The Urgent Need For School-based Primary Prevention Programs

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The prevalence of American youth who engage in antisocial and health-damaging behaviors is unacceptably high. 24% of American 10 to 17 year olds engage in multiple, interrelated social and health risk behaviors, such as delinquency and substance use. An additional 26% experiment with some risk behaviors. Such widespread involvement jeopardizes the development of young people who participate in such activities, and often negatively affects their peers, family members, and community.

Societal changes-such as dramatic alterations in family structures and stability, reduced amounts of support and guidance for young people by responsible adults, and changing demographics resulting in larger numbers of economically disadvantaged entering school-increase the likelihood that children will behave in antisocial ways, both in and out of school. These problems are especially pronounced for young urban adolescents. Urban young people encounter a diverse array of health-damaging environmental stressors while growing up in economically disadvantaged communities. In addition, rapid bodily changes, cognitive maturation, and increased social pressures can profoundly influence, and in some instances, disrupt the psychological functioning of young adolescents. Furthermore, the transition from self-contained elementary-school classrooms to the less structured middle-school culture often introduces new problems and concerns to compound those connected with growing up.

Difficult societal conditions and the high prevalence of problem behavior among our young people have prompted numerous calls for school-based, primary prevention efforts to address young adolescents' social and health needs. Clearly, the educational system offers the most efficient and systematic means available to enhance the positive development of large numbers of young people. In spite of a growing consensus regarding the urgent need for school-based primary prevention programs, there is less agreement about what constitutes the most appropriate prevention strategies or the extent to which such prevention programs have been effective.

To improve the quality of future school-based preventive interventions, researchers must evaluate well-conceptualized programs that are implemented with fidelity. Program conceptualization involves explicitly articulating the intermediate and distal outcomes a program intends to achieve, the intervention methods that will accomplish these objectives, and the models of change that guide the development of intervention strategies and practices. However, regardless of how well-conceptualized a program is, its potential for positive impact is lessened when program implementers have inadequate resources or time for effective program delivery; are poorly trained or supervised; or lack the skills or motivation to provide competent instruction. Well-conceptualized prevention programs that are implemented with low integrity may appear ineffective when, in fact, they could be beneficial. Unfortunately, few investigators who conduct program-outcome research also assess the quality of program implementation or examine relationships between such process variables and the behavioral outcomes of program participants.

The present study assesses the effects of a school-based social competence promotion (SCP) program designed to prevent antisocial behavior in a sample of young urban adolescents. The goal of SCP training is to enhance young people's capacities to coordinate interrelated cognitive, affective, and behavioral skills so they effectively handle developmentally relevant social tasks. Based on research and theory identifying factors related to aggressive, antisocial behavior, our SCP intervention attempts to: (a) teach students impulse-control, social-information-processing, and behavioral social skills, (b) foster pro-social attitudes, and (c) create environmental supports to encourage and reinforce the adaptive, real-life application of skills and values. Because aggression and peer rejection are two central high-risk predictors of future conduct problems and delinquency, the intervention emphasized social-cognitive skills and attitudes that reduce impulsive or aggressive behavior and promote social acceptance, such as: identifying, labeling, and controlling emotions; encoding relevant environmental cues; accurately interpreting the intentions of social partners; establishing pro-social, adaptive goals; generating effective, cooperative, non-aggressive solutions; realistically anticipating consequences; enacting social behaviors effectively; monitoring the effects of behaviors on others; and overcoming obstacles.

A growing suggests that family-based and small-group SCP treatment programs, which emphasize social-cognitive and behavioral skills training, can improve the skills, attitudes, and behaviors of antisocial children and youth. Similarly, classroom-based, primary prevention SCP programs for preschool and elementary-school children have enhanced students' problem-solving skills, social relationships, and behavioral adjustment. Although some studies document the potential efficacy of SCP training approaches, few studies have tested whether classroom-based, teacher-taught, preventive SCP programs can promote adaptive functioning and reduce aggressive, antisocial behavior in urban adolescents. The complex, multiple challenges of successfully implementing and evaluating innovative programs in urban middle schools may limit the number of investigators who conduct such research.

In the present study we assessed the effects of a classroom-based, preventive SCP program on the skills, attitudes, and behaviors of urban, young adolescent, middle-school students. Second, different sets of teachers rated the school-based behavioral changes of program students both in and out of the classrooms in which SCP instruction took place. This evaluation strategy enabled us to determine if the behavioral improvements of program students generalized beyond the training setting. Third, we examined the quality of program implementation and the relationship of program implementation to student behavioral outcomes. We hypothesized that program students would improve more than controls in social-cognitive problem-solving skills, pro-social attitudes, social acceptance, and behavioral conduct. We also predicted that most teachers would carry out the program effectively, and that students from classes with higher quality implementation would benefit more from training.

Participants included 421 fifth through eighth-grade students from 11 program (n = 238) and 9 control (n = 183) classes in four urban, multiethnic schools. Teachers sent consent forms home with 447 students before pre-assessment, and parents withheld permission for 26 students (5.8% of the sample). Approximately equal numbers of males (210) and females (211) participated. The final sample of students from low- and middle-income families consisted of 178 Whites, 167 Blacks, 72 Hispanics, and 4 students of other ethnic origins. Analyses revealed that the program and control groups did not differ with respect to grade level, gender, or race.

Following approval from the Superintendent of Schools, Board of Education, Director of Research and Special Programs, and building principals, we described the program and evaluation to teachers at four middle schools. Once teachers volunteered to participate, we assigned classes to program and control conditions based on scheduling and comparability of academic-ability grouping levels across conditions. Analysis of group differences indicated that program and control students were comparable with respect to academic achievement levels as measured by the Tests of Basic Skills. Participating teachers were compensated with stipends drawn from the school system's in-service training budget.

The SCP training program. The traffic light links an image that children are already familiar with to the skills and concepts involved in solving problems. The red light (step 1) emphasizes impulse-control and stress-management skills. Children identify common stresses in their lives and learn ways to inhibit impulsive, aggressive responses to stressful situations by stopping to calm down and think about the best ways to cope with them. The yellow light (steps 2 to 5) symbolizes thinking about the problem, and teaches multiple skills involved in effective problem solving and responsible decision making. Students learn an expanded feeling-word ; to identify problem situations and associated feelings; to establish positive, prosocial goals; to generate alternative solutions; to seek input or support from peers and adults when they have difficulty thinking of solutions; to anticipate realistically the effects their actions may have improve problem situations. The green light (step 6) focuses on successfully enacting solutions. Since even the best of solutions may fail if poorly executed, students learn planning, communication, and behavioral social skills, such as using appropriate timing, speaking with a friendly or respectful tone of voice, and monitoring the effects of their actions on others. Throughout the program, teachers emphasize the benefits of behaving cooperatively in most situations rather than passively or aggressively.

During the first half of the program, students learn the six steps and master problem-solving skills and concepts through discussing and role playing common interpersonal problems for young adolescents, such as coping with physical and verbal provocation by peers, meeting new peers, handling social pressures to take risks, and resolving conflicts with parents, siblings, or teachers. During the program's second half, students apply the framework to the real-life, daily situations they experience. The six-step process provides a helpful structure to guide students and teachers in addressing problems more thoughtfully. The lessons help students and teachers develop a common and framework that fosters clearer communication about problems that arise. Teachers learn to model the application of the six-step framework for students, and to "dialogue" with students as problems arise. Dialoguing involves asking students leading questions that guide them through the six-step framework to produce effective solutions to their problems. Dialoguing enhances the internalization, generalization, and maintenance of the SCP skills by helping students practice to calm down and reflect about problems rather than responding in antisocial ways, and to remain persistent in adaptive problem-solving when a first solution attempt fails.

Program implementation and teacher training. Classroom teachers and undergraduate aides co-taught sixteen 45-minute classroom sessions. They taught lessons once or twice per week, depending on school scheduling, over the course of a 12-week period. Direct instruction, role plays, class and small group discussions of problems, and cooperative learning activities were the primary methods used to convey program concepts. Parents were also involved in the program through cooperative homework assignments. These assignments encouraged parent-child discussions of common adolescent problems and the steps leading to their successful resolution. After the 16 sessions, teachers conducted brief weekly classroom activities and dialogued regularly with students to support the continued application of adaptive problem solving.

The two co-authors and an experienced teacher, who taught the program during the previous school year, trained the teachers and undergraduate aides. The training included ten 90-minute workshops that started before program implementation and continued throughout the 16-session intervention. At the start of each training meeting, teachers shared vignettes about program successes and discussed strategies for handling program difficulties. Then upcoming lessons were discussed, modeled by the trainers, and role played by the teachers and aides. Program staff provided on-site consultation and coaching during classroom lessons. After the 16-session program ended, three monthly, 2-hour teacher-training meetings focused on ways that teachers could support their students' continued application of SCP skills.

A multi-method, multi-rater assessment approach assessed change on 28 dependent variables. Three instruments yielded 16 measures of students' (a) problem-solving skills, (b) attitudes about conflict resolution, and (c) self-reported assertiveness in response to hypothetical situations. Teacher, peer, and self-report measures produced 12 convergent assessments of students' behavioral adjustment for two separate constructs: social acceptance, or the extent to which peers like a student; and behavioral conduct, or the degree to which individuals engage in impulsive, aggressive, or delinquent acts. Finally, two observers independently rated the quality of program implementation in each classroom.

Social problem-solving skills. The Middle-school Alternative Solutions Test (AST) is an individually administered problem-solving measure that assesses the ability to generate alternative solutions to age-relevant, hypothetical peer conflict situations. Given the curriculum focus on the deterrence of aggressive, antisocial behavior, we selected three problems based on their capacity to provoke aggression, and the staging of circumstances with minimal adult supervision. The three scenarios include: (a) being picked on by a peer, (b) being bothered by a peer when involved in an important activity, and (c) having a . Following the presentation of each problem, an interviewer asked students to name only those solutions they would actually do, rather than saying what a hypothetical peer might do or brainstorming all the ideas that one could possibly try.

Raters scored alternative solutions for a total of nine quantity and quality variables. The quantity of solutions represents the number of non-redundant responses generated across the three stories. The quality of solutions, found to be an important correlate of adjustment, is assessed in three different ways: (a) effectiveness - the average-rated effectiveness of solutions on a 4-point scale (1 = "very ineffective" to 4 = "very effective"); (b) planfulness - the number of planful solutions (e.g., responses that indicate consideration of timing, interpersonal skill, or step-by-step preparation); and (c) content - the percent of solutions that are aggressive, passive, help-seeking, non-confrontational, assertive, and cooperative.

Three raters each scored one-third of the pre and post-interviews. An additional person independently scored 25% of the interviews, from which inter-rater agreements were established. Kappa coefficients were .96 for quantity, .94 for effectiveness, .81 for planfulness, and .92 for the content of alternative solutions. One-week test-retest AST reliabilities for an independent sample of 38 sixth graders yielded Spearman-Brown coefficients of .84 for the quantity of alternative solutions generated, .85 for average effectiveness of solutions, and .86 for the number of planful solutions.

Attitudes about conflict-resolution strategies. The Problem-Solving Attitude Questionnaire was individually administered after the AST. It assesses beliefs about six different conflict-resolution strategies - i.e., physically aggressive, verbally aggressive, passive, help-seeking, assertive, and cooperative reactions. Students used a 4-point scale (1 = "not at all" to 4 = "a lot") to indicate how much they would like to spend time with a peer who used each strategy. The same three AST problems were used, based on their potential to evoke a range of conflict-resolution strategies including aggressive reactions. One week test-retest reliabilities for the endorsement of conflict-resolution strategies averaged .84, ranging from .82 for cooperative to .87 for physically aggressive responses.

Self-reported assertiveness. The Children's Assertive Behavior Scale measures children's self-reported tendency to respond assertively, passively, or aggressively in a variety of hypothetical situations. The present study included 13 of 27 items that focused on interpersonal interactions. Items scores ranged from -2 (most passive response) to 0 (assertive response) to 2 (most aggressive response). Absolute values of the 13 scores were summed and subtracted from the total possible score of 26, yielding a total assertiveness score ranging from 0 to 26 (high assertiveness). for the 13 items used in the present study was .60.

Teacher ratings of social acceptance and behavioral conduct. On this 6-item Teacher Rating Measure, teachers use a 5-point scale (1="not at all" to 5="very well") to rate how well each item describes a student. Preprogram scores were factor analyzed (principal components analysis) to yield two factors accounting for 72% of the variance. The first factor, termed behavioral conduct (teacher), consisted of four items (alpha = .85): impulse control, problem solving, teasing of peers, and academic motivation. The second factor, termed social acceptance (teacher), consisted of two items (alpha = .66): popularity among peers and being left out of groups. For both scales, individual items are reverse-scored as necessary so higher total scores represent better adjustment.

Two sets of teachers completed rating scales for each student. "Primary" teachers taught students in the program or control classrooms. "Secondary" teachers taught other departmentalized classes that program and control students might attend together (e.g., or art). These teachers were unaware of students' experimental condition. These two sets of ratings allowed the assessment of behavioral adjustment from more than one perspective and in more than one setting. In addition, ratings from teachers who were unaware of students' treatment condition provided a non-biased view of change in students' school behaviors. The correlations between the two sets of teachers were .59 (pre) and .66 (post) for the behavioral conduct scale and .22 (pre) and .39 (post) for the social acceptance scale. These moderate-sized correlations were expected since the teachers based their ratings on observations of students' behavior in different contexts. Because of these differences, we report analyses of primary and secondary teacher ratings separately.

Peer ratings of social acceptance and behavioral conduct. The 5-item Peer Rating Scale was adapted from the Class Play Sociometric Scale. Students rated each same-gender classmate on a 5-point scale (1 = "not at all that way" to 5 = "really that way") according to how well each item described the classmate. Factor analysis (principal components analysis, varimax rotation) of preprogram scores yielded two factors, accounting for 76% of the variance, that corresponded to those of the teacher rating scale. The first factor, behavioral conduct (peer), consisted of two items (alpha = .54): impulse control and teasing of peers. The second factor, social acceptance (peer), consisted of three items (alpha = .75): being liked, leadership among peers, and being left out of groups.

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