Review and special article
Effectiveness of Interventions to Prevent Youth Violence: A Systematic Review

https://doi.org/10.1016/j.amepre.2007.02.045Get rights and content

Objectives

To identify interventions effective in preventing youth violent behavior and commonalities of effective and ineffective interventions.

Methods

A systematic review of the literature on the effectiveness of youth violence interventions was conducted. Interventions were categorized according to the level of the intervention: primary (implemented universally to prevent the onset of violence), secondary (implemented selectively with youth at increased risk for violence), and tertiary (focused on youth who had already engaged in violent behavior). An intervention was considered effective if one or more violence outcome indicators was reported as significantly different at the p<0.05 level, and ineffective if none of the violence outcome indicators was significantly different at the p<0.05 level. Data collection and analysis were conducted in 2003 and updated in 2006.

Results

Forty-one studies were included in the review. Overall, 49% of interventions were effective. Tertiary-level interventions were more likely to report effectiveness than primary- or secondary-level interventions. Effective interventions evaluated by randomized controlled trials included Responding in Peaceful and Positive Ways, Aban Aya Youth Project, Moving to Opportunity, Early Community-Based Intervention Program, Childhaven’s Therapeutic Child-Care Program, Turning Point: Rethinking Violence, and a multisystemic therapy program. Differences among programs and within subpopulations could not be assessed because of inadequate data.

Conclusions

Increasing effectiveness was reported as the level of intervention increased from primary to tertiary. Approaches to evaluate prevention interventions need to be clarified and standardized.

Introduction

Although recent downward trends in violent crime arrest rates are encouraging, violence remains a significant cause of morbidity and mortality for youth in the United States,1 and its consequences carry substantial financial and societal costs.2, 3 Multiple violence prevention programs have been developed and implemented in diverse settings with various degrees of success. Because there are no uniformly applied standards to determine program effectiveness, rigorous evaluations of violence prevention programs are often lacking. As such, the literature on the effectiveness of violence prevention interventions is fragmented, with no clear consensus about which programs are effective in preventing violent outcomes in youth.

In a review of youth violence prevention strategies, Kellerman et al.4 reported on the effectiveness of programs in addressing one or more risk factors for juvenile delinquency and violence. However, the effectiveness of programs in specifically preventing or reducing violent behavior in youth was not addressed in the review by Kellerman et al.4 Another review of community and school programs to prevent violence established “blueprints,” or scientific standards for programs to judge effectiveness.5, 6 The blueprints review identified programs that met all four standards (“blueprints model programs”), and examined outcomes that included violent behavior, but also included crime, antisocial behavior, and drug and alcohol use.

Among the recent efforts to synthesize current knowledge about the effectiveness of youth violence prevention programs was the Surgeon General’s report on youth violence.3 Applying a set of standards based on scientific consensus to the literature on youth violence, the report identified interventions that were effective and ineffective in preventing violence and serious delinquency, and in preventing known risk factors for violence. This report relied heavily on published reviews and categorized programs as models, promising, or ineffective based on how well each program met 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.

This study examines the effectiveness of youth violence prevention interventions and differs from previous reviews first, by examining the effectiveness of interventions in specifically preventing violent behavior; second, by performing a systematic review of the literature on youth violence prevention using different inclusion and exclusion criteria that limited the review to the most current and scientifically-rigorous research conducted in the United States; and third, by using a quantitative approach to summarize the evaluation evidence. The objectives of this study were (1) to identify interventions effective in preventing youth violent behavior and (2) to identify commonalities of interventions that are effective and those that are not effective.

Section snippets

Methods

This work was part of a larger project to examine the risk factors for and prevention of violence and related health-risking social behaviors in adolescents. Detailed methods are published elsewhere,7 and are summarized briefly here. This research specifically addresses the effectiveness of interventions to prevent or reduce violent behavior in youth. Data collection and analysis were performed in 2003 and updated in 2006. The literature search, review, and synthesis of the evidence on the

Results

After elimination of duplicates, the initial and secondary searches identified a total of 14,453 citations for the project. Figure 1 displays the results of the screening and reviewing process for articles identified in the April and October 2003 searches; Figure 2 displays these processes for the 2006 update. Forty-seven articles representing 41 intervention studies were included in the final evidence assessment. Table 1 summarizes the effectiveness of the interventions by study design and

Discussion

Of the 41 studies included in the evidence assessment, 15 (37%) were RCTs. Focusing on the RCTs, two of six (33%) primary interventions, three of seven (43%) of secondary interventions, and two of two (100%) tertiary interventions were effective in reducing violent behavior in youth. Thus, it appears that one of the most important characteristics differentiating the effectiveness of interventions may be the level of the intervention. Given that the focus of this review is the prevention of

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