Getting To Impact: The Need for Community- and Policy-Level Strategies to Prevent Youth Violence

Editor’s Note: Sarah Bacon, Ph.D. is the Lead Behavioral Scientist for the CDC’s National Centers of Excellence in Youth Violence Prevention.

The burden of youth violence in the U.S. is heavy.  Even though overall rates of youth violence have declined, homicide is still the third leading cause of death among persons aged 10-24 years (Centers for Disease Control and Prevention (CDC), 2010).  Individuals, families, and communities all experience the damaging effects of violence.  The good news, though, is that violence is preventable.  We can stop it before it starts.  This is the primary goal of the public health approach to violence prevention.

How do we prevent youth violence?  Our scientific efforts in the Division of Violence Prevention at the CDC are directed toward answering this question, and we have learned some essential lessons.  First, we know that we should rely on proven strategies that have been scientifically evaluated and shown to be achieving the intended outcomes. We call this evidence of effectiveness.  (For more on understanding evidence, take a look at our Guide To Understanding Evidence).  Second, we know that approaches that work to prevent youth violence are comprehensive.  They work at the individual, family, school, and community levels, to change behavior and they provide a combination of preventive services for the entire population regardless of risk, and targeted strategies for groups experiencing risk. Individuals affect and are affected by the relationships, communities, and society in which they reside. So it is critical that prevention strategies include a range of activities that address multiple levels of influence. This comprehensive approach is more likely to have lasting prevention effects over time than any single intervention.

Several programs have enough evaluations showing that they work to be called “evidence based”.  For some great resources on evidence-based programs, take a look at Blueprints for Healthy Youth Development and  Much of the evidence supporting effectiveness of youth violence prevention programs is for strategies at the individual, family, and school level.  These programs provide an essential part of a comprehensive approach to youth violence prevention, but we also need to move toward greater depth of resources and options at the community and policy levels.  In order to prevent youth violence among the entire population, we need to move to broader scale interventions that reach greater numbers of people and affect the contexts in which they live. There are some emerging and promising strategies at the community and policy level that give cause for optimism about future success in this direction.

Community Policing, for example, puts the community and the police on equal footing as partners in violence prevention.  Police officers have the opportunity to engage the community in new ways:  walking the beat, talking with residents, and getting a more nuanced understanding of community dynamics and resources that can either contribute to the problem or the solution.  Community policing looks different everywhere, because it offers a custom fit for unique community-police relationships.  That reality poses a challenge for evaluation purposes, because Community Policing looks different from one community to the next.  Evaluation thus far, though, suggests this is a promising strategy at the community level.

Street outreach programs, like Cure Violence, offer promising community-level strategies as well.  These programs use outreach workers who are from the community and oftentimes have firsthand experience with the violence in a community.  The outreach workers attain a level of trust and access to the community that allows them to identify violence episodes as they are unfolding and use conflict resolution skills to interrupt the chain of violent reactions.  Outreach workers can also develop relationships with individuals in the community and help link them with educational and employment opportunities that decrease the likelihood of further violence. Results of evaluations so far are promising, and future evaluation work can help enlighten how the process is working, and when and where, and for whom.

A number of built environment and structural interventions show great promise for population-level effects on violence.  Crime Prevention Through Environmental Design, or CPTED is one such strategy.  Greening of urban spaces is another example. These strategies may involve something like planting a community garden in an abandoned lot, or providing consistent lawn maintenance around abandoned properties. Designing public spaces so that there is sufficient lighting and no spaces that are hidden from view can lead to reductions not only in fear of crime but also in the actual occurrence of violence.

There are also a few promising strategies for the prevention of youth violence at the economic and policy levels.  These strategies can be difficult to evaluate, so we are still learning about the effects of economic and policy strategies.  Business improvement districts, or BIDS, are public-private partnerships that invest resources in local services and activities such as street cleaning, private security, and adding green spaces, to increase the appeal and use of the area. A CDC-supported evaluation of this approach in Los Angeles found a 12% drop in robberies and an 8% drop in overall violent crime. Finally, there is emerging work on alcohol policy and the role it may have in violence prevention.  The concentration of places to buy alcohol, and especially places where single-serve alcohol drinks are consumed elsewhere, is highly correlated with rates of violence in a community.  Policies that limit access to alcohol by decreasing the number of outlets by density are associated with lower rates of violence and assaults.

When a program or strategy is provided, it is important that it look just the way the program developers originally intended.  We call this “implementation fidelity”, and it is an essential component of community-level strategies. There are core principles and processes that must be followed in order for them to be effective. This is the central challenge of these approaches to youth violence prevention because if they are poorly implemented, they are not only an inefficient use of resources but they also undermine a community’s belief that violence in their community is preventable and something can be done.

But we know that something can be done and that violence can be prevented. When we implement a comprehensive approach that includes effective strategies at the community level, we can make a real difference in community rates of violence and improve the safety and health of everyone living there.

The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.