Incorporating Well-Adjusted Peers in a Conduct Problems Prevention Program: Evaluation of Acceptability, Fidelity, and Safety of Implementation

In order to prevent iatrogenic effects associated with interventions that aggregate youth with behavior problems and to promote the integration of these youth into normative peer groups, a comprehensive evidence-based prevention program, Early Risers “Skills for Success” (August et al. in Preventing substance abuse: science-based programs for children and adolescents, American Psychological Association, Washington, 2007), was augmented to include well-adjusted children in a strategic peer affiliation component, or buddy system. A total of 190 kindergartners and first graders from five schools in a Midwestern US city were randomly assigned by school to receive the program or serve as controls. In the first summer program component, the children received 72 h of programming in academics, social skills, and creative arts, all within a highly structured social environment. The feasibility of the program was investigated through examination of acceptability, fidelity, and safety of programming, with special attention to acceptability and safety for well-adjusted peer mentors. Results showed that intervention fidelity, as measured by independent observers, was high. Acceptability was high as well, with no differences in attendance between well-adjusted children and children with behavioral problems. There was no evidence of iatrogenic effects or other unsafe outcomes: Peer-reported victimization did not increase, and well-adjusted children did not increase in aggression. In contrast, both well-adjusted children and their peers with behavior problems increased in teacher-rated social skills, and well-adjusted children increased in leadership. The results suggest that the pairing of well-adjusted children with behavior-problem children in a highly structured program such as Early Risers is a feasible program tactic in which the well-adjusted children may also derive some benefit.