School Violence Prevention: New CMHS School Violence Prevention Program: How to Intervene

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How to Intervene: What Programs Work? What are the Issues?

Over the last decade, researchers have developed a considerable scientific knowledge base regarding the fostering of resilience and the prevention of violence. Unfortunately, practitioners and policy makers have not always used this knowledge in creating programs, and all too often, these programs have not worked (Elliott and Tolan, 1998). Therefore, this CMHS initiative insists on the proposal and implementation of programs which have a solid base of evidence of their effectiveness.

Repeatedly, researchers stress that communities must be truly committed to these programs because the time required to overcome negative influences of disadvantaged neighborhoods, stressed families, poor school adjustment and performance, and delinquent gangs or peer networks is measured in years, not days or hours (Elliott and Tolan, 1998). Furthermore, researchers stress that the most effective interventions are those in which multiple systems that have an impact on children -- families, schools, community agencies, the faith community, and other such entities -- collaborate to decrease risk factors and enhance protective factors. Ideally, a committee to plan and execute an intervention would consist of school and university personnel, parents, families, other care givers, neighbors, medical and mental health providers, public health authorities, law enforcement professionals, faith organizations, other community groups, and both governmental and non governmental organizations.

Because of the multiplicity of risk and protective factors for violence, preventive interventions should be guided by theory that suggests the causal mechanisms that link these factors to future violence. Theory plays a critical role in specifying how different risk and protective factors interrelate and how and when they should be addressed through intervention. For example, it is common knowledge that the experiences of young children are shaped by the coping strategies of their parents, other family members, and/or extra-familial care givers. It is not surprising, then, that findings from studies of early childhood education programs show a strong connection between improvements in family functioning and parenting behavior and decreases in delinquent and antisocial behavior among children in adolescence.

One critical component of early intervention programs is that they must teach parents how to talk to their children in a manner that promotes the child’s acquisition of language. Hart and Risley (1995) found that, if a positive developmental trajectory of a child’s vocabulary acquisition was not established by the time the child entered elementary school, the child had a very high chance, like many children raised in poverty, of entering high school lacking the vocabulary used in more advanced textbooks. They concluded that:

Children’s early interactions set up an entire general approach to words as symbols for experience....Parent talk defines and labels what children should notice and think about the world, their family, and themselves and suggests how interesting and important various objects, events, and relationships are. Words and sentences, internalized as symbols, become a means for organizing experience and rationalizing and relating it, as well as the basis for logical thinking, problem solving, and self-control. The words and expressions that give utterance and preciseness to talk (and eventually, writing) to other people also serve when talking to oneself as thinking (Hart & Risley, 1995, pp. 99-100).

Other useful components of a program are to train teachers to teach cognitive and behavioral skills to students and to redefine schools to include families and communities and thereby provide adult supervision during the "violent hours" between 3:00 and 6:00 p.m. (Elliott, Hamburg, & Williams, 1998).

Evidence-Based Interventions

In the search for evidence-based interventions to inform the CMHS initiative, we consulted with our colleagues at the Center for Substance Abuse Prevention (CSAP) and the National Institute of Mental Health (NIMH), and we reviewed the model and promising resilience enhancing and violence prevention programs identified by several different organizations. It should be emphasized that these organizations use different standards of evidence-based criteria to identify those programs they feel are adequately sound to be recommended. The following key programs were reviewed:

A. United States Department of Justice, Preventing Crime: What Works, What Doesn’t, What’s Promising

A 1996 Federal law mandated that the Department of Justice (DOJ) provide Congress with an independent review of the effectiveness of State and local crime prevention programs funded, "with special emphasis on factors that relate to juvenile crime and the effect of these programs on youth violence." The law further mandated that the review "employ rigorous and scientifically recognized standards and methodologies" (Sherman et al., 1998). In 1997, DOJ presented to Congress the results of its study, Preventing Crime: What Works, What Doesn't, What's Promising.

This report was based on a systematic review of more than 500 scientific evaluations of crime prevention practices. In brief, the DOJ report concluded that the following principles are relevant to children, families, and schools:

What Works:

For infants aged 0 to 2: Frequent home visits by trained nurses and other professionals reduce child abuse and other injuries to infants.
For preschoolers under age 5: Classes with weekly home visits by preschool teachers substantially reduce arrests at least through age 15.
For delinquent and at-risk preadolescents: Family therapy and parent training reduce risk factors for delinquency such as aggression and hyperactivity.
For schools:

Organizational development for innovation: Building school capacity to initiate and sustain innovation through the use of school teams or other organizational development strategies reduces crime and delinquency.
Communication and reinforcement of clear, consistent norms about behavior through rules, reinforcement of positive behavior, and school- wide initiatives (such as anti-bullying campaigns) reduce crime, delinquency, and substance abuse.
Social competency skills curricula, such as Life Skills Training (L.S.T.), which teach, over a long period of time, such skills as stress management, problem solving, self-control, and emotional intelligence reduce delinquency, substance abuse, and conduct problems.
Coaching of high-risk youth in "thinking skills" and using behavior modification techniques or rewards and punishments reduces substance abuse.

B. The Center for Substance Abuse Prevention. As the lead Federal agency for substance abuse prevention, the Center for Substance Abuse Prevention (CSAP) has a major role in bridging the gap between prevention research and practice by identifying effective programs and practices, and disseminating that knowledge to the field. Many of the effective programs, while targeting alcohol and drug abuse issues, clearly have a positive impact on other aspects of the child’s healthy development, resilience, and mental health. For this reason, we would recommend that the effective programs proposed by CSAP be considered by any community, school, or organization intending to develop a comprehensive violence prevention program.

A CSAP (1998) expert review of family-focused approaches has determined that three approaches have a high level of evidence of effectiveness in reducing behavioral and emotional problems in youth, namely:

Behavioral parent training
Family skills training (which combines parent training, children’s skills training, and family relationship enhancement and communication practice sessions)
Structural or behavioral family therapy

Forty-five research-based parenting and family intervention models have been selected by CSAP for a current grant announcement to increase the capacity of communities to deliver best practices in effective parenting and family programs (see Exhibit III). The most recent catalogue of CSAP programs are contained in a current draft publication entitled, Science-based Practices in Substance Abuse Prevention: A Guide (1998). This document can be obtained from the Division of Knowledge Development and Evaluation at CSAP, (301) 443-9110. A further resource for communities and schools is: Understanding Substance Abuse Prevention -- Toward the 21st Century: A Primer on Effective Programs, which may be obtained from the Government Printing Office (GPO), Washington, D.C.

C. National Association of School Psychologists’ Exemplary Mental Health Programs: School Psychologists as Mental Health Service Providers

The National Assocaition of School Psychologists (NASP) defined "exemplary programs" using the following criteria:

Integrates theory, research, and practice
Addresses links among ecological systems (i.e., school, family, community, peer group)
Is framed within a continuum of services (prevention, risk-reduction, early intervention, and treatment)
Uses a collaborative-participatory model in which agency staff and program consumers participate in program development, implementation, and/or evaluation
Evaluates program acceptability, integrity, and effectiveness
Includes involvement of one or more school psychologists in program design, implementation, and/or evaluation (Nastasi, Varjas, & Bernstein, 1997)

Specific NASP-recommended programs may be obtained from the National Association of School Psychologists, Director of Professional Information and Communication, 4340 East West Highway, Suite 402, Bethesda, MD 20814; (301) 657-0270.

http://www.nasponline.org/index2.html

D. Center for the Study and Prevention of Violence

The Center for the Study and Prevention of Violence (CSPV) receives funding from the Centers for Disease Control and Prevention (CDC), NIMH, and DOJ. In 1996, CSPV initiated a project to identify "truly outstanding" violence prevention programs. After reviewing more than 400 prevention and intervention programs, CSPV developed a series of ten "Blueprints." These practical descriptions of the ten most effective programs allow States, communities, and individual agencies to:

Determine the appropriateness of an intervention for their State or community,
Provide a realistic cost estimate for the intervention,
Provide an assessment of the organizational capacity needed to ensure successful start-up and operation over time,
Give some indication of the potential barriers and obstacles that might be encountered when attempting to implement this type of intervention.

Each of these programs was required to meet rigorous selection criteria, including an experimental design, evidence of a statistically significant deterrent effect, replication in at least one additional site with experimental design and demonstrated effects, and evidence that the deterrent effect was sustained for at least one year post-treatment. According to Elliott, these high standards reflect "the level of confidence needed to build a violence prevention initiative, with the objective of allowing communities to implement these programs with the confidence of effectiveness in deterring violence, if implemented with integrity." See Exhibit I for a list of CSPV model and promising programs. Additional information can also be obtained from the CSPV website, http://www.colorado.edu/cspv.

E. Communities That Care: A Comprehensive Prevention Program: Promising Approaches

Communities That Care (CTC) is a comprehensive, research-based community mobilization and planning organization that helps communities mobilize schools, families, local agencies and organizations, the media, and young people themselves to collaborate in the creation of a safe, supportive environment for all. CTC has identified a number of "promising approaches" or prevention strategies that have been shown through high-quality research to be effective in reducing risk factors and enhancing protective factors for adolescent health and behavior problems (Communities That Care, 1996). To be considered a "Promising Approach" a program had to:

Address research-based risk factors for substance abuse, delinquency, teen pregnancy, school dropout, and violence,
Increase protective factors by (1) strengthening healthy beliefs and clear standards for behavior, or (2) building bonds to family, community, school, and/or positive peers by providing opportunities for meaningful contribution, teaching skills necessary for contributing and recognizing skillful performance,
Intervene at a developmentally appropriate age,
Have shown positive effects in high-quality tests. These programs have demonstrated significant effects on risk and protective factors in controlled studies or community trials. Some have also shown positive effects on health and behavior problems.

The Promising Approaches guide is divided into four focus areas: family, school, community-based youth programs, and community. The guide contains far too many programs to include in this document. A copy of the guide may be obtained from Channing Bete Company, One Community Place. Phone (877) 896-8532; FAX (800) 499-6464; E-mail: PrevSci@channing-bete.com; Web site: www.channing-bete.com.

F. The Literature on the Development of Resilience

In planning interventions, one would do well to heed the advice of researchers who have focused on resilience; their work "offers the prevention, education, and youth development fields solid research evidence for placing human development at the focus of everything that we do" (Benard, 1996). Essential components of strength-based, resilience-enhancing experiences -- whether at home, at school, or in the community -- are caring relationships, high expectations and adequate support to meet them, and opportunities to contribute to other people or to the world at large. See Exhibit II for sample programs. Additional information may be obtained from the Center for Mental Health Services (CMHS), State Programs Development Branch (SPDB), Room 18C-07, 5600 Fishers Lane, Rockville, MD 20857 or NDavis1@SAMHSA.gov.

G. U.S. Departments of Education and Justice, Annual Report on School Safety, 1998

This first Annual Report on School Safety presents a description of the nature and extent of crime and violence on school properties. Additionally, it presents summary information on model programs that have demonstrated success or are promising in addressing the problems and issues related to school crime. Communities can consider these programs in developing and implementing their comprehensive plans. The material is organized by the types of problems schools encounter such as aggression, fighting, bullying, family issues, gangs, racial and other bias related conflict, sexual harassment/sexual violence, substance abuse, truancy/drop out, vandalism, and weapons. Additional information may be obtained from the Safe and Drug-Free Schools Programs Office @ www.ed.gov/offices/OESE/SDFS and/or the Office of Juvenile Justice and Delinquency Prevention @ http://ojjdp.ncjrs.org/.

H. Proceedings of the National Suicide Prevention Conference: Advancing the National Strategy for Suicide Prevention

This October 1998 conference brought together suicide prevention experts from across the country to develop core recommendations that could be adopted as a national strategy. Distinguished researchers and experts reviewed the research literature and existing programs to determine which programs hold the most promise for the future of suicide prevention. Their recommendations for suicide prevention interventions in school-aged children are:

Public Education

a. Promote education and awareness to individuals at risk, their families, and care providers on signs and symptoms of depression and suicidal behavior.

b. Develop effective methods to reduce stigma and embarrassment about seeking help and accessing mental health services. Promote the message, "It is ok to seek help."

c. Develop and implement education programs for youth to help them self-identify symptoms of depression and suicidalilty and to provide information on the nature and treatment of mood disorders.

School Based Programs

a. Endorse proactive skill development beginning in early childhood. School programs should include coping skills for loss, impulse control, anger management, problem solving, conflict resolution, emotional lability, and depression management. In addition, they should promote developmental assets and resiliency.

b. Develop, implement, and evaluate specific screening projects for students entering middle school, high school, and college.

c. Incorporate suicide prevention in a proven, safe, and age appropriate comprehensive health curriculum for all students throughout the school years, with accompanying materials for family members.

d. Improve linkages between schools and mental health services for all.

e. Bring focus to school mental health efforts through training of administrators, teachers, school staff, and others.

f. Establish school-based health clinics for mental and physical health.

Detection/Treatment of Mental Illness

a. Identify, treat, and improve treatment (e.g. through services or referral) for youth with conduct disorders, substance abuse, and affective and psychotic disorders.

Alcohol and Other Drug Abuse

a. Reduce alcohol and other substance abuse among high risk populations.

Access to Mental Health/Health Services

a. Identify drop-outs and other youth without community affiliation as being at high risk, and treat accordingly.

Training

a. Develop education and training of people in communities who are likely to come into contact with persons at risk for suicide so that they can recognize and respond to them. Among those who should be trained are teachers, human resource managers, bus drivers, families, clergy, and law enforcement.

b. Develop culturally appropriate stress management techniques for youth.

c. Develop guidelines and training for practitioners who deal with children and youth. This training should include best practices, issues specific to youth, and appropriate diagnostic and treatment procedures.

Post-Intervention

a. Encourage the implementation of effective crisis intervention programs for the entire school community after a suicide.

Additional information may be obtained from the Suicide Prevention Advocacy Network, 5034 Odin’s Way, Marietta, GA 30068, (888) 649-1366, http://www.spanusa.org.

I. United States General Accounting Office

In addition to the recommendations of the above organizations, the U.S. General Accounting Office (GAO) (1995) has identified seven characteristics associated with the most promising violence prevention programs:

Comprehensive approach. These programs recognize violence as a complex problem that requires a multifaceted response, addresses more than one problem area, and involves a variety of services that link schools to the community.
Early start and long-term commitment. There is a focus on (1) reaching young children to shape attitudes, knowledge, and behavior while they are still open to positive influences and (2) sustaining the intervention over multiple years (for example, from K through 12^th grade).
Strong leadership and disciplinary policies. Leadership is strong at the school level. Principals and school administrators need to sustain stable funding, staff, and program components, and, most importantly, they must collaborate with others to reach program goals. In addition, student disciplinary policies are clear and consistently applied.
Staff development. Key school administrators, teachers, and staff are trained to handle disruptive students and mediate conflict as well as to understand and incorporate prevention strategies into their school activities.
Parental involvement. The schools seek to increase parental involvement in reducing violence by providing training in violence prevention skills, making home visits, and enlisting parents as volunteers.
Interagency partnerships and community linkages. The schools seek community support in making school antiviolence policies and programs work. To accomplish this, they develop collaborative agreements in which school personnel, local businesses, law enforcement officers, social service agencies, and private groups work together to address the multiple causes of violence.
Culturally sensitive and developmentally appropriate materials and activities. Program materials and activities are designed to be compatible with (1) students’ cultural values and norms by using bilingual materials and culturally appropriate program activities, role models, and leaders, and (2) participants’ age and level of development.

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