Intervention Review

School-based secondary prevention programmes for preventing violence

  1. Julie A Mytton1,*,
  2. Carolyn DiGuiseppi2,
  3. David Gough3,
  4. Rod S Taylor4,
  5. Stuart Logan5

Editorial Group: Cochrane Injuries Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 30 APR 2006

DOI: 10.1002/14651858.CD004606.pub2

How to Cite

Mytton JA, DiGuiseppi C, Gough D, Taylor RS, Logan S. School-based secondary prevention programmes for preventing violence. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004606. DOI: 10.1002/14651858.CD004606.pub2.

Author Information

  1. 1

    University of the West of England at Bristol, Centre for Child and Adolescent Health, Bristol, UK

  2. 2

    University of Colorado Denver, Colorado Injury Control Research Center, Colorado School of Public Health, Denver, CO, USA

  3. 3

    Institute of Education, Social Science Research Unit, London, UK

  4. 4

    University of Exeter, PenTAG, Peninsula Medical School, Exeter, UK

  5. 5

    Peninsula Medical School, Universities of Exeter & Plymouth, Institute of Health and Social Care Research, Exeter, UK

*Julie A Mytton, Centre for Child and Adolescent Health, University of the West of England at Bristol, Hampton House, Cotham Hill, Bristol, BS6 6JS, UK. juliemytton@doctors.org.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2006

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Early aggressive behaviour is a risk factor for later violence and criminal behaviour. Despite over 20 years of violence prevention interventions being delivered in the school setting, questions remain regarding the effectiveness of different interventions for children exhibiting aggressive behaviour.

Objectives

To examine the effect of school based violence prevention programmes for children identified as aggressive or at risk of being aggressive.

Search methods

We searched CENTRAL, Cochrane Injuries Group specialised register, MEDLINE, EMBASE, other specialised databases and reference lists of articles. We also contacted authors and organisations to identify any further studies.

Selection criteria

We included trials meeting the following criteria; 1) participants were randomly assigned to intervention and control groups; 2) outcome data were collected concurrently; 3) participants comprised children in mandatory education identified as exhibiting, or at risk of, aggressive behaviour; 4) interventions designed to reduce aggression, violence, bullying, conflict or anger; 5) school based interventions; 6) outcomes included aggressive behaviour, school and agency responses to acts of aggression, or violent injuries.

Data collection and analysis

Data were collected on design, participants, interventions, outcomes and indicators of study quality. Results of any intervention to no intervention were compared immediately post-intervention and at 12 months using meta-analysis where appropriate.

Main results

Of 56 trials identified, none reported data on violent injuries. Aggressive behaviour was significantly reduced in intervention groups compared to no intervention groups immediately post intervention in 34 trials with data, (Standardised Mean Difference (SMD) = -0.41; 95% confidence interval (CI) -0.56 to -0.26). This effect was maintained in the seven studies reporting 12 month follow-up (SMD = -0.40, (95% CI -0.73 to -0.06)). School or agency disciplinary actions in response to aggressive behaviour were reduced in intervention groups for nine trials with data, SMD = -0.48; 95% CI -1.16 to 0.19, although this difference may have been due to chance and was not maintained, based on two studies reporting follow-up to two to four months (SMD = 0.03; 95% CI -0.42 to 0.47). Subgroup analyses suggested that interventions designed to improve relationship or social skills may be more effective than interventions designed to teach skills of non-response to provocative situations, but that benefits were similar when delivered to children in primary versus secondary school, and to groups of mixed sex versus boys alone.

Authors' conclusions

School-based secondary prevention programmes to reduce aggressive behaviour appear to produce improvements in behaviour greater than would have been expected by chance. Benefits can be achieved in both primary and secondary school age groups and in both mixed sex groups and boys-only groups. Further research is required to establish whether such programmes reduce the incidence of violent injuries or if the benefits identified can be maintained beyond 12 months.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Are school-based programmes aimed at children who are considered at risk of aggressive behaviour, effective in reducing violence?

Violence is recognised as a major global public health problem, thus there has been much attention placed on interventions aimed at preventing aggressive and violent behaviour. As aggressive behaviour in childhood is considered to be a risk factor for violence and criminal behaviour in adulthood, violence prevention strategies targeted at children and adolescents, such as school-based programmes, are considered to be promising interventions.

Some school-based prevention programmes target all children attending a school or class, whilst others confine the intervention to those children who have already been identified as exhibiting, or threatening, behaviour considered to be aggressive, such an approach is known as 'secondary prevention'. A wide variety of school-based violence prevention programmes have been implemented over the last 20 years, yet we are still without a full understanding of their effectiveness.

The objective of this systematic review was to determine the effectiveness of school-based secondary prevention programmes to prevent violence (that is those interventions targeted at children identified as aggressive or at risk of being aggressive) .

The authors examined all trials investigating the effectiveness of secondary violence prevention programmes targeted at children in mandatory education compared to no intervention or a placebo intervention.

The authors found 56 studies; the overall findings show that school-based secondary prevention programmes aimed at reducing aggressive behaviour do appear to produce improvements in behaviour. The improvements can be achieved in both primary and secondary school age groups and in both mixed sex groups and boy-only groups.

Further research is needed to investigate if the apparent beneficial programmes effects can be realised outside the experimental setting and in settings other than schools. None of the studies collected data on violent injury, so we can not be certain of the extent to which an improvement in behaviour translates to an actual injury reduction. In addition, more research is needed to determine if the beneficial effects can be maintained over time, and if the benefits can be justified against the costs of implementing such programmes.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

學校為防止暴力而施行的次級預防計畫

早期的攻擊行為是後來暴力與犯罪行為的危險因子。儘管暴力預防的介入措施已施行於學校機構超過20年以上,但仍然存在著不同介入措施對於兒童表現攻擊行為效果的問題。

目標

探討學校針對有攻擊行為或具有攻擊危險因子之兒童所施行之暴力預防計劃之效果。

搜尋策略

我們檢索CENTRAL,Cochrane Injuries Group的專業登記資料庫,MEDLINE,EMBASE,其他專業的資料庫及文章的參考文獻。我們也連絡作者與機構以確定任何進一步的研究。

選擇標準

我們納入符合下列標準的試驗;1)研究對象被隨機分配到介入組與對照組;2)同時蒐集結果的資料;3)研究對象包括接受義務教育並已確定表現出攻擊或具有在攻擊危險下的兒童;4)介入措施旨在減少侵略,暴力,欺凌,衝突或憤怒;5)以學校為基礎的介入措施;6)結果包括攻擊行為,學校及機構對攻擊行為或暴力傷害的應對。

資料收集與分析

蒐集研究設計,研究對象,介入措施,結果及研究品質指標的資料。在適當情況下採用統合分析來比較任何介入措施與無介入措施在介入後立即與12個月時的結果。

主要結論

確認出56篇試驗,皆無有關暴力傷害的報告資料。34篇試驗的資料顯示,相較於無介入組,介入組在介入後其攻擊行為立即顯著減少(Standardised Mean Difference (SMD) = −0.41;95% confidence interval (CI)為−0.56至−0.26)。7篇研究指出12個月追蹤時仍維持這種效果(SMD = −0.40,(95% CI為−0.73至−0.06))。9篇試驗的資料顯示,學校或機構的紀錄處分可以減少介入組的攻擊行為,SMD = −0.48;95% CI為−1.16至0.19,但依據2篇追蹤二至四個月的研究指出(SMD = 0.03;95% CI為−0.42至0.47),這種差異也許是隨機發生的且不能維持。子群體分析的結果認為在改善人際關係或社交能力的介入措施也許比教授對挑釁不理會的應對技巧之介入措施來的有效,但在小學對照於中學的兒童,及男女混合對照於僅男性群體時,此效益是相近的。

作者結論

以學校為基礎的次級預防計畫對降低攻擊行為的改善大於隨機的預期。在小學與中學的年齡族群中可以達成此效益,且在兩者混合性別的族群與只有男性的族群中也可以。需要進一步研究以建立是否這樣的計畫可以減少暴力傷害的發生,或是否這種效益可以維持超過12個月。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

針對在攻擊行為風險下的兒童,以學校為基礎的計畫可以有效的減少其暴力? 暴力被認知為一種重要的全球公共衛生問題,因而有很多關注於預防攻擊及暴力行為的介入措施。兒童期的暴力行為被認為是一種成年時期暴力及犯罪行為的風險因素,目標族群為兒童及青少年的暴力預防策略被認為是有希望的介入措施,如以學校為基礎的計畫。某些以學校為基礎的預防計畫乃針對所有在學校就讀的兒童,而針對那些已確定有威脅、攻擊行為的兒童進行介入措施,這種作法被認為是‘次級預防’。各種廣泛以學校為基礎的暴力預防計畫已被實施超過20年,然而我們對於它們的效果仍然沒有全面了解。這篇系統性回顧的目的為確定以學校為基礎的次級預防計畫用以預防暴力的效果(即那些目標為確認具有攻擊性或遭受攻擊風險的兒童的介入措施)。作者探討所有的試驗,其評估目標為針對義務教育的兒童的次級暴力預防計畫相較於無介入措施或安慰劑介入措施的效果。作者發現56篇研究;所有的結果顯示目標為減少攻擊行為之以學校為基礎的次級預防計畫似乎可以改善行為。在小學與中學的年齡族群中,及兩者的混合性別族群及只有男性的族群中皆可以達成此效益。需要進一步研究以調查是否這種明顯效益的計畫效果可以被實現於實驗機構以外的機構且非學校的地方。沒有研究蒐集關於暴力傷害的資料,所以我們無法肯定何種程度的行為改善可以轉化為實際的傷害減少。此外,需要更多的研究確定是否有利的效果可以隨著時間繼續維持,及效益是否可以合理的對抗這種計畫執行所需的成本。