Violence Prevention: School-Based Programs

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends universal, school-based programs on the basis of strong evidence of effectiveness in preventing or reducing violent behavior.

The full CPSTF Finding and Rationale Statement and supporting documents for Violence Prevention: School-Based Programs are available in The Community Guide Collection on CDC Stacks.

Intervention

Universal school-based programs to reduce violence are designed to teach all students in a given school or grade about the problem of violence and its prevention or about one or more of the following topics or skills intended to reduce aggressive or violent behavior: emotional self-awareness, emotional control, self-esteem, positive social skills, social problem solving, conflict resolution, or team work. In this review, violence refers to both victimization and perpetration.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 53 studies (search period through December 2004).

Study Characteristics

  • Study sample sizes ranged from 21 to 39,168 students, with median of 563
  • 41 studies (77.4%) used direct measures of violence or aggression; 12 (23.6%) used proxy outcome measures
  • Follow-up time ranged from none (assessment immediately following intervention) to 6 years; median was 6 months
  • Characteristics of the evaluated programs:
    • Programs offered in pre-kindergarten, kindergarten, elementary, middle school, and high school classrooms
    • All children in a given grade or school received programs, regardless of prior violence or risk
    • Some programs targeted schools in high-risk areas with low socioeconomic status, high crime rates, or both
    • Elementary and middle school programs usually sought to reduce disruptive and antisocial behavior using approach focusing on modifying behavior by changing associated cognitive and affective mechanisms
    • In middle and high school, focus shifted to general violence and specific forms including bullying and dating violence, using approach emphasizing social skills training and behavioral skills development

Summary of Results

Fifty-three studies met inclusion criteria.

  • For all grades combined, 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, median effects on violent behavior were:
    • 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 reduction in violent behavior

Summary of Economic Evidence

Most studies reported program costs but no economic summary measures based on both costs and benefits.

Reported program costs varied widely: less than $200 per child for a program in nine Tucson schools; $2,449 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.

One study (Seattle Social Development Project) estimated both costs and benefits:

  • Average decrease in basic crime outcomes: 13%
  • Total benefits: $14,426 in 2003 U.S. dollars per participant
  • Net saving per participant: $9,837
  • Benefit of $3.14 for every dollar invested

Investment in universal school-based programs has potential for significant positive economic returns.

Applicability

Findings applicable to students in all school environments, regardless of socioeconomic status or crime rate, and among all school populations, regardless of predominant ethnicity of students.

Evidence Gaps

  • 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.

Implementation Considerations and Resources

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.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.