Universal School-based Program Research Articles

The Effectiveness of the Life Skills Program IPSY for the Prevention of Adolescent Tobacco Use

In this study, the effectiveness of a life skills program to impede tobacco use in early adolescence was scrutinized. The focus was on the mediating role of yielding to peer pressure. The universal school-based life skills program IPSY ( Information + Psychosocial Competence = Protection) against adolescent substance use was implemented over 3 years. Over the same time period, it was evaluated based on a longitudinal quasi-experimental design with an intervention and comparison group (4 measurement points; N = 1,657 German students, age 10 at T1). By applying a growth curve modeling approach, we found that participation in IPSY compared with non-participation predicted a slower increase in tobacco use over time, suggesting a significant intervention effect. Moreover, a parallel growth curve model revealed that less yielding to peer pressure induced by IPSY mediated the program effects on tobacco use over time.

Effectiveness of universal school-based programs for prevention of violence in adolescents.

Effectiveness of universal school-based programs for prevention of violence in adolescents.

Child, Teacher and Parent Perceptions of the FRIENDS Classroom-Based Universal Anxiety Prevention Programme: A Qualitative Study.

School-based mental health prevention programmes can be effective but their adoption within schools will depend on their social acceptability. We report a qualitative evaluation summarising the views of children (115), parents (20) and school staff (47) about a universal school-based anxiety prevention programme FRIENDS. This study was conducted as part of a large scale randomised controlled trial (n = 1362) involving 40 schools in the UK providing primary education to children aged 7–11. Reported overall experience of the programme was very positive, with all three major components of the cognitive behaviour therapy programme (emotional, cognitive, and behavioural) being accepted well and understood by children. The programme was considered to be enjoyable and valuable in teaching children important skills, particularly emotional regulation and coping. Children provided examples of using the skills learned during FRIENDS to manage their emotions and solve problems. However, teachers were concerned that the programme overlapped with the current school curriculum, required additional time and almost half were unable to identify any tangible changes in the children’s behaviour. Whilst this paper provides evidence to support the social validity of the FRIENDS anxiety prevention programme, the concerns raised by teachers question the longer-term sustainability of the programme.

The Effectiveness and Sustainability of a Universal School-Based Programme for Preventing Depression in Chinese Adolescents: A Follow-Up Study Using Quasi-Experimental Design

BackgroundA pilot study about the effectiveness of a universal school-based programme, “The Little Prince is Depressed”, for preventing depression in Chinese adolescents in Hong Kong was conducted and reported previously. This study used a larger sample to examine the effectiveness and sustainability of the programme.MethodsThis study used quasi-experimental design. Twelve schools enrolled in “The Little Prince is Depressed” programme either as an intervention or a control condition. The intervention schools carried out the 12-session programme in two phases: the professional-led first phase and the teacher-led second phase. All participants were required to complete a questionnaire at three time points measuring their (1) depressive, anxiety, and stress levels; (2) knowledge of mental health; (3) attitudes towards mental illness; (4) perceived social support; and (5) help-seeking behaviours.ResultsA total of 3,391 students participated in the study. The level of depressive symptoms did not reduce significantly at post-intervention; however, a delayed effect was observed at follow-up assessment for the participants of the teacher-led group in reducing anxiety and stress levels. Also, the knowledge of mental health and attitudes towards mental illness of the intervention-group participants significantly improved at post-test, and the outcomes were maintained at 4 to 5 months after the intervention in both the professional-led and the teacher-led conditions (p<.05). A preference among schoolchildren for whom to seek help from was identified.ConclusionsThe universal depression prevention programme was effective in enhancing knowledge of mental health and promoting a more positive attitude towards mental illness among adolescents in Hong Kong. In particular, the teacher-led group showed better outcomes than the professional-led group in reducing students’ anxiety and stress at follow-up period. The programme can achieve sustainability in schools if teachers are provided with adequate support.

A Comprehensive Evaluation of a Universal School-Based Depression Prevention Program for Adolescents.

The present study proposes and demonstrates a comprehensive framework for evaluation of a universal school-based depression prevention program. Efficacy was evaluated by considering the impact of continuous versus categorical approaches to operationalizing outcome, the effect of the intervention on key change agent variables, and moderation of intervention effects by student symptom severity at baseline. Participants 252 adolescent boys and girls (60% male), aged 13 to 17years (M = 13.62years, SD = 0.60years) from four schools in the state of Victoria, Australia, who were allocated by school into a waitlist = control (n = 88) or a CBT-based intervention (n = 164) group. The intervention involved six 45-min weekly sessions run during wellbeing classes. While the intervention and control groups did not differ in average improvement in symptoms by post-intervention, further analyses showed that responsiveness was highly variable within the intervention, and those with elevated depressive symptoms benefitted most. The proposed change agents of self-esteem, resilience, body image satisfaction, and perceived social support did not uniquely predict change in depressive symptoms but collectively accounted for substantial variance in this change process. Collectively, this framework provided insights into aspects of the intervention that worked and highlighted areas for improvement, thus providing clear direction for future research.

Universal screening for cardiovascular disease risk factors in adolescents to identify high-risk families: a population-based cross-sectional study.

BackgroundUniversal screening of children for dyslipidemia and other cardiovascular risk factors has been recommended. Given the clustering of cardiovascular risk factors within families, one benefit of screening adolescents may be to identify “at-risk” families in which adult members might also be at elevated risk and potentially benefit from medical evaluation.MethodsCross-sectional study of grade 9 students evaluating adiposity, lipids and blood pressure. Data collected by Heart Niagara Inc. through the Healthy Heart Schools’ Program. Parents completed questionnaires, evaluating family history of dyslipidemia, hypertension, diabetes and early cardiovascular disease events in parents and siblings (first-degree relatives), and grandparents (second-degree relatives). Associations between positive risk factor findings in adolescents and presence of a positive family history were assessed in logistic regression models.ResultsN = 4014 adolescents ages 14–15 years were screened; 3467 (86 %) provided family medical history. Amongst adolescents, 4.7 % had dyslipidemia, 9.5 % had obesity, and 3.5 % had elevated blood pressure. Central adiposity (waist-to-height ratio ≥0.5) in the adolescent was associated with increased odds of diabetes in first- (OR:2.0 (1.6–2.6), p < 0.001) and second-degree relatives (OR:1.3 (1.1–1.6), p = 0.002). Dyslipidemia was associated with increased odds of diabetes (OR:1.6 (1.1–2.3), p < 0.001), hypertension (OR:2.2 (1.5–3.2), p < 0.001) and dyslipidemia (OR:2.2 (1.5–3.2),p < 0.001) in first degree relatives. Elevated blood pressure did not identify increased odds of a positive family history.ConclusionsPresence of obesity and/or dyslipidemia in adolescents identified through a universal school-based screening program is associated with risk factor clustering within families. Universal pediatric cardiometabolic screening may be an effective entry into reverse cascade screening.

Supplemental Material for Effectiveness of Universal School-Based Programs for Prevention of Violence in Adolescents

Supplemental Material for Effectiveness of Universal School-Based Programs for Prevention of Violence in Adolescents

A cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of a school-based cognitive–behavioural therapy programme (FRIENDS) in the reduction of anxiety and improvement in mood in children aged 9/10 years

BackgroundAnxiety in children is common, impairs everyday functioning and increases the risk of severe mental health disorders in adulthood, yet few children with anxiety are identified and referred for treatment.ObjectiveTo investigate the clinical effectiveness and cost-effectiveness of a universal school-based preventative programme (FRIENDS) in reducing symptoms of anxiety and low mood.DesignCluster randomised controlled trial. Schools (n = 41) were randomly assigned after recruitment on a 1 : 1 : 1 basis to health-led FRIENDS, school-led FRIENDS and usual school provision.SettingPrimary schools in three local education authorities in the south-west of England.ParticipantsChildren (n = 1362) aged 9–10 years attending school and participating in personal, social and health education (PSHE).InterventionsThe FRIENDS programme is a cognitive–behavioural therapy programme that develops skills to counter the cognitive, emotional and behavioural aspects of anxiety. The FRIENDS programme was led by either a trained member of the school or a health leader external to the school and was delivered over 9 consecutive weeks. The comparison group received usual school PSHE lessons. Interventions were delivered in the academic year September 2011–July 2012.Main outcome measuresClinical effectiveness assessed by child report of symptoms of anxiety (Revised Child Anxiety and Depression Scale, RCADS); cost-effectiveness based on RCADS and quality-adjusted life-years (Child Health Utility 9 Dimensions, CHU-9D) between baseline and 6 months; process evaluation, evaluation of reach and attrition and qualitative feedback from children, school staff and parents.ResultsAt 12 months there was a difference in the adjusted mean RCADS scores for health-led FRIENDS compared with school-led FRIENDS [–3.91, 95% confidence interval (CI) –6.48 to –1.35] and for health-led FRIENDS compared with usual school provision (–2.66, 95% CI –5.22 to –0.09). At 24 months we were able to assess only 43.6% of our cohort. There were few differences in baseline characteristics between completers and non-completers. Child-reported anxiety in all three groups had reduced by 24 months and there were no longer any group effects. There were no between-group effects for any parent- or child-completed secondary outcomes at 12 or 24 months. The cost of the FRIENDS programme was £52–56 per child. We found no evidence that the FRIENDS programme was cost-effective over a 6-month period; however, our subgroup for the economic analysis differed significantly from our main trial cohort.ConclusionsAlthough greater reductions in anxiety were noted at 12 months when the FRIENDS programme was delivered by health leaders, these additional benefits were not maintained at 24 months. Children’s anxiety levels improved irrespective of the intervention that they received. Our economic evaluation and 24-month assessment had significant shortcomings. However, the universal delivery of specific anxiety prevention programmes will result in additional costs that may be beyond the finances available to most schools. Future work should identify the active ingredients and potential moderators of universal anxiety programmes to determine whether programme length can be reduced, short-term effectiveness maintained and cost-effectiveness improved. At present, our results find limited evidence to support the universal provision of specific anxiety prevention programmes in UK primary schools.Trial registrationCurrent Controlled Trials ISRCTN23563048.FundingThe National Institute for Health Research Public Health Research programme.

The enhanced Aussie Optimism Positive Thinking Skills Program: The relationship between internalizing symptoms and family functioning in children aged 9-11 years old.

The family context plays a critical role in the health of the child. This was the first study to examine the usefulness of the General Functioning subscale of the Family Assessment Device (FAD-GF) in assessing family functioning and its relationship to internalizing symptoms in school-aged children aged between 9 and 11 years of age. Eight hundred and forty-seven year 4 and 5 students from 13 schools (607 intervention students, and 240 control students) participated in the Aussie Optimism Positive Thinking Skills Program (AO-PTS) – a universal school-based program targeting internalizing symptoms. Students rated how ‘healthy’ they perceived their family to be at pre-test and at 6-months follow-up. Although some aspects of validity and reliability could be improved, results indicated that perceptions of family functioning at pre-test were predictive of internalizing symptoms at the 6-months follow-up. The FAD-GF therefore showed promise as a potential measure of family functioning for children as young as 9 years old. Regardless of children’s pre-test levels of perceived family functioning, no intervention effects were found on the anxiety and depression scales; this finding suggests that child perceptions of family functioning may act as a general protective factor against internalizing symptomology.

Are school-based mental health interventions for war-affected children effective and harmless?

In recent years, different approaches to large-scale mental health service provision for children in war-affected, mainly low- and middle-income, countries have been developed. Some school-based programs aiming at both strengthening resilience and reducing symptoms of trauma-related distress have been evaluated. In an article published in BMC Medicine, Tol and colleagues integrate their findings of the efficacy of universal school-based intervention across four countries and do not recommend classroom-based intervention as a treatment of trauma-related symptoms, since no consistent positive effects were found. On the contrary, for some children this type of universal intervention may impair recovery. Since universal school-based programs similar to the one evaluated here are widely implemented, Tol et al.’s results are highly relevant to inform the field of mental health service provision in war-affected countries.Please see related article http://www.biomedcentral.com/1741-7015/12/56.

Promoting Alternative Thinking Strategies Program in preventive intervention science

When the studies conducted in the preventive intervention field are evaluated, it is seen that intense discussions continue about the efficiencies, effectiveness, implementation process, adaptation and how these programs are implemented regarding different cultures. The goal of this study is to report developments of theoretical and practical in preventive intervention science and to introduce Promoting Alternative Thinking Strategies- PATHS program that is scientifically proven many times in terms of effectiveness and has become widespread gradually in many countries. PATHS is a universal school-based preventive intervention program which can be used to improve emotional social competence and reduce aggression and behavior problems for all children (both regular and special education) beginning in the preschool years through the end of elementary school. This study will build an intellectual base for practices of daily life and gaining prevalence for studies related to preventive intervention programs in early childhood education institutions. In this article problems encountered during implementation and requiring solutions critical issues will be discussed and recommendations will be made to resolve them. In this context, this study will contribute to preventive programs that are developed by considering problems and challenges in Turkish society and to the research based on comparison.

Evaluation of a School-Based Program Aimed at Preventing Depressive Symptoms in Adolescents

The aim of this pilot study was to evaluate the implementation of a universal school-based cognitive behavioral program whose target is to prevent depressive symptoms in adolescents. The study had a quasi-experimental design with pretest, posttest, and a 1-year follow-up and provides an illustrative calculation for the implementation costs of the intervention. Sixty-two students (aged 14) and seven tutors participated. A majority of the students and all of the tutors were satisfied with the intervention. The students, both females and males, rated their depressed symptoms as significantly lower after the course; and for the females, this was maintained 1-year postintervention. The implementation costs for the initial 2 years were about US$300 per student. Positive effects of a universal school-based cognitive behavioral intervention aiming at preventing depressive symptoms in adolescents were found, especially among females.

Supporting positive mental health development in adolescents with a group cognitive intervention

Background: Supporting positive mental health development in adolescents is an important school health concern, but there is a need to investigate the suitability of the interventions used. Aim: The aim is to investigate the experiences of school health professionals in conducting a universal school-based programme aimed at preventing depressive symptoms in adolescents. Methods: Twenty-two school health professionals participated in four focus groups. The interviews were analysed using qualitative content analysis. Findings: The overall theme identified in the study consists of ‘striking a balance between strictly following the manual and meeting the students’ needs’. Three subthemes emerged: ‘doing good and sowing seeds for the future’, working with insufficient tools, and ‘personal development as a professional and as an individual’. Conclusions: School health professionals conducting the programme found it valuable in a school setting, but considered support from the school administration essential.

For Whom Does It Work? Subgroup Differences in the Effects of a School-Based Universal Prevention Program

This study examined subgroup differences in the effectiveness of a universal classroom-based preventive intervention. The Good Behavior Game (GBG) was delivered in Grade 1 and 2 in a randomized controlled trial including 759 students. Changes in externalizing and internalizing problems were modeled from Kindergarten through Grade 2. Unlike previous research, a person-centered approach was employed to examine critical combinations of child, peer, family, and demographic characteristics at baseline as moderators of intervention impact. Six subgroups were identified that differed both in baseline risk profiles and intervention responsiveness. The GBG prevented the development of externalizing and internalizing behavior among low-risk children, children with emotional problems, and victimized children. No positive intervention effects were found for children from dysfunctional families and children with combinations of behavioral and social risks. The study presented a novel approach to study subgroup differences in universal preventive interventions and provides first evidence that universal school-based programs may not be effective for children with more severe risks and risks at multiple levels.

Preventing depression and promoting resilience: feasibility study of a school-based cognitive-behavioural intervention

The limited reach and effectiveness of psychological treatments for adolescent depression have fuelled interest in alternative approaches designed to promote resilience. Schools offer a convenient location for the widespread delivery of depression prevention programmes, although little research has evaluated the feasibility of delivering interventions in this setting. To investigate the feasibility of delivering and evaluating a universal school-based depression prevention programme for children aged 12-16 years. A three-arm pilot study was conducted in one UK secondary school (n = 834). Interventions had good reach (96%), with high rates of consent (89%) and reasonable retention (78%). The majority of intervention sessions were delivered as intended, with 85% of students attending seven or more sessions. The programme was acceptable to students and teachers, with the specific content of the active intervention being rated differently from the control programmes. Delivering and undertaking methodologically robust evaluations of universal school-based depression programmes is feasible.

Effectiveness of a universal school-based programme for preventing depression in Chinese adolescents: A quasi-experimental pilot study

Evidence of the effectiveness, rather than efficacy, of universal school-based programmes for preventing depression among adolescents is limited. This study examined the effectiveness of a universal depression prevention programme, "The Little Prince is Depressed" (LPD), which adopted the cognitive-behavioural model and aimed to reduce depressive symptoms and enhance protective factors of depression among secondary school students in Hong Kong. A quasi-experimental design was adopted for this pilot study. Thirteen classes were assigned to the intervention or control conditions according to the deliberation of the programme administrator of the four participating schools. Implementation was carried out in two phases, with a professional-led first phase and teacher-led programme second phase. LPD consisted of a 12-week school-based face-to-face programme with psycho-educational lessons and homework assignments. Students completed the programme generally showed positive development in help-seeking attitudes and self-esteem. For students who had more depressive symptoms at pre-assessment, the programme was found to be significant in enhancing cognitive-restructuring skills and support-seeking behaviours. The programme was not, however, found to be statistically significant in reducing depressive symptoms of the participants over the study period. A small sample size, a high attrition rate, and a short follow-up time frame. The LPD programme was successful in building resilience of the students in general and enhancing the cognitive-behavioural skills of students with depressive symptoms. While we did not find sufficient evidence for concluding that the LPD was effective in reducing depressive symptoms, we believe that these results highlight the challenges of implementing evidence-based practices generated from highly controlled environments in real-life settings.

The effectiveness of a universal school-based programme on coping and mental health: a randomised, controlled study of Zippy’s Friends

The purpose of this study was to evaluate Zippy’s Friends, a universal school programme that aims at strengthening children’s coping skills. The sample consisted of 1483 children (aged 7–8 years) from 91 second-grade classes in 35 schools. The schools were matched and randomly assigned to intervention or control conditions. Coping was assessed by the Kidcope checklist for children and an adapted version for parents. Parents and teachers reported mental health outcomes using the Strengths and Difficulties Questionnaire. Controlling for the hierarchical structure of the data, latent variable regression analysis indicated that the programme had a significant positive effect on coping and on the impact of mental health difficulties in daily life. Subgroup analyses suggested that coping was improved in girls and children from the low socio-economic subgroup, whereas the impact of mental health difficulties was reduced in boys.

Commentary on: ‘Universal school‐based prevention programmes for alcohol misuse in young people’

AbstractThis is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Foxcroft DR, Tsertsvadze A. Universal school‐based prevention programmes for alcohol misuse in young people. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD009113. DOI: 10.1002/14651858.CD009113.Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2012 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Universal school-based prevention programmes for alcohol misuse in young people

Universal school-based prevention programmes for alcohol misuse in young people

Preventing Behavior Problems Among Elementary Schoolchildren: Impact of a Universal School-Based Program in China

To evaluate the effect on problem behaviors of a universal school-based prevention curriculum of third grade students. Six regular classes in 1 elementary school were randomly assigned to an intervention (n = 208) or control (n = 209) group. A 13-session program was offered to students in the intervention group. The Achenbach Child Behavior Checklist (CBCL), parent report, was used to assess problem behaviors at baseline, at the conclusion of the curriculum, and again at 6-month follow up. The unadjusted mean estimates of behavioral problems were significantly lower in the intervention group posttest (at the conclusion of the curriculum), -3.53 (95% confidence interval [CI] = -6.59 to -0.48; p = .023) and at the 6-month follow up, -5.22 (95% CI: -8.27 to -2.16; p = .001). After adjusting for potential confounders, gender (female), father's educational status (high school), family relationships (good and average), and child's age in months, intervention groups (intervention posttest and intervention after 6-month follow up) showed significantly lower total behavioral scores. A universal school-based prevention program for Chinese elementary school-age children resulted in a significant positive change in behavioral problems. This is an important finding in the context of the Chinese 1-child policy that places great value on the achievement of the child.