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PROTOCOL: School‐based Interventions to Reduce Dating and Sexual Violence: A Systematic Review

2013; The Campbell Collaboration; Volume: 9; Issue: 1 Linguagem: Inglês

10.1002/cl2.106

1891-1803

Lisa De La Rue, Joshua R. Polanin, Dorothy L. Espelage, Terri Pigott,

Child Abuse and Trauma

Campbell Systematic ReviewsVolume 9, Issue 1 p. 1-43 PROTOCOLOpen Access PROTOCOL: School-based Interventions to Reduce Dating and Sexual Violence: A Systematic Review Lisa De La Rue, Lisa De La RueSearch for more papers by this authorJoshua R. Polanin, Joshua R. PolaninSearch for more papers by this authorDorothy L. Espelage, Dorothy L. EspelageSearch for more papers by this authorTerri D. Pigott, Terri D. PigottSearch for more papers by this author Lisa De La Rue, Lisa De La RueSearch for more papers by this authorJoshua R. Polanin, Joshua R. PolaninSearch for more papers by this authorDorothy L. Espelage, Dorothy L. EspelageSearch for more papers by this authorTerri D. Pigott, Terri D. PigottSearch for more papers by this author First published: 02 September 2013 https://doi.org/10.1002/CL2.106Citations: 5 Linked article: Systematic review. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat BACKGROUND Violence and assaults experienced by adolescents are of great concern to researchers, parents, educators, and administrators who strive to help youth be healthy and happy. The impact of sexual assaults or sexual coercion and physical and psychological abuse in intimate dating relationships has a significant impact on young people. Consequences of dating violence include decreased mental and physical health and lower life satisfaction (Banyard & Cross, 2008). Teen dating violence impacts the psychological well-being of youth (Black, Tolma, Callahan, Saunders, & Weisz, 2008), with youth who are victims being more likely to experience depression and suicidal behaviors (Vézine & Hérbert, 2007). Additionally, longitudinal studies have identified long-term consequences of intimate partner violence to include depression, binge eating, substance abuse, and antisocial behavior (Foshee et al., 2012). While extensive research has not yet examined the impact of teen dating violence on academic outcomes, research in this area suggests that victims may have more negative views of school and that this may be the result of increased feelings of depression and substance abuse associated with victimization experiences. Unfortunately, despite the alarming consequences noted above, researchers and educators struggle to prevent these problems. This is complicated by the fact that school-based prevention programs vary considerably, and often demonstrate small changes or no changes at all (Espelage, 2012; Espelage, Holt, & Isaia, 2007; Espelage & Low, in press). The present review will quantitatively synthesize prevention and intervention efforts implemented thus far in schools that sought to reduce or prevent the incidents of dating violence. The Problem, Condition or Issue Adolescents spend a significant amount of time with their peers in school and in their neighborhoods. Although the majority of these relationships with peers provide positive social experiences, for some youth, some relationships may also involve victimization. Many assaults experienced by youth happen within interpersonal relationships, including in friendships and with romantic partners, with one in every four assaults committed by youth occurring in a domestic relationship (i.e., family members, intimate partners) (Snyder & McCurley, 2008). Abuse in dating relationships is an all too frequent occurrence, with 1 in 10 teenage relationships involving violence (Mulford & Giordano, 2008). This latter type of victimization is often described as teen dating violence (Mulford & Giordano, 2008; Offenhauer & Buchalter, 2011) and can include controlling behaviors, physical, verbal, psychological/emotional, and sexual abuse (Holt & Espelage, 2005; Offenhauer & Buchalter, 2011). The rates of teen dating violence in middle and high school are substantial. One school-based study of 9th -12th graders found a rate of 8.7% for physical dating violence, and another nationally representative study found a 1-year incidence rate of 3.6% for 13 to 17 year olds (Hamby, Finkelhor, & Turner, 2012). While both males and females experience teen dating violence, the exact nature of the violence tends to vary by gender. About one in four girls experience sexual and physical abuse (Latta & Goodman, 2011), while boys report experiencing high amounts of psychological abuse (Molidor, 1995). Therefore, it is essential to provide information to adolescents about healthy dating relationships to reduce the incidence of teen dating violence, including sexual, physical, and mental abuse that young people may experience in unhealthy dating relationships. The experience of dating violence has consequences for the overall well-being of students. These experiences also challenge a student's ability to be successful in school. Negative ramifications of teen dating violence include mental health problems, low academic achievement, and aggressive conflict-management (Offenhauer & Buchalter, 2011). Research has also found that girls who are victims of violence in relationships are at risk of increased discipline problems at school (Vézina & Hébert, 2007). These consequences extend beyond externalizing symptoms. Psychological symptoms of dating violence can include feelings of incompetence, anxiety, paranoia, severe depression, isolation from family and friends, and guilt and self-blame (Molidor, 1995). There can also be long-term consequences of dating violence, which can include isolation and emotional/interpersonal withholding of support as well as continued experiences with abuse such as constant harassment and degradation (Molidor, 1995). These adverse outcomes highlight the importance of implementing policies that address dating violence as a precursor to ensuring the well-being of students and supporting their educational opportunities. Appropriate prevention efforts can reduce the risk of abuse and victimization for adolescents, and can contribute to their healthier development and overall well-being. However, policies and programs developed to meet the needs of young people who are victims of teen dating violence must be based on research, data, and best practices. Additionally, advocating for policy changes and funding to support school-implemented programs requires that there is solid empirical justification advocating the effectiveness of such prevention programs. Taken together, it is essential to gain a better understanding of the effectiveness of dating violence prevention programs implemented in schools, and this review aims to do this. The Intervention Myriad programs exist within schools to prevent teen dating violence. Programs may exist at a universal level, where the school introduces various stimuli or psycho-educational directives. These can include lessons provided to all students and educational posters on walls and in hallways. Researchers and administrators may also implement programs directed solely at classrooms or even individuals. Many programs, especially those implemented with young students (i.e., elementary school students), focus on altering the school culture in an effort to decrease aggression and promote respect (Flannery et al., 2003; Haynes, 1998). These prevention efforts have the goal of shifting the culture of the school in positive directions, partly by encouraging bystander support, where students are supportive of victims of dating violence while also not accepting of teen dating violence behaviors perpetrated by their peers. Programs implemented for older youth, including during middle school, spend more time trying to change dating attitudes and behaviors (Foshee et al., 1998; Macgowan, 1997). These programs focus on teaching the individual student skills that will foster healthy dating relationships. The Safe Dates program is an example of a school-based prevention program for adolescents (Foshee & Langwick, 2004). This program includes a 45-minute theater production, a 10-session curriculum, and a poster contest. The intent of the program is to prevent the onset and promote a decrease of dating abuse perpetration and victimization by helping students recognize the difference between caring, supportive relationships and controlling, manipulative, or abusive dating relationships. This program has been evaluated with a randomized trial, and the long-term impacts have been explored with follow-up assessments up to 4 years after the intervention. Adolescents exposed to Safe Dates reported less psychological, physical, and sexual dating perpetration and less physical dating violence victimization (Foshee et al., 2005). The program effects were mediated primarily by changes in dating violence norms, gender role norms, and awareness of community services. The authors suggest that teen dating violence programs should target efforts to change dating violence and gender-role norms, and increase awareness of community services (Foshee et al., 2005). Additional studies have also noted the positive effects of teen dating violence prevention programs implemented in schools (Foshee & McNaughton-Reyes, 2009). Therefore, current research supports the use of dating violence prevention programs in schools. However, there is still a gap in the knowledge about the overall effectiveness of these efforts. Specifically, there is a need to quantitatively synthesize empirical studies that have been conducted. Additionally, the different types of interventions, universal and psycho-educational, and those directed at individuals or classrooms, should be reviewed and synthesized. Why it is Important to do the Review During the preteen and teen years, students are learning skills they need to form positive relationships with others (Center for Disease Control and Prevention, 2012), and dating violence prevention programs in schools serve as one way to help young people build the necessary skills to promote healthy relationships. Since this is an ideal time to promote the development of healthy relationships and to prevent patterns of dating violence that can last into adulthood, it is important to ensure programs for youth that target these domains are effective. In addition, given the cost of implementing such programs and the time allotted during busy school days to engage in the material, understanding what programs are effective will also support the appropriate use of time and resources in schools. To date no previous authors have attempted to quantitatively synthesize empirical evaluations of school-based programs designed to prevent or reduce the incidence of dating violence among adolescents. As a result, there is a lack of knowledge surrounding the overall effectiveness of teen dating violence prevention programs in schools, and around what types of interventions are most effective. However, the information is available to integrate. Research has consistently detailed the implementation of programs, and many have included empirical information about the effectiveness of said programs. Law (n.d.) and Calvillo (2010) detail several large-scale prevention programs using a narrative review technique, and note overarching benefits of prevention programs including altering the school climate and changing attitudes supportive of teen dating violence. Foshee and McNaughton-Reyes' (2009) narrative review of school-based dating violence interventions programs noted that changes in dating abuse norms and attitudes can be made with interventions. And when there are changes in dating abuse norms and attitudes, there are actual changes in dating abuse behaviors. The National Resource Center on Domestic Violence has also conducted a narrative literature review but failed to utilize a systematic search process or detail all programs completely. These studies have demonstrated the effectiveness of school-based interventions in reducing violence within a narrative review framework (Foshee & McNaughton-Reyes, 2009; Topping & Barron, 2009) and set the foundation for a systematic review of the literature on dating violence prevention programs. While narrative reviews provide us with valuable insight, the subjective nature creates challenges when increasingly more studies are included. Therefore, the present review will be able to accommodate a large number of programs by quantitatively synthesizing multiple studies in order to evaluate the treatment effect of teen dating violence prevention programs, thus allowing us to better understand the effectiveness of such programs. Furthermore, Fellmeth and colleagues (2011) are conducting a review of educational skills-based interventions that aim to prevent initial or further relationship violence behaviors in individuals between the ages of 12 and 25. The present review will complement their work by examining the effectiveness of school based prevention programs that aim to change behaviors and attitudes supportive of teen dating violence, in addition to examining how these programs encourage peer support to reduce incidents of teen dating violence. Dating violence can involve a multitude of behaviors, including physical and emotional abuse, sexual violence and coercion, and/or behaviors that are intended to control or intimidate a dating partner. Students can be either perpetrators or victims of teen dating violence, with some youth being both a perpetrator and a victim. This review will include studies of programs implemented in schools (grades 4-12) that sought to address attitudes or beliefs supportive of teen dating violence, encourage bystander intervention or peer support, or sought to reduce the incidence of dating violence perpetration or sexual coercion in dating relationships. In order to best understand the effectiveness of the prevention programs, specific considerations must be made. First, there needs to be clear support that an intervention was indeed the cause of a change in attitudes and behaviors, therefore only those studies that implemented an experimental or quasi-experimental design with a control group should be included. Utilizing only studies that have included a control or comparison group will help clarify the specific effects of the prevention efforts. Pre-test-post-test and follow-up measures will help minimize the attribution of changes to experimenter, practice, attention, spontaneous maturation, or Hawthorne effects (Topping & Baron, 2009). Also, the focus needs to remain on middle and high schools, as this population has specific needs and constraints. This includes a need for developmentally specific material that can be implemented effectively in schools and classrooms. These components will be included within this review. This review will be the first to quantitatively synthesize empirical evaluations of school-based programs aimed to reduce behaviors or change attitudes related to dating violence. This review has the potential to impact school policy and prevent consequential victimization. If indeed programs are demonstrated to be effective at reducing behaviors or attitudes supportive of teen dating violence, the strong empirical support that is gained with this type of review will bolster efforts to advocate for administrative support and funding to implement prevention programs in schools. This review can also provide insight into the type of programming (i.e. universal, psycho-educational, individual or classroom level) that is most effective in preventing victimization in dating relationships. OBJECTIVES 1) Are dating violence prevention programs implemented in middle and high schools effective in changing attitudes or beliefs supportive of teen dating violence? 2) Are dating violence prevention programs implemented in middle and high schools effective in encouraging bystander intervention to stop the perpetration of dating violence and/or increase peer support for victims of dating violence? 3) Are dating violence prevention programs implemented in middle and high schools effective in reducing the incidence of dating violence perpetration, including reductions in mental and/or physical abuse, and/or sexual violence or coercion perpetrated in a dating relationship? 4) Are dating violence prevention programs implemented in middle and high schools effective in reducing incidences of dating violence victimization, including reductions in mental and/or physical abuse, and/or sexual violence or coercion experienced in a dating relationship? 5) Are there substantive or methodological variables that moderate the effect sizes? a. The variables that will be examined include: program characteristics, age, gender, location, racial composition, and SES. METHODOLOGY The purpose of the review is to synthesize the best available evidence on the effects of prevention programs designed to reduce teen dating violence perpetration and victimization. The following criteria will be employed to select studies for the review. Criteria for including studies in the review Types of research designs Only studies that have a well-defined control group will be included in the review. These may include wait-list controls, treatment-as-usual, and straw-man designs. Studies that compare a dating violence program to another dating violence program (i.e., treatment vs. treatment designs) will not be included. We will include studies where participants are assigned at the individual, group, school, district, or state level. Specifically, we plan to include the following designs: 1. Randomized controlled trials: Studies in which individual participants, classrooms, or schools were randomly assigned to control and treatment conditions. 2. Quasi-randomized controlled trials: Studies where assignment is through alternating last name (or some other quasi-random procedure) to intervention or control condition. 3. Quasi-experimental designs (i.e., where participants or groups are assigned to conditions non-randomly). Where applicable, we will calculate pre-test effect sizes to adjust the post-test effect size (Borenstein, Hedges, Higgins, & Rothstein, 2010). Presumably, most studies will use one of the following designs that we plan to include: 1) Regression discontinuity designs: studies that used a cut-score to assign program eligibility and that examined program impact around the cut-off score. 2) Propensity score matching that explicitly included baseline measures of enrolment; these designs ensure equivalence among the groups. 3) Matching on individual or group pre-test demographics. 4) Designs that included a variety of methods such as a combination of propensity score or covariate matching with difference-in-difference techniques. We will also note that randomized experiments have been considered paramount to quasi-experimental designs due to a theoretical lack of selection bias. A burgeoning literature insists, however, that quasi-experimental designs, given appropriate pre-test observations, have the ability to produce similarly efficient and unbiased estimates of a treatment effect (Shadish & Cook, 2009). As it is often infeasible to randomly assign students to conditions, we have chosen not to exclude studies based on lack of random assignment. As a result, we believe that including such studies will increase the total study sample size and provide a more complete picture of the literature. To ensure that theoretically high risk of selection bias does not bias the average effect size, we will conduct sensitivity analyses that remove potentially biased studies and re-calculate the average effect size. Types of participants The population of interest is 4th-12th grade students. Studies that include participants outside this range must provide summary statistics for the age groups of interest. For instance, a study might implement a program for students in 11th and 12th grade as well as freshman and sophomore college students. A study that provides summary statistics for the reviewed population, in this case 11th and 12th graders, will be included. However, studies that merely provide study-level statistics that fail to disaggregate information will be excluded. Types of interventions The intervention of interest is a school-based prevention program designed to reduce teen dating violence. The intervention may also seek to change other outcomes (i.e., bullying perpetration, sexual harassment, etc.); however, a clear goal, as provided by the authors, must state that the program sought to explicitly reduce teen dating violence behaviors, change attitudes supportive of teen dating violence, increase bystander intervention to reduce perpetration, or increase peer support for victims of dating violence. Studies that merely measure these as secondary outcomes will be excluded. Types of outcomes The primary outcomes of interest are: 1. Attitudes supportive of teen dating violence behaviors 2. Frequency of engagement in adolescent intimate partner violence behaviors, including perpetration of: a. Verbal aggression b. Relational aggression (controlling, jealously) c. Physical aggression/violence d. Sexual aggression/violence or coercion 3. Frequency of victimization in adolescent intimate partner violence behaviors, including being a victim of: a. Verbal aggression b. Relational aggression (controlling, jealously) c. Physical aggression/violence d. Sexual aggression/violence or coercion 4. Knowledge about teen dating violence and what behaviors constitute teen dating violence 5. Recognizing both safe and unhealthy behaviors in intimate partner disputes 6. Learning how to be a bystander who intervenes when dating violence is perpetrated or learning how to support a victim of dating violence Outcome information may be reported via self-report questionnaires, teacher reports and observations, or researcher reports and observations. Examples of measures may include modified versions of the Conflicts Tactics Scale (Straus, Hamby, Boney-McCoy, & Sugarman, 1996), which assesses the frequency of use and type of behaviors used when dealing with conflict; dating violence knowledge, which can include "true" or "false" questions on definitions of abuse, resources for help, etc. (Taylor, Stein, Mumford, & Woods, 2013); and measures of victimization, which ask how many times incidents of sexual and nonsexual violence have occurred while on a date (Foshee et al., 2000). The outcome's metric is often determined by the primary author and is therefore difficult to hypothesize prior to coding. Types of time points We plan to synthesize outcomes measured directly after intervention (i.e., post-test) and at follow-up. The first post-program measures will be considered outcomes that follow the intervention, and any subsequent measures will be considered as follow-up effects. In essence, two simultaneous syntheses will be presented. This technique allows for greater understanding of the programs' effects both short- and long-term while guarding against non-independence of effect sizes. Therefore, time will not be used as a moderator (as is sometimes the case). Instead program effects will be calculated as outcomes immediately following the completion of a program, and also as outcomes sustained for a period after a student has ended a program. Types of settings The review will include studies conducted within middle and high schools. Studies that utilize community centers or other locations outside the brick-and-mortar schools will be excluded. We will include, however, all types of schools (i.e., publicly or privately funded). After-school programs conducted at the school will be included. Example of included study Weisz and Black (2001) implemented a school-based intervention in an urban middle school to change students' knowledge about and attitudes toward dating violence. The authors recruited seventh-grade students by offering a $5 McDonald's gift card (n = 44). A control group was formed by randomly selecting students from the same school who chose not to participate in the program (n = 20). This study constituted a non-randomized design. The authors assessed pre-test equality using an independent t-test; the results indicated no significant differences at pre-test. Results at post-test indicted significant increases in knowledge about and attitudes toward sexual violence for students who received the intervention (gs = .20 & .17, respectively). Search Methods for Identification of Studies Electronic searches Relevant studies will be identified using electronic database searches, government policy databanks, and Internet search engines. We will place neither language nor date restriction on the search. We plan to search from 1960 – February 2013. The following "traditional" databases will be searched: 1. ERIC 2. PsycInfo 3. SocIndex 4. ASSIA 5. PubMed 6. Sociological Abstracts 7. GALE 8. Academic Search Premier The traditional databases include international publications. However, we will also search CBCA Education, the British Education Index, and the Australian Education Index for citations outside the US. The following "grey literature" databases will also be searched: 1. scientific.thomson.comdatabases 2. csa.com/factsheetsdatabases 3. apa.org/psyextradatabase 4. Proquest (for dissertations and theses) Search terms Search terms will be created using relevant key words that represent the studies of interest. Table 1 lists each of the relevant search terms. These terms will then be arranged to produce a Boolean search phrase for each combination. An example of the search phrase that will be used in ERIC is presented in Appendix A. Searching other resources Two further procedures will be conducted to ensure search breadth. First, the authors will scan and screen bibliographies of included studies. Hammerstrøm, Wade, and Jørgensen (2010) showed that this procedure has the ability to produce substantial additional studies even with the most robust searches of electronic databases. Second, the authors will contact high-profile researchers in this field. These contacts will ensure that relevant published studies are included and may engender the inclusion of "file-drawer" datasets yet unpublished (Rosenthal, 1991). We will identify high-profile researchers by identifying who has published extensively within the field of teen dating violence, and identifying who has received funding to explore teen dating violence prevention programs. Finally, we will search websites of foundations and organizations that aim to decrease the prevalence of sexual and dating violence among youth for studies that may not have been included from previous search efforts. Examples of foundations and organizations include Centers for Disease Control and Prevention, National Institute of Justice, Love is Respect, Robert Wood Johnson Foundation, and the American Association of University Women. To identify potential grey literature outside of indexed databases, we will also search Google, Google Scholar, and Bing search engines. This will locate conference abstracts, government documents, and other online material. We plan to include any studies that meet the inclusion criteria listed above regardless of source. Targeting specific journals One member of the review team will hand-search the Journal of Counselling Psychology and Prevention Science starting in 2000 to locate any additional studies or references. These journals were selected because they had high initial citation counts relative to the purpose of this review. Screening procedures The screening process will occur in two distinct phases. First, LD and JRP will independently screen each title and abstract obtained from the search procedures described above for inclusion (see Appendix B). Each reviewer will code each citation according to pre-determined inclusion criteria. This information will be stored in an EXCEL database. Disagreements will be handled by discussion and consensus agreement with a third reviewer (DLE). The decisions available to the reviewer are: 1) Yes, include for full article scan, 2) Unclear so include for full scan, 3) Unclear but do not include (include reason), and 4) No, this article should be eliminated (include reason). Citations that meet the inclusion criteria will be retrieved for full review using the University of Illinois and Loyola University Chicago library resources. Second, each of the first and second authors will also independently screen the full articles for inclusion (see Appendix C). As with the previous procedure, we will screen the studies using the inclusion criteria, keeping track of that information in an EXCEL database. Should the citation be excluded at this stage, the reviewer will provide a brief description of the reason for dismissal. Again, a discussion and agreement will be reached for each disagreement using a third reviewer. Data Extraction Extraction of study information At least two reviewers (LD, JRP) will independently code all of the included studies. The codebook (Appendix D) details the variety of study characteristics that will be coded. The codebook will be operationalized in a Microsoft Access database. Electronic coding is preferable to hand-coding because it reduces data entry errors (Cooper, 2010). Microsoft Access will be utilized because of the hierarchical nature of data extraction. For instance, a study may include multiple outcomes nested within multiple treatment groups. Access allows the rev