SCIENTIFIC STANDARDS FOR DETERMINING PROGRAM EFFECTIVENESS
The scientific community agrees on three standards for evaluating effectiveness: rigorous experimental design, evidence of significant deterrent effects, and replication of these effects at multiple sites or in clinical trials. For example, the level of evidence required to establish the effects of an agent or intervention in Mental Health: A Report of the Surgeon General (1999) was demonstration of the effects in randomized, controlled experimental studies that had been replicated. The U.S. Food and Drug Administration requires the same level of evidence before approving a new drug for use in humans. Unfortunately, this level of evidence has not been routinely required by agencies that recommend or fund youth violence prevention programs, though some organizations and most researchers are calling for establishment of meaningful criteria for program effectiveness (Elliott, 1998; Mendel, 2000, p. 74). Most researchers want evaluations to meet one or more of these three scientific standards for assessing effectiveness.
Rigorous experimental design includes, at a minimum, random assignment to treatment and control groups (Andrews, 1994; Center for Substance Abuse Prevention, 2000; Chamberlain & Mihalic, 1998; Howell et al., 1995; Lipsey, 1992a; Lonigan et al., 1998). A less stringent, but acceptable, study design is quasi-experimental, in which equivalent comparison and control groups are established but assignment of study participants to the groups is not random (Center for Substance Abuse Prevention, 2000; Howell et al., 1995; Lipsey, 1992b; Sherman et al., 1997; Tolan & Guerra, 1994).
Well-designed studies should also have low rates of participant attrition, adequate measurement, and appropriate analyses (Andrews, 1994; Center for Substance Abuse Prevention, 2000; Chamberlain & Mihalic, 1998). High attrition can undermine the equivalence of experimental and control groups. It can also signal problems in program implementation. Adequate measurement implies that the study measures, including the outcome measure, are reliable and valid indicators of the intended outcomes and that they are applied with quality, consistency, and appropriate timing (Tolan & Guerra, 1994).
In clinical trials, replication means conducting both efficacy and effectiveness trials (Lonigan et al., 1998). Efficacy trials test for benefits to participants in a controlled, experimental setting, and effectiveness trials test for benefits in a natural, applied setting. In practice, this distinction is often blurred, but the principle of independent replication at multiple sites is well established. Replication is an important element of program evaluation because it establishes that a program and its effects can be exported to new sites and implemented by new teams under different conditions. A program that is demonstrated to be effective at more than one site is likely to be effective at other sites as well.
Statistical significance is based on the level of confidence with which one can conclude that a difference between two or more groups (generally a treatment and a control group) results from the treatment delivered and not, for example, from the selection process or chance. A probability value of .05 is widely accepted as the threshold for statistical significance; a probability below this threshold (p < .05) indicates that a difference of this magnitude could happen by chance less than 5 percent of the time.
High-quality evaluations of youth violence prevention programs should be designed to demonstrate with this degree of confidence that a program is reducing the onset or prevalence of violent behavior or individual rates of offending (Andrews, 1994; Tolan & Guerra, 1994). Since serious delinquency is strongly related to violence, reductions in serious criminal behavior (or index crimes) are also considered to be acceptable outcome measures for identifying effective violence prevention programs (Andrews, 1994; Elliott, 1998; Lipsey, 1992a, 1992b). However, direct scientific evidence of a deterrent effect on violent behavior is certainly preferable.
Prevention programs are designed to prevent or reduce violent behaviors by acting on risk and protective factors. Reducing risk is a less stringent standard than reducing violence, but reducing risk undoubtedly holds some promise of preventing violence. Thus, significant changes in risk factors for violence are acceptable indications of program effectiveness (Gottfredson, 1997; Gottfredson et al., in press; Howell et al., 1995; Sherman et al., 1997). In addition, because most violence begins in adolescence, childhood interventions are concerned primarily with risk reduction.
A less widely accepted but nevertheless important standard for demonstrating effectiveness is long-term sustainability of effects (Elliott & Tolan, 1999). Although this criterion may not be required to establish effectiveness in other disciplines, it is very important in evaluating violence prevention programs because beneficial effects can diminish quickly after youths leave a treatment setting or program to return to their usual environment.
Effective programs produce long-term changes in individual competencies, environmental conditions, and patterns of behavior. Thus, successful programs get youths off a violent life course trajectory. The sustainability of effects is particularly difficult for early intervention programs, which can be implemented more than a decade before the peak age of onset for youth violence. Ideally, effects would be sustained though adolescence. On a practical level, programs in this report are considered to have demonstrated sustainability if the effects of the intervention continue for at least a year after treatment or participation in the designed intervention, with no evidence of a subsequent loss of effect (Elliott & Tolan, 1999).
Higher standards should be set for programs that are promoted and disseminated on a national level than for those being developed and implemented on a more restricted basis at the local level. Before a program is recommended and funded for national implementation, it is important to show clearly that it has a significant, sustained preventive or deterrent effect and that it can be expected to have positive results in a wide range of community settings (as long as it is implemented correctly and with the appropriate population). Programs that meet such high standards are designated
Model programs. Those that do not quite meet these rigorous standards are recognized and encouraged as Promising, with the caution that they be carefully evaluated.
Identifying ineffective programs is another element of assessing best practices. It is as important to know which programs do not work—and should not be supported with limited prevention funds—as it is to know which do work. The same scientific standards are used in judging effectiveness and ineffectiveness. Because it is generally unlikely that a high-quality evaluation will be conducted on a program that shows little sign of effectiveness, only two specific programs have been designated Does Not Work in this report.
Some general strategies identified as ineffective in this report may not actually be flawed; rather, their lack of effectiveness may result from poor program implementation or a poor match between program and target population. Alternatively, some approaches may appear ineffective when used in isolation because their effects are quite small and difficult to detect. These approaches should not be used alone, but they may be useful as components of more comprehensive strategies that have positive preventive effects. In other cases, however, a program or approach may be ineffective because the basic strategy is flawed—that is, the method or approach used to change the targeted risk or protective factors does not have the intended effect.
The following is a summary of the scientific standards for establishing the effects of a violence prevention program.
Model
• Rigorous experimental design (experimental or quasi-experimental)
• Significant deterrent effects on:
• Violence or serious delinquency (Level 1)
• Any risk factor for violence with a large effect (.30 or greater) (Level 2)
• Replication with demonstrated effects
• Sustainability of effects
Promising
• Rigorous experimental design (experimental or quasi-experimental)
• Significant deterrent effects on:
o Violence or serious delinquency (Level 1)
o Any risk factor for violence with an effect size of .10 or greater (Level 2)
• Either replication or sustainability of effects
Does Not Work
• Rigorous experimental design (experimental or quasi-experimental)
• Significant evidence of null or negative effects on violence or known risk factors for violence
• Replication, with the preponderance of evidence suggesting that the program is ineffective or harmful
Other standards have been proposed for youth violence prevention programs, particularly those intended for implementation on a national level. One of these is cost-effectiveness, a key consideration in program funding but not a scientific criterion for effectiveness. Unfortunately, there are no standardized cost criteria for violence prevention programs, so it is difficult to compare costs across programs (Elliott, 1998). Moreover, it is difficult to obtain reliable cost-benefit estimates for individual programs. Despite these obstacles, some researchers have conducted extensive reviews of the costs and benefits of violence and delinquency prevention and intervention programs (Greenwood, 1995; Greenwood et al., 1998; Karoly et al., 1998; Washington State Institute for Public Policy, 1999). Their findings will be discussed in the cost-effectiveness section of this chapter. This is an important and growing area of research.
Setting such stringent scientific standards automatically limits the number and types of programs that will be identified as effective in this report. The specific programs that can meet these standards will be determined in part by the nature of the program the design must lend itself to scientific evaluation and in part by whether funding has been made available for program evaluation. For instance, early childhood individual change programs are overrepresented in the list of effective programs. This fact is probably a result of the relatively large amount of funding allocated to the study of these programs and the relative ease with which experimental evaluations can be carried out. On the other hand, programs promoting change in the social structure, community-level programs, and programs that focus on environmental change more generally (in schools, neighborhoods, peer groups, and so on) are probably underrepresented in this report. Evaluation of such programs and strategies is more difficult and costly; therefore, fewer rigorous evaluations of these programs have been done.
Because of these limitations, the programs discussed in this report may not represent the overall balance of youth violence prevention programs currently being implemented in communities throughout the country. This shortcoming highlights the need for more research on program effectiveness and for the development of additional criteria and valid measures for assessing the effects of community- or school-based and environmental change programs. In addition, the imbalance should not be interpreted as an indication that such programs are less effective than programs that focus on individual change. Indeed, there is some evidence that school-based programs designed to change the social climate of the classroom or school are more effective than individual change programs (Gottfredson et al., in press).
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 5B, 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 51 summarizes effective and ineffective strategies, and Box 52 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
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
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
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 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.
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.
Footnote
4
For more information about DARE, see the following references: Aniskiewicz & Wysong, 1990; Center for the Study and Prevention of Violence, 1998; Dejong, 1987; Dukes et al., 1996; Ennett et al., 1994; Falco, 1994; Hansen & McNeal, 1997; Kochis, 1993; Mendel, 2000; Nyre, 1984; Nyre, 1985; Palumbo & Ferguson, 1995; Ringwalt et al., 1994; Rocky Mountain Behavioral Science Institute, 1995; Rosenbaum et al., 1994; Rosenbaum & Hanson, 1998; Sherman et al., 1997; Zagumny & Thompson, 1997.
Ineffective Secondary Prevention Approaches
Whereas the research presented above demonstrates that a large number of approaches and programs can have significant, positive effects on youth violence and violence-related risk factors, several popular prevention approaches used in high-risk populations have been shown to be ineffective. These include gun buyback programs, firearm training, and mandatory gun ownership.
Gun buyback programs, a particularly expensive strategy, have consistently been shown to have no effect on gun violence, including firearm-related homicide and injury. This finding may appear counterintuitive, given the fact that these programs do, in fact, take guns off the street. However, there is some evidence that most of the guns turned in are not functional and that most persons turning in guns have other guns at home. Two less popular strategies, firearm training and mandatory gun ownership, have also demonstrated no significant effects on firearm-related crimes. These approaches were expected to deter gun violence by increasing the number of private citizens who were trained to use guns properly and who owned firearms for protection.
Two community-based strategies for preventing youth violence, redirecting youth behavior and shifting peer group norms, have also shown a lack of effect in reducing youth violence. In fact, because both approaches tend to group high-risk youths together, they can actually increase the cohesiveness of delinquent peer groups and facilitate deviancy training (Dishion et al., 1994, 1995; Elliott & Menard, 1996; Patterson & Yoerger, 1997). Programs that aim to redirect high-risk youth toward conventional activities involve recreational, enrichment, and leisure activities, including the popular Midnight Basketball program. In general, programs that focus on shifting peer group norms have attempted to turn youth gangs into benign clubs. Instead, these programs have had no effect or have actually increased gang-related delinquent behavior.
Tertiary Prevention: Violent or Seriously Delinquent Youths
Each of the programs and strategies highlighted in this section is implemented on an indicated scale, that is, for young people who have already demonstrated violent or seriously delinquent behavior. The best information on general strategies that are effective or ineffective in reducing the risk of further violence among these youths comes from meta-analyses. The most rigorous and most frequently cited meta-analyses of violence prevention programs are those conducted by Lipsey and colleagues and by Andrews and colleagues (Lipsey, 1992a, 1992b; Lipsey & Wilson, 1998; Andrews, 1994; Andrews et al., 1990). This section draws largely on these analyses, which include interventions targeting youths involved in any delinquent behavior and those involved in serious delinquent behavior. To enhance readability, the meta-analyses are cited here rather than throughout the text. Effect sizes are a standardized mean difference, corrected for small sample size and method effects. This measure reflects the average difference (expressed in standard deviation units) between the program group and comparison groups in regard to violence, substance abuse, and risk factors.
Two major conclusions come from Lipsey’s research. The first is that effective treatment can divert a significant proportion of delinquent and violent youths from future violence and crime. This finding contradicts the conclusions of scientists two decades ago who declared that nothing had been shown to prevent youth violence. The second major conclusion is that there is enormous variability in the effectiveness of different types of programs for seriously delinquent youth. The most effective programs, on average, reduce the rate of subsequent offending by nearly half (46 percent), compared to controls, whereas the least effective programs actually increase the rate of subsequent offending by 18 percent, compared to controls. So, while some kinds of interventions substantially reduce youth violence and delinquency, others appear to be harmful (iatrogenic), actually increasing involvement in these behaviors.
Behavioral and Skill Development Interventions
Studies of male serious offenders demonstrate that treatment which includes a social perspective-taking/role-taking component can improve role-taking skills and reduce serious delinquent behavior for at least 18 months after treatment (Chandler, 1993). This finding is consistent with results from the Lipsey (Table 5 1) and Andrews studies, which indicate that multimodal, behavioral, and skills-oriented interventions are more effective than counseling and other less-structured approaches (see also Gendreau & Ross, 1987). In fact, in most youth populations universal, selected, or indicated behavioral and skills-oriented strategies are among the most effective violence prevention approaches.
Family Clinical Interventions
Although Lipsey reports only a small average effect size for reducing recidivism with family therapy (Table 5–1), the review literature indicates that specific strategies can be quite effective at preventing violence in delinquent youths and preventing further violence in already violent youths. One such approach is marital and family therapy by clinical staff. While marital and family therapy can include several different strategies, a common thread is the focus on changing maladaptive or dysfunctional patterns of family interaction and communication, including negative parenting behaviors, all risk factors for youth violence. Marital and family therapy shows consistent, positive effects on family functioning, child behavior, family interactions, and delinquency (Tremblay & Craig, 1995). Long-term studies have demonstrated positive effects of family therapy by clinical staff lasting up to 9 years.
Three Model tertiary youth violence prevention programs that use the family therapy approach are Functional Family Therapy, Multisystemic Therapy, and Multidimensional Treatment Foster Care. They are described below.
Functional Family Therapy (FFT) is actually a secondary and tertiary prevention program, since it targets youths 11 to 18 years old at risk of or already demonstrating delinquency, violence, substance use, conduct disorder, oppositional defiant disorder, or disruptive behavior disorder. FFT is a multistep, phasic intervention that includes 8 to 30 hours of direct services for youths and their families, depending upon individual needs. The phases of the intervention include engagement (to reduce the risk of early dropout), motivation (to change maladaptive beliefs and behaviors), assessment (to clarify interpersonal behavior and relationships), behavior change (including skills training for youths and parents), and generalization (in which individualized casework is used to ensure that new skills are applied to functional family needs).
Table 5-1. Average effect sizes Table 5-1 (click to enlarge)
These services are delivered in multiple settings by a wide range of interventionists, including supervised paraprofessionals, trained probation officers, mental health technicians, and mental health professionals with appropriate advanced degrees. The benefits of FFT include the effective treatment of conduct disorder, oppositional defiant disorder, disruptive behavior disorder, and alcohol and other drug abuse disorders; reductions in the need for more restrictive, costly services and other social services; reductions in the incidence of the original problem being addressed; and reductions in the proportion of youths who eventually enter the adult criminal justice system. In two trials, recidivism was found to be lower among participants than controls. Evidence of a diffusion effect was also found, with fewer siblings of participants acquiring a court record in the 2 to 3 years following treatment.
Multisystemic Therapy (MST) is an intensive family- and community-based treatment that addresses multiple determinants of antisocial behavior. This approach is implemented within a network of interconnected systems that includes one or more of the following contexts: individual, family, peer, school, and neighborhood. MST targets families with children in the juvenile justice system who are violent, substance-abusing, or chronic offenders and at high risk of out-of-home placement. Four types of services are delivered through a home-based model: strategic family therapy, structural family therapy, behavioral parent training, and cognitive-behavioral therapy. While the intensity of services ultimately depends on individual youth and family needs, the average MST family receives 60 hours of direct services delivered over a period of 4 months. Program outcomes in serious delinquents include reductions in long-term rates of rearrest, reductions in out-of-home placements, improvements in family functioning, and reductions in mental health problems among treated youths, compared to controls.
Multidimensional Treatment Foster Care is a multisystemic (multicontextual) clinical intervention that targets teenagers with histories of chronic and severe criminal behavior as an alternative to incarceration, group or residential treatment, or hospitalization. Meta-analyses conducted by Lipsey and others demonstrate that community-based treatment is more successful than residential treatment for this population of youths. Multidimensional Treatment Foster Care implementers recruit, train, and supervise foster families to offer youths treatment and intensive supervision at home, in school, and in the community. The program also provides parent training and other services to the biological families of treated youths, helping to improve family relationships and reduce delinquency when youths return to their homes. Youths who participate in this program also receive behavior management and skill-focused therapy and a community liaison who coordinates contacts among case managers and others involved with the youths. Evaluations indicate that Multidimensional Treatment Foster Care can reduce the number of days of incarceration, overall arrest rates, drug use, and program dropout rates in treated youths versus controls during the first 12 months after completing treatment; it can also speed the placement of youths in less restrictive, community settings.
Justice System Services
Justice system approaches to preventing youth violence can be effective when they focus on providing services rather than instituting greater penalties. One promising justice system approach is wraparound services, in which comprehensive services are tailored to individual youths, as opposed to trying to fit youths into predetermined or inflexible programs. Evaluations of Wraparound Milwaukee have shown reductions in recidivism and arrests during the year following participation.
One juvenile justice system approach to preventing youth violence meets the standards described above for a Promising program: Intensive Protective Supervision Project. This intervention removes delinquent youths (status offenders) under the age of 16 from criminal justice institutions and provides them with proactive and extensive community supervision. This program has been shown to have greater deterrent effects on referrals to juvenile court than standard protective supervision does.
Ineffective Tertiary Programs And Strategies
Several popular juvenile justice approaches to preventing further criminal behavior in delinquent youths have been shown to be consistently ineffective: specifically, boot camps, residential programs, milieu treatment, behavioral token programs, and waivers to adult court.
Boot Camps
Perhaps the most well known of these approaches, boot camps for delinquent youths are modeled after military basic training, with a primary focus on discipline. Compared to traditional forms of incarceration, boot camps produced no significant effects on recidivism in three out of four evaluations and trends toward increased recidivism in two. The fourth evaluation showed significant harmful effects on youths, with a significant increase in recidivism.
Boot camps typically focus very narrowly on physical discipline, a highly specific personal skill, rather than a broader range of skills and competencies, such as those addressed by effective programs. Boot camps are also a setting in which youths are exposed to other delinquent youths, who can act as models and positively reinforce delinquent behavior (Dishion et al., 1994).
Residential Programs
Residential programs, interventions that take place in psychiatric or correctional institutions, also show little promise of reducing subsequent crime and violence in delinquent youths. While some residential programs appear to have positive effects on youths as long as they remain in the institutional setting, research demonstrates consistently that these effects diminish once young people leave. Evaluations of two residential programs showed that participating youths were actually more likely to be rearrested and to report they had committed serious offenses during follow-up. In both studies, the comparison group consisted of youths assigned to regular training schools.
Two general approaches that are popular in residential settings are milieu treatment and behavioral token programs. Both strategies aim to change the organizational structures of residential programs. The milieu treatment approach is characterized by resident involvement in decision making and day-to-day interaction for psychotherapeutic discussion. While this approach shows some positive effects when individual responsibility is stressed, the more common strategy of group decision making has shown no positive effect on recidivism after release. Moreover, Lipsey and Wilson’s meta-analysis shows that milieu therapy is one of the least effective approaches to preventing recidivism in serious juvenile offenders (Table 5–1).
In behavioral token programs, youths are rewarded for conforming to rules, exhibiting prosocial behavior, and not exhibiting antisocial or violent behavior. Like some other residential approaches, behavioral token programs can have positive effects on targeted behaviors while youths are institutionalized. However, when this strategy is used alone, any such effects disappear when youths leave the program.
Waivers to Adult Court
Another popular justice system approach to deterring youth violence, waivers to adult court, can have particularly harmful effects on delinquent youths. The idea behind this approach, "adult time for adult crime," was widely accepted into practice in the 1990s, when youth violence escalated dramatically. Evaluations of these programs suggest that they increase future criminal behavior rather than deter it, as advocates of this approach had hoped. Moreover, placing youths in adult criminal institutions exposes them to harm. Results from a series of reports indicate that young people placed in adult correctional institutions, compared to those placed in institutions designed for youths, are eight times as likely to commit suicide, five times as likely to be sexually assaulted, twice as likely to be beaten by staff, and 50 percent as likely to be attacked with a weapon (Bishop, 2000; Bishop & Frazier, 2000; Fagan et al., 1989; Flaherty, 1980).
Counseling
Several counseling, therapy, and social work approaches to treating delinquent youths have also been shown to be ineffective in the review literature, a finding that is consistent with the results of Lipsey’s meta-analyses (Table 5–1). One "mainstay" (Tolan & Guerra, 1994, p. 15) of the juvenile justice system’s toolkit against youth violence, social casework, combines individual psychotherapy or counseling with close supervision of youths and coordination of social services. Even when implemented carefully and comprehensively, programs that use this approach have failed to demonstrate any positive effects on recidivism. In fact, one long-term follow-up of delinquent youths treated in this setting shows several significant negative effects, including increases in alcoholism, unemployment, marital difficulties, and premature death (McCord, 1978).
Meta-analyses also demonstrate that individual counseling can be one of the least effective prevention approaches for delinquent youths. However, the effects of this strategy appear to depend largely on the population. Though relatively ineffective for general delinquency and only marginally effective for institutionalized seriously delinquent youths, individual counseling emerged as one of the most effective intervention approaches for noninstitutionalized seriously delinquent youths in Lipsey’s studies (Table 5–1). The reason for this difference is unclear, but it illustrates the importance of program characteristics other than content, particularly the importance of matching the program to the appropriate target population. A meta-analysis by Andrews and colleagues (1990) confirms this finding, demonstrating that appropriate treatment can deter reoffending, whereas interventions that are poorly matched to the populations served can have no effect or a negative effect.
Shock Programs
One tertiary youth violence prevention intervention meets the scientific criteria established above for Does Not Work: Scared Straight. Scared Straight is an example of a shock probation or parole program in which brief encounters with inmates describing the brutality of prison life or short-term incarceration in prisons or jails is expected to shock, or deter, youths from committing crimes. Numerous studies of Scared Straight have demonstrated that the program does not deter future criminal activities. In some studies, rearrest rates were similar between controls and youths who participated in Scared Straight. In others, youths exposed to Scared Straight actually had higher rates of rearrest than youths not involved in this intervention. Studies of other shock probation programs have shown similar effects. (For more information on Scared Straight and similar shock probation interventions, see Boudouris & Turnbull, 1985; Buckner & Chesney-Lind, 1983; Finckenauer, 1982; Lewis, 1983; Sherman et al., 1997; Vito, 1984; Vito & Allen, 1981.)
COST-EFFECTIVENESS
Violence costs the United States an estimated $425 billion in direct and indirect costs each year (Illinois Center for Violence Prevention, 1998). Of these costs, approximately $90 billion is spent on the criminal justice system, $65 billion on security, $5 billion on the treatment of victims, and $170 billion on lost productivity and quality of life. The annual costs to victims are approximately $178 billion (Illinois Center for Violence Prevention, 1998). The most logical way to reduce these costs is to prevent violence altogether. Preventing a single violent crime not only averts the costs of incarceration, it also prevents the short- and long-term costs to victims, including material losses and the costs associated with physical and psychological trauma.
Despite these facts, policy in the United States continues to focus on get-tough laws and incarceration for serious violent criminals, as opposed to prevention and intervention (Greenwood, 1995). Federal spending on school-based crime, violence, and drug prevention programs is quite modest, compared to spending on crime and drug control strategies such as policing and prison construction (Gottfredson et al., in press). Not only are preventive approaches more beneficial than get-tough laws, some prevention and intervention strategies cost less over the long run than mandatory sentences and other get-tough approaches.
In an effort to determine the cost-effectiveness of California’s three-strikes-and-you’re-out law, which mandates life sentences for repeat offenders, Greenwood (1995) compared that approach to the benefits and cost-effectiveness of a number of crime prevention strategies. He estimated that each serious crime—homicide, rape, robbery, assault, or residential burglary-prevented by the three-strikes law cost the criminal justice system in California an additional $16,000 over the amount spent prior to this legislation. Using this price as the standard for cost-effectiveness, Greenwood calculated the costs per serious crime prevented of four prevention and intervention strategies: (1) early childhood intervention (perinatal home visitation continuing through the first 2 years, combined with 4 years of enriched day care programs) for high-risk families, (2) parent training for families with children who have shown aggressive behavior ("acted out") in school, (3) improved public school programs that target all youth, and (4) early interventions for very young delinquents. The costs calculated for each of these interventions included only direct program costs, not such indirect benefits as the money saved by averting incarceration or preventing victim trauma and its medical and social consequences.
Table 5 2 shows the benefits of the various prevention and intervention programs with respect to the number of serious crimes each can be expected to prevent over the course of 30 years. The major disadvantage of the prevention approach is clear there is a time lag between implementation of programs and the appearance of effects. Because of this time lag, programs that are cost-effective in the long run do not appear so in the short run. In addition, long periods between an intervention and the high-risk period of a youth’s life offer more opportunity for decay of a program’s effects (Greenwood et al., 1998). In the case of early childhood programs, it takes approximately 15 years before significant effects on youth violence can be appreciated, given the peak ages at which young people are involved in violence. Early intervention with delinquent youths that includes day treatment and home monitoring has a shorter lag time because the intervention is introduced later in life yet early in a violent career.
Table 5-2. Cost-effectiveness of early intervention in California Table 5-2 (click to enlarge)
Of the four approaches listed in Table 5 2, the most cost-effective in the long run is parent training, which costs only $392 to implement per serious crime averted after the program has been in effect 30 years. This is less than one-fortieth the estimated cost of preventing serious crime under the three-strikes law. Day treatment and monitoring for delinquent youths are also more cost-effective than mandatory sentencing, costing less than one-sixth as much as the three-strikes approach.
The least cost-effective of the four are prenatal and early childhood intervention and school-based programs that target all students. However, early childhood interventions that include prenatal home visitation and enhanced day care can be expected to halve the incidence of child abuse among high-risk families (that is, low-income families headed by a single mother).5 Moreover, early childhood intervention may improve educational achievement and reduce teen pregnancy rates. School-based programs have benefits other than prevention of violent crime, including higher educational achievement for all students. In a later analysis, Greenwood et al. (1998) found that school-based prevention programs that targeted disadvantaged youths specifically and included incentives (such as cash) for graduating from high school were almost 10 times as cost-effective as the three-strikes approach.
In general, Greenwood’s findings suggest that interventions targeting problem youths either children who act out or delinquent youths are more cost-effective than interventions that target general populations of youths. In addition, they confirm that prevention is truly more cost-effective in the long run than incarceration.
Costs aside, prevention may not have as great an effect on rates of violence as imposing longer mandatory sentences on repeat offenders. Other analyses demonstrate that the three-strikes law can reduce serious crime by 21 percent, whereas graduation incentives only reduce it by approximately 15 percent, parent training by 7 percent, early childhood intervention by 5 percent, and delinquent supervision by less than 2 percent (Greenwood et al., 1998). However, the four prevention and intervention strategies combined cost nearly $1.2 billion per year less to implement than the three-strikes strategy alone, and together they could prevent a substantial portion of the 80 percent of serious crimes that are not averted by mandatory sentencing (Greenwood et al., 1998). Graduation incentive programs could pay for themselves with the money they save by averting the eventual incarceration of many youths, and the other prevention and intervention strategies could pay for up to 40 percent of their costs in the same manner.
Studies of two targeted early childhood intervention programs, the Perry Preschool and the Elmira, New York, Prenatal and Infancy Home Visitation by Nurses, indicate that these programs can actually save the government up to three times their cost when delinquency prevention and other benefits are considered (Karoly et al., 1998). It is noteworthy that although the cost-effectiveness data in Table 5–2 were calculated using crime and population statistics for California, they have national implications with respect to the relative costs and benefits of violence prevention and incarceration.
Researchers at the Washington State Institute for Public Policy, who conducted a similar analysis (Aos et al., 1999), point out that the most effective programs are not always the most cost-effective. They note the importance of matching the intervention to the population a particular challenge for programmers, but one that has a critical effect on both the overall effectiveness and the cost-effectiveness of an intervention.
The results of the Washington study are summarized in Table 5–3. While this table includes only the programs and approaches discussed in this report, the Washington study actually included many more programs and strategies, including some targeting adult offenders. All cost estimates in Table Table 5–3 were calculated using the same methodology so that programs can be compared. Although most costs are calculated as direct, per-participant program costs, the costs of Multidimensional Treatment Foster Care are calculated relative to regular group home costs, and the costs of intensive supervision programs and boot camps are calculated relative to regular court probation costs. (Thus, the negative program cost of boot camps means that these programs cost less to implement than regular court probation programs.) This overall approach may not be the same one used by other researchers to calculate program costs, resulting in inconsistencies between costs in this table and those projected by individual program designers (Box 5 3).
Nevertheless, the Washington study offers some useful insights into the cost-effectiveness of youth violence prevention. Looking at the benefits to the criminal justice system alone (that is, benefits to the taxpayer), many early interventions and selected strategies come close to paying for themselves with the money they save; others actually achieve benefits that are greater than program costs. The Seattle Social Development Project, for instance, now saves $0.90 from reduced rates of crime for every tax dollar spent. Programs targeting at-risk or delinquent youths can be even more cost-effective. For example, taxpayers today can expect to save $14.07 in future criminal justice costs for every dollar spent on Multidimensional Treatment Foster Care.
The same trend holds when considering the benefits of youth crime prevention to both the criminal justice system and crime victims (personal and property losses)-the largest economic returns are achieved with interventions targeted at juvenile offenders, who are at greatest risk of future offending. The Model programs in this group return $11 to $22 for every dollar invested. However, even programs aimed at nonoffenders can achieve significant cost benefits when future savings to potential crime victims (due to a reduction in the number of victims) and the taxpayer are combined. According to the Washington study, society gains at least $0.50 over program costs for each dollar spent on the Perry Preschool Program, Prenatal and Infancy Home Visitation by Nurses, the Seattle Social Development Project, and Big Brothers Big Sisters of America.
In general, these analyses underestimate the benefits of prevention programs because they fail to consider many of the indirect benefits of preventing serious or violent offenses, such as increased work productivity, increased taxes realized, reduced welfare assistance costs, and reduced victim medical costs.
Table 5-3. Comparative costs and benefits of prevention and intervention
Table 5-3 (click to enlarge)
Footnotes
5
These reductions in child abuse were not considered in this analysis.
CONCLUSIONS
Clearly, we are past the era in which some observers believed that "nothing works" to prevent youth violence. Numerous programs have demonstrated their effectiveness in reducing risk factors for serious violence. At the same time, there is a pressing need to evaluate more youth violence prevention programs. Of the hundreds of programs currently in use throughout the United States, only six met the criteria for a Model program, and 21 met the criteria for a Promising program. Of the 266 school-based program modules reviewed by Gottfredson et al. (in press), all of which were formally evaluated against a control or comparison group, only 10 percent received the highest score for scientific rigor (the experimental design standard used here). For most violence, crime, and drug prevention programs now being implemented, there is simply no evidence regarding effectiveness. Although well-designed program evaluations are expensive and time-consuming, they are the only way to determine the effectiveness of existing youth violence prevention programs.
Nearly half of the most thoroughly evaluated strategies for preventing youth violence are ineffective, however, and a few are even harmful. It is in society’s best interest to evaluate programs before exposing children and adolescents to them--otherwise we run the risk of harming young people rather than helping them.
The most effective youth violence prevention programs are targeted appropriately, address several age-appropriate risk and protective factors in different contexts, and include several program components that have been shown to be effective. This finding is consistent with research showing that youth violence is affected by numerous risk and protective factors that span several environmental contexts (individual, family, school, peer group, community) and several stages of a youth’s life (see Chapter 4).
Box 5-3. What Model programs cost
Level 1 (Violence Prevention) Functional Family Therapy
$1,350 --$3,750 per family for 90 days (average 12 visits per family)
Multidimensional Treatment Foster Care
$2,691 per youth per month for an average of 7 months
Multisystemic Therapy
$4,500 per youth
Prenatal and Infancy Home Visitation by Nurses
$3,200 per family per year during the first 3 years of program operation; $2,800 per family per year when the program is fully operational
Seattle Social Development Project
Not available
Level 2 (Risk Prevention) Life Skills Training
$7 per student per year, plus a one-time minimum of $2,000 per day for 1 to 2 days of training
The Midwestern Prevention Project
$28 per student per year for school and parent programs
Source: Center for the Study and Prevention of Violence, 1998.
GOING TO SCALE
While identifying best practices in youth violence prevention is critical to reducing the number of young people involved in and affected by violence, it is not the last step. The manner in which a program is implemented can have an enormous impact on its effectiveness--even the best programs are effective only when implemented with high quality and fidelity to the program’s design. In other words, using an effective strategy is only part of what is required to achieve effective results. Details of program delivery, including characteristics of the youths receiving the intervention, the setting in which they are treated, and the intensity or duration of the intervention, play important roles in determining effectiveness. Programs must be delivered with design fidelity, to a specific population of youths, within a specific context, and for a specific period of time.
Unfortunately, very little is known about how to preserve a prevention program’s positive effects when it is implemented on a wide-scale or national level. What research has been conducted indicates that effective implementation is at least as important to a program’s success as the characteristics and content of the program itself (Petersilia, 1990; Lipsey, 1992a, 1992b). Studies of program implementation consistently find that effectiveness depends on the following principles, according to a review by Petersilia (1990, p. 130):
• The project addresses a pressing local problem.
• The project has clearly articulated goals that reflect the needs and desires of the "customer."
• The project has a receptive environment in both the parent organization and the larger system.
• The organization has a leader who is committed to the objectives, values, and implications of the project and who can devise practical strategies to motivate and effect change.
• The project has a director who shares the leader’s ideas and values and uses them to guide the implementation process and ongoing operation of the project.
• Practitioners make the project their own rather than being coerced into it; that is, they buy into it, participate in its development, and have incentives to maintain its integrity during the process of change.
• The project has clear lines of authority: There is no ambiguity as to who is in charge.
• The change and its implementation are not complex and sweeping.
• The organization has secure administrators, low staff turnover, and plentiful resources.
Gendreau et al. (1999) organize these same principles into four categories: general organizational factors, program factors, change agent factors, and staffing activities. While they acknowledge the importance of a program’s characteristics, such as its theoretical basis, they also stress that positive change and success are dependent on much more than the specific characteristics of a prevention program or intervention. Characteristics of the implementer, the environment in which the program is implemented, and even the target population have a significant influence on overall program effects.
Both the Petersilia and Gendreau et al. studies discuss characteristics of effective implementation within a correctional setting. The Centers for Disease Control and Prevention’s (CDC) Best Practices of Youth Violence Prevention (Thornton et al., 2000) and a recent review by Gottfredson et al. (2000) suggest that many of the same characteristics help determine the success of violence and delinquency prevention programs. In particular, the CDC study highlights the importance of training, monitoring, and supporting the staff who implement a program on the local level. An appropriate match between staff and the target population can also contribute to program success, particularly in parent- and family-based programs. Staff must be committed to the program, experienced with the general strategy being used, knowledgeable about the target community, and capable of managing group dynamics and overcoming resistance. Likewise, as noted by Petersilia, maintaining community involvement is a key element of program success. Finally, linking a youth violence prevention program to existing strategies and support agencies in the community or school can contribute to success (Thornton et al., 2000).
A similar group of implementation characteristics affects the success of school-based delinquency prevention programs, according to Gottfredson and colleagues (2000). In a study of more than 1,200 schools throughout the United States, they found that extensive, high-quality training and supervision, as well as support for the program from the principal of the school, are key elements of success. Schools also appear to have greater success with standardized materials and methods, as well as programs that can be incorporated into the regular school program. Consistent with Petersilia’s principles, local buy-in and initiation of school-based delinquency prevention are important predictors of program success. Multiple sources of information, including the use of an expert to assist with training and implementation, also help to ensure positive results. Improvements in any or all of these factors should improve the quality of the overall prevention program—and its effects on youths.
The CDC recommends monitoring the progress and quality of program implementation on a local level. This step can be particularly important when implementing Model programs. The proven effectiveness of these programs in multiple, long-term studies makes them suitable for implementation on a wide, or even national, scale, but even Model programs are successful only when implemented with fidelity. While it is not always necessary to conduct expensive outcome evaluations of Model programs, given their demonstrated positive effects and ongoing national evaluations, it is critical to monitor the quality of implementation on the local level.
Scientific research has established the effectiveness of a number of prevention programs, and evaluation studies are sure to identify more in the near future. Although the studies cited above offer valuable guidance, more research is needed on how to implement youth violence prevention programs with fidelity on a national scale, how to monitor program fidelity on this scale, and how to increase community and agency capacity for implementing these programs. In addition, large-scale program dissemination will affect the overall benefits of
individual youth violence prevention programs. Addressing these issues will require a major investment of time and resources, but it is the essential next step in the continuing effort to find effective solutions to the problem of youth violence.
Appendix 5-A Consistency of Best Practices Evaluations Appendix 5-A (click to enlarge)
Appendix 5-B Descriptions of Specific Programs That Meet Standards for Model and Promising Categories
MODEL PROGRAMS: LEVEL 1 (VIOLENCE PREVENTION)
Functional Family Therapy (FFT)
Contact information:
James F. Alexander, Ph.D. University of Utah Department of Psychology, SBS 502 Salt Lake City, UT 84121 (801) 581-6538
Evidence of effectiveness: In multiple clinical trials, FFT achieved significant reductions in the proportion of youths who reoffended (60 percent of treated youths were arrested after the program versus 93 percent of controls in one study and 11 percent versus 67 percent in another) and the frequency of offending up to 2.5 years after participation in the intervention. Diffusion effects on the siblings of target youths have also been observed, with significantly fewer siblings of FFT youths than control youths having juvenile court records 2.5 to 3.5 years after the program.
For further information:
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Alexander, J., Pugh, C., Parsons, B., Barton, C., Gordon, D., Grotpeter, J., Hansson, K., Harrison, R., Mears, S., Mihalic, S., Schulman, S., Waldron, H., & Sexton, T. (1998). Functional family therapy. In D. S. Elliott (Series Ed.), Blueprints for violence prevention. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Mendel, R. A. (2000). Less hype, more help: Reducing juvenile crime, what works—and what doesn't. Washington, DC: American Youth Policy Forum.
Multidimensional Treatment Foster Care
Contact information:
Patricia Chamberlain, Ph.D. Principal Investigator Clinic Director Oregon Social Learning Center 207 East 5th Street Suite 202 Eugene, OR 97401 (541) 485-2711
Evidence of effectiveness: A randomized evaluation of Multidimensional Treatment Foster Care compared to group care in boys only demonstrated the following results at a 12-month follow-up: Treated boys spent significantly more days in their placements, were less likely to run away from their placements, and spent twice as many days living with their families or relatives. One year after leaving treatment, treated boys had significantly larger decreases in arrest rates than controls, had significantly fewer arrests overall, and were significantly more likely not to have been arrested at all during follow-up. Treated boys also reported significantly fewer criminal activities (general delinquency, index offenses, and felony assaults). In prior evaluations that included both boys and girls, Multidimensional Treatment Foster Care improved rates of program completion, reduced rates of incarceration and number of days incarcerated during the first year after treatment, and resulted in a faster drop in rates of problem behavior for seriously impaired youths.
For further information:
• Chamberlain, P. (1998). Treatment foster care. Family strengthening series. (OJJDP Bulletin NCJ 173421). Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Chamberlain, P., & Mihalic, S. F. (1998). Multidimensional treatment foster care. In D. S. Elliott (Series Ed.), Blueprints for violence prevention. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Chamberlain, P., & Reid, J. (1998). Comparison of two community alternatives to incarceration for chronic juvenile offenders. Journal of Consulting and Clinical Psychology, 6, 624-633.
• Eddy, J. M., & Chamberlain, P. (2000). Family management and deviant peer association as mediators of the impact of treatment condition on youth antisocial behavior. Journal of Consulting and Clinical Psychology, 5, 857-863.
• Moore, K. J., Sprengelmeyer, P. G., & Chamberlain, P. (in press). Community-based treatment for adjudicated delinquents: The Oregon Social Learning Center's "Monitor" treatment foster care program. Residential Treatment for Children and Youth.
• Mendel, R. A. (2000). Less hype, more help: Reducing juvenile crime, what works—and what doesn't. Washington, DC: American Youth Policy Forum.
Multisystemic Therapy (MST)
Contact information:
Scott W. Henggeler, Ph.D. Director, Family Services Research Center Medical University of South Carolina Department of Psychiatry and Behavioral Sciences 171 Ashley Avenue Annex III Charleston, SC 29425-0742 (843) 876-1800
Evidence of effectiveness: This program has been evaluated in multiple, well-designed clinical trials. Studies conducted in Memphis, Tennessee, and South Carolina (among seriously delinquent youths) show that participation in MST can have significant positive effects on behavior problems (including conduct problems, anxiety-withdrawal, immaturity, and socialized aggression), family relations, and self-reported offenses immediately after treatment. Fifty-nine weeks after referral, seriously delinquent youth who participated in MST had slightly more than half as many arrests as controls (mean = 0.87 versus 1.52), spent an average of 73 fewer days incarcerated in justice system facilities, and showed reductions in aggression with peers. After 2.4 years, MST youths were half as likely as control youths to have been rearrested. In Columbia, Missouri, MST improved family relations and arrest rates, including arrests for violent and substance-related crimes, and demonstrated a dose-response effect, with program completers demonstrating significantly more benefits than dropouts.
For further information:
• Henggeler, S. W., Mihalic, S. F., Rone, L., Thomas, C., & Timmons-Mitchell, J. (1998). Multisystemic therapy. In D. S. Elliott (Series Ed.), Blueprints for violence prevention. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Thornton, T. N., Craft, C. A., Dahlberg, L. L., Lynch, B. S., & Baer, K. (2000). Best practices of youth violence prevention: A sourcebook for community action. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
Prenatal and Infancy Home Visitation by Nurses
Contact information:
David L. Olds, Ph.D. Director, Prevention Research Center for Family and Child Health 1825 Marion Street Denver, CO 80218 (303) 864-5200
Evidence of effectiveness: Prenatal and Infancy Home Visitation by Nurses has demonstrated effectiveness in both white and African American families in rural and urban settings. A 15-year follow-up of low-income, teenage mothers in whom this intervention was implemented in Elmira, New York, showed a 79 percent reduction in reports of child abuse and neglect, a 31 percent drop in subsequent births, a 44 percent decline in maternal behavioral problems, a 9 percent decline in maternal arrests, a 56 percent decrease in running away by children, and reductions of 56 percent in arrests of children and alcohol consumption by children. The program also increased the average spacing between children by more than 2 years. Preliminary results of a replication in Memphis, Tennessee, demonstrated positive effects on parental caregiving and childhood injuries and reductions in dysfunctional caregiving, including child abuse and neglect. Recent reanalysis of the 15-year follow-up in Elmira showed that the program's effects on child abuse and neglect were significantly diminished in families that reported high rates of domestic violence (more than 28 incidents since the birth of the study child). A new replication of the program in Denver has taken this limitation into account, adding elements on partner communication and assessment and referral for domestic violence. The evaluation of this replication has also been revised to account more accurately for the effects of the program on domestic violence, as well as the effects of domestic violence on the program outcomes (Reuters Health, 9/20/00).
For further information:
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Olds, D. L., Hill, P. L., Mihalic, S. F., & O'Brien, R. A. (1998). Prenatal and infancy home visitation by nurses. In D.S. Elliott (Series Ed.), Blueprints for violence prevention. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Howell, J. A. (Ed.). (1995). Guide for implementing the comprehensive strategy for serious, violent, and chronic juvenile offenders. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Thornton, T. N., Craft, C. A., Dahlberg, L. L., Lynch, B. S., & Baer, K. (2000). Best practices of youth violence prevention: A sourcebook for community action. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
Seattle Social Development Project
Contact information:
J. David Hawkins, Ph.D. Social Development Research Group University of Washington School of Social Work 130 Nickerson, Suite 107 Seattle, WA 98109 (206) 286-1805
Evidence of effectiveness: Evaluations of the Seattle Social Development Project demonstrate reductions at the end of grade 2 in aggression, antisocial and externalizing behaviors, and self-destructive behaviors in children who participated in the program during the 1st and 2nd grades. Other benefits of the program include lower rates of alcohol and delinquency initiation, improvements in family management practices and parent-child relationships, greater attachment and commitment to school, and less involvement with antisocial peers. Follow-up at age 18 shows that the Seattle Social Development Project significantly improves long-term attachment and commitment to school and school achievement and reduces rates of self-reported violent acts and heavy alcohol use. At follow-up, students who received the full intervention were also less likely than controls to be sexually active, to have had multiple sex partners, and to have been or have gotten someone pregnant (this difference was only marginally significant, at p = .057). Replications of this program have confirmed its benefits in both general and high-risk populations of youths.
For further information:
• Catalano, R. F., Harachi, T. W., Abbott, R.D., Haggerty, K. P., & Fleming, C. B. (draft). Raising healthy children through enhancing social development in elementary school: Results after 1.5 years. Seattle, WA: Social Development Research Group, University of Washington.
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: Seattle Social Development Project. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Hawkins, J. D., Catalano, R. F., Kosterman, R., Abbott, R., & Hill, K. G. (in press). Preventing adolescent health-risk behaviors by strengthening protection during childhood. Archives of Pediatrics and Adolescent Medicine.
• Hawkins, J. D., Catalano, R. F., Morrison, D., O'Donnell, J., Abbott, R., & Day, L. E. (1992). The Seattle Social Development Project: Effects of the first four years on protective factors and problem behaviors. In J. McCord & R. E. Tremblay (Eds.), Preventing antisocial behavior: Interventions from birth through adolescence. New York: The Guilford Press.
• Hawkins, J. D., Doueck, H. J., & Lishner, D. M. (1988). Changing teacher practices in mainstream classrooms to improve bonding and behavior of low achievers. American Educational Research Journal, 25, 31-50.
• Hawkins, J. D., Von Cleve, E., & Catalano, R. F. (1991). Reducing early childhood aggression: Results of a primary prevention program. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 208-217.
• Howell, J. A. (Ed.). (1995). Guide for implementing the comprehensive strategy for serious, violent, and chronic juvenile offenders. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Mendel, R. A. (2000). Less hype, more help: Reducing juvenile crime, what works—and what doesn't. Washington, DC: American Youth Policy Forum.
• O'Donnell, J., Hawkins, J. D., Catalano, R. F., Abbott, R. D., & Day, E. (1995). Preventing school failure, drug use, and delinquency among low-income children: Long-term intervention in elementary schools. American Journal of Orthopsychiatry, 65, 87-100.
• Sherman, L. W., Gottfredson, D., MacKenzie, D., Eck, J., Reuter, P., & Bushway, S. (1997). Preventing crime: What works, what doesn't, what's promising. Washington, DC: U.S. Department of Justice, Office of Justice Programs.
MODEL PROGRAMS: LEVEL 2 (RISK PREVENTION)
Life Skills Training (LST)
Contact information:
Gilbert Botvin, Ph.D. Principal Investigator Institute for Prevention Research Cornell University Medical College 411 East 69th Street KB-201 New York, NY 10021 (212) 746-1270
Evidence of effectiveness: More than a dozen studies have demonstrated the effectiveness of LST. On average, the program reduces tobacco, alcohol, and marijuana use by 50 to 75 percent. Long-term follow-up of students 6 years after participation in the intervention demonstrates that LST also reduces polydrug use by 66 percent, reduces pack-a-day cigarette smoking by 25 percent, and decreases the use of inhalants, narcotics, and hallucinogens.
For further information:
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Botvin, G. J., Mihalic, S. F., & Grotpeter, J. K. (1998). Life skills training. In D. S. Elliott (Series Ed.), Blueprints for violence prevention. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Sherman, L. W., Gottfredson, D., MacKenzie, D., Eck, J., Reuter, P., & Bushway, S. (1997). Preventing crime: What works, what doesn't, what's promising. Washington, DC: U.S. Department of Justice, Office of Justice Programs.
The Midwestern Prevention Project
Contact information:
Mary Ann Pentz, Ph.D. Principal Investigator
Sadina Rothspan, Ph.D. Project Manager University of Southern California Department of Preventive Medicine School of Medicine U.S.C. Norris Comprehensive Cancer Center 1441 Eastlake Avenue MS-44 Los Angeles, CA 90033-0800 (213) 764-0325
Evidence of effectiveness: Results of the Kansas City study showed that the Midwestern Prevention Project significantly reduces the increase in drug use that occurs in middle school. Specifically, cigarette, alcohol, and marijuana use were 5 percent, 2 percent, and 0 percent lower, respectively, in the Midwestern Prevention Project group at 6 months; 8 percent, 4 percent, and 3 percent lower after 1 year; and 9 percent, 2 percent, and 3 percent lower after 2 years. At 3 years, significant program effects on tobacco and marijuana use, but not alcohol use, remained. Based on early results of this program, a replication in Indianapolis (Project I-STAR) modified the Midwestern Prevention Project intervention by adding two sessions on alcohol use to the school curriculum, introducing a parent-training component a year earlier than in the initial study, adding a pretraining orientation for parent committee members, shortening the time between the various program components, and changing the community organization structure. In the Project I-STAR replication, the effects on cigarette and marijuana use through the high school years were similar to but smaller than the effects demonstrated in Kansas City. The magnitude of effects on inhalant, amphetamine, and LSD use was similar in the two cities. When the quality of implementation was taken into account, the effects of the program in Indianapolis reached the same magnitude as the effects demonstrated in Kansas City with respect to gateway drug use (tobacco, alcohol, and marijuana).
For further information:
• Pentz, M. A., Mihalic, S. F., & Grotpeter, J. K. (1998). The midwestern prevention project. In D. S. Elliott (Series Ed.), Blueprints for violence prevention. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
PROMISING PROGRAMS: LEVEL 1 (VIOLENCE PREVENTION)
Intensive Protective Supervision Project
Contact information:
Kathy Dudley Juvenile Services Division Administrative Office of the Courts P.O. Box 2448 Raleigh, NC 27602 (919) 662-4738
Evidence of effectiveness: Compared to regular protective supervision, Intensive Protective Supervision reduces referrals to juvenile court for delinquency during treatment and up to 1 year after case closing. One evaluation of a poorly implemented replication in North Carolina (additional sites were added to the original study group) showed a deterioration of program effects over time.
For further information:
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: Intensive Protective Supervision Project. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Land, K. C., McCall, P. L., & Williams, J. R. (1992). Intensive supervision of status offenders: Evidence on continuity of treatment effects for juveniles and a "Hawthorne effect" for counselors. In R. Tremblay & J. McCord (Eds.), Preventing antisocial behavior: Interventions from birth through adolescence. New York, NY: The Guilford Press.
• Sherman, L. W., Gottfredson, D., MacKenzie, D., Eck, J., Reuter, P., & Bushway, S. (1997). Preventing crime: What works, what doesn't, what's promising. Washington, DC: U.S. Depart-ment of Justice, Office of Justice Programs.
• Sontheimer, H., & Goodstein, L. (1993). Evaluation of juvenile intensive aftercare probation: Aftercare versus system response effects. Justice Quarterly, 10, 197-227.
Montreal Longitudinal Study/Preventive Treatment Program
Contact information:
Richard E. Tremblay University de Montreal Faculte des Arts et des Sciences GRIP 3050 Boulevard Eduoard-Monpetit C.P. 6128 Montreal, Quebec Canada H3C 317 (514) 343-6963
Evidence of effectiveness: No significant differences between treated and control boys were observed immediately after treatment, but 2 years later treated youths were involved in fewer fights, were half as likely to have serious school adjustment problems, and were less likely to be involved in delinquent activities than those in the control group. Boys followed to age 12 (3 years after the intervention) had significantly lower rates of delinquency, fighting, serious difficulties in school, and placement in special-education classes, and they were rated as significantly more well adjusted
in school than controls. Three years later, treated boys were less likely than untreated boys to report gang involvement, drunkenness, or drug use in the past year, delinquency, and having friends arrested by police. Because the effects of this intervention on girls are unknown, these benefits can be expected only when the intervention is implemented in boys.
For further information:
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: Preventive Treatment Program. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Greenberg, M. T., Domitrovich, C., & Bumbarger, B. (1991). Preventing mental disorders in school-age children: A review of the effectiveness of prevention programs. University Park, PA: Prevention Research Center for the Promotion of Human Development, Pennsylvania State University.
• Howell, J. A. (Ed.). (1995). Guide for implementing the comprehensive strategy for serious, violent, and chronic juvenile offenders. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Tremblay, R. E., Pagani-Kurtz, L., Masse, L. C., & Pihl, R. O. (1995). A bimodal preventive intervention for disruptive kindergarten boys: Its impact through mid-adolescence. Journal of Consulting and Clinical Psychology, 63, 560-568.
• Tremblay, R. E., Vitaro, F., Bertrand, L., LeBlanc, M., Beauchesne, H., Boileau, H., & David, L. (1992). Parent and child training to prevent early onset of delinquency: The Montreal Longitudinal Experimental Study. In J. McCord & R. Tremblay (Eds.), Preventing antisocial behavior: Interventions from birth through adolescence. New York: The Guilford Press.
Perry Preschool Program
Contact information:
David Weikart, Ph.D. High Scope Educational Research Foundation 600 North River Street Ypsilanti, MI 48198-0704 (734) 485-2000 http://www.highscope.org/
Evidence of effectiveness: Follow-up at age 19 of children enrolled in Perry Preschool demonstrates less delinquency and fewer arrests, less involvement in serious fights, less police contact, lower dropout rates, and fewer pregnancies and births. The intervention has also reduced antisocial behavior and misconduct in elementary school and shown positive effects on commitment to school, academic achievement, rates of employment, and job satisfaction at age 15.
For further information:
• Berrueta-Clement, J. R., Schweinhart, L. J., Barnett, W. S., Epstein, A. S., & Weikart, D. P. (1984). Changed lives: The effects of the Perry Preschool Program on youths through age 19. Ypsilanti, MI: The High/Scope Press.
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: Perry Preschool Program. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Epstein, A. S. (1993). Training for quality: Improving early childhood programs through systematic inservice training. Ypsilanti, MI: The High/Scope Press.
• Greenwood, P., Model, K. E., Rydell, C. P., & Chiesa, J. (1996). Diverting children from a life of crime: Measuring costs and benefits. Santa Monica, CA: RAND.
• Mendel, R. A. (2000). Less hype, more help: Reducing juvenile crime, what works—and what doesn't. Washington, DC: American Youth Policy Forum.
• Schweinhart, L. J., & Weikart, D. P. (1980). Young children grow up: The effects of the Perry Preschool Program on youths through age 15. Ypsilanti, MI: The High/Scope Press.
• Weikart, D. P., Bond, J. T., & McNeil, J. T. (1978). The Ypsilanti Perry Preschool Project: Preschool years and longitudinal results through fourth grade. Ypsilanti, MI: The High/Scope Press.
School Transitional Environmental Program (STEP)
Contact information:
Robert D. Felner, Ph.D. University of Rhode Island School of Education Kingston, RI 02881 (401) 277-5045
Evidence of effectiveness: Evaluations performed at the end of the 9th grade show that STEP students have fewer school absences, higher grade-point averages, more positive feelings about school, and a better self-concept than controls. In long-term studies, STEP students had lower dropout rates than controls (21 percent versus 43 percent), higher grades, and fewer absences. In a replication of the program in middle and junior high schools, both STEP and control students showed increases in substance use, delinquent acts, and depression, and decreases in academic performance and self-confidence. However, these changes were significantly smaller among STEP students than controls. Students who participated in STEP also had lower dropout rates than controls. Replication in students with lower risk profiles 1 year after participation in STEP confirmed these findings, showing lower rates of delinquency and higher self-esteem, academic performance, and school attendance than controls. This program has not been evaluated in small or high-achieving schools. In past studies, the program has worked best in large schools. The major limitation to the evaluation research on this program is that the first study lacked pretest measures; however, the researchers reported no differences between treated students and controls with respect to attendance and grades at baseline.
For further information:
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: School Transitional Environmental Program. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Felner, R. D., & Adan, A. M. (1988). The School Transitional Environment Project: An ecological intervention and evaluation. In H. H. Price, E. L. Cowen, R. P. Lorin, & J. Ramos-McKay (Eds.), 14 ounces of prevention: A casebook for practitioners. Washington, DC: American Psychological Association.
• Felner, R. D., Ginter, M., & Primavera, J. (1982). Primary prevention during school transitions: Social support and environmental structure. American Journal of Community Psychology, 10, 277-290.
• Felner, R. D., Brand, S., Adan, A. M., Mulhall, P. F., Flowers, N., Satrain, B., & DuBois, D. L. (1993). Restructuring the ecology of the school as an approach to prevention during school transitions: Longitudinal follow-ups and extensions of the School Transitional Environment Project (STEP). In L. A. Jason, K. E. Danner, & Kurasaki, K. S. (Eds.), Prevention and school transitions. New York: The Haworth Press.
• Howell, J. A. (Ed.). (1995). Guide for implementing the comprehensive strategy for serious, violent, and chronic juvenile offenders. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Reyes, O., & Jason, L. A. (1991). An evaluation of a high school dropout prevention program. Journal of Community Psychology, 19, 221-230.
• Sherman, L.W., Gottfredson, D., MacKenzie, D., Eck, J., Reuter, P., & Bushway, S. (1997, February). Preventing crime: What works, what doesn't, what's promising. Washington, DC: U.S. Department of Justice, Office of Justice Programs.
Striving Together to Achieve Rewarding Tomorrows (CASASTART, formerly Children At Risk [CAR])
Contact information:
Adele Harrell The Urban Institute 2100 M Street, N.W. Washington, DC 20037 (202) 261-5709
Evidence of effectiveness: Evaluations of CASASTART have demonstrated significant positive effects on drug use, including gateway drug use, immediately following participation and on violent crime and drug selling 1 year later. Compared to controls and comparison youths, youths who participated in CASASTART also reported significantly less lifetime drug sales and less involvement with delinquent peers. While the initial evaluation of this intervention included multiple, ethnically diverse sites, a true replication of this program has not been evaluated.
For further information:
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: CASASTART. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Harrell, A. V., Cavanagh, S., & Sridharan, S. (1998). Impact of the Children at Risk Program: Comprehensive final report II. Washington, DC: The Urban Institute.
• Thornton, T. N., Craft, C. A., Dahlberg, L. L., Lynch, B. S., & Baer, K. (2000). Best practices of youth violence prevention: A sourcebook for community action. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
Syracuse Family Development Research Program
Contact information:
J. Ronald Lally, Program Director
Peter L. Mangione, Senior Research Scientist Center for Child and Family Studies Far West Laboratory for Educational Research and Development
Alice S. Honig Syracuse University 201 Slocum Hall Syracuse University Syracuse, NY 13244 (315) 4434296
Evidence of effectiveness: The most dramatic effects of the program were demonstrated in a 10-year follow-up evaluation that showed reduced juvenile delinquency and improved school functioning. Children in the program also demonstrated more positive self-ratings, higher educational goals, and increased self-efficacy. Benefits to parents included greater encouragement of their children's success and increased family unity. The existing evaluation research on this program is limited by several factors: The program has not been replicated; there was relatively high attrition of families in the initial studies that may have led to a positive bias in the follow-up results; and allocation to treatment and control groups was not randomized. This program is no longer deliverable—that is, no technical assistance is available to those who wish to implement it.
For further information:
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: Syracuse Family Development Research Program. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Howell, J. A. (Ed.). (1995). Guide for implementing the comprehensive strategy for serious, violent, and chronic juvenile offenders. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Lally, J. R., Mangione, P. L., Honig, A. S., & Wittner, D. S. (1988). The Syracuse University Family Development Research Program: Long-range impact on early intervention with low-income children and their families. In D. R. Powell & I. E. Sigel (Eds.), Parent education as early childhood intervention: Emerging directions in theory, research and practice. Annual Advances in Applied Developmental Psychology, Volume 3. Norwood, NJ: Ablex Publishing.
• Mendel, R. A. (2000). Less hype, more help: Reducing juvenile crime, what works—and what doesn't. Washington, DC: American Youth Policy Forum.
PROMISING PROGRAMS: LEVEL 2 (RISK PREVENTION)
Bullying Prevention Program
Contact information:
Dan Olweus, Ph.D. Principal Investigator University of Bergen Research Center for Health Promotion Christiesgt, 13, N-5015 Bergen, Norway 47-55-58-23-27
Evidence of effectiveness: Initial evaluations of the Bullying Prevention Program were conducted in elementary and junior high school students in Bergen, Norway. Two years after the intervention, bully-victim problems in treated schools decreased by 50 percent. Antisocial behavior, including theft, vandalism, and truancy, also dropped during these years, while school climate improved. These changes showed a dose-response relationship. Multiple replications of this program have demonstrated similar effects in England, Germany, and the United States.
For further information:
• Olweus, D., Limber, S., & Mihalic, S. (1998). Bullying prevention program. In D. S. Elliott (Series Ed.), Blueprints for violence prevention. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Howell, J. A. (Ed.) (1995). Guide for implementing the comprehensive strategy for serious, violent, and chronic juvenile offenders. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Sherman, L. W., Gottfredson, D., MacKenzie, D., Eck, J., Reuter, P., & Bushway, S. (1997, February). Preventing crime: What works, what doesn't, what's promising. Washington, DC: U.S. Department of Justice, Office of Justice Programs.
Families and Schools Together (FAST Track)
Contact information:
The Conduct Problems Prevention Group
Karen Bierman Pennsylvania State University
John Coie Duke University
Kenneth Dodge Vanderbilt University
Mark Greenberg University of Washington 110 Henderson Building South University Park, PA 16802-6504 (814) 863-0112
John Lochman Duke University
Robert McMahon University of Washington 110 Henderson Building South University Park, PA 16802-6504 (814) 863-0112
Evidence of effectiveness: FAST Track has demonstrated effectiveness in students of diverse demographic backgrounds, including sex, ethnicity, social class, and family composition. Short-term follow-up at the end of grade 1 shows improvements in children's aggressive, disruptive, and oppositional behavior; peer ratings; parenting techniques; parent-child bonding; and maternal involvement in school activities. Long-term follow-up studies are in progress, but data are not yet available.
For further information:
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: FAST Track. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Conduct Problems Prevention Group (Bierman, K., Coie, J., Dodge, K., Greenberg, M., Lochman, J., & McMahon, R.). (1992). A developmental and clinical model for the prevention of conduct disorder: The FAST Track Program. Development and Psychopathology, 4, 509-527.
• Conduct Problems Prevention Group (Bierman, K., Coie, J., Dodge, K., Greenberg, M., Lochman, J., & McMahon, R.). (1996, May). Abstract: An initial evaluation of the FAST Track Program. Proceedings of the Fifth National Prevention Conference, Tysons Corner, VA.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Thornton, T. N., Craft, C. A., Dahlberg, L. L., Lynch, B. S., & Baer, K. (2000). Best practices of youth violence prevention: A sourcebook for community action. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
Good Behavior Game
Contact information:
Sheppard G. Kellam The Prevention Program Mason F. Lord Building Suite 500 5200 Eastern Avenue Baltimore, MD 21224 (410) 550-3445
Evidence of effectiveness: This intervention has shown positive effects in teacher reports of aggressive and shy behaviors in 1st-grade students. Long-term follow-up evaluations of the Good Behavior Game show sustained decreases in aggression among boys rated most aggressive in grade 1. Program effects on violence or delinquency have not been measured.
For more information:
• Barrish, H. H., Saunder, M., & Montrose, M. W. (1969). Good behavior game: Effects of individual contingencies for group consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis, 2, 119-124.
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: Baltimore Mastery Learning and Good Behavior Game Interventions. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Dolan, L., Turkan, J., Wethamer-Larsson, L., & Kellam, S. (1989). The good behavior game manual. Baltimore, MD: The Prevention Program. (Also available on the Internet, at www.bpp.jhu.edu)
• Howell, J. A. (Ed.). (1995). Guide for implementing the comprehensive strategy for serious, violent, and chronic juvenile offenders. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Kellam, S. G., Rebok, G. W., Ialongo, N., & Mayer, L. S. (1994). The course and malleability of aggressive behavior from early first grade into middle school: Results of a developmental epidemiologically based preventive trial. Journal of Child Psychology and Psychiatry, 35, 259-282.
• Kellam, S. G., & Rebok, B. W. (1992). Building developmental and etiological theory through epidemiologically based prevention intervention trials. In J. McCord & R. E. Tremblay (Eds.), Preventing antisocial behavior: Interventions from birth through adolescence. New York: The Guilford Press.
• Medland, M. B., & Stachnik, T. J. (1972). Good-behavior game: A replication and systematic analysis. Journal of Applied Behavior Analysis, 5, 45-51.
• Mendel, R. A. (2000). Less hype, more help: Reducing juvenile crime, what works—and what doesn't. Washington, DC: American Youth Policy Forum.
I Can Problem Solve
Contact information:
Myrna B. Shure MCP-Hahnemann University Clinical and Health Psychology Department Broad and Vine Streets, MS 626 Philadelphia, PA 19102-1192 (215) 762-7205
Evidence of effectiveness: In nursery school and kindergarten students, I Can Problem Solve significantly reduced impulsive and inhibited classroom behavior and improved problem-solving skills at posttest and 1 year. A second study demonstrated sustained improvements in classroom behavior and problem solving 3 to 4 years after the end of the program. In 5th- and 6th-graders, the program increased the use of positive and prosocial behaviors and improved peer relationships and problem-solving skills. In general, it appears that the program is more effective in high-risk students than in students from the general population. Prior studies of this intervention did not use a randomized study design and were limited by high attrition.
For further information:
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: I Can Problem Solve (ICPS). Boulder, CO: Center for the Study and Prevention of Violence, Institute for Behavioral Science, University of Colorado at Boulder.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Howell, J. A. (Ed.). (1995). Guide for implementing the comprehensive strategy for serious, violent, and chronic juvenile offenders. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Shure, M. B. (1993). Interpersonal problem solving and prevention: A five year longitudinal study—kindergarten through grade 4. Final Report #MH-40801. Washington, DC: National Institute of Mental Health.
• Shure, M. B., & Spivack, G. (1979). Interpersonal problem solving thinking and adjustment in the mother-child dyad. In M. W. Kent & R. E. Rolf (Eds.), Primary prevention of psychopathology, Volume 3: Social competence in children. Hanover, NH: University Press of New England.
• Shure, M. B., & Spivack, G. (1980). Interpersonal problem solving as a mediator of behavioral adjustment in preschool and kindergarten children. Journal of Applied Developmental Psychology, 1, 29-44.
• Shure, M. B., & Spivack, G. (1982). Interpersonal problem-solving in young children: A cognitive approach to prevention. American Journal of Community Psychology, 10, 341-355.
• Shure, M. B., & Spivack, G. (1988). Interpersonal cognitive problem solving. In R. H. Price, E. L. Cowen, R. P. Lorion, & J. R. McKay (Eds.), 14 ounces of prevention. Washington, DC: American Psychological Association.
• Shure, M. B., & Healey, K. N. (1993). Interpersonal problem solving and prevention in urban school children. Paper presented at the American Psychological Association Annual Convention, Toronto.
The Incredible Years Series
Contact information:
Carolyn Webster-Stratton, Ph.D. Parenting Clinic School of Nursing University of Washington Seattle, WA 98195
(206) 285-7565 www.incredibleyears.com
Evidence of effectiveness: In a series of six randomized trials, the parent program reduced conduct problems and improved parent-child relationships. In two randomized studies, the teacher program reduced peer aggression in the classroom, increased positive interactions with teachers and peers, and enhanced school readiness. Two randomized studies of the child program demonstrated reductions in conduct problems at home and school and improvements in problem solving with peers. Program effects have been shown to persist for at least one year after treatment.
For further information:
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Mendel, R. A. (2000). Less hype, more help: Reducing juvenile crime, what works—and what doesn't. Washington, DC: American Youth Policy Forum.
• Webster-Stratton, C., & Reid, M. J. (1999). Treating children with early-onset conduct problems: The importance of teacher training. Paper presented at the Association for the Advancement of Behavior Therapy, Toronto, Canada.
• Webster-Stratton, C., & Reid, J. J. (1999). Effects of teacher training in Head Start classrooms: Results of a randomized controlled evaluation. Paper presented at the Society for Prevention Research, New Orleans.
• Webster-Stratton, C. (1999). How to promote social and emotional competence in young children. London, United Kingdom: Sage Publishers.
• Webster-Stratton, C. (1998). Preventing conduct problems in Head Start children: Strengthening parent competencies. Journal of Consulting and Clinical Psychology, 66, 715-730.
• Webster-Stratton, C. (1994). Advancing videotape parent training: A comparison study. Journal of Consulting and Clinical Psychology, 62, 583-593.
• Webster-Stratton, C. (1990). Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children. Journal of Abnormal Child Psychology, 18, 479-492.
• Webster-Stratton, C. (1990). Long-term follow-up of families with young conduct-problem children: From preschool to grade school. Journal of Clinical Child Psychology, 19, 144-149.
• Webster-Stratton, C. (1984). Randomized trial of two parent-training programs for families with conduct-disordered children. Journal of Counseling and Clinical Psychology, 52, 666-678.
• Webster-Stratton, C., & Hammond, M. (1997). Treating children with early-onset conduct problems: A comparison of child and parent training interventions. Journal of Consulting and Clinical Psychology, 65, 93-109.
• Webster-Stratton, C., Kolpacoff, M., & Hollinsworth, T. (1989). The long-term effectiveness and clinical significance of three cost-effective training programs for families with conduct-problem children. Journal of Consulting and Clinical Psychology, 57, 550-553.
• Webster-Stratton, C., Kolpacoff, M., & Hollinsworth, T. (1988). Self-administered videotape therapy for families with conduct-problem children: Comparison of two cost-effective treatments and a control group. Journal of Consulting and Clinical Psychology, 56, 558-566.
• Webster-Stratton, C., Mihalic, S., Fagan, A. Arnold, D., Taylor, T., & Tingley, C. (in press). The incredible years series. In D. S. Elliott (Series Ed.), Blueprints for violence prevention. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
Iowa Strengthening Families Program
Contact information:
Richard Spoth Social and Behavioral Research Center for Rural Health ISU Research Park Building 2, Suite 500 2625 North Loop Drive Iowa State University Ames, IA 50010 (515) 294-4518 www.exnet.iastate.edu
Evidence of effectiveness: Evaluations of this program revealed program-related reductions in alcohol initiation of 30 to 60 percent 2 years after the intervention and lower rates of tobacco, alcohol, and marijuana use and drunkenness after 4 years. Short-term evaluations also demonstrate improvements in parenting practices, parent-child communication, and family bonding.
For further information:
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: Iowa Strengthening Families Program. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Spoth, R., Redmond, C., & Shin, C. (1998). Direct and indirect latent-variable parenting outcomes of two universal family-focused preventive interventions: Extending a public health-oriented research base. Journal of Consulting and Clinical Psychology, 66, 385-399.
• Spoth, R., Redmond, C., & Lepper, H. (in press). Alcohol initiation outcomes of universal family-focused preventive interventions: One- and two-year follow-ups of a controlled study. Journal of Studies on Alcohol.
• Spoth, R., Reyes, M., Redmond, C., & Shin, C. (1998). Assessing a public health approach to delay onset and progression of adolescent substance use: Latent transition and loglinear analyses of longitudinal family preventive intervention outcomes. Ames, IA: Social and Behavioral Research Center for Rural Health.
• Spoth, R. L., Redmond, C., & Shin, C. (1999). Randomized trial of brief family interventions for general populations: Reductions in adolescent substance use four years following baseline. Manuscript under review.
Linking the Interests of Families and Teachers (LIFT)
Contact information:
John B. Reid Oregon Social Learning Center 160 East 4th Avenue Eugene, OR 97401 (541) 485-2711
Evidence of effectiveness: In short-term evaluations, LIFT decreased children's physical aggression on the playground (particularly children rated by their teachers as most aggressive at the start of the study), increased children's social skills, and decreased aversive behavior in mothers rated most aversive at baseline, relative to controls. Three years after participation in the program, 1st-grade participants had fewer increases in attention-deficit disorder-related behaviors (inattentiveness, impulsivity, and hyperactivity) than controls. At follow-up, 5th-grade participants had fewer associations with delinquent peers, were less likely to initiate patterned alcohol use, and were significantly less likely than controls to have been arrested.
For further information:
• Eddy, J. M., Reid, J. B., & Fetrow, R. A. (2000). An elementary-school based prevention program targeting modifiable antecedents of youth delinquency and violence: Linking the Interests of Families and Teachers (LIFT). Journal of Emotional and Behavioral Disorders, 8, 165-176.
• Stoolmiller, M., Eddy, J. M., & Reid, J.B. (2000). Detecting and describing preventative intervention effects in a universal school-based randomized trial targeting delinquent and violent behavior. Journal of Consulting and Clinical Psychology, 68, 296-306.
• Reid, J. B., Eddy, J. M., Fetrow, R. A., & Stoolmiller, M. (1999). Description and immediate impacts of a preventative intervention for conduct problems. American Journal of Community Psychology, 24, 483-517.
Parent Child Development Center Programs
Contact information:
Dale Johnson-Stone Department of Psychology University of Houston-University Park Houston, TX 77004 (713) 743-8612
Evidence of effectiveness: Evaluations of this program have demonstrated enhanced school achievement in grades 2 and 3; improved parenting skills at the end of the program, at (the child's) age 4, and in grades 2 and 3; and reduced aggressive behavior by children at ages 4 to 7 and 8 to 11. Unfortunately, the evaluations of these programs conducted to date have been limited by high attrition rates.
For further information:
• Bridgeman, B., Blumenthal, J.B., & Andrews, S. R. (1981). Parent child development center: Final evaluation report. Washington, DC: Department of Health and Human Services, Office of Human Development Services.
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: Parent Child Development Center Programs. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Johnson, D. L., & Walder, T. (1987). Primary prevention of behavior problems in Mexican-American children. American Journal of Community Psychology, 15, 375-385.
• Howell, J. A. (Ed.). (1995). Guide for implementing the comprehensive strategy for serious, violent, and chronic juvenile offenders. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Thornton, T. N., Craft, C. A., Dahlberg, L. L., Lynch, B. S., & Baer, K. (2000). Best practices of youth violence prevention: A sourcebook for community action. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
Parent-Child Interaction Training
Contact information:
Joseph Strayhorn, Ph.D. Early Childhood Behavior Disorders Clinic 1 Allegheny Square Suite 414 Pittsburgh, PA 15212
Evidence of effectiveness: This intervention has shown positive effects on early antisocial behaviors and family management practices. In a randomized, 1-year follow-up, children who participated in Parent-Child Interaction Training improved significantly more than controls on teacher ratings of attention deficit, hyperactive, aggressive, and anxious behavior.
For further information:
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Howell, J. A. (Ed.). (1995). Guide for implementing the comprehensive strategy for serious, violent, and chronic juvenile offenders. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Strayhorn, J. M., & Weidman, C. S. (1991). Follow-up of one year after parent-child interaction training: Effects on behavior of preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 138-143.
• Thornton, T. N., Craft, C. A., Dahlberg, L. L., Lynch, B. S., & Baer, K. (2000). Best practices of youth violence prevention: A sourcebook for community action. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
Preparing for the Drug-Free Years
Contact information:
J. David Hawkins, Ph.D. University of Washington Social Development Research Group 9725 3rd Avenue N.E. Suite 402 Seattle, WA 98115 (206) 685-1997
Evidence of effectiveness: Evaluations of Preparing for the Drug-Free Years have demonstrated significant program-related positive effects on parenting skills, parent-child relationships, mothers' self-efficacy, and children's avoidance of alcohol initiation. Unfortunately, 43 percent of recruited families did not participate in the initial studies of this intervention, raising questions about the representativeness of the results.
For further information:
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: Preparing for the Drug-Free Years. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Spoth, R., Redmond, C., Shin, C., Lepper, H., Haggerty, K., & Wall, M. (1998). Risk moderation of proximal parent-child outcomes of a universal family-focused preventive intervention: A test of replication. American Journal of Orthopsychiatry, 68, 565-579.
• Spoth, R., Redmond, C., & Shin, C. (1998). Direct and indirect latent parenting outcomes of two universal family-focused preventive interventions: Extending a public health-oriented research base. Journal of Consulting and Clinical Psychology, 66, 385-399.
• Spoth, R., Redmond, C., Hockaday, C., & Yoo, S. (1997). Protective factors and young adolescent tendency to abstain from alcohol use: A model using two waves of intervention study data. American Journal of Community Psychology, 24, 749-770.
• Kosterman, R., Hawkins, J. D., Spoth, R., Haggerty, K. P., & Zhu, K. (1997). Effects of preventive parent training intervention on observed family interactions: Proximal outcomes from Preparing for the Drug-Free Years. Journal of Community Psychology, 25, 277-292.
Preventive Intervention
Contact information:
Brenna H. Bry, Ph.D. Graduate School of Applied and Professional Psychology Rutgers University, Box 819 Piscataway, NJ 08854
Evidence of effectiveness: Evaluations of this program demonstrate both short- and long-term effectiveness on violence-related risk factors, including higher grades and attendance at the end of the program; significantly lower drug use, school-related problems, and unemployment after 1 year; significantly fewer students with county court records at 5 years; and lower rates of reported criminal behavior at the 1.5 year follow-up (marginal significance, p < .075). Program effects on self-reported criminal behavior did not reach statistical significance, although the treatment and control groups did differ significantly with respect to the proportion of students with a juvenile record.
For further information:
• Bry, B. H. (1982). Reducing the incidence of adolescent problems through preventive intervention: One- and five-year follow-up. American Journal of Community Psychology, 10, 265-276.
• Bry, B. H., & George, F. E. (1980). The preventive effects of early intervention on the attendance and grades of urban adolescents. Professional Psychology, 11, 252-260.
• Bry, B. H., & George, F. E. (1979). Evaluating and improving prevention programs: A strategy from drug abuse. Evaluation and Program Planning, 2, 127-136.
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: Preventive Intervention. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
Promoting Alternative Thinking Strategies (PATHS)
Contact information:
Mark T. Greenberg Department of Human Development and Family Studies College of Health and Human Development Pennsylvania State University 110 Henderson Building South University Park, PA 16802-6504 (814) 863-0112
Evidence of effectiveness: Evaluations of this intervention have demonstrated that PATHS improves self-control, understanding and recognition of emotions, the ability to tolerate frustration, the use of effective conflict-resolution strategies, thinking and planning skills, and conduct problems, such as aggression. In students with special needs, PATHS has also been shown to significantly reduce symptoms of anxiety, depression, and sadness and to reduce conduct problems.
For further information:
• Greenberg, M. T., Kusche, C., & Mihalic, S. (1998). Promoting alternative thinking strategies (PATHS). In D. S. Elliott (Series Ed.), Blueprints for violence prevention. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Howell, J. A. (Ed.). (1995). Guide for implementing the comprehensive strategy for serious, violent, and chronic juvenile offenders. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
• Sherman, L. W., Gottfredson, D., MacKenzie, D., Eck, J., Reuter, P., & Bushway, S. (1997). Preventing crime: What works, what doesn't, what's promising. Washington, DC: U.S. Department of Justice, Office of Justice Programs.
• Thornton, T. N., Craft, C. A., Dahlberg, L. L., Lynch, B. S., & Baer, K. (2000). Best practices of youth violence prevention: A sourcebook for community action. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
The Quantum Opportunities Program
Contact information:
C. Benjamin Lattimore Opportunities Industrialization Centers of America, Inc. 1415 North Broad Street Philadelphia, PA 19122 (212) 236-4500, ext. 251
Andrew Hahn Brandeis University Heller Graduate School The Center for Human Resources Waltham, MA 02254-9110 (617) 736-3851
Evidence of effectiveness: In a multisite, randomized evaluation, a follow-up through the expected time of graduation showed that treated youths were significantly less likely than controls to be arrested (0.17 versus 0.58 arrests per person), were more likely to graduate (63 versus 42 percent), were more likely to attend postsecondary schools (42 versus 16 percent), were less likely to be dropouts, were more likely to receive an honor or award, were less likely to become teen parents, and were more likely to be involved in community service, be hopeful about the future, and consider their lives a success. Follow-up for 2 years after graduation revealed persistent, positive program effects.
For further information:
• Lattimore, C. B., Mihalic, S. F., Grotpeter, J. K., & Taggart, R. (1998). The quantum opportunities program. In D. S. Elliott (Series Ed.), Blueprints for violence prevention. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Developmental Research and Programs, Inc. (2000). Communities That Care® prevention strategies: A research guide to what works. Seattle, WA.
• Hahn, A., Leavitt, T., & Aaron, P. (1994). Evaluation of the quantum opportunities program (QOP). Did the program work? A report on the post-secondary outcomes and cost-effectiveness of the QOP program (1989-1993). Waltham, MA: Brandeis University Heller Graduate School Center for Human Resources.
• Mendel, R. A. (2000). Less hype, more help: Reducing juvenile crime, what works—and what doesn't. Washington, DC: American Youth Policy Forum.
Yale Child Welfare Project
Contact information:
Victoria Seitz Yale University Department of Psychology Box 11a, Yale Station New Haven, CT 06520
Evidence of effectiveness: An evaluation conducted 10 years after participation in the program showed that youths enrolled in the Yale Child Welfare Project missed significantly fewer days of school, required significantly fewer remedial and supportive school services, and were rated significantly less negative and more socially well adjusted by their teachers compared to controls. Some program effects on academic achievement showed significant diffusion effects on siblings. However, the sample in this study was small, with only 14 of the original 17 pairs of matched treatment and control youths available for evaluation at follow-up. In addition, this study used a quasi-experimental design. This program is no longer deliverable that is, no technical assistance is available to those who wish to implement it.
For further information:
• Center for the Study and Prevention of Violence. (1999). CSPV blueprints promising fact sheet: Yale Child Welfare Project. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado at Boulder.
• Seitz, V., Rosenbaum, L. K., & Apfel, N. H. (1985). Effects of family support intervention: A ten-year follow-up. Child Development, 56, 376-391.
Chapter 6 A Vision for the Future
In the late 1990s, people in the United States were stunned by a series of tragic shootings at schools that were planned and carried out by youths. These shocking, widely reported events prompted the preparation of this Surgeon General’s
report on youth violence. Yet these shootings were not characteristic of youth violence nationally. Moreover, at the time of the shootings, youth violence in the United States appeared to be on a downward trend.
Serious youth violence that is, physical assault by a child or adolescent that carries a significant risk of injuring or killing another person began to emerge as a social and public health problem of sizable proportions in the 1980s. Arrests of youths for index crimes (robbery, aggravated assault, rape, and homicide) peaked in 1993 after a decade of climbing rapidly, leading some observers to express doubt that anything could be done to halt the epidemic of youth violence. By 1999, after 6 years of sustained decline nationwide, arrests of youths for robbery, rape, and homicide began to resemble the pre-epidemic arrest rates of 1983. A striking exception to this trend was arrests for aggravated assault, which remained 70 percent above 1983 rates.
While arrest records and victimization reports indicated that youth violence was generally declining, other sources of information presented a different picture. In approaching youth violence as a public health problem, this report has looked beyond arrest and other criminal justice records to several national surveys in which high school age youths report in confidence on their violent behavior. These self-reports reveal that the propensity for and actual involvement of youths in serious violence have not declined with arrest rates. Rather, they have remained at the peak rates of 1993, a troublesome finding. In January 2001, as this report goes to press, the first indications of a long-awaited downturn in self-reported violent behavior are being countered by signs from the FBIs Uniform Crime Reports database that the decline in arrests of youths for violent crimes has bottomed out and, for some index crimes, has begun to climb again.
Clearly, the dynamics and magnitude of youth violence remain fluid and complex. Nevertheless, research in the past several decades has developed a wealth of information about the causes of youth violence and how to prevent it. Numerous studies have identified and examined specific risk factors for violence the personal and environmental features of young people’s lives that increase the statistical probability of their engaging in violent behaviors. Research also has begun to identify protective factors that appear to buffer the effects of risk factors. While this information has been accumulating, researchers, youth service practitioners, and others have been designing, implementing, and evaluating a variety of programs and strategies to reduce or prevent the occurrence of youth violence. The best of these interventions target populations of young people identified as being particularly at risk of becoming involved in a violent lifestyle.
Many effective intervention programs exist to reduce and prevent youth violence. The United States is well past the point where anyone can claim that "nothing works" to prevent youth violence or to modify the destructive life courses of youths who are either engaged in or appear to be headed for lifestyles characterized by violence. At the same time, however, many purported youth violence prevention programs used today are untested, and some are known to be ineffective or even deleterious to a child or adolescent’s healthy, safe development.
The courses of action highlighted below are potential next steps. These are not formal policy recommendations. Instead, they represent a vision for the future built on information we possess today. They are intended for policy makers, service and treatment providers, people affiliated with the juvenile justice system, researchers, and most important, the people of the United States. This vision for the future is presented with the hope that it will engage an expanding number of citizens in the challenge of redressing the problem of youth violence.
CONTINUE TO BUILD THE SCIENCE BASE
Scientific research is an essential underpinning of the public health approach to the problem of youth violence. Years of extensive research have revealed the scope of the problem, and we are beginning to understand how to intervene effectively to reduce and prevent violence. Yet most violence prevention programs used in schools, communities, and the justice system today have not been subjected to systematic scientific evaluation, so their effectiveness or lack of effectiveness is unknown. Given evidence that some well-intentioned prevention and intervention programs have proved to be harmful, it is imperative that all programs be scientifically evaluated. Research must also be prepared to address areas of emerging concern. One that has become increasingly clear is the need for studies to investigate intimate violence, or dating violence, among youths to identify patterns that predict continuation of such behaviors into adulthood and to design new types of interventions targeting this form of violent behavior. Another area of concern requiring research is the impact of violent interactive media, such as computer games, on serious violent behavior.
This Surgeon General’s report is issued at a time of unprecedented scientific opportunity in numerous disciplines developmental psychology, sociology, criminology, epidemiology, neuroscience, and many other fields. No single research specialty holds the key to understanding, treating, and preventing violence. Rather, they must work together. One of the greatest challenges to researchers today is finding new ways to use the tools, strategies, and insights from these diverse fields of research to reveal the many factors that may lead a young person toward or protect a young person from involvement in violence. A related need is to invest in cross-level research designs that will enable researchers to examine individual, family, and community factors simultaneously.
Research frequently examines questions and issues that crop up in the daily lives of millions of people the relationship of media depictions of violence to violent behavior is a key example; the impact of strategies to discourage firearm use is another. Such familiarity often increases the likelihood that a person will hold strong opinions regarding the effect of television or popular music, or the presence and use of weapons, on violent behavior. Appropriately designed and conducted research offers a factual basis, rather than opinion, for proposing and debating social policy. It is therefore critical to devise ways of giving people with diverse interests (including parents, teachers, and others) a voice in identifying urgent research questions and to inform them about the conclusions drawn from research.
ACCELERATE THE DECLINE IN GUN USE BY YOUTHS IN VIOLENT ENCOUNTERS
The carrying and use of guns by youths in violent encounters have declined dramatically since 1993, the peak of the violence epidemic. To accelerate that decline, we must seek to understand more completely the reasons for it. Are youths’ decisions not to carry or use guns in violent encounters related to any specific strategies put in place to discourage firearm use, or did the drop in firearm use result from other factors or conditions? Clearly, important questions remain about precisely what has happened in communities nationwide to reduce the frequency with which adolescents carry guns. While some research has addressed these questions (Blumstein & Wallman, 2000), further studies are imperative data documenting the continuing magnitude of violent behaviors suggest that a return to lethal violence is likely if adolescents once again carry and use guns in violent encounters.
FACILITATE THE ENTRY OF YOUTHS INTO EFFECTIVE INTERVENTION PROGRAMS RATHER THAN INCARCERATING THEM
In the 1990s, faced with the epidemic of violence and largely unaware that research had found some violence prevention programs to be effective as well as often buying into the "just desserts" philosophy the only option some legislators saw was to lock up violent youths to protect society. New evidence makes a compelling case that intervention programs can be cost-effective and can reduce the likelihood that youths will become repeat offenders. Given this evidence, it is in the country’s interest to place as many violent youths as possible in these programs, thus correcting the imbalance that now favors use of the criminal justice system over effective intervention programs. Reclaiming youths from a violent lifestyle has clear advantages over warehousing them in prisons and training schools.
Effective programs are not available in many communities. Special efforts must be undertaken to increase awareness of these programs, provide technical assistance and information about them, and devise incentives for states and communities to invest in tested programs. At present, states and communities are squandering substantial amounts of money on untested programs or programs known to be ineffective. Policy makers must be encouraged to focus existing resources on programs that work; evidence of effectiveness might be required, for example, as a condition of receiving Federal or local funding. An informed public is also critical in building support for effective alternatives to incarceration.
DISSEMINATE MODEL PROGRAMS WITH INCENTIVES THAT WILL ENSURE FIDELITY TO ORIGINAL PROGRAM DESIGN WHEN TAKEN TO SCALE
Experience has shown repeatedly that intervention programs shown to be effective in their original sites do not yield uniform outcomes when replicated elsewhere. Upon examination, program evaluators often find that subtle modifications have been introduced into the model program. Lack of a particular category of personnel in a given location, for example, may prompt a program director to substitute professionals or paraprofessionals without proper credentials. Face-to-face training sessions that initially encouraged interaction between a program originator and new staff may be supplanted by videotaped tutorials. The frequency of participants contacts with a program may be lessened or program duration abbreviated.
Legislators, agency administrators, and program directors should be encouraged to identify incentives for ensuring that the integrity of a model program is not compromised when it is replicated.
PROVIDE TRAINING AND CERTIFICATION PROGRAMS FOR INTERVENTION PERSONNEL
The major challenge in implementing effective intervention programs on a national scale is guaranteeing a well-trained staff that understands the intervention and its limitations. Staff must be adequately trained to deliver a particular intervention in the specific settings for which it was designed. Yet because the supply of appropriately trained individuals who are available to work in the variety of settings in which violence prevention programs operate is limited, operational entropy often sets in. Establishing formal training programs and university certification programs will help ensure the quality of interventions.
IMPROVE PUBLIC AWARENESS OF EFFECTIVE INTERVENTIONS
Identifying specific youth violence interventions as effective in this report will probably stimulate demand for these programs. Youth advocacy organizations have an opportunity to educate citizens on how to interact effectively with their local educational and juvenile justice systems, with appropriate sectors of the elected government, and with private organizations involved in youth violence prevention.
Media campaigns and public service announcements offer a means of increasing public awareness. News or documentary television programs featuring model programs have had a measurable impact both on the funding of the programs and
on the volume of requests from sites throughout the country for information about the programs. The 1938 film Boys Town, with Spencer Tracy and Mickey Rooney, proved highly beneficial to the reputation and funding opportunities available to Boys Town. Conceivably, featuring model youth violence prevention programs in popular films today could have an equivalent effect.
CONVENE YOUTHS AND FAMILIES, RESEARCHERS, AND PRIVATE AND PUBLIC ORGANIZATIONS FOR A PERIODIC YOUTH VIOLENCE SUMMIT
The move to a public health focus on violence involves new players and new collaborative partnerships among criminologists, psychologists, psychiatrists, sociologists, neuroscientists, and others. Physicians and other general medical service providers have important roles to play, but they are not yet sufficiently involved. Preparation of the Surgeon General’s report underscored the risks of disciplinary compartmentalization in the study of youth violence.
There is no common place where information needed by all parties interested in the problem of youth violence can be exchanged. A rich literature on research and services appears in the specialty journals of various disciplines, in professional newsletters, in the mass media, and increasingly on the World Wide Web. Lack of interaction between academic research centers and the community-based agencies responsible for implementing youth violence prevention programs or providing medical services to victims (many of whom are also perpetrators) can result in significant costs.
A periodic, highly visible national summit that receives wide popular as well as specialized media coverage would offer a way of disseminating information on new research findings, effective programs and strategies, best practices, and related information for diverse audiences.
IMPROVE FEDERAL, STATE, AND LOCAL STRATEGIES FOR REPORTING CRIME INFORMATION AND VIOLENT DEATHS
The proportion of law enforcement agencies nationwide that report arrests to the FBI’s Uniform Crime Reports (UCR) program has been declining. In 1999, participating agencies represented only 63 percent of the U.S. population. The accuracy of national estimates would be enhanced if this reporting rate were improved. In addition to expanding the participation rate, opportunities for improvement might entail:
• Including arrest rates for all racial and ethnic groups. Hispanics in particular are not represented in systematic data collection systems.
• Encouraging law enforcement agencies to participate in the National Incident-Based Reporting System. Developed by the UCR, the incident-based reporting system provides a much richer data set for tracking violent crime than the aggregated data available in the current UCR. Another potentially useful, innovative data set is the National Violent Death Reporting System proposed by the Centers for Disease Control and Prevention. This data set would help in monitoring the magnitude and characteristics of youth violence on a timely basis so that programmatic and policy responses can be more effectively planned and evaluated.
• Develop a standard set of questions for national self-report surveys (such as Monitoring the Future) that include serious violent offenses. Annual data from these surveys should be obtained from all adolescents age 11 through 17, not just high school seniors. At present, variation among surveys in the age of respondents, data obtained, and frequency of data collection severely limit any composite picture that might result. Data collection efforts must make use of the best methodology available and include follow-up questions on each reported violent event to determine weapon use, drug or alcohol involvement at the time of the event, seriousness of injury, victims’ relationship to offender, number of youths involved in the attack, and other details. Such data enable researchers to correct for the over reporting in the simple checklist used in most surveys.
CONCLUSION
Youth Violence: A Report of the Surgeon General offers compelling testimony that the safety and well-being of children and adolescents are issues of the utmost importance and urgency to individuals and organizations throughout the United States. The report has drawn on the expertise of countless persons in diverse private organizations in local, state, and Federal government agencies; in schools; and most important, in families all of whom are dedicating immense energy and caring to countering the most common threat to the lives of young Americans. Thanks to these efforts and to the insights and actions of young people themselves, it is clear today that youth violence is not an intractable problem; rather, it is a behavior that we can understand, treat, and prevent. This final chapter has offered courses of action intended to help inform the decisions that we must make as we strive to ensure that every child has the opportunity to grow and mature safely, healthily, and happily.