Multi-Level Interventions for Violence
Coumba Sy
New York University
GPH-GU 2140: Global Issues in Social and Behavioral Health
cs5751@nyu.edu
Tuesday, November 20, 2018
Introduction
In the recent years, there has been a heightened awareness that violence is a problematic issue that currently affects our society. Public health professionals have responded to identifying violence as one of the most prominent public health issues of this decade (Stein et al., 2003). Violence does indeed affect all racial, ethnic, and socioeconomic groups but, the outcome of violence has been highly associated amongst the poor and minority populations (Stein et al., 2003). As shown, in the Figure 1. conceptual framework, the outcome of violence has been affected by many social determinants of health. Interventions on an individual and community-level to target the outcome of violence are critically important because worldwide an estimated 227 children/ between the ages of 0-19 die daily as a result of violence as an outcome, based on socio-economic risk factors (Krug et al., 2002).
The purpose of this paper is to discuss public health interventions on an individual and community level for the reduction of violence as an outcome in the most vulnerable populations, in addition to the intervention’s effectiveness for the mentioned populations. Implementing and conducting preventative programs to reduce society’s propensity for violence can be done with the use of public health interventions such as, but not limited to: (1) individual cognitive-based behavioral therapies for at-risk children/adolescents and (2) school-based programs that develop cognitive, emotional, and social skills in children/adolescents.
Figure 1. Conceptual Framework for the Outcome of Violence
Individual-Level Intervention: Cognitive Behavioral Therapy Approach
A cognitive behavioral intervention approach to children/adolescents who suffer from mental health disorders (e.g. post-traumatic stress disorder (PTSD), anxiety, and depression) would target those individuals who are vulnerable to the outcome of violence because of their mental health disorders in addition to those children/adolescents who live in low-income & poverty-stricken neighborhoods. This stigmatized population often encounters episodes of child abuse and neglect, harsh housing conditions and as they age, limited success of full-time employment, and but not limited to substance/alcohol abuse problems (Hodgins et al., 2008). Cognitive behavioral interventions will allow for a therapeutic intervention to be conducted by trained clinicians in the home or clinical setting to help reduce symptoms of neglect and abuse during childhood, poor family functioning, involvement with delinquent peers and gang involvement, and alcohol consumption (Whitfield et al., 2003).
One example of this intervention is the, Nurse Family Partnership (NFP), which ran multiple interventions that were proven effective in reducing at risk-youth involvement in criminal/violent activities by having in-home visits to discuss mental health issues associated with substance and alcohol abuse amongst themselves and their parents, issues with lack of scholastic achievement, minimal social skills, and conduct issues (Olds et al., 1998). Evidence proves that with cognitive-based interventions there has been significantly lower rates of depression, decreased rates of substance abuse, and increased rates of high school retention and full-time employment (Olds et al., 1998).
Community Level-Intervention: School-Based Intervention Programs
Public health interventions that target at-risk children and adolescents who experience mental health issues, come from a family history of abuse and neglect, and/or grow up in poverty-stricken neighborhoods are intended to mitigate the outcome of violence. Research shows that factors such as limited academic achievement, poor social competence, and poverty tend to produce the outcome of violence (Farrington et al., 2007). Intervention programs that allow for the development of children’s/adolescents social, emotional, and cognitive skills will reduce risk factors of violent outcomes before they enter formal education (Schweinhart, 2005). School-enrichment intervention programs allow for the at-risk you to increase their chances of obtaining higher education and social success (Krug et al., 2002).
The evidence-based data for these school interventions are slightly robust and these interventions have proven to reduce aggressive behavior, caused by mental health issues and growing up in poverty-stricken neighborhoods, which will than cause an increase in educational attainment (Reynolds et al., 2008). An example of a school-based intervention program is, Second Step, which is a curriculum based on developing the skills of the students by teaching them empathy, problem-solving, anger management, and impulse control skills (Grossman et al., 1997). This program helped encourage students to avoid risky behaviors such as under-age drinking and risky sexual behavior (i.e. teenage pregnancy and multiple sexual partners) (Hawkins et al., 1999).
Discussion/Implications
The Governor of New York State, Andrew Cuomo, announced in July 2008, a $19 million investment to improve crime rates in the Bronx by establishing community centers, anti-violence engagement and education, mental health funding, anti-gang programs and more to reduce the outcome of violence amongst youth in this borough, which is known for increasing crime rates and numerous districts of low-income neighborhoods (NYS Governors Pressroom, 2018). These interventions would support the children/adolescents in this at-risk neighborhood but also reduce the risk factors such as alcohol abuse and gang-related activity that lead to the outcome of violence. Interventions aimed at an individual level in at-risk neighborhoods are far more difficult to conduct because socioeconomic factors are arguably not in the hands of the individual themselves but by the environment they are in, which is often why these individual interventions are conducted by using therapy initiatives. Interventions at the community level are able to target at-risk neighborhoods by engaging with a larger audience and conducting community-based programs. Comprehensive violence interventions will be directed at multi-level socio-economic factors such as access to educational attainment, full time employment opportunities, income equity and equality, and improved community policing.
Conclusion
More research and evidence-based data must be drawn on the impact of these interventions and how they can be adapted locally and globally. While the discipline of Public Health, continues to emerge, as professionals in the field we must continue to ensure that interventions tackling the outcome of violence move from a criminal-justice based system to a preventative approach that will renege the risk factors that contribute to this issue.
References
Farrington DP. Childhood risk factors and risk focused prevention. In Maguire M, Morgan R, Reiner R, eds. The Oxford Handbook of Criminology, 4th ed. Oxford, Oxford University Press, 2007, 602– 640.
Grossman DC et al. Effectiveness of a violence prevention curriculum among children in elementary school. A randomized controlled trial. JAMA, 1997, 277:1605–1611.
Hawkins JD et al. Preventing adolescent health-risk behaviors by strengthening protection during child- hood. Archive of Pediatrics & Adolescent Medicine, 1999, 153:226–234.
Hodgins S, Cree A, Alderton J, et al. From conduct disorder to severe mental illness: associations with aggressive behaviour, crime and victimization. Psychological Medicine 2008;38:975-987.
Krug EG et al., eds. World report on violence and health. Geneva, World Health Organization, 2002.
Olds D, Henderson CR, Cole R, et al. Long-term effects of nurse home visitation on children’s criminal and antisocial behavior. Journal of the American Medical Association 1998;280:1238-44.
Reynolds AJ, Temple JA. Cost-effective early child- hood development programs from preschool to third grade. Annual Review of Clinical Psychology, 2008, 4:109–139.
Schweinhart LJ, Montie J, Xiang Z, et al. Life time effects: the High/Scope Perry Preschool Study through age 40. Ypsilanti, MI: High/Scope Press, 2005.
Whitfield CL, Anda RF, Dube SR, et al. Violent childhood experiences and the risk of intimate partner violence in adults: assessment in a large health maintenance organization. Journal of Interpersonal Violence 2003;18:166-85.