Successful Prevention Programs for Children and Adolescents Issues in Clinical Child Psychology Series Editors: Michael C. Roberts, University of Kansas-Lawrence, Kansas Lizette Peterson, University of Missouri-Columbia, Missouri BEHAVIORAL ASPECTS OF PEDIATRIC BURNS Edited by Kenneth J. Tarnowski CHILDREN AND DISASTERS Edited by Conway F. Saylor CONSULTING WITH PEDIATRICIANS: Psychological Perspectives Dennis Drotar HANDBOOK OF ADOLESCENT HEALTH RISK BEHAVIOR Edited by Ralph J. DiClemente, William B. Hansen, and Lynn E. Ponton HANDBOOK OF CHILD BEHAVIOR THERAPY Edited by T. Steuart Watson and Frank M. Gresham HANDBOOK OF CHILDREN'S COPING: Linking Theory and Intervention Edited by Sharlene A. Wolchik and Irwin N. Sandler HANDBOOK OF DEPRESSION IN CHILDREN AND ADOLESCENTS Edited by William M. Reynolds and Hugh F. Johnston INTERNATIONAL HANDBOOK OF PHOBIC AND ANXIETY DISORDERS IN CHILDREN AND ADOLESCENTS Edited by Thomas H. Ollendick, Neville J. King, and William Yule MENTAL HEALTH INTERVENTIONS WITH PRESCHOOL CHILDREN Robert D. Lyman and Toni L. Hembree-Kigin SCHOOL CONSULTATION: Conceptual and Empirical Bases of Practice William P. Erchul and Brian K. Martens SUCCESSFUL PREVENTION PROGRAMS FOR CHILDREN AND ADOLESCENTS Joseph A. Durlak A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. Successful Prevention Programs for Children and Adolescents Joseph A. Durlak Loyola University Chicago Chicago, Illinois Springer Science+Business Media, LLC Library of Congress Catalog1ng-1n-PublIcatlon Data Durlak, Joseph A. Successful prevention programs for children and adolescents / Joseph A. Durlak. p. cm. — (Issues 1n clinical child psychology) Includes bibliographical references and Index. ISBN 978-1-4899-0067-8 1. Child psychopathology—Prevention. 2. Adolescent psychopathology—Prevention. I. Title. II. Series. RJ499.D86 1997 618.92'8905—dc21 97-18250 CIP ISBN 978-1-4899-0067-8 ISBN 978-1-4899-0065-4 (eBook) DOI 10.1007/978-1-4899-0065-4 © Springer Science+Business Media New York 1997 Originally published by Plenum Press, New York in 1997 Softcover reprint of the hardcover 1st edition 1997 http://www.plenum.com 10 987654321 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Preface "An ounce of prevention is worth a pound of cure." "A stitch in time saves nine." When it comes to child and adolescent problems, are these phrases meaningless cliches? Is it really worthwhile to spend valuable time and effort attempting prevention when so many of our young people experience adjustment problems and urgently need attention? Are prevention programs effective? What type of problems can be pre vented? Are there common elements or strategies that emerge among effective interventions? These are the questions addressed in this book. Prevention is a multidisciplinary constellation of approaches di rected at the prevention of disease and other types of negative outcomes and the promotion of health or other positive outcomes. Prevention works; that is, many well-done programs have significantly improved young people's subsequent adjustment, reduced future problems, or achieved both of these outcomes. Several programs have had dramatic effects. For instance, studies described in the following pages indicate that it is possible to reduce the future rate of clinical depression by 56%, serious acting-out behaviors by 50%, school vandalism by 79%, grade retentions by 33%, teenage pregnancies by 40%, and low-birth-weight infants by 42%. It is also possible to increase high school graduation rates by 24%, the proportion of children with positive mental health by 50%, and to double, triple, or quadruple the frequency of young peo ple's healthy practices. In some cases, prevention has literally saved lives by reducing alcohol-related traffic fatalities by 26%, deaths due to falls by 35%, and fatal poisonings in young children by 75%. Readers are likely to be pleasantly surprised, perhaps shocked, to learn of the success of so many prevention programs. For many years, rhetoric abounded regarding the value of prevention, but there were few solid scientific demonstrations of prevention effectiveness. In other v vi PREFACE words, people talked a lot about prevention, but did not practice it. That was then and this is now. There has been an explosion of research in prevention within the past 20 years, and there are now over 1200 pub lished prevention outcome studies. Thoughtfulness, patience, and systematic effort are required to mount effective prevention programs, and not every intervention has been successful. Therefore, it is important to highlight empirically vali dated programs. Such information is particularly important from a pol icy perspective because there are many current programs identified as prevention programs whose impact is unknown. These programs may not be very effective and can produce a false impression of what preven tion is and what it can accomplish. Furthermore, it is irresponsible to waste valuable and limited resources such as time, money, and person nel on programs of questionable impact when there are better alterna tives. Therefore, I discuss exemplary programs throughout this book. I have selected representative programs in different areas that have been carefully conceptualized, conducted, and evaluated. I emphasize pro grams that are theory driven; that is, programs that rest on a theoretical and conceptual base, or, at the very least, are guided by previous empiri cal findings and attempt to test specific a priori hypotheses. When examining program design, I looked for studies that addressed matters of internal and external validity. Internal validity affects the confidence of any conclusions about a program's impact. External validity involves the degree to which results can be generalized, and so I highlight inter ventions that have been replicated one or more times, especially if independent investigators evaluated similar programs conducted across different populations and settings. In terms of program evaluations, I looked for studies that used psychometrically adequate outcome measures and multiple measures, collected some follow-up data, and assessed changes in behavior or adjustment status. Prevention attempts to do something now to prevent later difficulties, so it is important to monitor program effects over time. Although several early preventive interventions attempted to change children's knowledge or attitudes, we now know that the critically important outcomes involve behavioral change. Have children's behav iors improved following intervention? Is academic performance en hanced? Does their health status change? Do they take fewer risks that would lessen the likelihood of negative consequences associated with driving, drinking, or having sex? I emphasize these types of outcomes when discussing the results of different programs. Space limitation prohibits discussing every well-done investiga- PREFACE vii tion. Nevertheless, the programs that are described represent good working models for the design, implementation, and evaluation of pre ventive interventions. In general, I use a weight of evidence approach to reach conclusions in each specific area and for the field of prevention in general. In summary, this text presents a panoramic snapshot of current findings in prevention with an emphasis on the very best programs. Hopefully, this book will encourage more students and profes sionals to become involved in prevention. Positive results from empiri cal studies will not automatically lead to more prevention, however. If prevention is as successful as current outcome data suggest, then it is appalling that most current efforts in medicine, mental health, educa tion, and the social services are still directed at treating individuals with established problems instead of trying to prevent such outcomes in the first place. The full potential of prevention will not be realized until we understand and overcome the political, personal, and administrative barriers that impede prevention practices. I have written this book for a wide audience that includes preven tionists, service providers, and students from multiple disciplines. Cov ering multiple fields should be instructive. Those already active in prevention should be pleased to learn that many of the strategies used in their domain are also being applied successfully in other areas. This convergence across diverse areas increases confidence that prevention rests on sound scientific principles. Others wishing to learn what pre vention is and how it is accomplished will encounter plenty of useful information. Prevention is a multidisciplinary science, and work in many different areas is discussed: mental and physical health, aca demics, child abuse, injuries, AIDS, pregnancy, and so on. As a result, this text is relevant to those in medicine and nursing, psychology, education, social work, social and child welfare, and family and policy studies. I want to acknowledge several people who have influenced my work. Many undergraduate and graduate students over the years have assisted me in my research on prevention and community psychology. I want to express my appreciation to this group for their interest, enthu siasm, and support. I undertook the task of writing this book cautiously. First, I wrote a monograph for Alan Kazdin's Developmental and Clini cal Psychology and Psychiatry series on school-based prevention pro grams (Durlak, 1995). His positive editorial reaction suggested that I had produced something of value and so I developed some confidence in my ability to undertake a larger project. Then Lizette Peterson and Mike Roberts, the co-editors of the Issues in Clinical Child Psychology series for Plenum, paid me the ultimate compliment of asking me to write this viii PREFACE book. Both Mike and Lizette were extremely helpful and supportive throughout the project. They showered me with reprints and materials to get me started on areas in which they, not I, were the experts, such as injury prevention and pediatric psychology. They were also quick to review chapter and manuscript drafts and they kept praising my work. All authors should have such kind and helpful editors. When I first met Mariclaire Cloutier at Plenum, I knew I was in good hands. She has waited patiently for this book and has marshalled it along during the publication process. Finally, my wife, Chris, has been a constant source of support and an invaluable editorial assistant. JOSEPH A. DURLAK Contents 1. Basic Concepts in Prevention ........................... 1 What Is Prevention? ........... ............................. 1 New Terminology for Prevention .......................... 1 Different Approaches to Prevention ......................... 2 Selecting Target Populations .............................. 2 Level of Intervention ..................................... 3 Indicated Prevention ....................................... 6 Multiple Goals of Prevention ............................... 6 Critical Questions in Prevention ............................ 7 Important Themes in Prevention ............................ 8 Multiple Causality ....................................... 9 Risk and Protective Factors ............................... 10 Health Promotion ........................................ 12 Developmental Pathways ................................. 13 Systematic Skills Training ................................ 17 Brief History of Prevention ................................. 17 Early History ............................................ 17 History of Prevention in Mental Health .................... 18 Current History of Prevention ............................. 20 Current Research and Practice on Prevention. . . . . . . . .. . . . . . 21 Plan of the Book ........................................... 24 Summary................................................. 24 2. Prevention of Behavioral and Social Problems ........... 27 Introduction ................ " .................. , . . .. . . . . . . 27 Primary Prevention Programs ............................... 28 Person-Centered Programs ............. ....... ............ 30 ix