Delinquency Prevention Programs Face A Number Of Obstacles To Critical Thinking

PREDICTING SERIOUS DELINQUENCY

Over the years, a number of studies have examined risk markers for or predictors of serious delinquency, chronic offending, and violent delinquency. Several excellent summaries of that literature exist (Hawkins et al., 1998; Lipsey and Derzon, 1998; Biglan et al., 2004; Farrington and Welsh, 2007). Lipsey and Derzon (1998, p. 88), using meta-analytic techniques, identified 793 effect sizes from 66 reports of 34 independent studies, and Hawkins and colleagues (1998) identified 39 studies and provided a substantive summary of the identified risk markers. Summarizing the rather voluminous findings from these reviews in a short space is a difficult task. For an overview, see Table 6-1.

This table shows the largest effect sizes for particular risk markers at different ages. As the table shows, the identified risk markers cut across a number of developmental domains, including prior offending and aggression, as well as peer, family, and school factors. Hawkins and colleagues (1998) also found significant risk markers in all of the developmental domains they examined: individual, family, school, peer, and community. To illustrate their findings, we summarize risk markers from the area of the family: “Within the family, living with a criminal parent or parents, harsh discipline, physical abuse and neglect, poor family management practices, low levels of parent involvement with the child, high levels of family conflict, parental attitudes favorable to violence, and separation from family have all been linked to later violence” (Hawkins et al., 1998, p. 146). We can draw several important conclusions from the results presented in these and other reviews.

First, there is no single risk marker that is very strongly associated with serious delinquency. As is true of other problem behaviors, there are multiple risk markers drawn from multiple domains, each of which, alone, is only modestly related to these outcomes. In other words, there is no single solution on which to focus efforts to prevent serious delinquency. This behavior pattern appears to come about from the accumulation of risk across many domains (Hawkins et al., 1998; Lipsey and Derzon, 1998; Biglan et al., 2004; Farrington and Welsh, 2007; Howell, 2009).

Second, risk for serious delinquency is generated across multiple developmental stages from infancy through childhood and into adolescence, with risk markers at each stage making contributions to the origins of serious delinquency. Although early risk markers have a role to play, they are clearly not determinative of these outcomes. However, early risk markers are predictive of the development of new risk markers for delinquency at subsequent ages. For example, risk indicators during early childhood, such as increased aggression and hyperactivity, are predictive of peer rejection and either peer isolation or attachment to delinquent peers; both of these

Shootings and deaths in schools throughout the United States have left parents believing that their communities are no longer safe from the most extreme examples of youth violence (Gallup, 1999). This perception, combined with the increased lethality of youth violence in the early 1990s, has lent urgency to the search for effective violence prevention efforts. Hundreds of youth violence prevention programs are being used in schools and communities throughout the country, yet little is known about the actual effects of many of them (Gottfredson et al., 2000; Tolan & Guerra, 1994). Few such programs have been rigorously evaluated, including many ongoing efforts (Elliott, 1998). The evaluations that have been done indicate that much of the money America spends on youth violence prevention is spent on ineffective -- sometimes even harmful -- programs and policies (Mendel, 2000).

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

Unfortunately, the news about effective programs has been slow to bring about change in school, community, and juvenile justice system prevention efforts, where precious resources continue to be spent on ineffective programs. Some experts believe that youth crime and violence rates could be "substantially" reduced simply by reallocating the 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 many challenges. The first lies in identifying effective prevention approaches and programs. Differentiating between effective and ineffective ones can be a difficult chore for schools, communities, and juvenile justice authorities. Numerous agencies and organizations have published recommendations on "what works" in youth violence prevention, but in many cases there is little consistency regarding the specific programs they recommend. The reason for this inconsistency is a lack of uniformly applied scientific standards for what works.

Promoting Healthy, Nonviolent Children

This chapter identifies a set of standards based on scientific consensus and applies those standards to the literature on youth violence prevention in order to identify with confidence general strategies and programs that work, that are promising, or that do not work to prevent youth violence. This information can be used by schools, communities, juvenile justice agencies, program funders, and others interested in youth violence prevention to aid their programming decisions. With this information in hand, it may be possible to fulfill the prediction that better use of existing prevention resources can substantially reduce the problem of youth violence.

The first section of this chapter describes the methods used in this report to identify best practices in youth violence prevention. The second describes currently accepted scientific standards for determining program effectiveness. The third section applies those standards to the existing youth violence prevention literature and presents findings on best practices -- what works, what is promising, and what does not work. The information in that section is based on currently available research and is not intended to be the final word on the subject. As more programs are evaluated, the standards outlined in this report can be used to identify additional programs and strategies that work in preventing youth violence.

The fourth section, on cost-effectiveness, is intended to enhance the information provided in the best practices section by adding another dimension to the determination of what works. The conclusion discusses the need to take the next step in preventing youth violence by learning how to preserve the benefits of successful prevention programs when implementing 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 method of combining the results of several studies to obtain more reliable estimates of the effects of a general type of treatment or intervention. This quantitative approach can be used to summarize program evaluation evidence and draw overall conclusions about the strength and consistency of the influence, or effect size, that particular types of programs have on violent behavior. In the field of youth violence, meta-analysis has been used primarily for evaluations of interventions with violent or delinquent youths.

The second, less empirical approach is to review the evaluation research and identify the general strategies that characterize effective programs. While such reviews are not quantitative, they are more easily conducted than meta-analyses, and they offer useful information for generating hypotheses and drawing general conclusions about the effectiveness of various strategies for preventing youth violence.

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

Strategies and programs are first classified as effective or ineffective. Effective strategies and programs are then further broken down into Model programs, which meet very high standards of demonstrated effectiveness, and Promising programs, which meet a minimum standard. Finally, within Model and Promising categories, a distinction is made between strategies 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 for Level 1 programs was based upon the major meta-analysis of program effectiveness (Lipsey & Wilson, 1998), which did not differentiate between those two outcomes. Serious delinquency 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 risk factors with large effect sizes (substance use, weak social ties, antisocial or delinquent peers, gang membership).1 For Promising strategies, Level 1 again refers to programs with demonstrated effects on violence and serious delinquency. Level 2 programs are those with demonstrated 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 strategies that affect small risk factors for youth violence, such as academic failure or anxiety and depressive disorders. Therefore, some effective programs or strategies that target small risk factors may not be included. However, such programs and strategies occasionally came to our attention; those that did were included if the risk factors they affected had an effect size of .10 or greater. Thus, risk factors such as child abuse and neglect, which have an effect size of less than .10, are not covered in this report.2 Also excluded are clinical trials of psychotropic medications, which have proved effective in treating some affective disorders that are risk factors for youth violence but have not been shown in rigorous clinical studies to reduce youth violence specifically. A review of these interventions can be found in Mental Health: A Report of the Surgeon General (1999).

Several major reviews of youth violence prevention and intervention programs have been published 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 section below on scientific standards for effectiveness, but they are not referred to repeatedly in the section on best practices. Citations not listed above will be included where appropriate.

Many reviews use either no explicit criteria or only minimal criteria for identifying the programs they recommend, making it difficult to draw clear conclusions about the effectiveness of individual violence prevention strategies. This report limits its identification of effective programs to those meeting a minimum standard of study design similar 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 an evaluation used an experimental or quasi-experimental design. This report applied that design standard to the extent possible, given the limitations described above.

This report also attempts to distinguish between absolute deterrent effects, in which an intervention is compared to no treatment, and marginal deterrent effects, in which the intervention or strategy is evaluated against another treatment. Marginal deterrent effects are effects of the intervention over and above the effects of another treatment strategy and thus may underestimate the true effects of the intervention, compared to receiving no treatment at all. In such cases, the nature of the comparison group is identified 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 general approach has a critical limitation: Within any given category of programs, there may be specific programs that are effective and others that are not; moreover, programs may be effective for some populations but not others (males but not females, for example). The general effect size is an estimate of the average effect and thus may not characterize any particular program or its use for a particular population. Often the effects of individual programs within each general strategy vary widely. For this reason, it is necessary to take one more step in the identification of best practices -- focusing specifically on individual programs that work.

Identifying specific programs that work requires a clear set of standards for judging effectiveness. This chapter describes the scientific community's consensus regarding standards and how this report applied those standards to the evaluation literature to place programs in one of three categories: Model (demonstrates a high level of effectiveness), 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 qualifications of a Model program. Many more have met the standards for a Promising program, and even more would probably meet these standards if evaluated appropriately. The fact that a program is not identified in this report as Promising or Model does not mean it is ineffective; in most cases it means only that it has not been rigorously evaluated. Those evaluated and found to be ineffective are identified as ineffective. While hundreds of programs are employed throughout the United States to prevent youth violence and treat young offenders, only those with a credible scientific evaluation are highlighted in this report. This shortfall underscores the need for a renewed focus on evaluation in the field of youth violence prevention.

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:
    - Violence or serious delinquency (Level 1)
    - 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 5-B, 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 5-1 summarizes effective and ineffective strategies, and Box 5-2 lists the programs discussed below by best practices category: Model, Promising, or Does Not Work.

Table

Box 5-1. Rating intervention strategies.

Table

Box 5-2. Rating prevention programs.

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.

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.

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 media program, school program, parent education and organization, community organization, and local health 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.

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.

Table

Table 5-1. Average effect sizes.

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).

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

Table 5-2. Cost-effectiveness of early intervention in California1.

Of the four approaches listed in Table 5-2

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