Costs and effectiveness of the fast track intervention for antisocial behavior.
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.


OBJECTIVE
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.


METHODS
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.


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


CONCLUSIONS
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.


CONCLUSIONS
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.


CONCLUSIONS
Future research should consider alternative approaches to prevention youth violence.
School of Public Health, University of North Carolina, Chapel Hill, NC, USA. mike4kids@gmail.com
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Foster
D000987:Antisocial Personality Disorder / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006293:Health Promotion / Q000191:economics* / Q000458:organization & administration*; D006801:Humans; D008403:Mass Screening; D008962:Models, Theoretical; D015397:Program Evaluation / Q000379:methods; D012574:Schools; D014754:Violence / Q000517:prevention & control