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VIOLENCE
Kimberly Hoagwood
If a society is to seriously address problems of youth violence, it must seek to understand its causes and intervene without delay. If it prefers to promote violence, it can engage pollsters, pundits, and media experts to decry it while simultaneously advertising it. Eliminating youth violence will require stepping outside the narrowing and popularized frameworks that provide unidimensional and generally individualized explanations and, instead, thinking deeply about the transactional meaning of youth violence in a violent society. Research investment on youth violence by the National Institutes of Health (NIH) has supported studies on correlates, consequences, prevention, and treatment of antisocial behavior. The social and behavioral sciences have tackled the problem of youth violence with a vengeance, and this work has yielded a vast amount of descriptive information about the manifestations of antisocial behavior, its prevalence and incidence, and the pattern of risk factors that place some children on trajectories that end in the adult criminal system. There is now ample consensus among social scientists that certain risks (such as academic failure, early psychiatric problems, and language delays) are highly correlated with poor outcomes. Many social scientists believe that the characteristics of children, families, and neighborhoods associated with later antisocial behavior syndromes can be specified and that the more persistent and difficult-to-treat behavior patterns are often established early. A resounding call for preventive efforts has hailed from many quarters. Not surprisingly, when preventive actions are called for, schools become a focal point. A free, appropriate public education is guaranteed for all children. Children spend almost as much time in school as they do watching television. Moreover, when children have mental health needs, it is the schools that provide services, not the mental health system (Burns et al., 1995). Schools are the hub of many communities, particularly in rural areas, so it is understandable that if preventive efforts targeted towards early intervention are to succeed, schools must be involved. At the same time, the host of social ills besieging children in this country, from homelessness to domestic violence to HIV to child neglect and abuse, place unprecedented pressures on schools to, in essence, become surrogate guardians for many children. Balancing the needs of these children against the mandate to educate and now to meet academic standards set by state agencies is a formidable task, and schools are finding their curricula bulging with special units on what are sometimes seen as nonacademic and irrelevant frills — social skills training, anger management, conflict resolution, and safe sex, to name a few. In a recent review of the distribution of research grant emphases in the area of violence, several NIH institutes classified their studies into one of three categories: (a) preintervention studies, which included risk or protective studies, population-based epidemiological studies, or basic prevention development; (b) efficacy studies, which included laboratory trials of the impact of specific preventive or treatment interventions targeted at disruptive behavior disorders, including conduct disorder; and (c) effectiveness research, which included studies of the effectiveness, dissemination, or transportability of interventions into community (nonacademic) settings. Approximately three quarters of the grants fell into the category of preintervention studies. The remainder were thinly spread between studies of the efficacy of specific interventions and (even more thinly) studies of their effectiveness in diverse communities. The articles in this special double issue are addressing the very important questions that characterize the latter two categories of study: the impact, efficacy, and effectiveness of violence prevention programs delivered in the schools and the organizational factors, including climate, culture, and context, that enable programs to have tenure beyond the life of the research teams who study them. In fact, the articles here reverse the trend that has constituted what Felton Earls recently called "the implicit logic of violence prevention" (NIH, 1999). While in the past, theories and interventions were formulated on the assumption that individual behavior or attitudes needed to be the first target, followed by an outward expansion towards communities, Earls suggested that it is not only possible but necessary to reverse the logic. The strongest factors influencing behavior are extra-individual, not intrapsychic. Advances in research methods designed to assess the impact of social settings and social networks have made such techniques available for studies of community-level interventions. In fact, had these techniques and methods been available three decades ago when community activism was at its height, one wonders whether more progress might have been made in building an evidence base for community interventions to stem violence. Several of the articles in this double issue specifically address issues of community milieu, school climate, social interactional variables, and other "extra-individual" influences that affect the implementation and impact of evidence-based intervention programs. A second corrective balance provided by this issue is the explicit contribution to the evidence base through inclusion of rigorously examined school service programs. The preventive and intervention programs demonstrate, through carefully crafted designs, clear reductions in youth violence and associated antisocial behaviors. This is noteworthy because the fugitive literature (i.e., not peer reviewed) is filled with anecdotal reports of poorly designed evaluations where outcomes are often positive but their meaning is unascertainable. Even worse, the majority of school programs currently in use across the country that are aimed at reducing violence in youth are completely untested, so outcomes of these programs are not even known. This is an important corrective because the promotion of untested practices can be worse than harmless; it can be dangerous. Del Elliot (NIH, 1999) pointed out that 95% of programs being used to reduce violence in communities have no scientific evidence for their effectiveness. The dangers of implementing popular but undocumented services has been recently demonstrated. An important article by Dishion, McCord, and Poulin (1999) reported that peer group interventions (including counseling sessions and summer camps run and supervised by adults) significantly increased among high-risk adolescents such problem behavior as substance abuse, delinquency, and violence. They referred to this as "deviancy training" to denote the positive reinforcement that occurs in teen groups via laughter, social attention, and interest in deviant behavior, which promotes further socially maladaptive behaviors. They also pointed out the need for specificity in targeting interventions to treatment needs: Youth who are depressed and have no comorbid disruptive behavior disorders have been effectively treated in groups using cognitive behavioral interventions (Clarke et al., 1995). Given Dishion et al.'s findings, however, it would be unwise to aggregate youth with disruptive behavior problems in such group treatments. These so-called negative findings are important not only in pointing practitioners away from bad practices, but also by advancing the science base in very fundamental ways. As Stephen Jay Gould pointed out, the idea of unilinear progress in science is false: "Science advances primarily by replacement, not by addition" (1981, p. 321). If science were linear, then negative findings or disproofs would hamper progress. But, in fact, this is not the case, as the example of deviancy training illustrates. This issue contributes to the knowledge base on school services by focusing attention on programs with demonstrable impact and on the social context in which the programs are embedded. But as Burns pointed out (1999), although the evidence base is being strengthened, attention must be paid simultaneously to achieving consensus about the criteria to apply to the evidence base, to determine what constitutes evidence and what constitutes clinically significant outcomes. Such criteria are needed for determining when effective programs are ready to be taken to scale and on how grand a scale. Establishing such criteria will require, among other aims, attention to the degree to which the body of knowledge addresses fundamental questions about causality. Although many theories in the social and behavioral sciences have been propounded over the past two decades to explain the origins of violence, theoretical progress on the causal bases of antisocial behavior has not occurred. Theories ranging from "risky shift" to "cognitive slippage" have come and gone. None have held sway or had staying power. Richters (1993; Richters & Cicchetti, 1997), whose penetrating work has pioneered new ways of thinking about these problems, pointed out that despite the multiplicative proliferation of theoretical models and descriptive information, progress has not occurred in understanding how the descriptive information about violence should be interpreted: Why do antisocial pathways develop for some children but not for others with the same risk profiles? Why does antisocial behavior remit or change direction in some? Why is such behavior difficult to treat once it has been established? One reason for the lack of progress may be that the methodological traditions, which consistently employ strategies for studying individual differences, presume causal homogeneity. That is, the study designs are crafted to test single multivariate theories, participants are recruited and classified into samples based on phenotypic similarities, and the same variables are assessed on all participants. Estimations of risk are formed on the basis of covariations across participants, and statistical covariation procedures are used to control for the possible influence of nuisance variables. Yet I have never met anyone who believes that violent, delinquent, or otherwise "antisocial" behaviors in children are causally homogeneous. Consequently, there is a mismatch between the methodological traditions widely followed in the social and behavioral sciences, which presume homogeneity, and the expectation that antisocial behavior problems are causally heterogeneous and that, in fact, multiple subtypes and trajectories exist. Areas for further reflection Nevertheless, there are many areas in which basic questions about youth violence cannot yet be answered. In addition to the absence of strong, testable, causal theories that take into account the subtypes of antisocial behavior, there are other areas that should be the target of further study.
Concluding remarks Author's Note References: Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. M. Z., & Erkanli, A. (1995). Children's mental health service use across service sectors. Health Affairs, 14, 147-159. Clarke, G. N., Hawkins, W., Murphy, M., Sheeber, L. B., Lewinsohn, P. M., & Seeley, J. R. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 312-321. Dishion, T. J., McCord, J., & Poulin, F. (1999). When interventions harm: Peer groups and problem behavior. American Psychologist, 54, 755-764. Gould, S. J. (1981). The mismeasure of man. New York: Norton. Habermas, J. (1989). The public sphere. In S. E. Bonner & D. M. Kellner (Eds.). Critical theory and society: A reader (pp. 136-142). New York: Routledge. National Institutes of Health (NIH). (1999, October 28-29). Expert Panel on Youth Violence Intervention Research. Plotz, D. (1999, September 20). Slate Magazine. Richters, J. E. (1997). The Hubble hypothesis and the developmentalist's dilemma. Development and Psychopathology, 9, 193-230. Richters, J. E., & Cicchetti, D. (1993). Mark Twain meets DSM-III-R: Conduct disorder, development, and the concept of harmful dysfunction. Development and Psychopathology, 5, 5-29.
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