Paths of effects from preschool to adult well-being: a confirmatory analysis of the child-parent center program

School engagement, school climate and youth externalizing behaviors: direct and indirect effects of parenting practices

This research aimed to explore the direct and indirect effects of students' school engagement, school climate and parenting practices on youth's externalizing behaviors. A quantitative methodology with a sample of 183 Portuguese students, aged between 11 and 16 years old, was used. The main results suggested negative associations between externalizing behaviors and higher levels of school engagement and positive school climate. Poor parental supervision, inconsistent discipline and corporal punishment were positively related with externalizing behaviors, contrary to parental involvement and positive parenting that were associated with lower levels of externalizing behaviors. However, negative parenting practices were associated with lower levels of school engagement. Additionally, the results indicated that parenting practices might influence youth's externalizing behaviors through school engagement.

Psychological well-being in midlife following early childhood intervention

The present study is the first to examine the relations between participation in a public early childhood intervention (the Child-Parent Center (CPC) program) and psychological well-being (or, positive functioning) into early mid-life. Data are drawn from the Chicago Longitudinal Study (CLS), which has followed a cohort of 1,539 individuals who grew up in urban poverty for over four decades. Approximately two-thirds of the original study cohort participated in the CPC program in early childhood; the rest comprise a demographically matched comparison group. Participants’ psychological functioning at age 35-37 was assessed using the Ryff Scales of Psychological Wellbeing. Results support a positive relationship between CPC preschool participation and long-term psychological wellbeing. Moderated mediation (e.g., whether CPC effects on wellbeing differ across subgroups) and potential mechanisms across multiple social-ecological levels (according to the 5-Hypothesis Model of early intervention) are also empirically investigated. Future directions for child development research, early childhood intervention, and public policy are discussed.

Relationship between parental mental health and developmental disorders in early childhood

Social intervention with children with disabilities and their families should be understood through the principles of family-centred practice. In Spain, early intervention is understood as interventions aimed at children from 0 to 6 years old and their families. Professionals carry out the reception, assessment and intervention. This study aims to analyse the relationship between mental and physical health, caregivers' levels of anxiety and depression and the child's development during the fostering and assessment phase. The sample is made up of 135 families using child development centres in the Balearic Islands. Four questionnaires were completed: Health-Related Quality of Life SF-12, Anxiety and Depression Scale, Child Behaviour Checklist (CBCL 1½-5) and socio-demographic questionnaire. The results show that parents of children with disabilities have higher levels of mental health impairment than physical health impairment. They also score higher on anxiety than on depression. It is worth noting that professional discipline is a variable to be taken into account in relation to parents' perception of their child's developmental improvement. In addition, the association between the developmental subscales, where the more the child is affected, the more the parents' mental health is affected. The same pattern occurs with caregivers' levels of anxiety and depression. In short, we propose a reflection on the application of family-centred practices during interventions, understanding the lack of professional training as a predictor of the quality of early intervention.

Closing Achievement Gaps Through Preschool-To-Third-Grade Programs

Achievement gaps by family income, race, and ethnicity have persisted for decades. Yet only in recent years has this major social problem become a national priority in the U.S. and many other countries as concern rises over growing economic inequalities. In this paper, we document gaps in school readiness and achievement in the U.S. and how they adversely affect the life course development of children and families from underrepresented groups. We emphasize the promising role of preschool-to-3^rd grade (P-3) programs to reduce a variety of achievement gaps through comprehensive strategies that enrich educational and family experiences during most of the first decade of life. Implementation of the core elements of effective learning experiences, collaborative leadership, aligned curriculum, parent involvement and engagement, professional development, and continuity and stability in the Child-Parent Center Program have shown relatively strong and sustained effects on school achievement, especially for Black children growing up in urban poverty. This evidence from the Chicago Longitudinal Study and other projects suggests that broader scale up of truly comprehensive approaches that begin early, continue through most of the first decade, and are multilevel in scope can make a bigger difference than many existing strategies in reducing achievement gaps and their persistence.

Scaffolding Parenting and Health Development for Preterm Flourishing Across the Life Course

Advances in obstetrics and neonatal medicine have resulted in improved survival rates for preterm infants. Remarkably, >75% extremely (<28 weeks) preterm infants who leave the NICU do not experience major neurodevelopmental disabilities, although >50% experience more minor challenges in communication, perception, cognition, attention, regulatory, and executive function that can adversely impact educational and social function resulting in physical, behavioral, and social health issues in adulthood. Even late premature (32-36 weeks) infants have more neurodevelopmental challenges than term infants. Although early intervention and educational programs can mitigate risks of prematurity for children's developmental trajectories, restrictive eligibility requirement and limitations on frequency and intensity mean that many premature infants must "fail first" to trigger services. Social challenges, including lack of family resources, unsafe neighborhoods, structural racism, and parental substance use, may compound biological vulnerabilities, yet existing services are ill-equipped to respond. An intervention system for premature infants designed according to Life Course Health Development principles would instead focus on health optimization from the start; support emerging developmental capabilities such as self-regulation and formation of reciprocal secure early relationships; be tailored to each child's unique neurodevelopmental profile and social circumstances; and be vertically, horizontally, and longitudinally integrated across levels (individual, family, community), domains (health, education), and time. Recognizing the increased demands placed on parents, it would include parental mental health supports and provision of trauma-informed care. This developmental scaffolding would incorporate parenting, health, and developmental interventions, with the aim of improved health trajectories across the whole of the life course.

Assessment of a Comprehensive Early Childhood Education Program and Cardiovascular Disease Risk in Midlife

IMPORTANCE

Educational attainment is an underrecognized factor associated with racial disparities in cardiovascular disease (CVD) risk. Early childhood programs providing comprehensive family services can promote educational and socioeconomic success, but few, if any, studies of large-scale programs have assessed their associations with midlife CVD risk and mediating factors.

OBJECTIVE

To examine the association between an early childhood program providing multisystemic services from ages 3 to 9 years with midlife CVD risk and whether years of education mediate these associations.

DESIGN, SETTING, AND PARTICIPANTS

Using a matched-group, quasi-experimental design, a cohort of Black and Hispanic children in the Chicago Longitudinal Study enrolled in an established early childhood program from 1983 to 1989 or the usual services were followed up for 30 years after the end of the intervention. A midlife survey on well-being was administered when the participants were aged 37 years. Analyses were conducted from September 1, 2020, to October 15, 2020.

INTERVENTION

The Child-Parent Center (CPC) Education Program provides school-based educational enrichment and comprehensive family services for 6 years, from ages 3 to 9 years (preschool to third grade [P-3]).

MAIN OUTCOMES AND MEASURES

General and hard Framingham Risk Scores (FRSs) were calculated from self-reported physical health and behavior profiles in the midlife Chicago Longitudinal Study survey. Years of education completed at age 34 years were measured primarily from administrative records.

RESULTS

There were 1539 participants in the original sample (1430 Black participants [92.9%]; 108 Hispanic participants [7.0%]; 1 White participant [0.1%]); 1104 of 1401 participants (78.8%) in the tracked sample completed a midlife survey on well-being by age 37 years, and 1060 participants had data available for analysis (mean [SD] age, 34.9 [1.4] years; 565 women [53.3%]), including 523 participants who grew up in high-poverty contexts. After adjusting for 17 baseline attributes and differential attrition via propensity score weighting, CPC preschool was associated with significantly lower general FRS (marginal coefficient, -2.2 percentage points [% hereafter]; 95% CI -0.7% to -3.6%; P = .004) and hard FRS (marginal coefficient, -1.6%; 95% CI -0.5% to -2.6%; P = .004), for a 20% reduction in cardiovascular disease risk. The program group was also less likely to have high-risk FRS status, including being in the top quartile of hard FRS (marginal coefficient, -7.2%; 95% CI, -0.3% to -11.6%; P = .02). Those who participated for 4 to 6 years (CPC P-3) had lower general FRS than those who participated for fewer years, but the difference was not significant (marginal coefficient, -1.2%; 95% CI, -2.5% to 0.2%; P = .09); longer participation was associated with placement in the median or higher risk category for general FRS (marginal coefficient, -7.9%; 95% CI -0.7% to -12.4%; P = .007) and hard FRS (marginal coefficient, -9.0%; 95% CI -0.6% to -11.4%; P = .02). Years of education completed by age 34 years accounted for up to 23% of the observed group differences for FRSs, including CPC preschool (general FRS, from -2.16% to -1.66%; difference = -0.5%) and P-3 (general FRS, from -1.16% to -0.71%; difference = -0.45%).

CONCLUSIONS AND RELEVANCE

In this quasi-experimental design study, a comprehensive early childhood program for a community cohort at high risk of disparities was associated with lower CVD risk later in life. Corroborating previous research, years of education through college matriculation accounted for a sizable percentage of this association. Early childhood enrichment may contribute to CVD prevention.

Preschool instructional approaches and age 35 health and well-being

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The association between preschool instruction and age-35 well-being was examined.

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Child-initiated instruction was consistently associated with adult well-being.

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Primarily teacher-directed instruction wasn’t a robust predictor of adult outcomes.

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Prevention efforts should blend child-initiated and teacher-directed instruction.

In this study we sought to explore the association between preschool instructional approach and health and well-being at age 35 for a large sample of low-income children. Participants included 989 low-income, minority children who attended Child-Parent Center preschools as part of the Chicago Longitudinal Study from 1983 to 1985. Preschool curriculum was obtained from teacher reports and validated by program evaluators. These data were categorized by raters as: high teacher-directed and child-initiated; low teacher-directed and child-initiated; low teacher-directed and high child-initiated; or high teacher-directed and low child-initiated. Data on adult outcomes were obtained through surveys and administrative records. Those in preschool classrooms with high teacher-directed and child-initiated instruction had increased odds of having a livable wage (Odds Ratio(OR) = 2.02, p = 0.001), and decreased odds of felony arrest (OR = 0.39; p < 0.001), jail or incarceration (OR = 0.35, p = 0.001), and conviction (OR = 0.52, p = 0.002) at age 35 than those in low teacher-directed and child-initiated classrooms. Participants experiencing low teacher-directed and high child-initiated instruction had increased odds of having a livable wage (OR = 2.01, p = 0.002) and decreased odds of felony arrest (OR = 0.46; p < 0.001), jail or incarceration (OR = 0.53; p = 0.023), and conviction (OR = 0.57, p = 0.01) at age 35. Findings were consistent across many model specifications and adjustments for potential attrition bias. Child-initiated instruction in preschool is a robust predictor of adulthood well-being. Early education prevention efforts to establish a blend of child-initiated and teacher-directed teaching philosophies affords the opportunity for long-term impacts on economic and criminal outcomes in adulthood.

Early child development in low- and middle-income countries: Is it what mothers have or what they do that makes a difference to child outcomes?

Child developmental theories and a large body of literature underscore the importance of both home and preschool influences on early childhood outcomes. We leveraged data from UNICEF'S Multiple Indicator Cluster Surveys, a nationally representative international household survey that has collected cohort comparable information on children's early development in over 118 low- and middle-income countries since 1995. We focused on data from 216,052 3- to 4-year-olds (106,037 girls) from 28 countries that had undertaken at least two surveys from 2010 to 2018. We considered the impact of maternal education and household wealth (what mothers/caregivers have) on home learning activities and sending children to early childhood programs (what mothers/caregivers do), on early child development. Our results indicated that maternal education, household wealth, home learning activities, participation in early childhood education (ECE) and scores on the early childhood development index (ECDI) generally increased over time and were significantly related to each other. Multilevel structural equation modeling revealed the mechanism through which maternal education and household wealth were associated with child outcomes. More wealthy and more educated mothers were more likely to send their child to an ECE program, which was in turn, associated with a higher ECDI score. Caregiver-reported participation in ECE had a large effect on the ECDI score while maternal education had a small effect on it. In comparison the effects of the home learning environment were much smaller. Taken together, findings suggest that education and wealth (what parents have) influence what they do (providing opportunities for learning), which in turn influences early child development. Furthermore, exposure to ECE services was particularly important for children's development. We conclude by discussing the policy implications of our findings and providing suggestions for future research.

Child development as social action: Reflections on four underrated contributions of Edward Zigler to science and society

In a career spanning six decades, Edward Zigler redefined developmental psychology as the equal integration of scientific inquiry and evidence with social policy formulation and analysis to improve child well-being. The theme of his accumulated work was advancing child development as social action for children and families. Besides early childhood intervention and policy, for which he devoted most of his time, Dr. Zigler did pioneering work in education and school reform, social policy, prevention, child maltreatment, family support, developmental disabilities, and in service to government. In this article, I reflect on four of Dr. Zigler's major contributions to science and society that are underrated and, in many respects, under-appreciated in the larger context of the field. These are (a) historical analysis of Head Start, (b) conceptualization and analysis of motivation as a key component of early childhood program impacts, (c) development of preschool-to-third-grade programs and school reforms, and (d) critical analysis of theory, research, policy, and practice. Together, these and other contributions by Dr. Zigler provide a strong foundation to build a better society for all.

Adverse childhood experiences: Mechanisms of risk and resilience in a longitudinal urban cohort

There is an extensive literature describing the detrimental effects of adverse childhood experiences (ACE; e.g., abuse, neglect, and household dysfunction) on physical and mental health. However, few large-scale studies have explored these associations longitudinally in urban minority cohorts or assessed links to broader measures of well-being such as educational attainment, occupation, and crime. Although adversity and resilience have long been of interest in developmental psychology, protective and promotive factors have been understudied in the ACE literature. This paper investigates the psychosocial processes through which ACEs contribute to outcomes, in addition to exploring ways to promote resilience to ACEs in vulnerable populations. Follow-up data were analyzed for 87% of the original 1,539 participants in the Chicago Longitudinal Study (N = 1,341), a prospective investigation of the impact of an Early Childhood Education program and early experiences on life-course well-being. Findings suggest that ACEs impact well-being in low-socioeconomic status participants above and beyond the effects of demographic risk and poverty, and point to possible mechanisms of transmission of ACE effects. Results also identify key areas across the ecological system that may promote resilience to ACEs, and speak to the need to continue to support underserved communities in active ways.

Does early childhood education enhance parental school involvement in second grade?: Evidence from Midwest Child-Parent Center Program

This paper examines the impact on parent involvement in second grade in the Midwest Child-Parent Centers (MCPC), a high-quality preschool-to-third-grade school reform model. A new focus of research on early childhood programs is understanding how early childhood learning gains can be sustained. Two-generation programs that provide diverse family services may be one approach. The MCPC expansion was implemented for a cohort of over 2000 Chicago and Saint Paul students beginning in preschool. Based on a comparison of the program and usual-service comparison groups matched at the school level via propensity scores, ratings were obtained for a subset of the sample by teachers and parents on parent involvement in school in second grade. After accounting for potential attrition bias via multiple imputation and propensity score weighting, results indicated that MCPC participation was associated with significantly higher parent involvement in school at the end of second grade both in the aggregate sample (Effect Size = 0.19 SD) and in Chicago (ES = 0.24). Differences in Saint Paul, however, were small (ES = 0.15) and not statistically significant. Robustness testing using different model specifications revealed similar results. Implications for assessing and sustaining early childhood learning gains are discussed with a focus on recognizing that parental involvement is an integral component of high-quality programs.

Early Childhood Education and Adult Depression: An Attrition Reanalysis With Inverse Propensity Score Weighting

In a previous study of the Child-Parent Centers (CPC) education program, preschool participation was linked to a 4.6 percentage point reduction (26%) in depressive symptoms at ages 22-24 over the matched comparison group enrolling the usual programs. The present study reanalyzed these data in the Chicago Longitudinal Study to address potential attrition bias since more than a quarter of the sample was missing on the outcome. Using inverse probability weighting (IPW) involving 32 predictors of sample retention, findings for the 1,142 participants growing up in high-poverty neighborhoods indicated that CPC participation was associated with a 7.1 percentage point reduction (95% CI = [-9.7, -5.4]) in one or more depressive symptoms (39% reduction over the comparison group). Although this marginal effect was within the confidence interval of the original study (95% CI = [-9.5, 0.3]), the 54% increase in the point estimate is substantial and of practical significance, suggesting underestimation in the prior study. Alternative analysis of different predictors and IPW models, including adjustments for program selection and attrition together, yielded similar results. Findings indicate that high-quality early childhood programs continue to be an important strategy for the prevention of depression and its debilitating effects on individuals and families.

Reducing poverty and inequality through preschool-to-third-grade prevention services

The contributions of psychology to the development and evaluation of preschool-to-third-grade prevention programs are analyzed with an emphasis on poverty alleviation through implementation of effective services for a greater number of children. The need to alleviate poverty and increase economic success is high. Early childhood programs have been found to be an effective strategy for promoting educational success and economic well-being, but the availability of high quality programs that are aligned and integrated with schools across the learning continuum is limited. Psychology has made major contributions to knowledge and practice in (a) defining and evaluating educational enrichment and (b) understanding mechanisms of behavioral change. As an empirical illustration of these contributions for enhancing economic well-being, we report new midlife income data in the Child-Parent Centers, a preschool-to-third-grade program that integrates the two major contributions to improve life course outcomes. Based on a well-matched alternative-intervention design with high sample retention (86%; N = 1,329), findings indicate that participation was associated with a 25% increase in average annual income at age 34 years ($22,708 vs. $18,130; p < .01). Graduates were also more likely to be in the top income quartile (≥$27,500; 30.7% vs. 20.2%; p < .01). Most of the main effects were explained by cognitive, school, and family factors, though further corroboration is needed. Implications for strengthening the impacts of early childhood programs as an avenue for increasing well-being and reducing inequality emphasize redressing ecological barriers, improving continuity and alignment with other strategies, and implementing effectiveness elements widely. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Community-Level Social Determinants and Children's School Readiness

The current study examined links between social determinants across communities and school readiness of children attending kindergarten in each community, in literacy, math, self-regulation, and social skills. Four types of social determinants were explored: socioeconomic, crime/violence, health and well-being, and access to resources. Data came from the Oregon Kindergarten Assessment, with 40,652 entering kindergarteners attending 706 schools in the fall of 2014. The 706 schools were nested within 36 counties. Variables representing social determinants were drawn from a variety of publicly available data sources from the year(s) most recently prior to the 2014-2015 school year. Bayesian multilevel modeling was conducted with children nested within schools, within counties. Children's school readiness in all four domains was negatively predicted by economic disadvantage at the school-level (indicated by other children with whom they attend Kindergarten), accounting for economic disadvantage in their own household. Moreover, school-level economic disadvantage amplified the negative effects of children's economic disadvantage on their school readiness. Four county-level social determinants also predicted one or more of the four school readiness outcomes, accounting for child- and school-level factors: child care supply, behavioral crime, maternal smoking, and adult health. County-level findings should be interpreted with caution due to a small sample and exploratory approach. However, this study is a first step to helping leaders address critical questions about how community risk factors like crime, and resources like child care, relate to school readiness among children in their communities.

Developmental cascade effects of a parenting-focused program for divorced families on competence in emerging adulthood

This 15-year longitudinal follow-up of a randomized controlled trial of a parenting-focused preventive intervention for divorced families examined cascade models of program effects on offsprings' competence. It was hypothesized that intervention-induced improvements in parenting would lead to better academic, work, peer, and romantic competence in emerging adulthood through effects on behavior problems and competencies during adolescence. Families (N = 240) participated in the 11-session program or literature control condition when children were ages 9-12. Data were drawn from assessments at pretest, posttest, and follow-ups at 3 and 6 months and 6 and 15 years. Results showed that initial intervention effects of parenting on externalizing problems in adolescence cascaded to work outcomes in adulthood. Parenting effects also directly impacted work success. For work outcomes and peer competence, intervention effects were moderated by initial risk level; the program had greater effects on youths with higher risk at program entry. In addition, intervention effects on parenting led to fewer externalizing problems that in turn cascaded to better academic outcomes, which showed continuity into emerging adulthood. Results highlight the potential for intervention effects of the New Beginnings Program to cascade over time to affect adult competence in multiple domains, particularly for high-risk youths.

Childhood predictors of adult obesity in the Chicago Longitudinal Study

Despite obesity being a major concern for both children and adults in the United States today, there are few successful childhood interventions that curb obesity later in life. The objective of the current study is to identify childhood predictors of adult obesity at multiple levels in a large longitudinal sample of participants from an economically disadvantaged childhood cohort. 1065 participants (93% Black) from the Chicago Longitudinal Study were interviewed as part of a 30-year follow-up between 2012 and 2017. Parent involvement, school quality, neighborhood human capital, socioemotional learning skills, and achievement motivation assessed before age 12 years were examined as predictors of Body Mass Index (BMI) at age 35 years. Child neighborhood human capital and socioemotional learning skills predicted a lower BMI in adulthood and a decreased likelihood of being classified as obese; when separately analyzed by sex, both neighborhood human capital and higher socioemotional learning skills predicted a decreased likelihood of obesity for males and females. Being female and higher birthweight were associated with larger adult BMI. Socioemotional learning and neighborhood human capital in childhood consistently predict a decreased likelihood of being obese at age 35 in this predominately Black sample. Future obesity intervention/prevention programs should aim to bolster childhood socioemotional learning resources and neighborhood capital.

Thirty years later: Locating and interviewing participants of the Chicago Longitudinal Study

Retaining study participants over time is essential for longitudinal studies to prevent selection bias and to achieve their long-term goals. The present paper examines the extent to which participants can be retained in a 30-year longitudinal study when a multi-pronged approach is employed. The paper specifically describes the approach that was used to locate and interview participants of the Chicago Longitudinal Study (CLS), three decades after the study began. The CLS is a prospective cohort investigation that examines the effects of the Child-Parent Center (CPC) program, a school-based intervention for low-income children from preschool through 3rd grade. The original CLS sample included a complete cohort of 1,539 children who were born in low-income areas in 1979-1980 and attended kindergarten in 1985-1986 at Chicago Public Schools. The CLS conducted a follow-up survey when participants were approximately age 35. After relatively slow initial progress, CLS researchers developed a comprehensive strategy to locate and interview participants, including: (a) adoption of detailed, manualized tracking protocol, (b) utilization of multiple search platforms, ranging from public search engines to social media, (c) assistance from state correctional facilities, and (d) neighborhood canvassing and in-person interviews. This tracking and interview process facilitated 735 completed interviews within 27 months, compared to 370 completed interviews in the 32 months prior to the launch of the comprehensive tracking protocol. Altogether, 1,105 interviews were conducted, representing an effective completion rate of 76.5%. Recommendations for strengthening response rates in other longitudinal studies are discussed.

A scoping review of mental health prevention and intervention initiatives for infants and preschoolers at risk for socio-emotional difficulties

BACKGROUND

Infant mental health has emerged as a unique area of practice and research distinguished from child and youth sub-specialties by its advocacy for a relational practice framework with an emphasis on parents/caregivers being integral to assessment, treatment, and prevention initiatives. A diverse array of initiatives offered across a broad spectrum of delivery methods is available to clinicians. However, to date, a large-scale mapping of the research evidence regarding these interventions has yet to be completed to help inform clinician's decisions regarding the best approaches for their clients. To address this knowledge gap, this study aimed to report on the landscape of research pertaining to mental health interventions for infants and preschoolers (0-5 years), and their families at risk for socio-emotional difficulties and negative developmental outcomes.

METHOD

A scoping review methodology was used to conduct a large-scale mapping of the intervention research pertaining to infants and preschoolers (0-5) at risk for socio-emotional difficulties. We searched MEDLINE, PsycINFO, EMBASE, Web of Science, The Cochrane Library, CINAHL, LILACS, ProQuest Nursing & Allied Health Source, World Cat, and ClinicalTrials.gov , from inception to December 31, 2012. We extracted information regarding publication date, geographical location, study design, level of risk, population, key intervention mechanism, and outcome measures.

RESULTS

We identified 533 potential studies from 1233 title and abstracts after the first round of screening. Full text article review in the second round of screening resulted in a total of 162 included articles for the final analysis. Results indicated that over 50% of interventions evaluated were randomized controlled trials conducted in Westernized countries. Most studies could be subdivided by level of risk within a preventative public health framework including universal, selected, indicated, and direct treatment for children formally diagnosed with a mental disorder. Risk factors experienced by children and their families were heterogeneously defined and numerous outcome measures across included studies. The results of this study are limited to the last search date of 2012.

CONCLUSIONS

Key intervention mechanisms spanned a range of approaches including parenting groups, dyadic, in-home, cognitive-behavioral therapy, and day care-based interventions. The findings are discussed in terms of implications for broad trends and gaps in research and policy for this population.

Dosage Effects in the Child-Parent Center PreK-to-3rd Grade Program: A Re-Analysis in the Chicago Longitudinal Study

Although substantial investments in early childhood intervention have continued, whether gains are sustained past kindergarten for routinely implemented programs is a critical research need. Using data from the Chicago Longitudinal Study (CLS; N=1,539; 50.3% female; 92.9% African American and 7.1% Hispanic), an on-going investigation of the Child-Parent Center (CPC) program for an inner-city cohort, this study investigates the effects of program duration from preschool to 3rd grade on school outcomes and whether the effects differ by gender. Regression analyses are conducted to compare the differences in outcomes among intervention groups. Inverse probability weighting (IPW) is used to adjust for potential attrition and selection biases. Findings indicate that relative to the preschool plus kindergarten (P-K) group, participation from preschool through third grade (P-3) is significantly associated with better academic functioning at both 3rd and 8th grades, better classroom adjustment at 3rd grade, lower rates of retention and school mobility, and few years of special education. Relative to the preschool through second grade (P-2) group, the P-3 group has significantly higher academic functioning in third grade. Results suggest that the P-3 dosage is associated with larger effects on academic functioning for girls and larger effects on social-emotional functioning for boys compare to the P-K dosage. Findings suggest that receiving up to third grade (P-3) of an early childhood education program have associated with persistent effects on developmental outcomes compared to the dosages of P-K. Multi-year programs have the potential to sustain early childhood gains and promote healthy development via improving academic functioning and school experiences.

The Legacy for Children™ Randomized Control Trial: Effects on Cognition Through Third Grade for Young Children Experiencing Poverty

OBJECTIVE

In an effort to promote the health and developmental outcomes of children born into poverty, the Centers for Disease Control and Prevention (CDC) conceptualized and designed the Legacy for Children™ (Legacy) public health prevention model. This article examines the impact of Legacy on children's cognitive and language development (intelligence quotient [IQ], achievement, language skills, and early reading skills) using both standardized assessments and parent-reported indictors through third grade.

METHODS

Data were collected from 2001 to 2014 from 541 mother-child dyads who were recruited into the 2 concurrent randomized controlled trials of Legacy in Miami and Los Angels. Cognitive and/or language outcomes of children were assessed annually from age 2 to 5 years as well as during a follow-up visit in the third grade.

RESULTS

Children experiencing Legacy at the Los Angeles site had significantly higher IQ and achievement scores at 2 and 6 years postintervention, equivalent to approximately one-third of an SD (4 IQ points). IQ results persisted over time, and the difference between intervention and comparison groups on achievement scores widened. There were no significant differences in cognitive outcomes in the Miami sample. There were no significant differences in language outcomes for either site.

CONCLUSION

Legacy shows evidence of effectiveness as an intervention to prevent cognitive delays among children living in poverty. The mixed findings across sites may not only reflect the impact of heterogeneous risk profiles noted by other intervention research programs but also warrant additional study.

A Multicomponent, Preschool to Third Grade Preventive Intervention and Educational Attainment at 35 Years of Age

IMPORTANCE

Educational attainment is the leading social determinant of health, but few studies of prevention programs have examined whether the programs are associated with educational attainment outcomes after the mid-20s, especially for large-scale programs that provide a longer duration of services.

OBJECTIVE

To examine the association between a preschool to third grade intervention and educational attainment at midlife and differences by program duration, sex, and parental educational level.

DESIGN, SETTING, AND PARTICIPANTS

This matched-group, alternative intervention study assessed 1539 low-income minority children born in 1979 or 1980 who grew up in high-poverty neighborhoods in Chicago, Illinois. The comparison group included 550 children primarily from randomly selected schools participating in the usual early intervention. A total of 989 children who entered preschool in 1983 or 1984 and completed kindergarten in 1986 were included in the Chicago Longitudinal Study and were followed up for 27 to 30 years after the end of a multicomponent intervention. A total of 1398 participants (90.8%) in the original sample had educational attainment records at 35 years of age. The study was performed from January 1, 2002, through May 31, 2015.

INTERVENTIONS

The Child-Parent Center Program provides school-based educational enrichment and comprehensive family services from preschool to third grade (ages 3-9 years).

MAIN OUTCOMES AND MEASURES

Educational outcomes from administrative records and self-report included school dropout, 4-year high school graduation, years of education, postsecondary credential, and earned degrees from associate's to master's or higher.

RESULTS

A total of 1539 participants (mean [SD] age, 35.1 [0.32] years; 1423 [92.9%] black and 108 [7.1%] Hispanic) were included in the study. After weighting on 2 propensity scores, preschool participants had higher rates of postsecondary degree completion, including associate's degree or higher (15.7% vs 10.7%; difference, 5.0%; 95% CI, 1.0%-9.0%), master's degree (4.2% vs 1.5%; difference, 2.7%; 95% CI, 1.3%-4.1%), and years of education (12.81 vs 12.32; difference, 0.49; 95% CI, 0.20-0.77). Duration of participation showed a consistent linear association with outcomes. Compared with fewer years, preschool to second or third grade participation led to higher rates of associate's degree or higher (18.5% vs 12.5%; difference, 6.0%; 95% CI, 1.0%-11.0%), bachelor's degree (14.3% vs 8.2%; difference, 6.1%; 95% CI, 1.3%-10.9%), and master's degree or higher (5.9% vs 2.3%; difference, 3.6%; 95% CI, 1.4%-5.9%). The pattern of benefits was robust and favored male participants for high school graduation, female participants for college attainment, and those from lower-educated households.

CONCLUSIONS AND RELEVANCE

This study indicates that an established early and continuing intervention is associated with higher midlife postsecondary attainment. Replication and extension of findings to other locations and populations should further strengthen confidence in the health benefits of large-scale preventive interventions.

Chronic absence, eighth-grade achievement, and high school attainment in the Chicago Longitudinal Study

Although not as commonly reported as average daily attendance, chronic absence data may be of significant importance for understanding student success. Using data from 1148 participants in the Chicago Longitudinal Study, we assessed the associations of chronic absence in the early middle grades, grades fourth through sixth, with eighth-grade achievement and three measures of high school attainment including four-year graduation by diploma, graduation by diploma by age 21, and any high school completion by age 21. The rate of chronic absenteeism, defined here as students missing approximately 14days of school or more in a year, was 15%. Using Ordinary Least Squares, probit regression, and inverse-probability-weighting regression-adjustment methods (IPWRA), results indicated that chronic absence in the early middle grades was negatively associated (d=-0.17) with eighth-grade math achievement and reduced the probability of four-year graduation by diploma by 18 percentage points, graduation by diploma by age 21 by 17 percentage points, and any high school completion by age 21 by 11 percentage points. IPWRA yielded similar estimates. Coefficients varied by subgroup with males and children of mothers who completed high school experiencing more detrimental effects. Associations of chronic absence with outcomes are important to understand because school interventions and practices which begin early can be effective in reducing the prevalence of absenteeism.

The Costs and Benefits of Investing in Universal Preschool: Evidence From a Spanish Reform

This study provides a cost-benefit analysis of expanding access to universal preschool education, focusing on a Spanish reform that lowered the age of eligibility for publicly provided universal preschool from age 4 to age 3. Benefits in terms of child development and maternal employment are estimated using evidence on the causal effects of this reform. In the baseline estimation the benefit-cost ratio is over 4, indicating sizeable net societal benefits of the preschool investment. The results show that the child development effects are the major determinant of the cost-benefit ratio; the employment gains for parents appear to play a relatively minor role. Overall, the cost-benefit analysis provides support for investing in high-quality preschool education.

[Prevalence of neurodevelopmental, behavioural and learning disorders in Pediatric Primary Care]

OBJECTIVES

To determine the prevalence of psychiatric disorders in primary care pediatrics in Atlantic Galicia.

METHODS

An observational, descriptive, cross-sectional prevalence study was carried out in 9 outpatient clinics in A Coruña and Pontevedra with a population of 8293 children between September and November 2015. A total of 1286 randomly selected patients from 0 to 14 years of age were included. From the medical history was registered: age, sex, psychiatric diagnosis established by DSM-IV-TR criteria in its five axes, professionals who participated in the diagnosis and treatment of the process and what type of treatment was received. Authorization was obtained from the Research Ethics Committee of Galicia number 2015/427.

RESULTS

148 of 1286 patients presented psychiatric pathology (11,5% IC 95% 9.73-13,29), 68% male. Between 0 and 5years, the prevalence was 4.5%; between 6y and 10y, 18.5% and between 11y and 14y 22%. Symptoms lasted a median of 25 months. The most frequent pathologies in 1286 patients were ADHD (5.36%), language disorders (3.42%), learning disorders (3.26%), anxiety-depressive disorders (2.4%) and behavior disorders (1.87%). Of the 148 cases, 47% had comorbidity with another mental disorder. Most of them required attention by multiple social, health and educational professionals; 33% received psychopharmacological treatment.

CONCLUSIONS

The prevalence of psychiatric disorders in pediatric primary care is frequent, chronic and complex, increases with age and requires many health, educational and social resources.

Impacts of Early Childhood Education on Medium- and Long-Term Educational Outcomes

Despite calls to expand early childhood education (ECE) in the United States, questions remain regarding its medium- and long-term impacts on educational outcomes. We use meta-analysis of 22 high-quality experimental and quasi-experimental studies conducted between 1960 and 2016 to find that on average, participation in ECE leads to statistically significant reductions in special education placement (d = 0.33 SD, 8.1 percentage points) and grade retention (d = 0.26 SD, 8.3 percentage points) and increases in high school graduation rates (d = 0.24 SD, 11.4 percentage points). These results support ECE's utility for reducing education-related expenditures and promoting child well-being.

Predictors of Depressive Symptoms in Emerging Adulthood in a Low-Income Urban Cohort

This study examined predictors of depressive symptoms in emerging adulthood in a sample of 1,142 individuals (94% African American) who grew up in urban poverty. Data were drawn from a longitudinal study that followed participants from age five and included participant, parent, and teacher surveys, and administrative records. Depressive symptoms were self-reported at age 22-24 using a modified version of the Brief Symptom Inventory (BSI; Derogatis, 1975). Binary logistic regression analyses identified several significant predictors of depressive symptoms in emerging adulthood, including: sex, adverse childhood experiences (ACE) score, socio-emotional adjustment in the classroom, juvenile arrest, and on-time graduation. Significant sex differences were also detected, with the final models fitting the male sample better than the full study or female samples. Implications for future research and intervention are discussed.

Processes of Early Childhood Interventions to Adult Well-Being

This article describes the contributions of cognitive-scholastic advantage, family support behavior, and school quality and support as processes through which early childhood interventions promote well-being. Evidence in support of these processes is from longitudinal cohort studies of the Child-Parent Centers and other preventive interventions beginning by age 4. Relatively large effects of participation have been documented for school readiness skills at age 5, parent involvement, K-12 achievement, remedial education, educational attainment, and crime prevention. The three processes account for up to half of the program impacts on well-being. They also help to explain the positive economic returns of many effective programs. The generalizability of these processes is supported by a sizable knowledge base, including a scale up of the Child-Parent Centers.

Generative Mechanisms in Early Childhood Interventions: A Confirmatory Research Framework for Prevention

This article reviews methodological and analytic approaches and impact evidence for understanding the mechanisms of effects of early childhood interventions, including delinquency and violence prevention. Illustrations from longitudinal studies of preschool preventive interventions are provided. We restrict our attention to preventive interventions for children from birth to age 5, including evidence from the Chicago Longitudinal Study (CLS), which investigates the impact of an established school-based early childhood intervention. Frameworks and evidence will be organized according to the Five-Hypothesis Model (5HM), which postulates that a variety of early childhood interventions impact later well-being through the promotion of cognitive and scholastic advantages, motivational advantages, social adjustment, family support behaviors, and school supports. Recommendations are made for advancing confirmatory approaches for identifying the most effective prevention programs using identification of generative mechanisms as a major methodological criterion.

Multi-Site Expansion of an Early Childhood Intervention and School Readiness

OBJECTIVES

To evaluate the impacts of the expansion of an evidence-based full- and part-day early childhood development program on multiple indicators of school readiness, attendance, and parental involvement for a large cohort of low-income children.

METHODS

This study involved the end-of-preschool follow-up of a nonrandomized, matched-group cohort of 2630 predominantly low-income, ethnic minority children who enrolled in the Midwest Child-Parent Centers (CPC) or alternative preschools in the fall of 2012 in 31 schools in Chicago, Illinois. The program provides comprehensive education, family support, and health services. In the preschool component assessed in this study, 1724 children aged 3 to 4 years in all 16 Chicago centers enrolled in the program. The comparison group included 906 children of the same age who participated in the usual preschool services in 14 matched schools.

RESULTS

Relative to the comparison group who enrolled in the usual preschool services and adjusted for covariates, CPC participants had higher mean scores on all performance-based assessments of literacy (59.4 vs 52.4; P = .001), socioemotional development (57.0 vs 51.8; P = .001), and physical health (34.5 vs 32.1; P = .001). They also had higher ratings of parental involvement in school (5.3 vs 4.0; P = .04). Group differences also translated into higher rates of meeting national assessment norms. Program estimates were similar for children attending new and established CPCs and according to age, race/ethnicity, and family income status.

CONCLUSIONS

The findings show that expansion of the program to new schools and more diverse populations is feasible and effective in promoting school readiness skills and parental involvement.

Conceptualizing and Measuring Safe, Stable, Nurturing Relationships and Environments in Educational Settings

Most children and adolescents older than five years spend at least six hours of their day in school settings. Like parents, education professionals can promote health and protect youth from harm by providing safe, stable, nurturing relationships and environments. The Centers for Disease Control and Prevention (CDC) has developed a framework which posits that safe, stable, nurturing relationships and environments are Essentials for Childhood and are fundamental to promoting health and well-being; protecting youth from maltreatment and other violence and victimization; and ensuring optimal, healthy development. In this paper, the authors propose an approach to applying safe, stable, nurturing relationships and environments to the school ecology; review select survey measures to examine these constructs within educational settings; and suggest available indicators to measure safety, stability, and nurturance within the school context.

Adverse Childhood Experiences and Adult Well-Being in a Low-income, Urban Cohort

OBJECTIVE

This study tests the association between adverse childhood experiences (ACEs) and multidimensional well-being in early adulthood for a low-income, urban cohort, and whether a preschool preventive intervention moderates this association.

METHODS

Follow-up data were analyzed for 1202 low-income, minority participants in the Chicago Longitudinal Study, a prospective investigation of the impact of early experiences on life-course well-being. Born between 1979 and 1980 in high-poverty neighborhoods, individuals retrospectively reported ACEs from birth to adolescence, except in cases of child abuse and neglect.

RESULTS

Nearly two-thirds of the study sample experienced ≥1 ACEs by age 18. After controlling for demographic factors and early intervention status, individuals reporting ACEs were significantly more likely to exhibit poor outcomes than those with no ACEs. Those with ≥4 ACEs had significantly reduced likelihood of high school graduation (odds ratio [OR] = 0.37; P < .001), increased risk for depression (OR = 3.9; P < .001), health compromising behaviors (OR = 4.5; P < .001), juvenile arrest (OR = 3.1; P < .001), and felony charges (OR = 2.8; P < .001). They were also less likely to hold skilled jobs (OR = 0.50; P = .001) and to go further in school even for adversity measured by age 5.

CONCLUSIONS

ACEs consistently predicted a diverse set of adult outcomes in a high-risk, economically disadvantaged sample. Effective and widely available preventive interventions are needed to counteract the long-term consequences of ACEs.

Classroom Quality at Pre-kindergarten and Kindergarten and Children's Social Skills and Behavior Problems

Focusing on the continuity in the quality of classroom environments as children transition from preschool into elementary school, this study examined the associations between classroom quality in pre-kindergarten and kindergarten and children's social skills and behavior problems in kindergarten and first grade. Participants included 1175 ethnically-diverse children (43% African American) living in low-wealth rural communities of the US. Results indicated that children who experienced higher levels of emotional and organizational classroom quality in both pre-kindergarten and kindergarten demonstrated better social skills and fewer behavior problems in both kindergarten and first grade comparing to children who did not experience higher classroom quality. The examination of the first grade results indicated that the emotional and organizational quality of pre-kindergarten classrooms was the strongest predictor of children's first grade social skills and behavior problems. The study results are discussed from theoretical, practical, and policy perspectives.

Using Benefit-Cost Analysis to Scale Up Early Childhood Programs through Pay-for-Success Financing

Increasing access to high-quality preschool programs is a high priority at local, state, and federal levels. Recently, two initiatives to expand preschool programming in Illinois and Utah have used funds from private investors to scale up existing programs. Private-sector social impact investors provide funding to nonprofit or public preschool providers to increase the number of children served. If the measured outcomes from preschool participation meet pre-determined goals, then the estimated government cost savings arising from these preschool interventions are used to repay the investors. Social impact investing with a "Pay for Success" contract can help budget-constrained governments expand proven or promising preventive interventions without the need to increase taxes. Cost-benefit analysis plays a crucial role in helping to identify which social, educational or health interventions are suitable for this type of innovative financing. Cost-benefit analysts are needed to design the structure of the success payments that the government will make to the private investors. This paper describes social impact borrowing as a new method for financing public services, outlines the contribution of cost-benefit analysis, and discusses the innovative use of social impact financing to promote scaling up of the evidence-based Child Parent Centers and other early childhood programs.

Association of a full-day vs part-day preschool intervention with school readiness, attendance, and parent involvement

IMPORTANCE

Early childhood interventions have demonstrated positive effects on well-being. Whether full-day vs part-day attendance improves outcomes is unknown.

OBJECTIVE

To evaluate the association between a full- vs part-day early childhood program and school readiness, attendance, and parent involvement.

DESIGN, SETTING, AND PARTICIPANTS

End-of-preschool follow-up of a nonrandomized, matched-group cohort of predominantly low-income, ethnic minority children enrolled in the Child-Parent Centers (CPC) for the full day (7 hours; n = 409) or part day (3 hours on average; n = 573) in the 2012-2013 school year in 11 schools in Chicago, Illinois.

INTERVENTION

The Midwest CPC Education Program provides comprehensive instruction, family-support, and health services from preschool to third grade.

MAIN OUTCOMES AND MEASURES

School readiness skills at the end of preschool, attendance and chronic absences, and parental involvement. The readiness domains in the Teaching Strategies GOLD Assessment System include a total of 49 items with a score range of 105-418. The specific domains are socioemotional with 9 items (score range, 20-81), language with 6 items (score range, 15-54), literacy with 12 items (score range, 9-104), math with 7 items (score, 8-60), physical health with 5 items (score range, 14-45), and cognitive development with 10 items (score range, 18-90).

RESULTS

Full-day preschool participants had higher scores than part-day peers on socioemotional development (58.6 vs 54.5; difference, 4.1; 95% CI, 0.5-7.6; P = .03), language (39.9 vs 37.3; difference, 2.6; 95% CI, 0.6-4.6; P = .01), math (40.0 vs 36.4; difference, 3.6; 95% CI, 0.5-6.7; P = .02), physical health (35.5 vs 33.6; difference, 1.9; 95% CI, 0.5-3.2; P = .006), and the total score (298.1 vs 278.2; difference, 19.9; 95% CI, 1.2-38.4; P = .04). Literacy (64.5 vs 58.6; difference, 5.9; 95% CI, -0.07 to 12.4; P = .08) and cognitive development (59.7 vs 57.7; difference, 2.0; 95% CI, -2.4 to 6.3; P = .38) were not significant. Full-day preschool graduates also had higher rates of attendance (85.9% vs 80.4%; difference, 5.5; 95% CI, 2.6-8.4; P = .001) and lower rates of chronic absences (≥10% days missed; 53.0% vs 71.6%; difference, -18.6; 95% CI, -28.5 to -8.7; P = .001; ≥20% days missed; 21.2% vs 38.8%; difference -17.6%; 95% CI, -25.6 to -9.7; P < .001) but no differences in parental involvement.

CONCLUSIONS AND RELEVANCE

In an expansion of the CPCs in Chicago, a full-day preschool intervention was associated with increased school readiness skills in 4 of 6 domains, attendance, and reduced chronic absences compared with a part-day program. These findings should be replicated in other programs and contexts.

Effects of Head Start REDI on children's outcomes 1 year later in different kindergarten contexts

One year after participating in the Research-based, Developmentally Informed (REDI) intervention or "usual practice" Head Start, the learning and behavioral outcomes of 356 children (17% Hispanic, 25% African American; 54% girls; Mage  = 4.59 years at initial assessment) were assessed. In addition, their 202 kindergarten classrooms were evaluated on quality of teacher-student interactions, emphasis on reading instruction, and school-level student achievement. Hierarchical linear analyses revealed that the REDI intervention promoted kindergarten phonemic decoding skills, learning engagement, and competent social problem-solving skills, and reduced aggressive-disruptive behavior. Intervention effects on social competence and inattention were moderated by kindergarten context, with effects strongest when children entered schools with low student achievement. Implications are discussed for developmental models of school readiness and early educational programs.

School-based early childhood education and age-28 well-being: effects by timing, dosage, and subgroups

Advances in understanding the effects of early education have benefited public policy and developmental science. Although preschool has demonstrated positive effects on life-course outcomes, limitations in knowledge on program scale, subgroup differences, and dosage levels have hindered understanding. We report the effects of the Child-Parent Center Education Program on indicators of well-being up to 25 years later for more than 1400 participants. This established, publicly funded intervention begins in preschool and provides up to 6 years of service in inner-city Chicago schools. Relative to the comparison group receiving the usual services, program participation was independently linked to higher educational attainment, income, socioeconomic status (SES), and health insurance coverage, as well as lower rates of justice-system involvement and substance abuse. Evidence of enduring effects was strongest for preschool, especially for males and children of high school dropouts. The positive influence of four or more years of service was limited primarily to education and SES. Dosage within program components was mostly unrelated to outcomes. Findings demonstrate support for the enduring effects of sustained school-based early education to the end of the third decade of life.

Age 26 cost-benefit analysis of the child-parent center early education program

Using data collected up to age 26 in the Chicago Longitudinal Study, this cost-benefit analysis of the Child-Parent Centers (CPC) is the first for a sustained publicly funded early intervention. The program provides services for low-income families beginning at age 3 in 20 school sites. Kindergarten and school-age services are provided up to age 9 (third grade). Findings from a complete cohort of over 1,400 program and comparison group participants indicated that the CPCs had economic benefits in 2007 dollars that exceeded costs. The preschool program provided a total return to society of $10.83 per dollar invested (18% annual return). The primary sources of benefits were increased earnings and tax revenues and averted criminal justice system costs. The school-age program had a societal return of $3.97 per dollar invested (10% annual return). The extended intervention program (4-6 years) had a societal return of $8.24 (18% annual return). Estimates were robust across a wide range of analyses including Monte Carlo simulations. Males, 1-year preschool participants, and children from higher risk families derived greater benefits. Findings provide strong evidence that sustained programs can contribute to well-being for individuals and society.

Paths of effects from preschool to adult well-being: a confirmatory analysis of the child-parent center program

The current study investigated the contribution of 5 hypotheses to the estimated effects of preschool in the Child-Parent Centers on occupational prestige, felony arrest, and depressive symptoms in adulthood in the Chicago Longitudinal Study. An alternative-intervention, quasi-experimental design included over 1,400 low-income participants (93% of whom were Black) who attended preschool for 1-2 years or the usual early educational intervention and were traced to age 24. LISREL analysis of 5 hypotheses (cognitive advantage, family support, school support, motivational advantage, and social adjustment) indicated that while each individually accounted for part of the estimated direct effect of preschool on adult well-being, the best fitting model across outcomes included indicators of all 5 hypotheses. The full model completely accounted for the direct effect of preschool on occupational prestige and official felony arrest, and 79% on depression symptoms. Key mediators included cognitive skills at school entry, school quality in the elementary grades, juvenile arrest, and school completion. The identified processes may help establish, strengthen, and sustain effects in other programs and settings.

How do we assess family supports and fairness in early intervention?

Public Law 99-457 extended the landmark Public Law 94-142 legislation to include early intervention for infants and toddlers with or at-risk for development of developmental disabilities. Currently over 300,000 infants and toddlers and their families in the United States receive services through Part C of the Individuals with Disabilities Education legislation. The law fostered interagency collaborations and included the child's parent or caregiver as an integral part of the intervention team. This article reviews the 26 years of legislation associated with educating young children with disabilities and the resulting early intervention service delivery system. Analyses and review of studies of Part C services are offered to inform policies that enhance early identification, family engagement, and intervention delivery.

Early Childhood to Young Adulthood: An Introduction to the Special Issue

The identification and understanding of alterable influences on well-being are at the nexus of developmental science and social policy. These influences span the life course but child, family, and school experiences in the first two decades are particularly instrumental to health and well-being. To investigate some of these influences, we report data from the Chicago Longitudinal Study. The study investigates the life course development of 1,539 children (93% African American and 7% Hispanic) who were born in 1979-1980, grew up in the highest-poverty neighborhoods in Chicago, and attended early childhood intervention programs beginning in preschool. The goals of the study are to determine the effects of participation in the Child-Parent Center Program, document patterns of child and family well-being over time, and identify child, family, school, and community factors that can promote children's well being. We describe major intervention findings and summarize the contributions of a variety of personal, family, and school experiences in promoting multiple domains of well-being.