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Book Title: Treating and Preventing Adolescent Mental Health Disorders
> pp. [515]-[519]
UNDEFINED: AUTHORS
Treating and Preventing Adolescent Mental Health Disorders
Print ISBN 9780195173642, 2005
pp. [515]-[519]
rive at overall conclusions about youth development programs. Before identifying “best practice,” we need to know that there is “good practice,” otherwise such selectivity runs the risk of capitalizing on chance findings or inadvertently highlighting unusual programs. Of the many thousands of youth development programs in the United States, a reviewer seems able to find at most several hundred evaluation efforts, of which a few dozen typically satisfy the methodological criteria set forth. Often the reviews conclude by identifying a small number of model programs (as judged by rigorous evaluations) that are then described in detail. Table 26.1 lists some of the frequently cited model programs and their design features. (More detailed descriptions of most of these programs as well as many others are available at http://www.casel.org/about sel/SELintro.php
by following the link to programs/curricula). These programs are not the only ones that work, but the evidence for their effectivess is especially solid because it usually involved evaluation with random assignment, multiple outcome measures, and long-term follow-up. Table 26.2 summarizes some of the more recent reviews of empirical studies of the effectiveness of youth development programs in reducing problems and/or promoting well-being. As can be seen, the outcome measures ranged from the positive to the negative, although individual reviews tended to focus on only a few classes of outcomes. Every review offered its own conclusions about what works, but we rely here on syntheses provided by Eccles and Gootman ( 2002), Nation et al. ( 2003), and Park and Peterson ( 2004). The bottom line is that youth development programs can promote the positive and reduce the negative. Each of the reviews was able to point to empirical evidence that at least some programs achieved one or more of their stated goals, as shown by demonstrable effects on the outcomes of interest. However, caution is introduced by the following disclaimers: (1) lack of random assignment in many program evaluations; (2) inconsistent measures across studies, especially of positive outcomes; and (3) in most cases, lack of long-term follow-up data (i.e., years after the program is done). A common thread of programs that work is
supportive relationships (between youth participants and group leaders, teachers, parents, and so on) and, not surprisingly, fidelity of implementation. One-shot programs do not work well, although it is unclear just how long a program needs to be before it begins to work. Structured programs are more effective, a feature that can be achieved by manualizing the program, or spelling out in detail just what one does to make the program a reality. Everyone concludes, although these may be articles of faith more than evidence-based facts, that programs need to take account of the multiple links among socializing agents and that community norms supporting the goals of a program must be in place (cf. Schinke & Matthieu, 2003). The reader will note that most of the reviews have been of programs and not of more general institutions that might promote well-being among youth. The Johnson et al. ( 2003) review is an exception—the socializing system of religion has been consistently associated with desired outcomes, although this is a purely correlational conclusion and leaves unanswered the hypothetical question of what coerced participation in religious activities would produce. (History tells us that this would be a disaster if done on a large scale, but we also wonder about the effects of parents forcing unwilling offspring to attend church.) The Child Trends ( 2003) research briefs are another exception, because they survey the effects of not only specific programs but also more general institutions and socializing systems. And what about communities? Epidemiological research tells us that problems are more likely to occur in some communities than others, but the studies are not fine-grained and in any event we know that problems co-occur. Not enough is known about the community set-tings that help youth thrive in all the ways that we have described, although extensive re-search with subjective well-being shows that demographic variables (a proxy for certain community-level variables given ethnic, socioeconomic, and educational stratification in the United States) are but weakly associated with life satisfaction. Recent studies of character strengths in adults similarly show few consistent demographic correlates except gender and,
end p.515
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Table 26.1
Model Youth Development ProgramsBig Brothers and Big Sisters (Tierney & Grossman, 2000) |
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Ongoing community-based mentoring program (3–5 contact hours per week) that matches low-income children and adolescents, many from single-parent homes, with adult volunteers with the expectation that a caring and supportive relationship will develop
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Evaluated with random-assignment design, long-term follow-up
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Outcome measures included academic achievement, parental trust, violence, alcohol and drug use, and truancy.
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| Caring School Community (Solomon, Battistich, Watson, Schaps, & Lewis, 2000) |
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Twenty-five-session school-based program that targets drug use and violence through community-building exercises
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Evaluated with quasiexperimental design using multiple comparison groups, long-term follow-up
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Outcome measures included social acceptance, alcohol and drug use, loneliness, social anxiety, and antisocial behavior (carrying weapons, vehicle theft).
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| Penn Resiliency Program (Gillham & Reivich, 2004) |
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Twelve-session school-based program for preventing depression among children and adolescents by teaching cognitive-behavioral skills, especially those involved in optimistic thinking
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Evaluated with random-assignment design, long-term follow-up
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Outcome measures included depression and anxiety (symptoms and diagnoses), physical health, violence, and optimism.
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| Promoting Alternative Thinking Strategies (Greenberg & Kusche, 1998) |
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Thirty-to 45-session school-based program that promotes emotional and social competence through structured exercises emphasizing self-control and social problem-solving
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Evaluated with random-assignment design, long-term follow-up
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Outcome measures included social problem-solving, emotional understanding, conduct problems, adaptive behavior, social planning, and impulsivity.
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| Quantum Opportunities Program (Hahn, Leavitt, & Aaron, 1994) |
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Year-round multiyear community-based program (750 contact hours per year) for very poor adolescents that provides educational, community service, and development activities and financial incentives for participation
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Evaluated with random-assignment design, long-term follow-up
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Outcome measures included high school graduation, college attendance, positive attitudes, volunteer work, and criminal activity.
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| Queensland Early Intervention and Prevention of Anxiety Project (Spence, 1996) |
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Ten-session school-based program for preventing anxiety disorders among children by teaching cognitive-behavior skills, especially how to cope with anxiety by graduated exposure
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Evaluated with random-assignment design, long-term follow-up
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Outcome measures included anxiety (symptoms and diagnoses).
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| Skills, Opportunities, and Recognition (Hawkins, Catalano, Kosterman, Abbott, & Hill, 1999) |
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Multiyear school-based program infused into the entire curriculum that targets positive development and academic competence by reducing risk factors and increasing connections to school and family through cooperative classroom learning
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Evaluated with random-assignment design, long-term follow-up
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Outcome measures included academic achievement, attachment to school, violence, alcohol use, and sexual intercourse.
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| Teen Outreach Program (Allen, Philiber, Herrling, & Kuperminc, 1997) |
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Nine-month school-based weekly discussion curriculum for adolescents that focuses on life skills, parent–child communication, future planning, and volunteer service (20 hours per week)
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Evaluated with random-assignment design, long-term follow-up
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Outcome measures included initiation of intercourse and contraceptive use.
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end p.516
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Table 26.2
Reviews of Empirical Studies of Youth Development ProgramsHattie, Neill, & Richards (1997)
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Reviewed 96 evaluations of adventure programs (e.g., Outward Bound) and excluded 9 as being of poor scientific quality. Also excluded school-based programs as insufficiently challenging. Included only programs that had comparison groups, adequate measures, and detailed methodological descriptions
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Outcome measures included self-control, self-confidence, decision making, school achievement, leadership, assertiveness, emotional stability, time management, and flexibility.
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Kirby (1997)
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Reviewed 50 pregnancy prevention programs, each of which included at least 100 teenagers, had comparison groups
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Outcome measures included sexual behavior, contraceptive behavior, and pregnancy and birth rates.
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Durlak & Wells (1997)
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Reviewed 177 primary prevention programs for “normal” youth under the age of 19; included only programs with comparison groups, about 60% with random assignment, most based in school settings
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Outcome measures included psychological problems such as anxiety, conduct disorder, and depression, and personal competencies (assertiveness, communication, self-confidence).
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Durlak & Wells (1998)
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Reviewed 130 secondary prevention programs for “at-risk” youth under the age of 19; included only programs with comparison groups, about 70% with random assignment, most based in school settings
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Outcome measures included psychological problems such as anxiety, conduct disorder, and depression, and personal competencies (assertiveness, communication, self-confidence).
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Elliot & Tolan (1998)
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Reviewed 10 violence prevention programs (chosen from 450) with comparison groups and random assignment, “significant” results, replication, results sustained for at least 1 year.
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Outcome measures included delinquency, drug use, and violent behavior.
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Roth, Brooks-Gunn, Murray, & Foster (1998)
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Reviewed 60 community-based prevention and intervention programs for youth and selected 15 for their final review; included only studies with comparison groups
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Outcome measures included positive behaviors and competencies, problem behaviors, and resistance skills.
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Greenberg, Domitrovich, & Bumbarger (1999)
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Started with 130 prevention programs that were either universal (targeting all youth), selective (targeting at risk youth), or indicated (targeting youth showing early signs of disorders but not meeting diagnostic criteria) and reviewed 34 in detail that included a comparison group, pre-and post-test measures, and a written manual specifying theory and procedures
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Outcome measures included symptoms of externalizing and/or internalizing disorders.
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Catalano, Berglund, Ryan, Lonczak, & Hawkins (1999)
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Reviewed 77 promotion programs for youth, and 25 in detail; included only programs with comparison groups and at least one significant result
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Outcome measures included bonding, resilience, competence, self-determination, spirituality, self-efficacy, opportunities for positive involvement, recognition for positive involvement, identity, belief in the future, and prosocial norms.
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Tobler et al. (2000)
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Reviewed 207 school-based drug use prevention programs targeted at youth in general; included only programs with comparison groups; about two-thirds used random assignment of participants
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Outcome measures included self-reported drug use.
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Wilson, Gottfredson, & Najaka (2001)
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Reviewed 165 school-based programs for youth attempting to reduce problem behaviors; included only studies with comparison groups
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Outcome measures included crime, substance abuse, truancy, school dropout, and other conduct problems.
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Center for the Study and Prevention of Violence (2003)
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Elaborated the Elliot and Tolan (1998) review to include 33 programs
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Outcome measures included delinquency, drug use, and violent behavior.
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CASEL (2003)
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Reviewed 242 school-based programs whose descriptions were rated by experts as satisfying the principles of how to impart social and emotional intelligence and in particular the 80 programs that were multiyear
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Outcome measures included social and emotional competence.
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Roth & Brooks-Gunn (2003)
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Drawing on earlier reviews to identify programs, evaluated 48 studies of programs that targeted one or more of these positive youth outcomes. Notable was the attempt to categorize programs according to program goals, program atmosphere, and program activities, and relate these features to effectiveness.
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Outcome measures included competence, confidence, connections, character, and caring.
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Johnson, Tierney, & Siegel (2003)
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Reviewed “hundreds” of studies of religiousness and participation (e.g., frequency of religious attendance, frequency of prayer, and/or degree of religious salience) and their correlates; none of these studies was experimental, but the results were overwhelmingly supportive of the hypothesis that religious participation is associated with reduced negative outcomes and increased positive outcomes.
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Outcome measures included problem behavior (suicide, promiscuous sexuality, drug and alcohol use, delinquency) and prosocial behavior.
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Child Trends (2003)
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Reviewed 1,100 studies of youth development, summarizing them in research briefs identifying “what works”
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Outcome measures included teenage pregnancy, healthy lifestyle, social skills, educational achievement, positive mental and emotional health, and civic engagement.
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Berkowitz & Bier (2004)
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Reviewed 72 different school-based character education programs; included only studies with character-relevant outcomes, comparison groups, and pre–post (change) data.
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Outcome measures included academic motivation and aspirations, academic achievement, prosocial behavior, bonding to school, democratic values, conflict resolution skills, moral reasoning maturity, responsibility, respect, self-efficacy, self-control, self-esteem, social skills, and trust in and respect for teachers.
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Nelson, Westhues, & Macleod (2004)
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Reviewed 34 programs for at-risk preschoolers in terms of positive and negative outcomes classified as cognitive or socioemotional. Included studies with comparison groups and long-term follow-up.
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Outcome measures included cognitive, socioemotional, and parent/family outcomes.
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Stice & Shaw (2004)
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Reviewed 51 programs for preventing eating disorders among adolescents; included only studies with comparison groups
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Outcome measures included body dissatisfaction, dieting, negative affect, and bulimic symptoms.
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end p.517
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end p.518
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among African-Americans, religiosity, a finding reported by many previous researchers (Peterson & Seligman, 2004).
CONCLUSIONS AND FUTURE DIRECTIONS
In this final section, we take stock of the youth development field from the positive perspective. We start with what we know, and we conclude with our recommendations for ways in which positive youth development research and application might counter mental disorders in youth at risk.
There is agreement at least within the contemporary United States about the positive characteristics of youth. Labels will vary, but the features proposed by different groups overlap substantially. These are best regarded as a family of characteristics, each of which exists in degrees. Children and adolescents are not simply doing well or doing poorly, and accordingly, we need to take a broad and nuanced view of the goals of positive youth development. There is agreement that indicators and indices of positive youth development must do more than ascertain the absence of disorder and distress. Much further work needs to be done to craft generally useful measures of positive constructs and to see that these are routinely used in evaluations of youth programs (Moore et al., 2004). There is, of course, agreement that positive
characteristics are valuable in their own right but, more importantly for the purpose of this volume, that positive characteristics can buffer against the development of the most common psychological disorders among youth (Pollard et al., 1999). Furthermore, we can encourage optimal development through youth programs, either those that already exist (e.g., Big Brothers and Big Sisters) or those explicitly designed by psychologists, prevention scientists, and youth development practitioners for this purpose (e.g., the Penn Resiliency Program). There is also agreement that the personal characteristics of group leaders are critical for the success of their programs, as is parental support. From the existing program evaluation research, investigators have agreed that programs are apt to be most successful—increasing positive outcomes and reducing negative outcomes—if they have the following features:
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More is better. Weekend workshops are not effective interventions; however, programs in which youth spend many hours over extended periods of time are effective in reducing negative outcomes and encouraging positive outcomes.
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Earlier is better. In general, the most effective programs do not wait for their participants to enter adolescence but instead start with younger children (cf. Zigler & Berman, 1983). However, among preschoolers, the optimal age remains unclear (Nelson, Westhues, & MacLeod, 2004). For eating disorders, prevention programs work better for older adolescents (Stice & Shaw, 2004).
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Appropriate timing is better. When do inter
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end p.519
doi:10.1093/9780195173642.003.0027
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