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|  | **Chapter 5:**Prevention and Intervention

Promoting Healthy, Nonviolent Children

Methods of Identifying Best Practices

Scientific Standards for Determining Program Effectiveness
- Model  PromisingDoes Not Work
Stategies and Programs: Model, Promising, and Does Not Work
Primary Prevention: General Populations of Young People
- Ineffective Primary Prevention Programs  Secondary Prevention: Children at High Risk of ViolenceIneffective Secondary Prevention Approaches
- Tertiary Prevention: Violent or Seriously Delinquent Youths  Ineffective Tertiary Programs and Strategies
Cost-Effectiveness

Conclusions

Going to Scale

References

Appendix 5-A: Consistency of Best Practices Evaluations

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

Model Programs: Level 1 (Violence Prevention)
- Functional Family Therapy (FFT)  Multidimensional Treatment Foster CareMultisystemic Therapy (MST)
- Prenatal and Infancy Home Visitation by Nurses  Seattle Social Development Project
Model Programs: Level 2 (Risk Prevention)
- Life Skills Training (LST)  The Midwestern Prevention Project
Promising Programs: Level 1 (Violence Prevention)
- Intensive Protective Supervision Project  Montreal Longitudinal Study/Preventive Treatment ProgramPerry Preschool Program
- School Transitional Environmental Program (STEP)  Striving Together to Achieve Rewarding Tomorrows (CASASTART, formerly Children At Risk [CAR])Syracuse Family Development Research Program
Promising Programs: Level 2 (Risk Prevention)
Bullying Prevention Program
- Families and Schools Together (FAST Track)  Good Behavior GameI Can Problem Solve
- The Incredible Years Series  Iowa Strengthening Families ProgramLinking the Interests of Families and Teachers (LIFT)
- Parent Child Development Center Programs  Parent-Child Interaction TrainingPreparing for the Drug-Free Years
- Preventive Intervention  Promoting Alternative Thinking Strategies (PATHS)The Quantum Opportunities Program
- Yale Child Welfare Project       Chapter 5Prevention and Intervention
Shootings and deaths in schools throughout the United States have left parentsbelieving that their communities are no longer safe from the most extreme examples ofyouth violence (Gallup, 1999). This perception, combined with the increased lethality ofyouth violence in the early 1990s, has lent urgency to the search for effective violenceprevention efforts. Hundreds of youth violence prevention programs are being used inschools and communities throughout the country, yet little is known about the actualeffects of many of them (Gottfredson et al., 2000; Tolan & Guerra, 1994). Few suchprograms have been rigorously evaluated, including many ongoing efforts (Elliott, 1998).The evaluations that have been done indicate that much of the money America spends onyouth violence prevention is spent on ineffective—sometimes evenharmful—programs and policies (Mendel, 2000).

At the same time, researchers know much more today about how to prevent youth violencethan they did two decades ago, when some declared that "nothing works" toprevent violence (Lipton et al., 1975; Sechrest et al., 1979). This is clearly no longerthe case. Over the past few decades, social scientists have made great strides inuncovering the causes and correlates of youth violence. 

Unfortunately, the news about effective programs has been slow to bring about change inschool, community, and juvenile justice system prevention efforts, where preciousresources continue to be spent on ineffective programs. Some experts believe that youthcrime and violence rates could be "substantially" reduced simply by reallocatingthe money now spent on ineffective policies and programs to those that do work (Mendel,2000, p. 1).

The strategy of using prevention resources to their fullest potential presents manychallenges. The first lies in identifying effective prevention approaches and programs.Differentiating between effective and ineffective ones can be a difficult chore forschools, communities, and juvenile justice authorities. Numerous agencies andorganizations have published recommendations on "what works" in youth violenceprevention, but in many cases there is little consistency regarding the specific programsthey recommend. The reason for this inconsistency is a lack of uniformly appliedscientific standards for what works.
PROMOTING HEALTHY, NONVIOLENT CHILDREN
This chapter identifies a set of standards based on scientific consensus and appliesthose standards to the literature on youth violence prevention in order to identify withconfidence general strategies and programs that work, that are promising, or that do notwork to prevent youth violence. This information can be used by schools, communities,juvenile justice agencies, program funders, and others interested in youth violenceprevention to aid their programming decisions. With this information in hand, it may bepossible to fulfill the prediction that better use of existing prevention resources cansubstantially reduce the problem of youth violence.

The first section of this chapter describes the methods used in this report to identifybest practices in youth violence prevention. The second describes currently acceptedscientific standards for determining program effectiveness. The third section appliesthose standards to the existing youth violence prevention literature and presents findingson best practices—what works, what is promising, and what does not work. Theinformation in that section is based on currently available research and is not intendedto be the final word on the subject. As more programs are evaluated, the standardsoutlined in this report can be used to identify additional programs and strategies thatwork in preventing youth violence. 

The fourth section, on cost-effectiveness, is intended to enhance the informationprovided in the best practices section by adding another dimension to the determination ofwhat works. The conclusion discusses the need to take the next step in preventing youthviolence by learning how to preserve the benefits of successful prevention programs whenimplementing them on a national scale. 
METHODS OF IDENTIFYING BEST PRACTICES
Identifying the best practices for preventing youth violence involves two approaches,each with its own limitations. The first is meta-analysis, a rigorous statistical methodof combining the results of several studies to obtain more reliable estimates of theeffects of a general type of treatment or intervention. This quantitative approach can beused to summarize program evaluation evidence and draw overall conclusions about thestrength and consistency of the influence, or effect size, that particular types ofprograms have on violent behavior. In the field of youth violence, meta-analysis has beenused primarily for evaluations of interventions with violent or delinquent youths. 

The second, less empirical approach is to review the evaluation research and identifythe general strategies that characterize effective programs. While such reviews are notquantitative, they are more easily conducted than meta-analyses, and they offer usefulinformation for generating hypotheses and drawing general conclusions about theeffectiveness of various strategies for preventing youth violence. 

In identifying best practices, this report relies heavily on recently published reviewsand focuses mainly on strategies and programs with demonstrated effects on youth violenceand on the major risk factors for youth violence. 

Strategies and programs are first classified as effective or ineffective. Effectivestrategies and programs are then further broken down into Model programs, which meet veryhigh standards of demonstrated effectiveness, and Promising programs, which meet a minimumstandard. Finally, within Model and Promising categories, a distinction is made betweenstrategies and programs that have demonstrated effects on violence and serious delinquency(Level 1) and those that have demonstrated effectiveness on known risk factors (Level 2).

The decision to include serious delinquency along with violence as a criterion forLevel 1 programs was based upon the major meta-analysis of program effectiveness (Lipsey& Wilson, 1998), which did not differentiate between those two outcomes. Seriousdelinquency was a major risk factor for violence in both the early and late onset of risk(see Chapter 4). Level 2 Model programs are those that address any of the other riskfactors with large effect sizes (substance use, weak social ties, antisocial or delinquentpeers, gang membership).1 For Promising strategies, Level 1 again refers to programs withdemonstrated effects on violence and serious delinquency. Level 2 programs are those withdemonstrated effects on *any* risk factor with an effect size of .10 or greater.

No attempt was made to systematically search the literature for programs and strategiesthat affect small risk factors for youth violence, such as academic failure or anxiety anddepressive disorders. Therefore, some effective programs or strategies that target smallrisk factors may not be included. However, such programs and strategies occasionally cameto our attention; those that did were included if the risk factors they affected had aneffect size of .10 or greater. Thus, risk factors such as child abuse and neglect, whichhave an effect size of less than .10, are not covered in this report.2 Also excluded areclinical trials of psychotropic medications, which have proved effective in treating someaffective disorders that are risk factors for youth violence but have not been shown inrigorous clinical studies to reduce youth violence specifically. A review of theseinterventions can be found in *Mental Health: A Report of the Surgeon General*(1999).

Several major reviews of youth violence prevention and intervention programs have beenpublished in the past decade. This chapter draws mainly upon the following:3- Preventing Crime: What Works, What Doesn’t, What’s Promising.  A Report to the United States Congress  (Sherman et al., 1997)
- The Office of Juvenile Justice and Delinquency Prevention’s  A Sourcebook:    Serious, Violent, and Chronic Juvenile Offenders  (Howell et al., 1995) 
- The Office of Juvenile Justice and Delinquency Prevention’s  Guide for    Implementing the Comprehensive Strategy for Serious, Violent, and Chronic Juvenile    Offenders  (Howell, 1995)
- The Centers for Disease Control and Prevention’s  Best Practices of Youth    Violence Prevention: A Sourcebook for Community Action  (Thornton et al., 2000)
- The American Youth Policy Forum’s  Less Hype, More Help: Reducing Juvenile Crime,    What Works—And What Doesn’t  (Mendel, 2000) 
- The Center for the Study and Prevention of Violence’s  Blueprints for Violence    Prevention  (Elliott & Tolan, 1999) 
- "School-Based Crime Prevention" (Gottfredson et al., in press)

To improve readability, the reviews listed above are cited here and in the sectionbelow on scientific standards for effectiveness, but they are not referred to repeatedlyin the section on best practices. Citations not listed above will be included whereappropriate.

Many reviews use either no explicit criteria or only minimal criteria for identifyingthe programs they recommend, making it difficult to draw clear conclusions about theeffectiveness of individual violence prevention strategies. This report limits itsidentification of effective programs to those meeting a minimum standard of study designsimilar to the maximum standard described in Sherman et al. (1997) and Gottfredson et al.(in press). In those two reports, a scientific methods score of 4 or 5 indicates that anevaluation used an experimental or quasi-experimental design. This report applied thatdesign standard to the extent possible, given the limitations described above. 

This report also attempts to distinguish between absolute deterrent effects, in whichan intervention is compared to no treatment, and marginal deterrent effects, in which theintervention or strategy is evaluated against another treatment. Marginal deterrenteffects are effects of the intervention over and above the effects of another treatmentstrategy and thus may underestimate the true effects of the intervention, compared toreceiving no treatment at all. In such cases, the nature of the comparison group isidentified in the text.

Both meta-analyses and reviews can be used to identify successful strategies,approaches, or types of programs used to prevent youth violence. However, this generalapproach has a critical limitation: Within any given category of programs, there may bespecific programs that are effective and others that are not; moreover, programs may beeffective for some populations but not others (males but not females, for example). Thegeneral effect size is an estimate of the average effect and thus may not characterize anyparticular program or its use for a particular population. Often the effects of individualprograms within each general strategy vary widely. For this reason, it is necessary totake one more step in the identification of best practices—focusing specifically onindividual programs that work. 

Identifying specific programs that work requires a clear set of standards for judgingeffectiveness. This chapter describes the scientific community’s consensus regardingstandards and how this report applied those standards to the evaluation literature toplace programs in one of three categories: Model (demonstrates a high level ofeffectiveness), Promising (meets minimal standards of effectiveness), or Does Not Work(consistent evidence of no effects or harmful effects). 

Few existing violence prevention and intervention programs have met the qualificationsof a Model program. Many more have met the standards for a Promising program, and evenmore would probably meet these standards if evaluated appropriately. The fact that aprogram is not identified in this report as Promising or Model does not mean it isineffective; in most cases it means only that it has not been rigorously evaluated. Thoseevaluated and found to be ineffective are identified as ineffective. While hundreds ofprograms are employed throughout the United States to prevent youth violence and treatyoung offenders, only those with a credible scientific evaluation are highlighted in thisreport. This shortfall underscores the need for a renewed focus on evaluation in the fieldof youth violence prevention.
**Footnotes**1
As indicated in Chapter 4, drug use has a large effect    size as an early risk factor but a small effect size as a late risk factor. It is included    here as an outcome criterion for level 2 Model programs because most of the existing drug    prevention programs begin in the early period, or before adolescence.2
This limitation in the review of programs and strategies should    not be interpreted as a judgment that such programs are unimportant. Programs that    successfully address multiple risk factors, even those with very small individual effect    sizes, may be very useful and should be supported and disseminated. Given limited funding,    however, it seems prudent to invest in those programs that have greater potential effects    on violence prevention.3
Reviews by the Hamilton Fish Institute (2000), Drug    Strategies Research Institute (1998), and the Center for Substance Abuse Prevention's    (2000) online list of model programs were also considered. For the most part, these    sources used criteria for selecting the programs they recommend different from those used    in this report, or their recommendations overlap those in the primary sources for violence    prevention listed above.
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