title: Short-term effects of the "Together at School" intervention program on children's socio-emotional skills: a cluster randomized controlled trial.
abstract: BACKGROUND
  Together at School is a universal intervention program designed to promote socio-emotional skills among primary-school children. It is based on a whole school approach, and implemented in school classes by teachers. The aim of the present study is to examine the short-term effects of the intervention program in improving socio-emotional skills and reducing psychological problems among boys and girls. We also examine whether these effects depend on grade level (Grades 1 to 3) and intervention dosage.
  
  
  METHODS
  This cluster randomized controlled trial design included 79 Finnish primary schools (40 intervention and 39 control) with 3 704 children. The outcome measures were the Strengths and Difficulties Questionnaire (SDQ) and the Multisource Assessment of Social Competence Scale (MASCS) with teachers as raters. The intervention dosage was indicated by the frequencies six central tools were used by the teachers. The data was collected at baseline and 6 months later. Intervention effects were analyzed using multilevel modeling.
  
  
  RESULTS
  When analyzed across all grades no intervention effect was observed in improving children's socio-emotional skills or in reducing their psychological problems at 6-month follow-up. Among third (compared to first) graders the intervention decreased psychological problems. Stratified analyses by gender showed that this effect was significant only among boys and that among them the intervention also improved third graders' cooperation skills. Among girls the intervention effects were not moderated by grade. Implementing the intervention with intended intensity (i.e. a high enough dosage) had a significant positive effect on cooperation skills. When analyzed separately among genders, this effect was significant only in girls.
  
  
  CONCLUSIONS
  These first, short-term results of the Together at School intervention program did not show any main effects on children's socio-emotional skills or psychological problems. This lack of effects may be due to the relatively short follow-up period given the universal, whole school-based approach of the program. The results suggest that the grade level where the intervention is started might be a factor in the program's effectiveness. Moreover, the results also suggest that for this type of intervention program to be effective, it needs to be delivered with a high enough dosage.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT02178332 ; Date of registration: 03-April-2014.
authors.affiliation: Department of Health, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland. olli.kiviruusu@thl.fi.
authors.forename: Olli
authors.initials: O
authors.lastname: Kiviruusu
authors.affiliation: Department of Health, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland.|Department of Education, PO Box 22, FI-33471, Ylöjärvi, Finland.
authors.forename: Katja
authors.initials: K
authors.lastname: Björklund
authors.affiliation: Department of Health, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland.|Department of Education, PO Box 22, FI-33471, Ylöjärvi, Finland.
authors.forename: Hanna-Leena
authors.initials: HL
authors.lastname: Koskinen
authors.affiliation: Standards and Methods, Statistics Finland, FI-00022, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Liski
authors.affiliation: School of Social Sciences and Humanities/Psychology, University of Tampere, FI-33014, Tampere, Finland.
authors.forename: Jallu
authors.initials: J
authors.lastname: Lindblom
authors.affiliation: Department of Health, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland.|Department of Education, PO Box 22, FI-33471, Ylöjärvi, Finland.
authors.forename: Heini
authors.initials: H
authors.lastname: Kuoppamäki
authors.affiliation: Department of Health, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland.|Department of Education, PO Box 22, FI-33471, Ylöjärvi, Finland.
authors.forename: Paula
authors.initials: P
authors.lastname: Alasuvanto
authors.affiliation: Department of Education, PO Box 22, FI-33471, Ylöjärvi, Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Ojala
authors.affiliation: Department of Health, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Samposalo
authors.affiliation: Department of Education, PO Box 22, FI-33471, Ylöjärvi, Finland.
authors.forename: Nina
authors.initials: N
authors.lastname: Harmes
authors.affiliation: Department of Health and Social Care Systems, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland.
authors.forename: Elina
authors.initials: E
authors.lastname: Hemminki
authors.affiliation: School of Social Sciences and Humanities/Psychology, University of Tampere, FI-33014, Tampere, Finland.
authors.forename: Raija-Leena
authors.initials: RL
authors.lastname: Punamäki
authors.affiliation: Centre for Research Methods, Department of Social Research, University of Helsinki, PO Box 18, FI-00014, Helsinki, Finland.
authors.forename: Reijo
authors.initials: R
authors.lastname: Sund
authors.affiliation: Department of Health, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland.|Department of Child Psychiatry, University of Turku, FI-20014, Turku, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Santalahti
mesh_terms: D002648:Child; D003299:Cooperative Behavior; D004644:Emotions; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008603:Mental Health; D015397:Program Evaluation; D012572:School Health Services; D066107:Social Skills
keywords: Children; Intervention; Intervention dosage; RCT; Socio-emotional skills; Whole school approach