There is a need to move from efficacy to effectiveness research. Researchers affiliated with the JHU CPEI have a long history of conducting research on the intersection between efficacy (e.g., randomization of teachers and students at the level of classroom, within school controls, rigorous training of teachers and mental health professionals, and intervention manuals) and effectiveness (e.g., the absence of participant exclusion criteria, the teachers and other interveners were employees of the schools, not randomly assigned) (e.g., lalongo et al., 2001; Bradshaw et al., in press). Recent research reviews of efficacy studies document the growing number of preventive interventions that either reduce the onset of common mental disorders or decrease the duration and disability of initial episodes of these disorders (Burns et al., 2002;Coie et al., 1993;Greenberg et al., 1999, 2001;Hawkins & Catalano, 2004;Kazdin, 2000;National Advisory Mental Health Council's Services Research and Clinical Epidemiology Workgroup, 2006;Olds et al., 1999;Rones &Hoagwood, 2000;SAMHSA, 2007;Weisz et al., 2005; Wilson &Lipsey, 2007). Federal initiatives, (e.g., Safe Schools/Healthy Students and the Safe and Drug Free School Program) require applicants to use empirically validated interventions. Despite the large number of efficacy studies that demonstrate effective prevention or problem reduction when treated early, few studies examine (1) whether efficacious programs exhibit equally positive outcomes when implemented in natural service/treatment settings;(2) how dosage and quality of implementation affect outcomes;(3) how different program models and training strategies affect outcomes;and (4) the conditions necessary for successful program outcomes in natural settings with local ownership of the intervention process (Mrazek &Haggerty, 1994). The next challenge facing prevention and intervention scientists is to help practitioners put effectively """"""""proven programs"""""""" into practice and achieve the same outcomes as observed in research studies. There is a continuing need for research on the combination of evidence-based and promising universal interventions. In addition to the aim of moving from efficacy to effectiveness, we will continue to address the need for integrated prevention models that seamlessly combine different types of universal interventions at the elementary school level (K-5). Currently, there is little integration between models and thus schools are not able to systematically integrate different universal program strategies (e.g., school-wide discipline, individual teacher support for classroom management, social-emotional learning programs). Neither developers nor services researchers have made substantial effort to integrate programs and develop combined packages that schools can implement. We began this work in our current ACISR with an innovative model that integrates the Good Behavior Game (GBG;Barrish et al., 1969) and Promoting Alternative Thinking Strategies (PATHS;Greenberg &Kusche, 2004) (referred to as GBG+ PATHS). Strong pilot findings under ACISR funding has led us to recently receive funding from the Institute of Education Sciences (IES) for a 27-school, randomized controlled evaluation of GBG+PATHS versus GBG alone and standard setting (control).The proposed school-based intervention work we now propose includes pilot testing of the combination of complimentary, evidenced-based, universal interventions. As described in PRC Initiative 1, we are proposing to combine Positive Behavior Intervention Supports (PBIS;Sugai &Horner, 2006) and Classroom Checkup (CCU;Reinke et al., 2007) with the GBG+PATHS combination. We expect that the combination of PBIS and CCU should further improve teacher implementation of GBG+PATHS and in turn increase their impact on early aggressive and, later antisocial behavior, substance abuse, and depression. There is a need for universal, selective, and indicated preventive interventions at multiple developmental periods. While continuing to focus on the elementary school years, K to grade 5, we are proposing to extend our intervention efforts to the middle school years. This new focus on middle school years, as reflected in PRC Initiatives 2-4, focuses on the further development of anti-social behavior that is shown by both """"""""early"""""""" and """"""""late starter"""""""" models as described by Patterson et al. (1992) and others (Moffitt, 1993). According to Patterson and colleagues, there are at least two major pathways or trajectories to serious antisocial behavior, substance abuse, and academic failure (also see Moffitt, 1993). The """"""""early starter"""""""" trajectory begins in the toddler years, when parental success in teaching their child to interact within a normal range of compliance and aversive behavior is a prerequisite for the child's healthy social development. The second pathway - the """"""""late starters"""""""" - characterizes the relatively high prevalence of late onset antisocial behavior and academic failure in the middle school years. Given the high rate of adolescent aggression, delinquency and school failure in high-risk urban environments, developing both universal and indicated interventions in the middle school years are essential to the reduction in disruptive aggression, delinquency, and school failure/drop-out. In the middle-school period programs are needed that both support teachers and schools to create safe and orderly school and classroom environments, further teach essential social and emotional skills (i.e. skills in emotion regulation, social problem solving and conflict resolution skills), and develop effective school-based indicated interventions that can be used by school-based professional staff. Without these multi-level models of intervention, it is likely that at-risk middle school students will drift into a deviant peer group, where antisocial behavior, substance abuse, poor academic achievement, and rejection of mainstream social values, mores and institutions are reinforced. Moreover, these youth will lack the necessary social survival skills to succeed as in the school, peer group, and family social fields and are at increased for depression (Patterson et al., 1982). Consequently, a sole focus on early intervention efforts may fail to address the needs of youth. Consistent with our second overarching aim, PRC Initiative 2 involves the pilot and feasibility testing of an extension of our K-5 integration of GBG+PATHS for grades 6-8. In PRC Initiative 3, we will develop and test the impact of another universal prevention program for middle school youth which aims to prevent depression using a classroom-based preventive intervention. As described above, the Patterson model suggests that depression may be a consequence of antisocial behavior, particularly in the middle school years. Thus, we are proposing to test alternative delivery models of the Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) curriculum with BCPSS sixth graders. Finally, at the indicated level, PRC Initiative 4 seeks to develop and pilot test a developmental extension of Coping Power (Lochman &Wells, 1007) for grades 6-8. Coping Power was originally developed for aggressive/disruptive 4 and 5th graders and our current ACISR has been testing the feasibility of Coping Power in BCPSS to ensure it addressed contextual and cultural factors relevant to urban youth. In the current application, we propose to make developmental adaptations to the Coping Power Program and make other augmentations to increase generalizability and parental engagement during the middle school years.
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