We tested the impact of the school-based Rochester Resilience Project designed to strengthen emotional self-regulation skills in the context of assisting children in addressing individualized goals. The intervention targeted children with elevated aggressive-disruptive and social-emotional problems identified through a population-based screening of all kindergarten – 3rd graders in two urban schools. In 14 lessons, children were taught a hierarchical set of skills: monitoring emotions; self-control and reducing escalation of emotions; and maintaining control and regaining equilibrium. The implementation model and sequence of adult-child interactions was designed to assist children in developing proceduralized skills (Sun 1997
) that can be used with increasing flexibility in situations of emotional activation.
The intervention had a positive impact on children’s classroom behaviors and rates of disciplinary incidents, including improved behavior control (i.e., fewer aggressive-disruptive problems), on-task learning behaviors and peer social skills, and less shy-withdrawn and more assertive behaviors. The reductions in classroom problems reported by teachers were medium-sized, with average standardized effect sizes ranging from 0.31–0.47. On peer social skills, the intervention impact varied by sex. For girls, the intervention had a large effect on improved peer social skills (standardized ES=0.90), whereas social skills did not change for boys. The intervention also reduced rates of office disciplinary referrals and suspensions. Relative to controls, children receiving the intervention had a 46% mean decrease in office disciplinary referrals and a 43% decrease in mean suspensions during the 4-month intervention period. On disciplinary referrals, the intervention impact was primarily to reduce the frequency of those events rather than the propensity to have any referrals. For out-of-school suspensions, the intervention reduced both the propensity to have a suspension and the frequency. Specifically, whereas 1.8% (2/111) of children in the intervention condition received a suspension up to a maximum of one time, 6.1% of controls (7/115) were suspended, with five suspensions being the maximum number.
Rather than targeting a single problem area, our intervention targeted children with emerging problems characteristic of externalizing behavior patterns, shy-withdrawn behaviors characteristic of internalizing problems, as well as problems such as ‘off-task’ behaviors related to classroom academic functioning. Conceptually, this focus stems from our intervention model that teaches a common set of skills to enhance emotional self-control and reduce reactivity that are then individualized to address specific goals. Pragmatically, this addresses observations that aggressive-disruptive, internalizing and learning problems frequently co-occur in young children (e.g., Wyman et al. 2009
) and evidence that problems across multiple domains have an additive risk effect (Kellam et al. 1982
). Overall, our findings suggest that the intervention reduced problems across the targeted domains, irrespective of different patterns of classroom problems prior to the intervention. The intervention also reduced the escalation of formal disciplinary incidents and suspensions, which are associated over time with lower academic achievement and school bonding and with increased conduct problems (Bryant et al. 2000
; Huisinga and Jakob-Chien 1998
). Evidence that the intervention reduced serious behavior problems was strengthened by the reduction in suspensions, in addition to reducing more frequently occurring office referrals. Suspensions were initiated by principals and required a formal hearing, and the school district’s policy required that suspensions only occur in response to a few specific infractions, including hitting a teacher or carrying a weapon. Such specificity increases the validity of those records (Irvin et al. 2004
Older child age was not associated with enhanced benefit from this intervention, contrary to our hypothesis. We expected that older children would be better equipped to learn and apply new emotion self-regulation skills due to their more advanced language development and capacity for planning and self-directed behavior. However, the present study leaves unanswered several questions regarding the relationship between age, cognitive maturation, and children’s adoption and maintenance of skills. First, this study did not ascertain the extent to which children employed skills they learned in the intervention or maintained gains beyond the 4-month intervention. During the intervention period, children received regular support from a school-based interventionist. Congruent with the developmental concept of scaffolding, we expect that children’s capacity to use new strategies for emotion self-regulation in an increasingly independent fashion beyond the intervention period will be more dependent on cognitive maturity and executive function skills such as shifting attention, response inhibition, and planning (Pennington and Ozonoff 1996
). Thus, cognitive maturity may be more important for ongoing maintenance and transfer of skills.
A number of questions about the mechanisms whereby this intervention enhanced children’s adaptation can be addressed in future studies. Children learned cognitive and behavioral skills to assist them in monitoring emotions, decreasing emotional reactivity and increasing self-calming, which, according to our intervention model, were posited to reduce individualized, targeted problems. However, cognitive and behavioral skill training may also directly strengthen executive-functioning skills related to academic performance and functioning (Riggs et al. 2006
). Teachers were given information about the skills children learned. Although not specifically trained to teach or ‘coach’ children to use those skills, teachers may have learned new strategies that improved their classroom management and interaction with children. Clarifying the extent to which the gains in children’s adaptation observed in this study were due to children’s adoption of new emotional self-regulation strategies, to enhanced teacher competence with children, or both due to transactional changes in teacher-child interactions, are questions for future research. In addition, few studies have evaluated different components of children’s knowledge and attitudes about skills they learn through interventions, including declarative knowledge, efficacy to use skills, or the extent to which new skills become proceduralized. Developing measures to assess those domains of skill knowledge and testing their impact on mediating improved functioning associated with interventions should be an important priority to clarify and enhance conceptual models underlying skill-based interventions. Further investigation of differences in intervention impact for girls and boys is also warranted. We found that girls benefited more than boys in terms of improved peer social skills, and the reasons are unknown. We note that all Mentors were female. It is possible that congruence of child-Mentor pairs on sex and other characteristics may influence the extent to which children perceive mentors as valid models for assisting them with social skills. How the fit between children and their interventionists on sex and other characteristics influences learning and transfer of cognitive and behavioral skills is an intriguing issue that warrants future study.
The high rate of children’s participation in this intervention trial underscores a strength of school-based programs, which is the ability to provide an accessible intervention to many children who otherwise might not receive services. Currently, approximately one in eight children with an emotional or behavioral disorder ever receive treatment in the mental health system (O’Connell et al. 2009
); in family-based intervention trials, often a large proportion of those eligible never participate in that intervention (Braver and Smith 1996
). In comparison, in the present school-based program that used interventionists employed by and based in schools, most eligible children participated. Over two years, 285 children out of the population of kindergarten—3rd grade children ‘screened positive’ for elevated classroom problems, 261 enrolled in the intervention, and 226 (or 79% of all eligible) completed the four-month follow-up. Among 111 children in the intervention arm, the average number of intervention lessons completed was 12.2 out of 14. In addition to effectiveness, the reach or proportion of the population that participates in or receives an intervention has a major effect on the potential population-level impact of that intervention (Glasgow et al. 2004
). This study demonstrates the potential for the Rochester Resilience Project model to reach large numbers of low income minority children who have low access to mental health services. Determining the efficacy and effectiveness of this intervention under different implementation conditions are also important questions for future research.
The implementation model for this intervention was designed to assist children in adopting skills that they can apply flexibly and appropriately in contexts that present challenges to them. An important aspect of this model is providing opportunities for children to practice skills in ‘hot cognition’ contexts (Damasio 1994
) to promote transfer of new learning, which also requires reinforcement by adults. To further extend and strengthen the transfer of new learning, we suggest several areas for further investigation. First, testing the impact of additional training for teachers in using the intervention skills and addressing specific challenges in supporting children’s use of skills can clarify the role of teachers and other adults in promoting children’s maintenance of skills. Second, additional active cueing or ‘coaching’ of children by school-based interventionists to use skills in different settings and contexts of the school (e.g., hallway transitions) can determine the amounts of in-vivo practice required to assist children in adopting new strategies. The role of parents in reinforcing children’s use of skills should also be investigated; parent involvement and use of skills with their child may be essential to promote skill transfer and maintenance over time.
Several limitations of this study should be noted. Teachers, who were the primary source of information about children’s functioning, were aware of the time-period in which children were receiving intervention or served as controls. Although school records for disciplinary referrals were another source of information, teachers’ knowledge of children’s status could have influenced their propensity to refer children to school administrators to address behavior concerns. Thus, teacher expectations cannot be ruled out as a source of bias. This study’s reliance on teacher ratings also limited the potential to capture children’s internalizing problems; in general, concordance is low between children’s self-report of distress and reports from adults, including teachers (Wyman et al. 2009
). In addition, this wait-listed study did not provide evidence about intervention impact after the intervention period. Assessing the longer-term impact of children’s participation on their functioning in school and in other settings, including peer groups, is needed to determine the potential for the school-based Rochester Resilience Project model to strengthen adaptation among young urban children in adversity.