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Psychology in the Schools, Vol. 52(1), 2015 §C   2014 Wiley Periodicals, Inc.
View this article online at wileyonlinelibrary.com/journal/pits DOI: 10.1002/pits.21811

SCHOOL-BASED CHILD ABUSE PREVENTION PROGRAMS
MARLA R. BRASSARD AND CHRISTINA M. FIORVANTI
Teachers College, Columbia University


Child abuse is a leading cause of emotional, behavioral, and health problems across the lifespan. It is also preventable. School-based abuse prevention programs for early childhood and elementary school children have been found to be effective in increasing student knowledge and protective behaviors. The purpose of this article is to help school psychologists understand the potential positive impact of abuse prevention programs in their school, choose a high-quality program for their population, and be aware of the practical considerations of implementation. §C   2014 Wiley Periodicals, Inc.


There is overwhelming evidence that psychological, behavioral, and health problems co-occur and stem largely from preventable conditions, including child abuse and neglect (e.g., Biglan, Flay, Embry, & Sandler, 2012; Felitti et al., 1998; National Research Council & Institute of Medicine of the National Academies Committee on the Prevention of Mental Disorders and Substance Abuse among Children, Youth, and Young Adults: Research Advances and Promising Interventions, 2009). School-based abuse prevention programs have been found to be effective in increasing student knowledge and protective behaviors for various populations and age groups. The purpose of this article is to help school psychologists working in early childhood and elementary schools understand the potential positive impact of abuse prevention programs in their school, choose a high-quality program for their population, and gain awareness of the practical considerations of implementation. The first part of the article reviews the large research literature on the components of effective programs. The second half of the article focuses on reviews of available manualized prevention programs appropriate for implementation in schools by school psychologists or at their initiative.

LITERATURE REVIEW
A wave of research on the development of child sexual abuse prevention programs took place in the 1980s. Comprehensive meta-analyses were then conducted on sexual abuse prevention programs and revealed the most effective programs (Daro, 1994; Davis & Gidycz, 2000; MacIntyre & Carr, 2000; Zwi et al., 2007). Many programs covered in these reviews also included material directed at preventing more general types of abuse and abduction. In the late 1980s and early 1990s, researchers expanded their focus from child sexual abuse to the development of child-focused prevention programs for physical abuse, stranger danger, and a combination of abuse types.
Notably, there are no known child-focused school-based programs for the prevention of psy- chological abuse or interpersonal violence (MacMillan et al., 2009), however, it is a component    of several of the child-focused sexual and physical abuse prevention programs reviewed below (i.e., Safe Child and Stay Safe). There are also no manualized evidence-based school-based pro- grams on the prevention of psychological or physical neglect by parents, most likely because it is difficult for children to protect themselves from neglect. The most recent review of child neglect treat- ment studies identified two intervention programs for neglected preschool children that were rated as “good” (Allin, Wathen, & MacMillan, 2005). Both interventions were random clinical trials with peer interaction, supervised by therapists, as the primary treatment (Fantuzzo et al., 1996; Udwin, 1983).

Correspondence to: Marla R. Brassard, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027. E-mail: mrb29@columbia.edu

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School psychologists in early childhood programs could potentially implement these treatments if, with further research and development, they became manualized programs. Elements related to child abuse prevention program effectiveness are reviewed below to provide a framework for program selection.

Curriculum Components: Varied Presentation and Opportunities for Practice
Meta-analyses and reviews have pinpointed several active ingredients for effective abuse pre- vention programs targeting children and youth. Active practice of material appears to be particularly important for programs targeting sexual and physical abuse, and stranger danger (Daro, 1994; Davis & Gidycz, 2000; Kenny, Capri, Thakkar-Kolar, Ryan, & Runyon, 2008; MacIntyre & Carr, 2000; Zwi et al., 2007). Higher effect sizes were reported for programs that provided opportunities for active participation, including roleplaying, video modeling, and discussion. Successful programs were more likely to teach prevention skills through behavioral skills training. Specifically, students learned more and mastered skills better when the training involved the students engaging in active re- hearsal, followed by shaping and reinforcement, as compared with passive learning, such as watching the presenter model skills, hearing a lecture, or viewing a film. Roleplaying and verbal discussion were both related to higher effect sizes than no participation. Wurtele, Marrs, and Miller-Perrin (1987) confirmed the finding that practice is critical by comparing a participant modeling condition, in which students observed a skill and then practiced it, and a symbolic modeling condition, in which students simply observed the skill; results were better for the participant modeling condition.
The same meta-analyses also found that both curriculum content and mode of presentation were significant. Prevention programs for sexual and physical abuse focus upon teaching specific concept knowledge about abuse, teaching skills for avoiding and responding to instances of potential abuse, or a combination of both. Successful programs were more likely to use a variety of methods, including interesting activities, such as didactic instruction, videos, puppet shows, and plays, to introduce information and provide opportunities for practice. Reviewers found that the programs with the best outcomes, in terms of children’s increased knowledge and/or use of skills, were more likely  to be comprehensive; they cover a range of concepts and safety skills, involve didactic instruction followed by group discussion, employ active behavioral skills training, and utilize video modeling (MacIntyre & Carr, 2000; Zwi et al., 2007). It is beneficial for programs to be integrated into the regular school curriculum, to be tailored to children’s individual age groups and cognitive levels, and to include additional skill development in positive areas, such as assertiveness, problem-solving, and communication (Daro, 1994).

Duration of Program: Long Duration and More Sessions are Better
Of the thirty sexual abuse prevention studies reviewed by MacIntyre and Carr (2000), which were required to meet methodological requirements, including a minimum sample size and a posttest, the majority of programs involved three sessions. The number of sessions ranged from one 25-minute session to weekly 90-minute sessions for an entire school term. They found better results for programs of longer duration with trained facilitators. Davis and Gidycz’s (2000) meta-analysis of school-based sexual abuse programs that were included based upon criteria, such as having a control group and measuring outcomes, found an increase in effect size with more sessions. They reported that programs presented over four or more sessions yielded the highest effect sizes. Notably, the number of sessions was more important than the amount of intervention overall, with many brief sessions having better results than fewer long sessions. However, Zwi et al.’s (2007) meta-analysis of randomized or quasi-randomized evaluation studies of school-based sexual abuse prevention programs reported inconclusive results in terms of program duration.


Outcome Assessment: The Importance of Assessing Skills, Not Just Knowledge
A critical issue in pinpointing the most effective programs is determining how outcomes should be measured. Abuse prevention program evaluation studies have measured a variety of outcome variables, including the amount of knowledge learned about concepts, the amount of knowledge retained over time, the development and use of protective behavior skills, and the change in anxiety levels (Zwi et al., 2007). Many assessment tools have been created for evaluation purposes, some of which have become standardized questionnaires, including the Children’s Safety Knowledge and Skills Questionnaire (Kraizer, 1981), the Choice of Safety Strategy Questionnaire (Taal & Edelaar, 1997), and the “What If” Situations Test (Wurtele, Hughes, & Owens, 1998). Questionnaire test items include questions of general concept knowledge, skill knowledge, attitudes, and beliefs about the acceptability of violence, and vignette decision-making.
In addition to questionnaires, concept and skill knowledge can be assessed with student inter- views aimed at understanding how they would behave in different potential situations. The “What If” Situations Test has been used as a scripted roleplay assessing student responses and body language when faced with persuasion and encouragement to go along with inappropriate situations (Kraizer, Witte, & Fryer, 1989). Fryer, Kraizer, and Miyoshi (1987a) went one step further to assess child be- haviors at pre- and posttest using a staged situation in which an unfamiliar research assistant asked a child to leave the school building with him/her. Direct behavioral observations offer greater external validity than other assessment methods, but also may include greater risks and ethical dilemmas warranting further consideration (Conte, 1987). Davis and Gidycz (2000) found that behavioral observations and questionnaires were better able to detect program effects than interviews using potential vignettes.
Notably, no known child-focused program evaluation study has reported rates of abuse preva- lence for participants versus nonparticipants. However, one study found that victims of child sexual abuse who had previously participated in a specific school-based prevention program were more likely to have meaningfully reported the abuse, were more likely to tell their teachers, and their reports were more likely to be substantiated (MacIntyre & Carr, 1999b). The current research on child-focused physical and sexual abuse prevention programs indicates how well programs impart students with prevention knowledge and skills, but it is unknown if the actual risk/likelihood of abuse has been reduced or if instances of abuse were truly prevented.

Family Involvement
In a recent review of the literature, Kenny et al. (2008) reported that parent involvement com- ponents of abuse prevention programs are related to increased program success in part because    of increased communication about abuse and more repetition of concepts. More indirectly, the likelihood and willingness of parents to talk to their children about sensitive topics may improve the strength of the parent–child relationship. Parents showed significant improvements in their knowledge of abuse and their attitudes about abuse after their child participated in an abuse pre- vention program that included a minor parent education component and targeted physical, sexual, and psychological abuse (MacIntyre & Carr, 1999a). Another study demonstrated that watching a parent education video on sexual abuse increased the likelihood that parents voiced an intention to talk to their children about sexual abuse, as well as the likelihood that they actually talked to their children about the topic (Burgess & Wurtele, 1998). These findings are very promising in light of literature stating that parent knowledge about abuse allows them to keep their children safer (Wurtele & Kenny, 2010). Wurtele and Kenny (2010) review barriers to parent involvement, including poor attendance at meetings and uneasiness about the topic, and offer practical suggestions for achieving family participation.


Training/Qualifications: Any Professional will Do, but Training is Key!
Qualifications/occupations of facilitators was not found to be a significant variable, with effec- tive programs taught by teachers, parents, mental health professionals, and law enforcement officers (Davis & Gidycz, 2000; MacIntyre & Carr, 2000). However, training was found to be essential. The physical and sexual abuse prevention programs reviewed below typically include training manuals and/or training DVDs, or they include enough curricular materials that the program is easily learned with little formal training. A few programs offer the option for program-affiliated trainers to visit a school district and perform training (e.g., Safe Child). It is recommended that school psychologists assume the role of learning the intervention that is chosen for implementation and then conduct trainings to teach the teachers/facilitators who will be directly implementing the program. School psychologists would also be expected to provide continuous support and trouble-shooting for facil- itators during implementation, and to collect data on program fidelity and outcomes. A qualitative study that explored teachers’ experiences implementing school-based physical and sexual abuse prevention programs shed light on possible issues that may arise when teachers implement abuse curricula without proper training and support, including teachers modifying content to align with their personal beliefs (Johnson, 1994). This study highlights the importance of addressing teacher beliefs and experiences, having an alternative option if a teacher does not feel they are able to deliver the curriculum appropriately, and including checks on program fidelity to ensure consistent implementation.
Age: Young Children can Learn Self-Protection Skills
The data on how the age of a child impacts their ability to benefit from physical and sexual abuse prevention programs have been somewhat mixed, with some critiques indicating that young children do not learn or retain the material as well as older children (Berrick, 1989; Daro, 1994; Davis & Gidycz, 2000). However, there is a good deal of research indicating that preschool and kindergarten students can learn self-protection skills and abuse concepts (Kraizer, 1992; Wurtele  & Owens, 1997). In addition, it is helpful for children to be re-exposed to concepts from year to year as the repetition helps them to fully master the skills. For these reasons, preschool students should be exposed to abuse prevention programs, as long as they are delivered in an age-appropriate way. Modifications that can be made to make programs more appropriate for younger ages include more family involvement, more exciting activities, more focus on concrete (vs. abstract concepts), more opportunities for practice, and more repetition (Kenny et al., 2008). Alternatively, choosing a program specifically designed for the preschool age group would be a good practice.
Other Variables: Higher Self-Esteem is Related to Better Use of Protective Skills
Fryer, Kraizer, and Myoshi (1987b) found a relationship between child self-esteem and use of protective behaviors, such that children with greater self-esteem demonstrated better protection behaviors when confronted with scenarios of sexual abuse, physical abuse, and stranger danger. For this reason, abuse prevention programs that aim to build self-esteem and confidence should be strongly considered.

METHODS
A thorough search was performed to locate school-based abuse prevention programs that were evaluated in high-quality research studies and found to have positive outcomes. Programs for all ages, from preschool through high school, were reviewed. Abuse was defined as any maltreatment from an elder toward a minor, including physical, sexual, and psychological. Only abuse prevention programs for children were identified because adolescent programs focus on romantic partner violence with


a secondary emphasis on self-protection, broadly defined (e.g., Safe Dates, Foshee & Langwick, 2010). Although school-based dating violence programs of high quality were identified, they were excluded because of space limitations. Other forms of peer aggression and bullying were excluded as stand-alone programs, but included if peer aggression was one of several targeted components that also included abuse by an adult. Upon finding several comprehensive meta-analyses that compared sexual abuse prevention programs, the researchers decided to exclude those that only targeted child sexual abuse to not be redundant. Interested readers should see Daro (1994) for a description and review of the major child sexual abuse prevention programs (most were developed in the 1980s and early 1990s) and Zwi et al. (2007) for a recent meta-analysis of this large research literature. Programs that included sexual abuse prevention techniques in combination with more general abuse prevention techniques were included in the review.
Programs to be reviewed and discussed were chosen through three main search strategies. First, the search terms “abuse,” “prevention,” “child,” “sexual abuse,” “school,” and “program” were used in various combinations in databases, including PsycINFO, Education Full Text, ERIC, JSTOR, and ProQuest. Second, recent volumes of specific journals, including Child Abuse & Neglect, Child Abuse Review, Journal of Child Sexual Abuse, Prevention Science, and American Journal of Public Health, were reviewed for relevant articles. Third, recent meta-analyses and reviews of the literature were used to identify any additional studies or programs that may have been missed (Daro, 1994; Davis & Gidycz, 2000; MacIntyre & Carr, 2000; Zwi et al., 2007). Finally, only programs meeting the following characteristics were considered for reviews: (a) evidence indicating promising or demonstrated effectiveness in addressing one or more treatment goals of reducing or being likely to reduce child abuse; (b) school-based; (c) had three or more sessions, and was not just videos or a play; (d) was affordable (i.e., under $1000); (e) could be implemented by most school psychologists in that it did not require extensive formal training, licensing, or payment for a service (e.g., puppet troupe); and (f) the program had a name (some did not and therefore could not be identified for purchase). This resulted in a total of 15 programs.
To be able to comment on the specific curricular materials and practical implementation con- siderations, we attempted to order the 15 programs that met criteria a–f above. After a thorough Internet search for contact and ordering information, it was discovered that many programs were out of print and no longer easily accessible. From the list of programs considered to have promising results, only four were available. We purchased three programs and downloaded one program for free from the Internet (see Table 1). While reviewing and evaluating programs, particular atten- tion was paid to variables that directly impacted the ease of implementation, including the cost, accessibility, range of ages covered, training and skill level needed to implement the intervention, and time commitment. We also considered program effectiveness, as greater efficacy might justify greater investment in an intervention, and the attractiveness of the materials to participants (children, teachers, parents). The presence of key components found to be important to effective programs, as revealed by meta-analyses, was also noted.

PROGRAM REVIEWS
Stay Safe
The Stay Safe curriculum (Cullen et al., 1998; MacIntyre & Lawlor, 1991) for children in grades prekindergarten to sixth grade was developed by the Child Abuse Prevention Program in Dublin, Ireland, to target both abuse (sexual, physical, emotional) and bullying (note: only abuse materials were reviewed for this article). As far as accessibility and ease of implementation, Stay Safe is ideal with detailed curricula for four different age groups available for free download (http://www.staysafe.ie/index.htm). In prekindergarten through fourth grades, teachers  implement





Table 1
School-based Programs to Prevent Abuse of Children



Program/Article


Target Population


Purpose and Curriculum Components


Number and Length of Sessions


Empirical Findings/ Measure Used


Training Details, Cost,
and Contact Comments


Safe Child Program Grades Pre-K to

. To prevent sexual

. Ten sessions of

. Successful

. Training manual and

. Strong focus on

(Kraizer & Coalition for Children, (1994–2005)

third grade

abuse by known
people, stranger danger, physi- cal/emotional abuse, and to teach safety skills when children are alone
. Focuses on “What
If” situation role-plays. Also
uses video, safety rules, and discussion
. Three phases:
teacher training, parent seminar, and child program
. Materials:
parent/teacher training DVD, child DVD, manual, lesson plans, parent handbook, and many other resources

20 minutes
each for Pre-K and kindergarten
. Five longer
sessions for Grades 1–3

performance on a
behavioral test was associated with higher self-esteem and higher posttest knowledge on Children Need to Know Knowledge Attitude Test

DVD are included
with program
. Training can be
arranged with Dr. Kraizer or school psychologist can do it
. To order programs
contact:
. Coalition for
Children, PO Box 6304, Denver, CO 80206 or
www.safechild.org
. 303-809-9001
. Cost: Preschool
$95.00, K–third grade: $395.00

role-playing
scenarios and skill building, both at school and at home
. School age curricula
cover identification of emotional abuse
. Program focuses on
what children can do to protect themselves



(Continued)









Table 1
Continued

Target Purpose and Curriculum Number and Length Empirical Findings/ Training Details, Cost,
Program/Article Population Components of Sessions Measure Used and Contact Comments

Stay Safe Program Grades Pre-K (Cullen, MacIntyre,  through sixth

. Targets all types
of abuse and

. Nine sessions
of 20-30

. Teachers reported more
open relationships with

. Presented by teachers
. Thorough

. Modifications and
tips for use with

& Lawlor, 1998)

(arranged in four age groups of two grades each)

bullying
. Uses role-play,
repetition, homework, safety rules, stories, games, and discussion
. Materials: lessons
by grade, posters, parent program guide, and additional written materials (e.g., sample letters, consent forms)

minutes for
grades pre-K through fourth grade
. Five sessions of
30 minutes each for fifth/sixth grade

students
. Participants showed
significant gains on the
Personal Safety
Knowledge and Skills Questionnaire
. Significant gains in
self-esteem for
7-year-old participants
. Significant gains in
knowledge for parents and teachers
. Program participants
more likely to disclose abuse in retrospective study

curriculum, minimal
prep time
. No formal training
required to deliver the program.
Program encourages all staff members be trained to identify/report child abuse
. Available online:
(http://www.staysafe.ie)
. Cost: free

children with special
needs
. Focus is on building
positive skills: feeling vocabulary, communication, assertiveness, and self-esteem
. Emphasis on family
involvement
. Includes student
assessments
. Covers information
on emotional abuse



(Continued)







Table 1
Continued



Program/Article


Target Population


Purpose and Curriculum Components


Number and Length of Sessions


Empirical Findings/ Measure Used


Training Details, Cost,
and Contact Comments


Talking About Touching (Committee for Children, 1985–2001)


Grades Pre-K to third grade

. Designed to
prevent sexual and physical abuse, delivered within context of general safety lessons
. Uses various
modes of presentation: didactics, stories, puppets, safety rules, games/activities, songs, discussion, modeling, and role-play
. Materials:
teacher’s guide, big lesson cards, book, CD of songs, posters, family video and family handouts

. 10–15 lessons
per grade that could be completed in 30-40 minutes
. Lessons are
specified for individual grade

. Participants of all ages
showed significant improvement in knowledge and prevention skills
. Teachers felt positively
about the program, felt it was needed, and easy to implement
. Parents who watched
the training video were more likely to talk to their kids about abuse

. Taught by teachers
. No formal training
required by authors to use the program
. Recommends all
staff be trained to recognize/report abuse
. www.cfchildren.org
. 800-634-4449 Ext.
200.
. Cost: Pre-K to K:
$269.00, Grade 1–3:
$239.00

. Family video and
handouts available in Spanish
. Uses modeling,
practice, feedback, and reinforcement



(Continued)









Table 1
Continued

Target Purpose and Curriculum Number and Length Empirical Findings/ Training Details, Cost,
Program/Article Population Components of Sessions Measure Used and Contact Comments

Teaching young children personal body safety: The Body Safety Training Program (Wurtele, 1986–2007)

Ages 3-7 . Targets sexual
abuse and stranger danger
. Uses didactics,
safety rules, stories, role-plays using “What If” games, and review/repetition
. Materials: manual
of program curriculum, including detailed lessons with facilitator scripts, and book of pictures to accompany curriculum

. Ten lessons
. Meant to be
presented in groups of 6–10 children of similar ability levels
. Lessons can be
presented in 30-45 minutes

. Significant increase for
pre-K participants from pretest to posttest on the Personal Safety Questionnaire, a measure of knowledge gained
. Main effects found for
participants’ ability to identify inappropriate situations on the “What-If” Situations Test vignettes

. Presented by teachers
. No formal training
. swurtele@uccs.org
. (719) 255-4150
. Cost: $40.00

. Facilitators are
encouraged to use positive reinforcement
. Solicitation of
student ideas for role-plays allows teachers to understand their thoughts and concerns




the brief 20- to 30-minute lessons once a week in the classroom for 9 weeks. In fifth and sixth grades, there are five weekly sessions of 30 minutes each. Rather than focusing upon protection skills, Stay Safe emphasizes the primary importance of simultaneously building positive skills in children, including confidence, self-esteem, assertiveness, feeling vocabulary, strong communica- tion, and understanding of personal space. Teachers are encouraged to empower children through their teaching and interaction style by listening to students, making them feel heard, giving them important roles, encouraging them to share their opinions and feelings, giving them responsibility, scaffolding their skills, and focusing on their strengths. As far as personal safety skills, goals in- clude identifying and expressing safe and unsafe feelings, enjoying normal affection, identifying and dealing with inappropriate touches, not keeping secrets about touches, differentiating good and bad secrets, identifying helpful adults, understanding strangers, and learning how to deal with strangers. Children are taught that it is not their fault if they are abused. Family involvement is stressed with a parent guide and section of the website devoted specifically to parents to explain the program and provide tips for parents in talking to their children about the personal safety lessons. The authors recommend having a parent meeting before beginning the program and offer examples of frequently asked questions to fully prepare school psychologists and teachers.
In terms of implementation, the program was designed to be delivered by teachers in the classroom. School psychologists would be expected to build school- and district-level support for the program, train teachers in the curriculum, communicate with parents about the program and obtain parent permission for participation, hold a parent meeting, respond to teacher questions/concerns, hold periodic teacher meetings to address program fidelity, hang posters around the school, collect and analyze data on student outcomes, collect and analyze data on teacher experiences, and make program changes as necessary. School psychologists would engage in these tasks each year to ensure that the program is implemented consistently and reliably. The program materials are very comprehensive and minimal preparation is required from teachers on a weekly basis. Each lesson outlines materials needed and includes prompts for discussions, tips for each activity, homework handouts, posters, and ideas for follow-up activities. Sample forms to announce the program to parents and parent consent forms are included, as are assessments to measure student retention of skills and knowledge. The materials are simple and attractive, and the activities are fun.
In terms of content, each lesson is taught didactically or through stories, and then followed  by active student participation through such activities as discussion, roleplay, puppets, games,   and drawing. Repetition and review of the previous lesson is included at the start of each new lesson. Notably, Stay Safe includes a lesson to teach children when it is appropriate (if someone makes them feel uncomfortable) and when it is inappropriate (when someone asks them to do homework or chores) to say no to an adult’s request, which is important to make sure the lessons do not generalize in negative ways. The program acknowledges that it may be very hard for children to tell someone about an incident of abuse. It also mentions that someone they tell might not believe or help them, and encourages children to keep telling until someone helps. Children are taught that if a friend shares an incident, they should encourage the friend to tell an adult.

Pros
As far as positive outcomes that have been measured, teachers reported better, more open
relationships with their students after the Stay Safe program. A major advantage of this pro-    gram is that modifications are provided to teach the curriculum to children with various special needs, including learning difficulty, physical disability, hearing impairment, visual impairment, and emotional/behavioral difficulties (MacIntyre, Lawlor, & Cullen, 1996). It may be particularly helpful for school psychologists to teach or co-teach the lessons when they are being delivered  to


children with special needs. Another advantage of Stay Safe is the acknowledgement of the im- portance of training all staff, not just the teachers who will be implementing the program. School psychologists would be expected to train all staff members on this topic in order for the environment within the school to be one of understanding, acknowledging, and preventing abuse before it occurs, and intervening immediately if it does occur. Both the facilitator and parent manuals and website sections explain types and signs of abuse, including emotional abuse, which receives little to no attention in other programs. It is critical that teachers, parents, and other staff members understand what abuse is to effectively identify and address it. Stay Safe brings up the issue of a teacher’s abuse history and how that may impact their ability and comfort level in implementing the program, which is a serious consideration. Teachers who are more uncomfortable with the material may request that the school psychologist co-teach on certain lessons. Tips are also included for using the program with children who have been abused or exposed to violence.
A large-sample study compared the Stay Safe program with wait-list controls and found signif- icant improvements in safety knowledge and skills on the Children’s Safety Knowledge and Skills Questionnaire, with gains maintained at 3-month follow-up (MacIntyre & Carr, 1999a). Younger participants (7-year-olds) also made significant improvements in self-esteem compared with the control group. Parent and teacher knowledge and attitudes were also measured, and significant im- provements were found for those whose children participated in the Stay Safe program compared to controls. MacIntyre & Carr (1999b) compared children who were evaluated at a child sexual abuse hospital clinic on whether or not they had previously participated in Stay Safe and found that program participants were more likely to have meaningfully disclosed the abuse, and were more likely to tell their teachers.

Cons
One could consider a disadvantage of the program to be that the lessons for younger children are very basic and positive, seemingly just setting the framework for later protective skill-building.

Teaching Young Children Personal Body Safety: The Body Safety Training Program
The Body Safety Training program, also known as the Behavioral Skills Training program (Wurtele, 1986–2007), targets children aged 3–7 years and teaches body safety skills over 10 lessons of unspecified length. The reviewed version of the program was designed to be taught by teachers to small groups of students during classroom time. The manual recommends that children of similar ability levels (unspecified) be placed in groups of 6–10 to increase opportunities for practice and facilitate steady progress. There is another version of the program, which was not reviewed, designed for parents to use with their children at home. The materials included with the program are the manual containing the program curriculum and detailed lessons, and a book of simple, black and white pictures to accompany the lessons. The program manual includes information for facilitators about abuse, including the significance of the problem, the rationale for a prevention program, signs of current abuse, and tips for responding to suspected abuse, including helping the child understand it is not their fault. The manual also provides basic information on program implementation and    a brief overview of what will be covered; more detail in this section would be helpful. School psychologists would be expected to thoroughly review the manual themselves, build support for the program, train teachers in the curriculum, and provide guidance and support to teachers as it is implemented. Because the program is to be delivered in small groups, which would pose a large time commitment for teachers, school psychologists may choose to teach one small group per classroom. It may be beneficial for school psychologists to deliver the program to students who have a special need, learning disability, abuse history, or exhibit more challenging behaviors.


The program moves from basic safety lessons, such as safety rules to follow in the car, in the street, or home alone, to more sensitive topics, such as guidelines for when it is and is not appropriate for someone to touch their private parts. The presentation of safety rules is followed by opportunities for practice using “What If” games, which are essentially discussion prompts/roleplays of potential situations that allow children to brainstorm ideas for how they could/should respond. Stories with pictures are used to teach the lessons and present potential scenarios. Facilitators are reminded to use much positive reinforcement and encouragement throughout the lessons. The lessons provided within the manual provide a script for facilitators; however, it is somewhat simple and may not reflect the style of every  individual. Lessons covered include “You  are the boss of your body”   (p. 6), Rules are made to keep you safe, “A  stranger is someone you don’t know” (p. 15), Ask  first before going with or taking something from a stranger, It is only okay for someone to touch and look at your privates if you need help keeping them clean or you are hurt, also known as the “Body Safety Rule” (pp. 17–19), and Don’t keep secrets about someone touching your private parts. The program encourages children to identify and depend upon trustworthy adults, such as school counselors, teachers, caregivers, and police officers, for help in making decisions. Rules for how to respond in the face of an abusive situation are also presented, for example, saying you have to ask your parent and trying to get away and get help in response to a stranger offering a gift or a ride.

Pros
Ten lessons allows for adequate repetition and practice across time to retain the concepts. The
lesson plans all seem to cover an appropriate amount of material to be presented in 30- to 45-minute lessons. Review and repetition of concepts is used throughout to solidify learned safety rules and skills. “What If” games are a great way for students to roleplay skills they have learned and get immediate feedback and reinforcement from the facilitator. At certain points throughout the manual, facilitators are encouraged to solicit roleplay ideas from students, which is helpful in understanding what the students are thinking and following up with their concerns. Students are also encouraged to come up with their own ideas for how to handle difficult situations. The pictures include both boys and girls of different ethnicities, and the stories include a variety of male, female, older children, and adult offenders. Positive stories are mixed in with the more difficult stories. Students practice providing their personal information, such as phone numbers, which could be very helpful if they were lost or separated. The use of safety rules to dictate behavior has been found particularly helpful for young children, who may have difficulty accurately using their feelings to dictate their behavior. The program also accurately defines strangers simply as people that children do not know. Children are taught that they do not have to be afraid of strangers, but that they do have to follow rules about them. Although discussing rules for touching private parts, the manual teaches children that it is okay for them to touch their own private parts in private, which is important to not have young children get confused and feel uncomfortable about their own bodies. The manual places a big emphasis on having children not keep secrets and to tell if something happens. It also covers the possibility that an adult might not listen carefully, might not act on the information, or might not believe the child, which is a very real possibility that kids should have tools to address.
A review was conducted of the results of five previous evaluation studies on the Body Safety Training program taught across 5 days with preschoolers randomly assigned to the treatment or control group (Wurtele & Owens, 1997). Children were pre- and posttested with a behavioral assessment using scripted roleplays on the What-If Situations Test (WIST-III; Wurtele et al., 1998), as well as a typical knowledge test, the Personal Safety Questionnaire (PSQ; Wurtele et al., 1998). Results on the PSQ increased significantly from pre- to posttest for program participants and there were main effects for the participants’ ability to identify inappropriate situations on the  WIST-III,


but no main effects for appropriate situations. Overall, the data indicate that Body Safety Training participants consistently show increased prevention skills and sexual abuse knowledge compared to the control group, but results are more mixed with regard to participant ability to differentiate appropriate and inappropriate requests and touches (Wurtele, 1990; Wurtele, Kast, Miller-Perrin, & Kondrick, 1989).

Cons
The pictures are relatively low-quality, black and white cartoons, rather than photos, and some of the scenarios depicted are controversial. Likewise, some information from the lesson scripts is worded in a way that might be considered threatening or scary to some children (“Policemen have guns. They sometimes use them to shoot people who do bad things” [p. 10]; “There are some people who try to touch and look at girls’ and boys’ private parts” [p. 21]). This program brings up many of the unfortunate scenarios that may happen to children, presumably thinking that if children are aware of those situations, they will be more prepared. It may be challenging for some teachers to work with children in small groups if there is limited additional assistance in the classroom. This could be remedied by having the school psychologist teach some groups, as described above, but this may not be possible for every school psychologist, depending upon their other responsibilities. The wording of the script seems slightly “fake” and may not seem natural for every teacher (e.g., “Who is the boss of your body?” “That’s right, YOU are the boss of your body” [p. 6]; “Okay, now because your body is special (don’t you think your body is special?), we are going to learn some rules to keep your body safe” [p. 7]). Facilitators can choose to present the lesson concepts in a modified way, but this would require additional preparation and may impact the integrity of the program.
Minimal games and activities are provided, besides the “What If” game scenarios that are presented more as discussion questions than true roleplays. Many of the discussion questions simply ask children to repeat the learned rules verbatim and do not require flexible application. Furthermore, children in this age range (3–7 years) would likely have difficulty staying seated for lengthy lectures and extended discussions. Facilitators should note this and present the questions as roleplays to allow for active practice of skills. The stories are also generally presented in black and white terms; additional ambiguous stories and roleplays would be helpful to give children practice in making judgment calls. Although safety rules can be very helpful for young children, they are limiting in that there are exceptions to the rules and this is confusing to children. For example, by telling children to lock the doors and windows and never leave while home alone, a problem arises if there is a fire and the child has to evacuate. In addition, the program provides rules for staying home alone, which should not be experienced by children in the target age range of 3–7 years old. The manual is also slightly inconsistent as it explains times when it is okay for adults to touch or look at children’s private parts, but then presents a rule that it is not okay for anybody to touch or look at a child’s private parts, without any mention of the exceptions. This rule is named and subsequently referred to as the “Body Safety Rule,” which is a neutral catchphrase but may be too ambiguous for young children.

Talking about Touching
The Talking about Touching program (Committee for Children, 1985–2001), for grades prekindergarten to third grade, is a teacher-delivered program developed primarily as a sexual abuse prevention curriculum, but also covering physical abuse, personal safety (e.g., fire, knives), and assertiveness. It is delivered within a “framework of safety” (p. 5), meaning that general safety lessons frame the discussion and lead the way for presentation of more sensitive topics. Only the program designed for children in grades 1 through 3 was reviewed for this article, as the cost   for


all age levels was beyond the prescribed budget. Notably, information from the program website indicates that the Pre-K/kindergarten curriculum is similarly designed to those for the other grades, including lesson cards, a book, a DVD, and facilitator and parent resources that cover personal safety and touching safety. There are between 10 and 15 lessons for each grade to be delivered    by teachers in the classroom. School psychologists would take on a more indirect role in program implementation. They would be expected to garner support for the program, hold a parent meeting to show the video, explain the program, and hold a discussion, train teachers in the curriculum, and troubleshoot with teachers throughout implementation. In addition, this program emphasizes the importance of building a school environment in which all staff can recognize the signs of abuse and there is a written procedure for addressing these signs. School psychologists might be expected to train school staff (including custodians, bus drivers, and food service workers) on the facts of abuse, how to notice the signs, and what to do if they are confronted with a concerning situation. The school psychologist would also be responsible for making sure that school policies are written appropriately, based on the suggestions in the manual. Finally, in accordance with the typical job description of the school psychologist, he or she would be expected to serve as a resource to all staff members in the event that they were concerned about a student and wanted to obtain consultation on the manner.
The Talking about Touching program utilizes various presentation methods and includes many useful, attractive materials, including Teacher’s Guide Manual, large lesson cards with photos, large book, small book, CD of songs, three “Safety Steps” posters, family video, and discussion guide and handout for the family video, in English and Spanish. The program is research-based and the manual provides a helpful review of the prevention literature and rationale for certain aspects of the program. The literature review emphasizes the importance of practice, active presentation modes, family involvement, and clear safety rules, rather than having children rely solely on their feelings to make decisions. It is also acknowledged that the program does not focus on “stranger danger” because research indicates that children know most abusers beforehand. Based upon the tenets of social learning theory, Talking about Touching utilizes the key techniques of skill modeling, practice, feedback, and reinforcement.
The informative manual provides statistics, common facts about abuse, the impact of abuse, facts about abuse disclosure, signs of abuse, information regarding reporting, and tips for ongoing response to abused children. As modeling and practice of skills are key components of the program, the manual provides helpful suggestions to facilitators for using these techniques. Although not required, the manual suggests that teachers use puppets to present lessons to younger children,     as this increases their interest and has been found effective in the research. The program also recommends using puppets to demonstrate unsafe touches, which may be less threatening for many students, and allowing students to roleplay with puppets. The included storybook strikes a good balance between covering relevant issues, while staying positive and entertaining. The lesson cards are extremely well-designed with a large picture on one side (for students to see) that accompanies a story or scenario, and detailed information for the facilitator on the other side, including concepts, objectives, necessary materials, notes to the teacher, introduction, story and discussion, activities, summary, ideas for transfer of learning, and take home reminder. The stories are engaging and the activities are hands-on, which is useful to sustain student attention. Overall, the materials allow for easy, consistent implementation with minimal prep time required by teachers.
The curriculum emphasizes positive skill development, including assertiveness, self-esteem, and communication. Earlier lessons cover basic safety skills, such as bike safety, fire safety, and gun safety. Safety rules include “The always ask first rule” (p. 6), “Say no to unwanted touch”     (p. 6), “The touching rule: No one should touch your private body parts except to keep you clean and healthy” (p. 7), “If someone breaks the touching rule: Say words that mean ‘no,’ Get away,


and Tell a grown-up” (p. 7), and “Children should not keep secrets about touching” (p. 7). It should be noted that while the emphasis is placed on using rules to guide decisions rather than strictly feelings, the program does connect safe and unsafe touches to feelings, which is important for ambiguous situations when rules might not neatly apply. Some goals of the program are to have students identify safe people, to speak up if they do not like something, to tell someone if something upsetting happens, to say no assertively (standing tall with a strong voice and making eye contact), and to reassure them that it is not their fault.
The parent component is well developed and thoughtful. The manual emphasizes to facilitators the importance of involving families in order for information given to children about safety to be consistent across home and school. This would be a joint endeavor between the school psychologist and teachers. School psychologists would typically be in charge of reaching out to families, holding the initial meeting, and answering ongoing questions about the program. Teachers would be expected to send home the included parent handouts after each lesson to keep families informed about the curriculum progress. Achieving strong family involvement requires little additional work by school psychologists and teachers as the program includes various parent handouts and explains in detail when and how to inform parents about the program. For example, there is an outline for what to cover during the initial parent meeting, as well as a video to show and discussion questions for afterward. The video is 30 minutes long and provides facts about abuse, guidelines for providing a safe and nurturing environment, realistic examples of how and when to talk to children about safety and touching, and suggestions for responding to a disclosure of abuse. The video is accessible, funny, and informative. It is acknowledged that these are uncomfortable topics for many parents, but encourages them to stay calm and try not to react when discussing sensitive topics with their children, which helps to keep the lines of communication open and not have children feel embarrassed to ask questions. The video teaches parents how to take advantage of natural teaching opportunities to discuss sensitive issues and how to roleplay with their kids. Books are also suggested as a less threatening way to bring up sensitive topics. One main goal of the video is to have parents think about how well they really know the people that spend time alone with their children. The manual also contains worksheets about certain lessons to be sent home and the manual and lesson cards clearly indicate when to do so. The manual has an entire section titled “Involving Families,” which contains additional resources, such as guidelines for choosing babysitters and recommended books. During lessons, students are encouraged to discuss what they learned with their parents.

Pros
Talking about Touching is a well-designed program with many advantages. The materials  are
child friendly and fun, with big, colorful, nonthreatening visuals and upbeat songs. There are various modes of presentation (e.g., lecture, stories, songs, puppets, books, activities), which have been shown to be effective in the literature and ensure that students stay interested. The key components of skills practice and roleplaying are emphasized. As the lessons are designed for individual grades, the curriculum is likely to be more developmentally appropriate and allows for consistent presentation each year without excessive repetition. The curriculum is also culturally sensitive, recommending that correct terms be used for body parts, but acknowledging that this might be not appropriate     in every community and allowing for alternatives. The manual also acknowledges the issue of teacher/facilitator abuse history and recommends that teachers not be required to implement the program if they are uncomfortable. The school psychologist might take on the role of facilitator   in such a situation. The family component is comprehensive and heavily emphasized, and English and Spanish translations allow more families to be involved. Finally, the issue of children reporting abuse by a parent or family member is skillfully framed as a way for the parents to get help. Notably,


as many cases of abuse are by known people, including relatives, students work to identify a support network that includes nonfamily members. School psychologists are invited to visit the classroom during an early lesson to introduce her/himself as a resource available to talk about concerns.
Research documents that participation in the Talking about Touching program was related to significant improvements in student knowledge and prevention skills for all ages (Madak & Berg, 1992; Sylvester, 1996). Teachers’ had positive attitudes about the program, felt it was needed, indicated that implementation was not difficult, and expressed few concerns about negative side effects. A posttest questionnaire and phone interview found that parents who were randomly assigned to watch the “What Do I Say Now?” video were more likely to talk to their children about child sexual abuse than the control group (Burgess & Wurtele, 1998).

Cons
The main negative aspect of the program is that the name might seem threatening to some children and cause them to approach the lessons with an inaccurate preconceived notion. The only other criticism is that the curriculum talks about reporting the incident and getting help if an older person wants to touch a child’s private parts, but it should be modified to include peers as well. Although the issue is different, it is still important for students to think this is a serious issue warranting the need to speak up.

Safe Child Program
The Safe Child Program (Kraizer & Coalition for Children, 1994–2005), which evolved from the Children Need to Know Personal Safety Program, aims to prevent sexual abuse by people known to the child, abuse and abduction by strangers, physical and emotional abuse, and to teach safety for children while in self-care. Although the Safe Child program is available for Pre-K through grade three, only the preschool program was thoroughly reviewed, as it was not possible to order all age levels due to budgetary constraints. Notably, the school age curricula appear to use a similar format to the preschool curriculum, as manuals with outlined lessons and videos of roleplays are included. Teachers present the preschool and kindergarten programs over ten sessions with approximately 20-minute lessons each day, whereas the first through third grade curricula include five lessons each. The preschool program materials consist of the Implementation and Training Guide/Resource Manual DVD for facilitators and parents, the “All about Strangers” and “Your Body Belongs to You” DVDs for preschoolers, and two CDs containing written resource materials, such as manuals, lesson plans, a training guide, a parent handbook, answers to frequently asked questions, and many other resources. The kindergarten program includes the “It’s Your Body” and “Strangers Aren’t Bad” DVDs, first grade includes the “Speak Up for Yourself” DVD, second grade includes the “The Choice Is Yours” DVD, and third grade includes the “Being Your Own Best Friend” DVD. The content changes across the grades with the older grades focusing more on what children can do to keep themselves safe and also includes some information on identifying and managing emotional abuse. There is a strong emphasis placed upon the positive, nonthreatening, preventive nature of the program, described by the developer as a way to teach skills to reduce children’s vulnerability as opposed to scaring kids.
The Safe Child Program is described as a three-phase approach comprised of teacher training, parent seminar, and the child program, consisting of the video to ensure accurate presentation of lessons and ample opportunities for practice through roleplaying scenarios. The school psycholo- gist would lead the teacher training and parent seminar components, and then the teachers would implement the child program with ongoing support and guidance from the school psychologist. The training DVD is designed to educate facilitators, staff, and parents about abuse, prevention research,


and the specific components of the Safe Child program. One main message of the DVD is that the program does not talk to or teach kids about child abuse, rather it is a way to talk to kids about safety and prevention in a natural, realistic way. Another message is that the majority of incidents of abuse take place with a person known to the child, meaning that kids need more than just “stranger danger” education to stay safe. Adults often encourage children to show affection for relatives or family friends that they do not know well simply to be polite, but children must feel like they have the right to say no to touches that make them feel uncomfortable. The training DVD strongly emphasizes the importance of roleplaying and demonstrates countless examples of the researcher engaging in roleplays with the students. The “What If” game, which is basically brainstorming how one should behave in a potential scenario through roleplay and discussion, is presented as a key tool for both parents and facilitators to use with kids. The roleplays focus on positive skills, including being assertive, speaking up, communicating a message clearly, matching nonverbal communication to words, asking an adult for help, and getting someone’s attention when needed. It is recommended that school psychologists utilize hands-on roleplay practice during the teacher training and parent seminar, as is demonstrated in the DVDs, to ensure that the content is well understood.
Another main message of the DVD is that many children hesitate at first but give in when adults use threats to coerce them, meaning that it is critical to give kids tools to withstand the coercion. Dialogue and commentary takes place throughout the roleplays to highlight certain lessons (e.g., “By moving away, you show that you really mean no” “If you don’t want to sit on my lap, does that mean you don’t like me?”). One notable characteristic of the roleplay scenarios is that they are realistic situations in which children could find themselves, rather than contrived stories based on preconceptions. The researcher notes that the roleplays should allow children to use and practice safety skills, without increasing their fear or anxiety. There is a big emphasis on empowering children to take care of themselves when they are alone. The training DVD briefly covers the research evidence supporting the program, which demonstrates that children who participate in the Safe Child program change their behavior so they are more likely to use safety skills when confronted with a dangerous situation.
The child DVD is similar to the training DVD in that it consists mostly of roleplay situations between the researcher and students who appear to range in age from 5 to 8 years. There are five video clips on the “Your Body Belongs to You” unit and five clips on the “All about Strangers” unit, with individual segments typically lasting around 5 minutes and segueing into the opportunity for the students to practice with their teachers. The researcher reviews the past lessons, presents safety rules and then demonstrates how to apply those rules through actual roleplays with children. The roleplay examples displayed in the video range from the child knowing the safety skill well and executing it confidently, to the child being hesitant and needing to be talked through the situation, to the child failing to use the safety skill and getting corrective feedback and a chance to try again. The researcher is supportive and encouraging throughout all of these examples. Some notable lessons include teaching children to say no assertively with their words and bodies by moving away and using eye contact, helping children understand there are certain situations when it is okay to say no to an adult, explaining the difference between a secret and a surprise, helping children to recognize when they have an adult’s attention to share important information, teaching children that adults cannot read their minds, and correcting children’s misconceptions about strangers. The videos seem intentionally repetitive as children practice the same key skills, build upon them, and learn to apply them to different situations.
One of the strengths of the Safe Child program is the wealth of informative written materials that accompany the DVDs, which are available in English, Spanish, French, and Creole. These thoughtful and comprehensive materials are based in the research and cover a wide range of implementation issues, including funding, training, and evaluation. Materials for school psychologists and teachers


provide detailed guidance for direct implementation and help to ensure the program’s integrity across individual facilitators. Although the school psychologist should conduct initial training, the training manual also helps teachers to understand their role as facilitator, as well as specifically what to say and do during each lesson. Every lesson plan includes objectives, introduction of basic concepts, discussion outlines, roleplay ideas, and follow-up activities, requiring very little prep time for teachers other than reading the relevant materials. Teachers can choose to use the discussion points verbatim as a script or to adapt them to fit their style and personality. A particularly helpful component is the inclusion of typical comments and questions from children as well as appropriate example responses. Parent letters, homework activities, graduation certificates, and assessments are also provided. The school psychologist would be expected to maintain communication with parents about the program and deliver relevant materials. On school and community levels, useful resources are provided for school psychologists in navigating initial implementation of the Safe Child program and helping to ensure continued success over time. Although Dr. Kraizer offers to run trainings, the detailed training manual and guide makes it easy for school psychologists to do so with good fidelity. An outline for conducting the parent seminar and a parent handbook encourages the thoroughness of the family involvement component. Information is also provided on gaining support for the program, securing funding, and evaluating the program to make improvements.

Pros
The Safe Child program has many beneficial characteristics. First, the program is easy to  im-
plement as all necessary materials for training and implementation are included, and the lesson plans are highly scripted, requiring little prep work. Second, the program combines the critical components of intensive facilitator training, parent education, and child lessons with abundant op- portunities for rehearsal. The key method of teaching and practice is through roleplay, which is supported by the research as critical for students to competently learn and retain skills. Further- more, in contrast to other programs, the roleplay examples are subtle enough that the appropriate response is not always obvious, requiring children to use flexible thinking and make judgment calls. Third, another advantage is the inclusion of material on the prevention of emotional and physical abuse. Children learn that adults may take out their stress on children through hitting      or hurtful words, but this is not okay and they need to tell someone to get help. Fourth, the        Safe Child program touches on important issues of consideration that may be overlooked and tips for handling them, such as using the program with children who have been abused in the past, dealing with personal issues of teachers, and being respectful of cultural differences. Finally, the program strives to be developmentally appropriate and the manual includes information about  how children of different ages might respond to the program and how to adjust the curriculum accordingly.
Evaluation research shows consistent positive effects for the program on measures of be- havioral change. When simulated roleplays at posttest were used to measure acquisition of self- protection skills, significantly more children in the treatment group passed the behavioral test than in the control group, with results maintained at 6-month follow-up (Fryer et al., 1987a, b). Participants who passed the behavioral assessment were more likely to have higher pretest self- esteem and posttest knowledge scores. Another evaluation was performed with a large sample size (N = 670) using a scripted roleplay of “What-If” situations with scores based upon children’s ver- bal responses and body language when faced with a persuasive roleplay situation (Kraizer et al., 1989). Significant changes were found from pre- to posttest on the role play assessment for treat- ment as compared to control groups, with behavioral outcomes related to scores on knowledge tests.


Cons
As far as drawbacks of the program, it appears somewhat dated in terms of the visual pre- sentation, music, facts, and statistics, but still relevant and applicable. As far as implementation, the program requires minimal additional prep work, but a good deal of time to read all included materials. The most significant negative consideration is that the roleplaying, as demonstrated by the author, is very hands-on and may be uncomfortable for some facilitators and students. Although the roleplaying is a critical component for student mastery of the safety skills, some educators may not want to touch children in the way demonstrated by the researcher to allow them to practice the skills.

INTEGRATED  SUMMARY  AND RECOMMENDATIONS
School-based abuse prevention programs have been found to be effective in increasing student knowledge and protective behaviors for various populations. Because of their efficacy and relative ease of implementation, we recommend the programs reviewed above to school psychologists working at the preschool and elementary/early middle school level (pre-K through grade 6). All of the programs reviewed are worthy of consideration for implementation. We recommend that school psychologists consider their situation and select a program that they think would be the best fit for their staff, student population, and budget. In general, we were more impressed with the Safe Child, the Stay Safe, and the Talking about Touching Programs than we were with the Body Safety Training Program for the reasons stated above in our review. The Stay Safe Program covers the broadest age range (pre-K through grade 6) and is the only one that includes older elementary/early middle school students. The others cover preschool through grade 2/3. If a school psychologist wants to implement only one program across the pre-K through elementary school continuum, including children with special needs, then this would be the program to choose. If working in an early childhood program, all of these programs would be appropriate. Talk about Touching is available in Spanish and Safe Child has Spanish, French, and Creole versions.
To establish a successful program(s), we recommend that school psychologists take a leadership role, even if they are not directly involved in program delivery. Their role would be to train staff well, have refreshers every year, include some aspect of parent involvement (e.g., parent seminar, homework, newsletter, etc.), address any uncomfortable feelings from teachers and do not require they implement the program if they do not feel comfortable, and conduct ongoing evaluations     of consumer acceptability (students, teachers, parents) and impact to make improvements in the program. To maintain an effective program, we recommend that someone be appointed to oversee it, build a structure to monitor progress, ensure training is available each year for new teachers and as a refresher for staff, build awareness for the program and its impact among parents and community members, and make it a priority to protect class time for this important initiative.

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