Irwin N. Sandler

Promoting and Protecting Youth Mental Health through Evidence-Based Prevention and Treatment.

For decades, empirically tested youth interventions have prevented dysfunction by addressing risk and ameliorated dysfunction through treatment. The authors propose linking prevention and treatment within an integrated model. The model suggests a research agenda: Identify effective programs for a broadened array of problems and disorders, examine ethnicity and culture in relation to intervention adoption and impact, clarify conditions under which programs do and do not work, identify change mechanisms that account for effects, test interventions in real-world contexts, and make tested interventions accessible and effective in community and practice settings. Connecting the science and practice of prevention and treatment will be good for science, for practice, and for children, adolescents, and their families.

Locus of control as a stress moderator: The role of control perceptions and social support

The study investigated the effects of locus of control beliefs as an individual difference variable on (a) the relationship between negative life events and psychological disorder, (b) perceptions of control over negative life events, and (c) the receipt and impact of social support. Ninety-three college undergraduates (52 internals, 41 externals) reported the negative events which occurred to them in the past year, their perceived control over these events, the amount of socially supportive transactions they received, and their psychological symptomatology (anxiety and depression). The correlation between negative events and anxiety was greater for externals than for internals. However, locus of control did not effect ratings of control over negative events or the correlations between high and low control negative events and psychological disorder. Locus of control did effect the receipt and impact of social support. Externality was positively related to the quantity of support received (r(90) = .21, p less than .05) but the stress-buffering effect of support was obtained for internals and not externals. Implications of the results from understanding the process by which locus of control moderates the effects of stress are discussed.

The family bereavement program: efficacy evaluation of a theory-based prevention program for parentally bereaved children and adolescents.

This article presents an experimental evaluation of the Family Bereavement Program (FBP), a 2-component group intervention for parentally bereaved children ages 8-16. The program involved separate groups for caregivers, adolescents, and children, which were designed to change potentially modifiable risk and protective factors for bereaved children. The evaluation involved random assignment of 156 families (244 children and adolescents) to the FBP or a self-study condition. Families participated in assessments at pretest, posttest, and 11-month follow-up. Results indicated that the FBP led to improved parenting, coping, and caregiver mental health and to reductions in stressful events at posttest. At follow-up, the FBP led to reduced internalizing and externalizing problems, but only for girls and those who had higher problem scores at baseline.

Toward a multimethod approach to assessing the effects of social support

Two studies were done to assess the direct and stress-buffering effects of social support on psychological symptoms of college students. Three conceptually distinct measures were used to assess different aspects of social support: receipt of supportive transactions, satisfaction with support received, and social support network characteristics. The results indicated a significant direct and stress-buffering effect for support satisfaction in reducing psychological symptomatology. Two measures of support network size were used: number of people who were both a source of supportive and of upsetting interactions (conflicted support network), and number of people who were only mentioned as a source of support (unconflicted support network). Conflicted network size was positively related to symptomatology and increased the relationship between stress and symptomatology. No direct or interaction effects were obtained for unconflicted network size in predicting symptomatology.

Long-Term Impact of Prevention Programs to Promote Effective Parenting: Lasting Effects but Uncertain Processes

This article reviews findings from 46 randomized experimental trials of preventive parenting interventions. The findings of these trials provide evidence of effects to prevent a wide range of problem outcomes and to promote competencies from one to 20 years later. However, there is a paucity of evidence concerning the processes that account for program effects. Three alternative pathways are proposed as a framework for future research on the long-term effects of preventive parenting programs: (a) through program effects on parenting skills, perceptions of parental efficacy, and reduction in barriers to effective parenting; (b) through program-induced reductions in short-term problems of youth that persist over time, improvements in youth adaptation to stress, and improvements in youth belief systems concerning the self and their relationships with others; and (c) through effects on contexts in which youth become involved and on youth-environment transactions.

Putting the Pieces Together: An Integrated Model of Program Implementation

Considerable evidence indicates that variability in implementation of prevention programs is related to the outcomes achieved by these programs. However, while implementation has been conceptualized as a multidimensional construct, few studies examine more than a single dimension, and no theoretical framework exists to guide research on the effects of implementation. We seek to address this need by proposing a theoretical model of the relations between the dimensions of implementation and outcomes of prevention programs that can serve to guide future implementation research. In this article, we focus on four dimensions of implementation, which we conceptualize as behaviors of program facilitators (fidelity, quality of delivery, and adaptation) and behaviors of participants (responsiveness) and present the evidence supporting these as predictors of program outcomes. We then propose a theoretical model by which facilitator and participant dimensions of implementation influence participant outcomes. Finally, we provide recommendations and directions for future implementation research.

On the Limits of Coping: Interaction between Stress and Coping for Inner-City Adolescents.

This study examined the effects of four coping dimensions—active coping, avoidance, distraction, and support—on conduct problems, depression, and achievement in a multiethnic, inner-city sample of early adolescents. The main effects of coping were examined, along with stress X coping interactions. For girls, active coping interacted with family and community stress to predict conduct problems and grades, respectively, and with community stress to predict depression. These interactions revealed a classic stress-buffering effect for active coping. For boys, although active coping interacted with community and peer stress to predict depression and with community and family stress to predict grades, these findings did not support the stress-buffering effect. Although avoidant coping was positively associated with depression and poor grades at low levels of stress, it was associated with more adaptive functioning on these outcomes at higher levels of stress.

An experimental evaluation of theory-based mother and mother–child programs for children of divorce.

This study evaluated the efficacy of 2 theory-based preventive interventions for divorced families: a program for mothers and a dual component mother-child program. The mother program targeted mother-child relationship quality, discipline, interparental conflict, and the father-child relationship. The child program targeted active coping, avoidant coping, appraisals of divorce stressors, and mother-child relationship quality. Families with a 9- to 12-year-old child (N = 240) were randomly assigned to the mother, dual-component, or self-study program. Postintervention comparisons showed significant positive program effects of the mother program versus self-study condition on relationship quality, discipline, attitude toward father-child contact, and adjustment problems. For several outcomes, more positive effects occurred in families with poorer initial functioning. Program effects on externalizing problems were maintained at 6-month follow-up. A few additive effects of the dual-component program occurred for the putative mediators; none occurred for adjustment problems.

Coping Efficacy and Psychological Problems of Children of Divorce

Three models of the relations of coping efficacy, coping, and psychological problems of children of divorce were investigated. A structural equation model using cross-sectional data of 356 nine- to twelve-year-old children of divorce yielded results that supported coping efficacy as a mediator of the relations between both active coping and avoiding coping and psychological problems. In a prospective longitudinal model with a subsample of 162 of these children, support was found for Time 2 coping efficacy as a mediator of the relations between Time 1 active coping and Time 2 internalizing of problems. Individual growth curve models over four waves also found support for coping efficacy as a mediator of the relations between active coping and psychological problems. No support was found for alternative models of coping as a mediator of the relations between efficacy and symptoms or for coping efficacy as a moderator of the relations between coping and symptoms.

The critical role of nurturing environments for promoting human well-being.

The recent Institute of Medicine report on prevention (National Research Council & Institute of Medicine, 2009) noted the substantial interrelationship among mental, emotional, and behavioral disorders and pointed out that, to a great extent, these problems stem from a set of common conditions. However, despite the evidence, current research and practice continue to deal with the prevention of mental, emotional, and behavioral disorders as if they are unrelated and each stems from different conditions. This article proposes a framework that could accelerate progress in preventing these problems. Environments that foster successful development and prevent the development of psychological and behavioral problems are usefully characterized as nurturing environments. First, these environments minimize biologically and psychologically toxic events. Second, they teach, promote, and richly reinforce prosocial behavior, including self-regulatory behaviors and all of the skills needed to become productive adult members of society. Third, they monitor and limit opportunities for problem behavior. Fourth, they foster psychological flexibility-the ability to be mindful of ones thoughts and feelings and to act in the service of ones values even when ones thoughts and feelings discourage taking valued action. We review evidence to support this synthesis and describe the kind of public health movement that could increase the prevalence of nurturing environments and thereby contribute to the prevention of most mental, emotional, and behavioral disorders. This article is one of three in a special section (see also Muñoz Beardslee, & Leykin, 2012; Yoshikawa, Aber, & Beardslee, 2012) representing an elaboration on a theme for prevention science developed by the 2009 report of the National Research Council and Institute of Medicine.