Setting course for every school – it's the turtle's turn

Twiggle the turtle is a furry green puppet who spends his time in classrooms helping preschool children develop their social and emotional learning. He is key player/actor in the PATHs program developed by the Prevention Research Center [1] at Penn State University in the US. [See What prevention science can offer all Ireland's children [2] and Penn State on the PATHS to resilience [3]]

Whenever Twiggle feels sad, angry or worried, he talks about his feelings with Henrietta the hedgehog, Duke the dog and Daphne the duck. When these friends fall out, they try to find ways of getting on better.

Randomized controlled trials have shown that PATHS [4] is effective in different settings and with different children in improving their emotional regulation and reducing behavioral difficulties.

Now Together 4 All is implementing a modified version of PATHS in six primary schools in the Craigavon community outside Belfast. [See: Running the marathon from Craigavon to the cutting-edge [5]]

The short-term goal is to improve the behavior, mutual respect and understanding of children in those neighborhoods, but there is a long-term hope of seeing the program taken to scale – in other words, of getting Twiggle into every school in Northern Ireland.

This is the challenge of what is called ‘Type 2 translation’ – how to integrate proven models into service systems.

Brian Bumbarger and Daniel Perkins from PRC describe the disappointing state of play in a recent article in the UK Journal of Children's Services. They say proven programs are underutilized; they reach only a small proportion of the children who could benefit from them; they are delivered optimally to even fewer children and they are likely to fizzle out after initial testing – as soon as the funding runs out.

Type 2 translational research is investigating these paradoxical waters and trying to expose the factors that contribute to the adoption, quality of implementation and sustainability of proven models.

In the case of T4A, much effort was invested in establishing children’s needs in the area before deciding what services to implement. For example, an epidemiological study involving over 2,200 children between the ages of seven and 18 showed that the behavior of the average child in the T4A areas was worse and levels of conduct disorder significantly higher (20%) than in the UK as a whole (12%).

It uncovered other issues, including poor emotional health, problems with peers and a lack of pro-social skills. Extensive qualitative consultations with 1,600 children and over 700 parents and professionals also highlighted the problem of bullying. PATHS was selected because of its track record in addressing such issues.

T4A set up a headteachers’ forum which meets about once a month to agree all major steps in the project. The forum is said to have been extremely helpful in terms of agreeing the parameters for the work (for example, it must fit with regular school hours and allow teachers sufficient time for lesson preparation).

It also explored the controversial rationale behind RCTs and eventually supported the evaluation. The random allocation was conducted publicly at one of the meetings.

In laying solid foundations T4All matched up to a strategic framework recommended by the Society for Prevention Reasearch.

The second step was “institutional or individual adoption”. In order to encourage take-up of the program, T4A coordinated two study tours including visits to US schools where PATHS is being implemented. There were opportunities to observe the program in action, to talk to staff and children, take photographs and collect materials. Participants also heard from two of the program designers, Mark Greenberg and Celene Domitrovich.

Some previously skeptical head teachers returned with an almost evangelical zeal for the initiative. The principals also agreed to second a teacher from one of the primary schools in the Craigavon area to work on adapting PATHS lesson materials for the Northern Ireland context.

The goal was “adaptation with fidelity”. The adaptations ranged from changing Americanisms – for example, replacing “mad” with “angry” – to identifying suitable supplementary materials and cross-curricular links. Throughout this process of adaptation, there was regular phone contact with the developers to ensure that the modifications were not undermining the logic of the intervention.

Next came steps taken to ensure “effective implementation”. Three prevention coordinators have begun visiting neighborhood schools to model lessons, prepare materials and work one-to-one with children who need extra help. Classroom teachers will also receive two days training from the US PATHS trainers, and other school staff – caretakers, kitchen staff, bus drivers, playground supervisors – will be trained. Each school also has an in-school coordinator.

A plan to ensure “sustainability” is in place. Stakeholders from central government, philanthropy, community groups, schools and other relevant children’s services providers have been involved in the implementation. It should mean there will be a readiness to support the roll-out of the program if it is found to be effective. It should also reduce the likelihood of any bad decision at the start jeopardizing extension of the program later.

A Professor of Education has also been working with T4A to incorporate a unit on mutual respect and understanding and to check that the program meets the requirements of the new Northern Ireland education curriculum.

Finally, the first four years of funding for T4A are guaranteed from philanthropy and there have been talks with government about securing funding subsequently for a wider roll-out or further testing as necessary.

• For Brian Bumbarger and Daniel Perkins’s article “After randomised trials: issues related to the dissemination of evidence-based interventions”, see the Journal of Children’s Services 3 (2), 55-64