Melodie Wenz-Gross

Implementing a Primary Prevention Social Skills Intervention in Urban Preschools: Factors Associated with Quality and Fidelity

Research Findings: Preschool behavior problems are of increasing concern to early childhood educators. Preventive interventions are being developed, but implementation in underresourced child care programs is challenging. This study describes the implementation of an adapted Second Step curriculum to increase childrens social skills and decrease behavior problems in preschool classrooms. Teacher training/coaching, organizational supports, and procedures for sustainability are described. Measures included baseline classroom characteristics, lesson completion and fidelity, and teacher satisfaction. Teachers completed 88% of the lessons across 2 years. Follow-up monitoring in Year 3, once all training was terminated, found that 95% of lessons were delivered with higher fidelity than in the first 2 years. Teachers were satisfied with the training, felt that the curriculum improved childrens social skills, and stated that they would continue to use the curriculum. Lesson completion and fidelity were associated with various teacher characteristics, training attendance, classroom characteristics, teacher and child turnover, and the percentage of children with developmental delays in the classroom. Practice or Policy: The results support the implementation strategy and suggest that paying attention to teacher morale, general skill development, and a period of ongoing support for training is important and will lead to sustainable and high implementation rates.

A Pilot Study of a Primary Prevention Curriculum to Address Preschool Behavior Problems

Behavior problems among preschool children are common. They are important targets for intervention because early externalizing problems and self-regulation issues tend to persist without appropriate attention, and can affect later mental health and school achievement outcomes. However, few preschool curricula addressing social and emotional development exist, and evidence for effects are mixed. In this study, the Second Step Pre/Kindergarten Social and Emotional Learning curriculum was adapted and tested in a small cluster randomized pilot study of community preschool classrooms to determine if it could improve outcomes in: (1) individual children’s teacher-rated behavior problems and prosocial skills; (2) classroom climate (classroom interactions and two measures of disruptive behavior); and (3) teacher interaction skills. Year 1 outcomes were modest and were accounted for by baseline differences. In Year 2, classroom climate, measured by independent observers, differed significantly in intervention classrooms, largely because of declines in control classrooms, and there was some evidence for better teacher interaction skills in intervention classrooms. The pattern of effects suggests important impacts on classroom quality worth investigating in a larger study. Both fidelity and implementation rates, as well as positive teacher responses to the curriculum, indicate potential for widespread adoption.

An assessment of satisfaction with ambulatory child psychiatry consultation services to primary care providers by parents of children with emotional and behavioral needs: the Massachusetts Child Psychiatry Access Project University of Massachusetts Parent Satisfaction Study

This study evaluated parents’ experience with University of Massachusetts (UMass) Child Psychiatry Access Project (MCPAP), a consultation service to primary care providers (PCP), aimed at improving access to child psychiatry. Parent satisfaction questionnaire was sent to families referred to UMass MCPAP by their PCP, asking about their concerns leading to the referral, the satisfaction from the service provided, adequacy of the follow up plan, and outcome. Seventy-nine percent of parents agreed or strongly agreed that the services provided were offered in a timely manner. Fifty percent agreed or strongly agreed that their child’s situation improved following their contact with the services. Sixty-nine percent agreed or strongly agreed that the service met their family’s need. The results suggest moderate to high parental satisfaction with MCPAP model, but highlight ongoing challenges in making successful referrals for children’s mental health services in the community, following MCPAP recommendations.

From complexity to reality: Providing useful frameworks for defining systems of care

Because systems of care are not uniform across communities, there is a need to better document the process of system development, define the complexity, and describe the development of the structures, processes, and relationships within communities engaged in system transformation. By doing so, we begin to identify the necessary and sufficient components that, at minimum, move us from usual care within a naturally occurring system to a true system of care. Further, by documenting and measuring the degree to which key components are operating, we may be able to identify the most successful strategies in creating system reform. The theory of change and logic model offer a useful framework for communities to begin the adaptive work necessary to effect true transformation. Using the experience of two system of care communities, this new definition and the utility of a theory of change and logic model framework for defining local system transformation efforts will be discussed. Implications for the field, including the need to further examine the natural progression of systems change and to create quantifiable measures of transformation, will be raised as new challenges for the evolving system of care movement.

Using Prenatal Advocates to Implement a Psychosocial Education Intervention for Posttraumatic Stress Disorder during Pregnancy: Feasibility, Care Engagement, and Predelivery Behavioral Outcomes

BACKGROUND Pregnant women with posttraumatic stress disorder (PTSD) engage in more high-risk behavior and use less prenatal care. Although treating depression in pregnancy is becoming widespread, options for addressing PTSD are few. This study was designed to test the feasibility of implementing a manualized psychosocial PTSD intervention, Seeking Safety, delivered by prenatal advocates. METHODS All women entering prenatal care at two federally qualified health centers were screened for current symptoms of PTSD. One site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women that indicated clinical or subclinical PTSD symptoms. Baseline and pre-delivery interviews were conducted, which collected background characteristics and assessed PTSD severity and coping skills. Medical records were collected to document care visits. Documentation of participation rates, fidelity to the treatment, and qualitative feedback from advocates and participants was collected. RESULTS More than one-half (57.3%) of the intervention women received all Seeking Safety sessions and fidelity ratings of the session showed acceptable quality. Using an intent-to-treat analysis, intervention women participated in significantly more prenatal care visits (M = 11.7 versus 8.9; p < .001), and had a significantly higher rate of achieving adequate prenatal care (72.4% vs. 42.9%; p < .001). Although not significant when accounting for baseline differences, intervention women also reduced negative coping skills but not PTSD symptoms. CONCLUSIONS Using prenatal care advocates to deliver Seeking Safety sessions to women screening positive for PTSD symptoms at entry to prenatal care is a promising intervention that seems to increase prenatal care participation and may reduce negative coping strategies.

Discrepancies in parent and teacher ratings of low-income preschooler's social skills

ABSTRACT Parent–teacher rating discrepancies in rating of childrens social skills were examined in a low-income, ethnically diverse preschool sample, using the Social Skills Improvement System-Rating Scales [Gresham, F. M., & Elliott, S. N. (2008). Social Skills Improvement System – Rating Scales. Minneapolis, MN: Pearson Assessments]. Participants included 663 preschool children (326 male, 336 female, M = 3.51 years, SD = 0.50) rated in the Fall of their preschool year. Children were drawn from 68 classrooms in 13 preschool sites. The results indicated that mean parent ratings were significantly greater than mean teacher ratings for the Social Skills Scale. The mean parent–teacher ratings were not significantly different for the Problem Behaviours Scale. Follow-up analyses indicated that parent–teacher ratings differed across six of the seven Social Skills sub-scales. These differences were significantly associated with family income. Implications for parents, teachers, and educational policy are explored.

Pathways to Kindergarten Readiness: The Roles of Second Step Early Learning Curriculum and Social Emotional, Executive Functioning, Preschool Academic and Task Behavior Skills

Efforts to improve the achievement gap between low-income children and their more affluent peers has led to the development of classroom interventions and curricula to increase executive functioning (EF) and social-emotional skills (SE), thought to be foundational for learning. The Second Step Early Learning (SSEL) curriculum is a commercially available curriculum designed to improve school readiness by building EF and SE skills. However, although widely used, it has not been widely studied. Modeling SSEL’s underlying theory of change, structural equation modeling (SEM) was used to longitudinally examine the effects of the curriculum on low-income preschool children’s kindergarten school readiness through the hypothesized mediating role of EF and SE skills in improving pre-academic skills and task behavior in preschool. In a cluster randomized trial, 972 children attending 63 preschool classrooms within 13 low-income Head Start or community preschools were individually tested at the beginning (T1) and end of preschool (T2, n = 836) and followed into kindergarten. Children’s average age at T1 was 53 months, with 51% male, 42% Anglo-American, 26% African–American, and 40% Hispanic-American. Children’s EF, social skills, pre-literacy/language, and pre-math skills were assessed by trained child assessors blind to study conditions at T1 and T2. Assessors also rated children’s task behavior in the testing situation at T1 and T2. School records of children’s kindergarten screening scores were obtained on 345 children at T3. It was expected that SSEL would have both direct and indirect effects on kindergarten readiness through improvements in children’s SE and EF skills preschool academic skills and on-task behavior. We found no direct effects of SSEL on either pre-academic or on-task behavior outcomes in preschool, nor on later kindergarten readiness. However, SSEL significantly increased EF, and as expected by SSEL’s theory of change, growth in EF predicted gains in both pre-academics (particularly pre-math), and on-task behavior in preschool. End-of-year pre-academic skills and on task behavior in turn predicted better kindergarten readiness. Further, SE (although not impacted by SSEL) had direct and indirect effects on kindergarten readiness. Thus, overall, our findings largely support SSEL’s theory of change, particularly in relation to EF.

Postpartum outcomes of a pilot prenatal care-based psychosocial intervention for PTSD during pregnancy

This study examines postpartum posttraumatic stress disorder (PTSD) symptoms and secondary outcomes including postpartum depression and birth outcomes for pregnant women who screened positive for PTSD and received a psychosocial education intervention compared to women with PTSD in the usual prenatal care setting. All women entering prenatal care at two federally qualified health centers were screened for symptoms of current PTSD; one site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women with clinical or subclinical PTSD. Women were not blind to condition. Baseline and postpartum interviews, including demographic characteristics and assessment of mental health, social support, and coping skills, were conducted. Medical record data was collected to document preterm delivery and low birth weight. Of the 149 participants at baseline, 128 (86%) participated in the postpartum interview. Intervention women, compared to controls, significantly decreased PTSD symptoms, and showed a non-significant trend for improved social support. However, depression, coping, and birth outcomes did not differ. This study suggests some initial support for the Seeking Safety intervention in prenatal care settings and requires further research to determine the best approaches to its implementation.