Connecting the Dots to Prevent Youth Violence

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Connecting the Dots to Prevent Youth Violence

• A Training and Outreach Guide for Physicians and
  Other Health Professionals

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• Youth violence opportunities for prevention
• Name
• Date
• Institution
• Health Professional Training

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• The problem
• The United States has the highest youth homicide
  and suicide rate among the wealthiest developed
  nations (Task Force on Violence, 1999).

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• Impact of violence on health
• Homicide is the second leading cause of death
  for youth ages 15-19 (Cohen Potter, 1999).
• Medical costs just for firearm injuries are
  estimated at 2.3 billion a year (Cook et al,
  1999).

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• Impact on health
• Recent research shows changes to brain structure
  and chemistry following exposure to extreme
  violence (Niehoff, 1999).

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• The public health approach
• Like polio and other public health threats,
  violence can be prevented.

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• The causes of youth violence
• Risk factors
• Protective factors

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• Violence is learned by being victimized
• Approximately 826,000 children were victims of
  maltreatment in 1999 (US DHHS).
• Experiencing child abuse and neglect increases
  the likelihood of arrest as a juvenile by 53
  and of committing violent crimes by 38.
  (Widom, 1992).

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• Violence is learned
• The 3.3 million children who witness domestic
  abuse each year are 15 times more likely to
  become victims or perpetrators of violence
  (Carlson, 1994 Horn, 2000).
• They are also more likely to be victimized in
  intimate relationships as adults as well as to
  become a perpetrator or victim of violence on
  the streets (Widom, 1992).

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• Violence is learned by exposure to violent media
• By age 18, a child has seen 200,000 acts of
  violence on TV and other media.
• Studies suggest that children confronted
  incessantly by violent images may become immune
  to the horror of violence and may come to accept
  violence as a way to solve problems (AMA, 1996
  Donnerstein et al, 1994).

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• Alcohol and drugs are risk factors
• 50 of youth homicide victims have elevated blood
  alcohol levels (Mann, et al, 1998 Adams et al,
  1992 Prothrow-Stith, 1992).
• 50 of youth who perpetrate homicide have
  elevated blood alcohol levels (Mann, et al, 1998
  Adams et al, 1992 Prothrow-Stith, 1992).

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• Firearms
• Teenage boys are more likely to die from gunshot
  wounds than from all natural causes combined
  (Coordinating Council on Juvenile Justice and
  Delinquency Prevention, 1996).
• Family and friends are the primary source of guns
  for young people (Sheley Wright, 1998).

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• A combination of factors
• Violence is not the result of a single factor.
• Violence is the result of the interaction of
  multiple individual, situational, contextual,
  and societal influences (National Youth Violence
  Prevention Resource Center, 2001).

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• What health care professionals can do
• Educate youth about ways to reduce risk and
  increase protection.
• Screen youth for risk and exposure.
• Refer them to comprehensive support programs.
• (Brandt, 1997 Sege et al, 2001 Cohn, 2001)

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• Three Phases of the Haddon Matrix
• Pre-injury Prenatal care Routine preventive
  care Acute care unrelated to injury from
  violence
• Injury
• Post-injury Acute Urgent Emergency care
  related to injury from violence
• (National Committee for Injury Prevention and
  Control, 1989)

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• Post-injury educate
• Educate parents on methods to help child avoid
  re-injury, and to cope with emotional trauma.
• Educate young people on the same topics.

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• Post-injury assess
• Document injuries and surrounding events.
• Seek further psychiatric evaluation.
• Risk factors for re-injury
• Is conflict settled?
• Does person feel safe leaving health setting?
• Is he/she thinking about revenge?
• Is there a safe place to go while things cool off?

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• Post-injury refer
• Refer young people and families to mental health
  and crisis services.
• Refer to long-term comprehensive services.
• Notify authorities in case of abuse/neglect or
  when plans for revenge warrant.

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• Dont forget invisible victims
• of violence
• Child witnesses to domestic violence are
  victimswe often forget them.
• In a cycle of violence, many young perpetrators
  have also been witness to and victims of
  violence.
• (Widom, 1992)

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• Post-injuryinvisible injuries
• Educate caregivers on emotional impact of
  witnessing violence and methods to help child
  cope.
• Screen young people for exposure.
• Refer to comprehensive programs with mental
  health services.

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• Three Phases of the Haddon Matrix
• Pre-injury Prenatal care Routine preventive
  care Acute care unrelated to injury from
  violence
• Injury
• Post-injury Acute Urgent Emergency care
  related to injury from violence
• (National Committee for Injury Prevention and
  Control, 1989)

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• Pre-injury educate
• Educate parents on strategies to build protective
  socio-emotional competencies.
• Educate on the effects of media violence and ways
  to reduce exposure.
• Educate on firearms and ways to reduce risk such
  as safe storage procedures.

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• Pre-injury screen
• Age-appropriate screening for risk factors
  throughout childs development.
• Examples of tools for use with adolescents
• Fighting
• Injuries
• Sex
• Threats
• Self-defense

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• Pre-injury refer
• Connect young people who show risk and their
  families to comprehensive and effective
  prevention programs.

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• Effective programs
• Early start
• Long-term
• Intense
• Strong connection with supportive adult
• Involve many sectors (health care, schools,
  police, community, business).
• (Dryfoos, 1990 Burt and Resnick, 1992 US
  DHHS, 2001).

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• Galveston, TexasIsland Youth Programs

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• Beyond the clinic
• Work with schools.
• Work with community coalitions.
• Advocate for effective policy.
• (Commission for the Prevention of Youth
  Violence, 2000).

The Ecological Framework
Environment
Community
Family
Individual