The implementation of this large-scale prevention science efficacy trial has faced several key challenges. The evaluation design includes a high-risk control group and a normative comparison group being followed longitudinally at each of the four sites. The Fast Track program involves a developmentally-based, long-term, comprehensive intervention designed to prevent conduct problems in adolescence, applied in four demographically diverse communities. In 1990, the Fast Track project was initiated to evaluate the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders ( Conduct Problems Prevention Research Group, 1992). Thus, one critical “next step” in this field was the implementation and evaluation of a large, multicomponent, long-term trial. In addition, processes of implementation and the impact of programs preventing conduct problems have not yet been examined in communities that vary widely in terms of their demographic characteristics and cultural heritage. Yet, despite evidence that child-conduct problems can be reduced in short-term clinical trials, only one Canadian study to date suggests that conduct disorder can be prevented effectively in longer-term trials ( Kazdin, 1987 Tremblay, Masse, Pagani, & Vitaro, 1996). In addition, several promising intervention strategies have been developed, demonstrating evidence of effectiveness in short-term trials targeting single risk and protective factors associated with the development of conduct disorder ( Kazdin & Weisz, 1998). That is, a rich prospective data base has elucidated the epidemiology of risk for conduct disorder, and identified causal processes linking individual, family, school, and neighborhood characteristics to risk and protection ( Loeber et al., 1993 Patterson, Capaldi, & Bank, 1991). The prevention of conduct disorder is well-suited to a prevention science approach toward community-based preventive intervention, because the critical elements needed to support the application of this model exist ( Weissberg & Greenberg, 1998). Prevention science begins with the assumption that effective prevention efforts will target risk and protective factors identified by developmental theory and research as causally associated with the emergence and course of a disorder ( Coie et al., 1993 Institute of Medicine, 1994).
This paper discusses these issues, providing examples from the Fast Track project to illustrate the process of program implementation and the evidence available regarding the success of this science-based program at engaging communities in sustainable and effective ways as partners in prevention programming. Critical questions about this approach to prevention center around the extent to which such a science-based program can be effective at (1) engaging community members and stakeholders, (2) maintaining intervention fidelity while responding appropriately to the local norms and needs of communities that vary widely in their demographic and cultural/ethnic composition, and (3) maintaining community engagement in the long-term to support effective and sustainable intervention dissemination.
Representing a prevention science approach toward community-based preventive intervention, the Fast Track intervention design was based upon the available data base elucidating the epidemiology of risk for conduct disorder and suggesting key causal developmental influences ( R. In 1990, the Fast Track Project was initiated to evaluate the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders in four demographically diverse American communities ( Conduct Problems Prevention Research Group, 1992).
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