An Evaluation of an Integrated Approach to Prevention and Early Intervention

 描述(由申请人提供)：小学期间的攻击性/破坏性行为是青春期和青春期反社会行为、药物滥用以及低教育和低职业素养的强烈指标。良好行为游戏(GBG)和促进另类思维策略(PATH)代表了几种普遍的小学预防性干预措施中的两种，这些干预措施已经在大规模的随机对照试验中被证明对攻击性/破坏性行为有直接和有益的影响。路径寻求通过教师主导的教学来减少此类行为，旨在促进情绪调节和解决社会问题，而GBG为教师提供了一种有效的手段，在类似游戏的环境中使用社交学习原则来减少攻击性/破坏性行为。然而，重要的是，在我们的第一代和第二代约翰·霍普金斯大学预防性干预研究中心(JHU PIRC)的现场试验中，GBG对攻击性/破坏性行为的影响被证明是温和的。路径也是如此。我们最近完成了一项27所学校的随机对照试验，检验这些干预措施的组合，即我们所说的PAX路径，是否会比单独使用GBG对攻击性/破坏性行为产生显著更大的影响。我们期待更大影响的理由是，GBG的使用应该会减少攻击性/破坏性行为，这应该会促进在PATH中教授的情绪调节和社交问题解决技能的获得。在1年后的测试中，通往PAX的路径确实比单独使用GBG在攻击性/破坏性行为方面的减少要略大一些。然而，最具攻击性/颠覆性的学生仍未能从通往PAX干预的TE途径中充分受益。因此，在本申请中，我们建议研究增加不可思议的年数(IY)，这是一种旨在减少攻击性/破坏性行为的循证预防和治疗干预措施，是否会比仅通过PAX干预的途径对这些行为产生更大的影响。我们还建议研究到PAX IY的路径的组合是否导致到PAX干预的路径的实施频率增加。我们假设，与单独使用PAX路径的教师相比，PAX路径IY条件下的教师会认为PAX路径更有效，因此更有可能实施。将招募四个队列，每组12所学校，学校随机分配到3种干预条件中的一种：1)对照；2)仅通往PAX的路径；或3)通往PAX IY的路径。对学生成绩的评估将在最初学年的秋季和春季的前测试和后测试中进行，并在6个月和一年的跟踪中进行。

 DESCRIPTION (provided by applicant): Aggressive/disruptive behavior in the elementary school years is a strong indicator of antisocial behavior, drug abuse and low educational and occupational attainment in adolescence and young adulthood. The Good Behavior Game (GBG) and Promoting Alternative Thinking Strategies (PATHS) represent two of a handful of universal, elementary school, preventive interventions which have been shown in large scale, randomized controlled trials to have an immediate and beneficial impact on aggressive/disruptive behavior. PATHS seeks to accomplish reductions in such behavior via teacher led instruction aimed at facilitating emotion regulation and social problem-solving, whereas the GBG provides teachers with an efficient means of reducing aggressive/disruptive behavior using social learning principles within a game-like context. Importantly, however, the effects of the GBG on aggressive/disruptive behavior proved modest in our 1st and 2nd generation Johns Hopkins University Preventive Intervention Research Center (JHU PIRC) field trials. This has been the case for PATHS as well. We recently completed a 27-school, randomized controlled trial examining whether the combination of these interventions, which we refer to as PATHS to PAX, would yield significantly greater impact on aggressive/disruptive behavior than the GBG alone. Our rationale for expecting greater impact was that the use of the GBG should result in reductions in aggressive/disruptive behavior, which should then facilitate the acquisition of the emotion regulation and social problem-solving skills taught in PATHS. PATHS to PAX did result in a modestly greater reduction in aggressive/disruptive behavior than the GBG alone at 1-year post-test. Yet, the most aggressive/disruptive students still failed to sufficiently benefit from te PATHS to PAX intervention. Accordingly, in this application, we propose to examine whether the addition of the Incredible Years (IY), an evidence-based preventive and treatment intervention aimed at reducing aggressive/disruptive behavior, would yield greater impact on these behaviors than the PATHS to PAX intervention alone. We also propose to examine whether the combination of the PATHS to PAX + IY results in increased frequency of implementation of the PATHS to PAX intervention. We hypothesize that relative to teachers in the PATHS to PAX alone condition, teachers in the PATHS to PAX+IY condition will perceive PATHS to PAX as more efficacious and will therefore be more likely to implement it. Four cohorts of 12 schools each will be recruited with schools randomly assigned to 1 of 3 intervention conditions: 1) Control; 2) PATHS to PAX Alone; or 3) PATHS to PAX+IY. Assessments of student outcomes will be carried out at pre-test and post-test in the fall and spring of the initial school year foreach cohort and at a 6-month and one year follow-up.