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’ programmes Big 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 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 Strong African American Families SPORT In Shape Steps to Respect Triple 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 targeted Number of programmes targeting the RPFs Number of RPFs Total72

RPFs targeted by 10+ programmes Risk factorsProtective 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 factorsProtective 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: PATHS Outcome areaOutcomes affected (developmental stage) Emotional well-beingSelf-regulation (6-11) BehaviourAbsence of enduring negative behaviour (6-11) EducationSchool readiness (6-11)

PATHS cont’d DomainRisk factors targetedProtective 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 Therapy Outcome area Outcomes affected (developmental stage) BehaviourHas 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 DomainRisk factors targetedProtective 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 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),