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Intervention Summary

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Al's Pals: Kids Making Healthy Choices

Al's Pals: Kids Making Healthy Choices is a school-based prevention program that seeks to develop social-emotional skills such as self-control, problem-solving, and healthy decisionmaking in children ages 3-8 in preschool, kindergarten, and first grade. The program fosters both the personal traits of resilience and the nurturing environments children need to overcome difficulties and fully develop their talents and capabilities. Through fun lessons, engaging puppets, original music and materials, and appropriate teaching approaches, the Al's Pals curriculum helps young children regulate their own feelings and behavior; creates and maintains a classroom environment of caring, cooperation, respect, and responsibility; teaches conflict resolution and peaceful problem-solving; promotes appreciation of differences and positive social relationships; prevents and addresses bullying behavior; conveys clear messages about the harms of alcohol, tobacco, and other drugs; and builds children's abilities to make healthy choices and cope with life's difficulties. The program consists of a year-long, 46-session interactive curriculum delivered by trained classroom teachers who use Al's Pals teaching approaches to infuse the concepts into daily interactions with the children. Ongoing communication with parents is also part of Al's Pals. Teachers regularly send parents letters to update them about the skills the children are learning, suggest home activities to reinforce these concepts, and inform parents about their child's progress.

Descriptive Information

Areas of Interest Mental health promotion
Substance abuse prevention
Outcomes Review Date: July 2008
1: Social competence and prosocial behaviors
2: Antisocial/aggressive behaviors
Outcome Categories Mental health
Social functioning
Violence
Ages 0-5 (Early childhood)
6-12 (Childhood)
Genders Male
Female
Races/Ethnicities Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings School
Other community settings
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History Since being pilot tested in 1993, Al's Pals: Kids Making Healthy Choices has been implemented in 34 States and in Ontario, Canada. The program has been implemented in approximately 4,000 early childhood classrooms in more than 700 elementary schools in more than 250 school districts. An additional 700 preschools, child care centers, Head Start programs, after-school programs, faith-based programs, and other community-based child-serving organizations have used the intervention. Within the United States, more than 135 evaluation studies have been conducted involving more than 24,500 children across 1,665 classrooms. The longest continuous length of implementation is 17 years, with the average length of implementation being 6 years.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations Program materials are available in Spanish.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal

Quality of Research
Review Date: July 2008

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Loos, M. E. (n.d.). Addendum and clarification: Results of Michigan Study 1996-1997 as presented in "Multi-year evaluation of the effectiveness of a resilience-based prevention program for young children."

Lynch, K. B., Geller, S. R., & Schmidt, M. G. (2004). Multi-year evaluation of the effectiveness of a resilience-based prevention program for young children. Journal of Primary Prevention, 24(3), 335-353.

Study 2

Lynch, K. B., & McCracken, K. (2001). Highlights of findings of the Al's Pals intervention: Hampton City Public Schools, 1999-2000 (with addendum and clarification for NREPP review prepared by M. E. Loos). Richmond: Virginia Institute for Developmental Disabilities, Virginia Commonwealth University.

Study 3

Lynch, K. B., & McCracken, K. (2001). Highlights of findings of the Al's Pals: Kids Making Healthy Choices intervention implemented in Greater Des Moines, Iowa, 1999-2000 (with addendum and clarification for NREPP review prepared by M. E. Loos). Richmond: Virginia Institute for Developmental Disabilities, Virginia Commonwealth University.

Supplementary Materials

Lynch, K. B., Geller, S. R., Hunt, D. R., Galano, J., & Dubas, J. S. (1998). Successful program development using implementation evaluation. Journal of Prevention and Intervention in the Community, 17(2), 51-64.

Outcomes

Outcome 1: Social competence and prosocial behaviors
Description of Measures Social competence and prosocial behaviors were assessed using the following measures:

  • Child Behavior Rating Scale, a 30-item scale developed for these studies to measure behaviors related to the development of resiliency and prosocial behaviors. Each item was rated on a 5-point scale from 1 (almost never does) to 5 (almost always does).
  • Preschool and Kindergarten Behavior Scale's 34-item Social Skills scale, which consists of 3 subscales: Social Cooperation, Social Interaction, and Social Independence. Each item is rated on a 4-point scale from 0 (never true) to 3 (often true).
  • Social Interaction subscale of the Adapted Preschool and Kindergarten Behavior Scale, a shortened version of the Preschool and Kindergarten Behavior Scale. Each item is rated on a 4-point scale from 0 (never true) to 3 (often true).
Teachers completed the measures in the week prior to the introduction of the intervention (pretest) and 2 weeks after program completion (posttest).
Key Findings In one study, participants in the intervention group showed statistically significant improvements in prosocial behaviors and social independence from pre- to posttest compared with the assessment-only control group (p < .01 and p < .05, respectively).

In two other studies, participants in the intervention group showed statistically significant improvements in prosocial behaviors and social interaction skills from pre- to posttest compared with the assessment-only control group (p < .001 for both analyses in one study; p < .01 and p < .001, respectively, in the other study).
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.9 (0.0-4.0 scale)
Outcome 2: Antisocial/aggressive behaviors
Description of Measures Antisocial/aggressive behaviors were assessed using the following measures:

  • Preschool and Kindergarten Behavior Scale's 42-item Problem Behavior scale, which consists of 5 subscales: Self-Centered/Explosive, Attention Problems/Overactive, Antisocial/Aggressive, Social Withdrawal, and Anxiety/Somatic Disorders. Each item is rated on a 4-point scale from 0 (never true) to 3 (often true).
  • Antisocial/Aggressive and Social Withdrawal subscales of the Adapted Preschool and Kindergarten Behavior Scale, a shortened version of the Preschool and Kindergarten Behavior Scale. Each item is rated on a 4-point scale from 0 (never true) to 3 (often true).
Teachers completed the measures in the week prior to the introduction of the intervention (pretest) and 2 weeks after program completion (posttest).
Key Findings In one study, participants in the intervention group showed statistically significant improvements in problem behaviors from pre- to posttest compared with the assessment-only control group (p < .05 for all analyses).

Two other studies evaluated antisocial/aggressive and social withdrawal behaviors in an intervention group and an assessment-only control group. In one study, participants in the intervention group showed statistically significant improvements in antisocial/aggressive and social withdrawal behaviors from pre- to posttest compared with the assessment-only control group (p < .05 and p < .01, respectively). The other study found no significant differences between the two groups from pre- to posttest.
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 3.0 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 0-5 (Early childhood) 51% Male
49% Female
50% White
25% Black or African American
25% Race/ethnicity unspecified
Study 2 0-5 (Early childhood)
6-12 (Childhood)
51% Male
49% Female
83% Black or African American
16% Race/ethnicity unspecified
1% White
Study 3 0-5 (Early childhood) 57% Male
43% Female
95% White
2% Hispanic or Latino
2% Race/ethnicity unspecified
1% Black or African American

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Social competence and prosocial behaviors 3.2 3.2 3.0 2.8 2.3 3.2 2.9
2: Antisocial/aggressive behaviors 3.3 3.3 3.0 2.8 2.3 3.2 3.0

Study Strengths

The measures used in the studies have good psychometric properties. The teachers and teacher's assistants received systematic training to implement the program, and a variety of other methods were also used to enhance the fidelity of implementation (e.g., participatory evaluation, classroom observation, teacher reports). Appropriate analyses were conducted to assess the effects of the intervention.

Study Weaknesses

In two studies, attrition rates differed between the intervention and comparison classrooms, and it is unclear how researchers accounted for this attrition. In two studies, classrooms were not randomized and pretest scores were different on some scales, which introduced potential selection bias.

Readiness for Dissemination
Review Date: July 2008

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Al's Pals price list

Al's Pals Web site, http://www.wingspanworks.com/educational_programs

PRO-ED, Inc. (2002). Preschool and kindergarten behavior scales (adapted). Austin, TX: Author.

Virginia Commonwealth University. (1997). Al's Pals, 2006-2007, child behavior rating scale. Richmond, VA: Author.

Virginia Commonwealth University. (1997). Al's Pals, 2006-2007, implementation observation form. Richmond, VA: Author.

Virginia Commonwealth University. (1997). Al's Pals child code numbers, 2006-2007, teacher record. Richmond, VA: Author.

Wingspan (Producer). (2003). An introduction to Wingspan programs featuring Al's Pals: Kids Making Healthy Choices [DVD]. Glen Allen, VA: Author.

Wingspan. (2006). Instructions for beginning of the year teacher ratings of child behavior. Glen Allen, VA: Author.

Wingspan. (2007). Instructions for end of the year teacher ratings of child behavior. Glen Allen, VA: Author.

Wingspan. (n.d.). Advanced training packet. Glen Allen, VA: Author.

Wingspan. (n.d.). Al's Pals, 2006-2007, overview of forms. Glen Allen, VA: Author.

Wingspan. (n.d.). Al's Pals, 2006-2007, teacher information sheet. Glen Allen, VA: Author.

Wingspan. (n.d.). Al's Pals: Kids Making Healthy Choices--Online training overview. Glen Allen, VA: Author.

Wingspan. (n.d.). Al's Pals: Kids Making Healthy Choices--Program kit. Glen Allen, VA: Author.

Wingspan. (n.d.). Al's Pals top 10 frequently asked questions. Glen Allen, VA: Author.

Wingspan. (n.d.). Core training packet. Glen Allen, VA: Author.

Wingspan. (n.d.). Curriculum progress and student update form--Al's Pals: Kids Making Healthy Choices, 2006-2007. Glen Allen, VA: Author.

Wingspan. (n.d.). For Al's Pals community coordinators--Tips for effective implementation of Al's Pals: Kids Making Healthy Choices. Glen Allen, VA: Author.

Wingspan. (n.d.). For Al's Pals school system coordinators--Tips for effective implementation of Al's Pals: Kids Making Healthy Choices. Glen Allen, VA: Author.

Wingspan. (n.d.). For principals and center directors--Tips for effective implementation of Al's Pals: Kids Making Healthy Choices. Glen Allen, VA: Author.

Wingspan. (n.d.). Information related to reliability and validity of instruments. Glen Allen, VA: Author.

Wingspan. (n.d.). Post data instructions to site coordinators. Glen Allen, VA: Author.

Wingspan. (n.d.). Pre data instructions to site coordinators. Glen Allen, VA: Author.

Wingspan. (n.d.). Refresher training packet. Glen Allen, VA: Author.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
4.0 4.0 4.0 4.0

Dissemination Strengths

The program curriculum and all accompanying audiovisual materials and teaching tools are well designed and comprehensive. The curriculum is only available upon completion of training provided by the developer. Training is offered at the developer's site, at the implementation site, and online. An outreach specialist is assigned to each implementation site to provide an array of support before, during, and after implementation. Tips for effective implementation, multiple fidelity monitoring tools, and clear data management and outcome measurement protocols are provided to support quality assurance. Implementers encountering problems with quality assurance are invited to attend free online meetings for guidance from the developer.

Dissemination Weaknesses

No weaknesses were identified by reviewers.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Curriculum kit $685 each Yes
2-day core training at centralized location $300 per person Yes (one core training option is required)
2-day core training on site $6,500 for a group of 24, or $8,000 for a group of 30, plus trainer travel costs Yes (one core training option is required)
Seven 2-hour online core training sessions $325 per person or $4,300 for a group of 15 Yes (one core training option is required)
3-hour refresher training at centralized location $1,500 for a group of 30 No
3-hour online refresher training $85 per person or $1,250 for a group of 20 No
3-hour advanced training at centralized location $1,500 for a group of 30 No
3-hour online advanced training $85 per person or $1,250 for a group of 20 No
Ongoing technical assistance/consultation Free No
Evaluation services package $300 per classroom for online data entry, or $400 per classroom for paper data entry (minimum of four classrooms required) No
Monitoring observation form Free No
Quality assurance review services Free No

Additional Information

Over a 5-year period, implementing Al's Pals: Kids Making Healthy Choices costs approximately $9-$15 per child, depending on the number of children in the classroom. Start-up costs include training on the intervention and the purchase of materials.

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

Loos, M. E. (2003). Highlights of findings of Al's Pals: Kids Making Healthy Choices implemented in Parkside Elementary School, Spotsylvania County Public Schools, Virginia, 2002-2003. Glen Allen, VA: Wingspan.

Loos, M. E. (2003). Highlights of findings of Al's Pals: Kids Making Healthy Choices implemented in Russell County Public Schools, Virginia, 2002-2003. Glen Allen, VA: Wingspan.

Loos, M. E. (2004). Highlights of findings of Al's Pals: Kids Making Healthy Choices coordinated by Richmond Pediatric Associates, 2003-2004. Glen Allen, VA: Wingspan.

Loos, M. E. (2004). Highlights of findings of Al's Pals: Kids Making Healthy Choices coordinated by Western Tidewater CSB, 2005-2006. Glen Allen, VA: Wingspan.

Loos, M. E. (2004). Highlights of findings of Al's Pals: Kids Making Healthy Choices implemented in Portsmouth City Public Schools, Virginia, 2003-2004. Glen Allen, VA: Wingspan.

Loos, M. E. (2005). Highlights of findings of Al's Pals: Kids Making Healthy Choices coordinated by the Regional Prevention Center of Wyandotte County, Kansas, 2004-2005. Glen Allen, VA: Wingspan.

Loos, M. E. (2007). Highlights of findings of Al's Pals: Kids Making Healthy Choices implemented in Alabama Head Start Classrooms by Mountain Lakes Behavioral Health Care, 2006-2007. Glen Allen, VA: Wingspan.

Lynch, K. B. (1998). Results of Henrico County after-school prevention program replication study, 1996-1997, Al's Pals: Kids Making Healthy Choices. Richmond: Virginia Institute for Developmental Disabilities, Virginia Commonwealth University.

* Lynch, K. B., & McCracken, K. (2001). Highlights of findings of the Al's Pals intervention: Hampton City Public Schools, 1999-2000. Richmond: Virginia Institute for Developmental Disabilities, Virginia Commonwealth University.

* Lynch, K. B., & McCracken, K. (2001). Highlights of findings of the Al's Pals: Kids Making Healthy Choices intervention implemented in Greater Des Moines, Iowa, 1999-2000. Richmond: Virginia Institute for Developmental Disabilities, Virginia Commonwealth University.

Contact Information

To learn more about implementation or research, contact:
Susan R. Geller, M.S.
(804) 967-9002
sgeller@wingspanworks.com

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