Longer Term Outcomes of
Two Universal, First-Grade
Preventive Intervention Trials
Nicholas Ialongo,
Lisa Ulmer, Sheppard Kellam, &
C. Hendricks Brown
Prevention Intervention Research Center
Johns Hopkins Bloomberg School of
Public Health
Major Contributors to the Development of
PIRC Interventions:
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Mary Alice Bond, M.A.
Joyce Epstein, Ph.D.
Becky Fetrow, M.A.
Elizabeth Ramsey, Ph.D.
Ruth Handel, Ph.D.
Nancy Karweit, Ph.D
Irving Sigel, Ph.D.
Grover Whitehurst, Ph.D.
Carolyn Webster-Stratton, Ph.D.
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Schools Committee: Classroom and Family
Prevention Trials
Juanita Lewis, Director, Office of Superintendent (Co-Chair)
Sheppard Kellam, Director, Prevention Research Center (Co-Chair)
Elva J. Edward, Community Relations and Crisis Response
Louise Fink, Coordinator, Special Pupil Services
Carla Ford, Interim Coordinator, Office of Early Learning Years
Claudia Brown, Principal, Brehms Lane Elementary School
Linda Chinnia, Principal, Liberty Elementary School
Janet Cooper, Principal, Grove Park Elementary School
Charlene Cooper-Boston, Principal, Beechfield Elementary School
Elaine Davis, Principal, Hilton Elementary School
Lillian Jones, Principal, Callaway Elementary School
Barbara Lee, Principal, Cross Country Elementary School
Angela Peck, Principal, Yorkwood Elementary School
Shirley Zongker, Principal, Farring Elementary School
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Intervention Types:
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Universal
Selected
Indicated
Treatment / Services
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JHU PIRC Interventions
Integrate 4 Perspectives:
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Public Health
Epidemiology
Life Course Development
Sociology
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Preventive Intervention
Trials Serve a Dual Purpose:
ƒ Test for intervention efficacy /
effectiveness
ƒ Test developmental theory
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Immediate objectives of
the interventions:
ƒ Promote first graders’:
ƒ Academic achievement
ƒ Self-esteem and psychological well-being
ƒ Reduce first graders’:
ƒ Attention problems
ƒ Aggressive and shy behaviors
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Long-term objectives of
the interventions:
ƒ Promote:
ƒ Educational, social, and occupational
success
ƒ Prevent:
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Antisocial behavior
Substance abuse
Depression
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Two first-grade
interventions
ƒ Family-School Partnership (FSP) Intervention
targeting:
ƒ Parent-school communication
ƒ Parent “teaching” and discipline practices
ƒ Classroom-Centered (CC) Intervention
targeting:
ƒ Teacher classroom behavior management practices
ƒ Teacher instructional practices
ÎBoth delivered over course of first-grade year
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Family-School Partnership:
Parent Components / Tools
ƒ Parent workshops (led by teacher and school
mental health professional) aimed at:
ƒ Establishing effective parent-school partnerships
ƒ Strategies to enhance their child’s learning
ƒ Effective ways to discipline their child
ƒ Learning tools available to parents:
ƒ Parent lending library
ƒ A “Fun Math” kit
ƒ Voice mail system to communicate with teachers
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Family-School Partnership:
Teacher Components / Tools
ƒ In-service training for teachers to assist them
in:
ƒ Creating an environment that invites parent
involvement
ƒ Communicating more appropriately with culturally
diverse families
ƒ Identifying classroom factors and teaching practices
that hinder or promote parent involvement
ƒ Planning and executing a successful parent-teacher
conference
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Classroom-Centered (CC)
Intervention Components
ƒ Curriculum to promote math and reading
achievement - “Mastery Learning”
ƒ Classroom behavioral components:
ƒ Good Behavior Game - to promote positive
behavior using peer supports
ƒ Weekly class meeting – teachers guide
students in a 6-step problem solving protocol
to resolve conflicts and develop social
competencies
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Hypothesized Mechanisms:
Antisocial Behavior &
Substance Abuse
ƒ Improved parent and teacher behavior
management practices
ƒ Reductions in early coercive / aggressive
behavior
ƒ Reduced likelihood of peer, teacher, and
parent rejection
ƒ Increased likelihood of acquiring “social
survival skills”
ƒ Less likely to drift into deviant peer groups
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Hypothesized Mechanisms:
Anxious / Depressive
Symptoms
ƒ Improved teacher and parent
instructional practices provide support for
learning
ƒ Improved achievement
ƒ Improved perceptions of competence and
control
ƒ Improved psychological well-being
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Design
ƒ Effectiveness trial – existing teachers and
school mental health professionals delivered
interventions
ƒ Completely randomized block design:
ƒ 3 first grade classrooms in 9 urban elementary
schools (primarily African-American)
ƒ Randomly assigned to an intervention or a standard
setting classroom
ƒ Children and teachers randomly assigned to
classrooms within each school
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Assessment design and
methods
ƒ Pretest assessment early fall of first
grade
ƒ Teacher, school mental health professional,
parent, peer, and youth reports
ƒ Post-test late spring of first grade
ƒ Annual follow-up each spring since 1st
grade
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Constructs assessed:
ƒ Proximal targets:
ƒ Grades, standardized achievement scores,
attendance, special education, disciplinary removals
ƒ Attention / concentration problems
ƒ Aggression
ƒ Shy / withdrawn behaviors
ƒ Distal targets:
ƒ Conduct, affective, anxious, substance abuse
symptoms and disorders
ƒ Grades, standardized achievement scores,
attendance, special education, disciplinary removals
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Proximal Impact Grades 1-2
ƒ Improved reading and math achievement
ƒ Decreased teacher-rated total problem
behaviors
ƒ Decreased peer-nominated aggression
ƒ Decreased parent-rated total problem
behaviors
ƒ Increased psychological well-being
Ialongo, Werthamer, Brown,
Kellam, & Wang (1999)
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Highlights of
Intervention Impact:
th
End of 6 Grade
Classroom Centered vs. Control
(6th grade boys)
ProbabIlIty of Event
Odds Ratio: 0.42, 95% CI (0.18-0.98)
0.10
0.09
0.08
0.07
0.06
0.05
0.04
0.03
0.02
0.01
0.00
*
Control
Classroom Centered
Conduct Disorder
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Classroom Centered vs. Control
(6th grade)
ProbabIlIty of Event
Odds Ratio: 0.73, 95% CI (0.56-0.95)
0.35
0.30
*
0.25
0.20
Control
Classroom Centered
0.15
0.10
0.05
0.00
Suspension
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Classroom Centered vs. Control
(6th grade)
ProbabIlIty of Event
Odds Ratio: 0.53, 95% CI (0.38-0.76)
0.25
0.20
0.15
*
Control
Classroom Centered
0.10
0.05
0.00
Parent Report: Child Receive Mental
Health Service
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Classroom Centered vs. Control
(6th grade)
ProbabIlIty of Event
Odds Ratio: 0.56, 95% CI (0.32-0.99)
0.40
0.35
0.30
0.25
0.20
0.15
0.10
0.05
0.00
*
Control
Classroom Centered
School Mental Health Professional
Report: Child Receive Mental Health
Service
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Classroom Centered vs. Control
(6th grade)
ProbabIlIty of Event
Odds Ratio: 0.37, 95% CI (0.20-0.70)
0.25
0.20
0.15
*
Control
Classroom Centered
0.10
0.05
0.00
Teacher Report: Child Needs Mental
Health Service
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Family – School Partnership vs. Control
(6th grade)
ProbabIlIty of Event
Odds Ratio: 0.69, 95% CI (0.32-1.49)
0.09
0.08
0.07
0.06
0.05
0.04
0.03
0.02
Control
Family-School
Partnership
0.01
0.00
Conduct Disorder
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Family – School Partnership vs. Control
(6th grade)
ProbabIlIty of Event
Odds Ratio: 0.59, 95% CI (0.35-0.97)
0.30
0.25
0.20
*
0.15
Control
Family-School
Partnership
0.10
0.05
0.00
Suspension
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Family – School Partnership vs. Control
(6th grade)
ProbabIlIty of Event
Odds Ratio: 0.66, 95% CI (0.32-0.1.32)
0.20
0.18
0.16
0.14
0.12
0.10
0.08
0.06
0.04
0.02
0.00
Control
Family-School
Partnership
Parent Report: Child Receive Mental
Health Service
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Family – School Partnership vs. Control
(6th grade)
ProbabIlIty of Event
Odds Ratio: 0.66, 95% CI (0.32-1.33)
0.35
0.30
0.25
0.20
Control
0.15
0.10
Family-School
Partnership
0.05
0.00
School Mental Health Professional
Report: Child Receive Mental Health
Service
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Family – School Partnership vs. Control
(6th grade)
ProbabIlIty of Event
Odds Ratio: 0.72, 95% CI (0.47-1.11)
0.25
0.20
0.15
Control
0.10
Family-School
Partnership
0.05
0.00
Teacher Report: Child Needs Mental
Health Service
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Percent StartIng Tobacco Use
Kaplan-Meier Estimates of Impact of
Interventions on Youth Tobacco Smoking
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Intervention Status
Control
Classroom Centered
Family-School Partnership
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20
10
0
6
7
8
9
10
11
12
13
14
AGE
Storr, Ialongo, Kellam, & Anthony
(2002)
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Highlights of
Intervention Impact:
th
11 Grade
Classroom Centered vs. Control
(11th grade)
ProbabIlIty of Event
Odds Ratio: 0.30, 95% CI (0.12-0.78)
0.07
0.06
0.05
0.04
0.03
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Control
Classroom Centered
0.02
0.01
0.00
Experimentation with Illicit/Hard Drugs
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Classroom Centered vs. Control
(11th grade boys only)
ProbabIlIty of Event
Odds Ratio: 0.48, 95% CI (0.20-1.17), p < .10
0.08
0.07
0.06
0.05
+
Control
Classroom Centered
0.04
0.03
0.02
0.01
0.00
Conduct Disorder: Youth Report (boys)
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Classroom Centered vs. Control
(11th grade)
ProbabIlIty of Event
Odds Ratio: 0.40, 95% CI (023.-0.70)
0.30
0.25
0.20
0.15
*
Control
Classroom Centered
0.10
0.05
0.00
School Suspension in Last Year
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Classroom Centered vs. Control
(11th grade)
ProbabIlIty of Event
Odds Ratio: 0.39, 95% CI (0.20-0.74)
0.30
0.25
0.20
0.15
*
0.10
Control
Classroom Centered
0.05
0.00
Teacher Report: Youth Received
Counseling for Behavior Problems
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Classroom Centered vs. Control
(11th grade)
ProbabIlIty of Event
Odds Ratio: 0.47, 95% CI (0.24-0.93)
0.18
0.16
0.14
0.12
0.10
0.08
0.06
0.04
0.02
0.00
*
Control
Classroom Centered
Received Special Education
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Classroom Centered vs. Control
(11th grade)
ProbabIlIty of Event
Odds Ratio: 0.57, 95% CI (0.34-0.96)
0.25
0.20
0.15
*
Control
Classroom Centered
0.10
0.05
0.00
Teacher Report: Youth Needs Special
Education
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Preliminary Conclusions
ƒ Evidence of distal impacts of first-grade
universal interventions (10 years later)
ƒ Effects for school and externalizing outcomes
but not internalizing outcomes
ƒ Effects of CC interventions stronger and longer
lasting than FSP effects
ƒ CC = Teachers received 60 hours training /
supervision
ƒ FSP = Parents received nine 90-minute sessions;
children well-behaved
ƒ Impact seems to be greatest for youth at
moderate risk
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Future Directions for
Understanding Distal Impact
ƒ Moderator analyses – for whom, to what
degree, for how long and in what contexts are
interventions most effective
ƒ Mediational analyses to examine hypothesized
mechanisms
ƒ Use of growth modeling methods to examine
change in trajectories over time
ƒ Growth mixture methods to examine differential
intervention effects for different trajectories
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Future Directions for
Prevention Trials
ƒ Combinations of CC and FSP
interventions may lead to additive if not
synergistic effects
ƒ Integration of selected and indicated
interventions within universals
ƒ Visit http://www.bpp.jhu.edu for slides
and more information regarding new
PIRC trials
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