Program

Oct 28, 2015

OVERVIEW

The Fast Track prevention project is a ten-year, multi-component intervention designed to start in first grade. It is targeted at students who are aggressive or disruptive in school and at home. The program aims to prevent antisocial behaviors by promoting and improving child competencies, the school context, parent-school relationships, and parenting skills. Program components include a classroom curriculum (PATHS), tutoring, home visiting, group skills training, mentoring, and various individualized services for high-risk children.

The intervention has been continuously analyzed since a pilot began in 1991-1993, and the most recent results examine participants at age 25. Fast Track has modest positive impacts on social, academic, and behavioral outcomes of high-risk children. Furthermore, parents of high-risk children in Fast Track exhibit better parenting behaviors, including less harsh discipline, than parents of other children. Fast Track also has impacts on the overall classroom—as indicated by more positive ratings of classroom atmosphere, and lower levels of disruptive behavior among non-target children. At age 25, people who were assigned to the program are happier, have fewer psychiatric and substance abuse problems, are less likely to have risky sex, and are arrested less often for severe violence and drug-related crimes.

DESCRIPTION OF PROGRAM

Target population: At-risk school-age children and adolescents, grades 1 through 10

The Fast Track Prevention Project is a comprehensive, ten-year-long intervention program for children and teens. At-risk children, who teachers and parents have rated as aggressive and disruptive, begin the program in first grade and continue until the end of tenth grade. It is conducted in school, after school, and in the homes of the children. Fast Track is designed to reduce conduct problems and improve academic, behavioral, and social outcomes.

The program is multi-dimensional, and is administered at different levels depending on the needs of the children. All children in Fast Track classrooms are administered the PATHS (Promoting Alternative Thinking Strategies) teacher-led curriculum, and teachers are given training and support. PATHS was designed to help children develop emotional communication, social understanding, self-control, and problem-solving abilities. Students who are identified as high-risk participate in a variety of other Fast Track activities. These extra components include social skills training groups, tutoring in reading, and classroom-based peer pairing (to promote friendships). Parents of these children participate in training groups that promote positive family-school relationships, as well as teach behavior management skills. For the children who are most at-risk, Fast Track includes multiple home visits, to teach parents problem-solving, self-efficacy, and life management skills.

Additional components are added in later grades. In grade four, a one-on-one adult mentoring program is added to promote positive identity development. In grades five and six, children receive a middle school transition program, and parent-youth groups meet to discuss adolescent issues. In grades seven and eight, the youth meet in forums to discuss career opportunities, life skills, and summer employment, and receive the Oyserman’s School-to-Jobs possible selves intervention. Beginning in grade seven, individualized programs based on need are also available to help with parental monitoring, peer affiliation, academic achievement, and social cognition.

Multiple Program Components:

  1. Universal classroom intervention: an average of 57 lessons from the PATHS curriculum are delivered to classrooms during each year of elementary school.
  2. Teacher training: Teachers receive training on the PATHS curriculum, are provided supervision, and receive informal feedback on classroom management.
  3. High-risk child-focused intervention: In addition to classroom lessons, high-risk children receive:
    1. School-based peer pairing and academic tutoring on reading skills, three times per week during the first two years of the program;
    2. Child social skill groups focused on emotional understanding and communication, friendship skills, self-control skills, and social problem solving skills (2-3 times per week, for 30 minutes; 9-22 sessions per year, depending on the grade);
    3. A mentoring program starting in fourth grade.
  4. High-risk family-focused intervention: Families of high-risk children participate in a variety of activities, such as:
    1. Family group meetings (for families of children in Grades 1 through 3, which meet 5 to 22 sessions per year:22 in Grade 1, 14 in Grade 2, and 5-8 in Grade 3);
    2. 30-minute parent-child sharing sessions, after the family group meetings;
    3. Biweekly home visits focused on improving parenting skills, fostering feelings of efficacy and empowerment, and increasing problem-solving skills.
  5. Three standard prevention activities for grades 6-10
    1. A middle school transition program;
    2. Parent and youth groups on adolescent topics: developmental issues are addressed with four meeting for parents and youth during Grade six
    3. Youth forums in Grade seven and eight, to address vocational opportunities, budgeting and life skills, job interview skills, and summer employment opportunities;

Classroom skills training is delivered by trained teachers and Educational Coordinators (ECs)– mainly former teachers. Peer group interventions are implemented by trained paraprofessionals, while parent groups are facilitated by clinicians with advanced degrees in counseling or social work and extensive experience with high-risk families.

The total cost of the program is $58,000 per child over 10 years.

EVALUATION(S) OF PROGRAM

All Studies:

Although there have been ten studies that meet criteria for rigor, all are based on a single intervention conducted on three cohorts starting in 1991, 1992, and 1993, respectively.

Evaluated population: 7,606 first-graders, in 401 classrooms, across 55 schools, in four cities: Durham, NC; Nashville, TN; Seattle, WA; and rural central PA. All schools were located in high-crime, poor neighborhoods.

891 of the participating students were considered high-risk, and were eligible to receive the full intervention. In this group, 69 percent were male (615), 47 percent were white (416), and 51 percent African American (452). More than half came from single-parent families (518), and almost a third had a parent who did not attain a high school degree (254). The mean age at baseline was 6.5.

6,715 low-risk students from 378 classrooms were eligible to participate in the classroom component alone. Fifty-five percent of them received free- or reduced-price lunch, ranging from 39 percent in rural Pennsylvania to 80 percent in Durham, NC.

Approach: Schools were matched in pairs and then randomly assigned to the intervention or control condition (intervention=445 students; comparison=446 students). Consent was received from a total of 845 high-risk students.

Study 1: Greenberg, M. T. (1998, August). Testing developmental theory of antisocial behavior with outcomes from the Fast Track Prevention Project. Paper presented at the American Psychological Association, Chicago, IL.

Evaluated population: The high-risk group of first-graders described above.

Approach: See above for details on randomization procedure. This study examined outcomes after one year in the program, including teacher and parent ratings of child social cognition, academic progress, social competence, and conduct problems.

Results: Overall, participation in Fast Track produced a variety of positive impacts. Compared with the control group, Fast Track children improved their social-cognitive and academic skills, exhibited lower levels of aggressive behavior at home and school, were less likely to be placed into special education, and a were more likely to become completely free of conduct problems (37 percent, vs. 27 percent in the control group. Parents of the program participants used harsh discipline less frequently than their control group counterparts. Impacts did not differ by demographic characteristics.

Study 2: Conduct Problems Prevention Research Group (1999a). Initial Impact of the Fast Track prevention trial for conduct problems: I. The high-risk sample. Journal of Consulting and Clinical Psychology, 67, 631-647.

Evaluated Population: The high-risk group of first-graders described above.

Approach: See above for details on randomization procedure. This study examined outcomes after one year in the program, including child social cognition and reading, child peer relations and social competence, parenting behavior and social cognition, and child aggressive-disruptive behavior.

Results: There were significant impacts on six of the eight outcome measures for child social cognition and reading. There were also impacts on two of the five measures for child peer relations and social competence. For parenting behavior; there were impacts on one of the three measures for harsh discipline; one of two measures for warmth/positive involvement; one of three measures for appropriate/consistent discipline; one of two measures for learning and school involvement; and on parent rating of behavior change. Finally, there were positive impacts on four of twelve child aggressive-disruptive behavior measures. These four outcomes included special-education services, which showed an interaction indicating that the intervention impact held for boys only. There were no significant impacts on parent social cognition outcomes.

Study 3: Conduct Problems Prevention Research Group (1999b). Initial Impact of the Fast Track prevention trial for conduct problems: II. Classroom effects. Journal of Consulting and Clinical Psychology, 67, 648-657.

Evaluated Population: The 6,715 students who were not part of the high-risk group described above, after one year in the program. The mean reading level was at the 47th percentile (across all sites except Durham, which utilized its own achievement testing system).

Approach: See above for details on randomization procedure. This study examined outcomes after one year in the program, including teacher reports, peer nominations of aggression, hyperactive-disruptive behavior, pro-social behavior and likability, and observer ratings.

Results: After one year of program participation, intervention classrooms received more positive ratings of classroom atmosphere (Effect Size =.31), lower levels of peer-nominated aggression (Effect Size = -.22), and lower levels of hyperactive-disruptive behavior (Effect Size = -.22) than comparison classrooms. Teacher ratings of behavior were not significant.

Study 4: Conduct Problems Prevention Research Group (2002a). Evaluation of the first 3 years of the Fast Track prevention trial with children at high risk for adolescent conduct problems. Journal of Abnormal Child Psychology, 30, 19-35.

Evaluated Population: The high-risk group of students described above, at age 10.

Approach: See above for details on randomization procedure. This study examined child conduct problems, child social cognition, child academic progress, child social competence, and parenting behavior. Assessments were made three years after the start of program participation.

Results: For child conduct problems, there were positive impacts on five of eight outcome measures. For parenting behaviors, there were impacts on two of four measures. There were no significant impacts for any subscales of child social cognition, child academic progress, or child social competence.

Study 5: Conduct Problems Prevention Research Group (2004). The Effects of the Fast Track Program and Serious Problem Outcomes at the End of Elementary School. Journal of Clinical Child and Adolescent Psychology, 33(4):650-661.

Evaluated Population: The high-risk group of students described above, at grades four and five.

Approach: See above for details on randomization procedure. In this study, four domains were of interest, including: social cognition and social competence; involvement with peer deviance; home and community conduct problems; and academic and behavioral problems in the school setting.

Results: Intervention children, when compared with children in the control group, had moderate but significantly lower rates on three of the four domains: social cognition and social competence problems (p<.01), involvement with peer deviance (p<.01), and home and community conduct problems (p<.01). There was no statistically significant impact on academic or behavioral problems, which was the only domain based on objective measures such as school records.

In a separate analysis, examining intervention impacts on continuous domain scores, the authors found a similar pattern of significant results with social cognition and social competence problems (p<.01), and home and community conduct problems (p<.02). However, the effect associated  with involvement with peer deviance was only marginally significant (p<.10), and academic and behavioral problems in school remained non-significant. Additionally, effect-sizes for the social cognition and social competence domain (.18) and home and community conduct problems domain (.15) were small.

Study 6: Conduct Problems Prevention Research Group. (2007). Fast Track randomized controlled trial to prevent externalizing psychiatric disorders: Findings from grades 3 to 9. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1250-1262

Evaluated Population: The high-risk group of students described above, after grades 3, 6, and 9. For subgroup analyses, the students (who were already considered an “at risk” population) were split into two groups: high risk students (top 3 percent) and those who were considered moderate risk (everyone else).

Approach: See above for details on randomization procedure. The outcomes assessed in this study were criterion counts (number of symptoms) and psychiatric diagnoses after grades three, six, and nine, for conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder (ADHD), any externalizing disorder, and self-reported antisocial behavior.

Results: For students in grade three, there were no impacts of any of the variables on either criterion count or psychiatric diagnoses. Subgroup analyses showed impacts on criterion count for students categorized as high risk for oppositional defiant disorder and ADHD. Additionally, subgroup analyses showed impacts on psychiatric diagnoses associated with all four variables.

For students in grade six, there were no impacts associated with any of the variables on criterion count. Subgroup analyses show an impact on ADHD for students categorized as high-risk. There were no impacts found for psychiatric diagnoses.

For students in grade nine, the intervention had a positive impact on criterion counts for antisocial behavior. Subgroup analyses for criterion count showed impacts on conduct disorder, ADHD, and antisocial behavior. No impacts were found for psychiatric diagnoses. Subgroup analyses revealed impacts for conduct disorder, antisocial behavior, and any externalizing disorder.

Study 7: Jones, D., Godwin, J., Dodge, K. A., Bierman, K. L. Coi, J.D., Greenberg, M. T., Lochman, J. E., McMahon, R. J., & Pinderhughes, E. E. (2010). Impact of the Fast Track prevention program on health services use by conduct-problem youth. Pediatrics, 125, 130-136.

Evaluated Population: The high-risk group of students described above, at grade 12.

Approach: See above for details on randomization procedure. The outcomes assessed in this study were the use of health and mental health services in the past year for students when they were in twelfth grade (2 years after the end of the intervention). Eight specific outcome variables were measured: 1) parent-reported number of youth general health service visits; 2) parent-reported number of youth pediatric heath service visits; 3) parent-reported number of youth emergency department visits; 4) parent-reported number of general hospital, emergency department, or pediatric service visits for the youth’s emotional, behavioral, academic, drug, or alcohol problems; 5) youth report of any outpatient visits to a mental health professional for emotional or behavioral problems; 6) youth report of any inpatient mental health service 7) parent-reported number of youth outpatient visits to a mental health professional for emotional or behavioral problems; and 8) parent report of any youth inpatient mental health services.

Results: Based on parent report data, the intervention significantly reduced use of professional general health, pediatric, and emergency department services. Youth in the control group were 30 percent more likely to use general health services for any reason, and 56 percent more likely to use general health services for mental health purposes. Based on youth self-report data, the intervention reduced the use of outpatient mental health services. No impacts were found on the use of inpatient mental health services.

Study 8: Lochman, J. E., Bierman, K. L., Coie, J. D., Dodge, K. A., Greenberg, M. T., McMacho, R. J., & Pinderhughes, E. E. (2010). The difficulty of maintaining positive intervention effects: A look at disruptive behavior, deviant peer relations, and social skills during the middle school years. The Journal of Early Adolescence, 30, 593-624.

Evaluated Population: The high-risk group of students described above, during the middle school years.

Approach: See above for details on randomization procedure. Outcomes assessed in this study were disruptive behavior problems, involvement with deviant peers, and social skills during the middle school years.

Results: The intervention was shown to have a positive impact on children’s hyperactive and self-reported delinquent behaviors in seventh grade. However, there were no impacts on other externalizing behavior problems or social skills. There was a negative impact on children’s involvement with deviant peers. In eighth grade, intervention children reported that they had best friends who were engaged in significantly more deviant activity than did the control children

Study 9: Conduct Problems Prevention Research Group. (2011). The effects of the Fast Track preventive intervention on the development of conduct disorder across childhood. Child Development, 82, 331-345.

Evaluated Population: The high-risk group of students described above, at grades 3, 6, 9, and 12. For subgroup analyses, the students (who were already considered an “at-risk” population) were split into two groups: high-risk students (top 3 percent), and those who were considered moderate-risk (everyone else).

Approach: See above for details on randomization procedure. Outcomes assessed in this study were psychiatric diagnoses after grades 3, 6, 9 and 12 for conduct disorder (CD) (split by parent informant, CD-P, and child informant, CD-C), oppositional defiant disorder (ODD) (split by parent informant, ODD-P, and child informant, ODD-C), parent report of attention deficit hyperactivity disorder (ADHD-P), and any externalizing disorder (EXT).

Results: No main impacts were found for the intervention. However, subgroup analyses revealed positive impacts for CD-P, ODD-P, ADHD-P, and EXT, based on initial risk. For highest-risk individuals, impacts were found for CD-P, ODD-P, ADHD-P, and CD-C. For moderate-risk individuals, impacts were found for CD-P.

Study 10: Dodge, K. A., Bierman, K. L., Cole, J. D., et al. (2015). Impact of early intervention on psychopathology, crime, and well-being at age 25. American Journal of Psychiatry, 172(1), 59-70.

Evaluated Population: The high-risk group of students described above, at age 25.

Approach: See above for details on randomization procedure. Subjects were interviewed at age 25, roughly nine years after the end of the intervention. They were also asked to name a peer who knew them well, and those peers (blind to the intervention group) were also interviewed. Study participants were evaluated for externalizing and internalizing conditions and behaviors; problematic substance use; overall health, happiness, and strength; education and employment; sexual experiences; parenting behaviors and feelings; and conviction of crimes, weighted for severity. If either the participant or their peer indicated a problem, they were included as having the problem. Analysis accounted for clustering at the school level.

Results:

The intervention was found to reduce the incidence of internalizing, externalizing, and substance abuse problems at age 25. This finding held for both males and females, blacks and whites, high- and moderate-risk groups, and for all sites and cohorts. Significant positive impacts were found on antisocial personality disorder, avoidant personality, alcohol abuse, and the use of serious illegal drugs (excluding marijuana). The intervention also increased overall happiness. It did not improve the general health of participants, or their personal strength. There were also no impacts on the incidence of ADHD, somatic disorders, anxiety, depression, problematic binge drinking, or heavy marijuana use.

Children who were assigned to the intervention were arrested for fewer drug-related crimes and fewer violent crimes, weighted for severity. There were no impacts on property or public order crimes.

The study also found that the intervention reduced the number of sexual partners and the incidence of risky sexual behavior. There were no impacts on relationship violence.

The study also examined the parenting behaviors of the participants. There were impacts on the severity of spanking, especially among males, but no impacts on coercive parenting, self-reported parenting skills, or self-reported parenting satisfaction.

There were also no impacts on full-time employment or high school graduation by age 25.

SOURCES FOR MORE INFORMATION

Website: http://www.fasttrackproject.org/

References:

Greenberg, M. T. (1998, August). Testing developmental theory of antisocial behavior with outcomes from the Fast Track Prevention Project. Paper presented at the American Psychological Association, Chicago, IL.

Conduct Problems Prevention Research Group (1999a). Initial Impact of the Fast Track prevention trial for conduct problems: I. The high-risk sample. Journal of Consulting and Clinical Psychology, 67, 631-647.

Conduct Problems Prevention Research Group (1999b). Initial Impact of the Fast Track prevention trial for conduct problems: II. Classroom effects. Journal of Consulting and Clinical Psychology, 67, 648-657.

Conduct Problems Prevention Research Group (2002a). Evaluation of the first 3 years of the Fast Track prevention trial with children at high risk for adolescent conduct problems. Journal of Abnormal Child Psychology, 30, 19-35.

Conduct Problems Prevention Research Group (2004). The Effects of the Fast Track Program and Serious Problem Outcomes at the End of Elementary School. Journal of Clinical Child and Adolescent Psychology, 33(4):650-661.

Conduct Problems Prevention Research Group. (2007). Fast track randomized controlled trial to prevent externalizing psychiatric disorders: Findings from grades 3 to 9. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1250-1262

Jones, D., Godwin, J., Dodge, K. A., Bierman, K. L. Coi, J.D., Greenberg, M. T., Lochman, J. E., McMahon, R. J., & Pinderhughes, E. E. (2010). Impact of the Fast Track prevention program on health services use by conduct-problem youth. Pediatrics, 125, 130-136.

Lochman, J. E., Bierman, K. L., Coie, J. D., Dodge, K. A., Greenberg, M. T., McMacho, R. J., & Pinderhughes, E. E. (2010). The difficulty of maintaining positive intervention effects: A look at disruptive behavior, deviant peer relations, and social skills during the middle school years. The Journal of Early Adolescence, 30, 593-624.

Conduct Problems Prevention Research Group. (2011). The effects of the Fast Track preventive intervention on the development of conduct disorder across childhood. Child Development, 82, 331-345.

Dodge, K. A., Bierman, K. L., Cole, J. D., et al. (2015). Impact of early intervention on psychopathology, crime, and well-being at age 25. American Journal of Psychiatry, 172(1), 59-70

KEYWORDS: Children (3-11), Adolescents(12-17), Elementary, Middle School, High School, Co-ed, White/Caucasian, Black/African American, High-Risk, Urban, Rural, School-based, Home-Based, Cost, Parent or Family Component, Parent Training, Home Visitation, Skills Training, Mentoring, Tutoring, Anxiety Disorders, Conduct Disorders, Depression, Aggression, High School Completion, Employment, Alcohol Use, Marijuana/Illicit Drugs, Dating Violence, Child Maltreatment, Sexual Activity, Delinquency, Parent-child Relationship, Academic Achievement, Reading, Other Social/Emotional Health.

Program information last updated 10/28/2015.

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