Bill Pfohl, NCSP
NASP President 2005-06
billnasp@aol.com
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Why Prevention?
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In NASP Training Standards
Blueprint II area – Prevention, Promotion of
Wellness & Crisis Intervention
No place all information tied together for trainers
or practitioners
Our job roles – consultation, parent training,
pre-referral intervention, school safety; suicide,
MH needs of our youth.
Position Paper – Prevention & Intervention
Research in the Schools
Grant activity by NASP office with EDC, AIR,
CASEL, SMHP
Futures Conference outcome focus
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We Do Not Have Enough Resources to Provide Helping Services to
All Children Who Need Them
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Epidemiological data suggest that 15% to 22% of the nation’s
young people experience social, emotional, and mental health
problems that require treatment.
Approximately 25-30% of American children experience school
adjustment problems.
For some economically disadvantaged urban districts, school
maladjustment runs as high as 60%.
Research documents clear associations between school
maladjustment and later serious problem behaviors.
Unfortunately, 70% to 80% of children in need are not getting
appropriate mental health services.
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CASEL at UIC
Youth Risk Behavior Survey (CDC, 2003)
Behaviors
U.S. %
Had 5 or more alcoholic drinks in a couple of hours (30 days)
28.3
Used marijuana (life)
40.2
In a physical fight on school property (12 months)
12.8
Carried a gun (30 days)
5.4
Did not go to school because felt unsafe at school or on way
to or from school (30 days)
6.6
Felt so sad or hopeless almost every day for two weeks or
more in a row that stopped doing some usual activities (12
months)
28.6
Made a plan to attempt suicide (12 months)
16.5
Currently sexually active (3 months)
34.3
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CASEL at UIC
But WHY? - Really
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NASP Shortages – estimated at
9,000 between 2000 and 2010!
Total: 15,000 by 2020!
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D. Erasmus
“Prevention is Better Than
Cure”
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Ben Franklin
“An Ounce Of Prevention is
Worth a Pound of Cure”
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History
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Mental Hygiene Movement – early 1900’s
Child Guidance Clinics – 1920’s and 1930’s
Crisis Theory (Eric Lindemann) – 1940’s
Joint Commission on Mental Health and
Mental Illness – 1961
Community Mental Health Centers Act 1963
Advocates (e.g., Albee, Cowen, Caplan,
Goldston)
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History (continued)
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Task Panel on Prevention, President’s
Commission on Mental Health - 1978
APA Task Force on Prevention – 1980’s
Committee on the Prevention of Mental
Disorders, Institute of Medicine - 1994
APA Presidential Task Force on Prevention
(Seligman) – 1998
Priorities for Prevention Research at NIMH
(NAMHC Workgroup report) - 2001
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2002 Futures Conference
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Prevention was envisioned as a primary
activity of school psychologists
Every outcome area from the Conference
stressed the centrality of prevention in the
practice of school psychologists – 12 out
of 15 priority goals involved prevention in
some way
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Do I Practice Prevention Already?
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Prevention Activities
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Screening
Safe schools
Pre-referral
Suicide
Social skills
Bully-proofing
Parent training
Consultation
Early literacy
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Social competency
Resiliency classrooms
Counseling
Drug education
Violence prevention
Health promotion
Character education
School reform
Mental health
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What is
prevention?
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Theory Base
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Mental Health
Community Psychology
Social Psychology
Consultation
Early Childhood education
Parent training
What Works research
Public health
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Caplan’s (1964) Terms
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Primary prevention: decrease the number
of new cases of disorders
Secondary prevention: early identification
and efficient treatment of existing cases
Tertiary prevention: rehabilitation to
reduce the severity of impairment caused
by an existing disorder
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NIMH Intervention Spectrum
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Continuum of Effective Behavior
Support
Students with
Chronic/Intense
Problem Behavior
(1 - 7%)
Tertiary Prevention
Secondary Prevention
Students At-Risk
for Problem
Behavior
(5-15%)
Students
without
Serious
Problem
Behaviors
(80 -90%)
Primary Prevention
Specialized Individual
Interventions
(Individual Student
System)
Specialized Group
Interventions
(At-Risk System)
Universal Interventions
(School-Wide System
Classroom System)
Adelman & Taylor
All Students in School
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The Goal: Full Integration of
Prevention Into School Culture
Addressing Barriers
Instruction
(Prevention)
Student
Management
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Prevention, risk,
and resilience
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What has worked?
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Primary Mental Health Project (Cowen) –
1950’s
Head Start – Economic Opportunity Act of
1964
Project RE-ED (Hobbs) - 1968
Healthy Start – Hawaii – 1970’s
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Legacy of Longitudinal Studies of
Developmental Risk
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Kauai Longitudinal Study
Newcastle Thousand Family Study
Boston Underclass Study
Oakland Growth Study
Rochester Longitudinal Study
Isle of Wight study
Minnesota Longitudinal Study of Parents
and Children
Doll & Lyon, 1998
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Risk = Children are More Likely To Be
Unsuccessful Adults
Risk
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Poverty
Low parent education
Marital/family dysfunction
Poor parenting
Child maltreatment
Poor health
Parental illness
Large family
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Adult outcomes
Mental illness
Physical illness
Educational disability
Delinquency/ criminality
Teen parenthood
Financial dependence
Unemployment
Low social competence
Low adult intelligence
Doll & Lyon, 1998
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Resilience = Vulnerable Children
Who Become Successful Adults
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Individual
Positive social
orientation
Friendships
Internal locus of control
Positive self-concept
Achievement orientation
Community engagement
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Family & community
Close bond with one
caretaker
Effective parenting
Nurturing from other
adults
Access to positive adult
models
Connections with prosocial organizations
Effective schools
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Dryfoos’ conclusions
1.
2.
3.
A significant proportion of children will fail to
grow into successful adults without major
changes is how they are taught and nurtured.
Families and schools require transformations to
more adequately raise and educate children.
New community resources and arrangements
are needed to support the development of
young people.
Dryfoos, 1994
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Prevention =
Increasing strengths
+
Reducing problems
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Strengths That Matter in Schools
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Sustain warm and caring relationships
with adults
Sustain high academic and personal
efficacy
Promote satisfying peer relationships
Promote student’s self-control
Promote goal setting and decision-making
Doll, Zucker, & Brehm, 2004; Resilient Classrooms
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Mental Health: “The possession of skills
necessary to cope with life's challenges”
NASP, 2002
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Mental Health:
A Report of the Surgeon General
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Identifying the factors that place children at risk
is the first line of prevention
 Cannot separate health from mental health
 20% of children and youth have a
diagnosable mental illness
Helping children receive services is the 2nd step
Barriers to help
 Stigma
 Lack of knowledge about treatment
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Summarized in COPS Promoting Mental Health in Schools
Reducing Problems
Prevalence of Disorders
National Comorbidity Survey Replication, Kessler et al., 2005
12-month Lifetime
Any disorder
26.2%
46.4%
Anxiety Disorders
18.1%
28.8%
Mood Disorders
9.5%
20.8%
Impulse Control Disorders
8.9%
24.8%
Substance Use Disorders
3.8%
14.6%
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When do disorders begin?
National Comorbidity Survey Replication, Kessler et al., 2005
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The age of onset for most disorders was
concentrated in the first two decades of
life
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Anxiety disorders – 11 years average age of
onset
Impulse Control disorders – 11 years average
age of onset
Substance Use disorders – 20 years average
age of onset
Mood disorders – 30 years average age of
onset
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The majority sought treatment eventually,
but usually waited between 6 and 23
years
We should direct a greater part of our
thinking about public health interventions
to the child and adolescent years
Outreach efforts need to increase access
to and the initiation of treatments
Interventions need to improve
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Societal Problems That Matter
(but may not always be in the DSM)
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Substance abuse
Violence
Delinquency and criminal behavior
Financial dependence and unemployability
School failure
Cost to society – pay me now or pay me
later
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What works?
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Greenberg et al., 2003
There is solid and growing empirical base
indicating that well-designed, well
implemented school-based prevention and
youth development programming can
positively influence a diverse array of social,
health, and academic outcomes. p. 470
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Evidence-based interventions are
treatments with rigorous empirical
evidence demonstrating that they have a
significant, positive impact on children’s
social and emotional well-being.
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What works in prevention?
Nation et al., 2003, American Psychologist
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Comprehensive: Programs need to
provide an array of interventions to
address the most salient precursors of the
problem. This includes both multiple
interventions, and interventions in multiple
settings (school, community, family)
Varied teaching methods: Programs need
to incorporate interactive discussion and
hands-on experience
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What works in prevention?
Nation et al., 2003, American Psychologist
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Sufficient dosage: Programs need to be of
sufficient length and intensity, with more
intensity when there is more risk
Theory driven: Programs need an empirical
rationale for the prevention program,
incorporating both etiological evidence of the
causes and intervention evidence of the best
methods.
Positive relationships: Programs need to provide
strong, positive relationships between children
and parents, children and peers, children and
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other adult caretakers.
What works in prevention?
Continued
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Appropriately timed: Programs need to occur at
the time in a child’s life when they will have
maximal impact. (e.g. drop out prevention
programs need to occur in 4th to 6th grades
when the trajectory into dropping out of school
begins.)
Socioculturally relevant: Programs need to be
relevant within the local community norms,
cultural beliefs, and practices
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What works in prevention?
Continued
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Outcome evaluation: Programs need to
include evaluations to determine program
effectiveness, even if they are anecdotally
believed to be effective
Well-trained staff: Programs need
providers that are carefully-selected,
highly trained and supervised
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Evidence-based School Prevention
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Schrumpf et al.'s (1997) Peer mediation
training program for elementary through
high school. Includes a program guide
and accompanying video. (Schrumpf, F.,
Crawford, D., & Usedal, H.C. (1997).
Peer Mediation: Conflict Resolution in
Schools, Revised Edition. Champaign, IL:
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Research Press)
McGinnis' and Goldstein's (1997)
Skillstreaming the Elementary School
Child, Revised.
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Murphy's and/or Sklare's Solution Focused
approaches to problem solving and conflict
resolution. Solution-Focused Counseling
in Middle and High School, 1997 by John
J. Murphy;
Brief Counseling That Works by Gerald B.
Sklare 2005.
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Evidence-based interventions for
behavioral self control
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Kendall and Braswell’s (1985) Stop & Think program
teaches individual children to stop and evaluate their
behavior before acting. Their research has shown this to
be an effective strategy for impulsive children.
Eddy et al.’s (2000) LIFT [Linking the Interests of
Families and Teachers] program teaches children specific
social behaviors, incorporates a ‘Good Behavior Game’ at
recess, and provides parents with instruction in good
discipline through 6 meetings at their child’s school. The
program has been identified as a Blueprints Promising
Program of the Center for the Study and Prevention of
Violence.
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Evidence-Based Interventions for
peer relationships
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Olweus’ (1999) Bullying Prevention Program alerts
teachers, students and parents to the varying and subtle
forms of bullying and prepares them to respond
promptly and decisively to discourage bullying. The
program was identified as a ‘Blueprints Model Program’
by the Center for the Study and Prevention of Violence.
Greenberg, Kusche & Mihalic’s (1998) PATHS program
teaches children emotional literacy, self control, social
competence and interpersonal problem solving skills. It
has been identified as a Blueprints Model Program of the
Center for the Study and Prevention of Violence.
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Evidence-Based Interventions
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Sheridan’s Conjoint Behavioral
Consultation showed effect sizes ranging
from 1.08 to 1.11 in solving academic and
behavioral problems (Sheridan, Eagle,
Cowen & Mickelson, 2001)
Huggin et al. (1993). ASSIST program
series, Teaching Friendship Skills for
primary and intermediate populations.
Longmont: Sopris West.
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Evidence-based Interventions
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Shure’s (1993) I Can Problem Solve - ICPS
Kendall & Bartel’s (1990) Teaching
problem solving to students with learning
and behavior problems – Cool Cats
Elias & Tobias’s (1996) Social Problem
Solving interventions
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Basic Principles – Crystal
Kruykendall (2005)
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Three Needs of all Children
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Affection = love is an action word
Appreciation = we want you in our schools
Achievement = will find a way to succeed
Be a “Merchant of Hope”
“We must give the best of ourselves to get
the best of our kids”
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Climate Counts
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Proximity
Courtesy
Praise and affirmation
Acceptance of feelings
Appreciation of differences
Build on strengths
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What is NASP
doing?
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NEAT
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National Emergency Assistance Team
School safety
Crisis intervention
Training
Curriculum
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Katrina and Rita
Hurricanes
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One of the most devastating disasters to
hit the United States in its history
School psychologists are instrumental in
making sure the trauma doesn’t become
life-impairing
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Making prevention easier to
find…
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NASP 2006 in Anaheim!
Coming soon: Prevention website
Communiqué inserts
The top 100 references
Continuing Professional Development
Advocating for prevention
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Position statements
Blueprint
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What you can do
Occasionally you have to go out on a limb,
because that is where the fruit is
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Sell, Sell, Sell
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It works
It is effective and efficient
Supported by research
Logical – face validity
Good use of personnel
Biggest impact!
Big picture thinking
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Four Major Phases of System Change
 Creating Readiness
 Initial Implementation (start-up & phase-in)
 Institutionalization (maintenance, sustainability)
 Ongoing Evolution & Creative Renewal
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Edward Young
“Who would not give a trifle
to prevent what he would
give a thousand worlds to
cure?”
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Bill Pfohl
“Prevent failure,
do not wait for it”
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Finding Out More
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Adelman, H. & Taylor, L. (2005) The School
Leader’s Guide to Student Learning Supports:
New Directions for Addressing Barriers to
Learning. Thousand Oaks, CA: Corwin Press.
Or find out more information from
http://smhp.psych.ucla.edu/
This is a concise guide to the resources and
information available from the Center for Mental
Health in the Schools at UCLA. The book
provides an extensive and carefully constructed
rationale for prevention services, strategies for
supporting student learning in schools, and a
guide to resources.
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Howard S. Adelman & Linda Taylor
(2006). The implementation
guide to student learning
supports in the classroom and
schoolwide: New directions for
addressing barriers to learning.
Thousand Oaks, CA.: Corwin Press.
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Brock, S., Lazarus, P., & Jimerson, S. (Eds.).
(2002). Best practices in school crisis
prevention and intervention. Bethesda,
MD: National Association of School
Psychologists.
A NASP publication that is more relevant than
ever in the aftermath of Hurricane Katrina.
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Mrazek, P. J., & Haggerty, R. J. (Eds). (1994).
Reducing risks for mental disorders: Frontiers for
preventive intervention research. Washington,
DC: National Academy Press.
An Institute of Medicine report that’s been heavily
cited. It proposed replacing Caplan’s scheme
(primary, secondary, and tertiary) with universal,
selective, and indicated . The World Health
Organization now uses this system.
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Society for Prevention Research. (2004).
Standards of evidence: Criteria for
efficacy, effectiveness and dissemination.
Falls Church, VA: Author.
This is a very concise and helpful document
for those who are involved in prevention.
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Weissberg, R. P., & Kumpfer, K. L. (Eds.).
(2003). Prevention that works for children
and youth [Special Issue]. American
Psychologist, 58(6/7).
This is a very comprehensive special issue
on prevention. Every article is helpful.
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Center for School Mental Health Assistance,
University of Maryland
http://csmha.umaryland.edu/
Center for the Study and Prevention of
Violence: lists evidence-based
interventions that have been identified
through systematic research reviews
http://www.colorado.edu/cspv
National Technical Assistance Center
on Positive Behavioral Interventions and
Supports (PBIS)
http://www.pbis.org/primaryprevention.htm
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Research and Training Center on Family
Support and Children's Mental Health at
Portland State University, Portland,
Oregon http://www.rtc.pdx.edu/
North Carolina Healthy Schools Project
focuses on improving the health of
students and staff by providing
coordination and resources in eight
component areas of school health.
http://www.nchealthyschools.org/
Center for Effective Collaboration and
Practice - Focuses on Prevention issues in
regular and special education; great
source
http://www.air.org/cecp/
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