Parent and Child Risk Profiles as Predictors of Response to a Conduct Problem Preventive Intervention.

Current evidence-based prevention programming targeting child externalizing problems demonstrates modest overall effect sizes and is largely ineffective for a sizable proportion of youth who participate. However, our understanding of the youth and family characteristics associated with response to specific programming is quite limited. The current study used child and family risk profiles as predictors of response trajectories to the Early Risers conduct problem preventive intervention. A sample of 240 kindergarten-aged youth displaying elevated school-based aggression were randomized by school to either the Early Risers intervention or a control condition. Using a number of child and family risk variables, a latent profile analysis produced a solution consisting of five unique risk profiles. Three low and mixed risk profiles were associated with a limited response to the intervention. One high-risk profile characterized by maladaptive parenting and elevated child externalizing demonstrated notably improved trajectories of externalizing behavior over a 3-year period relative to the control condition. Another high-risk profile characterized by inconsistent discipline, high parental distress, and elevated child internalizing and externalizing symptoms seemed to have positive developmental trends disrupted by the intervention relative to the control condition, potentially consistent with an iatrogenic effect relative to the control condition. The study results support continued efforts to use broader risk profiles to examine heterogeneity in response to preventive interventions and, with replication, will have implications for intervention tailoring.

Self-Regulatory Profiles and Conduct Problems in Youth Referred to Juvenile Diversion.

The current study utilized a person-centered approach to explore how self-regulatory profiles relate to conduct problems in an ethnically diverse sample of 197 adolescents referred to juvenile diversion programming. Utilizing a multidomain, multimethod battery of self-regulation indicators, three common profiles emerged in a latent profile analysis. The profiles represented an Adaptive group, a Cognitively Inflexible group, and an Emotionally Dysregulated group. Group membership was associated with severity and type of conduct problems as well as callous and unemotional traits. The Adaptive group demonstrated lower severity conduct problems when compared to the other groups. The Emotionally Dysregulated group was more likely to commit violent offenses and demonstrated higher levels of some callous and unemotional traits than youth characterized by cognitive inflexibility.

Bi-national cross-validation of an evidence-based conduct problem prevention model.

OBJECTIVES: To (a) explore the preferences of Mexican parents and Spanish-speaking professionals working with migrant Latino families in Minnesota regarding the Mexican-adapted brief model versus the original conduct problems intervention and (b) identifying the potential challenges, and preferred solutions, to implementation of a conduct problems preventive intervention. METHOD: The core practice elements of a conduct problems prevention program originating in the United States were adapted for prevention efforts in Mexico. Three focus groups were conducted in the United States, with Latino parents (n = 24; 2 focus groups) and professionals serving Latino families (n = 9; 1 focus group), to compare and discuss the Mexican-adapted model and the original conduct problems prevention program. Thematic analysis was conducted on the verbatim focus group transcripts in the original language spoken. RESULTS: Participants preferred the Mexican-adapted model. The following key areas were identified for cultural adaptation when delivering a conduct problems prevention program with Latino families: recruitment/enrollment strategies, program delivery format, and program content (i.e., child skills training, parent skills training, child-parent activities, and child-parent support). For both models, strengths, concerns, barriers, and strategies for overcoming concerns and barriers were identified. CONCLUSIONS: We summarize recommendations offered by participants to strengthen the effective implementation of a conduct problems prevention model with Latino families in the United States. This project demonstrates the strength in binational collaboration to critically examine cultural adaptations of evidence-based prevention programs that could be useful to diverse communities, families, and youth in other settings. (PsycINFO Database Record

Being "SMART" About Adolescent Conduct Problems Prevention: Executing a SMART Pilot Study in a Juvenile Diversion Agency.

The development of adaptive treatment strategies (ATS) represents the next step in innovating conduct problems prevention programs within a juvenile diversion context. Toward this goal, we present the theoretical rationale, associated methods, and anticipated challenges for a feasibility pilot study in preparation for implementing a full-scale SMART (i.e., sequential, multiple assignment, randomized trial) for conduct problems prevention. The role of a SMART design in constructing ATS is presented. The SMART feasibility pilot study includes a sample of 100 youth (13-17 years of age) identified by law enforcement as early stage offenders and referred for precourt juvenile diversion programming. Prior data on the sample population detail a high level of ethnic diversity and approximately equal representations of both genders. Within the SMART, youth and their families are first randomly assigned to one of two different brief-type evidence-based prevention programs, featuring parent-focused behavioral management or youth-focused strengths-building components. Youth who do not respond sufficiently to brief first-stage programming will be randomly assigned a second time to either an extended parent- or youth-focused second-stage programming. Measures of proximal intervention response and measures of potential candidate tailoring variables for developing ATS within this sample are detailed. Results of the described pilot study will include information regarding feasibility and acceptability of the SMART design. This information will be used to refine a subsequent full-scale SMART. The use of a SMART to develop ATS for prevention will increase the efficiency and effectiveness of prevention programing for youth with developing conduct problems.

Moderating effects of parental well-being on parenting efficacy outcomes by intervention delivery model of the early risers conduct problems prevention program.

Parent-focused preventive interventions for youth conduct problems are efficacious when offered in different models of delivery (e.g., individual in-home, group center-based). However, we know little about the characteristics of parents associated with a positive response to a particular model of delivery. We randomly assigned the parents of an ethnically diverse sample of kindergarten through second grade students (n = 246) displaying elevated levels of aggression to parent-focused program delivery models emphasizing receiving services in a community center largely with groups (Center; n = 121) or receiving services via an individualized in-home strategy (Outreach; n = 125). In both delivery models, parents received parent skills training and goal setting/case management/referrals over an average of 16 months. Structural equation modeling revealed a significant interaction between parental well-being at baseline and intervention delivery model in predicting parenting efficacy at year 2, while controlling for baseline levels of parenting efficacy. Within the Outreach model, parents with lower levels of well-being as reported at baseline appeared to show greater improvements in parenting efficacy than parents with higher levels of well-being. Within the Center model, parental well-being did not predict parenting efficacy outcomes. The strong response of low well-being parents within the Outreach model suggests that this may be the preferred model for these parents. These findings provide support for further investigation into tailoring delivery model of parent-focused preventive interventions using parental well-being in order to improve parenting outcomes.

The Early Risers preventive intervention: testing for six-year outcomes and mediational processes.

We examined effects of the Early Risers "Skills for Success" early-age-targeted prevention program on serious conduct problems following 5 years of continuous intervention and one year of follow-up. We also examined if intervention effects on proximally-targeted variables found after 3 years mediated intervention effects on conduct problems found after 6 years. Participants included 151 at-risk children (106 males and 45 females) followed from first through sixth-grade, from 23 semi-rural schools in Minnesota. After 6 years, program children showed fewer oppositional defiant disorder (ODD) symptoms than control children. Program children did not significantly differ from controls on number of conduct disorder (CD) symptoms, DSM-IV diagnoses of ODD and CD, or drug use involvement. Results of the mediation analysis indicated that fewer ODD symptoms among program youth after 6 years were partially mediated by social skills and effective discipline. The study provides support for the early-starter model of conduct problems development that provides the framework for the Early Risers intervention. The study's implications for prevention and limitations are discussed.

Implementation and Evaluation of Evidence-Based Psychotherapeutic Practices for Youth in a Mental Health Organization.

The current initiative and program evaluation study is a demonstration of the research to practice process in youth-focused psychotherapy. We collaborated within a community-university partnership to create practice and research infrastructure in order to develop, implement, and evaluate two new models of service founded on evidence-based psychotherapeutic practice parameters. The two new service models incorporated validated interventions to address behavior problems in elementary age children, and depression in adolescents, which were delivered in separate but similarly run intensive outpatient programs within a mental health setting. We utilized a rigorous training, technical assistance, fidelity monitoring, and outcome measurement strategy to promote the integrity and quality of services provided. The resultant programs were delivered with acceptable to high fidelity and effects on youth and parenting measures collected during program and from pre to post showed a decrease in targeted problems in youth and positive benefits for families. This initiative and program evaluation adds to the accumulating research-to-practice literature in children's mental health.

A 10-year randomized controlled trial of the Early Risers conduct problems preventive intervention: effects on externalizing and internalizing in late high school.

OBJECTIVE: The purpose of this study was to examine the long-term effects of the Early Risers "Skills for Success" Conduct Problems Prevention Program (ER; August, Bloomquist, Realmuto, & Hektner, 2007), a multifaceted program targeting social, emotional, behavioral, and academic risk and protective factors to promote adaptive psychological development. METHOD: Based on the random assignment of their school, 245 kindergartners (mean age = 6.6 years, SD = 0.57; 68.6% male) with elevated teacher-rated aggressive behavior either participated in ER for 3 intensive years plus 2 booster years or served as controls. Participants were assessed annually during the intervention with teacher and parent reports and at 2 follow-up points. In the current study, 129 of the original participants were reassessed with diagnostic interviews in late high school (mean age = 16.3, SD = 0.52), and multiple imputation was used to deal appropriately with missing data. RESULTS: Program participants had significantly fewer symptoms of conduct disorder, oppositional defiant disorder, and major depressive disorder than did controls. The program's effect on increasing social skills and parent discipline effectiveness by Grade 3 mediated these effects. CONCLUSIONS: The results of this study provide further evidence of the long-term positive effects of multicomponent, elementary-age, targeted conduct problems prevention programs. Training children in social skills and parents in effective discipline are possible mechanisms to divert maladaptive developmental cascades.

Executive functioning as a mediator of conduct problems prevention in children of homeless families residing in temporary supportive housing: a parallel process latent growth modeling approach.

A culturally diverse sample of formerly homeless youth (ages 6-12) and their families (n = 223) participated in a cluster randomized controlled trial of the Early Risers conduct problems prevention program in a supportive housing setting. Parents provided 4 annual behaviorally-based ratings of executive functioning (EF) and conduct problems, including at baseline, over 2 years of intervention programming, and at a 1-year follow-up assessment. Using intent-to-treat analyses, a multilevel latent growth model revealed that the intervention group demonstrated reduced growth in conduct problems over the 4 assessment points. In order to examine mediation, a multilevel parallel process latent growth model was used to simultaneously model growth in EF and growth in conduct problems along with intervention status as a covariate. A significant mediational process emerged, with participation in the intervention promoting growth in EF, which predicted negative growth in conduct problems. The model was consistent with changes in EF fully mediating intervention-related changes in youth conduct problems over the course of the study. These findings highlight the critical role that EF plays in behavioral change and lends further support to its importance as a target in preventive interventions with populations at risk for conduct problems.

Going-to-scale with the Early Risers conduct problems prevention program: use of a comprehensive implementation support (CIS) system to optimize fidelity, participation and child outcomes.

The present study is a descriptive report of a comprehensive implementation support (CIS) service that was used to promote high levels of program fidelity in a going-to-scale intervention trial of the Early Risers conduct problems prevention program. The program was delivered across 27 geographically dispersed, elementary school sites over a two-year period. In this study we examined the level of fidelity achieved by program implementers across intervention components, the rate of child and parent participation across intervention components, and proximal child outcomes targeted by the intervention across two years of programming. Results showed that over the two-year intervention period the program was implemented with high fidelity, participation rates were acceptable, and children made positive gains on target outcomes similar to those found in previous randomized controlled trials. The results suggest that implementation support services may be advantageous in the wide-scale implementation of prevention programs that aim to achieve high implementation fidelity.

Identifying unmet mental health needs in children of formerly homeless mothers living in a supportive housing community sector of care.

This study reports psychosocial characteristics of a sample of 111 children (K to 2nd grade) and their mothers who were living in urban supportive housings. The aim of this study was to document the various types and degree of risk endemic to this population. First, we describe the psychosocial characteristics of this homeless sample. Second, we compared this homeless sample with a grade-matched, high-risk, school-based sample of children (n = 146) who were identified as showing early symptoms of disruptive behaviors. Third, we compared the parents in both samples on mental health, parenting practices, and service utilization. Results showed that children living in supportive housing were in the at-risk range and had comparable levels of externalizing problems, internalizing problems, school problems and emotional strengths with the school-based risk sample receiving prevention services at a family support community agency. Mothers in supportive housing reported significantly higher psychological distress, less optimal parenting practices and greater service utilization. These findings are among the first to provide empirical support for the need to deliver prevention interventions in community sectors of care.

Moving from science to service: transposing and sustaining the Early Risers prevention program in a community service system.

This paper summarizes an effort to transpose and sustain the evidence-based Early Risers "Skills for Success" conduct problems prevention program in a real world community service system. The Early Risers program had previously been implemented by a local agency within the context of research-based operations. In the current initiative, responsibility for funding and operating the program was transferred from program developers to a local community agency and county service system. There is a description of how the local community partnership adopted the program and real world program evaluation data pertaining to costs and implementation of the program over 2 years (N = 168 children) is presented. It is demonstrated that the local community system provided ongoing funding and that the agency implemented the program with acceptable exposure and participation. Editors' Strategic Implications: The authors carefully assess multiple elements of fidelity and share important lessons regarding community-based implementation, obstacles, and collaboration. The article should be of interest to anyone considering a replication of the evidence-based Early Risers program and also to a broader audience of researchers and practitioners involved in translational research.

Fidelity at a distance: assessing implementation fidelity of the Early Risers prevention program in a going-to-scale intervention trial.

The present study examined the feasibility of an innovative technology designed to assess implementation fidelity of the Early Risers conduct problems prevention program across 27 geographically dispersed school sites. A multidimensional construct of fidelity was used to assess the quantity of services provided (exposure), the degree to which program strategies conformed to the manual (adherence), and how well implementers delivered the program (quality of delivery). The measurement technology featured a fidelity monitoring system that required (a) weekly reporting on a web-based documentation system to assess program exposure and adherence, and (b) five annually administered telephone interviews with a technical assistant to assess quality of program implementation. The results showed that the fidelity monitoring system was feasible, with all sites achieving 100% compliance in completion of their required on-line reporting and on average over 80% of the required teleconference interviews. User feedback indicated satisfaction with the web-based program. The system was successful in measuring multiple indices of fidelity. The strengths and limitations of measuring fidelity at a distance with web-based and teleconferencing technologies are discussed.

Implementing an evidence-based preventive intervention in neighborhood family centers: examination of perceived barriers to program participation.

: This study examined parents' perceived barriers to participation in a multicomponent prevention program implemented by a community agency serving culturally diverse urban neighborhoods. The Early Risers Participation Interview (ER-PI), modeled after Kadzin et al.'s (1997) Barriers to Treatment Participation Scale, was administered to parents (N = 138) of children who were screened for disruptive behavior and were randomized into a two-year intervention condition. Results showed that the perceived barriers score provided significant information in differentiating low and high participators after controlling for child, parent, and family characteristics. Early identification and resolution of parents' perceived barriers to participation may be key to implementing multifaceted preventive programs successfully in inner-city neighborhoods. EDITOR'S STRATEGIC IMPLICATIONS: The authors present promising practices for client engagement and retention. The experimental, longitudinal design is notable, especially in the evaluation of a community-run prevention program.

Can evidence-based prevention programs be sustained in community practice settings? The Early Risers' Advanced-Stage Effectiveness Trial.

This study evaluated institutional sustainability of the Early Risers "Skills for Success" conduct problems prevention program. In a previous early-stage effectiveness trial Early Risers had been successfully implemented by a nonprofit community agency with guidance, supervision, technical assistance and fiscal support/oversight provided by program developers. The current advanced-stage effectiveness trial applied a randomized, control group design to determine whether this community agency could replicate earlier positive findings with a new cohort of participants, but with less direct involvement of program developers. An intent-to-intervene strategy was used to compare children randomly assigned to Early Risers or a no-intervention comparison group. Compared to results obtained in an early-stage effectiveness trial, program attendance rates were much lower and only one positive outcome was replicated. Failure to replicate program effects was not attributed to poor program implementation, because data collected pertaining to exposure, adherence and quality of delivery were acceptable, and a participation analysis showed that families who attended at higher levels did benefit. It was difficulties that the community agency experienced in engaging families in program components at recommended levels that primarily accounted for the results. Possible organizational barriers that impeded sustainability included unreliable transportation, poor collaboration between the agency and the local public school system, high staff turnover, agency downsizing, and fiduciary responsibility and accountability. It was concluded that both program developers and program providers need to be proactive in planning for sustainability.

The early risers longitudinal prevention trial: examination of 3-year outcomes in aggressive children with intent-to-treat and as-intended analyses.

The effects of participation following a 3-year preventive intervention trial targeting elementary school children with early-onset aggressive behavior were evaluated. Intent-to-treat analyses revealed that program participants, compared with controls, showed greater gains in social skills, academic achievement, and parent discipline, with mean scores in the normative range on the latter two constructs. As-intended participation in the Family Program, which included separate parent and child education and skills-training groups, was associated with improved parent discipline practices and gains in children's social skills, with level of child aggression moderating gains in academic achievement. Recommended level of FLEX family support contact time was associated with gains in academic achievement, concentration problems, and social skills, with parents of severely aggressive children showing greater reductions in parent distress.

Dissemination of an evidence-based prevention innovation for aggressive children living in culturally diverse, urban neighborhoods: the Early Risers effectiveness study.

This study evaluated the effectiveness of the Early Risers "Skills for Success" Program when implemented by neighborhood family resource centers available to urban children and their families. Kindergarten and first-grade children (n = 327) enrolled in 10 schools were screened for aggressive behavior, and randomized to two model variations of the Early Risers Program or a no-intervention control condition. The full-strength model (CORE + FLEX) included child and parent/family components whereas the partial model (CORE-only) offered only the child component. The intervention was delivered over two continuous years. CORE + FLEX children showed higher levels of program attendance than their CORE-only counterparts but no differences on outcomes measures were observed between models. When both program models were collapsed and compared to controls, program children showed significant gains on measures of school adjustment and social competence, the most aggressive program children showed reductions in disruptive behavior, and program parents reported reduced levels of stress.