Going to scale with family-centered, school-based interventions: Challenges and future directions

Students who display problem behaviors at school are at risk for a variety of difficulties, including poor academic achievement, poor school attendance, depression, and substance use (Barry, Lyman, and Grofer Klinger, 2002 ; Patterson, Reid, and Dishion, 1992 ), all of which can be challenging for teachers and school administrators to manage (Dishion and Stormshak, 2007 ; Walker, Colvin, and Ramsey, 1995 ). Many schools also lack the infrastructure necessary to systematically and effectively support children and adolescents with academic, behavioral, or mental health concerns (Eccles and Harold, 1993 ; Ringeisen, Henderson, and Hoagwood, 2003 ). However, schools are an ideal location to implement evidence-based prevention and intervention programs to address problem behaviors because youths spend a considerable amount of time there (Dishion, 2011 ). The World Health Organization (WHO, 2008) and Centers for Disease Control (CDC, 2013 ) promote school settings as particularly important for actions that target and improve outcomes for child and adolescent health. Moreover, using schools as service delivery settings may increase opportunities to provide health services to underserved populations, such as rural populations, low-income families, and ethnically diverse youths. As such, local, state, and federal policies have increasingly called for the use of evidence- based practices in school settings. Although schools have become consistent venues for intervention efforts, research is limited on effective implementation and execution of these programs to high-quality standards. Schools are thus left without effective or efficient plans when they choose to adopt empirically based interventions. Clearly, the unique issues and challenges presented by program scale-up must be addressed.