Justificación

Intervention Description Background

Promoting Alternative Thinking Strategies (PATHS) is a universal prevention program that was developed by Carol Kusché, Ph.D., of the University of Washington and Mark Greenberg, Ph.D. of Pennsylvania State University.

This program is an elementary school-based (K-5) program that is delivered by the teachers to reduce and prevent emotional and behavioral problems. PATHS is delivered by national certified

trainers through PATHS, LLC, based in Seattle, Washington. Since 2000, it has been disseminated to approximately 80,000 students in the United States, Switzerland, UK, The Netherlands, Germany, Belgium, Greece, Australia, Mexico, and South America. More than 200 organizations are receiving some type of PATHS services at any given time (M. Greenberg, personal communication, September 28, 2006).

Characteristics of the intervention

PATHS is a 5-year program that is implemented in the schools by teachers and counselors. The program is aimed at students who are either in mainstream or special education classes. The goal of the program is to increase social and emotional competencies while reducing aggressive, acting- out behaviors.

It is recommended that sites hire a PATHS coordinator to assist with implementation and help to ensure its quality. A coordinator should have a background in teaching with a solid foundation and experience in social and emotional learning. Figure 4

Promoting Alternative Thinking Strategies Type of EBP  Prevention

Setting  School-based (including alternative schools and charter school programs)

Age  5–12

Gender  Males

 Females Training/Materials Available  Yes

Outcomes  Increase in ability to label feelings.

 Increases in self-control.  Reductions in classroom

aggression.

 Decrease in teacher-reported internalizing and externalizing negative behaviors.

PATHS is delivered by trained teachers three times a week for approximately 20 to 30 minutes. A manual is available with specific instructions and developmentally appropriate lessons that address five major domains: self-control; emotional understanding; positive self-esteem; relationships; and interpersonal problem-solving skills (Greenberg, Kusché, & Mihalic, 1998). Each domain has subgoals according to the developmental level of each child.

The PATHS program is delivered in developmentally tailored lessons by teachers using a variety of teaching methods. The curriculum consists of an instructional manual, six volumes of lessons, pictures, photographs, posters, Feeling Faces, and additional material. There are three major units:

 The Readiness and Self Control Unit (12 lessons);

 The Feelings and Relationships Unit (56 lessons); and

 The Interpersonal Cognitive Problem-Solving Unit (33 lessons).

A Supplementary Unit covers issues in friendship and moral decisionmaking and reviews lessons in the other units. The large instructional manual provides the scope and sequencing of the lessons for each developmental group. Younger children are exposed to the Turtle Unit (Readiness and Self-Control), which teaches readiness and self- control through metaphorical storytelling and behavioral support.

For children in the latter elementary years, a more cognitively advanced approach has a greater focus on problem-solving tasks and lessons. Flexibility exists in the program to allow teachers to tailor the lessons to their individual teaching style.

Research Base and Outcomes

Research on the effects of PATHS has been conducted since 1983, including five randomized control designs. Studies have examined the effectiveness of the program in real world settings, in samples of regular and special education classrooms, and with culturally diverse students that include African Americans, Hispanics, American Indians, and Asian Americans. Riggs (2006) specifically studied the effects of PATHS administered as a part of an after-school program with rural Latino children.

Research supports many positive outcomes of the PATHS intervention, such as reducing classroom aggression, internalizing problems, self-reporting depressive symptoms, and increasing developmental understanding of, and fluency with, discussing emotional experiences. Positive outcomes have been noted in both 1- and 2-year followup studies. See Table 4.

Table 4: Promoting Alternative Thinking Strategies: Research Base and Outcomes

Reference Research Design and Sample* Outcomes

Greenberg, Kusché, Cook, & Quamma (1995)

Randomized design with 30 classrooms of children (n= 286, grades 2-3) randomly assigned to be exposed to the PATHS curriculum or the control group to measure the effects of the intervention on a child’s emotional understanding.

Pre-post test measures and interview questions used to test children’s understanding of emotional situations.

Study population:         58% Male 42% Female 58% White 32% African American 4% Asian American 2.5% Filipino Americans 2.5% American Indians 1% Hispanic

Children exposed to PATHS demonstrated increased range of affective vocabulary and fluency in discussing emotional experiences, beliefs regarding management of emotions, and developmental understanding of some aspects of emotions.

The Conduct Problems Prevention Research Group (1999)

Randomized control design (n=378), 198 1st grade classrooms assigned to treatment group (the PATHS intervention) and 180 assigned to the control group; all from high-crime neighborhoods.

Study population:

 Mean percentage of minority students (primarily African American) across all 378 schools was 49%. The range was from 1% to 90%.

After 1 year, children exposed to PATHS demonstrated reductions in classroom aggression and increases in self-control.

Kam, Greenberg, & Kusché (2004)

Experimental research design examining the long-term effects of the PATHS curriculum on the adjustment of school-age children receiving special education services.

Special education classrooms (n = 18) were randomly assigned to the control group (no PATHS- intervention) or the treatment group (PATHS- intervention). Children (n = 133) grades 1st–3rd at start. Data collected for 3-successive years.

Study population:      73% Male 27% Female 66% White 20% African American 14% Other

For special education children, the PATHS intervention indicated reduced growth of internalizing and externalizing negative behaviors by teacher reports at 2 years after intervention.

Additionally, PATHS intervention produced sustained reduction in child-reported depressive symptoms.

Riggs, Greenberg, Kusché, & Pentz (2006)

Randomized design studied the PATHS curriculum on 30 classrooms with 318 children, grades 2–3, to measure 1-year post-intervention outcomes on teacher-reported externalizing and internalizing behavioral problems, as well as mediation through tasks assessing executive functions. Study population:      50% Male 50% Female 55% White 33% African American

22% Asian American, American Indian or other racial background

Results showed significant effects at posttest on children’s inhibitory control and verbal fluency. Findings 1 year later showed significant teacher effects on students’ externalizing and internalizing problems.

Domitrivich, Cortes, & Greenberg (2007)

Randomized design studied PATHS curriculum with children (grades K–6) from 20 classrooms (n = 246). 10 classrooms received PATHS curriculum; 10 were control classrooms.

Study population:       49% Male 51% Female 38% White 47% African American 10% Hispanic

5% Other racial background

After exposure to PATHS, children in the PATHS classrooms had higher emotion knowledge skills and received higher ratings from parents and teachers for social competency than children in the control classrooms.

Implementation and Dissemination Infrastructure Issues

Readiness:

No formal readiness instruments are available. An informal assessment process is conducted with an interested site and the PATHS trainers. Training/coaching and materials

 Training is provided through PATHS Training, LLC.

 Training new sites requires a 2- to 3-day onsite visit, which involves teachers, school administrators, and on occasion, parents.

 Ongoing technical assistance and coaching usually consist of weekly or biweekly

observations by curriculum consultants. These booster sessions can be individualized to the site. They can also last up to 4 to 5 years after initial implementation of PATHS. In subsequent years of PATHS implementation, teachers will receive a half-day of training.

 Whole school staff discussions occur quarterly.

 Trainer certification is available through PATHS Training, LLC. This certification requires working as a local PATHS coordinator and demonstrating leadership in assisting sites in implementing PATHS locally. This process will last 2 years, before advancing to intensive training. Fifteen trainers are in the United States.

 Materials available for purchase:

 Complete PATHS curriculum

(includes readiness curriculum) ($679);

 PATHS Basic Kit ($579);

 PATHS Readiness and Self-Control Turtle Kit ($159); and

 Costs of additional materials ($100).

 Parent materials are available in Spanish. Information about the curriculum can be obtained at: http://www.prevention.psu.edu/projects/

PATHSCurriculum.html

Information about purchasing the curriculum can be obtained at: http://www.channing-bete.com/ prevention-programs/paths/.

Cost of training/consulting

 Complete training and ongoing technical assistance costs are approximately $4,000 to $5,000 plus travel and per diem expenses for 1 trainer, 2 days, and 30 participants.

 For onsite training only (for 2 days and up to 30 participants), costs are approximately $3,000 plus travel and per diem expenses for the trainer.

 The developers project that the cost to implement PATHS is approximately $25 per student. Total costs including training and technical assistance for first year operations at an elementary school are around $10,000. In the following year, the costs would decrease to about $10 per student. Thus, the cost to implement the program over 3 years is approximately $15 per student. These costs do include some training materials, as outlined previously.

Developer involvement

The developers, Dr. Greenberg and Dr. Kusché, are actively involved in developing and modifying the program. However, PATHS, LLC, based in Seattle, is responsible for assessing interested parties in the PATHS program, assigning trainers, and managing the training process.

Mark T. Greenberg, Ph.D.

Director, Prevention Research Center Henderson South – 112

Pennsylvania State University University Park, PA 16803 Phone: (814) 863-0112 Fax: (814) 865-2530 Email: [email protected] Carol A. Kusché, Ph.D. PATHS, LLC 927 10th Avenue East Seattle, WA 98102 Phone: (206) 323-6688 Email: [email protected]

Monitoring fidelity and outcomes

 Fidelity measures are available for sites to use. For some sites that are participating in a research study, the fidelity measures are required and sent monthly to PATHS, LLC. However, sites that are not a part of a study are not required to collect or report fidelity measures.

 Both fidelity and teacher-reported outcome measures are available at no charge from the publisher (Channing-Bete, Inc). Sites are advised to collect and report their outcome measures. PATHS, LLC does offer support to sites interested in using outcome data to better inform program decisionmaking.

Financing the intervention

 Most schools use Safe & Drug-Free school funds, school board funds, and short-term grants from local and federal agencies.

 The program is not covered by Medicaid (M. Greenberg, personal communication, September 28, 2006).

Resources/Links:

To order PATHS materials, go to:

http://www.channing-bete.com/prevention-programs/ paths/paths.html

University of Colorado’s Center for the Study and Prevention of Violence:

http://www.colorado.edu/cspv/

References

Conduct Problems Prevention Research Group. (1999). Initial impact of the fast track prevention trail for conduct problems: II. Classroom effects.

Journal of Consulting and Clinical Psychology, 67 (5), 648–657.

Domitrivich, C. E., Cortes, R. C., & Greenberg, M. T. (2007). Improving young children’s social and emotional competence: A randomized trial of the Preschool “PATHS” curriculum. Journal of Primary Prevention, 28, 67–91.

Greenberg, M. T. (personal communication, September 28, 2006).

Greenberg, M. T., Kusché, C. A., Cook, E. T., & Quamma, J. P. (1995). Promoting emotional competence in school-aged children: The effects of the PATHS curriculum. Development and Psychopathology, 7, 117–136.

Greenberg, M. T., & Kusché, C.A. (1998). Preventive intervention for school-age deaf children: The PATHS curriculum. Journal of Deaf Studies and Deaf Education, 3(1), 49–63.

Greenberg, M. T., Kusché, C., & Mihalic, S. F. (1998). Promoting Alternative Thinking Strategies (PATHS): Blueprints for Violence Prevention, Book Ten. Blueprints for Violence Prevention Series (D.S. Elliott, Eds.). Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.

Kam, C., Greenberg, M.T., & Kusché, C. A. (2004). Sustained effects of the PATHS curriculum on the social and psychological adjustment of children in special education.

Journal of Emotional and Behavioral Disorders, 12(2), 66–78.

Kam, C., Greenberg, M. T., & Walls, C. T. (2003). Examining the role of implementation quality in school-based prevention using the PATHS curriculum. Prevention Science, 4(1), 55–63. Riggs, N. R. (2005). After-school program

attendance and social development of rural Latino children of immigrant families. Journal of Community Psychology, 34(1), 75–87. Riggs, N. R., Greenberg, M. T., Kusché, C. A.,

& Pentz, M. A. (2006). The mediational role of neurocognition in the behavioral outcomes of a social-emotional prevention program in elementary school students: Effects of the PATHS curriculum. Prevention Science, 7(1), 91–102.