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REVIEW ARTICLE

A Systematic Review of School-Based Interventionsto Prevent BullyingRachel C. Vreeman, MD; Aaron E. Carroll, MD, MS

Objective : To conduct a systematic review of rigor-ously evaluated school-based interventions to decreasebullying.

Data Sources : MEDLINE, PsycINFO, EMBASE, Edu-cational Resources Information Center, Cochrane Col-laboration, the Physical Education Index, and Sociol-ogy: A SAGE Full-Text Collection were searched for theterms bullying and bully.

Study Selection : We found 2090 article citations andreviewed the references of relevant articles.Tworeview-ers critically evaluated 56 articles and found 26 studiesthat met the inclusion criteria.

Interventions : The types of interventions couldbe cat-egorized as curriculum (10studies), multidisciplinaryorwhole-school interventions (10 studies), social skillsgroups (4 studies), mentoring (1study),andsocialworkersupport (1 study).

Main Outcome Measures : Data were extractedregarding direct outcome measures of bullying (bully-

ing, victimization, aggressive behavior, and school

responses to violence) and outcomes indirectly relatedto bullying (school achievement, perceived schoolsafety, self-esteem, and knowledge or attitudes towardbullying).

Results : Only 4 of the 10 curriculum studies showeddecreased bullying, but 3 of those 4 also showed no im-provement in some populations. Of the10 studies evalu-ating the whole-school approach, 7 revealed decreased

bullying, with youngerchildrenhaving fewer positive ef-fects. Three of the social skills training studies showedno clear bullying reduction. The mentoringstudy founddecreased bullying for mentored children. The study of increased school social workers found decreased bully-ing, truancy, theft, and drug use.

Conclusions : Many school-based interventions di-rectly reduce bullying, with better results for interven-tions that involvemultipledisciplines.Curricular changesless often affect bullying behaviors. Outcomes indi-rectly related to bullying are not consistently improvedby these interventions.

Arch Pediatr Adolesc Med. 2007;161:78-88

B ULLYING IS A FORM OF AG-gression in which 1 or morechildren repeatedly and in-tentionally intimidate, ha-rass, or physically harm avictim. 1 Victims of bullying are perceivedby their peersas physicallyor psychologi-callyweaker thanthe aggressor(s),andvic-tims perceive themselves as unable to re-taliate. 2 Although bullying, harassment,andvictimizationcantakemanyforms, the

key elements of this behavior are aggres-sion, repetition, and the context of a re-lationship with an imbalance of power. 3

Bullying can impact the physical, emo-tional, and social health of the childreninvolved. Victims of bullying more oftenreport sleep disturbances, enuresis, ab-dominal pain, headaches, and feeling sadthan children who are not bullied. 4,5 Bul-lies, their victims, and those who are bothbullies and victims have significantly in-

creased risk for depressive symptoms andsuicidal ideation. 6,7 Students who reportvictimization are 3 to 4 times more likelyto report anxiety symptoms than unin-volved children. 8,9 The effects of bullyingonemotionalhealthmay persist over time;1 study 10 showedthat children bullied re-peatedly through middle adolescencehadlower self-esteem and more depressivesymptoms as adults. Victims of bullyingare more likely to feel socially rejected or

isolated and to experience greater socialmarginalization and lower social status. 11Bullying impacts a childs experience of

school on numerous levels. Bullying cre-ates problemswith schooladjustment andbonding, affecting the victims comple-tion of homework or desire to do well atschool. 6,12 In 1 study, 13 20% of grade-school children reported being fright-enedthrough muchof the schoolday.Bul-lyingseemsto increase schoolabsenteeism,

Author Affiliations: ChildrensHealth Services Research,Indiana University School of Medicine (Drs Vreeman andCarroll), and The Regenstrief Institute for Health Care(Dr Carroll), Indianapolis, Ind.

(REPRINTED) ARCH PEDIATR ADOLESC MED/VOL 161, JAN 2007 WWW.ARCHPEDIATRICS.COM78

2007 American Medical Association. All rights reserved. on August 4, 2010www.archpediatrics.comDownloaded from
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with victimized children becoming more school avoid-ant as the victimization increases. 14 Furthermore, in-volvement in bullyingaffects academic performance, al-though studies 15-18 show mixed results regarding whichchildren are most affected. Most bullying takes place atschool, particularly at times and places where supervi-sion is minimal. 19 Schools where adults tolerate more bul-lying may have more severe bullying problems. 10

As schoolbullying increasingly becomesa topic of pub-

licconcernandresearchefforts,a growing numberofstud-ies examines school-based interventions targeted to re-duce bullying.Althoughmany of these interventions havebeen rigorously evaluated, the evaluations reveal mixedresults. 20 For example, evaluations of the Olweus Bully-ing Prevention Program, a comprehensive whole-school intervention on which many subsequent pro-grams have been based, report reductions of 30% to 70%in the student reports of being bullied and bullying oth-ers.2,20-22 In contrast, evaluation of a similar comprehen-sive prevention program implemented in Belgium didnotshow significant differences in victimization or bullyingscoresamong primary or secondaryschool students. 23 Al-thoughsome reviewarticles have describedseveralof these

interventions, to our knowledge, no systematic reviewsof interventions to reduce bullying have been publishedin peer-reviewed literature. The objective of this studywas to review rigorously evaluated school-based inter-ventions to reduce or prevent bullying with the goal of determining whether these interventions worked.

METHODS

Wesearchedseveral bibliographicdatabases, includingMEDLINE(January 1,1966, throughAugust23, 2004),PsycINFO,EMBASE,Educational Resources Information Center, the Physical Edu-cation Index, Sociology: A SAGE Full-Text Collection, and theCochrane Clinical Trials Registry (all as of August 23, 2004). We used the search terms bullying or bully as Medical SubjectHeadings or keywords. We used a keyword search because itwasmore robust than searches usingonlyMedical SubjectHead-ings. One of us (R.C.V.) reviewed the titles of all returned ar-ticles and the bibliographies of all relevant review articles todetermine which studies examined a school-based interven-tion to prevent or reduce bullying. Articles were immediatelyexcluded if they obviously did not include an intervention ordid not occur at a school.

After articles that clearly did not meet the inclusion crite-ria were excluded, both of us (R.C.V. and A.E.C.), blinded tothe journal citation and article text other than the Methodssection, independently reviewed the articles. The 2 reviewersindependently decided on trial inclusionusing a standard formwith predeterminedeligibility criteria.Disagreementswere re-

solved by consensus reached after discussion. For inclusion, astudyneeded to describe an experimental intervention with con-trol and intervention groups and to include a follow-up evalu-ation with measured outcomes. In addition, the interventionneeded to be school based and designed to reduce or preventbullying. Each article was analyzed to determine the studymethod, interventioncomponents, outcomesmeasured, and re-sults.There was no assessment of quality in choosing or evalu-ating study outcomes beyond the inclusioncriteria.We didnotexcludeor discount studies based on baseline similarities amongtreatment groups, study power, retention rates, or programin-tensity because these characteristics are not associated defini-

tively with the strength of treatment effects. 24 Duplicate pub-lications or multiple articles that reported identical outcomesmeasured over the same period on the same population wereexcluded.

We extracted data from the selected articles regarding di-rectoutcome measures of bullying, including bullying, victim-ization, aggressive behavior, violence, school responses to vio-lence,andviolent injuries.Data were also extracted foroutcomesthought to be indirectly related to bullying, such as schoolachievement,perceptionof school safety, self-esteem,or knowl-

edge about or attitudes toward bullying.

RESULTS

The systematic literature search identified 2090 articles.The online search of MEDLINE yielded 353 articles,and the search of EMBASE yielded 269 articles, 9 of which were not found by the MEDLINE search. Thesearch of PsycINFO yielded 897articles, Educational Re-sourcesInformation Center yielded 552articles, thePhysi-cal Education Index yielded 16 articles, and Sociology: ASAGE Full-Text Collection yielded 3 articles. An addi-tional 4 potential studies 25-28 were identified throughsearches of bibliographies and were also reviewed. Oncearticles that obviously did not address school-based in-terventions were excluded, 321 relevant articles re-mained. Reviewing the abstracts of these articles allowedfor the further exclusion of articles that did not addressschool-based interventions. Fifty-six articleswerethenas-sessed by both of the reviewers. Articles were most com-monlyexcluded at this stage because they were notevalu-ations of interventions, they did not have controlgroups,or they did not address bullying.

The 26 studies that met the selection criteria variedsubstantiallyin intervention type, studypopulation, studydesign, and outcome measures. The detailed character-istics of the studies are reported in Table 1 . The inter-ventions could be divided into 5 categories: curriculuminterventions, multidisciplinary or whole-school inter-ventions, targeted socialandbehavioral skillsgroups, men-toring, and increased social work support. To maximizeclarity and clinical usefulness, we present the subse-quent results of the review based on the type of inter-vention. All26studies investigatedinterventionsfor somegroup of primary school students, but the primary gradelevels varied from first to eighth grade. Six stud-ies22,23,30,39,41,48 included secondary school students (olderthan eighth grade) in their interventions and outcomes.The selected studies reported a range of outcomes thatwere subsequently categorized into direct and indirectoutcomes. The direct and indirect outcomes of all of the

studies are reported inTable 2

.CURRICULUM INTERVENTIONS

Ten studies 23,26,29-36 evaluated the implementationof newcurriculum. The curriculum interventions includedvid-eotapes, lectures, and written curriculum, and varied inintensity from a single videotape followed by classroomdiscussion to 15 weeks of classroom modules. The de-tails of the study designs,participants, intervention type,and important outcomes of the curriculum interven-




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tions are all described in Table 1. The studies all used apretest, posttest, control group design; 6 of the 10 stud-ies randomized the assignment of the groups. 23,29-31,35,36

The curriculuminterventions didnot consistently de-crease bullying, and several actually suggested that thebullyingwithintheinterventiongroup increased(Table2).Of the 10 studies of curriculum interventions, 6 showed

no significant improvements in bullying. 23,26,30,32,33,36 Al-though bullying and victimization did not change sig-nificantly, Boulton andFlemington 30 did find that thestu-dentsin the interventiongroup broadened their definitionof bullying slightly, and Englert 32 found that the teach-ers reported a significant decrease in observed physicaland verbal violence ( P .01).

Table 1. Study Characteristics

Source Country SubjectsControlGroup

InterventionGroup

Grade Levelor AgeGroup

StudyDesign Intervention

EducationalTheory*

Methodof Group

Assignment

Curriculum InterventionsBaldry and

Farrington,292004

Italy 239 studentsin 10 classes

106 students 131 students Aged 10-16 y Pretest,posttest,randomized,controlledtrial

3-d interventionprogram(3-h sessions,once a week,for 3 wk)

Social cognitivecompetenceskills

Randomallocation byclass

Boulton andFlemington,301996

UnitedKingdom 170 studentsin 8 classesat 1 school

4 classes 4 classes Grades 7-10(aged11-14 y)

Randomizedmatchedpairs

Short videotapedintervention(Sticks andStones) withclassdiscussion

Not given One class ineach yearrandomizedto theinterventiongroup

Cowie et al,261994

UnitedKingdom

2 schools,16 classes,148 students

5 classes 11 classes Aged 7-12 y Pretest,posttest,control groupdesign

Cooperativegroup workcurriculum

Cooperativegroup work,effect oninterpersonalrelationships

Schools selectedbased oninterest

Elliott andFaupel,311997

UnitedKingdom

64 students 32 students 32 students Grades 4and 5

Pretest,posttest,randomized,controlledtrial

Videotape andcurriculum

Groupinterpersonalproblemsolving

Randomized bystudent

Englert,321999

UnitedStates

71 studentsin 3 classes

23 students(1 class)

24 students in theproblem-solving group(1 class) and24 students inthe cooperativetask group(1 class)

Grade 4 Pretest,posttest,control groupdesign

2 curricula: one inproblem-solving trainingand one incooperativetaskdevelopment

Problem-solvingandcooperativetaskdevelopment

Assigned by class

Kaiser-Ulrey,332003

UnitedStates

125 students 67 students 58 students Grade 7 Pretest,posttest,control groupdesign

12-wkantibullyingcurriculum

Psychoeducation,empathy,problem-solving,dissemination

Assigned incohort groups

Rican et al,341996

Czecho-slovakia

198 studentsin 8 classes

98 students 100 students Grade 4(medianage, 10 y)

Pretest,posttest,control groupdesign

Videotape,curriculumchanges,class charter

Not given Assigned by class

Stevenset al,232000

Belgium 24 schoolstotal (728primaryschoolstudents and1465secondaryschoolstudents)

193 primaryschoolstudentsand 229secondaryschoolstudents

130 primaryschoolstudents and219 secondaryschoolstudents

Primary andsecondaryschools

Pretest,posttest,randomized,controlledtrial

Videotape,curriculumchanges,class charter,role-playingwithin classes

Social cognitiveorientationemphasizingcognitiveperspectivetaking,problem-solvingstrategies, andsocial skills

Randomlyassigned byschool toexperimentalor controlgroup

Teglasi andRothman,352001

UnitedStates

59 students: 17aggressiveand 42nonaggres-sive

8 aggressivestudents

8 aggressivestudents

Grades 4and 5

Pretest,posttest,time-laggedcomparison

15-wk curriculum Socialproblem-solving skills;reorganizationof schemas forsocialinformationprocessing andproblem-solvingthroughexperientiallearning

Partialrandomization:nonaggressivechildrenrandomlyplaced ingroups of 4;1-2 aggressivechildrenrandomlyselected, addedto groups

Wardenet al,361997

UnitedKingdom

120 studentsin 6 schools

60 students(10 fromeach of the2 primaryclasses ineach of 6schools)

60 students (10from each ofthe 2 primaryclasses in eachof 6 schools)

Aged 6 and10 y

Pretest,posttest,randomized,controlleddesign

KidscapeChildrensSafety TrainingProgramcurriculumimplementedover 4 wk

General safetyrules appliedwith specificstories and roleplays

Kids randomlyselected withinschool groups,but 3interventionschoolsselected theprogram

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Table 1. Study Characteristics (cont)

Source Country Subjects Control GroupIntervention

GroupGrade Levelor Age Group


EducationalTheory*

Method of GroupAssignment

Multidisciplinary or Whole-School InterventionsAlsaker and

Valkanover,252001

Switzerland 319 studentsin 16kindergartens

8 kindergartens(n = 152)

8 kindergartens(n = 167)

Kindergarten(aged 5-7 y)

Pretest, posttest,control groupdesign

Whole-schoolapproach

Teacher trainingonwhole-schoolapproach withemphasis onrules andsocial-cognitiveskills

By school;interestedteachersselectedfor theintervention

Meltonet al,281998

UnitedStates

6389 studentsin 39 schools

Year 1: 28schools;year 2:21 schools

Year 1: 11schools; year2: 18 schools

Grades 4-6(aged 9-11 y)



Interventions atlevel of school,curriculum,individualstudents;materials forschool staff andinvolvedcommunitymembers

Districts matchedbydemographics;one district ineach pairassigned tofirst year ofintervention

Menesiniet al,372003

Italy 293 studentsin 2 middleschools

5 classes(n = 115)

9 classes(n = 178)

Grades 6-8 Pretest, posttest,control groupdesign

Befriendingintervention

Training andimplementationof peersupporterswithin schools

Assigned byclass basedon teacherswillingness toparticipate

Metzleret al,382001

UnitedStates

1403 studentsin 3 middleschools

2 schools(n = 758)

1 school(n = 645)


Comprehensivebehaviormanagementprogram

Rule system,training,increased praisesystems

Assigned byschool

Mitchellet al,392000

Australia 38 schools,primary andsecondary

18 schools 21 schools Primary andsecondary

Pretest, posttest,randomized,controlleddesign

Health-promotingschoolsintervention

School staffworkshop,resource kit forschool, networkmeetings forstaff, financialsupport forschool-basedactivities

Randomized byschool

Olweus,221994

Norway 2500 studentsin 42 primaryand secondaryschools

NA NA Primary andsecondary

Quasi-experimentalwithtime-laggedage cohort


Teacher training,parent advice,videotapedcurriculum,feedback forstaff; emphasison rules andsanctions

Time-laggedcohorts, notrandomized

Rahey andCriag,402002

Canada 491 studentsin 2 primaryschools

1 school(n = 251)

1 school(n = 240)


Whole-schoolprogramimplementedover 12 wk

Curriculum, peermediationprogram,groups forbullies andvictims, teachertraining;emphasis onconflictresolution,empathy, andlistening skills

Assigned byschool

Roland,412000

Norway 7000 studentsin 37 primaryand secondaryschools

NA NA Primary andsecondarystudents

Age-cohortdesign withtime-laggedcomparisons


Teacher training,curriculum;emphasis onrules andsanctions

Time-laggedcohorts, notrandomized

Sanchezet al,422001

UnitedStates

747 studentsat 12 schools

6 schools(n = 378-380)

6 schools(n = 362-367)

Grade 5 Pretest, posttest,randomized,matchedpairs,controlleddesign


Expect RespectModel withclassroomcurriculum,staff training,policydevelopment,and supportservices forindividuals

6 pairs ofmatchedschools,1 school ineach pairrandomlyassignedto theintervention

Twemlowet al,432001

UnitedStates

110 studentsat 2 schools

1 school(n = 64)

1 school(n = 46)

Primary school Pretest, posttest,control groupdesign


Socialsystems/ psychodynamicintervention,including zerotolerance,discipline plan,physicaleducation plan,and mentoringprogram

Assigned byschool;methodnot given

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Of the4 studies that did show less bullyingafter a cur-riculum intervention, 3 also showedmore bullying or vic-timization in certain populations or with certain mea-surementtools. 29,34,35 Thestudyby Baldry and Farrington 29showed a decrease in self-reported victimization amongolder children ( P .05), butyounger children actually re-ported more victimization ( P .01), and there were nosignificant differences in either victimization or bully-ing overall. Teglasi and Rothman 35 found that teachersreported decreased antisocial behavior for children notidentified as aggressive and increased aggressive behav-ior for the children previously identified as aggressive(P .01 for both). The individual self-reports for aggres-

sion didnot reveal any significant effects from the inter-vention. A study by Rican et al 34 found significant de-creases in peer nominations of bullying ( P=.02) andvictims ( P=.03) using unspecified broad criteria, butno change in victimizationusing narrower criteria. Only1 curriculum interventionshowed unequivocal improve-ments, and this was in an indirect outcome. The ran-domized trial of Elliott andFaupel 31 of a group problem-solving curriculum resulted in increased generation of responses to a simulated bullying situation by the inter-vention group.

WHOLE-SCHOOL MULTIDISCIPLINARYINTERVENTIONS

Ten studies 22,25,28,37-43 evaluated interventions usinga mul-tidisciplinary whole-school approach that included somecombination of schoolwide rules and sanctions, teachertraining, classroom curriculum, conflict resolution train-ing, andindividual counseling. Table 1 describes thecom-ponents of each of these multidisciplinary studies in de-tail. Thewhole-schoolstudiesinvolvedmore subjects thanthe curriculum interventions, with up to 42 schools in asingle study. Only 2 of the studies 39,41 evaluated inter-ventions among secondary school students, and the rest

looked at primary schools. In contrast to the curricu-lum studies, only 2 of the whole-school studies incor-porated randomization in their study design. Two of thestudies 41,50 used a quasi-experimental design with time-lagged age cohorts.

Twostudies, both evaluating the seminal OlweusBul-lying Prevention Program, revealed disparate results. TheOlweus Bullying Prevention Program pioneered thewhole-school approach to preventing and reducing bul-lying with an intervention program in Bergen, Norway,that includedtrainingfor school personnel, materials for

Table 1. Study Characteristics (cont)

Source Country Subjects Control GroupIntervention

GroupGrade Levelor Age Group


EducationalTheory*

Method of GroupAssignment

Social and Behavioral Skills Group Training InterventionsDeRosier,44

2004United

States415 students

withsignificantpeerrelationshipdifficulties

n = 217 n = 198 Grade 3 Pretest, posttest,randomized,controlleddesign

S.S. GRINsocial skillsgroup training

Social learningand cognitivebehavioraltechniques

Randomassignmentby student

Fast et al,45

2003 UnitedStates 127 students n = 105 n = 22 (12aggressiveand 10nonaggressivestudents)

Grade 7 Quasi-experimentalintervention foraggressivestudents only;no matchedcontrol

Peer mediatorgroup training Peer mediationto improveindividualbehavior andaffect socialnorms

Selected basedon aggressionlevel

Meyer andLesch,462000

SouthAfrica

54 students at3 schools,all malesidentified asbullies

n = 18 Interventionalbehavioralskills group(n = 18) andsupportiveplay group(n = 18)

Grades 6-7 Pretest, posttest,randomized,matched pairswith controldesign

Behavioral skillsgroup

Socialinteractionalmodel forbehavioralskillsdevelopment

Matched byaggressionlevel, thenrandomlyallocated toexperimentalcondition

Tierney andDowd,472000

UnitedKingdom

30 students withemotional andbehavioralconcerns,includingvictimization

n = 15 n = 15 Grade 8 Pretest, posttest,matched cohort

Social skillstraining group(6 sessions)

Social skillstraining onspeaking/ listening,friendships,bullying,knowing onesself, andknowing others

Students selectedif causingconcern;matched tocontrol

Other InterventionsBagley and

Pritchard,481998

UnitedKingdom

670 students at2 primaryschools and2 secondaryschools

1 primary and1 secondaryschool

1 primary and1 secondaryschool

Primary andsecondary


Increased socialworkers

Focus on familyand childcounseling andon addressingbullying

Assigned byschool

King et al,492002

UnitedStates

311 fourth-gradestudents at1 school

Nonmentoredstudents(n = 283)

At riskstudents(n = 28)

Grade 4 Cohort s tudy Mentoringprogram twicea week

Focus onrelationshipbuilding,self-esteemenhancement,goal setting,and tutoring

Students selectedbased on riskyhealthbehaviors,depression,and risk forschool failure

Abbreviation: NA, data not applicable.* For multidisciplinary or whole-school interventions, components are given.




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Table 2. Study Outcomes by Intervention Type

SourceIntervention

TypeDirect Outcomes: Bullying, Aggressive Behavior, Violence,

and School Responses to Violence

Indirect Outcomes: School Achievement,Perceived School Safety, Self-esteem,

and Knowledge or Attitudes About Bullying

Baldry andFarrington,292004

Curriculum No difference in victimization or bullying overall (P = .08); lessvictimization in older students (aged 14-16 y) (t = 2.19,P .05);worse victimization for younger students (t = 2.73,P .01)

Not measured

Boulton andFlemington,301996

Curriculum No significant change in bullying others No significant difference in attitudes toward bullying;did broaden definition of bullying slightly to includename-calling (P = .40), telling nasty stories aboutother people (P = .55), and forcing people to dothings they do not want to do (P .05)

Cowie et al,261994

Curriculum No significant effect on bullying behavior (increase in both groups);small decrease in reporting of victimization

Not measured

Elliott andFaupel,31 1997

Curriculum Not measured Improved generation of responses to bullying: groupinterpersonal problem-solving curriculumproducing 3 times more solutions (105 responses)than control group (32 responses)

Englert,32 1999 Curriculum No change from childrens reports; no statistically significantdifference for individual classrooms; control classroom studentsreported significantly fewer incidents of being bullied thanproblem-solving classroom students before and after theintervention (P .01); teacher observations of significant decreasein observed physical and verbal violence, with mean scoresdecreasing from 3.40 to 1.60 (P .01) for the problem-solvinggroup and mean scores decreasing from 3.80 to 1.40 (P .01)for the cooperative task group

No change; neither intervention group showedsignificant improvement in problem solving vs thecontrol group (P .01); no significant differences inself-esteem scores preintervention andpostintervention; cooperative task classroomactually had significantly lower self-esteem scoresthan problem-solving or control classroompostintervention (P .05)

Kaiser-Ulrey,332003

Curriculum No change; MANCOVA for outcomes of bullying incidence,victimization incidence, prosocial behaviors, and parentalinvolvement revealed no significant multivariate effect betweengroups; nonparametric analysis of evidence of bullying andvictimization revealed no improvement

Improved social skills; MANCOVA for outcomes ofempathy, prosocial behaviors, global self-esteem,and parental involvement revealed no significantmultivariate effect between the groups;nonparametric analysis of social skillsdevelopment, talking to friends about bullying,talking to parents about bullying, and programsuccess revealed no improvement, except forimproved social skills in the intervention group(P = .01)

Rican et al,341996

Curriculum Improvement in bullying: intervention classes had significantly fewerbullies nominated by peers after the intervention (7.1% comparedwith 11.2% using broader criterion to define bullies;P = .02);decreased victimization by some criteria: victims defined by abroader criterion (7.1% in intervention classes compared with14.3% in control classes (P = .03); for narrower criterion, theintervention group did not have a significant change in percentageof victims, but still had a significant change in percentage ofbullies (P = .02)

Not measured

Stevens et al,232000

Curriculum No significant change for primary students in involvement inbully-victim behaviors (P .07); no significant change forsecondary students at posttest 2

No significant changes for primary or secondarystudents in attitude toward bullies and victims,self-efficacy, and intention to intervene

Teglasi andRothman,352001

Curriculum Improved for nonaggressive children; worsened for aggressivechildren; teacher reports showed decreases in externalizing andantisocial behaviors for children not identified as aggressive(P .01) and increases in externalizing aggressive behavior forchildren previously identified as aggressive (P .01); a 2 analysisof the relationship between identification status and treatmentresponse indicated aggressive children were more likely to have alow response rate (P .001); less externalizing children respondbetter to treatment (P .001); individual self-reports did not revealany significant effects from the intervention

Not measured

Warden et al,361997

Curriculum Not measured No improvement in responses to bullying situation foreither 6- or 10-year-old children; for other safetysituations, responses of the intervention groupwere rated as significantly more safe than those ofthe untrained control group; responses of olderchildren were rated as significantly safer than thoseof younger children on all 3 testings (P .001)

Alsaker andValkanover,252001

Multidisciplinary No changes in teacher or child reports of bullying behavior; decreasedvictimization on teacher and child reports; on peer reports, theintervention group had a 15% reduction in the proportion ofchildren nominated as victims by peers in contrast with a 55%increase in children in the control group nominated as victims;teacher reports showed reduction in physical bullying and indirectbullying through isolation, but an increase in verbal bullying;neither childrens peer nominations nor teacher ratings showed

any evidence of decrease in bullying behaviors in the interventionor control group; childrens reports in both groups showed a slightincrease in nominations of bullying (no statistics given)

Increased awareness of school rules regardingbullying

Melton et al,281998

Multidisciplinary After 2 y of the intervention, no significant differences in bullying,antisocial behavior, or victimization (victimization increased in bothgroups); no significant change in victimization rates in interventionschools at year 1 or 2; intervention schools did have a decline inthe rate of bullying by 20% after the first year of the intervention(in contrast with a 9% increase in bullying rates in the controlschools), but after 2 y of the intervention, there were no significantdifferences in bullying, general antisocial behaviors, or attitudestoward bullying between the intervention and control students; nosignificant program effects for 7 original control schools thatreceived only 1 y of the intervention

No differences in attitudes toward bullying

(continued)




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Table 2. Study Outcomes by Intervention Type (cont)

SourceIntervention

TypeDirect Outcomes: Bullying, Aggressive Behavior, Violence,

and School Responses to Violence

Indirect Outcomes: School Achievement,Perceived School Safety, Self-esteem,

and Knowledge or Attitudes About Bullying

Menesiniet al,372003

Multidisciplinary Bullying remained stable for the intervention group (although itincreased for the control group); no change in victim ordefendant scales; levels of bullying or probullying behaviors inthe intervention group remained stable, whereas probullyingscales increased in the control group (P .05)

No decrease in provictim attitudes as seen in the controlgroup

Metzleret al,382001

Multidisciplinary Improved discipline referrals for seventh graders (P = .04);improved harassment among males (P = .02); no changes forsixth and eighth graders; no change in physical or verbalattacks

Improved perception of safety for sixth graders(59.3%-75.6% at the first year to 72.2% at the secondyear) and seventh graders (56.4%-60.2% at the first yearto 69% at the second year); no change for eighth graders,nor in the comparison school

Mitchellet al,392000

Multidisciplinary Not measured Improved awareness of health-promoting school conceptwith significantly greater proportion of staff hearing ofhealth-promoting school concept (P = .04), readingrelevant material (P .001), and attending in-servicetraining on health-promoting schools (P .001); nosignificant changes in health-related policies or practicesoccurred in the intervention group, including those relatedto bullying

Olweus,221994

Multidisciplinary Decreased level of bully-victim problems, peer reports ofbullying, and general antisocial behavior; for outcomes ofbullying others, boys averaged a 16% reduction and girlsaveraged a 30% reduction after 8 mo; after 20 mo, reductionsaveraged 35% for boys and 74% for girls; reductions invictimization averaged 48% for boys after 8 mo and 58% forgirls; reductions increased to 52% for boys and 62% for girlsafter 20 mo

Improved, with better social climate and satisfaction withthe school

Rahey andCriag,40

2002

Multidisciplinary No significant decrease in bullying; decreased level ofvictimization (P .05) and peer isolation (P .01) for olderstudents (grades 5-8); increased level of victimization (P .05)and exclusion (P .01) for younger students (grades 1-4)

Improved perception of school safety (P .01) and being wellliked (P .001) for older students (grades 3-8); worsenedperception of school safety (P .01) and of being well liked(P .01) for younger students (grades 1-2)

Roland,412000

Multidisciplinary Increase in bullying (a 24% increase in boys and a 14% increasein girls); increased victimization in boys (by 44%); increasedsocial exclusion for boys (by 12.5%); more positive outcomesfor schools implementing programs fully

Not reported

Sanchezet al,422001

Multidisciplinary Not measured No significant increase in knowledge of bullying; interventionstudents more likely to report seeing bullying (P .05) andexpressed greater readiness to intervene personally(P .05); intervention students were less likely to tell anadult about bullying (P .05)

Twemlowet al,432001

Multidisciplinary Improved discipline referrals and suspension rates; disciplinaryreferrals decreased from 74 for physical aggressiveness in1994-1995 to 34 after the first year of the intervention, andstabilized at 36 during the second year of the intervention;referrals for other infractions went from 162 to 97 after thefirst year, and to 93 after the second year; suspension rateswere significantly lower in the intervention group, at about9% after the first year (P .02) and 4% after the second year(P .004) (the control school suspension rate did not varysignificantly, ranging between 14% and 19%)

Improved academic achievement scores (from 40th to 58thpercentile for third and fifth graders), whereas the controlschool did not change over the same period

DeRosier,442004

Social skillsgroup

Significantly improved aggression on peer report (P .001);improved bullying behavior on self-report (P .05); fewerantisocial affiliations on self-report (P .05) only for childrenwho were more aggressive at baseline

Improved peer liking (P .05); improved self esteem(P .05); improved self-efficacy (P .05); improved socialanxiety (P .05) for all children in the treatment group;significant multivariate main effect for treatment condition(P .05)

Fast et al,452003

Social skillsgroup

No significant change in discipline referrals, aggressive behavior,or impulsivity; improved scores on teachers Behavior RatingIndex for Children for highly aggressive students, with adifference in means of 9.05 (P .05)

Improved self-concept for highly aggressive students by anaverage of 11.33 points (P .05), while the remainder ofthe class had a declining self-concept (P .05)

Meyer andLesch,462000

Social skillsgroup

No improvement in bullying on peer reports or self-reports Not measured

Tierney andDowd,472000

Social skillsgroup

Improved interactions with peers by teacher report;no clear change in victimization on self-report

Decreased level of teacher worry; significant progress inareas of friendships and behavior on teacher reports, butno significant change in level of happiness or confidence

Bagley andPritchard,481998

Increased socialworkers by2.5 workers

Improved bullying in primary school and no improvement insecondary school; improved theft, truancy, fighting, and druguse in primary and secondary schools (P .05); primaryproject schools self-reports of bullying incidents went from28% to 22%, a 21% decrease, withP .05 (control schoolrates went from 28% to 30%, a 7% increase); secondaryintervention schools self-reported rates of bully or bulliedinvolvement went from 10% to 12% (a 20% increase), whilecontrol school went from 14% to 13% (a 7% decrease)

Not measured

King et al,492002

Mentoringprogram

Improved bullying and fighting; at posttest, mentored studentswere significantly less likely to have bullied a peer in the past30 d (t 27 = 3.47,P .002) and to have physically fought with apeer in the past 30 d (t 27 = 3.48,P .001) than at pretest(results not compared with the control group)

Less depression (t 27 = 2.97,P = .006); significantimprovements in mentored students overall self-esteem,school connectedness, peer connectedness, and familyconnectedness; compared with control group children,the mentored group achieved significantly higher schoolconnectedness and family connectedness, but self-esteemand peer connectedness did not differ significantly; of the28 students in the program, 20 (71%) showed academicletter-grade improvements from the first quarter

Abbreviation: MANCOVA, multiple analysis of covariance.




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social workers focused on problem behaviors, includ-ing bullying. Compared with matched control schools,they found a significant decrease in self-reported bully-ing within the primary school ( P .05), but worseningbullying in the secondaryschool. Forself-reportsof theft,truancy, fighting, anddrug use, the primary andsecond-ary intervention schools had significant improvements(P .05). A study by King et al 49 investigated the effectsof a mentoring program for at-riskchildren. The men-

tored studentsweresignificantly lesslikely thantheir non-mentoredage-matchedpeers to report bullying( P .002),physically fighting ( P .001), and feeling depressed(P=.006) in the past 30 days.

COMMENT

As governments, schools, and educators invest increas-ing amounts of money and time into antibullying inter-ventions, thefindingsof this review provide evidence forhowto best achieve thedesired outcome of decreasedbul-lying withinschools. Bysystematicallygathering andcom-piling the growing number of studiesevaluatingthese in-

terventions, it becomesclear that some of theantibullyinginterventions actuallydecrease bullying,while others haveno effect or even seem to increase the amount of bully-ing. Grouping thestudiesbythetype of intervention seemsto offer the most insight into what leads to success.

The curriculum interventions were generally de-signedtopromote anantibullyingattitudewithintheclass-room andtohelp children develop prosocialconflict reso-lutionskills. Most of these interventions drewon thesocialcognitive principles of behavioral change, 52,53 with fo-cuson changingstudentsattitudes, alteringgroup norms,and increasing self-efficacy. Curriculum changes areoftenattractivebecause they usually require a smaller com-mitment of resources, personnel, and effort. Neverthe-

less, the interventions that consisted only of classroom-level curriculum seldom improved bullying. The basisin social, cognitive, behavioral change may explain partof the problem;previouswork 54,55 suggests that youngerchildren benefit less from these techniques. However, thefailure of classroom-level interventions for older andyounger students points to the systemic nature of bul-lying and supports the theory of bullying as a socio-cultural phenomenon. If bullying is a systemic groupprocess involving bullies, victims, peers, adults, par-ents, schoolenvironments,andhome environments, 56 anintervention on only 1 level is unlikely to have a signifi-cant consistentimpact.Furthermore, ifbullying is,assomepropose, a socioculturalphenomenon springing from the

existence of specified social groups with different levelsof power, 57 then curriculum aimed at altering the atti-tudes and behaviors ofonlya small subsetof those groupsis unlikely to have an effect.

Similarly, the targeted interventions providing train-ing in social skillsdid not clearly improve bullying or vic-timization. 45-47 The failure of these interventions, alsobased largely on social, cognitive, behavioral changes,points again to the inability of a single-level interven-tionto combatbullyingeffectively.Interestingly, the olderchildrenhadworseoutcomes from thesocial skills train-

inggroups than the younger children. 44 The 1 study look-ingat younger childrenfound decreased aggression,bul-lying, and antisocial affiliations. Although one cannotgeneralize from a single study, it is possible that address-ing social skills changes in the context of a small tar-geted group during a particular developmental windowcould be effective.Overall, thestudiesof socialskillsgroupinterventionssuggest again that failing to address the sys-temic issues and social environment related to bullying

undermines success.The whole-school interventions, which included mul-tiple disciplines and complementary components di-rected at different levelsof the school organization, moreoften reduced victimization and bullying than the inter-ventions that only included classroom-level curricula orsocial skills groups. The whole-school interventions ad-dress bullying as a systemic problem meriting a sys-temic solution. They seek to alter the schools entire en-vironment and to involve individuals, peer groups,classrooms, teachers, and administration. The success of the whole-school interventions suggests that bullyingdoes, indeed, spring from factors external to individualchildrens psychosocial problems, including a complex

process of social interactions. An evaluation of whole-school approaches by Smith et al 56(p557) in 2004 suggeststhat these interventions may reflect a reasonable rate of return on the investment inherent in low-cost, nonstig-matizing primary prevention programs. Our review of-fers further support for using whole-school interven-tions to reduce or prevent bullying.

Despite the evidence pointing toward the value of whole-school approaches, significant barriers may stilllimit their effectiveness. The implementation of the in-tervention can vary significantly, and this clearly altersthe results. The original antibullying whole-school ap-proach studied in Bergen by Olweus 51 and the evalua-tion of the same program in Rogalandby Roland 27,41 pro-

duced the most strikingly disparate results. The contrastmay have been the result of decreased school staff par-ticipation at the Rogaland schools. 27 In addition, the Ol-weus program does not include detailed instructions forreplicating an identical program in another school set-ting. Difficulty in replicating this program may contrib-ute to the lack of success when used in other settings,such as South Carolina. 28 Although the adaptation of theinterventions in different settings may create more cul-turally appropriate interventions, thesemodificationsmayproduce some of the variance in success. Unfortunately,the specific components of a given interventionare gen-erally not described sufficiently to enable faithful repli-cation. The specific school environment could also sig-

nificantly impact effectiveness. The small class size,excellent teacher training, and tradition of social wel-fare intervention in some settings could enablebetter ef-fects. Thesuggestion thatwhole-schoolinterventions maynot work as well for younger children, seen in 2 of thestudies, 25,40 also merits consideration. This, albeit lim-ited, evidence may support a developmental theory,whereby bullying begins in early childhood as individu-als assert themselves to gain dominance and then gradu-ally evolvesaschildrenuseless sociallyreprehensive waysto dominate others. 58 Schoolwide rules and changes in




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the schools overall responses to bullying may not be aseffective in theyounger population beforetheyfollowtheirnatural developmental progression intoconformity withsocial norms.

There are several limitations to this systematic re-viewthat warrant consideration. We only includedstud-iesin theEnglish language.Althoughwe may have, there-fore, overlooked some relevant studies, we located fewnonEnglish-language studies that required exclusion.

Some of the included studies did not have ideal meth-odological strength; however, many of the studies werereasonably well done and offered important counterbal-ances to the findings. The study results may be overes-timated because, in many cases, schools or districts wererandomizedto treatment conditions, but thestudentswereevaluatedas theunit ofanalysis.Theunit of analysisprob-lem could result in a higher type I error if intraclass cor-relation is not taken into account. 59 Even so, many of thestudies that did this still found no treatment effects. Theuse of variable outcome measures may further limit theability to measure accurately the effects of these inter-ventions. The most commonoutcomemeasureswereself-reportsof victimization andbullying that maynotwholly

correspond with information obtained from peers orteachers or fromobservations. 60 Still, self-reports are thestandard measure used in most studies evaluating be-havioral interventions. Despite the diversity of the evi-dence reviewed, the studies were primarily performed inEurope and the United States, which may limit the gen-eralizability of the conclusions. In addition, several in-terventions with positive results, including interven-tions using mentoring, increased social workers by 2.5workers,andsocial skillsgroups foryoungerchildren,wereonly studied on a single occasion, thus limiting their gen-eralizability. Finally, while we attempted to separate outthe most effective components or intervention strategies,many of the studies involved numerous complementary

components that were not evaluated individually.In conclusion, fairly consistent evidence suggests thatchildrens bullying behavior can be significantly reducedby well-planned interventions. The chance of success isgreater if the intervention incorporatesa whole-school ap-proachinvolvingmultiple disciplinesandthewhole schoolcommunity.Theschoolstaffs commitment to implement-ing the intervention also may play a crucial role in its suc-cess. Theuseof curriculum or targetedsocialskillsgroupsalone lessoftenresults inanydecrease inbullyingandsome-times worsensbullyingandvictimization. Cautionshouldbe exercised in supposing that antibullying interventionsinvariably produce the intended results. This review re-veals that not allprograms have proved effective. Most re-

ductions in bullying tend to be relatively smallandrelatedmore to theproportionof childrenbeingvictimizedratherthan the proportion engaging in bullying. Additional re-search to evaluate bullying behaviors andantibullying in-terventions is clearly needed.

Accepted for Publication: August 3, 2006.Correspondence: Rachel C. Vreeman, MD, ChildrensHealth Services Research, Indiana University School of Medicine, 699 West Dr, Riley Research Room 330, In-dianapolis, IN 46202 ([email protected]).

Author Contributions: Dr Vreeman had full access to allthe data in the study and takes responsibility for the in-tegrity of the data and the accuracy of the data analysis.Study concept and design:Vreeman and Carroll. Acquisi-tion of data: Vreeman. Analysis and interpretationof data:Vreeman and Carroll. Drafting of the manuscript: Vree-man. Critical revision of the manuscript for important in-tellectual content: Vreeman andCarroll. Statistical analy-sis: Vreeman and Carroll. Administrative, technical, and

material support: Vreeman and Carroll. Study supervi-sion: Vreeman and Carroll.Financial Disclosure: None reported.Disclaimer: The views expressed herein are those of theauthors anddo notnecessarily represent the views of In-diana University School of Medicine.

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