NHS Health Scotland
Outcome Indicators


6.7 Activities targeting violence and bullying across the lifespan will increase knowledge, awareness and skills in relation to life skills and contribute towards an increase in pro-social behaviour and decrease in aggressive behaviour. This, in turn, will contribute to decreased violence and bullying and result in improved mental health outcomes.


Home visiting and parenting interventions
There is limited review level evidence that parenting interventions are effective in improving outcomes associated with physically abusive parents, however, there is evidence that they are cost effective in improving parenting and provided access to peer-based support. The authors of this review concluded that whilst evidence is inconclusive there are few other interventions that have better established levels of empirical support regarding intervention with physically abusive parents.[1]

There is review level evidence that home visiting programmes can be effective in reducing maltreatment (abuse or neglect) of visited children. The review found an overall mean effect size of 39%. Programmes delivered by professional visitors (nurses or mental health workers) seem to yield greater effects than those delivered by paraprofessionals. For paraprofessional visitors, effects are mixed, and beneficial effects are generally found in programmes of longer duration (i.e. 2 years).[2]

Based on review level evidence, NICE technology appraisal guidance 102 recommended group-based parent-training/education programmes for the management of children aged 12 and above with conduct disorders.[3] NICE technology appraisal guidance is developed for use in England and Wales however NHS Quality Improvement Scotland advised that this technology appraisal is valid for use in Scotland.

School-based programmes
There is some evidence to suggest that universal and comprehensive approaches to promoting mental wellbeing in primary schools is effective in improving outcomes relating to bullying and violence.4, 5 Informed by reviews of effectiveness evidence, NICE public health guidance on promoting social and emotional wellbeing in primary education recommended that: schools adopt a universal approach; and schools provide a comprehensive programme to help develop children’s social and emotional skills and wellbeing and that the programme should include a curriculum that integrates the development of social and emotional skills within all subject areas, training and development for teachers and practitioners, and support to help parents and carers develop their parenting skills. TheNHS Health Scotland Commentary on this guidance supported the action points subject, where appropriate, to adaptation to fit Scottish organisational arrangements.6 NICE Public Health Guidance 20 Promoting social and emotional wellbeing in secondary education makes six action recommendations: strategic frameworks, key principles and conditions, curriculum approaches, working with parents and families, working in partnership with young people and training and continuing professional development. TheNHS Health Scotland Commentary on this guidance supported the action points subject, where appropriate, to adaptation to fit Scottish organisational arrangements.[7]

Pre-school programmes
Longitudinal studies of the High/Scope Perry Preschool Project demonstrated very long-term effects from a weekly half day preschool intervention combined with home visits during a two-year period at ages three and four. Children in the intervention, who were African-American and came from impoverished backgrounds, had improved cognitive development, better achievement and school completion and fewer conduct problems and arrests than the control children in a randomized study. For example, significant benefit was found at age 19 and age 27 on lifetime arrests (40% reduction) and repeated arrests (a 7-fold reduction).[8]

The review on wellbeing and work undertaken for the Foresight Mental Capital and Wellbeing Project [9] identified ‘Dignity at Work’ initiatives, the development of measurement tools and building a culture at work ‘as appropriate ways of behaviour are clearly communicated and supported’ (CIPD 2005 p.45) as useful strategies to combat bullying. A state-of-science review of violence at work10 note there is general agreement among researchers that effective violence management requires an ‘integrated organisational approach’ including improving individual, team and organisational action before incidents happen (prevention), as they unfold (response), and afterwards (rehabilitation). Amongst other things, such measures include environmental design, clear workplace violence policies, effective systems for monitoring staff whereabouts, emergency action plans, training programmes and employee counselling. Training is almost universally advocated as a principal means of responding to workplace violence however there is a relative paucity of well-designed evaluation studies into the effectiveness of training.


  1. Barlow J, Johnston I, Kendrick D, Polnay L & Stewart-Brown S. (2006). Individual and group-based parenting programmes for the treatment of physical child abuse and neglect. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD005463. DOI: 10.1002/14651858.CD005463.pub2.

  2. Bilhuka O et al. (2005). The effectiveness of early childhood home visitation in preventing violence: a systematic review. American Journal of Preventive Medicine, 28:11-39.

  3. NICE (2006). NICE technology appraisal guidance 102 Parent training/education programmes in the management of children with conduct disorder. NICE: London.

  4. NICE (2008). Public health guidance 12: Promoting social and emotional wellbeing in primary education. NICE: London.

  5. NICE (2009). NICE public health guidance 20 Promoting young people’s social and emotional wellbeing in secondary education. NICE: London. http://guidance.nice.org.uk/PH12  

  6. NHS Health Scotland (2008). Health Scotland Commentary on NICE Public Health Guidance 12: Promoting social and emotional wellbeing in primary education. NHS Health Scotland: Edinburgh.

  7. NHS Health Scotland (2010). Scottish Perspective on NICE public health guidance 20: Promoting social and emotional wellbeing in secondary education. NHS Health Scotland: Edinburgh. http://www.healthscotland.com/documents/4037.aspx  

  8. Hosman C & Jané-Llopis E (2005). The Evidence of Effective Interventions for Mental Health Promotion. In H Herman, S Saxena & R Moodie (Eds). Promoting mental health: Concepts, emerging evidence and practice. WHO: Geneva.

  9. Dewe, P. and Kompier, M (2008). Foresight Mental Capital and Wellbeing Project. Wellbeing and work: Future challenges. The Government Office for Science: London..

  10. Leather P & Zaroka T (2008). State-of-Science Review: SR-C11: Violence at work. The Government Office for Science: London.