August, G. J., Realmuto, G. M., Hektner, J. M., & Bloomquist, M. L (2001). An integrated components intervention for aggressive elementary school children: The Early Risers Program. Journal of Counseling and Clinical Psychology, 69(4), 614–626. https://doi.org/10.1037/0022-006X.69.4.614

Type of Study: Randomized controlled trial
Number of Participants: 245

Population:

• Age — Mean=6.6–6.7 years
• Race/Ethnicity — Intervention Group: 15% Minority; Control Group: 7% Minority
• Gender — Intervention Group: 64% Male; Control Group: 74% Male
• Status — Participants were Kindergarten students at 20 schools who were screened by teacher rating of aggressive-disruptive behaviors.

Location/Institution: Semirural, Midwestern United States

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the Early Risers [now called Early Risers: Skills for Success] program, which aims to alter the developmental trajectory of children with early onset aggressive behavior. The Early Risers program features 4 CORE components: (a) an annual 6-week summer school program, (b) a teacher consultation and student mentoring program, (c) child social skills groups, and (d) parent education and skills-training groups, all delivered in tandem with a FLEX family support program individually tailored to address the unique needs of families. Participants were randomly assigned to the Early Risers intervention group or a control group. Children in targeted kindergartens were screened by teacher for involvement; randomization occurred at the school level, with children who were attending intervention schools receiving the Early Risers program. Measures utilized include the Teacher Observation of Classroom Adaptation-Revised, Parent Observation of Classroom Adaptation, Behavioral Assessment System for Children (BASC), Teacher’s Scale of Child’s Actual Competence and Social Acceptance, and the Woodcock-Johnson Tests of Achievement Revised (WJ-R). Results indicate that following 2 years of intervention, Early Risers children showed significant improvement relative to controls in academic achievement and school behaviors. Change in behavioral self-regulation was moderated by level of child aggression, with intervention effects found for only the most severely aggressive children. Parents with high program attendance rates showed improvement in discipline methods. Limitations include variation in the amount of FLEX services received by families, lack of postintervention follow-up, and lack of blinding to the group assignment of parents and teachers who completed the outcome measures.

Length of controlled postintervention follow-up: None.

August, G. J., Hektner, J. M., Egan, E. A., Realmuto, G. M., & Bloomquist, M. L. (2002). The Early Risers longitudinal prevention trial: Examination of three-year outcomes in aggressive children with intent-to-treat and as-intended analyses. Psychology of Addictive Behaviors, 16(4s), 27–39. https://doi.org/10.1037/0893-164X.16.4S.S27

Type of Study: Randomized controlled trial
Number of Participants: 245

Population:

• Age — Mean=6.6–6.7 years
• Race/Ethnicity — Intervention Group: 15% Minority; Control Group: 7% Minority
• Gender — Intervention Group: 64% Male; Control Group: 74% Male
• Status — Participants were Kindergarten students at 20 schools who were screened by teacher rating of aggressive-disruptive behaviors.

Location/Institution: Semirural, Midwestern United States

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as August et al. (2001). The purpose of the study was to evaluate the effectiveness of the Early Risers program [now called Early Risers: Skills for Success]. Participants were randomly assigned to the Early Risers intervention group or a control group. Measures utilized include the Teacher Observation of Classroom Adaptation-Revised, Parent Observation of Classroom Adaptation, Behavioral Assessment System for Children (BASC), Teacher’s Scale of Child’s Actual Competence and Social Acceptance, and the Woodcock-Johnson Tests of Achievement Revised (WJ-R). Results indicate that after three years of intervention, Early Risers participants compared with controls, showed greater gains in social skills, academic achievement, and parent discipline, with mean scores in the normative range on the latter two constructs. As-intended participation in the Family Program, which included separate parent and child education and skills-training groups, was associated with improved parent discipline practices and gains in children’s social skills, with level of child aggression moderating gains in academic achievement. Recommended level of FLEX family support contact time was associated with gains in academic achievement, concentration problems, and social skills, with parents of severely aggressive children showing greater reductions in parent distress. Limitations include reliance on parent and teacher self-report data, as they were not blinded to the group assignment; and lack of postintervention follow-up.

Length of controlled postintervention follow-up: None.

August, G. J., Lee, S. S., Bloomquist, M. L., Realmuto, G. M., & Hektner, J. M. (2003). Dissemination of an evidence-based prevention innovation for aggressive children living in culturally diverse, urban neighborhoods: The Early Risers effectiveness study. Prevention Science, 4(4), 271–286. https://doi.org/10.1023/A:1026072316380

Type of Study: Randomized controlled trial
Number of Participants: 327

Population:

• Age — Mean=6.3 years
• Race/Ethnicity — 81% African American, 10% Other, and 9% Caucasian
• Gender — 263 Male and 64 Female
• Status — Participants were children in kindergarten and first grade.

Location/Institution: A large Midwestern Metropolitan city

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of the Early Risers: Skills for Success program when implemented by neighborhood family resource centers available to urban children and their families. Participants were Kindergarten and first grade students enrolled in 10 schools who were screened for aggressive behavior and randomized to one of three groups: the Early Risers: Skills for Success Program CORE + FLEX, the Early Risers: Skills for Success Program CORE only, or a no-intervention control condition. The full-strength model (CORE + FLEX) included child and parent/family components whereas the partial model (CORE-only) offered only the child component. The intervention was delivered over two continuous years. Measures utilized include the Child Behavioral Checklist—Teacher Rating Form (CBC-TRF), Child Academic Achievement Woodcock–Johnson Tests of Achievement—Revised (WJTA), Teacher Reports of Child Behaviors Behavioral Assessment System for Children—Teacher Rating Scale (BASC-TRS), Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSP), Walker–McConnell Scale of Social Competence and School Adjustment (WMS), Parent Reports of Child Behaviors Behavioral Assessment System for Children—Parent Rating Scale (BASC-PRS), Parent Reports of Parenting Practices/Stress/Family Environment Alabama Parenting Questionnaire (APQ), Parenting Stress Index (PSI), and the Family Environment Scale (FES). Results indicate that CORE + FLEX children showed higher levels of program attendance than their CORE-only counterparts but no differences on outcome measures were observed between the models. When both program models were collapsed and compared to controls, Early Risers: Skills for Success children showed significant gains on measures of school adjustment and social competence, the most aggressive program children showed reductions in disruptive behavior, and program parents reported reduced levels of stress. Limitations include adaptations made to the program, high attrition rate, lack of postintervention follow-up, and lack of generalizability due to high African American population.

Length of controlled postintervention follow-up: None.

August, G. J., Egan, E. A., Realmuto, G. M., & Hektner, J. M. (2003). Four years of the Early Risers early-age-targeted preventive intervention: Effects on aggressive children's peer relations. Behavior Therapy, 34(4), 453–470. https://doi.org/10.1016/S0005-7894(03)80030-8

Type of Study: Randomized controlled trial
Number of Participants: 1489

Population:

• Age — Not specified
• Race/Ethnicity — Not specified
• Gender — 765 Female and 724 Male
• Status — Participants were moderately to highly aggressive fourth-grade children and their classmates.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the original sample of intervention and controls from August et al. (2001) and then added a new sample of remaining students as a comparison. The purpose of the study was to examine the Early Risers [now called Early Risers: Skills for Success] program in regard to behavioral reputation, likeability, and friendship after 4 years of an ongoing randomized controlled prevention trial designed to interrupt the developmental trajectory of young aggressive children by improving peer relations. Participating schools were randomly assigned either into Early Risers or to a control group. Measures utilized include the Child Behavior Checklist–Teacher’s Report Form (CBCL-TRF). Results indicate that Early Risers program children, as compared to controls, obtained higher reputation scores on leadership and social etiquette, and chose friends with lower aggression. Self-reported quality of friendship also differed between groups, with program children reporting more companionship and recreation, program girls reporting more validation and caring, and severely aggressive program children reporting less aggression towards others than their control counterparts. Limitations include reliance on self-reported measures, the lack of a baseline measure equivalent to the peer assessment data, high rate of attrition, and lack of follow-up.

Length of controlled postintervention follow-up: None.

August, G. J., Lee, S. S., Bloomquist, M. L., Realmuto, G. M., & Hektner, J. M. (2004). Maintenance effects of an evidence-based prevention innovation for aggressive children living in culturally diverse urban neighborhoods: The Early Risers effectiveness study. Journal of Emotional and Behavioral Disorders, 12(4), 194–205. https://doi.org/10.1177/10634266040120040101

Type of Study: Randomized controlled trial
Number of Participants: 327

Population:

• Age — Mean=6.3 years
• Race/Ethnicity — 81% African American, 10% Other, and 9% Caucasian
• Gender — 263 Male and 64 Female
• Status — Participants were children in kindergarten and first grade.

Location/Institution: A large Midwestern Metropolitan city

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as August et al. (2003). 81% African American, 10% Other, and 9% Caucasian The purpose of the study was to assess the ability of the Early Risers: Skills for Success program to maintain program effects 1-year postintervention. Participant schools were randomly assigned either into Early Risers: Skills for Success or to a control group. Measures utilized include the Woodcock-Johnson Tests of Achievement (WJTA), the Behavior Assessment System for Children–Teacher Rating Scales (BASC-TRS), the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSP), the Walker-McConnell Scale of Social Competence and School Adjustment (WMS), the Alabama Parenting Questionnaire (APQ), and the Parenting Stress Index (PSI). Results indicate that following the active intervention phase, Early Risers: Skills for Success children, compared to controls, showed significant gains in school adjustment and social competence but not in academic achievement. At the 1-year follow up, program effects were not maintained. There are also significant relationships between children’s level of participation and measures of their social competence, externalizing problems, and academic achievement. Limitations include reliance on self-reported measures; the most serious may be that level of participation was not, and could not be, a randomly assigned condition; no way of knowing who in the control group would have participated more or less if afforded the opportunity, so comparisons do not yield easily interpretable findings; and low levels of participation also hindered the ability of the study to determine the maintenance effects of the full-strength intervention.

Length of controlled postintervention follow-up: 1 year.

August, G. J., Bloomquist, M. L., Lee, S. S., Realmuto, G. M., & Hektner, J. M. (2006). Can evidence-based prevention programs be sustained in community practice settings? The Early Risers' advanced-stage effectiveness trial. Prevention Science, 7(2), 151–165. https://doi.org/10.1007/s11121-005-0024-z

Type of Study: Randomized controlled trial
Number of Participants: 295

Population:

• Age — Mean=6.3 years
• Race/Ethnicity — 79% African American, 11% Caucasian, and 10% Other
• Gender — 186 Male and 109 Female
• Status — Participants were children in kindergarten and first grade.

Location/Institution: A large Midwestern Metropolitan city

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the institutional sustainability of the Early Risers: Skills for Success conduct problems prevention program. Participants were children who met screening criteria, and were assigned to Early Risers: Skills for Success or an assessment-only control group using a stratified randomization process. Participants were randomized using stratification by risk status (high/moderate), gender (boy/girl), grade (K, first), and neighborhood center (one of four geographically based centers). Measures utilized include the Woodcock-Johnson III Tests of Achievement (WJ III ACH), the Social Skills Rating System-Teacher Form (SSRS-T), the Parent-Teacher Involvement Questionnaire-Teacher (CPPRG), the Social Skills Rating System-Parent (SSRS-P), the Adult-Adolescent Parenting Inventory-Revised (AAPI-2), and Beck Depression Inventory-II (BDI-II). Results indicate that only one positive outcome found in the earlier studies of Early Risers: Skills for Success was replicated in the current study: Early Risers: Skills for Success children differed from controls in improved teacher-rated problem behavior. In contrast to earlier results, no group differences were observed on other program targets such as academic achievement and social adjustment, initial behavior severity did not moderate any outcomes, and there were no significant program effects observed on any of the targeted parent outcomes. Failure to replicate program effects could not be attributed directly to poor fidelity of program implementation. Indices of program implementation (fidelity) indicated that the program was delivered with acceptable exposure, adherence, and quality of delivery. Limitations include lower participation rates (as compared to the earlier studies), high staff turn-over rates, and changes in the agencies delivering services during the study.

Length of controlled postintervention follow-up: None.

Bernat, D. H., August, G. J., Hektner, J. M., & Bloomquist, M. L. (2007). The Early Risers preventive intervention: Testing for six-year outcomes and mediational processes. Journal of Abnormal Child Psychology, 35(4), 605–617. https://doi.org/10.1007/s10802-007-9116-5

Type of Study: Randomized controlled trial
Number of Participants: 151

Population:

• Age — 6–7 years
• Race/Ethnicity — Not specified
• Gender — 106 Males and 45 Females
• Status — Participants were Kindergarten students who were screened by teacher rating of aggressive-disruptive behaviors.

Location/Institution: 23 Semi-Rural schools in Minnesota

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as August et al. (2001). The purpose of the study was to examine effects of the Early Risers: Skills for Success early-age-targeted prevention program on serious conduct problems following 5 years of continuous intervention and one year of follow-up. The study also examined if intervention effects on proximally targeted variables (e.g., changes in social skills, academic achievement, and effective discipline practices) found after 3 years mediated intervention effects on conduct problems found after 6 years. Participants were randomized to either Early Risers: Skills for Success or a control group. Measures utilized include the Child Behavior Checklist-Teacher Rating Form (TRF), the Woodcock Johnson Tests of Achievement-Revised, the Learning Problems Scale of the BASC-TRS, the Teacher’s Scale of Child’s Actual Competence and Social Acceptance, the Alabama Parenting Questionnaire, the Parenting Practices Questionnaire, Parent and Teacher Observation of Classroom Adaptation, the Kaufman Brief Intelligence Test, and the Diagnostic Interview Schedule for Children—Parent (NIMH DISC-IVP) and Youth versions (NIMH DISC-IV-Y). Results indicate that after 6 years, Early Risers: Skills for Success children showed fewer oppositional defiant disorder (ODD) symptoms than control children. Early Risers: Skills for Success children did not significantly differ from controls on number of conduct disorder (CD) symptoms, DSM-IV diagnoses of ODD and CD, or drug use involvement. Results also indicate that fewer ODD symptoms among program youth after 6 years were partially mediated by social skills and effective discipline. Limitations include high attrition rate at the follow-up time point and possible reporter bias due to reliance on self-report measures.

Length of controlled postintervention follow-up: 1 year.

Hektner, J. M., August, G. J., Bloomquist, M. L., Lee, S., & Klimes-Dougan, B. (2014). A 10-year randomized controlled trial of the Early Risers conduct problems preventive intervention: Effects on externalizing and internalizing in late high school. Journal of Consulting and Clinical Psychology, 82(2), 355–360. https://doi.org/10.1037/a0035678

Type of Study: Randomized controlled trial
Number of Participants: 129

Population:

• Age — Mean=16.3 years
• Race/Ethnicity — Not specified
• Gender — 63% Male
• Status — Participants were Kindergarten students at 20 schools who were screened by teacher rating of aggressive-disruptive behaviors and followed up again in grade 11 of high school.

Location/Institution: Semirural, Midwestern United States

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as August et al. (2001). The purpose of the study was to examine the long-term effects of the Early Risers “Skills for Success” (ER) [now called Early Risers: Skills for Success] conduct problems prevention program to promote adaptive psychological development. Participants were randomly assigned based upon their school either in ER for 3 intensive years plus 2 booster years or served as controls. Measures utilized include the Behavioral Assessment System for Children—Teacher and Parent Rating Scales (BASC-TRS and BASC-PRS), the Alabama Parenting Questionnaire, and the Parenting Practices Questionnaire. Results indicate that program participants had significantly fewer symptoms of conduct disorder, oppositional defiant disorder, and major depressive disorder than did controls. The program’s effect on increasing social skills and parent discipline effectiveness by grade 3 mediated these effects. Limitations include reliance on self-reported measures, relatively high rate of attrition, and rate of severe problems in the current sample was also lower than could be accommodated by the sample size.

Length of controlled postintervention follow-up: 9 years.

Piehler, T. F., Bloomquist, M. L., August, G. J., Gewirtz, A. H., Lee, S. S., & Lee, W. S. (2014). Executive functioning as a mediator of conduct problems prevention in children of homeless families residing in temporary supportive housing: A parallel process latent growth modeling approach. Journal of Abnormal Child Psychology, 42(5), 681–692. https://doi.org/10.1007/s10802-013-9816-y

Type of Study: Randomized controlled trial
Number of Participants: 137 families (223 children)

Population:

• Age — Mean=8.12 years
• Race/Ethnicity — 50% African American, 20% Self-identified as Multiracial, 19% Caucasian, 6% Native American, 3% Hispanic, and 2% Asian
• Gender — Not specified
• Status — Participants were homeless families living in supportive housing sites.

Location/Institution: Large Metropolitan area in the Midwest

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the Early Risers conduct problems prevention program [now called Early Risers: Skills for Success] in a supportive housing setting. Participants within the 16 housing sites were randomly assigned to Early Risers or treatment as usual comparison conditions at each site. Measures utilized include the Parental Locus of Control Scale, the Behavior Assessment System for Children (2nd edition; BASC2), and the Behavioral and Emotional Rating Scale: A Strength-Based Approach to Assessment (2nd edition; BERS2). Results indicate that the Early Risers demonstrated reduced growth in conduct problems over the 4 assessment points. In order to examine mediation, a multilevel parallel process latent growth model was used to simultaneously model growth in executive functioning (EF) and growth in conduct problems along with intervention status as a covariate. A significant mediational process emerged, with participation in the intervention promoting growth in EF, which predicted negative growth in conduct problems. The model was consistent with changes in EF fully mediating intervention-related changes in youth conduct problems over the course of the study. Limitations include reliance on self-reported measures, extension of childhood age norms for multiple participants in computing standardized scores from questionnaire data, and small sample size.

Length of controlled postintervention follow-up: 1 year.

Gewirtz, A. H., DeGarmo, D. S., Lee, S., Morrell, N., & August, G. (2015). Two-year outcomes of the Early Risers prevention trial with formerly homeless families residing in supportive housing. Journal of Family Psychology, 29(2), 242–252. https://doi.org/10.1037/fam0000066

Type of Study: Randomized controlled trial
Number of Participants: 161 families

Population:

• Age — Mean=8.10 years
• Race/Ethnicity — 50% African American, 20% Self-identified as Multiracial, 19% Caucasian, 6% Native American, 3% Hispanic, and 2% Asian
• Gender — Not specified
• Status — Participants were homeless families living in supportive housing sites.

Location/Institution: Large Metropolitan area in the Midwest

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Piehler et al. (2014). The purpose of the study was to report 2-year outcomes from a cluster randomized, controlled trial of the Early Risers [now called Early Risers: Skills for Success] program implemented as a selective preventive intervention in supportive housing settings for homeless families. Participants within the 16 housing sites were randomly assigned to Early Risers or treatment as usual comparison conditions at each site. Measures utilized include the Parental Locus of Control scale, the Behavior Assessment System for Children (2nd edition; BASC2), and the Behavioral and Emotional Rating Scale: A Strength-Based Approach to Assessment (2nd edition; BERS2). Results indicate that two years postbaseline, intent-to-treat (ITT) analyses indicated that parents in the Early Risers group showed significantly improved parenting self-efficacy, and the parent report indicated significant reductions in the Early Risers group children’s depression. No main effects of ITT were shown for observed parenting effectiveness. However, over time average levels of parenting self-efficacy predicted observed effective parenting practices and observed effective parenting practices predicted improvements in both teacher and parent-report of child adjustment. Limitations include reliance on self-reported measures and results cannot be generalized to two-parent or male-headed homeless families.

Length of controlled postintervention follow-up: None.

The following studies were not included in rating Early Risers: Skills for Success on the Scientific Rating Scale...

August, G. J., Egan, E. A., Realmuto, G. M., & Hektner, J. M. (2003). Parceling component effects of a multifaceted prevention program for disruptive elementary school children. Journal of Abnormal Child Psychology, 31(5), 515–527. https://doi.org/10.1023/A:1025401115430

The study used a subsample from August et al. (2001). The study examined predictors and outcomes of attendance in two standard components of the Early Risers [now called Early Risers: Skills for Success] intervention. Measures utilized include the Child Behavioral Checklist/Teacher Report Form (CBCL/TRF), the K-BIT, Teacher Observation of Classroom Adaptation-Revised, Parent Observation of Classroom Adaptation, Behavioral Assessment System for Children (BASC), Teacher’s Scale of Child’s Actual Competence and Social Acceptance, and the Woodcock-Johnson Tests of Achievement Revised (WJ-R). Results indicate that higher attendance in the Summer Program was associated with higher child social competence at Year 3 for all children. For academic achievement, higher attendance in the Summer Program was associated with higher scores for mild/moderately disruptive children and lower scores for highly disruptive children in Year 3. Higher attendance in the Family Program was associated with lower aggression scores for mild/moderately disruptive children. Limitations include a lack of information on whether outcomes were a function of self-selection or dosage factors, concerns about generalizability due to a predominately Caucasian population, and lack of postintervention follow-up. Note: This article was not used in the rating of Early Risers: Skills for Success in the Mental Health Prevention and Early Intervention (Child & Adolescent) Programs topic area since it does not examine outcomes/intervention effects.

Bloomquist, M. L., August, G. J., Lee, S. S., Piehler, T. F., & Jensen, M. (2012). Parent participation within community center or in-home outreach delivery models of the Early Risers Conduct Problems Prevention Program. Journal of Child and Family Studies, 21(3), 368–383. https://doi.org/10.1007/s10826-011-9488-6

The study examined patterns of parent participation in the Early Risers Conduct Problems Prevention Program [now called Early Risers: Skills for Success] using two family-focused service delivery models: a community center model (Center) and an in-home outreach-based model (Outreach). Participants were randomly assigned, via a stratified randomization procedure at the subject level, to Center or Outreach family-focused conditions. Measures utilized included the Biographical Questionnaire, the Behavioral Assessment System for Children, Parent Rating Scales (BASC-2-PRS), the Parenting Relationship Questionnaire (PRQ), the Brief Symptom Inventory 18 (BSI 18), and the Parent Views of Intervention Questionnaire (PVIQ). Results indicate that parents in the Center model demonstrated greater overall participation in family-focused components of Early Risers program. Parent motivation with parent-focused expectancies for the intervention represented the strongest predictor of parent participation across both delivery models. Family income differentially predicted parent participation across the two models, with low income predicting greater participation in the Center model and lower participation in the Outreach model. A qualitative finding emerged showing that parents receiving parent skills in the Center model via groups preferred to learn skills related to facilitating overall family relationships, whereas parents receiving parent skills via individual Outreach meetings preferred to improve a child’s behavior and emotion skills. Limitations include reliance on self-reported measures and lack of follow-up. Note: This article was not used in the rating of Early Risers: Skills for Success in the Mental Health Prevention and Early Intervention (Child & Adolescent) Programs topic area since it does not examine outcomes/intervention effects.

Utržan, D. S., Piehler, T. F., Gewirtz, A. H., & August, G. J. (2017). Stressful life events and perceived parental control in formerly homeless families: Impact on child-internalizing symptoms. American Journal of Orthopsychiatry, 87(3), 317–325. https://doi.org/10.1037/ort0000236

The study examined the impact of the Early Risers “Skills for Success” [now called Early Risers: Skills for Success] program, using secondary data examined on the impact of perceived parental control on the association between stressful life events (SLEs) and child internalizing symptoms in formerly homeless families. Participants within the 16 housing sites were randomly assigned to Early Risers or comparison conditions at each site. Measures utilized included the Early Risers Biographical Questionnaire, the Parental Locus of Control Scale, the Behavior Assessment System for Children (second edition; BASC2), and the Behavioral and Emotional Rating Scale: A Strength-Based Approach to Assessment (second edition; BERS2). Results indicate that experiencing more SLEs and a perceived absence of parental control over child behavior were positively associated with child internalizing symptoms. A significant interaction between SLEs and perceived absence of parental control over child behavior in predicting child internalizing symptoms was also found. Limitations include reliance on self-reported measures and causal inferences cannot be made from non-experimental and cross-sectional data. Note: This article was not used in the rating of Early Risers: Skills for Success in the Mental Health Prevention and Early Intervention (Child & Adolescent) Programs topic area since it does not examine outcomes/intervention effects.