Impact of Community-Based Interventions on Youth Externalizing Behaviors: A Modified Systematic Review

Background and purpose: Externalizing behaviors such as aggression, violence, delinquency, and antisocial traits can have harmful effects on youth including poor social relationships, poor school performance, decrease in prosocial behavior development, and an increased risk for juvenile justice involvement. Thus, evaluating community-based interventions that focus on reducing harmful behaviors and preventing future juvenile justice involvement is critical.

The purpose of this review was to assess the impact of community-based prevention programs and explain patterns across studies. The modified systematic review answered the following question: What is the effectiveness of community-based programs that incorporate common intervention and skill building components in reducing externalizing behaviors among youth?

Methods: Search Strategy: A PRISMA flow diagram was utilized to identify, screen, and determine eligibility of published studies for inclusion. A total of 679 articles were reviewed. Inclusion criteria: Studies were required to meet the following criteria: 1) randomized control trial or comparison study, 2) youth aggression, violence, delinquency, or antisocial traits as an outcome measure, 3) interventions were community-based, and 5) measures for outcomes included both a youth and caregiver assessment. Exclusion criteria: Articles were excluded from the review if the study was conducted in secure facilities; evaluated sexual offender behavior; or if the study was a systematic review, a qualitative study, or an HIV related study.  Additionally, studies were excluded if substance use as the outcome, the sample included youth with severe and persistent mental illness, the intervention was a name-brand program (i.e. MST, FFT), if recidivism was the outcome, or if the study outcome was validation of an assessment instrument.

Results: Nine studies of home, community, and classroom interventions were included in the final synthesis.  In the included studies, assessment of outcomes ranged from combinations of youth, parent, and or teacher components. All studies described small to moderate effects of the intervention on reducing externalizing behaviors including aggression, violence, delinquency, and antisocial traits. Comparing effects from posttest with change over time, parents reported a negative impact at posttest, however a positive impact with change over time.  Teachers reported a consistent positive effect at both posttest and change over time, and youth reported a positive change over time effect. Studies with a multi-modal approach had the greatest impact. Sampling bias, response bias, and social desirability may have influenced findings.

Conclusions and implications: Findings from this review were consistent with other meta-analyses and systematic reviews, although variations in study design, validated measures that appropriately measure the intended construct, and overlap between intervention components created challenges in evaluating findings. Intervention effects for programs that included an in-home and community-based component and/or a combined youth and parent intervention were most effective in reducing externalizing behaviors; suggesting a collaborative approach yields a greater outcome for targeted prevention of externalizing behaviors in youth. Acknowledging the resilience of families is an important component to practice, and if provided with appropriate resources, families can develop internal solutions to reduce externalized behaviors.