Photo of the printed cover of the publication "The CMHS Approach to Enhancing Youth Resilience and Preventing Youth Violence in Schools and Communities"    

The CMHS Approach to Enhancing Youth Resilience and
Preventing Youth Violence in Schools and Communities

For more information contact: Bernard S. Arons, M.D., Director, Center for Mental Health Services,
The Parklawn Building, 5600 Fishers Lane, Room 17-105, Rockville, Maryland 20857
1-800-789-2647 • www.mentalhealth.org

 


Table of Contents

Foreword

Introduction

The Need for Resilience Enhancing and Violence Prevention Initiatives

Understanding Youth Violence
Patterns of Adolescent Violence
Perspectives on Violence
Risk and Protective Factors and Processes
Ethnic Minority and Cultural Issues


The Public Health Approach to Enhancing Resilience and Preventing Violence in Schools and Communities

Preventing Violent Behaviors–Mental Health Interventions
The Role of Schools


How to Intervene: What Programs Work?

What Are the Issues?
Evidence-Based Interventions


Conclusion

Appendixes

Exhibit 1—Model and Promising Programs
Exhibit 2—Evidence-Based Programs That Foster Resilience
Exhibit 3—Exemplary, Model, and Promising Programs to Strengthen Families


Bibliography


link to previous section link to next section
How to Intervene: What Programs Work?
Evidence-Based Interventions

Model and promising resilience-enhancing and violence prevention programs have been identified by several different organizations, both governmental and nongovernmental. The following section describes the publications that these organizations provide. It should be emphasized that not all use the same standards of evidence-based criteria to judge the soundness of the programs that are recommended.

A. United States Department of Health and Human Services, Youth Violence: A Report of the Surgeon General

This report, published in 2001, includes descriptions of 27 youth violence prevention programs that have met scientific standards for program effectiveness in the Model and Promising categories. It also identifies programs that do not work. The chapter on Prevention and Intervention is a definitive discussion of best practices and the evaluation of program effectiveness, and it distills the major reviews of youth violence prevention programs published in the last ten years. Youth Violence: A Report of the Surgeon General, as well as Mental Health: A Report of the Surgeon General (1999) and the National Action Agenda for Children's Mental Health (2001), is available on-line at http://www.surgeongeneral.gov.

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

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

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

  • For infants from 0 to 2: Frequent home visits by trained nurses and other professionals reduce child abuse and other injuries to infants.
  • For preschoolers under age 5: Classes with weekly home visits by preschool teachers substantially reduce arrests at least through age 15.
  • For delinquent and at-risk preadolescents: Family therapy and parent training reduce risk factors for delinquency such as aggression and hyperactivity.
  • For schools: organizational development for innovation. Building school capacity to initiate and sustain innovation through the use of school teams or other organizational development strategies reduces crime and delinquency.
  • Communication and reinforcement of clear, consistent norms about behavior through rules, reinforcement of positive behavior, and schoolwide initiatives (such as anti-bullying campaigns) reduce crime, delinquency, and substance abuse.
  • Social competency skills curricula, such as Life Skills Training (L.S.T.), which teach over a long period of time skills such as stress management, problem solving, self-control, and emotional intelligence, reduce delinquency, substance abuse, and conduct problems.
  • Coaching high-risk youth in thinking skills and using behavior modification techniques or rewards and punishments reduces substance abuse.

The most recent lists of DOJ model and promising programs are updated regularly at the University of Maryland Web site,
http://www.preventingcrime.org.


C. The Center for Substance Abuse Prevention (CSAP)

As the lead Federal agency for substance abuse prevention, CSAP plays a major role in bridging the gap between prevention research and practice by identifying effective programs and practices and disseminating that knowledge to the field. Many of the effective programs that target alcohol and drug abuse issues clearly have a positive impact on other aspects of a child's healthy development, resilience, and mental health. For this reason, the effective programs proposed by CSAP should be considered by any community, school, or organization intending to develop a comprehensive violence prevention program.

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

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

Forty-five research-based parenting and family intervention models were selected by CSAP for grants to increase the capacity of communities to deliver best practices in effective parenting and family programs (see Exhibit III). Another resource for communities and schools is Understanding Substance Abuse Prevention—Toward the 21st Century: A Primer on Effective Programs. This publication, as well as the most up-to-date list of CSAP model programs, may be viewed at the Web site of the Substance Abuse and Mental Health Services Administration, http://www.samhsa.gov/csap.

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

The National Association of School Psychologists (NASP) defined “exemplary programs” using the following criteria:

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

A list of NASP-recommended programs may be obtained from the National Association of School Psychologists, Director of Professional Information and Communication, 4340 East West Highway, Suite 402, Bethesda, MD 20814. Phone (301) 657-0270. http://www.naspweb.org.


E. Center for the Study and Prevention of Violence
The Center for the Study and Prevention of Violence (CSPV) receives funding from the Centers for Disease Control and Prevention (CDC), NIMH, and DOJ. In 1996, CSPV initiated a project to identify “truly outstanding” violence prevention programs. After reviewing more than 450 prevention and intervention programs, CSPV developed a list of ten “Blueprints.” Descriptions of these ten most effective programs allow States, communities, and individual agencies to

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

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


F. Communities That Care® Prevention Strategies: A Research Guide to What Works

Communities That Care (CTC) is a comprehensive, research-based community mob-ilization and planning organization that helps schools, families, local agencies and organizations, the media, and young people themselves collaborate in the creation of a safe, supportive environment for all. CTC has identified a number of prevention strategies that have been shown through high-quality research to be effective in reducing risk factors and enhancing protective factors for adolescent health and behavior problems. These prevention strategies are used in programs that

  • Address research-based risk factors for substance abuse, delinquency, teen pregnancy, school dropout, and violence;
  • Increase protective factors by (a) strengthening healthy beliefs and clear standards for behavior, or (b) building bonds to family, community, school, and/or positive peers by providing opportunities for meaningful contribution, teaching skills necessary for contributing, and recognizing skillful performance;
  • Intervene at a developmentally appropriate age; and
  • Have shown positive effects in high-quality tests.

The guide lists programs that have demonstrated significant effects on risk and protective factors in controlled studies or community trials and some that have also shown positive effects on health and behavior problems.
Communities That Care® Prevention Strategies: A Research Guide to What Works divides the list of programs into four categories: family, school, community, and community-based youth programs. The guide contains far too many programs to include in this document. A copy of the guide may be obtained from Developmental Research and Programs, Inc., 130 Nickerson, Suite 107, Seattle, WA 98109. Phone (800) 736-2630; FAX (206) 286-1462. http://www.drp.org.

G. Center for Mental Health Services, Literature on the Development of Resilience

In planning interventions, one would do well to heed the advice of researchers who have focused on resilience; their work “offers the prevention, education, and youth development fields solid research evidence for placing human development at the focus of everything that we do” (Benard, 1996). Essential components of strength-based, resilience-enhancing experiences—whether at home, at school, or in the community—are caring relationships, high expectations and adequate support to meet them, and opportunities to contribute to other people or to the world at large. See Exhibit II for sample programs. Additional information may be obtained from the Center for Mental Health Services (CMHS), Special Programs Development Branch (SPDB), Room 17C-05, 5600 Fishers Lane, Rockville, MD 20857, or NDavis1@samhsa.hhs.gov.
H. U.S. Departments of Education and Justice, Annual Reports on School Safety.

Since 1998, the U.S. Departments of Education and Justice have jointly prepared annual reports on school safety to describe the nature and extent of crime and violence on school properties. The 1999 and 2000 reports also highlight the communities which have received Safe Schools/Healthy Students grants from CMHS and Federal Partners in Justice Education, and summarize information on effective programs. The material is organized by the types of problems schools encounter, such as aggression, fighting, bullying, family issues, gangs, racial and other bias-related conflict, sexual harassment/sexual violence, substance abuse, truancy/dropout, vandalism, and weapons. Resources for more information about school safety and crime issues are listed. The reports are on-line at the Web sites of the Safe and Drug-Free Schools Programs Office (www.ed.gov/offices/OESE/SDFS) and the Office of Juvenile Justice and Delinquency Prevention (www.ncjrs.org/ojjdp).

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


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

Public Education

  • Promote education and awareness to individuals at risk, their families, and care providers on signs and symptoms of depression and suicidal behavior.
  • Develop effective methods to reduce stigma and embarrassment about seeking help and accessing mental health services. Promote the message, “It is OK to seek help.”
  • Develop and implement education programs for youth to help them self-identify symptoms of depression and suicidalilty and to provide information on the nature and treatment of mood disorders.
School-Based Programs
  • Endorse proactive skill development beginning in early childhood. School programs should include coping skills for loss, impulse control, anger management, problem solving, conflict resolution, emotional liability, and depression management. In addition, they should promote developmental assets and resiliency.
  • Develop, implement, and evaluate specific screening projects for students entering middle school, high school, and college.
  • Incorporate suicide prevention in a proven, safe, and age-appropriate comprehensive health curriculum for all students throughout the school years, with accompanying materials for family members.
  • Improve linkages between schools and mental health services for all.
  • Bring focus to school mental health efforts through training of administrators, teachers, school staff, and others.
  • Establish school-based health clinics for mental and physical health.

Detection/Treatment of Mental Illness

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

Alcohol and Other Drug Abuse

  • Reduce alcohol and other substance abuse among high-risk populations.

Access to Mental Health/Health Services

  • Identify dropouts and other youth without community affiliation as being at high risk and treat accordingly.
Training
  • Educate and train community people who are likely to come into contact with persons at risk for suicide so that they can recognize and respond to them. Among those who should be trained are teachers, human resource managers, bus drivers, families, clergy, and law enforcement officers.
  • Develop culturally appropriate stress management techniques for youth.
  • Develop guidelines and training for practitioners who deal with children and youth. This training should include best practices, issues specific to youth, and appropriate diagnostic and treatment procedures.

Post-Intervention

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

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

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

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