Empecemos (let's start) - an indicated prevention programme for children with early-onset conduct problems, their families and teachers
At a glance
Country of origin
- Spain
Level(s) of intervention
- Indicated prevention
Empecemos is a multi-component programme, addressing the child itself, its parents and its teachers with the aim of reducing the further development of behavioural problems. It addresses the reciprocal, influential links between family problems, rejection by peers, maladjustment at school, and limited self-control and emotional processing skills, which usually generate a snowball effect, by which the opportunities for healthy development are increasingly reduced. Without proper intervention, conduct disorders become more chronic, and a maladjusted lifestyle becomes increasingly consolidated, resulting in problem substance use, together with antisocial, impulsive and emotional disorders.
Empecemos has been implemented in Galicia (northern Spain) and is ready to be implemented elsewhere.
Keywords
No dataLinks to this programme in other registries
Implementation Experiences
Read the experiences of people who have implemented this programme.Contact details
Estrella Romero.
Facultad de Psicología, Santiago de Compostela.
E.mail: estrella.romero[a]usc.es
Overview of results from the European studies
Studies overview
In the Romero et al 2017 study, a screening process identified children with significant conduct problems both at home with their family and at school, and the programme was implemented in eight schools. It included a long-term follow-up of 56 children for seven years. Multivariate analysis showed significant differences in attitudes (higher in the control group) and in the intention of using tobacco or alcohol (also higher in the control group). When the proportion of adolescents that will “probably yes” use tobacco was analysed, 11% of the intervention group was willing to use, compared with 42% of the control group (chi-squared: 7.59, 1 df, p < .001). As to adolescents that will “probably yes” use alcohol, 11% of the intervention group chose this response,compared with 35% of the control group (chi-squared: 6.23, 1 df, p < .01). No differences were found in age at onset. There were significant differences in the frequency of actual tobacco usel, but no significant differences in relation to aggressive conduct, despite the fact that facing rage is one of the most emphasised contents of the component for children. Also no significant differences were found in emotional control skills or in empathy, which seems to suggest that the specific effects on interpersonal emotions are attenuated over time and, therefore, that these components require reinforcements during the intervention. No significant effects were found in cannabis use; probably due to its later onset than tobacco and alcohol use.
The Romero et al. 2019 study assessed the efficacy of Empecemos in 128 children with behavioural problems in 18 public schools in urban and semi-urban areas: 67 in the intervention condition and 59 controls. There was random allocation to IG or CG at school level: 9 schools each. The tutors of the children enrolled them in the third to fifth years of primary education completing a brief screening instrument (10 items). Inclusion criteria were higher score at a T of 70 in the “Externalizing” dimension of this instrument. The data suggest that Empecemos improves emotional, cognitive and social skills, and reduces conduct problems, especially teacher-reported conduct problems. The study did not assess substance use related outcomes but showed significant effects when comparing the evolution of the intervention group versus the control group in other relevant behavioural outcomes.
The limited sample size (common in these types of studies with high-risk children) weakens the statistical strength of both analyses carried out. Key issues for the rating: The studies all focus on different components and target groups. Only one study is a RCT with less than 12 month follow-up (post-test after 1 month) that only examined child outcomes, plus the IG had significantly higher age compared to CG (Romero et al., 2019).
Countries where evaluated
- Spain
Characteristics
Protective factor(s) addressed
- Family: attachment to and support from parents
- Family: opportunities/rewards for prosocial involvement with parents
- Family: positive family management
- Individual and peers: skills for social interaction
- Individual and peers: prosocial behaviour
- Individual and peers: coping skills
- School and work: opportunities for prosocial involvement in education
- School and work: rewards and disincentives in school
Risk factor(s) addressed
- Family: family conflict
- Family: family management problems
- Individual and peers: anti-social behaviour
- Individual and peers: favourable attitudes towards anti-social behaviour
- Individual and peers: sensation-seeking
- School and work: low commitment/attachment to school/workplace
Outcomes targeted
- Emotional well-being
- Emotion regulation, coping, resilience
- Other mental health outcomes
- Positive relationships
- Relations with parents
- Relations with peers
- Other relationships (community, school)
- Substance-related behaviours
- Bullying
- Social behaviour (including conduct problems)
Description of programme
This multi-component programme is based on the principles of social learning and is inspired by empirically validated programmes, such as Coping Power and Incredible Years. The use of audiovisual material facilitates modelling and the transmission of content as a more direct and flexible means than didactic instruction, written schemes or mere discussion. The objectives of Empecemos are to change parents’ educational practices, encouraging effective behaviour monitoring, positive educational practices and proper context structuring. It also aims to improve the quantity and quality of positive interactions between parents and children by reversing the cycle of coercion, through the promotion of shared activities and time together. Parents are trained to enhance positive behaviours, through the use of praise and incentives for positive behaviour. This provides parents with resources to deal with problem behaviours, through the establishment of limits that are appropriate to age and development of the child, in addition to the imposition of mild and non-violent sanctions for misconduct. Beyond this, the programme strives to strengthen family-school ties, by promoting participation in school activities and encouraging constructive interviews with the teachers. Empecemos consists of 19 sessions applied in the school context, which train children in recognition and emotional regulation skills. Empecemos incorporates, as one of its three components, a direct intervention module on children (emotional, cognitive and social skills necessary to display a socially competent behaviour style). Although Empecemos was conceived of as a joint and coordinated intervention programme for families, teachers and children, its implementation showed that the intensive and simultaneous involvement of these three agents is not always possible. Work overload, difficulties in combining schedules due to family responsibilities, situations of personal stress, or scepticism regarding the effectiveness of interventions often make it difficult to participate in interventions aimed at families and teachers.
