Chapter 5

Ineffective Primary Prevention Programs

School-Based Programs

Some educational approaches that target universal populations have shown a consistent lack of effect in scientific studies. Peer-led programs, including peer counseling, peer mediation, and peer leaders, are among them. In a 1987 review of these interventions, Gottfredson concluded that there is no evidence of a positive effect and that these strategies can actually harm high school students. Results of a meta-analysis confirmed this finding, adding that adult-led programs are as effective as, or more effective than, peer-led programs in reducing youth violence and related risk factors. Nonpromotion to succeeding grades is another educational approach that can have harmful effects. Studies of this approach demonstrate negative effects on student achievement, attendance, behavior, and attitudes toward school.

One school-based universal prevention program meets the criteria for Does Not Work: Drug Abuse Resistance Education, or DARE. DARE is the most widely implemented youth drug prevention program in the United States. It receives substantial support from parents, teachers, police, and government funding agencies, and its popularity persists despite numerous well-designed evaluations and meta-analyses that consistently show little or no deterrent effects on substance use. Overall, evidence on the effects of the traditional DARE curriculum, which is implemented in grades 5 and 6, shows that children who participate are as likely to use drugs as those who do not participate. However, some positive effects have been demonstrated regarding attitudes toward police.

Researchers have suggested several reasons for DARE’s lack of effectiveness. The program is most commonly criticized for its limited use of social skills training and for being developmentally inappropriate. Specifically, DARE is implemented too early in child development: It is hard to teach children who have not gone through puberty how to deal with the peer pressure to use drugs that they will encounter in middle school.

Changes are being made at the national level in an attempt to improve the program’s effectiveness. DARE developers have added social skills training sessions to the core curriculum and have developed a modified version of the curriculum that can be used in older student populations. These versions of DARE have not yet been evaluated.⁴

Secondary Prevention: Children at High Risk of Violence

Secondary prevention programs and strategies are implemented on a selected scale, for children at enhanced risk of youth violence, and are aimed at preventing the onset and reducing the risk of violence. Programs that target the families of high-risk children are among the most effective in preventing violence. Several family-based strategies and programs are included in the discussion below.

Parent Training

One effective approach involves training parents to use specific child management skills. A review by Dumas (1989) shows that parent training can lead to clear improvements in children’s antisocial behavior (including aggression) and family management practices. In individual studies with disruptive/aggressive/hyperactive boys and girls, parent training has resulted in reduced aggressive, antisocial, and delinquent behaviors; lower arrest rates (including arrests for assault); less overall delinquency; and academic improvement. The following five Promising youth violence prevention programs include parent-training components.

The Montreal Longitudinal Study, sometimes called the Preventive Treatment Program, is a 2-year intervention aimed at preventing delinquency among 7- to 9-year-old boys from low-income families who have been identified as disruptive. The program has two major components: school-based social skills training (19 sessions) and parent training (17 sessions). The parent-training sessions, provided every 2 weeks for the duration of the intervention, teach parents to read with their children, monitor and reinforce their children’s behavior, use effective discipline, and manage family crises. A long-term follow-up of Canadian boys enrolled in this program found positive effects on academic achievement and avoidance of gang involvement, drug and alcohol use, and delinquency up to age 15.

The Syracuse Family Development Research Program targets parents and children in impoverished families. It provides weekly home visitation with parent training by paraprofessional child development trainers and 5-year individualized day care that includes child training on social and cognitive skills and child behavior management. The Perry Preschool Program provides early education to children age 3 and 4 from families with low socioeconomic status. The preschool lasts 2 years and is designed to offer high-quality early childhood education and promote young children’s intellectual, social, and physical development. In addition, this intervention provides weekly home visits by teachers and referrals for social services, when needed. Both of these programs have demonstrated long-term effects (up to age 19) on delinquency, academic achievement, and other school-related outcomes. In addition, the Perry Preschool Program has produced significant reductions in antisocial behavior, serious fights, police contacts, and school dropout rates.

Parent training is one of a broad range of family services offered through Parent Child Development Center Programs, which target low-income families with children age 2 months to 3 years. The parent-training component of this intervention targets mothers as the primary caregivers and focuses on infant and child development, home management, and family communication and interaction skills. The programs have positive effects on a variety of risk factors for youth violence, including child antisocial behavior and fighting and mother-child relationships.

The Parent-Child Interaction Training program targets low-income parents with preschool children who have at least one behavioral or emotional problem. Parents enrolled in the program participate in a series of four to five small-group sessions in which they learn a variety of parenting skills such as management of child behavior. This intervention has been shown to improve family management practices and reduce children’s antisocial behaviors, including aggression and anxiety.

Home Visitation

Another effective family-based approach to preventing youth violence is home visitation, in which a nurse or other professional goes to the child’s home and provides training, counseling, support, monitoring, or all of these services to first-time, low-income, or otherwise at-risk mothers. This strategy is particularly effective when implemented before children develop behaviors that put them at risk of violence.

Home visitation, with or without early childhood education programs, has shown significant long-term effects on violence, delinquency, and related risk factors in a number of studies. The degree of effect is dependent on several factors, including length (only long-term programs have demonstrated consistent effects), delivery (nurses appear to be the most effective home visitors, although some positive effects have been demonstrated with other types of visitors), and timing (the earlier these programs begin, the better).

Prenatal and Infancy Home Visitation by Nurses is the only home visitation program that meets the criteria for a Model youth violence prevention program. It also incorporates all of the characteristics associated with the most effective home visitation programs: It is delivered by nurses, it begins early (before the child’s birth), and it is long term, lasting from before birth to age 2. Home visits are scheduled at intervals from 1 week to 1 month throughout the 2-year intervention. The program targets low-income, at-risk pregnant women bearing their first child. The goals are (1) to improve pregnancy outcomes and child care, health, and development, (2) to build a social support network around the family, and (3) to enhance mothers’ personal development, including educational achievement, participation in the workforce, and personal competency skills and self-efficacy.

Prenatal and Infancy Home Visitation by Nurses has a number of long-term, positive effects on youth violence and related outcomes, including fewer arrests and less alcohol use by youths at age 15 and lower rates of child abuse and neglect, compared to controls. While child abuse and neglect are not usually considered a violence outcome in this report, they are included here because the intervention is designed for mothers who are still youths themselves.

Multicontextual Programs

Several Promising secondary youth violence prevention programs address multiple contexts that affect a child’s risk of future violence: home, school, and community. The Yale Child Welfare Project is a Promising program that uses in-home visitation and day care to deliver parent training and other family and child services. This intervention targets healthy, first-born infants of mothers with incomes below the poverty level who live in inner cities. The 30-month program includes weekly home visits (usually by a social worker), pediatric medical care, psychological services, and early education (day care) for children. Ten-year follow-up of families involved in the Yale Child Welfare Project shows that the program has positive effects on parent involvement in their children’s education, academic achievement (less need for remedial and supportive services), and antisocial behavior.

Striving Together to Achieve Rewarding Tomorrows, CASASTART, formerly known as the Children At Risk (CAR) program, targets at-risk youths age 11 to 13 who live in severely distressed neighborhoods. The intervention has eight core components, each targeting a different context that affects the risk of violence: community-enhanced policing/enhanced enforcement, case management for youth and families, criminal/juvenile justice intervention, family services, after-school and summer activities, educational services, mentoring, and incentives for participation. Evaluations of CASASTART demonstrate that it has positive effects on avoidance of gateway drug use, violent crime, and drug sales and that these effects are sustained up to 1 year after participation.

The most comprehensive of these Promising multicontextual interventions is Families and Schools Together, or the FAST Track project. This intervention combines several of the strategies identified in this chapter as effective: social skills training, parent training, home visitation, academic tutoring, and classroom behavior management techniques. The program targets children identified as disruptive in kindergarten and aims to prevent severe, chronic conduct problems by increasing communication and strengthening bonds between the school, home, and child, thereby enhancing social, cognitive, and problem-solving skills and improving peer relationships. FAST Track has positive effects on several risk factors associated with youth violence, including academic achievement and parent-child relationships. Although initial evaluations did not show any effects of this program on children’s antisocial behaviors, the long-term follow-up studies now in progress should be able to determine whether FAST Track has a significant effect on this violence-related outcome.

Another comprehensive Promising intervention, The Incredible Years Series, is a series of curricula for parents, teachers, and children aimed at promoting social competence and preventing, reducing, and treating conduct problems in at-risk children age 3 to 8. In each of these three curricula, trained facilitators use videotapes to encourage problem solving and discussion. The parent-training component focuses mainly on parent competence and school involvement; the teacher-training component targets classroom behavior management; and the child-training component includes sessions on social skills, empathy, anger management, and conflict resolution. Evaluations of this intervention demonstrate positive effects on child conduct at home and cognitive problem solving with peers.

Academic Programs

Several educational approaches are effective at improving academic achievement, a weak but nevertheless important risk factor for late-onset youth violence (see Chapter 4). An effective secondary prevention strategy for improving academic performance is compensatory education, which targets students at risk of academic failure. Compensatory education strategies (such as cross-age or adult tutoring) that involve pulling students out of their regular classes to receive extra assistance in reading and math can improve long-term academic performance for all students, regardless of their achievement level. Moreover, when older students tutor younger students, both groups show academic gains. A meta-analysis of peer and cross-age tutoring of elementary and middle school students showed substantial effect sizes for academic achievement in both tutors and those tutored (Cohen et al., 1982). In more recent years, the compensatory education approach has been expanded to include schoolwide interventions.

Preventive Intervention is a 2-year, school-based behavioral reinforcement program that begins in grade 7 and targets students with low academic motivation, family problems, or disciplinary problems. The intervention includes behavior monitoring and reinforcement in the classroom as well as enhanced communication (through regular classroom meetings and reports to parents) between teachers, students, and parents regarding behavior and attendance at school.

Educational assistance is one of three major components of the Quantum Opportunities Program, a community-based intervention that targets adolescents from families receiving public assistance. Students who participate in this program are assigned to a peer group and a caring adult and receive up to 250 hours of educational services to enhance academic skills; activities targeting personal development, life skills, career planning, and other areas; and service opportunities in the community. The intervention begins at grade 9 and continues through high school.

Both of these programs have demonstrated positive effects on several aspects of academic achievement, and Preventive Intervention has been shown to reduce drug use and the risk of having a county court record 5 years after participation.

Moral-Reasoning, Problem-Solving, Thinking Skills

As seen in some of the programs above, interventions that aim to improve youths’ moral-reasoning, problem-solving, and thinking skills are also effective approaches to reducing youth violence in high-risk populations. For instance, one moral-reasoning-based intervention implemented in "behavior-disordered" high school students has demonstrated lasting positive effects by reducing police contacts and official school disciplinary actions (Arbuthnot & Gordon, 1986). Evidence of the effectiveness of social problem-solving interventions includes a study of children and young adolescents referred for treatment of antisocial behavior; these youths showed significantly lower aggression scores after treatment and lower rates of externalizing behavior 1 year later (Kazdin et al., 1989).

The evidence supporting thinking skills approaches is similar, with particularly impressive results from two interventions: Lochman’s Anger-Coping Intervention and Rotheram’s social skills training intervention. Lochman (Lochman, 1992; Lochman et al., 1984) reports large reductions in disruptive-aggressive behavior immediately after the program and reductions in substance use 3 years later in high-risk, aggressive boys in grades 4 through 6. Rotheram’s studies (1982) demonstrate improvements in academic achievement and in aggressive problem-solving responses—both risk factors for violent behavior. Researchers speculate that one reason for the effectiveness of social skills interventions is that they are often more comprehensive in scope than other types of cognitive-behavioral approaches to preventing youth violence and related outcomes.