Infants & Young Children:
An Analysis of Classroom-Based and Parent-Focused Social–Emotional Programs for Young Children
Barton, Erin E. PhD; Steed, Elizabeth A. PhD; Strain, Phillip PhD; Dunlap, Glen PhD; Powell, Diane PhD; Payne, Crystal J. MEd
Department of Special Education, Vanderbilt University, Nashville, Tennessee (Dr Barton); University of Colorado Denver, Denver, Colorado (Drs Steed and Strain); University of South Florida, Tampa, Florida (Drs Dunlap and Powell); University of Nevada, Reno, Nevada (Dr Dunlap); and Georgia State University, Atlanta, Georgia (Ms Payne).
Correspondence: Erin E. Barton, PhD, Department of Special Education, Vanderbilt University, 230 Appleton Place, Peabody 228, Nashville, TN 37203 ( email@example.com).
The authors declare no conflict of interest.
The purpose of this article was to describe a comprehensive and updated review of available classroom and parenting social–emotional programs for young children. The review analyzed 10 classroom curricula and 8 parenting interventions focused on social–emotional development and the research associated with each. The efficacious adoption criteria introduced by Joseph and Strain (2003)
were used to analyze the evidence for each program. Most (i.e., 12 of 18, 67%) of the programs received medium or high ratings. Results of this analysis and implications for practice and future research are discussed.
ONE OF THE more robust, consistent, and long-standing findings in the behavioral sciences is the relation between early peer-related social skills and children's later academic, social, and overall quality of life (Dunlap & Powell, 2009; Strain & Timm, 2001). Social–emotional competence in the preschool years predicts important outcomes well into adulthood such as job and relationship success as well as longevity and the ability to recover from life-threatening disease (Christakes & Fowler, 2011). In addition to these important correlational findings, there is a strong, inverse relation between children's social–emotional competence and the absence of challenging behavior (Dunlap & Fox, 2011). Although success in the social–emotional domain is not a perfect antidote to challenging behavior, it is clear from decades of intervention research that improvement in key social–emotional skills can directly lead to the prevention and reduction of severe challenging behavior (Dunlap et al., 2006).
Although it is very difficult to make definitive statements about the percentage of young children who display social and emotional deficits, it is certain that most early educators will experience such children every year in every preschool class. For example, Asher and Coie (1990) estimated that upward of 20% of all preschoolers who are otherwise developing typically show signs of significant social isolation and withdrawal from peers. When one adds socioeconomic risk to the equation, then estimates of serious concern rise to about 30% (Qi & Kaiser, 2003). Given these numbers, it is not surprising that providers and programs across the country struggle to find the right interventions to address such concerns.
Social–emotional competence involves both preventing challenging behaviors and intentionally teaching specific social–emotional skills. Thus, programs that provide practitioners and families with functional and relevant information about a child's social–emotional competence, identify potential target skills, and describe practices for intentionally teaching target skills are needed and critical. Valid and reliable social–emotional curricula should help practitioners identify children with social–emotional delays, address (to prevent) challenging behaviors, and guide practitioners in promoting social–emotional competence in all young children. Given the importance of early identification, programs should be available for both classroom teachers and practitioners working with parents and families in natural settings. Family-focused interventions should support practitioners in enhancing families' competence in support-ing their child's social–emotional development. Although there have been several recent literature reviews of approaches to preventing and reducing challenging behavior in young children (Conroy, Dunlap, Clarke, & Alter, 2005; Dunlap & Fox, 2011; Wood, Blair, & Ferro, 2009), there has been only one published, peer-reviewed synthesis of social–emotional programs (Joseph & Strain, 2003).
Joseph and Strain's review (2003) sought to (1) identify peer-reviewed social–emotional curricula, (2) present evaluative criteria to be used in determining the likelihood of efficacious adoption, and (3) describe specific areas of need for further research and curricula development. The efficacious adoption criteria created by Joseph and Strain included such things as the generalization of treatment effects to other settings and measurement of social validity. The criteria were intended to measure the probability that results from prior research would be realized during real-world utilization of the social–emotional curricula in an early childhood setting (Joseph & Strain, 2003). Only two of the reviewed curricula had a high confidence rating, meeting at least seven of the nine criteria. Four of the eight curricula met three or fewer of the criteria, indicating a low probability of efficacious adoption potential (Joseph & Strain, 2003). Since this review was published, multiple new curricula have emerged and additional peer-reviewed studies of social–emotional curricula have been published.
The purpose of this review was to summarize and synthesize current information on classroom-based and family-focused programs designed to promote the social–emotional competence of young children (birth to 5 years of age). We used the efficacious adoption criteria introduced by Joseph and Strain to analyze the evidence for each program and to expand and update their 2003 review. These criteria allowed us to evaluate each program and synthesize across programs to identify implications for adoption potential and areas for future research.
Search criteria and data extraction
The literature review process was conducted using the procedures outlined by Joseph and Strain (2003). We used the following inclusion criteria to identify programs that (a) specifically target social–emotional competence and behavioral outcomes, (b) are focused on children birth through 5 years of age, (c) have a published manual, and (d) have at least one published, peer-reviewed article reporting social–emotional or behavioral outcomes for children birth to 5 years of age. We identified 18 total programs (i.e., 10 classroom-based and 8 parent-focused) that met all inclusion criteria. This included 10 additional programs not analyzed in the review by Joseph and Strain (2003). Their review included one parent intervention and seven classroom-based curricula. Three of the classroom-based curricula analyzed in their review did not meet our inclusion criteria.
Data extraction was conducted in five steps. First, a literature review was conducted using online library databases to identify peer-reviewed research articles that included a classroom-based or parenting social–emotional program and included child participants from birth through 5 years of age. All study types (e.g., randomized control group and quasi-experimental designs) were included. Second, each identified classroom curriculum was reviewed for descriptive information regarding target population, delivery method, format, and inclusion of a comprehensive home component, training requirements, and interventionists. Parent-focused interventions were also reviewed for these components except that the inclusion of a classroom (not a home) component was examined. Third, the theoretical basis and overall child outcomes were examined across both classroom and parent programs. Fourth, the nine criteria used by Joseph and Strain (2003) were used to analyze the research studies examining the efficacy of each classroom curriculum (Table 1). Replications across settings were not considered relevant for parenting interventions (i.e., should be conducted in the natural setting); thus, the parenting interventions were analyzed across eight criteria. Fifth, the quality indicators were synthesized for each program, and the efficacious adoption ratings (Joseph & Strain, 2003) were used to identify the level of evidence (overall confidence rating) for each program. A high confidence rating was given when the literature regarding the program had seven or more of the quality indicators. A medium confidence rating was given when the literature regarding the program had four to six of the quality indicators. A low confidence rating was given when the literature regarding the program had three or fewer of the quality indicators.
The first author coded for the presence or absence of each of the nine (or eight for parenting interventions) dimensions of quality for research studies associated with each classroom-based and parenting program. A second rater similarly trained with a doctoral degree in early intervention/special education and expertise in social–emotional interventions independently rated each study along the same nine (or eight for parent-focused interventions) quality indicators. Interrater reliability was assessed by dividing the number of agreements by the number of agreements plus disagreements and multiplying by 100. Overall interrater reliability was 99% with 98% agreement for classroom-based curricula and 100% agreement for parenting interventions.
Table 2 provides descriptive information regarding the classroom curricula including the name, authors, target population, delivery method, format duration, home component, training requirements, and intended interventionists. In general, the classroom curricula targeted preschoolers (n = 5) or preschoolers and kindergarten/early elementary age children (n = 5). All curricula were designed for children aged 3 years and older. Most (n = 7) of the 10 classroom curricula used a whole classroom delivery method, and the curricula durations ranged from 4 weeks (n = 1) to the entire academic year (n = 2); most (n = 6) ranged from 20 to 35 weeks. Only three of the classroom curricula had a home component. One curriculum required training prior to implementation (Al's Pals; Geller, 1999) and six had training available but did not require training prior to implementation. The interventionists were primarily teachers (n = 8).
Table 3 provides descriptive information regarding the parenting interventions. In general, the parenting interventions targeted young children starting at birth (n = 5) through the early elementary years (n = 4). Three programs included children older than 8 years (e.g., Family Checkup [FCU], Dishion, Stormshak, & Kavanagh, 2011; Triple P Stepping Stones [TPSS], Sanders, Mazzucchelli, & Studman, 2003). Five programs used individual sessions to deliver content and five used group sessions (two programs used both group and individual sessions). The programs' durations ranged from three sessions with follow-up for a year (FCU, Dishion et al., 2011) to 24 home visits over a year (Child and Family Interagency Resources, Support, and Training [Child FIRST], Lowell, Carter, Godoy, Paulicin, & Briggs-Gowan, 2011). Only one curriculum included a classroom component (Child FIRST, Lowell et al., 2011), although the classroom component had not been evaluated. Seven of the eight programs required training prior to implementation. The interventionists for these programs represented a range of disciplines. Seven of the eight programs included mental health professionals as interventionists, four included social workers, and two included teachers.
Theoretical framework and child outcomes
Table 4 summarizes the theoretical basis or conceptual framework for each program and intended child outcomes. Most programs (n = 11) follow multiple theoretical frameworks. Six of the 18 programs were guided by social learning theory. Six programs used behavioral frameworks. All 18 programs examined child social–emotional outcomes. Most (n = 16) of the 18 programs focused on both increases in positive, prosocial behaviors and decreases in negative, challenging behaviors. However, only two parenting interventions focused on decreases in negative behaviors.
Quality indicator ratings
Table 5 presents the quality indicator ratings and the level of evidence for adoption potential for the 10 classroom and eight parenting programs. Of the 10 classroom curricula included in this review, two had a high level of evidence meeting seven to nine indicators, four had a medium level of evidence meeting four to six indicators, and four had a low level of evidence meeting three or fewer indicators. Of the eight parenting interventions reviewed, four had a high level of evidence meeting seven to eight indicators, two had a medium rating meeting four to six indicators, and two had a low level of evidence meeting three or fewer indicators. Thus, the majority (12 of the 18) of the programs identified in this review had medium- to high-level confidence ratings on the basis of the efficacious adoption criteria (Joseph & Strain, 2003). The next section provides a synthesis of the quality indicators across the programs with medium to high ratings.
Six of the 10 classroom curricula met at least four of the quality indicators. However, only two met all nine quality indicators (First Step to Success, Walker et al., 1997; Incredible Years [IY]; Webster-Stratton, 2006). All 10 of the curricula had studies that reported evidence across culturally or linguistically diverse groups of children and families. Eight of the 10 curricula had studies that reported measuring intervention fidelity. Four curricula had studies that reported treatment generalization, and three had studies that reported maintenance of treatment outcomes after the intervention ended. Social validity was reported only for five curricula. However, only three of these five measured social validity of both the treatment and the outcomes. Six of the 10 curricula replicated outcomes across settings. However, only three of the 10 curricula replicated outcomes across clinical groups. Five of the 10 curricula had evidence of replication across researchers.
Four of the eight parenting interventions met all eight quality indicators. Two met six of the eight criteria; FCU (Dishion et al., 2011) lacked documentation of the measurement of social validity of the procedures or outcomes and Child FIRST (Lowell et al., 2011) lacked replication across clinical populations and research groups. The two parenting interventions with low levels of evidence had limited replications. Also, Dare to Be You did not have studies that reported treatment generalization or social validity (Miller-Heyl, MacPhee, & Fritz, 2000). Pathways to Competence did not have studies that reported treatment fidelity or maintenance (Landy & Thompson, 2006).
Descriptions of classroom-based curricula
First Step to Success
First Step to Success (Walker et al., 1997) was designed as a school-based early intervention for children who exhibit externalizing problematic behaviors at school entry (i.e., in kindergarten). First Step is made up of three components: (1) universal screening to identify children at risk for behavioral issues, (2) classroom instruction in prosocial skills with adults and peers, and (3) parent training to assist generalization of skills across school and home settings. A qualified behavior coach oversees the program over 30 days. A multitude of studies have established the effectiveness of First Step to improve the social and academic outcomes of young children at risk for antisocial behavior (e.g., Epstein & Walker, 2002; Golly, Stiller, & Walker, 1998; Seeley et al., 2009). Implementation of First Step has been associated with positive behavior changes (e.g., reductions in challenging behavior, increases in engagement) for targeted kindergarteners and first graders. Students have maintained these improvements over academic years (Epstein & Walker, 2002). Recently, Walker et al. (2009) conducted a randomized trial of First Step using a diverse sample of first- through third-grade students in Albuquerque Public Schools. The study found that intervention students made improvements in their academic performance and reduced their problem behavior when compared with control students (Walker et al., 2009). Analysis of a subset of the Albuquerque sample found significant behavioral and academic improvements for students with attention-deficit/hyperactivity disorder when compared with students with attention-deficit/hyperactivity disorder receiving instruction as usual (Seeley et al., 2009). The First Step curricula met all nine quality indicators, suggesting a high level of evidence of adoption potential.
Incredible Years: Child training
The IY Child Training program (Webster-Stratton, 2006) was developed to treat children 3–7 years of age who were referred to a clinic for oppositional defiant disorder or early-onset conduct disorder. The curriculum is implemented with a child who presents with clinically significant aggressive behavior in a clinic setting over 18–22 weekly 2-hour sessions. Additional 12–16 sessions are provided for children's parents in a weekly 2.5-hour group setting. Two randomized control group studies have demonstrated the efficacy of the program to increase children's problem-solving strategies and play skills and decrease children's conduct problems across home and school settings (Webster-Stratton & Hammond, 1997; Webster-Stratton & Reid, 1999). Independent researchers have conducted replications of IY and demonstrated similar findings across diverse racial/ethnic groups (e.g., Barrera et al., 2002) and in other countries (e.g., Hutchings, Lane, Owen, & Gwyn, 2004). The IY Child Training program met all nine of the quality criteria, suggesting a high level of evidence of adoption potential.
Incredible Years: Dina Dinosaur
The IY Dina Dinosaur classroom curriculum was developed as an adaptation of the IY Child Training program so that preschool and kindergarten teachers could use a prevention-based approach in their classrooms (Webster-Stratton, 1990). The IY Dina Dinosaur classroom curriculum is based on cognitive social learning theory and uses video modeling, role-play, practice, and reinforcement to promote prosocial behaviors and reduce challenging behavior. The curriculum includes sixty 45-min lessons that are implemented one to three times per week. One randomized clinical trial has documented the efficacy of IY Dina Dinosaur to improve children's social behavior (e.g., compliance, social contact) and decrease their aggressive behavior (Webster-Stratton, Reid, & Stoolmiller, 2008). Furthermore, IY Dina Dinosaur teachers were observed to use more positive classroom management techniques and reported more parental involvement than control teachers. The IY Dina Dinosaur classroom curriculum met five of the nine criteria, indicating a medium level of evidence of adoption potential. The study reviewed did not address treatment generalization or maintenance of intervention effects over time. The IY Dina Dinosaur classroom curriculum has yet to be replicated across clinical or research groups.
I Can Problem Solve
The I Can Problem Solve (ICPS) curriculum was first developed in the 1970s to teach young children at risk how to manage classroom conflict situations by reading other children's cues, taking others' perspectives, and generating appropriate solutions to problems (Shure, 2000). Preschool teachers implement 50 lessons over 12 weeks in small groups. Evaluation studies have demonstrated that use of the ICPS curriculum is associated with improvements in children's ability to generate alternative solutions, children's description of consequences to solutions, and teachers' behavioral ratings (Feis & Simons, 1985; Shure & Spivak, 1979, 1980, 1982; Shure, Spivack, & Jaeger, 1972). The ICPS curriculum met six of the nine quality indicators, suggesting a medium level of evidence of adoption potential. Reviewed research did not measure treatment fidelity or procedural social validity. Replication has not yet occurred across clinical groups. There have been no research updates for the ICPS curriculum since 1985.
Al's Pals: Kids Making Healthy Choices (Geller, 1999) is a resiliency-based program developed for children 3–8 years of age at risk for observing domestic conflict, violence, and drug abuse in their homes and communities. The focus of the program is on supporting preschool teachers to nurture children's resilience-related qualities, such as strong verbal communication skills, empathy, and adaptability. Al's Pals involves two 15-min lessons each week for 23 weeks. The lessons use games, creative play, puppetry, children's books, photographs, and songs to convey concepts, teach social skills, and facilitate discussion and role play of positive choice making when confronted with difficult situations. Research on Al's Pals has demonstrated that implementation of the year-long curriculum is associated with improvements in children's social–emotional competence and coping skills and reductions in children's challenging behavior (Dubas, Lynch, Galano, Geller, & Hunt, 1998; Lynch, Geller, & Schmidt, 2004). Al's Pals and the parent education component have been researched in pilot, controlled, and replication studies across multiple years and states (Lynch et al., 2004). The curriculum has been analyzed in preschool programs serving children at risk and in “typical” childcare programs (Lynch et al., 2004). The Al's Pals curriculum met five of the nine criteria. Individual research studies reviewed did not examine treatment generalization or maintenance. Research has not yet addressed social validity of outcomes or been replicated across clinical groups.
Social Skills in Pictures, Stories, and Songs
Social Skills in Pictures, Stories, and Songs (Serna, Nielsen, & Forness, 2007) was designed as a proactive universal intervention for children at risk for social–emotional behavior disorders (Forness, Serna, Kavale, & Nielsen, 1998). The program addresses areas of social development such as following directions, sharing, and problem solving. The curriculum is built around four characters (e.g., Rosie Roadrunner) and their associated stories and songs that address specific social skills. Implementation of the program includes the introduction of a character, identification of a problem, guided steps to solving that problem, and a solution to the problem using a specific skill with original storybooks and songs, puppets, and role-play activities. Parents are given information about the skills being introduced at school and strategies they can use to support the skills at home. One study found that children in Head Start classrooms using Social Skills in Pictures, Stories, and Songs had stronger gains in clinical levels of behavioral problems (Serna, Nielsen, Lambros, & Forness, 2000). In a similar study, Head Start preschoolers whose teachers utilized Social Skills in Pictures, Stories, and Songs maintained pretest behavior levels whereas their peers in the control group worsened on teacher reports of challenging behavior (Serna, Nielsen, Mattern, & Forness, 2003). The Social Skills in Pictures, Stories, and Songs curricula met four of the nine criteria, indicating a medium level of evidence of adoption potential. The studies reviewed did not address treatment generalization, treatment maintenance, or social validity of outcomes or procedures. This curriculum has not been replicated across settings.
Descriptions of parenting interventions
Parent–Child Interaction Therapy
Parent–Child Interaction Therapy (PCIT) is a treatment for young children with emotional and behavioral disorders focused on improving the quality of the parent–child interactions and their relationship (Eyberg, Nelson, & Boggs, 2008). The PCIT uses principles of both attachment and social learning to teach authoritative parenting. This type of parenting is focused on developing a nurturing and responsive relationship with your child, maintaining control, and using effective communication strategies. The PCIT teaches parents to establish nurturing and secure relationship with their children, while increasing their children's prosocial behaviors and reducing challenging behaviors (Eyberg & Bussing, 2011). The PCIT uses live assessment-driven coaching, systematic generalization, and practice-based homework to teach parenting skills during play and routines in clinic settings. The coaching initially focuses on enhancing parent–child interactions and then teaches parents to address and reduce their children's challenging behaviors and increase prosocial behaviors (Bell & Eyberg, 2002). Since it was developed, PCIT has been extensively studied using quasi-experimental and randomized control designs, and its efficacy has been widely documented (Brestan & Eyberg, 1998; Eyberg & Bussing, 2011). The PCIT has been shown to be effective for culturally diverse groups of children with severe challenging behaviors (Eyberg & Boggs, 1998; Eyberg et al., 2008; Fernandez, Butler, & Eyberg, 2011), intellectual disabilities and comorbid oppositional defiant disorders (Bagner & Eyberg, 2007), prenatal exposure to alcohol (Bertrand, 2009), exposure to trauma (Urquiza, 2010), and developmental disorders and chronic medical conditions (Chase & Eyberg, 2008). Likewise, PCIT has been effective for children who are at risk and families with histories of abuse. For example, several studies have shown that abusive parents who received PCIT were less likely to be reported again for abuse (Chaffin et al., 2004) and use of corporal punishment and physical coercion (Chaffin, Funderburk, Bard, Valle, & Gurwitch, 2011) and reported reduced parental stress (Timmer, Urquiza, Zebell, & McGrath, 2005). Also, studies have shown that PCIT is effective for increasing parent competence with Mexican American (McCabe & Yeh, 2009), Chinese (Leung, Tsang, Heung, & Yiu, 2009) and Australian families (Phillips, Morgan, Cawthorne, & Barnett, 2008). Follow-up studies have shown that the effects of PCIT are lasting and treatment gains are maintained over time (Hood & Eyberg, 2003). Furthermore, measures of social validity across studies show that parents are highly satisfied with the processes and outcomes of PCIT. Parents also report reduced stress and psychopathology. Thus, the research on PCIT is extensive and rigorous. The PCIT met all eight quality indicators and had a high level of evidence to support efficacious adoption.
Triple P Standard
Triple P is a universal preventative parenting intervention with multiple levels aimed at increasing the knowledge, skills, and confidence of parents to prevent behavioral, emotional, and developmental problems in children (Sanders, 2008). Triple P uses a public health framework and was designed to ensure efficient dissemination at the universal or population level to have a maximum impact on community levels of behavioral, emotional, and developmental problems. However, the program includes multiple levels of intensity depending on the individual family's needs. The levels range from Level 1, which targets all parents interested in learning about new parenting skills, to Level 5, which addresses the needs of parents with children with severe challenging behaviors or families with severe dysfunction/crises. Triple P uses principles of social learning, child and family behavior therapy, and applied behavior analysis across each level. Because it was developed in 1992, Triple P has been extensively studied using quasi-experimental and randomized control designs and its efficacy has been widely document in more than 200 published reports. For example, multiple studies across researchers have shown that Triple P is cost-efficient (Foster, Prinz, Sanders, & Shapiro, 2008) and effective for reducing problem behaviors in young children and increasing parent well-being and positive parenting behaviors (e.g., Ireland, Sanders, & Markie-Dadds, 2003; Markie-Dadds & Sanders, 2006; Morawska & Sanders, 2006; Sanders, Bor, & Morawska, 2007). Likewise, multiple meta-analyses have documented the efficacy of each level of Triple P at increasing positive parenting skills, decreasing dysfunctional parenting styles, and improving behaviors in young children (de Graaf, Speetjens, Smit, de Wolff, & Tavecchio, 2008; Nowak & Heinrichs, 2008; Thomas & Zimmer-Gembeck, 2007). Furthermore, researchers are continuing to study adaptations of Triple P that might improve dissemination efforts or efficacy of the intervention. For example, Sanders, Baker, and Turner (2012) created an online version of Triple P (TPOL) and using a randomized trial found the parents receiving TPOL significantly reduced parental anger, dysfunctional parenting styles, and child problem behaviors, and increased parental confidence. Furthermore, the social validity measures were high, indicating that TPOL parents were satisfied with the treatment and outcomes. Finally, Triple P has been adopted and extensively studied in populations around the world (Switzerland; Bodenmann, Cina, Ledermann, & Sanders, 2008; Japan; Matsumoto, Sofronoff, & Sanders, 2010). In sum, the Standard Triple P curriculum met all eight quality indicators and had a high level of evidence, and research is continuing to refine and enhance the curriculum.
Triple P Stepping Stones
Triple P Stepping Stones is based on the Triple P framework and principles but was created for parents of children with special needs (Sanders et al., 2003). Triple P Stepping Stones uses a multilevel design in which parents are taught to manage challenging behaviors, cope with stress, develop a parent–child relationship, and teach their child new skills. Research on TPSS is emerging and evidence indicates that it is effective for reducing child problem behaviors, increasing positive parenting practices, and decreasing parental stress. For example, Roberts, Mazzucchelli, Studman, and Sanders (2006) conducted the first randomized trial of TPSS and found that it was effective for parents of preschoolers with developmental and learning delays and effects were maintained at a 6-month follow-up. Plant and Sanders (2007) examined an adapted version of TPSS focused on caregiving coping skills in a randomized control trial of 74 preschool children and a waitlist control group. Parents and children in both intervention groups had reduced child problem behaviors, and improved parental confidence and outcomes were maintained after a 1-year follow-up. Also, parents in both intervention groups reported high level of satisfaction with the intervention and the outcomes. Whittingham, Sofronoff, Sheffield, and Sanders (2009a) replicated these results with parents of children with Autism Spectrum Disorders and found that parents were satisfied with the training format and content and the outcomes of the TPSS program (Whittingham, Sofronoff, Sheffield, & Sanders, 2009b). Sofronoff, Jahnel, and Sanders (2011) conducted a randomized controlled trial to examine the effects of TPSS with parents of children with disabilities aged 2–10 years. The TPSS group had significant reductions in child problem behaviors, improvements in parenting style, and reduced parent conflict. These results have been replicated across researchers and cultural groups (e.g., Hampel et al., 2010). Similar to Standard Triple P, TPSS has extensive empirical support. Triple P Stepping Stones met all eight quality indicators and had a high level of evidence to support efficacious adoption.
Incredible Years: Parent Training
The Incredible Years Parent Training (IYPT; Webster-Stratton, 2006) program is focused on strengthening parent competencies and promoting parent involvement to enhance academic and social–emotional competence and reducing challenging behaviors and conduct disorders in young children. The IYPT is part of the IY training series, which includes trainings for practitioners, teachers, and parents. With more than a dozen randomized trials documenting its effectiveness, the IY training series, including the IYPT, is one of the most studied interventions addressing child social–emotional competence. In fact, the American Psychological Association Division 12 identified the IYPT as a well-established psychosocial treatment of childhood conduct problems. The IYPT series includes trainings for parents of children birth through 12 years of age. Each training curriculum consists of 14–16 weekly group sessions focused on teaching parents developmentally appropriate ways to play with their children, using praise and rewards, setting limits, and handling challenging behaviors. The sessions are typically conducted in small groups (e.g., 8–14 parents) and use demonstration videos, group discussion, self-reflection, problem solving, role-play, practice, and homework activities. Several studies have documented the efficacy of the IYPT for reducing child challenging behaviors and increasing parents' positive parenting behaviors. Eight randomized trials have documented the efficacy of IYPT over controls (e.g., Webster-Stratton, 1994; Webster-Stratton & Herman, 2008; Webster-Stratton, Reid, & Hammond, 2004), and at least six independent replications have been published (Jones, Daley, Hutchings, Bywater, & Eames, 2007; Linares, Montalto, Li, & Oza, 2006; Taylor, Schmidt, Pepler, & Hodgins, 1998). For example, Webster-Stratton et al. (2004) demonstrated that IYPT reduced problems behaviors in young children at school and home, decreased negative parenting behaviors in both mothers and fathers, and increased positive parenting behaviors. Furthermore, Reid, Webster-Stratton, and Hammond (2003) documented the long-term effects of IYPT for improving or alleviating conduct problems in children with oppositional defiant disorder. Additional studies have demonstrated that IYPT is related to improved parent and child outcomes for children attending Head Start programs (Webster-Stratton, 1998; Webster-Stratton, Reid, & Hammond, 2001), children at risk (Gross et al., 2003), children with intellectual disabilities (McIntyre, 2008; McIntyre & Phareuf, 2008), and children with depressive and internalizing symptoms (Webster-Stratton & Herman, 2008). Overall, the IYPT met all eight quality indicators giving IYPT a high level of evidence.
The FCU (Dishion et al., 2011) curriculum in early childhood is focused on motivating parent engagement using individually selected intervention practices. The curriculum uses a preventive model that is designed to be brief, assessment-driven, tailored to each family's unique ecology, and targets key developmental transition points (e.g., toddlerhood, transition to school). The FCU initially consists of three structured sessions: (a) a rapport-building interview to assess family well-being and identify areas of concern, (b) a comprehensive family assessment, and (c) a feedback session in which the family selects interventions from a menu of options. After the three initial sessions, families receive several follow-up sessions focused on parenting behaviors or contextual factors (e.g., caregiver mental health, accessing community resources for food or shelter, family routines). The FCU can be provided in family homes or community settings. Two randomized controlled studies have examined the outcomes of FCU with young children. First, a pilot study including 120 two-year old boys with early identified conduct problems and their mothers found that the boys' conduct problems decreased and the mothers' positive and proactive parenting practices increased with a minimal number of sessions (M = 3.26; Gardner, Shaw, Dishion, Burton, & Supplee, 2007). Furthermore, the reductions in conduct problems and increased maternal involvement maintained after 2 years for the mother–son dyads with the highest risk factors (Shaw, Dishion, Supplee, Gardner, & Arnds, 2006) and indirectly improved school readiness (Lunkenheimer et al., 2008). Furthermore, children categorized into comorbid or internalizing behavior problem groups in the FCU treatment group were more likely to fall into the normative group after 2 years of treatment (Connell et al., 2008). Overall, FCU met six of the eight quality indicators, giving it a medium level of evidence. However, none of the studies measured or reported social validity of the outcomes or procedures.
Child FIRST is a home-based therapeutic intervention approach focused on enhancing parent–child interactions and prompting social–emotional and cognitive development in young children from multirisk families. Following an ecological framework, Child FIRST uses a system of care approach to provide comprehensive, individualized, and integrated community-based supports to multirisk families (Lowell et al., 2011). Child FIRST consists of two integrated components: (a) a system of care to support the family's well-being (e.g., housing, community resources, domestic violence support) and (b) a focus on enhancing the parent–child relationship and supporting positive parent–child interactions. A clinical team consisting of a mental health clinician and a care coordinator provide psychotherapy and support to the parent–child relationship and help the family access community resources, respectively. Crusto et al. (2008) published an evaluation of Child FIRST with 132 multirisk families with young children who were exposed to violence. Results indicated a significant decrease in parent stress and an increase in child social–emotional development. They also noted a decrease in the children's exposure to traumatic events. Parents reported high satisfaction with the services. These findings were replicated in the first randomized controlled trial of Child FIRST (Lowell et al., 2011). In this randomized controlled trial, 157 diverse, low-income families with young children with social–emotional or behavioral problems were randomly assigned to receive Child FIRST or a control group receiving basic community services. Children in the Child FIRST group were less likely to have language problems and externalizing behaviors. Likewise, mothers in the Child FIRST group reported less stress, psychopathology, and involvement in Child Protective Services. Furthermore, families in the Child FIRST group accessed significantly more community resources and services than the control group. The outcomes maintained at 6- and 12-month follow-up assessments. With these two studies, Child FIRST met six of the eight quality indicators and has a medium level of evidence to support efficacious adoption. Although these studies provide promising evidence to support Child FIRST with multirisk families, additional studies are warranted. For example, additional studies across research groups and clinical populations measuring generalized outcomes are needed.
The purpose of this article was to review and analyze programs that focused on social–emotional competence and behavioral outcomes for young children. Eighteen programs were identified and reviewed using the efficacious adoption criteria described by Joseph and Strain (2003). Joseph and Strain (2003) included analyses and descriptions of eight social–emotional programs. The current review included further analyses and updates for five of these programs. Three newly developed and researched classroom and eight parenting social–emotional programs were added to the current review.
Overall, this review highlighted several major strengths across these programs. First, the majority (12 of the 18) of the programs identified in this review had medium to high confidence ratings based on the efficacious adoption criteria (Joseph & Strain, 2003). This is a promising finding and suggests that the field has evidence-based social–emotional programs that are effective for increasing the social–emotional competence of a variety of children across settings. Second, there were more highly rated social–emotional programs (six classroom-based and six parenting programs with medium to high ratings) in the current review than in the review by Joseph and Strain (2003; they had four classroom-based social–emotional programs with medium- to high-quality indicator ratings). This suggests that there might be more published, evidence-based curricular resources for teachers and parents to address positive social–emotional outcomes for young children. Third, almost all (16 of the 18, 89%) of the programs focused on increases in prosocial behavior, rather than just decreasing challenging behaviors. This is important because social–emotional competence in the preschool years prevents challenging behaviors and predicts important outcomes later in life. The review also highlights several key findings specific to classroom and parenting programs, cultural and linguistic diversity, and future research. These are discussed in subsequent sections.
All of the classroom-based social–emotional curricula reviewed were designed for use with young children in school or clinic settings. Teachers were the intended interventionists for eight of the 10 curricula. Mental health professionals and master's-level clinicians were the intended users of two of the curricula (Reaching Educators, Children, and Parents; Han, 2001; IY; Webster-Stratton, 2006). The expectation for teacher (as opposed to clinician) implementation increases the likelihood that positive social gains will be observed across classroom routines and activities. Training was required for one curriculum (Al's Pals; Geller, 1999) but not required for five of the curricula. Overall, the classroom-based curricula reviewed used fairly short lessons (e.g., 15–20 min) in small and large groups, making them feasible to implement in most early childhood settings (e.g., childcare, private preschool, Head Start, public kindergarten). Most curricula had a minimal, one-time cost that involves the purchase of books and related materials (e.g., CDs and puppets).
Social validity and treatment generalization or maintenance were not measured in the majority of studies associated with reviewed classroom-based curricula. It is important that future studies include analyses of teacher and other stakeholders' (e.g., early childhood administrators, clinicians, family members) perceptions of the value of intended social, emotional, and behavioral outcomes and program procedures. Treatment generalization and maintenance were not measured in most studies of classroom-based curricula reviewed. The social–emotional intervention literature has been plagued with issues of generalization and maintenance of positive effects (Mathur & Rutherford, 1996). For effective curricula to have lasting and meaningful impact for young children, the interventions need to ensure that children exhibit newly learned skills across contexts, targeted behaviors, and time.
Three of the reviewed classroom-based social–emotional curricula had a comprehensive home component (Reaching Educators, Children, and Parents, Han, 2001; First Step, Walker et al., 1997; IY, Webster-Stratton, 2006). These curricula provide direct support to families with a child who exhibits challenging behavior through in-home coaching or small group parent-training sessions. Most of the remaining curricula had an element of family involvement through resources or notes sent home to inform families about strategies being used at school and suggestions for activities to do at home. This level of support and one-way communication from school to home might not be sufficient for families with children who engage in challenging behavior across school and home settings. First Step, IYCT, and Reaching Educators, Children, and Parents provide models for more intensive and bidirectional help for families to encourage positive social–emotional skills at home.
Three of the classroom curricula reviewed mentioned the program's use within a recommended tiered system for providing universal, targeted, and individualized supports to children and families, such as positive behavioral interventions and supports. For example, First Step (Walker et al., 1997) is based on a tiered framework that includes universal screening for social–emotional difficulties, school-based interventions, and home-based intervention with families (Walker et al., 1998). Second Step (Committee for Children, 1991) describes its curriculum within the context of positive behavioral interventions and supports as a universal and classroom-based prevention program to reduce challenging behavior and teach social skills. Finally, IYCT (Webster-Stratton, 2006) fits within a tiered system of supports as a clinic or school-based curriculum that uses more intensive, small group intervention for young children with the most serious challenging behavior and social–emotional issues. The remaining classroom-based interventions did not mention tiered supports or a programwide framework. They provide universal and classroomwide support for children at risk for social–emotional difficulties. In these cases, classrooms or schools are likely to need more resources (e.g., mental health or behavioral consultation) to support young children who already exhibit clinically significant challenging behavior.
Overall, the parenting interventions in this review were more likely to have high efficacious adoption ratings than the classroom curricula. Six of the eight parenting interventions received high ratings, whereas only two of the 10 classroom curricula received high ratings. This suggests that more research has been conducted regarding the parenting interventions. The effectiveness of a family-centered approach has been well established in early childhood. In fact, a family-centered approach is central to the general philosophy and framework of early intervention (McWilliam, 2010; Powell & Dunlap, 2010). Research consistently supports early intervention approaches that focus on enhancing parents' capacity to meet the needs of their young children. The influence of parents on their child's development is critical; parents are the most important facilitators of learning for infants and toddlers (Dunst & Trivette, 2009; Powell & Dunlap, 2010). A substantial research base supports the role of parents in shaping their child's social–emotional development and addressing challenging behaviors (Dunst & Kassow, 2008; Fettig & Barton, 2012). This review supports previous research and identifies several promising parenting interventions with substantial research support.
Cultural and linguistic diversity
Almost all of the programs met the criteria regarding replications across culturally and linguistically diverse groups. This is a strength of these programs and indicates that many programs have been adapted for and analyzed with diverse families. For example, Walker et al. (2009) conducted a randomized trail of First Steps with a diverse sample of children from Albuquerque Public Schools. The Incredible Years Child Training has been replicated across diverse groups within the United States and in other countries (Barrera et al., 2002; Hutchings et al., 2004). The success of the Triple P Standard (Bodenmann et al., 2008) and PCIT (McCabe & Yeh, 2009) parenting interventions has been replicated with diverse families in the United States and across the world. The rise in children and families from culturally and linguistically diverse backgrounds who are served in early childhood programs requires an increased awareness and use of culturally and linguistically responsive practices. Language barriers, families' levels of acculturation, and the range of culturally appropriate social and communication behaviors are likely to impact family involvement, children's behaviors, and the teachers' perceptions of their behaviors (Harris, Barton, & Alpert, 2012). However, many early childhood professionals are not adequately trained to support families and children from culturally and linguistically diverse backgrounds (Division for Early Childhood, 2010). Many of these programs might support professionals in using culturally and linguistically responsive practices. However, the specific adaptations included in the programs for working with diverse children and families were not analyzed in this review; thus, conclusions about each program's cultural responsivity are speculative.
This review identified several important areas for future research. First, although not directly investigated in this analysis, several programs were examined across children or families experiencing multiple risk factors. For example, Child FIRST was studied with diverse, low-income families with young children with behavior problems (Lowell et al., 2011). Family checkup was studied with mothers with a range of risk factors and found maternal involvement maintained for mothers with the highest number of risk factors (Shaw et al., 2006). Likewise, the Al's Pals; Social Skills in Pictures, Stories, and Songs; and the IYPT curricula were examined in programs serving children with multiple risk factors (Serna et al., 2000; Webster-Stratton et al., 2006). However, additional replications of the remaining programs across children and families experiencing multiple risk factors (e.g., poverty, mental health issues, substance abuse, child abuse) are warranted. These should include examining effective practices for identifying and ensuring that children and families at risk have access to these programs.
Second, only a handful of these programs conducted replications with children with disabilities. For example, the success of IYPT was replicated with children with intellectual disabilities (McIntyre, 2008). Sofronoff et al. (2011) examined the effects of TPSS with parents of children with disabilities aged 2–10 years. Likewise, PCIT was examined with families with children with intellectual disabilities and oppositional defiant disorders (Bagner & Eyberg, 2007). These studies provide preliminary support for the adoption of these programs with adaptions for children with disabilities. However, the number of replications is inadequate and additional replications are warranted, particularly for classroom programs.
Third, an emerging literature exists examining the role of caregivers and family-focused strategies for promoting social–emotional development in young children (Powell & Dunlap, 2010). This literature has identified several effective family-coaching practices. For example, effective programs typically include a focus on routines, use of live or video modeling, opportunities for practice, and performance-based feedback. However, additional studies of effective family-coaching practices are needed.
Fourth, future reviews of social–emotional programs may utilize alternative standards to judge research merit, such as What Works Clearinghouse. Alternatively, future research might involve a meta-analysis of research on social–emotional interventions for young children. Projects such as these may provide more information about effect sizes and the scientific integrity of research on social–emotional programs targeting young children. This might address the limitations of the current review that appraises the attributes of currently available and researched social–emotional programs. At the time of this review, there was an insufficient body of research on social–emotional programs for young children that involved well-controlled, replicated randomized trials for a review using the What Works Clearinghouse criteria or a meta-analysis.
Fifth, programs examined in this review required a range of resources, time, and training; thus, costs varied and the cost-efficacy was rarely examined. One exception is the IYPT. The cost-efficacy of the IYPT has been recently examined and a public sector, multiagency framework for examining the cost-efficacy has been developed (Charles, Edwards, Bywater, & Hutchings, 2013). Future studies might use this framework to examine the cost-efficacy of these programs.
Finally, six of the eight parenting interventions and two of the 10 classroom curricula received high adoption ratings. Clearly, additional replications of the classroom curricula are needed. The wide variation in adoption ratings across classroom curricula begs the question of what standard or threshold one should use for selecting an approach. Does one consider only those entries with the best evidence to date? We think that there is no simple answer. Ratings for curricula are a snapshot of data at a moment in time and do not necessarily suggest the “ultimate” adoption feasibility for a particular client group, type of provider, or type of setting. What we do suggest is that potential adopters closely examine the data available for each choice under consideration and utilize the ratings herein as a key determinant in their decision making.
The purpose of this review was to synthesize and analyze classroom and parenting programs focused on social–emotional development for young children. These programs generally emphasized both teaching new social–emotional skills and preventing or reducing challenging behaviors. Six of the eight parenting interventions received high ratings, which suggests that there are effective parenting interventions available. Two of the 10 parenting interventions had high ratings and four had medium ratings. Thus, although additional research is warranted, promising programs exist. The programs with high ratings have been tested in real-world, diverse community settings and have strong potential for generalized success across settings, children, and families. Ensuring that all families and children have access to settings using these programs is the next logical step.
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challenging behavior; preschool; social–emotional; young children
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