tion programs, school is only one of several components that also may include family or community-based interventions. However, given the extra costs associated with multicomponent interventions, they are more often used with either selective or indicated models (e.g., the Incredible Years; Webster-Stratton, 1998), or with universal models that occur in high-risk neighborhood schools (e.g., Seattle Social Development project; Hawkins, Kosterman, et al., 2005).
In one study of scale-up of an intervention to help foster parents improve their children’s emotional and behavioral functioning (Multidimensional Treatment Foster Care), a “cascading training model” was used and tested for effectiveness. After an initial phase representing an efficacy trial, a second phase of treatment for foster parents was delivered by paraprofessionals, who were intensively overseen by an onsite supervisor and an experienced clinical consultant. During a third phase, the paraprofessionals trained a second cohort of staff. In this phase, the clinical consultants oversaw the supervision but did not have any direct contact with the new staff. The evaluation found that both phases resulted in decreases in children’s problem behaviors, with no significant difference between the two phases. This suggests that intensive training and supervision can enable “third-generation” staff to scale up and implement an intervention with fidelity (Price, Chamberlain, et al., 2008).
Few preventive interventions have been tested in primary care settings, although collaborative treatment models involving primary care and behavioral health staff have begun to emerge (Forrest, Glade, et al., 1999; Guevara, Rothbard, et al., 2007), and physicians should routinely screen for behavioral and developmental concerns (see Chapter 8). Pediatric primary care settings are seeing significant numbers of patients with mental health problems (Horowitz, Leaf, et al., 1992; Briggs-Gown, Horwitz, et al., 2000; Kelleher, McInerney, et al., 2000), with some estimates that the number of office visits for mental health problems has increased by 2.5 (Kelleher, McInerney, et al., 2000; Zito, Safer, et al., 1999). One promising primary care intervention involves a strategy to encourage teens to use a primary care Internet-based intervention to prevent depression (Van Voorhees, Ellis, et al., 2007). As outlined in Chapter 8, primary care settings represent a significant opportunity for development of new approaches to identify and respond to parents’ concerns about their children’s behavioral and