CSO Perspectives: Behavioral Health Prevention Efforts Prepare Kids to Learn in School

By Bryan A. Wolf, MD, PhD, Chief Scientific Officer and Director of the Research Institute

As the summer comes to a close and children prepare to head back to school, it is an opportunity for us all to sit up straight and study up on the value of the work that we do as pediatric researchers to help children thrive.

Some of the children returning to classrooms across the country are able to do so because of treatments and cures for diseases, or vaccines and other interventions to prevent them, that were pioneered here at The Children’s Hospital of Philadelphia and at our peer institutions. Perhaps less obvious, but equally important, is that children who have never had complex or serious illnesses are showing up prepared to learn and excel thanks in part to innovations in behavioral health research.

I am proud to share two such research efforts at CHOP that show enormous potential benefit for children by placing a focus on positive behavior and preventing behavioral health problems before they severely impede learning and social development — and doing so with an eye toward future large-scale implementation.

One of these projects is a small-group in-school educational program that teaches positive social skills, called Friend to Friend (F2F). F2F has been in development and testing by Stephen Leff, PhD, and his team in CHOP’s Violence Prevention Initiative (VPI), for more than 15 years, in collaboration with students, parents, teachers, and other school stakeholders. F2F is targeted to urban, ethnic minority girls, and designed to help girls find friendlier alternatives to relational aggression, the set of behaviors colloquially known as “mean girl” behaviors that are often a component of bullying.

Within the past year, Dr. Leff and colleagues published findings showing, first, that one year after a randomized controlled trial of F2F, participating relationally aggressive girls had sustained improvements in social behaviors. Most recently, a related study showed that even though the program was targeted to girls at the highest risk of relational aggression, it benefited the entire classroom environment, including uninvolved girls, boys, and teachers.

The VPI team is optimistic that the program will translate well to other urban schools and urban settings in Philadelphia and beyond. Read more about the team’s research in the latest issue of Bench to Bedside.

Another effort I want to highlight has a parallel emphasis on promoting the positive in order to prevent behavioral problems, but it starts at a much younger age. Joanne Wood, MD, MSHP, has taken a proactive approach with a group parenting intervention called CARE, which she helped implement and evaluate during PolicyLab’s work with the city of Philadelphia helping caregivers in the foster care system.

Dr. Wood and colleagues Philip Scribano, DO, MSCE and Steven Berkowitz, MD, in PolicyLab realized that many more children could benefit from this approach, simply because behavioral problems in preschool-age children are extremely common. But, in some cases, negative and reactive parenting can lead to increased child behavior problems and downstream undesired effects on school readiness, academic outcomes, and behavioral health disorders. They began offering PriCARE, a six-session adaptation of the CARE program, to parents and caregivers who had concerns about the behavior of their 2- to 6-year-old children.

“Often for mental health interventions, children have to have a diagnosed condition to receive services,” Dr. Wood said. “And really we want to keep kids from getting there.” P

riCARE, offered for parents’ convenience at a CHOP primary care setting, showed benefits for parent-reported child behavior and parenting attitudes in Dr. Wood’s recently completed randomized controlled pilot trial. More sessions of PriCARE are getting underway at two CHOP primary care locations, and Dr. Wood is preparing for a more robust follow-up trial to continue strengthening the evidence base for this approach. Find out more about the program and the research in Bench to Bedside.

Efforts like PriCARE and F2F have great potential to prepare more children in more places to return to school ready to learn, ready to engage with friends in healthy social behavior, and ready to succeed in all that they do.

Bryan Wolf, MD, PhD, is chief scientific officer and director of The Children’s Hospital of Philadelphia Research Institute.