Promoting Alternative Thinking Strategies (PATHS)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Promoting Alternative Thinking Strategies (PATHS) has been rated by the CEBC in the area of: Disruptive Behavior Treatment (Child & Adolescent).

Target Population: Universal populations (all children) as well as in small group settings for children with more serious behavior problems

For children/adolescents ages: 4 – 12

Brief Description

The PATHS® curriculum is a comprehensive program that is designed to reduce aggression and behavior problems and increase emotional and social competencies in preschool through elementary school-aged children. This curriculum is designed to be used by educators and counselors to help children with poor classroom behavior and performance. Although primarily focused on the school setting (small groups and classroom), information and activities are also included for use with parents.

Program Goals:

The goals of Promoting Alternative Thinking Strategies (PATHS)® are:

  • Decrease internalizing symptoms (sadness anxiety and withdrawal)
  • Decrease aggressive symptoms
  • Decrease hyperactive/disruptive behavior
  • Decrease peer aggression
  • Increase self-control
  • Increase emotional understanding
  • Increase use of cognitive abilities and strategies (executive functions)
  • Increase use of effective conflict-resolution strategies
  • Increase engagement/attention in the classroom

Essential Components

The essential components of Promoting Alternative Thinking Strategies (PATHS)® include:

  • The PATHS® curriculum consists of over 100 structured social-emotional group sessions. Different lessons are used at different developmental levels. The lessons are designed to improve the following for the children in the group:
    • Self-control (Example activities: Turtle Technique or the Control Signals Poster)
    • Management of emotions/emotion regulation through labeling emotions (Example activity: Feeling faces)
    • Social skills (Example activity: Teaching of specific friendship skills)
    • Problem-solving skills (Example activity: Use of the Problem Solving Poster – over age 10)
  • Within a school year, the average grade uses approximately 40 lessons which are delivered on a twice per week basis (some lessons may take more than one session).
  • The recommended group size is between 6 and 12 children.

Child/Adolescent Services

Promoting Alternative Thinking Strategies (PATHS) directly provides services to children/adolescents and addresses the following:

  • Aggression, hyperactive-disruptive behavior, anxiety, poor engagement in the classroom and with peers

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • School

Homework

Promoting Alternative Thinking Strategies (PATHS) includes a homework component:

Children and parents are given homework tasks and worksheets for some sessions.

Languages

Promoting Alternative Thinking Strategies (PATHS) has materials available in languages other than English:

Chinese, Croatian, Dutch, German, Italian, Portuguese, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • A/V: In order to monitor implementation, it is necessary to have video and/or audio taping capabilities.
  • Space/room requirements: Space for a small group meeting

Minimum Provider Qualifications

Master’s Degree or PhD in psychology, counseling, social work, education, etc.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

On-site – Regional - Training Institute now being created at Pacific Clinics (Pasadena, CA)

Number of days/hours:

Initial 2-day workshop, later 1-day booster day (3-6 months later). To become certified, there is a further process that involves video review (or live observation) of two successful sessions (as rated by Master Trainers). In addition, monthly calls can be provided to improve/maintain quality.

Implementation Information

Since Promoting Alternative Thinking Strategies (PATHS) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Promoting Alternative Thinking Strategies (PATHS) as listed below:

There are criteria/guidelines to be met for who should receive training.

Formal Support for Implementation

There is formal support available for implementation of Promoting Alternative Thinking Strategies (PATHS) as listed below:

PATHS Education Worldwide provides active support for implementation by video review as well as onsite or Skype consultation.

Fidelity Measures

There are fidelity measures for Promoting Alternative Thinking Strategies (PATHS) as listed below:

There is a fidelity rating measure which has 23 items. It covers Generic Group Competencies, PATHS Specific Competencies, Response to Supervision, and Global Implementation Rating. More information can be obtained from Dorothy Morelli at Dorothy@pathseducation.com.

Implementation Guides or Manuals

There are implementation guides or manuals for Promoting Alternative Thinking Strategies (PATHS) as listed below:

There is an implementation manual that is part of the PATHS Curriculum (published by Channing-Bete). More information can be obtained from Dorothy Morelli at Dorothy@pathseducation.com.

Research on How to Implement the Program

Research has not been conducted on how to implement Promoting Alternative Thinking Strategies (PATHS).

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Greenberg, M. T., Kusché, C. A., Cooke, E. T., & Quamma, J. P. (1995). Promoting emotional competence in school-aged children: The effects of the PATHS curriculum. Development and Psychopathology, 7, 117-136.

Type of Study: Clustered randomized controlled trial (randomization at the school level)
Number of Participants: 286

Population:

  • Age — 6 to 10 years
  • Race/Ethnicity — 165 Caucasians, 91 African Americans, 11 Asian Americans, 7 Filipino Americans, 7 Native Americans, 1 Hispanic, and 4 Other
  • Gender — 167 Males and 119 Females
  • Status — Participants were children in 2nd and 3rd grade.

Location/Institution: Seattle, Washington

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the effectiveness of the Promoting Alternative Thinking Strategies (PATHS) curriculum on the emotional development of school-aged children. Schools were randomly assigned to intervention or control condition. Approximately 30% of the children were in a self-contained special needs classroom with the remainder in regular education. Measures included the Recognition of Emotion Concepts subtest from the Kusche Affective Interview – Revised (KAI-R) and the Child Behavior Checklist –Teacher Report Form (CBCL- TRF). Results indicate that PATHS was effective for both low-and high-risk (special needs) children in improving their range of vocabulary and fluency in discussing emotional experiences, their efficacy beliefs regarding the management of emotions, and their developmental understanding of some aspects of emotions. In some instances, greater improvement was shown in children with higher teacher ratings of psychopathology. Limitations include lack of follow-up.

Length of postintervention follow-up: None.

Greenberg, M. T., & Kusché, C. A. (1998). Preventive interventions for school-age deaf children: The PATHS curriculum. Journal of Deaf Studies and Deaf Education, 3(1), 49-63.

Type of Study: Clustered randomized controlled trial (randomization at the classroom level)
Number of Participants: 57

Population:

  • Age — 67 to 146 months (~5 to 12 years)
  • Race/Ethnicity — 46 Caucasian and 11 Other
  • Gender — 30 Female and 27 Male
  • Status — Participants were deaf children in 1st through 6th grade with disruptive behaviors.

Location/Institution: Seattle-Tacoma area of Washington

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the effectiveness of the Promoting Alternative Thinking Strategies (PATHS) curriculum on the social, cognitive, and behavioral status of elementary school age deaf children. Classrooms of deaf children were randomly assigned to PATHS or waitlist control groups, which received PATHS during Year 2 of the study. Measures utilized include the Performance Scale of the Wechsler Intelligence Scale for Children-Revised (WISC-R), The Matching Familiar Figures Test (MFFT), the Reading Comprehension section of the special edition of the Stanford Achievement Test for Hearing Impaired Students (SAT), Social Problem Solving Assessment Measure-Revised (SPSAM-R), the Kusche Emotional Inventory (KEI), the Meadow/Kendall Social-Emotional Assessment Inventory for Deaf Students (MKSEAI), The Health Resources Inventory (HRI), the Walker Behavior Problem Identification Checklist (WBPIC), the Child Behavior Checklist (CBCL), Child Behavior Profile, and the Eyberg Child Behavior Inventory (ECBI). Results indicate that PATHS was effective in promoting improved social and cognitive competence for deaf children. Results also indicate that the intervention led to significant improvement in students' social problem-solving skills, emotional recognition skills, and teacher- and parent-rated social competence. Limitations include the small sample size, that the subjects did not receive the entire PATHS intervention, and the lack of a control group at follow-up.

Length of postintervention follow-up: 1 and 2 year (for the intervention group only – the control group received in the intervention during the second year of the study).

McMahon, R. J., Bierman, K. L., Coie, J. D., Dodge, K. A., Greenberg, M. T., Lochman, J. E., & Pinderhughes, E. E. (1999). Initial impact of the Fast Track prevention trial for conduct problems: I. Classroom Effects. Journal of Consulting and Clinical Psychology, 67(5), 648-657.

Type of Study: Clustered randomized controlled trial (randomization at the school level)
Number of Participants: 6,715

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were children in 1st grade.

Location/Institution: Nashville, Tennessee; Durham, North Carolina; Seattle, Washington; and central Pennsylvania

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the effectiveness of the Promoting Alternative Thinking Strategies (PATHS) curriculum and teacher consultation. Schools in four targeted locations were randomized to the PATHS intervention or the control group. Measures utilized include the Authority Acceptance Scale of the Teacher Observation of Classroom Adaptation—Revised (TOCA–R) and the Social Health Profile (SHP). Results indicated significant improvements in the domains of aggression and peer relations. Improvements were shown in the areas of better rule following, better classroom atmosphere, and more on-task behavior. Limitations include lack of inter-rater reliability information and the removal of the highest risk students from the sample (as they received additional interventions), which may have impacted the classroom environment.

Length of postintervention follow-up: None.

Kam, C. M., Greenberg, M. T., & Walls, C. T. (2003). Examining the role of implementation quality in school-based prevention using the PATHS curriculum. Prevention Science, 4, 55-63.

Type of Study: Quasi-experimental matched-group design (matched at the school level)
Number of Participants: 164 in the intervention group

Population:

  • Age — Not specified
  • Race/Ethnicity — 79.42% African American (in the overall study)
  • Gender — 47.14% Males (in the overall study)
  • Status — Participants were children in 1st grade with special needs.

Location/Institution: Three elementary schools in Harrisburg, Pennsylvania

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study describes findings regarding quality of implementation in an effectiveness trial conducted in a high-risk, American urban community. This delinquency prevention trial used the Promoting Alternative Thinking Strategies (PATHS)® curriculum as its major program component. Three schools implemented PATHS and were compared to 3 other schools in the same school district. Measures included the Teacher Social Competence Rating Scale and measures of principal support and implementation quality. Results indicate the intervention was effective in improving children’s emotional competence and reducing their aggression in schools. In addition, both principal support and the quality of teacher implementation at the classroom level were critical factors in determining the success of the program dissemination on child outcomes. In this study, significant intervention effects were only found in those settings where both principal support and implementation quality was high; that is, neither high implementation quality nor high principal support by itself predicted intervention effectiveness. Limitations include the lack of direct measures of principal support or organizational climate.

Length of postintervention follow-up: None.

*Kam, C. M., Greenberg, M. T., & Kusché, C. A. (2004). Sustained effects of the PATHS curriculum on the social and psychological adjustment of children in special education. Journal of Emotional and Behavioral Disorders, 12(2), 66-78.

Type of Study: Clustered randomized controlled trial (randomization at the classroom level)
Number of Participants: 133

Population:

  • Age — Mean age at study entry = 8 years, 8 months
  • Race/Ethnicity — 88 White, 27 African American, and 18 Other
  • Gender — 97 Male and 36 Female
  • Status — Participants were children in 1st through 3rd grade with special needs.

Location/Institution: Seattle, Highline, and Shoreline school districts

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study is a follow-up of a subset of subjects from Greenberg, M. T., Kusche, C. A., Cook, E. T., & Quamma, J. P. (1995). This study examined the long-term effectiveness of the Promoting Alternative Thinking Strategies (PATHS) curriculum on the adjustment of school-age children with special needs. Eighteen special education classrooms were assigned to either PATHS or a control group. Measures utilized include the Kusche Emotional Inventory (KEI), the Children’s Depression Inventory (CDI), the Child Behavior Checklist Teacher Report Form (CBCL-TRF), and the Teacher-Child Rating Scale (TCRS). Results indicate that the PATHS curriculum was effective when implemented in special education environments. It had significant impact in regards to teacher reports of externalizing and internalizing problems and substantial reductions in self-reported depression in children. Limitations include generalizability beyond self-contained special needs classrooms and that other interventions may have occurred in the classrooms.

Length of postintervention follow-up: 1 month, 1, 2, and 3 years.

Riggs, N. R., Greenberg, M. T., Kusché, C. A., & Pentz, M. A. (2006). The mediational role of neurocognition in the behavioral outcomes of a social-emotional prevention program in elementary school students: Effects of the PATHS curriculum. Prevention Science, 7(1), 91-102.

Type of Study: Clustered randomized controlled trial (randomization at the school level)
Number of Participants: 318

Population:

  • Age — 7 to 9 years
  • Race/Ethnicity — 55% Caucasian, 33% African American, and 22% Other
  • Gender — 50% Female
  • Status — Participants were children in 2nd and 3rd grade.

Location/Institution: Seattle, Washington

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The current study examines the underlying neurocognitive conceptual theory of action of the Promoting Alternative Thinking Strategies (PATHS) curriculum. Participants were regular education students enrolled in the second or third grade. Measures utilized include the Wechsler Intelligence Scale for Children-Revised (WISC-R), The Stroop Test, The Verbal Fluency Subtest of the McCarthy Scales of Children Abilities, and the Child Behavior Checklist Teacher Report Form (CBCL-TRF). Results indicate children who participated in the PATHS intervention demonstrated greater inhibitory control and verbal fluency at follow-up than did children in comparison classrooms. Limitations include that only a limited number of indicators of inhibitory control and verbal fluency were used.

Length of postintervention follow-up: 1 year.

Domitrovich, C. E., Cortes, R. C., & Greenberg, M. T. (2007). Improving young children's social and emotional competence: A randomized trial of the Preschool "PATHS" curriculum. Journal of Primary Prevention, 28, 67-91.

Type of Study: Clustered randomized controlled trial (randomization at the building level)
Number of Participants: 246

Population:

  • Age — Mean age = 51.40 months (~4 years, 3 months)
  • Race/Ethnicity — 47% African American, 38% European American, 10% Hispanic, and 5% Other
  • Gender — 126 Female and 120 Male
  • Status — Participants were children enrolled in the Head Start program.

Location/Institution: Central Pennsylvania

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This paper reports the results from a study evaluating an adaptation of the Promoting Alternative Thinking Strategies (PATHS) curriculum for preschool-age children in Head Start. Classrooms were assigned to PATHS or a wait-list control group. Child assessments and teacher and parent reports of child behavior assessments were collected at the beginning and end of the school year. Measures utilized include the Recognition of Emotion Concepts subtest from the Kusche Emotional Inventory (KEI), the Assessment of Children’s Emotions Scales (ACES), the Denham Puppet Interview (DPI), the Day/Night task, Luria’s tapping test, the Attention Sustained subtest from the Leiter-Revised Assessment Battery, the Challenging Situations Task (CST), Teacher-Report of Child: Preschool and Kindergarten Behavior Scales (PKBS), Parent-Report of Child: Head Start Competence Scale (HSCS), and the Peabody Picture Vocabulary Test-Third Edition (PPVT-III). Results indicate parents of preschool children who received the PATHS preschool program described their children as significantly more socially and emotionally competent than did parents of children in comparison classrooms. Further, teachers rated PATHS children as less socially withdrawn at the end of the school year compared to controls. Limitations include use of behavior ratings by teachers who were not blinded to study assignment, rather than direct observations of child behavior, and analyses were conducted at the individual child level even though the unit of randomization was the classroom.

Length of postintervention follow-up: None.

Bierman, K. L., Coie, J. D., Dodge, K. A., Greenberg, M. T., Lochman, J. E., McMahon, R. J., & Pinderhughes, E. (2010). The effects of a multiyear universal social–emotional learning program: The role of student and school characteristics. Journal of Consulting and Clinical Psychology, 78(2), 156.

Type of Study: Clustered randomized controlled trial (randomization at the school level)
Number of Participants: 2,937

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were children in Grades 1, 2 and 3 with disruptive behaviors.

Location/Institution: Nashville, Tennessee; Seattle, Washington and central Pennsylvania

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This article is a follow-up study of a subset of subjects from McMahon, R. J., Bierman, K. L., Coie, J. D., Dodge, K. A., Greenberg, M. T., Lochman, J. E., & Pinderhughes, E. E. (1999). This article examines the impact of a universal social–emotional learning program, the Promoting Alternative Thinking Strategies (PATHS) curriculum and teacher consultation. The study examined the main effects of intervention as well as how outcomes were affected by characteristics of the child (baseline level of problem behavior, gender) and by the school environment (student poverty). The study involved a sets of schools randomized within 3 U.S. locations; the longitudinal analysis involved children of multiple ethnicities who remained in the same intervention or control schools for Grades 1, 2, and 3. Measures utilized include the Teacher Observation of Classroom Adaptation—Revised (TOCA–R), the Teacher Report Form of the Child Behavior Checklist, and the Social Health Profile (SHP). Results indicate modest positive effects of sustained PATHS exposure included reduced aggression and increased prosocial behavior (according to both teacher and peer report) and improved academic engagement (according to teacher report). Peer report effects were moderated by gender, with significant effects only for boys. Most intervention effects were moderated by school environment, with effects stronger in less disadvantaged schools, and effects on aggression were larger in students who showed higher baseline levels of aggression. Limitations include the removal of the highest risk students from the sample (as they received additional interventions) – this may have impacted the school environment. In addition, differences across classrooms in teacher ratings of behavior may be less than accurate estimates and teachers and peer raters were not blinded to the condition assignment.

Length of postintervention follow-up: None.

*Malti, T., Ribeaud, D., & Eisner, M. P. (2011). The effectiveness of two universal preventive interventions in reducing children's externalizing behavior: A cluster randomized controlled trial. Journal of Clinical Child & Adolescent Psychology, 40(5), 677-692.

Type of Study: Clustered randomized controlled trial (randomization at the school level)
Number of Participants: 1,675

Population:

  • Age — Mean age at entry = 7.45 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were children entering Grade 1.

Location/Institution: Zurich, Switzerland

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article reports the effectiveness of two universal prevention programs in reducing externalizing behavior in elementary school children. Schools were randomly allocated to one of the four treatment conditions (Promoting Alternative Thinking Strategies [PATHS], Triple-P, PATHS + Triple-P, control). Measures utilized include the Social Behavior Questionnaire (SBQ). Results indicate that intention-to-treat analyses revealed that long-term effects on teacher- and parent-rated externalizing behavior were greater for the PATHS than for the control group. However, for most outcomes, no statistically significant positive effects were observed. Limitations include missing data and results may not generalize to schools where children do not have the same teacher and peers across the first school grades, because teachers and students in Swiss schools are likely to have continued to use the PATHS skills.

Length of postintervention follow-up: 2 years.

Crean, H. F., & Johnson, D. B. (2013). Promoting Alternative Thinking Strategies (PATHS) and elementary school aged children’s aggression: Results from a cluster randomized trial. American Journal of Community Psychology, 52, 56-72. doi:10.1007/s10464-013-9576-4

Type of Study: Clustered randomized controlled trial (randomization at the school level)
Number of Participants: 779

Population:

  • Age — Not Specified
  • Race/Ethnicity — 389 White/Caucasian, 291 African-American, 147 Hispanic, and 79 Other
  • Gender — 442 Female and 337 Male
  • Status — Participants were children in 3rd grade at the start of the study.

Location/Institution: 8 schools in a Northeastern urban school district, 4 in a Northeastern suburban school district, and 2 in a Midwestern suburban school district

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study reports on aggressive outcomes from the Promoting Alternative Thinking Strategies (PATHS) curriculum. Fourteen elementary schools were randomly assigned to an intervention or a control condition and third grade students were followed through the fifth grade. Measures include the Teacher Report on Students (TRS); Teacher-Child Rating Scales (TCRS); Aggression Conduct Problems Subscales, Teacher Version of the Behavior Assessment Scale for Children-2 (BASC-2), and the What Would I Do? assessment. Results indicate that PATHS had beneficial effects on student aggressive outcomes at the end of fifth grade. Teachers noted less aggressive behavior, less conduct problems, and less acting out problems. Limitations include students only received a portion of the PATHS curriculum (the intervention typically begins in Kindergarten or First grade, and some students entered the school after the intervention began), raters were not blind to condition, and lack of post-intervention follow-up.

Length of postintervention follow-up: None.

References

Greenberg, M. T., Kusché, C. A., & Conduct Problems Prevention Research Group. (2011). Grade level PATHS (Grades 3-5). South Deerfield, MA: Channing-Bete Co.

Kusché, C. A., & Greenberg, M. T. (2006). Teaching emotional literacy in elementary school classrooms: The PATHS Curriculum. In M. Elias & H. Arnold (Eds.), The educator's guide to emotional intelligence and academic achievement social-emotional learning in the classroom (pp.15-160). Thousand Oaks, CA: Corwin.

Kusché, C. A., & Greenberg, M. T. (2012). The PATHS curriculum: Promoting emotional literacy, prosocial behavior, and caring classrooms. In S. R. Jimerson, A. B. Nickerson, M. J. Mayer, & M. J. Furlong (Eds.), The handbook of school violence and school safety: International research and practice (pp.435-446). New York: Rutledge.

Contact Information

Name: Dorothy Morelli
Agency/Affiliation: PATHS Education Worldwide
Website: pathseducation.com
Email:
Phone: (615) 364-6606

Date Research Evidence Last Reviewed by CEBC: December 2015

Date Program Content Last Reviewed by Program Staff: April 2014

Date Program Originally Loaded onto CEBC: April 2014