the impacts of thresholds of quality in this and other scales measuring early childhood care and education environments is currently lacking. Nursery and preschool programs represent a clear opportunity to intervene early in the lives of young children.

Implementation of Prevention Programs in Schools

The implementation of universal school-based interventions faces considerable challenges, including access to and approval of schools that are often overburdened with other academic and policy-related priorities. Multiple levels of approval from superintendents, principals, teachers, and school boards and community partners may also be required. In addition, the relatively low dosage that is common to most universal strategies may not offer sufficient exposure to impact children already at very high risk for a specific disorder (e.g., depression or anxiety). Universal interventions are likely to be most effective when they have sufficient duration and intensity, target the development of protective factors and resilience likely to impact risk for multiple disorders, or target problems common to a large segment of the population (e.g., bullying, early alcohol use).

Nevertheless, there are several opportunities for successful implementation in schools, particularly since there has been a substantial change in legislation focused on evidence-based prevention at both the federal and state levels. Two dramatic examples are the Safe and Drug-Free Schools Act of 1999, which states “principles of effectiveness,” and the No Child Left Behind Act of 2001 (NCLB), which calls for school districts to implement evidence-based programming (Hallfors and Godette, 2002). Other opportunities have been created by several state legislatures that have mandated the use of character education in schools.

Prevention programs relevant to schools focus on the school and its structure (organizational features, school rules), classroom behavior management, and curricula that teach students new skills, recently termed social-emotional learning (see Chapters 6 and 7). Some form of curricula-oriented prevention programs for substance abuse is in a large number of the nation’s middle schools.

Schools have also become a venue for both targeted and indicated interventions. As an example, Title I Part A provides additional funding to schools that have poverty levels above 40 percent, and such programs can be delivered either universally or in a targeted fashion to those at higher risk. Some school-based indicated interventions focus on children who are showing early indications of a potential disorder (e.g., high rates of aggressive behavior, anxiety, depression, or other forms of maladjustment). These interventions are also usually provided in special groups, and most support the development of social and emotional learning skills. For some preven-

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