Greenberg, M. T., Kusché, C. A., Cook, E. T., & Quamma, J. P. (1995). Promoting emotional competence in school-aged children: The effects of The PATHS Curriculum. Development and Psychopathology, 7(1), 117–136. https://doi.org/10.1017/S0954579400006374

Type of Study: Randomized controlled trial
Number of Participants: 286

Population:

• Age — 6–10 years
• Race/Ethnicity — 165 Caucasian, 91 African American, 11 Asian American, 7 Filipino American, 7 Native American, 4 Other, and 1 Hispanic
• Gender — 167 Male and 119 Female
• Status — Participants were children in 2nd and 3rd grade.

Location/Institution: Seattle, Washington

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of the Promoting Alternative Thinking Strategies (PATHS®) curriculum [now called The PATHS Curriculum] on the emotional development of school-aged children. Participants were randomly assigned to intervention or control conditions. Approximately 30% of the children were in a self-contained special needs classroom with the remainder in regular education. Measures utilized include 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 controlled postintervention follow-up: None.

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: II. Classroom effects. Journal of Consulting and Clinical Psychology, 67(5), 648–657. https://doi.org/10.1037/0022-006X.67.5.648

Type of Study: Randomized controlled trial
Number of Participants: 6,715

Population:

• Age — Not specified
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were children in 1st grade public education classrooms (3 successive cohorts, at-risk students not included).

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

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of the Promoting Alternative Thinking Strategies (PATHS®) curriculum [now called The PATHS Curriculum] and teacher consultation. Participants 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 indicate that there were 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 controlled 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(1),  55–63. https://doi.org/10.1023/A:1021786811186

Type of Study: Other quasi-experimental
Number of Participants: Intervention: 164

Population:

• Age — Not specified
• Race/Ethnicity — Overall Study: 79% African American
• Gender — Overall Study: 47% Male
• Status — Participants were children in 1st grade with special needs.

Location/Institution: Three elementary schools in Harrisburg, Pennsylvania

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to describe findings regarding quality of implementation in an effectiveness trial conducted in a high-risk, American urban community. The delinquency prevention trial used the Promoting Alternative Thinking Strategies (PATHS®) curriculum [now called The PATHS Curriculum] as its major program component. Participants were three schools that implemented PATHS® and were compared to three other non-intervention schools in the same school district. Measures utilized include the Teacher Social Competence Rating Scale and measures of principal support and implementation quality. Results indicate that 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. 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 controlled 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. https://doi.org/10.1177/10634266040120020101

Type of Study: Randomized controlled trial
Number of Participants: 133

Population:

• Age — Mean=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 basic study design, measures, results, and notable limitations)
The study used a subset of the same sample as Greenberg et al. (1995). The purpose of the study was to examine the long-term effectiveness of the Promoting Alternative Thinking Strategies (PATHS®) curriculum [now called The PATHS Curriculum] on the adjustment of school-age children with special needs. Participants were randomly 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 reduced the rate of growth for teacher-reported internalizing and externalizing behaviors 2 years after PATHS and produced a sustained reduction in depressive symptoms reported by the children. Limitations include lack of generalizability beyond self-contained special needs classrooms, and other interventions may have occurred in the classrooms.

Length of controlled 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. https://doi.org/10.1007/s11121-005-0022-1

Type of Study: Randomized controlled trial
Number of Participants: 318

Population:

• Age — 7–9 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 basic study design, measures, results, and notable limitations)
The study used a subset of the same sample as Greenberg et al. (1995). The purpose of the study was to examine the underlying neurocognitive conceptual theory of action of the Promoting Alternative Thinking Strategies (PATHS®) curriculum [now called The PATHS Curriculum]. Participants were randomly assigned to either the intervention group or to a control group comparison. 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 that at one-year follow-up, PATHS® intervention children demonstrated significantly fewer behavior problems both with regard to teacher-reported externalizing and internalizing behaviors. Results also indicate that 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 controlled 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(2), 67–91. https://doi.org/10.1007/s10935-007-0081-0

Type of Study: Randomized controlled trial
Number of Participants: 246

Population:

• Age — Mean=51.40 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 basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of an adaptation of the Promoting Alternative Thinking Strategies (PATHS®) curriculum [now called The PATHS Curriculum] for preschool-age children in Head Start. Participants 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 that 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 the 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 controlled 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), 156–168. https://doi.org/10.1037/a0018607

Type of Study: Randomized controlled trial
Number of Participants: 2,937

Population:

• Age — Not specified
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were children who had received the PATHS curriculum in Grades 1, 2 and 3 as part of the Fast Track project (at-risk students not included.

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

Summary: (To include basic study design, measures, results, and notable limitations)
The study used a subset of the same sample as McMahon et al. (1999). The purpose of the study was to examine the impact of a universal social–emotional learning program, the Promoting Alternative Thinking Strategies (PATHS®) curriculum [now called The PATHS Curriculum] and teacher consultation, and to examine the main effects of the 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). Participants were 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 that there were modest positive effects of sustained PATHS® exposure that 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 with 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 controlled 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. https://doi.org/10.1080/15374416.2011.597084

Type of Study: Randomized controlled trial
Number of Participants: 1,675

Population:

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

Location/Institution: Zurich, Switzerland

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of two universal prevention programs in reducing externalizing behavior in elementary school children. Participants were randomly allocated to one of the four treatment conditions (Promoting Alternative Thinking Strategies [PATHS®] [now called The PATHS Curriculum], Triple-P, PATHS + Triple-P, or 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® group 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 controlled 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(1–2), 56–72. https://doi.org/10.1007/s10464-013-9576-4

Type of Study: Randomized controlled trial
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: Eight 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 basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of the Promoting Alternative Thinking Strategies (PATHS®) curriculum [now called The PATHS Curriculum] in reducing aggression and externalizing behavioral problems. Participants were randomly assigned to the PATHS® intervention or a control condition that received traditional education as usual. Measures utilized 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 that 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 postintervention follow-up.

Length of controlled postintervention follow-up: None.

Panayiotou, M., Humphrey, N., & Hennessey, A. (2020). Implementation matters: Using complier average causal effect estimation to determine the impact of the Promoting Alternative Thinking Strategies (PATHS) curriculum on children's quality of life. Journal of Educational Psychology, 112(2), 236–253. https://doi.org/10.1037/edu0000360

Type of Study: Randomized controlled trial
Number of Participants: 5,218

Population:

• Age — 7–9 years (Mean= 8.12 years)
• Race/Ethnicity — 68% Caucasian, 11% Asian, 7% Afro-Caribbean, 6% Mixed Race, 5% Unknown, 3% Other/Unclassified Race, and 1% Chinese
• Gender — 51% Male
• Status — Participants were children in Year 3–5 in the English elementary school system.

Location/Institution: 45 schools in England

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the impact of the Promoting Alternative Thinking Strategies (PATHS) curriculum [now called The PATHS Curriculum] on children’s psychological well-being, peer social support, and school connectedness. Participants were randomly assigned to a treatment group that implemented PATHS or a control group that continued their usual provision for 2 years. Measures utilized include the Kidscreen-27 (KS27), Strength and Difficulties Questionnaire (SDQ), and the Social Skills Improvement System. Results indicate that PATHS led to a small, statistically significant improvement in children’s psychological wellbeing, but had no discernible impact on their peer social support or school connectedness. Multilevel complier average causal effect estimation using dosage as a compliance marker increased PATHS effect size for psychological wellbeing and revealed significant medium to large effects for peer social support and school connectedness. Limitations include the use of solely self-reported outcome measures; raters were not blind to condition; inability to model teacher characteristics, because of the lack of classroom membership information for the control schools; and the limitations of the implementation measure in that it provided only a relative “snapshot” of implementation.

Length of controlled postintervention follow-up: 2 years.