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Health Equity: High School Completion Programs

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What the CPSTF Found

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.

The systematic review was conducted on behalf of the CPSTF 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.

Context

High school completion is an established predictor of long-term health. In the United States, a high school education can add about 7 years to one’s life expectancy.

The proportion of students who complete high school varies markedly by race and ethnicity. In 2010, 83% of whites, 66% of blacks, 71% of Hispanics, 94% of Asian/Pacific Islanders, and 69% of American Indian/Alaska Natives completed high school.

High school completion rates are also associated with family income, and those from the lowest quartile are the least likely to have completed their education.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 272 kB].

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. Economic evidence is presented separately.

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
Program Description

The social-emotional skills training most commonly used 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
Program Description

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
Program Description

These programs assign trained adult mentors or counselors to 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. Mentors work closely with students, encouraging respect and personal growth as they 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 into 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
Program Description

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 CPSTF has separate findings for Out-of-School-Time-Academic Programs (reading-focused, math-focused, general, minimal academic content).

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
Program Description

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
Program Description

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
Program Description

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.

Staff also may mentor students, model use of problem-solving skills, make themselves available for students to discuss personal concerns, or 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
Program Description

Students participating in these interventions plan and carry out community service projects. 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
Program Description

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).

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 272 kB].

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).
    • Benefits were measured by lifetime economic benefits to society and to 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.

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).

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

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • 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)?

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.

Publications

Hahn RA, Knopf JA, Wilson SJ, et al. Programs to increase high school completion: a Community Guide systematic health equity review. American Journal of Preventive Medicine. 2015;48(5):599-608.
Qu S, Chattopadhyay SK, Hahn RA, 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. American Journal of Preventive Medicine. 2015;48(5):609-12.
Hahn RA, Chattopadhyay SK. Linking studies to assess the life expectancy associated with eighth grade school achievement. Preventive Medicine Reports. 2019;16(100980). doi:https://doi.org/10.1016/j.pmedr.2019.100980.
Mackenbach JP. Commentary: Education programs are likely to improve health, but will they improve health equity?. American Journal of Preventive Medicine. 2015;48(5):e5-6.

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