Preventing Youth Violence, Part 2

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Raymond B. Flannery Jr., Ph.D., FAPM,
Harvard Medical School,
The University of Massachusetts Medical School

Part 1 of these two essays on youth violence examined the basic cultural, biological, sociological, and psychological theories of youth violence and the continuum of early (disrupted mastery, attachment, meaning), serious (depression, substance abuse, untreated psychological trauma), and urgent (conduct disorder, moral depravity) warning signs of individual at-risk youth. Part 1 also noted that there are usually multiple warning signs in any given troubled child/adolescent and that the warning signs are related to the potential sources of violence in the various theories.

A common pattern of multiple determinants is what I refer to as the anomic cycle of violence. (1) In this pattern, busy parents are pursuing material gains. This leaves less time for child-rearing. Children sense this abandonment, feel rejected, become depressed, and often angry. They self-medicate these feelings and states with alcohol or drugs. The drugs disinhibit the cortical control centers of the brain, weapons are easily available, and violence may follow. In this example, many of the youth warning signs are present, several of the theories of violence are involved, and multiple interventions will be necessary.

How to implement these needed interventions is the subject of this part 2. It permits only an overview of the various interventions. An in-depth presentation on how to field these interventions may be found elsewhere for individual (1) and for group (2) approaches. We begin first with individual interventions.

Individual Interventions

There are five basic guidelines that inform individual interventions and that instill or restore the three domains of good physical and mental health (reasonable mastery, caring attachments to others, and a meaningful prosocial purpose in life):
– Safety First
– Fostering Attachments
– Fostering Mastery
– Medical and Psychiatric Conditions
– Fostering Meaningful Prosocial Purposes

Safety First.
It is important to implement all of the above guidelines to ensure adequate coping and these may be done in any order that makes sense for a given child. However, safety must always come first. No one can concentrate on learning more adaptive coping, if one is fearful for his or her safety. Here are some common safety examples:

(1) Actual use of Weapon or Loss of Control by Child: In these situations the child is too angry to reason with and one should call for help immediately.

(2) Child in Coma: If you are trained, provide any needed CPR. Summon help and gather observational information at the scene (for example, discarded drug vials). Do not disturb anything while you await help, as it may be a crime scene.

(3) Suicidal Child: If you believe a child to be suicidal, ask the child if he or she wants to kill him/herself. If the child answers yes, ask if the child has a plan. Very specific plans should be taken very seriously. Third, ask the child what keeps the him or her alive. Listen here for important caring attachments. If the child says he or she wants to commit suicide or has a specific plan and/or no good reason to stay alive, do not leave the child unattended and take the child to the nearest emergency room.

(4) Threatening Harm: If the child is agitated and threatening to assault or harm someone but is in tenuous control, stand back seven feet, talk continuously with the child, try to ascertain the perceived grievance, and begin to think through possible immediate strategies that might defuse the anger.

(5) Rape by Child: If you are being raped by a youth, first do what you need to do to survive. This is especially true if the youth has a weapon. Yelling Fire, urinating, or stating that you have AIDS may deter some rapists. Unfortunately, it may increase excitement in others.

(6) Robbery by Child: If you are being robbed by a youth, give up everything that you are asked for. Do not run after the thief. Material goods can be replaced. You would, however, need to resist a robber who wanted to also take you prisoner.

When you are sure that you, the youth, and any other concerned parties are safe, then proceed to the next guideline that you have chosen to work on.

Fostering Attachments.
The instilling or restoring of caring attachments is complicated and may take several months. At-risk youth perceive themselves as having been rejected by adults so often that they trust no one. Rebuilding attachments must begin with restoring trust.

Trust is based on predictable behavior and prosocial values. Predictable behavior means that what a person says he or she will do the person actually does. Ask a mistrustful child to assess the behavior of an honest adult over time to see if the child detects any unpredictable behavior. When this does not happen, one can begin a discussion with the child of the honest-adult values and what these values mean for safety and support.

Next, children need to learn empathy and sharing, experiences that they may not have had in their lives. Empathy is the recognition of an emotional state in another person and allows us to have compassion toward others. It is the basis for developing moral values. Have the at-risk youth practice understanding the emotional states of others. The skill of sharing is best taught in small ways beginning with the child receiving from others and then, at some point, sharing something of the child with others. Explore the helpful outcomes for all parties in the process of sharing.

Lastly, at-risk youth need to grieve. All have sustained multiple losses: parents, teachers, relatives, friends, and so forth. Anger is a component of unresolved grief that can manifest itself in violence, so it is helpful to resolve the grief early on. Review what was life like before the loss, what it was like after the loss, what it is like now, and what would be helpful to reduce the sadness.

Fostering Mastery.
In some ways, fostering reasonable mastery is the easiest guideline to implement. Assess the skill deficiencies of the child in the areas of personal self-care, interpersonal skills, and academic skills that we have noted. Draw up a plan of the needed skills, select the most appropriate adult to act as teacher, and begin to inculcate the needed skills. Start with simple tasks first to foster success in mastery and to enhance motivation to continue. One might also wish to instill the general skills of stress-resistant persons (3) as part of this skills-based program. Stress-resistant individuals exhibit reasonable mastery, caring attachments, healthy lifestyles, humor, and meaningful purpose in life centered on helping others.

Medical and Psychiatric Conditions.
All at-risk youth should receive needed physical and psychological evaluations to rule out any underlying medical or psychiatric problems that might contribute to violence. Endocrine work-ups may prove of assistance, if the child has been under severe stress for a prolonged period.

Beyond this, some at-risk youth issues may require professional assistance. A severely depressed child may need a short-term hospitalization to prevent suicidal actions as the depression is lifting. Substance abuse may require an in-house detoxification. Conduct disorder and long-standing, severe antisocial behavior may require a full team effort and a residential stay to support limit-setting on maladaptive coping.

Fostering Meaningful Prosocial Purpose.
As the at-risk youth begins to grow and adapt successfully, it is important to instill the prosocial values found in the major faith traditions. These values are akin to the Protestant Work Ethic and emphasize honesty, hard work, personal responsibility, and concern for others. These values may be taught by word, adult example, and behaviors in which the child volunteers to help others.

Group Interventions

Let us turn now to group interventions. These are two types. The first are group approaches for many of the tasks noted above in helping individual at-risk youth, and these are to be encouraged when needed and when available. The second type includes possible group interventions at the societal level, interventions that can both address the prevention needs of at-risk youth and also restore the sense of community cohesion that is negatively impacted during periods of anomie (discussed in part 1). Here are some possible programs that each of the five major institutions of any society may field in their communities.

(1) Business. The first way business can address youth violence and social concern for others is to be profitable. When a business is profitable, it is providing income to its employee families and this strengthens families and caring attachments. Profitable businesses are also paying taxes that support municipal services such as policing, schooling, and youth programs. A second way business can be helpful is by providing family-friendly programs such as flex time, job sharing, part-time work, and compressed work hours. Each work-hour arrangement provides parents with flexibility to be able to attend to child rearing needs. A third business approach to strengthening and reducing violence in the community is to direct fiscal resources and sometimes employee work hours to special areas associated with potential youth violence. Corporations have addressed community needs in many ways (for example, supporting Habitat for Humanity housing, developing programs to assist domestic violence victims, educating youth to alternatives to violence in media programming, and the like).

(2) Government. Government at the state and local levels can similarly implement policies that both strengthen families and also reduce the risk of youth violence. These policies might include education and retraining programs as workforce needs change, public-works programs that provide youth employment, and specific tax policies that transfer income to those in need. In addition, government is in a unique position to create special programs for at-risk youth. Youth employment and recreation programs, domestic-violence-reduction initiatives, and community policing have proved to be great assistance in many communities in the country.

(3) Schools. Schools are also in a unique position to emphasize youth violence-prevention strategies. First, among these initiatives is to provide an education adequate for the postindustrial state. This includes an adequate physical plant, a relevant curriculum, enough teachers and assistants for each classroom, and any needed books and supplies. Secondly, schools are in a good position to address youth violence risk factors during school hours. Sensitivity training for cultural diversity, substance abuse education, and the teaching of verbal-conflict resolution skills are of obvious relevance. Thirdly, school systems can use their buildings after school hours to further reduce possible youth violence. Much youth violence begins when the school day ends and keeping schools open after classes has been shown to be of assistance. Programs after school hours in school buildings have included neighborhood health centers, well-baby clinics wherein mothers can also meet the teachers, tutoring programs for students in need, and the use of the gym and auditorium for recreational programs and the theater arts.

(4) Families. Parents today face serious time-scarcity issues and a bewildering array of child- rearing issues embedded in competing value systems. Communities need to provide multiple supports for parents. Programs for parents might include stress management, financial and debt management, domestic violence, substance abuse, and adequate day-care resources. Communities are also able to create programs and services that particularly target issues related to youth violence. Programs addressing the continuum of youth warning signs; educating parents to the warning signs of substance abuse, depression/suicide; psychological trauma; and assisting parents in how to teach their children media literacy (explaining the implications and consequences of what is being viewed) are available in some form and to some extent in many communities, and other unaddressed areas may be added. All of these initiatives strengthen families and help to keep youth at home, off the street, and out of gangs.

(5) Religion. Religious-faith traditions teach values and provide theological and emotional support in times of pain and suffering. (4) In addition, faith traditions provide important social services, such as soup kitchens, homeless shelters, big-brother programs, education and training, and recreational opportunities. Religious-faith members at times also become involved in larger community and social issues. Pressing for worker’s rights and working with police and community social agencies to reduce youth violence are examples of involvement in larger issues.

Help for the Helpers

Rearing children and/or working with troubled youth is stressful; time-consuming; physically and mentally exhausting; and, at times, potentially dangerous. Those who do this work need to sustain and care for themselves as they address the issue of preventing youth violence. This topic requires an essay in its own right, but a comprehensive support program for helpers should include a safe work environment, risk-management strategies to provide care to potentially violent clients or suspects in a safe manner, basic stress-management strategies, an understanding of psychological trauma, and crisis intervention procedures in the aftermath of traumatic youth violence. (5)

Youth violence is a serious public health hazard in many countries. In these two essay/blogs on youth violence, I have reviewed the theories of youth violence as well as its continuum of warning signs. We have seen that incidents of youth violence are most frequently multi-determined and we have surveyed the range of individual and group solutions that can be fielded by parents, teachers, counselors, and communities to address these issues. No individual can implement all of the possible strategies. However, the collective individual efforts of all of us can dramatically reduce the risk of youth violence. The sense of cohesive community can be restored even in an age of anomie. (1, 2)

1. Flannery, R. B. Jr. Preventing Youth Violence: A Guide for Parents, Teachers, and Counselors. New York: American Mental Health Foundation, 2012.
2. Flannery, R. B., Jr. Violence in America: Coping with Drugs, Distressed Families, Inadequate Schooling, and Acts of Hate. New York: American Mental Health Foundation, 2012.
3. Flannery R. B. Jr. Becoming Stress-Resistant through the Project SMART Program. Ellicott City, MD: Chevron Publishing, 2003.
4. Durant, W. and A. The Lessons of History. New York: Simon and Schuster, 1968.
5. Flannery R. B. Jr. The Violent Person: Professional Risk Management Strategies for Safety and Care. New York: American Mental Health Foundation, 2009.

Dr. Raymond B. Flannery, Jr., Ph.D. FAPM, is an internationally recognized scholar and lecturer on the topics of violence, victimization, and stress management. Dr. Flannery is available for lectures and workshops for all types of groups and may be reached at the American Mental Health Foundation. elomke [at] americanmentalhealthfoundation [dot] org

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