Blueprints for Europe: Evidencebased programmes and how they
affect outcomes and risk and
protective factors
Nick Axford, Delbert S. Elliott and
Michael Little
Standards of evidence
• Intervention specificity
- is the programme focused, practical and logical?
• Evaluation quality
- does the evaluation produce valid and reliable findings?
• Intervention impact
- how much positive change in outcomes can be attributed to the
programme?
• Dissemination readiness
- is the programme ready for implementation in communities and
public service systems?
Blueprints ‘Model’ programmes
Big Brother Big Sisters
Nurse Family Partnership
Functional Family Therapy
Olweus Bullying Prevention
Incredible Years
PATHS
Life Skills Training
Project TND
Multidimensional Treatment
Foster Care
Multisystemic Therapy
Blueprints ‘Promising’ programmes
ATLAS
BASICS
BMRP
Fast Track
Good Behaviour Game
Guiding Good Choices
I Can Problem Solve
LIFT
Orebro Prevention Program
Perry Pre-School
Preventive Treatment Program
Project Northland
Raising Healthy Children
Strengthening Families 10-14
Strong African American
Families
SPORT
In Shape
Steps to Respect
Triple P
Outcomes
• 5 stages: infancy (0-2), early childhood (3-5), middle childhood (611), adolescence (12-17), early adulthood (18-24)
• 5 areas (and KDOs)
- Positive relationships (e.g. safe from abuse and neglect)
- Emotional well-being (e.g. free from depression/anxiety)
- Positive behaviour (e.g. does not use illicit substances)
- Educational skills/attainment (e.g. school readiness)
- Physical health (e.g. healthy gestation and birth)
Outcomes with 5+ programmes
• Positive relationships
- Positive relationships with positive peers (6-11)
- Positive relationships with positive parents (12-17)
• Positive behaviour
- Absence of enduring negative behaviour (6-11, 12-17)
- Does not participate in crime or violence (6-11, 12-17)
- Has not tried illicit substances (6-11)
- Does not use illicit substances (12-17)
- Does not use illicit substances or cigarettes or drink excessive
alcohol (18-24)
• Educational skills and attainment
- At least adequate academic performance (6-11, 12-17)
Outcomes with 0 programmes
• Positive relationships
- Positive relationships with positive parents (0-2, 18-24)
- Positive relationships with positive peers (0-2, 3-5)
- Positive relationships with prosocial adults (6-11, 12-17)
• Emotional well-being
- Free from depression/anxiety (3-5)
- Free from suicidal ideation/behaviours (6-11)
- Self-regulation (12-17, 18-24)
• Positive behaviour
- Absence of risky sexual behaviour (6-11)
• Educational skills and attainment
- At least adequate academic performance (18-24)
• Physical health
- Freedom from obesity (3-5, 6-11, 12-17)
- Freedom from chronic health/developmental impairments (6-11, 18-24)
Outcomes with 1-4 programmes
•
Positive relationships
- Positive relationships with positive parents (3-5, 6-11)
- Positive relationships with positive peers (12-17)
- Safe from abuse and neglect (3-5, 6-11, 12-17, 18-24)
•
Emotional well-being
- Self-regulation (3-5, 6-11)
- Free from depression and anxiety (6-11, 12-17, 18-24)
- Free from suicidal ideation and behaviours (6-11, 12-17, 18-24)
•
Positive behaviour
- Absence of enduring negative behaviour (3-5)
- Does not participate in crime or violence (18-24)
- Absence of risky sexual behaviour (12-17, 18-24)
- Absence of teen/unintended pregnancy (12-17, 18-24)
•
Educational skills and attainment
- Ready for school (3-5)
- Graduation from High School (18-24)
- Entry into stable post-secondary education, training, employment (18-24)
•
Physical health
- A healthy gestation and birth (0-2)
- Freedom from chronic health impairments or developmental impairments (3-5, 12-17)
Summary (1)
• Outcomes generally well covered:
- behaviour, crime, violence
- drug/substance misuse
• Outcomes needing particular attention:
- abuse/neglect
- anxiety/depression
- physical health (including obesity)
- risky sexual behaviour and teen/unintended pregnancy
• Developmental stages needing attention:
- Infancy (1 programme), early childhood (6), early adulthood (9)
- Compares with middle childhood (15) and adolescence (24)
Risk and protective factors
• 5 stages: infancy (0-2), early childhood (3-5), middle childhood (6-11),
adolescence (12-17), early adulthood (18-24)
• 5 areas (and RPFs):
- Individual and peer (e.g. hyperactivity / problem-solving)
- Family (e.g. family conflict / parent support)
- School and work (e.g. repeated a grade / commitment to
school)
- Community (e.g. community disorganisation / collective efficacy)
- Economic (e.g. family poverty / adolescent employment)
Programmes x RPFs targeted
Number of programmes
targeting the RPFs
0
Number of RPFs
1-4
26
5-9
14
10+
12
Total
72
20
RPFs targeted by 10+ programmes
Risk factors
Protective factors
1. Individual
•Interaction with anti-social
peers
•Early initiation of anti-social
behaviour
•Early initiation of drug use
•Interaction with prosocial peers
•Problem-solving skills
•Refusal skills
•Skills for social interaction
2. Family
•Family conflict
•Poor family management
•Opportunities and rewards for
prosocial involvement with parents
•Attachment to & support from
parents
•Parent involvement in education
3. School
-
-
4. Community -
-
5. Economic
-
-
Sample RPFs targeted by 0-1 programmes
Risk factors
Protective factors
1. Individual
•Romantic partner substance use •Interaction with prosocial romantic
•Gang involvement
partner
2. Family
•Age of mother at first live birth
•Romantic partner violence
•Attachment to and support from
romantic partner
•Pregnancy progress assessment
3. School
•Repeated a grade
•Special/educational needs
•Opportunities for prosocial
involvement at work
4. Community •Community disorganisation
•Low neighbourhood
attachment
5. Economic
•Difficulty paying
rent/mortgage/bills
•Overcrowded living situation
•Collective efficacy
•Primary caregiver / young adult
employment
•Primary caregiver highest level of
Example: PATHS
Outcome area
Outcomes affected (developmental stage)
Emotional well-being Self-regulation (6-11)
Behaviour
Absence of enduring negative behaviour
(6-11)
Education
School readiness (6-11)
PATHS cont’d
Domain
Risk factors targeted
Protective factors targeted
Individual/peer
•Early initiation of anti-social
behaviour
•Favourable attitudes to antisocial behaviour
•Interaction with anti-social
peers
•Problem-solving skills
•Skills for social interaction
•Opportunities and rewards for
prosocial peer involvement
•Clear morals and standards of
behaviour
•Interaction with prosocial peers
Family
•Parent attitude favourable to
anti-social behaviour
School
•Opportunities for prosocial
involvement in education
•Commitment and attachment to
school
Example: Multisystemic Therapy
Outcome
area
Behaviour
Outcomes affected (developmental stage)
Has not tried illicit substances (12-17)
Absence of enduring negative behaviour (12-17)
Does not participate in crime/violence (12-17)
Multisystemic Therapy cont’d
Domain
Risk factors targeted
Protective factors targeted
Individual/p
eer
•Rebelliousness
•Early initiation of anti-social
behaviour
•Early initiation of drug use
•Interaction with anti-social peers
•Peer substance use
•Problem-solving skills
•Opportunities and rewards for prosocial
peer involvement
•Interaction with prosocial peers
•Clear morals and standards of behaviour
Family
•Aggressive/violent parenting
•Neglectful parenting
•Family conflict
•Poor family management
•Parent attitude favourable to antisocial behaviour
•Attachment to and support from parents
•Parent involvement in education
•Opportunities for prosocial involvement in
education
•Rewards and disincentives in school
•Commitment and attachment to school
School
Community
•Low neighbourhood attachment
•Opportunities and rewards for prosocial
involvement in the community
Summary (2)
• High variability in extent to which the 72 RPFs are targeted
• Over a quarter (20) not targeted by any programme, only
12 targeted by 10 programmes
• Focus is mainly on proximal RPFs (especially individual,
peer and family)
• Striking lack of focus on distal RPFs (community and
economic factors)
• Programmes are mostly targeting RPFs in middle childhood
and adolescence (little in infancy, early childhood or early
adulthood)
• Most programmes target multiple risk and protective
factors, often across domains
Mediation analysis
• Mediation analysis conducted in:
- 6 out of 10 ‘Model’ programmes
- 7 out of 20 ‘Promising’ programmes
• Evidence to support theoretical model in all
but 2 of 13 where mediation analysis done
Implications
• For programme developers:
- Useful basis for design
- Important gaps in outcomes affected
- Attention to other RPFs?
• For evaluators:
- More research on impact on RPFs
- More mediation analyses
• In Europe:
- Develop programmes that meet Blueprints standards
- Test adapted versions of US programmes
Axford, N., Elliott, D. S. and Little, M. (2012) ‘Blueprints for
Europe: promoting evidence-based programmes in children’s
services’ [Blueprints para Europa: Promoviendo Programas
Basados en la Evidencia en los Servicios de Atención a la
Infancia], Psychosocial Intervention 21 (2), 205-214.
www.psychosocial-intervention.org/
www.colorado.edu/cspv/blueprints/
www.dartington.org.uk