Damon E. Jones

The High Costs of Aggression: Public Expenditures Resulting From Conduct Disorder

OBJECTIVES We explored the economic implications of conduct disorder (CD) among adolescents in 4 poor communities in the United States. We examined a range of expenditures related to this disorder across multiple public sectors, including mental health, general health, school, and juvenile justice. METHODS We used self- and parental-report data to estimate expenditures during a 7-year period in late adolescence of a sample of youths. We contrasted expenditures for youths with CD and youths with oppositional defiant disorder, elevated symptoms (no CD diagnosis), and all others. Diagnosis was determined with a structured assessment. RESULTS Additional public costs per child related to CD exceeded

Fostering High-Quality Teaching With an Enriched Curriculum and Professional Development Support:The Head Start REDI Program

70000 over a 7-year period. CONCLUSIONS Public expenditures on youths with CD are substantially larger than for youths with closely related conditions, reflecting the importance of prevention and early treatment for the disorder.

Effects of family foundations on parents and children: 3.5 years after baseline.

This randomized controlled trial tested whether teaching quality in Head Start classrooms could be improved with the addition of evidence-based curriculum components targeting emergent language or literacy and social-emotional development and the provision of associated professional development support. Participants were lead and assistant teachers in 44 Head Start classrooms. Teachers received 4 days of workshop training along with weekly in-class support from a mentor teacher. End-of-year observations indicated that compared with the control group, intervention teachers talked with children more frequently and in more cognitively complex ways, established a more positive classroom climate, and used more preventive behavior-management strategies. Results supported the conclusion that enriched curriculum components and professional development support can produce improvements in multiple domains of teaching quality.

Issues in the Economic Evaluation of Prevention Programs.

This study investigated the ability of a psychosocial prevention program implemented through childbirth education programs to enhance the coparental and couple relationship, parental mental health, the parent-child relationship, and child outcomes. A sample of 169 heterosexual, adult couples expecting their first child was randomized to intervention and control conditions. The intervention families participated in Family Foundations, a series of eight classes delivered before and after birth, which was designed as a universal prevention program (i.e., applicable to all couples, not just those at high risk). Intent-to-treat analyses utilizing data collected from child age 6 months through 3 years indicated significant program effects on parental stress and self-efficacy, coparenting, harsh parenting, and childrens emotional adjustment among all families, and maternal depression among cohabiting couples. Among families of boys, program effects were found for child behavior problems and couple relationship quality. These results indicate that a universal prevention approach at the transition to parenthood focused on enhancing family relationships can have a significant and substantial positive impact on parent and child well-being.

Effects of the Communities That Care Model in Pennsylvania on Change in Adolescent Risk and Problem Behaviors

Economic analysis plays an increasingly important role in prevention research. In this article, we describe one form of economic analysis, a cost analysis. Such an analysis captures not only the direct costs of an intervention but also its impact on the broader social costs of the illness or problem targeted. The key question is whether the direct costs are offset by reductions in the other, morbidity-related costs, such as the use of expensive services. We begin by describing how economists think about costs. We then outline the steps involved in calculating the costs of delivering an intervention, including both implicit and explicit costs. Next we examine methods for estimating the morbidity-related costs of the illness or problem targeted by the intervention. Finally, we identify the challenges one faces when conducting such an analysis. Throughout the article, we illustrate key points using our experiences with evaluating the Fast Track intervention, a multiyear, multicomponent intervention targeted to children at risk of emotional and behavioral problems.

Early identification of children at risk for costly mental health service use.

Despite the public health burden of adolescent substance use, delinquency, and other problem behavior, few comprehensive models of disseminating evidence-based prevention programs to communities have demonstrated positive youth outcomes at a population level, capacity to maintain program fidelity, and sustainability. We examined whether the Communities That Care (CTC; Hawkins and Catalano 1992) model had a positive impact on risk/protective factors and academic and behavioral outcomes among adolescents in a quasi-experimental effectiveness study. We conducted a longitudinal study of CTC in Pennsylvania utilizing biannual surveillance data collected through anonymous in-school student surveys. We utilized multilevel models to examine CTC impact on change in risk/protective factors, grades, delinquency, and substance use over time. Youth in CTC communities demonstrated less growth in delinquency, but not substance use, than youth in non-CTC communities. Levels of risk factors increased more slowly, and protective factors and academic performance decreased more slowly, among CTC community grade-cohorts that were exposed to evidence-based, universal prevention programs than comparison grade cohorts. Community coalitions can affect adolescent risk and protective behaviors at a population level when evidence-based programs are utilized. CTC represents an effective model for disseminating such programs.

Siblings Are Special: Initial test of a New Approach for Preventing Youth Behavior Problems

Children and adolescents with serious and persistent conduct problems often require large public expenditures. Successfully diverting one high risk child from unfortunate outcomes may result in a net savings to society of nearly

Individual Factors Associated With Professional Development Training Outcomes of the Head Start REDI Program

2 million, not to mention improving the life of that child and his or her family. This figure highlights the potential of prevention, which often rests on the ability to identify these children at a young age. This study examined the ability of a short conduct-problems screening procedure to predict future need for mental health assistance, special education services, and the juvenile justice system during elementary schoolages. The screen was based on teacher and parent report of child behavioralhabits in kindergarten, and was used to identify children as either at risk or not at risk for behavioral problems. Service outcomes were derived from a service-use assessment administered to parents at the end of the sixth grade, while special education information was gathered through a survey of school records. Study participants (463 kindergarten children; 54% male, 44% African American) were from economically disadvantaged neighborhoods in four diverse communities across the United States. Results indicated that, while controlling for demographic background variables, the risk indicator strongly predicted which children would require services related to conduct disorder or behavioral/emotional problems. Additional analyses revealed that the dichotomous high risk indicator was nearly as strong as the continuous screening variable in predicting the service-use outcomes, and that the screening of both parents and teachers may not be necessary for determining risk status.

Service Use Patterns for Adolescents with ADHD and Comorbid Conduct Disorder

PURPOSE A growing body of research documents the significance of siblings and sibling relationships for development, mental health, and behavioral risk across childhood and adolescence. Nonetheless, few well-designed efforts have been undertaken to promote positive and reduce negative youth outcomes by enhancing sibling relationships. METHODS Based on a theoretical model of sibling influences, we conducted a randomized trial of Siblings Are Special (SIBS), a group-format afterschool program for fifth graders with a younger sibling in second through fourth grades, which entailed 12 weekly afterschool sessions and three Family Nights. We tested program efficacy with a pre- and post-test design with 174 families randomly assigned to condition. In home visits at both time points, we collected data via parent questionnaires, child interviews, and observer-rated videotaped interactions and teachers rated childrens behavior at school. RESULTS The program enhanced positive sibling relationships, appropriate strategies for parenting siblings, and child self-control, social competence, and academic performance; program exposure was also associated with reduced maternal depression and child internalizing problems. Results were robust across the sample, not qualified by sibling gender, age, family demographics, or baseline risk. No effects were found for sibling conflict, collusion, or child externalizing problems; we will examine follow-up data to determine if short-term impacts lead to reduced negative behaviors over time. CONCLUSIONS The breadth of the SIBS programs impact is consistent with research suggesting that siblings are an important influence on development and adjustment and supports our argument that a sibling focus should be incorporated into youth and family-oriented prevention programs.

Long-term follow-up of a randomized trial of family foundations: effects on children's emotional, behavioral, and school adjustment.

Research Findings: This study examined factors associated with process and content outcomes of the training provided in the context of Head Start REDI (Research based Developmentally Informed), a preschool curriculum designed to enhance the quality of interactions (social–emotional and language–literacy) between teachers and children. REDI professional development included 4 days of training and weekly coaching. Data for 22 intervention teaching pairs (N = 44) were used in the study. With the exception of years of education and emotional exhaustion, distal teacher factors (i.e., professional characteristics, personal resources, and perceptions of the work environment) were unrelated to implementation fidelity, whereas openness to consultation showed a significant association. Practice or Policy: The findings emphasize the importance of teacher engagement in the training process for program effectiveness.