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Table 1 Summary of included reports and interventions of the theory synthesis

From: A systematic review and synthesis of theories of change of school-based interventions integrating health and academic education as a novel means of preventing violence and substance use among students

Intervention name Description of intervention Country Targeted grade and age of participant Integration Report
4Rs (Reading Writing, Respect and Resolution) A literacy-based social-emotional learning curriculum for elementary school students. There are two components: (1) a seven-unit, 21–35 lesson literacy-based curriculum in conflict resolution and social-emotional learning for children in primary school (to grade 5); and (2) intensive professional development for teachers. USA Kindergarten to grade 5 (ages 5–11) Each unit uses children’s literature is used to help students understand anger and develop skills in listening, cooperation, assertiveness, and negotiation. Additionally, 4Rs aims to develop literacy skills in children to capitalise on the mutual positive effect that social-emotional and academic learning have on each other. Aber 2011 [61]
Brown 2010 [51]
Flay 2009 [36]
Jones 2008 [52]
Jones 2010 [75]
Jones 2011 [59]
Sung 2015 [76]
Bullying Literature Project This programme aims to reduce bullying by introducing themes related to bullying through children’s literature. It also provides an opportunity for children to role-model practical skills to address or avoid bullying. USA Grade 4 (ages 9–10) The Bullying Literature Project integrates themes related to bullying into the children’s literature used within a standard English curriculum. Couch 2015 [77]
Wang 2015 [78]
Wang 2017 [79]
DRACON This programme uses drama to develop cognitive understanding of conflict and bullying and to empower students to manage their own conflict, both personally and within the broader school community. Australia Primary and secondary school students (ages 5–18) Conflict literacy is taught through ‘enhanced forum theatre’ and other drama techniques. Malm 2007 [60]
English classes (no name) Teachers were trained, and working in pairs in the summer, they developed integrated health/English material, with a specific emphasis on the prevention of drug and alcohol use. USA Grades 8 and 9 (ages 13–15) Health topics were infused into English classes. English was chosen as it was felt to be the subject into which non-traditional concepts could be discussed and is taken by all students. Holcomb 1993 [66]
Hashish and Marijuana The goal of the curriculum is to develop scientific knowledge of hashish and marijuana and to strengthen students’ problem-solving and decision-making skills through both didactic and participatory learning approaches. Israel Upper secondary school (ages 15–18) The programme was entirely integrated into chemistry classes, where lessons around hash and marijuana teach the chemical aspects of the drugs. Behaviour change was addressed through more participatory teaching methods. Zoller 1981 [80]
Infused-Life Skills Training (I-LST) This intervention integrates the messaging of standard life skills training (self-image and self-improvement, decision-making, smoking, marijuana, alcohol, etc.) into core academic classes like English, science, maths, and so forth for healthier behaviours, including reduced substance use. USA Middle/junior high school (ages 12–15) The entire interventions hinges on the effective infusion of health messaging into the core academic curriculum. Bechtel 2006 [67]
Kids, Adults Together (KAT) This programme has a classroom component in which children learn about alcohol, a parent evening in which students prepare presentations for parents and a take-home DVD about alcohol that is to be watched with parents for normalisation of reduced alcohol use. UK Grades 5 and 6 (ages 10–12) The classroom curriculum is delivered across many subjects and students develop academic skills alongside understanding of alcohol at every opportunity. For example, in arts classes, students will learn design skills by making anti-alcohol posters. Segrott 2015 [71]
Learning to Read in a Healing Classroom The intervention has two components delivered specifically to active treatment schools: teacher learning circles, which are opportunities for teachers to learn from master educators about classroom practices that enhance growth and development, and teacher resource materials, which included literacy components and social-emotional learning components. These resource materials are intended to integrate social-emotional learning alongside learning to read. Materials were provided in French. Democratic Republic of Congo Years 3–5 (ages 8–11) The classroom component includes materials to support teachers in creating safe and supportive learning environments, as well as using literature to teach students emotional regulation, self-expression and how to interact with peers. Torrente 2015 [81]
Aber 2017 [82]
Linking the Interests of Families and Teachers (LIFT) The programme aims to reduce future delinquency by positively rewarding and reinforcing good behaviours. The intervention includes classroom, playground and family components. USA Grades 1 and 5 (ages 6–7 and 10–11) The fifth grade classroom component also develops study skills that align with the fifth grade curricula. DeGarmo 2009 [83]
Eddy 2000 [84]
Eddy 2015 [85]
Reid 1999 [86]
Reid 2002 [87]
Peaceful Panels Throughout art classes, students participated in anti-bullying lessons (from the Second Step program for eighth grade students on empathy and communication in handling a grievance) and comic-making lessons. They then prepared artwork to demonstrate their understanding of how to resolve conflict. USA Grades 8 and 9 (ages 13–15) Conflict resolution lessons were integrated fully within art classes and creation of art was used as a medium to reflect on learning. Wales 2013 [88]
Positive Action Positive Action is a social-emotional and character development programme aimed at encouraging positive behaviours through positive thoughts and actions. Lessons cover six units: self-concept; positive actions for mind and body; positive social-emotional actions; managing oneself; being honest with oneself; and continually improving oneself. USA Kindergarten to grade 12 (ages 5–18) The methods of education used promote active learning and learning skills development alongside behaviour change. Teachers are also encouraged to tie lessons into academic content. Beets 2008 [89]
Beets 2009 [90]
Flay 2009 [36]
Flay 2010 [58]
Lewis 2012 [91]
Malloy 2015 [92]
Promoting Alternative Thinking Strategies (PATHS) PATHS aims to develop social and emotional competencies in children for reduced aggression and behaviour problems. Throughout the elementary school years, students receive lessons grouped under three units: readiness and self-control; feelings and relationships; and inter-personal problem solving. USA Kindergarten to grade 5 (ages 5–11) Both reading and writing are bridged to PATHS in most lessons by including supplementary suggestions for teachers to utilise such things as quality children’s literature to reinforce lesson concepts. Further, teachers can directly tie PATHS concepts to English, social studies/history and other subject areas. Crean 2013 [93]
Flay 2009 [36]
Greenberg 2006 [62]
Kusché 2012 [94]
Raising Healthy Children A four-component (school, student, peer and family) intervention that promotes positive youth development by targeting risk and protective factors at different stages of development. The focus is around prosocial bonding, social-emotional learning, and the development of problem-solving skills. USA Grades 1–8 (ages 6–14) Staff were trained to promote reading as part of school intervention strategies. Also, in grades 4–6, there were after-school study groups and group-based workshops in high school, all of which aimed to increase academic achievement Brown 2005 [69]
Catalano 2003 [95]
Roots of Empathy A programme that brings a visiting baby and their parent into a classroom as a springboard for learning empathy. Students learn messages of social inclusion, respect, how to build consensus, how to contribute to a safe and caring classroom, and develop emotional literacy. Australia, Canada, UK Grades 1–9 (ages 6–15) Connections with literacy, writing, art, music, mathematics and science are made. Lessons may involve literature to encourage children to explore their own emotions and experiences. Children may also make artwork to reflect these feelings, which is often compiled and used in follow-up activities. Cain 2008 [64]
Gordon 2003 [96]
Hanson 2008 [97]
Second Step The intervention was delivered by teachers after implementation training. The dose includes 15 weeks of classroom lessons taught weekly or every 2 weeks throughout the school year for 3 years. The intervention consists of manualised content including didactic lessons, group activities, and multimedia content including modelling of skills. USA Grade 6 (ages 11–12) Students receive academic homework integration assignments, and teachers are encouraged to connect lessons to current events. Espelage 2013 [98]
Espelage 2015a [99]
Espelage 2015b [100]
Farrell 2015 [101]
Low 2016 [102]
Steps to Respect A bullying prevention programme that has both a classroom curriculum aimed at teaching emotional intelligence, bullying prevention and bystander skills to children and a schoolwide component that trains teachers and administrators to change policies around disciplining bullying and providing mentoring to prevent future occurrences USA Grades 3–6 (ages 8–12) In the classroom curriculum, children’s literature is used to frame lessons and develop social-emotional and anti-bullying skills Brown 2011 [70]
Frey 2009 [103]
The Gatehouse Project Through teaching a curriculum and establishing a school-wide adolescent health team, Gatehouse aims to: build a sense of security and trust in students; enhance skills and opportunities for good communication; and build a sense of positive regard through participation in school life. Australia Grade 8 (ages 13–14) The program adopts a critical literacy approach. Concepts are taught using literature, poetry, song, film and visual materials. There is a deliberate link made between the programme’s goals and academic goals. Bond 2008 [104]
Patton 2000 [65]
Patton 2003 [105]
Youth Matters Youth Matters promotes the development of healthy relationships between students, staff and schools. It also promoted skills around social resistance and social competency through a curriculum. The curricula also emphasised both the bully and the victim perspective. USA Grades 4 and 5 (ages 9–11) Each module uses a 30–40-page story that is intended to help schools meet academic standards in both health education and English. Jenson 2007 [106]