Does It Cost?

  39. HOW DOES IT WORK? “Domain-Specific” Effects

  40. MEDIATION OF GRADE 4 OUTCOMES Grade 3 MediatorsGrade 4 Outcomes Home Parenting Behavior Change Aggressive/Oppositional Behavior School Authority Acceptance Peer Social Preference Problems/Prosocial Behavior Change Social Cognition Hostile Attributions Association with Substance Using Peers (p< .10) CPPRG (2002d)

  41. HOW DOES IT WORK? “Domain-Specific” Effects Must Address Each Setting in Which the Child Lives Suggests Importance of Multicomponent Intervention

  42. KEY QUESTIONS Does Fast Track Work? How Does It Work? Does It Work Equally Well for Everyone? How Much Does It Cost?

  43. Works Comparably for: Boys and girls European- and African-American children Urban and rural communities DOES IT WORK EQUALLY WELL FOR EVERYONE?Elementary School

  44. DOES IT WORK EQUALLY WELL FOR EVERYONE? Elementary School No Consistent Moderation by: Demographics - gender, race, site, cohort Child variables - IQ Family variables - marital status, SES, parent mental health/substance use Neighborhood variables - poverty, instability, quality

  45. HOWEVER – By Grade 9, Effects Depend on Child’s Severity of Risk as Measured 10 Years Earlier During Kindergarten! DOES IT WORK EQUALLY WELL FOR EVERYONE?Antisocial Behavior

  46. Highest-Risk Youth (top 3% at Kindergarten) Much Less Likely To: Have an externalizing disorder diagnosis - Oppositional defiant disorder, conduct disorder, attention deficit-hyperactivity disorder (ADHD) Engage in self-reported antisocial behavior No Intervention Effect for Moderate-Risk Youth DOES IT WORK EQUALLY WELL FOR EVERYONE? Antisocial Behavior inGrade 9 CPPRG, 2007

  47. INTERVENTION EFFECTSGrade 9 DISC Diagnosis of Conduct Disorder 0.04 (CPPRG, 2007) *p<.05 (Intervention x Risk Level)

  48. INTERVENTION EFFECTS Grade 9 DISC Diagnosis of “Any” Externalizing Disorder 0.13 (CPPRG, 2007) *p<.05 (Intervention x Risk Level)

  49. INTERVENTION EFFECTSGrade 9 Self-Reported Antisocial Behavior 1.66 (CPPRG, 2007) *p<.05 (Intervention x Risk Level)

  50. INTERVENTION EFFECTSLifetime Prevalence of Conduct Disorder (through Grade 12) 0.12 CPPRG (under review)

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