Raising Healthy Children

Program Goals

Raising Healthy Children (RHC) is a comprehensive, school-based preventive intervention that concentrates on promoting positive youth development by using a social developmental approach to target risk and protective factors. The school and family environment are incorporated into the individual programming, which targets the child. The program covers children from kindergarten through high school with developmentally and age-appropriate material at different stages. The main goals of RHC are to increase school commitment, academic performance, and social competency and to reduce antisocial behavior.



Target Population

RHC is targeted toward all elementary through high school students and their parents. Teachers are involved in the programming but the emphases are on children and their families.



Program Theory

The working hypothesis of RHC is that children learn patterns of behavior from socializing units of family and school. As children age, peers play a larger role in their behavior. Socialization involves four related principles: 1) perceived opportunities for involvement in activities and interactions with others, 2) actual degree of involvement and interactions, 3) skills to participate successfully in these interactions and activities, and 4) reinforcement perceived from these interactions and activities. When socializing processes are consistent, a social bond develops between the child and the socializing unit. This bond will guide the child’s behavior, inhibiting certain actions while encouraging others. The goal is to have children socialize and form bonds with prosocial people, leading to positive behaviors and youth development.


 

Program Components

The multifaceted program targets teachers, parents, and students. Teachers receive workshops that concentrate on training them to use classroom management skills and effective learning strategies that can reduce students’ early aggressive behaviors and academic risk factors while increasing protective factors. Some examples of workshop topics are proactive classroom management, cooperative learning methods, and strategies to enhance student motivation. These workshops are supported with classroom coaching and monthly booster sessions to reinforce teaching strategies. Teachers may  be provided with a substitute for a half-day so they can observe another teacher using the RHC teaching strategies in the classroom. The school intervention component concentrates on enhancing students’ learning, interpersonal, and problem-solving skills, while also increasing academic performance and bonding to school.



Students receive classes and exercises in social and emotional development, conflict resolutions, consequential thinking, and problem-solving. These lessons are tailored to the child’s age, as the program covers the grades of kindergarten through high school. For instance, younger students may participate in afterschool tutoring sessions and study clubs during elementary school, but older students may be involved in individualized learning sessions and group-based workshops in middle and high schools. The student component of RHC is designed to improve academic performance, increase bonding to the school, teach refusal skills, and build up prosocial beliefs about healthy and conventional behaviors. RHC also offers summer camp programs for students with academic or behavioral problems who were personally recommended by their teachers in elementary school as well as social skills booster retreats in middle school. The program provides students with peer intervention strategies that teach social, emotional, and problem-solving skills.


 

Parents also are provided with structured multisession workshops, special topical workshops, and in-home sessions for selected families. The parental workshops are delivered by school–home coordinators (SHCs). These staff members are expert classroom teachers and specialists who are specially trained to provide services to parents and families. Parents learn how to provide reinforcement for good behavior and consequences for bad behavior and to communicate with their children. Topics can include “Raising Healthy Children,” “How to Help Your Child Succeed in School,” and “Preparing for the Drug-Free Years.” The standard training for parents is five workshops or in-home sessions. Those who need extra support can receive 12 sessions. There are an additional six booster sessions designed to help parents as their child grows, transitions to high school, and begins to encounter more challenging issues. The family intervention component of RHC is designed to enhance parenting skills, decrease family conflict, and make clear family standards and rules about specific student behaviors (such as substance use, dating, and sex).

Intervention ID: 
202
Ages: 
7 to 16
Rating: 
Promising
Evaluation: 

Study 1

Catalano and colleagues (2003) used an experimental design to study 938 elementary students from first or second grade enrolled in 10 schools in the Pacific Northwest. These children were randomly divided into two groups: those receiving the Raising Healthy Children (RHC) prevention program and a control group.


 

The study sample was drawn from 10 suburban elementary schools that were paired on socioeconomic status and attendance patterns. One school from each pair was randomly assigned to the RHC experimental group (n=5 schools) or to the control group (n=5 schools). After asking for participation and obtaining consent, the final sample size was 938 first and second grade students—497 in the treatment schools and 441 in the control schools. The entire sample was 53 percent male, with an average age of 7.43 years. The vast majority of the sample was white (almost 82 percent), followed by Asian/Pacific Islander (7.4 percent), Latino (3.9 percent), African American (3 percent), Native American (3.3 percent), and other races (0.4 percent).


 

The RHC experimental schools received the complete intervention program. This included workshops for teachers that concentrated on classroom management, reducing academic risks, and enhancing protective factors. At the conclusion of each workshop, RHC staff offered classroom coaching for teachers. In addition, during the first year of the project, teachers participated in monthly booster sessions to refresh and instill the skills learned at workshops.


 

Parents received training from school-home coordinators (SHCs), who were classroom teachers or specialists in providing services to parents and families. Parents had multiple training options. There were five sessions of parenting group workshops, special topic workshops, and in-home problem-solving sessions. Monthly newsletters were also sent to participating parents to remind them of upcoming workshops and to reinforce learned content.


 

Students received the intervention through summer camps conducted by SHCs. Those attending summer camps were recommended by teachers or parents because of poor academic performance or behavioral problems. This was coupled with in-home services to reduce the student’s problematic behavior in class and so they could work on their academic skills.


 

Teachers, parents, and students in the control schools received treatment as usual. Because of the research design used, no programmatic elements of RHC were received by any of the control schools.


 

Data collection occurred four times during the 1½-year study period. Baseline measures were collected before the intervention, followed by another data collection in the spring of year 1 and two more collections in the spring and fall of year 2. Data was obtained from teachers, parents, and students. Teachers completed a student behavior checklist on each participant. Parents were phoned at home and completed a 45-minute interview in addition to the behavioral checklist. Lastly, students were administered a survey in the spring of years 1 and 2. Altogether this resulted in multiple waves of data from multiple sources over the course of the study.


 

Data from the teacher surveys was used to measure: commitment to school, academic performance, social competency, and antisocial behavior. Items from the Teacher Observation of Classroom Adaptation—Revised and the Child Behavior Checklist—Teacher Report were used in conjunction with other study-developed questions to measure these concepts and behavior. Parents used a similar instrument to provide similar information on their child’s academic performance and behavior. Students completed a self-report survey that included a social competency scale and an antisocial scale.


 

Analyses were conducted 18 months after implementation and concentrated on academic and behavioral improvements within the school environment. Hierarchical linear models were used to determine the growth rate and level of each intervention across the multiple sources of data. This analysis incorporates two models of change. The first model determines whether the variance across individuals is due to sampling error. The second model examines whether the experimental or treatment condition predicts values for individuals, after controlling for baseline measures and descriptive information.



Study 2

Brown and colleagues (2005) used an experimental design to examine the long-term effects of RHC. This was a continuation of the study by Catalano and colleagues (2003) that included a slightly larger sample of students who had moved into the participating school districts after the study was initiated. Children were followed as they aged and entered middle school where they are exposed to different risk factors and encounter new life challenges. The main focus of this study was to examine the effects of RHC on adolescent substance use.


 

RHC uses a social developmental approach and the intervention adjusts as children age. The experimental schools received the complete intervention program. Workshops for teachers concentrated on classroom management, reducing academic risks, and enhancing protective factors. These workshops were given to teachers while students were in the first grade and again during the first year of middle school. The middle school workshops differ in content from the elementary school workshops in order to address the different classroom and behavioral challenges that teachers face. At the conclusion of each workshop, RHC staff offered classroom coaching for teachers. To monitor and enhance the fidelity of the project, teachers participated in monthly booster sessions to refresh and instill the skills learned at workshops.


 

Parents received training from SHCs and had multiple training options. There were parenting group workshops, special topic workshops, and in-home problem-solving sessions as well as monthly newsletters. These group and individual sessions occurred from grades 1 through 8. Like the teacher workshops, the parent workshops focused on different developmental issues as children aged and their lives changed. Middle school and high school workshops for parents spent more time discussing substance use and risky behavior than those given during elementary school. During high school, booster sessions were given at home, and students completed behavioral assessments.


 

The student intervention consisted of volunteer participation in afterschool tutoring sessions and study clubs from fourth through sixth grades. Similar to the rest of the intervention, elementary school sessions focused more on antisocial behavior and school commitment while sessions for middle school and high school students addressed alcohol and drug use. Students also received booster sessions and group workshops during the middle and high school years.


 

Teachers, parents, and students in the control schools received treatment as usual. Because of the research design used, no programmatic elements of RHC were received by any of the control schools.


 

Data collection occurred annually from sixth through tenth grades while students were in school. Those who missed school during a collection visit were contacted at home and completed their assessments by mail, phone, or in person with a member of the research team.


 

Measures of substance use were taken from self-reports of frequency of alcohol, marijuana, and cigarette use during the previous year and the previous month. Data analysis consisted of a two-part latent growth model. The first part of the model screened out nonusers from users. The second part of the model consisted of continuous indicator variables that represented the frequency of substance use amongst users. By using this method, students who never used any illicit substance did not contribute data to the growth rates and models of substance use. Only those students who had ever used illicit substances contributed information to the growth rate.

Outcomes: 

Although the results from Study 1 found significant and positive effects on Raising Healthy Children (RHC) program students’ academic performance, antisocial behavior, and social competency based on teacher data, the results were not supported by parent and child data. In addition, the preponderance of evidence in Study 2 indicated that the RHC program did not have an effect on students. Specifically, although the intervention did have an effect on the frequency of alcohol and marijuana use, there was no significant impact on prevalence of alcohol, marijuana, and cigarette use.


 

Study 1


School Commitment and Academic Performance

The results from the analyses conducted by Catalano and colleagues (2003) of the teacher data showed that students who received the RHC program had a significantly higher level of commitment to school than the students in the control condition. Program students also had a significantly higher level of teacher-rated academic performance than control students. The parent data showed that RHC students had significantly higher academic performance and school commitment ratings than control students.


 

Antisocial Behavior

The teacher data showed that students receiving the RHC program had a significantly lower level of antisocial behavior, compared with control group students, and displayed a decreasing growth rate as well. The growth rate for the control students actually increased, and they had a higher level of antisocial behavior by the end of the study. However, the parent and child self-report data did not reveal any significant difference between the treatment and control groups for antisocial behavior.

 

Social Competency

Reports from teachers showed that students receiving the RHC program displayed an increasing growth rate for social competency and had a significantly higher level of social competency than the control students. The growth rate for the control students actually decreased during the course of the study. However, the parent and child self-report data did not reveal any significant difference between the treatment and control groups for social competency.


 

Study 2


Alcohol Use

Brown and colleagues (2005) found that the prevalence rate of alcohol use increased from grades 6 through 10. Specifically, 29 percent of all students in the 6th grade had used alcohol at least once in the past 12 months, compared with 51 percent in the 10th grade. There was no significant difference between the RHC intervention group and the control group for change in alcohol use compared with nonuse. The intervention had no effect on prevalence.


 

However, there was a significant intervention effect evidenced for the frequency of alcohol use. The intervention was unable to prevent children from trying or from using alcohol, but it did reduce their frequency of alcohol use compared with the control condition.


 

Marijuana Use

There also was a general increase in prevalence for marijuana. From the 7th to the 10th grade, there was an 8 percent increase in prevalence, resulting in 31 percent of all students’ having used marijuana once in the past 12 months. There was no significant difference between the RHC intervention group and the control group for change in marijuana use compared with nonuse. The intervention had no effect on prevalence.


 

However, there was a significant intervention effect evidenced for the frequency of marijuana use. The intervention was not able to prevent children from trying or using marijuana, but it did reduce their frequency of marijuana use compared with the control condition.


 

Cigarette Use

The prevalence of cigarette use doubled, from 9 percent in the 7th grade to 18 percent in 10th grade. There also was no intervention effect displayed for prevalence or frequency of cigarette use. Students receiving the RHC intervention tried and used cigarettes at the same levels as those in the control condition.