Running head: PREVENTION PROGRAMS IN SCHOOLS 1

Prevention Programs in Elementary Schools:

A Rationale for Implementation

Sasha Gordon

University of Utah

Comprehensive Qualifying Examination

Jamie Bennett

December 1, 2017
PREVENTION PROGRAMS IN SCHOOLS 2

Introduction

According to the World Health Organization (2017), approximately 20% of children

around the world experience serious mental disorders. This means that one in every five youth

meet or will meet criteria for a serious mental health disorder. Some of the most commonly

diagnosed disorders are ADHD, mood disorders, major depression, anxiety disorders, conduct

disorders, and eating disorders (Merikangas et al., 2011). Evidence shows that when these are

left untreated, they often lead to increased risk of other problems such as substance abuse,

violence, low academic achievement, and suicide (Skryabina, Taylor, & Stallard, 2017).

In light of these statistics, improving the mental health of children is recognized as a

global priority, and there has been an emphasis on developing prevention programs to address

these issues (Skryabina, et al., 2016, p. 1297). Wahl et al. (2014) suggest that prevention is one

of the most effective strategies to deal with the burdens associated with psychological diseases.

Additionally, Goldstein, Brooks, and DeVries (2013) state that no child is immune to the

fast-paced environment in which they are growing up, and even children fortunate to not face

significant adversity or trauma, or to be burdened by intense stress or anxiety, experience the

pressures around them and the expectations placed upon them (p. 74). Thus, prevention

programs can be beneficial for all children by supporting the development of strengths and

resilience to deal with change and to cope with challenges.

With todays educational policies and expectations, especially the emphasis on test scores

and academic achievement, it can be easy to overlook the importance of focusing on a childs

social and emotional development at school. However, educators are increasingly acknowledging

that healthy development and the ability to excel in life requires more than just academic

competence (Rose, Miller, & Martinez, 2009). Many researchers are encouraging schools to
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regularly offer mental health promotion and prevention programs to help children and youth

develop skills and resources to help them achieve positive outcomes.

The purpose of this paper is to provide a rationale for implementing universal prevention

programs in school curriculum. Information will be provided to show why schools can be an

opportune setting to focus on the prevention of mental health disorders and the development of

resilience to cope with other challenges and difficulties. Additionally, this paper will provide

knowledge to suggest appropriate formats and age groups with which to focus these prevention

efforts, as well as what key outcomes can be anticipated. Finally, some of the barriers and

restrictions to these programs will be outlined, with a focus on what can be done to address these

difficulties.

Rationale for Prevention Programs in Schools

Prevention programs can take many different forms. Some programs focus on specific

issues, while others address more overarching developmental needs. For example, specific

programs may address issues such as mental health, physical illness, violence, academic

competence, risky behaviors, and poverty (Weissberg, Kumpfer, & Seligman, 2003). Other

programs attempt to support the development of resilience to help children face whatever

challenges they may experience. Whatever the focus of the program may be, the primary goal of

prevention is to reduce the incidence, duration, or intensity of undesirable outcomes while also

supporting the acquisition of skills that will increase the likelihood of positive development and

outcomes (Smokowski, 1998, p. 341).

There are three main levels of prevention programs that can be implemented in various

settings: universal, selective, and indicated. Universal programs are those that are implemented

with an entire population, regardless of the risk status of individuals within the population. They
PREVENTION PROGRAMS IN SCHOOLS 4

are focused on building strengths and competencies, with a hope that doing so will reduce the

likelihood or severity of future problems (Higgins & OSullivan, 2015). Selective programs

focus on high-risk populations, and indicated prevention programs target individuals that are not

only considered high-risk, but have also begun to show some signs of disorder (Weissberg et al.,

2003). Taub and Pearrow (2013) also differentiated between primary and secondary prevention

programs, with primary programs being delivered to all students, with or without problem

behaviors or mental health disorders. Secondary programs are those designed to target

individuals that have begun to show signs of problem behaviors.

Many arguments can be made to suggest that selective and indicated programs can be

beneficial and efficient since they are more focused and directed towards specific populations.

However, universal programs implemented in school and community settings have also been

shown to provide significant benefits. This paper will focus on three specific arguments that can

be made in favor of integrating universal prevention programs into primary education

curriculum: (1) schools can reach a larger majority of children and their families than other

programs; (2) child development is largely fostered within the school setting, so prevention

programs in schools provide the opportunity to support positive development; and (3) early

prevention programs are more cost effective than the interventions required when significant

problems have developed.

Universal Programs Reach More Children

One of the biggest arguments that can be made for implementing universal prevention

programs is that schools are the largest system capable of impacting children and their families.

Through primary preventative programs in schools, more students can be reached than can be

done by school counselors or community programs, making schools the most efficient and
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systematic means available to promote the psychological, social, and physical health of school

age children (Taub & Pearrow, 2013, p. 374).

Although school counselors are charged with intervention and prevention programming,

they often deal with high caseloads and struggle to meet the demands for counseling services

(Rose et al., 2009). Mallin, Walker, and Levin (2013) explain that less than 20% of children in

need of mental health services actually receive them. However, schools are in a unique position

to enhance mental health promotion and prevention because of the ability to observe and directly

intervene in a setting where children spend a majority of their time (Taub & Pearrow, 2013). One

way to meet the needs of these students is to implement evidence-based practices in universal

classrooms, where the teacher can facilitate the program for the class as a whole (Rose et al.,

2009). By implementing such proactive universal programs targeted at whole classes or schools,

the children who may not otherwise receive services have the opportunity to do so. These types

of large-scale programs can also serve to reduce some of the stigmatization of mental health

problems, and provide more social support for individuals from their teachers and peers (Rose et

al., 2009).

Universal Programs Can Support Positive Development

Another benefit directly related to the large reach that schools have is that because

children spend such a large portion of their time in school, research has found that the school

environment plays an important role in promoting positive development (Mallin et al., 2013).

Smokowski (1998) wrote, schools are an opportune setting for programs because they have

consistent contact with children during developmentally critical times and can initiate social,

behavioral, and physical interventions (p. 354). Additionally, because of this sustained contact

with students, schools offer many protective factors that can support positive development and
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resilience such as positive role models, social support, and the teaching of positive values

(Smokowski, 1998). Although the modeling of skills can be taught in everyday interactions in

schools, the implementation of prevention programs provides opportunities for more directed and

rigorous teaching of proficiencies that promote physical and mental health (Mallin et al., 2013).

For example, such programs can teach important life skills such as problem solving,

communication, decision-making, assertiveness, and social skills that not only foster positive

development and increased academic competence, but also serve as protective mechanisms

against mental health disorders or negative behaviors.

Universal Programs Are More Cost Effective

Finally, a third argument to support the implementation of universal prevention programs

is that early intervention is more cost-effective, since the resources spent on an adolescent are

enormous compared to the cost of interventions spent early in a childs life (Taub & Pearrow,

2013, p. 373). In some ways it might seem counterintuitive to suggest that it is less expensive to

provide early prevention efforts to all children, even those who are not considered at-risk, or

showing signs of mental health disorders. However, there are many reasons why prevention

programs can be more financially effective and time-efficient than selective and indicated

preventative efforts, and even more so than treatment later on. One of these reasons is that the

average delay between onset of mental health disorders and symptoms and treatment is between

8-10 years (National Institute of Mental Illness, n.d.). This suggests that while approximately

20% of children have been diagnosed with various mental illnesses, they are likely not the only

ones suffering from these problems. When schools focus on programs designed for only those

students at-risk or already diagnosed with mental illnesses, they may be missing out on many

others who have not yet been identified, and who may end up needing help later.
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As was mentioned above, many children in need of mental health services do not receive

them. Some of the effects of this lack of intervention that can be seen in schools are attention

difficulties, highly problematic behavior, confrontational relationships, aggravated physical

complaints, and lower academic achievement (Mallin et al., 2013). Additionally, the National

Institute of Mental Illness (n.d.) reports that approximately 50% of children with mental health

disorders eventually drop out of school, and 70% of youth in juvenile justice systems have some

form of mental illness. Each of these things can incur further costs for schools and society in

general.

Another reason these programs are more cost-effective is that no child is free from

challenges in their lives, so programs that support the development of social and emotional skills

and protective factors can help children prepare for whatever challenges they will face in their

lives. With the training and support of such programs, children will be better equipped to

effectively handle difficult situations on their own, without needing other services. Taub &

Pearrow (2013) suggest that there are many choices of programs that schools can choose to

implement that can be time-efficient and cost-effective in the long run, especially if they result

in a reduction of teacher and staff time for responding to students behavior and more time for

classroom instruction, and if they lead to increased student time spent in the classroom instead of

in the principals office, detention, or in suspension (p. 381).

Anticipated Outcomes of Prevention Programs

Many studies have been conducted to test various prevention programs and identify

outcomes. When school-wide prevention programs involve teachers, family, community, and

peers, they have been found to produce positive results even for the children that are considered

to be the most at-risk, or vulnerable. According to a meta-analysis of over 180 studies, universal
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preventative efforts focused on social and emotional development have led to a significant

increase in prosocial behaviors such as self-control, decision-making, respect for self and others,

and higher self-esteem. The analysis also found that such programs led to a decrease in negative

behaviors such as aggression, violence, and emotional distress. (Taub & Pearrow, 2013, p. 374).

Similarly, Goldstein et al. (2013) suggested that preventative efforts with a focus on developing

strengths have the potential to help children deal more effectively with stress and pressure, to

cope with everyday challenges, to bounce back from disappointments, adversity, and trauma, to

develop clear and realistic goals, to solve problems, to relate comfortably with others, and to

treat oneself and others with respect (p. 74). Additionally, these strengths have been found to

contribute to greater academic competence.

Appropriate Age and Formats

Most research suggests that early prevention programs are most beneficial with young

children. For example, a meta-analysis of programs indicated that those geared toward younger

children usually showed the greatest effect sizes. Specifically, they found that children in

preschool through the early elementary grades are likely to benefit most from interventions that

increase students awareness and expression of feelings, as well as interventions that enhance

cognitive based social problem-solving skills (Taub & Pearrow, 2013, p. 382).

Masten (2014) also reported that transitional periods of development appear to be periods

of high potential success with prevention programs. Specifically, she identified preschool, early

adolescence, and the transition to adulthood. According to this, programs aimed towards students

in the beginning of their school years as well as those years before and during the transition to

adolescence have the potential to produce successful results. Additionally, the National Institute

of Mental Health (n.d.) explained that 50% of all lifetime cases of mental illnesses begin by age
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14. The transition to adolescence typically takes place around the age of 12-13. This means that

the latter elementary school years and early middle school grades can be effective times to

implement universal prevention programs to support the social and emotional development of all

students.

More broadly, Weissberg et al. (2003) suggest that prevention programs are most

effective when they are continuous and comprise a series of socioculturally appropriate and

coordinated programs for each particular stage of development: prenatal, infancy, toddlerhood,

preschool years, elementary school years, middle childhood, and adolescence (p. 429). This is

based on the understanding that development is a continuous process and experiences build upon

each other as children are growing.

Essentially, the general agreement is that prevention programs can be beneficial at

various ages, as long as they are developmentally appropriate. Programs are most ideal when

they begin targeting these developmental levels early in life, and are extensive, multiyear, and

ecological (Smokowski, 1998, p. 356).

In addition to the most effective ages for implementation, there are certain characteristics

that make some programs more beneficial than others. For example, the most successful

programs tend to be driven by theory and based on empirical research. Additionally, they focus

on teaching both generic and problem-specific skills, meaning that the most effective programs

are likely the ones that focus on resilience or overall social and emotional learning, rather than

targeting only specific negative behaviors (Smokowski, 1998).

Another important factor when considering the formatting of preventative efforts is that

programs seem to be most beneficial when they incorporate the individual, others, and the

environment. Durlak et al. (2011) explained that the schools that choose to partner with
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community programs also experience further benefits with their prevention programs. Among

other things, these programs help students learn to be successful not only in school, but also in

their community.

Barriers to Implementation

Although researchers have found many benefits that support the development and

implementation of universal prevention programs in schools, there are still several barriers that

make it difficult to actually utilize such programs. Some of these restrictions are things such as

public policy and funding, the difficulty in choosing programs and who will implement them,

and a lack of time, resources, and training for effective implementation.

Public Policy and Funding

One of the largest barriers relates to public policy and a lack of necessary funding.

Despite the increasingly high rates of mental health, substance abuse, violence, and delinquency

problems among children and adolescents, public policy for prevention programs has not always

been a high priority (Weissberg et al., 2003). Much of the public policies in place have been

created in a reactive manner rather than proactively, meaning that legislation most often comes

only after concern for a problem has reached high levels. Because of this, schools and districts

often struggle to find the funding needed to implement universal preventative programs.

Along those same lines, there seems to be a lack of consistency with policy and

implementation. As Mallin et al. (2013) stated, Policy is nothing without effective

implementation (p. 104). Adelman and Taylor (n.d.) suggest that many of the prevention

programs in schools are focused on reducing specific negative behaviors. Because of this,

advocates of various programs often end up competing for the same resources, resulting in

programs that are so fragmented that they often produce inappropriate redundancy,
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counterproductive competition, and work against the type of systemic collaboration that is

essential for establishing inter-program connections (p. 2). This causes the programs to be more

costly and less effective, and tends to lead to prevention programs being overshadowed by

efforts to increase academic achievement.

Determining Which Programs to Use

Another difficulty that arises when considering primary preventative programs is

determining which programs to use. Rose et al. (2009) wrote, Selecting an appropriate

intervention and program can be a difficult task. To successfully implement an intervention

program, schools must decide on which goals to set for social development improvement, which

programs work, possible resistance by teachers and parents, funding issues, parental consent, and

other barriers (p. 405). Many programs have been developed, but not all of them have

undergone sufficient research, making it difficult to determine which programs will be most

effective and will receive the most support by all stakeholders.

Additionally, it can be difficult to decide who will facilitate the programs. The funds are

often not available to hire external psychologists to come in and run the program, which means

the responsibility usually falls on school psychologists or classroom teachers. There are benefits

and drawbacks to each of these. For example, school counselors are more knowledgeable about

psychological problems and what can be done in intervention and prevention efforts.

Additionally, they have the ability to come in and form a new, unbiased relationship with

students that could benefit the work they are doing. In contrast, teachers know the students and

have usually already developed a long-term relationship with the group, and can build on that

throughout the program. They also have background knowledge in pedagogy and child

development that can support them while facilitating mental health prevention programs. Finally,
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teachers have the ability to draw connections and repeat the contents of the program at other

appropriate times during the school day (Wahl et al., 2014).

In terms of widespread universal prevention programs, teachers might be preferable

because the programs can be implemented more easily in the normal school curriculum and for

many schools the other options are too expensive (Wahl et al., 2014, p. 5296). However, results

from some studies have shown smaller effect sizes when teachers deliver such programs as

compared to trained counselors and psychologists. Wahl et al. (2014) suggest that some possible

reasons for these effect sizes are due to teachers many other classroom responsibilities and less

training in mental health promotion and prevention.

Lack of Time & Resources

A third problem often cited as a barrier to universal preventative programs in schools is a

lack of time and resources. There seems to be an unfortunate dichotomy within many educational

sectors that causes some educators to think that nurturing social and emotional development is

mutually exclusive from encouraging academic achievement. With so much emphasis placed on

high-stakes testing and accountability, a common thought is that there is barely enough time to

cover all of the curriculum, and school-wide mental health promotion and prevention programs

might take away from that limited time. However, it is important for educators to understand that

focusing on positive development is not simply an extra curriculum that takes time away from

academic work. Goldstein et al. (2013) wrote, Strengthening a students feeling of well-being,

self-esteem, and dignity should not be an afterthought. If anything, a students sense of

belonging, security, and self-confidence in the classroom provides the scaffolding that supports

the foundation for enhanced learning, motivation, self-discipline, responsibility, and the ability to

deal more effectively with obstacles and mistakes (p. 82).

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However, even with the acknowledgement that schools play an important role in

developing not only childrens cognitive development, but also their social and emotional

development, schools have limited resources. According to Durlak et al. (2011), Given time

constraints and competing demands, educators must prioritize and effectively implement

evidence-based approaches that produce multiple benefits (p. 406). Because of this, many

programs are considered too expensive, resource-dependent, time-consuming, or complicated to

implement in the schools (Rose et al., 2009, p. 405).

What Can Be Done?

It is evident that prevention efforts are becoming more utilized in school systems.

However, there is still work to be done to increase the benefits of these programs. One of the

biggest ways to improve preventative efforts in schools is to encourage collaboration and

coordination between families, schools, community organizations, public health services, and

policymakers to work together to strengthen each others efforts rather than working

independently to implement programs that attempt to compensate for perceived deficits in social

settings (Weissberg et al., 2003, p. 427).

Additionally, as these partnerships come together, it is important to base programs on

theoretical and empirical foundations with continuous formative evaluations to ensure that they

are as effective as possible. Research needs to be done using randomized clinical trials to test the

reliability and validity of programs. Specifically, longitudinal studies can be conducted to

measure the long-term results of universal prevention programs. The hope is that implementing

early comprehensive interventions will establish a strong foundation for development in later

years (Taub & Pearrow, 2013).

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Many states have also written education standards to address social and emotional

development to encourage teachers to focus more on these topics. Ideally, as these things become

more of a focus in education, they will enhance academic competence and also reduce the

negative problems that are often the result of a lack of social and emotional competence or the

difficulties that arise from mental health disorders that are not being treated. In fact, studies have

shown that mastery of social-emotional skills is associated with greater well-being and academic

success, while failure to develop these competencies can lead to personal, social, and academic

problems (Durlak et al., 2011).

Conclusion

The idea of mental health in schools is often associated only with mental illness or

diagnosable problems. However, schools also have the responsibility to provide programs that

will promote social-emotional development, prevent mental health and psychosocial problems,

and enhance resiliency and protective buffers (Adelman & Taylor, n.d., p. 6). By doing so,

schools will be able to reach larger numbers of children, encourage positive development, and

reduce the likelihood of negative outcomes. Although there are many barriers that can make it

difficult for schools to provide these programs, there are worthwhile things that can be done to

make them more easily accessible. As Weissberg et al. (2003) stated, Well-coordinated and

research-based strategies that prevent problems and enhance the social-emotional health of all

children are a sound investment in the future of the United States (p. 427).
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