Principal Investigator: Hill Walker
Level of Intervention: Selected
Target Population: At-risk Kindergarten children with early signs of antisocial behavior patterns
References: Walker, Kavanagh, Stiller, Golly, Severson, & Feil (1998); Walker, Stiller, Severson, Feil, & Golly (1998).
Theory (Risk & Protective Factors Targeted):
This intervention is based on the early-starter model of the development of antisocial behavior. Early signs of conduct problems can be detected as early as preschool. Many children bring a pattern of antisocial behavior with them from home when they enter school. This early pattern can be indicative of the beginning of a very stable pattern of maladaptive behavior that predicts more severe problems (e.g. peer rejection, school dropout, delinquency) in middle childhood and adolescence that are then less amenable to treatment.
Description of Intervention:
The program goal is to divert antisocial kindergartners to more adaptive patterns of behavior and to develop the necessary competencies for social-behavioral adjustment. The total program takes approximately 3 months. Intervention consists of three modules: 1) universal screening procedure, 2) school intervention, 3) home intervention. Each consultant managed the school and home components for a caseload of 2-3 subjects.
This module is an adapted version of the CLASS program for Acting-Out Children (Hops & Walker, 1988). The program is not a curriculum but is designed to work in conjunction with existing academic program. The goal is to teach the target child more adaptive behavior that fosters academic and social success. Behavioral criterions are set daily and the child is given feedback on their behavior. The child is rewarded if he/she earns 80% of the available points. The program usually requires two months (30 program days) to implement because performance criterion must be met each day before the program proceeds. The consultant begins by implementing the program in the classroom (Consultant phase) but eventually turns the program over to the teacher and provides supervision and support (Teacher phase). During the Maintenance phase the teacher, consultant, and parent maintain the childs improved behavior primarily through praise.
HomeBase is a 6-week skill building program based on research conducted at Oregon Social Learning Center (OSLC). Program consultants who visit the parents home once a week for 45-60 minutes conduct the home intervention. Parents are expected to monitor the childs school behaviors, provide privileges as reinforcement for school success, and help build child competencies in 1) Communication & Sharing, 2) Cooperation, 3) Limit Setting, 4) Problem-Solving, 5) Friendship Making, & 6) Developing Confidence. The consultant provides the parent with a handbook and activities to use after each skill is introduced.
The program consultant is considered a key part of the interventions, investing 50-60 hours in implementation over a 3-month period. Their duties are to consult with teachers to implement the universal screening and identify potential targets, to encourage parental participation and conduct the homeBase module, and overall program coordination and implementation.
Subjects were screened with the Early Screening Project (Walker, Severson, & Feil, 1995), a downward extension of the Systematic Screening for Behavioral Disorders (SSBD; Walker & Severson, 1990). ESP is the most comprehensive screen but the program provides a choice of four options. ESP utilizes 3 screenings to identify at-risk students. In stage 1 of the multiple-gating procedure, the teachers rank-order 5 children in their class that best fit a standardized description of externalizing problems and 5 that best fit a description of internalizing problems. In stage 2, teachers complete a series of rating scales that included the ESP adaptive scale, ESP maladaptive scales, and the aggression sub-scale of the Child Behavior Checklist-Teacher Report Form (CBCL-TRF, Achenbach, 1991) on the 3 highest ranked students from each list. In the third stage, children were observed in classroom and free play settings to assess their academic engagement (AET). The ESP was nationally normed on a sample of 2,853 children age 3 to 6.
The total sample consisted of 46 Kindergarten students. These subjects were from two cohorts that participated over two years. The sample was 26% female and 7% minority status. Thirty seven percent of the students were considered low-income. Eleven children qualified for special education services (5 LD, 4 speech-language, 2 severely emotional-disturbed).
The program utilized a delayed treatment design. Students observed in ESP screening Stage 3, whose baseline AET levels averaged 65% or lower, and who scored greater than 1 SD above the CBCL Aggression subscales normative mean were randomly assigned to experimental or wait-list control groups.
Findings were similar for Cohorts 1 and 2 (both made substantial average gains) so the samples were combined and compared to wait-list controls. Baseline measures were used as covariates in all analyses.
At the post-intervention point, students who participated in First Steps were rated by teachers as significantly more adaptive (p<.001), less aggressive (p<.001), and less maladaptive (p<.001) compared to control students. Observations made of the students (AET; Rich & Ross, 1989) indicated that the intervention subjects spent more time engaged academically (p<.05) compared to controls. There were no differences between groups on teacher ratings of withdrawn behavior. Similar results were found at followup for Cohort 1 at first and second grade, and for Cohort 2 at first grade.
Strengths & Limitations:
The First Steps program is a multi-component program that targets Kindergarten children who exhibit emerging patterns of antisocial behavior with interventions in the classroom and in the home. Using a randomized clinical trial, the authors demonstrated that children who received the program exhibited significantly less disruptive behavior, more adaptive behavior, and improved in their ability to engage in the learning process. The changes were noted in both teacher reports and observations of the students. One strength of the study was that the teachers who completed the followup assessments in first and second grade were different from the teachers who taught the children in kindergarten. The measures that were used in the evaluation were extensively researched and met high standards for validity and reliability. Two weaknesses of the evaluation were the small size of the sample and the fact that there were very few minority students. It is important to note, however, that the program staff was well trained and the evaluation utilized a number of implementation measures to ensure the fidelity of the program. Although the wait-list design prevented the investigators from assessing maintenance of the changes over an extended period of time, significant treatment effects were maintained one and two years after the intervention ended. The authors replicated the program in a small sample with similar results (Golly, et al., 1998) and independent replications of the program are currently underway.