American Journal of Psychiatry published long-term RCT results of the 1990s Fast Track mental health program for children. Quick take: Not reliable evidence; the study is inaccurately described and analyzed as if children (vs. schools) were randomized, likely leading to false positive results.
Program:
Fast Track "blended parent behavior-management training, child social-cognitive skills tutoring, home visiting, and classroom social-ecology change from grades 1 through 10 to prevent children with early-emerging conduct problems from experiencing such problems in adulthood."
Study Design & Findings:
The study randomized 55 schools (with a sample of 891 kindergartners) to Fast Track vs control. An earlier, age-25 follow-up found moderately promising effects on crime and other outcomes. The new, age-34 report examines effects on the children of program participants. The goal is to see if program impacts extend to the next generation.
For that next generation, the study reports: (i) no discernible effects on child mental health, and (ii) statistically significant reductions in children's use of some health - including mental health - services.
Importantly, however, the published paper doesn't mention that 55 schools were randomized, and instead describes and analyzes the study as if 891 children were individually randomized. Below is the paper's inaccurate study flow diagram.
And below is the 2022 study preregistration describing the school-level randomization. Analyzing the study as if individuals (vs schools) were randomized can easily lead to false-positive findings; thus the reported effects on children's health service use are not reliable.
Comment:
I'd encourage the researchers to reanalyze the study correctly. It's possible some of the positive findings will hold up but, even if not, the results of such a large, long-term RCT are of great policy value.