This article proposes that universal and targeted preventive interventions should be compared and evaluated in terms of their benefit–cost ratio in achieving population‐wide impact on mental ...disorders and related outcomes. Universal approaches attempt to affect every individual in a population, whereas targeted approaches select candidates for intervention based on screening of demographic or behavioral characteristics. Unique assets and challenges of each approach in achieving population impact in a cost‐efficient way are discussed, along with spillover effects, sensitivity and specificity, developmental processes, timing of intervention, and the relation between severity of risk and plasticity. A general targeted‐efficiency framework is proposed as a heuristic to evaluate the collective merits of universal and targeted approaches in specific cases. A tiered approach that combines universal and targeted identification strategies is proposed, and examples are described. Issues for high‐priority research are identified.
Read the Commentary on this article at doi: 10.1111/jcpp.13196
A model of the development of hostile attributional style and its role in children's aggressive behavior is proposed, based on the translation of basic science in ethology, neuroscience, social ...psychology, personality psychology, and developmental psychology. Theory and findings from these domains are reviewed and synthesized in the proposed model, which posits that (a) aggressive behavior and hostile attributions are universal human characteristics, (b) socialization leads to the development of benign attributions, (c) individual differences in attributional style account for differences in aggressive behavior, and (d) interventions to change attributions have the potential to alter antisocial development. Challenges for future research are described.
Child development science has not fully realized its mission to improve population outcomes for children and eliminate disparities across race and income groups. One domain with great need but also ...great potential is the challenge parents face in raising a young child. A system of universal primary psychosocial care is proposed, with three components: a comprehensive infrastructure of community resources, such as North Carolina's Smart Start; financial supports for specific interventions, such as pre‐kindergarten; and a way to help families identify and address family‐specific needs, such as Family Connects. Empirical studies demonstrate the promise of each component for population impact and disparity elimination but also the need for continued improvement. Developmental scientists are called upon to fulfill their mission.
Acting alone, psychologists rarely achieve population impact on important mental health and well-being outcomes for families and young children. The traditional Institute of Medicine model of moving ...from efficacy trials to effectiveness trials to scaling up has not succeeded, partly due to degradation of program quality and impact during scale-up and partly due to a failure to consider system-context issues at the outset. Analysis of barriers to population impact leads to the proposal of a new comprehensive system of care that includes both top-down coordination among community agencies providing services and bottom-up outreach to every family to connect them with services. The North Carolina Smart Start Initiative is a top-down approach to improving the community-level quality of early childcare and education services. A natural experiment demonstrates that it improves population indicators of children's education outcomes. Family Connects is a bottom-up approach that reaches all families giving birth in a community through brief home visits to assess needs and connect families with community resources. A randomized controlled trial reveals increased community connectedness, lower maternal anxiety, reduced emergency health episodes, and lower rates of investigations for child abuse. These initiatives point toward the promise of population impact through psychological interventions in early life that are delivered in a collaborative system of care.
In the interest of improving child maltreatment prevention, this prospective, longitudinal, community-based study of 499 mothers and their infants examined (a) direct associations between mothers' ...experiences of childhood maltreatment and their offspring's maltreatment, and (b) mothers' mental health problems, social isolation, and social information processing patterns (hostile attributions and aggressive response biases) as mediators of these associations. Mothers' childhood physical abuse—but not neglect—directly predicted offspring victimization. This association was mediated by mothers' social isolation and aggressive response biases. Findings are discussed in terms of specific implications for child maltreatment prevention.
Research predicting academic achievement from early academic, attention, and socioemotional skills has largely focused on elementary school outcomes and rarely included peer assessments of social ...competence. We examined associations between these early child characteristics and academic outcomes into young adulthood using the Fast Track normative sample (n = 386). Reading achievement after fifth grade was significantly higher in children with better early reading skills and significantly lower in children with early attention difficulties. Math achievement was predicted by early reading and math skills, while school grades were significantly lower in children with lower peer acceptance and higher attention difficulties. Children with early attention difficulties were 40% less likely to graduate from high school. Years of education by young adulthood was significantly reduced in children with lower early reading skills, lower social acceptance, and higher attention difficulties; these early child characteristics affected long-term academic outcomes indirectly through their impact on intermediate academic outcomes.
Abstract Purpose This study aimed to advance a public health perspective on links between education and health by examining risk and protective factors that might alter the relation between dropping ...out of high school and subsequent negative outcomes. Methods A community sample (N = 585) was followed from age 5 to 27 years. Data included self and parent reports, peer sociometric nominations, and observed mother-teen interactions. Results High school dropouts were up to four times more likely to experience individual negative outcomes (being arrested, fired, or on government assistance, using illicit substances, having poor health) by age 27 years and 24 times more likely compared to graduates to experience as many as four or more negative outcomes. Links between dropout and negative outcomes were more pronounced for individuals who were in low socioeconomic status families at age 5 years, rejected by elementary school peers, and became parents at a younger age; the dropout effect was decreased for individuals who had been treated for a behavioral, emotional, or drug problem by age 24 years. Conclusions Addressing school dropout as a public health problem has the potential to improve the lives of dropouts and reduce societal costs of dropping out.
This randomized controlled trial tested the efficacy of early intervention to prevent adult psychopathology and improve well-being in early-starting conduct-problem children.
Kindergarteners ...(N=9,594) in three cohorts (1991-1993) at 55 schools in four communities were screened for conduct problems, yielding 979 early starters. A total of 891 (91%) consented (51% African American, 47% European American; 69% boys). Children were randomly assigned by school cluster to a 10-year intervention or control. The intervention goal was to develop social competencies in children that would carry them throughout life, through social skills training, parent behavior-management training with home visiting, peer coaching, reading tutoring, and classroom social-emotional curricula. Manualization and supervision ensured program fidelity. Ninety-eight percent participated during grade 1, and 80% continued through grade 10. At age 25, arrest records were reviewed (N=817, 92%), and condition-blinded adults psychiatrically interviewed participants (N=702; 81% of living participants) and a peer (N=535) knowledgeable about the participant.
Intent-to-treat logistic regression analyses indicated that 69% of participants in the control arm displayed at least one externalizing, internalizing, or substance abuse psychiatric problem (based on self- or peer interview) at age 25, in contrast with 59% of those assigned to intervention (odds ratio=0.59, CI=0.43-0.81; number needed to treat=8). This pattern also held for self-interviews, peer interviews, scores using an "and" rule for self- and peer reports, and separate tests for externalizing problems, internalizing problems, and substance abuse problems, as well as for each of three cohorts, four sites, male participants, female participants, African Americans, European Americans, moderate-risk, and high-risk subgroups. Intervention participants also received lower severity-weighted violent (standardized estimate=-0.37) and drug (standardized estimate=-0.43) crime conviction scores, lower risky sexual behavior scores (standardized estimate=-0.24), and higher well-being scores (standardized estimate=0.19).
This study provides evidence for the efficacy of early intervention in preventing adult psychopathology among high-risk early-starting conduct-problem children.
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