Intervention Summary

Positive Action Pre-K Program

The Positive Action Pre-K Program is a classroom-based intervention that aims to improve social-emotional skills among preschool students. The Positive Action Pre-K Program, one component of Positive Action (reviewed by NREPP separately), builds intrinsic motivation by teaching and reinforcing the intuitive philosophy that one feels good about oneself when taking positive actions. The philosophy is illustrated by the intervention's Thoughts-Actions-Feelings Circle, in which positive thoughts lead to positive actions, positive actions lead to positive feelings about oneself, and positive feelings lead to more positive thoughts.

Positive actions for the whole self--the body, mind, and feelings--are presented in six units:

Unit 1: The Positive Action Philosophy and Thoughts-Actions-Feelings Circle
Unit 2: Positive Actions for Your Body and Mind
Unit 3: Positive Actions for Managing Yourself Responsibly
Unit 4: Positive Actions for Getting Along With Others
Unit 5: Positive Actions for Being Honest With Yourself and Others
Unit 6: Positive Actions for Improving Yourself Continually

The intervention consists of 130 scripted lessons implemented by the classroom teacher. Typically four of these 15-minute lessons are taught each week. Lessons involve a variety of methodologies and materials such as puppets, activities, stories, games, posters, music, poems, stickers, visual aids, and other manipulatives. Implementers may decide to present all 130 lessons or select the lessons within each unit that best meet the needs of their students.

The Positive Action Pre-K Program can be implemented with other parts of the larger Positive Action program, such as grade-specific curricula from kindergarten through 12th grade and components that reinforce the skills learned in the classroom (e.g., sitewide climate development, counselor, family, and community components). In the study reviewed for this summary, only the prekindergarten classroom component was used, and classrooms provided a condensed version of the program consisting of 60 lessons.

Descriptive Information

Areas of Interest	Mental health promotion Substance use disorder prevention
Outcomes	1: Social-emotional skills
Outcome Categories	Mental health Social functioning
Ages	0-5 (Early childhood)
Genders	Data were not reported/available.
Races/Ethnicities	Data were not reported/available.
Settings	School
Geographic Locations	Urban Suburban Rural and/or frontier
Implementation History	The Positive Action Pre-K Program curriculum kit was developed and field tested for 8 years until it was released to the public. Approximately 50 sites have used the program, serving about 1,500 individuals in 22 States and British Columbia, Canada. One evaluation was conducted in Virginia.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: No Evaluated in comparative effectiveness research studies: No
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Universal

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Flay, B. R. Randomized evaluation of the Positive Action Pre-K program. Unpublished manuscript.

Outcomes

Outcome 1: Social-emotional skills
Description of Measures	Social-emotional skills were rated using a 33-item instrument containing 3 items assessing each of 11 different domains: understanding of positive and negative actions, self-concept, physical health, intellectual health, self-management, self-control, being respectful of others, consideration for others, social bonding, honesty with self and others, and self-improvement. For each item (e.g., "has a good understanding of which behaviors are positive and which are negative," "feels good about him/herself when he/she does positive actions," "likes to learn," "shows self-control," "can cooperate with others, can compromise when necessary"), the instructor used a 7-point scale ranging from "not at all" to "totally" to indicate the degree to which the item described the student. A mean score was calculated for each scale and for the overall instrument. Higher scores on all scales represented better skills.
Key Findings	Students in three preschools were randomly assigned to a classroom implementing the intervention (a total of seven classrooms) or a classroom providing instruction as usual (a total of five classrooms). Intervention classrooms provided a condensed version of the Positive Action Pre-K Program consisting of 60 lessons. From pre- to posttest, students who received the intervention had greater improvement in overall social-emotional skills than control group students (p < .05). Analyses conducted separately for each of the 11 domains revealed that intervention group students improved on all 11 scales, while control group students either showed no change or worsened (p < .05 on all scales).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	1.6 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	0-5 (Early childhood)	Data not reported/available	Data not reported/available

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Social-emotional skills	2.5	1.8	2.0	1.0	1.0	1.5	1.6

Study Strengths

The instrument used to measure social-emotional skills had adequate to good reliability scores overall and within each of the 11 individual scales. Data were collected on the number of lessons each student received and the level of student engagement in the sessions. Students received an average of 4.8 lessons per week, close to the expected 5-6 lessons per week for full implementation. Of the six instructors who implemented the program and provided fidelity data, four indicated that they delivered almost all of the lessons targeted for the study. Instructors reported that students were engaged at a high level and talked with their parents at a moderate level, and they estimated that students discussed the program outside of the classroom at a moderate level. Pretest and posttest data were matched, and children without both assessments were excluded from analyses. A randomized controlled study design was used.

Study Weaknesses

The social-emotional skills instrument may not be valid for preschool-age children, as some of the items assess characteristics that are developmentally advanced for children of this age. Although efforts were made to measure fidelity, the study did not use independent observations of the instructors or a checklist of topics covered, nor did it attempt to assess adherence to the program manual. No explanation is provided as to why one instructor and one preschool did not submit posttest data or why more students were rated at posttest than pretest. Several confounding variables were present in the study: No analysis was conducted to compare students with and without matched pre- and posttest data; the same instructors who implemented the program in the classroom also rated the children's social-emotional skills, which could have introduced bias into the assessment; and despite the children's random assignment to teachers, intervention and control groups differed significantly on all scales at pretest. Because demographic data on the groups were not provided, it is not known whether the groups were similar or whether demographic covariates should have been included in the analyses. The sample size was small.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Positive Action: Elementary Orientation Training Workshop Preview:

Allred, C. G. Positive Action elementary orientation training workshop manual (3rd ed.). Twin Falls, ID: Positive Action.
Allred, C. G. Behavior management booklet. Twin Falls, ID: Positive Action.
Allred, C. G. The Positive Action program: Guidelines for implementing with fidelity. Twin Falls, ID: Positive Action.
Other materials, including folder on implementation readiness, fliers, posters, sample press releases, and calendars.

Positive Action: Pre-Kindergarten Instructor's Curriculum Kit:

Allred, C. G. Positive Action all songs lyrics. Twin Falls, ID: Author.
Allred, C. G. Positive Action: PreKindergarten instructor's manual. Twin Falls, ID: Positive Action.
Positive Action, Inc. Book of names. Twin Falls, ID: Author.
Positive Action, Inc. Positive Action food guide pyramid. Twin Falls, ID: Author.
Positive Action, Inc. Certificate of completion. Twin Falls, ID: Author.
Positive Action, Inc. Parent invitation: Master copy. Twin Falls, ID: Author.
Positive Action, Inc. Positive Action all songs CD, with lyrics. Twin Falls, ID: Author.
Positive Action, Inc. Pre-K ICU messages: Master copy. Twin Falls, ID: Author.
Positive Action, Inc. Positive Action PreKindergarten instructor's resources CD. Twin Falls, ID: Author.
Other materials, including activity sheets, visual aids, posters, magnets, and manipulatives (e.g., wash cloth, bean bag, toothbrush, puppets).

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
4.0	3.5	3.8	3.8

Dissemination Strengths

The instructor's manual is highly detailed and easy to follow and provides thorough guidance to prepare teachers and other school personnel to implement the program. Many of the audio and visual materials provided are appropriately designed to appeal to prekindergarten learners. Tips for using the implementation materials, as well as scripts for introducing subjects and engaging young children, are included. The developer has provided guidelines for adapting the scripted sessions for different settings. Various in-person and Webinar training options are available, as are less expensive self-training workshop kits. The program Web site offers a variety of free and easily accessible measures to help ensure program quality and effectiveness.

Dissemination Weaknesses

For sites selecting the self-training option, it is unclear how the developer provides them with implementation guidance and how they access the developer to ask questions. Some materials (e.g., teacher implementation checklists) were developed for the larger Positive Action program, not specifically the Positive Action Pre-K Program, and therefore might not correspond well to the needs of the prekindergarten population.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Pre-Kindergarten Instructor's Curriculum Kit	$450 each	Yes
Orientation Workshop Kit (Elementary Orientation)	$550 each	Yes, for some training options
Professional Development Kit (includes CD-ROM, reference materials, assessment tools, and a behavior management booklet)	$350 each	Yes, for some training options
Self-Training Ongoing In-Service Workshop Kit	$300 each	No
Self-Training Media Training Workshop Kit	$200 each	No
1-day implementation training on site or in Idaho	$3,000 per site for up to 50 participants, plus travel expenses if on site	No
Attendance at another organization's 1-day implementation training	$250 per person, per hour	No
Implementation training Webinar	$250 per hour	No
1-day train-the-trainer implementation workshop on site or in Idaho	$3,000 per site for up to 50 participants, plus travel expenses if on site	No
Implementation train-the trainer Webinar	$250 per hour	No
1-day professional development training on site or in Idaho	$3,000 for up to 50 participants, plus travel expenses if on site	No
Professional development training Webinar	$250 per hour	No
1-day professional development train-the-trainer workshop on site or in Idaho	$3,000 for up to 50 participants, plus travel expenses if on site	No
Professional development train-the trainer Webinar	$250 per hour	No
1-day ongoing in-service or media training on site or in Idaho for schools, districts, or community organizations	$3,000 for up to 50 participants, plus travel expenses if on site	No
Ongoing in-service or media training Webinar	$250 per hour	No
Consultation and technical assistance from developer by phone or email	Free for brief consultation or $300 per hour for time-intensive support	No
Implementation, progress, and outcome monitoring surveys	Free	No
Online administration of surveys and analysis by Positive Action evaluator	Implementation monitoring surveys: $250 per teacher Progress monitoring surveys: $2.50 per student Outcome monitoring surveys: $5.00 per student	No
Evaluation services consulting by phone or email	$400 per hour	No

Additional Information

Contact the developer for more information on the kits required for each training option.