Tennessee Lives Count: Statewide gatekeeper training for youth suicide prevention.

Youth suicide remains a significant public health problem in the United States. In 2004, the Garrett Lee Smith Memorial Act provided states and tribes with funding to implement and evaluate youth suicide prevention programs. The Tennessee Lives Count project was developed through a collaborative model at the state level and delivers an enhanced version of the Question, Persuade, Refer gatekeeper training program to individuals working with youth across the state. This article describes the development of the project and preliminary outcomes of 416 participants in child welfare, juvenile justice, health, and education systems at pretest, posttest, and 6-month follow-up. The findings suggest the training has an immediate and long-term impact on perceived knowledge of suicide prevention, self-efficacy, and attitudes about the inevitability of suicide. Policy and practice implications are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An effectiveness trial of a selected dissonance-based eating disorder prevention program for female high school students: Long-term effects.

Objective: Efficacy trials found that a dissonance-based eating disorder prevention program in which female high school and college students with body image concerns critique the thin ideal reduced eating disorder risk factors, eating disorder symptoms, and future eating disorder onset. The present effectiveness trial tested whether this program produces effects through long-term follow-up when high school clinicians recruit students and deliver the intervention under real-world conditions. Method: Female high school students with body image concerns (N = 306; M age = 15.7 years, SD = 1.1) were randomized to the dissonance intervention or an educational brochure control condition and completed assessments through 3-year follow-up. Results: Dissonance participants showed significantly greater decreases in body dissatisfaction at 2-year follow-up and eating disorder symptoms at 3-year follow-up than controls; effects on other risk factors, risk for eating disorder onset, and other outcomes (e.g., body mass) were marginal or nonsignificant. Conclusions: Although it was encouraging that some key effects persisted over long-term follow-up, effects were on average smaller in this effectiveness trial than previous efficacy trials, which could be due to (a) facilitator selection, training, and supervision; (b) the lower risk status of participants; or (c) the use of a control condition that produces some effects. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Investigation of the effectiveness of a school-based suicide education program using three methodological approaches.

The study demonstrates how to conduct nonexperimental yet rigorous evaluation of suicide education programs when random assignment with control group design is not feasible under practical or ethical constraints. To achieve this goal, the authors show how rigorous evaluation of a school-based suicide education program (Raising Awareness of Personal Power [RAPP]) is conducted by means of three methodological approaches: the rolling group design, the internal referencing strategy, and the minimum competency approach. A total of 779 high school students in seven public high schools in Northern Colorado participated in the current study. Results based on the three approaches provide converging evidence that the RAPP program was effective not only in producing positive change in participants' knowledge, attitudes, and self-efficacy about suicide and suicide prevention, but also in reaching predetermined levels of knowledge and positive reactions to the program. Furthermore, the three approaches demonstrate practicality, usefulness, and rigorousness for future field evaluations if the formal experimental design could not be conducted in practice. Implications for program evaluation are further discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized prevention trial for early conduct problems: Effects on proactive parenting and links to toddler disruptive behavior.

Despite knowledge of early pathways to conduct problems, few preventive interventions are specifically designed to modify disruptive behavior in toddlerhood. One potential prevention target is proactive and positive parenting, which is associated with reduced risk of conduct problems in preschoolers. This randomized trial with 120 low-income 2-year-old boys examined whether a brief family-centered intervention that reduces disruptive behavior (D. Shaw, T. Dishion, L. Supplee, F. Gardner, & K. Arnds, 2006) also leads to increases in proactive and positive parenting. It also explored whether change in parenting predicts change in disruptive behavior. In the intervention group, proactive and positive parenting skills increased among parents of 3-year-olds. Change in proactive and positive parenting of 2- to 3-year-old toddlers correlated with change in child disruptive behavior, although the mediation effect of positive parenting was of only borderline significance. Findings suggest that even within a brief and multifaceted preventive intervention, change in proactive parenting skills contributes modestly but significantly to change in child problem behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementation of a school-based prevention program: Effects of counselor and school characteristics.

The authors explore 2 broad categories of factors that could influence the intervention dissemination process: individual interventionist characteristics and school-level characteristics. Counselors from 32 schools received training in the Coping Power youth violence prevention intervention. Interventionist characteristics found to affect the implementation process included counselors’ agreeableness and conscientiousness. Counselor agreeableness was positively associated with completion of session objectives, the number of sessions scheduled, and engagement with parents. Counselor conscientiousness was associated with engagement with children. In terms of school-level characteristics, counselors who were cynical about organizational change had poorer quality of engagement with children and parents if they worked in schools with environments that allowed staff limited autonomy and with greater managerial control. These findings have implications for screening of practitioners for training of evidence-based programs and for providing education during intervention training about practitioner and setting characteristics that are related to optimal intervention implementation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial.

Despite the serious and costly problems presented by juvenile sexual offenders, rigorous tests of promising interventions have rarely been conducted. This study presents a community-based effectiveness trial comparing multisystemic therapy (MST) adapted for juvenile sexual offenders with services that are typical of those provided to juvenile sexual offenders in the United States. Youth were randomized to MST (n = 67) or treatment as usual for juvenile sexual offenders (TAU-JSO; n = 60). Outcomes through 12 months postrecruitment were assessed for problem sexual behavior, delinquency, substance use, mental health functioning, and out-of-home placements. Relative to youth who received TAU-JSO, youth in the MST condition evidenced significant reductions in sexual behavior problems, delinquency, substance use, externalizing symptoms, and out-of-home placements. The findings suggest that family- and community-based interventions, especially those with an established evidence-base in treating adolescent antisocial behavior, hold considerable promise in meeting the clinical needs of juvenile sexual offenders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal impact of two universal preventive interventions in first grade on educational outcomes in high school.

This study examined the longitudinal effects of 2 first-grade universal preventive interventions on academic outcomes (e.g., achievement, special education service use, graduation, postsecondary education) through age 19 in a sample of 678 urban, primarily African American children. The classroom-centered intervention combined the Good Behavior Game (H. H. Barrish, Saunders, & Wolfe, 1969) with an enhanced academic curriculum, whereas a second intervention, the Family–School Partnership, focused on promoting parental involvement in educational activities and bolstering parents’ behavior management strategies. Both programs aimed to address the proximal targets of aggressive behavior and poor academic achievement. Although the effects varied by gender, the classroom-centered intervention was associated with higher scores on standardized achievement tests, greater odds of high school graduation and college attendance, and reduced odds of special education service use. The intervention effects of the Family–School Partnership were in the expected direction; however, only 1 effect reached statistical significance. The findings of this randomized controlled trial illustrate the long-term educational impact of preventive interventions in early elementary school. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Crisis intervention training program: Influence on staff attitudes in a postacute residential brain injury rehabilitation setting.

Purpose/Objective: Acquired brain injury produces a host of behavioral changes, and specialized training in proper management of these behaviors is essential to resolve crises and calm aggressive clients. This study was conducted to determine whether crisis intervention training was effective in increasing staff comfort with difficult client behaviors in a residential rehabilitation program for individuals with postacute acquired brain injury and whether changes would be maintained over time. Research Method/ Design: Twenty-five rehabilitation staff members participated in Nonviolent Crisis Intervention training and completed the Rehabilitation Situations Inventory before training, immediately following completion of the program, and 1 month later. Results: Immediately following completion of the program, participants reported increased comfort when faced with client behaviors related to motivation and adherence, sexuality, and aggression and when interacting with other staff and client families. Changes in comfort level with sexual situations, aggression, and staff/staff interactions were maintained 1 month post training. Conclusions/Implications: These results suggest that crisis intervention training is effective in increasing levels of staff comfort with difficult situations commonly experienced in the rehabilitation setting and the changes are maintained following training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of implementation intentions on prevention of smoking uptake among adolescents: A cluster randomized controlled trial.

Objective: To test the efficacy of implementation intentions in reducing smoking uptake in a sample of adolescents. Design: Classes of adolescents (aged 11–12 years) were randomly allocated to one of four conditions: implementation intention, self-efficacy, two control conditions. An implementation intention or a self-efficacy manipulation (both formed in relation to how to refuse offers of cigarettes) was completed by intervention condition participants at 0, 4, 8, 12, 16, 20, and 24 months. Main Outcome Measures: Long-term smoking behavior (self-report and objective) was assessed at 48 months post-baseline. Results: There were no differences between the two control conditions and the self-efficacy condition. Controlling for baseline smoking, sex, attitudes to smoking, friends and family smoking, and the multilevel nature of the data, intention-to-treat analyses indicated the implementation intention manipulation significantly reduced self-reported smoking compared to the other three conditions combined. Analyses on objectively assessed smoking (carbon monoxide breath measure) in a random subsample of participants also indicated that the implementation intention manipulation compared to the other three conditions significantly reduced smoking. Conclusion: Implementation intentions can reduce smoking in adolescent samples. Implications for using implementation intentions to reduce smoking in adolescents are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized controlled trial of a brief intervention for increasing participation in parent management training.

Evidence-based treatments exist for a range of child and adolescent behavior problems; however, effects are often limited by poor treatment attendance and adherence. The authors developed and evaluated the efficacy of a brief (5 to 45 min) intervention designed to increase treatment attendance and adherence in a sample of 76 parents referred for treatment of their child's oppositional, aggressive, and antisocial behavior. The results of this randomized controlled trial showed that parents who received this brief intervention had greater treatment motivation, attended significantly more treatment sessions, and had greater adherence to treatment according to both parent and therapist report. This study provides researchers and clinicians with a brief and efficacious method of increasing motivation, attendance, and adherence for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intergroup helping as status relations: Effects of status stability, identification, and type of help on receptivity to high-status group's help.

Integrating research on social identity processes and helping relations, the authors proposed that low-status group members who are high identifiers will be unwilling to receive help from the high-status group when status relations are perceived as unstable and help is dependency-oriented. The first experiment, a minimal group experiment, found negative reactions to help from a high-status outgroup when status relations were unstable. The 2nd and 3rd experiments, which used real groups of Israeli Arabs and Israeli Jews, replicated this finding and showed that high identifiers were less receptive to help from the high-status outgroup than low identifiers. The 4th experiment, a help-seeking experiment with real groups of competing high schools, found that the least amount of help was sought from a high-status group by high identifiers when status relations were perceived as unstable and help was dependency-oriented. Theoretical and applied implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couples' groups for parents of preschoolers: Ten-year outcomes of a randomized trial.

This paper reports the results of a 10-year follow-up of two variations of a couples' group preventive intervention offered to couples in the year before their oldest child made the transition to kindergarten. One hundred couples were randomly assigned to (1) a low-dose control condition, (2) a couples' group meeting for 16 weeks that focused more on couple relationship issues among other family topics, or (3) a couples' group meeting for 16 weeks that focused more on parenting issues among other family issues, with an identical curriculum to condition (2). Earlier papers reported that both variations of the intervention produced positive results on parent-child relationships and on the children's adaptation to kindergarten and first grade, and that the groups emphasizing couple relationships also had additional positive effects on couple interaction quality. The present paper uses growth curve analyses to examine intervention effects extending from the children's transition to kindergarten to the transition to high school—10 years after the couples groups ended. There were 6-year positive effects of the pre-kindergarten interventions on observed couple interaction and 10-year positive effects on both parents' marital satisfaction and the children's adaptation (hyperactivity and aggression). Discussion includes a focus on the implications of these results for family policy, clinical practice, and the need to include a couples focus in preventive interventions to strengthen family relationships and enhance children's adaptation to school. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Prevention of depressive symptoms in adolescents: A randomized trial of cognitive-behavioral and interpersonal prevention programs.

This study evaluated the efficacy of 2 programs for preventing depressive symptoms in adolescents. Participants were 380 high school students randomly assigned to a cognitive-behavioral program (CB), an interpersonal psychotherapy-adolescent skills training program (IPT-AST), or a no-intervention control. The interventions involved eight 90-min weekly sessions run in small groups during wellness classes. At postintervention, students in both the CB and IPT-AST groups reported significantly lower levels of depressive symptoms than did those in the no-intervention group, controlling for baseline depression scores; the 2 intervention groups did not differ significantly from each other. The effect sizes, using Cohen's d, for the CB intervention and the IPT-AST intervention were 0.37 and 0.26, respectively. Differences between control and intervention groups were largest for adolescents with high levels of depressive symptoms at baseline. For a high-risk subgroup, defined as having scored in the top 25th percentile on the baseline depression measure, the effect sizes for the CB and the IPT-AST interventions were 0.89 and 0.84, respectively. For the whole sample, sociotropy and achievement orientation moderated the effect of the interventions. Intervention effects were short term and were not maintained at 6-month follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bully Busters abbreviated: Evaluation of a group-based bully intervention and prevention program.

The present study sought to examine the efficacy of an abbreviated version of the Bully Busters program, a psychoeducationally based group intervention and prevention program designed to increase teacher's knowledge and use of bullying intervention skills, as well as teacher self-efficacy in intervening with bullying so as to subsequently effect change in the school climate. Teacher-participants attended seven group sessions designed to provide them with exposure to the didactics of the model, as well as to engage them in active learning, role-playing, and cognitive and emotional processing of their experiences of the impact of bullying behaviors on their teaching efficacy as well as the school climate. Materials and experiences from these groups were then taken to the classroom and implemented with the student-participants vis-à-vis classroom exercises. The findings suggest that an abbreviated group-based version of the Bully Busters program can have positive effect on teacher reports of efficacy in intervening with bullying behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An integrated components preventive intervention for aggressive elementary school children: The Early Risers program.

The Early Risers prevention program aims to alter the developmental trajectory of children with early onset aggressive behavior. The program features 4 CORE components: (a) an annual 6-week summer school program, (b) a teacher consultation and student mentoring program, (c) child social skills groups, and (d) parent education and skills-training groups, all delivered in tandem with a FLEX family support program individually tailored to address the unique needs of families. At baseline, the mean age of the sample was 6.6 years. Following 2 years of intervention, program children showed significant improvement relative to controls in academic achievement and school behaviors. Change on behavioral self-regulation was moderated by level of child aggression, with intervention effects found for only the most severely aggressive children. Parents with high program attendance rates showed improvement in discipline methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of school-wide positive behavioral interventions and supports (PBIS) on the organizational health of elementary schools.

Positive Behavioral Interventions and Supports (PBIS) is a universal, school-wide prevention strategy that is currently implemented in over 7,500 schools across the nation to reduce disruptive behavior problems through the application of behavioral, social learning, and organizational behavioral principles. PBIS aims to alter school environments by creating improved systems and procedures that promote positive change in student behavior by targeting staff behaviors. The present study examined the impact of PBIS on school organizational health using data from a large randomized controlled trial of PBIS conducted in 37 elementary schools. Longitudinal multilevel analyses on data from 2,507 staff revealed a significant effect of PBIS on staff reports of the schools' overall organizational health, resource influence, and staff affiliation over a 3-year period. This study indicated that changes in school organizational health are important consequences of the PBIS whole-school prevention model, and might in turn be a potential mediator of the effect of PBIS on student performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls.

Efficacy trials indicate that an eating disorder prevention program involving dissonance-inducing activities that decrease thin-ideal internalization reduces risk for current and future eating pathology, yet it is unclear whether this program produces effects under real-world conditions. The present effectiveness trial tested whether this program produced effects when school staff recruit participants and deliver the intervention. Adolescent girls with body image concerns (N = 306; M age = 15.7, SD = 1.1) randomized to the dissonance intervention showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, dieting attempts, and eating disorder symptoms from pretest to posttest than did those assigned to a psychoeducational brochure control condition, with the effects for body dissatisfaction, dieting, and eating disorder symptoms persisting through 1-year follow-up. Effects were slightly smaller than those observed in a prior efficacy trial, suggesting that this program is effective under real-world conditions, but that facilitator selection, training, and supervision could be improved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating a prevention program for teenagers on sexual coercion: A differential effectiveness approach.

The authors evaluated a coeducational program for teenagers on preventing sexual coercion in dating situations. Students examined individual and social attitudes underlying coercive sexual behavior and learned communication skills aimed at preventing or dealing with unwanted sexual advances. Instruction was enhanced by video and an interactive video virtual date. Outcomes were assessed using sexual attitude scales with a sample of 458 high school students. Student health education classes were randomly assigned to either a treatment or a control condition. Findings, based on a latent variable model of differential effectiveness, showed that students in the treatment group with initial coercive attitude scores at or above the mean benefited significantly more than students with the same range of scores in the control group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biofeedback-based behavioral treatment for chronic tinnitus: Results of a randomized controlled trial.

Many tinnitus sufferers believe that their tinnitus has an organic basis and thus seek medical rather than psychological treatments. Tinnitus has been found to be associated with negative appraisal, dysfunctional attention shift, and heightened psychophysiological arousal, so cognitive-behavioral interventions and biofeedback are commonly suggested as treatments. This study developed and investigated the efficacy of a biofeedback-based cognitive-behavioral treatment for tinnitus. In total, 130 tinnitus patients were randomly assigned to an intervention or a wait-list control group. Treatment consisted of 12 sessions of a biofeedback-based behavioral intervention over a 3-month period. Patients in the wait-list group participated in the treatment after the intervention group had completed the treatment. Results showed clear improvements regarding tinnitus annoyance, diary ratings of loudness, and feelings of controllability. Furthermore, changes in coping cognitions as well as changes in depressive symptoms were found. Improvements were maintained over a 6-month follow-up period in which medium-to-large effect sizes were observed. The treatment developed and investigated in this study is well accepted and leads to clear and stable improvements. Through demonstration of psychophysiological interrelationships, the treatment enables patients to change their somatic illness perceptions to a more psychosomatic point of view. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ecological effects of universal and selective violence prevention programs for middle school students: A randomized trial.

This study reports the findings of a multisite randomized trial evaluating the separate and combined effects of 2 school-based approaches to reduce violence among early adolescents. A total of 37 schools at 4 sites were randomized to 4 conditions: (1) a universal intervention that involved implementing a student curriculum and teacher training with 6th-grade students and teachers, (2) a selective intervention in which a family intervention was implemented with a subset of 6th-grade students exhibiting high levels of aggression and social influence, (3) a combined intervention condition, and (4) a no-intervention control condition. Analyses of multiple waves of data from 2 cohorts of students at each school (N = 5,581) within the grade targeted by the interventions revealed a complex pattern. There was some evidence to suggest that the universal intervention was associated with increases in aggression and reductions in victimization; however, these effects were moderated by preintervention risk. In contrast, the selective intervention was associated with decreases in aggression but no changes in victimization. These findings have important implications for efforts to develop effective violence prevention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)