Violence Prevention: School-Based Programs

• 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.

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.

Hahn R, Fuqua-Whitley D, Wethington H, et al. Effectiveness of universal school-based programs to prevent violent and aggressive behavior: a systematic review. American Journal of Preventive Medicine. 2007;33(2S):S114–29.

Task Force on Community Services. A recommendation to reduce rates of violence among school-aged children and youth by means of universal school-based violence prevention programs. American Journal of Preventive Medicine. 2007;33(2S):S112-13.

Centers for Disease Control and Prevention. The effectiveness of universal school-based programs for the prevention of violent and aggressive behavior: a report on recommendations of the Task Force on Community Preventive Services. MMWR. 2007;56(RR-7):1-16. Available at: http://www.cdc.gov/mmwr/PDF/rr/rr5607.pdf.

Wilson SJ, Lipsey MW. School-based interventions for aggressive and disruptive behavior: update of a meta-analysis. American Journal of Preventive Medicine. 2007;33(2S):S130-43.

Prothrow-Stith D. A major step forward in violence prevention. American Journal of Preventive Medicine. 2007;33(2S):S109-11.

Bilchik S. The importance of universal school-based programs in preventing violent and aggressive behavior. American Journal of Preventive Medicine. 2007;33(2S):S101-3.

Gottfredson DC. Some thoughts about research on youth violence prevention. American Journal of Preventive Medicine. 2007;33(2S):S104-6.

Modzeleski W. School-based violence prevention programs: offering hope for school districts. American Journal of Preventive Medicine. 2007;33(2S):S107-8.

Effectiveness Review

Analytic Framework

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.

Effectiveness Review

No content is available for this section.

Economic Review

No content is available for this section.

Effectiveness Review

Aber JL, Jones SM, Brown JL, Chaudry N, Samples F. Resolving conflict creatively: evaluating the developmental effects of a school-based violence prevention program in neighborhood and classroom context. Dev Psychopathol 1998;10:187 213.

Alsaker FD, Valkanover S. Early diagnosis and prevention of victimization in kindergarten. In: Juvonen J, Graham S, eds. Peer harassment in school: the plight of the vulnerable and victimized. New York: Guilford Press, 2001:175-95.

Battistich V, Schaps E, Watson M, Solomon D, Lewis C. Effects of the Child Development Project on students’ drug use and other problem behaviors. J Prim Prev 2000;21:75 99.

Bosworth K, Espelage D, DuBay T, Daytner G, Karageorge K. Preliminary evaluation of a multimedia violence prevention program for adolescents. Am J Health Behav 2000;24:268 80.

Boulton MJ, Flemington I. The effects of a short video intervention on secondary school pupils’ involvement in definitions of and attitudes towards bullying. Sch Psychol Int 1996;17:331 45.

Conduct Problems Prevention Research Group. Evaluation of the first 3 years of the Fast Track prevention trial with children at high risk for adolescent conduct problems. J Abnormal Child Psychol 2002;30:19-35.

DuRant RH. Comparison of two violence prevention curricula for middle school adolescents. J Adolesc Health 1996;19:111 7.

DuRant RH, Barkin S, Krowchuck DP. Evaluation of a peaceful conflict resolution and violence prevention curriculum for sixth-grade students. J Adolesc Health 2001;28:386 93.

Elias MJ, Gara MA, Schuyler T, Branden-Muller LR, Sayette MA. The promotion of social competence: longitudinal study of a preventive school-based program. Am J Orthopsychiatry 1991;61:409 17.

Esbensen FA, Osgood DW, Taylor TJ, Peterson D, Freng A. How great is G. R. E. A. T.? Results from a longitudinal quasi-experimental design. Criminol Public Policy 2001;1:87 118.

Farrell AD, Meyer AL. The effectiveness of a school-based curriculum for reducing violence among urban sixth-grade students. Am J Public Health 1997;87:979 84.

Farrell AD, Meyer AL, White KS. Evaluation of Responding in Peaceful and Positive Ways (RIPP): a school-based prevention program for reducing violence among urban adolescents.J Clin Child Psychol 2001;30:451 63.

Farrell AD, Valois RF, Meyer AL. Evaluation of the RIPP-6 violence prevention program at a rural middle school. Am J Health Educ 2002;33:167 72.

Farrell AD, Valois RF, Meyer AL, Tidwell R.P. Impact of the RIPP violence prevention program on rural middle school students. J Prim Prev 2003;24:143 67.

Flannery DJ, Liau AK, Powell KE, et al. Initial behavior outcomes for the PeaceBuilders universal school-based violence prevention program. Dev Psychol 2003;39:292 308.

Flay BR, Allred C. Long-term effects of the Positive Action program. Am J Health Behav 2003;27(suppl 1):S6 21.

Flay BR, Allred CG, Ordway N. Effects of the Positive Action program on achievement and discipline: two matched-control comparisons. Prev Sci 2001;2:71 89.

Flay BR, Graumlich S, Segawa E, Burns JL, Holliday MY. Effects of 2 prevention programs on high-risk behaviors among African-American youth: a randomized trial. Arch Pediatr Adolesc Med 2004;158:377 84.

Foshee VA, Bauman KE, Greene WF, Koch GG, Linder GF, MacDougall JE. The Safe Dates program: 1-year follow-up results. Am J Public Health 2000;90:1619 22.

Gesten EL, Rains MH, Rapkin BD, et al. Training children in social problem-solving competencies: a first and second look. Am J Community Psychol 1982;10:95 115.

Greenberg MT, Kusche C. Preventive intervention for school-aged deaf children: the PATHS curriculum. J Deaf Stud Deaf Educ 1998;3:49 63.

Grossman DC, Neckerman HJ, Koepsell TD, et al. Effectiveness of a violence prevention curriculum among children in elementary school: a randomized controlled trial. JAMA 1997;277:1605 11.

Hawkins JD, Catalano RF, Kosterman R, Abbott R, Hill KG. Preventing adolescent health-risk behaviors by strengthening protection during childhood. Arch Pediatr Adolesc Med 1999;153:226 34.

Hindley P, Reed H. Promoting alternative thinking strategies (PATHS): mental health promotion with deaf children in school. In: Decker S, Kirby S, Greenwood A, Moore D, eds. Taking children seriously: applications of counseling and therapy in education. London: Continuum International Publishing Group, 1999:113-30.

Ialongo N, Werthamer L, Kellam SG. Proximal impact of two first-grade preventive interventions on the early risk behaviors for later substance abuse, depression and antisocial behavior. Am J Community Psychol 1999;27:599 641.

Johnson DW, Johnson RT, Dudley BS. Effects of peer mediation training on elementary school students. Mediation Q 1992;10:89 99.

Johnson DW, Johnson RT, Dudley BS, Ward M, et al. The impact of peer mediation training on the management of school and home conflicts. Am Educ Res J 1995;32:829 44.

Kenney DJ, Watson TS. Reducing fear in the schools: managing conflict through student problem solving. Educ Urban Soc 1996;28:436 55.

Lynch KB, Geller SR, Schmidt MG. Multi-year evaluation of the effectiveness of a resilience-based prevention program for young children. J Prim Prev 2004;24:335 53.

McMahon SD, Washburn JJ. Violence prevention: an evaluation of program effects with urban African-American students. J Prim Prev 2003;24:43 62.

McMahon SD, Washburn J, Felix ED, Yakin J, Childrey G. Violence prevention: program effects on urban preschool and kindergarten children. Appl Prev Psychol 2000;9:271 81.

Nelson G, Carson P. Evaluation of a social problem-solving skills program for third- and fourth-grade students. Am J Community Psychol 1988;16:79 99.

O’Donnell L, Stueve A, Doval AS, et al. Violence prevention and young adolescents’ participation in community youth service. J Adolesc Health 1999;24:28 37.

Olweus D. Bully/victim problems in school: facts and intervention. Eur J Psychol Educ 1997;12:495 510.

Orpinas P, Horne A. School bullying: changing the problem by changing the school. Sch Psychol Rev 2003;32:431 44.

Orpinas P, Kelder S, Frankowski R, Murray N, Zhang Q, McAlister A. Outcome evaluation of a multi-component violence-prevention program for middle schools: the Students for Peace project. Health Educ Res 2000;15:45 58.

Orpinas P, Parcel GS, McAlister A, Frankowski R. Violence prevention in middle schools: a pilot evaluation. J Adolesc Health 1995;17:360 71.

Palumbo DJ, Ferguson JL. Evaluating Gang Resistance Education and Training (GREAT): is the impact the same at that of Drug Abuse Resistance Education (DARE)? Eval Rev 1995;19:597 619.

Pepler DJ, Craig WM, Ziegler S, Charach A. An evaluation of an anti-bullying intervention in Toronto schools. Can J Commun Ment Health 1994;13:95 110.

Reid JB, Eddy JM, Fetrow RA, Stoolmiller M. Description and immediate impacts of a preventive intervention for conduct problems. Am J Community Psychol 1999;27:483 517.

Renfro J, Huebner R, Ritchey B. School violence prevention: the effects of a university and high school partnership. J Sch Violence 2003;2:81 99.

Rickel AU, Eshelman AK, Loigman GA. Social problem solving training: a follow-up study of cognitive and behavioral effects. J Abnormal Child Psychol 1983;11:15 28.

Roland E. Bullying: a developing tradition of research and management. In: Tattum D, ed. Understanding and managing bullying. Oxford: Heinemann Education, 1993:15 30.

Roush G, Hall E. Teaching peaceful conflict resolution. Mediation Q 1993;11:185 91.

Sandy SV, Boardman SK. The peaceful kids conflict resolution program. Int J Conflict Manag 2000;11:337 57.

Sawyer MG, MacMullin C, Graetz B, Said JA, Clark JJ, Baghurst P. Social skills training for primary school children: a one-year follow-up study. J Paediatr Child Health 1997;33:378 83.

Shapiro J, Burgoon JD, Welker CJ, Clough JB. Evaluation of The Peacemakers Program: school-based violence prevention for students in grades four through eight. Psychol Sch 2002;39:87 100.

Shure MB, Spivack G. Interpersonal problem-solving in young children: a cognitive approach to prevention. Am J Community Psychol 1982;10:341 55.

Stevens V, De Bourdeaudhuij I, Van Oost P. Bullying in Flemish schools: an evaluation of anti-bullying intervention in primary and secondary schools. Br J Educ Psychol 2000;70:195 210.

Taylor CA, Liang B, Tracy AJ, Williams LM, Seigle P. Gender differences in middle school adjustment, physical fighting, and social skills: evaluation of a social competency program. J Prim Prev 2002;23:261 73.

Weissberg RP, Gesten EL, Carnrike CL, et al. Social problem-solving skills training: a competence building intervention with 2nd-4th grade children. Am J Community Psychol 1981;9:411 24.

Whitney I, Rivers I, Smith P, Sharp S. The Sheffield project: methodology and findings. In: Smith P, Sharp S, eds. School bullying: insights and perspectives. London: Routledge, 1994;20 56.

Winer JI, Hilpert PL, Gesten EL, Cowen EL, Schubin WE. The evaluation of a kindergarten social problem solving program. J Prim Prev 1982;2:205 16.

Economic Review

Aber JL, Pedersen S, Brown JL, Jones SM, Gershoff ET. Changing children’s trajectories of development: two-year evidence for the effectiveness of a school-based approach to violence prevention. New York: Mailman School of Public Health, Columbia University: National Center for Children in Poverty, 2003.

Aos S, Lieb R, Mayfield J, Miller M, Pennucci A. Benefits and costs of prevention and early intervention programs for youth. Olympia: Washington State Institute for Public Policy, 2004. Available at: www.wsipp.wa.gov/rptfiles/04-07-3901.pdf.

Greenberg MT, Kusche C. Preventive intervention for school-aged deaf children: the PATHS curriculum. J Deaf Stud Deaf Educ 1998;3:49 63.

Greenberg MT, Kusche C, Mihalic SF. Blueprints for violence prevention. Book 10. Promoting Alternative Thinking Strategies (PATHS). Boulder CO: Center for the Study and Prevention of Violence, 1998.

Vazsonyi A, Belliston L, Flannery D. Evaluation of a school-based, universal violence prevention program: low-, medium-, and high-risk children. Youth Violence Juvenile Justice 2004;2:185 206.

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.

• 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.

• School-Based Violence Prevention