Social and Economic Costs of Violence Workshop Summary (2012) / Chapter Skim
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8 Investing in Prevention
8 Investing in Prevention
Pages 113-140
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From page 113... ...
Prevention Institute Prevention has tremendous value, and there are many ways to think about its value in the context of preventing violence. Prevention is a systematic process that reduces the frequency or severity of illness or injury, 113
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Efficient government 10. Prevention reduces suffering and saves lives Direct Costs of Not Preventing Violence One way to appreciate the value of preventing violence is to understand the costs of violence.
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Every subsequent encounter that one child has with the criminal justice, social services, and medical systems as he grows up makes violence more and more expensive for communities, taxpayers, and the larger society. These expenses pile up when violence is not prevented, and "economic costs provide, at best, an incomplete measure of the toll of violence," according to the Centers for Disease Control and Prevention (CDC, 2007)
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neighborhoods, violence is so traumatizing that 77 percent of children exposed to a school shooting and 35 percent of urban youth exposed to community violence develop PTSD, far higher than the rate for soldiers deployed to combat areas in the last 6 years (20 percent) (Kilpatrick et al., 2003; National Center for PTSD, 2007, 2009)
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Prevention preempts both the direct and the indirect costs of violence and translates into huge savings. Direct Savings By preventing violence before it happens, investments are made now rather than paying more later to cover the outsized after-the-fact costs of violence.
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From page 118... ...
Preventing violence would reduce demand for healthcare services by lowering these incidence and prevalence rates, which would void the associated healthcare costs for thousands of people who would otherwise have fallen ill. Advantages of a Prevention Approach Criminal justice has historically received most attention when it comes to violence, but effectively addressing this problem requires an approach that emphasizes prevention and also includes intervention, enforcement, and successful reentry.
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From page 119... ...
Approaching violence from only a criminal justice perspective limits the types of partners involved and narrows the scope of possible solutions, whereas focusing on prevention brings multiple partners to the table. A Good Solution Solves Multiple Problems Addressing the risk and resilience factors of violence through prevention reduces the likelihood of other poor health and behavior outcomes, such as teen pregnancy, substance abuse, mental health problems, and school failure (Felitti, 2002; Shonkoff et al., 2009)
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From page 120... ...
Investing in prevention reduces the prevalence and severity of violence and related injury and disability, as well as of associated conditions, such as chronic disease, mental illness, and poor learning. This means reduced healthcare expenditures related to violence and associated health conditions.
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Social Development Research Group, University of Washington School of Social Work Prevention science emerged in the late twentieth century as a discipline built on the integration of life course development research, community epidemiology, and preventive intervention trials. Advances in prevention science have important implications for the healthy development of adolescences.
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From page 122... ...
Over time, an evidence base of "what works" has been established, and several lists of tested and effective programs have been made available to the public. Implementing scientifically tested and effective prevention programs to address youth risk and protective factors is a viable strategy for reducing prevalent and costly problem behaviors, including adolescent substance use and delinquency.
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123 INVESTING IN PREVENTION TABLE 8-1 Many Youth Problem Behaviors Share Underlying Risks ety Anxi t e u Abus n and op-O ncy cy a Pregn quen ol Dr tance essio ce n Delin Depr Scho Viole Subs Teen RISK FACTORS Community Availability of drugs ✓ ✓ Availability of firearms ✓ ✓ Community laws and norms ✓ ✓ ✓ favorable to drug use, firearms, and crime Media portrayals of violence ✓ ✓ Media portrayals of substance abuse ✓ Transitions and mobility ✓ ✓ ✓ ✓ Low neighborhood attachment and ✓ ✓ ✓ community disorganization Extreme economic deprivation ✓ ✓ ✓ ✓ ✓ School Academic failure beginning in late ✓ ✓ ✓ ✓ ✓ ✓ elementary school Lack of commitment to school ✓ ✓ ✓ ✓ ✓ Family Family history of problem behavior ✓ ✓ ✓ ✓ ✓ ✓ Family management problems ✓ ✓ ✓ ✓ ✓ ✓ Family conflict ✓ ✓ ✓ ✓ ✓ ✓ Favorable parental attitudes and ✓ ✓ ✓ involvement in problem behavior Peer and Individual Early, persistent antisocial behavior ✓ ✓ ✓ ✓ ✓ ✓ Rebelliousness ✓ ✓ ✓ Friends engage in problem behavior ✓ ✓ ✓ ✓ ✓ Gang involvement ✓ ✓ ✓ Favorable attitudes toward problem ✓ ✓ ✓ ✓ behavior Early initiation of problem behavior ✓ ✓ ✓ ✓ ✓ Constitutional factors ✓ ✓ ✓ ✓
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Adds Value to Evidence-Based Prevention Programs CTC provides education, skills, and tools for building community capacity to change youth outcomes: • CTC's five-phase process provides communities with education and tools for assessing and prioritizing local risk, protection, and youth outcomes. • CTC provides tools for assisting communities in matching prioritized risk and protective factors with tested, effective preventive interventions.
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From page 125... ...
The board develops a vision statement to guide its prevention work and establishes work groups to perform core implementation and maintenance tasks: board maintenance, risk and protective factor assessment, resource assessment and analysis, public relations, youth involvement, and funding. Phase 3: Develop a Community Profile In phase 3, the CTC board develops a community profile of risk, protection, and problem behaviors among community youth; targets two to five risk and protective factors for preventive action; and identifies existing prevention resources and gaps.
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Following Community Resource Assessment Training, board members survey service providers to measure the extent to which high-quality, research-based prevention programs targeting local prioritized risk and protective factors are already available in the community and identify existing gaps. The community is educated about prevention resources, and parties are recognized for their contributions to positive youth development.
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A longitudinal panel of 4,407 children has been surveyed annually from grades 5 through 10, 1 year after intervention support for CTC ended, so that the sustainability of the CTC prevention system and effects on youth outcomes could be evaluated. Effects on community prevention systems were evaluated using reports of key leaders from CTC and control communities.
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From page 128... ...
These differences were sustained 1 year after the intervention phase of CYDS had ended. Exposure to targeted risk factors increased significantly less rapidly in panel youth in CTC communities than in control communities through grade 10, and levels of exposure to targeted risk factors were significantly lower in the panel in CTC communities than in control communities in the spring of grade 10.
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From page 129... ...
The CTC Milestones and Benchmarks Survey was used to track progress in the implementation of core components of the CTC prevention system. In each year of the intervention, CTC communities enacted an average of 90 percent of the key features of the CTC prevention system, including developing a community board, prioritizing risk and protective factors, selecting tested and effective preventive interventions from the CTC Prevention Strategies Guide, carrying out selected implementation programs with fidelity, and periodically assessing risk and protective factors and child and adolescent well-being through surveys of students (Fagan et al., 2009; Quinby et al., 2008)
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g e n g T L e rt rs h y* ts es rs ills io in -1 se io n t ar le te ut or ic el t rin n te u TA AR A C Sk s o C is 10 at ce ai ua ho en Yo n Ab s ut s Si ct M W al TO C Tr SM es ho d T e ev g ar ar g ig y d ol ilie ily Ev W oj lls ue ru Pr a d in St i l Le t /B s oo l D Pr g nt am St am d er Sk nt rA en Va G Al o F F in re th an fo re N ly g fe l o pm ng n e i s Pa Li o Pa ills Br ni id Bu at rd el e u p a g s Sk ci G th ev w t Bi ti g eu o D es ar lw en tT u m r P O Q ra ec St g s oj n' ro Pr o P Li Percentage of Required Material or Components Actually Delivered Percentage of Required Number, Length, and Frequency of Session Actually Delivered FIGURE 8-1 Adherence to prevention program design specifications in Community Youth Development Study communities averaged across all intervention years.
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Significant differences in the initiation of delinquency were first observed in the spring of grade 7. Panel youth from CTC communities were 25 percent less likely than panel youth from control communities to initiate delinquent behavior, and they remained so in grade 8.
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, when CTC panel youth were 29 percent less likely to initiate alcohol use and 28 percent less likely to initiate cigarette smoking than panel youth from control communities. Differences in the initiation of delinquency, alcohol use, and cigarette smoking from grades 5 through 10 led to cumulatively lower rates of initiation over time (see Figure 8-2)
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leads to significant reductions in the cumulative initiation in delinquency and substance abuse. NOTE: The percentage of youth initiating delinquency, alcohol use, and cigarette smoking from grade 5 to grade 10 is significantly lower in youth exposed to CTC.
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In addition, it is clear from the Community Youth Development Study that high-quality training and technical assistance are important to ensuring successful implementation of CTC with fidelity. CTC Guiding Principles • Increase the use of tested and effective prevention policies and pro grams, while recognizing that communities are different and need to decide locally what policies and programs to use.
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2010. Implementation of the Communities That Care prevention system by coalitions in the Community Youth Development Study.
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2008. Implementing effective community-based prevention programs in the Community Youth Development Study.
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2008b. Testing Communities That Care: The rationale, design and behavioral baseline equivalence of the Community Youth Development Study.
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2010. Addressing the intersection: Preventing violence and promoting healthy eating and active living.
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:212-217. Weiss, B., and Southern California Injury Prevention Research Center, UCLA School of Public Health, Prevention Institute.
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