Social Determinants of Health: High School Completion Programs
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends high school completion programs for students at high risk for non-completion. The CPSTF also recommends high school completion programs for a subset of students who are at risk of non-completion because they are pregnant or have children.
For this systematic review, program effectiveness is measured as the increased rate of high school completion by the intervention group when compared with the control group. Using this measure, evidence shows the following types of high school completion programs are effective for the general at-risk student population (listed in approximate order of effectiveness):
- Vocational training
- Alternative schools
- Social-emotional skills training
- College-oriented programming
- Mentoring and counseling
- Supplemental academic services
- School and class restructuring
- Multiservice packages
- Attendance monitoring and contingencies
- Community service
- Case management
Included studies only evaluated attendance monitoring programs and multiservice packages with students at risk of high school non-completion because they were pregnant or had children, and both types of programs were found to be effective.
Economic evidence shows high school completion programs produce substantial economic benefits to government and society. And for most programs, benefits exceed costs for all students at risk for non-completion, including students who are pregnant or have children.
Because academic achievement is linked with long-term health, and because out-of-school-time academic programs are commonly implemented in racial and ethnic minority or low-income communities, these programs are likely to improve health equity. Equity in health is widespread, achievable equality in health and in the major social determinants of health in all the principal social divisions of a population.
The full CPSTF Finding and Rationale Statement and supporting documents for Social Determinants of Health: High School Completion Programs are available in The Community Guide Collection on CDC Stacks.
Intervention
High school completion programs aim to increase the likelihood that students receive either a high school diploma or a general educational development (GED) diploma.
Programs take many forms and may be delivered in schools or other community settings. They may target at-risk students as individuals or as groups (e.g., students who are pregnant or have children), or they may include all students in schools with low high school completion rates.
Programs may have a single focus, such as mentoring, or they may be multiservice programs that change several features of the school environment to promote high school completion.
About The Systematic Review
This CPSTF finding is based on evidence from a meta-analysis published in 2011 (Wilson et al., search period 1985-2010/2011). An updated search for studies published between 2010 and August 2012 identified 10 additional studies, which had results consistent with those from the meta-analysis.
Study Characteristics
- Interventions were conducted in the United States, Canada, and the United Kingdom
- In 75% of the studies, most students were from racial or ethnic minorities
- Most studies included students from predominantly low-income families
- Males and females were equally represented in programs for high-risk populations; only females were included in programs for students who were pregnant or had children
Summary of Results
Overall Effectiveness
- High-risk student populations exposed to high school completion programs were more likely to complete high school when compared with control groups
- Wilson et al. reported an 8.5 median percentage point increase in the rate of high school completion by students in intervention programs compared with students in the control conditions (317 study arms)
- Evidence from the updated search showed a 6.5 median percentage point increase (10 studies)
- Pregnant or parent student populations exposed to an intervention were more likely to complete high school when compared with control groups
- Wilson et al. reported an 11.7 median percentage point increase in the rate of high school completion by students in intervention programs compared with students in the control conditions (51 study arms)
- The updated search did not find studies specific to this population
Types of High School Completion Programs
This review assessed 11 different types of high school completion programs. They are listed below in approximate order of effectiveness:
- Vocational Training: Students who received vocational training had high school completion rates that were, on average, 15.9 percentage points greater than those in comparison populations (86.2% vs. 70.3%, respectively; 51 study arms)
- Alternative Schooling: Students who attended alternative schools had high school completion rates that were, on average, 15.5 percentage points greater than those in comparison populations (69.3% vs. 53.8% respectively; 30 study arms)
- Social-Emotional Skills Training: Students who received social-emotional skills training had high school completion rates that were, on average, 13.7 percentage points greater than those in comparison populations (86.0% vs. 72.3%, respectively; 12 study arms)
- College-Oriented Programming: Students who participated in college-oriented programs had high school completion rates that were, on average, 10.4 percentage points greater than those in comparison populations (91.3% vs. 80.9%, respectively; 25 study arms)
- Mentoring and Counseling: Students who received mentoring and counseling had high school completion rates that were, on average, 9.4 percentage points greater than those in comparison populations (93.1% vs. 83.7%, respectively; 27 study arms)
- Supplemental Academic Services: Students who received supplemental academic services had high school completion rates that were, on average, 8.8 percentage points greater than those in comparison populations (89.8% vs. 81.0%, respectively; 28 study arms)
- School and Class Restructuring: Students whose schools or classes were restructured had high school completion rates that were, on average, 8.3 percentage points greater than those in comparison populations (91.9% vs. 83.6%, respectively; 105 study arms)
- Multiservice Packages: Among high-risk populations: 7.7 percentage points greater (89.3% vs. 81.6%, respectively; 23 study arms). Among students who were pregnant or had children: 11.0 percentage points greater (43.0% vs. 32.0%, respectively; 47 study arms)
- Attendance Monitoring and Contingencies: Among high-risk populations: 6.7 percentage points greater (80.1% vs. 73.4%, respectively; 26 study arms). Among students who were pregnant or had children: 12.4 percentage points greater (30.4% vs. 18.0%, respectively; 39 study arms)
- Community Service: Students who participated in community service programs had high school completion rates that were, on average, 6.3 percentage points greater than those in the comparison populations (97.4 vs. 91.0%, respectively; 24 study arms)
- Case Management: Students who participated in a case management intervention had high school completion rates that were, on average, 3.6 percentage points greater than those in the comparison populations (92.9 vs. 96.5%, respectively; 17 study arms)
Summary of Economic Evidence
Overall findings showed interventions to increase high school completion produced substantial economic benefits to government and society.
The economic review included 47 studies (search period January 1985–October 2012). Studies reported program costs (37 studies), program benefits measured as lifetime benefits per additional high school graduate (10 studies), cost-benefit analyses (22 studies), and cost-effectiveness analyses (37 studies). All economic values are reported in 2012 U.S. dollars.
- Lifetime benefits per additional high school graduate from a governmental perspective ranged from $187,000 to $240,000 (4 studies) and benefits from a societal perspective ranged from $347,000 to $718,000 (6 studies)
Economic results varied by program type. For example:
- Vocational Training: Estimated benefit-to-cost ratios of 2.9:1 and 6.8:1 (2 analyses)
- School and Class Restructuring: Estimated benefit-to-cost ratios ranging from 1.3:1 to 9.3:1 (8 analyses)
- Community Service: Estimated benefit-to-cost ratio of 68.2:1 (1 analysis)
Applicability
Based on this review, the CPSTF finding should be applicable to high-risk, pregnant and parent student populations in high-income countries as well as male and female students of all racial and ethnic backgrounds.
Program effectiveness differed on various dimensions:
- Programs implemented in school settings were more effective than those implemented outside of school in community venues
- Well-implemented programs were more effective than those that reported implementation problems
- Among pregnant or parent student populations, programs were more effective for older as compared with younger students
Evidence Gaps
- In multiservice packages, how does each component contribute to program effectiveness?
- How effective are these programs at increasing rates of GED completion?
- What is the optimal duration for each type of program?
- How effective are these programs with students in institutions (e.g., prisons, residential settings for various forms of treatment)?
Implementation Considerations and Resources
Common challenges to program implementation include the following:
- Attendance, which is often especially low among those most in need
- Noncompliance with program requirements
- Inadequate staff training and high turnover
Attendance and monitoring programs that deny family benefits when students fail to attend school may raise ethical concerns. They also can make it more difficult for families to send students to school if, for example, students need to work to make up for the loss of family assistance.
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.