Increased availability of research-supported, school-based prevention programs, coupled with the growing national policy emphasis on use of evidence-based practices, has contributed to a shift in research priorities from efficacy to implementation and dissemination. A critical issue in moving research to practice is ensuring high-quality implementation of both the intervention model and the support system for sustaining it. The paper describes a three-level framework for considering the implementation quality of school-based interventions. Future directions for research on implementation are discussed.

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Background-The Good Behavior Game (GBG), a method of classroom behavior management used by teachers, was tested in first-and second-grade classrooms in 19 Baltimore City Public * Supplementary data on Cohort 2 and additional information on the Good Behavior Game intervention are available with the online version of this paper at http://dx.doi.org by entering doi: xxxxxxxx.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Schools beginning in the 1985-1986 school year. The intervention was directed at the classroom as a whole to socialize children to the student role and reduce aggressive, disruptive behaviors, confirmed antecedents of later substance abuse and dependence disorders, smoking, and antisocial personality disorder. This article reports on impact to age 19-21. NIH Public AccessMethods-In five poor to lower-middle class, mainly African American urban areas, three or four schools were matched and within each set randomly assigned to one of three conditions: 1) GBG, 2) a curriculum-and-instruction program directed at reading achievement, or 3) the standard program. Balanced assignment of children to classrooms was made, and then, within intervention schools, classrooms and teachers were randomly assigned to intervention or control.Results-By young adulthood significant impact was found among males, particularly those in first grade who were more aggressive, disruptive, in reduced drug and alcohol abuse/dependence disorders, regular smoking, and antisocial personality disorder. These results underline the value of a first-grade universal prevention intervention.Replication-A replication was implemented with the next cohort of first-grade children with the same teachers during the following school year, but with diminished mentoring and monitoring of teachers. The results showed significant GBG impact for males on drug abuse/dependence disorders with some variation. For other outcomes the effects were generally smaller but in the same direction.

The present study used general growth mixture modeling to identify pathways of antisocial behavior development within an epidemiological sample of urban, primarily African American boys. Teacher-rated aggression, measured longitudinally from 1st to 7th grade, was used to define growth trajectories. Three high-risk trajectories (chronic high, moderate, and increasing aggression) and one low-risk trajectory (stable low aggression) were found. Boys with chronic high and increasing trajectories were at increased risk for conduct disorder, juvenile and adult arrest, and antisocial personality disorder. Concentration problems were highest among boys with a chronic high trajectory and also differentiated boys with increasing aggression from boys with stable low aggression. Peer rejection was highest among boys with chronic high aggression. Interventions with boys with distinct patterns of aggression are discussed.Antisocial behavior is among the most common and serious mental health problems presently faced in the United States (Kessler et al., 1994). Conduct disorder is one of the most prevalent disorders of childhood (3%-10%; Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993) and is associated with an array of other problems, including school failure, substance abuse, and adult psychiatric disorder (

In this article, we examine the impact of two universal, first-grade preventive interventions on the prevalence of conduct problems and disorder and mental health service need and use in early adolescence. The classroom-centered (CC) intervention was designed to reduce the risk for later conduct problems and disorder by enhancing teachers' behavior management in first grade, whereas the Family-School Partnership (FSP) intervention targeted improvement in parent-teacher communication and parents' child behavior management strategies. At Grade 6, or age 12, CC and FSP intervention children received significantly lower ratings from their teachers for conduct problems than control children. CC and FSP children were also significantly less likely than control children to meet diagnostic criteria for Conduct Disorder and to have been suspended from school in the last year. In addition, the CC intervention was associated with significantly lower rates of child mental health service need and utilization. Overall, the CC intervention appeared to be the more effective of the two in reducing the prevalence of conduct problems and disorder at age 12 and in reducing mental health service need and utilization. Nevertheless, future studies may show that the combination of CC and FSP interventions produces additive or even synergistic effects.

School-based prevention programs can positively impact a range of social, emotional, and behavioral outcomes. Yet the current climate of accountability pressures schools to restrict activities that are not perceived as part of the core curriculum. Building on models from public health and prevention science, we describe an integrated approach to school-based prevention. These models leverage the most effective structural and content components of social-emotional and behavioral health prevention interventions. Integrated interventions are expected to have additive and synergistic effects that result in greater impacts on multiple student outcomes. Integrated programs are also expected to be more efficient to deliver, easier to implement with high quality and integrity, and more sustainable. We provide a detailed example of the process through which the PAX-Good Behavior Game and the Promoting Alternative Thinking Strategies (PATHS) curriculum were integrated into the PATHS to PAX model. Implications for future research are proposed.

Multiple group analysis and general growth mixture modeling was used to determine whether aggressive-disruptive behavior trajectories during elementary school, and their association with young adulthood antisocial outcomes, vary by gender. Participants were assessed longitudinally beginning at age 6 as part of an evaluation of 2 school-based preventive programs. Two analogous trajectories were found for girls and boys: chronic high aggression-disruption (CHAD) and stable low aggressiondisruption (LAD). A 3rd class of low moderate aggression-disruption (LMAD) for girls and increasing aggression-disruption (IAD) for boys also was found. Girls and boys in analogous CHAD classes did not differ in trajectory level and course, but girls in the CHAD and LAD classes had lower rates of antisocial outcomes than boys. Girls with the LMAD trajectory differed from boys with the IAD trajectory.

Objective-This paper reports the impact of two first-and second-grade classroom based universal preventive interventions on the risk of Suicide Ideation (SI) and Suicide Attempts (SA) by young adulthood. The Good Behavior Game (GBG) was directed at socializing children for the student role and reducing aggressive, disruptive behavior. Mastery Learning (ML) was aimed at improving academic achievement. Both were implemented by the teacher.⋆ Supplementary data on the second cohort can be accessed with the online version of this paper at http://dx.doi.org by entering *Corresponding author. Tel.: +1 410 502 0629. E-mail address: hwilcox1@jhmi.edu (H.C. Wilcox). Conflict of interest All other authors declare that they have no conflicts of interest.Contributors: Dr. Wilcox led data analyses, managed the literature searches, participated in project management and supervision of the NIDA young adult assessment, wrote the first draft and incorporated coauthor feedback on all subsequent drafts.Dr. Kellam was P.I. of the main grants that supported this work throughout the period of the trial and the young adult outcomes, with the important exceptions of the Prevention Science Methodology grant led by Dr. Brown and many of the grants supporting studies and measures of drug use from early childhood into early adulthood and suicidality led by Dr. Anthony. Both Brown and Anthony collaborated with Kellam in the initial forming of the designs and periodic follow-up. Kellam led the Life Course/Social Field and Developmental Epidemiological conceptual frame that underlies the work, and led the trial reported here including the measures and choice of the intervention and its lead staff persons and the precision of its implementation. He led the community and institutional base building and its maintenance including the core partnership with Baltimore City Public School System. He collaborated in defining the research question reported in this paper and the analytic strategies employed. Lastly, he participated in the writing of the manuscript and its final assessment prior to submission.Drs. Brown, Anthony, and Wang provided supervision on data analyses and interpretation. Brown and Wang also undertook mediation analysis.Drs. Poduska and Ialongo participated in manuscript writing, data design and collection, and project supervision. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptMethods-The design was epidemiologically based, with randomization at the school and classroom levels and balancing of children across classrooms. The trial involved a cohort of firstgrade children in 19 schools and 41 classrooms with intervention at first and second grades. A replication was implemented with the next cohort of first grade children with the same teachers but with little mentoring or monitoring.Results-In the first cohort, there was consistent and robust GBG-associated reduction of risk for suicide ideation by age 19-21 years compared to youths in standard setting (control) classrooms regardless of any type o...