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Chapter 5:
Prevention and Intervention

Promoting Healthy, Nonviolent Children

Methods of Identifying Best Practices

Scientific Standards for Determining Program Effectiveness

Stategies and Programs: Model, Promising, and Does Not Work

Cost-Effectiveness

Conclusions

Going to Scale

References

Appendix 5-A: Consistency of Best Practices Evaluations

Appendix 5-B: Descriptions of Specific Programs That Meet Standards for Model and Promising Categories

Model Programs: Level 1 (Violence Prevention)

Model Programs: Level 2 (Risk Prevention)

Promising Programs: Level 1 (Violence Prevention)

Promising Programs: Level 2 (Risk Prevention)

Chapter 5


STRATEGIES AND PROGRAMS: MODEL, PROMISING, AND DOES NOT WORK

It is important to reiterate that the specific programs and general strategies discussed in this report have been identified from recent reviews of the literature on youth violence prevention. Although this information is growing rapidly, youth violence prevention remains a young field, and only limited evaluation data are available for many strategies and programs. Therefore, the absence of a particular strategy or program from this section does not in any way imply that it is ineffective; rather, the information available is not sufficient to justify any conclusions about its effectiveness.

Model and Promising programs meet the scientific criteria for effectiveness outlined above within the populations in which they have been tested (as indicated in the text). These programs are widely regarded by the youth violence prevention community as effective. Appendix 5–A shows the consistency with which they have been recommended by various independent groups of researchers as best practices in youth violence prevention. With only a few exceptions, each of the programs has already been identified as a best practice in two or more other reports on what works in youth violence prevention.

This section is divided into prevention and intervention efforts. True prevention, or primary prevention, is defined in this report as lessening the likelihood that youths in a treatment or intervention program will initiate violent behavior, compared to youths in a control group. In some cases, the prevention of risk factors for violent behavior is considered the outcome, and the reduced likelihood of youths’ encountering this risk is the measure of effectiveness. Therefore, prevention programs are designed to target youths who have not yet become involved in violence or encountered specific risk factors for violence. Prevention efforts include general strategies and programs that target general (universal) populations of youths.

Intervention, on the other hand, is defined as reducing the risk of violence among youths who display one or more risk factors for violence (high-risk youths) or preventing further violence or the escalation of violence among youths who are already involved in violent behavior. These types of interventions are also known as secondary and tertiary prevention, respectively. Thus, intervention includes programs that target high-risk (selected) populations of youths or already violent (indicated) youths. Although there is some overlap between prevention and intervention efforts, programs that are most effective in general populations of young people are not always effective in reducing further violence among seriously delinquent youths.

The programs discussed below are listed in Appendix 5–B, along with more detailed information on each one. Specific results of the evaluations are found there; findings are described in general terms in this chapter. Box 5–1 summarizes effective and ineffective strategies, and Box 5–2 lists the programs discussed below by best practices category: Model, Promising, or Does Not Work.

Primary Prevention: General Populations of Young People

All of the programs and strategies discussed in this section are primary prevention approaches to reducing youth violence—that is, they are implemented on a universal scale and aim to prevent the onset of youth violence and related risk factors. Some are designed to change individual risk factors, others target environmental risk factors, and a few are designed to change both.

Box 5-1. Rating intervention strategies

Effective Strategies

Primary Prevention: Universal

Skills training

Behavior monitoring and reinforcement

Behavioral techniques for classroom management

Building school capacity

Continuous progress programs

Cooperative learning

Positive youth development programs

Secondary Prevention: Selected

Parent training

Home visitation

Compensatory education

Moral reasoning

Social problem solving

Thinking skills

Tertiary Prevention: Indicated

Social perspective taking, role taking

Multimodal interventions

Behavioral interventions

Skills training

Marital and family therapy by clinical staff

Wraparound services

Ineffective Strategies

Primary Prevention: Universal

Peer counseling, peer mediation, peer leaders

Nonpromotion to succeeding grades

Secondary Prevention: Selected

Gun buyback programs

Firearm training

Mandatory gun ownership

Redirecting youth behavior

Shifting peer group norms

Tertiary Prevention: Indicated

Boot camps

Residential programs

Milieu treatment

Behavioral token programs

Waivers to adult court

Social casework

Individual counseling

Skill- and Competency-Building Programs

Skills-oriented programs are among the most effective general strategies for reducing youth violence and risk factors for youth violence. In fact, two universal programs that take this approach have met the criteria for a Model program: Life Skills Training and the Midwestern Prevention Project.

Life Skills Training (LST) is designed to prevent or reduce gateway drug use. The program targets students in middle or junior high school, with initial implementation in grades 6 and 7 and booster sessions for the next 2 years. The curriculum has three major components: self-management skills, social skills, and information and skills related specifically to drug use. Teachers use a variety of techniques, including instruction, demonstration, feedback, reinforcement, and practice, to train students in these three core areas. Evaluations show that the program can cut tobacco, marijuana, and alcohol use. Moreover, long-term effects of participation in Life Skills Training include a lower risk of polydrug use, pack-a-day smoking, and inhalant, narcotic, and hallucinogen use.

Box 5-2. Rating prevention programs

Model
Level 1 (Violence Prevention)

Seattle Social Development Project

Prenatal and Infancy Home Visitation by Nurses

Functional Family Therapy

Multisystemic Therapy

Multidimensional Treatment Foster Care

Level 2 (Risk Prevention)

Life Skills Training

The Midwestern Prevention Project

Promising
Level 1 (Violence Prevention)

School Transitional Environmental Program

Montreal Longitudinal Study/Preventive Treatment Program

Syracuse Family Development Research Program

Perry Preschool Program

Striving Together to Achieve Rewarding Tomorrows

Intensive Protective Supervision Project

Level 2 (Risk Prevention)

Promoting Alternative Thinking Strategies

I Can Problem Solve

Iowa Strengthening Families Program

Preparing for the Drug-Free Years

Linking the Interests of Families and Teachers

Bullying Prevention Program

Good Behavior Game

Parent Child Development Center Programs

Parent-Child Interaction Training

Yale Child Welfare Project

Families and Schools Together

The Incredible Years Series

Preventive Intervention

The Quantum Opportunities Program

Does Not Work

Drug Abuse Resistance Education

Scared Straight

The Midwestern Prevention Project targets middle school students (grades 6 or 7). Its goal is to reduce the risk of gateway drug use associated with the transition from early adolescence to middle through late adolescence by training youths to avoid drug use and situations in which drugs are likely to be used. The program has five major components that are implemented in stepwise fashion over the course of approximately 4 years: mass media program, school program, parent education and organization, community organization, and local health policy. The mass media program spans the duration of the project, while the other components are introduced at a rate of approximately one per year. The school-based component forms the core of the program. This project has demonstrated positive effects on a number of outcomes that are closely related to youth violence. For instance, it has been shown to reduce daily smoking and marijuana use and to lessen marijuana use, hard drug use, and smoking through age 23. In addition, the project has facilitated improvements in parent-child communication about drug use and in the development of prevention programs, activities, and services within communities.

Two school-based programs that focus on teaching important social skills to students, Promoting Alternative Thinking Strategies and I Can Problem Solve, meet the criteria for a Promising program. The Promoting Alternative Thinking Strategies (PATHS) curriculum is taught to elementary school students at entrance through grade 5. Lessons targeting emotional competence (expression, understanding, and regulation), self-control, social competence, positive peer relations, and interpersonal problem-solving skills are delivered three times a week in 20- to 30-minute sessions. Evaluations of PATHS show that this program has positive effects on several risk factors associated with violence, including aggressive behavior, anxiety and depression, conduct problems, and lack of self-control. The effectiveness of PATHS has been demonstrated for both regular-education and special-education students.

I Can Problem Solve has been used effectively with students in nursery school, kindergarten, and grades 5 and 6. The main goal of this program, which is implemented in 12 small-group sessions over 3 months, is to train children to use problem-solving skills to find solutions to interpersonal problems. In evaluations, I Can Problem Solve has improved classroom behavior and children’s problem-solving skills for up to 4 years after the end of the intervention. Whereas this program is appropriate for all children, it has been most effective with children living in poor, urban areas.

Training Programs for Parents

Skills-training programs for young people can also be effective when combined with parent training. Two such programs that have been designated Promising are the Iowa Strengthening Families Program and Preparing for the Drug-Free Years. Both programs are different from LST, the Midwestern Prevention Project, PATHS, and I Can Problem Solve in that they are family-based rather than school-based.

The Iowa Strengthening Families Program, which targets 6th-graders and their families, is made up of seven weekly sessions of parent and child training designed to improve parenting skills and family communication. The program has been evaluated in rural, Midwestern schools with primarily white, middle-class students. Preparing for the Drug-Free Years is a family competency training program that promotes healthy, protective parent-child interactions and includes skills training for youths. Like the Iowa Strengthening Families Program, it has been implemented successfully with middle school students and their families in the rural Midwest. Preparing for the Drug-Free Years involves five sessions. One session on peer pressure includes both students and their parents, while the remaining sessions include only parents and focus on the following areas: risk factors and family protective factors for adolescent substance use, effective parenting skills, managing anger and family conflict, and facilitating positive child involvement in family activities. These programs have demonstrated positive effects on child-family relationships and avoidance of alcohol, tobacco, and marijuana use for up to 4 years after participation.

Linking the Interests of Families and Teachers (LIFT), another Promising program, also combines school-based skills training for children with parent training. The classroom component of the program targets 1st-grade and 5th-grade students and includes twenty 1-hour sessions delivered over 10 weeks. A peer component of the program focuses on encouraging positive social behavior during playground activities. The third component of LIFT is parent training, in which parent groups meet weekly for 6 weeks. The program focuses on reducing children’s antisocial behaviors, involvement with delinquent peers, and drug and alcohol use. Children who participate in LIFT exhibit less physical aggression on the playground, better social skills, and, in the long term, less likelihood of associating with delinquent peers, using alcohol, or being arrested.

Behavior Management Programs

Strategies that take a behavioral approach to youth violence can also have positive, consistent effects on violence, delinquency, and related risk factors. The behavioral approaches shown to be effective in preventing youth violence on a universal scale are generally school-based and include behavior monitoring and reinforcement of attendance, academic progress and school behavior, and behavioral techniques for classroom management.

Much of the evidence on the effectiveness of behavior monitoring and reinforcement comes from studies conducted by Bry and colleagues (Bry, 1982; Bry & George, 1979, 1980). These studies provide evidence that interventions focusing on enhancing positive student behavior, attendance, and academic achievement through consistent rewards and monitoring can reduce substance use, self-reported criminal activity, and arrests, as well as enhance academic achievement in middle school students. In one study, for example, students exposed to this type of intervention were far less likely than students in a control group to have a delinquency record 5 years after the program.

Behavioral techniques for classroom management are a general strategy for changing the classroom environment. According to a review by O’Leary and O’Leary (1977), the best strategies for promoting positive classroom behavior are establishing clear rules and directions, use of praise and approval, behavior modeling, token reinforcement, self-specification of contingencies, self-reinforcement, and behavior shaping. Several strategies aimed at reducing negative student behaviors are also effective: ignoring misbehavior, reinforcing behavior that is incompatible with negative behavior, relaxation methods, and using disciplinary techniques such as soft reprimands, timeouts, and point loss and fines in token economies.

The Seattle Social Development Project is an excellent example of a program that includes classroom behavior management among its core components. The goal of this Model program is to enhance elementary school students’ bonds with school and their families while decreasing a number of early risk factors for violence. Like other Model programs in this report, the initiative includes both individual and environmental change approaches and multiple components known to improve the effectiveness of violence prevention efforts. In addition to classroom behavior management, the components include child skills training and parent training, discussed later in this section.

Through these three components, which target prosocial behavior, interpersonal problem solving, academic success, and avoidance of drug use, the Seattle Social Development Project reduces the initiation of alcohol, marijuana, and tobacco use by grade 6 and improves attachment and commitment to school. At age 18, youths who participated in the full 5-year version of this program have lower rates of violence, heavy drinking, and sexual activity (including multiple sexual partners and pregnancy) and better academic performance than controls. The Seattle Social Development Project has been used effectively in both general populations of youths and high-risk children attending elementary and middle school.

Classroom behavior management is also a core component of three Promising programs: the Bullying Prevention Program, the Good Behavior Game, and the School Transitional Environmental Program. The Bullying Prevention Program targets students in elementary, middle, and junior high school. It begins with an anonymous student questionnaire designed to assess bullying problems in individual schools. Using this information, parents and teachers implement school-, classroom-, and individual-level interventions designed to address the bullying problems identified in the questionnaire, including individual work with students identified as bullies and victims. At the classroom level, teachers and students work together to establish and reinforce a set of rules about behavior and bullying, creating a positive, antibullying climate. This program has both individual change and environmental change objectives.

In elementary and junior high schools in Bergen, Norway, bullying problems were cut in half two years after the intervention. Antisocial behavior, including theft, vandalism, and truancy, also dropped during these years, and the social climate of the school improved. Replications have been conducted in England, Germany, and the United States, with similar effects.

Like the Bullying Prevention Program, the Good Behavior Game uses classroom behavior management as the primary means of reducing problem behaviors. The Good Behavior Game targets elementary school children and seeks to improve their psychological well-being and decrease early aggressive or shy behavior. While both of these programs can reduce antisocial behavior, their effects on violence and delinquency have not yet been measured.

This intervention has shown positive effects, as measured by teachers’ reports of aggressive and shy behaviors in first-graders. Long-term evaluations show sustained decreases in aggression among boys rated most aggressive in first grade. Effects on violence and delinquency have not been measured.

The third Promising primary intervention program that makes use of classroom behavior management is the School Transitional Environmental Program, or STEP. STEP is based on the Transitional Life Events model, which postulates that stressful life events, such as transitions between schools, place children at risk of maladaptive behavior. The program’s goals are to reduce the stress and disorganization often associated with changing schools by redefining the role of homeroom teachers. Behavior management is used to create an environment that promotes academic achievement and reduces school behavior problems and absenteeism. Participation in this program has been shown to reduce substance use and delinquency while improving academic achievement and school dropout rates. The STEP program has been most successful with students entering junior and senior high schools in urban, predominantly nonwhite communities. The program is also effective with students at high risk of behavioral problems.

Capacity-Building Programs

Several other school-level environmental approaches are effective in reducing youth violence and related outcomes. For instance, those that focus on building a school’s capacity to plan, implement, and sustain positive changes can significantly reduce student delinquency and drug use. One program in which students were empowered to address school safety problems resulted in significant reductions in fighting and teacher victimization. Program Development Education is an example of this approach to reducing youth violence. It is a structured organizational development approach used to help organize, plan, initiate, and sustain school change. This approach has demonstrated positive effects on delinquency rates lasting at least 2 years into the program.

Teaching Strategies

Two other school-based primary prevention strategies are effective at reducing the risk of academic failure, a risk factor for youth violence: continuous progress programs and cooperative learning. Continuous progress programs are designed to allow students to proceed through a hierarchy of skills, advancing to the next level as each skill is mastered. This approach has shown consistent, positive effects on academic achievement in elementary school students in seven separate evaluations.

Cooperative learning is another innovative environmental change approach that can improve academic achievement in elementary school children. Quite different from continuous progress programs, cooperative learning programs place students of various skill levels together in small groups, allowing students to help each other learn. Studies by Slavin (1989, 1990) show that this approach has positive effects on attitudes toward school, race relations, attitudes toward mainstreamed special-education students, and academic achievement.

Community-Based Programs

Community-based strategies can also affect youth violence at the universal level. One such strategy is positive youth development programs. While the evidence is not yet strong enough to classify the Boys and Girls Clubs and the Big Brothers Big Sisters of America programs as Model or Promising, it is strong enough to conclude that the general strategy of these and similar programs is effective at reducing youth violence and violence-related outcomes. For instance, evaluations of Boys and Girls Clubs have shown reductions in vandalism, drug trafficking, and youth crime. An evaluation of a Canadian after-school program demonstrated large reductions in arrests. Although this general strategy is included with the primary prevention efforts, it can also be considered a secondary prevention strategy, since the specific youth development programs listed above are usually implemented in high-risk neighborhoods.


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