Rationale, Design, Interventions, and Outcomes Across 20 Years
In 1990, the National Institute of Mental Health funded scientists from four US universities to work collaboratively to translate scientific knowledge into a comprehensive program to reduce serious violence by intervening to support children and families at risk beginning at school entry. This program, known as Fast Track, was evaluated through a randomized controlled trial that included 891 children from 28 neighborhoods in four US communities (three urban and one rural). With the current rise in violent crime, it is timely to bring to public attention the findings of the Fast Track Project, which attempted to alter the pathway known as the “school to prison pipeline.” The findings have shown that a series of multi-level interventions that support families, schools, and children beginning at age 5 can succeed in reducing convictions for violent crime through age 25, as well as show numerous other beneficial outcomes.
Generations of research have clearly confirmed that chronic violence most often emerges when children grow up in high-risk communities and experience multiple, sequential adversities, including a harsh home life, unstable supports from family and schools, deficits in social and emotional competencies, peer social rejection, and academic difficulties. Emerging research suggests that the risk for chronic violence accumulates over time – and the outcomes of at-risk youths might be changed with the right kind of early supports across the domains of the child’s life.
The Developmental Model for Intervention.
The Fast Track intervention was guided by a set of developmental theories that posited the interaction of multiple influences at different developmental periods that influence child antisocial behavioral development. We conceptualize conduct problems as a chronic condition that emerges in a cumulative fashion, aggravated by age-related stressors at key developmental transition points such as school entry and the transitions into middle school, and then high school. Thus, we thought that an effective preventive intervention should continue across developmental periods, with more intensive efforts positioned around these transitional stress points. We believed that preventive intervention would be stronger if it was more comprehensive and attentive to the social contexts of the family, peer group, classroom, and neighborhood, as well as the connections between these contexts (e.g., family and school connection).
This comprehensive developmental model suggests two strategic points in childhood for preventive intervention. At school entry, and later in emerging adolescence, there are identifiable constellations of child and family variables that indicate high risk for emerging and escalating conduct disorder (CD). Conduct disorder comprises a cluster of oppositional and anti-social behaviors including aggressive behavior (including fighting and bullying), destructive behavior (including arson and vandalism), deceitful behavior (including lying and stealing), and violation of rules (including excessive non-compliance and running away). It is not uncommon for children and teens to have behavior-related problems at some time during their development. However, the behavior is considered to be a conduct disorder when it is long-lasting and when it violates the rights of others, goes against accepted norms of behavior, and disrupts the child’s or family’s everyday life. Because elementary school entry is a significant developmental transition, and failure has not yet occurred, families may be hopeful and motivated to support their child’s school success. In addition, during developmental transitions, families are both under more stress and often more open to learning new skills, which may foster responsiveness to proactive interventions such as Fast Track.
Elementary School Model
The Fast Track elementary-school intervention based upon this developmental model included an integrated set of intervention components to promote competencies in children (social-emotional skills training and academic tutoring), parents (parent management training and home visiting), and teachers (prevention curriculum and classroom management consultation), and to strengthen bonds of communication between parents and teachers. Given our conceptual model, one goal was to promote a more positive school environment for all children as well as building the social and social-cognitive skills of high-risk aggressive children. For this reason, the Fast Track intervention featured a classroom-level (universal) intervention component, as well as components specifically for children at high-risk and their families (targeted interventions). We hypothesized reciprocal benefits for these universal and targeted interventions. As classroom climate improves as a function of the classroom-level intervention and teacher consultation, it should promote a more positive socializing environment for the high-risk children, thus facilitating more appropriate behavior and attitudes. Conversely, as the targeted intervention components affect the high-risk group, these children will be less disruptive in the classroom and less aggressive on the playground, enhancing the classroom climate and corresponding learning and social opportunities for all children. For more information on the elementary school model, see Chapter 4 of CPPRG (2020).
Figure 1. Core Components of the Fast Track Elementary School Intervention
A second logical point for intervention is at the transition into middle school and early adolescence, where key issues include the control of aggressive and disruptive behavior, the acquisition and use of prosocial skills for integrating into the mainstream peer culture, and concentrated assistance with academic skills. Youths may also profit from individual competency-enhancing experiences related to their own developing goals and interests (both in and outside of school) to maintain or restore self-esteem and positive expectations for success. Parents of high-risk adolescents need to establish effective and non-punitive limit-setting and maintain or regain an active interest in their activities so that reasonable monitoring of adolescent behavior can occur. Furthermore, some active partnership between parents and the schools must take place if the monitoring of homework, school attendance, and resistance to deviant peer group involvement is to take place.
The adolescent intervention phase focused on four major domains of youth functioning: 1) academic achievement; 2) peer relations; 3) adult involvement, supervision, and monitoring; and 4) attitudes, identity, values, and beliefs. Parallel to the elementary intervention organization, these domains were targeted with a combination of standard program components that were offered to all participating families (e.g., youth and parent group sessions, middle school transition program, mentoring by a community adult), and other components that were delivered adaptively, with the level and type of service tailored for individual youth based on tri-annual assessments of child and family functioning and needs. For more information on the adolescent school model, see Chapter 6 of CPPRG (2020).
Summary of the Intervention Model
The significance of the Fast Track Project was that it addressed three organizing principles for the prevention of serious violent delinquency: 1) it started early, 2) it was comprehensive, and 3) it was carried out over the long-term of development. Fast Track included six design innovations. First, the intervention model was built on a clear developmental conceptualization of the problem of early aggression and its developmental trajectory, and the intervention procedures and targets were derived from this model. Second, it was based on the belief that combining universal and targeted interventions at the same time would lead to reciprocal effects. Third, we defined periods of intensive prevention efforts based on important transitions or choice points in which children are at most risk and we believed families are most receptive. Fourth, the program took a multisystemic focus. We not only attempted to build appropriate skills, attitudes, and expectancies in each system (family, school, peer), but also to focus on building positive relations between these systems. Fifth, the intervention was structured in a manner that recognizes that this is a developmental problem that is unlikely to be solved in a single developmental period. Finally, we engaged parents and other family members as collaborative partners in the process of helping their children succeed.
Fast Track provided interventions to children, families, and schools beginning when children entered first grade and continuing through 10th grade. In summary, fundamental aims of the program were to enhance children’s success in school, to support parents and teachers in managing problem behaviors, to promote self-regulation and healthy relations with peers and adults, and to coordinate the efforts of parents and teachers. Individual support for children and parents was provided in age-appropriate ways from first through 10th grade. Mentors from the community were provided beginning in middle school to begin preparing the youth for the transition from school to jobs. The intensity of the program gradually phased down with increasing age.
A variety of interventions that were developmentally timed were provided each year and annual evaluations assessed serious behavior problems and violent behavior, drug use, and court records beginning in adolescence and following youth through age 25.
The Fast Track program was evaluated through a randomized controlled trial in four quite diverse urban and rural communities in the United States. Children were identified as “high-risk” at the end of kindergarten as a result of reports from teachers and parents on factors such as aggressive-disruptive behavior, poor peer relations, defiance of adult authority and hyperactivity/inattention. Depending on the community, approximately 20% of the children were identified for the indicated FT interventions. Across all 55 schools, children were recruited in three annual cohorts, starting in fall of 1991, resulting in a total high-risk sample of 891 children (of the 9,594 that were screened; approximately 70% boys). Clusters of schools were matched on demographic characteristics, and then one cluster in each set was randomly assigned to intervention and one cluster as control. Children were assigned to the intervention or control group based on the school they attended in the fall of their first grade, when the intervention was initiated (n’s = 445 for intervention and 446 for control).
Children who were randomly assigned to receive the Fast Track Program were compared to children who were randomly assigned to the control group from these same communities from first grade to age 25.
Elementary Age Findings
Overall, during the elementary school years the findings indicate that random assignment to the Fast Track program (herein called Fast Track) produced modest levels of continued improvement in social-emotional competence, peer relations, and learning and reductions in harsh parenting through the end of elementary school. More importantly, these results demonstrated that Fast Track reduced the risk experienced by children with early-onset conduct problems of becoming involved in serious problems evident at the end of elementary school in grades 4 and 5 (CPPRG, 2004). The positive impact of Fast Track held across groups of boys and girls, Black and white children, and urban and rural communities.
Middle School Age Findings
In contrast to earlier findings of the efficacy of the Fast Track intervention during the elementary school years, few differences between the intervention and control groups emerged during the middle school years. Although rates of disorder were not reduced for the entire sample, consistent reductions emerged for youths at the highest risk (the top 3% on the screen score). Benefits were evident for this high-risk group in 3rd grade, and these continued through the middle and high school years. At each time point, the highest-risk youths in the Fast Track intervention sample had significantly fewer symptoms of CD than the control condition. Across all three grades, the highest-risk Fast Track intervention children also had lower rates of ADHD symptoms. In 3rd grade, they also had significantly lower rates of oppositional defiant disorder (ODD) symptoms and in 9th grade significantly lower rates of CD symptoms. Fast Track’s efficacy did not differ across diverse subgroups of participants. the intervention effects held across all 4 sites, and for males, females, African Americans, European Americans.
High School Age Findings
Findings in high school using official juvenile court records indicated that Fast Track intervention youths had 29% lower odds of court-recorded arrests than for control youths. Further, the intervention delayed the onset of the most severe forms of self-reported criminal behavior; the odds of high-risk intervention youths initiating self-reported delinquent behavior was only 82% of the initiation rate for control youths. Assessment of externalizing psychiatric disorder by age 18 showed a 32% reduction in the Fast Track intervention youths. A parallel finding is that intervention youths themselves also reported having fewer outpatient mental health service visits than control youths (grades 11-12). However, contrary to our hypotheses, the Fast Track intervention did not have effects on academic outcomes or graduation rates, substance abuse, or risky sexual behavior during early and mid-adolescence.
By age 25, the court records of the children receiving the intervention showed a 31% reduction in conviction as adults for serious and violent crimes compared to the matched control group (Dodge et al., 2015). These same records showed a 36 % reduction in convictions for drug-related crimes. The results were published in a series of peer-reviewed professional journals over the past 20 years and summarized in a recent book (The Fast Track Program for Children at Risk: Preventing Antisocial Behavior; CPPRG, 2020).
At age 25, Fast Track intervention young adults, compared to controls, continued to display lower prevalence of externalizing problems (including reductions in rates of antisocial personality disorder), internalizing problems (including lower rates of avoidant personality disorder), substance use problems, risky sexual behavior, reduced levels of spanking their own children, and higher wellbeing and happiness. These findings were robust across self- and peer raters. Fast Track’s efficacy did not differ across diverse subgroups of participants. the intervention effects held across all four sites, and for males, females, African Americans, European Americans, moderate-risk children, and high-risk children. In addition, the Fast Track young adults were significantly more likely to be civically engaged: they were more likely to register to vote and to actually vote, than was the case for control participants (Holbein, 2017). The intervention participants thus appeared to be constructively aware of their social world and interested in participating in democratic actions that create policy, rules and resources for their community and larger society. However, despite this broad set of positive outcomes, Fast Track did not have a significant impact on education or employment.
Fast Track was designed as a model demonstration project to evaluate the potential of coordinated, sustained prevention programming on the trajectories of antisocial development among children showing high levels of aggression at school entry. The success of the program indicates the value of moving ahead with models of application that preserve the key features of the successful Fast Track model using sustainable infrastructures and organization of school- and community-based service providers. That is, rather than one provider facilitating all prevention services (as was done in the demonstration project), we envision the coordinated efforts of multiple service providers to create a similar set of evidence-based supports for schools and families across different developmental periods of childhood and early adolescence.
Conduct Problems Prevention Research Group (2020). The Fast Track Program for children at risk: Preventing antisocial behavior. Guilford Press: New York.