Program

Apr 08, 2013

OVERVIEW

The Early Risers “Skills for Success” is a multi-year program that aims to reduce aggressive behaviors using a summer program for children, teacher consultation, child social skills groups, and a parent education and skills training program. The program targets elementary school children in kindergarten and first grade who exhibit aggressive behaviors to prevent them from developing more serious anti-social behaviors. The CORE program focuses on the children, while the CORE + FLEX adds an individualized case management program focusing on the family.  Experimental evaluations of Early Risers found significant impacts for children who participated in the intervention on some measures of school adjustment, academic competence, peer relations, and social competence, and for parents on parental stress. However, a follow-up study found that impacts were no longer significant after one year. Another follow-up study found that there was a significant impact on symptoms of oppositional defiant disorder and conduct disorder, but not on diagnoses or on substance use. In addition, subgroup analyses by severity showed that the program was more effective with children who with high levels of aggression at baseline. Finally, a study comparing the CORE only program to CORE + FLEX found that there were no differences in outcomes between the two versions of the program.

DESCRIPTION OF PROGRAM

Target population: The program targets elementary school children who exhibit aggressive behaviors and are at risk for more serious anti-social behavior.

The goal of the Early Risers program is to promote positive socio-emotional development into middle childhood and adolescence by targeting younger children who exhibit aggressive behaviors.  There are two main components to the Early Risers program; a child-focused intervention (CORE) and a family-focused support and empowerment program (FLEX).

The CORE component consists of an annual summer school program, a teacher consultation and student mentoring program, a child social skills group, and a parent education and skills training group. Participants in the intervention participate in the summer program four days a week for six weeks alongside an equal number of low risk children who serve as peer mentors. Time is split between academic learning centers, social skills training groups, creative arts/sports skills development, large group recreation, and lunch/recess. The summer program is adapted from Pelham’s Summer Treatment Program for children with disruptive behavior (Pelham, 1994), and involves a point system, daily report card,  and a “buddy system” which pairs aggressive children with non aggressive peers for activities to promote development of social skills. The teacher consultation and student mentoring component of CORE consists of family advocates making weekly visits to schools during the school year to review student progress and consult with teachers, primarily on classroom accommodations, teaching life skills curriculum lessons, advocacy for supplemental services, and facilitating parent-teacher communication. The family advocates also mentored students. The child social skills group and parent education and skills training group are conducted together in biweekly two hour sessions from October to May during the school year in groups of 8 to 12 families. Sessions start with a communal meal, followed by separate parent and child groups, and conclude with a parent-child interactive activity. The parent and child groups followed the Incredible Years Series curriculum.

The FLEX component is a case management program in which families work with family advocates to decide what actions are necessary for family and child wellness. It focuses on asset appraisal and risk assessment, family goal setting and strategic planning, service options, and monitoring of goals and adjusting as necessary. It is done by phone or using home visits.

The program ranges in cost from $1,200 to $2,000 per child, per year.  Training for the program runs from three to five days and costs $5,000.

EVALUATION(S) OF PROGRAM

Study 1a

August, G. J., Realmuto, G. M., Hektner, J. M., & Bloomquist, M. L. (2001). An integrated components preventive intervention for aggressive elementary school children: The Early Risers program. Jounal of Consulting and Clinical Psychology, 69(4), 614-626.

Evaluated Population:  The evaluated sample included 245 students recruited as kindergarteners across 20 schools at two regional sites.  The schools were located in semi-rural areas with a majority of low to low-middle socioeconomic status Caucasian families. The students in the sample were identified in kindergarten as being at-risk for early-onset aggressive behavior. The mean age of the sample was 6.6 years old, and boys made up 69 percent of the sample.  In the intervention group 15.3 percent of the children were minorities, and in the control group 6.6 percent were minorities. Approximately 24 percent of the participants were in single parent families.

Approach: At each of the two sites, five schools were randomly assigned to the intervention and five schools to the control group. Kindergarten students at all 20 schools were screened for being at risk for aggression, and those who were at risk were asked to participate in the study, resulting in the final sample of 245 students. Those at risk students who were in schools randomly assigned to the intervention received both CORE and FLEX components of the Early Risers program. Students from control schools did not receive any aspect of the Early Risers program. Attrition over the two years was 18% and did not differ between intervention and control groups.

Outcome measurements included teacher report, parental report, and directly-assessed child measures. Four main outcomes were measured: academic competence, behavioral self-regulation, social competence, and parent investment in the child. Assessments occurred each year in May and June.

Results: As a result of the program, academic competence improved over time for the intervention group. The intervention group also had significantly higher academic competence than the control group at the end of year 2 (effect size=.26). There was no significant overall program impact on behavioral self-regulation, and both groups improved over time. However, subgroup analyses by severity showed that among children who were severely aggressive at baseline, the intervention group improved, while the control group stayed the same. Both the intervention and control groups improved over time on social competence, but there was no difference between the groups. There was no change over time in parent investment for either group.

Study 1b

August, G. J., Hektner, J.M., Egan, E. A., Realmuto, G. M., & Bloomquist, M.L. (2002). The Early Risers Longitudinal Prevention Trial: Examination of 3-Year Outcomes in Aggressive Children With Intent-to-Treat and As-Intended Analyses. Psychology of Addictive Behaviors, 16 (4S) S27-S39.

Evaluated Population:  This study is a follow-up to Study 1a and thus uses the same initial sample. By the end of year 3, 199 of the 245 participants (81.2%) were still in the study. There was no difference between children who dropped out and those who remained in the study.

Approach: See Study 1a for randomization procedures. During the third year of the intervention, the parent sessions reviewed previous content rather than using a formal curriculum.

Four main outcomes were measured on an annual basis from baseline through the end of year 3: academic competence (academic achievement and concentration problems), behavioral self-regulation (impulsivity, hyperactivity, and aggression), social competence (social skills and adaptability), and parent investment in the child (nurturance, parent distress, and effective discipline).

Results:

In terms of academic competence, at the end of year 3 there was a significant improvement in academic achievement compared with control children, but there was no impact on concentration problems. There were no overall impacts on behavioral self-regulation at the end of year 3. However, subgroup analyses by severity found that among children with mild aggression at baseline, the control group showed greater improvement in impulsivity. Among children with severe aggression at baseline, the intervention group showed greater improvement in impulsivity, but there was no significant difference in impulsivity between the two groups when controlling for baseline scores. In terms of social competence, at the end of year 3 there was a significant improvement in social skills compared with control children, but there was no impact on adaptability. In terms of parent investment, at the end of year 3 there was a marginally greater improvement in effective discipline compared with control group parents, but there was no impact on nurturance or parent distress.

Study 1c

August, G. J., Egan, E. A., Realmuto, G. M., & Hektner, J. M. (2003). Four years of the Early Risers early-age-targeted preventive intervention: Effects on aggressive children’s peer relations. Behavior Therapy, 34, 453-470.

Evaluated Population: This is a follow-up to Study 1a and thus uses the same initial sample. At the end of year 4, 179 of the original 245 children (73.1%) were still in the study. Only children in schools with at least two students in the study were asked to participate in measures for this evaluation, and there were two schools that refused to participate. The final evaluated sample consisted of 125 4th grade children, which included 75 program children and 50 control children.

Approach: See Study 1a for randomization procedures. At baseline there were no significant differences between the program and control children. Data were collected on the outcome measures of peer reputation (leadership, social etiquette, sensitive-isolated, and aggressive-disruptive), likability, friendship selection, and best friend’s peer reputation.

Results: In terms of peer reputation, intervention children had higher leadership and social etiquette scores, compared with control children, but there was no impact on sensitive-isolated or aggressive-disruptive scores. In terms of best friend’s peer reputation, program children’s best friends had lower aggressive-disruptive scores than best friends of control children, but there was no impact on best friend’s leadership, social etiquette, or sensitive-isolated scores. Subgroup analyses by gender and reciprocity of friendships showed that for boys with reciprocal friendship, the best friends of boys in the control group had higher social etiquette scores than the best friends of boys in the program group. There was no program impact on the outcomes of likability or friendship selection.

Study 1d

Bernat, D. H., August, G. J., Hektner, J. M., Bloomquist, M. L. (2007). The Early Risers preventive intervention: Testing for six-year outcomes on meditational processes. Journal of Abnormal Psychology, 35, 605-617.

Evaluated Population: This is a follow-up to Study 1a and thus uses the same initial sample. Out of the 245 students who began the study, only 151 (61.6%) completed the measures at the end of year 6. Children who remained in the study were more likely to be white and had higher IQs, compared with children who dropped out. Therefore, the findings of this study may be affected by bias caused by sample attrition.

Approach: See Study 1 for randomization procedures. Intervention participants received the CORE and FLEX programs for the first three years (grades 1-3), and a booster phase for the final two years (grades 4-5). The booster phase included all five components of the CORE and FLEX programs, but with reduced intensity. Control group students did not receive any aspect of the Early Risers program.

Data related to the positive factors targeted by the program (potential mediators of program success, such as social skills, academic achievement, and effective discipline) were collected at baseline and at the end of year 2 from youth, parents, and teachers. Data related to program outcomes (conduct problems and drug use) were collected following completion of the program, when children were in sixth grade.

Results: There was no significant difference for diagnoses of oppositional defiant disorder (ODD) or conduct disorder between groups, but program parents and youth did report significantly fewer ODD symptoms than those in the control group. The effect size for parent report was .34, and the effect size for youth report was .47. There were no program effects found for use of tobacco, alcohol, marijuana, or other drugs. There was a significant impact on social skills, academic achievement, and effective discipline.

Study 2a

August, G. J., Lee, S.S., Bloomquist, M. L., Realmuto, G. M., & Hektner, J. M. (2003) Dissemination of an evidence-based prevention innovation for aggressive children living in culturally diverse, urban neighborhoods: The Early Risers effectiveness study. Prevention Science, 4 (4), 271-286

Evaluated population: Participants consisted of 327 first grade and kindergarten children who exhibited aggression using the Aggression Scale of the Child Behavioral Checklist – Teacher Rating Form. Participants were recruited from 10 schools in a large Midwestern metropolitan city and the average age of participants was 6.3. A majority of participants were from poor, African American families and 45 percent came from single parent homes.

Approach: Children were randomly assigned to receive a child and parent intervention (CORE + FLEX), a child intervention only (CORE), or to a control group. The child intervention only consisted of 107 members, the child and parent intervention consisted of 111 members, and 109 people made up the control group. The program was implemented by two neighborhood family centers that were each affiliated with five elementary schools. Quantitative data were collected from teachers, parents, and children. Data were collected at baseline and twice more following each intervention year on academic achievement, internalizing and externalizing behavior problems, school adjustment, social competence, parenting stress, and parenting style.

Nineteen per cent of the participants in the program dropped out during the first year and 16 percent dropped out during the second year. There were no baseline differences between those who dropped out and those who persisted with the exception of initial aggression score. On this measure, children in the CORE only group who dropped out had higher aggression scores than those from the control group.

Results: Results of the study indicated no differences between the CORE-only and CORE + FLEX groups. As a result, the researchers collapsed data from these two groups and compared the program group to the control group.

Children in the program group increased their school adjustment over the two year period, while children in the control group improved somewhat during the first year and then worsened in the second year, resulting in the program children having significantly higher school adjustment scores at the end of year 2 (effect size=.31).

Although there was no difference between program children and control children in the change in teacher reported social competence from baseline to the end of year 2, the program children showed significantly greater improvement from the end of year 1 to the end of year 2, compared with the control children who returned to baseline levels. There was no impact on parent reported social competence.

There was a marginal impact of  the intervention over time on teacher reported internalizing behavior problems, with control children getting worse and program children staying stable. At the end of year 2 children in the program group had significantly lower teacher reported internalizing behavior problems (effect size=.23), however, there was no impact of the intervention on parent reported internalizing behavior problems.

Although there was no overall impact on teacher reported externalizing behavior problems, subgroup analyses by severity showed that in the second year of the program, severely aggressive children in the control group worsened, while severely aggressive children in the program group maintained the gains they had made during the first year of the program. However, there was only a marginal difference in teacher reported externalizing behavior problems between severely aggressive children in the program group and those in the control group. There was no impact on parent reported externalizing behavior problems.

There was a significant difference between the program and control groups in change in parenting stress over time, with parenting stress remaining stable for the program group and increasing for the control group (effect size=.25).

There were no impacts on academic achievement or parenting style.

Study 2b

August, G. J., Lee, S. S., Bloomquist, M. L., Realmuto, G. M., & Hektner, J. M. (2004). Maintenance effects of an evidence-based prevention innovation for aggressive children living in culturally diverse urban neighborhoods: The Early Risers effectiveness study. Journal of Emotional and Behavioral Disorders, 12(4), 194-205.

Evaluated population: This is a follow-up to Study 2a, and thus uses the same sample. Attrition was 19 percent in the first year of the study, 13 percent in the second year, and 14 percent in the follow-up year.

Approach: See Study 2a for randomization procedures.

Children were assessed each spring for three years to provide baseline and 1-year and 2-year data.  They were also assessed one year after the intervention ended.  Participants were assessed on academic achievement, internalizing and externalizing behavior problems, school adjustment, social competence, parenting stress, and parenting style.

Results: Results of the study indicated no differences between the CORE-only and CORE + FLEX groups. As a result, the researchers collapsed data from these two groups and compared the program group to the control group. The significant impacts that had been found at the end of year 2 (see Study 5) were no longer significant at the one-year follow-up. However, when the change in social competence from the end of year 1 to follow-up was examined, the researchers found that children in the program group improved during year 2 and maintained those gains through the follow-up, while children in the control group worsened during year 2 and remained stable through the follow-up.

SOURCES FOR MORE INFORMATION

Contact information

Gerald J. August, Ph.D.

Division of Child and Adolescent Psychiatry

2450 Riverside avenue, F256/2B West

Minneapolis, MN 55454-1495

612-273-9711 (phone)

612-273-9779 (fax)

References

August, G. J., Egan, E. A., Realmuto, G. M., & Hektner, J. M. (2003). Four years of the Early Risers early-age-targeted preventive intervention: Effects on aggressive children’s peer relations. Behavior Therapy, 34, 453-470.

August, G. J., Lee, S. S., Bloomquist, M. L., Realmuto, G. M., & Hektner, J. M. (2003) Dissemination of an evidence-based prevention innovation for aggressive children living in culturally diverse, urban neighborhoods: The Early Risers effectiveness study. Prevention Science, 4 (4), 271-286.

August, G. J., Lee, S. S., Bloomquist, M. L., Realmuto, G. M., & Hektner, J. M. (2004). Maintenance effects of an evidence-based prevention innovation for aggressive children living in culturally diverse urban neighborhoods: The Early Risers effectiveness study. Journal of Emotional and Behavioral Disorders, 12(4), 194-205.

August, G. J., Realmuto, G. M., Hektner, J. M., & Bloomquist, M. L. (2001). An integrated components preventive intervention for aggressive elementary school children: The Early Risers program. Jounal of Consulting and Clinical Psychology, 69(4), 614-626.

August, G. J., Hektner, J.M., Egan, E. A., Realmuto, G. M., & Bloomquist, M.L. (2002). The Early Risers Longitudinal Prevention Trial: Examination of 3-Year Outcomes in Aggressive Children With Intent-to-Treat and As-Intended Analyses. Psychology of Addictive Behaviors, 16 (4S) S27-S39.

Bernat, D. H., August, G. J., Hektner, J. M., Bloomquist, M. L. (2007). The early risers preventive intervention: Testing for six-year outcomes on meditational processes. Journal of Abnormal Psychology, 35, 605-617.

Pelham, W.E. (1994). Children’s summer day treatment program 1994 program manual. Unpublished manuscript, University of Pittsburgh School of Medicine, Western psychiatric Institute and Clinic, Pittsburgh, PA.

KEYWORDS: Aggression, Black/African American, White/Caucasian, Urban, High-risk, Children (3-11), Conduct/Disruptive Disorders, Early Childhood, Elementary School, Parent or Family Component, Kindergarten, Social Skills/Life skills, Life Skills Training, School-based, Cost, Males and Females, Tobacco Use, Alcohol Use, Marijuana/Illicit/Prescription Drugs, Other Relationships, Summer Program, Parent Training/Education, Home Visitation, Anxiety Disorders/Symptoms, Depression/Mood Disorders, Academic Achievement/Grades.

Program information last updated 4/8/13.