Secondary Prevention for Youth Violence - Semantic Scholar

Secondary Prevention for Youth Violence: A Review of Selected School-Based Programs Irma A. Molina, MSW Catherine N. Dulmus, PhD Karen M. Sowers, PhD

In the United States, school violence is an issue of national concern. Many schools have responded to the problem by implementing prevention strategies that are, in general, of limited or unknown efficacy. Therefore, it is imperative that school officials be aware of efficacious school-based secondary violence prevention programs for at-risk youth, in order to select and implement a program that best meets their needs. Early intervention for youth violence at the elementary school level is necessary to prevent violence in adolescence and adulthood. This article reviews reports of studies on seven efficacious school-based secondary prevention programs for youth violence among elementary school children. Programs that show promising results are those that use cognitive-behavioral interventions and social skills training among at-risk elementary school children. We conclude with implications for crisis intervention and brief treatment practices, as well as recommendations for future research. [Brief Treatment and Crisis Intervention 5:95–107 (2005)] KEY WORDS: elementary school, secondary prevention, school-based, violence.

In the United States in the year 2000, more than 400,000 youths aged 10–19 years were injured as a result of violent acts (National Center for Injury Prevention and Control [NCIPC], 2004a), making school violence an issue of national concern. Findings from the 1999 Youth Risk Behavior Survey for grades 9 through 12 revealed that during the 30 days preceding the

From the University of Tennessee College of Social Work. Ms. Molina is a doctoral student. Contact author: Irma A. Molina, University of Tennessee College of Social Work, 4 Henson Hall, Knoxville, Tennessee 37996. E-mail: [email protected]. doi:10.1093/brief-treatment/mhi007

survey, 6.9% of respondents reported carrying a weapon on school property. In the 12 months preceding the survey, 35.7% of students reported being in a physical fight at least once, and 4% suffered injuries that required medical treatment. Almost 9% of students reported being intentionally hit, slapped, or physically hurt by a boyfriend or girlfriend during the previous 12 months (NCIPC, 2004b). School-associated violent deaths that occurred between 1994 and 1999 represent less than 1% of all homicides and suicides among school-aged children. During this period, of the 172 student victims, 15 were in elementary school. Students in senior high schools (grades 9–12) or schools

Brief Treatment and Crisis Intervention Vol. 5 No. 1, ª Oxford University Press 2005; all rights reserved.

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that combined high school grades with lower grades had a school-associated violent death rate that was 14 times higher than that among students in elementary schools (Anderson et al., 2001). In a 1996–97 survey of U.S. public high schools, it was reported that 60% of violent acts occurred in 4% of the schools surveyed. Serious violence, such as physical attacks, fighting with a weapon, property crime, murder, and robbery, is not a problem for many schools. However, for 4% of the public high schools surveyed, aggressive and antisocial behaviors among students on campus are common (Cantor & Wright, 2002). Many schools respond to youth problem behaviors such as those described above by implementing prevention strategies that are, in general, of limited or unknown efficacy. Some preventive interventions can even have negative consequences. Therefore, it is imperative that school authorities be informed of efficacious school-based secondary violence prevention programs for youth in order to select and implement an evidencebased prevention program that best meets their needs. Thus, the purpose of this article is to examine and compare selected school-based secondary violence prevention programs that have yielded efficacious results. In particular, the review will focus on programs intended for elementary school students aged 6 to 12 years or those in grades 1 through 6. Based on the review, we will describe recommendations for practice and future research. We favor early intervention for school violence because aggressive and antisocial behaviors in children are found to increase over time (Stormont, 2002; White, Earls, Robins, & Silva, 1990). Children who become violent before age 13 generally are confirmed on a path of criminal tendency and exhibit a pattern of escalating violence throughout childhood (U.S. Surgeon General, 2001, chap. 1). Early intervention for youth violence at the elementary school level is imperative to prevent

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its development into adolescence and adulthood (Walker, Severson, Feil, Stiller, & Golly, 1998). Youth violence is costly to society if not averted (Connor, 2002).

Definitions of Terms School violence refers to various aggressive and antisocial behaviors among students that range from serious physical acts involving the use of lethal weapons (Cantor & Wright, 2002) to less serious physical behaviors like shoving and pushing (Juvonen, 2001). School violence also includes acts that result in emotional harm and hurting others’ feelings, like verbal harassment, rumor mongering (Juvonen, 2001), verbal threats (Petersen, Pietrzak, & Speaker, 1996), and cheating and lying (Sheehan, Kim, & Galvin, 2004). Other forms of school violence include bullying (Nansel, Overpeck, Haynie, Ruan, & Scheidt, 2003) and dating-related aggression (Hilton, Harris, Rice, Krans, & Lavigne, 1998). Secondary prevention is defined as targeting youth who show early yet mild signs of aggression and antisocial behaviors, or those who are at risk for developing such problem behaviors (Connor, 2002). Secondary prevention reduces the risk factors for violence among at-risk youth and enhances protective factors against it (U.S. Surgeon General, 2001, chap. 5). It involves assessment, selection, and treatment of students who have been identified by teachers, counselors, staff, and/or peers as aggressive, as troublemakers, and/or as at risk for school failure. These students need specialized intervention because they are less likely to respond well to universal interventions than students not at risk (Sugai, Sprague, Horner, & Walker, 2000). At-risk youth refers to children who display one or more risk factors for violence. They are at risk for higher criminality or serious violent behaviors later in life (U.S. Surgeon General,

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2001, chap. 1). Risk factors for aggression refer to factors in the individual that increase the likelihood for developing the problem behavior. Risk factors for youth aggressive behaviors include a history of neglect and abuse, poverty, family stress and conflict, and drug and alcohol involvement (Walker et al., 1998). Other risk factors found are lack of parent support and involvement, poor anger management skills, lack of academic interest (Hunt et al., 2002), hyperactivity and aggression in early childhood, gender, and controlling type of parenting (Stormont, 2002). Reported as the strongest risk factors during childhood are involvement in serious criminal behavior, substance abuse, male gender, physical aggression, low family socioeconomic status, and antisocial parents (U.S. Surgeon General, 2001, chap. 1). The greater the length of exposure and the number of risk factors present, the more negative will be the developmental outcome for the child (Patterson et al., 1992, as cited in Walker et al., 1998). Behavioral manifestations of risk factors include defiance of adults, restlessness/overactivity, aggression, disruptive classroom behavior, lack of self- regulation, and poor school readiness (Walker et al, 1998). A school-based violence prevention program is one that has been tested in a school setting during school time among students at risk. The intervention program is incorporated into the school curriculum (Farrell, Meyer, Kung, & Sullivan, 2001). The program generally targets at-risk children alone or at-risk children and their families (Flannery, 1998).

Rationale for a School-Based Secondary Prevention Program Schools are appropriate venues for violence prevention programs for several reasons: (1) Schools are a primary and natural context for human interaction and social development

(Bronfenbrenner, 1979); (2) schools are often the setting in which interpersonal conflicts occur (Farrell et al., 2001); (3) school-environment safety is a major issue for all schools, thus it makes sense for violence prevention programs to be school based; (4) a perceived violent-school environment adversely affects learning outcomes; (5) schools should be concerned about the issue because violent and aggressive behaviors in school are known precursors for adult crimes and more serious problem behaviors in adult life that threaten schools and society in general; and (6) because youth problem behaviors have been attributed to lack of family rules and structure as well as lack of parental supervision and involvement (Petersen et al., 1996; Price & Everett, 1997), it is important for schools to step in when the parents have failed to discipline their children. When children fail to develop the necessary prosocial skills, because of the absence of positive role models or because they are exposed to antisocial behaviors at home, it is imperative that schools assume the responsibility for teaching prosocial skills to at-risk students for the safety and security of the school environment.

Empirical Review Selection Seven secondary prevention programs for school violence were reviewed for this article. The studies were selected from a thorough, computerized literature search of scientific databases including PsycInfo, PubMed, Social Work Abstracts, Sociological Abstracts, and ERIC (Educational Resources and Information Clearinghouse). The search words used were school violence, secondary prevention, schoolbased, elementary school, ages 6–12, at-risk, aggressive, and combinations of these words limited to studies published from 1990 to the


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present, a time frame deemed most useful and relevant to meet the needs of present-day U.S. elementary schools. A summary of the studies reviewed is presented in Table I. To be included for this review, a study had to meet the following criteria: (1) It used an experimental research design, specifically the randomized clinical trial, with participants randomly assigned to either an intervention or a control group; (2) outcome measures included aggressive and hyperactive behaviors and were concurrently administered on the experimental and control groups; (3) the study population consisted of children in elementary school; (4) the intervention was designed for students identified as at risk; (5) study sites for the prevention program were elementary schools in the United States; (6) the study was conducted during school time; (7) self-directed violence like suicide or self-directed injury like suicide attempts were not among the outcome measures for the study; and (8) the study was published no earlier than 1990. Only seven studies met these criteria for review. Interventions The preventive interventions that were tested in the studies we reviewed included attributional retraining (Hudley et al., 1998; Hudley & Graham, 1993), social skills training (Pepler, King, Craig, Byrd, & Bream, 1995), cognitivebehavioral therapy (Lochman, Coie, Underwood, & Terry, 1993), peer coping skills (Prinz, Blechman, & Dumas, 1994), and a combination of child, parent, and teacher training for lowincome students and students at risk for the development of serious externalizing behavioral disorders (Braswell et al., 1997; O’Donnell, Hawkins, Catalano, Abbott, & Day, 1995). Most of the intervention programs required the participation of students either as study participants or as raters (Hudley et al., Lochman et al., Prinz et al., Hudley & Graham). Three of

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the studies had a parent component to the intervention (Braswell et al., Pepler et al., O’Donnell et al.). The rest of the programs had only child-focused interventions. Following completion, evaluation of the school-based prevention program was conducted after 2 months (Hudley & Graham), 6 months (Prinz), 6 months to 1 year (Hudley et al.), 3 and 9 months (Pepler), 1 year (Lochman), 2 years (Braswell), and 5 years (O’Donnell). Sampling Sample size of the studies reviewed ranged from 52 (Lochman) to 453 (Braswell). Five studies had more than 100 participants (Hudley et al.; Braswell; O’Donnell; Prinz; Hudley & Graham). Two studies had less than 100 participants (Lochman; Pepler). The mean sample size for the seven studies was 178.86. The students targeted for the intervention consisted of aggressive children (Hudley et al.; Pepler; Lochman; Prinz; Hudley & Graham), children at risk for developing attention deficit and hyperactivity disorder (Braswell), and students considered at high risk for delinquency, drug use, and academic failure based on their socioeconomic status (O’Donnell). Selection of participants for intervention consisted of teacher ratings and peer nominations (Hudley et al.; Hudley & Graham), peer nomination ratings only (Lochman), teacher ratings only (Prinz; Pepler), teacher and parent ratings (Braswell), and participant self-reports, teacher ratings, and low socioeconomic status (O’Donnell). The interventions were implemented with children in third through sixth grades (Hudley et al.), first through fourth (Braswell), first through sixth (Pepler; O’Donnell), fourth (Lochman), first through third (Prinz), and fourth through sixth (Hudley & Graham). Except for Pepler, none of the studies reported the ages of the children participants.



TABLE I. Summary of Studies

Study

Design/sample

Intervention/independent variable

Hudley, Britsch, Wakefield, Smith, Demorat, & Cho, 1998

Pretest-posttest control group with 6-month and 1-year follow-up N = 262 Intervention 1 = 102 Intervention 2 = 126 Control = 34

Intervention 1: Brain Power Program, a 12-lesson attributional retraining intervention with the following components: strengthening aggressive boys’ ability to accurately detect others’ intentions; increasing the likelihood that aggressive boys would first attribute negative outcomes to accidental causes; and linking appropriate, nonaggressive behavioral responses to ambiguously caused, negative social outcomes. Intervention 2: The attention group received training in nonsocial problem-solving skills. Control: No intervention

Dependent variable(s)/ outcome measure

Who did assessments

Finding(s)

Self-control: Social Skills Teachers Rating SystemÿTeachers Peers (SSRS-T) Judgments of intent: SSRS-T Questionnaire contained three hypothetical scenarios that assessed student’s judgment of intent.

Changes in self-control as rated by four teacher rating scores (pre- and postintervention as well as 6- and 12-month follow-up) were greatest for students in the attributional intervention group, and the behavioral improvements persisted across time. They also displayed reductions in judgments of hostile intent, although these changes were not maintained beyond postintervention assessment.

Study

Design/sample


Braswell, August, Bloomquist, Realmuto, Skare, & Crosby, 1997

Pretest-posttest control group with four assessment points within a 2-year period N = 453 Intervention = 309 Control = 144

Intervention: Minnesota Competence Enhancement Project, a multicomponent intervention for children at risk for the development of serious externalizing behavioral disorders. The intervention package included the following: child problem-solving and social skills training for identified children; schoolwide teacher education about disruptive behavior and classroom contingency management methods; parent education; and home-school collaboration efforts. Control: Children in the information/attention group (IAC) did not receive direct intervention; teachers and parents participated in informational meetings.


Who did assessments

Finding(s)

Externalizing behavior problems: Behavioral Assessment for Children (BASC); structured behavioral observations

Teachers Parents

All three BASC child measures showed significant improvement over time, with adjustment increasing and school maladjustment and clinical maladjustment decreasing across assessment intervals, but did not differ by condition. Overall, the multicomponent enhancement intervention condition did not produce initial outcomes beyond those achieved by the IAC condition. Children in both conditions rated themselves as more positively adjusted, but teacher measures did not reflect similar change over time.


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TABLE I continued. Summary of Studies

Study

Design/sample


Study

Design/sample


Pepler, King, Craig, Byrd, & Bream, 1995

Pretest-posttest control group with 3- and 9-month follow-up N = 74 Intervention = 40 Control = 34

Intervention: Earlscourt Social Skills Group Program (ESSGP), a didactic program designed to improve the self-control and social skills of aggressive, noncompliant children between the ages of 6 and 12. The program is designed to improve two domains of children’s functioning (behavioral and social-cognitive) within several systems (home, school, and peer). Parents’ groups were offered to parents of children in the program to facilitate children’s learning of the skills. Control: Children in the wait-list control group received social skills training in the subsequent spring session.


Who did assessments

Finding(s)

Externalizing behavior problems: Child Behavior Checklist (parent rating, teacher rating)

Teachers Peers Parents

Teacher ratings showed fewer externalizing behavior problems in the social skills training group as compared with the wait-list control group. Improvements in the targeted behavior problems were maintained at 3 months and to a lesser extent at 9 months. Peer assessments of aggressiveness for children in the ESSGP group were not significantly different from those in the control group.

Study

Design/sample


O’Donnell, Hawkins, Catalano, Abbott, & Day, 1995

Pretest-posttest control group with 6-year follow-up N = 106 Intervention = 44 Control = 62

Intervention: The Seattle Development Project that combined modified teaching practices in mainstream classrooms, child social skills training, and developmentally adjusted parent training Control: No intervention

Utilization of problemsolving strategies: Problemsolving rating scale Parent depression, confident coping, and involvement: BASC Parent Personality Profile Parents’ perceptions of their ability to control their children and their lives: Parent Locus of Control scale Parent behavioral management practices: Behavioral Management Self-Assessment

Peer assessment of aggression: Revised class play method of peer assessment

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Study

Design/sample



Who did assessments

Finding(s)

Conventional and antisocial Teachers involvement and interaction, use of cooperative team learning methods, social competence, delinquency, and drug use: Self-report surveys Teacher instructional practices: Structured observational recording system

Boys and girls in the high-risk intervention group had significantly greater use of cooperative method, had more reinforcement for classroom participation, and were more significantly attached than boys and girls in the control group. Teacher reports of child interactions with antisocial peers were significantly lower for the intervention group as compared with control. No significant differences on norms on substance abuse, delinquency, and drug initiation between the intervention and control condition

Study

Design/sample


Prinz, Blechman, & Dumas, 1994

Pretest-posttest control group with 6-month follow-up N = 196 Intervention = 100 Control = 96

Intervention: Peer coping skills (PCS) training aimed at enabling better information exchange. The training includes the tasks group rules, reunion probes, group activity, and group reward. Control: No intervention


Who did assessments

Finding(s)

Teachers Aggression, anxiety, Peers internalizing problems: Teacher Report Form on the Child Behavior Checklist Prosocial coping: Videotaped observations Peer acceptance: Peer sociometric rating of acceptance Social skills: WalkerMcConnell Social Skills Scale

Children in the PCS group showed significant improvement in prosocial coping via information exchange, had reduction in teacher-rated aggression, and had increases in teacher-rated information exchange and social skills as compared with the control group. The competent nonaggressive children in the PCS did not exhibit adverse effects and showed significantly greater improvements in observed prosocial coping via information exchange compared with their non-PCS counterparts.

Study

Design/sample


Hudley & Graham, 1993

Pretest-posttest control group design with 2-month follow-up

Intervention 1: Attributional intervention, a 12-lesson cognitive intervention whose goal was to train aggressive boys not to infer hostile peer intent in negative social encounters. The curriculum provided: (1) specific activities for understanding the concepts of self-intent and ambiguity in interpersonal relations; practice in identifying intentionality in others; (3) specific activities for distinguishing between intended and unintended outcomes; and (4) practice in making attributions.


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Study

Design/sample


N = 108 (randomly assigned Intervention 2: Attention training focused on nonsocial to any of the following problem-solving skills groups: attributional Control: No intervention intervention, attention training, or no-treatment control) Dependent variable(s)/ outcome measure

Who did assessments

Finding(s)

Judgment of intent, feelings Teachers of anger, and aggressive Peers behavior in response to both hypothetical and actual peer provocation: Attributional questionnaire; observations Aggression, prosocial behavior, and academic performance: These subscales of Coie’s (1990) teacher checklist Number of school disciplinary referrals: School records

Aggressive subjects in the attribution retraining program showed reduction in both the bias to presume hostile intent and a preference for aggressive behavior in both hypothetical and laboratory situations of ambiguous provocation, as compared with the attention training and control groups. Aggressive intervention subjects were rated as significantly less aggressive by their teachers.

Study


Design/sample

Lochman, Coie, Underwood, Pretest-posttest control & Terry, 1993 group with 1-year follow-up N = 52 Intervention = 26 Aggressive-rejected intervention group (ARI) = 9 Rejected-only intervention group = 17 Control = 26 Aggressive-rejected control group (ARC) = 9 Rejected-only control group = 17

Intervention: Social relations training program made up of four components: (a) social problem solving; (b) positive play training; (c) group entry skills training; and (d) dealing effectively with strong negative feelings. The intervention included both positive social skills training and cognitive-behavioral elements. Control: Usual school counseling services


Who did assessments

Finding(s)

Self-worth (Perceived Competence Scale for Children) Aggression, social rejection, and prosocial behavior: Teacher Behavior Checklist; peer nomination ratings

Teachers Peers

The ARI group had significant reductions in aggression and social rejection and improvements in peer prosocial behavior at postintervention and 1-year follow-up compared with the ARC group.

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Dependent Variables Many dependent variables were measured in the selected intervention studies. The variables were aggression (Hudley et al.; Pepler; Prinz; Hudley & Graham; Lochman); judgment of intent (Hudley et al.; Hudley & Graham); prosocial behavior/coping (Prinz; Hudley & Graham; Lochman); self-control (Hudley et al.); self-worth and social rejection (Lochman); academic performance and number of school disciplinary referrals (Hudley & Graham); anxiety, internalizing problems, peer acceptance, and social skills (Prinz); utilization of problem-solving strategies, parent depression, confident coping, involvement, parent perception of control, and parent behavioral management practices (Braswell); and antisocial involvement, social competence, conventional involvement and interaction, delinquency, drug use, teacher instructional practices, and use of cooperative team learning methods (O’Donnell).

Results Five of the seven studies reported beneficial effects for participants (Hudley et al.; Pepler; Prinz; Hudley & Graham), and two reported mixed results (Braswell; O’Donnell). The significant beneficial findings included: (1) Changes in self-control were greatest for students in the attributional intervention group, and the behavior improvements persisted across time (Hudley et al.); (2) there were fewer externalizing behavior problems in the social skills training group compared with the control group (Pepler); (3) parent ratings of child behavior problems reflected improvement following training that was maintained over time (Pepler); (4) children in the peer coping skills group showed significant improvement in observed prosocial coping, had significant reduction in aggression, and had significant increases

in information exchange and social skills relative to the control group (Prinz); (5) aggressive subjects in the attribution retraining program showed reduction in both the bias to presume hostile intent and a preference for aggressive behavior compared with the attention training and control groups (Hudley & Graham); and (6) the aggressive-rejected intervention group had significant reductions in aggression and social rejection and improvements in peer prosocial behavior at postintervention and 1-year followup compared with the aggressive-rejected control group (Lochman). Of those reporting mixed results, the Braswell study reported that scores on all three measures of the Behavioral Assessment System for Children—the Teacher Rating Scales, the Parent Rating Scales, and Self-Report of Personality— showed significant improvements over time but did not differ by condition. The multicomponent enhancement intervention condition did not produce initial outcomes beyond those achieved by the information attention control condition. The O’Donnell study reported no significant differences on variables pertaining to norms on substance abuse between the intervention group and the control group for either high-risk girls or high-risk boys; girls in the intervention group reported significantly greater reinforcement for classroom participation and were significantly more attached and more committed to school compared with their control counterparts. Notably, the two studies (Braswell; O’Donnell) that reported mixed results both had a multicomponent intervention that included child, parent, and teacher training. Parental attendance in the programs for the two studies was also reported. These programs were evaluated for a longer period of time (2 years and 5–6 years, respectively) than were the other studies reviewed. Most of the studies measured the efficacy of treatment on the children’s functioning at school as rated by teachers and peers. Only


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one study (Pepler) had parents’ assessment of the intervention efficacy on the child’s functioning at home. Interventions reported to be efficacious were (1) attributional retraining, a cognitive intervention that strengthens ability to accurately detect others’ intentions (Hudley et al.; Hudley & Graham); (2) social skills training that involved modeling, role playing, feedback, and positive reinforcement (Pepler); (3) peer coping skills designed to promote prosocial coping and information exchange skills (Prinz); and (4) cognitive-behavioral training that included positive social skills training, reinforcement of prosocial behavior, and more adaptive social problem-solving skills (Lochman). In general, most of the successful programs used cognitive- behavioral techniques and social skills training in dealing with students who were identified as aggressive or at risk.

Crisis Intervention School violence is considered one of the crises that is particularly common in elementary schools. Being sudden and unanticipated, it upsets elementary students’ normal psychological state. As a result, crisis happens due to students’ subjective perception of their inability to deal with the hazardous situation. School-violence prevention relies on understanding the dynamics and causes of the precipitating event (Sandoval, 2002). At-risk students have certain stressors in their lives that make them more vulnerable to crisis, especially if the precipitating events are not dealt with at the right time and with the right intervention. Designing school-based violence prevention programs must consider the risk and protective factors in individual and environmental domains in order to impact the development of nonviolent behavior (Farrell et al., 2001).

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Sandoval (2002) outlined five general strategies in school-based prevention programs to prevent various crises: (1) educational workshops and programs, (2) anticipatory guidance, (3) screening programs, (4) consultation, and (5) research. Screening and identifying at-risk students and referring them for inclusion in prevention programs is a great step in thwarting their potential for violence. A timely assessment and screening for the early signs of violence is a big factor in preventing the occurrence of a violent incident, which will also save schools the resources in dealing with catastrophic incidents such as school shootouts. Some of the interventions identified for potentially violent students are (1) counseling that may focus on teaching skills such as anger management and social skills, (2) positive behavioral programming, (3) conflict resolution and management, and (4) social skills and anger management training. These interventions have been validated by the findings of this review, which documented that efficacious programs for at-risk youths at the elementary school level include cognitive-behavioral interventions and social skills training. Youths experiencing initial trauma respond well to behavioral interventions followed by cognitive therapy, while those not experiencing severe trauma do well with cognitive interventions (Wells & Miller, 1993, as cited in Roberts, 2002). In this article review, the use of cognitive-behavioral therapy alters the at-risk students’ current thinking on aggression and educates them on appropriate prosocial behavior.

Brief Treatment Secondary prevention programs target at-risk youths who show early signs of aggression and antisocial behaviors, and aim at reducing the risk factors for violence to prevent escalation of



problem behavior into violent behavior. From a prevention perspective, enhancing the protective factors and reducing the risk factors will significantly help in reducing the potential for violent behavior among at-risk youths. Although the efficacy of brief treatment has been demonstrated (Anderson & Lambert, 1995; Koss & Shiang, 1994; Lambert & Bergin, 1994), inaccurate assessment of clients of brief therapy can be risky (Dulmus & Wodarski, 2002). Outcome studies comparing various forms of psychosocial treatment regularly find that certain types of intervention work better than others for particular client problems (Dulmus & Wodarski, 2002). Although this article did not evaluate the usefulness of brief treatment but rather the efficacy of secondary prevention programs for school violence among elementary school children, some of the components of brief treatment, like problem-focused, actionoriented, and structured interventions, were present in the training programs reviewed. Since most of the gains in the treatment groups were maintained over protracted periods of time, it would be reasonable to say that brief treatment is as effective as long treatment for children. Based on the findings of these efficacious programs, brief treatment interventions can be developed that will be useful for tertiary prevention programs calling for specialized individual interventions to students with chronic intense problem behaviors.

Implications for Future Research This paper examined the efficacy of seven school-based secondary prevention programs for at-risk elementary school children on measures of child functioning. There are very limited data on school-based secondary prevention programs for elementary school students published between 1990 and 2004. Most

research on secondary prevention programs has overlapped elementary and middle school students and often included children coming from different age groups. Hence, more research needs to be done on programs intended specifically for children in elementary school. It would be hard to determine program efficacy for a particular age group if the participants in the study came from various ages and levels of development. Different age groups have different skills and issues associated with their level of development. Schools should implement efficacious prevention programs that are developmentally appropriate, because those programs will best meet the students’ needs. Most prevention programs reviewed were child focused, with little or no parental involvement. The extent of involvement by most parents in the studies was in terms of giving consent for the inclusion of their children. The programs involved school authorities in the planning and implementation. Research that involves parents in assessing the transferability of efficacy of school-based programs to the home setting should be done. Not only should modification of aggressive behavior at school be our goal, but also transferability and behavior maintenance in other social systems as well, like the home and community. If a lasting behavior change is to exist, it is important for prevention programs to target the other social contexts that influence and affect an at-risk student’s behavior. Changing the at-risk student alone will not have a significant impact if other social contexts, like the home or neighborhood, do not reinforce the positive changes gained from the prevention program. Of the programs reviewed, only three had a parental component, and, as noted, parental involvement in these programs was low. Prevention programs should aim at changing multiple domains—not only the individual, but the family and the community as well.


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