BOX 6-9

Fast Track: A Comprehensive, Long-Term, Multilevel Intervention for Students at High Risk of Antisocial Behavior

Fast Track is a multisite randomized controlled trial of a comprehensive and extended intervention to prevent antisocial behavior (Conduct Problems Research Group, 1999a, 1999b). Schools in Washington State, North Carolina, Tennessee, and rural Pennsylvania were chosen to participate because they had high rates of crime and poverty in their neighborhoods. Schools at each site were matched on demographics and randomized to the intervention or a usual care control condition. Three successive cohorts of kindergarten students in these schools were screened for teacher-rated conduct problems. Those who scored among the top 40 percent were further screened using parent ratings of behavior problems. The standardized sum of these scores was used to select a sample of 446 control children and 445 intervention children who scored highest in conduct problems.

The intervention continued through 10th grade. In the younger grades, it included parenting behavior management training, social and cognitive skills training for students, tutoring in reading, and home visiting. In 5th and 6th grades there was increased focus on monitoring and limit setting. In 7th and 8th grades, students received lessons on identity and vocational goal setting.

During 7th and 10th grades, assessments occurred three times a year, and further individualized interventions were implemented with each youth, based on his or her behavior and needs. The children and their families were also exposed to the PATHS program (see Box 6-7).

The Conduct Problems Research Group (2007) reports the effects of the intervention as of 9th grade, primary among which was less antisocial behavior for the intervention students. There were no main effects on the incidence of diagnoses of conduct disorder, oppositional defiant disorder, or attention deficit hyperactivity disorder (ADHD). Among the highest-risk youth who received the intervention, only 5 percent received a conduct disorder diagnosis, while 21 percent received it in the usual care condition (the rate was 4 percent in the normative sample). The rate of ADHD diagnosis was also significantly lower in the high-risk intervention sample than in the high-risk usual care sample. It is likely that providing this intervention only to high-risk children would have a favorable benefit-to-cost ratio.

intervention that has already demonstrated positive effects separately. For example, the Linking Interests of Families and Teachers (LIFT) project incorporated behavioral parent skills training and a variant of the Good Behavior Game, with preventive effects sustained at three-year follow-up (Eddy, Reid, and Fetrow, 2000). The Fast Track project (see Box 6-9) incorporates PATHS as one part of a comprehensive, long-term intervention with universal, selective, and indicated components. The long-term effects of Fast Track were most significant for the highest-risk participants.

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