Violence Prevention: School-Based Programs
Summary of CPSTF Finding
CPSTF Finding and Rationale Statement
About The Systematic Review
Summary of Results
- For all grades combined, the median effect was a 15.0% relative reduction in violent behavior among students who received the program (interquartile interval: -44.1% to -2.3%; 65 study arms).
- By school level, the median effects on violent behavior were as follows.
- High school students: median relative reduction of 29.2% (interquartile interval not calculated; 4 study arms)
- Middle school students: median relative reduction of 7.3% (interquartile interval: -35.2% to 2.3%; 21 study arms)
- Elementary school students: median relative reduction of 18.0% (interquartile interval: -44.8% to -2.5%; 34 study arms)
- Pre-kindergarten and kindergarten students: median relative reduction of 32.4% (interquartile interval not calculated; 6 study arms)
- All intervention strategies (e.g., informational, cognitive/affective, and social skills building) were associated with a reduction in violent behavior.
Summary of Economic Evidence
Reported program costs varied widely:
- Less than $200 per child for a program implemented in nine schools in the Tucson metropolitan area
- $2449 per teacher and $98 per child for a program in 15 New York City elementary schools
- $15-$45 per student per year for a 3-year program, depending on staff turnover.
The only study that estimated both costs and benefits was based on the Seattle Social Development Project, a comprehensive, intensive, and long-term program that focused on elementary schools in a high-crime urban area.
- The average decrease in basic crime outcomes was 13%.
- The total benefits, including cost savings to taxpayers because of reduced expenses for the criminal justice system and reduced personal and property losses for crime victims, were estimated to be $14,426 in 2003 U.S. dollars per participant.
- Net saving per participant amounted to $9837.
- This program showed a benefit of $3.14 for every dollar invested in the program.
Investment in universal school-based programs to prevent violence has the potential for significant positive economic returns in the future.
Some school programs are more effective than others. What characteristics of the programs, or perhaps of the settings in which they are implemented, make some programs or settings more or less effective?
There appears to be a decrease in program effectiveness as time after the completion of the program increases. It will be important to explore ways to extend the benefit of programs, either within the programs themselves or with booster programs.
Are school programs equally effective for high-risk and low-risk children, and in high-risk and low-risk environments? Are programs targeted to high-risk children overall more effective, and, if so, more cost effective, than universal programs?
Many programs assessed in the review were not ongoing, standing programs, but instead were conducted for purposes of research. Because research programs are often more effective than ongoing programs perhaps because of the intensity of monitoring and implementation it will be important to understand what maximizes the effectiveness and sustainability of ongoing programs.
In what ways is the effectiveness of universal school-based programs to prevent violence moderated by the predominant ethnicity of the student population? How might addressing cultural and social differences in diverse populations improve the effectiveness of school programs?
Studies of the economic efficiency of school programs, measured, for example, as net benefits or cost-benefit ratio, should assess not only violent or criminal behavior averted, but all current and future social, health, academic, and labor-market outcomes associated with school violence prevention programs. It will be interesting to assess what proportion of the total benefits is crime-related. It will be important to assess the extent to which the data used in the derivation of the summary measure are nationally representative.
- Study sample sizes ranged from 21 to 39,168 students, with a median sample size of 563.
- Forty-one studies (77.4%) used direct measures of violence or aggression, and 12 studies (23.6%) used proxy outcome measures.
- Follow-up time ranged from none (assessment immediately following the end of the intervention) to 6 years; the median follow-up time was 6 months.
- Following are characteristics of the evaluated programs:
- Programs were offered in pre-kindergarten, kindergarten, elementary, middle school, and high school classrooms.
- All children in a given grade or school, regardless of prior violence or risk for violent behavior, received the programs.
- Some programs targeted schools in high-risk areas, including those with low socioeconomic status, high crime rates, or both.
- Elementary school and middle school programs usually sought to reduce disruptive and antisocial behavior using an approach that focuses on modifying behavior by changing the associated cognitive and affective mechanisms.
- In middle and high school, the focus of programs shifted to general violence and to specific forms of violence, including bullying and dating violence. The interventions used an approach that made greater use of social skills training and emphasizes the development of behavioral skills rather than changes in cognition, consequential thinking, or affective processes.
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When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.
Summary Evidence Table
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Criminal Justice Reference Service), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases in June and July 2002, and updated in December 2004.
The references listed in all retrieved articles were reviewed, and experts on the systematic review development team and elsewhere were consulted. The studies in this review were published as journal papers, governmental reports, books, and book chapters.
Articles published prior to December 2004 were considered for inclusion in the systematic review if they evaluated a universal school-based program; assessed at least one of the violent outcomes specified in the analytic framework; were conducted in countries with high-income economies (as defined by the World Bank); a reported on a primary study rather than, for example, a guideline or review; and compared a group of people exposed to the intervention with a comparison group that had not been exposed or had been less exposed.
Studies with a total sample size fewer than 20 students were excluded because results from such studies were regarded as unreliable. While searching for evidence, the team also sought information about effects on other outcomes not related to violence, such as changes in school performance and drug use.
Considerations for Implementation
- Improvements have been reported for social behavior more broadly, including reduced drug abuse and delinquency, and traditional academic outcomes, such as attendance and school performance.
- Schools and their curricula are subject to many requirements and demands. Because violence prevention may not be seen as necessary or central, it may be difficult to introduce effective programs.
- The need for teacher training may make acceptance and implementation difficult.
- Some programs may make additional demands on parents and the community.
- Fidelity of program implementation can be an obstacle to program success, and may be particularly problematic when implemented by communities without investigator scrutiny. Programs may want to provide ways for school or community implementers to monitor fidelity.
Healthy People 2030
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.
- Reduce the proportion of public schools with a serious violent incident — AH‑D03
- Reduce the rate of minors and young adults committing violent crimes — AH‑10
- Reduce physical fighting among adolescents — IVP‑11
- Reduce the rate of adolescent and young adult victimization from violent crimes — AH‑R11
- Reduce the number of young adults who report 3 or more adverse childhood experiences — IVP‑D03
Health Impact in 5 Years (HI-5)
HI-5 highlights community-wide approaches that have demonstrated 1) positive health impacts, 2) results within five years, and 3) cost effectiveness and/or cost savings over the lifetime of the population or earlier.