Intergenerational Effects of the Fast Track Intervention on Next-Generation Child Outcomes: A Preregistered Randomized Clinical Trial
Publication: American Journal of Psychiatry
Abstract
Objective:
The authors sought to determine whether the Fast Track mental health intervention delivered to individuals in childhood decreased mental health problems and the need for health services among the children of these individuals.
Methods:
The authors examined whether Fast Track assignment in one generation of children (generation 2; G2) from grades 1 through 10 reduced parent-reported mental health problems and health services use in these children’s children (generation 3; G3) 18 years later relative to a control group. The Fast Track intervention blended parent behavior-management training, child social-cognitive skills tutoring, home visits, and classroom social-ecology changes across grades 1–10 to ameliorate emerging conduct problems among the G2 children. For this study, 1,057 G3 children of Fast Track participants (N=581 intervention group, N=476 control group) were evaluated.
Results:
G3 children of G2 parents who were randomized to the Fast Track intervention group used fewer general inpatient services and fewer inpatient or outpatient mental health services compared with G3 children of G2 parents randomized to the control group. Some of these effects were mediated: randomization to Fast Track predicted fewer internalizing problems and less use of corporal punishment among G2 adults at age 25, which subsequently predicted less general inpatient service use and outpatient mental health service use among the G3 children by the time the G2 parents were 34 years old. There were no significant differences between G3 children from these two groups on the use of other health services or on mental health measures.
Conclusions:
Fast Track was associated with lower use of general inpatient services and inpatient and outpatient mental health services intergenerationally, but effects on parent-reported mental health of the children were not apparent across generations. Investing in interventions for the mental health of children could reduce service use burdens across generations.
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History
Received: 7 November 2022
Revision received: 8 May 2023
Revision received: 3 August 2023
Revision received: 21 August 2023
Accepted: 8 September 2023
Published online: 7 February 2024
Published in print: March 01, 2024
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Competing Interests
Drs. Dodge and McMahon have royalty agreements with Guilford Publications. The other authors report no financial relationships with commercial interests.
Funding Information
The Fast Track project has been supported by NIMH (grants R18MH48043, R18MH50951, R18MH50952, R18MH50953, R01MH062988, R01MH117559, K05MH00797, and K05MH01027), NIDA (grants R01DA016903, R01DA036523, R01DA11301, K05DA15226, RC1DA028248, and P30DA023026), National Institute of Child Health and Human Development (grant R01HD093651), and the Department of Education (grant S184U30002). The Center for Substance Abuse Prevention also provided support through a memorandum of agreement with NIMH. Additional support for this study was provided by a British Columbia Children’s Hospital Research Institute Investigator Grant Award and a Canada Foundation for Innovation award (to Dr. McMahon).The members of the Conduct Problems Prevention Research Group are, in alphabetical order, Karen L. Bierman, Ph.D. (Pennsylvania State University), John D. Coie, Ph.D. (Duke University), D. Max Crowley, Ph.D. (Pennsylvania State University), Kenneth A. Dodge, Ph.D. (Duke University), Mark T. Greenberg, Ph.D. (Pennsylvania State University), John E. Lochman, Ph.D. (University of Alabama), Robert J. McMahon, Ph.D. (Simon Fraser University and the British Columbia Children’s Hospital Research Institute), and Ellen E. Pinderhughes, Ph.D. (Tufts University). Drs. Bierman, Coie, Dodge, Greenberg, Lochman, McMahon, and Pinderhughes are the principal investigators on the Fast track project and developers of the Fast Track curriculum.
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