Effectiveness of Community-Based Programs on Aggressive Behavior Among Children and Adolescents: A Systematic Review and Meta-Analysis

Abstract

Adolescent aggressive behavior has increasingly become a central issue affecting the safety of both school campuses and the broader society. Despite the existence of numerous community interventions targeting this issue, there has been a paucity of efforts to consolidate the findings on the effectiveness of community-based programs in preventing aggressive behavior. This meta-analysis sought to address this gap by reviewing and assessing the impact of community-based initiatives on reducing adolescent aggression. A thorough search was carried out on 12 electronic databases: EBSCO, ERIC, PubMed, PsycINFO, MEDLINE, EMBASE, Scopus, Web of Science, ProQuest Dissertations and Theses, the China National Knowledge, Wanfang Databases, and China Science and Technology Journal Database. Sixteen studies were finalized, and meta-analyses were performed using a random effect model on RevMan v5.4 software developed by Cochrane. The analysis encompassed 16 published studies, involving a total of 2,585 participants. The key components of existing programs for aggression reduction included providing behavioral skills and training for adolescents, employing a problem-solving approach to address behavioral issues, offering psychological treatment, and emphasizing community supervision. The results indicate a significant positive effect of community-based interventions on aggression reduction (standardized mean difference = −0.26, 95% confidence intervals [−0.39, −0.13], Z = 3.84, p < .001). The subgroup analyses revealed that the intervention’s effectiveness was moderated by the duration of the intervention, its theoretical foundation, and the sample size. This study furnishes empirical evidence supporting the enhancement of policies and practices to foster community engagement in mitigating aggressive behavior.

Keywords

community aggressive behavior children adolescent systematic review meta-analysis

Introduction

The issue of aggression among children and adolescents is a global concern that has garnered significant attention due to its widespread occurrence—affecting as many as three out of every 10 children—and the detrimental effects it has on both victims and perpetrators (González-Cabrera et al., 2022; López et al., 2022). In a specific study conducted by Modecki et al. (2014), the prevalence rates of victimization and aggression were reported to be 36% each. According to a meta-analysis conducted by Jadambaa et al. (2019), the average prevalence of victimization varied depending on the time frame considered, with rates of 18.9% for lifetime, 15.1% for the previous year, and 15.2% for the previous 3 months. In this research, aggressive behavior is characterized as a behavioral manifestation, wherein physical strength is employed with the intention of causing harm or impairment to an individual or object (Connor et al., 2003; Stanford et al., 2003). Therefore, this study incorporates two types of aggression: proactive aggression (utilizing aggressive conduct as a method to accomplish personal objectives, such as exerting dominance over another child or obtaining an item) and reactive aggression (responding to a particular incident, regardless of its actual occurrence, wherein the child perceives something as a potential threat; Amad, 2021; Pardini et al., 2014).

Studies have found that children and adolescent aggressive behavior exerts a substantial and enduring influence on both the perpetrators and the victims, with repercussions extending to mental health issues such as depression, anxiety, and substance abuse (Fite et al., 2022; Grebneva et al., 2019; Mozley et al., 2018; Zapolski et al., 2018). Specifically, proactive aggression has been found to have a connection with higher levels of psychopathic traits and reduced psychophysiological activity, such as a low resting heart rate (Raine et al., 2014). Reactive aggression has been discovered to be correlated with difficulties in controlling behavior and exaggerated emotional reactivity (Dodge et al., 2015). Meta-analyses underscore the central role of environmental factors, particularly community-based interventions, in addressing child and adolescent behavioral issues and promoting mental health (Farahmand et al., 2012; Nahmias et al., 2019; Savaglio et al., 2023). Despite this, a research gap persists in delineating the specificities of various community intervention programs, including critical practice elements like intervention duration, type, target demographic, and focus. To bridge this gap, it is imperative to undertake more nuanced studies exploring community characteristics through diverse research designs and evaluating community-based preventative and therapeutic strategies. This meta-analysis endeavors to scrutinize community-based programs and assess the efficacy of such interventions in mitigating child and adolescent aggressive behavior.

The Role of Community in Aggressive Behavior

Child and adolescent aggressive behavior, a multifaceted phenomenon scrutinized in diverse fields, such as psychology, sociology, and criminology, manifests in various forms including physical violence, verbal hostility, and relational aggression, which encompasses tactics such as social exclusion and rumor propagation to harm others. Numerous theories have been posited to elucidate the underlying causes of such behavior in children and adolescents, generally concentrating on individual and environmental determinants. For instance, theories like the social learning theory (Bandura, 1969), frustration–aggression theory (Berkowitz, 1989), and cognitive-neoassociation theory (Berkowitz, 2012) hone in on individual factors, while the social control theory (Wiatrowski, 1978) and social disorganization theory (Sampson & Groves, 1989) emphasize the role of social elements. Moreover, the general aggression model suggests that aggressive behavior stems from a complex interplay between individual and situational factors, essentially positing that individuals are shaped by their environments (Bushman & Anderson, 2002). A substantial corpus of research corroborates the notion that unfavorable environments during formative years are linked to behavioral issues in childhood and adolescence (Figge et al., 2018; Otto et al., 2017; Ungar & Hadfield, 2019). Consequently, analyzing child and adolescent behavior within the context of their environment offers a rational approach.

Children and adolescents are highly influenced by their surroundings, with their behavioral and cognitive processes being shaped significantly by social environments and rewards (Aisenberg & Herrenkohl, 2008; Blakemore & Mills, 2014). Drawing from the social ecological systems theory, it becomes imperative to comprehend the intricate dynamics between individual, social, and environmental factors in steering human behavior (Bronfenbrenner, 1994; Bronfenbrenner & Morris, 1998). In addition to family and school environments, the community serves as a pivotal context where children and adolescents frequently interact. The community milieu stands as a crucial determinant in molding children’s and adolescents’ psychological and behavioral development (Grieb et al., 2019; Lee & Kwon, 2015; Prince et al., 2019). This environment encompasses a myriad of physical, social, and cultural elements, including positive role models and support networks, which foster positive socialization and diminish the propensity for aggressive conduct (Alexander, 2021; Brook et al., 2011; Farina et al., 2008; Valdimarsdóttir & Bernburg, 2015).

Numerous studies affirm the adverse effects of community violence exposure on children’s and adolescents’ emotional, cognitive, and behavioral spheres, establishing it as a significant predictor of violent or aggressive tendencies in this demographic (Foell et al., 2021; Fowler et al., 2009; Guerra et al., 2003; Kersten et al., 2017; Linares et al., 2001; Patchin et al., 2006; Schwab-Stone et al., 2013). Moreover, residing in communities characterized by high levels of poverty and unemployment increases the likelihood of children and adolescents engaging in aggressive behavior (Curto et al., 2011; McCrea et al., 2019). A deprived community backdrop escalates the risk of children adopting violent behaviors, potentially solidifying aggression as a persistent personality trait that can extend into adulthood and permeate various spheres of life.

Community-Based Programs on Aggression Reduction for Children and Adolescents

Previous research has highlighted substantial disparities between the developmental predictors of child and adolescent offending within the general community and the predictors of recidivism among justice-involved children and adolescents (Basto-Pereira & Farrington, 2022; Basto-Pereira et al., 2015). A prevailing scholarly consensus advocates for an approach centered on adolescents’ developmental stages and opportunities for behavioral modification, as opposed to mere punitive measures (Larzelere et al., 2010; Mallett, 2016; Yeager et al., 2018). Consequently, community involvement in the prevention and rectification of adolescent aggressive behavior is vital.

Several meta-analyses have identified effective strategies within aggression reduction programs for adolescents. One such analysis determined that adolescents participating in family and community-based initiatives exhibited superior functioning compared to 70% of those engaged in alternative interventions (Curtis et al., 2004). The strategy of empowering parents and communities has emerged as a potent tool in ameliorating adolescent behavioral issues, with training for local parents as peer facilitators and the implementation of manual, group-based interventions in community settings not only garnering high user satisfaction but also significantly diminishing reported child behavioral problems (Cupples et al., 2011; Day et al., 2012; Konrad, 2007).

Furthermore, meta-analytic results have shown that environment-centric programs considerably bolster mental health and foster positive behavior in low-income urban adolescents (Farahmand et al., 2012). However, the efficacy of such interventions for nonimpoverished adolescents remains unexplored. Another study, focusing on Positive Youth Development (PYD) projects, posits that community-based interventions should be integral to strategies aimed at reducing youth violence, especially in previously unevaluated social and service environments. These strategies necessitate meticulous planning and rigorous evaluation (Melendez-Torres et al., 2016). It is pertinent to note that this analysis exclusively encompassed studies on the impact of PYD interventions on violence outcomes, thereby excluding other community-based intervention studies.

The social ecosystem theory serves as a prevalent theoretical framework in the study of child and adolescent development (Partelow, 2018). Addressing child and adolescent problematic behaviors through a multifaceted approach that encompasses various systems enhances the efficacy of intervention programs. Predominantly, programs aimed at mitigating aggressive or violent tendencies in children and adolescents are situated within classroom or family environments, concentrating solely on the risk and protective factors associated with such behaviors (Cooper et al., 2000; Matjasko et al., 2012; Weaver & Maddaleno, 1999). Nonetheless, strategies anchored to a singular perspective tend to achieve limited success (Farrell et al., 2016).

Community-based interventions typically engage professional therapists or groups to assist parents and children in need, offering a blend of group and individual approaches to address aggressive tendencies in children and adolescents (Atienzo et al., 2017; Balsamo & Poncin, 2016; Letourneau et al., 2009; Lipman et al., 2006). Furthermore, these projects often work to negate the effects of adverse peer influences, fostering a positive environment for child and adolescent interactions (Westermark et al., 2011). It is thus highly advocated to integrate aggression prevention strategies within community contexts, encouraging family and service centers to collaboratively support community-wide efforts in curbing aggressive behaviors. Consequently, it is imperative for aggression prevention initiatives to undertake community-based projects, leveraging a systems-oriented approach to equip both parents and children and adolescents with pertinent knowledge and skills.

Child and adolescent aggressive behavior constitutes a systemic issue, necessitating macro-level interventions rather than individual-focused approaches. Scholarly research substantiates the potential of community-based interventions in mitigating aggressive tendencies in adolescents (Atienzo et al., 2017). These interventions target fundamental triggers of aggressive behavior, including poverty, insufficient social support, and exposure to violence. Community-based strategies employ several mechanisms to curb adolescent aggressive behavior. A prevalent approach, particularly for individuals exhibiting severe aggressive behaviors such as juvenile delinquents, integrates family foster care with community intervention. This collaborative strategy involves the adolescent, foster family, and case manager in crafting a dynamic and personalized intervention program, with the community overseeing and managing the process to circumvent negative influences from other subsystems (Balsamo & Poncin, 2016; Hansson & Olsson, 2012; Ryon et al., 2017; Westermark et al., 2011). Furthermore, community settings frequently offer psychotherapy and skill training for adolescents, equipping parents and children with essential knowledge and strategies. This approach has proven effective in enhancing parental expertise and fostering children’s and adolescents’ ability to regulate their behavior (Florsheim et al., 2000; Lipman et al., 2006; Murray & Belenko, 2005; Valentine et al., 2019). For example, a community-based intervention was carried out by Overbeek et al. (2013), targeting children and parents exposed to interparental violence. The findings of this study revealed a significant reduction in internalizing and externalizing problems, alongside post-traumatic stress symptoms among the children.

To date, there has been limited comprehensive quantitative research encompassing all community-based intervention projects, leaving a gap in understanding the efficacy of various intervention types. Moreover, discerning specific details of these interventions, including the duration of the programs, the demographic of the child and adolescent participants, and the level of family support, is pivotal to the success of these initiatives. Synthesizing the effectiveness across different categories will not only enhance the comparability of studies on community-based programs but also facilitate researchers in meticulously planning and executing their intervention strategies. Undertaking a systematic review of the repercussions of community-based programs on reducing aggression will further offer insights for fostering positive community–family dynamics through integrated interventions. Consequently, this study seeks to furnish a contemporary synthesis of evidence regarding the efficacy of programs aimed at preventing and treating child and adolescent aggressive behavior.

Method

Search Strategy

Twelve electronic databases were searched for relevant studies from their respective inception dates to July 7, 2023: EBSCO, ERIC, PubMed, PsycINFO, MEDLINE, EMBASE, Scopus, Web of Science, ProQuest Dissertations and Theses, the China National Knowledge, Wanfang Databases, and China Science and Technology Journal Database (Atienzo et al., 2017; Castillo-Eito et al., 2020). We used the following groups of search terms: “child* OR adolescen* OR teen* OR juvenile OR youth OR young people OR student* OR pupil*” and “interven* OR program* OR training OR prevent* OR treatment OR therapy OR education” and “aggress* OR violen* OR bully* OR crime OR externalizing OR delinquen* OR devian* OR antisocial OR problem behavior* OR assaultive behavior OR conduct OR behavior disorder*” and “commnutiy OR neighbour*.” We manually searched the reference lists of review articles to identify further relevant studies. The electronic database search yielded 1,550 studies, which were scanned by the two reviewers independently according to inclusion and exclusion criteria.

Study Selection

We included in the synthesis studies that met five criteria: (a) implemented a randomized controlled trial or quasi-experimental design; (b) focused on children or adolescents as participants (i.e., under 18 years of age); (c) empirical studies investigating the effects of a community-based intervention or program on aggressive behavior; (d) provided quantitative data on appropriate outcome measures of aggression; and (e) full-text access available in English or Chinese. The following criteria were used to exclude studies from our synthesis: (a) not quantitative studies, such as a review article or qualitative research; (b) aimed at examining the correlations between community-related factors and aggression without intervention; (c) having no randomized control trial or quasi-experimental design; (d) programs did not address aggressive behaviors among children and adolescents; and (e) the interventions were conducted on adolescent minority or disadvantaged groups (e.g., autistic, adolescents with mental health issues, cognitively impaired, or sexual minority groups), which may require special design based on their conditions. After abstract screening using criteria mentioned above, 1,394 papers in total were eliminated, and the remaining 156 studies underwent a closer inspection in preparation for full-text screening.

Data Extraction

Each study included was assigned a number for recording purposes. We developed a coding sheet in order to define the variables of each study. The items were coded as follows: (a) study details (first author, year of publication, country, and sampling); (b) participant details (child age, gender proportion, and participant source); (c) intervention details (program name, research design, intervention method, duration, content of program and theoretical basis); (d) outcome details (outcome, measurement, informant); and (e) publication quality assessment. The two reviewers independently extracted the above variables from the studies. Immediate post-test values were of primary interest as not all studies conducted follow-up measurements. The review extracted the mean and standard deviation values for all included studies that reported results using continuous data.

Quality Appraisal

The quality of the measurement tool and the study was assessed separately. We adopted Clement et al. (2013) three risk levels: low risk, high risk, and unclear risk to assess the quality of measurement. Low risk: Cronbach ≥ 0.7; High risk: Cronbach < 0.7 or measurement without reference. Unknown risk: Scales do not indicate whether they are applicable to local samples.

The risk of bias was assessed according to the modified Jadad scale in the domains of random sequence generation, allocation concealment, blinding of participants and personnel, and completed withdrawals and dropouts. The total score, ranging from 0 to 7, is calculated to assess quality. According to Oremus et al. (2001), a score of 1 to 3 indicates low quality, while a score of 4 to 7 denotes high quality.

If data were unavailable throughout the review process, they were acquired by making every effort to contact the authors; if they remained unavailable, the relevant literature was excluded. Differing opinions were settled through discussions after the ratings were completed independently by two reviewers with training.

Statistical Analysis

Version 5.4 of the Review Manager software was used to carry out this procedure. The effect sizes of the studies with 95% confidence intervals (CIs) were summarized in forest plots. We computed effect sizes as a standardized mean difference (SMD) in each study as the effect measure under the inverse-variance method (Vøllestad et al., 2012). Effect sizes were defined accordingly: very small (0.1), small (0.2), medium (0.5), large (0.8), very large (1.2), and huge (2.0) (Sawilowsky, 2009).

A heterogeneity test was conducted to identify the variance among studies. Cochran’s Q statistics and the I² were used to estimate and represent heterogeneity among studies (Huedo-Medina et al., 2006). A funnel plot was performed to investigate whether there could be missing data due to publication bias (Egger et al., 1997).

Results

Search Outcomes

A total of 1,550 articles were found from the 12 listed electronic databases and relevant reference lists. After removing duplicates and articles based on their titles and abstracts, 156 articles were left for full-text screening. The full-text screening excluded another 140 articles, leaving 16 relevant studies to be included in this review. Figure 1 shows the procedures for article selection.

Figure 1.

Illustration of the search results and the procedures for article selection.

Quality Appraisal

According to the three risk levels proposed by Clement et al. (2013) for the measurement scale, 15 studies were low risk, one study was of unknown risk, and there were no high-risk studies. The modified Jadad scale was used to evaluate the quality of the included literature, with 10 low-quality literatures (0–3 points) and 6 high-quality literatures (4–7 points).

Study Characteristics

The 16 studies analyzed 2,585 adolescents from five different locations: USA (n = 9), UK (n = 2), Sweden (n = 2), Canada (n = 2), and Ireland (n = 1). There were 14 RCTs and 2 quasi-experiments. The sample sizes ranged from 29 to 439 adolescents aged 2 to 18 years. Detailed study characteristics are presented in Table 1.

Table 1.

Summary of the Included Studies.

Author (Year)/Country	Project Name	Research Design	Participant Source	Sample Characteristics	Content of Intervention	Intervention Method	Outcome Measure	Theoretical Basis	Publication Quality Assessment
Chamberlain et al. (1998) USA	Multidimensional Treatment Foster Care (MTFC)	Randomized controlled trial 6 months, 24 sessions	Mandatory	79 Adolescents Age: 12–17, m = 14.9 % Girls: 0	(a) Individual therapy focused on skill building in problem-solving, social perspective taking, and nonaggressive methods of self-expression; (b) Family therapy focused on parent management training, including an emphasis on supervision, encouragement, discipline, and problem-solving.	Case work	General Delinquency (Elliott Behavior Checklist) Self-Reported	Social Learning Theory Family System Theory Coercion Theory	Measurement: Low Risk Jadad Scale: 3
Eddy et al. (2000) USA	MTFC	Randomized controlled trial 6 months, 24 sessions	Mandatory	79 Adolescents Age: 12–17, m = 14.9 % Girls: 0	(a) Foster family focused on the use of behavior management methods to establish and maintain a structured, supervised, and consistent daily living environment; (b) Youth participated in weekly individual therapy sessions focused on prosocial skill building in problem solving, perspective taking, and emotional expression.	Case work	Antisocial Behavior (Self-Reported Delinquency) Self-Reported	Social Learning Theory Family System Theory Coercion Theory	Measurement: Unclear Risk Jadad Scale: 2
Ellen (2008) Canada	The SNAP™ Under 12 Outreach Program	Randomized controlled trial 3 months, 12 sessions	Nonmandatory	209 Children Age: 6–11, m = 9.7 % Girls: 0	(a) Children’s groups utilize cognitive-behavioral self-control and problem-solving techniques; (b) Parent groups teach child management techniques. (c) Optional additional services.	Group work	Aggression (Child Behavior Checklist [CBCL]) Parents-Report	Social-Ecological Theory	Measurement: Low Risk Jadad Scale: 1
Florsheim et al. (2000) USA	Working Alliance	Quasi-Experiment 3 months, NA	Nonmandatory	111 Adolescents Age: m = 15.6 % Girls: 0	Developing the collaborative relationship between a client and his or her therapist, facilitating the occurrence of positive psychological change, including (a) behavioral therapy (b) cognitive therapy (c) psychodynamic therapy.	Group work	Delinquent and Aggressive Syndromes (CBCL–TRF Externalizing Scale) Teacher-Report	NA	Measurement: Low Risk Jadad Scale: 1
Friman et al. (1993) USA	Community-Based Parent Training Programs	Randomized controlled trial 2 months, NA	Nonmandatory	116 Children and Adolescents Age: 2–17, m = 9.7 % Girls: 44.83%	Eight-Week Parent Training Program includes weekly 2-hr meetings, large group presentations, small group role play, individual meetings with the parent trainer, weekly assignments, frequent phone contact, and periodic reassessment of family goals.	Group work	Externalizing Problems (Eyberg Child Behavior Inventory [ECBI]) Parents-Report	Social Learning Theory	Measurement: Low Risk Jadad Scale: 3
Green et al. (2014) UK	MTFC	Randomized controlled trial 9 months, 36 sessions	Nonmandatory	29 Adolescents Age: 11–16 % Girls: NA	Providing a consistent reinforcing environment in which young people are mentored and encouraged; a clear structure with clearly specified boundaries to behavior and specified consequences, close supervision; and diversion from associations with antisocial peers and help to develop positive social skills.	Case work	Offending Behaviors (Health of the Nation Outcome Scales for Children and Adolescents) Significant Other-Report	Social Learning Theory Family System Theory Coercion Theory	Measurement: Low Risk Jadad Scale: 6
Hansson et al. (2012) Sweden	MTFC	Randomized control trial 9–12 months, 36–48 sessions	Nonmandatory	46 Adolescents Age: 12–17, m = 14.9 % Girls: 10.87%	(a) Youth is placed in a foster home where the foster parents have been trained according to the MTFC manual. (b) Developing formalized cooperation between a treatment team and the youth, the youth’s parents, the youth’s school, leisure activity supervisors, and child-welfare personnel.	Case work	Symptom Load of the Children (CBCL) Parents-Report	Social Learning Theory Family System Theory Coercion Theory	Measurement: Low Risk Jadad Scale: 4
Le et al. (2011) USA	Roosevelt Village Center	Randomized control trial NA, NA	Nonmandatory	338 Adolescents Age: 12–18 % Girls: NA	Students receive academic tutoring and homework help for half of each session, and then alternate between cultural enrichment and extracurricular activities for the rest of the session.	Group work	Delinquency (Self-Reported Delinquency) Self-Reported	Multicultural Theoretical Framework	Measurement: Low Risk Jadad Scale: 3
Leve et al. (2005) USA	MTFC	Randomized control trial 6 months, NA	Mandatory	81 Adolescents Age: 13–17, m = 15.3 % Girls: 100%	(a) Daily telephone contact with the foster parents; (b) Weekly group supervision and support meetings for foster parents; (c) An individualized, in-home, daily point-and-level program for each girl; (d) Individual therapy for each girl; (e) Family therapy focusing on parent management strategies; (f) Close monitoring of school attendance, performance, and homework completion; (g) Case management to coordinate the interventions in the foster family, peer, and school settings; (h) Program staff on call at all times for foster and biological parents; and (i) Psychiatric consultation as needed.	Case work	Delinquency (CBCL) Parents-Report	Social Learning Theory Family System Theory Coercion Theory	Measurement: Low Risk Jadad Scale: 2
Liao (2014) USA	Adoption Preservation, Assessment, and Linkage	Quasi-Experiment 6 months, NA	Nonmandatory	439 Adolescents Age: 12–18, m = 15.9 % Girls: NA	(a) Detect whether the youth still lives in the home or the placement is maintained through a friendly home visit; (b) Provide needs assessments and referral services with families to address their service needs; (c) Help prevent out-of-home placement and increase long-term stability before the post-permanency families went into crisis.	Group work	Externalizing Behavior (Behavior Problems Index) Caregivers-reported	Ecological Systems Theory Family Stress-Coping Theory	Measurement: Low Risk Jadad Scale: 3
Lipman et al. (2006) Canada	Community-Based Anger Management	Randomized control trial 2.5 months, 16 sessions	Nonmandatory	97 Adolescents Age: 7–11, m = 9.3 % Girls: 17.07%	(a) The three parent/caregiver psychoeducation/skill-building group sessions were held before the start of the children’s group; (b) The children’s group sessions used a problem-solving process: including managing temper and choosing alternative strategies; (c) The children’s group sessions include role-playing, discussion, and homework assignments to apply newly acquired anger management skills.	Group work	Aggressive Behavior (Child Behavior Questionnaire) Parents-Report	Cognitive-Behavioral Therapy	Measurement: Low Risk Jadad Scale: 4
McGilloway et al. (2012) Ireland	Incredible Years BASIC parent training program	Randomized control trial 3–4.5 months, 12–18 sessions	Nonmandatory	149 Children Age: 2–8 % Girls: NA	Collaborative-based intervention that uses group discussions and role plays in combination with video material to illustrate various parenting and discipline strategies.	Group work	Problem Behavior (ECBI Problem Subscale) Parents-Report	NA	Measurement: Low Risk Jadad Scale: 6
Oscós-Sánchez et al. (2021) USA	A Violence Prevention Program (VPP)	Randomized control trial 2.5 months, NA	Nonmandatory	303 Adolescents Age: 10–24 % Girls: 56%	The content of the activities focused on four risk or protective factors. VPP activities focused on (a) initial perpetration of violence; (b) exposure to community violence; (c) mental health (depression and alcohol use); and (d) social injustice.	Group work	Violent and Aggressive Behavior (Physical Violence and Aggression Scale) Self-Reported	Social-Ecological Theory	Measurement: Low Risk Jadad Scale: 3
Oscós-Sánchez et al. (2021) USA	Positive Youth Development Program (PYDP)	Randomized control trial 2.5 months, NA	Nonmandatory	303 Adolescents Age: 10–24 % Girls: 56%	PYDP activities focused on (a) doing well in school; (b) developing a sense of purpose; (c) developing supportive relationships with adults; and (d) developing supportive relationships with peers.	Group work	Violent and Aggressive Behavior (Physical Violence and Aggression Scale) Self-Reported	Social-Ecological Theory	Measurement: Low Risk Jadad Scale: 3
Sinclair et al. (2016) UK	MTFC	Randomized control trial 9–12 months, NA	Nonmandatory	171 Adolescents Age: 10–16 % Girls: 45.61%	(a) Daily telephone contact with the foster parents; (b) Weekly foster parent group training; (c) Individual therapy for each girl emphasized here-and-now problems; (d) Family therapy (e) School functioning was closely monitored.	Case work	Externalizing Behavior (Children’s Global Assessment Scale) Significant Other-Report	Social Learning Theory Family System Theory Coercion Theory	Measurement: Low Risk Jadad Scale: 5
Westermark et al. (2010) Sweden	MTFC	Randomized control trial 12 months, 48 sessions	Nonmandatory	35 Adolescents Age: 13.9–16.9, m = 15.4 % Girls: 48.57%	The treatment includes formalized cooperation between a treatment team and the youth’s parents, school, leisure activities and social services. The youth is placed individually in a specialized foster home.	Case work	Delinquent and Aggressive Syndromes (CBCL-Externalizing Scale) Mother-report	Social Learning Theory Family System Theory Coercion Theory	Measurement: Low Risk Jadad Scale: 5

Overview of Community-Based Interventions for Aggressive Children and Adolescents

In the analysis of 16 studies, various intervention programs were identified. Five programs centered on instructing behavior techniques and skills (Ellen, 2008; Friman et al., 1993; Le et al., 2011; McGilloway et al., 2012; Oscós-Sánchez et al., 2021), three adopted a problem-solving approach (Lipman et al., 2006; Oscós-Sánchez et al., 2021), and seven emphasized community supervision encompassing family life, peer interaction, and school performance (Chamberlain & Reid, 1998; Eddy & Chamberlain, 2000; Green et al., 2014; Hansson & Olsson, 2012; Leve et al., 2005; Sinclair et al., 2016; Westermark et al., 2010). A singular intervention focused on the psychological treatment of aggressive adolescents (Florsheim et al., 2000).

The Multidimensional Treatment Foster Care (MTFC) program (Green et al., 2014), a community-based multimodal initiative, was prevalent, featured in seven studies and aimed to address adolescents’ behavioral issues through collaborative efforts involving treatment teams, parents, schools, leisure activity supervisors, and child welfare personnel. Other notable programs include the SNAP™ Under 12 Outreach Program, Working Alliance, Community-Based Parent Training Programs, Roosevelt Village Center, and Adoption Preservation, Assessment, and Linkage.

Generally, these interventions encompassed four primary facets: skills-focused curriculum learning, problem behavior resolution, daily supervision, and psychotherapy, grounded in theories such as social learning, social-ecological, control theory, cognitive-behavioral theory, and family system theory. The delivery methods varied, with 10 programs utilizing therapists and others relying on trained social workers, program staff, and parents. While most offered workshops and training for implementation, some supplemented with additional resources such as information sessions, online materials, or manuals. The community was the sole focus in five programs, whereas others integrated additional layers including family participation. Data collection methods also differed, with self-reporting employed in five studies and reports from significant others (parents or teachers) utilized in 11 studies. Detailed descriptions of each program are delineated in Table 1.

General Synthesis of Effect Size

Given the presence of heterogeneity between studies (Chi² = 35.40, p = .002, I² = 58%), the random effects model was used. Since the 16 articles we included all provided continuous data, we calculated SMD as the effect sizes for each study. Overall, the effect size of existing community-based interventions on adolescent aggression was statistically significant (SMD = −0.26, 95% CI [−0.39, −0.13], Z = 3.84, p = .0001) among 2,585 participants (Figure 2). No outliers were identified by the sensitive analyses. Due to the significant heterogeneity in the effect sizes of the studies, we continued to perform the subgroup analysis (Sedgwick, 2013).

Figure 2.

Effect size of all included studies (n = 16).

Subgroup Analyses

The subgroup analysis yielded that certain variables significantly influence the effectiveness of the intervention. Firstly, intervention duration exhibited a notable impact; interventions exceeding 6 months demonstrated a medium significant effect size (SMD = −0.36, 95% CI [−0.49, −0.24], Z = 5.83, p < .001) with no heterogeneity (I² = 0%, p = .88), whereas those under 6 months did not yield a significant effect size (see Figure 3). Secondly, the theoretical foundation of the intervention was pivotal; interventions grounded in theory manifested a medium significant effect size (SMD = −0.38, 95% CI [−0.50, −0.25], Z = 5.75, p < .001) and exhibited no heterogeneity (I² = 0%, p = .85), in contrast to those lacking a theoretical basis (see Figure 4). Thirdly, sample size was a determinant factor; interventions involving less than 150 participants were more effective (SMD = −0.39, 95% CI [−0.53, −0.25], Z = 5.40, p < .001) with no heterogeneity (I² = 0%, p = .45), compared to those with a larger participant pool (see Figure 5). Lastly, focusing on the intervention approach, supervision-centric interventions exhibited the most significant effects (SMD = −0.41, 95% CI [−0.58, −0.23], Z = 4.57, p < .001) with no heterogeneity, outperforming other approaches analyzed in the 16 studies (see Figure 6).

Figure 3.

Forest plot of aggressive behavior frequency according to duration of intervention.

Figure 4.

Forest plot of aggressive behavior frequency according to theoretical foundations.

Figure 5.

Forest plot of aggressive behavior frequency according to sample size.

Figure 6.

Forest plot of aggressive behavior frequency according to intervention focus.

The Appraisal of Publication Bias

Egger’s correlation tests, Begg–Mazumdar rank correlation, and funnel plots were utilized to look for any potential publication bias in the included articles. Figure 7 illustrates that most of the studies were distributed symmetrically around the combined effect size. This symmetric shape indicated no publication bias, which was further supported by the Egger’s correlation test (p = .153) and Begg–Mazumdar rank correlation (p = .558).

Figure 7.

Funnel plot of community-based programs on aggressive behavior prevention (n = 16).

Discussion

This meta-analysis endeavored to assess the efficacy of community-based interventions in mitigating aggressive behavior in children and adolescents. The results affirm that community-based initiatives constitute potent strategies for diminishing the incidence of aggressive tendencies in this demographic. This study undertook a rigorous examination of the efficacy of community-based initiatives, drawing upon robust data derived from randomized controlled trials and quasi-experiments. Notably, this review stands as a pioneering effort in gauging the impact of community programs across a spectrum of outcomes pertinent to both the prevention and interventions of aggressive behavior in adolescents. Furthermore, it delved into the attributes of the studies that could potentially influence the outcomes of the programs.

Firstly, delineating the intervention programs based on duration revealed notable disparities in their efficacy in curbing aggressive behavior among children and adolescents. It is well established that the intervention’s duration serves as a crucial moderator in determining its success, a notion corroborated by previous reviews. In this meta-analysis, we categorized the intervention periods into two groups: 0 to 6 months and over 6 months, discovering that the latter yielded more fruitful results. This aligns with existing literature, which posits that extended programs often secure more substantial and enduring effects on problematic behaviors (De Koker et al., 2014; Lochman & Lenhart, 1993; Nation et al., 2003). For instance, a systematic review by Limbos et al. (2007) affirmed the superior success rate of long-term interventions. Conversely, a subset of research suggests that concise interventions, spanning just a few months, can indeed mitigate youth violence (Castillo-Eito et al., 2020; Fagan & Catalano, 2013). Nevertheless, it is imperative for adolescents exhibiting aggressive tendencies to undergo sufficient intervention, particularly in community settings necessitating prolonged engagement for optimal effectiveness. Given the situational nature of aggressive behavior in children and adolescents, which fluctuates across different environments (Halperin et al., 2003), interventions confined to a singular setting may foster temporary improvements, yet fail to prevent the recurrence of aggression elsewhere. Community-based interventions, characterized by their multidimensional approach encompassing family oversight, peer engagement, and school involvement (Casey & Lindhorst, 2009), demand extended durations to holistically address aggressive tendencies across various contexts. Furthermore, considering the repetitive and persistent nature of aggression in this demographic (Leff & Waasdorp, 2013), short-term interventions yielded transient benefits.

Moreover, interventions grounded in multiple theoretical frameworks tend to exert a more pronounced impact compared to those based on a singular theoretical basis. This can be attributed to the multifaceted nature of aggressive behavior, which is shaped by individual and systemic factors encompassing a range of risk and protective elements such as personal attributes, peer dynamics, familial circumstances, educational environments, and community experiences. Consequently, a profound comprehension of the underpinnings and repercussions of aggressive behavior is imperative to devise efficacious strategies to mitigate it. In endeavoring to elucidate the genesis and ramifications of aggressive tendencies in adolescents, a plethora of theories offer explanatory insights and intervention approaches. Freud’s psychoanalytic theory, for instance, posits aggression as a biological instinct inherent in children (Mitchell, 1993), while the social learning theory articulates the acquisition or alteration of aggressive tendencies through observational learning. Moreover, the social-ecological theory delves into the potential determinants of aggressive behavior from a multisystemic vantage point (Espelage & Swearer, 2009).

Fagan and Jones (1984) advocated for an intervention theory that encompasses both the causal factors and behavioral modification processes, taking into account pivotal contextual facets and individual disparities in psychosocial development that could potentially escalate the propensity for violent and deviant conduct. This approach facilitates a nuanced methodological guidance throughout the evaluative and interventional phases, enabling the anticipation of outcomes (DeWall et al., 2011). Illustratively, the MTFC program, which leverages the principles of social learning theory, family system theory, and coercion theory, has demonstrated remarkable success in diminishing aggressive behavior in children and adolescents and reducing recidivism among juvenile offenders (Westermark et al., 2011). Within this framework, the social control and coercion theories aid in deciphering the motivations and origins of adolescent aggression, while the family system theory steers the intervention process. Thus, the integrative application of diverse theories furnishes a more holistic perspective for intervention, enhancing its systematic approach.

Furthermore, a discernible disparity in the efficacy of reducing adolescent aggressive behavior was observed when delineating intervention projects based on the number of participants, specifically differentiating between those involving less than 150 participants and those encompassing more than 150 participants. Typically, the sample size in such experimental setups is predicated on statistical tenets and the overarching research design (Whitehead et al., 2016). Several meta-analyses have corroborated the notion that sample size significantly affects the study’s effectiveness (Barth et al., 2016; Dechartres et al., 2013; White et al., 2019). For instance, one investigation revealed that the substantiation of intervention efficacy predominantly hinges on a limited sample size (Kirby et al., 2017). Furthermore, during the intervention implementation phase, the sample size can potentially alter the results, carrying a risk of overestimating the treatment effect (Levine et al., 2009; Nüesch et al., 2010). Nevertheless, practical constraints and the intrinsic attributes of adolescent aggression prevention and intervention initiatives dictate that a substantial participant pool can engender issues such as the amplification of deviant behavior (Dishion & Tipsord, 2011), inadequate resource distribution, and diminished personal engagement and participation. Consequently, it is incumbent upon future research to accentuate personalized and tailored implementation strategies.

Lastly, our categorization of the studies based on intervention approaches delineated four primary strategies employed in community-based interventions: (a) emphasizing the community’s corrective supervisory role for adolescents; (b) developmental skills training, which encompasses teaching adolescents emotional and problem management, as well as interpersonal and cooperative skills; (c) a problem-centric approach that addresses the most pressing, current, and significant behavioral issues; and (d) psychotherapy, utilizing methods such as psychoanalysis and cognitive-behavioral therapy. Our analysis revealed that interventions leveraging the community’s supervisory and monitoring functions yielded the most substantial impact in mitigating adolescent aggression. This outcome can potentially be attributed to the fact that these programs foster a positive living environment for young individuals, emphasizing multisystemic oversight ranging from family dynamics to peer interactions and school involvement. Moreover, they engage professional intervention teams to closely scrutinize the daily behaviors of predominantly delinquent youths. This finding corroborates the beneficial impact of community correction and supervision on minors involved in criminal activities (Bouchard, 2018). Consequently, it is imperative that forthcoming community intervention initiatives incorporate multidimensional supervision and management strategies targeting adolescents. Table 2 provides a summary of the critical findings of this review.

Table 2.

Summary of Critical Findings.

Critical Findings
Overall, community-based interventions have a significant positive effect on aggression reduction.
Longer duration interventions (more than 6 months) are more effective than shorter duration interventions (less than 6 months) in reducing the frequency of child and adolescent aggression.
Community-based interventions with a theoretical foundation are more effective than those without a theoretical foundation in reducing the frequency of child and adolescent aggression.
The effectiveness of the intervention is influenced by the number of participants, particularly when distinguishing between interventions involving less than 150 participants and those encompassing more than 150 participants.
Community-based interventions leveraging the community’s supervisory and monitoring functions yield the most significant impact in mitigating child and adolescent aggression.

Implications

This study elucidates the efficacy of community-related interventions in mitigating aggressive behavior among adolescents. From a theoretical standpoint, it is recommended that researchers and practitioners employ a well-founded theoretical framework to guide the design of such interventions. Leveraging a variety of theoretical foundations, particularly those that advocate for top-down approaches to intervention and prevention, can significantly enhance the comprehensiveness of these initiatives. For instance, the social-ecological development model is prevalently utilized in programs that scrutinize both the risk and protective factors at various systemic levels associated with aggressive behavior. Similarly, the principles of social learning and social control theory (Wiatrowski, 1978) offer substantial insights into the dynamics of aggressive behavior, thereby facilitating more effective program designs. Consequently, the incorporation of multiple theories into each facet of program implementation can potentially optimize the outcomes. Furthermore, the findings underscore the pivotal role of intervention duration as a moderator, suggesting that future community initiatives should meticulously consider this element to enhance intervention efficacy. Ensuring adequate duration and intensity of the intervention can foster positive and enduring changes in adolescent behavior.

At a practical juncture, it is imperative to enhance the mechanisms of community intervention given its notable efficacy in diminishing aggressive behavior among adolescents. Future strategies should prioritize the establishment of facilities that foster community engagement and facilitate the meticulous monitoring of adolescents’ daily undertakings. Moreover, a concerted effort to amalgamate the expertise of therapists, social workers, and project personnel is vital to deliver specialized services to adolescents facing challenges. Both individualized and group interventions remain crucial in this endeavor. Empirical evidence underscores the potency of sustained interventions, spanning over 6 months, in altering aggressive tendencies in adolescents. This suggests that community interventions wield a subtle yet deep-seated impact, gradually molding the adolescents’ psychological landscape and behavioral patterns through a nurturing environment. Furthermore, the triumph of approaches such as MTFC and multisystemic therapy accentuates the necessity for collaborative efforts encompassing various systems. Initiatives aimed at ameliorating aggressive tendencies could commence with fortifying familial structures and extending to the vigilant oversight of peer associations and extracurricular engagements. Consequently, it is advocated that subsequent research endeavors explore the synergies between school, family, and community in curtailing instances of aggression. Table 3 shows a summary of the implications of this review.

Table 3.

Implications of the Review.

Implications
For research, it is recommended that future research needs to delve deeper into community interventions, encourage communities to assess their risks and protective factors, and tailor services to the subtle needs of children and adolescents of different ages.
For practice, future community initiatives should consider intervention duration to enhance intervention efficacy. In addition, future community-based intervention should prioritize the establishment of facilities that foster community engagement and facilitate the meticulous monitoring of adolescents’ daily undertakings.
For policy, policymakers and practitioners should adopt a multidimensional theoretical framework to guide the design of such interventions and policies.

Limitations and Future Research Direction

The findings of this study should be interpreted with circumspection due to several limitations. Firstly, while certain studies met the inclusion criteria, they were excluded due to the absence of vital statistics such as mean and standard deviation in their reports, potentially introducing bias in the results. Furthermore, the analysis relied heavily on the detailed data available from the included studies, which was inherently limited, resulting in incomplete subgroup classifications and restricted research outcomes. A notable limitation was the lack of distinction between post-treatment and follow-up results in the analyzed studies, with only a few offering insights into the longevity of the intervention impacts through follow-up assessments. The generalizability of the aggression reduction outcomes remains ambiguous, exacerbated by the geographical and linguistic confinement of the study to English-language research conducted in Europe, the United States, and Canada, thereby overlooking potentially significant data from Asian and African regions.

Despite these limitations, the review substantiates the efficacy of community-based interventions in mitigating aggressive behaviors among children and adolescents. It advocates for future research to delve deeper into community interventions, encouraging communities to assess their levels of aggression, and risk and protective factors, to tailor services to the nuanced needs of adolescents and children of varying ages. It is imperative for community service personnel to institute a regular data collection mechanism to monitor service delivery and refine programs based on the insights garnered. Moreover, there is a call to extend the follow-up duration in intervention studies beyond the prevalent span of 6 months to 3 years, to facilitate a more comprehensive understanding of the interventions’ long-term effects. Besides the duration of treatment, the frequency of an intervention is also an important factor. Future studies could explore how the dosage or intensity of the intervention varies with the change of participants’ behavior.

Footnotes

Acknowledgements

The authors appreciate the support from the Zhejiang Provincial Cultural Innovation Research Center.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the MOE (Ministry of Education in China) Project of Humanities and Social Sciences (Grant No. 22YJC880024).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

ORCID iDs

Shan Jiang

Lin Wang

Author Biographies

Shan Jiang, PhD, is a tenure-track associate professor in the Department of Sociology at Zhejiang University. He obtained his PhD in Social Welfare at the Chinese University of Hong Kong. His research focuses on child and adolescent well-being from a contextual-developmental perspective.

Yinglin Chen is a master of social work at the Department of Sociology, Zhejiang University. Her research focuses on psychosocial development of children and adolescents.

Lin Wang, PhD, is an assistant professor in the Department of Social Work at Fudan University. Her current research interests focus on child welfare, child development, and bullying. She is interested in using quantitative methods as tools to investigate the mechanisms to aggressive behavior among adolescents.

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