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School-based prevention programs are initiatives implemented into school settings that aim to increase children's academic success and reduce high-risk problem behaviors.

Overview

An estimated 20-40% of youth have a psychiatric disorder, yet up to 80% of those in need do not receive mental health services (Merikangas et al., 2011). Preventing mental health problems and promoting healthy behavior among youth has become a critical policy issue (Greenberg et al., 2005). The Report of the Surgeon General’s Conference on Children’s Mental Health stated the importance of fostering a solid emotional foundation in children in order to facilitate learning (U.S. Public Health Service, 2000, p. 3). However, children and families face significant barriers to accessing and receiving community-based mental health services (Kazdin et al., 1997). As a result, schools have been identified as ideal avenues through which to reach youth. Prevention programs, also known as universal, are offered to the general population or to those identified as at risk for developing a problem (O’Connell, Boat, & Warner, 2009). This differentiates them from intervention or treatment programs, which are intended for individuals who already have a problem or meet criteria for a disorder.  

Approaches

A number of school-based programs have been developed to target specific outcomes, including problems such as bullying, substance use, and antisocial behavior^[6][7]. Others have been developed to foster positive youth development^[8] and academic performance^[9]. While each of these programs focuses on distinct issues and outcomes, research suggests that in adolescent-focused initiatives, many utilize the same practice elements, including communication skills, problem solving, insight building, and assertiveness training^[10]. These results suggest that certain core skills may be critical to seemingly disparate desired outcomes, which may have implications for clinical decision making as well as policy. A meta-analysis of 213 school-based prevention programs promoting social and emotional learning (SEL) looked at outcomes in six different domains: social and emotional skills, attitudes toward self and others, positive social behaviors, conduct problems, emotional distress, and academic performance. Findings suggested that SEL programs had positive effects across all six domains, demonstrating the broad impact of universal school-based prevention programs  

Social and emotional skills

Attitudes toward self and others

Positive social behaviors

Conduct problems

Emotional distress

Academic performance

Barriers to implementation

While 59% of schools in the U.S. report having programs that foster children’s social and emotional needs, evidence-based initiatives have not been widely implemented. Schools may be unaware of the evidence base, reflecting the gap between research and practice. Schools that are aware of effective programs may lack funding necessary to implement the program. Should schools receive funding for implementation, research shows that programs are often poorly implemented, resulting in low fidelity and weak outcomes. Additionally, some prevention programs may not be a good fit with the local context and may require tailoring. Finally, schools may struggle to sustain programs due to limited resources.