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Promoting Health Equity Through Education Programs and Policies: High School Completion Programs

Task Force Finding

The Community Preventive Services Task Force recommends high school completion programs for students at high risk for non-completion, based on strong evidence of effectiveness. The Task Force also recommends high school completion programs for a subset of students who are at risk for non-completion because they are pregnant or have children, based on strong evidence of effectiveness.

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; and case management. For students who are at risk of high school non-completion because they are pregnant or have children, the only program types evaluated in included studies were attendance monitoring and multiservice packages, and both were found to be effective.

Based on economic evidence, interventions to increase high school completion 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 high school completion 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 among all the principal social divisions of a population.

Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Intervention Definition

High school completion programs aim to increase the likelihood that students receive either a high school diploma or a general educational development (GED) diploma. These 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 Task Force 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. The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to the use of educational interventions for the promotion of health equity.

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. found a median percentage point increase of 8.5 (range: 3.6 to 15.9; 317 study arms) in the rate of high school completion by students in intervention programs compared with students in the control conditions.
    • Evidence from the updated search showed a median percentage point increase of 6.5 (range: -11.4 to 9.5; 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. found a median percentage point increase of 11.7 (range: 11.0 to 12.4; 51 study arms) in the rate of high school completion by students in intervention programs compared with students in the control conditions.
    • The updated search did not find studies specific to this population
Types of High School Completion Programs

Eleven different types of high school completion programs were included in this review. They are listed below in approximate order of effectiveness. Economic evidence is presented below in a separate section.

Vocational Training

Program Description: Vocational training prepares students for specific occupations. In addition to participating in the vocational curriculum, students commonly take a portion of the regular academic curriculum, participate in academic remediation, and learn life skills. Training may include occupational internships outside of school settings. Programs also may include training-related support services (such as transportation assistance and childcare), and assistance with job placement.

Effectiveness: 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

Program Description: Alternative schools are designed to provide educational and other services to students whose needs are not adequately addressed in traditional schools. Alternative schools often include students who have been expelled from regular schools and students who have quit school or seem likely to do so, including students who are pregnant or have children. Alternative schools are commonly situated away from traditional high schools and offer small classes and intense remediation for problems students encountered in regular schooling. They are often established in low-income communities, and may offer social services, such as childcare and support groups to address challenging issues. Teachers in alternative schools may act as mentors as well as instructors.

Effectiveness: 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

The type of social-emotional skills training used in high school completion programs most commonly aims to increase emotional self-awareness and regulation, improve self-esteem and attitudes about school, or prevent drug use. One approach to social-emotional skills training, cognitive behavioral therapy, is used to address counterproductive emotions, behaviors, and cognitive processes. It commonly combines stress management or relaxation techniques, cognitive exploration (including correction of inaccurate cognitions), and the reframing of counterproductive cognitions and behaviors.

Some programs train students who are pregnant or have children to be able to teach cognitive–behavioral management to their children.

Effectiveness: 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

These programs help high school students prepare for college by providing remedial courses, college guidance counseling to help with school selection and application, assistance with scholarship applications, and in some cases actual scholarships.

Effectiveness: 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

These programs assign trained adult mentors or counselors who help students focus on their school work or career objectives and deal with personal issues. Mentors and counselors are expected to work within the context and framework of students' home and community environments. They work closely with students, encouraging respect and personal growth as students progress toward high school completion and, in some cases, college. Mentors are most often volunteers who work with students throughout high school to help them graduate and get accepted to college. Some programs that help students prepare for college also provide financial support for college.

Effectiveness: 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

In these interventions, services such as remedial education, tutoring, or homework assistance are provided to students who have demonstrated academic difficulties in school or who may be at risk for having academic difficulties. Several federal programs fund these types of interventions. The Community Preventive Services Task Force issued separate findings on Out-of-School-Time-Academic Programs.

Effectiveness: 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

Schools may be reorganized with the objective of improving school engagement and learning. Reorganization may include the creation of small learning communities, career academies designed to orient student learning to particular occupational fields, block schedules (i.e., longer class periods that increase concentrated learning and decrease transition time), or class size reduction that allows more attention to students' individual needs.

Effectiveness: 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

Multiservice packages combine more than one of the intervention types described in this review. Most often, multiservice packages are comprehensive programs that include an academic component, vocational training, and case management. Some interventions also provide diverse services that may include housing, health care, homework assistance, guidance, counseling, recreational opportunities, or enrichment activities such as access to performing arts.

Effectiveness among high-risk populations: Students who received this intervention had high school completion rates that were, on average, 7.7 percentage points greater than those in the comparison populations (89.3% vs. 81.6%, respectively; 23 study arms).

Effectiveness among students who were pregnant or had children: Students who received this intervention had high school completion rates that were, on average, 11.0 percentage points greater than those in comparison populations (43.0% vs. 32.0%, respectively; 47 study arms).

Attendance Monitoring and Contingencies

In these programs, trained staff monitor students' attendance in school and provide mentoring services to increase attendance and school participation. Staff also review students' academic performance, provide feedback to students, and update parents on students' progress. They may also mentor students, model use of problem-solving skills, make themselves available for students to discuss personal concerns, and work with students to increase their level of school engagement. Students in attendance monitoring programs may receive rewards or "contingencies" such as cash awards for their attendance and participation in school.

Effectiveness among high-risk populations: Students who received this intervention had high school completion rates that were, on average, 6.7 percentage points greater than those in the comparison populations (80.1% vs. 73.4%, respectively; 26 study arms).

Effectiveness among students who were pregnant or had children: Students who received this intervention had high school completion rates that were, on average, 12.4 percentage points greater than those in comparison populations (30.4% vs. 18.0%, respectively; 39 study arms).

Community Service

Students participating in these interventions plan and carry out community service projects. These interventions are commonly coupled with a life-skills curriculum.

Effectiveness: 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

Case management connects students and families with appropriate services, and monitors students' progress.

Effectiveness: 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).

Study Characteristics

  • Interventions were conducted in the U.S., 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.

Applicability

Based on the settings and populations from included studies, results are applicable to:

  • High-risk, pregnant and parent student populations in high-income countries
  • 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.

Economic Evidence

Overall findings showed interventions to increase high school completion produced substantial economic benefits to government and society.

The economic review is based on evidence from 47 studies (search period January 1985–October 2012). Included 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 the 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).
    • Benefits were measured by lifetime economic benefits to society and to the government per additional high school graduate, including productivity loss averted, and healthcare, crime, and welfare costs averted.
    • Some benefit analyses also included indirect education cost – the extra costs to families and school systems when students are motivated to continue their education and stay in school longer.
Types of High School Completion Programs

Cost-effectiveness and cost-benefit analyses were done by intervention type. The Task Force Finding and Rationale Statement includes more information about the data and calculations used to reach these figures.

Vocational Training
  • Estimated cost per student ranged from $2,100 to $10,500 (2 studies).
  • Estimated cost per additional high school graduate ranged from $30,300 to $69,500 (2 studies).
  • Estimated benefit-to-cost ratios of 2.9:1 and 6.8:1 (2 analyses).
Alternative Schooling
  • Estimated cost per student ranged from $1,700 to $12,900 (4 studies).
  • Estimated cost per additional high school graduate ranged from $21,100 to $322,800 (4 studies).
  • Estimated benefit-to-cost ratios of 0.6:1 and 1.6:1 (2 analyses).
Social-Emotional Skills Training
  • Estimated cost per student ranged from $1,100 to $7,200 (2 studies).
  • Estimated cost per additional high school graduate ranged from $8,600 to $178,800 (2 studies).
  • No cost-benefit analyses were identified for this type of program.
College-Oriented Programming
  • Estimated cost per student ranged from $3,400 to $5,800 (3 studies).
  • Estimated costs per additional high school graduate of 30,600 and $265,700 (2 studies); one additional study reported an infinitely high* estimate because the program was found to be ineffective.
  • Estimated benefit-to-cost ratios of 0.8:1 (1 analysis).
Mentoring and Counseling
  • Estimated cost per student ranged from $600 to $4,500 (2 studies).
  • Estimated cost per additional high school graduate ranged from $11,200 to $90,400 (2 studies).
  • Estimated benefit-to-cost ratios of 2.1:1 (1 analysis).
Supplemental Academic Services
  • Estimated cost per student ranged from$800 to $14,100 (2 studies).
  • Estimated cost per additional high school graduate of $48,300 (1 study), and another study reported an infinitely high* estimate because the program was found to be ineffective.
  • Estimated benefit-to-cost ratios of 4.2:1 (1 analysis).
School and Class Restructuring
  • Estimated cost per student ranged from $2,200 to $16,000 (9 studies).
  • Estimated cost per additional high school graduate ranged from $20,100 to $145,100 (9 studies).
  • Estimated benefit-to-cost ratios ranging from 1.3:1 to 9.3:1 (8 analyses).
Multiservice Packages

Among high-risk populations:

  • Estimated cost per student ranged from$4,100 to $22,500 (4 studies).
  • Estimated cost per additional high school graduate ranged from $56,500 to $131,100 (3 studies), and one study reported an infinitely high* estimate because the program was found to be ineffective.
  • Estimated benefit-to-cost ratios of 1.6:1 and 2.8:1 (2 analyses).

Among students who were pregnant or had children:

  • Estimated cost per student ranged from $14,800 to $17,800 (3 studies).
  • Estimated cost per additional high school graduate ranged from $67,200 to $194,600 (3 studies).
  • Estimated benefit-to-cost ratios of 1.1:1 and 1.2:1 (2 analyses).
Attendance Monitoring and Contingencies

Among high-risk populations:

  • Estimated cost per student ranged from $2,800 to $5,700 (3 studies).
  • Estimated cost per additional high school graduate ranged from $33,600 to $70,900 (3 studies).
  • Estimated benefit-to-cost ratios of 2.6:1 and 5.6:1 (2 analyses).

Among students who were pregnant or had children:

  • Estimated cost per student was $300 (1 study).
  • Estimated cost per additional high school graduate $99,800 (1 study).
  • No cost-benefit analyses were identified for this type of program.
Community Service
  • Estimated cost per student was $300 (1 study).
  • Estimated cost per additional high school graduate was $3,000 (1 study).
  • Estimated benefit-to-cost ratio of 68.2:1 (1 analysis).
Case Management
  • Estimated cost per student was $22,800 (1 study).
  • Estimated cost per additional high school graduate was infinitely high* because the program was found to be ineffective (1 study).
  • No cost-benefit analyses were identified for this type of program.

* When an economic study estimated program cost, but determined the program to be ineffective (i.e., an estimated effect of zero), the cost per additional graduate was reported as infinitely high (i.e., program cost/0 effect).

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion. The Community Guide does not conduct systematic reviews of implementation.

Common challenges to program implementation include:

  • Attendance, which is often especially low among those most in need
  • Noncompliance with program requirements
  • Inadequate staff training and high turnover

Supporting Materials

Publications

Hahn RA, Knopf JA, Wilson SJ, Truman BI, Milstein B, Johnson RL, Fielding JE, Muntaner CJM, Jones CP, Fullilove MT, Moss RD, Ueffing E, Hunt PC, and the Community Preventive Services Task Force. Programs to increase high school completion: a Community Guide systematic health equity review Adobe PDF File [PDF - 918 kB]. Am J Prev Med 2015;48(5):599–608.

Qu S, Chattopadhyay SK, Hahn RA, the Community Preventive Services Task Force. High school completion programs: a Community Guide systematic economic review. Journal of Public Health Management & Practice 2016;22(3):E47–56.

Community Preventive Services Task Force. High school completion programs recommended to improve health equity Adobe PDF File [PDF - 118 kB]. Am J Prev Med 2015;48(5):609–12.

Mackenbach JP. Commentary: Education programs are likely to improve health, but will they improve health equity? Adobe PDF File [PDF - 110 kB]. Am J Prev Med 2015;48(5):e5–6.

Read other Community Guide publications about Promoting Health Equity Through Education Programs and Policies in our library.

Promotional Materials

Community Guide News

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References

Wilson SJ, Tanner-Smith EE, Lipsey MW, Steinka-Fry K, Morrison J. Dropout prevention and intervention programs: Effects on school completion and dropout among school-aged children and youth. Campbell Systematic Reviews, 2011. Available at URL: http://campbellcollaboration.org/lib/project/158/.




Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Promoting health equity through education programs and policies: high school completion programs. www.thecommunityguide.org/healthequity/education/highschoolcompletion.html. Last updated: MM/DD/YYYY.

Review completed: December 2013