Socioemotional Promotion, Prevention, and Intervention Programs for Preschoolers: A Systematic Literature Review and Meta-Analysis

INTRODUCTION: More than 25% of children under 5 are at risk for developmental, behavioral, or social delays. The personal and societal costs of these delays are significant, especially in urban, low-income, chronically disadvantaged communities. Prevention/early intervention efforts during early childhood are effective, cost-saving, and have the potential to address disparities in health and achievement. The purpose of this study is to conduct a systematic and comprehensive meta-analytic review of socioemotional promotion, prevention, and intervention programs for preschoolers. This study supplements recent reviews on related topics by 1) including promotion and prevention in addition to intervention; 2) integrating studies utilizing controlled single-subject designs; and 3) attending to the mediational role of treatment integrity, which is known to predict intervention outcome (Durlak & DuPre, 2008).

METHOD: With the assistance of a librarian, the following controlled vocabulary was defined: “social emotional” AND “intervention” AND “preschoolers” (AND “treatment integrity). Separate Boolean queries with and without “treatment integrity” were conducted within PsycInfo, ERIC, and MEDLINE. Published articles in English were obtained without any date restrictions. A total of 1686 articles were retrieved; 1279 articles without and 407 articles with “treatment integrity.” Duplicates (n = 95) were removed. The titles and abstracts of the 1591 unique articles were then reviewed by the primary investigator and screened in (n = 327; 21%), after which they were abstracted by trained research assistants.

RESULTS: Studies (1944-2013) mostly focused on or included 3-5 year olds (n = 279; 85.4%). Most studies included both boys and girls (n = 231; 70.6%); and were conducted across diverse locations (n = 98; 30% urban) and with diverse populations (n = 86; 26.3% majority people of color; n = 95; 29.1% majority low SES). About half of studies were conducted in the preschool setting (n = 136; 41.6%) and focused on health promotion (n = 60; 18.3%), prevention (n = 102; 31.2%), or clinical intervention (n = 117; 35.8%). Most programs were implemented by caregivers or community-based clinicians (n = 11; 3.4% parents; n = 56; 17.1% teachers; n = 65; 19.9% clinicians). Fidelity of implementation was monitored in over half of the studies (n = 188; 57.5%). Research methods utilized also varied, with about half of studies featuring randomized controlled trials and sample sizes typically averaging around 117 children. Using weights based on study quality, a meta-analysis of current  on conducting a meta-analysis using a random effects inverse-variance model, with attention to whether treatment integrity mediates program outcome.

CONCLUSIONS: A strong evidence base exists for programs targeting socioemotional development in preschoolers, including a growing number of studies which focus on low-income, ethnically diverse children. This review describes the state of the field while attending to limitations in previous reviews; will provide a variety of effect sizes related to various types of programming for preschoolers across contexts and settings; and will point to future directions for research.