Afterword
The science of youth violence prevention: Progressing from developmental epidemiology to efficacy to effectiveness to public policy

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Abstract

Public policy in the United States has historically considered youth violence as a moral problem to be punished after the fact, but growing scientific evidence supports a public health perspective on violent behavior as an interaction between cultural forces and failures in development. Prevention science has provided a bridge between an understanding of how chronic violence develops and how prevention programs can interrupt that development. Articles in this journal supplement provide yet another bridge between efficacious university-based programs and effective community-based programs. It is suggested that yet one more bridge will need to be constructed in future research between community-based programs that are known to be effective and community-wide implementation of prevention efforts at full scale. This last bridge integrates the science of children’s development, the science of prevention, and the science of public policy.

Introduction

T he major public policy of the United States with regard to violent behavior has always been after-the-fact incarceration and punishment by its justice system. The prevention of youth violence has been a task left largely to the Department of Justice, with little emphasis and funding. In the early 1900s, the first juvenile courts were created in Chicago in recognition of the distinct problems of delinquent youth. These courts have since sporadically recognized the importance of delinquency diversion, but they have not fully supported early prevention efforts. Recently, the success of the juvenile court system has been questioned, and recent public dissatisfaction has led to limits on the jurisdiction of juvenile courts that now make it easier for arrested youth to be remanded to adult court. Thus, prevention of youth violence through the justice system has been a failure.

Perhaps the premise of “prevention by detention” has been wrong. Because of its support of the research described in the articles in this supplement, the Centers for Disease Control and Prevention (CDC) is to be commended for helping to shift the focus of this national problem toward early prevention based on a new conceptualization of violence as a public health problem.

Historically, the problem of violence has been conceptualized as one of moral failure. Police, judges, and courts have assumed that all individuals have the capacity for nonviolent behavior and that violent actions result from free choices to behave immorally. Incarceration has been the logical societal response, both for retribution and for the safety of citizens. As long as the problem of violence prevention is left to local departments of corrections, an assumption of moral failure will prevail and prevention policies will consist primarily of efforts to protect society from “evil” through metal detectors in schools, police officers on the streets, and the death penalty.

The emergent discipline of developmental psychopathology and scientific research supported by the National Institutes of Health (mainly the National Institute of Mental Health [NIMH]) over the past 2 decades have led to a different conceptualization of the problem.1 Building on clinical anecdotes that adolescent and adult violent behavior almost always can be traced back to origins in early life, recent research has demonstrated through more rigorous prospective studies that with reasonable statistical accuracy adolescent violence can be predicted from indicators as early as 5 years of age. Furthermore, as Dahlberg and Potter2 report in this supplement, a consensus is growing that early-starting violent behavior develops through a combination of risk factors that include family history of antisocial behavior; early family disorganization and inconsistent, harsh discipline; peer social rejection and conflict; failure to succeed in traditional education; social alienation and gravitation toward deviant peer groups; and the loss of hope for success in the mainstream culture. The emerging conceptualization is that chronic violent behavior results from life-course developmental experiences. The source of violent behavior resides at the intersection of the individual and the culture interacting over time. No doubt, this conceptualization is not new; this perspective dates back to Plato.3 However, recent scientific evidence favoring this conceptualization has brought renewed emphasis to this point and to a new basis for early prevention efforts. As Ikeda et al.4 have noted in this supplement, the CDC has seized on this new perspective in its decision to fund the projects described here.

This conceptualization is compatible with a reframing of the problem as a public health epidemic. In the late 1980s, the CDC brought attention to the magnitude of the problem and supported innovative efforts to prevent violence in youth. Its director at the time, David Satcher,5 declared that, “[w]e must begin to think about violence prevention as we do a healthy diet.” Stabilization of youth violence rates over the past several years suggests that the problem is no longer epidemic but instead has become endemic to our society.6 Nonetheless, framing the problem as a public health concern evokes the interdisciplinary methods of the public health field and the resources of multiple institutions, including mental health, education, and community planning. The problem is not merely an individual’s moral failure; rather, the problem is a failure of society to provide adequately for its children. The focus shifts from retribution to rehabilitation, and from punishment to prevention.

Section snippets

The science of prevention

Prevention science in children’s mental health has emerged as a rigorous and vibrant field devoted to preventing psychopathology by drawing on knowledge acquired through the study of children’s development in context across time.7 To date, this field has been characterized by three logically sequential stages in the general development of prevention programs, and these stages also apply to the study of youth violence prevention. First, prospective, descriptive, and laboratory studies have

Developmental psychopathology and epidemiology

Over a dozen major longitudinal studies of the development of antisocial behavior patterns in youth have been undertaken since 1980.6 These studies have applied the methods of the emergent discipline of developmental psychopathology, including:

  • Prospective inquiry of large samples across long periods of time

  • Statistical identification of risk factors for later violent behavior, as well as factors that buffer or protect high-risk youth from becoming antisocial

  • Behavior-genetic methods to identify

Efficacy of prevention

The knowledge acquired through developmental studies has had enormous impact on the creation of preventive interventions that have been implemented and evaluated rigorously in randomized clinical trials called efficacy studies. The importance of a sound scientific base for prevention is ironically captured by the failure of the largest delinquency prevention study of the middle twentieth century, the Cambridge–Somerville Youth Study.12 This program was innocently based on well-intentioned but

Effectiveness of prevention

Although efficacy studies demonstrate that prevention programs can have a positive impact on preventing children’s aggressive behavior when implemented with high fidelity under closely scrutinized circumstances, it is not clear that these same programs do have an effect when implemented in a community environment. Research on the treatment (not prevention) of conduct disorder by Weisz et al.17 has shown that therapies for children that had been efficacious when implemented in a university

Full-scale implementation and impact

Prevention scientists (and the articles in this supplement) have taken the scholarly study of prevention effectiveness only to the point of asking whether a program would be effective if implemented in a community setting on a small scale. Although the studies reported in this supplement are laudatory in stretching the field, they do not address questions that must become the final stage of prevention science: How can effective programs be brought to scale, and what is the systemic impact?

These

Acknowledgements

This research was supported by Research Scientist Award number K05 MH01027 from the National Institute of Mental Health.

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