Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 13, Issue 3, 2010. Pages: 101-119
Published Online: 30 September 2010

Costs and Effectiveness of the Fast Track Intervention for Antisocial Behavior

E. Michael Foster*

School of Public Health, University of North Carolina, Chapel Hill, NC, USA

* Correspondence to: E. Michael Foster, School of Public Health, University of North Carolina, Chapel Hill, Rosenau Hall, Campus Box# 7445, Chapel Hill, NC 27599-7445, USA
Tel.: +1-919-966 3773
Fax: +1-919-966 0458
E-mail: mike4kids@gmail.com

Source of Funding: This work was supported by National Institute of Mental Health (NIMH) grants R18 MH48043, R18 MH50951, R18 MH50952, and R18 MH50953. The Center for Substance Abuse Prevention and the National Institute on Drug Abuse also have provided support for Fast Track through a memorandum of agreement with the NIMH. This work was also supported in part by Department of Education grant S184U30002 and NIMH grants K05MH00797 and K05MH01027. The economic analysis of the Fast Track project is supported through NIMH grant R01MH62988. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

Abstract

For prevention programs to be cost effective, they must reduce negative outcomes that generate significant societal costs. This study examined the Fast Track intervention--a 10-year, multi-component prevention program targeting antisocial behavior--on outcomes affecting societal costs using data through late adolescence. The outcomes included the use of health and mental health services, involvement in the juvenile justice system, substance use, and school achievement. In general, the intervention did not affect broad measures of the outcomes for these population targeted. Further analyses of sub-groups and more nuanced measures should be interpreted in light of these null effects.

Background: Antisocial behavior is enormously costly to the youth involved, their families, victims, taxpayers and other members of society. These costs are generated by school failure, delinquency and involvement in the juvenile justice system, drug use, health services and other services. For prevention programs to be cost effective, they must reduce these costly behaviors and outcomes.

Aim: The Fast Track intervention is a 10-year, multi-component prevention program targeting antisocial behavior. The intervention identified children at school entry and provided intervention services over a 10-year period. This study examined the intervention's impact on outcomes affecting societal costs using data through late adolescence.

Methodology: The intervention is being evaluated through a multi-cohort, multi-site, multi-year randomized control trial of program participants and comparable children and youth in similar schools, and that study provides the data for these analyses. Schools within four sites (Durham, NC; Nashville, TN; Seattle, WA; and rural central Pennsylvania) were selected as high-risk based on crime and poverty statistics of the neighborhoods they served. Within each site, schools were divided into multiple sets matched for demographics (size, percentage free/reduced lunch, ethnic composition); one set within each pair was randomly assigned to the intervention and one to the control condition. Within participating schools, high-risk children were identified using a multiple-gating procedure. For each of three annual cohorts, all kindergarteners (9,594 total) in 54 schools were screened for classroom conduct problems by teachers. Those children scoring in the top 40% within cohort and site were then solicited for the next stage of screening for home behavior problems by the parents, and 91% agreed (n = 3,274). The teacher and parent screening scores were then standardized within site and combined into a sum score. These summed scores represented a total severity-of-risk screen score. Children were selected for inclusion into the study based on this screen score, moving from the highest score downward until desired sample sizes were reached within sites, cohorts, and conditions.

Results and Discussion: The intervention lacked both the breadth and depth of effects on costly outcomes to demonstrate cost-effectiveness or even effectiveness.

Limitations: The outcomes examined here reflect effects observed during measurement windows that are not complete for every outcome. Data are lacking on some potential outcomes, such as the use of mental health services before year 7.

Conclusion and Implications: The most intensive psychosocial intervention ever fielded did not produce meaningful and consistent effects on costly outcomes. The lack of effects through high school suggests that the intervention will not become cost-effective as participants progress through adulthood.

Future Research: Future research should consider alternative approaches to prevention youth violence.

Received 24 January 2010; accepted 26 August 2010