Edward G. Feil

First Step to Success An Early Intervention Approach for Preventing School Antisocial Behavior

This article reports results of a 4-year study designed to develop and initially evaluate a combined home and school intervention approach to preventing school antisocial behavior. The First Step to Success program targets at-risk kindergartners who show the early signs of an antisocial pattern of behavior (e.g., aggression, oppositional-defiant behavior, severe tantrumming, victimization of others). First Step to Success consists of three interconnected modules: (a) proactive, universal screening of all kindergartners; (b) school intervention involving the teacher, peers, and the target child; and (c) parent/caregiver training and involvement to support the childs school adjustment. The major goal of the program is to divert at-risk kindergartners from an antisocial path in their subsequent school careers. Two cohorts of at-risk kindergartners, consisting of 24 and 22 students, were identified and exposed to the First Step to Success program during the 1993–1994 and 1994–1995 school years, respectively. A randomized, experimental, wait-list control-group design was used to evaluate intervention effects. Cohort 1 and 2 subjects were followed up through Grades 2 and 1, respectively, with differing teachers and peer groups. Results indicated a measurable intervention effect for both cohorts and persistence of gains into the primary grades.

Feasibility and use of an Internet support service for diabetes self-management.

Diabetes self-management is a challenging task due to its complexity and ever-present barriers to self-care. A key issue for patients, providers, and healthcare systems is how to deliver personalized behavioral support in ways that are affordable and can reach most patients. The Internet offers several advantages in this regard because it is available 24 hours a day, low cost, and capable of reaching thousands of patients. Although Internet sites for diabetes support are popular, they have not been evaluated. For this study, a Web site for diabetes self-management that emphasized personalized goal setting, feedback, and social support was developed. Over a 10-week period, 111 different persons logged onto D-NET for a total of 21 046 accesses. Users included persons across a broad age range (up to age 77 years) and duration of diabetes. The most popular areas of the site were the Social Support Conference and the Diabetes Information Pages. User ratings revealed high satisfaction with the service. The Internet has great potential for providing needed support and services for patients with diabetes and other chronic illnesses.

Evaluation of an Internet-based smoking cessation program: Lessons learned from a pilot study

The potential contribution of the Internet to smoking cessation seems huge, given that a majority of Americans now have both computers and telephones. Despite the proliferation of Web sites offering smoking cessation support, there is little empirical evidence regarding the efficacy of Internet-delivered cessation programs. We developed a cessation Web site and conducted a short-term evaluation of it, examining recruitment approaches, Web site use patterns, alternative retention incentives and re-contact modes, satisfaction, and cessation rate. The intervention included modules on social support and cognitive-behavioral coping skills configured to take advantage of the interactive and multimedia capabilities of the Internet. Cessation and satisfaction data were obtained from a subsample of 370 subjects followed for 3 months. The program was rated as easy to use, and the social support group component was used most frequently. The cessation rate (abstinence for the previous 7 days) at 3 months was 18%, with nonrespondents (n~161) considered smokers. Among a variety of traditional and Internet-based recruitment strategies, the most successful made use of Internet user groups and search engines. Methodological and procedural issues posed in conducting research on the Internet are discussed.

First Step to Success: Intervening at the point of school entry to prevent antisocial behavior patterns

This article provides a description of the First Step to Success early intervention program for preventing development of antisocial behavior patterns among young, at-risk children. A brief review of the risk factors and family conditions associated with antisocial behavior patterns is provided as a context and rationale for early intervention approaches designed to divert at-risk children from this path. First Step to Success was developed as a response to the increasing numbers of at-risk children who begin school with the early signs of antisocial behavior due to the risk factors to which they have been exposed. This intervention program is coordinated and delivered by a school professional who can serve teachers and parents in a consultant capacity (e.g., school psychologist, early interventionist, school counselor, behavioral specialist, and so forth). The program has three modular components: proactive, universal screening, school intervention, and parent training. These components are applied in concert with each other to teach the at-risk target child an adaptive pattern of school-related behavior. A description of these components, and guidelines for implementing them, are presented as well. ©1998 John Wiley & Sons, Inc.

A Randomized Controlled Trial of the First Step to Success Early Intervention: Demonstration of Program Efficacy Outcomes in a Diverse, Urban School District.

This article reports on a randomized controlled trial of the First Step to Success early intervention that was conducted over a 4-year period in Albuquerque Public Schools. First Step is a selected intervention for students in Grades 1 through 3 with externalizing behavior problems, and it addresses secondary prevention goals and objectives. It consists of three modular components (screening, school intervention, parent training); lasts approximately 3 months; and is initially set up, delivered, and coordinated by a behavioral coach (e.g., school counselor, behavior specialist, social worker). Project Year 1 of this efficacy trial was devoted to gearing-up activities (e.g., hiring, training, planning, logistical arrangements); Years 2 and 3 each involved implementing First Step with approximately 100 behaviorally at-risk students. Students, teachers, and classrooms were randomly assigned to either intervention or usual care comparison conditions. Year 4 activities focused on conducting long-term, follow-up assessments and implementing sustainability procedures to preserve achieved gains. Pre-post teacher and parent ratings of student behavior and social skills showed moderately robust effect sizes, ranging from .54 to .87, that favored the intervention group. Direct measures of academic performance (oral reading fluency, letter—word identification) were not sensitive to the intervention. The implications and limitations of the study are discussed.

Technologies for expanding the reach of evidence-based interventions: Preliminary results for promoting social-emotional development in early childhood

In great demand are efficient mechanisms for delivery of evidence-based interventions for promoting social-emotional development and early positive behavior of all children, and especially for those with or at risk for disabilities. The rise of Internet use has created potentially new avenues for intervention delivery, which, when paired with the many recent advances in computer networking and multimedia technology, is fueling this demand. This article describes the development of an Internet-based, computer-delivered parent-training intervention, Infant Net, with infants at risk for poor social-emotional outcomes. Results of a randomized control trial of the Infant Net intervention with 40 parent-infant dyads showed significant increase, reflecting a medium to large effect size, in infant social engagement and engagement with the environment for infants in the intervention group as compared to the control group. Implications are discussed with regard to future research.

Computer‐Based Intervention with Coaching: An Example Using the Incredible Years Program

Increases in personal computer ownership and Internet use patterns provide a potential avenue for dissemination of evidence‐based prevention and treatment interventions. The authors describe the implementation of a psychoeducational intervention (the Incredible Years parenting program, which is designed to promote behavioral change in parents and children) using a hybrid model combining computer‐ and web‐based delivery with professional intervention via phone calls, electronic messages, and home visits. The model attempted to simulate many of the parent training methods shown to be successful in the original program. The intervention was implemented with 90 Head Start families who reported elevated levels of child behavior problems. Of the 45 families offered the intervention in the final year of the project, 37 (82%) completed at least half the program and 34 (76%) completed the entire intervention using procedures refined in light of the initial years experience. These participants reported high achievement of their self‐determined goals and were highly satisfied with the intervention. The combination of technology with professional coaching represents a potential model for adapting and disseminating evidence‐based interventions.

Expanding the Reach of Preventive Interventions Development of an Internet-Based Training for Parents of Infants

There are major obstacles to the effective delivery of mental health services to poor families, particularly for those families in rural areas. The rise of Internet use, however, has created potentially new avenues for service delivery, which, when paired with the many recent advances in computer networking and multimedia technology, is fueling a demand for Internet delivery of mental health services. The authors report on the adaptation of a parenting program for delivery via the Internet, enhanced with participant-created videos of parent-infant interactions and weekly staff contact, which enable distal treatment providers to give feedback and make decisions informed by direct behavioral assessment. This Internet-based, parent-education intervention has the potential to promote healthy and protective parent-infant interactions in families who might not otherwise receive needed mental health services.

Screening for Emotional and Behavioral Delays: The Early Screening Project

Over 2500 preschool children from across the United States were screened for emotional and behavioral problems using the 3 stage, multiple-gating procedures of The Early Screening Project (ESP). Preschool teachers were asked to nominate, rank, and rate children in their classroom on both externalizing and internalizing behavioral dimensions. The behaviors were then independently confirmed through direct observations in natural preschool environments. Gender disparities also were addressed. Significant differences were found between children who did and did not exceed the ESPs normative referral criteria. The ESP can minimize both the time and cost of preschool assessments while providing accurate screening for emotional and behavior problems with less gender bias. Additionally, the ESP can promote early prevention interventions for all young children.

Using Different Measures, Informants, and Clinical Cut-Off Points to Estimate Prevalence of Emotional or Behavioral Disorders in Preschoolers: Effects on Age, Gender, and Ethnicity

The early identification and remediation of emotional or behavior disorders are high priorities for early-childhood researchers and are based on the assumption that problems such as school failure can be averted with early screening, prevention, and intervention. Presently, prevalence, severity, and topography of mental health needs among low-income preschoolers and their families have not been well documented. Tools for screening and intervention for behavior problems in preschool children are few and many of those tools have not been studied within diverse Head Start systems. In this study, five instruments of symptoms and functional impairment, completed by teachers and two completed by parents, were obtained on a sample of 1,781 Head Start children from diverse racial and ethnic backgrounds from the Head Start Mental Health Research Consortium. Clinical cut-off scores were used to identify children who could be considered at relatively serious risk for emotional or behavioral disorders. At-risk classifications using clinical cut-offs at both 1.0 and 1.5 standard deviations for each measure were examined singly and in combination and then compared to the overall sample for age, gender, and ethnicity. Identification of children considered at risk ranged from a low of 1% to a high of 38%, with evidence of differential effects on age, gender, or ethnicity for some individual measures, but these tended to diminish when combinations of symptom and impairment measures were used. Implications for choosing instruments to establish eligibility for emotional or behavioral disorders in preschoolers are discussed.