Blueprints for Europe: Evidence-based 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’ programmesBig Brother Big Sisters

Functional Family Therapy

Incredible Years

Life Skills Training

Multidimensional Treatment Foster Care

Multisystemic Therapy

Nurse Family Partnership

Olweus Bullying Prevention

PATHS

Project TND

Blueprints ‘Promising’ programmes

ATLASBASICSBMRPFast TrackGood Behaviour GameGuiding Good ChoicesI Can Problem SolveLIFTOrebro Prevention ProgramPerry Pre-School

Preventive Treatment ProgramProject NorthlandRaising Healthy ChildrenStrengthening Families 10-14Strong African American FamiliesSPORTIn ShapeSteps to RespectTriple P

Outcomes

• 5 stages: infancy (0-2), early childhood (3-5), middle childhood (6-11), 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 targetedNumber of programmes targeting the RPFs

Number of RPFs

0 20

1-4 26

5-9 14

10+ 12

Total 72

RPFs targeted by 10+ programmesRisk 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•Gang involvement

•Interaction with prosocial romantic 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

•Collective efficacy

5. Economic •Difficulty paying rent/mortgage/bills•Overcrowded living situation

•Primary caregiver / young adult employment•Primary caregiver highest level of education

Example: PATHSOutcome 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’dDomain Risk factors targeted Protective factors targeted

Individual/peer •Early initiation of anti-social behaviour•Favourable attitudes to anti-social 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 TherapyOutcome area

Outcomes affected (developmental stage)

Behaviour 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’dDomain Risk factors targeted Protective factors targeted

Individual/peer

•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 anti-social behaviour

•Attachment to and support from parents•Parent involvement in education

School •Opportunities for prosocial involvement in education•Rewards and disincentives in school•Commitment and attachment to 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