# EVIDENCE-BASED PREVENTION PRACTICES

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**BEHAVIORAL HEALTH SERVICES DIVISION**

**PREVENTION SERVICES BUREAU**

**DEPARTMENT OF HEALTH**

**STATE OF NEW MEXICO**

**November 2003**

EVIDENCE-BASED PREVENTION PRACTICES

**CONTENTS**

#### Part I Evidence-based Prevention Principles and Research Findings 1

A.  **Prevention Principles 1**

B.  **Institute of Medicine Framework 3**

C.  **Scientific Development of Prevention Programs 4**

D.  **Current Knowledge on Risk and Protective Factors 7**

#### Part II Prevention Research Findings for 

#### Parents/Families of Children Ages 0-6 18

#### Part III Evidence-Based Substance Abuse Prevention Programs

####  Parents/Families of Children Ages 0-6 38

*The programs and strategies described are examples of
scientifically-defensible prevention efforts and research based
conclusions. There may be other proven practices, and there will be more
programs, findings, and principles determined to be
scientifically-defensible with additional research. Furthermore,
inclusion of a strategy, program, finding or principle does not imply
endorsement by the State of New Mexico nor the Center for Substance
Abuse Prevention.*

Materials compiled and prepared by the Behavioral Health Services
Division, Department of Health, State of New Mexico, and Michael Coop,
Coop Consulting. Sources include the following:

-   Preventing Drug Use Among Children and Adolescents: A Research-Based
    Guide by the National Institute for Drug Abuse, 2003.

-   Schinke, S, Brounstein, P and Gardner, S. *Science-Based Prevention
    Programs and Principles, 2002*. DHHS Pub. No. (SMA) 03-3764.
    Rockville, MD: Center for Substance Abuse Prevention, Substance
    Abuse and Mental Health Services Administration, 2002. For source
    citations consult the original publication, available at
    http://modelprograms.samhsa.gov/template.cfm?page=pubs_2002report.

For comments or questions, contact Don Maestas, Chief, Prevention
Services Bureau, Behavioral Health Services Division, Department of
Health, State of New Mexico, 505-827-2601.

**Part I**

##### EVIDENCE-BASED PREVENTION PRINCIPLES 

**AND RESEARCH FINDINGS**

**A. Prevention Principles for Children and Adolescents**

> Excerpted from *Preventing Drug Use Among Children and Adolescents: A
> Research-Based Guide* by the National Institute for Drug Abuse, 2003)

In more than 20 years of drug abuse research, the National Institute on
Drug Abuse (NIDA) has identified important principles for prevention
programs in the family, school, and community. NIDA-supported
researchers have tested these principles in long-term drug abuse
prevention programs and have found them to be effective.

-   Prevention programs should be designed to enhance \"protective
    factors\" and move toward reversing or reducing known \"risk
    factors.\" Protective factors are those associated with reduced
    potential for drug use. Risk factors are those that make the
    potential for drug use more likely:

    -   Protective factors include strong and positive bonds within a
        prosocial family; parental monitoring; clear rules of conduct
        that are consistently enforced within the family; involvement of
        parents in the lives of their children; success in school
        performance; strong bonds with other prosocial institutions,
        such as school and religious organizations; and adoption of
        conventional norms about drug use.

    -   Risk factors include chaotic home environments, particularly in
        which parents abuse substances or suffer from mental illnesses;
        ineffective parenting, especially with children with difficult
        temperaments or conduct disorders; lack of mutual attachments
        and nurturing; inappropriately shy or aggressive behavior in the
        classroom; failure in school performance; poor social coping
        skills; affiliations with deviant peers or peers displaying
        deviant behaviors; and perceptions of approval of drug-using
        behaviors in family, work, school, peer, and community
        environments.

-   Prevention programs may focus on a variety of drugs of abuse, such
    as tobacco, alcohol, inhalants, and marijuana or may focus on a
    single area of drug abuse such as the misuse of prescription drugs.

-   Prevention programs should include general life skills training and
    training in skills to resist drugs when offered, strengthen personal
    attitudes and commitments against drug use, and increase social
    competency (e.g., in communications, peer relationships,
    self-efficacy, and assertiveness).

-   Prevention programs for children and adolescents should include
    developmentally appropriate interactive methods, such as peer
    discussion groups and group problem solving and decision-making,
    rather than didactic teaching techniques alone.

-   Prevention programs should include parents\' or caregivers\'
    components that train them to use appropriate parenting strategies,
    reinforce what the children are learning about drugs and their
    harmful effects, and that open opportunities for family discussions
    about the use of legal and illegal substances and family policies
    about their use.

-   Prevention programs should be long-term (throughout the school
    career), with repeat interventions to reinforce the original
    prevention goals. For example, school-based efforts directed at
    elementary and middle school students should include booster
    sessions to help with the critical transitions such as from middle
    to high school.

-   Family-focused prevention efforts have a greater impact than
    strategies that focus on parents only or children only.

-   Community programs that include media campaigns and policy changes,
    such as new regulations that restrict access to alcohol, tobacco, or
    other drugs, are more effective when school and family interventions
    accompany them.

-   Community programs need to strengthen norms against drug use in all
    drug abuse prevention settings, including the family, the school,
    the workplace and the community.

-   Schools offer opportunities to reach all populations and also serve
    as important settings for specific subpopulations at risk for drug
    abuse, such as children with behavior problems or learning
    disabilities and those who are potential dropouts.

-   Prevention programming should be adapted to address the specific
    nature of the drug abuse problem in the local community.

-   The higher the level of risk of the service population, the more
    intensive the prevention effort must be and the earlier it must
    begin.

-   Prevention programs should be age-specific, developmentally
    appropriate, and culturally sensitive.

-   Effective prevention programs are cost-effective. For every \$1
    spent on drug use prevention, communities can save \$4 to \$5 in
    costs for drug abuse treatment and counseling.\*

The following are critical areas for prevention planners to consider
when designing a program:

-   Family Relationships - Prevention programs can teach skills for
    better family communication, discipline, and firm and consistent
    rulemaking to parents of young children. Research also has shown
    that parents need to take a more active role in their children\'s
    lives, including talking with them about drugs, monitoring their
    activities, getting to know their friends, and understanding their
    problems and personal concerns.

-   Peer Relationships - Prevention programs focus on an individual\'s
    relationship to peers by developing social-competency skills, which
    involve improved communications, enhancement of positive peer
    relationships and social behaviors, and resistance skills to refuse
    drug offers.

-   The School Environment - Prevention programs also focus on enhancing
    academic performance and strengthening students\' bonding to school,
    by giving them a sense of identity and achievement and reducing the
    likelihood of their dropping out of school. Most curriculums include
    the support for positive peer relationships (described above) and a
    normative education component designed to correct the misperception
    that most students are using drugs. Research has also found that
    when children understand the negative effects of drugs (physical,
    psychological, and social), and when they perceive their friends\'
    and families\' social disapproval of drug use, they tend to avoid
    initiating drug use.

-   The Community Environment - Prevention programs work at the
    community level with civic, religious, law enforcement, and
    governmental organizations and enhance anti-drug norms and prosocial
    behavior through changes in policy or regulation, mass media
    efforts, and community-wide awareness programs. Community-based
    programs might include new laws and enforcement, advertising
    restrictions, and drug-free school zones - all designed to provide a
    cleaner, safer, drug-free environment.

> *\** Pentz, M.A. \"Costs, benefits, and cost effectiveness of
> comprehensive drug abuse prevention.\" *In W. J. Bukoski, ed. Cost
> Effectiveness and Cost Benefit Research of Drug Abuse Prevention:*
> Implications for Programming and Policy. NIDA Research Monograph. In
> Press.
>
> *For more information on these principles and on programs that
> incorporate them, please order Preventing Drug Use Among Children and
> Adolescents: A Research-Based Guide for the Community. This
> publication is available from the National Clearinghouse for Alcohol
> and Drug Information (NCADI) at 1-800-729-6686.*

##### B. Institute of Medicine Framework

Prevention activities are classified within a framework developed by the
Institute of Medicine (IOM). This IOM model divides prevention into
three categories along a focused audience continuum, that is, the degree
to which any individual person is identified as an individual at risk
for substance abuse. The at-risk determination is based on a combination
of the risk and protective factors associated with alcohol and other
drug problems.

[Universal]{.underline}

Universal prevention interventions are designed to reach the entire
population, without regard to individual risk factors, and they
generally are designed to reach a very large audience. Participants are
not recruited to participate in the program and the degree of individual
substance abuse risk of the program participants is not assessed. The
program is provided to everyone in the population (community, school, or
neighborhood) regardless of whether they are at risk for substance
abuse. General examples of universal preventive interventions include
the use of seat belts, immunizations, prenatal care, and smoking
prevention (IOM 1994).

Examples of universal preventive interventions for substance abuse
include substance abuse education for all children within a school
district, media and public awareness campaigns within inner-city
neighborhoods, and social policy changes, for example reducing
availability by reducing the number of liquor outlets in a municipality.

#### [Selective]{.underline}

Selective prevention interventions focus on subgroups of the general
population that are determined to be at risk for substance abuse.
Recipients of selective prevention interventions are known to have
specific risks for substance abuse and are recruited to participate in
the prevention effort because of that group's profile, but the degree of
individual vulnerability or personal risk of members of the identified
subgroup generally is not assessed. Vulnerability is presumed on the
basis of their membership in the at-risk group. Knowledge of specific
risk factors within the service group allows program designers to
address specific risk reduction objectives. Selective programs generally
run for a longer period of time and require more time and effort from
participants than universal programs.

General examples of selective prevention interventions include home
visitation and infant day care for low birth-weight children and annual
mammograms for women with a family history of breast cancer (IOM 1994).
Examples of selective prevention interventions for substance abuse
include special clubs and groups for children of alcoholics, rites of
passage programs for at-risk males, and skill training programs that
impact young children of substance abusing parents, or families who live
in high crime or impoverished neighborhoods.

[Indicated]{.underline}

Indicated prevention interventions identify individuals who are
experiencing early signs substance abuse and other related problem
behaviors associated with substance abuse and provide them with special
programs. The individuals identified at this stage, though showing signs
of early substance use, have not reached the point where a clinical
diagnosis of substance abuse can be made. Indicated prevention
approaches are used for individuals who may or may not be abusing
substances, but exhibit risk factors \-- such as school failure,
interpersonal social problems, delinquency, and other antisocial
behaviors, and psychological problems such as depression and suicidal
behavior \-- that increase their chances of developing a drug abuse
problem. Indicated prevention approaches require a precise assessment of
an individual's personal risk and level of related problem behaviors,
rather than relying on the person's membership in an at-risk group as in
the selected approach. Programs are frequently extensive and highly
intensive; they typically operate for longer periods of time, at greater
frequency of contact and require greater effort on the part of the
participant than do selective or universal programs. Programs require
highly skilled staff who have clinical training and counseling skills or
other clinical intervention skills.

General examples of indicated prevention in the health field include
training programs for children experiencing early behavioral problems,
medical control of hypertension, and regular examinations of persons
with a history of basal cell skin cancer (IOM 1994). In the field of
substance abuse, an indicated prevention intervention would be a
substance abuse program for high school students who are experiencing a
number of problem behaviors, including truancy, failing academic grades,
juvenile depression, suicidal ideation, and early signs of substance
abuse.

###### C. Scientific Development of Prevention Programs

> Excerpted from: Schinke, S, Brounstein, P and Gardner, S.
> *Science-Based Prevention Programs and Principles, 2002*. DHHS Pub.
> No. (SMA) 03-3764. Rockville, MD: Center for Substance Abuse
> Prevention, Substance Abuse and Mental Health Services Administration,
> 2002. For source citations consult the original publication, available
> at
>
> <http://modelprograms.samhsa.gov/template.cfm?page=pubs_2002report>.

Though variations among program developers exist, the construction of
nearly every prevention program begins with an understanding of factors
that place people at risk for---or protect them from---problem behavior.
This understanding comes from theory and a conceptual framework.

**Conceptual Framework.** Theory and theoretical frameworks in the
substance abuse prevention field have been evolving over time, often
through induction based on applied empirical research. Among the most
important developments in substance abuse prevention theory and
programming in recent years has been a focus on risk and protective
factors as a unifying descriptive and predictive framework.

**Risk Factors.** Risk factors include biological,
psychological/behavioral, and social/ environmental characteristics such
as a family history of substance use, depression or antisocial
personality disorder, or residence in neighborhoods where substance use
is tolerated. Put simply, one often tested and supported hypothesis
derived from this framework is that the more risk factors a child or
youth experiences, the more likely it is that she or he will experience
substance use and related problems in adolescence or young adulthood.
Researchers have also found that the more the risks in a child's life
can be reduced---for example, by effectively treating mental health
disorders, improving parents' family management skills, and stepping up
enforcement of laws regarding sales of illicit drugs to minors and
drinking and driving---the less vulnerable that child will be to
subsequent health and social problems.

**Protective Factors and Resilience.** Protective factors, such as solid
family bonds and the capacity to succeed in school, help safeguard youth
from substance use. Research has also demonstrated that exposure to even
a substantial number of risk factors in a child's life does not mean
that substance abuse or other problem behaviors will inevitably follow.
Many children and youth growing up in presumably high-risk families and
environments emerge relatively problem-free. The reason, according to
many researchers, is the presence of protective factors that reduce the
likelihood that a substance abuse disorder will develop. Research on
protective factors explores the positive characteristics and
circumstances in a person's life and seeks opportunities to strengthen
and sustain them as a preventive device. Among these resilient children,
protective factors appear to balance and buffer the negative impact of
risk factors. From a substance abuse prevention perspective, protective
factors function as mediating variables that can be identified to
prevent, postpone, or reduce the impact of use. Concepts of risk and
resilience enhance understanding of how and why youth initiate or
refrain from substance use. Although not all risk and protective factors
are susceptible to change--- genetic susceptibility to substance use,
for example--- research demonstrates that their influence can often be
assuaged or enhanced.

**Domains.** Risk and protective factors exist at every level at which
an individual interacts with others and the society around him or her.
Clearly, the individual brings a set of qualities or characteristics to
each interaction, and these factors act as a filter, coloring the nature
and tone of these interactions---whether positive or negative. One
useful way to look at this interplay is to organize interactions by the
six life or activity domains in which they chiefly occur. On the basis
of more than 30 years of study, researchers have delineated specific
subcategories of risk within each domain. They include:

> **Individual** biological and psychological dispositions, attitudes,
> values, knowledge, skills, problem behaviors

**Peer** norms, activities, bonding

**Family** function, management, bonding

**School** bonding, climate, policy, performance

**Community** bonding, norms, resources, awareness/mobilization

**Society/** norms, policy/sanctions

**Environment**

Research also has revealed that domains are not static in their impact
but interact with each other and change over time. As an individual
develops, his or her perceptions and interactions with family, peers,
schools, work, and community alter. CSAP depicts this more intricate set
of relationships through its Web of Influence model (Figure 1).

The Web of Influence model illustrates the complex series of
interactions that occur between the individual and the six external
domains that can result in substance use and other problem behaviors.

[Figure 1: The Web of Influence]{.underline}

> **Individual**

######## Risk and

# Protective

######### Factors

###### D. Current Knowledge on Risk and Protective Factors

> Excerpted from: Schinke, S, Brounstein, P and Gardner, S.
> *Science-Based Prevention Programs and Principles, 2002*. DHHS Pub.
> No. (SMA) 03-3764. Rockville, MD: Center for Substance Abuse
> Prevention, Substance Abuse and Mental Health Services Administration,
> 2002. For source citations consult the original publication, available
> at
> <http://modelprograms.samhsa.gov/template.cfm?page=pubs_2002report>.
>
> **Note: Source citations, which are referenced by endnote numbers, are
> provided at the end of this section.**

Research findings guide prevention science by identifying risk and
protective factors that respectively increase and decrease the
likelihood of substance use and abuse. Those research findings are
neither fixed nor immutable, but rather change as research studies
report new findings. To keep up with this dynamic process, each
*Science-Based Prevention Programs and Principles* report, including
this one, presents the results of recent research on risk and protective
factors. In the following sections, *italicized findings* are those
reported in the past year. New findings on risk and protective factors
emerge continuously. Because of the evolving knowledge base, new
findings do not always support prior knowledge and may even run contrary
to conventional wisdom. What is more, results of a single study, which
is the modal instance in the following review, may not represent a trend
or offer definitive evidence; such results may be unique to the
circumstances and population of the particular research.

**Individual**

Inappropriate expression of anger increases the chances of forming
deviant peer associations and of developing deviant norms around
substance use and other risks.^36^ Conduct disorders, anxiety, and
aggression may be precursors of later drug use.^37,38,39,40^ Arrests for
assault correlate with youthful substance abuse.^41^

*Posttraumatic stress disorder appears to predate substance abuse
problems, according to a large and growing literature on the topic*.^50^

Aggressive and disruptive classroom behavior predicts substance abuse,
particularly among boys.^52^

*Religiosity, already shown to protect youth against substance use
problems, also appears to protect against substance use among children
of opiate addicts, who are at high risk for substance use*. ^53^

Youth who have conventional values are less likely to abuse
substances,^56^ as are youth who value academic achievement more than
independence.^57^

Youth who possess a variety of social competencies, or life skills,
resist substance abuse;^58^ decision-making skills, personal efficacy,
and beliefs about the social benefits of smoking are important in
preventing cigarette smoking.^59^

*Youth with low social competence may turn to smoking and drinking
because they perceive important social benefits from doing so*.^60^

**Family**

Poor parenting practices exacerbate antisocial behavior in childhood and
adolescence and can predict adolescent substance abuse.^67,68,69^
Children's substance use also is predicted by nonexistent or
inconsistent parental discipline,^70,71^ whereas disciplinary techniques
that include clear limit-setting and consistent rewards for positive
behavior are associated with reduced substance use.^72,73^

*Children exposed to parental substance use are at high risk for
becoming substance abusers.*^74^

*Maternal illicit drug use is positively associated with children's
behavior problems, whereas maternal alcohol use has a less consistent
impact.*^75^ *More than parents, older siblings appear to influence
younger siblings toward substance use and abuse.*^76^

Fetal alcohol syndrome (FAS) results in lifetime debilitation and
affects 5,000 infants born each year in this country. Estimated cost of
related disabilities is about \$2 million per child. FAS, caused by
maternal alcohol use during pregnancy, is entirely preventable.^77^

Low parent-child bonding is associated with substance use risk.^78^
Bonding is of particular consequence for migrant families,^79^ as is
perceived parent-child communication in these families.^80,81^
Prevention programs that acknowledge and address differential family
acculturation have produced positive effects.^82^

Personal problems of drug-dependent mothers may influence their
children's problems indirectly by increasing family problems.^83^

Positive family dynamics are associated with positive bonding among
family members,^84^ and close and mutually reinforcing parent-child
relationships are linked with less substance abuse.^85^

*Women who are substance users are more likely to be victims of domestic
violence than those who are not*.^88^

Strong parent-child attachment leads to children's internalization of
traditional norms and behavior that, in turn, leads to less substance
use.^89^

Age,^90^ increased family size,^91^ parental smoking, sibling smoking,
and living with a single parent are associated with regular active
smoking in adolescents.^92^ Parental substance abuse disorders also
predict substance abuse in adolescent children.^93^

Parental monitoring and supervision of children's activities and
relationships protect against substance abuse.^94,95,96^

Besides such risk factors for substance use as age, mental health
status, and use of psychoactive medications, youth also report an
unstimulating family atmosphere, living situations that do not include
their mother and father, and negative perceptions of health.^97^

*Skills training for parents of substance-abusing adolescents can
increase parental coping skills and improve family functioning, family
communication, and youth's abstention from marijuana use*.^98^

**School**

Poor school performance, absenteeism, prior dropout status, and
referrals from school personnel of youth at risk for dropout predict
future truancy, dropout, and drug use. ^99,100,101,102,103,104^ In
contrast, outstanding school performance can reduce the likelihood of
frequent drug use;^105^ engagement in school activities and sports, less
frequency of being drunk, and better family role models reduce the
likelihood of future substance use.^106^

School bonding protects against substance abuse and other problem
behaviors.^107^

Negative, disorderly, and unsafe school climates can contribute to
problematic developmental outcomes among students.^108^

*School conflict, as well as family and personal factors, can contribute
to adolescent substance abuse*.^109^

Teacher and student perceptions of firm and clear rule enforcement are
linked with reduced school disorder, an outcome associated with
substance nonuse. ^110^

A severe lag between chronological age and school grade places youth at
risk for substance abuse.^111^ Youth in alternative high schools face
elevated risks of substance use.^112^ Compared to public school
students, those in private schools report higher rates of alcohol use,
drunk driving, binge drinking, smoking, marijuana use, and drug-impaired
sexual activity.^113^

Though many school-based prevention programs employ a social-influences
approach based on cognitive-behavioral theory, new data call the
efficacy of this approach into question ^115,116^

*Prevention programs can be effective with multiple populations and in
diverse settings.* ^117^

**Community**

Ready access to tobacco, alcohol, and illicit drugs increases the
likelihood that youth will

use substances.^147,148,149,150^

*Immigrant youth in the United States have relatively low rates of
alcohol and marijuana use, though these youth report high levels of
pressure from immigrant and nonimmigrant peers toward such use and
experience less parental support to avoid risk behaviors*.^151^

*Youth in rural areas are more likely than urban youth to have
parent-reported substance use problems*. ^153^

Communities lacking economic and social resources are vulnerable to high
rates of adolescent substance abuse.^156,157,158,159,160^

Community awareness and media efforts can improve perceptions of the
likelihood of apprehension and can reduce noncompliance.^162^

Counter-advertising on their hazards reduces sales of
cigarettes^163.164^ and their consumption; ^165,166,167^ conspicuous
labeling influences awareness and behavior. ^168,169,170^

**Environmental**

The ability to purchase alcohol is related to consumption and problem
behavior,^172,173,174,175,176,177,178^ whereas minority ethnic
status^179^ is related to increased ability to purchase cigarettes.

*Policy analysis indicates that the most effective ways to reduce
adolescent drinking are tax or price increases, increased minimum age
for drinking, graduated licensing, and/or zero tolerance
policies*.^180,181,182,183,184,185,186,187,188,189^

The likelihood of smoking is increased among adolescents who are willing
to use a cigarette promotional item; smoking initiation decreases when
such items are lost or youth become unwilling to use them.^190^

Cigarette brand-specific magazine advertising influences brand market
share, brand of initiation among new smokers, brand smoked by current
smokers, and attention to the brand advertised.^191^ Declines in
cigarette promotions and advertising and increases in antismoking
message awareness have been reported by some students.^192^

Neighborhood anti-drug strategies (e.g., citizen surveillance,
nuisance-abatement programs) can dislocate dealers and reduce the number
and density of retail drug markets while also lowering other
crimes.^193,194,195,196,197,198^

*Correlational evidence links increased substance use with certain types
of television viewing among youth. These data suggest that parents
should limit the quantity and selection of television their children
watch, particularly programming that glorifies various substance
use*.^199^

Raising the minimum purchase age for alcohol decreases use among
youth,^200,201^ particularly beer consumption,^202^ and lowers
alcohol-related traffic accidents.^203,204^

*Because active enforcement of youth access laws using unannounced
compliance checks has been shown to reduce the rate of illegal tobacco
sales to minors and may reduce youth smoking, efforts to increase the
level of enforcement should be promoted*.^205^

**Endnotes/Citations**

36\. Oetting, E. R., & Lynch, R. S. (in press). Peers and the prevention
of adolescent alcohol use. In W. J. Bukoski & Z. Sloboda (Eds.),
*Handbook for drug abuse prevention, theory, science, and practice.*
Westport, CT: Greenwood Publishing Group.

37\. Hinshaw, S. P., Lahey, B. B., & Hart, E. L. (1993). Issues of
taxonomy and comorbidity in the development of conduct disorder.
*Development and Psychopathology, 5,* 31--49.

38\. Loeber, R. (1990). Development and risk factors of juvenile
antisocial behavior and delinquency. *Clinical Psychological Review,
10,* 1--42.

39\. Farrington, D. P. (1991). Childhood aggression and adult violence:
Early precursors and later life outcomes. In D. J. Pepler & K. H. Rubin
(Eds.), *The development and treatment of childhood aggression* (pp.
5--29). Hillsdale, NJ: Erlbaum.

40\. Pliszka, S. R., Sheman, J. O., Barrow, M. V., & Irick, S. (2000).
Affective disorder in juvenile offenders: A preliminary study. *The
American Journal of Psychiatry, 157,* 130--133.

41\. Weisz, J., Martin, S., Walter, B., & Fernandez, G. (1991).
Differential prediction of young adult arrests for property and personal
crimes: Findings of a cohort follow-up study of violent boys from North
Carolina's Willie M. program. *Journal of Child Psychology and
Psychiatry, 32,* 783--792.

50\. Jacobsen, L. K., Southwick, S. M., & Kosten, T. R. (2001).
Substance use disorders in patients with posttraumatic stress disorder:
A review of the literature. *American Journal of Psychiatry, 158,*
1184--1190.

52\. Kellam, S. G., & Anthony, J. C. (1998). Targeting early antecedents
to prevent tobacco smoking: Findings from an epidemiologically-based
randomized field trial. *American Journal of Public Health, 88*(10),
1490--1495.

53\. Miller, L., Weissman, M., Gur, M., & Adams, P. (2001).
Religiousness and substance use in children of opiate addicts. *Journal
of Substance Abuse, 13,* 323--336.

56\. Newcomb, M. D., & Felix-Ortiz, M. (1992). Multiple protective and
risk factors for drug use and abuse: Cross-sectional and prospective
findings. *Journal of Personality and Social Psychology, 63*(2),
280--296.

57\. Wynn, S. R., Schulenberg, J., Kloska, D. D., & Laetz, V. B. (1997).
The mediating influence of refusal skills in preventing adolescent
alcohol misuse. *The Journal of School Health, 67*(9), 390--395.

58\. Botvin, G. J., Schinke, S. P., Epstein, J. A., Diaz, T., & Botvin,
E. M. (1995). Effectiveness of culturally-focused and generic skills
training approaches to alcohol and drug abuse prevention among minority
adolescents: Two-year follow-up results. *Psychology of Addictive
Behaviors, 9*(3), 183--194.

59\. Epstein, J. A., Griffin, K. W., & Botvin, G. J. (2000). A model of
smoking among inner-city adolescents: The role of personal competence
and perceived social benefits of smoking. *Preventive Medicine, 31,*
107--114.

60\. Griffin, K. W., Epstein, J. A., Botvin, G. J., & Spoth, R. L.
(2001). Social competence and substance use among rural youth: Mediating
role of social benefit expectancies of use. *Journal of Youth and
Adolescence, 30,* 485--498.

67\. Dishion, T. J., Capaldi, D., Spracklen, K. M., & Li, F. (1995).
Peer ecology of male adolescent drug use. *Development and
Psychopathology, 7,* 803--824.

68\. Jones, D. C., & Houts, R. (1992). Parental drinking, parent-child
communication, and social skills in young adults. *Journal of Studies on
Alcohol, 53*(1), 48--56.

69\. Jackson, C., Henriksen, L., Dickinson, D., & Levine, D. (1997). The
early use of alcohol and tobacco: Its relation to children's competence
and parents' behavior. *American Journal of Public Health, 87*(3),
359--364.

70\. Kumpfer, K., & Alvarado, R. (1995). Strengthening families to
prevent drug use in multi-ethnic youth. Salt Lake City: University of
Utah, Health Education Department.

71\. Yoshikawa, H. (1994). Prevention as cumulative protection: Effects
of early family support and education on chronic delinquency and its
risks. *Psychological Bulletin, 115,* 28--54.

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**Part II**

**PREVENTION RESEARCH FINDINGS FOR WORKING WITH PARENTS/FAMILIES OF
CHILDREN AGES 0-6**

**A. Risk and Protective Factors Identified in the Research Literature
from Various Early Childhood Programs that can Support Choosing and
Implementing an Evidence Based Program for Children Ages 0 to 6 and
Their Parents**

> Excerpted from: NIDA NOTES, Volume 14, Number 6, March 2000,
> [www.drugabuse.gov/NIDA_Notes/NNVol14N6/tearoff.html](http://www.drugabuse.gov/NIDA_Notes/NNVol14N6/tearoff.html).

**Risk Factors**

Research has shown that although there are many risk factors for drug
abuse, the most crucial ones are those that influence a child\'s early
development within the family, such as the following:

-   parents who abuse drugs or suffer from mental illness;

-   a lack of strong parent-child attachments in a nurturing
    environment;

-   poor parental monitoring; and,

-   ineffective parenting, particularly with children who suffer from
    conduct disorders or have difficult temperaments.

Other risk factors involve a child\'s interaction in environments
outside the family, and typically affecting youth in elementary school
and later in adolescence \-- in school, among peers, or in the community
at large. Especially as youth become older, these risk factors include
the following:

-   inappropriate classroom behavior or failing school performance;

-   poor social skills or affiliation with deviant peers; and,

-   a perception that drug use is acceptable within peer, school, or
    community environments.

### 

### Protective Factors

### 

The most important protective factors, like risks, come from within the
family, but include factors that influence a child in other
environments. Among protective factors identified by research from the
National Institute on Drug Abuse (NIDA) include the following:

-   strong bonds and clear rules of conduct within a family;

-   involvement of parents in a child\'s life; and,

-   successful school performance *(which for this age group may be
    described as school readiness)*.

As youth become older, other protective factors are perhaps just as
influential:

-   strong bonds with positive institutions such as school and religious
    organizations; and,

-   a child\'s agreement with the social norm that drug use is not
    acceptable.

**B. Attachment Theory as a Framework to Work with Infants and Toddlers
for Prevention Interventions**

> Excerpted from Byron Egeland and Martha F. Erickson, University of
> Minnesota, Edited from the *Zero to Three* Journal, October/November,
> 1999,
> [www.zerotothree.org/vol20-2.html](http://www.zerotothree.org/vol20-2.html).

A major emphasis of our work has been to understand why and how some
children from high-risk backgrounds develop in a competent fashion and
others develop social, emotional, or behavior problems. One answer to
this question is consistent with the findings of many researchers and
was known by our grandmothers. Basically, love, nurturance, and
emotionally responsive care from a primary caregiver are essential for
normal, healthy development. Although the importance of love and
nurturance may seem simple and obvious, attachment theory and research
have led to a deeper understanding of the early care-giving
relationship, how it supports the child\'s early development, and how
defining characteristics of a particular relationship are incorporated
into the child\'s sense of self and carried forward into subsequent
relationships (Sroufe, 1999).

Attachment is the term used by John Bowlby (1969, 1982) to describe the
affective bond that develops between an infant and a primary caregiver.
Attachment is a pattern of interaction that develops over time as the
infant and caregiver interact, particularly in the context of the
infant\'s needs and bids for attention and comfort. Bowlby described the
infant as biologically predisposed to use the caregiver as a haven of
safety or a secure base while exploring the environment, when the infant
feels threatened he/she will turn to the caregiver for protection and
comfort. The caregiver\'s response to such bids help mold the attachment
relationship into a pattern of interaction that develops over the first
year of life. The history of this developing relationship between infant
and caregiver allows the infant to begin to anticipate the caregiver\'s
response to bids for comfort.

Sroufe (1996) has described the attachment relationship in terms of the
dyadic regulation of the infant\'s emotions and arousal. Since young
infants are not capable of regulating their own emotions they require
the assistance of a primary caregiver in modulating their fluctuating
emotions. The young infant is equipped to express distress through
crying and other means that are signals to the caregiver to respond.
Responding to the infant\'s signals keeps the distress and arousal
within reasonable limits and represents the beginning stages of
coordination in the regulation process. In the first few months of the
infant\'s life the caregiver is solely responsible for regulating the
infant\'s emotions which requires sensitivity to the infant\'s signals.
To be well regulated requires a sensitive and responsive caregiver, one
who is adept at interpreting the meaning of the infant\'s behavior and
who responds in an appropriate fashion.

Infants become better at expressing their needs and intentions as they
get older and caregiver regulation evolves into mutual regulation
(Tronick, 1989) \-- or as Stern (1985) calls it, \"attunement\". By the
second half of the first year, infants behave in ways that elicit
certain caregiver responses. This coordinated pattern of interaction is
carried forward and forms the basis for the development of
self-regulation. The development of this coordinated pattern of
interaction is subsumed within the framework of Bowlby\'s attachment
theory (Sroufe, 1996). According to this view, the attachment
relationship is central to the regulation of emotion and arousal.

# Assessing Qualitative Differences in Attachment

For the past 30 years, most researchers (including our own team) have
assessed the quality of parent-infant attachment by using the Strange
Situation (Ainsworth & Wittig, 1969), a separation and reunion procedure
that is intended to be a moderately stressful experience for the infant,
thus revealing how the infant uses the caregiver to help him or her cope
with this stress. Because the attachment relationship is based on the
infant\'s history of interacting with a primary caregiver over the
course of the first year, the Strange Situation procedure is appropriate
for infants 12-18 months of age. The premise of the Strange Situation is
that the stress will reveal individual differences in the expectations
infants have built up over time about the availability of caregivers in
times when needed (Weinfield, Sroufe, Egeland, & Carlson, 1999). A basic
tenet of attachment theory is that the infant seeks comfort and
reassurance from the caregiver during times of distress and at other
times uses the caregiver as a secure base from which to explore. It is
this balance between the infant\'s exploration and seeking proximity to
the caregiver when upset that forms the basis for judging the quality of
the attachment relationship in the Strange Situation.

Securely attached infants have confidence in the availability of their
caregivers as a source of comfort in times of distress. Through their
prior experience with a sensitive and responsive caregiver these infants
develop a confidence that supportive care is available to them. And,
because their own cues and signals have been responded to, they develop
confidence in their own ability to solicit the care they need.

A history of insensitive, inconsistent, or unresponsive care results in
an anxious attachment relationship. Anxious attachments fall into one of
three broad types. A history of inconsistent care leads to a heightened
expression of attachment behaviors such as crying and clinging to the
caregiver. These infants are likely to be preoccupied with the
whereabouts of the caregiver and fearful of exploring and mastering
their environments. This pattern of anxious attachment is known as
anxious resistant. In contrast, infants classified as anxious avoidant
have learned to cut off attachment behaviors in times of distress.
Rather than displaying signs of distress such as crying and seeking
proximity to the caregiver for comfort, these infants avoid contact and
interaction with their caregivers. In response to a history of
interacting with a chronically unresponsive caregiver, the anxious
avoidant infant has come to expect that the caregiver is unavailable for
comfort and protection in times of distress. Finally, some infants
develop what is called a disorganized attachment. These children look
confused, presenting contradicting behaviors simultaneously, such as
reaching out to their caregiver with a grimace on their face or starting
to approach then stopping in place and \"freezing.\" A pattern often
associated with abuse, disorganized attachment suggests the child has
learned that the person who is supposed to be a place of refuge at times
of threat is also the source of threat.

# Developmental Consequences of Attachment 

As we have followed the children in the Parent-Child Project from birth
to adulthood, we have found a history of responsive care and secure
attachment associated with a number of positive developmental outcomes.
The patterns of anxious attachment were more likely associated with
later behavior problems and emotional disturbance. Securely attached
infants as preschoolers were judged by teachers and independent
observers to have higher self esteem, to positively engage and respond
to other children, and to be more empathetic compared to preschool
children with a history of anxious attachment (Sroufe, 1983; Erickson,
Sroufe & Egeland, 1985). They were judged to be more self-reliant;
however, they were also more effective in using adults when appropriate.
In middle childhood, those who were securely attached as infants were
more likely to be accepted by their classmates and were better at
forming close relationships with friends compared to those who were
anxiously attached. In adolescence, the capacity for intimacy,
self-disclosure, and successful functioning in mixed gender peer groups
evolved (Sroufe, Egeland, & Carlson, 1999). Recently, we have observed
75 of our participants interacting with their romantic partners.
Preliminary findings indicate that the qualitative features of the
romantic relationship are associated with attachment patterns in
infancy. Young adults with a history of secure attachment in infancy
were observed to interact in a more positive way with their romantic
partners. For example, they expressed and reciprocated positive affect,
were less hostile, and were better able to resolve conflict compared to
couples in which our participants were classified as anxiously attached
as infants.

We also have found that a secure attachment has served as a protective
factor for children whose families have experienced high levels of
stressful life events. In comparing competent with less competent
children of highly stressed families, we found a history of early
competence was a major protective factor against the adverse effects of
stressful life events. The early history of competence was characterized
by a secure attachment at 12 and 18 months and a good quality
mother-child relationship observed in a set of teaching tasks at 42
months (Egeland & Kreutzer, 1991).

From preschool through adolescence, children with anxious attachment
histories were more likely to have behavioral and emotional problems.
For example, anxiety disorders diagnosed at age 17-1/2 were associated
with a history of anxious resistant attachment (Warren, Huston, Egeland,
& Sroufe, 1997). The developmental pathway associated with antisocial
behavior involved an anxious avoidant attachment leading to alienation
and difficulty regulating emotion, which in turn were related to
antisocial behavior (Egeland et al., in press). And symptoms of
psychopathology in adolescence, particularly dissociative symptoms, were
related to a disorganized pattern of attachment in infancy (Carlson,
1998). An anxious attachment is not necessarily a cause of later
problems but it places the young child on a pathway that increases the
likelihood of such problems.

Overall these findings have indicated that the early attachment
relationship provides an important foundation for later development and
that a secure attachment may serve as a protective factor against the
negative impact of various adversities and risk factors. Our findings
and those of other investigators are quite compelling and suggest that
efforts aimed at promoting a secure attachment may prevent various forms
of problems among children in high-risk circumstances. In addition to
influencing social, emotional, and behavioral outcomes, attachment
relationships also may be related to the course of brain development
(Egeland et al., in press). For example, anxiously attached infants --
and particularly those classified as disorganized -- have significantly
higher levels of the stress hormone cortisol, as measured in samples of
saliva taken during the Strange Situation procedure (Hertsgaard, Gunnar,
Erickson & Nachmias, 1995). Neuroscientists hypothesize that high levels
of cortisol may undermine the development of neural connections and the
capacity of the brain to regulate emotion.

# C. Infant Mental Health

> Excerpted from *Zero to Three Policy Center Fact Sheet*,
> [www.zerotothree.org](http://www.zerotothree.org/).

Infant mental health is the capacity of the child from birth to three to
experience, regulate and express emotions; form close and secure
interpersonal relationships; and explore the environment and learn.
**Infant mental health is synonymous with healthy social and emotional
development**.

-   Social and emotional development is just as important as literacy
    and language skills in helping young children be "ready for school"

-   Infants and toddlers can have serious psychiatric disorders such as
    depression, attachment disorders, and traumatic stress disorders

-   Many young children are expelled from preschool and childcare for
    behavior problems.

A 2002 study of unmet needs of infants, toddlers and families in
Illinois found the following:

-   42% of childcare programs have asked families to withdraw their
    infant or toddler because the program was unable to handle the
    child's social or emotional problems (e.g., biting, tantrums,
    hitting, throwing objects, inconsolable crying, sleep problems);

-   Between 16% - 24% of infants and toddlers have social/emotional
    problems; and,

-   62% of all programs report that the amount of mental health services
    is not adequate to meet community needs.

**Mental Health Disorders in Young Children**

Unlike adults, babies and toddlers have a fairly limited repertoire of
responses to stress and trauma. Early mental health disorders might be
reflected in physical symptoms (poor weight gain, slow growth,
constipation), overall delayed development, inconsolable crying, sleep
problems, or in older toddlers, aggressive or impulsive behavior. Some
early mental health disorders may resemble conditions of later life,
including withdrawal, sleeplessness or lack of appetite due to
depression, anxiety, and traumatic stress reactions.

**What Are The Consequences of Not Intervening Early?**

Untreated infant mental health disorders can have disastrous effects on
children's functioning and future outcomes.

-   Research indicates that early attachment disorders predict
    subsequent aggressive behavior.

-   A child whose parent is clinically depressed often withdraws. This
    withdrawal ultimately affects their language skills and other
    development.

-   Infants and toddlers in foster care represent a group of children
    that have been seriously maltreated; they exhibit behavior problems
    such as failure to thrive, tantrums, self-endangering, aggression,
    and inability to be consoled. A child who is not secure in relating
    to others, doesn't trust adults, is not motivated to learn, or who
    cannot calm themselves or be calmed enough to tune into teaching
    will not benefit from early educational experiences. In fact, more
    and more young children are being expelled from childcare and
    preschool for behavior problems, and supports are not available for
    these children, their parents, or their caregivers. Without
    intervention, these problems will escalate.

**Infant Mental Health Practice**

Infant mental health practice is based on research about healthy social
and emotional development, relationships, and mental health disorders.
Mental health treatment is services provided to young children with
diagnosed mental health disorders (significant behavior, eating or
sleeping problems, attachment disorders, clinical depression of the
child or parent, or mental illness in the parent). Services usually
focus on both the child and parents or caregivers and are provided by
skilled practitioners and may be provided in a variety of settings
including childcare, Early Head Start, programs for pregnant women, and
home visitation.

# D. Social and Emotional Competence, School Readiness, and Later School Success

> Excerpted from *A Good Beginning: Sending America's Children to School
> with the Social and Emotional Competence They Need to Succeed,* The
> Child Mental Health Foundations and Agencies Network (FAN);
> [www.nimh.nih.gov/childhp/fdnconsb.htm](http://www.nimh.nih.gov/childhp/fdnconsb.htm).

Many parents worry as their children step on the bus for the first day
of kindergarten, a day that marks their transition from home to school.
And often, so do the children. Learning to be apart from their families
is one of the toughest tasks of young children's lives. But if a child
is socially and emotionally ready for school, this transition, as well
as the early years of school, is more likely to be successful. Learning
in school involves a series of social interactions with adults and other
children. To be ready to learn, children must have built a solid social
and emotional foundation. A child who is socially and emotionally ready
for school and thus ready to learn has many, though not all, of the
following characteristics: he or she is confident, friendly, has
developed or will be able to develop good relationships with peers, and
is able to concentrate on and persist at challenging tasks. The child
must also be able to effectively communicate frustrations, anger, and
joy and must be able to listen to instructions and be attentive.

How do children "become" socially and emotionally ready for school?
Social and emotional competence is rooted in the relationships that
infants and toddlers experience in the early years of their life. During
the first year, their major social and emotional milestone is the
development of a secure attachment with their mother, father, or other
primary caregiver. At age 2, they learn to master the concepts of
self-awareness, independence, and self-control. Children who do not
achieve these age-appropriate social and emotional milestones face a far
greater risk for early school failure. For example, children who have
not formed secure attachments to a parent(s) or primary caregiver during
their first year of life are less likely to be socially and emotionally
competent during their second year of life. Children who master these
social and emotional milestones during the infancy, toddler and
preschool years are more likely to make a successful transition to
school.

While many parents, child development professionals and policy makers
have been presented with a great deal of information regarding the
importance of early brain development, few know what research has now
confirmed: Social and emotional school readiness is critical to a
successful kindergarten transition, early school success, and even later
accomplishments in the workplace. Those children who are not successful
in the early years of school often fall behind from the start and may be
plagued by later behavioral, emotional, academic, and social development
problems. Parents, teachers, and policy makers need to know that many
young children are entering school without the social and emotional
competence that will allow them to successfully transition from home to
school. In a recent survey, up to 46% of kindergarten teachers reported
that half their class or more had specific problems in a number of areas
in transitioning to school (Cox et al., in press).

Research on the risk factors for early school problems is reviewed in
the paper *Risk Factors for Academic and Behavioral Problems at the
Beginning of School* (Huffman et al., 2000). Major points from the paper
include the following:

-   We now have a substantial amount of research on those risk factors
    that contribute to difficult early school transitions. **Low birth
    weight, poor cognitive functioning, and low socioeconomic status are
    risk factors for early school problems.** The risk factors for early
    school failure are not just related to individual children, but to
    their families, peers, daycare setting, school environment,
    community, and neighborhood in which they live.

We have begun to define and identify some of the causal risk factors for
early school failure. **These include the following: 1) cognitive
deficits, 2) early behavior problems, 3) parental psychological
problems, 4) problematic parenting practices, and 5) difficulties with
peers and teachers.** Strikingly, several of the risk factors for early
school problems appear to be related to a child's difficulties in
establishing and maintaining early, important relationships with
parents, peers, and teachers.

We can use what we now know to systematically design and implement
interventions. Interventions need to address multiple levels, since risk
factors can occur at various levels (e.g., the individual, family, and
community levels).

Interventions should be provided to address the causal and malleable
risk factors for early school failure (e.g., problematic relationships
with parents, teachers, and peers). Over the past decade, research in
this area has accelerated, and many federal programs and policies have
been implemented to improve the social and emotional development of
young children. Many of these federal policies and programs are examined
in *Resource Guide to Selected Federal Policies Affecting Children's
Emotional and Social Development and Their Readiness for School*
(Cavanaugh et al., 2000). The programs reviewed by Cavanaugh et al. are
those directly linked to the risk factors identified by Huffman et al.
This extensive review includes programs designed to improve a young
child's health, early care and education, family support/child welfare
systems, socioeconomic status, and nutritional needs. The paper makes
the following major points:

Multiple disciplines are involved in creating this system of early
childhood care. Policy makers and practitioners from the many agencies
that are responsible for the well-being of the nation's children (child
health, early childhood care and education, the family and child welfare
system, nutrition, socioeconomic status) need to be involved in the
creation and implementation of the programs to improve the social and
emotional school readiness of young children. To improve the delivery of
these services, more opportunities should be provided to increase the
flow of knowledge between agencies and disciplines.

More leaders are needed to champion the development of a seamless,
comprehensive system of early childhood care. Individuals at the highest
levels of government, as well as the philanthropic and business
communities, must take up this task in order to move this effort
forward.

Knowledge about what works to prevent poor early school outcomes should
be transferred to those who care for children on a daily basis,
including all teachers, childcare workers, pediatricians, and children's
mental health professionals. There is a critical need to harness the new
research findings and to integrate the patchwork system of early
childhood care to improve the social and emotional competence of the
nation's children, with the ultimate goal of sending all children to
school healthy and ready to learn.

**Risk and Protective Factors Identified in the Literature by Huffman et
al. for Young Children**

**Individual Level Risk Factors**

-   Low birth weight and neurodevelopmental delay

-   Other medical problems (particularly, psychophysiological problems
    (e.g., problems in brain or other organs that limit child's
    cognitive and self-regulatory capacities)

-   Early cognitive deficits

-   Difficult temperament and personality (e.g. hyperactivity or
    aggressive behavior)

-   Early behavior and adjustment problems

**Individual Level Protective Factors**

-   Child's self-confidence

-   Higher cognitive functioning

-   Easy temperament and personality

-   Early history of positive functioning

## Microsystem Level (Family, Peers, Daycare, and School) Risk Factors

-   Family composition (e.g., divorce and remarriage)

-   Low level of maternal education

-   Parental substance abuse

-   Problematic maternal relationship history

-   Parental psychological problems

-   Poor parenting practices Maltreatment

-   Insecure attachment in early years

-   Difficulties with peer relationships

-   Childcare by someone other than the mother (e.g., childcare
    facility). This can include negative characteristics of kindergarten
    and first grade classes (e.g., large class sizes, fewer
    parent-teacher meetings)

-   Poor relationships with teachers

## Microsystem Level Protective Factors

-   Residence with both parents or remarriage after divorce

-   Higher level of maternal education

-   Stable, organized, and predictable family environment

-   Cooperative parental coping

-   Social support, internal perceptions of control (girls)

-   Secure attachment in early years

-   Larger number of classroom friends (in particular, high-quality
    childcare at an early age (for children who have insecure
    attachments to a primary caregiver) or emotional support from an
    alternative caregiver

-   Warm and open relationships with teachers

## Exosystem Level (Neighborhood and Socioeconomic Status) Risk Factors

-   Immigrant status

-   Minority status

-   Low socioeconomic status

## Exosystem Level (Neighborhood and Socioeconomic Status) Protective Factors

-   Higher socioeconomic status

***Macrosystem Level (Cultural Beliefs and Values)***

-   No risk or protective factors reported

## E. Key Outcome Domains

> Excerpted from *SESS: Starting Early Starting Smart: Key Principles in
> Providing Integrated Behavioral Health Services for Young Children and
> Their Families*, 2001, [www.samhsa.gov](http://www.samhsa.gov/)

If considering a comprehensive, wraparound approach to prevention and
early intervention services, a model such as "Starting Early Starting
Smart" provides a useful framework for service provision. The
prevention, problem identification and referral and early intervention
services that are a part of this model are described below.

#### 

**Family Support, Advocacy, and Care Coordination**

The core component, or "hub" of the intervention wheel, is the provision
of comprehensive, wrap-around services referred to variously as Family
Advocacy, Care Coordination, or Case Management (all used
interchangeably here). These services are delivered within the context
of a familiar and accessible setting by a central provider who is then
supported by a more extensive multidisciplinary team and on-call crisis
intervention staff. Utilization levels of the on-call crisis
intervention staff will vary depending on the severity of risk in the
population served; however, it is ideal for these services to be
flexibly available both onsite and in the home. The multidisciplinary
team should include families in treatment and program decisions. The
team should meet regularly (weekly works well) to jointly staff cases.
Multidisciplinary team members may include family members, child
development specialists, physicians, nurses, educators, social workers,
psychologists, health care providers, mental health providers, substance
abuse specialists, and others. Working together on a regular basis
allows team members to get to know each other's strengths, skills, and
clinical expertise. Further, the team becomes familiar with all program
families and is therefore better able to provide for a broad range of
needs.

Intensive, integrated care coordination is in sharp contrast to
traditional case management where the staff have large case loads and
work only in the office setting to make calls and offer linkage
referrals. Traditional approaches frequently offer little or no
follow-up or in-depth involvement with clients. The emphasis in the SESS
approach is on the process of building trust and rapport with families
through an ongoing, supportive relationship. In order for this to
succeed, there must be a central person who is in frequent contact with
the family through telephone calls, home visits, and meetings onsite and
elsewhere in the community. Through the development of relationships
with families, the Family Advocate identifies service needs, helps
families utilize services, and empowers families. Identification of
service needs may include formal and informal assessments or interviews
with families, as well as general observations onsite and in home
environments.

Helping families utilize services involves the provision of logistical
support, such as scheduling and following-up on service appointments,
assisting with paperwork, providing transportation to service locations,
translating, and arranging childcare during appointments. The referral
process in the SESS approach utilizes facilitated referrals, rather than
traditional linkage referrals that simply provide clients with phone
numbers and encourage them to make contact on their own. In a
facilitated referral approach, Family Advocates communicate with the
referral agency directly and may offer a specific contact person for
families, perhaps even accompanying the client to the appointment. The
process also incorporates routine follow-up to ensure needed services
are received, and any barriers to service access are reduced or
overcome.

Initial and ongoing family needs are assessed by Family Advocates in
multiple areas, not only behavioral health. Basic and social service
needs often must be addressed for the benefits of behavioral health
services to be realized. Human needs are best understood in a hierarchy
(Maslow, 1970), which holds that if basic needs are unmet, it is
difficult to focus on other, more advanced needs. Some basic needs
current SESS programs have found often require attention include
housing, food, clothing, financial assistance, vocational or employment
services, childcare, legal services, and the like. Another key area to
be assessed and addressed is physical health care of both the children
and adults in a family. This may include consultation with medical
providers, high-risk nursing follow-up services, health
education/prevention, assistance obtaining medical insurance coverage,
and facilitating needed medical appointments for children (e.g., well-
and sick-child visits, timely immunizations) and adults (e.g., routine
medical care, family planning services). This needs assessment, combined
with multidisciplinary staff input regarding specific behavioral health
issues, contributes to an individualized service plan developed through
a strength-based, family-participatory process. While there are many
intervention program components that may be offered, the most
efficacious occur when services are matched to the individual family
needs through this planning process. In essence, there is no particular
best intervention approach, but it is the delivery of carefully chosen
programs, within the service integration's basic foundation and the
context of a trusting relationship, that is most important.

**Behavioral Health Service Components**

As described, core Behavioral Health Service Components include
Substance Abuse Prevention, Substance Abuse Treatment, Mental Health
Services, and Family/Parenting Services. Any SESS program should include
basic screening and assessment, resource identification, and referral
within each of these areas. Furthermore, assessment processes should be
ongoing rather than static, one-time evaluations, since family
circumstances change and disclosure may increase over time. One cannot
assume after asking about behavioral health service needs once that
answers remain the same.

Substance Abuse Prevention assessment may include evaluation of both
caregivers' and child(ren)'s knowledge and exposure, family history, and
personal experiences with alcohol, tobacco, and other drugs (ATOD). The
Substance Abuse Treatment area is more applicable to caregivers, since
the typical age of onset for drug use is beyond the SESS targeted early
childhood age range of 0-7 years. Evaluation in this area involves a
detailed assessment of caregivers' personal history and patterns of ATOD
use and treatment, beliefs or perceptions of this behavior, and ways the
activity has affected daily functioning and adaptation.

Mental Health Services may be applicable to both the adult caregivers
and child(ren) in a family. Adult evaluation may include brief
assessment of mental status, mental, emotional, or somatic symptoms,
formal diagnosis, history of or current suicidal thoughts and actions,
and current level of daily functioning. For young children, early
routine developmental screening of mental, motor, social, and emotional
growth is an important service that can lead to early intervention and
amelioration of difficulties in many cases.

Family/Parenting Services screening should include the evaluation of
parenting beliefs, stressors, behaviors, and needs via formal testing
and/or staff observations on site and in home environments. Evaluations
in the home are especially useful because they provide a picture of the
family environment and parent-child interaction in a more naturalistic
setting. In addition, it is useful to learn the family's history and
current status with regard to family violence and involvement with Child
Protective Services, as well as the perceived impact of substance abuse
and mental health issues on parenting.

When designing a SESS integrated service program, some intervention
services beyond screening and assessment should be incorporated from
within each of the Behavioral Health Service categories. Programs are
developed and implemented to meet the developmental, prevention and/or
treatment needs of the families who are served. A particular agency's
choice of which service "bundles" to select will depend on what is
appropriate to the specific setting and service population. However, all
resulting programs will have the common basic foundation, as described
above, that informs and guides the development and provision of
intervention services. Each Behavioral Health Service category listed
below has within it a progression of intervention choices that vary in
duration and intensity level, according to the needs and characteristics
of the service population. Specific intervention recommendations are not
made since there is no one single best family intervention program
(Kumpfer, 1999).

There are numerous published and commercially available intervention
components available, and providers should carefully select the best
ones appropriate for their community's needs and resources. There are
many good resources for conducting this selection process. Sloboda and
David (1997) offer some guiding principles that are elaborated by
Kumpfer (1999) and overlap with the SESS basic foundation principles
discussed above. In addition, descriptive collections of "model"
programs and "proven practices " can be found in the Strengthening
America's Families Web site, CSAP's model prevention programs Web site,
and the NIDA Web site (Center for Substance Abuse Prevention, 2000;
National Institute on Drug Abuse, 2000; Office of Juvenile Justice and
Delinquency Prevention, 2000). Decisions about what components to select
should be based on sound empirical evidence and/or theoretical
grounding, as well as the unique needs of the population and setting.
The next sections will summarize how key aspects of substance abuse
prevention, substance abuse treatment, mental health services, and
family/parenting services can be provided in a SESS program.

##### Substance Abuse Prevention

A recent focus on the family environment as an important determinant of
initial substance use has led to early prevention efforts that focus on
caregivers and their children (Brounstein & Zweig, 1999; Center for
Substance Abuse Prevention, 1998a; Center for Substance Abuse
Prevention, 1998b; Grover, 1998). Current research advocates
comprehensive community-based programs that influence individual
behavior and attitudes through education and awareness of substance
abuse and its consequences, engagement into formal treatment as needed,
and support to reduce stress and improve overall functioning (Catalano,
Haggerty, Gainey, & Hoppe, 1997; Szapocznik et al., 1988), with more
intensive and earlier prevention efforts as the risk level of the
service population increases (Sloboda & David, 1997; U.S. Department of
Health and Human Services, 2000).

Family-focused prevention efforts will have the greatest impact if they
focus on both caregivers and children, work with young children before
patterns become entrenched, apply developmentally, culturally, and
gender appropriate strategies, remove potential barriers to
participation (e.g., transportation, childcare), address multiple risks
simultaneously, and build on families' strengths (Grover, 1998; Kumpfer,
1997; Szapocznik, 1997). Protective factors should also be a focus, such
as increasing social support and parental self-concept and satisfaction
in order to improve overall functioning and decrease likelihood of
maladaptive coping styles, such as substance use. Substance abuse
prevention activities in a SESS program may include the following:

-   Distribution of multimedia educational materials in print, video,
    and/or audio format;

-   Educational activities and curricula that impact children, adults,
    and/or families to increase awareness of substance abuse and its
    consequences and encourage adaptive coping mechanisms for dealing
    with stress;

-   Ongoing assessment of needs and provision of social support by SESS
    intervention staff; and,

-   Encouragement of the development and maintenance of positive and
    appropriate family and peer support systems.

###### Family and Parenting Services

Effective parenting, including clear communication, appropriate limit
setting, and a responsive and nurturing parent-child relationship can
help foster the healthy development of children and protect them from
behavioral and emotional difficulties (Belcher & Shinitzky, 1998; Center
for Substance Abuse Prevention, 1998b; Resnick et al., 1997). Parents
who are at-risk due to substance abuse and/or mental health difficulties
may have more difficulty establishing and maintaining healthy
relationships with their children and benefit from supports in this
area.

Prevention efforts must focus on education and skills training that will
assist parents in supporting their children's social and emotional
development (Kumpfer, 1998). Efforts focusing on the early parent-child
relationship will help prevent future substance abuse as well as other
health risk behavior such as violence, early sexual activity, and school
dropouts (Hawkins, Catalano, Kosterman, Abbott, & Hill, 1999; Kumpfer,
1996). There are many curriculum-based parenting programs available.
Evaluation criteria and descriptions of effective programs can be found
in Kumpfer (1999) and at the Strengthening America's Families Web site
sponsored by the Office of Juvenile Justice and Delinquency Prevention
(Center for Substance Abuse Prevention & Office of Juvenile Justice and
Delinquency Prevention, 2000; Office of Juvenile Justice and Delinquency
Prevention, 2000). Some global concepts often included in such programs
include developmentally appropriate child behavior and expectations,
child health and development, positive/appropriate discipline
techniques, effective communication skills and parent-child interaction,
structured play activities, and building child self-esteem, social
competence and life skills. Specific SESS activities related to
family/parenting services may include the following:

-   Educational and anticipatory guidance-based curriculums regarding
    parenting and child development may be delivered to parents in group
    or individual sessions onsite or in homes;

-   In-home sessions may incorporate informal observation of the entire
    family, resulting in offering responsive support and modeling of
    appropriate parenting skills by SESS staff;

-   Site-based groups or classes on parenting may go beyond simple
    educational groups to utilize a more therapeutic approach that
    incorporates group process and/or parent- child activities to
    process and demonstrate parenting skills;

-   Open-ended and ongoing family/parenting support and/or advocacy
    groups may be appreciated by some parents. These groups can be open
    to all participants or may be focused towards specific groups such
    as fathers, grandmothers, young mothers, or alternate caregivers;

-   Offering family recreation activities that are attended by SESS
    intervention staff and families provides an engaging context in
    which to observe family interactions and provide support and
    feedback in a natural and informal manner; and,

-   Individual parenting-oriented counseling sessions focus on specific
    child behavior problems or developmental issues may also be needed
    by some parents. When issues are focused on parent-child
    relationship issues, interactional approaches such as videotaping
    and/or reviewing interactions with parents are useful therapeutic
    tools (e.g., Bernstein, Hans, & Percansky, 1991; McDonough, 1995;
    McDonough, 2000; Robert-Tissot, Cramer, Stern, Serpa, & et al, 1996;
    Sluckin, 1998).

Stressful experiences during the formative years can affect brain
development and place children at risk for developing a variety of
cognitive, behavioral, and emotional difficulties (Fox, Calkins, & Bell,
1994; Schore, 1996; Spreen, Risser, & Edgell, 1995). The array of
possible negative outcomes suggests that multiple services, including
those related to substance abuse and mental health, should be made
available early in a child's life. Primary health care and early
childhood education settings represent potentially powerful settings in
which to identify families with young children (Bernstein, Hans, &
Percansky, 1991). The idea is to intervene as early as possible within
the parent-child relationship, utilizing comprehensive, family-centered
behavioral health services in a familiar and accessible setting. The
parent-child relationship, especially in early childhood years, is
viewed as a prime vehicle for bolstering child and family protective
factors and preventing child behavioral and developmental problems. A
major expected outcome or goal of intervention and prevention activities
is to facilitate resiliency in young children and families affected by
substance abuse and mental health issues.

A program aimed at impacting the family functioning and environment that
a child matures in might wisely look at the domains and outcomes
identified by the Starting Early Starting Smart programs funded by
SAMHSA. These, as a comprehensive approach to creating a healthy child,
might be considered one way to conceptualize the needed components of a
program in order to produce positive outcomes.

+--------------------------+-------------------------------------------+
| **Key Domains and        |                                           |
| Outcome Indicators       |                                           |
| Identified in**          |                                           |
|                          |                                           |
| **SAMHSA's Starting      |                                           |
| Early Starting Smart     |                                           |
| Programs**               |                                           |
+--------------------------+-------------------------------------------+
| Child Development        | Mental and Motor Development              |
|                          |                                           |
|                          | Global Cognitive Skills                   |
|                          |                                           |
|                          | Language Processing Skills                |
|                          |                                           |
|                          | School Readiness                          |
|                          |                                           |
|                          | Behavioral and Emotional Development      |
+--------------------------+-------------------------------------------+
| Caregiver/Family         | Caregiver Behavioral Health Status        |
| Functioning              |                                           |
|                          | Parenting Role Stress and Skills          |
|                          |                                           |
|                          | Caregiver-Child Interactions              |
|                          |                                           |
|                          | Quality of Home and Care-giving           |
|                          | Environment                               |
+--------------------------+-------------------------------------------+
| Family Health and Safety | Child Health                              |
|                          |                                           |
|                          | Caregiver Health                          |
|                          |                                           |
|                          | Family Conflict Management and            |
|                          | Communication                             |
|                          |                                           |
|                          | Parenting Role Stress and Skills          |
|                          |                                           |
|                          | Child Maltreatment                        |
+--------------------------+-------------------------------------------+

##### Key Principles

Planning a program involves a comprehensive community-based assessment.

Families must participate as full partners.

Collaboration with other community providers that serves families is
fundamental.

A culturally relevant intervention approach is essential.

A strengths-based program serves both families and staff.

##### F. School Readiness: Principles of Effective Services for Young Children 

> Excerpted from *Set for Success: Building a Strong Foundation for
> School Readiness Based on the Social-Emotional Development of Young
> Child*r*en, "The Roots of School Readiness in Social and Emotional
> Development,* Thompson, Ross. The Kauffman Early Education Exchange,
> 2002, www.emkf.org.

Effective services to promote emotional health and school readiness are
as follow:

-   Grounded in developmental knowledge;

-   Relationship-based;

-   Family supportive;

-   Consistent with the culture of early childhood programs;

-   Delivered in settings trusted by the families;

-   Responsive to the community and cultural context; and,

-   Attuned to outcome measures, especially those associated with school
    readiness.

##### 

##### The Social and Emotional Foundations of School Readiness

Two conclusions arise from the research on early social and emotional
development. First, the preschool years are a period of considerable
growth in the psychological foundations of school readiness. Besides the
core cognitive capabilities that develop in early childhood, advances in
the child's understanding of other people, self-understanding, emotional
growth, self-control, conscience and peer relationships provide an
essential bedrock of skills necessary for learning in the classroom.
Young children with positive early experiences are well prepared to be
attentive, cooperative, motivated to succeed and capable of working with
others. Second, supportive relationships are the common core ingredient
of positive early social and emotional development. More specifically,
the science of early childhood development shows the following:

**• The quality of relationships with parents are significant and
primary.**

> Owing to the deep emotional attachments of young children, the
> security (or insecurity) of these relationships influences how
> children see themselves and other people. Parents guide the earliest
> forms of self-understanding and self-concept that make children
> confident in exploring and learning by how they respond to the child's
> achievements and misbehavior. Parents influence the development of
> capacities for self-management, emotion regulation and cooperating
> with others through instruction, support and example. Parents shape
> the growth of social skills through opportunities for the child to
> interact with other people (including peers) and gentle coaching in
> social competence. Parents provide learning opportunities through
> everyday experiences that they sensitively exploit to promote new
> understanding. Warm, nurturing, sensitive parenting is a cornerstone
> of healthy social and emotional development because of how
> parent-child relationships tutor a young child about the world they
> inhabit.

**• The quality of childcare, and the caregiver-child relationship, are
significant influences on social and emotional development***.*

> Although studied less extensively than experiences at home, it is
> clear that experience in childcare has far-reaching consequences for
> early development. As parents do at home, childcare providers also
> influence the growth of self-concept, social skills and capacities for
> emotion regulation, and childcare may be an especially important
> context for learning how to get along with peers as well as adults.
> The quality of the relationships between caregivers and children are
> crucial to the benefits of childcare, just as they are crucial to the
> impact of experiences at home. Moreover, the broader quality of the
> childcare setting is also an important influence on social and
> emotional development because of how childcare quality indexes the
> opportunities provided for new learning, support for constructive peer
> play and manageable, predictable routines and emotional demands on
> children.

**• Young children have a strong intrinsic drive toward healthy
development, but it can be undermined by troubled relationships with the
people who matter to them.**

> These risks have been noted in the preceding review, and include
> punitive, denigrating parenting; family environments characterized by
> marital conflict, violence, and/or adult affective disorders;
> childcare settings of poor quality or relational instability (the high
> turnover of caregivers in childcare often results in insecure
> attachment relationships with children, see Howes, 1999); home or
> childcare environments with overwhelming, unpredictable emotional
> demands for children; and the many stresses associated with poverty.
> Unfortunately, for the young children most at risk of social and
> emotional dysfunction, their life experience is characterized by more
> than one of these threats. These conclusions reflect the findings of
> research on early social and emotional development. But when we turn
> to research that specifically examines the foundations of school
> readiness, its conclusions are very consistent:
>
> First, *the quality of the mother-child relationship in early
> childhood is an important influence on how well children will function
> in kindergarten.* (Estrada, Arsenio, Hess,& Holloway, 1987;
> Peisner-Feinberg et al., 2000; Pianta, Nimetz, & Bennett, 1997). When
> young children enjoy warm, supportive relationships with their
> mothers, they subsequently exhibit greater academic competence in
> kindergarten and early primary grades, and they are more competent in
> the classroom --- that is, they are more socially skilled, show fewer
> problems with conduct or frustration and have better work habits. In
> an important longitudinal study, Estrada and colleagues (1987) found
> that a measure of the emotional quality of the mother-child
> relationship at age 4 was associated with the child's cognitive
> competence at that age, and was predictive of school readiness
> measures at ages 5 and 6, IQ at age 6, and school achievement at age
> 12.These findings are consistent with a large body of research showing
> how the parent-child relationship influences intellectual growth
> (Bradley, Caldwell, & Rock, 1993; Gottfried & Gottfried, 1984), and
> emphasizes the relevance of this relationship to school readiness.
> here are many reasons why a positive mother-child relationship would
> enhance children's school readiness, based on the research reviewed
> above. A positive, secure relationship provides immediate support for
> the child's social and cognitive competence, as well as inspiring
> self-confidence, capacities for self-management and interest in
> learning.
>
> Second, *the quality of child care influences how well children will
> function in school* (Lamb, 1998; NICHD Early Child Care Research
> Network, 2000;National Research Council, 2001; Peisner-Feinberg et
> al., 2000). In another longitudinal study, Peisner-Feinberg and
> colleagues (2000) found that the quality of childcare classroom
> practices predicted language and math skills through second grade.
> Classroom practices also predicted the quality of children's peer
> relationships and behavior problems several years later. In this
> study, "classroom practices" included assessments of whether
> procedures were developmentally appropriate for young children, the
> use of a child-centered teaching method, and the teacher's sensitivity
> and responsiveness to the children. Thus the overall classroom
> environment influenced cognitive and social competence in school up to
> second grade. These conclusions have been confirmed by other studies
> of early childhood education (National Research Council, 2001).
> Moreover, *the relationship between child care providers and young
> children also influences children's school functioning* (Lamb, 1998;
> Peisner-Feinberg et al., 2000; Pianta et al., 1997). Just as at home,
> the warmth and sensitivity of the childcare provider enhances
> children's social competence (and reduces proneness to behavior
> problems) in kindergarten and the early primary grades. But research
> has shown that the closeness of their relationship also predicts
> children's subsequent classroom thinking, attention skills and concept
> development. In short, cognitive and social competence is enhanced
> when children are in childcare settings with secure, positive
> relationships with caregivers. In the context of warm, secure
> relationships with their caregivers, children's intellectual growth is
> also enhanced. In the conversations they share, the structure that
> adults provide, and the sensitivity to children's developmental
> readiness to learn, these relationships provide an avenue for new
> learning of all kinds, as well as children's curiosity and motivation
> to learn. Thus it is perhaps unsurprising that in care settings with
> caregivers who are better educated and trained, young children become
> more intellectually and socially competent (Lamb, 1998;National
> Research Council, 2001).
>
> Third, *the quality of child care may be especially influential for
> children who are otherwise at risk of academic or social problems in
> school* (Caughey, DiPietro,& Strobino, 1994;National Research Council,
> 2001; Peisner-Feinberg et al., 2000).Children from socio-economically
> disadvantaged settings benefit more significantly from high quality
> childcare than do children from middle-income families. This may
> derive from how a supportive relationship with a childcare provider
> and developmentally appropriate classroom practices can buffer some of
> the stresses associated with economically challenging living
> conditions. The quality of care is important. Poor quality care does
> not differentially benefit at-risk children \-- nor, for that matter,
> any children.
>
> Fourth, *the relationship between the child and a teacher in
> kindergarten is an important contributor to school adaptation* (Birch
> & Ladd, 1997; Pianta & Steinberg, 1992). Consistent with the
> importance of relationships throughout early childhood, children who
> enjoy warm, positive relationships with their kindergarten teachers
> are more excited about learning, more positive about coming to school,
> more self-confident and achieve more in the classroom than do children
> who experience more troubled or conflictual relationships with their
> teachers. Thus the importance of relationships to socio-emotional and
> cognitive functioning, established from early childhood, extends also
> to the early primary school years. Moreover, other relationships are
> also important. For example, the quality of children's peer
> relationships in kindergarten are also associated with school
> adjustment: children who experience greater peer acceptance and
> friendship tend to feel more positively about coming to school and
> perform better in the classroom (Ladd, Kochenderfer, & Coleman, 1996,
> 1997).

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Birch, S., & Ladd, G. (1997). The teacher-child relationship and
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**Part III**

**EVIDENCE-BASED SUBSTANCE ABUSE PREVENTION PROGRAMS FOR
PARENTS/FAMILIES OF CHILDREN AGES 0-6**

This section includes descriptions of several strategies or approaches
that are often important components of successful comprehensive
prevention programs, and some research conclusions for these approaches.
These descriptions might actually be called program categories or types
of activities. These include home visiting programs, media literacy
education, parenting and family skills programs, and tutoring programs.
Many of the model programs described in the previous section include one
or more of these approaches as part of their program. You will also
observe in some of the model program descriptions that mentoring
initiatives are frequently an important part of a comprehensive program.

The strategies described in this section are candidates for
consideration as one component of a comprehensive, community-wide
prevention initiative that focuses in many domains with multiple
strategies, addressed at various age groups. Individually, however, they
do not provide a comprehensive prevention program, but as part of a
larger community prevention initiative, each of these could play an
important role if they address known risk factors in your community.

Science-based principles, practices, and models can improve prevention
programming in the local community. The substance abuse prevention body
of knowledge is evolving rapidly. We currently know more about what is
effective in prevention then we have at any other time in history. To
learn more read \"Science-based Practices in Substance Abuse Prevention:
A Guide\" prepared by P.J. Brounstein, J.M. Zweig, and S.E. Gardner
under contract with the CDM Group, Inc. for the Center for Substance
Abuse Prevention. To view this document, visit:
<http://modelprograms.samhsa.gov/pdfs/pubs_Principles.pdf>

The programs and strategies listed in this publication are examples of
scientifically defensible prevention efforts. Although we reviewed the
literature and sought out practices with rankings such as model,
effective and promising, there are likely to be other proven practices
that are not listed. Furthermore, inclusion of a strategy/program in
this publication does not imply endorsement by the New Mexico Department
of Health/Behavioral Health Services Division.

Much of the information for this section was adapted from the following
web sites:

SAMHSA Model Programs,
[http://modelprograms.samhsa.gov](http://modelprograms.samhsa.gov/)

Western CAPT, <http://www.unr.edu/westcapt>

+------------------+---------------------------------------------------+
| **Title:**       | ####### Al's Pals: Kids Making Healthy Decisions  |
+------------------+---------------------------------------------------+
| **Type:**        | Universal                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Information Dissemination                         |
| Strategy:**      |                                                   |
|                  | Education                                         |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood, Elementary School                |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | Rural, suburban, urban, children ages 3-8 of all  |
| Populations:**   | socioeconomic backgrounds, African-American,      |
|                  | Caucasian                                         |
+------------------+---------------------------------------------------+
| **Risk           | Early and Persistent Antisocial Behavior          |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Ranking:**     | SAMHSA Model Program                              |
+------------------+---------------------------------------------------+
| **Contact:**     | Susan R. Geller, President                        |
|                  |                                                   |
|                  | Wingspan LLC                                      |
|                  |                                                   |
|                  | 4196-A Innslake Dr.                               |
|                  |                                                   |
|                  | Glen Allen, VA 23060                              |
|                  |                                                   |
|                  | <sgeller@wingspanworks.com>                       |
|                  |                                                   |
|                  | [www.                                             |
|                  | wingspanworks.com](http://www.wingspanworks.com/) |
|                  |                                                   |
|                  | Phone: 804 967-9002                               |
|                  |                                                   |
|                  | Fax: 804 967-9003                                 |
+------------------+---------------------------------------------------+

Al\'s Pals: Kids Making Healthy Choices, a resiliency-based early
childhood curriculum and teacher training programs, has 46 core lessons
that capture real-life childhood experiences and provide opportunities
for the children to acquire and practice social and emotional skills.
Designed for preschool, kindergarten, and first-grade children, the
lessons are delivered by a classroom teacher for 10 to 15 minutes twice
a week. An original hand puppet named Al is at the heart of the program
and serves as a positive role model. In addition to Al and puppet pals
Ty and Keisha, children are engaged through a wide range of teaching
tools including scripted puppet-led discussions, guided creative play,
original songs, posters, color photographs, message pads, and books.

Through the lessons, children learn and practice positive ways to
express feelings, relate to others, communicate, differentiate between
safe and unsafe substances and situations, brainstorm ideas, and solve
problems. By reinforcing the Al\'s Pals concepts throughout the day, the
teacher shapes a caring environment, encouraging independent thinking,
use of self-control, healthy decision-making, and peaceful problem
solving. A nine-lesson booster curriculum may be used during the second
or third grade to reinforce skills learned through the core lessons.

Al\'s Pals includes a parent component. Letters from Al are regularly
sent home to inform parents about the life skills their children are
learning and suggest activities parents can use to help their children
practice and retain these skills. The curriculum also includes
\"Al-a-Grams\" school-to-home messages, delivered home by the children,
which recognize positive behavior noted at school (e.g., caring about
others' feelings or calming down.)

> Excerpt from SAMHSA Model Program website,
> [http://modelprograms.samhsa.gov](http://modelprograms.samhsa.gov/).

+------------------+---------------------------------------------------+
| **Title:**       | ####### Birth to Three Program                    |
+------------------+---------------------------------------------------+
| **Type:**        | Universal                                         |
|                  |                                                   |
|                  | Selective                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Information Dissemination                         |
| Strategy:**      |                                                   |
|                  | Education                                         |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood                                   |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | Teen Parents, Parents with Infants, Pregnant and  |
| Populations:**   | Parenting Women in Recovery                       |
+------------------+---------------------------------------------------+
| **Risk           | Family Management Problems                        |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Protective     | Bonding                                           |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Ranking:**     | Promising                                         |
+------------------+---------------------------------------------------+
| **Contact:**     | Minalee Saks, Executive Director\                 |
|                  | Birth To Three                                    |
|                  |                                                   |
|                  | 86 Centennial Loop\                               |
|                  | Eugene, Oregon 97401 \                            |
|                  | E-mail: <msaks@birthto3.org>                      |
|                  | or <birthtothree@birthto3.org>\                   |
|                  | Web-site:                                         |
|                  | [http://w                                         |
|                  | ww.birthto3.org](http://www.birthto3.org/)        |
|                  |                                                   |
|                  | Phone: (541) 484-5316                             |
|                  |                                                   |
|                  | Fax: (541) 484-1449                               |
+------------------+---------------------------------------------------+

Birth To Three is designed for a broad range of parents with infants and
young children (0-7 years of age). Birth To Three\'s mission is to
strengthen families and promote the well being of children through
parent education and support. Programs include the following:

> First 3 Years Program (for families with infants, one and two year
> olds)
>
> Make Parenting A Pleasure (for parents with children ages birth to
> seven who are experiencing a higher level of stress)
>
> Teen Parent Program (for pregnant and parenting teens and their
> partners ages 12-21)
>
> Crecer: To Grow Up (for families with children ages birth to five
> whose primary language is Spanish)
>
> Healthy Start and Welcome Baby (for first time parents of newborns)
>
> Parenting Now! (for the general population of parents of children ages
> birth to six): this is a new curriculum not yet evaluated by OJJDP.

All programs are built on the following assumptions:

> Parenting is the most important and challenging job there is.
>
> Parents are their children\'s first and most important teachers.
>
> There are many right ways to be a parent or a child.
>
> Parents are the foundation of the family.
>
> Getting and giving support is essential for parents.
>
> Excerpt from materials provided by Birth to Three.

+------------------+---------------------------------------------------+
| **Title:**       | ####### DARE To Be You                            |
+------------------+---------------------------------------------------+
| **Type:**        | Universal, Selective                              |
+------------------+---------------------------------------------------+
| **CSAP           | Education                                         |
| Strategy:**      |                                                   |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood, 2-5 Years Olds and Their Parents |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | Rural, Suburban, Urban, Special Needs             |
| Populations:**   |                                                   |
+------------------+---------------------------------------------------+
| **Risk           | Family Management Problems                        |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Protective     | Bonding, Skills                                   |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Ranking:**     | SAMHSA Model Program, Effective by CSAP,          |
|                  | Effective by OJJDP                                |
+------------------+---------------------------------------------------+
| **Contact:**     | Jan Miller-Heyl, MS\                              |
|                  | DARE To Be You, Colorado State University,        |
|                  |                                                   |
|                  | 215 N. Linden, Suite E\                           |
|                  | Cortez, Colorado 81321\                           |
|                  | E-mail: <darecort@coop.ext.colostate.edu>         |
|                  |                                                   |
|                  | Phone:    (970) 565-3606    Fax:  (970) 565-4641  |
+------------------+---------------------------------------------------+

DARE To Be You (DTBY) is a multilevel, primary prevention program for
children 2 to 5 years old and their families. It significantly lowers
the risk of future substance abuse and other high-risk activities by
improving parent and child resiliency factors in the areas of
communication, problem solving, self-esteem, and family skills. Program
interventions are designed to do the following: improve parents\' sense
of competence and satisfaction with being a parent; provide parents
knowledge and understanding of appropriate child management strategies;
improve parents\' and children\'s relationships with their families and
peers; and, boost children\'s developmental levels

The DARE To Be You program should have a site sponsor---a key agency
that works with families. Sponsors may be preschool educational
programs, schools, family centers or coalition groups. The program is
delivered to families at a site convenient to the families in a location
comfortable for families to attend. The program consists of three
components including the following:

> Family Component, which offers parent, youth, and family training and
> activities for teaching self-responsibility, personal and parenting
> efficacy, communication and social skills, and problem-solving and
> decision-making skills. It consists of an initial 12-week family
> workshop series (30 hours) and semiannual 12-hour reinforcing family
> workshops. (After-DARE support groups are also recommended.)
>
> School Component, which trains and supports teachers and childcare
> providers who work with the target youth.
>
> Community Component, which trains community members who interact with
> target families, health department, social services, family center
> personnel, probation, and counselors.

Both School and Community Component participants have the same 15-hour
training requirement. Training for childcare providers and involved
community members will also be held at a placed deemed appropriate by
the site sponsor.

> Excerpt from materials provided by DARE To Be You staff in December
> 2001.

+------------------+---------------------------------------------------+
| **Title:**       | ####### E                                         |
|                  | arly Childhood Substance Abuse Prevention Program |
+------------------+---------------------------------------------------+
| **Type:**        | Selective                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Information Dissemination                         |
| Strategy:**      |                                                   |
|                  | Education                                         |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood                                   |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | Children Ages 3-5 in Preschool setting            |
| Populations:**   |                                                   |
+------------------+---------------------------------------------------+
| **Risk           | Favorable Parental Attitudes and Involvement in   |
| Factors:**       | Substance Abuse                                   |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
|                  | Bonding                                           |
+------------------+---------------------------------------------------+
| **Ranking:**     | Promising                                         |
+------------------+---------------------------------------------------+
| **Contact:**     | Jan Hudak\                                        |
|                  | 1527 N. Juniper\                                  |
|                  | Tacoma, WA 98406\                                 |
|                  | Phone: (253) 756-6817\                            |
|                  | E-mail: <ljhudak@earthlink.com>                   |
+------------------+---------------------------------------------------+

The Early Childhood Substance Abuse Prevention Project is a preschool
and daycare program, which consists of three components:

1.  \"I\'m So Glad You Asked\" prevention curriculum\
2.  \"Cherishing Yourself and Your Child\" parenting curriculum\
3.  Work within the community, raising awareness of how substance abuse
impacts the family

The \"I\'m So Glad You Asked\" curriculum aims to help children mitigate
the risks associated with a substance-abusing family environment. 
\"Cherishing Yourself and Your Child\" (CY&YC) is a relational parenting
curriculum that focuses on building the kind of supports, connections
and interactive processes between parents and children that promote
healthy physical/psychological growth and learning that create mutually
empathetic relationships. The curriculum has six sections with numerous
activities that can be used for at least 15 (1.5 hour) sessions or
more: 1) Parent Needs/Child Needs; 2) Communicating; 3) Working Through
Difficult Feelings; 4) Inner Child of The Past; 5) Discipline vs.
Punishment; and 6) Discovering Our Inner Nurturer.

Program Objectives:

> Increase the resiliency and protective factors in preschool children
> by increasing their self-esteem, decision-making abilities,
> communication skills, and factual knowledge of substances.
>
> Increase the parenting knowledge and skills of parents enrolled in
> drug treatment programs and parents enrolled in a family development
> program for parents who have committed child abuse.
>
> Increase effective family functioning and reduce the risk of family
> substance abuse for the targeted families.

This program is not currently available for replication. Revisions are
being made to the curricula and new materials are being developed.

> Excerpt from *Program Findings Sheet*, Center for Substance Abuse
> Prevention, Division of Knowledge Development and Evaluation \-- Part
> of CSAP\'s Promising Practices Series, 1998.

+------------------+---------------------------------------------------+
| **Title:**       | ####### Families and Schools Together             |
+------------------+---------------------------------------------------+
| **Type:**        | Selective                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Information Dissemination                         |
| Strategy:**      |                                                   |
|                  | Education                                         |
|                  |                                                   |
|                  | Problem Identification and Referral               |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood, Elementary School                |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | Rural, Medium-sized, Urban, Preschool, Infants,   |
| Populations:**   | Toddlers, Special Needs, Hispanic, Native         |
|                  | American, Caucasian, African American             |
+------------------+---------------------------------------------------+
| **Risk           | Family Management Problems                        |
| Factors:**       |                                                   |
|                  | Favorable Parental Attitudes and Involvement in   |
|                  | Substance Abuse                                   |
|                  |                                                   |
|                  | Lack of Commitment to School                      |
+------------------+---------------------------------------------------+
| **Protective     | Bonding                                           |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Ranking:**     | SAMHSA Model Program, Effective by CSAP, OJJDP    |
+------------------+---------------------------------------------------+
| **Contact:**     | Pat Davenport, Executive Director\                |
|                  | FAST National Training and Evaluation Center\     |
|                  | PO Box 14500\                                     |
|                  | Madison, WI 53704\                                |
|                  | Web-site: [http://www.wc                          |
|                  | er.wisc.edu/FAST](http://www.wcer.wisc.edu/fast)\ |
|                  | Email: <fast@chorus.net>         Phone: (608)     |
|                  | 663-2382   or (888) 629-2481                      |
|                  |                                                   |
|                  | Fax: (608) 663-2336                               |
+------------------+---------------------------------------------------+

FAST uses a collaborative, whole family approach to achieve its goals. A
10-week curriculum for Early Childhood, of multiple-family group
activities, followed by ongoing monthly meetings, incorporates the
following activities: structured family communication exercises, family
feelings identification exercises, parent support meetings,
winning-as-a-family-unit exercises, a substance abuse education
component, graduation, and development of a school-based parent advisory
council of FAST program graduates. The FAST program is designed to:

\(1\) Enhance family functioning by strengthening the parent-child
relationship in specific ways and empowering the parents to become
primary prevention agents for their own children

\(2\) Prevent the target child from experiencing school failure by
improving the child\'s behavior and performance, empowering parents as
partners in the education process, and increasing family feelings of
affiliation with their schools

\(3\) Prevent substance abuse by the child and the family members by
increasing knowledge and awareness of substance abuse and its impact on
child development and linking the family to assessment and treatment
services if necessary

\(4\) Reduce the everyday stress that parents and children experience by
developing an ongoing support group for parents of at-risk students,
linking participants to needed resources, and building the self-esteem
of each family member.

> Excerpt from *Strengthening America\'s Families:  Promising Parenting
> Strategies for Delinquency Prevention*, Office of Juvenile Justice and
> Delinquency Prevention, 1993, p.50.

+------------------+---------------------------------------------------+
| **Title:**       | ####### Growing Up Strong                         |
+------------------+---------------------------------------------------+
| **Type:**        | Universal                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Information Dissemination                         |
| Strategy:**      |                                                   |
|                  | Education                                         |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood, Preschool                        |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        |                                                   |
| Populations:**   |                                                   |
+------------------+---------------------------------------------------+
| **Risk           | High-Risk Behaviors                               |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
|                  | School Readiness                                  |
+------------------+---------------------------------------------------+
| **Ranking:**     |                                                   |
+------------------+---------------------------------------------------+
| **Contact:**     | Southwest Prevention Center                       |
|                  |                                                   |
|                  | 555 Constitution Ave., Suite 222                  |
|                  |                                                   |
|                  | Norman, OK 73072                                  |
|                  |                                                   |
|                  | 405 325-1446                                      |
|                  |                                                   |
|                  | bearl@ou.edu                                      |
+------------------+---------------------------------------------------+

Growing Up Strong is a mental wellness and substance abuse prevention
curriculum for preschoolers, which facilitates social and emotional
competence, thus increasing chances for positive school experience. GUS
reaches out to children through public/private school Pre-K programs;
Head Start programs, childe care centers and home childcare programs.

GUS conceptualizes mental wellness as a combination of psychological and
behavioral competencies. Heightened decision-making, problem-solving and
assertive abilities of children result in a positive self-concept that
is expressed through appropriate and effective behaviors.

> Excerpt from Southwest Prevention Center's Growing Up Strong brochure.

+------------------+---------------------------------------------------+
| **Title:**       | ####### Healthy Families America                  |
+------------------+---------------------------------------------------+
| **Type:**        | Selective                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Problem Identification and Referral               |
| Strategy:**      |                                                   |
|                  | Education                                         |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood, Parents with Children 0-5        |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | Single Parent, Low Income, Substance Abuse        |
| Populations:**   | Problems, Physical Abuse and Violence             |
+------------------+---------------------------------------------------+
| **Risk           | Constitutional Factors                            |
| Factors:**       |                                                   |
|                  | Family Management Problems                        |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
|                  | Bonding                                           |
+------------------+---------------------------------------------------+
| **Ranking:**     | Effective by OJJDP                                |
+------------------+---------------------------------------------------+
| **Contact:**     | Healthy Families America\                         |
|                  | 200 S. Michigan Avenue, Suite 1700\               |
|                  | Chicago, IL 60604 Phone:  (312) 663-3520 Fax:     |
|                  | (312) 939-8962                                    |
+------------------+---------------------------------------------------+

Prevent Child Abuse America (PCA America), formerly known as the
National Committee To Prevent Child Abuse, sponsors the Healthy Families
America home visiting initiative in over 400 sites across the nation.
The Healthy Families is a voluntary home visitation program designed to
promote healthy families and healthy children through a variety of
services including child development, access to health care and parent
education. The program serves families identified as at-risk, with
children 0-5 years.

Program goals include prevention of negative birth outcomes (low birth
weight, substance abuse, criminal activity, child abuse and neglect);
increased parenting skills; healthy pregnancy practices; and the use of
social systems. Assessments are conducted either prenatally or at the
time of birth. Home visiting can begin either prenatally or shortly
after birth. The Family Support Worker (FSW) visits at least once a week
for up to one year. The FSW helps establish support systems, teaches
problem-solving skills, enhances positive parent-child interaction, and
offers information, education and referrals to community resources. Once
a family is in the program, they can receive services for up to 5 years.

> Excerpts from Strengthening America\'s Families\' web-site,
> <http://www.strengtheningfamilies.org/index.html> and updated with
> information from Prevent Child Abuse America\'s web-site,
> <http://www.healthyfamiliesamerica.org/index.html>.

+------------------+---------------------------------------------------+
| **Title:**       | **Home Instruction Program for Preschool          |
|                  | Youngsters (HIPPY)**                              |
+------------------+---------------------------------------------------+
| **Type:**        | Selective                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Education                                         |
| Strategy:**      |                                                   |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood                                   |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | Parents of 3, 4 and 5 year olds                   |
| Populations:**   |                                                   |
+------------------+---------------------------------------------------+
| **Risk           | Academic Failure Beginning in Late Elementary     |
| Factors:**       | School                                            |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Ranking:**     | Effective, OJJDP                                  |
+------------------+---------------------------------------------------+
| **Contact:**     | HIPPY USA\                                        |
|                  | 220 East 23rd Street, Suite 300\                  |
|                  | New York, NY  10010\                              |
|                  | E-mail: <info@hippyusa.org>                       |
|                  |                                                   |
|                  | Phone:  (212) 532-7730 ext. 400      Fax:  (212)  |
|                  | 532-7899                                          |
+------------------+---------------------------------------------------+

The Home Instruction Program for Preschool Youngsters (HIPPY) is a
home-based parent involvement, school readiness program. It helps
parents of three-, four- and five-year-old children prepare their
children for success in school and beyond.\
The two basic tenets of HIPPY are that:\
1. All children can learn; and,\
2. All parents want what\'s best for their children.

The HIPPY program is made up of four basic features:\
1. The curriculum, which (for each year) includes: thirty weeks of
activities (five days for each week) for parents to do with their
children, nine storybooks and 20 manipulative shapes;\
2. The home visitors who are paraprofessional staff and themselves
parents in the program, supervised by a professional coordinator;\
3. Role-play as the method of teaching the curriculum, both when
coordinators train home visitors and when home visitors work with
parents; and\
4. Home visits as the primary method of delivery, but with group
meetings that allow parents to meet and discuss/learn about common
issues and children to interact with other children in a supervised
environment.

Parents of three- and four-year-old children are recruited into the
program by the HIPPY coordinator, who chooses some of the parents to
hire as home visitors. The home visitors \"practice\" doing HIPPY with
their own child and then visit each of their case load of families
(10-15 per part-time home visitor) on a bi-weekly basis, to role-play
the upcoming week\'s curriculum, review the previous week\'s activities
and discuss any issues the parent may have. On the weeks when no home
visit takes place, a group meeting is held and role-play of the
curriculum takes place with parents as a group and then an enrichment
activity (chosen by the parents) is conducted. Once the group meeting is
over, or the home visit has taken place, the parent works, one-on-one,
with his/her child for 15-20 minutes per day for five days.

> Excerpt from materials provided by HIPPY USA.

+------------------+---------------------------------------------------+
| **Title:**       | **Home Visiting**                                 |
+------------------+---------------------------------------------------+
| **Type:**        | Universal                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Information Dissemination                         |
| Strategy:**      |                                                   |
|                  | Education                                         |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood, Parents of Pre-School Children   |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | African American, Caucasian, Hispanic, Low        |
| Populations:**   | Income, Children of High-Risk Mothers             |
+------------------+---------------------------------------------------+
| **Risk           | Family Management Problems                        |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
|                  | Bonding                                           |
+------------------+---------------------------------------------------+
| **Ranking:**     | Effective by OJJDP                                |
+------------------+---------------------------------------------------+
| **Contact:**     | For more information on this best practice, you   |
|                  | can order a free copy of *Preventing Crime: What  |
|                  | Works, What Doesn\'t, What\'s Promising*,         |
|                  | University of Maryland/Department of Criminology  |
|                  | and Criminal Justice and the U.S. Department of   |
|                  | Justice/Office of Justice Programs, 1997, from    |
|                  | the [National Criminal Justice Reference          |
|                  | Service](http://www.ncjrs.org/), (800) 851-3420.  |
|                  |                                                   |
|                  | For a copy of a summary of the \"Blueprint\"      |
|                  | (step-by-step instructions that will help         |
|                  | communities plan and implement youth crime and    |
|                  | violence prevention strategies) for this          |
|                  | program contact:\                                 |
|                  |  [Center for the Study and Prevention of          |
|                  | Violence](http://www.                             |
|                  | Colorado.EDU/cspv/blueprints/model/index.html), \ |
|                  |  Web-site:                                        |
|                  | <http://www.colorado.edu/cspv/blueprints>\        |
|                  |  Institute of Behavioral Science\                 |
|                  |  University of Colorado at Boulder\               |
|                  |  Campus Box 442\                                  |
|                  |      Boulder, CO  80309-0442\                     |
|                  |      (303) 492-8465                               |
+------------------+---------------------------------------------------+

Home visitation varies enormously in dosage levels, content, skill, and
context. Yet there are common effects reported across all these
variations. The common core of home visitation is a visitor who cares
about child rearing sitting down in a home with a parent and a child.
Visitors can be nurses, social workers, preschool teachers,
psychologists, or paraprofessionals. They can provide cognitive
information, emotional support, or both. They can actively teach
parents, with hands on the children. Or they can passively watch and
listen, merely giving parents a good listening to. They can be trained
in health, human development, cognitive and social skills instruction,
or some mixture of these subjects. They provide a bridge between the
parent, usually a mother, and the outside world.

> Excerpt from *Preventing Crime: What Works, What Doesn\'t, What\'s
> Promising*, University of Maryland, Department of Criminology and
> Criminal Justice and the U.S. Department of Justice, Office of Justice
> Programs, 1997, pages 4-10 through 4-15.

+------------------+---------------------------------------------------+
| **Title:**       | **Meld...Parenting That Works**                   |
+------------------+---------------------------------------------------+
| **Type:**        | Universal                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Education                                         |
| Strategy:**      |                                                   |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood                                   |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | African American, Hispanic, Asian, Special Needs, |
| Populations:**   | Single Parents, First-Time Parents, Young Parents |
+------------------+---------------------------------------------------+
| **Risk           | Early and Persistent Antisocial Behavior          |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
|                  | Bonding                                           |
+------------------+---------------------------------------------------+
| **Ranking:**     | Effective by OJJDP                                |
+------------------+---------------------------------------------------+
| **Contact:**     | Teri Holgate\                                     |
|                  | Meld\                                             |
|                  | 219 North Second Street, Suite 200\               |
|                  | Minneapolis, MN  55008\                           |
|                  | E-mail: <tholgate@meld.org>                       |
|                  |                                                   |
|                  | Phone: (612) 332-7563 x 111                       |
+------------------+---------------------------------------------------+

Meld programs bring parents with common needs together into groups that
meet over two years. They learn, grow, and become friends while solving
problems and creating healthy families. Volunteer group facilitators are
experienced parents who are carefully selected, trained and supported by
a Meld professional in each community. Meld replicates its programs in
new communities by certifying agency professionals to coordinate local
programs and train local volunteers. Program coordinators receive
training, consultation, and materials that guide program management.
Meld's network of certified professionals shares information, ideas,
support, and a common belief in the essential components of the Meld
program. Meld provides these sites with ongoing support and supervision
while giving local efforts national visibility. Meld offers programs
that use the peer-led self-help model of parents learning from each
other:

Meld for Young Moms:  Information and support for young single moms with
children from birth to age two.

Meld for Young Dads:  Helping young fathers (up to age 25) understand
and participate in their child's life.

Meld for New Parents:  First time parents learn about child development
from birth through age

Meld Special:  Support for parents of children with special needs, from
birth to age 3.

Meld for Growing Families:  Information and support for young moms with
children age 3 to 5.

Meld para la Nueva Familia:  For Hispanic/Latino immigrant families
struggling with bilingual/bicultural issues.

Meld for African American Young Mothers:  Culturally appropriate support
and information for adolescent African American mothers. 

> Excerpt from materials provided by Meld, December 2001.

+------------------+---------------------------------------------------+
| **Title:**       | **Parents as Teachers**                           |
+------------------+---------------------------------------------------+
| **Type:**        | Universal                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Education                                         |
| Strategy:**      |                                                   |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood                                   |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | Parents with children ages 0-5                    |
| Populations:**   |                                                   |
+------------------+---------------------------------------------------+
| **Risk           | Academic Failure Beginning in Late Elementary     |
| Factors:**       | School                                            |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
|                  | Bonding                                           |
+------------------+---------------------------------------------------+
| **Ranking:**     | Effective by OJJDP                                |
+------------------+---------------------------------------------------+
| **Contact:**     | Parents as Teachers National Center, Inc.\        |
|                  | 2228 Ball Drive\                                  |
|                  | St. Louis, MO 63146                               |
|                  |                                                   |
|                  | E-mail:   <info@patnc.org>\                       |
|                  | Phone:  (314) 432-4330 or  (866) 728-4968         |
|                  | Fax: (314) 432-8963                               |
+------------------+---------------------------------------------------+

Parents as Teachers (PAT) is an international early childhood parent
education and family support program serving families throughout
pregnancy until their child enters kindergarten, usually age 5. The
program is designed to enhance child development and school achievement
through parent education accessible to all families. It is a universal
access model.

The program provides the following services: 1) *personal visits\--*
PAT-certified parent educators help parents understand and have
appropriate expectations for each stage of their child\'s development;
2) *group meetings*\--parents meet to enhance their parenting knowledge,
gain new insights and share their experiences, common concerns and
successes; 3) *developmental screenings*\--Parents as Teachers offers
periodic screening of overall development, health, hearing, and vision
to provide early detection of potential problems and prevent later
difficulties in school; and 4) *linkage to a resource network*\--
families are helped to access other needed community services that are
beyond the scope of the PAT program.

> Excerpt from Strengthening America\'s Families\' web site,
> <http://www.strengtheningfamilies.org/index.html> with modification by
> Parents As Teachers staff on August 2, 2001.

+------------------+---------------------------------------------------+
| **Title:**       | **Promoting Alternative Think Strategies          |
|                  | (PATHS)**                                         |
+------------------+---------------------------------------------------+
| **Type:**        | Universal                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Information Dissemination                         |
| Strategy:**      |                                                   |
|                  | Education                                         |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood, Elementary School                |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | Rural, Suburban, Urban                            |
| Populations:**   |                                                   |
+------------------+---------------------------------------------------+
| **Risk           | Early and Persistent Antisocial Behavior          |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Ranking:**     | SAMHSA Model Program                              |
+------------------+---------------------------------------------------+
| **Contact:**     | Carol A. Kusché, Ph.D.\                           |
|                  | Mark T. Greenberg, Ph.D.\                         |
|                  | Prevention Research Center\                       |
|                  | Henderson Building S-109\                         |
|                  | Pennsylvania State University\                    |
|                  | University Park, PA 16802\                        |
|                  | Phone: (814) 863-0112\                            |
|                  | Fax: (814) 865-2530\                              |
|                  | E-mail: <mxg47@psu.edu>\                          |
|                  | Web site:                                         |
|                  | [www.prevention.psu.edu/PATH                      |
|                  | S/](http://modelprograms.samhsa.gov/template_cf.c |
|                  | fm?page=exit&link=www.prevention.psu.edu/PATHS/)\ |
|                  | Channing Bete Company\                            |
|                  | One Community Place\                              |
|                  | South Deerfield, MA 01373\                        |
|                  | Phone: (877) 896-8532\                            |
|                  | Fax: (800) 499-6464\                              |
|                  | E-mail: <PrevSci@channing-bete.com>\              |
|                  | Web site:                                         |
|                  | [www.preventionscie                               |
|                  | nce.com](http://modelprograms.samhsa.gov/template |
|                  | _cf.cfm?page=exit&link=www.preventionscience.com) |
+------------------+---------------------------------------------------+

PATHS (Promoting Alternative THinking Strategies) is a comprehensive
program for promoting emotional and social competencies and reducing
aggression and acting-out behaviors in elementary-school-aged children,
while simultaneously enhancing the educational process in the classroom.
This innovative curriculum for kindergarten through sixth grade (ages 5
to 12) is used by educators and counselors as a multiyear, prevention
model. The PATHS curriculum provides teachers with systematic and
developmentally based lessons, materials, and instructions for teaching
their students the following:

> Emotional literacy
>
> Self-control
>
> Social competence
>
> Positive peer relations
>
> Interpersonal problem-solving skills

The PATHS curriculum has been shown to improve protective factors and
reduce behavioral risk factors. Evaluations have demonstrated
significant improvements for program youth, including those in general
education and special needs settings. Although primarily focused on
school and classroom settings, information and activities are also
included for use with parents.

> Excerpt from SAMHSA Model Program website,
> [http://modelprograms.samhsa.gov](http://modelprograms.samhsa.gov/).

+------------------+---------------------------------------------------+
| **Title:**       | **Perry Preschool Project-High/Scope Approach**   |
+------------------+---------------------------------------------------+
| **Type:**        | Selective                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Education                                         |
| Strategy:**      |                                                   |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood                                   |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | Low Socioeconomic Families, African American      |
| Populations:**   |                                                   |
+------------------+---------------------------------------------------+
| **Risk           | Early and Persistent Antisocial Behavior          |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
|                  | Bonding                                           |
+------------------+---------------------------------------------------+
| **Ranking:**     | Effective by CSAP                                 |
+------------------+---------------------------------------------------+
| **Contact:**     | Gavin Haque\                                      |
|                  | High Scope Educational Research Foundation\       |
|                  | 600 North River ST\                               |
|                  | Ypsilanti, MI  48198-2898\                        |
|                  | Web-site:                                         |
|                  | [http                                             |
|                  | ://www.highscope.org](http://www.highscope.org/)\ |
|                  | Email:                                            |
|                  | [G                                                |
|                  | avinH@highscope.org](mailto:larrys@highscope.org) |
|                  | Phone:  (734) 485-2000 or                         |
|                  |                                                   |
|                  | \(800\) 407-7377    Fax: (734) 485-0704           |
+------------------+---------------------------------------------------+

The High/Scope Approach, based on the work of Jean Piaget and other
constructivists, calls for teachers sharing control with their students
while providing exciting classroom experiences based on children\'s
strengths, needs, and interests.

Research from the High/Scope Perry Preschool study indicates that such
an intervention program promotes the general welfare of students and
their families through greater employment opportunities, lower
participation in welfare programs, lower teenage pregnancy rates, and a
decrease in violent crime.

The High/Scope Approach can be implemented in many types of settings:
center-based, home-based, and shared environments. Successful programs
that implement High/Scope\'s approach share the following
characteristics:

\*  A developmentally appropriate curriculum that views children as
active, self-initiated learners.\
\*  Small classrooms of 20 children and at least 2 staff who allow a
more supervised and supportive learning environment.\
\*  Staff who are trained in early childhood development and education,
who receive supervision and on-going instruction, and who actively
communicate with parents.\
\*  Sensitivity to the non-educational needs of disadvantaged children
and their families, which includes providing meals and recommending
other social service agencies.\
\*  Ongoing monitoring and evaluation of both teachers\' activities and
children\'s behaviors and development.

> Information provided by Gavin Haque of High Scope Education Research
> Foundation, June 28, 2001.

+------------------+---------------------------------------------------+
| **Title:**       | **Project Achieve**                               |
+------------------+---------------------------------------------------+
| **Type:**        | Universal, Selective                              |
+------------------+---------------------------------------------------+
| **CSAP           | Information Dissemination                         |
| Strategy:**      |                                                   |
|                  | Education                                         |
+------------------+---------------------------------------------------+
| **Service        | Preschool, Elementary                             |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | 3-14 Year Olds                                    |
| Populations:**   |                                                   |
+------------------+---------------------------------------------------+
| **Risk           | Early and Persistent Antisocial Behavior          |
| Factors:**       |                                                   |
|                  | School Failure                                    |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
|                  | Communication and Problem-Solving                 |
|                  |                                                   |
|                  | Prosocial Behavior and Conflict Resolution        |
+------------------+---------------------------------------------------+
| **Ranking:**     | SAMHSA Model Program                              |
+------------------+---------------------------------------------------+
| **Contact:**     | Sopris west, Inc                                  |
|                  |                                                   |
|                  | 4093 Specialty Place                              |
|                  |                                                   |
|                  | Longmont, CO 80504                                |
|                  |                                                   |
|                  | 800 547-6747                                      |
|                  |                                                   |
|                  | www.sopriswest.com                                |
+------------------+---------------------------------------------------+

Project ACHIEVE is an innovative school reform and school effectiveness
program developed for use in preschool, elementary, and middle schools
(students 3 to 14 years old). It is designed to help schools,
communities, and families develop, strengthen, and solidify their
youths' resilience, protective factors, and self-management skills.
Project ACHIEVE works to improve school and staff effectiveness and
places particular emphasis on increasing student performance in the
areas of:

• Social skills and social-emotional development

• Conflict resolution and self-management

• Achievement and academic progress

• Positive school climate and safe school practices

Project ACHIEVE implements school wide positive behavioral and academic
prevention programs that focus on the needs of all students. It also
develops and implements strategic intervention programs for at-risk and
underachieving students, and it coordinates comprehensive and
multifaceted "wrap-around" programs for students with intensive needs.

> Excerpt from SAMHSA Model Program website,
> [http://modelprograms.samhsa.gov](http://modelprograms.samhsa.gov/).

+------------------+---------------------------------------------------+
| **Title:**       | **Raising A Thinking Child**                      |
+------------------+---------------------------------------------------+
| **Type:**        | Universal                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Education                                         |
| Strategy:**      |                                                   |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood, Elementary School                |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | African American, Caucasian, Special Needs,       |
| Populations:**   | Children 4-7 years olds and their Parents, Middle |
|                  | and Upper Middle Income Caucasian Families, ADHD  |
+------------------+---------------------------------------------------+
| **Risk           | Early and Persistent Antisocial Behavior          |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Ranking:**     | Effective by OJJDP                                |
+------------------+---------------------------------------------------+
| **Contact:**     | Myrna Shure, Ph.D.\                               |
|                  | Drexel University\                                |
|                  | 245 North 15th Street, MS 626\                    |
|                  | Philadelphia, PA  19102-1192\                     |
|                  | E-mail: <mshure@drexel.edu> Phone: (215)          |
|                  | 762-7205                                          |
|                  |                                                   |
|                  | Fax: (215) 762-8625                               |
+------------------+---------------------------------------------------+

The focus of this program is on developing a set of interpersonal
cognitive problem solving (ICPS) skills that relate to overt behaviors
as early as preschool. By enhancing ICPS skills, the ultimate goal is to
increase the probability of preventing later, more serious problems by
addressing the behavioral predictors early in life.

In addition to behavioral outcomes, the parent intervention is designed
to help parents use a problem solving style of communication that guides
young children to think for themselves. The program was originally
designed for mothers or legal guardians of African-American, low-income
four year-olds. The program now includes parents of children up to age
seven and has been expanded to include middle and upper-middle income
populations in the normal behavioral range as well as those displaying
early high-risk behaviors. These include those diagnosed with Attention
Deficit Hyperactivity Disorder and other special needs.

The program takes ten to twelve weekly sessions to complete, although a
minimum of six weeks is sufficient to convey the approach. The first
section focuses on learning a problem-solving vocabulary in the form of
games.

The second section concentrates on teaching children how to listen. It
also teaches them how to identify their own and other's feelings, and to
realize that people can feel different ways about the same thing.

 In the last section children are given hypothetical problems and are
asked to think about people's feelings, consequences to their acts, and
different ways to solve problems.

During the program, parents are given exercises to help them think about
their own feelings and become sensitive to those of their children.
Parents also learn how to find out their child's view of the problem and
how to engage their child in the process of problem solving.

> Excerpt from Strengthening America\'s Families\' web site,
> <http://www.strengtheningfamilies.org/index.html>.

+------------------+---------------------------------------------------+
| **Title:**       | **Second Step**                                   |
+------------------+---------------------------------------------------+
| **Type:**        | Universal                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Information Dissemination                         |
| Strategy:**      |                                                   |
|                  | Education                                         |
+------------------+---------------------------------------------------+
| **Service        | Early Childhood, Elementary School                |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | Suburban, Urban, Rural, Ages 2-14                 |
| Populations:**   |                                                   |
+------------------+---------------------------------------------------+
| **Risk           | Early and Persistent Antisocial Behavior          |
| Factors:**       |                                                   |
|                  | Aggression                                        |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
|                  | Social Emotional Competence                       |
+------------------+---------------------------------------------------+
| **Ranking:**     | SAMHSA Model Program                              |
+------------------+---------------------------------------------------+
| **Contact:**     | Barbara Guzzo\                                    |
|                  | Committee for Children\                           |
|                  | Client Support Services Dept.\                    |
|                  | 568 First Avenue, Suite 600\                      |
|                  | Seattle, WA 98104\                                |
|                  | Phone: (800) 634-4449\                            |
|                  | Fax: (206) 438-6765\                              |
|                  | E-mail: <info@cfchildren.org>\                    |
|                  | Web site:                                         |
|                  | [www.cfchildren.org/program_ss.shtml](h           |
|                  | ttp://modelprograms.samhsa.gov/template_cf.cfm?pa |
|                  | ge=exit&link=www.cfchildren.org/program_ss.shtml) |
+------------------+---------------------------------------------------+

Second Step is a classroom-based social skills program for preschool
through junior high students (4 to 14 years old). It is designed to
reduce impulsive, high-risk, and aggressive behaviors; and increase
children\'s social-emotional competence and other protective factors.

Group discussion, modeling, coaching, and practice are used to increase
students\' social competence, risk assessment, decision-making ability,
self-regulation, and positive goal setting. The program's lesson content
varies by grade level and is organized into three skill-building units
covering the following:

> Empathy: teaches young people to identify and understand their own
> emotions and those of others;
>
> Impulse control and problem solving: helps young people choose
> positive goals; reduce impulsiveness; and evaluate consequences of
> their behavior in terms of safety, fairness, and impact on others;
> and,
>
> Anger management: enables young people to manage emotional reactions
> and engage in decision making when they are highly aroused.
>
> Excerpt from SAMHSA Model Program website,
> [http://modelprograms.samhsa.gov](http://modelprograms.samhsa.gov/).

+------------------+---------------------------------------------------+
| **Title:**       | **Too Good For Drugs**                            |
+------------------+---------------------------------------------------+
| **Type:**        | Universal                                         |
+------------------+---------------------------------------------------+
| **CSAP           | Information Dissemination                         |
| Strategy:**      |                                                   |
|                  | Education                                         |
+------------------+---------------------------------------------------+
| **Service        | Elementary School                                 |
| Population:**    |                                                   |
+------------------+---------------------------------------------------+
| **Special        | K-12, Ages 5-18                                   |
| Populations:**   |                                                   |
+------------------+---------------------------------------------------+
| **Risk           | Favorable Attitudes Toward Drug Use               |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Protective     | Skills                                            |
| Factors:**       |                                                   |
+------------------+---------------------------------------------------+
| **Ranking:**     | SAMHSA Model Program                              |
+------------------+---------------------------------------------------+
| **Contact:**     | Susan K. Chase\                                   |
|                  | Director of Training\                             |
|                  | Prevention Education Programs\                    |
|                  | Mendez Foundation\                                |
|                  | 601 S. Magnolia Avenue\                           |
|                  | Tampa, FL 33606\                                  |
|                  | Phone: (800) 750-0986 ext.206\                    |
|                  | Fax: (813) 251-3237\                              |
|                  | E-mail: <schase@mendezfoundation.org>\            |
|                  | Web site:                                         |
|                  | [www.mendezfoundati                               |
|                  | on.org/](http://modelprograms.samhsa.gov/template |
|                  | _cf.cfm?page=exit&link=www.mendezfoundation.org/) |
+------------------+---------------------------------------------------+

Too Good For Drugs (TGFD) is a school-based prevention program designed
to reduce the intention to use alcohol, tobacco, and illegal drugs in
middle and high school students. Developed by the Mendez Foundation for
use with students in kindergarten through 12th grade (5 to 18 years
old), TGFD has a separate, developmentally appropriate curriculum for
each grade level, and is designed to develop:

Personal and interpersonal skills relating to alcohol, tobacco, and
illegal drug use

Appropriate attitudes toward alcohol, tobacco, and illegal drug use

Knowledge of the negative consequences of alcohol, tobacco, and illegal
drug use and benefits of a drug-free lifestyle

Positive peer norms

The program\'s highly interactive teaching methods encourage students to
bond with prosocial peers, and engages students through role-play,
cooperative learning, games, small group activities and class
discussions. Students have many opportunities to participate and receive
recognition for involvement. TGFD also impacts students through a family
component used in each grade level: \"Home Workouts\" is available for
use with families in kindergarten through 8th grade, and \"Home Pages\"
is used in high school.

> Excerpt from SAMHSA Model Program website,
> [http://modelprograms.samhsa.gov](http://modelprograms.samhsa.gov/).