SNAP® (Stop Now And Plan) Model Programs

Categories

Categories associated with best practice:

  • Community
  • Health Equity
  • Individual
  • Organization
  • Children (ages 6-12) icon
  • Teens (ages 13-18) icon
  • Before-After School Icon 1
  • Best Practices
  • Canada
  • Community/ Neighbourhood
  • Elementary School Icon 1
  • Health Care Setting
  • Mental Health Icon 2
  • Preventing Violence Icon 1

Determinants of Health: Personal health practices and coping skills, Social relationships (including those that respect diversity), Social support networks, Healthy child development

Overview

SNAP® is an evidence-based, gender specific, manualized, multi-component cognitive behavioral program for at-risk children age 6 to 11 with serious disruptive behaviour concerns (aggression, rule-breaking, and conduct problems) and their families. SNAP focuses on teaching children (and their parents/caregivers) emotion regulation, self-control, and problem solving skills with a special emphasis on challenging cognitive distortions , replacing with realistic thinking, and helping children make better choices in the moment. The goal is to improve social competencies, reducing disruptive behaviour, risk of police contact, and discipline issues while improving effective parent management skills.

SNAP utilizes a structured curriculum, role plays, and facilitated discussions to help children learn to identify triggers and make connections between their bodies’ physiological responses (or “body cues”), thoughts, feelings, and emotional responses. This helps foster the development of effective emotion regulation skills to help them calm down and come up with an effective plan of action. To ensure success, these plans need to: a) keep the children’s problems small, b) make them feel like a winner, and c) avoid hurting anyone, anything, or themselves (Augimeri et al., 2014).

Guiding the use of the technique are the nine principles with specific indicators that have been identified to describe the approach to service delivery and guide SNAP programming. Those principles include the scientist-practitioner paradigm, being client centered, gender specific, eco-systemic, collaborative, community responsive, strength and skill based, and offering continuing services and accountable service excellence. Further, there are five core treatment theories based on a developmental approach that form the theoretical underpinnings of the SNAP model; they are Systems, Social Interactional Learning, Cognitive-Behavioral, Attachment, and Feminist Theories.

The Early Assessment Risk List (EARL-20B for boys or EARL-21G for girls), a structured clinical risk/need assessment device for use with aggressive and delinquent children, is also completed to provide a comprehensive framework for evaluating risk factors known to influence a child’s propensity to engage in future antisocial behavior. Informed by the eco-systemic assessment, the risk assessment takes into account multi-informant perspectives (child, parent, teacher, and clinician), identifies the unique treatment needs of children and their families, and assists clinicians with treatment planning in order to mitigate these risks.

The core program components of SNAP include manualized 13-week gender-specific SNAP Children’s Groups (SNAP Boys; SNAP Girls) with concurrent SNAP Parent Groups. Typically, children’s and parent’s groups is where the SNAP technique is taught and lays the foundation for additional SNAP treatment components based on risk and need (e.g., Stop Now And Plan Parenting – Family Counseling, School Support, Individual Counseling/Mentoring, Community Connections/Advocacy, and Youth Leadership). In addition, the SNAP Parent Group provides the caregivers with effective child management strategies with a special emphasis on challenging cognitive distortions or thinking errors, reducing isolation, and enhancing parent-child relationships. For girls that have completed the SNAP Girl’s group, there is also a manualized mother-daughter group called Girls Growing Up Healthy (GGUH; core component for girls) that focuses on enhancing relationship capacity, healthy relationships, and physical and sexual health. Also, there is a SNAP Youth Leadership Club – a component offered in both the boys’ and girls’ programs for youth who have completed the core components of the SNAP program but continue to be high risk. Staff provide group, individual, and family work to prepare at-risk youth for self-sufficiency, increase motivation for school involvement and success, improve their workforce career trajectories, and reduce their Involvement with the law.

Lastly, the SNAP model has undergone several stringent research and evaluation protocols targeting this population. It has been evaluated and re-evaluated using the scientist-practitioner paradigm to ensure both that there are no iatrogenic effects and that the necessary program components are delivered in the appropriate intensity to maximize treatment gains based on the child and family’s individual level of risk and need. Summary of key findings include: SNAP can improve executive functioning (thought processes) in just 13 weeks (Lewis et al, 2008; Woltering et al., 2015); “out performs treatment as usual” (Burke & Loeber, 2015); and the “monetary benefits greatly exceed monetary costs, reduces crime by 33% and saves money” (Farrington & Koegl, 2015).

Primary Source Document

Burke J, Loeber R, The effectiveness of the Stop Now And Plan (SNAP) program for boys at risk for violence and delinquency Prevention Science, 16(2), 242-253

Contact information of developer(s) and/or implementer(s)

SNAP Model - Dr. Leena K. Augimeri, Director, SNAP Scientific and Program & Centre for Children Committing Offences, Child Development Institute

46 St. Clair Gardens

Toronto, Ontario M6E 3V4, Canada

Telephone; 416-603-1827- ext 3112

SNAP Implementation - Nicola Slater, Manager, SNAP Business Development & Affiliate Relations, Child Development Institute

Telephone; 416-603-1827 ext. 2148

Intervention Focus

Intervention Goal / ObjectiveLevel(s) TargetedEquity Focus
Short to long term effects:
  • Decrease risk across key family risk indicators (based on the EARLs) including: Parenting Style, Supports, Stressors./li>
  • Individual level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.
Long term effects: Fewer children with official youth criminal justice system convictions at follow-up.
  • Individual level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.
For Caregivers from pre to post intervention (immediate/short term effects):
  • Improved child management strategies
  • Enhance problem-solving skills and coping abilities
  • Increased parental competency./li>
  • Individual level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.
For Child from pre to post intervention (Short to long term effects)
  • Decrease risk across key child risk indicators (based on the EARLS see above) including: Antisocial behaviour, Antisocial Attitudes, Authority Contact, Peer Socialization, Coping Ability, & Likeability
  • Individual level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.
For Child from pre to post intervention (immediate/short term effects)
  • Improved emotional regulation & increased self-control
  • Decreases in disruptive behaviours that include: aggression, rule-breaking, externalizing, conduct and/or oppositional concerns
  • Increased social competence/skills
  • Decreased internalizing behaviours (anxiety and depression)
  • Individual level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.
For Child from pre to post intervention (Moderate term effects)
  • Increased remorse
  • Improved executive functioning
  • Treatment gains maintained up to 15 months post treatment
  • Individual level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.

Health Issue(s) that is/are addressed by the Intervention

Health Promotion

  • Mental Health

Risk Reduction

  • Prevent violence
  • Other

Specific Activities of the Intervention

  • Information sessions offered about a risk factor or condition
  • Training offered to deliver the intervention
  • Group process/program
  • Other training session
  • Partnership development

Priority/Target Population for Intervention Delivery

Life Stage

  • Children (age 6-12 years)
  • Youth (age 13-18 years)

Settings

Educational Settings

  • Before/after school childcare (ages 5-12)
  • Elementary school

Community Setting

  • Home
  • Community/neighbourhood
  • Health care setting
  • Child and youth camp
  • Other

Outcomes

Outcomes and Impact Chart
Level of ImpactDescription of OutcomeEquity Focus
Individual LevelChildren who received SNAP had significantly fewer charges against them relative to those who received treatment as usual.
Those in TAU had significantly more (b=0.97, SE=.49, 95 % confidence interval=.01–1.93; IRR=2.6) charges against them (mean=0.61, SD=1.47) than those in SNAP (mean=0.23, SD=0.85).
Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.
Individual LevelTreatment gains of the experimental group maintained 15 months post treatment.
The results suggest that the treatment group differences generally hold across the 3-month to 1year follow-up with effect sizes showing moderate ranges.
Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.
Individual LevelChildren receiving SNAP showed greater decreases across internalizing behaviours (anxiety and depression).
Significant treatment condition differences, favoring SNAP, were found for the CBCL subscales of Internalizing, Withdrawn Depressed and Anxious Depressed. As outlined in Table 3 of the Primary source document.
Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.
Individual LevelBehavioural improvement pre to post intervention (immediate effects) compared to children in the control.
Children who received SNAP decreased significantly more than those receiving treatment as usual on the Aggression and Conduct subscales of the Child Behavior Checklist pre to post intervention, and these effects were maintained over time. Compared to Treatment As Usual (TAU), those in SNAP showed significantly lower AGG (B =-4.85, SE=1.53, p=.002), RB (B = -2.96, SE=2.82, p =.005), CP (B=-4.96, SE = 1.18, p<.001), and EXT (B=-4.12, SE=1.01, p<.001).
Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.

Adaptability

Implementation History

  • Multiple implementations - Different settings/populations/providers - The intervention showed significant adaptability as it has been implemented in different settings or with different populations or by different provider(s). This can include multiple implementations during the same time period. Each implementation of the intervention must have been substantially the same and must have demonstrated positive results for the primary objectives of the intervention.

Expertise Required for Implementation within the Context of the Intervention

  • Requires specialized skills that are easily available within the context - The intervention requires the participation of personnel with advanced skills (e.g. medical doctors, epidemiologists, social workers) but that are easily available within the intervention context.

Are there supports available for implementation

Yes. Before implementation activities begin with an organization a SNAP Request for Qualifications (RFQ) is completed. Should this show satisfactory results training and consultation plans are created. Once an agreement has been reached, two or three lead staff from the affiliate organization attends a 3-day lead staff training conducted by lead trainers. This training includes operational details, staff and site preparation, training and model review, viewing of SNAP group sessions, paperwork requirements and an overview of SNAP Implementation Tool (SNAPiT) that supports consultation, supervisory and internal fidelity/integrity responsibilities. Additionally, the SNAP License Agreement is started (and is renewed annually thereafter), which stipulates the services SNAP purveyors will provide (e.g., training, consultation, technical and evaluation support) as well as the fidelity and integrity activities the affiliate organization is required to engage in to ensure the on-going implementation of SNAP programming is being effectively monitored and supported. A 9-day core SNAP training is then scheduled. For the core SNAP training, SNAP Trainer/Consultant team will train all SNAP program and supervisory staff. For ongoing fidelity reviews, affiliate organizations are required to submit video tapes through SNAPiT (an online system - in the absence of live observation by a CDI SNAP consultant) so that both competency and adherence forms may be completed and reviewed with the team. Other monitoring activities include the completion of Consultation Feedback Surveys (conducted every 3-4 months) that are completed by CDI SNAP staff as well as affiliate SNAP staff to ensure consultation activities are on track and effective.

Are there resources and/or products associated with the interventions

Yes. Booklets, manuals, assessment tools, SNAPiT (SNAP Implementation Tool), testimonials, posters, etc. For a complete list please contact the program developers