A. Dirk Hightower

School-based prevention for children at risk : the primary mental health project

The Primary Mental Health Project Roots and Wellsprings How PMHP Operates: An X-Ray PMHPs Early Evolution Setting up and Conducting a PMHP PMHP Mini-Programmes: Extending and Refining the Basic Offerings Evaluating the Effectiveness of PMHP Disseminating the PHMP Programme Model The Social Problem-Solving Programme The Children of Divorce Intervention Programme The Study Buddy Programme The Rochester Child Resilience Programme Conclusion: Where From, Where to? Playground Equipment, Materials and Supplies Child Associate Information and PMHP Assessment Instruments.

Preventive intervention with latency-aged children of divorce: A replication study

This replication study assessed the efficacy of a school-based preventive intervention for latency-aged children of divorce. The Children of Divorce Intervention Program (CODIP) emphasizes support, identifying and expressing divorce-related feelings, training situationally relevant communication, problem solving, and anger control skills, and enhancing self-esteem. Fifty-four children of divorce participated in the 11-session program conducted in small groups. Their adjustment was contrasted at pre and post with that of demographically matched peers (N = 78) from intact families on teacher, parent, self-report, and group leader measures. Children of divorce were less well adjusted than their peers before the intervention. They improved significantly after the intervention, approaching youngsters from intact families in adjustment status. The replication data support CODIPs efficacy as a preventive alternative for children of divorce. Needed future development and research steps are considered.

Behavior Problems Among Inner-City Children With Asthma: Findings From a Community-Based Sample

OBJECTIVE. Previous studies have suggested a relationship between childhood asthma and behavior problems. However, few studies have used community-based samples to assess the prevalence of behavior problems among urban children with asthma symptoms. The objective of this study was to evaluate the relationship between asthma symptoms and behavior among a population-based sample of inner-city children and to determine the prevalence of behavioral comorbidity among children with asthma symptoms. METHODS. In 2003, parents of children who were entering kindergarten in the city of Rochester completed a detailed survey regarding the childs background, medical history (with specific questions about asthma symptoms), and behavior. We compared children with no asthma symptoms, intermittent symptoms, and persistent symptoms with regard to positive peer social skills (eg, makes friends easily), negative peer social skills (eg, fights with other children), task orientation (eg, concentrates well), and shy/anxious behavior (eg, is withdrawn) (validated scales; range: 1–4). We used multivariate regression to determine the independent association between symptom severity and behavioral outcomes. RESULTS. A total of 1619 children were included (response rate: 80%; mean age: 5.1 year), and 15% had asthma symptoms (8% persistent, 7% intermittent). Average negative peer scores were worse for children with persistent asthma symptoms compared with children with intermittent and no symptoms (mean scores: 1.88, 1.70, and 1.65). Children with persistent symptoms also scored worse than children with no symptoms on the assessment of task orientation (2.85 vs 3.03) and shy/anxious behavior (2.11 vs 1.89). Among children with persistent asthma symptoms, >20% scored >1 SD below average on 2 or more scales, compared with 16% of children with intermittent symptoms and 10% with no symptoms. CONCLUSIONS. Urban children with persistent asthma symptoms demonstrate more behavior problems across several domains compared with children with no symptoms. These findings suggest a clear need for an early biopsychosocial approach to care for vulnerable children with asthma.

School Readiness Among Urban Children With Asthma

BACKGROUND Children with chronic illnesses, including asthma, are at risk for school problems. Developmental problems, however, may begin before school entry, and the developmental status of preschool children with asthma has not been evaluated. OBJECTIVE To test the hypothesis that urban preschool children with asthma have lower parent-reported developmental scores compared with children without asthma. METHODS A comprehensive survey of children beginning kindergarten in 1998 in the urban school system in Rochester, NY, collected parent reports of demographic, medical, and developmental data. We compared children with asthma with and without limitation of activity to children without asthma for motor, language, socioemotional, and school readiness skills and the need for extra help with learning. Linear and logistic regression were used to determine associations between asthma and developmental outcomes. RESULTS Among the 1058 children in this sample, 9% had asthma, including 5% with asthma with limitation of activity. After adjustment for multiple potential confounding variables, the children with asthma with limitation had lower scores on school readiness skills compared with children without asthma (2.0 vs 2.5, P <.001). Further, the parents of children with asthma with limitation were substantially more likely (P <.05) to describe them as needing extra help with learning (74% vs 56%; odds ratio, 3.2; 95% confidence interval, 1.5--7.8). CONCLUSIONS Urban preschool children with significant asthma had poorer parent-reported school readiness skills and a greater need for extra help with learning compared with children without asthma. This finding suggests that developmental problems for children with asthma may begin before school entry.

Relations among family discord, caregiver communication, and children's family representations.

This study examined associations among family discord, caregiver communication quality about emotionally stressful family events, and child internal representations of family security in 50 preschool children and their primary caregivers. Consistent with risk and protective models, findings indicate that childrens representations were predicted by the interaction between family discord and caregiver communication quality. Children exhibiting the highest level of secure representations of the family experienced a consistency between low levels of family discord and communications emphasizing family security. Conversely, incongruency between family experiences and communication, reflected in high levels of family discord and communications underscoring family security, was associated with the lowest level of child secure representations. Results suggest that child representations hinge on the fit between caregiver communication quality and family experience.

The primary mental health project: Thirty years after

Summary This article summarizes the 30‐year history of the Primary Mental Health Project (PMHP), a school‐based program for early detection and prevention of young childrens school adjustment problems. The article first describes PMHPs rationale and basic practices, gives examples of how the project has grown and evolved over the years, and summarizes some of its important research findings. The report also reviews several more recent PMHP emphases including its systematic work in program dissemination and its active efforts to develop effective primary prevention program modules. PMHPs approach offers a bona fide alternative to mental healths established, after the fact, restorative ways.

Barriers to primary prevention efforts in the schools: Are we the biggest obstacle to the transfer of knowledge?

Abstract Dialogue and debate regarding the definition of prevention has subsided and has been replaced by research and information regarding pathways to dysfunction and effective primary prevention strategies. In spite of the solid research base and the strong desire of practitioners to apply prevention strategies, there continues to be sporadic implementation in schools. Barriers to the implementation of primary prevention programs include traditional professional practice within psychology, lack of communicating pertinent information between professions and policymakers, commitment of resources, and limited understanding of the pathways to successful and widespread implementation. Recommendations to address these barriers are discussed.

School-Located Influenza Vaccinations: A Randomized Trial

OBJECTIVE: Assess impact of offering school-located influenza vaccination (SLIV) clinics using both Web-based and paper consent upon overall influenza vaccination rates among elementary school children. METHODS: We conducted a cluster-randomized trial (stratified by suburban/urban districts) in upstate New York in 2014–2015. We randomized 44 elementary schools, selected similar pairs of schools within districts, and allocated schools to SLIV versus usual care (control). Parents of children at SLIV schools were sent information and vaccination consent forms via e-mail, backpack fliers, or both (depending on school preferences) regarding school vaccine clinics. Health department nurses conducted vaccine clinics and billed insurers. For all children registered at SLIV/control schools, we compared receipt of influenza vaccination anywhere (primary outcome). RESULTS: The 44 schools served 19 776 eligible children in 2014–2015. Children in SLIV schools had higher influenza vaccination rates than children in control schools county-wide (54.1% vs 47.4%, P < .001) and in suburban (61.9% vs 53.6%, P < .001) and urban schools (43.9% vs 39.2%; P < .001). Multivariate analyses (controlling for age, grade, vaccination in previous season) confirmed bivariate findings. Among parents who consented for SLIV, nearly half of those notified by backpack fliers and four-fifths of those notified by e-mail consented online. In suburban districts, SLIV did not substitute for primary care influenza vaccination. In urban schools, some substitution occurred. CONCLUSIONS: SLIV raised seasonal influenza vaccination rates county-wide and in both suburban and urban settings. SLIV did not substitute for primary care vaccinations in suburban settings where pediatricians often preorder influenza vaccine but did substitute somewhat in urban settings.

Examining the Factorial Structure of the T-CRS 2.1

The factor structure of the Teacher–Child Rating Scale (T-CRS 2.1) was examined using confirmatory factor analysis (CFA). A cross-sectional study was carried out on 68,497 children in prekindergarten through Grade 10. Item reduction was carried out based on modification indices, standardized residual covariance, and standardized factor loadings. A higher order model with a general super-ordinate factor fit the data well, and is consistent with the notion of a unidimensional non-cognitive set of learning-related skills. Model-based reliability estimates are provided.