Sma11 4634 Ebpspromisingpractices Idbd

Evidence-Based Interventions
for Disruptive
and Promising Behavior
Practices Disorders
Evidence-Based Interventions
for Disruptive
and Promising Behavior
Practices Disorders
U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration
Acknowledgments
This document was produced for the Substance Abuse and Mental Health Services Administration
(SAMHSA) by Abt Associates, Inc., and the National Association of State Mental Health Program
Directors (NASMHPD) Research Institute (NRI) under contract number 280-2003-00029 with
SAMHSA, U.S. Department of Health and Human Services (HHS). Sylvia Fisher and Pamela
Fischer, Ph.D., served as the Government Project Officers.
Disclaimer
The views, opinions, and content of this publication are those of the authors and contributors
and do not necessarily reflect the views, opinions, or policies of the Center for Mental Health
Services (CMHS), SAMHSA, or HHS.
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or copied without permission from SAMHSA. Citation of the source is appreciated. However,
this publication may not be reproduced or distributed for a fee without the specific, written
authorization from the Office of Communications, SAMHSA, HHS.
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call SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727)
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Recommended Citation
Substance Abuse and Mental Health Services Administration. Interventions for Disruptive Behavior
Disorders: Evidence-Based and Promising Practices. HHS Pub. No. SMA-11-4634, Rockville, MD:
Center for Mental Health Services, Substance Abuse and Mental Health Services Administration,
U.S. Department of Health and Human Services, 2011.
Originating Office
Center for Mental Health Services

Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road
Rockville, MD 20857
HHS Publication No. SMA-11-4634

Printed 2011
Evidence-Based and Promising Practices
This booklet provides indepth information about each

intervention to help stakeholders identify and select evidence- Interventions
based practices (EBPs) that might best fit the needs and
preferences of communities, providers, practitioners, families, for Disruptive
and youth.
Behavior
Disorders
For references, see the booklet, The Evidence.

This KIT is part of a series of Evidence-Based Practices KITs created
by the Center for Mental Health Services, Substance Abuse and
Mental Health Services Administration, U.S. Department of Health
and Human Services.
This booklet is part of the Interventions for Disruptive Behavior

Disorders KIT, which includes six booklets:
How to Use the Evidence-Based Practices KITs
Characteristics and Needs of Children with Disruptive

Behavior Disorders and their Families
Selecting Evidence-Based Practices for Children with

Disruptive Behavior Disorders to Address Unmet Needs:
Factors to Consider in Decisionmaking
Implementation Considerations
Evidence-Based and Promising Practices
Medication Management
What’s in Evidence-Based Practice
and Promising Practices
Introduction........................................................................ 1 Interventions
Triple P – Positive Parenting Program.................................... 3
Project ACHIEVE................................................................ 11 for Disruptive
Second Step...................................................................... 19
Promoting Alternative Thinking Strategies........................... 25
Behavior
First Steps to Success......................................................... 31 Disorders
Early Risers: Skills for Success............................................. 37
Adolescent Transitions Program.......................................... 43
Incredible Years................................................................. 49
Helping the Noncompliant Child........................................ 55
Parent-Child Interaction Therapy......................................... 61
Parent Management Training — Oregon............................. 67
Brief Strategic Family Therapy............................................ 73
Problem-Solving Skills Training........................................... 79
Coping Power................................................................... 83
Mentoring........................................................................ 89
Multisystemic Therapy....................................................... 95
Functional Family Therapy............................................... 107
Multidimensional Treatment Foster Care............................ 113
Evidence-Based
Introduction
In Selecting Evidence-Based Practices for Children with Disruptive Behavior

Disorders to Address Unmet Needs: Factors to Consider in Decisionmaking in this
KIT, several tables summarize information about some of the main features of the
KIT’s 18 EBPs. This booklet has indepth information about each intervention to help
stakeholders identify and select EBPs that might best fit the needs and preferences
of communities, providers, practitioners, families, and youth.
18 Evidence-Based Practices Summarized in This Booklet

Prevention / Multilevel Intervention
 Triple P—Positive Parenting Program  Incredible Years
 Project ACHIEVE  Helping the Noncompliant Child
 Second Step  Parent Child Interaction Therapy
 Promoting Alternative Thinking Strategies  Parent Management Training — Oregon
 First Steps to Success  Brief Strategic Family Therapy™
 Early Risers: Skills for Success  Problem-Solving Skills Training
 Adolescent Transitions Program  Coping Power
 Mentoring
 Multisystemic Therapy
 Functional Family Therapy
 Multidimensional Treatment Foster Care
Evidence-Based and Promising Practices 1

The interventions are each presented in the A key part of Research Base and Outcomes for each
same format with the following information, EBP is a summary table that allows for quick
when applicable: access to information about the researchers,
the design, and outcomes. These tables include
 Intervention Description
important information from relevant studies, and
 Background culturally and linguistically relevant information
 Characteristics of the intervention from the research studies is highlighted. For most
interventions, this means that the populations
 Research Base and Outcomes used in the studies have been noted. For some,
 Implementation and Dissemination this means that research on cultural and linguistic
adaptations of the intervention has been included.
 Infrastructure issues
For example, the booklet notes that a culturally
 Training/coaching and materials adapted version of Parent Management Training—
 Cost of training/consulting Oregon is being evaluated with Spanish-speaking
Latino parents and is called Nuestras Familias.
 Developer involvement
 Monitoring fidelity and outcomes Implementation and Dissemination covers such
topics as: infrastructure issues, training/coaching
 Financing the intervention
and materials, the cost of training/consultations,
 Resources/Links current developer involvement and contact
 References information, the monitoring of fidelity and
outcomes, and means of financing the intervention.
The Intervention Description covers background This information was obtained in large part
information about the origin of the intervention, through telephone interviews with the developers
the developers, the population of interest, and of the EBPs and was then verified through edits
essential characteristics of the intervention. and review.
Each intervention concludes with information

about applicable Resources, including Web links,
and a list of References.
2 Evidence-Based and Promising Practices

Triple P – Positive Parenting Program
Figure 1
Intervention Description
Triple P – Positive Parenting Program
Type of EBP  Prevention/Multilevel
Background Setting  Clinic

 Home
Triple P — Positive Parenting Program is a multi-  School
level system of parenting and family support Age  0–16
programs that apply to prevention, early Gender  Males
intervention, and treatment. Triple P was  Females
developed by Matthew R. Sanders, Ph.D., and Training/Materials  Yes
colleagues from the Parenting and Family Support Available
Centre in the School of Psychology, University of Outcomes  Increase in parental confidence
Queensland in Australia.  Improvements in dysfunctional

parenting styles
 Reduction in child behavior problems
During the past few years, Triple P has been
disseminated to approximately 25 organizations
within the United States and to 15 countries.
Dissemination has been carried out as follows: Characteristics of the intervention
 Statewide in Wyoming as the centerpiece of the Triple P aims to prevent or reduce severe
Wyoming Parenting Initiative (more than 500 behavioral, emotional, and developmental
practitioners trained to date). problems in children by enhancing the knowledge,
 In 18 counties in South Carolina through the skills, and confidence of parents. It is designed for
U.S. Triple P System Population Trial. Funded families with children from birth to 16 years of age.
by the Centers for Disease Control and Triple P can be delivered by a range of specialists
Prevention, this trial is being conducted by the in the field of primary care (for example, nurses,
University of South Carolina and the University physicians), mental health (for example, social
of Queensland. workers, psychologists, counselors), and education
(for example, family/parent liaisons, day care
 At the Children’s Medical Center of Akron, administrators, school counselors).
Ohio, and other parts of Ohio.
 Through organizations in California, Delaware, It has been translated into 10 languages, most
Florida, Georgia, Missouri, and Pennsylvania. recently Spanish. Adaptations can be made for
different cultural groups by using examples specific
 In 14 countries in North America, Europe, and
to the culture of a group.
the Asia-Pacific region, where Triple P
International is disseminated.
Triple P offers five different levels of service that
increase in intensity as child and family needs
increase (Sanders, Markie-Dodds, & Turner, 2003):

Level 1 Level 3
Level 1 is a universal prevention approach and is Level 3 is a more narrowly focused intervention
intended for all parents interested in information designed for parents with specific concerns about
about their child’s development. Level 1 is intended their child’s behavior and development that require
to support communities that have already begun to consultations or active parent-skills training.
implement the other levels of Triple P. Strategies Services include one to four brief intervention
include the following: sessions combining advice, rehearsal, and self-
evaluation to learn how to manage specific
 Media resources (newspaper-, radio-, or
behavior problems (for example, toilet training,
television-disseminated community service
tantrums, and sleep disturbances). The settings
announcements);
and practitioners are the same as in Level 2.
 Self-directed information resources (parenting
tip sheets and videos) with information about
how to solve developmental and minor behavior Level 4
problems; Level 4 is a more broadly focused parent training
 Group presentations; and intervention for parents wanting intensive training
in positive parenting skills for children with more
 Telephone referral services. severe behavior problems. Eight to 10 sessions
focus on improving parent-child interaction,
Level 2 applying parenting skills to a broad range of
focused behaviors, and generalizing skills. Services
Level 2 is a brief selective intervention aimed at may combine self-directed strategies, telephone
parents with specific concerns about their child’s or face-to-face meetings with a clinician, or group
behavior and development. Services include advice sessions. Practitioners are mental health, child
for specific child behavior problems and may be welfare, or other health care professionals.
self-directed or involve telephone or face-to-face
interaction with a clinician or participation in
group sessions.
Level 2 usually consists of one or two 20-minute

sessions. The settings can be maternal and child
health services, physician practices, daycare
centers, or schools. Practitioners who deliver
the intervention are parent-support staff in their
respective settings.

Level 5
Research Base and Outcomes
Level 5 is the Enhanced Triple P and is an
intensive, individually tailored intervention for Triple P has a strong research base that includes
families that have children with behavior problems multiple studies and evaluations dating back to
and other family stressors (for example, parent 1977. The research assesses the effectiveness of
depression, partner conflict). Services include various levels of Triple P for children from infancy
the following: to 16 years of age.
 Active parenting-skills training;
Research designs include 29 randomized clinical
 Home visits; trials (RCT), 11 controlled single-subject
 Mood management; evaluations, 9 effectiveness evaluations, 6
dissemination trials, and papers examining
 Stress coping skills; and
predictors, mediators, and moderators of
 Partner support skills. intervention effects. Culturally and ethnically
diverse research studies include one RCT with
Services may involve self-directed strategies, samples of children from China. Triple P has been
telephone or face-to-face meetings with a clinician, evaluated with people treated in a broad array of
or group sessions. Practitioners are mental health, settings including health care, mental health, social
child welfare, or other health care professionals. services, education, community centers, and
workplaces. Trends in outcomes are evidenced
Modified levels are also available to meet the by the specific studies referenced in Table 1.
developmental needs of the children and parents,
such as a self-directed workbook for parents.

Table 1: Triple P – Positive Parenting Program: Research Base and Outcomes
Reference Research Design and Sample* Outcomes
Sanders & Randomized Control Trial (RCT) of families (n = 20) with a Both interventions demonstrated:
Christensen (1985) child (2–7 years) with Oppositional Defiant Disorder (ODD)  Significant reductions in observed child disruptive behavior
comparing Child Management Training (Standard Triple P/ and mother aversive behavior.
Level 3) without planned activities training and Standard
Triple P (Level 4).  Significant increased use of focused parenting strategies.
Study population:
 60% Male
 40% Female
Connell, Sanders & RCT of families (n = 60) with a child (age 7–12) comparing  No differences found between the therapist-directed and
Markie-Dadds (1997) Enhanced Triple P (for stepfamilies), Enhanced Self-Directed self-directed programs.
(in Sanders, Markie- Triple P and a waitlist (WL) control parents and stepparents
 Children in intervention groups showed significant reductions
Dadds, & Turner, of children with ODD or (Conduct Disorder) CD.
in parent reported disruptive behaviors.
2003)
 Significant reductions in parenting conflict were reported by
parents and stepparents in the intervention conditions only.
Sanders, Markie- RCT comparing Standard Triple P, Self-Directed Triple P,  Children in the three intervention conditions showed greater
Dadds, Tully & Bor Enhanced Triple P and a waitlist (WL) control of parents improvement on mother-reported disruptive behaviors than
(2000) (n = 305) with children (mean age of 3 years) with clinically the waitlist (WL) control.
elevated disruptive behavior, and at least one family adversity
 Only those in the Enhanced Triple P and the Standard Triple
factor (for example, low income, maternal depression,
P conditions showed significant improvement on observed
relationship conflict, single parent).
disruptive child behavior and father reports.
Study population:
 Parents in two practitioner-assisted programs also showed
 68% Male significant reduction in dysfunctional parenting strategies
 32% Female (self-report) for both parents.
 Predominately White
Sanders & McFarland RCT of parents (n = 47) with a child (3–9 years) with ODD Both interventions demonstrated:
(2000) or CD and mothers with major depression comparing Standard  Reduction in observed and parent reported disruptive
Triple P and Enhanced Triple P. child behavior.
 Reductions in parental levels of depression.
 Increase in parental confidence.
Ireland, Sanders, & RCT of families (n = 44) concerned about their child’s (2–5 Both interventions were associated with significant:
Markie-Dadds (2003) years) disruptive behaviors and concurrent clinically elevated  Improvements in parent-reported disruptive behavior.
marital conflict. Families assigned to Group Triple P or Group
Triple P with a partner support module.  Reduction in dysfunctional parenting strategies.
 Reduction in parenting conflict.
 Improvements in relationship satisfaction and
communication.
Bor, Sanders, & RCT with parents of children (n = 87, Mean age=3) with co-  Both intervention programs were associated with significantly
Markie-Dadds (2002) morbid significantly elevated disruptive behavior and attention lower parent reported child behavior problems and
problems. dysfunctional parenting and significantly greater parenting
Study population: confidence.
 68% Male  No condition effects were found for parent or teacher reports
of disruptive behavior or for parental adjustment, parenting
 32% Female
conflict or relationship satisfaction.
Leung, Sanders, RCT of Chinese parents in Hong Kong (n = 91) with children Intervention was associated with significant:
Leung, Mak, & Lau (3–7 years) with conduct-related problems assigned to either  Reduction in child behavior problems.
(2003) Triple P intervention group (n = 46) or the waitlist control
group (n = 45). 69 completed the study, 25 female and  Reduction in dysfunctional parenting styles.
44 male.  Increase in parental confidence.
Study population:
 100% Chinese
*Study sample’s gender and race/ethnicity data provided where available.

Implementation and Dissemination Training/coaching and materials
 The level of the Triple P intervention that is

implemented and the setting determines the
Infrastructure issues
preservice level of training. For Levels 2 and 3
(described previously) paraprofessionals that
Readiness
consult with families around parenting are
Triple P America does not have specific readiness eligible for training, whereas Levels 4 and 5
assessments, but relies instead on initial information- require more clinically trained professionals.
gathering conversations with sites to clarify their  Training consists of two onsite visits of 2 to 3
needs and determine how Triple P interventions days each in which intensive training is followed
might address these needs. by practice and competency demonstrations.
There are 8 to 10 weeks between the first and
Stakeholder buy-in: second onsite training visits. The training
methods include didactic presentation, self-
 The intervention focuses on five developmental
study with practitioner manuals, videos, active
periods from infancy to adolescence. Within
practice and discussion in small groups, and
each period, the reach of the intervention
roleplaying. People who successfully complete
can vary from being very broad (focusing
the training become accredited Triple P providers.
on an entire population) to quite narrow
(focusing only on high-risk children).  All of the training is delivered by Triple P
Stakeholders must buy into the approach America. No established structure exists for
of specifying developmental periods. training trainers. To deal with staff turnover,
agencies may send staff to other sites where
 It is important to have buy-in of managers,
training is being held and pay for the individual
supervisors, families and family advocacy
training slots used.
groups, and executive level decisionmakers
that control funds.  Manuals, facilitator kits, and training are
available through the Triple P Institute.
 Triple P should be integrated into a community
or organization’s strategic plan.
The Triple P Web site is easy to navigate and offers
a detailed explanation about the intervention
Possible barriers: and cost involved (http://www.triplep-america.com).
For information about accessing training,
A specific barrier to successful implementation
contact Dr. Ron Prinz.
occurs when the agency or staff do not work with
families at times that are convenient for families. Dr. Ron Prinz
This potential barrier is not specific to Triple P Triple P America
but rather to any parenting or family intervention. 4840 Forest Drive, #308
Columbia, SC 29206
triplepa@bellsouth.net
(803) 787-9944

Cost of training/consulting  The goal of Triple P America is for sites to
become independent through their initial
 According to Triple P America, the most cost- training and consultation, through the quality
efficient way of implementing the Standard of their materials and Web site, and by using
Triple P (Level 4) is to train a group of 20 a self-regulatory framework in peer support
practitioners. The cost for training a group networks and supervision.
this size is $21,000, which includes two training
 For ongoing implementation, Triple P attempts
visits involving 3 days for the first visit and 2
to meet sites’ needs through telephone, email,
days (10 practitioners per day) for the second
or site visits when needed, but they do not
visit. This amount also covers the practitioner
encourage long-term dependence.
manuals, a practitioner kit, and a video for
parents, as well as all of the trainer’s travel costs.
 For small organizations that do not have 20 Monitoring fidelity and outcomes
staff members, an alternative is to develop
collaborative training with other agencies.  Fidelity checklists are included in the manuals
for every level of the Triple P intervention.
 Triple P America does not encourage long-term These checklists facilitate self and supervisor
or intensive ongoing consultation. Consultation tracking of intervention implementation
services are available on a contractual basis. and fidelity.
 Additional costs must be considered for the  Triple P does not have any requirements
self-directed parenting resource materials. related to ongoing fidelity monitoring. It is the
In addition, at higher levels of Triple P, there responsibility of each organization to ensure
will be a cost for covering home visits if these fidelity and to measure outcomes. However,
are required at the level being implemented. every Triple P manual has designated
measurement instruments that are suitable
for outcome measurement.
Developer involvement
 Triple P America is the primary disseminator

of Triple P in the United States. Financing the intervention
 Triple P America’s trainer staffing pattern Funding used for startup costs of Triple P include
is flexible. It can usually expand its capacity grants, state funds, and agency budgets. (R. Prinz
to accommodate new sites. personal communication, March 22, 2006.)

Leung, C., Sanders, M., Leung, S., Mak, R.,
Resources/Links
& Lau, J. (2003). An outcome evaluation of the
implementation of Triple P–Positive Parenting
Triple P-America Web site:
Program in Hong Kong. Family Process, 42(4),
http://www.triplep-america.com.
531–544.
R. Prinz (personal communication,

References
March 22, 2006).
Bor, W., Sanders, M. R., & Markie-Dadds, C.
Sanders, M. R. & Christiansen, A. P. (1985). A
(2002). The effects of Triple P–Positive
comparison of the effects of child management
Parenting Program on preschool children with
and planned activities in five parenting
co-occurring disruptive behavior and attentional/
environments. Journal of Abnormal Child
hyperactive difficulties. Journal of Abnormal
Psychology, 13, 101–117.
Child Psychology, 30, 571–587.
Sanders, M. R., Markie-Dadds, C., & Turner, K.

Connell, S., Sanders, M. R. & Markie-Dadds, C.
M. T. (2003). Theoretical, scientific, and clinical
(1997). Self-directed behavioral family-
foundations of the Triple-P Positive Parenting
intervention for parents of oppositional children
Program: A population approach to the
in rural and remote areas. Behavioral
promotion of parenting competence. Parenting
Modification, 21(4), 379–408.
Research and Practice Monograph, 1, 1–24.
Ireland, J. L., Sanders, M. R. & Markie-Dadds, C.
Sanders, M. R., & McFarland, M. (2000).
(2003). The impact of parent training on marital
Treatment of depressed mothers with disruptive
functioning: A comparison of two group versions
children: A controlled evaluation of cognitive
of the Triple P–Positive Parenting Program
behavioral family intervention. Behavior
for parents of children with early-onset conduct
Therapy, 31, 89–112.
problems. Behavioural and Cognitive
Psychotherapy, 31, 127–142.

Project ACHIEVE
The intervention uses professional development,

inservice training, and onsite technical assistance
and consultation to train school personnel at each
facility. Consultation and training services are
Background
provided directly by Dr. Knoff and his master
Project ACHIEVE is a universal, school-based trainers. Most work is completed onsite, with
intervention that applies to many educational offsite technical assistance available. All materials
settings. Howard M. Knoff, Ph.D., developed are available in English with some also available
Project ACHIEVE and is its director. He also in Spanish.
works as the director of the federally funded State
Improvement Grant for the Arkansas Department
of Education’s Special Education Unit in Little Figure 2
Rock, Arkansas.
Project ACHIEVE
Project ACHIEVE training has been conducted
in more than 1,500 schools and districts in 40 states Setting  School-based (including
alternative schools and charter
since its inception in 1990. school programs)
Age  3–14
Gender  Males
Characteristics of the intervention
 Females
Project ACHIEVE is a comprehensive school- Training/Materials Available  Yes

based prevention program that focuses on several Outcomes  Decrease in discipline
different areas, including academic engagement problems.
and achievement, positive behavioral support  Decrease in Special Education

referrals and placements.
systems, school safety, and parent and community
 Increase in positive school
involvement. It was designed for use in preschools climate.
and elementary and middle schools for children 3  Improvements in academic
to 14 years of age, and has been implemented in achievement.
alternative schools, charter schools, self-contained
special education facilities, and select high schools.
Teachers and school administrators are responsible

for delivering and sustaining Project ACHIEVE,
which is implemented over a 3-year period by
following carefully sequenced steps.

Project ACHIEVE’s seven components are behavioral interventions and classroom
as follows: management procedures. Using Project
ACHIEVE’s evidence-based Positive
1. The Strategic Planning, Organizational Analysis, Behavioral Self-Management System,
and Development Component focuses on assessing this whole-school approach involves students,
the organizational climate, administrative style, staff, administration, and parents building
staff decisionmaking, and other interactive and reinforcing the following:
and interpersonal processes within a school.  Students’ interpersonal, problem-solving
Important to this component is developing 1- and conflict-resolution skills and interactions;
and 3-year school improvement plans.
 Positive, safe, supportive, and consistent school
2. The Problem Solving, Teaming, and Consultation climates and settings; and
Processes Component focuses on the causes  School and district capacity such that the entire
of students’ behavior and on assessment process becomes self-sustaining.
leading to intervention to improve behavior.
This response-to-intervention component 6. The Parent and Community Training, Support,
emphasizes a problem-solving/consultation/ and Outreach Component connects parents
intervention mode of operation that directly to the school to promote collaboration and
contrasts with past wait-to-fail and refer-test- improve the chances of students’ success in
place approaches, and is applied with students school. The theory is that using coordinated
experiencing academic and behavioral concerns. community-based efforts will increase support,
resulting in more positive outcomes.
3. The Effective School, Schooling, and Professional
Development Component focuses on helping 7. The Data Management, Evaluation, and
students maximize their time spent on Accountability Component assesses outcomes
academics and other school-related tasks. collected through consumer satisfaction
Professional- and development-related activities methods and other data, such as time and
are highlighted in this component to increase cost-effectiveness of the overall Project
the knowledge, skill sets, and confidence of ACHIEVE intervention, as well as students’
teachers, administrators, or counselors who academic and behavioral progress.
implement the program.
4. The Academic Instruction Linked to Academic Research Base and Outcomes

Assessment, Intervention, and Achievement
Component matches students’ current academic Project ACHIEVE’s effectiveness has been
challenges to the appropriate curriculum demonstrated through the following:
to improve their overall performance.
The instructional environment consists of the  One quasi-experimental design;
interdependent interactions in a classroom of  One qualitative design program evaluation
the teacher-instructional process, the student, using semi-structured interviews conducted
and the curriculum. by the American Institutes for Research
through a contract with the U.S. Department
5. The Behavioral Instruction Linked to Behavioral of Education’s Office of Special Education
Assessment, Intervention, and Self-Management Programs (OSEP); and
Component assesses and focuses on a student’s
behavior by matching it with appropriate

 Continued longitudinal studies from research Project ACHIEVE as part of a 5-year grant from
school sites. Project ACHIEVE results are also the U.S. Department of Education’s OSEP.
reported annually in Arkansas as a part of its
state improvement grant, through which As seen in Table 2, research has included White,
approximately 45 schools are implementing African American, and Hispanic participants.
Table 2: Project Achieve: Research Base and Outcomes

Knoff & Batsche (1995) Quasi-experimental design with matched comparison of one For the treatment school:
elementary-level treatment school and one control school. Data  Decrease in referrals for special education.
collected in treatment school for 1 year pretreatment and 3 years
posttreatment. Data collected in control school for 1 year.  Decrease number of students placed in special
education.
Study population:
 Decrease in disciplinary referrals.
Treatment school:
 Decrease in student grade retention, decrease in
 60% White
incidences of out-of-school suspension, positive gains
 30% African American on the California Test of Basic Skills.
 10% Other
Comparison school:
 41% White
 54% African American
 6% Other
Killian, Fish, & Pre-post study with a comparison group. Participants were For the treatment school:
Maniago (2006) students in grades 3–6, and their parents and guardians. Students  Consistent decreases in undesirable behaviors occurred
in the treatment school received Project ACHIEVE curriculum. Date across all grades in both classroom and non-classroom
collected before implementing the curriculum and at 1-year post- settings.
implementation.
 Decreases in serious offenses—for example, in the areas
of theft and students’ use of physical force.
 Decreased discipline referrals to the principal’s office.
 School suspensions for disciplinary reasons decreased.
Project ACHIEVE Longitudinal data collection from designated research schools. Overall discipline referral to office decreased 16%.
research school results No control group comparison.  School-based discipline referrals decreased 11%.
Knoff personal Study populations by school:
 School bus discipline referrals decreased 26%.
communications (2006) Jessie Keen Elementary School
 Out-of-school suspension decreased 29%.
 60% White
 Grade retention decreased 47%.
 Special Education referrals decreased 61%.
 10% Other
Cleveland Elementary School
 20% White
 17% Hispanic
 1% Other
Hotchkiss Elementary School
 14% White
 39% Hispanic
 5% Other
* Study sample’s gender and race/ethnicity data provided when available.

Family and child involvement:
Implementation and Dissemination
 Consumers play a role in implementation,
especially in designing and implementing
Infrastructure issues the Positive Behavioral Self-Management
System and through activities organized and
Readiness: implemented by the Community and Family
Outreach Committee. Students are involved in
 Sites undergo a formal readiness assessment to
the core components of the process but are not
determine their organizational and motivational
directly involved in the decision about whether
readiness and ability to implement the program.
Project ACHIEVE is brought to the school.
 Project ACHIEVE will work with sites
 Dr. Knoff is involved with the community,
for 12 to 18 months to build their capacity
especially when social and cultural norms within
for implementation, should they not already
the community make it important (for example,
have the capacity to implement the program.
in American Indian communities). He often
presents at Parent Nights to discuss home-
Staffing: based discipline and behavior management,
and he attempts to engage families through his
 Project ACHIEVE has a set of broad-based
involvement in individual intervention-focused
criteria for sites to use to help them hire staff
cases in the school.
to implement the program.
 One prerequisite is an organizational analysis
Implementation timeline:
and realignment (if needed) of the committee
structure of the school and the development of Project ACHIEVE is a 3-year intervention with
a master calendar of meetings and professional carefully sequenced steps that must be followed.
development activities. A sample timeline is as follows (H. Knoff, personal
communication, June 22, 2006):
 A resource analysis is completed to identify the
instructional, assessment, and intervention skills
 Pre-Year 1: Organizational development and
of staff in and available to the school.
strategic planning; writing of Project ACHIEVE
 School administration and teachers are goals and objectives in the School Improvement
actively involved in implementing the program. Plan; evaluating the school’s mission statement,
Facilitators are chosen to receive additional organizational/committee structure, and
training so they can guide the program and resources; completing articulation activities
interventions in future years, at times through and audits relative to problem areas in the
the DVD series, along with the ongoing school, early intervention referrals, and
support training provided by Dr. Knoff identifying students who need interventions
and his master trainers. for the next school year.
 Year 1: Social skills training, SPRINT Problem
Solving training (separate sessions for the entire
staff and specialists/study team), release time
for planning, meetings, and technical assistance.

 Year 2: Social skills/SPRINT training and  Certain mandates when the school focuses
booster sessions, Behavioral Observation and largely on classroom instruction, academic
Instructional Environment Assessment training, assessment, and academic outcomes to the
Curricular-Based Assessment and Measurement detriment of other Project activities that more
(CBA/CBM) training, academic and behavioral effectively support these important areas.
intervention training; release time for planning,
 The availability of trained personnel and the
meetings, and technical assistance.
willingness of administrators to rethink using
 Year 3: Booster sessions in all components; these personnel as consultants, along with their
parent-involvement planning; training and direct service responsibilities.
facilitation; grade-level intervention planning
 The loss of principals, other administrators, and
and implementation; leadership and facilitators’
staff who leave the school or system after being
training; release time for planning, meetings,
trained, only to be replaced by new staff who
and technical assistance.
need training. This occurs sometimes in the first
 Beyond Year 3: Continued, sustained year of the project.
implementation of all components; academic
and behavioral intervention focus for students
not responding to interventions; continued Training/coaching and materials
release time for all grade-level teams to plan
and implement the activities identified on their  Depending on the existing status and skills of
Action Plans; additional consultation and school staff, training typically involves 5 to 8
technical assistance as needed. days during Year 1; 4 to 8 days during Year 2;
and 4 to 6 days during Year 3. With consultation,
travel, and material costs, Year 1 costs average
Possible barriers: approximately $30,000 to $35,000; Year 2 costs
 Some of the barriers to effective average approximately $20,000 to $25,000; and
implementation are as follows (H. Knoff, Year 3 costs average approximately $15,000.
personal communication, June 22, 2006):  Dr. Knoff and his five to six master trainers
 Organizational, administrative, financial, are available for onsite consultation, booster
and resource limitations. sessions, and offsite assistance such as web-
based training, teleconferencing, and web
 The lack of personnel skilled in implementing conferencing.
and providing consultation and technical
assistance in academic and behavioral  A 12-set DVD series has all the content that
interventions for students not responding to helps in training the staff, who are considered
effective instruction and preventative strategies. to be facilitators. All personnel are actively
involved in implementing the program, but
 Administrative personnel taking the time to Dr. Knoff works most closely with the school
learn about the program to make it the central principal, whom he considers to be the CEO
feature of the School Improvement Plan and of this process; the chairs of the school
process. Not focusing attention to proactive improvement, discipline, SPRINT, and
versus reactive activities. community and family outreach committees;
 Systemic barriers that may be locally driven. and the various members of these committees.

 Training may vary according to the site, but Developer involvement
ultimately it is a three-pronged approach aimed
at providing knowledge, skills, and confidence.  Dr. Knoff is still actively involved in providing
Demonstrations, consultation, technical consultation services (onsite/offsite), writing
assistance, and supervision are also provided. research reports, and assessing readiness for a
school to implement Project ACHIEVE.
 There are materials for the Stop and Think
Social Skills program that are readily available  Dr. Knoff has a fully prepared grant insert that
for purchase. Schools are advised to commit can be provided to those writing state, Federal,
to implementing Project ACHIEVE fully, and foundation grants that will involve Project
as opposed to just purchasing the materials. ACHIEVE implementation.
The following items are available for purchase: For information about implementing Project
ACHIEVE, contact Dr. Knoff.
 Stop & Think Social Skills Program
(book, cue cards, stickers, stamps, t-shirts, Howard M. Knoff, Ph.D.
pencils, and other materials for use in the 49 Woodberry Road
classroom). Materials available for purchase Little Rock, AR 72212
at Sopris West Publishers (1-800-547-6747) or Phone: (501) 312-1484
http://www.sopriswest.com. Fax: (501) 312-1493
Email: knoffprojectachieve@earthlink.net
 The Stop & Think Social Skills Program for
Parents (involving a manual and 75-minute
training DVD) is available through Dr. Knoff. Monitoring fidelity and outcomes
Information on training and materials can be  A series of implementation check sheets address
obtained at: http://www.projectachieve.info. the different facets of the project to be used in
monitoring adherence to the protocol.
 Two formal questionnaires for evaluating the
Cost of training/consulting
discipline and behavior management attitudes
 Costs will vary, but on average it costs $25,000/ and staff interaction characteristics of the school
year ($75,000 total) to implement (see above). are used as pre- and post-measures of
organizational development and change.
 Cost per pupil to implement ranges from $30
to $150/per student, many times it depends  Formal fidelity measures have been developed
on the need and cost of substitute teachers through a number of Federal and state grants
to release staff for training and other activities. that have implemented Project ACHIEVE
in various schools.
 All of these costs include consulting services,
travel, and materials (printed and DVD).

 Discipline data is collected through a free
Resources/Links
software program, the Automated Discipline
Data Review and Evaluation Software System
For more indepth information about Project
(ADDRESS), which is loaded directly onto a
ACHIEVE, please visit the following Web sites:
school’s computer system and used in-house.
 Through the onsite consultation services, the  Helping America’s Youth:
developer and master trainer develop other http://www.findyouthinfo.gov/
outcome measures designed to sensitively
 Project ACHIEVE Home Page:
evaluate each year’s Project ACHIEVE goals
http://www.projectachieve.info
and objectives as written into the School
Improvement Plan.  U.S. Department of Health and Human
Services/Substance Abuse and Mental Health
Services Administration, National registry of
Financing the intervention Evidence-Based Programs and Practices:
http://www.nrepp.samhsa.gov/
Schools and districts have used several different
funding sources to help finance Project ACHIEVE:  U.S. Department of Justice/Office of Juvenile
Justice and Delinquency Prevention:
 Title I funds of the Elementary and Secondary http://www.ojjdp.gov.mpg
Education Act of 1965 (20 U.S.C. 6301 et seq.)
 American Institutes for Research/Center
 Special education funds for Effective Collaboration and Practice:
 School improvement funds http://cecp.air.org/
 Safe and Drug-Free School funds  U.S. Department of Health and Human
Services, Substance Abuse and Mental Health
 Safe Schools/Safe Community funds
Services Administration, Center for the
 Counseling in the Schools funds Application of Prevention Technologies:
http://captus.samhsa.gov/
 Private foundation funding
 Collaborative for Academic and Social-
 No Child Left Behind funds
Emotional Learning: http://www.casel.org
 Medicaid dollars for services that are part of the
 The Arkansas State Improvement Grant:
program (but cannot reimburse for the entire
http://www.arstateimprovementgrant.com
program itself)

References
Killian, J. M., Fish, M. C., & Maniago, E. B. (2006).

Making schools safe: A system-wide school intervention
to increase student prosocial behaviors and enhance
school climate. Journal of Applied School Psychology,
23(1), 1–30.
Knoff, H. (personal communication, June 22, 2006).
Knoff, H. M., & Batsche, G. M. (1995). Project ACHIEVE:

Analyzing a school reform process for at-risk and
underachieving students. School Psychology Review,
24(4), 579–603.
Second Step
The Second Step program focuses on the following

three age groups:
 Preschool/kindergarten;
Background
 First through fifth grade; and
The Second Step program is a universal prevention  Middle school.
and intervention program for children ages 4 to14.
The program, developed in the mid-1980s, is In the youngest group, students are exposed to
disseminated by the Committee for Children, photo-lesson cards, puppets, and sing-alongs that
an organization based in Seattle, Washington. facilitate group discussions, skill practice, and
With wide implementation throughout the United transfer of learning. In the elementary age group,
States and 21 other countries and regions, the students are exposed to videos, photo-lesson cards,
Second Step program is currently being taught teacher-led discussions, role plays, and homework,
to more than 7 million children with over 21,000 all addressing the three skill areas.
trained practitioners.
The middle school curriculum uses fully scripted
lessons, videos, and reproducible activity sheets.
Characteristics of the intervention Also, a family guide helps families reinforce
social and emotional skills at home, including
The Second Step program is a classroom-based
communicating feelings, solving problems,
prevention program designed to reduce impulsive
and managing conflict.
and aggressive behavior. It is classified as a
prevention program and is therefore appropriate
for most children.
Figure 3
The program is divided into the following three Second Step
main skill-building areas: Type of EBP  Prevention
 Empathy; Setting  School
 Impulse control and problem solving; and Age  4–14 years
Gender  Males
 Anger management.
 Females
Training/Materials Available  Yes

It is delivered in sequential lessons by classroom
teachers or counselors using curriculum kits. Outcomes  Increase in prosocial behavior
and social reasoning.
 Improvement in self-regulation
of emotions.
 Decreased verbal and physical

aggression.
 Decreased behavioral problems.

Outcome measures collected from teacher ratings
were either not supported by the research or not
present over time. Studies have included White,
At least a dozen research studies examined the
African American, and Hispanic participants.
Second Step program. In outcome measures
collected from direct observations and child
Information about research conducted on the
interviews, support exists for the intervention in
Second Step program is shown in Table 3.
reducing behavior problems, decreasing physical
aggression, and increasing prosocial behavior.
Table 3: Second Step: Research Base and Outcomes

Grossman et al,. The first randomized control trial design with children (n = 790, grades Immediate results at the end of the intervention
(1997) 2 and 3) from six matched pairs of schools. Assigned to either the Second for treatment group: significant decreases in
Step intervention group or the control group. observed physical aggression and significant
Outcomes were collected at three points: before the intervention, 2-week increases in observed neutral/prosocial behavior.
followup, and 6-month followup. Trained observers, parents, and teachers Most significant changes not present at
provided the rating of the students’ behavior. 6-month followup.
Study population:
 53% Male
 37% Female
 79% White
McMahon, Washburn, Quasi-experimental design with pre- and post- evaluation of Significant gains in knowledge collected in
Felix, Yakin, & Childrey predominantly African American and Hispanic children (n =109, interviews and decreases in problem behaviors
(2000) ages 3–7). found on the basis of direct observations.
Data collected through child interviews (assessing knowledge and However, teachers’ ratings did not change
skills related to empathy, impulse control, problem solving, and anger significantly from the pre-intervention to
management), teacher ratings, and behavioral observations. post-intervention.
Study population:
 42% Male
 58% Female
 21% Hispanic
 1% White
Taub (2002) Quasi-experimental evaluation of the Second Step curriculum among Compared to the control group, students who
3rd through 5th grade students (n = 54) in a rural elementary school. received Second Step lessons increased in social
Teachers rated children’s social competence and antisocial behavior, competence and decreased in antisocial behavior.
and observers rated children’s prosocial behaviors. Observational data further validated that
program students showed higher levels of peer
interaction skills and rule-adherence compared to
control students.
Van Schoiack-Edstrom, Quasi-experimental evaluation of the Second Step Middle School 6th grade students who received the Second Step
Frey, & Beland (2002) curriculum to examine the effects on levels of and attitudes toward program endorsed less social exclusion; the 7th
physical and relational aggression in 6th and 7th grade students from grade females showed less endorsement of physical
five schools (n = 714) from the United States and Canada. aggression, and both females and males receiving
Two-thirds of the students were taught Second Step lessons over a year; the program perceived less social difficulty.
the remaining third were not. No differences were found for social exclusion.
Study population: Results indicate that the Second Step program has
potential for modifying attitudes toward aggression
 49% Male
and reducing relational aggression among
 51% Female
early adolescents.
 Schools ranged from 4–89% White.

Table 3: Second Step: Research Base and Outcomes
McMahon & Pre- and post-study among 5th through 8th grade African American Students who participated in the Second Step lessons
Washburn (2003) students (n=156) to evaluate the impact of the Second Step Middle increased social skills knowledge and prosocial and
School curriculum on social skills knowledge, aggressive behavior, empathy skills.
prosocial behavior, and school bonding. Changes in empathy were also related to lower levels
Study population: of aggression at posttest.
 36% Male
 64% Female
Frey, Nolen, Van Children (n =1253, ages 7–11) from 15 elementary schools assigned Intervention group demonstrated a greater increase
Schoiack-Edstrom, to the Second Step intervention group or the control group. Students’ in prosocial behavior and social reasoning than the
& Hirschstein (2005) behavior and progress assessed with self-reports, teacher ratings, and control group.
direct observations. Differences in teacher ratings of behavior were
Study population: present at Year 1 but not Year 2.
Approximate school populations
 51% Male
 49% Female
 70% White
 18% Asian American
Edwards, Hunt, Sample of 4th and 5th grade students (n = 455) to investigate the Students showed significant gains in knowledge
Meyers, Grogg, effectiveness of a version of the Second Step curriculum adapted to about empathy, anger management, impulse
& Jarrett (2005) include an anti-bullying component. control, and bully-proofing.
Study population: Report card data also revealed modest gains in
 32% Hispanic prosocial behavior.
 30% White
Schick & Cierpka Experimental study among children (n = 335, ages 5–8) who Students who participated in the Second Step
(2005) participated in Faustlos (German version of the Second Step program). program showed significant declines in anxious,
Change in empathy and aggression was assessed against the control depressed, and socially withdrawn behavior
group by teachers and parents who completed a measure of internalizing compared to the control groups, based on parents’
and externalizing behaviors. ratings.
Study population: Parent reports also revealed significant gender
 51% Male differences: Only girls in the experimental group
 49% Female showed decreases in physical aggression and
 100% German increased social competence when compared to
control students.

The Second Step Staff Training is a 1-day course Developer Involvement
designed to help participants learn to teach the
Second Step curriculum to students. This training The organization’s program developers dedicate
provides hands-on experience with the curriculum themselves to ongoing revision of the programs
and helps teachers strengthen social-skills teaching to maintain their effectiveness. The Committee
techniques and identify opportunities to model for Children also remains focused on sustained
and reinforce skills. As part of the program, partnerships with clients anchored in outstanding
each site receives a set of four staff-training videos customer support and training and directed to
that can be used to reinforce the skills that were clients’ long-term success.
learned and train new staff. (This training is
available only onsite.) For more information, visit the
Committee for Children’s Web site:
Information about training and http://www.cfchildren.org/programs/ssp/overview/
materials can be obtained at:
http://www.cfchildren.org/programs/ssp/overview/
Monitoring fidelity and outcomes
Evaluation instruments are available for school

and district administrators to gauge fidelity of
 The regional Second Step Training for Trainers implementation and assess outcomes of the Second
costs $499 per person ($399 per person if Step program.
registered by Early Bird Discount deadline
designated for each location). Sites are not required to submit fidelity or outcome
data. The Committee for Children monitored the
 The maximum number of people recommended
outcomes during the pilot phase for the Second
for the onsite Second Step Training for Trainers
Step program.
is 40 people. The cost for 25 people is $4,975.
Each additional person is $100. The total cost
for a training of 40 is $6,475 plus travel-
Financing the intervention
related expenses.
 The onsite Second Step Staff Training costs According to C. Glaze (personal communication,
$1,600 plus travel-related expenses. June 21, 2006):
 After participants have attended one initial  Approximately 80 percent of those who
training session, Committee for Children implement the Second Step program use
trainers are available to provide onsite Safe and Drug Free Schools funding to
consultation, booster sessions, or additional purchase the curriculum.
training. The fee for this service is $125
per hour.  Often, some of the resources required for
training services derive from a site’s staff
 The cost for materials will vary according to development budget.
the curriculum kits purchased and ranges from
$159 to $289. Volume discounts are available
for orders over a certain size.
 No certification is needed to implement
the Second Step program.

Larsen, T., & Samdal, O. (2007). Implementing
Resources/Links
Second Step: Balancing fidelity and program
adaptation. Journal of Educational and
Committee for Children: http://www.cfchildren.org.
Psychological Consultation, 17, 1–29.
Training Information:
McMahon, S. D., & Washburn, J. J. (2003).
http://www.cfchildren.org/programs/ssp/overview/ Violence prevention: An evaluation of program
effects with urban African American students.
Office of Juvenile Justice and Prevention
Journal of Primary Prevention, 24, 43–62.
Programs: http://www.dsgonline.com/mpg2.5//
TitleV_MPG_Table_Ind_Rec.asp?id=422
McMahon, S. D., Washburn, J. J., Felix, E. D., et
al., (2000). Violence prevention: Program effects
on urban preschool and kindergarten children.
References
Applied and Preventive Psychology, 9, 271–281.
Cooke, M. B., Ford, J., Levine, J., et al., (2007).
Orpinas, P., Parcel, G. S., Mcalister, A.,
The effects of city-wide implementation of
Frankowski, R. (1995). Violence prevention
Second Step on elementary school students’
in middle schools: A pilot evaluation. Journal
prosocial and aggressive behaviors. The Journal
of Adolescent Health, 17, 360–370.
of Primary Prevention, 28, 93–115.
Schick, A., & Cierpka, M. (2005). Faustlos:

Edwards, D., Hunt, M. H., Meyers, J., Grogg, K.
Evaluation of a curriculum to prevent violence
R., & Jarrett, O. (2005). Acceptability and
in elementary schools. Applied and Preventive
student outcomes of a violence prevention
Psychology, 11, 157–165.
curriculum. Journal of Primary Prevention,
26, 401–418.
Sprague, J., Walker, H., Golly, A., et al., (2001).
Translating research into effective practice:
Frey, K. S., Nolen, S. B., Van Schoiack-Edstrom,
The effects of a universal staff and student
L., & Hirschstein, M. K. (2005). Effects of
intervention on indicators of discipline and
a school-based social-emotional competence
school safety. Education & Treatment of
program: Linking children’s goals, attributions,
Children, 24, 495–511.
and behavior. The Journal of Applied
Developmental Psychology, 26, 171–200.
Taub, J. (2002). Evaluation of the Second Step
violence prevention program at a rural
Glaze, C. (personal communication,
elementary school. School Psychology Review,
June 21, 2006).
31, 186–200.
Grossman, D. C., Neckerman, H. J., Koepsell, T.
Van Schoiack-Edstrom, L., Frey, K. S., & Beland,
D., et al., (1997). Effectiveness of a violence
K. (2002). Changing adolescents’ attitudes about
prevention curriculum among children in
relational and physical aggression: An early
elementary school. The Journal of the American
evaluation of a school-based intervention. School
Medical Association, 277, 1605–1611.
Psychology Review, 31, 201–216.

Implementation and Dissemination Training/coaching and Materials
Infrastructure issues Training models
The Committee for Children offers two training

Readiness:
models for the Second Step program. The
The Committee for Children offers unlimited, organization hosts 25 to 30 regional trainings
free implementation support for the Second Step in cities across North America. Attendance at
program. A knowledgeable team of program a regional training allows participants to network
implementation specialists, all former educators, with professionals outside their organization and
is available by phone to help interested parties can be a more cost-effective option when looking
plan for, implement, and sustain the program. to train one person or a small group of people.
Additional support is available in the form of Committee for Children trainers are also available
written materials that provide detailed information for travel to any community to deliver onsite
on a range of topics, such as how to secure buy-in, Second Step training exclusively for school, agency,
develop roll-out plans, involve families, provide or district staff, providing the opportunity to plan
ongoing support, and evaluate the program. program implementation as a group, address local
A funding specialist is on staff to provide up-to-date issues, and network with colleagues.
grant announcements and funding opportunities.
Training programs
Possible barriers:
 Lack of sponsorship at school or district level. The Second Step Training for Trainers is a 2½-day
course designed to help participants learn to teach
 Lack of buy-in—No commitment on the part the curriculum efficiently and return to their
of teachers and other adults responsible for schools or agencies to conduct their own staff
implementing the program. trainings, thus providing “local expertise.”
 Lack of time—Some mandates have influenced
school districts to focus solely on academics, In addition, participants can provide ongoing
leaving little room for social and emotional “booster” trainings, train new staff as they are
learning programs. hired, and assist with implementation support.
Each participant receives a comprehensive
 Constant leadership changes in administration
trainer’s manual, CD-ROM, and a set of four
affect the ability to sustain program
staff training videos.
implementation over time.
 Lack of funding. Professional development credits are available for
 Lack of parent or caregiver involvement, hence completion of the regional Second Step Training
no support outside of the classroom setting. for Trainers. (This training is available both
regionally and onsite.)
 No ongoing implementation support.

Promoting Alternative Thinking Strategies
It is recommended that sites hire a PATHS

coordinator to assist with implementation and
help to ensure its quality. A coordinator should
have a background in teaching with a solid foundation
Background
and experience in social and emotional learning.
(PATHS) is a universal prevention program that Figure 4
was developed by Carol Kusché, Ph.D., of the
University of Washington and Mark Greenberg,
Type of EBP  Prevention
Ph.D. of Pennsylvania State University.
Setting  School-based (including
alternative schools and charter
This program is an elementary school-based (K-5) school programs)
program that is delivered by the teachers to reduce Age  5–12
and prevent emotional and behavioral problems. Gender  Males

 Females
PATHS is delivered by national certified
trainers through PATHS, LLC, based in Seattle,
Outcomes  Increase in ability to label
Washington. Since 2000, it has been disseminated feelings.
to approximately 80,000 students in the United  Increases in self-control.
 Reductions in classroom
States, Switzerland, UK, The Netherlands, Germany, aggression.
Belgium, Greece, Australia, Mexico, and South  Decrease in teacher-reported
America. More than 200 organizations are receiving internalizing and externalizing
negative behaviors.
some type of PATHS services at any given time
(M. Greenberg, personal communication, September
28, 2006).
PATHS is delivered by trained teachers three
times a week for approximately 20 to 30 minutes.
Characteristics of the intervention A manual is available with specific instructions
and developmentally appropriate lessons that
PATHS is a 5-year program that is implemented address five major domains: self-control;
in the schools by teachers and counselors. The emotional understanding; positive self-esteem;
program is aimed at students who are either in relationships; and interpersonal problem-solving
mainstream or special education classes. The goal skills (Greenberg, Kusché, & Mihalic, 1998).
of the program is to increase social and emotional Each domain has subgoals according to the
competencies while reducing aggressive, acting- developmental level of each child.
out behaviors.

The PATHS program is delivered in developmentally
tailored lessons by teachers using a variety of
teaching methods. The curriculum consists of
Research on the effects of PATHS has been
an instructional manual, six volumes of lessons,
conducted since 1983, including five randomized
pictures, photographs, posters, Feeling Faces, and
control designs. Studies have examined the
additional material. There are three major units:
effectiveness of the program in real world settings,
 The Readiness and Self Control Unit in samples of regular and special education
(12 lessons); classrooms, and with culturally diverse students
 The Feelings and Relationships Unit that include African Americans, Hispanics,
(56 lessons); and American Indians, and Asian Americans. Riggs
(2006) specifically studied the effects of PATHS
 The Interpersonal Cognitive Problem-Solving administered as a part of an after-school program
Unit (33 lessons). with rural Latino children.
A Supplementary Unit covers issues in friendship Research supports many positive outcomes of the
and moral decisionmaking and reviews lessons in PATHS intervention, such as reducing classroom
the other units. The large instructional manual aggression, internalizing problems, self-reporting
provides the scope and sequencing of the lessons depressive symptoms, and increasing developmental
for each developmental group. Younger children understanding of, and fluency with, discussing
are exposed to the Turtle Unit (Readiness and emotional experiences. Positive outcomes have
Self-Control), which teaches readiness and self- been noted in both 1- and 2-year followup studies.
control through metaphorical storytelling and See Table 4.
behavioral support.
For children in the latter elementary years, a more

cognitively advanced approach has a greater focus
on problem-solving tasks and lessons. Flexibility
exists in the program to allow teachers to tailor
the lessons to their individual teaching style.

Table 4: Promoting Alternative Thinking Strategies: Research Base and Outcomes
Greenberg, Kusché, Randomized design with 30 classrooms of children (n= 286, grades 2-3) Children exposed to PATHS demonstrated increased
Cook, & Quamma randomly assigned to be exposed to the PATHS curriculum or the control range of affective vocabulary and fluency in
(1995) group to measure the effects of the intervention on a child’s emotional discussing emotional experiences, beliefs regarding
understanding. management of emotions, and developmental
Pre-post test measures and interview questions used to test children’s understanding of some aspects of emotions.
understanding of emotional situations.
Study population:
n 58% Male
42% Female
58% White
32% African American
4% Asian American
2.5% Filipino Americans
2.5% American Indians
1% Hispanic
The Conduct Randomized control design (n=378), 198 1st grade classrooms assigned After 1 year, children exposed to PATHS demonstrated
Problems to treatment group (the PATHS intervention) and 180 assigned to the reductions in classroom aggression and increases
Prevention Research control group; all from high-crime neighborhoods. in self-control.
Group (1999) Study population:
n Mean percentage of minority students (primarily African American)
across all 378 schools was 49%. The range was from 1% to 90%.
Kam, Greenberg, Experimental research design examining the long-term effects of the For special education children, the PATHS intervention
& Kusché (2004) PATHS curriculum on the adjustment of school-age children receiving indicated reduced growth of internalizing and
special education services. externalizing negative behaviors by teacher reports
Special education classrooms (n = 18) were randomly assigned to the at 2 years after intervention.
control group (no PATHS- intervention) or the treatment group (PATHS- Additionally, PATHS intervention produced sustained
intervention). Children (n = 133) grades 1st–3rd at start. Data collected reduction in child-reported depressive symptoms.
for 3-successive years.
Study population:
n 73% Male
27% Female
66% White
14% Other
Riggs, Greenberg, Randomized design studied the PATHS curriculum on 30 classrooms with Results showed significant effects at posttest on
Kusché, & Pentz 318 children, grades 2–3, to measure 1-year post-intervention outcomes children’s inhibitory control and verbal fluency.
(2006) on teacher-reported externalizing and internalizing behavioral problems, Findings 1 year later showed significant teacher
as well as mediation through tasks assessing executive functions. effects on students’ externalizing and internalizing
Study population: problems.
n 50% Male
50% Female
55% White
22% Asian American, American Indian or other racial background
Domitrivich, Cortes, Randomized design studied PATHS curriculum with children (grades K–6) After exposure to PATHS, children in the PATHS
& Greenberg (2007) from 20 classrooms (n = 246). 10 classrooms received PATHS curriculum; classrooms had higher emotion knowledge skills
10 were control classrooms. and received higher ratings from parents and teachers
Study population: for social competency than children in the control
classrooms.
n 49% Male
51% Female
38% White
10% Hispanic
5% Other racial background

 Materials available for purchase:
 Complete PATHS curriculum
(includes readiness curriculum) ($679);
Infrastructure Issues
 PATHS Basic Kit ($579);
Readiness:  PATHS Readiness and Self-Control

Turtle Kit ($159); and
No formal readiness instruments are available.
An informal assessment process is conducted  Costs of additional materials ($100).
with an interested site and the PATHS trainers.  Parent materials are available in Spanish.
Information about the curriculum can be obtained

Training/coaching and materials at: http://www.prevention.psu.edu/projects/
PATHSCurriculum.html
 Training is provided through PATHS
Training, LLC.
Information about purchasing the curriculum
 Training new sites requires a 2- to 3-day can be obtained at: http://www.channing-bete.com/
onsite visit, which involves teachers, school prevention-programs/paths/.
administrators, and on occasion, parents.
 Ongoing technical assistance and coaching
usually consist of weekly or biweekly Cost of training/consulting
observations by curriculum consultants. These  Complete training and ongoing technical
booster sessions can be individualized to the assistance costs are approximately $4,000
site. They can also last up to 4 to 5 years after to $5,000 plus travel and per diem expenses
initial implementation of PATHS. In subsequent for 1 trainer, 2 days, and 30 participants.
years of PATHS implementation, teachers will
receive a half-day of training.  For onsite training only (for 2 days and up
to 30 participants), costs are approximately
 Whole school staff discussions occur quarterly. $3,000 plus travel and per diem expenses
 Trainer certification is available through for the trainer.
PATHS Training, LLC. This certification  The developers project that the cost to
requires working as a local PATHS coordinator implement PATHS is approximately $25
and demonstrating leadership in assisting sites per student. Total costs including training
in implementing PATHS locally. This process and technical assistance for first year
will last 2 years, before advancing to intensive operations at an elementary school are
training. Fifteen trainers are in the United States. around $10,000. In the following year, the
costs would decrease to about $10 per student.
Thus, the cost to implement the program over
3 years is approximately $15 per student.
These costs do include some training materials,
as outlined previously.

Developer involvement Monitoring fidelity and outcomes
The developers, Dr. Greenberg and Dr. Kusché,  Fidelity measures are available for sites to
are actively involved in developing and modifying use. For some sites that are participating in
the program. However, PATHS, LLC, based in a research study, the fidelity measures are
Seattle, is responsible for assessing interested required and sent monthly to PATHS, LLC.
parties in the PATHS program, assigning trainers, However, sites that are not a part of a study are
and managing the training process. not required to collect or report fidelity measures.
Mark T. Greenberg, Ph.D.  Both fidelity and teacher-reported outcome
Director, Prevention Research Center measures are available at no charge from the
Henderson South – 112 publisher (Channing-Bete, Inc). Sites are
Pennsylvania State University advised to collect and report their outcome
University Park, PA 16803 measures. PATHS, LLC does offer support to
Phone: (814) 863-0112 sites interested in using outcome data to better
Fax: (814) 865-2530 inform program decisionmaking.
Email: mxg47@psu.edu
Carol A. Kusché, Ph.D. Financing the intervention

PATHS, LLC
 Most schools use Safe & Drug-Free school
927 10th Avenue East
funds, school board funds, and short-term
Seattle, WA 98102
grants from local and federal agencies.
Phone: (206) 323-6688
Email: ckusche@attglobal.net  The program is not covered by Medicaid
(M. Greenberg, personal communication,
September 28, 2006).

Greenberg, M. T., Kusché, C., & Mihalic, S. F.
Resources/Links:
(1998). Promoting Alternative Thinking
Strategies (PATHS): Blueprints for Violence
To order PATHS materials, go to:
Prevention, Book Ten. Blueprints for Violence
http://www.channing-bete.com/prevention-programs/
Prevention Series (D.S. Elliott, Eds.). Boulder,
paths/paths.html
CO: Center for the Study and Prevention of
Violence, Institute of Behavioral Science,
University of Colorado’s Center for the Study
University of Colorado.
and Prevention of Violence:
http://www.colorado.edu/cspv/
Kam, C., Greenberg, M.T., & Kusché, C. A.
(2004). Sustained effects of the PATHS
curriculum on the social and psychological
References
adjustment of children in special education.
Journal of Emotional and Behavioral Disorders,
Conduct Problems Prevention Research Group.
12(2), 66–78.
(1999). Initial impact of the fast track prevention
trail for conduct problems: II. Classroom effects.
Kam, C., Greenberg, M. T., & Walls, C. T. (2003).
Journal of Consulting and Clinical Psychology,
Examining the role of implementation quality
67 (5), 648–657.
in school-based prevention using the PATHS
curriculum. Prevention Science, 4(1), 55–63.
Domitrivich, C. E., Cortes, R. C., & Greenberg,
M. T. (2007). Improving young children’s social
Riggs, N. R. (2005). After-school program
and emotional competence: A randomized trial
attendance and social development of rural
of the Preschool “PATHS” curriculum. Journal
Latino children of immigrant families. Journal
of Primary Prevention, 28, 67–91.
of Community Psychology, 34(1), 75–87.
Greenberg, M. T. (personal communication,
Riggs, N. R., Greenberg, M. T., Kusché, C. A.,
& Pentz, M. A. (2006). The mediational role
of neurocognition in the behavioral outcomes
Greenberg, M. T., Kusché, C. A., Cook, E. T.,
of a social-emotional prevention program in
& Quamma, J. P. (1995). Promoting emotional
elementary school students: Effects of the
competence in school-aged children: The effects
PATHS curriculum. Prevention Science, 7(1),
of the PATHS curriculum. Development and
91–102.
Psychopathology, 7, 117–136.
Greenberg, M. T., & Kusché, C.A. (1998).

Preventive intervention for school-age deaf
children: The PATHS curriculum. Journal of
Deaf Studies and Deaf Education, 3(1), 49–63.

First Steps to Success
Coaches have a critical role in the program:

 Working in the classroom;
 Gaining parent and guardian’s support;
Background
 Monitoring the program during the teacher
First Steps to Success was developed in the early component;
1990s by Hill M. Walker, Ph.D., and his colleagues
 Assisting parents and guardians in mastering
at the University of Oregon. This school-based
the program; and
program with home components is for kindergarten
children who display early signs of aggression,  Troubleshooting for the entire duration
oppositional behavior, and severe temper tantrums. of the program.
The goal is to divert future antisocial behavior. Coaches will work alongside the teacher and
Within the past 2 years, more than 20 organizations, parent to provide them with skills to identify the
and between 1,500 and 2,000 practitioners have maladaptive behavior and reward good behavior.
been trained to deliver First Steps to Success.
Figure 5
Characteristics of the intervention First Steps to Success

Type of EBP  Prevention/Multi-level
The program comprises three interconnected Setting  Home
components and is implemented in 3 to 4 months.  School
First Steps to Success is designed for children with Age  5–6
challenging behaviors, aggression, and acting out, Gender  Males

 Females
and who victimize others in the school environment.
Outcomes  Decrease in aggression

Coaches are trained to work with two to three  Increase time spent on
students who coordinate the school and home academics
 More positive behavior
components. Staff members who implement the demonstration.
program should possess a master’s degree and have
clinical experience.

The three interconnected modules of First Steps
to Success are as follows:
The research base for the First Step to Success
1. Screening: A range of methods are used to
program includes one experimental waitlist control
assess kindergarteners, from teacher-reports
group design, one replication study with a pre-post
to direct observation.
test design, a multiple case study design, a program
evaluation, and a multiple-baseline across groups
2. School intervention: This component focuses on
design with qualitative interviews as displayed in
the child’s behavior in school using a contingency
the table below.
reward system. A consultant initially works with
the student closely in the classroom, offering
Students and families from culturally diverse
direct feedback using color cards to identify
backgrounds were used in the studies: Hispanic,
behavior. Children work toward a reward by
African American, and American Indian. The
demonstrating positive behavior.
research points to a number of positive changes in
the behavior of children identified to be at risk of
3. Home intervention: The home-based model
developing a serious pattern of antisocial behavior.
focuses on helping parents and caregivers
support the child’s progress. Six skills are
Research also finds that when the program is
practiced in the home to help the children
implemented in kindergarten, positive behavior
succeed in the school environment:
changes are maintained through 1st and 2nd grade.
 Communication and sharing; See Table 5.
 Cooperation;
 Limit setting;
 Problem solving;
 Friendship making; and
 Developing confidence.

Table 5: First Steps to Success: Research Base and Outcomes
Walker, Kavanagh, Randomized experimental waitlist control group cohort design of children Children who participated in the First Steps to
Stiller, Golly, in kindergarten (n = 46) identified as at risk for developing serious Success program showed significantly more adaptive
Severson, & Feil patterns of antisocial behavior, randomly assigned into one of two control behavior, less aggression, and less maladaptive
(1998) groups (no First Steps to Success Intervention) or one of two intervention behavior. Children who received First Steps to
groups (First Steps to Success Intervention). Children assessed for reduction Success demonstrated more engagement in
of aggression and improvement in using new prosocial behaviors. schooling activities.
Data collected at pretest, posttest and 1st grade followup and 2nd Results were similar at the 1st grade and 2nd
grade followup. grade followup.
Study population:
 74% Male
 26% Female
 93% White
 7% Children of minority status
Golly, Stiller, & Pre-post test design replication research study (n = 20) of kindergarten- Outcomes in the replication study were similar
Walker (1998) aged children identified to have high aggression ratings, low-adaptive to the original study.
behavior ratings, high-maladaptive behavior ratings. Limitations include First Steps to Success program showed significantly
a lack of a control group. more adaptive behavior, less aggression, and less
Study population: maladaptive behavior.
 95% Male
 5% Female
 95% White
 5% American Indian
Overton, McKenzie, Multiple case study (n = 16) using semistructured parent and teacher Behavioral improvements as evidenced by increases
King, & Osborne interviews. of the Child Behavior Checklist were significant,
(2002) Study population: but variable. Reports from semistructured interviews
with parents/caregivers and teachers were
 73% Male
generally positive.
 27% Female
 23% White
 23% White and African American
 4% Hispanic
 4% American Indian and White
Walker, Golly, Program evaluation of the implementation of First Steps to Success Results closely replicated the original study for
McLane, Kimmich Program to focus on children grades K-2, (n = 181). behavioral outcomes for students. Evaluators
(2005) found satisfaction from teachers and parents.
Fidelity varied widely.
Diken & Rutherford A multiple-baseline across groups design with qualitative interviews with Students’ social play behaviors significantly increased
(2005) American Indian students (n = 4, 2 at kindergarten level, 2 at 1st grade when First Steps to Success intervention initiated.
level). Outcome measures of direct observations and teacher and parent Substantial decreases in problem behaviors reported
interviews. by teachers.
Study population: Three of the 4 parents reported significant changes
 75% Male in problem behaviors of students.
 25% Female Parents reported high satisfaction with the program.

Dr. Walker and colleagues are researching the Cost of training/consulting
implementation of First Steps to Success through
two large grants from the Institute of Education The cost of training up to 30 coaches and 50
Sciences within the U.S. Department of Education. teachers is $1,000 to $1,500 per day plus the cost
Both studies are randomized control trials with of the materials, training, and airfare (H. Walker,
a year-long followup of experimental and control personal communication, June 6, 2007).
condition participants. One is an efficacy trial
in Albuquerque, New Mexico; the other is an
effectiveness trial involving five sites nationally Developer involvement
(H. Walker, personal communication, June 6, 2007.)
The developer, Dr. Walker, is actively involved in
developing and modifying the program, providing
coaching/teacher training and followup technical
assistance. Information about training can be
obtained by contacting the developer:
Training/coaching and materials Hill M. Walker, Ph.D.
Institute on Violence and Destructive Behavior
 Five expert trainers are available to provide 1265 University of Oregon
training to sites. The coaches participate in a Eugene, OR 97403
2-day training to learn about the program and hmwalker@uoregon.edu
the implementation sequence. The teachers Phone: (541) 346-2583
participate in a 1-day training to learn about Fax: (541) 346-2594
their responsibilities. The training structure
incorporates didactic teaching, role plays,
and question/answer demonstration. Monitoring fidelity and outcomes
 A manual is provided to the site once training
Instruments for measuring fidelity of critical
and implementation begin. The training
program features and the quality of the
materials have been translated in Spanish,
implementation are available. Coaches are
French, and Japanese.
required to complete program implementation-
 Information on purchasing the curriculum can monitoring forms that document application and
be obtained at: http://store.cambiumlearning.com quality of the procedures (H. Walker, personal
communication, June 6, 2007). Outcome measures
are collected from designated research sites but
not from nonresearch sites.
The program is usually funded through local school

district, state, and federal government budgets (H.
Walker, personal communication, August 30, 2006).

Walker, H. (personal communication,
Resources/Links
June 7, 2007).
 Office of Juvenile Justice and Prevention
Walker, H. M. (1998). First steps to prevent
Program: http://www.ojjdp.gov/MPG
antisocial behavior. Teaching Exceptional
Children, 30(4), 16–19.
 Sopris West Educational Services (to order
materials): http://www.sopriswest.com. Walker, H. M., Golly, A., McLane, J., & Kimmich,
 University of Oregon’s Institute on Violence M. (2005). The Oregon First Step to Success
and Destructive Behavior: replication initiative: Statewide results of an
http://www.uoregon.edu/~ivdb. evaluation of the program’s impact. Journal
of Emotional and Behavioral Disorders, 13(3),
163-172. doi:10.1177/10634266050130030401.
References
Walker, H. M., Kavanagh, K., Stiller, B., et al.,
Diken, I. H., & Rutherford, R. B. (2005). First (1998). First Steps to Success: An early
Step to Success early intervention program: intervention approach for preventing school
A study of effectiveness with American Indian antisocial behavior. Journal of Emotional and
children. Education and Treatment of Children, Behavioral Disorders, 6(2), 66–80.
28 (4), 444–465.
Walker, H. M., Stiller, B., & Golly, A. (1998). First
Golly, A., Stiller, B., & Walker, H. M. (1998). First Step to Success: A collaborative home-school
Step to Success: Replication and social validation intervention for preventing antisocial behavior
of an early intervention program. Journal of at the point of school entry. Young Exceptional
Emotional and Behavioral Disorders, 6(4), Children, 1(2), 2–6.
243–250.
Walker, H. M., Stiller, B., Severson, H. H., & Golly,
Overton, S., McKenzie, L., King, K., & Osborne, J. A. (1998). First Step to Success: Intervening at
(2002). Replication of the First Step to Success the point of school entry to prevent antisocial
Model: A multiple-case study of implementation behavior patterns. Psychology in the Schools,
effectiveness. Behavioral Disorders, 28(1), 35(3), 259–269.
40–56.

Early Risers: Skills for Success
Figure 6
Early Risers: Skills for Success
Type of EBP n Prevention
Background Setting n Home
n School
The Early Risers: Skills for Success program Age n 6–12
is a multicomponent, competency skill-based Gender n Males
intervention designed for children ages 6 to 12 n Females
years who display, or are at risk of displaying, Training/Materials Available n Yes
conduct-related problems and substance use. Outcomes n Gains in academic achievement.

n Reduction in self-regulation
problems.
The Early Risers program was developed by n Improved social skills and
adaptability.
Gerald August, Ph.D., George Realmuto, M.D.,
and Michael Bloomquist, Ph.D., at the Center
for Prevention and Children’s Mental Health
at the University of Minnesota. The program has The program unfolds over 2 to 3 years and
been in existence since 1996 and has evolved from emphasizes four domains:
a school-based to a community-based prevention
 Child academic competence;
and intervention program.
 Child behavioral self-regulation;
The program has been implemented in more  Child social-emotional competence; and
than 30 organizations within the past 4 to 5 years
(G. August, personal communication, July 17, 2006).  Parent investment (August, Realmuto, Hektner,
& Bloomquist, 2001).
Characteristics of the intervention Children are identified in early elementary grades

through teacher nomination and standardized
The Early Risers program provides comprehensive teachers’ ratings of child behavior. The
mental health promotion services to early elementary intervention is delivered by a “family advocate”
school-age children displaying early onset aggressive, who is usually a bachelor-degreed professional with
disruptive, and socially withdrawn behaviors and to at least 2 years’ experience working with children
their families. The intervention model is grounded and families.
in social learning, social cognition, and social
bonding theoretical perspectives. To effectively deliver services, the family advocate
must have the flexibility to work unconventional
The model features child-focused and family- hours and be willing to visit families and children
focused components, each of which offers skill- in multiple settings, such as home, school, or
building and support services delivered in unison community (G. August, personal communication,
over time. The Early Risers program involves July 17, 2006).
collaboration between community public schools,
community agencies, and University of Minnesota The family advocate coordinates services for both
prevention specialists. the child-focused and family-focused components.
The child-focused component consists of a set of

education/skills training and support interventions  Family Nights with Parent Education
for children. Child-focused interventions include (standardized): Children and parents come to
the following: a center or school during the evening. Children
participate in fun activities while their parents
 Summer Day Camp (standardized): This interaction meet in small groups for 60 minutes of parent-
is designed for delivery during the summer focused education and skills training designed
months. It works best when offered 4 days per to enhance parent’s knowledge of child
week for 6 weeks. Implementers are required development and parenting skills. This is
to offer three 1-hour curricula each day: social- followed by parent-child “bonding” activities.
emotional skills education and training, reading Family Nights occur five times during the
enrichment and appreciation, and creative arts school year between October and May.
experiences. A behavioral management protocol
 Family Support (tailored): This program is
is administered throughout all activities.
individually designed to address each family’s
 School Year Friendship Groups (standardized): specific needs, strengths, and maladaptive
Children are invited to attend small group patterns. It is delivered in four phases:
sessions before, during, or after school. This
 Asset appraisal and needs assessment;
program provides advancement of social-
emotional skills education and training, reading  Goal setting;
enrichment and appreciation, and creative arts  Brief interventions and resources; and
experiences. A behavioral management protocol
is administered throughout all activities.  Monitoring and reformulating goals.
 Monitoring and Mentoring School Support In addition, if indicated, more intensive and
(tailored): This feature occurs throughout each tailored parent skills training is provided.
school year and is intended to help and modify
academic instruction as well as address children’s
behavior while in school, through the support of Research Base and Outcomes
the family advocate. In addition, a primary goal
is to bridge family and school to foster continued The evaluation of the Early Risers program
success in learning. A home reading program is includes an initial efficacy study, an early-stage
such a bridge. effectiveness trial, and an advanced-stage
effectiveness trial, all with randomized control
The goal of the family-focused component is to designs. See Table 6. The initial study was
empower families and to allocate the appropriate conducted with a semi-rural, White sample, while
resources to help families reach their identified the validation study was conducted with a mostly
goals. Family-focused interventions include African American, urban sample.
the following:
Overall, research supports significant relationships
between children’s level of participation throughout
the Early Risers program (more than 1 year or
more) and social competence, school adjustment,
and academic achievement. August et al., (2004;
2006) point to the need for longer durations of
interventions or booster sessions to maintain positive
results, as well as the concern for attrition rates.

Table 6: Early Riser: Research Base and Outcomes
August, Realmuto, Efficacy Study: Randomized, controlled design of, children (n = 245) For intervention schools, the most severely aggressive
Hektner, & rated high risk by the Child Behavior Checklist – Teacher Rating form; children improved behavior at Years 2 and 3.
Bloomquist (2001) 124 children at intervention schools and 121 children at control schools. Children improved on indicators of school achievement
August, Hektner, Data are published for 2- and 3-year immediate intervention effects, at Years 2 and 3.
Egan, Realmuto, & and followup at Year 4 and Year 6. Program children evidenced better social adjustment
Bloomquist (2002) Study population: at Year 3, and did better on a sociometric assessment
August, Egan,  White families of social status at Year 4 (less rejected and more
Hektner, & accepted by prosocial peers).
Realmuto (2003) Parents with high program participation showed
Bernat, August, improvements in self-reported discipline methods
Hektner, & at Years 2 and 3.
Bloomquist (2007) Program children and their parents reported
significantly fewer ODD symptoms at Year 6.
Fewer ODD symptoms for program children at Year 6
were related to previous Year 3 improvements in child
social skills and parent effective discipline practices
(that is, mediational analyses).
August, Lee, Early-Stage Effectiveness Trial: Randomized, controlled design (n = 327), Program children exhibited significant gains
Bloomquist, kindergarten and 1st grade children from 10 low socioeconomic schools on measures of school adjustment and social
Realmuto, & screened positive for aggressive behavior. competence.
Hektner (2003) Two years of continuous active intervention and 1 year of no formal The most aggressive program children showed
August, Lee, intervention. Three groups: the full Early Risers program (child- and reductions in disruptive behavior.
Bloomquist, family-focused), partial Early Risers (child-focused only), and no Program children’s parents reported lower levels
Realmuto, & intervention (control group). of stress.
Hektner (2004) Because initial analysis comparing experimental groups showed no Program children maintained social competence
significant differences between groups on any outcome variables, the full gains at Year 3.
Early Risers program and partial Early Risers Program were collapsed and
School adjustment improvements and externalizing
compared as an augmented group to the control group.
problems were not maintained at Year 3.
Data are published for two immediate intervention effects and followup
at Year 3.
Study population:
 20% White
August, Bloomquist, Advanced-Stage Effectiveness Trial: Overall attendance rates were poor and this was
Lee, Realmuto, & Randomized, controlled design (n = 295), kindergarten and 1st grade attributed to the community agency insufficiently
Hektner (2006) children from 16 low socioeconomic schools with 2/3 of the population allocating resources to engaging families (for example,
exhibiting a positive screen for aggressive behavior. limited funding of transportation, agency downsizing,
and high staff turnover).
Two years of continuous active intervention. In this initiative, a
community agency assumed “ownership” of the program by funding it Although program children exhibited significant gains
and its staff implemented all components with only technical assistance on teacher’s ratings of disruptive behavior, no other
from program developers. previous findings were replicated.
The Early Risers program and a no intervention control group were Dosage analysis, however, determined that program
compared. Data are published for 2-year immediate intervention effects. children who did attend at acceptable levels exhibited
gains on indicators of social and academic competence,
Study population:
and a math achievement test.
 69% Male
It was concluded that attention to family engagement
 31% Female and adequate resource allocation is essential to obtain
positive program effects.
 89% White
 11% Minority

Implementation and Dissemination Cost of training/consulting
The overall training, technical assistance, and

supportive services costs range from $5,000 to
$8,000. The cost to implement the Early Risers
program is about $1,500 per child, per year.
Readiness:
The program provides a checklist used to screen

and assess the capacity of the interested parties, Developer involvement
and determine if Early Risers would be appropriate.
Currently, the developers are still very involved
For those sites that might not be best suited for the
in implementing and disseminating Early Risers.
Early Risers program, the developers attempt to
For more information, contact Dr. August.
recommend a more “compatible” program.
Gerald J. August, Ph.D.
For those sites that are appropriate, it may take 3 Division of Child and Adolescent Psychiatry
to 6 months to start the program due to recruitment University of Minnesota
and screening. 2450 Riverside Avenue, F256/2B West
Minneapolis, MN 55454-1495
Phone: (612) 273-9711
Possible barriers:
Fax: (612) 273-9779
Some barriers to the implementation augus001@umn.edu
and sustainability are as follows:
 Funding problems;
 Turnover of key personnel; and
The fidelity of program delivery (that is, exposure,
 Loss of a key staff member to ensure
adherence, quality) is monitored throughout.
quality implementation and sustainability
Information is systematically collected and
of the program.
reviewed by the university prevention specialists,
community agency supervisory staff, and family
advocates. This includes examination of child
Training/coaching and materials
and parent attendance, documentation of services
 The training program is usually held over a provided, direct observation of intervention
4-day period at the designated host site. About provision, and consumer satisfaction data.
20 family advocates and program supervisors Adjustments in programming, staffing, and
can participate in the training at once. training are made based on fidelity monitoring.
 A Skills for Success training manual, video, and

At this present time, the developers of the program
other programmatic resources are available for
are completing the development of a web-based
an additional charge.
fidelity monitoring system. This system is being
 The developers maintain an ongoing designed as a self-report mechanism offering
relationship with a site for up to 2 years. background information (number of children
and families served), how the program was
 The Early Risers Program is affiliated
delivered, and the methods used. A family
with the University of Minnesota.
advocate is to log-on once a week to offer this
 Information about training and materials can information. This is not a specific requirement,
be obtained at: http://www.psychiatry.umn.edu/ but is strongly encouraged.
research/earlyrisers/home.html

The developers assist sites with collecting and August, G. J., Lee, S. S., Bloomquist, M. L., et al.,
interpreting outcome data. Part of the training (2003). Dissemination of an evidence-based
focuses on identifying someone at the site who prevention innovation for aggressive children
will collect this data. living in diverse, urban neighborhoods.
Prevention Science, 4, 271–286.
Financing the intervention August, G. J., Lee, S. S., Bloomquist, M. L.,

Realmuto, G. M., & Hektner, J. M. (2004).
Early Risers is typically paid for by local grant
Maintenance effects of an evidence-based
money (G. August, personal communication, July
prevention innovation for aggressive children
17, 2006) or through access to local county dollars
living in culturally diverse urban neighborhoods:
earmarked for prevention (Bloomquist et al., 2006).
The Early Risers effectiveness study. Journal
of Emotional and Behavioral Disorders, 12,
194–205.
Resources/Links
August, G. J., Realmuto, G. M., Gewirtz, A. (2007).
University of Minnesota-Department of Psychiatry:
Early-age targeted prevention of mental health
http://www.psychiatry.umn.edu/research/earlyrisers/
problems and juvenile delinquency for
home.html
maltreated children: The Early Risers Skills
for Success community integration program.
References The Link, 5 (4), 1–14.
August, G. J. (personal communication, August, G. J., Realmuto, G. M., Hektner, J. M.,

July 17, 2006). & Bloomquist, M. L. (2001). An integrated
components preventive intervention for
August, G. J., Bloomquist, M. L., Lee, S. S., et al., aggressive elementary school children:
(2006). Can evidence-based prevention programs The Early Risers program. Journal of
be sustained in community practice setting? The Consulting and Clinical Psychology, 69,
Early Risers advanced-stage effectiveness trial. 614–626.
Prevention Science, 7(2), 151–165.
Bernat, D., August, G.J., Hektner, J. M., &
August, G. J., Egan, E. A., Hektner, J. M., & Bloomquist, M.L. (2007). The Early Risers
Realmuto, G. M. (2003). Four years of the Early preventive intervention: Testing for six-year
Risers early-age-targeted preventive outcomes and mediational processes. Journal
Intervention: Effects on aggressive children’s of Abnormal Child Psychology, 35(4), 605–617.
peer relations. Behavioral Therapy, 34, 453–470.
Bloomquist, M. L., Lee, S. S., & August, G. J.
August, G. J., Hektner, J. M., Egan, E. A., et al., (2006). Sustainability of the Early Risers
(2002). The Early Risers longitudinal prevention program financial infrastructure through a local
trial: Examination of 3-year outcomes in county and community-based family services
aggressive children with intent-to-treat and agency. Paper presented at the 14th Annual
as-intended analyses. Psychology of Addictive Meeting of the Society for Prevention Research,
Behaviors, 16, 27–39. San Antonio, TX.

Adolescent Transitions Program
Figure 7
Brief Description
Adolescent Transitions Program
Background Setting  School
Age  11–18
The Adolescent Transitions Program (ATP)
Gender  Males
developed by Thomas Dishion, Ph.D., and Kate
 Females
Kavanagh, Ph.D., is a multilevel, family-centered
intervention that seeks to prevent teen antisocial
Outcomes  Reduction in negative parent-
behavior and drug experimentation. ATP was child interactions.
designed as a group psychoeducational intervention  Decrease in antisocial behaviors
focused on family management practices and at school.
reducing deviant peer influences; it was offered  Effective in reducing youth

smoking.
to high-risk adolescents and families in an
outpatient setting.
Continued research by developers led to a

significant growth of the program, including Characteristics of the intervention
implementation in the middle school setting and
offering levels of the intervention that permeate There are three levels of the ATP intervention:
the entire school environment (Dishion & universal, selective, and indicated.
Kavanagh, 2003).
Level 1: Universal
Today, ATP is a three-tiered intervention that has
both parent and child curricula delivered in both The first level is aimed at the entire school
group and individual formats. The parent curriculum population. A main component is the development
focuses on understanding family dynamics and of a Family Resource Center (FRC) within the
effective parent management skills through school; a full-time coordinator is hired as a school
encouragement, limit setting and supervision, employee to operate the center.
problem solving, and communication patterns.
The goals of the FRC include:
The child curriculum focuses on a social learning  Encouraging referrals of at-risk students
approach to behavior change through limit setting, and families;
problem solving, goal setting, outlining the
 Providing parents information about services;
appropriate steps to achieve goals, and developing
peer support for prosocial behavior (Dishion &  Disseminating information about parenting; and
Kavanagh, 2003).  Working with school and community
professionals on topics of identification
and effective treatment of at-risk students
(Dishion & Kavanagh, 2003).

Formats for disseminating information to parents Level 3: Indicated
include the following: The third level of the intervention is direct support
 School orientation meetings; focused on parents to help change clinically
significant problems through a variety of services
 Media on effective parenting and norms;
identified collectively as The Family Intervention
 Classroom-based parent-child exercises that Menu. Services, administered by masters-level
support family management practices; and clinicians known as “Group Leaders,” include
 Phone calls and letters to parents about their the following:
child’s activities at school.
 Family Management Group: A 12-week group
The format for disseminating information to with 8 to 10 families using exercises, roleplays,
students is the Success Health and Peace (SHAPe) videotapes, and booster sessions available
curriculum: 6 sessions, 40 to 60 minutes each, monthly at the conclusion of groups for at
delivered weekly in health class or homeroom, least 3 months. A parent consultant who has
implemented by teachers, yet supported and completed the program can help guide the
coordinated by FRC staff. group’s conversation and can be a bridge
between parents and group leaders.
 A home-school card
Level 2: Selective
 One to two sessions on special topics from
The second level of the intervention provides
the Family Management Curriculum
selective assessment, identification, and professional
support for at-risk children and their families  Monthly monitoring
through the administration of the Family Check-Up
 Individual Family Management Therapy
(FCU). The three-session intervention is designed
from the Family Management Curriculum
to gather information about the family to develop
a plan to support the well-being of the child  Referrals to more intensive services
and family.
 Session 1: The initial family interview is 90
minutes in length and includes two therapists,
the parents, and the adolescent. The Family
ATP research studies include randomized clinical
Intake Questionnaire–Adolescent Version is
trials as well as replication studies. The research
used to gain background information.
supports the intervention in successfully reducing
 Session 2: The comprehensive assessment of the adolescent problem behaviors of substance use
family includes a videotaped session to measure as well as increasing family communication and
family management practices and the completion relationships. Research participants include
of a Family Assessment Task. American Indians, African Americans, Asian
 Session 3: The family feedback session is aimed Americans, and Latinos. Specific outcomes
from ATP studies are outlined in Table 7.
at encouraging family engagement in the ATP
process, the maintenance of positive family
practices, as well as making changes in parenting
problems (Dishion & Kavanagh, 2003).

Table 7: Adolescent Transition Program: Research Base and Outcomes
Dishion & Andrews Level 3 Research Study: Both Family Management Curriculum (FMC) and
(1995); Total n =158 families with high-risk young adolescents (ages 11–14) self-regulation were associated with reduction in
Dishion et al., in a randomized clinical trial (n = 119) assigned to one of four group negative engagement between parent and child.
(1996) (in Dishion intervention conditions Teachers reported less antisocial behaviors for
& Kavanagh, 2003) 1) Family Management Curriculum (FMC) with parent focus, youth in FMC groups.
2) FMC adolescent focus, Interventions with aggregated high-risk youth

showed escalations in tobacco use and problem
3) FMC parent & adolescent focus,
behavior at school, beginning at termination
4) self-directed change (materials only). and persisting to followup when compared to
Intervention lasted 12 weeks. An additional n = 39 families of young control group.
adolescents were recruited as a quasi-experimental control. Followup Parent-only condition nearly eliminated onset
at 1 year. of youth smoking at 1 year, yet results faded after
Study population: 1 year.
 52.5% Male
 47.5% Female
 95% White
Irvine, Biglan, Replication Study of Level 3 Research: For the intervention group:
Metzler, Smolkowski, Randomized clinical trial with high-risk rural families (n = 303) assigned Improvements in problem- solving interactions.
& Ary (1999) to parent-focused FMC intervention group or a waitlist control group. Parents’ overactivity and lax approach to child’s
Study population: behavior reduced.
 61% Male Parent’s positive feelings toward child improved.
 39% Female Parent-reported antisocial behaviors
decreased significantly.
 88% White
Measures of child adjustment improved.
 2% Hispanic
 7% Other
Dishion, Kavanagh, Multilevel Research Study Intervention reduced initiation of substance use
Schneiger, Nelson, 4-year longitudinal study of multiethnic 6th grade students (n = 672) and in both at-risk students and those not at risk.
& Kaufman (2002); their families randomly assigned to ATP intervention or to control condition. Families assigned to the Family Check Up
Dishion, Nelson, Study population: (FCU) intervention maintained positive parental
& Kavanagh (2003) monitoring practices; parents of high-risk
 52% Male
adolescents decreased parental monitoring from
 48% Female grades 7 to 9.
 41% White Prevention effect of the FCU on substance abuse
was mediated by changes in parental monitoring.
 7% Hispanic
Level 2 Research Study
Within the context of the above study, high-risk youth and families (n = 71)
selected for either Family Check Up (FCU) intervention (n = 35) or to the
control group (no FCU) (n = 36).
Study population:
 39% Male
 61% Female
 32% White
 14% Multiethnic
 3% Hispanic

Possible barriers:
According to Dishion & Kavanagh (2003) and
Dishion (personal communication September
Infrastructure issues 13, 2006) barriers to implementation include
the following:
As indicated by Dishion (personal communication,
September 13, 2006):  A lack of performance based standards, lack
of funding, and changes in interest of the
administrative leadership;
Readiness:
 A lack of engagement of parents; and
 On average, it takes 6 months from the initial
contact with trainers for school staff training  Attitudes of negativity and avoidance
to begin. of the intervention.
 Top performance sites have strong leadership
and organization that supports a culture of
fidelity where professionals working with
families are enthusiastic about having Family As indicated by Dishion (personal communication,
Management Groups taped and then examined September 13, 2006):
to improve their work.
 Stage 1 training includes a 4- to 5-day workshop
 Careful selection and training of staff is critical for school and staff personnel on specific
to the success of the program. program components.
 It is advantageous for sites to secure state  Stage 2 training involves reviewing video-taped
funding and school district support before sessions of group leaders to provide specific feed
implementing the program. back about work.
 Stage 3 training, an advanced series of
Facilitators:
workshops around issues that experts have to
According to Dishion & Kavanagh (2003): deal with when implementing the intervention,
is currently in development.
 School administration facilitates the
implementation of the program by rewarding  Ongoing support is provided by the developers
effective group leaders and parent consultants. by telephone and email. Communication is
voluntary, with the frequency determined by
 For a successful program, the school staff should
the site’s needs.
value and support the Family Resource Center.
 Currently, program materials may be purchased
 A committee of school staff and parents should
and implemented in a component fashion
meet to decide how the FRC would fit into the
(for example, choosing to implement only
school system.
the Family Checkup Intervention.)
 Space is needed in the school for the FRC:
 Training of trainers who are then qualified
office, confidential meeting rooms, file
to train for their agency is available.
cabinet, comfortable furniture, a telephone,
a video-camera to record sessions, and  Materials are available in Spanish.
computer software.
Information about training
 An organized school operating system with
and materials can be obtained at:
a clear referral and reporting system is
http://www.uoregon.edu/~cfc/atptraining.htm
fundamental to successful implementation.

Cost of training/consulting Additional information can be obtained at:
http://www.uoregon.edu/~cfc/atp.htm.
The ATP program works individually with sites
to tailor the training to available resources of
school budgets. There is a per service fee for Developer involvement
training and consultation:
The developers are currently involved in training
and implementing the program:
Level 1: Universal:
Tom Dishion, Ph.D. & Kate Kavanagh, Ph.D.
Family Resource Centers Training Child and Family Center
 Length: 6 hours 195 West 12th Avenue
University of Oregon
 Limit: 20 people Eugene, OR 97401-3408
 1–2 people, $500 + $25 each/materials Phone: (541) 346-4805
Fax: (541) 348-4858
 3–5 people, $750 + $25 each/materials
Email: tdishion@uoregon.edu
kavanagh@uoregon.edu
Level 2: Selective:
Family Check-Up Training

 Length: 2 days
Currently, monitoring fidelity occurs through
 Limit: 20 people the process of a trained supervisor’s review
 1–2 people, $1350 + $75 each/materials of videotapes of group leaders working with
(includes feedback on your implementation) the families.
 3+ people, $1850 + $75 each/materials (includes  Fidelity ratings are provided by supervisors.
feedback on implementation).  Sites are required to provide fidelity data
to the developer every 6 months.
Level 3: Indicated:  Collecting and reporting outcome measures
Family Management Curriculum Training is recommended.
 Length: 1.5 days  No formal training is provided to sites to

develop systems to collect, analyze, or use
 Limit: 20 people
outcome data collected.
 1–2 people, $750 + $75 each/materials
(excluding tapes)
 3+ people, $1000 + $75 each/materials
(excluding tapes) Financing the intervention is through a site
budget, primarily through federal grants.
Consultation
 $75/hour (any format: tape review, video

conferencing, phone, review of materials,
and so forth).
 There are additional travel fees and expenses
if the training takes place at the program site.

Resources/Links References
For information on the Child and Family Andrews, D. W., Saberman L. H., & Dishion, T. J.
Research Center at the University of Oregon, (1995). The adolescent transitions program for
see http://www.uoregon.edu/~cfc/atp.htm. high-risk teens and their parents: Toward a
school-based intervention. Education &
For information about purchasing available Treatment of Children, 18(4), 478–498.
resources, see http://www.guilford.com/cgi-bin/
cartscript.cgi?page=cpap/dishion.htm&cart_id. Dishion, T. J. (personal communication,
For additional information, see also
http://www.strengtheningfamilies.org/html/ Dishion, T. J., & Andrews, D. W. (1995). Preventing
programs_1999/08_ATP.html. escalation in problem behaviors with high-risk
young adolescents: Immediate and 1 year
outcomes. Journal of Consulting and Clinical
Psychology, 63(4), 538–548.
Dishion, T. J., & Kavanagh, K. (2002). The

Adolescent Transitions Program: A family-
centered prevention strategy for schools. In J. B.
Reid, J. J. Snyder, & G. R. Patterson (Eds.),
Antisocial behavior in children and adolescents:
A developmental analysis and the Oregon Model
for Intervention (pp. 257–272). Washington, DC:
American Psychological Association.
Dishion, T. J., & Kavanagh, K. (2003). Intervening

in Adolescent Problem Behavior: A family-centered
approach. New York: The Guilford Press.
Dishion, T. J., Kavanagh, K., Schneiger, A., Nelson.

S., & Kaufman, N. (2002). Preventing early
adolescent substance use: A family-centered
strategy for the public middle school. Prevention
Science, 3(3), 191–201.
Irvine, A. B., Biglan, A., Smolkowski, K., Metzler,

C.W., & Ary, D.V. (1999).The effectiveness of
a parenting skills program for parents of middle
school students in small communities. Journal
of Consulting and Clinical Psychology, 67(6),
811–825.

Incredible Years
Figure 8
Incredible Years
Type of EBP  Intervention
Background Setting  Home
 School
The Incredible Years series has been developed
Age  2–12
since the 1980s by Carolyn Webster-Stratton,
Gender  Males
Ph.D., of the University of Washington. Numerous
 Females
studies have demonstrated many positive outcomes
for children and their families in a variety of
Outcomes  Increase in parent’s use
settings and countries. of effective limit-setting,
nurturing, and supportive
parenting.
The program has been disseminated in more
 Improvement in teacher’s use
than 46 states, Canada, Norway, Denmark, Wales, of praise.
New Zealand, and Great Britain. In addition, the  Reductions in conduct
program has been tested with different cultural problems at home and school.
groups, such as East African, Vietnamese,

Hispanic, and Chinese populations. Many of
the materials have been translated into different The BASIC program (parent training) is the core
languages to meet these varying cultural, ethnic, component of Incredible Years, with the Teacher
and linguistic needs. Training and Child training program
complementing BASIC. The BASIC program
has a preschool version (ages 2 to 5 years) and
Characteristics of the intervention a school-age version (ages 6 to 12 years).
The Incredible Years program offers a comprehensive
The BASIC program also has three other training
array of materials for parents and teachers and is
components: the School Readiness Series, the
tailored developmentally for children. The goal
School Age Program, and the ADVANCE program.
of this intervention is to reduce child aggression
(ages 2 to 12) by teaching parents and teachers
how to manage children’s misbehavior and BASIC is a 12- to 14-week group-based program
promote children’s problem-solving strategies, using video-vignettes to trigger group discussion.
emotional regulation, and social competence. The emphasis is on parents’ learning behavior
management, social and emotional coaching skills,
empathy, and ways to meet their children’s
It can be delivered by parents, teachers, counselors,
temperamental and developmental needs.
social workers, and therapists. These people must
possess a bachelor’s degree, but a master’s degree is
recommended for the parent and teacher program.
Children who are actively displaying clinical levels
of externalizing problems or who are at risk of
aggressive behavior can receive the Incredible Years
intervention components. Therefore, Incredible
Years can be considered a multilevel prevention
and intervention program.

BASIC also consists of parents’ learning effective
and nonviolent discipline strategies. The School
Age component strives to assist parents with ways
Extensive research has examined the efficacy
to strengthen their children’s academic performance
and effectiveness of the Incredible Years series.
at home and bridge the communication between
Numerous randomized control group trials have
school and home. The ADVANCE program is a
been conducted by Webster-Stratton and
complement to the BASIC program, a 10- to
colleagues, with at least an additional 15 studies
12-week supplement that addresses marital issues,
by independent researchers replicating and
communication skills, anger and depression
measuring the effectiveness of the intervention.
management, and parental problem-solving skills.
This supplement helps parents develop a better
Studies include eight randomized clinical trials by
understanding of their own interpersonal issues
the developer and colleagues and five replication
and provides them with new coping skills.
studies by independent investigators examining
the parent training component (BASIC);
The Teacher Training program is a 6-day workshop
two randomized clinical trials evaluating the
for teachers, counselors, and school psychologists
effectiveness of the child training program;
to teach basic classroom management strategies
and two randomized clinical trials examining
for dealing with misbehavior and promoting
the teacher training program.
positive peer relationships through student skill-
building. Detailed behavior plans for managing
Studies have been conducted with different ethnic
children with externalizing and internalizing
populations and in varying treatment settings (for
problems are developed.
example, foster care, daycare facilities, Head Start
Families). Studies have been conducted in the
The Child Training Program (Dinosaur Curriculum)
United States, Canada, Norway, and the United
focuses on appropriate classroom behavior,
Kingdom (http://www.incredibleyears.com). The
increased positive social skills, emotional literacy,
intervention has been tested with various cultural
anger management, and problem-solving skills
groups: East African, Vietnamese, Chinese, and
for managing conflict. There is both a prevention
Hispanic (St. George, personal communication,
classroom version of this curriculum as well as
April 19, 2006).
a small group treatment version.
Table 8 provides an overview of research outcomes.
The treatment version is offered to small groups
For those interested, an extensive list of research
of children (five to six per group) with conduct-
articles is available at: http://www.incredibleyears.com.
related problems. The treatment groups are usually
offered once a week for 2 hours or twice a week
for an hour. The classroom version is offered two
to three times weekly in circle-time discussions
followed by small group activities. There are lesson
plans for preschool through second grade.

Table 8: Incredible Years: Research Base and Outcomes
BASIC Program
Webster-Stratton (1981, 8 randomized control trials and 5 replication studies Increases in parent positive affect such as praise and
1982, 1984, 1990, Study population: reduced use of criticism and negative commands.
1994, 1998; In press); Increases in parent use of effective limit-setting
1982 study (n = 35)
Webster-Stratton & by replacing spanking and harsh discipline with
 66% Male
Hammond (1997); nonviolent discipline techniques and increased
 34% Female
Webster-Stratton, monitoring of children.
Hollingsworth, & 1984 study (n = 35) Reductions in parental depression and increases
Kolpacoff (1989);  71% Male in parental self-confidence.
Webster-Stratton,  10% Female Increases in positive family communication and
Kolpacoff, & 1988 and 1989 study (n = 114) problem-solving.
Hollingsworth (1988); Reduced conduct problems in children¹s interactions
 69% Male
Reid, Webster-Stratton,  31% Female with parents and increases in their positive affect
& Beauchaine (2001); and compliance to parental commands.
1997 study (n = 97)
Gross et al., (2003); Reduced conduct problems, increased emotional
 74% Male
Reid, Webster-Stratton regulation with parents. Mothers were more
 26% Female
& Hammond (2007) supportive and less critical with their children.
 86% White
Teachers reported parents were more involved
2001 study(n = 634)
in school, and children were less aggressive in
 54% Male the classroom.
 46% Female
 54% White
 11% Hispanic
2003 study (n = 208)
 29% Hispanic
 4% White
 4% Multiethnic
 6% Other
Teacher Training Series

Webster-Stratton et al., 2 randomized control trials Increases in teacher use of praise and
(2004); Study population: encouragement and reduced use of criticism
Webster-Stratton et al., and harsh discipline.
 2004 study
(2001)  90% Male Increases in children’s positive affect and
 10% Female cooperation with teachers, positive interactions
 79% White with peers, school readiness and engagement
with school activities.
Reductions in peer aggression in the classroom.
Child Training Series

Webster-Stratton & 2 randomized control trials Increases in children’s appropriate cognitive
Hammond, 1997; Study population: problem-solving strategies and more prosocial
Webster-Stratton conflict management strategies with peers.
1997 study (n = 97)
et al., 2004 Reductions in conduct problems at home
 74% Male
and school.
 26% Female
 86% White
2004 study (n = 159)
 90% Male
 10% Female
 79% White

** Table adapted from version found at http://www.incredibleyears.com.

Certified group leaders are eligible for certification
as mentors, which allows them to train others in
authorized workshops in their own agency. To
become certified as a mentor, one must have either
a master’s or doctoral degree. Certification is an
An agency readiness questionnaire is available additional training process and mentors in training
for download on the Incredible Years Web site. receive close supervision and contact with the
After a site reviews and determines some of their developer, Dr. Webster-Stratton and other certified
readiness issues, the Incredible Years staff is trainers. Certification costs range from $150 to
available to help sites address their issues. $700.
For some sites, assistance is offered in securing
money by helping with grant writing. Some of the training materials have been
translated into multiple languages. The BASIC
For Incredible Years to be successfully implemented parent program has translated manuals in Spanish,
and sustained, an agency and school must have French, Norwegian, Swedish, Dutch, Danish,
continued funding support. In addition, it is Russian, and Portuguese. In addition, some of the
important to have staff go through the mentoring programs are also being used in Hong Kong,
and group certification process to help continue Singapore, and Malaysia.
to implement the program with fidelity.
The Parent Training curriculum comprises
different sets of materials and manuals that are
Training/coaching and materials appropriate for different developmental age
groups. The training time is approximately 3 days.
The training and materials for each program series The BASIC parent training program has two
vary. Each training series focuses on the parents, versions, one for early childhood (2 to 7 years) and
child, and teacher. All of the training manuals and one for school age (5 to 12 years). In addition,
other supportive materials can be ordered through there is an advanced training program for school-
the Incredible Years Web site. age youth. There is also a school readiness program
available to help prepare children for school. Costs
Prices for the manuals and materials range from a for these training sets vary according to the
few hundred dollars for a single program to $1,800 material purchased.
dollars for one complete parent training set of
BASIC and ADVANCE. The Dinosaur training curriculum is available for
use by teachers or counselors and therapists. The
Trainings are tailored to meet the needs of the training time for this series lasts about 2 to 3 days.
identified site. Mental health agencies or schools This training program can be implemented in
may choose to be trained by the Incredible Years either a small group of children displaying
certified trainers onsite or offsite, depending on aggressive behavior or as a prevention program for
the size of the audience. For larger groups, 15 to an entire classroom. Puppets, videos, and manuals
25 people, onsite training is offered. Offsite are used to facilitate learning.
training would occur in the Seattle, Washington,
area. Cost for the training varies depending on the The teacher classroom-management training
type of training that a site chooses. curriculum has different training manuals and
materials. The training lasts about 3 days for group
Certification is also offered by Incredible Years and leaders. Teachers participate in training that lasts
is highly recommended. Certification indicates that 5 to 6 days. The different programs are geared
a group leader is offering the program with fidelity. toward preschool and school-age children.

There are supplemental video vignettes and Monitoring fidelity and outcomes
instructions for teachers working with the
Dinosaur program and school-aged population. Fidelity measures exist for the curricula within the
Incredible Years program. Incredible Years is not
collecting fidelity measures on a widespread basis.
Outcome measures are recommended, but
The cost for each site will vary depending on sites do not have to report this information to
the type of training requested and the materials Incredible Years.
purchased. Training offsite in Seattle ranges
from $300 to $400 per person. Training at one’s
agency costs $1,500/per day for one trainer, plus Financing the intervention
transportation costs and other travel expenses.
Consultation services range from $150 to According to the developer, many sites receive
$200/per hour. grants; others build the program into their ongoing
services to receive funding from their state.
Incredible Years does not track financing
Developer involvement information from sites that have successfully
implemented the program.
Dr. Webster-Stratton is directly involved in
disseminating the Incredible Years program. She
continues to deliver these programs with families, Resources/Links
teachers, and children and to serve as a consultant
to other research projects trying to replicate her http://www.incredibleyears.com
program. At the same time, she conducts her own
research studies evaluating new program
components of the Incredible Years Series. References
Currently she is evaluating the program with
parents of children with Attention Deficit
Gross, D., Fogg, L., Webster-Stratton, C., et al.,
Disorder. To obtain more detailed information
(2003). Parent training of toddlers in day care
about Incredible Years, please contact the
in low-income urban communities. Journal of
Administrative Director:
Consulting and Clinical Psychology, 71(2),
Lisa St. George 261–278.
Administrative Director
Incredible Years Reid, M. J., Webster-Stratton, C., & Beauchaine, T.
1411 8th Avenue West (2001). Parent training in Head Start: A
Seattle, WA 98119 comparison response among African American,
(888) 506-3562 or (206) 285-7565 Asian American, Caucasian, and Hispanic
http://www.incredibleyears.com mothers. Prevention Science, 2(4), 209–227.
incredibleyears@incredibleyears.com
Reid, M. J., Webster-Stratton, C., & Hammond,
M. (2007). Enhancing a classroom social
competence and problem-solving curriculum by
offering parent training to families of moderate-
to high-risk elementary school children. Journal
of Clinical Child and Adolescent Psychology,
36(4), 605–620.

St. George, L. (personal communication, Webster-Stratton, C., Hollingsworth, T.,
April 19, 2006). & Kolpacoff, M. (1989). The long-term
effectiveness and clinical significance of three
Webster-Stratton, C. (1981). Videotape modeling: cost-effective training programs for families with
A method of parent education. Journal of Clinical conduct-problem children. Journal of Consulting
Child & Adolescent Psychology, 10(2), 93–98. and Clinical Psychology, 57(4), 550–553.
Webster-Stratton, C. (1982). Teaching mothers Webster-Stratton, C., Kolpacoff, M., &

through videotape modeling to change their Hollingsworth, T. (1988). Self-administered
children’s behavior. Journal of Pediatric videotape therapy for families with conduct-
Psychology, 7(3), 279–294. problem children: Comparison with two cost-
effective treatments and a control group. Journal
Webster-Stratton, C. (1984). Randomized trial of Consulting and Clinical Psychology, 56(4),
of two parent-training programs for families 558–566.
with conduct-disordered children. Journal of
Consulting and Clinical Psychology, 52(4), Webster-Stratton, C., Reid, J.M., and Hammond,
666–678. M. (2004). Treating children with early-onset
conduct problems: Intervention outcomes for
Webster-Stratton, C. (1990). Long-term follow- parent, child, and teacher training. Journal of
up of families with young conduct problem Clinical Child and Adolescent Psychology, 33(1),
children: From preschool to grade school. 105–124.
Journal of Clinical Child Psychology, 19(2),
144–149. Webster-Stratton, C., Reid, J., & Stoolmiller, M.
(in press). Preventing conduct problems and
Webster-Stratton, C., (1994). Advancing videotape improving school readiness: Evaluation of the
parent training: A comparison study. Journal Incredible Years Teacher and Child Training
of Consulting and Clinical Psychology, 62(3), Programs in high-risk schools.
583–593.
Webster-Stratton, C. & Reid, J. M. (2003). The
Webster-Stratton, C. (1997). From parent training Incredible Years parents, teachers and children
to community building. The Journal of training series: A multifaceted treatment
Contemporary Human Services, Families approach for young children with conduct
in Contemporary Society, 78(2), 156–171. problems. In A. E. Kazdin and J. R. Weisz
(Eds.). Evidence-based psychotherapies for
Webster-Stratton, C. (1998). Preventing conduct children and adolescents (pp. 224–240). New
problems in Head Start children: strengthening York: The Guilford Press.
parenting competencies. Journal of Consulting
and Clinical Psychology, 66(5), 715–730. Webster-Stratton, C., Mihalic, S., Fagan, A., et al.,
(2001). The Incredible Years: Parent, Teacher
Webster-Stratton, C. & Hammond, M. A. (1997). And Child Training Series: Blueprints for
Treating children with early-onset conduct Violence Prevention, Book Eleven. (D.S. Elliott,
problems: A comparison of child and parent Ed.). Boulder, CO: Center for the Study and
training interventions. Journal of Consulting Prevention of Violence, Institute of Behavioral
and Clinical Psychology, 65(1), 93–109. Science, University of Colorado.

Helping the Noncompliant Child
Figure 9
Helping the Noncompliant Child
Type of EBP n Intervention
Background Setting Clinic
Home
Helping the Noncompliant Child (HNC) is a
Age 3–8
parent-training program that was developed out
Gender Males
of the original work in the late sixties by Constance Females
Hanf, Ph.D., and Rex Forehand, Ph.D., of the
Training/Materials Available Yes
Universities of Vermont and Georgia, respectively.
Outcomes Improvement in parenting skills
Robert McMahon, Ph.D., of the University of Improvement in child’s
Washington modified Hanf’s program to develop behavior and compliance
HNC more than 30 years ago.
HNC offers a controlled learning environment

for parents to learn new “adaptive” ways to The parent-training program is divided into
interact with their children. Currently, it is being the following two phases:
implemented in more than a dozen states and  Differential Attention; and
several foreign countries (for example, Canada,
 Compliance Training.
United Kingdom, Australia) (Forehand, 2006).
The length of the program depends on each family,
but typically a total of 8 to 10 sessions are standard
for both training periods. Average sessions last
Helping the Noncompliant Child’s primary approximately 75 to 90 minutes. Ideally, sessions
treatment goal is the secondary prevention of should occur about twice a week. If parents do
serious conduct disorder problems in preschool not have the resources or time for twice weekly
and early elementary school-aged children, and sessions, the therapists are encouraged to keep
the primary prevention of subsequent juvenile in phone contact.
delinquency (Office of Juvenile Justice and
Delinquency Prevention Model Programs Guide). Therapists who deliver the HNC program must
possess a master’s degree. Throughout the training,
The program is delivered to boys and girls 3 to 8 a therapist will assign homework to facilitate
years of age who are at risk for or are displaying parents’ practicing what they have learned in
aggressive and oppositional behaviors. It is best the controlled environment. It is essential to
implemented in a therapeutically controlled the program that parents agree to practice the
environment, such as a clinic-based playroom with parenting skills between sessions as directed
a one-way mirror and audio equipment (although by the therapist.
the mirror and audio equipment are not required).
HNC can also be delivered in the child and family’s In the Differential Attention phase, a major goal
home. Children and their parents meet while the is to break out of the coercive cycle of interaction
therapist helps guide parents with practicing new by establishing a positive, mutually reinforcing
skills and focusing on the positive and negative relationship between the parent and child.
behaviors of the child.

Parents learn to systematically use different types
of positive attention (that is, verbally tracking the
child’s behavior, praise, positive physical attention)
HNC has been extensively researched since
to increase desirable child behaviors. They also
the 1970s in a series of studies that examined
learn a planned ignoring procedure to decrease
various aspects of the intervention (McMahon
undesirable child behaviors (McMahon &
& Forehand, 2003). Research has included
Forehand, 2003).
the following:
Succession through the phases depends on parent’s  Clinic laboratory observation studies
skill acquisition as assessed by the therapist to examine the effects of the individual
(observational forms available in training book). components of HNC.
During the Compliance Training phase, parents  Clinic laboratory observation and comparative
learn to do the following: studies to examine immediate outcomes of the
 Give clear, concise instructions to their child; program as a whole in the laboratory setting.
 Provide positive attention for child compliance  Studies in community settings using single
to the instruction; and group or comparison group with pre-post tests
and followup to examine generalizability of the
 Use a brief time-out procedure for child
effects across time, settings, siblings,
noncompliance.
and behaviors.
Parents also learn to use rules, and to implement  Studies assessing: social validity, side effects,
the phase I and II skills in settings outside the procedures for enhancing generalization, and
home. Therapists extensively employ demonstration self-administered written forms of components
and role-play procedures to teach the different of the intervention.
skills to the parent and to the child who also  Two independent replication studies comparing
participates in the treatment sessions. HNC to other interventions.
Samples, while predominantly Caucasian, have

included African American populations as well
(McMahon & Forehand, 2003; NREPP).
Research has shown many positive outcomes:

improvements in parenting skills and child
compliance in the home to within the normal
range; improvements of parents’ perceptions
of their children’s adjustment, regardless of the
children’s age (within the 3- to 8-year-old range)
or the families’ socioeconomic status (although
families from lower socioeconomic backgrounds
are less likely to complete the program); and
maintenance effects ranging from 6 months to
more than 14 years after treatment termination
(McMahon & Forehand, 2003). See Table 9.

Table 9: Helping the Noncompliant Child: Research Base and Outcomes
Peed, Roberts, & Mothers (n = 12) and their children (2.5–8.5 years) assigned to either Both parents and children in treatment group report
Forehand (1977) a treatment or a waitlist control group. Parent training conducted in a demonstrated multiple positive behavior changes of
controlled learning environment. parent-child interactions such as parents’ perceptions
Study population: of children. The control group did not change over
the waiting period.
 67% Male
 33% Female
Wells, Forehand, Noncompliant, clinic-referred children and their mothers (n = 12) who Clinic-referred children significantly increased their
& Griest (1980) received parent training program (HNC) compared to non-clinic, noncompliance from pretreatment to post treatment,
treatment normative group (n = 12). whereas the non-clinic group did not. For the clinic
Study population: group only, untreated child inappropriate behaviors
decreased significantly (aggression, tantrums, crying)
 62.5% Male
 37.5% Female
Baum et al., (1986) Children (n = 34, 6–10 years) and their parents received either HNC Observed behavior improvements in the HNC
In McMahon & intervention or a parent discussion group based on Systematic Training for group at both post-treatment and 6–8month
Forehand (2003) Effective Parenting (STEP). followup. No change in behavior for STEP group.
Wells & Egan Families (n = 19) with a child (ages 3–8 years) with OD, randomly assigned Observation measures of parent child behaviors
(1988) to receive either social learning based parent training (HNC) or family found HNC more effective than family
systems therapy. systems therapy.
Onsite practice and followup supervision can

be provided. On an individualized basis, the
trainers can offer further onsite or offsite
technical assistance.
 Trainees of the model should be prepared
Readiness: to role-play.
No formal readiness assessment is used for sites  If staff turns over, the developers will consult
interested in becoming trained to deliver HNC. within the agency to help them train the
new staff.
Training/coaching and materials The trainer’s manual, training videotape, and

self-help book for parents must be purchased
 Currently, qualified trainers are readily available separately (see http://casat.unr.edu/bestpractices/view.
to provide training in HNC for all areas of php?program=45).
the country.
 The training requires at least 2 days. The training manual is Dr. McMahon and
Dr. Forehand’s (2003) book, Helping the
 There is no minimum number of training
Noncompliant Child: Family-Based Treatment for
participants. However, there is a maximum
Oppositional Behavior, New York: Guilford Press.
of 16 to 20 participants in a training session.
The developers encourage trainees to read the
book prior to the training.

The book for parents (Parenting the Strong- Monitoring fidelity and outcomes
Willed Child, Forehand & Long, 2002) has
been translated into several languages and is A fidelity checklist is available from Dr.
available from McGraw-Hill for $14.95. Forehand at rex.forehand@uvm.edu. Measures
for assessing outcomes are available from
The training videotape is available from Child McMahon and Forehands’ 2003 book, Helping the
Focus, 17 Harbor Ridge Road, South Burlington, Noncompliant Child: Family-Based Treatment for
VT 05403, for $29.95. Oppositional Behavior.
To obtain information on training and materials, The developers are not actively involved in collecting
contact Dr. McMahon. fidelity measures for program sites, although sites
can choose to submit fidelity data to the developers.
Robert J. McMahon, Ph.D.
University of Washington  Developers are willing to help sites develop
Department of Psychology, Box 351525 systems to collect, analyze, and use data to
Seattle, WA 98195-1525 improve services.
Phone: (206) 543-5136  Sites do not have to submit outcome measures
Fax: (206) 685-3157 to the developers, but it is highly recommended.
Email: mcmahon@u.washington.edu

 According to Dr. Forehand, the majority of
 Training costs: $1,500/day plus expenses financing is through state funding or private
(2- day minimum). grant dollars.
 Per Dr. Forehand (personal communication,  Some third-party payers for mental health
June 23, 2006) the typical cost to train therapists services (for example, Medicaid, private
and to provide ongoing support in providing insurers) will also reimburse for the components
Helping the Noncompliant Child would average of the service as outpatient therapy.
$7,000 to $12,000, depending on the extent to
which post-initial training booster sessions and  To sustain the program, the developers advise
telephone consultation are involved. This that the cost of the program be built into
includes materials. multiple years of funding. The developers
are willing to collaborate on an ongoing basis
after the program has been implemented.
 Developers can be contacted directly to help

implement the intervention.
 The developers are responsible for providing the
2-day onsite training as well as followup services.

Peed, S., Roberts, M., & Forehand, R. (1977).
Resources/Links
Evaluation of the effectiveness of a standardized
parent training program in altering the
To learn more about Helping the Noncompliant
interaction of mothers and their noncompliant
Child, see:
children. Behavior Modification, 1(3), 323–350.
 Office of Juvenile Justice and Delinquency
Prevention (OJJDP) Model Programs Guide: Sayger, T., Horne, A., Walker, J., & Passmore, J.
http://www.ojjdp.gov/MPG
(1988). Social learning family therapy with
 McMahon and Forehand’s (2003) book, aggressive children: Treatment outcome and
Helping the Noncompliant Child: Family- maintenance. Journal of Family Psychology,
Based Treatment for Oppositional Behavior. 1(3), 261–285.
Wells, K. C., & Egan, J. (1988). Social learning and

References systems family therapy for childhood
oppositional defiant disorder: Comparative
Fonagy, P., & Kurtz, A. (2002). Disturbance of treatment outcome. Comprehensive Psychiatry,
conduct. In P. Fonagy, M. Target, D. Cottrell, J. 29(2), 138–146.
Phillips, & Z. Kurtz (Eds.). What works for
whom: A critical review of treatments for Wells, K. C., Forehand, R., & Griest, D. L. (1980).
children and adolescents (pp. 106–192). New Generality of treatment effects from treated to
York: Guilford Press. untreated behaviors resulting from a parent
training program. Journal of Clinical Child
Forehand, R. (personal communication, Psychology, 9(3), 217–219.
June 23, 2006).
McMahon, R., & Forehand, R. (2003). Helping the

noncompliant child: Family-based treatment for
oppositional behavior (2nd edition). New York:
Guilford Press.
McMahon, R. J., Wells, K. C., & Kotler, J. S.

(2006). Conduct problems. In E. J. Mash & R.
A. Barkley (Eds.). Treatment of childhood
disorders: Third edition (pp. 137–268). New
York: Guilford Press.

Parent-Child Interaction Therapy
Figure 10
Parent-Child Interaction Therapy
Age 2–7
Parent-Child Interaction Therapy (PCIT) is a
Gender Males
parent training/coaching program for families
Females
with children 2 to 7 years of age who are exhibiting
disruptive behaviors. This program has been in
Outcomes Improvement in parent-child
existence since the early seventies. interaction style.
Improvement in child behavior
problems.
It was developed by Shelia Eyberg, Ph.D., of the
University of Florida. The development of PCIT
was influenced by the earlier work of Constance
Hanf, Ph.D., and Diane Baumrind, Ph.D. PCIT is structured through 10 to 16 weekly 1-hour
sessions with either the parent alone or parent and
Dr. Hanf was focused on working with mothers to child together, and delivered by trained master’s
increase their child’s compliance, and Dr. Baumrind or doctoral level therapists. These sessions
studied how different parenting styles affect children. consist of the following (Herschell et al., 2002;
Currently, PCIT is being implemented in the http://www.pcit.org, retrieved 2006):
United States, Puerto Rico, Norway, and Hong
Kong. It has been implemented in laboratory  Pre-treatment assessment of child and family
clinical settings, community mental health systems, functioning;
Head Start programs, schools, and foster care  Teaching, coaching, and feedback in the CDI
settings (R. Chase, personal communications, skills phase;
 Teaching, coaching, and feedback in the PDI
skills phase;
Characteristics of the intervention  Teaching generalization skills related to rules
at home, behavior in public, and behavior
The program has two phases that are based on with siblings;
attachment theory and social learning theories.
In the first phase of the training, Child Directed  Five to 10 minutes of homework per day
Interaction (CDI), parents learn how to strengthen practicing learned interactions; and
their attachment to their child through being warm,  Posttreatment assessment of child and
responsive, and sensitive to their child’s behavior. family functioning.
In the second phase of the training, Parent Clients progress through the sessions of each phase
Directed Interaction (PDI), parents learn how to by achieving set skills that are monitored and
be strong authority figures with their child through assessed by the therapist. In research settings, the
giving directions in age-appropriate, positive ways; therapist uses a one-way mirror to observe the
setting consistent limits; and learning how to parent-child interactions and coaches the parents
appropriately implement consequences, such through a microphone in their ear (Herschell,
as time-out.

2002). In nonlaboratory community settings, some interaction style of parents and in improving
changes to the therapy have been made, but the behavior problems of children at home and in
effectiveness of PCIT with these changes is school, in comparison to waitlist control groups,
unknown (Franco et al., 2005). normal classroom control groups, untreated
classroom control groups, modified treatment
groups, treatment dropouts, and in comparison
Research Base and Outcomes to children with varying severity of problems
(Herschell et al., 2002).
PCIT originated in 1982 and has been tested in a
number of replication and followup studies. PCIT New directions of the research include support for
has been found to be efficacious in improving the a culturally sensitive adaptation of PCIT for Puerto
Rican families (Matos et al., 2006). See Table 10.
Table 10: Parent-Child Interaction Therapy: Research Base and Outcomes

Eyberg & Robinson Families (n = 7) with one child (age 2–7) with a behavioral problem and Significant improvements on observer ratings of
(1982) also a sibling (age 2–10) without a behavioral problem. Changes observed child behavior, untreated sibling behavior, and
in pre-post test observed ratings. parental adjustment.
Study population:
 86% Male
 14% Female
McNeil, Eyberg, Children (n = 30). Control Group design, but not randomly assigned. PCIT group reduced problem behaviors at home,
Eisenstadt, Children treated with PCIT (n = 10) compared with normative control group improvements on the number of classroom
Newcomb, (n = 10) and problem behavior control group (n = 10). measures for disruptive behaviors.
& Funderburk
(1991)
Schuhmann, Boggs et al., (2004) In McMahon et al., (2005) Randomized control design Followup study from Schumann et al., (1998)
Foote, Eyberg, with families with 3–6 year old child with ODD (n = 64) assigned to compared 23 families that completed PCIT to 23
Boggs, and Algina treatment of PCIT or a waitlist control condition. families that dropped out.
(1998); Study population: PCIT group demonstrated greater reductions in child
 77% White behavior problems; parents expressed decreases
in stress and increase in control; parent interacted
 14% African American more positively with their child and were more
 9% Hispanic, Asian American, and Multiethnic successful in gaining their child’s compliance. Effects
maintained at 4-month followup.
Families who completed treatment maintained gains
at followup. Families who did not returned to pre-
treatment levels of child behavior problems.
Nixon, Sweeney, Randomized control design with families with behaviorally disturbed Outcomes of an abbreviated version of PCIT
Erickson, & Touyz children (n = 54, ages 3–5) assigned to PCIT standard group, PCIT modified was comparable to the regular PCIT at 6-month
(2003, 2004) group, or no treatment control group. followup; treatment gains were maintained at 1
Study population: and 2 years.
 70% Male
 30% Female
 95% White
 5% Australian Chinese, Australian Indian, Australian Koori

Family involvement:
PCIT includes therapy orientation sessions to
describe the intervention, as well as the time and
Infrastructure issues tasks required of the family, to assess the family’s
willingness, to discuss barriers, and to problem-
Readiness: solve. The weekly therapy can be a burden for
families with transportation difficulties or child
There is no formal readiness assessment.
care issues (R. Chase, personal communication,
Facilities and equipment:
It is advantageous to implement PCIT in similar

conditions to which it was initially tested (that is,
using a one-way mirror as the therapist coaches Sheila Eyberg, Ph.D., and Stephen Boggs, Ph.D.,
the parent in another room through a small are the master trainers with graduate students.
microphone in the parent’s ear). For information
about how to access this equipment, go to Training is provided two to three times per year
http://www.pcit.org. at the University of Florida and two times per year
at the University of Oklahoma. Training is also
However, these conditions cannot always be provided at local sites for special projects, research
met in community settings (R. Chase, personal grants, and in other countries than the U.S.
communication, September 21, 2006). An alternative
adaptation is for the therapist to sit next to the PCIT experts at the University of Oklahoma
mother and coach by whispering in her ear. Health Sciences Center are currently investigating
an alternative co-therapy PCIT training model
using Internet-based remote live consultation.
Implementation challenges:
Implementation in a community mental health The basic PCIT training involves a 5 full-day
system (Franco, 2005) presented the following intensive workshop in PCIT, which includes an
challenges and issues: overview of PCIT, assessment procedures, coding
 Time commitment for implementation at system to identify interaction processes and skills
each level of PCIT needed from clinicians, acquired by parents in each phase, specific
supervisors, and families. clinician skills training in the two phases of
treatment, and adherence to the manualized
 Management needed to remove barriers treatment sessions. Training involves didactic
to clinician and family involvement. instruction, role-playing, and a case demonstration.
 Additional training to ensure fidelity, as well  There is no standard booster training.
as ongoing supervision and consultation.
 A comprehensive treatment manual
 Keeping the interest and motivation of families is available (Eyberg & Calzada, 1998).
to complete each phase of PCIT—it often takes
longer to master skills than prescribed.  The materials are available in English
and Spanish.
 Supervisor training involves a 3-day
advanced training.
To obtain information about materials and training,

contact: http://www.pcit.org

Cost of training/consulting Monitoring fidelity and outcomes
 The cost per clinician trainee is $3,000.  Fidelity adherence checklists are used for
every session to monitor adherence to the
 There is an additional cost for audiovisual
treatment manual.
equipment, which is desirable but not necessary.
See http://www.pcit.org for pricing.  Outcome measures for monitoring progress are
recommended and are described on the PCIT
 There is no annual or ongoing cost
Web site. These include the following:
for consultation.
 Eyberg Child Behavior Inventory;
 Sutter-Eyberg Student Behavior Inventory-
Revised;
After the training, no ongoing formal relationship  Dyadic Parent-Child Interaction Coding System
is expected between the developer and sites. to measure the quality of parent-child interactions;
However, consultation is available through
 Therapy Attitude Inventory;
email, telephone, and onsite visits as needed.
 Child Rearing Inventory; and
There are no ongoing data collection requirements
 Parenting Locus of Control – Short Form.
by the developer, unless the site is part of a research
study. To contact the developer:
The developers do not follow a site to collect data
or monitor fidelity, unless the project is part of a
Sheila Eyberg, Ph.D.
formal research or evaluation grant.
Child Study Laboratory
Department of Clinical and Health Psychology
University of South Florida
P.O. Box 100165
Gainesville, FL 32610 PCIT has been funded through research and
Phone: (352) 273-6145 evaluation grants. In some states, it is financed
through private insurance companies and Medicaid
as family therapy.

Matos, M., Torres, R., Santiago, R., et al., (2006).
Resources/Links
Adaptation of parent-child interaction therapy
for Puerto Rican families: A preliminary study.
PCIT Web site: http://www.pcit.org.
Family Process, 45(2), 205–222.

References
(2006). Conduct problems. In E. J. Mash & R.
A. Barkley (Eds.). Treatment of childhood
Chase, R. (personal communication, September
21, 2006).
Eyberg, S. M., & Robinson, E. A. (1982). Parent-
McNeil, C. B., Eyberg, S., Eisenstadt, T. H., et al.,
child interaction training: Effects on family
(1991). Parent-child interaction therapy with
functioning. Journal of Child Psychology, 11,
behavior problem children: Generalization of
130–137.
treatment effects to the school setting. Journal
of Clinical Child Psychology, 20, 140–151.
Eyberg, S. M., & Calzada, E. J. (1998). Parent-
child interaction therapy: Procedures manual.
Nixon, R., Sweeney. L., Erickson, D., & Touyz, S.
Gainesville, FL: University of Florida.
(2003). Parent-child interaction therapy:
A comparison of standard and abbreviated
Franco, E., Soler, R. E., & McBride, M. (2005).
treatment for oppositional defiant preschoolers.
Introducing and evaluating Parent-Child
Journal of Consulting and Clinical Psychology,
Interaction Therapy in a system of care. Child
71(2), 251–260.
and Adolescent Psychiatric Clinics of North
America, 14, 351–366.
Schuhmann, E. M., Foote, R., Eyberg, S. M., et
al., (1998). Efficacy of parent-child interaction
Herschell, A. D., Calzada, E. J., Eyberg, S. M., &
therapy: Interim report of a randomized trial
McNeil, C. B. (2002). Parent-child interaction
with short term maintenance. Journal of Clinical
therapy: New directions for research. Cognitive
Child and Adolescent Psychology, 27, 34–45.
and Behavioral Practice, 9, 16–27.

Parent Management Training — Oregon
Figure 11
Parent Management Training — Oregon
Home
The Parent Management Training–Oregon
Age 4–12
(PMTO) model is based on social interaction
Gender Males
theory developed by Gerald Patterson, Ph.D.,
Females
Marion Forgatch, Ph.D., and colleagues at
the Oregon Social Learning Center (OSLC).
Outcomes Significant reductions in
Currently, Dr. Forgatch of OSLC is leading child’s behavior problems.
dissemination efforts. Reductions in coercive
parenting.
Increases in effective parenting.
PMTO is considered a behavioral preventive and
clinical intervention model designed to enhance
effective parenting and reduce coercive practices
while making relevant adaptations for contextual Parents or guardians of identified children and
factors (Forgatch, Patterson, & DeGarmo, 2005). youth must participate in treatment, since it is
aimed at them.
Currently, PMTO is disseminated nationally in
more than 30 sites in Norway. In the Netherlands, PMTO is a manualized approach to treatment as
PMTO is disseminated with 30 therapists from detailed in Parenting Through Change (Forgatch,
four agencies who are currently in training within 1994) and Marriage and Parenting in Stepfamilies
three major regions in the country (Amsterdam, (Forgatch & Rains, 1997). Training materials are
Drenthe, and Leiden). also available (Forgatch, Rains, & Knutson, 2005;
Knutson, Rains, & Forgatch, 2006).
The purveyors of PMTO are mentoring four
supervisors in coaching. Within the United States, PMTO has five essential implementation components
PMTO has been disseminated in 13 sites in the (Forgatch, Patterson, & DeGarmo, 2005):
state of Michigan.
 Skill encouragement teaches prosocial
development through breaking behavior down
Characteristics of the intervention to small steps and contingent positive
reinforcement.
PMTO is designed for boys and girls ages 4 to 12
years who have displayed serious acting-out and  Discipline decreases deviant behavior with
disruptive behaviors. It is implemented in clinic appropriate and contingent use of mild
and home-based settings by trained therapists sanctions.
(master’s level), lasting approximately 20 sessions,
 Monitoring (supervision) tracks children’s
although it can vary depending on individual family
activities, associates, and location.
needs and skill acquisition.

 Problem-solving skills help families negotiate generalized across settings, may be maintained
agreements, establish rules, and set for up to 2 years posttreatment, may benefit other
contingencies. children in the same family, and also may extend to
other deviant behaviors beyond those emphasized
 Positive involvement assists parents with offering
in treatment (Fonagy & Kurtz, 2002).
loving, positive attention.
Cross-cultural replications of PMTO have been

Research Base and Outcomes conducted in Norway (McMahon, Wells, & Kotler,
2005; Ogden, Forgatch, Askeland, Patterson, &
The program has been evaluated extensively in Bullock, 2005). Replication studies of culturally
community settings. In addition, a number of adapted parent management training are being
comparison studies have been conducted using conducted with Latino clients (Forgatch, personal
random assignments for treatment. communication, June 22, 2006; Martinez &
Eddy, 2005).
Studies with active control groups have yielded
promising results (Fonagy & Kurtz, 2002; Evidence from a sample of studies indicating
McMahon, Wells, & Kotler, 2005). The evidence specific results are located in Table 11.
supports the claim that treatment effects may be

Table 11: Parent Management Training-Oregon: Research Base and Outcomes
Bernal, Klinnert, Randomized control trial design of families (n = 36) of a child (ages 5–12) Parent reports and paper-and-pencil tests of child
& Schultz (1980) with conduct problem were assigned to behavioral parent training, client- deviance and parent satisfaction showed a superior
centered counseling or waitlist. 6-month, 1-year, and 2-year followups. outcome for behavioral parent training over client-
Study population: centered treatment and waitlist control group, and
no difference between the latter two groups.
 86% Male
 14% Female At followup, there was no maintenance of
this superiority.
Christensen, Randomized clinical trial of families (n = 36) with problem children ( 4–12 PMTO individual and group interventions both
Johnson, Phillips, years) assigned to either PMTO- individual format, PMTO- group format or superior to bibliotherapy as indicated by measures
& Glasgow (1980) bibliotherapy (control group). of parent attitude and observational data collected
Study population: from audio recordings made in homes of families.
 78% Male
 22% Female
Patterson, Randomized clinical trial design assigned families (n = 19) to parent Reductions in a child’s conduct problem behaviors
Chamberlain & training (PMTO) or waitlist control group (which became a comparison when parents have been exposed to parent
Reid (1982) In treatment group by default as 8 of the 9 families in the control group training versus waiting list control/comparison
McMahon, Wells, obtained treatment from other clinics in the community; treatment styles treatment group.
& Kotler (2005) ranged from eclectic to behavioral).
Study population:
 68% Male
 32% Female
Patterson & Families (n = 70) with children with conduct problems (6–12 years) Preliminary results indicated parent training
Chamberlain randomly assigned to parent training or eclectic family therapy. intervention reduced child conduct problem
(1988); behavior significantly.
Reid (1987) (in Mothers in parent training group reported
McMahon, Wells, significant reductions in self-reported
& Kotler (2005)) depression levels.
Bank et al., (1991) Randomized control trial design assigned families (n = 55) of chronically Results indicated that the parent training families
offending adolescent delinquents (13–18 years) to parent training courses exerted quick and effective control over their sons’
or services typically provided by the court system. official delinquency rates.
Study population: Relative to the controls, parent training families
 100% Male were able to establish control with significantly
less reliance on incarceration.
Forgatch & Randomized control trial of divorcing mothers (n = 238) with sons in Grades Demonstrated positive effects of the intervention
Degarmo (1999) 1–3 (mean age 7.8 years) assigned to either treatment or control group to in reducing coercive parenting, prevented
examine the efficacy of group-based parent training. decay in positive parenting, and improved
Study population: effective parenting.
 100% Male
 86% White
 2% Hispanic
 9% Multiethnic
Martinez & Eddy Randomized control trial implementing a culturally adapted PMTO Findings provide strong evidence for the feasibility
(2005) intervention, “Nuestras Familias,” with Spanish-speaking Latino parents of delivering the intervention in a larger community.
(n = 73) with middle school-aged youth at risk for problem behaviors, Parent Outcomes:
assigned to either intervention group or control group.
Increased measures of general parenting, skill
Study population: encouragement, and overall effective parenting.
 56% Male Youth Outcomes:
 44% Female
Decreased measures of aggression, externalizing
 100% Hispanic
likelihood of smoking and use of alcohol, marijuana,
and other drugs.

 Practitioners create a “fictional family” that is
recorded on a DVD to demonstrate their skills,
which expert trainers review.
Infrastructure issues  After review of the fictional family case,
practitioners enroll three families and record
Readiness: their sessions. Direct feedback is provided by
the expert trainers.
 A set of readiness questions is available to
assess sites’ abilities to effectively implement  Feedback continues to occur until about eight
the program. DVD-recorded sessions of three families are
reviewed.
 Sites are selected if they have a long-term
commitment to engage in evaluation, are willing  After review of these eight sessions (on average),
to be subjected to evaluation, and are willing two new families are enrolled with
to devote the time to implement the program. approximately four sessions reviewed for final
certification purposes.
 If sites do not have the capacity (for example,
time, staffing, and financial resources) to  Ongoing support and coaching is provided
implement, the disseminators of PMTO through a network of coaches.
suggest that they not use this intervention.  There are approximately six PMTO trainers
In some cases, the purveyors will recommend at the current time.
other programs, such as Triple P, or the
Incredible Years. Two books contain some of the manual and
training materials, Parenting Through Change
Staffing: (Forgatch, 1994) and Marriage and Parenting
in Stepfamilies (Forgatch & Rains,1997).
 A readiness checklist is available for agency
leaders and managers to use when hiring staff Materials related to PMTO are available in
to implement the intervention. Norwegian, Dutch, Icelandic, and Spanish
 PMTO trainers consider staff selection to be an languages. Additionally, cultural adaptations for
extremely high and important priority. One issue language, materials, and methods are negotiated
that is particularly important concerns staff between the program purveyors and the program
biases toward behavioral approaches. recipients during the training process with each
new culture. The fundamental method of training
for professionals and for families is role-playing
Training/coaching and materials and not didactic (M. Forgatch, personal
communication, July 22, 2006).
According to Dr. Forgatch (2006), 18 workshop
days are spread over the course of a year to The company that handles readiness, training, and
adequately train practitioners. implementation efforts is Implementation Sciences
 The first two workshops are about a month International, Inc.
apart, followed by three more. After the second
workshop, practitioners should be working
with families. Next, another set of three
trainings occurs, which should take place
2 to 3 months apart.

Developer involvement Resources/Links
Dr. Forgatch is the key developer of the intervention.
Substance Abuse and Mental Health
She currently is involved in helping others use the
Services Administration, National registry
program as part of a dissemination group that is
of Evidence-Based Programs and Pratices:
directly involved with implementation efforts.
http://nrepp.samhsa.gov/
Contact information:
Marion S. Forgatch, Ph.D.
References
Executive Director
Implementation Sciences International, Inc.
Bank, L., Marlowe, J. H., Reid. J. B., Patterson, G.
2852 Willamette Street, #172
R., et al., (1991). A comparative evaluation of
Eugene, OR 97405
parent-training interventions for families of
Email: marionf@oslc.org
chronic delinquents. Journal of Abnormal Child
Psychology, 19(1), 15–33.

Bernal, M. E., Klinnert, M. D., & Schultz, L. A.
A site must commit to implementation with (1980). Outcome evaluation of behavioral parent
complete fidelity. Part of the readiness checklist training and client centered parent counseling
assesses a site’s ability to do this and plans for for children with conduct problems. Journal
followup fidelity checks. of Applied Behavior Analysis, 13, 677–691.
A recent study by Forgatch, Patterson, & Christensen, A., Johnson, S. M., Phillips, S., &
DeGarmo (2005) found that using the Fidelity Glasgow, R. E. (1980). Cost effectiveness in
of Implementation Rating System to measure behavioral family therapy. Behavior Therapy,
adherence to the program was effective. 11, 208–226.
Specifically, if the program is implemented “true
to the model,” parenting practices were improved. DeGarmo, D. S., & Forgatch, M. S. (2005). Early
development of delinquency within divorced
families: Evaluating a randomized preventive
Financing the intervention intervention trial. Developmental Science, 8(3),
229–239.
In Michigan, for example, the state and agency
collaborate in funding for PMTO training. DeGarmo, D. S., Patterson, G. R., & Forgatch,
Medicaid is also involved in financing. M. S. (2004). How do outcomes in a specified
parent training intervention maintain or wane
In Norway and the Netherlands, the government over time? Prevention Science, 5, 73-89.
pays for the majority of the training and services;
agencies share the cost. Fonagy, P., & Kurtz, A. (2002). Disturbance of
conduct. In P. Fonagy, M. Target, D. Cottrell,
J. Phillips, & Z. Kurtz (Eds.), What works for
whom: A critical review of treatments for
children and adolescents (pp.106–192). New

Forgatch, M. (personal communication, Knutson, N., Rains, L. A., & Forgatch, M. S.
June 22, 2006). (2006). PMTO modules: Workshop trainer guide,
Edition 1. Eugene, Oregon: Implementation
Forgatch, M. S., & DeGarmo, D. S. (2002). Sciences International, Inc.
Extending and testing the social interaction
learning model with divorce samples. In J. B. Martinez, C., & Eddy, M. (2005). Effects of
Reid, G. R. Patterson & J. Snyder (Eds.), culturally adapted parent management training
Antisocial behavior in children and adolescents: on Latino youth behavioral health outcomes.
A developmental analysis and model for Journal of Consulting and Clinical Psychology,
intervention (pp. 235–256). Washington DC: 73(4), 841–851.
American Psychological Association.
Forgatch, M. S., & DeGarmo, D. (1999). Parenting (2006). Conduct problems. In E. J. Mash
through change: An effective parenting & R. A. Barkley (Eds.), Treatment of Childhood
training program for single mothers. Journal Disorders: 3rd Edition (pp. 137–268). New York:
of Consulting and Clinical Psychology, 67, Guilford Press.
711–724.
Ogden, T., Forgatch, M. S., Askeland, E.,
Forgatch, M. S., Patterson, G. R., & DeGarmo, Patterson, G. R., & Bullock, B. M. (2005).
D. (2005). Evaluating fidelity: Predictive validity Implementation of parent management training
for a measure of competent adherence to the at the national level: The case of Norway. Journal
Oregon model of parent management training. of Social Work Practice Psychotherapeutic
Behavior Therapy, 36 (1), 3–13. approaches in health, welfare, and the
community, 19(3), 317–329.
Forgatch, M. S., DeGarmo, D. S., & Beldavs, Z.
(2005). An efficacious theory-based intervention Patterson, G. R., & Chamberlain, P. (1988).
for stepfamilies. Behavior Therapy, 36(4), Treatment process: A problem at three levels.
357–365. In L. C. Wynne (Ed.), The state of the art in
family therapy research: Controversies and
Forgatch, M. S., & Rains, L. (1997). MAPS: recommendations (pp. 189–223). New York:
Marriage and Parenting in Stepfamilies (parent Family Process Press.
training manual). Eugene, OR: Oregon Social
Learning Center. Patterson, G. R., Chamberlain, P., & Reid, J. B.
(1982). A comparative evaluation of a parent-
Forgatch, M. S., Rains, L. A., & Knutson, N. M. training program. Behavior Therapy, 13, 638–650.
(2005). A Course in PMTO: The Basic OSLC
Intervention Model (Vol. 4). Oregon Social
Learning Center; Eugene, OR: Implementation
Sciences International, Inc.

Brief Strategic Family Therapy
Figure 12
Brief Strategic Family Therapy
Home
Brief Strategic Family Therapy™ (BSFT™)
Age 6–18
is a family therapy intervention for children and
Gender Males
adolescents aged 6 to 18 years who have engaged,
Females
or are engaging, in substance use, coupled with
behavioral problems at home and school.
Outcomes Decrease in substance abuse.
Improved engagement in
BSFT™ was developed by the Spanish Family therapy.
Guidance Center (which later became the Center Decrease in problematic
behavior.
for Family Studies) at the University of Miami,
Increased family functioning.
over 35 years ago to focus on drug use and behavior
Decrease in socialized
problems of Cuban American adolescents. aggression and conduct
disorder.
For the first 15 years of BSFT™’s existence,
therapists worked solely within the Hispanic
population. However, since 1991, BSFT™
research has included African Americans. Within Sessions last for approximately 60 to 90 minutes,
for an average of 12 to 16 sessions. BSFT™
the past 2 years, more than 40 organizations and
focuses on three central constructs: system,
120 practitioners have participated in BSFT™
structure/patterns of interaction, and strategy
training (J. Szapocznik, personal communication,
(Szapocznik & Williams, 2000). The process
of BSFT™ involves three components: joining,
diagnosis, and restructuring.
Characteristics of the intervention  Joining is very important and occurs at two
levels. These levels involve, first, establishing a
BSFT™ can be delivered in a variety of settings, relationship with each family member and, then,
such as social service agencies, mental health establishing a relationship with the entire family
clinics, and local community health agencies. system. There are a number of techniques that
For youth to receive BSFT™ they must have a may be used to join with the family.
permanent family environment, thus excluding
foster children. BSFT™ is delivered by clinicians  Diagnosis involves identifying the maladaptive
with master’s level or higher degrees. patterns that encourage the problematic youth
behavior. Therapists carefully observe and
examine the family’s interactions along five
domains: structure, resonance, developmental
stage, identified patient, and conflict resolution.

 Restructuring involves the therapists deciphering
family patterns of interactions and developing
specific plans to change maladaptive patterns.
Numerous studies over the past 35 years have
This is a problem-focused intervention aimed
examined the effectiveness of BSFT™. Many
at the level of family system interactions that
of these studies were experimental in design,
prevent each member from being successful.
using randomized control trials to measure the
BSFT™ is designed to help the entire family
effectiveness of the BSFT™ intervention compared
system attain a higher level of functioning and
to other interventions and/or a control group.
to reduce problems such as the adolescent’s
Studies have demonstrated significant and positive
drug use and behavior problems.
effects of the BSFT™ intervention. Study
populations have included primarily Hispanic
families. A sample of specific research studies
are listed in Table 12.

Table 12: Parent Management Training-Oregon: Research Base and Outcomes
Szapocznik, Hispanic families with adolescents with behavior problems (n = 37 in 1983 Treatments equally effective in:
Kurtines, Foote, study, n = 35 in 1986 study) randomly assigned to either conjoint family or  Reducing substance use
Perez-Vidal, & one-person structured family therapy (BSFT™).
Hervis (1983; 1986)  Reducing behavior problems
Study population:
 Improving family functioning
 100% Hispanic
Szapocznik et. al., Examined the effectiveness of an enhanced engagement for hard to reach Increased engagement in therapy in the treatment
(1988) cases. Hispanic families (n = 108) in which adolescents (males and females) group:
were observed with, or suspected of drug use, were randomly assigned to  93% of families in the treatment group
either the enhanced-engagement BSFT™ group or the control group (BFST™ engaged in therapy vs. 42% of families in the
engagement as usual condition). control group.
Study population:
 77% of families in the treatment group
 100% Hispanic completed treatment vs. 25% of the control
group families.
Szapocznik, et al., Hispanic male children (n = 69, ages 612) with moderate behavioral and Reduction of problem behaviors in both treatment
(1989 emotional problems were randomly assigned to either the structured family groups.
therapy (BSFT™), psychodynamic therapy, or a recreational group. For BSFT™ improved family functioning at
Study population: 1-year followup.
 100% Male
 100% Hispanic
Santisteban et al., A basic one-group pretest/posttest/followup design with Hispanic and African Intervention effective in reducing behavior problems
(1997) American children (n = 122, ages 12–14) exhibiting problem behaviors and improving family functioning.
assigned to BSFT intervention.
Study population:
 66% Male
 34% Female
 84% Hispanic
Santisteban et Hispanic boys and girls (N=79) randomly assigned to either BSFT™ Participants in BSFT™ treatment group demonstrated
al., (2000) (In treatment group or group counseling control group. reduction of problem behaviors, reduction in
Szapocznik & Study population: socialized aggression and conduct disorder more
Williams, 2000) than group counseling.
 100% Hispanic
Santisteban et al., Hispanic adolescents (males and females) displaying behavioral and drug BFST™ more effective in reducing marijuana use
(2003) problems (n = 126, ages 12–18) were randomly assigned to BSFT™ or than control group.
group counseling. BFST™ treatment group demonstrated improved
Study population: family functioning.
 75% Male
 25% Female
 100% Hispanic

 After approximately 8 months of supervision,
BSFT™ trainees are certified in the practice
of BSFT™. This certification is renewable every
2 years. Recertification would involve additional
costs to the agency.
Readiness:  All requests for training are made through the

University of Miami’s Center for Family Studies,
 The BSFT™ Team has several teleconferences,
BSFT™ Training Institute.
followed by an onsite visit to agencies to assess
their funding options, sustainability plan, and  Information about training and materials can
ability to deliver family services successfully. be obtained at: http://www.bsft.org/
Possible barriers:
 The culture of the agency can affect the
successful implementation of the practice of The cost for training workshops and supervision
BFST™. Specifically, some agencies put more in BSFT™ is $60,000 per agency. This figure
emphasis on seeing as many clients as possible. includes supervision for up to 8 months and all
On the other hand, some agencies are more the materials, workshops, and phone consultations.
actively engaged in retaining and keeping their Costs of BSFT trainer travel and per diem would
clients in treatment, which would be a good fit be separately reimbursed. Contact:
for the BFST™ model (J. Szapocznik, personal
communication, Sepstember 11, 2006). Adrienne Englert
BSFT™ Training Institute Manager
1425 NW 10th Ave
Training/coaching and materials Sieron Bldg, First Floor
Miami, FL-33136
 Training infrastructure for the BSFT™
Phone: (305) 243-7585
intervention can be tailored to meet the
Fax: (305) 243-2320
individual needs of the agency. BSFT™ training
Email: aenglert@med.miami.edu
requires acquiring basic clinical skills in family
systems therapy.
 BSFT™ involves four 3-day workshops followed Developer involvement
by weekly supervision. Training methods involve
didactic teaching, role playing, and videotape José Szapocznik, Ph.D., and colleagues of
reviews. These workshops are conducted at the the University of Miami’s Center for Family
agency site. The first workshop introduces the Studies are involved in actively implementing
basic concepts of BSFT™ using the training and refining BSFT™.
manual as guidance. The second workshop
uses videotapes to teach how to diagnose
family processes and to set up in-session
family interactions. After the second workshop,
therapists initiate treatment with new families,
tape their sessions, and then send the tapes
to be reviewed by BSFT™ trainers. The last
two workshops are devoted to rehearsing very
specific BSFT™ strategies for orchestrating
change within the family system.

Monitoring fidelity and outcomes Resources/Links
 Fidelity measures are collected weekly during
Office of Juvenile and Justice Prevention Program:
the 8 months of supervision. After the 8 months
of supervision, BSFT™ trainers collect fidelity http://www.ojjdp.gov/MPG
measures at certification and re-certification.
 Outcome measures are not reported by the sites. http://www.bsft.org/
However, BSFT™ trainers will work with the
sites interested in research to help them collect
and analyze data. References
Financing the intervention Feaster, D. J., Robbins, M. S., Horigian, V.,

& Szapocznik, J. (2004). Statistical issues in
BSFT’s startup costs and training have been multisite effectiveness trials: The case of brief
funded using various grants. The BSFT™ Training strategic family therapy for adolescent drug
Institute will assist agencies with securing funding abuse treatment. Clinical Trials, 1, 428–439.
through grant support. Many of the agencies fund
ongoing BSFT™ services through their regular Robbins, M. S., & Szapocznik, J. A. (1999). Brief
state funding. strategic family therapy. Office of Juvenile Justice
and Delinquency Prevention Program Bulletin,
Some of the funding also comes from Medicaid 1–11.
(J. Szapocznik, personal communication, September
11, 2006). In addition, third-party insurance payers Santisteban, D. A., Suarez-Morales, L., Robbins,
can also fund the program through billing family M. S., & Szapocznik, J. (2006). Brief strategic
therapy codes, or even case management. family therapy: Lessons learned in efficacy
research and challenges to blending research
and practice. Family Process, 45(2), 259–271.
Santisteban, D. A., Coatsworth, J., D., Perez-Vidal,

A., et al., (1997). Brief Structural/Strategic
Family Therapy with African American and
Hispanic youth. Journal of Community
Psychology, 25(5), 453-471.

Santisteban, D. A., Perez-Vidal, A., Coatsworth, Szapocznik, J. Kurtines, W. M., Foote, F. H., et al.,
J. D., et al., (2003). Efficacy of brief strategic (1986). Conjoint versus one-person family
family therapy in modifying Hispanic adolescent therapy: Further evidence for the effectiveness
behavior problems and substance use. Journal of conducting family therapy through one person
of Family Psychology, 17(1), 121–133. with drug-abusing adolescents. Journal of
Consulting and Clinical Psychology, 54(3),
Szapocznik, J. (personal communication, 395–397.
Szapocznik, J. Kurtines, W. M., Foote, F. H., et al.,
Szapocznik, J., & Williams, R. A. (2000). Brief (1983). Conjoint versus one-person family
strategic family therapy: Twenty-five years of therapy: Some evidence for the effectiveness of
interplay among theory, research and practice conducting family therapy through one person.
in adolescent behavior problems and drug abuse. Journal of Consulting and Clinical Psychology,
Clinical Child Family Psychological Review, 3 51(6), 889–899.
(2), 117–134.
Szapocznik. J., Rio, E., Murray, R., et al., (1989).

Structural family versus psychodynamic child
therapy for problematic Hispanic boys. Journal
of Consulting and Clinical Psychology, 57(5),
571–578.
Szapocznik, J., Vidal-Perez, A., Brickman, A., et al.,

(1988). Engaging adolescent drug abusers and
their families in treatment: A strategic structural
systems approach. Journal of Consulting and
Clinical Psychology, 56(4), 552–557.
Problem-Solving Skills Training
Figure 13
Problem-Solving Skills Training
Home
Problem-Solving Skills Training (PSST) is a
Age 6–14
cognitive behavioral approach for treating children
Gender Males
ages 6 to 14 years with conduct and delinquency-
Females
related problems. This intervention was developed
by Alan Kazdin, Ph.D., and his colleagues out
Outcomes Improvement in behavior as
of the earlier work of Myrna Shure, Ph.D., and rated by teachers and parents.
George Spivak, Ph.D., on problem-solving Family life functioning
techniques for children. improvements.

PSST is administered in 20 therapeutic sessions
PSST emphasizes teaching skills related to the that last approximately 45 to 50 minutes each,
later stages of information processing (McMahon, and is delivered in either a clinic or a home setting
Wells, & Kotler, 2005). The goal of this intervention by a master’s level therapist.
is to improve a child’s interpersonal and cognitive
problem-solving skills. This intervention is used PSST does not work with the children in groups,
with another intervention, Parent Management only individually with the child and parent.
Training (McMahon, Wells, & Kotler, 2005). The therapist works with the child to review
his or her process for addressing interpersonal
The Parent Management Training portion of situations and encourages the child to use a
the intervention is administered to parents or step-by-step approach with self-talk to achieve
caregivers for approximately 15 sessions, lasting effective solutions (Fonagy & Kurtz, 2002).
approximately 1.5 to 2 hours each.
Modeling and direct reinforcement are techniques
The therapist works with the parents or caregivers the therapist uses. Components of PSST will include
as the agents of change to help identify and address practice, feedback, homework assignments, role-
the child’s maladaptive thinking and behaviors playing, and reinforcement schedules (Fonagy
(McMahon, Wells, & Kotler, 2005). & Kurtz, 2002).
Additionally, the children receive in vivo practice

to apply the skills in a variety of settings. In vivo
practices involve structured assignments to
help children apply problem-solving skills
in everyday situations.

Research has continued to demonstrate that the
PSST intervention significantly decreases aggression
at home and in school, decreases deviant behaviors
PSST is an evidence-based intervention that has
and increases prosocial behaviors. Additionally,
been extensively researched in randomized control
research has demonstrated greater impact on
designs for the past 30 years, with Kazdin and
outcomes when PSST is combined with Parent
colleagues’ formative research beginning in the late
Management Training and Parent Problem-Solving
1980s. Research studies have included samples of
Intervention. See Table 13.
youth from both inpatient and outpatient settings,
and both White and African American populations.
Table 13: Problem-Solving Skills Training: Research Base and Outcomes

Kazdin, Esveldt- Psychiatric hospitalized children (n = 56, ages 7–13) randomly assigned to PSST group had significantly greater decreases
Dawson, French, PSST intervention group, relationship-based therapy, or control group. in externalizing, aggressive behaviors, behavioral
& Unis (1987) Behavioral ratings were obtained from parents and teachers pre- and post- problems at home/school, and increases in prosocial
treatment (after 1 year) to determine improvements. behavior and adjustment.
Study population:
 80% Male
 20% Female
 77% White
Kazdin, Esveldt- Psychiatrically hospitalized children (n = 40, ages 7–12) were randomly PSST/PMT group showed a reduction in aggression
Dawson, French, assigned to either a combined PSST and PMT intervention group or a at home and at school, as well as increases in
& Unis (1987) minimal intervention control group. prosocial behavior.
In Fonagy & Kurtz
(2005)
Kazdin, Bass, Siegal, Random-assignment of mixed sample inpatient/outpatient children (n = Both PSST groups showed significant reductions in
& Thomas (1989) 112, ages 7–13) to a PSST group, a PSST group plus in vivo practice outside deviant behaviors at 1-year followup: children in
the treatment setting, or relationship therapy (control group). control group did not improve.
Kazdin, Siegel, Children referred for severe antisocial behavior (n = 97, ages 7–13) and All three groups were associated with significant
& Bass (1992) their families randomly assigned to a PSST only group, a PMT only group, improvements at home, in school and in the
or a combined PSST /PMT group. community. Improvement was demonstrated in
Study population: overall child dysfunction, prosocial confidence,
and aggressive/antisocial and delinquent behavior.
 78% Male
There was a greater impact demonstrated in
 22% Female the combined PSST/PMT group on measures
 69% White of aggression, antisocial behavior, delinquency,
parental stress, and depression.
Kazdin & Whitley Children (n = 127, ages 6–14) and their families randomly assigned Children’s disruptive behavior improved whether
(2003) to a PSST and PMT group or a PSST, PMT and Parent Problem-Solving or not the PPS intervention was introduced; the PPS
Intervention (PPS) group. families experienced greater therapeutic change
Study population: and reduced barriers to treatment participation.
 79% Male
 21% Female
 69% White
 5% Hispanic
 3% Multiethnic

Implementation and Dissemination References
Fonagy, P. & Kurtz, A. (2002). Disturbance of

Training/coaching and Materials conduct. In P. Fonagy, M. Target, D. Cottrell,
J. Phillips, & Z. Kurtz (Eds.). What works
Typically, a therapist would need a 6-month
for whom: A critical review of treatments
training period to learn how to deliver PSST.
for children and adolescents, (pp.106–192).
Therapists are usually trained through academic
New York: Guilford Press.
research programs. A formalized intensive training
for therapists is available for Parent Management Kazdin, A., Bass, D., Siegel, T., & Thomas,
training and soon will be available for PSST. C. (1989). Cognitive-behavioral therapy and
relationship therapy in treatment of children
For information about training and materials, referred for antisocial behavior. Journal of
contact: http://www.yale.edu/childconductclinic/. Consulting and Clinical Psychology, 57(4),
522–535.
Cost of training/consulting Kazdin, A. E., Esveldt-Dawson, K., French, N. H.,

Not applicable because training is not & Unis, A. S. (1987). Problem-solving skills
currently available outside of clinical training and relationship therapy in the treatment
academic research programs. of antisocial child behavior. Journal of Consulting
and Clinical Psychology, 55(1), 76–85.
Developer involvement Kazdin, A. Siegel, T., Bass, D. (1992). Cognitive

Problem-Solving Skills Training and Parent
The developer, Alan Kazdin, is not actively involved Management Training in the treatment of
in disseminating or implementing PSST. However, antisocial behavior in children. Journal of
workshops may be available for those interested in Consulting and Clinical Psychology, 60(5),
training. A formalized intensive training program 733–747.
is available for Parent Management Training at:
http://www.yale.edu/childconductclinic/. Kazdin, A. E. (2003). Problem-solving skills
training and parent management training for
conduct disorder. In A. E. Kazdin & J. R. Weisz
Monitoring fidelity and outcomes (Eds.). Evidence-based psychotherapies for
children and adolescents, (pp. 241–262). New
Fidelity measures are in place. In addition, therapists
are observed in a live session delivering PSST.
Kazdin, A. E. & Whitley, M. K. (2003). Treatment
of parental stress to enhance therapeutic change
Financing the Intervention
among children referred for aggressive and
PSST is typically covered by Medicaid, antisocial behavior. Journal of Consulting and
as it is clinic-based. Clinical Psychology, 71(3), 504–515.

Resources/Links (2005). Conduct problems. In E. J. Mash &
R. A. Barkley (Eds.), Treatment of childhood
http://www.yale.edu/childconductclinic/ disorders: Third edition (pp. 137–268). New

Coping Power
cognitively distort incoming social cues and

situations and inaccurately interpret events.
Additionally, these children have an inability
to effectively problem solve.
Background
The Coping Power program is an empirically Parents of aggressive children also affect the way
supported program that was derived from the in which a child handles a situation, and a negative
original Anger Coping Program. In the original pattern can be created between parent and child.
Anger Coping Program, only a child component Therefore, Coping Power focuses on addressing
existed. In the Coping Power program, there is these cognitive distortions with the children and
a child and a parent component. assisting parents with modifying their reactions
to their children’s behavior.
The program was developed by John Lochman,
Ph.D., of the University of Alabama and Karen Figure 14
Wells, Ph.D., of Duke University School of
Coping Power
Medicine. Coping Power has been disseminated
and implemented in rural and urban settings
Setting n School
in North Carolina; three counties in Alabama;
Age  9–11
a residential school for deaf children; international
Gender n Males
locations such as the Netherlands, Puerto Rico,
n Females
and Spain; a university–public school system
Training/Materials Available n Yes
collaborative project; a medical school–community
Outcomes  Decrease in substance abuse.
center and a graduate training center in Oregon.
 Improvement in social skills.
 Less aggressive belief system.
The program is intended for boys and girls,

approximately 9 to 11 years of age (4th to 6th Coping Power has two components that work with
grade), who have been screened for disruptive one another. The entire Coping Power program
and aggressive behavior. It has also been adapted can be delivered in 15 to 18 months in a school.
for younger and older children.  The child component consists of 33 group
sessions, which include eight sessions in the
It is considered a prevention and intervention first intervention session (first academic year)
program, based on social-cognitive principles, that and 25 in the second intervention year (second
is most often implemented in a school environment. academic year). The group sessions last about
The social-cognitive model focuses on the contextual 40 to 60 minutes with approximately four to
parenting processes and on children’s sequential six children in each group led by a master’s
cognitive processing (Lochman & Wells, 2004). level clinician.
Children with disruptive and aggressive behaviors

During the child component sessions, the therapists
emphasize behavioral and personal goal setting,
awareness of feelings, use of coping self-
The Coping Power intervention, and its formative
statements, distraction techniques, relaxation
intervention, Anger Coping, has been extensively
methods, organizational and study skills,
researched for over 20 years, with more than 48
perspective taking, and social skills building.
controlled studies in a variety of settings (Fonagy
 The parent component consists of 16 group & Kurtz, 2002). The first randomized control study
sessions over the same 15- to 18-month period. was in 1984 (Lochman, Burch, Curry, & Lampron).
Group sessions usually last 90 minutes and
occur at the school. Sessions include groups Research has demonstrated associations between
of four to six single parents or couples led the Coping Power intervention and improvements
by master’s level clinicians. in children’s social skills, as rated by teachers, and
less aggressive beliefs and anger in social situations.
Parents acquire skills through training in Studies have included both Caucasian and African
identification of prosocial and disruptive behaviors, American youth and families.
rewarding appropriate child behaviors, giving
effective instructions, establishing age appropriate Currently, the program is being evaluated in four
rules and expectations, developing effective grant-funded intervention research studies and
consequences, and creating open communication. has been translated and disseminated in clinical
trials in the Netherlands (retrieved 11/3/2006,
http://www.bama.ua.edu/~lochman/program_
background.htm). The Coping Power program has
also been disseminated to aggressive deaf children
in a residential setting (Lochman et al., 2001).
See Table 14.
Table 14: Coping Power: Research Base and Outcomes

Lochman, Burch, First controlled evaluation with aggressive boys (n = 76, ages 9–12 years), At 1-month followup, study found that anger coping
Curry, & Lampron teacher-identified sample, assigned to one of four groups: anger coping, groups were more effective in reducing aggressive
(1984); goal setting, anger coping plus goal setting, or no treatment. and disruptive off-task behaviors as an intervention
Lochman & Subsample followup of the 1984 study, examined 7-month outcomes. than either a behavioral program with goal setting
Lampron (1988). or a control group.
Study population:
In Fonagy et al., High levels of on-task behavior maintained;
 100% Male
(2005) disruptive behavior reductions not maintained.
 47% White
Lochman, Lampron, Randomized control trial with youth (n = 32, ages 9–13) assigned to one Both treatment groups superior to control group;
Gemmer, & Harris of three groups: coping power intervention with teacher consultation, coping however, there was no significant difference between
(1989). In Fonagy power intervention, regular, or control group. treatment groups.
et al, (2005); 3-year followup study demonstrated a reduction
Lochman (1992). in substance abuse use and alcohol use compared
In Fonagy et al., to untreated boys. As well, booster sessions
(2005) significantly contributed to maintenances of reduced
off-task behavior.

Table 14: Coping Power: Research Base and Outcomes
Lochman & Wells Randomized control trial examining the post-intervention and 1-year Coping Power intervention demonstrated significant
(2002b; 2003) followup effects of Coping Power. Aggressive children (n = 245, grades preventive effects in children’s substance use,
5th and 6th) were randomly assigned to Coping Power, Coping Power reductions in proactive aggression, improved social
plus a universal intervention (Coping with the Middle School Transitions), competence, and greater teacher-rated behavioral
the universal intervention alone, or a control group. improvement at intervention’s end in comparison
Study population: to control group. (Lochman & Wells, 2002b).
 66% Male The 1-year followup effects were replicated in

a second sample, as Coping Power produced
 34% Female reductions in delinquency, substance use, and
 78% African American aggressive behavior relative to two comparison
conditions (Lochman & Wells, 2003).
 21% White
 Less than1% Hispanic
van de Weil, Randomized control trial of children (n = 77, ages 8–13 years) with ODD The Dutch adaptation of Coping Power (Utrecht
Matthys, Cohen- or CD in outpatient treatment, randomly assigned to either Dutch adaptation Coping Power Program) has produced cost-effective
Kettenis, & van of Coping Power (UCPP: Utrecht Coping Power Program) or to care as usual. postintervention effects on children’s aggressive
Engeland, (2003); Study population: behaviors, and has produced significant reductions
van de Weil, in substance use at a 4-year followup, in comparison
 88% Male
Matthys, Cohen- to care-as-usual.
Kettenis, Maassen,  12% Female
Lochman, & van  100% Dutch
Engeland (In press);
Zonnevylle-Bender,
Matthys, van de
Wiel, & Lochman
(2007).
Lochman & Wells Experimental design to test the effectiveness of Coping Power and its At 1-year followup, study indicated that boys in
(2004) sustained effects after 1 year. 4th and 5th grade boys (n = 183) screened child intervention plus parent group had lower
for aggression who met criteria randomly assigned to the child-intervention rates of self-reported covert delinquent behavior.
only group, child plus parent intervention group, or the control group. Boys who received coping power intervention
Study population: demonstrated increased behavioral improvements
during the academic year following treatment,
 100% Male
as indicated by teacher reports.
 61% African American Coping Power demonstrated clearer effects on
 38% White Caucasian boy’s parent-rated substance abuse use
and school behavior functioning than seen for
 1% Other
minority children parent ratings; most minority
children were African American. However, covert
delinquency outcomes produced equivalent effects
for minority and Caucasian children.
Lochman, Randomized control trial evaluating an abbreviated version of Coping The abbreviated version of Coping Power produced
Boxmeyer, Powell, Power (24 child sessions; 10 parent sessions) with aggressive boys and girls significant postintervention effects on children’s
Roth, & Windle (n = 240) assigned to Coping Power intervention group or to the control externalizing behavior problems.
(2006) condition.
Study population:
 64% Male
 36% Female
 30% White
 1% Other race or ethnicity

Implementation and Dissemination Developer involvement
The developers are currently involved in the

program. Currently an informal group offers the
training and consultation services. Those wishing
to learn more about training services should
Readiness:
contact Dr. Nicole Powell or Dr. Lochman
 There is no formalized process for assessing a directly through email or phone.
site’s readiness to implement the program. The Nicole Powell, Ph.D.
developers conduct telephone screens to assess Department of Psychology
a site’s willingness and ability to implement, but University of Alabama
use no instrument. 348 Gordon Palmer
 According to Dr. Lochman, a key issue in PO Box 870348
deciding to work with a site is its willingness Tuscaloosa, AL 35487
to do some type of evaluation after staff have Phone: (205) 348-3535
received the training. Email: npowell@as.ua.edu
 There is no readiness assistance to those sites

John Lochman, Ph.D.
that may not have the full capacity to implement
Department of Psychology
their program.
University of Alabama
348 Gordon Palmer
Training/coaching and materials PO Box 870348
Tuscaloosa, AL 35487
 Usually, Dr. Lochman and a doctoral-level
Phone: (205) 348-7678
researcher travel to sites to conduct a 3-day
Fax: (205) 348-8648
workshop.
Email: jlochman@as.ua.edu
 The 3-day workshop covers the background
and development of the program and reviews
the empirical findings of Coping Power. Monitoring fidelity and outcomes
 Monthly consultations are included in the costs.  Developers ask that sites use an objectives
These are conference calls that usually last 60 to checklist to ensure implementation of Coping
90 minutes and may occur more frequently than Power as designed. Measures are self-reported
once a month depending on the agreement with by the staff.
the site.
 The Coping Power program does not require
 Training materials have been translated collection of outcome data from the sites, but
in Dutch and Spanish. encourages evaluation of outcomes.
Information on training and
materials can be obtained at: Financing the intervention
http://www.bama.ua.edu/~lochman/index2.htm
 Some sites use the Safe and Drug Free Schools
funding to help finance the intervention.
 Other sites use local community funding
The cost for training is approximately $5,000 and grant funding to help pay for the Coping
plus travel expenses and material costs. Power program.

Lochman, J. E., & Wells, K. C. (2002b). The
Resources/Links
Coping Power Program at the middle school
transition: Universal and indicated prevention
The Coping Power Web site:
effects. Psychology of Addictive Behaviors,
http://www.bama.ua.edu/~lochman/index2.htm
16(4S), S40–S54.
Office and Juvenile Justice and
Lochman, J. E. & Wells, K. C. (2003).
Delinquency Prevention Model Programs:
Effectiveness study of Coping Power Program
http://www.dsgonline.com/mpg
and of classroom intervention with aggressive
children: Outcomes at a 1-year follow-up.
Behavior Therapy, 34, 493–515.
References
Lochman, J. E., FitzGerald, D. P., Gage, S.M.,
Fonagy, P. & Kurtz, A. (2002). Disturbance of
et al., (2001). Effects of social-cognitive
conduct. In P. Fonagy, M. Target, D. Cottrell,
intervention for aggressive deaf children: The
J. Phillips, & Z. Kurtz (Eds.). What works
Coping Power program. Journal of the American
for whom: A critical review of treatments for
Deafness and Rehabilitation Association, 35,
children and adolescents (pp.106–192). New
39–61.
van de Weil, N. M. H., Matthys, W., Cohen-

Lochman, J. (personal communication,
Kettenis, P., & van Engeland, H. (2003).
June 14, 2006).
Application of the Utrecht Coping Power
Program and care as usual to children with
Lochman, J. E., Boxmeyer, C., Powell, N., et
disruptive behavior disorders in outpatient
al.,(2006). Masked intervention effects: Analytic
clinics: A comparative study of cost and course
methods for addressing low dosage of intervention.
of treatment. Behavior Therapy, 34, 421–436.
New Directions for Evaluation, 110, 19–32.
Van de Wiel, N. M. H., Matthys, W., Cohen-
Lochman, J. E., Burch, P., R., Curry, J. F.,
Kettenis, P. T., et al. (2007). The effectiveness
& Lampron, L., B. (1984). Treatment and
of an experimental treatment when compared
generalization effects of cognitive-behavioral
with care as usual depends on the type of care
and goal setting interventions with aggressive
as usual. Behavior Modification 31(3), 298–312.
boys. Journal of Consulting and Clinical
Psychology, 52(5), 915–916.
Zonnevylle-Bender, M. J. S., Matthys, W., van
de Wiel, N. M. H., & Lochman, J. (in press).
Lochman, J. E. & Wells, K. C. (2004). The coping
Preventive effects of treatment of DBD in
power program for preadolescent aggressive
middle childhood on substance use and
boys and their parents: Outcome effects at the
delinquent behavior. Journal of the American
1-year follow-up. Journal of Consulting and
Academy of Child and Adolescent Psychiatry 46,
Clinical Psychology, 72(4), 571–578.
33–39.
Lochman, J. E., & Wells, K. C. (2002a). Contextual
social-cognitive mediators and child outcome:
A test of the theoretical model in the Coping
Power Program. Development and
Psychopathology, 14, 945–967.

Mentoring
Figure 15
Mentoring
Background Setting  Home
Age  6–18
Mentoring programs are the formal mechanisms
Gender  Males
for developing positive, supported, professional
 Females
relationships between at-risk youth and caring
adults. The process of mentoring holds the belief
Outcomes  Increased confidence in school
that when youth have the presence of a caring, performance.
available adult in youth’s lives, they are more likely  Improved family relationships.
to become successful adults themselves. (Jekielek,  Increased prosocial behaviors.
Moore, Hair, & Scarupa, 2002).
While mentoring programs vary in structure and

emphasis, overall, mentoring is an effective tool
for positively effecting the development of youth Characteristics of the intervention
(Jekielek et al., 2002). Two key organizations in Mentoring organizations are located in a number
the mentoring field are: of settings: schools, communities, faith-based
 MENTOR/The National Mentoring Partnership: organizations, agencies, juvenile corrections,
An organization started in 1990 to support and on the Internet through e-mentoring.
and encourage the efforts of new and existing The characteristics of mentoring vary and
mentoring programs by providing research, include traditional one-on-one mentoring, group
policy recommendations, and practical tools mentoring, team mentoring, peer mentoring,
to help connect youth with mentors; it is the and e-mentoring (http://www.mentoring.org/start_a_
“mentor’s mentor” (http://www.mentoring.org). program/planning_and_design/).
 Big Brothers Big Sisters of America (BBBSA):

BBBSA is an example of a traditional one-on-one
The largest organized mentoring affiliation
mentoring program with a strict, standard process
in the U.S. The Big Brother and Big Sister
that is clearly specified. Services start with a case
programs started in 1902 and became a united
manager, who often has a B.A. or M.A. in social
organization in 1977. Today, more than 500
work, and has the responsibility of following the
agencies work as partners of BBBSA under
life of the mentor-youth relationship. Services can
the shared mission statement that youth can
be conceptualized in seven stages (McGill, 1998):
become “confident, competent and caring
individuals by providing committed volunteers,  Inquiry: An initial referral made to the agency
national leadership, and standards of excellence” on behalf of the youth or an initial contact from
(McGill, 1998, p. 13). potential mentors.
 Orientation: Face-to-face contact between
volunteers and program staff to determine
if BBBSA fits a volunteer’s needs.

 Volunteer screening: A written application,
background check, written references, a
psychosocial interview, and a home assessment,
Even though mentoring programs have existed
which may or may not include a home visit.
for more than 100 years, research that evaluates
 Youth assessment: A written application, an the benefits of these programs has appeared in
interview with parent and child, and a home the literature only for roughly the past 20 years
assessment to establish the goals for the (DuBois et al., 2002). A meta-analysis, conducted
mentor relationship. The case manager places by DuBois et al., (2002), reviewed 55 evaluations
information into a formal individualized case of mentoring programs.
plan that is updated over time.
 Matching: Made based on needs of the youth, Favorable effects were found across age, gender,
volunteers’ abilities, and considerations of race, ethnicity, and family structure. The largest
program staff. effect sizes were observed with youth at risk due
to environmental conditions or disadvantage; no
 Match supervision: Encouragement and support overall favorable effect was found, however, for
provided to aid in the effectiveness of the youth at risk due to individual-level characteristics
match. Contact consists of an initial conversation (that is, youth with significant personal problems).
within the first 2 weeks of the match with the
youth, the parent or guardian, and the mentor; Research also supports the finding that the effects
monthly contact with all parties are held for the of a mentoring program are enhanced significantly
first year; and a written evaluation is prepared by adherence to theory and empirically based
at the end of the first year. “best practices.” (DuBois et al., 2002). Table 15,
 Closure: It is the responsibility of the case Mentoring: Research Base and Outcomes, highlights
manager to officially close the relationship if outcomes from a longitudinal BBBSA study.
either the youth or mentor decides they can no
longer fully participate, or if the youth reaches
the age of 18 years.
Mentors commit to at least 1 year of volunteer

service, with an average contact of 4 hours per
mentor-youth meeting, three times a month.
While the actual activities are not structured
by BBBS, the mentor and youth participate in
developmentally appropriate activities: taking a
walk, playing catch, watching television, watching
a sporting event, going to the library, or just
hanging out (McGill, 1988).

Table 15: Mentoring: Research Base and Outcomes
Tierney, Grossman, 18-month study of adolescents (n = 959, 10–16 years) from eight BBBSA Compared to waitlist control group, mentored
& Resch (1995); agencies, randomly assigned to a mentor or a waitlist. youth were:
Grossman & Rhodes Study with the same sample above examined the effects and predictors  46% less likely to initiate drug use.
(2002) of youth mentor relationships.
 27% less likely to initiate alcohol use.
Study population:
 Almost one-third less likely to hit someone.
 62% Male
 Skipped half as many school days.
 38% Female
 Felt more competent at schoolwork and showed
 71% African American improvement in grade point average.
 18% Hispanic  Displayed better relationships with their
 11% Other parents and peers at the end of the 18-month
study period.
Adolescents in relationships that lasted 1 year
or longer reported the largest number of
improvements, with progressively fewer effects
emerging among youth who were in relationships
that terminated earlier.
Adolescents in relationships that terminated in
less than 6 months reported decrements in several
indicators of functioning.
Older adolescents, as well as those referred for
services, or those who had sustained emotional,
sexual, or physical abuse were most likely to be
in early terminating relationships.

Components:
 Resources needed for implementing a mentor
program include office space with privacy, a
Infrastructure issues place for mentor training and for locked files,
volunteer recruitment materials, liability
Readiness: insurance, and staffing.
Factors to consider during the planning process  The National Mentoring Institute provides
include the following (DuBois et al., 2002): a Checklist for Program Progress: Program
Design and Planning in Section IV of How
 Recruitment of prospective mentors;
to Build a Successful Mentoring Program
 Screening process of mentors to include Using the Elements of Effective Practice,
background checks; available online (http://www.mentoring.org).
 Levels of training and supervision provided This document outlines the process from
to mentors; pre-implementation to program evaluation.
 Characteristics of the youth participants;

Startup:
 Qualities of the mentor-youth relationships
that are formed; and According to the BBBSA model, creating a new
program takes roughly 1 year and includes the
 Assessment of the intervention.
following (McGill, 1998):
 An advisory board should be created with
Recommended implementation practices:
members of other local organizations who
Recommended implementation practices include may be interested in BBBSA program in
the following: the community.
 The use of mentors with backgrounds in the  A needs-assessment should be conducted,
helping professions (Dubois et al., 2002). including a plan and timetable for
 Ongoing training for mentors beyond initial implementation, to be drafted by the
training (Dubois et al.). advisory board.
 Structured activities for mentors and youth  The needs assessment is reviewed by the
(Dubois et al.). national staff.
 Appropriate framing of the mentor-youth  If a program is accepted, permission

relationship; time is needed for the relationship is granted to use BBBSA’s name for
to form (Pryce, Kelly, & Keller, 2007); realistic fundraising, startup costs; the site becomes
expectations but frequent, regular contact an “Agency-in-formation.”
between the mentor and youth is needed  When a site graduates to a “Provisional
(Dubois et al, 2002). Member,” services are allowed to begin,
 Encouragement of parents to know the mentors following guidelines and standards.
and to be involved in supporting the relationship  For the creation of a BBBSA mentoring
(Dubois et al.). program as a satellite office for an existing
 Communication and collaboration among program, the local or national program should
parent, mentors, and the agency (Pryce, Kelly, be contacted, and an advisory board would
& Keller). be formed (McGill, 1998).
 Monitoring program implementation and
adjusting the program accordingly (Dubois et al.).

 Effective programs incorporate standard, Cost of training/consulting
recommended procedures in their operations
(Pryce, Kelly, & Keller, 2007); program  Training and consultation costs vary depending
effectiveness increases in direct proportion on the program. Some state programs are free.
to the number of specific program practices Other national conferences have a registration
that are employed (DuBois et al., 2002). fee along with travel expenses.
 Extensive program design and planning tools
Possible barriers: are available for free on the National Mentor
Institute’s Web site (http://www.mentoring.org).
 A limited number of adults to serve as mentors
(Grossman & Garry, 1997).
Specifically for BBBSA:
 A scarcity of organizational resources necessary
 Cost of the Educational Institutes is shared by
to carry out a successful program (Grossman &
the local organization and the national office;
Garry, 1997).
the local organization pays for travel expenses
(McGill, 1998).
Training/coaching and materials  Startup budget needed for an independent

agency is $30,000 to $50,000; startup budget
 Twenty-seven State Mentoring Partnerships needed for a satellite program is $20,000
offer training (http://www.mentoring.org/find_ to $40,000.
resources/state_partnerships/).
 An initial fee is paid to BBBSA for consultation
 The National Mentoring Institute offers and materials during the needs assessment
information on training opportunities process. An additional $3,000 fee is charged
(http://www.mentoring.org/events/) as well as if the program becomes a Provisional Member.
online training for face-to-face mentoring
(http://apps.mentoring.org/training/TMT/index.adp)
or e-mentoring (http://www.Mentoring.org/emc).
Extensive literature on program design and Contact the National Mentoring Partnership at:
planning tools is also provided, including the
MENTOR/National Mentoring Partnership
downloadable document, How to Build a
1600 Duke Street, Suite 300
Successful Mentoring Program Using the
Alexandria, VA 22314
Elements of Effective Practice. The document
Phone: (703) 224-2200
may be downloaded from this Web site in
http://www.mentoring.org
Spanish. (http://www.mentoring.org/downloads/
mentoring_418.pdf),
Contact the Big Brothers Big Sisters of America’s
 BBBSA has developed a number of 2- and National Office at:
5-day Educational Institutes for training
Big Brothers Big Sisters of America National Office
executive directors, middle managers, and
230 North 13th Street
case managers. A “train-the-trainer” program
Philadelphia, PA 19107
is offered by BBBSA for mentor training for
Phone: (215) 567-7000
local program staff. It consists of 10 2-hour
Email: national@bbbsa.org
modules on the topics of relationship-building,
communication skills, and child development
(McGill, 1998). Contact the national
organization (http://www.bbbsa.org).

Monitoring fidelity and outcomes References
 The National Mentoring Institute supports
Grossman, J. B., & Garry, E. M. (April, 1997).
monitoring outcomes. Section IV of How to
Mentoring—A proven delinquency prevention
Build a Successful Mentoring Program Using
strategy. Office of Juvenile Justice and
the Elements of Effective Practice provides
Delinquency Prevention, Juvenile Justice
information on program evaluation. (http://www.
Bulletin, 1–7.
mentoring.org/downloads/mentoring_418.pdf).
 The BBBSA program outlines fidelity standards Bloomquist, L., & Schnell, S. (2002). Helping
in Standards and Required Procedures for children with aggression and conduct problems:
One-to-One Service. Standards are reinforced Best practices for intervention. The Guilford
through training and conferences on the national Press: New York, NY.
and regional levels and agency evaluations.
DuBois, D., Holloway, B., Valentine, J., & Harris
Adherence to the national standards is required
C. (2002). Effectiveness of mentoring programs
for member affiliation (McGill, 1998).
for youth: A meta-analytic review. [Special issue]
American Journal of Community Psychology,
30(2), 157–197.
 The National Mentoring Institute provides Grossman, J., & Rhodes, J. (2002). The test of
information about how to develop a financial time: Predictors and effects of duration in youth
plan for diversified funding in Section V of mentoring relationships. American Journal of
the downloadable document How to Build Community Psychology, 30(2), 199–219.
a Successful Mentoring Program Using the
Jekielek, S., Moore, K., Hair, E., & Scarupa, H.
Elements of Effective Practice (http://www.
(2002). Mentoring: A promising strategy for
mentoring.org/downloads/mentoring_418.pdf).
youth development. Child Trends Research
 The U.S. Department of Education had a Brief. Washington, DC.
competition for funding under its Mentoring
Programs grants through FY 2009 when $50 McGill, D. E., Mihalic, S. F., & Grotpeter, J. K.
million was available for funding. This program (1998). Blueprints for Violence Prevention, Book
provided competitive grants to support school- Two: Big Brothers Big Sisters of America. Center
based mentoring programs for children in need for the Study and Prevention of Violence:
of assistance. The National Mentoring Institute Boulder, CO.
will work to restore funding.
Pryce, J., Kelly, M., & Keller, T. (2007). What
makes mentoring effective? How research can
guide you in selecting a program. Focal Point:
Resources/links
Research, Policy, & Practice in Children’s Mental
Health, 19–21.
For more information on MENTORING/
The National Mentoring Partnership, see Rhodes, J., & DuBois D. (2006). Understanding
http://www.mentoring.org. and facilitating the youth mentoring movement.
Social Policy Report: The Society for Research
For more on Big Brothers Big Sisters of America, in Child Development, 20(3), 3–18.
see http://www.bbbsa.org.
Tierney, J., Grossman, J., & Resch, N. (1995). Making
a difference: An impact study of Big Brothers Big
Sisters. Philadelphia: Public/Private Ventures.

Figure 16
Multisystemic Therapy
Multisystemic Therapy
Intervention Description Setting  Home

 School
Age  12–18
Background Gender  Males

 Females
Multisystemic Therapy (MST) is an intensive Training/Materials Available  Yes
family and community-based treatment for Outcomes  Decreased arrests and re-arrests.
youth with serious conduct-related problems  Increased school attendance.
and substance abuse issues. It was developed in  Decreased behavior problems.
the late 1980s and early 1990s, and limited training  Decreased substance use.
in the model was provided by the Family Services
Research Center (FSRC) of the Medical University
of South Carolina, Department of Psychiatry and
Behavioral Sciences.
Since 1996, MST Services has been the university- MST treatment is a multi-faceted family and
licensed organization responsible for transporting community-based treatment for youth who
and implementing MST to community sites. are at imminent risk of out-of-home placement
More than 350 MST teams are implementing due to serious antisocial behavior and substance
the program throughout the United States and abuse problems. Intervention strategies integrate
in nine other countries. techniques from empirically supported treatments
including the following:
A significant amount of the growth in MST
 Structural and strategic family therapies;
programs has come through the 20+ MST
“training organizations” known as MST Network  Parent management training;
Partners; see below under Training/coaching  Marital therapies;
and Materials for more information about Network
Partner organizations.  Behavioral therapy; and
 Cognitive–behavioral therapy.
MST Network Partners directly support transporting
and implementing more than 250 of the existing Treatment sessions involve identifying strengths
350 teams. Teams are comprised of three to four in the everyday contexts of the youth and family
therapists each carrying a caseload of four to six (for example, youth, family, peers, school,
families and a clinical supervisor. neighborhood, community) that can be used as
levers for change to address the combination of
known risk factors in those contexts that contribute
to the youth’s referral problems.

MST is delivered by trained master’s level or highly The treatment of MST is guided by the
experienced bachelor’s level therapists. Therapist nine MST principles (retrieved from
implementation of MST is supported by model- http://www.mstservices.com/text/treatment.html#nine):
specific training, onsite clinical supervision, and
 Comprehensive assessment to understand the
expert consultation from doctoral- or master’s-
child and family problems and functioning in
level people trained in MST. All therapists have a
relation to their broader systemic context.
small caseload and are available to the family on a
24-hour basis.  Therapeutic contacts emphasize the positive
and use systemic strengths as levers for
The course of treatment ranges from 3 to 5 months. positive change.
Treatment occurs in the family’s home and other  Interventions are designed to promote responsible
locations (for example, school, neighborhood, mall, behavior and decrease irresponsible behavior
etc.) in which the youth’s problems occur and must among family members.
be addressed. Therapists and families together
develop and continuously revise interventions  Interventions are present-focused and action-
on the basis of observations of intervention success oriented, emphasizing specific and well-defined
and failure, and plan how to address problem areas problems.
and goals for treatment. To measure and determine  Interventions focus on sequences of behavior
progress, the therapist and family set and review within and between multiple systems that
goals weekly. maintain the identified problems.
 Interventions are developmentally appropriate
The main focus of MST is to cultivate among the
and fit the developmental needs of the youth.
youth’s caregivers the skills and naturally occurring
resources to effectively address the challenges  Interventions are designed to require daily
presented by the youth’s behavior problems. or weekly effort by family members in trying
In school settings, the therapists work to facilitate out new behaviors and ways of relating.
a collaborative relationship between the school  Intervention effectiveness is evaluated
and parents needed to conjointly design strategies continuously from multiple perspectives, with
to improve identified performance and behavior MST team members assuming accountability
problems at school. for overcoming barriers to successful outcomes.
With respect to peers, therapists work with the  Interventions are designed to promote
youth’s caregivers and the caregivers of the youth’s treatment generalization and long-term
peers to decrease association with delinquent and maintenance of therapeutic change.
drug-involved friends and increase association with
positive peers.

Table 16 summarizes studies of MST that involved
substance abusing and delinquent youths, and
youth experiencing serious emotional disturbance
Fifteen published studies on the effectiveness of
(http://www.mstservices.com/text/research.html,
the MST program were conducted between 1986
retrieved 05/03/07).
and 2005. Of these 15 studies, 14 randomized
control trials and one quasi-experimental design
have demonstrated positive effects.
Table 16: Multisystemic Therapy: Research Base and Outcomes

Henggeler, Rodick, Quasi-experimental design study with delinquents (n = 57) MST At posttreatment, MST group improved family
Borduin, Hanson, comparison to diversion services. relations, decreased behavior problems, and
Watson, & Urey (1986) Study population: decreased association with deviant peers.
 84% Male
 16% Female
 35% White
Henggeler, Borduin, Randomized control trial with adolescent (n = 200) who were At 3 years, MST group demonstrated reduced
Melton, Mann, Smith, serious juvenile offenders. MST compared to individual counseling alcohol and marijuana use and decreased drug-
Hall, Cone, & Fucci and usual community services. related arrests.
(1991) Study population:
 67% Male
 33% Female
 70% White
Henggeler, Melton, & Randomized control trial with violent and chronic juvenile  At 59 weeks, MST group improved family
Smith (1992); offenders relations, improved peer relations, decreased
Henggeler, Melton, (n = 84). MST compared to usual community services. recidivism (43%), decreased out-of-home
Smith, Schoenwald, & Studies population: placement (64%).
Hanley (1993)  77% Male  At 2.4 years, MST group decreased recidivism
(doubled survival rate).
 26% Female
 42% White
 2% Hispanic
Borduin, Mann, Cone, Violent and chronic juvenile offenders (n = 176). MST compared  At 4 years, MST group improved family relations,
Henggeler, Fucci, Blaske, to individual counseling. decreased psychiatric symptomatology, decreased
& Williams (1995); Studies population: recidivism (69%), decreased rearrests (54%).
Schaeffer & Borduin  68% Male  At 13.7 years MST group decreased days
(2005) incarcerated (57%).
 32% Female
 70% White

Henggeler, Melton, Randomized control trial with violent and chronic juvenile At 1.7 years, MST group decreased psychiatric
Brondino, Scherer, & offenders symptomatology, decreased days in out-of-home
Hanley (1997) (n = 155). MST compared to juvenile probation services – high placement (50%), decreased recidivism (26% not
rates of incarceration. significant), treatment adherence linked with long-
Studies population: term outcomes.
 82% Male
 18% Female
 19% White
Henggeler, Rowland, Randomized control trial with youths (n = 116, final sample n  At 4 months postrecruitment: MST decreased
Randall, Ward, Pickrel, = 156) presenting psychiatric emergencies. MST compared to externalizing problems (CBCL), improved family
Cunningham, Miller, Psychiatric hospitalization. relations, increased school attendance, higher
Edwards, Zealberg, Studies population: consumer satisfaction, 75% reduction in days
Hand, & Santos (1999); hospitalized, 50% reduction in days in other
 65% Male
Schoenwald, Henggeler, out-of-home placement, decreased rates of
Brondino, & Rowland  35% Female attempted suicide.
(2000);  65% African American  Favorable 4-month outcomes noted above
Huey, Henggeler, dissipated.
 38% White
Rowland, Halliday-
 1% Other
Boykins, Cunningham,
Pickrel, & Edwards
(2004);
Henggeler, Rowland,
Halliday-Boykins,
Sheidow, Ward, Randall,
Pickrel, Cunningham, &
Edwards (2003);
Sheidow, Bradford,
Henggeler, Rowland,
Halliday-Boykins,
Schoenwald, & Ward
(2004)
Henggeler, Pickrel, & Randomized control trial with substance abusing and dependent  At 1 year: Decreased drug use at posttreatment,
Brondino (1999); delinquents (n = 118). MST compared to Usual community decreased days in out-of-home placement (50%),
Schoenwald, Ward, services. decreased recidivism (26%, not significant), and
Henggeler, Pickrel, & Studies population: treatment adherence linked with decreased drug
Patel (1996); use.
 79% Male
Brown, Henggeler,  At 1 year: Incremental cost of MST nearly offset
 21% Female
Schoenwald, Brondino, by between-groups, differences in out-of-home
& Pickrel (1999);  50% African American placement, increased attendance in regular
school settings.
Henggeler, Clingempeel,  47% White
Brondino, & Pickrel  At 6 months: Decreased violent crime.
(2002)  At 4 years: Increased marijuana abstinence.
 1% Hispanic
Ogden & Halliday- Randomized control trial with Norwegian youths (n = 100) with  At 6-month postrecruitment, decreased
Boykins (2004); serious antisocial behavior. MST compared to usual Child Welfare externalizing and internalizing symptoms,
Ogden & Hagen Services. decreased out-of-home placements,
(in press) Study population: increased social competence and, increased
consumer satisfaction,
 63% Male
 18-month followup, decreased externalizing and
 37% Female
internalizing symptoms; decreases in out-of-home
 100% Norwegian placements.

Rowland, Halliday- Randomized control trial with youths (n = 31) with serious At 6 months postrecruitment, decreased symptoms,
Boykins, Henggeler, emotional disturbance. MST compared to Hawaii’s intensive decreased minor crimes, decreased days in out-of-
Cunningham, Lee, Continuum of Care. home placement (68%).
Kruesi, & Shapiro (2005) Study population:
 58% Male
 42% Female
 83% Multiracial (White and Asian American)
 10% White
Timmons-Mitchell, Randomized control trial with juvenile offenders (felons, n = 93) At 18-month followup improved youth functioning,
Kishna, Bender, & at imminent risk of placement. MST compared to usual community decreased re-arrests (37%).
Mitchell (2006) services.
Study population:
 78% Male
 22% Female
 77.5% White
 15.5% African American
 4.2% Hispanic
 2.8% Multiethnic
Henggeler, Halliday- Randomized control trial with substance abusing and dependent At 12 months postrecruitment: MST enhanced
Boykins, Cunningham, juvenile offenders in drug court (n = 161). MST compared to four substance use outcomes. Drug courts were more
Randall, Shapiro, treatment conditions, including Family Court with usual services effective than Family Court at decreasing self-
& Chapman (2006) and Drug Court with usual services. reported substance use and criminal activity.
Study population:
 83% Male
 17% Female
 31% White
 2% Multiethnic
Henggeler, Rodick, Quasi-experimental design study with delinquents (n = 57). MST At posttreatment, MST group improved family
Borduin, Hanson, comparison to diversion services. relations, decreased behavior problems, and
Watson, & Urey (1986) Study population: decreased association with deviant peers.
 84% Male
 16% Female
 35% White
Table adapted from http://www.mstservices.com/text/research.html, retrieved May 3, 2007.


Training is conducted on certain dates; schedules
are available through http://www.mstservices.com.
Infrastructure issues The MST training curriculum consists of a 5-day

orientation training, booster sessions every quarter,
weekly onsite clinical supervision for treatment
Readiness:
teams and supervisors, and weekly consultation
A site assessment process guides the exploration from a doctoral- or master’s-level MST expert.
of interested service systems, provider organizations, In addition to these trainings are supervisor
and communities concerning the needs for trainings and “advanced” supervisor training.
which MST is perceived as a possible solution, the
demonstrated capacity of MST to meet those needs,
Orientation training:
and the readiness of the partners in implementation
(that is, referral agencies, payers, provider agencies, The initial orientation training is 5 days long,
consumers, MST Services or one of its Network and all service provider agency staff with clinical
Partners) to launch an MST program. treatment and clinical supervisory responsibility
for the youth and families treated in the MST
Initial steps in the needs assessment process program must attend all 5 days of training.
typically take place over the telephone and
subsequent steps involve one or more site visits Agencies collaborating in the development and
conducted by MST Services. The site visit is support of the MST program are also invited
designed to include critical community stakeholders and can also send key administrators or other
in the process of learning about the MST model, stakeholders to learn about MST on the first day
considering the extent to which identified service of the orientation training. The goal of the 5-day
needs can be met by MST and determining the orientation training is for participants to become
viability of implementing and sustaining MST familiar with the strategies used in MST, to
services in the existing community practice context. understand the causes of serious behavior problems
in youth and how to treat those problems, and the
theory and research behind the treatment.
Staffing:
MST Services can provide selection criteria The clinical interventions focused on the family,
for staffing an MST program. In addition, MST peer group, school, and identified youth are
Services offers protocols for supervisors and discussed, and participants practice assessing
therapists that include sample job advertisements, the nature of the problems and strategies to begin
initial screening criteria, and interview questions. to address them. Participants practice assessing
clinical problems and delivering MST interventions
in group exercises and role-plays.
Training is available only to “licensed” MST Quarterly booster sessions:

programs. As a general rule, all trainings are
As therapists gain field experience with MST,
held onsite except for orientation trainings
quarterly booster sessions are conducted onsite
for replacement staff, which are conducted
by the MST Expert assigned to work with the team
in Charleston, South Carolina, as well as at
for ongoing training and quality assurance. The
designated Network Partner sites, such as those
purpose of these 1.5-day boosters is to provide
in Middletown, Connecticut; Denver, Colorado;
additional training in areas identified by therapists
and Latrobe, Pennsylvania.
(for example, marital interventions, treatment of

parental depression in the context of MST) and Network partners and the
to facilitate indepth examination, enactment, and train-the-trainer approach:
problem-solving of particularly difficult cases. MST has a train-the-trainer approach. When
certain conditions allow (for example, scale of
Weekly calls: implementation, adherent implementation, etc.),
an MST training organization can be developed
Weekly phone consultation is provided for each
with the support of MST Services. Such
treatment team (therapists and supervisor) by
organizations are called MST Network Partners.
their assigned MST Expert. Consultation sessions
focus on promoting adherence to MST treatment
This network of organizations is committed to the
principles, developing solutions to difficult clinical
transport of the MST model with full integrity and
problems, and designing plans to overcome any
fidelity. It is a key to the transport strategy
barriers to obtaining strong treatment adherence
employed by MST Services.
and favorable outcomes for youths and families.
MST Network Partner organizations employ staff
As noted earlier, high treatment adherence is critical
fully trained in MST program development as well
to obtaining favorable long-term outcomes for
as clinical staff training and development and
serious juvenile offenders, and, as such, the central
quality assurance monitoring. MST Services
goal of the training and consultation process is to
maintains an ongoing working relationship with
maximize adherence to the MST principles.
each MST Network Partner organization, focused
on staff development, quality improvement, and
Supervisor orientation training: quality assurance activities.
 Training is offered on select dates in Charleston,
Network Partners are able to offer training
South Carolina.
to new sites and communities. More than 20
 This training is offered for supervisors during network partner organizations directly support
the first 6 months of performing the job. over two-thirds of the MST teams operating
Training is highly interactive and helps around the world. For a list of MST Network
supervisors practice their skills. In addition, Partners, see the MST Services Web site:
supervisors identify their strengths and http://www.mstservices.com/text/network%20partners.htm.
weaknesses in areas of clinical development,
community collaboration, group supervision,
Manualization:
and hiring.
Several manuals are available for implementing
different aspects of MST.
Advanced supervisor training:
This level of training is offered only once a year in Henggeler, S. W., & Schoenwald, S. K. (1998).
Charleston, South Carolina. It is designed for those MST Supervisory Manual. New York:
supervisors who have been in their position 6 Guilford Press.
months or more. Three different topical areas are
addressed at least once a year: Henggeler, S. W., Schoenwald, S. K., Borduin,
 Group supervision; C. M., Rowland, M. D., & Cunningham,
P. B. (1998). Multisystemic treatment of
 Clinician development; and antisocial behavior in children and adolescents.
 Program continuous quality improvement Treatment manuals for practitioners. New York:
management. Guilford Press.

Henggeler, S. W., Schoenwald, S. K., Rowland, Developer involvement
M. D., & Cunningham, P. B. (2002).
Serious emotional disturbance in children and The developers of MST are not directly involved
adolescents: Multisystemic Therapy. New York: in the transport and implementation of MST,
Guilford Press. although the protocols for treatment, clinical
supervision, and expert consultation they designed
Schoenwald, S. K. (1998). Multisystemic Therapy form the basis for the training procedures and
Consultation Manual. New York: Guilford Press. materials used in such transport.
Strother, K. B., Swenson, M. E., & Schoenwald, S. MST Services is the university-licensed company
K. (1998). Multisystemic Therapy Organization responsible for the transfer of MST technologies
Manual. Charleston, SC: MST Institute. to community settings, and thus responsible for
supporting the transport and implementation
For information on training and materials, go to of MST. The MST model developers oversee the
http://www.mstservices.com. work of MST Services through their involvement
on its Board of Directors.
Cost of training/consulting MST Network Partner organizations employ staff

fully trained in MST program development, clinical
Costs can depend on how many MST teams a site staff training and development, and quality assurance
chooses to create. A team usually involves three to monitoring. MST Services maintains an ongoing
five staff members, including the team supervisor. working relationship with each MST Network
It would cost approximately $26,000 for a single Partner organization focused on staff development,
team to become trained and receive ongoing quality improvement and quality assurance activities.
support. At a larger scale of implementation, these
costs can decline to as low as $17,000 per team.
However, other costs are not included in this price, Monitoring fidelity and outcomes
such as licensing fees of $4,000 per agency and
other per diem and travel costs for staff to receive MST Services requires that sites submit fidelity
the initial training or advanced training. data through a secured Internet-based data
collectionsite at http://www.mstinstitute.org.
When viewed as a part of the cost of services to
clients, the total cost of all training, licensure, and In addition to the submission of fidelity data,
travel range from $500 per youth treated to $300 sites submit their outcome data through
per youth treated depending on the scale of the http://www.mstinstitute.org.
MST system being supported.
Additionally, when a system has developed its own Financing the intervention
MST Network Partner infrastructure, almost all of
Many sites pursue funding for MST through
the above costs are internal to the system itself in
various child human service systems, often juvenile
the form of salaries paid to staff and associated
justice or child welfare.
staff support costs.
Medicaid may provide reimbursement for some
components of MST.

child abuse and neglect. Journal of Consulting
Resources/Links
and Clinical Psychology, 55, 171–178.
http://www.mstservices.com
Burns, B. J., Hoagwood, K., & Mrazek, P. J. (1999).
Effective treatment for mental disorders in
http://www.mstinstitute.org
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University of Colorado Center for the
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(2000). Strengthening America’s families:
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expert consultation, therapist fidelity, and child U.S. Department of Health and Human Services
outcomes. Journal of Clinical Child and (1999). Mental health: A report of the Surgeon
Adolescent Psychology, 33, 94–104. General. Rockville, MD: U.S. Department of
Health and Human Services, National Institutes
Schoenwald, S. K., Sheidow, A. J., Letourneau, of Health, National Institute of Mental Health.
E. J., & Liao, J. G. (2003). Transportability of
multisystemic therapy: Evidence for multilevel U.S. Public Health Service (2001). Youth violence:
influences. Mental Health Services Research, 5, A report of the Surgeon General. Washington,
223–239. DC: Author.
Schoenwald, S. K., Ward, D. M., Henggeler, S. W., Van Wijk, A., Loeber, R., Vermeiren, R., et al.,
Pickrel, S. G., & Patel, H. (1996). Multisystemic (2005). Violent juvenile sex offender compared
therrapy treatment of substance abusing or with violent juvenile nonsex offenders:
dependent adolescent offenders: Costs of Explorative findings from the Pittsburgh Youth
reducing incarceration, inpatient, and residential Study. Sexual Abuse, A Journal of Research and
placement. Journal of Child and Family Studies, Treatment, 17, 333–352.
5, 431–444.

Functional Family Therapy
 Reducing the personal, societal, and economic

consequences that can result from various
disruptive behaviors of youth; and
Background  Offering this intervention at lower cost,
in terms of time and money as compared
Functional Family Therapy (FFT) is an empirically to more expensive treatment.
based clinical system that focuses on youth who
are at risk of, or currently displaying, aggressive
Figure 17
behavior, violence, and substance-use.
Functional Family Therapy
FFT has been in existence for more than 30 years Type of EBP  Intervention
with well-documented results. It was originally Setting  Clinic
developed by James Alexander, Ph.D., and Bruce  Home
Parsons, Ph.D., of the University of Utah.  Juvenile Court
Age  11–18
More than 50 percent of the current practices Gender  Males
of FFT are implemented in the juvenile justice  Females
system. However, FFT can be offered in a variety Training/Materials Available  Yes
of settings: mental health, schools, child welfare, Outcomes  Reduction in recidivism.
probation, parole/aftercare, and as an alternative  Reduction in out-of-home

placements.
to incarceration or out-of-home placement.
Characteristics of the intervention The program is implemented on average in 8 to 12

1-hour sessions. However, for more challenging
FFT is a short-term therapy designed for male
cases, longer duration of treatments may be needed.
and female youth ages 11 to 18 years. The
youth must be part of a psychosocial system that
The program is designed to be administered by
constitutes a family and not currently have active
licensed professionals with a master’s degree or
homicidal or suicidal ideation, nor substance use
paraprofessionals who are highly supervised by a
that requires detoxification.
master’s-level clinician. FFT can be implemented
in a home, clinic, or juvenile court program. It must
The three main goals that are fundamental to the
be implemented in sequential phases, each
success of the program are (Alexander et al., 2002):
of which has its own assessment process and
 Changing maladaptive behaviors of youth intervention components.
and relational dynamics of families, especially
ones that may not be motivated to change;

Engagement and Motivation:
This phase is concerned particularly with family
member’s expectations about treatment and The efficacy of FFT has been supported by 29
positive effects resulting from treatment. Clinicians years of evaluation. Fourteen studies between 1973
identify and assess protective and risk factors. and1998 included primarily matched and randomly
They also help label the cognitive, behavioral, assigned comparison/control groups, with followup
and emotional expectations of each family member. periods of 1, 2, 3, and 5 years (Alexander et al., 2002).
Cognitive therapy techniques are used to help FFT has been implemented in rural and urban
replace negative or maladaptive attributions settings, and with families from diverse racial/
such as hopelessness and lack of motivation, ethnic groups, including Caucasian, African
with positive ones. American, Asian American, Hispanic/Latino,
and American Indian. (Diverse populations were
primarily included in replication studies). As of
Behavior change:
2002, the developers noted recidivism rates did
Various behavioral techniques are applied not vary across ethnic/racial groups, supporting
during this phase, such as cognitive reframing, the generalizability of the intervention (Alexander
communication skills training, and contingency et al., 2002).
management. In this phase, the therapist is
modeling, labeling, and directing positive In addition, research from the Washington State
behavioral change. Institute for Public Policy 2004 report on the
cost effectiveness of evidence-based practices
Generalization:
for prevention and intervention provides support
for FFT; in 2003, the national rate net benefit over
In this phase, the clinician’s job is to sustain the costs per child was $26,216, or $13.25 per day
momentum of change as well as to foster family (Aos et al., 2004).
independence from therapy. If families are
involved in multiple systems, clinicians help Included in Table 17 is a sample of the studies that
the family address these various systems, such demonstrate positive outcomes across varied group
as school and legal. participants (Alexander et al., 1998).
Throughout the intervention, interpersonal

interactions among family members are assessed
and addressed to improve family functioning.

Table 17: Functional Family Therapy: Research Base and Outcomes
Alexander (1971); RCT of 40 adolescent (ages 13–16 years) delinquents arrested and detained FFT and FFT + Individual Therapy produced
Alexander & Barton for runaway, ungovernable, or habitually truant randomly assigned to one significantly greater improvements in
(1976; 1980) of four groups: communication style (less defensive, hostile, and
 FFT + Individual Therapy, submissive communication) than other conditions.
 FFT only,
 Individual Therapy only, or
 Control Group with minimum attention from a probation officer.
Study population:
Alexander & Adolescents (n = 99, ages 13–16) arrested and detained for running FFT group demonstrated significant improvements
Parsons (1973) away, declared ungovernable or habitually truant, randomly assigned in family interactions compared to all other groups.
to one of 4 groups:
 FFT,
 Client-Centered Family Therapy,
 Eclectic psychodynamic family therapy,
 Nontreatment control group.
Study population:
 44% Male
 56% Female
Regas & Sprenkle Adolescents (n = 55) diagnosed with ADHD, referred to child protective Positive increases in family concept of FFT group;
(1982) from services randomly assigned to one of three groups, both treatment groups demonstrated significant
Alexander (2002)  FFT, improvements on ADHD behaviors at home and
at school.
 Group therapy, or
 No treatment control group.
Friedman (1989) Adolescent drug abusers (n = 166, mean age =17.8) randomly assigned FFT group demonstrated greater parental
to one of two groups: involvement and lower family dropout rate.
 FFT or
 parent group.
Study population:
 60% Male
 40% Female
 89% White
 11% Nonwhite
Hannson (1998) 2-year study of Swedish Adolescents (n = 95) referred following arrest for Reduced maternal depression, somatization,
from Alexander serious offenses, randomly assigned to one of two groups: FFT or social and anxiety in FFT group.
(2002) service as usual.
Study population:
 Predominantly male
 100% Swedish

Possible barriers:
As identified by the developers, two barriers
to implementation are funding to sustain FFT
Infrastructure issues and the referral process to maintain a consistent
caseload of appropriate FFT clients. These two
Readiness: issues seem to pose the greatest challenge
to implementation efforts (Kopp, 2006).
Before implementation, FFT, LLC (the
dissemination organization of FFT) undertakes
a formalized assessment process for determining Training/coaching and Materials
sites’ ability to implement the program. It can
be in the form of conference calls, reviewing The training of staff in the use of FFT is a systemic
applications for funding of FFT, and in-house process that is gradually phased in and usually
discussions with sites. occurs over a 1-year period, though different levels
of certification require additional time. To become
A 1-day stakeholder meeting is held at the site a trained FFT user, specific steps must be followed.
with site representatives and informal discussions Additionally, FFT has four levels of certification:
with therapists. There is flexibility in assisting sites
with adopting FFT.
FFT therapist:
Through the initial readiness assessment, FFT Inc.  Requires 1 year of training with supervision
works to gain buy-in. Depending on the community, and followup support.
consumers are sometimes involved in the decision
to adopt the program.
FFT clinical supervisor:
 Requires 1 year of training as a FFT therapist

Staff selection: (see above), an additional year of training with
Developers have mock interview questions to help supervision and followup support, plus the
agencies choose the therapists to implement the supervision courses necessary to receive
program. Many agencies modify the interview designation as a certified FFT clinical supervisor.
questions that are specific to the agency.  Such staff generally are clinically responsible
for all cases of FFT and for providing group
Staff must be open to being monitored by and individual supervision within agencies.
supervisors for quality implementation (fidelity) FFT Clinical Supervisors carry a minimum
to the FFT model. number of active cases.

FFT Trainers: Contact for training and implementation:
 Requires all training at the clinical supervisor
Holly DeMaranville
level plus a supervised course, ongoing
Functional Family Therapy, LLC
consultation in FFT training, and active
1611 McGilvra Boulevard East
participation in the FFT Inc. organization.
Seattle, WA 98112
Cell phone: (206) 369-5894
To be considered a certified site, the following
Fax: (206) 664-6230
components are necessary:
Email: hollyfft@comcast.net
 Two-day initial onsite clinical training; Web site: http://www.fftinc.com.
 Clinical FFT externship for one member
of the site;
 Two-day offsite team clinical training;
 Detailed information about cost
 Followup training and supervision visits
of implementation is available at
(three visits per year at 2 days each);
http://www.fftinc.com.
 Weekly phone consultation in Year 1, biweekly
 The cost associated with Phase 1, including
phone consultation for team lead in Year 2;
implementation and training of three to eight
 Supervision consultants with FFT supervisors therapists to become certified FFT users, an
for first 2 years of implementation; and externship, assessment, onsite clinical training,
 Use of all components of FFT Family ongoing telephone consultation, three followup
Assessment Protocol and Clinical Services site visits, and offsite team training in Indiana, is
System, and appropriate caseload and team size. $36,000, plus the cost of staff travel.
 The cost associated with Phase 2, including
FFT, LLC has a built-in infrastructure to handle site certification supervision training, phone
requests for training, support, and materials. consultations, and followup onsite training,
In relation to capacity for training, FFT, LLC is approximately $18,000.
employs and contracts 25 to 35 people, ranging
 Other ongoing FFT site certification training
from IT technical support to administrative and
activities costs average $7,000. This includes
clinical personnel.
onsite day visits, monthly hour-long phone
consultations, and access to Clinical Services
Training materials are available to families
System (a web-based fidelity monitoring system).
in English and Spanish.

Developer involvement Resources/links
The developers are still involved with the
Federal Web site providing interactive tools and
program, and do provide some initial and
other resources to help youth-serving organizations.
advanced clinical training.
http://www.findyouthinfo.gov
Functional Family Therapy, Inc.

http://www.fftinc.com
 Staff at FFT, LLC help programs develop
systems to collect and analyze data to make Office of Juvenile Justice and Deliquency
systemic improvements. Prevention Model Programs Guide.
http://www2.dsgonline.com/mpg
 A web-based monitoring system, the Clinical
Services System, is used to monitor and
report fidelity.
References
 Therapist notes are reviewed by expertly trained
supervisors and results of the Counseling Aos, S., Lieb, R., Mayfield, J., et al., (2004).
Process Questionnaire (completed by family Benefits and costs of prevention and early
members) are reviewed. intervention programs for youth. Olympia, WA:
Washington State Institute for Public Policy.
 Each site may use its outcome data to satisfy
grant requirements or other fund-related
requirements. FFT, LLC is mostly interested Alexander, J., & Parsons, B. (1973). Short-term
in increasing sites’ ability to use their data behavioral intervention with delinquent families:
to improve adherence to the program. Impact on family process and recidivism. Journal
of Abnormal Psychology, 81, 219–225.
Financing the intervention Alexander, J., Pugh, C., Parsons, B., & Sexton, T.
(2000). Blueprints for violence prevention:
FFT can be financed in various ways, depending Functional Family Therapy. Golden, CO:
on state policies and practices. For example, in the Venture Publishing.
state of Washington, current legislation and funding
is attached to programs such as FFT. In Pennsylvania, Friedman, A. (1989). Family therapy vs. groups:
grant dollars are used to pay for FFT to develop Effects on adolescent drug abusers. American
a statewide quality improvement process for the Journal of Family Therapy, 17(4), 335–347.
Commission on Crime and Delinquency.
Henggeler, S. W., & Sheidow, A. J. (2003). Conduct
Medicaid dollars may be used to pay for some of disorder and delinquency. Journal of Marital
the services, but again it may be state dependent. and Family Therapy, 29(4), 505–522.
FFT Medicaid codes are available in the states of
New Mexico and Pennsylvania. Additionally, some Kopp, D. (personal communication,
states may use a Medicaid waiver, rehabilitation, June 13, 2006).
or home-based and community-based service codes.
(2005). Conduct Problems. In E. J. Mash &
R. A. Barkley (Eds.). Treatment of childhood

Multidimensional Treatment Foster Care
Figure 18
Multidimensional Treatment Foster Care
Background Setting  Clinic
 Home
Multidimensional Treatment Foster Care (MTFC)
 School
was developed in the early 1980s by Patricia
Age  3–18
Chamberlain, Ph.D., and colleagues at the Oregon
Gender n Males
Social Learning Center to address serious and
n Females
violent juvenile offenders who would otherwise
Training/Materials Available n Yes
need to be placed in a group or residential program.
Outcomes  Decrease in arrest rates.
 Decrease in violent activity
Thirteen years later, Philip Fisher, Ph.D., and involvement.
colleagues developed the MTFC program for  Fewer runaways.
preschoolers (MTFC-P). This intervention is  Less chance of incarceration

after completing program.
similar to the earlier developed MFTC but is
 Fewer permanent replacement
tailored to meet the developmental needs of failures (MTFC-P).
preschoolers who display early aggressive and
acting-out behavior and can benefit from intensive
treatment in the home and community.
Treatment families are recruited and screened
MFTC has been disseminated in many states before youth are placed in their homes. Formal
and countries, such as Great Britain, Sweden, training, ongoing supervision, and weekly meetings
and the Netherlands. Within the last 2 years, with parents are held to help families address
more than 65 organizations have implemented problems and to note youth progress. A trained case
MTFC (P. Chamberlain, personal communication, manager connects daily with the treatment family
June 6, 2007). and is also available to the child’s biological family.
In both MTFC and MTFC-P, the goal is for the

Characteristics of the intervention youth to continue to sustain contact with his or her
biological family and for that family to get services
MTFC is delivered by trained treatment families to
while the child is in placement so that they are
provide intensive supervision and support to children
better prepared when the child returns home.
and adolescents at home, in the community, and at
Youth participate in skill-enhancing therapy.
school. MTFC and MTFC-P children considered
eligible for services are those who are at risk of
Treatment families maintain close contact with the
being placed or are currently placed outside the
schools about their child’s behavior and progress
home in the child welfare, mental health, or
in the school environment. If the youth is involved
juvenile justice systems. Therefore, many of the
with a probation system or other youth system, the
children referred to MTFC and MTFC-P come
case manager helps the youth and treatment family
from one of these agencies.
maintain contact.

found that youth in MFTC have fewer runaway
incidences and are arrested less often than youth
in group care. Research supports that MTFC
MTFC has been researched extensively since
youth have significantly fewer days in locked
1990. The research base includes randomized
settings (detention, training schools, hospitals, etc.)
control trials examining the effect of the
at followup. (http://www.mtfc.com). For preschool
intervention over control groups (retrieved from
children, those in MTFC-P had fewer placement
http://www.mtfc.com/program_effectiveness.html).
disruptions in followup. Further information about
Across studies, evidence supports the intervention.
MFTC studies is presented in Table 18.
Specifically, the research on adolescents has
Table 18: Multidimensional Treatment Foster Care: Research Base and Outcomes
Chamberlain (1990) Youth committed to state training schools (n = 32, ages 12–18), matched TFC participants spent fewer days incarcerated.
comparison design on age, sex, and date of commitment. Youth selected
for either Treatment Foster Care (TFC) group or another community based
treatment.
Followup period of 2 years.
Study population:
 Male 62.5%
 Female 37.5%
Chamberlain & Reid Randomized control trial design with youth from Oregon State Hospital, TFC placed out of hospital at higher rate; more TFC
(1991) (n = 20, ages 9–18) assigned to either TFC or typical community treatment. were placed in family homes.
Followup period of 7 months.
Study population:
 Male 60%
 Female 40%
Chamberlain, Randomized control trial design with foster care families (n = 70) ETS group had greater foster parent retention and
Moreland & Reid assigned to assessment only group (AO), increased payment only group (IP), fewer disruptions in placement than AO or IP group.
(1992) or enhanced training and support (ETS) with TFC methods.
Followup period of 7 months.
Study population:
 Male 60%
 Female 40%
 86% White
 4% Hispanic
 4% American Indian, Asian American, Mixed
Chamberlain & Reid Randomized control trial of male juvenile offenders (n = 79, 12–17 years, At follow up, MTFC group had half as many
(1997) mean offenses = 13), assigned to MTFC or group care for 1-year period. arrests, fewer days incarcerated, and higher rates
Study population: of program completion.
 100% male
 85% White
 6% Hispanic

Table 18: Multidimensional Treatment Foster Care: Research Base and Outcomes
Eddy, Bridges, & Randomized control trials, youth (n = 79), assigned to either MTFC group MTFC youth were significantly less likely to commit
Chamberlain (2004) or service as usual/ group care. violent offenses; 5% of MTFC youth had two or
Data collected every 6 months for 2 years. more criminal referrals for violent offenses at 2 years
compared to 24% of the control group.
Study population:
 100% male
 85% White
 6% Hispanic
Fisher, Burraston, Randomized control trial of children (n = 90, ages 3–6) assigned to foster Children in the MTFC-P program experienced fewer
& Pears (2005) care placement or MTFC-P placement. permanent placement failures.
Study population:
 Male 63%
 Female 37%
 85% White
 11% Hispanic
Leve, Chamberlain, Randomized control trial of girls with chronic delinquency (n = 81, MTFC youth had a greater reduction in the number
& Reid (2005) ages z13–17) assigned to either MTFC or group care (GC). of days spent in locked settings and in caregiver-
Study population: reported delinquency.
 Female 100% MTFC group has 42% fewer criminal referrals than
GC youth at 12-month followup.
 74% White
 9% Hispanic
 2% Other or Mixed Ethnicity
Chamberlain (1990) Youth committed to state training schools (n = 32, ages 12–18), matched TFC participants spent fewer days incarcerated.
comparison design on age, sex, and date of commitment. Youth selected
for either Treatment Foster Care (TFC) group or another community
based treatment.
Followup period of 2 years.
Study population:
 Male 62.5%
 Female 37.5%

Implementation and Dissemination Training/coaching and materials
TFC Consultants, Inc. disseminates MTFC

(http://www.mtfc.com).
 Four trainings are offered per year in Eugene,
Readiness: Oregon. Each site sends a team of key
professionals, including a supervisor, to attend
The formal readiness process involves a conversation, the training. The training for program supervisors
a self-evaluation form, and, if needed, a site visit. lasts approximately 5 days. The remaining
A discussion is held with the site to determine key professionals attend 4 days of training.
whether it is advantageous to bring this program The training uses didactic and role- playing
to their site. instruction methods. In addition, the attendees
also observe a foster parent meeting with
A readiness checklist is used as a resource. Before a supervisor.
sending the checklist, an initial conversation is held
and a packet of information is sent. After receipt  Upon completion of the staff training, the
and completion of the readiness checklist by the MTFC or MTFC-P program is ready for
site, the Oregon team reviews the checklist and implementation. Members of the Oregon
further discusses the process. team come to the site to conduct the first
foster parent meeting with site staff observing.
After this meeting, telephone calls with the site
Staffing: consultant and review of videotaped foster
Criteria are available for MTFC and MTFC-P parent and clinical meetings are conducted.
sites that outline the staff best suited to implement  Up to 6 days of onsite consultation are
the program. available to sites throughout the startup
and implementation.
Possible barriers:  Typically, sites will be fully operational after
Challenges for both MTFC and MTFC-P include a full year.
funding, the need for solid organizational structure  Sites can become MTFC or MTFC-P certified
with key champions helping to drive and sustain after successfully graduating seven youth. The
implementation efforts, and the need for practitioner criterion-based certification requirements are
commitment to the model. available on the MTFC Web site. A self-
evaluation tool is available, but the certification
review is conducted by a research group not
connected with the program’s disseminating
group, TFC Consultants. Initial certification
lasts 1 year; recertification can last up to 2 years.
TFC Consultants are available to offer support
to those sites that are not ready for certification.

For information on training and materials, contact: Financing the intervention
TFC Consultants, Inc.
Many sites apply for grant dollars and use funds
Gerard Bouwman, President
from child welfare, early childhood special
Telephone: (541) 343-2388 ext. 204
education funds, and county mental health funds
Cell phone: (541) 954-7431
to finance the MTFC or MTFC-P intervention.
Fax: 541-343-2764
Sites with an older youth population have used
gerardb@mtfc.com
juvenile justice funding.
Center for Research to Practice
The treatment foster care element of the
Rebecca Fetrow
intervention may be covered by Medicaid.
Program Evaluation
Telephone: (541) 343-3793
beckyf@cr2p.org
Resources/Links
http://www.mtfc.com
 There is no cost for the readiness process,

unless a site visit is required. References
 The cost to implement either MTFC
Chamberlain, P. (personal communication,
or MTFC-P is $40,000 to $50,000.
June 6, 2007).
Chamberlain, P. (1990). Comparative evaluation of

specialized foster care for seriously delinquent
 MTFC: The developer, Dr. Patricia Chamberlain, youths: A first step. Community Alternatives:
is still involved in disseminating the program. International Journal of Family Care, 2(2), 21–36.
 MTFC-P: The developer, Philip Fisher, PhD,
Chamberlain, P. (2002). Treatment foster care.
is currently involved in disseminating the
In Burns, B., & Hoagwood, K. (Eds.)
preschool program.
Community Treatment for Youth: Evidence-
based interventions for severe emotional and
behavioral disorders (pp. 117–138). Oxford
University Press: New York.
 Fidelity measures exist for both MTFC and
MTFC-P. TFC Consultants collect fidelity Chamberlain, P., & Mihalic, S. F. (1998).
data from sites. Multidimensional Treatment Foster Care:
Blueprints for Violence Prevention, Book Eight.
 The reporting of outcomes is required when
Blueprints for Violence Prevention Series (D.S.
implementing MTFC and MTFC-P to obtain
Elliott, Series Editor). Boulder, CO: Center for
certification.
the Study and Prevention of Violence, Institute
of Behavioral Science, University of Colorado.

Chamberlain, P., Moreland, S., & Reid, K. (1992).
Enhanced services and stipends for foster
parents: Effects on retention rates and outcomes
for children. Child Welfare, 71(5), 387–401.
Chamberlain, P., & Reid, J. B. (1991). Using a

specialized foster care community treatment
model for children and adolescents leaving
the state mental health hospital. Journal of
Community Psychology, 19, 266–276.
Chamberlain, P., & Reid, J. B.(1998). Comparison

of two community alternatives to incarceration
for chronic juvenile offenders. Journal of
Consulting & Clinical Psychology, 66(4),
624–634.
Eddy, J., Whaley, B., & Chamberlin. P. (2004). The

prevention of violent behavior by chronic and
serious male juvenile offenders: A 2-year follow
up of a randomized clinical trial. Journal of
Emotional and Behavioral Disorders, 12(1), 2–8.
Leve, L., & Chamberlain, P. (2005). Intervention

outcomes for girls referred from juvenile justice:
Effects on delinquency. Journal of Consulting
and Clinical Psychology, 73 (6), 1181–1185.
Fisher, P., Burraston, B., & Pears, K. (2005).

The early intervention foster care program:
Permanent placement outcomes from a
randomized trial. Child Maltreatment, 10(1),
61–71.
Smith, D.K. (2004). Risk, reinforcement, retention

in treatment, and reoffending for boys and girls
in Multidimensional Treatment Foster Care.
Journal of Emotional and Behavioral Disorders,
12(1), 38–48.
*Extensive reference list is available from

http://www.mtfc.com.

Evidence-Based
Acknowledgments
The development of the Guide was funded by the Child, Adolescent and Family
Branch of the SAMHSA Center for Mental Health Services. The Guide was
developed by a team composed of:
Barbara J. Burns, Ph.D. Mary Beth Nazzaro, M.A.

Duke University School of Medicine NASMHPD Research Institute, Inc.
Sylvia K. Fisher, Ph.D. Jeanne C. Rivard, Ph.D.

SAMHSA/CMHS NASMHPD Research Institute, Inc.
Vijay Ganju, Ph.D. Kristin Roberts, B.B.A.

Abt Associates NASMHPD Research Institute, Inc.
G. Michael Lane, Jr., M.A., M.P.H.

NASMHPD Research Institute, Inc.

Acknowledgments
The development team would like to extend our deepest appreciation to the scores of individuals who
contributed their valuable time in reviewing, editing, and providing feedback to enhance the usefulness of
this Guide to the field. In particular, we would like to thank:
n The Children’s Mental Health Implementation n The Evidence-based Practices Subcommittee of

Resource Kit Expert Consensus Panel who the Outcomes Roundtable for Children and
guided our initial planning efforts and provided Families who assisted us in reviewing the
critical feedback in the early stages of research base of interventions as they pertained
development. The panel was composed of: Uma to culturally and ethnically diverse groups and
Ahluwalia, Ph.D.; Karen Blase, Ph.D.; Rachele who urged us to develop a supplement to the
Espiritu, Ph.D.; Tina Donkervoet; Luz Garay; Guide with brief information for families about
Darcy Gruttadaro, J.D.; Mary Hargrave, Ph.D.; each of the intervention and prevention EBPs.
Mareasa Isaacs, Ph.D.; Teresa Kramer, Ph.D.;
n Darcy Gruttadaro, J.D. of the Children’s
Gary MacBeth, MSW, M.Ed.; Danna Mauch,
Division of the National Alliance on Mental
Ph.D.; Mary McBride, Ph.D.; Kenneth Rogers,
Illness (NAMI) and Sandra Spencer of the
M.D.; Ben Saunders, Ph.D.; Jackie Shipp;
Federation of Families on Children’s Mental
Luanne Southern, M.S.W.; Sandra Spencer;
Health (FFCMH) who provided us with
Mark Weist, Ph.D.
guidance and feedback in developing the brief
n Kenneth Rogers, M.D. who developed the supplement for families.
section on medication management.
n Twenty-three independent reviewers consisting
n Mary Tierney, M.D. who helped us to develop of family members, practitioners,
the financing section with information about administrators, and evaluators from agencies
Medicaid programs. across the nation.
n Karen Blase and Sandra Naoom of the National
Implementation Research Network (NIRN)
who contributed tremendously by interviewing
the intervention developers for details related to
implementing the evidence-based practices
covered in the Guide.

HHS Publication No. SMA-11-4634
Printed 2011
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Evidence-Based Interventions

U.S. Department of Health and Human Services

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Center for Mental Health Services

HHS Publication No. SMA-11-4634

This booklet provides indepth information about each

For references, see the booklet, The Evidence.

This booklet is part of the Interventions for Disruptive Behavior

How to Use the Evidence-Based Practices KITs

Characteristics and Needs of Children with Disruptive

Selecting Evidence-Based Practices for Children with

Evidence-Based and Promising Practices

In Selecting Evidence-Based Practices for Children with Disruptive Behavior

18 Evidence-Based Practices Summarized in This Booklet

Evidence-Based and Promising Practices 1

Each intervention concludes with information

2 Evidence-Based and Promising Practices

Background Setting  Clinic

Queensland in Australia.  Improvements in dysfunctional

Evidence-Based and Promising Practices 3

Level 2 usually consists of one or two 20-minute

4 Evidence-Based and Promising Practices

Evidence-Based and Promising Practices 5

*Study sample’s gender and race/ethnicity data provided where available.

6 Evidence-Based and Promising Practices

 The level of the Triple P intervention that is

Evidence-Based and Promising Practices 7

 Triple P America is the primary disseminator

8 Evidence-Based and Promising Practices

R. Prinz (personal communication,

Sanders, M. R., Markie-Dadds, C., & Turner, K.

Evidence-Based and Promising Practices 9

The intervention uses professional development,

Project ACHIEVE is a comprehensive school- Training/Materials Available  Yes

and achievement, positive behavioral support  Decrease in Special Education

Teachers and school administrators are responsible

Evidence-Based and Promising Practices 11

4. The Academic Instruction Linked to Academic Research Base and Outcomes

12 Evidence-Based and Promising Practices

Table 2: Project Achieve: Research Base and Outcomes

* Study sample’s gender and race/ethnicity data provided when available.

Evidence-Based and Promising Practices 13

14 Evidence-Based and Promising Practices

Evidence-Based and Promising Practices 15

16 Evidence-Based and Promising Practices

Evidence-Based and Promising Practices 17

Killian, J. M., Fish, M. C., & Maniago, E. B. (2006).

Knoff, H. (personal communication, June 22, 2006).

Knoff, H. M., & Batsche, G. M. (1995). Project ACHIEVE:

The Second Step program focuses on the following

 Impulse control and problem solving; and Age  4–14 years

Training/Materials Available  Yes

 Decreased verbal and physical

 Decreased behavioral problems.

Evidence-Based and Promising Practices 19