A Comprehensive Technical Package 

for the Prevention of Youth Violence 

and Associated Risk Behaviors

National Center for Injury Prevention and Control 

Division of Violence Prevention

A Comprehensive Technical Package 

for the Prevention of Youth Violence 

and Associated Risk Behaviors

Prepared by:

Corinne David-Ferdon, PhD

Alana M. Vivolo-Kantor, PhD, MPH

Linda L. Dahlberg, PhD

Khiya J. Marshall, DrPH, MPH

Neil Rainford, MHSE

Jeffery E. Hall, PhD

2016

Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Atlanta, Georgia
 2 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk 

Behaviors is a publication of the National Center for Injury Prevention and Control of the 

Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention

Thomas R. Frieden, MD, MPH, Director

National Center for Injury Prevention and Control

Debra E. Houry, MD, MPH, Director

Division of Violence Prevention

James A. Mercy, PhD, Director

Suggested citation:

David-Ferdon, C., Vivolo-Kantor, A. M., Dahlberg, L. L., Marshall, K. J., Rainford, N. & Hall, 

J. E. (2016). A Comprehensive Technical Package for the Prevention of Youth Violence and 

Associated Risk Behaviors. Atlanta, GA: National Center for Injury Prevention and Control, 

Centers for Disease Control and Prevention.
A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 3

Contents

Acknowledgements.............................................................................................................................................. 5

Partner Review ........................................................................................................................................................ 5

Overview ................................................................................................................................................................... 7

Promote Family Environments that Support Healthy Development................................................15

Provide Quality Education Early in Life.........................................................................................................18

Strengthen Youth’s Skills ...................................................................................................................................21

Connect Youth to Caring Adults and Activities.........................................................................................25

Create Protective Community Environments............................................................................................29

Intervene to Lessen Harms and Prevent Future Risk...............................................................................33

Benefits Relative to Costs..................................................................................................................................37

Sector Involvement .............................................................................................................................................39

Monitoring and Evaluation...............................................................................................................................41

Conclusion..............................................................................................................................................................42

References...............................................................................................................................................................43

Appendix: Summary of Strategies and Approaches to Prevent Youth Violence...........................60

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 5

Acknowledgements

This technical package is based on decades of youth violence prevention research, and we are appreciative of the hard 

work of the many individuals who have developed a tremendous amount of knowledge that makes the prevention 

of youth violence possible. We thank Division, Center, CDC leadership and other CDC prevention scientists, including 

Sarah Bacon, Kevin Vagi, and Brad Bartholow, for their input, careful review, and helpful feedback on earlier iterations 

of this resource. We thank Alida Knuth for her formatting and design expertise. 

We also extend our gratitude to all of our partners for their helpful feedback, support, and encouragement for this 

resource. We would like to especially thank the American Institutes for Research, American Psychological Association, 

Equal Justice USA, Michigan Youth Violence Prevention Center, Monterey County Health Department, National League 

of Cities, North Carolina Rural Academic Center of Excellence in Youth Violence Prevention, Prevention Institute, Safe 

States Alliance, and our Federal colleagues in the National Institute for Occupational Safety and Health and in the 

Office of Minority Health for their helpful written feedback on this package.

Partner Review

CDC provided an overview of the youth violence technical package to partners and grantees in a series of webinars. A 

draft of the youth violence technical package was also shared with partners and grantees following the webinars. These 

partner organizations are listed below.

Striving To Reduce Youth Violence Everywhere 

(STRYVE) Action Council

American Academy of Pediatrics 

American Association of School Administrators

American Psychological Association

American Public Health Association

Association of State and Territorial Health Officials 

Boys and Girls Clubs of America

Community Anti-Drug Coalitions of America

Hope Matters International

Illinois Children’s Mental Health Partnership

Local Initiatives Support Corporation

National Association of County and City Health Officials 

National Association of Students Against Violence Everywhere 

National Council of Juvenile and Family Court Judges

National League of Cities

Prevention Institute

Safe States Alliance

Young Men’s Christian Association

STRYVE Technical Assistance and Grantees

American Institutes for Research

Boston Public Health Commission (MA)

Houston Health Department (TX)

Monterey County Health Department (CA)

Multnomah County Health Department (OR)

Federal Partners

United States Department of Justice

Office of Minority Health

National Institute for Occupational Safety and Health

National Centers of Excellence in Youth Violence Prevention

Chicago Center for Youth Violence Prevention

Clark-Hill Institute for Positive Youth Development

Denver National Center of Excellence in Youth Violence 

Prevention

Johns Hopkins Center for the Prevention of Youth Violence

Michigan Youth Violence Prevention Center

North Carolina Rural Academic Center of Excellence in Youth 

Violence Prevention

University of Louisville Youth Violence Prevention Center

CDC’s Division of Violence Prevention Policy Network

American Academy of Pediatrics

American College of Preventive Medicine

American Foundation for Suicide Prevention

American Psychological Association

California Coalition Against Sexual Assault

Futures Without Violence

National Association of County and City Health Officials

National Resource Center on Domestic Violence

National Sexual Violence Resource Center

North Carolina Coalition Against Sexual Assault

Prevent Child Abuse America

Prevention Institute

Safe States Alliance

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 7

Overview

This technical package represents a select group of strategies 

based on the best available evidence to help communities and 

states sharpen their focus on prevention activities with the greatest 

potential to prevent youth violence and its consequences. These 

strategies include promoting family environments that support 

healthy development; providing quality education early in life; 

strengthening youth’s skills; connecting youth to caring adults 

and activities; creating protective community environments; 

and intervening to lessen harms and prevent future risk. The 

strategies represented in this package include those with a focus on 

preventing youth violence from happening in the first place as well 

as approaches to reduce the immediate and long-term harms of 

youth violence in order to prevent future violence. Preventing youth 

violence requires multiple, complementary strategies, and those 

outlined in the package reflect the mature research-base about 

how to strengthen individual’s skills and relationships to prevent 

youth violence.1,2 It also includes promising evidence about ways 

to address broader community issues that affect the likelihood of 

youth violence. 

This package supports CDC’s STRYVE initiative for preventing 

youth violence. In particular, this package articulates a select set 

of strategies and specific approaches to achieve STRYVE’s vision of 

safe and healthy youth achieving their full potential (see box to the 

right). Commitment, cooperation, and leadership from numerous 

sectors, including public health, education, justice, health care, 

social services, business, and government, can bring about the 

successful implementation and long-term impact of this package.

What is a Technical Package?

A technical package is a compilation of a core set of strategies to 

achieve and sustain substantial reductions in a specific risk factor 

or outcome.3

 Technical packages help communities and states 

prioritize prevention activities based on the best available evidence. 

This technical package has three components. The first component 

is the strategy or the preventive direction or actions to achieve the 

goal of preventing youth violence. The second component is the 

approach. The approach includes the specific ways to advance the 

strategy. This can be accomplished through programs, policies, and 

practices. The evidence for each of the approaches in preventing 

youth violence or its associated risk factors is included as the third 

component. This package is intended as a resource to guide and 

inform prevention decision-making in communities and states. 

CDC’s Striving To 

Reduce Youth Violence 

Everywhere Initiative

STRYVE’s vision is safe and healthy youth 

who can achieve their full potential as 

connected and contributing members 

of thriving violence-free families, 

schools, and communities. STRYVE

works to:

• Increase public health 

leadership to prevent youth 

violence

• Promote the widespread use 

of youth violence prevention 

strategies based on the best 

available evidence

• Achieve national reductions in 

youth violence 

STRYVE has several interacting 

components that all contribute to the 

achievement of the vision, including 

national partnerships, online training 

and tools, and technical assistance.

http://www.cdc.gov/

violenceprevention/stryve/index.html
Preventing Youth Violence is a Priority

Youth violence is a significant public health problem that affects thousands of young people each day, and in turn, 

their families, schools, and communities. Youth violence occurs when young people between the ages of 10 and 24 

years intentionally use physical force or power to threaten or harm others.1,4 Youth violence typically involves young 

people hurting other peers who are unrelated to them and who they may or may not know well. Youth violence can 

take different forms. Examples include fights, bullying, threats with weapons, and gang-related violence. A young 

person can be involved with youth violence as a victim, offender, or witness. Different forms of youth violence can also 

vary in the harm that results and can include physical harm, such as injuries or death, as well as psychological harm, 

increased medical and justice costs, decreased property values, and disruption of community services.5

Youth violence is highly prevalent. Youth violence is a leading cause of death and nonfatal injuries in the United 

States. Homicide is the third leading cause of death among persons aged 10 to 24 years.6 The majority of these 

homicides are from firearm violence. In 2014, 86% of youth homicide victims were killed with a firearm.6

 The number 

of young persons who are treated for nonfatal physical assault-related injuries in emergency departments in the 

United States is more than 115 times higher than the number killed.6

 Each day approximately 12 young people are 

victims of homicide and an additional 1,374 are treated in emergency departments for nonfatal physical assaultrelated injuries.6

 Additionally, self-report information indicates that 1 in 5 high school students was bullied at school 

or in a physical fight in the past year.7 Although the rates of youth homicide and crime are declining, these promising 

trends are inconsistent across population groups and the public health burden remains too high. For instance, the 

decline in homicide rates among non-Hispanic Black youth is less than the decline for non-Hispanic White youth.8

Homicide has been the leading cause of death for non-Hispanic Black youth for more than three decades and is the 

second leading cause of death for Hispanic youth.6

Youth violence is a significant problem that negatively impacts youth in urban, suburban, rural, and tribal 

communities. The rates and forms of youth violence, however, vary across subgroups of youth and communities. 

Relative to females and non-Hispanic White youth, young males and racial/ethnic minorities experience the greatest 

burden of youth violence with higher prevalence of homicide, physical injuries, and fighting.6,7 Females and sexual 

minority youth have higher prevalence of in-person and electronic bullying than males and heterosexual peers.7 Youth 

gang activity and violent crime are higher in larger cities than suburban and rural communities.9,10

 8 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

Youth violence 

is a leading cause of 

death and nonfatal 

injuries in the 

United States.
A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 9

The health and economic consequences of youth violence are substantial. Youth violence has serious and lasting 

effects on the physical, mental, and social health of young people. It is a leading cause of death for young people and 

results in more than 500,000 medically treated physical injuries each year.6 The impact of youth violence extends well 

beyond physical consequences. Youth who experience violence as victims, perpetrators, or witnesses are more likely 

to have behavioral and mental health difficulties, including future violence perpetration and victimization, smoking, 

substance use, obesity, high-risk sexual behavior, depression, academic difficulties, school dropout, and suicide.11-15

An entire community feels the burden of youth violence. For instance, youth homicides and nonfatal physical 

assault-related injuries result in an estimated $18.2 billion annually in combined medical and lost productivity costs 

alone.6

 This estimate is a fraction of the true economic consequences of youth violence because it does not include 

criminal justice system costs, such as arrest, prosecution, incarceration, and re-entry, or the costs associated with 

addressing the psychological and social consequences for victims, perpetrators, and their families. It also does not 

include the costs incurred by communities to address victims’ needs (e.g., property damage, lost wages, physical and 

mental health care) that result from youth violence and crime or the substantial economic impacts on communities’ 

healthcare system, property values, and social services systems.5,16,17 The costs of responding to youth violence 

significantly limit the resources states and communities have to address other needs and goals.

Youth violence starts early in the lifespan. Physical aggression can be common among toddlers, and most 

children learn alternatives to using violence to solve problems and express their beliefs and emotions before starting 

elementary school.18 A subset of children, however, continue to be aggressive, and if their problematic behaviors are 

not addressed their aggression can persist and increase.2

 In addition to early physical aggression, many other factors 

associated with the future perpetration of violence, such as impulsivity, poor emotional control, and weak social and 

problem-solving skills, are evident in early childhood.19-21 Many risks for violence, such as child abuse and neglect, 

academic problems, and poor supervision and management of children’s behavior, also emerge early and heighten 

the likelihood for violence during adolescence and young adulthood. These signs provide opportunities to change 

behaviors and conditions before violence patterns are established and become harder to modify.18

Youth violence is associated with several risk and protective factors. Youth violence is influenced by the 

interaction of multiple factors, including a young person’s characteristics and experiences as well as by the 

relationships, community, and society within which young people develop. No one factor, in isolation, leads to the 

development of youth violence, and the presence of risks does not always mean a young person will experience 

violence. Individual and interpersonal risks for perpetrating violence include impulsiveness, youth substance 

use, antisocial or aggressive beliefs and attitudes, low levels of school achievement, weak connection to school, 

experiencing child abuse and neglect, exposure to violence in the home or community, involvement with delinquent 

peers or gangs, lack of appropriate supervision, parental substance abuse, and parental or caregiver use of harsh 

or inconsistent discipline.1,2,5,21,22 Depression, anxiety, chronic stress and trauma, and peer conflict and rejection are 

also associated with youth violence perpetration and victimization.2,23-27 Youth who are arrested, particularly before 

age 13, have a heighten risk for future violence and crime, school dropout, and substance abuse.18,20,28-30 In addition, 

unsupervised access to a firearm is a contributing factor for lethal youth violence.31,32 An increased risk for youth 

violence and crime is associated with many community factors, such as residential instability, crowded housing, 

density of alcohol-related businesses, poor economic growth or stability, unemployment, concentrated poverty, 

neighborhood violence and crime, lack of positive relationships among residents, and views that drug use and 

violence are acceptable behaviors.33-37 Some racial/ethnic minority youth are exposed to high levels of community 

violence and other neighborhood problems, which contribute to disparities in youth violence, violence-related 

injuries and death, and other difficulties.38-40

Evidence is mounting that many factors can buffer or reduce the likelihood of youth violence, and multiple 

protective factors can even offset the potential harmful influence of risk factors that have accumulated over a child’s 

development.41-43 Protective factors include healthy social, problem-solving, and emotional regulation skills and a 

young person’s school readiness and academic achievement.41,43-45 Positive and warm parent-youth relationships 

in which parents set consistent, developmentally appropriate limits and demonstrate interest in their children’s 

education and social relationships are associated with healthy child and adolescent development and the prevention 

of violent behavior.33,44,46-52 Additional factors that contribute to healthy adolescent development and decrease 
 10 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

aggressive behavior include youth feeling connected to their schools, experiencing academic success, having positive 

relationships with teachers and other caring adults, and interacting with prosocial and nonviolent peers.18,44,53-55

Physical environments of schools, parks, and business and residential areas that are regularly repaired and maintained 

and designed to increase visibility, control access, and promote positive interactions and appropriate use of public 

spaces also are buffers to violence.56-58 Additional community buffers against violence and associated risks include 

household financial security, safe and stable housing, economic opportunities, increasing access to services and social 

support, residents willingness to assist each other, and collective views that violence is not acceptable.59-63

Youth violence is connected to other forms of violence. 

The different forms of violence, including youth violence, 

child abuse and neglect, teen dating violence, adult 

intimate partner violence, sexual violence, and suicide, 

have many common risk and protective factors.64,65 Many of 

these risks are the result of exposure to chronic stress that 

can alter and harm prenatal and child and adolescent brain 

development and, in turn, negatively impact attention, 

impulsivity, decision-making, learning, emotional control, 

and response to stress.64,66-68 Chronic stress includes such 

issues as living in impoverished neighborhoods, living 

in dilapidated housing, frequently moving, experiencing 

food insecurity, experiencing racism, limited access to 

support and medical services, and living in homes with 

violence, mental health problems, substance abuse, and 

other instability. Some forms of violence can increase the 

risk for other forms of violence. For example, individuals 

who experience child abuse and neglect are significantly 

more likely to be in physical fights, be affiliated with a 

gang, damage property, and attempt suicide during 

adolescence and young adulthood than those who 

do not experience child maltreatment.69 Bullying is 

associated with an increased risk for weapon carrying, 

physical fighting, and other forms of violence, such as 

suicide, teen dating violence, and subsequent sexual 

harassment perpetration.70-74 Approaches that address risk 

and protective factors that are common across multiple 

forms of violence may be an effective and efficient way to 

prevent violence.64

Youth violence can be prevented. A strong and growing research base demonstrates that there are multiple 

prevention strategies that are scientifically proven to reduce youth violence victimization and perpetration and 

associated risk factors.1,2,21,75-77 As described in the Benefits Relative to Cost section of this technical package, many 

evidence-based youth violence prevention programs and policies have economic benefits, with community 

savings far outweighing implementation costs.78-80 Strategies are available that benefit all youth regardless of their 

level of risk as well as individuals and environments at greatest risk. Because youth violence results from multiple 

individual, family, and environmental factors that can accumulate over a child’s development, the use of one 

strategy will have limited effects on an entire community’s level of violence and its ability to sustain initial program 

benefits. A comprehensive approach that simultaneously targets multiple risk and protective factors is critical 

to having a broad and continued impact on youth violence.1,22,81-83 Stopping youth violence before it occurs and 

sustaining this proactive approach throughout childhood and adolescence can be done with available programs, 

practices, and policies.
A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 11

Assessing the Evidence

This technical package includes programs, practices, and policies with evidence of impact on youth violence victimization, 

perpetration, and risk or protective factors for youth violence. To be considered for inclusion in the technical package, 

the program, practice, or policy selected had to meet at least one of these criteria: a) meta-analyses or systematic reviews 

showing impact on youth violence victimization or perpetration; b) evidence from at least one rigorous (e.g., randomized 

controlled trial [RCT] or quasi-experimental design) evaluation study that found significant preventive effects on youth 

violence victimization or perpetration; c) meta-analyses or systematic reviews showing impact on risk or protective factors 

for youth violence victimization or perpetration; or d) evidence from at least one rigorous (e.g., RCT or quasi-experimental 

design) evaluation study that found significant impacts on risk or protective factors for youth violence victimization or 

perpetration. Finally, consideration was also given to the likelihood of achieving beneficial effects on multiple forms 

of violence; no evidence of harmful effects on specific outcomes or with particular subgroups;* and feasibility of 

implementation in a United States (U.S.) context if the program, policy, or practice has been evaluated in another country.

The evidence base for youth violence prevention, particularly for approaches focused on building youth’s skills and 

positive family environments and relationships, is strong as evidenced by multiple meta-analyses and systematic 

reviews demonstrating impact of these approaches on behavioral outcomes. In terms of the strength of the evidence, 

meta-analyses or systematic reviews of programs that have demonstrated effects on behavioral outcomes provide a 

higher level of evidence. However, the evidence base is not that strong in all areas. For instance, there has been less 

evaluation of the effects of programs and policies that address community issues that affect the likelihood of youth 

violence. Community-level approaches in this package showing impacts on risk (e.g., community crime rates, drug use) 

or protective factors (e.g., positive adult supervision and role models, positive school climate) reflect the developmental 

nature of the evidence base in this area and the use of the best available evidence at a given time.  

Despite being an important contributor to lethal and nonlethal violence among youth, there is a dearth of evidence regarding 

effective approaches to reduce youths’ unsupervised access, possession, and use of firearms. This particular gap was noted in 

the Institute of Medicine and the National Research Council’s report Priorities for Research to Reduce the Threat of Firearm-Related 

Violence.

88 For these reasons, strategies and approaches specific to unsupervised access, possession, and weapon use are not 

included, although many of the strategies and approaches that are included in the package are designed to address risk and 

protective factors to prevent youth from becoming involved in firearm-related violence in the first place.

In terms of the strategies and approaches in the package, it is important to note that there can be significant 

heterogeneity among the programs, policies, or practices that fall within one approach or strategy area in terms 

of the nature and quality of the available evidence. Not all programs, policies, or practices that utilize the same 

approach (e.g., home visitation, mentoring) are equally effective, and even those that are effective may not work 

across all populations.2,8 Tailoring programs and conducting more evaluation may be necessary to better understand 

effectiveness across different population groups and communities.90 The examples provided in this technical package 

are not intended to be a comprehensive list of evidence-based programs, policies, or practices for each approach, 

but rather illustrate models that have been shown to impact youth violence victimization or perpetration or have 

beneficial effects on risk or protective factors for youth violence and could be implemented in communities. 

Identifying activities with evidence of impact on victimization, perpetration, and risk or protective factors for youth 

violence is only the first step. In practice, the effectiveness of the programs, policies and practices identified in this 

package will be strongly dependent on how well programs are implemented as well as the partners and communities 

in which they are implemented.91,92 The readiness of the program for broad dissemination and implementation 

(e.g., availability of program materials, training and technical assistance) can also influence program effects.93,94

Implementation guidance to assist practitioners, organizations and communities will be developed separately.

*Research shows some programs, practices, and policies have harmful effects on youth’s behavior.2,29,84-87 Reasons for harmful effects may include 

lack of youth’s skill development in real-world settings, limited adult supervision, and increased opportunities for delinquent youth to associate 

with each other. Examples of ineffective approaches include: transfer of juvenile offenders to the adult criminal system; shock and military-style 

programs (e.g., Scared Straight, boot camps); residential or individual treatment used in isolation; training youth to mediate peer conflict in 

school settings; and not promoting youth to succeeding grades.
 12 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

Contextual and Cross-Cutting Themes

The strategies and approaches included in this technical package represent different levels of the social ecology, with efforts 

intended to impact individual behaviors and also the relationships, families, schools, and communities that influence risk 

and protective factors for youth violence. The strategies and approaches are intended to work in combination and reinforce 

each other to prevent youth violence in a comprehensive and long-term way (see box below). While individual skills are 

important and research has demonstrated the preventive effects of many youth skill development programs, approaches 

addressing relationships with parents, peers, and other caring adults as well as approaches that influence school and 

community environments are equally important to have the greatest public health impact. 

 Preventing Youth Violence

Strategy Approach

Promote family environments that 

support healthy development

• Early childhood home visitation

• Parenting skill and family relationship programs

Provide quality education early in life • Preschool enrichment with family engagement

Strengthen youth’s skills • Universal school-based programs

Connect youth to caring adults and 

activities

• Mentoring programs

• After-school programs

Create protective community 

environments

• Modify the physical and social environment 

• Reduce exposure to community-level risks 

• Street outreach and community norm change

Intervene to lessen harms and 

prevent future risk

• Treatment to lessen the harms of violence exposures

• Treatment to prevent problem behavior and further involvement 

in violence

• Hospital-community partnerships

The social and cultural context of communities and organizations is critically important to take into account when 

selecting strategies and approaches for implementation. Practitioners in the field may be in the best position to assess 

the needs and strengths of their communities and work with partners to make decisions about the combination of 

approaches included here that are best suited to their context. Data-driven strategic prevention planning models, 

such as Communities That Care (CTC), PROmoting School-community-university Partnerships to Encourage Resiliency 

(PROSPER), and the Cardiff Violence Prevention Partnership, can support communities in using data to assess local risks 

and protective factors to inform the selection and ongoing monitoring of evidence-based programs. These datadriven partnerships and activities can contribute to significant reductions in violence, violence-related injuries, and 

crime as well as cost savings for the medical, educational, and justice systems.95-102
A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 13

The strategies and approaches in this package have the potential to reduce multiple forms of violence (e.g., child 

abuse and neglect, teen dating violence, sexual violence) and other adolescent health problems (e.g., teen pregnancy, 

sexually transmitted infections). The strategies and approaches in this technical package can improve young people’s 

adaptive behavior and academic success. For instance, school-based programs that strengthen youth’s problemsolving and conflict management skills can reduce physical and verbal violence, bullying, teen dating violence, 

sexual violence, alcohol and drug use, and sexual risk behaviors.76 They can also be used to strengthen academic 

performance, improve graduation rates, and create a positive school climate. Given that many risks for youth violence 

are evident before adolescence, programs that are designed to promote healthy child development and reduce the 

likelihood of child abuse and neglect can also potentially prevent violence in the teen years and in adulthood.103-105 The 

interconnection of these experiences and risk and protective factors suggests that the implementation of strategies 

and approaches to prevent youth violence can have substantial, long-term health, social, and economic benefits.64,65

However, it is also important to note that child abuse and neglect, teen dating violence, and sexual violence may also 

require additional prevention activities than those outlined in this technical package. CDC has developed technical 

packages for these other forms of violence to help communities identify additional strategies and approaches.106-109

Public health has a clear responsibility to help reduce the health burden of youth violence, has expertise applying 

science to reduce the risk for complex health problems, and can act to reduce youth violence.1 This package includes 

strategies where public health agencies are well positioned to bring leadership and resources to implementation 

efforts. It also includes strategies where public health can serve as an important collaborator (e.g., strategies 

addressing community-level risks), but where leadership and commitment from other sectors, such as business, is 

critical to implement a particular policy or program (e.g., business improvement districts). The role of various sectors 

in the implementation of a strategy or approach in preventing youth violence is described further in the section on 

Sector Involvement.

In the sections that follow, the strategies and approaches with the best available evidence for preventing youth 

violence are described.  

The strategies 

and approaches 

in this technical 

package can improve 

young people’s 

adaptive behavior 

and academic 

success.

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 15

Promote Family Environments that 

Support Healthy Development

Rationale

The family environment plays a key role in shaping youth’s physical, emotional, social, and behavioral health, and 

this influence extends from early childhood through late adolescence and beyond.110-111 Family environments that 

are unstable, stressful, lack structure and supervision, have poor relationships and communication between family 

members, and use harsh or limited discipline with children are risk factors for youth violence and contribute to 

young people developing other risks, such as poor problem-solving skills and early and continued perpetration of 

aggression.33,48,112,113 Decades of research show that nurturing and supportive family environments where caregivers 

build warm and caring relationships with children, monitor children’s activities and friendships, set age-appropriate 

expectations and rules, and use consistent and nonviolent discipline significantly lower the risk for youth violence 

and other adolescent health risk behaviors.33,46-52 The promotion of positive family environments throughout a child’s 

development is connected to caregivers’ knowledge about healthy and age-appropriate child development as well as 

the ways families communicate, manage behavior, and resolve conflict. 

Approaches

There are a number of approaches that can help families create and maintain supportive, nurturing, and structured 

environments at every stage of a young person’s development.

Early childhood home visitation programs provide information, caregiver support, and training about child health, 

development, and care to families in their homes, and help families access services. Home visiting programs may 

be delivered by nurses, professionals, or paraprofessionals.114 Many programs are offered to low-income, first time 

mothers to help them establish healthy family environments.114 The content and structure of programs can also 

vary depending on the model being utilized, with some being highly manualized and others being more flexible in 

delivery.114 Some programs begin during pregnancy, while others begin after the birth of the child and may continue 

up through the child entering elementary school.

Parenting skill and family relationship programs provide caregivers with support and teach communication, 

problem-solving, and behavior monitoring and management skills. These programs can be self-directed or delivered 

to individual families or groups of families. For families at high risk for conflict and child behavior problems, tailored 

delivery to individual families yields greater benefits than group administration.47,115,116 Single-parent families 

often participate in these programs, and some programs have sessions primarily with parents while others include 

parent, youth, and family sessions. Programs are typically designed for families with children in a specific age 

range, with some designed for preschool and elementary aged children and others for middle and high-school 

aged youth.49,115 Specific program content typically varies by the age of the child but often has consistent themes 

of child development, parental monitoring and management of children’s behavior, appropriate use of rewards 

and punishment, parent-child communication and relationships, and youth’s interpersonal and problem-solving 

skills.49,51,52,115
 16 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

Potential Outcomes

• Reductions in behavior problems and disruptive behavior at home and school

• Reductions in physical fighting, aggression, and delinquency

• Reductions in arrests, convictions, and probation violations

• Reductions in alcohol and drug use by youth and parents

• Reductions in family conflict

• Reductions in child abuse and neglect

• Reductions in parental depression and stress

• Increases in compliance to caregiver’s directions

• Increases in prosocial behavior (e.g., social skills, such as concern for others, empathy, and cooperation) 

• Increases in parent-child connection, communication, and relationship quality

• Increases in positive parenting practices, such as monitoring and supervision of youth’s activities, use of consistent 

and nonviolent discipline, and involvement and support of youth

Evidence

Approaches that enhance family environments have demonstrated effects in preventing youth violence and other 

adolescent health risk behaviors.46-52,104

Early childhood home visitation. Home visiting programs are effective in improving parenting behaviors and 

children’s social and emotional development, but the evidence is mixed with some programs showing strong effects 

and others showing few to no effects potentially due to the varying content and delivery of these programs.114,117

Families participating in the Nurse Family Partnership® (NFP) program had 45% fewer childhood behavior problems and 

parental coping problems as recorded by physicians relative to nonparticipating families, and participating youth by 

age 15 had significantly fewer arrests, convictions, and probation violations.104,118 Female youth at age 19 whose family 

participated in NFP were significantly less likely than a comparison group to be arrested (10% versus 30%) and convicted 

(4% versus 20%).103 NFP also demonstrated significant impacts on risk and protective factors for youth violence, including 

reducing child abuse and neglect and substance use by parents and youths.104,119 The Home Visiting Evidence of 

Effectiveness Review identifies other home visiting programs that may work for communities, depending on available 

resources and the context in which the home visiting program is delivered.114

Parenting skill and family relationship programs. Multiple systematic reviews of various parent skill and family 

relationship approaches have demonstrated beneficial impacts on perpetration as well as risk and protective factors 

for youth violence.33,47,49,51,52,76 One example is The Incredible Years®, which is designed for families with young children 

up to 12 years of age and can be implemented with additional components for teachers and children in school. 

A meta-analysis of effects associated with The Incredible Years® found significant decreases in children’s disruptive 

behaviors at home and school and increases in their prosocial behaviors.120 Impacts on other risk and protective 

factors include reductions in parental depression and stress, improvements in children’s compliance with parental 

directions, stronger parent-child connections and communication, and improvements in positive parenting practices 

related to monitoring, discipline, and mother-child interactions.76,121 Behavioral benefits are broader and sustained 

longer when both the parent and child participate in the program.121 Parent Management Training-Oregon ModelTM

(PMTO) is another example where participating youth, relative to controls, have demonstrated significantly lower 

rates of behavior problems, aggression, and arrest.122,123 Other program benefits of PMTO include increases in positive 

parenting practices and the family’s socioeconomic status.124,125
Several other effective programs focus on families with youth ages 10–17. This transitional period into adolescence 

is when risk behaviors can increase and more severe forms of violence can emerge. Examples of effective programs 

include Strengthening Families 10–14, Coping Power, and Familias UnidasTM. Four years after participating in the 

Strengthening Families 10–14 program, self-report data from youth indicated significant relative reductions in physical 

fighting (32%), throwing items to cause injury (54%), and purposely damaging property (77%) as well as lower levels 

of observer-rated family conflict.126 Relative to families in control conditions, participating families also reported lower 

youth substance use and improvements in parent-child affective quality and child management skills.127-129 Rigorous 

evaluations of Coping Power show significantly lower rates of youth delinquency and aggressive acts, parents’ lack 

of support, and youth substance use among participating families relative to controls one and three years after 

participating in the program.130-132 One study of Familias UnidasTM found reductions in adolescent aggression and 

other behavior problems over time among participating families relative to controls. Program participants relative to 

controls also demonstrated improvements in protective factors for adolescent behavior problems, including increased 

parental involvement and support of youth, positive parenting practices, parent-child communication, parental 

monitoring, and youth’s substance use.133-135

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 17

Approaches that 

enhance family 

environments have 

demonstrated effects 

in preventing 

youth violence.
 18 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

Provide Quality Education Early in Life

Rationale

Quality early childhood education can improve children’s cognitive and socioemotional development and increase 

the likelihood that children will experience safe, stable, nurturing relationships and environments and long-term 

academic success and health, including lower rates of behavior problems, aggression, and crime.136,137 High-quality 

early education environments, such as ones that are licensed and accredited, promote youth’s social skill and 

cognitive development, strengthen connections to school, and reduce problem behaviors at school and at home.138,139

These benefits in turn contribute to stronger scholastic achievement and less family stress and conflict throughout 

childhood and adolescence. Early childhood education that includes parental engagement can strengthen youth 

outcomes, family involvement in children’s future education, and parenting practices and attitudes.137,140,141 These 

integrated approaches also create pathways for youth and families to access ancillary supports, such as employment, 

transportation and meal assistance, and mental and physical health services, which can further address risks and build 

buffers against future violence. 

Approaches

Preschool enrichment with family engagement is an approach for enhancing the foundation for a child’s academic, 

social, and behavioral development through adolescence and into adulthood. 

Preschool enrichment with family engagement programs provide high-quality early education and support to 

economically disadvantaged families to build a strong foundation for the children’s future learning and healthy 

development and lower risks for future academic and behavioral problems. Programs are generally available to 

children and families who meet basic qualifications, such as being residents in a high-poverty school area eligible for 

federal Title I funding, demonstrate need and agree to participate, or have incomes at or below the federal poverty 

level.142 Program content and delivery vary based on the model used and can include home visits, connections to 

community supports, and half- to full-day child care and school programs. Parental involvement is emphasized as 

critical in the child’s development and in increasing children’s success in school. Programs often begin in infancy or 

toddlerhood and may continue into early or middle childhood. 

Potential Outcomes 

• Reductions in aggressive behavior

• Reductions in arrests, convictions, and incarceration

• Reductions in child abuse and neglect, welfare encounters, and out-of-home placements

• Reductions in grade retention and special education services

• Reductions in smoking, alcohol, and drug use 

• Reductions in parent’s use of harsh verbal and physical discipline

• Increases in cognitive and language development

• Increases in nurturing and supportive parent-child interactions, effective child behavior management strategies, 

and home environments supportive of learning 

• Increases in high school completion, college attendance, and number of years of education

• Increases in full-time employment and health insurance in adulthood
A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 19

Quality 

early childhood 

education can increase 

the likelihood that 

children will experience 

safe, stable, nurturing 

relationships and 

environments.

Evidence

Evidence exists that preschool enrichment programs with family engagement can reduce children’s aggression and 

conduct problems as well as reduce youth’s perpetration of violence and aggression during adolescence and young 

adulthood, with benefits stronger and more stable when preschool and family supports extend into early elementary 

school.143

Preschool enrichment with family engagement programs can lower the prevalence of problems in early childhood, 

including aggression and child abuse and neglect, and have broader and long-term impacts on parent-child 

interactions and youth’s academic achievement, substance use, and perpetration of violence and crime. Examples of 

effective programs are Child Parent Centers (CPCs) and Early Head Start (EHS). CPCs have been evaluated in multiple, 

long-term studies. For instance, when followed to age 20, low-income minority children who participated in the 

CPC preschool program, relative to youth in other early childhood programs, had significantly lower rates of juvenile 

arrest (16.9% versus 25.1%), violent arrests (9.0% versus 15.3%), and multiple arrests (9.5% versus 12.8%).105 At age 24, 

relative to youth with fewer years of CPC participation (e.g., preschool only), youth who participated in the program 

for 4 to 6 years had a 22% reduction in arrests for violence as well as significantly lower rates for violent convictions 

and multiple incarcerations.143 Across studies, youth participating in CPCs also experience numerous other benefits 

relative to comparison groups, including lower rates of substantiated reports of child abuse and neglect, out-of-home 

placements, grade retention, special education services, depression, and substance use as well as higher rates of high 

school completion, attendance in four-year colleges, health insurance, and full-time employment in adulthood.79,105,141,143

Multiple evaluations of EHS demonstrate significant program impacts on violence as well as other short- and longterm benefits. For instance, relative to families accessing community services, the 3-year-old children of families 

participating in EHS demonstrated significantly less aggressive behavior, had better cognitive and language 

development, and had parents who were more emotionally supportive, provided more language and learning 

stimulation, read to their children more often, and spanked less.144 Children in EHS also had significantly fewer child 

welfare encounters and substantiated reports of physical or sexual abuse encounters between the ages of 5 and 9 

than did children in the control group, and EHS slowed the rate of subsequent child welfare encounters.145 Children in 

EHS were more likely to have a substantiated report of neglect which is likely not due to EHS. Rather, enrollment in EHS 

may have increased monitoring of families and the visibility of young children experiencing neglect.145 The EHS homebased program when fully implemented also showed participating families had many benefits two years after the 

program relative to a comparison group, including children with fewer social behavior problems, stronger parent-child 

engagement, and home environments more supportive of learning.146

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 21

Strengthen Youth’s Skills 

Rationale

Strengthening youth’s skills is an important component of a comprehensive approach to preventing youth 

violence. The likelihood of violence increases when youth have under-developed or ineffective skills in the areas of 

communication, problem-solving, conflict resolution and management, empathy, impulse control, and emotional 

regulation and management.2,33,147-149 Skill-development has an extensive and robust research base, which shows 

building youth’s interpersonal, emotional, and behavioral skills can help reduce both youth violence perpetration 

and victimization.2,21,76,77,150-152 Enhancing these skills can also impact risk or protective factors for youth violence, 

such as substance use and academic success.150,152,153 These life skills can help youth increase their self-awareness, 

accuracy in understanding social situations, ability to avoid risky situations and behaviors, and capacity to resolve 

conflict without violence. 

Approaches

Universal school-based programs are a widely used approach to help youth develop skills to prevent violence and 

engage in healthy behaviors. 

Universal school-based programs (sometimes also referred to as social-emotional learning approaches) work in 

childhood and adolescence to enhance interpersonal and emotional skills, including communication and problemsolving, empathy, emotional awareness and regulation, conflict management, and team work.150,151 This approach 

also provides information about violence, seeks to change the way youth think and feel about violence, and provides 

opportunities to practice and reinforce skills. The content and format of skill development programs vary depending 

on the model being utilized. These school-based approaches often include guidance to teachers and other school 

personnel on ways to build youth’s skills, monitor and manage behavior, and build a positive school climate to reduce 

aggression and violence, such as bullying, and support academic success. These approaches are typically delivered to 

all students in a particular grade or school. These approaches can be used in all grade levels but are primarily used in 

elementary and middle schools.98

Potential Outcomes 

• Reductions in perpetration and victimization of verbal and physical aggression

• Reductions in bullying and conduct problems

• Reductions in delinquency

• Reductions in the involvement in violent and nonviolent crime in young adulthood

• Reductions in smoking, alcohol, and drug use 

• Reductions in depression and suicidal ideation 

• Reductions in other adolescent risk behaviors (e.g., sex without a condom, multiple sex partners, risky driving) 

• Increases in emotional regulation, understanding social situations, and developing effective and nonviolent solutions

• Increases in academic proficiency

• Increases in positive bystander behavior 

• Increases in anti-bullying school policies

• Increases in positive school climate
 22 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

Evidence

The evidence suggests that universal school-based programs can reduce aggressive behavior, including bullying, and 

other risky behaviors associated with youth violence. 

Universal school-based programs. Multiple systematic reviews of various universal school-based programs 

demonstrate beneficial impacts on youth’s skills and behaviors, including delinquency, aggression, bullying 

perpetration and victimization, and bystander skills that lower the likelihood of violence and support 

victims.76,77,151,154,155 For example, the Task Force for Community Preventive Services found a 15% relative reduction in 

violent behavior among students in pre-kindergarten through high school.151 Using different outcome measures, the 

median relative reduction in aggression and violent behavior associated with universal school-based programs varied 

by grade level, with a 32% reduction for pre-kindergarten and kindergarten students, 18% reduction for elementary 

students, 7% reduction for middle school students, and 29% reduction for high school students. Researchers 

suggest the benefits of these school-based approaches could be strengthened if programs implemented at early 

grade levels are continued into the critical high school years.98 These programs were effective in reducing youth 

violence in different types of school environments, including ones with varying socioeconomic status, crime rates, or 

predominant race/ethnicity of students.151

Examples of effective classroom-based programs are Good Behavior Game (GBG), Promoting Alternative THinking 

Strategies® (PATHS), Life Skills® Training (LST), and Steps to Respect (STR). The GBG has demonstrated that participants 

had significantly lower levels of classroom aggression in elementary school, and some studies of the long-term effects 

of GBG showed significantly lower levels of aggression in middle school and lower prevalence of antisocial personality 

disorder and violent crime by age 19 to 21.156-159 These effects were for male youth with relatively higher levels of early 

aggression when compared to youth in alternative intervention conditions.157-159 These participants also had lower 

prevalence of alcohol abuse, smoking, and suicidal ideation by the time they reached young adulthood.157,160

Multiple evaluations of PATHS show significant program impacts on aggression, violent behaviors, and a number of 

developmental risk factors for violent behavior among participants in both regular and special education classrooms.76

For instance, randomized controlled trials of PATHS found participants relative to controls were better able to regulate 

their emotions, understand social problems, develop effective solutions, and decrease their use of aggressive 

responses to conflict.161 At the one-year follow-up, participants also reported fewer depression symptoms and had 

fewer conduct problems.161 An independent randomized evaluation replication, which tracked students from 14 

schools over a period of 3 years, found less self-reported aggressive problem-solving and fewer teacher-reported 

conduct problems among participants relative to controls.162 Relative to controls, participants also demonstrated 

greater reading and math proficiency in fourth grade and writing proficiency in fifth and sixth grade.163

In multiple short- and long-term randomized trials of the LST program, participants demonstrated significant 

improvements in social skills, such as assertiveness and self-control, and a lower prevalence of many risk behaviors, 

including smoking, alcohol and drug use, HIV risk behavior, and unsafe driving.76 A randomized trial of program 

benefits on violence outcomes across 41 schools found student participants in a one-year LST program, relative to 

students receiving a standard health education curriculum, reported a 32% reduction in delinquency, a 36% reduction 

in frequent delinquency (≥ 3 events), and a 26% reduction in frequent fighting (≥ 3 events).164 Stronger prevention 

benefits were found for youth who participated in at least half of the program, including less physical and verbal 

aggression, fighting, and delinquency.164
STR is one school-based program with demonstrated impacts on bullying and youth violence protective factors. 

A longitudinal evaluation of STR found after the second year of implementation, participants had a 31% decrease 

in bullying and victimization, 36% decrease in non-bullying aggression, and 72% decrease in harmful bystander 

behavior.165 A large scale replication evaluation found significantly lower levels of physical bullying perpetration 

among participants relative to controls, and significant increases in school anti-bullying policies, positive school 

climate, and positive bystander behavior.166

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 23

Universal 

school-based 

programs can 

reduce aggressive 

behavior, including 

bullying and other 

risky behaviors.

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 25

Connect Youth to Caring Adults 

and Activities

Rationale

Young people’s risk for violence can be buffered through strong connections to caring adults and involvement in 

activities that help young people grow and apply new skills.44,53,147 Relationships with caring adults, in addition to 

parents or caregivers, can influence young people’s behavioral choices and reduce their risk for involvement in 

crime and violence, alcohol and other substance use, and high-risk sexual behavior.44,53,55 These caring adults could 

include teachers, coaches, extended family members, neighbors, and community volunteers. Exposure to positive 

adult role models helps youth learn acceptable and appropriate behavior.54 Through positive interpersonal 

relationships and learning activities, youth can also develop broad and healthy life goals, improve their school 

engagement and skills, and establish networks and have experiences that improve their future schooling and 

employment opportunities.147 These connections and experiences and the many benefits they contribute to, such 

as enhanced academic performance, are protective against involvement in crime and violence.42,167

Approaches

Mentoring and after-school programs are two approaches for connecting youth to caring adults and engaging 

youth in activities to reduce or buffer against their risk for violence perpetration and victimization. 

Mentoring programs pair youth with a volunteer from the community with the goal of fostering a relationship 

that will contribute to the young person’s growth opportunities, skill development, and academic success.89,168

Mentoring programs may be delivered without any set location for mentoring activities or be implemented in 

a specific location, such as a community center or faith-based organization. Mentoring programs can also be 

implemented in school settings (e.g., volunteers meet with youth on school grounds) and include academic 

support and enrichment activities.168,169 Program models can involve one-to-one matching of an adult mentor 

with a youth or take a group mentoring approach. The level of training and support provided to mentors varies 

depending on the model used. Programs can varying in how similar mentors and youth are in their interests and 

how frequently they spend time together.168,169 Mentoring programs can be delivered to any youth from early 

childhood through adolescence without regard to known risk factors, although programs more typically focus on 

youth perceived to be at risk for problems in academics, behavior, or health.168

After-school programs provide opportunities for youth to strengthen their social and academic skills and 

become involved in school and community activities to expand their prosocial experiences and relationships. 

These approaches also address key risk and protective factors for youth violence by helping to provide supervision 

during critical times of the day, such as from 3:00 to 6:00 p.m. when youth crime and violence peak.170 After-school 

programs range from those offering tutoring and homework assistance to more formal skill-based programming 

and structured learning activities.168 Opportunities to develop and practice leadership, decision-making, selfmanagement, and social problem-solving skills are important components of programs that work.171,172 Afterschool programs may be offered on school grounds or in community settings.168
 26 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

Potential Outcomes

• Reductions in perpetration and victimization of violence

• Reductions in physical fighting and delinquency

• Reductions in involvement in gang activity

• Reductions in rates of arrests for violent and nonviolent crime

• Reductions in drug selling 

• Reductions in alcohol and drug use

• Reductions in truancy

• Reductions in rates of school dropout

• Increases in academic performance and perceptions of academic abilities

• Increases in graduation rates

• Increases in parent-child relationships and parental trust

• Increases in positive relationships with teachers or prosocial adults

Evidence

Evidence suggests that mentoring and after-school approaches can benefit youth in a number of ways, including 

reducing their risk for involvement in crime and violence, although the evidence of effectiveness varies by model 

and program. 

Mentoring programs. Systematic reviews and meta-analyses of mentoring programs show strong support for 

improvements in outcomes across behavioral, social, emotional, and academic domains.53,89,169 Big Brothers Big 

Sisters of America (BBBS) is the oldest and best known example of a one-on-one mentoring program implemented 

in community and school settings in the United States.173 An evaluation of the community-based BBBS mentoring 

program found positive impacts on a number of problem behaviors.174 At the 18-month follow-up, mentored youth 

had skipped half as many days of school as control youth and were 46% less likely to have initiated illegal drugs 

and 27% less likely to have initiated alcohol use, which are important risk factors for youth violence. Mentored 

youth were also 32% less likely to have engaged in a physical fight. Other benefits included stronger academic 

competence and improvements in parental trust. Although the benefits were significant for both boys and girls, 

many of the strongest gains were among the Little Sisters. 

A national evaluation of the school-based mentoring program of BBBS found that mentored youth performed better 

academically, had more positive perceptions of their academic abilities, and were more likely to report having a 

special adult in their lives for support relative to a control group of non-mentored youth—factors that protect against 

youth violence.175 Impacts on other youth outcomes were influenced by relationship factors. Higher-quality mentoring 

relationships were associated with improvements in parental and student-teacher relationships.176 These, in turn, were 

associated with better youth outcomes, such as increased prosocial behavior and decreases in problem behaviors, 

such as getting into a physical fight in the neighborhood and vandalizing property.176
After-school programs. The evidence for after-school programs varies with some programs showing few or small 

effects and others showing significant benefits on academic, behavioral, and social-emotional outcomes.55,171,172,177

These mixed effects likely are due to differences in program models, duration, program structure, staff, and diversity 

of participants.172 One example with demonstrated benefits on schooling and delinquency outcomes is the Los 

Angeles’ Better Educated Students for Tomorrow (LA’s BEST) program. A rigorous, longitudinal evaluation of LA’s BEST

found significant positive effects on academic achievement and reductions in arrests for youth crime and violence, 

especially among those who attended at least 10 days per month and had significant adult contact, relative to 

control students from the same schools who attended fewer days and relative to control students from matched 

schools.178

Another example is the After School Matters (ASM) program, which offers apprenticeship experiences in technology, 

science, communication, the arts, and sports to high-school students in Chicago Public Schools.179 An initial 

impact study of academic outcomes found that ASM students had fewer course failures, higher graduation rates 

and lower school dropout rates by age 18 than non-ASM students.180 A rigorous, randomized controlled trial of the 

program across 10 predominately lower-income, racially/ethnically diverse high schools found a number of other 

positive outcomes. Participating youth missed fewer days of school, had better attitudes toward school, higher selfregulation, and were less likely to sell drugs or participate in gang activity than control youth.181

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 27

Mentoring and 

after-school 

approaches can 

benefit youth in a 

number of ways, 

including reducing their 

risk for involvement 

in crime and 

violence.

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 29

Create Protective Community Environments

Rationale

Creating protective community environments in which young people develop is a necessary step towards achieving 

population-level reductions in youth violence. Communities can include places with any defined population with 

shared characteristics and environments, such as schools, towns, cities, youth-serving organizations or institutions, 

and areas (e.g., parks, business districts, public transportation hubs) where individuals regularly interact. Approaches 

that modify the characteristics of these places are considered community-level approaches. Such approaches can 

involve, for example, changes to policies or the physical and social aspects of settings in order to reduce risk factors 

and increase protective factors for youth violence.1

 These changes can have a significant influence on individual 

behavior by creating a context that promotes social norms that protect against violence.182 These approaches can 

improve perceived and actual safety and reduce opportunities for violence and crime and, in turn, increase protective 

factors, such as residents having more prosocial interactions and opportunities to support youth. Approaches that 

create protective environments can reduce violence-related injury and death as well as have long-term benefits by 

reducing children’s exposure to violence and the consequences of this exposure.39,183

Approaches

The current evidence suggests three approaches with promise for modifying the characteristics of settings associated 

with youth violence victimization and perpetration. 

Modify the physical and social environment. These approaches prevent youth violence and crime by enhancing 

and maintaining the physical characteristics of settings where people come together in order to foster social 

interaction, strengthen connectedness, and increase collective efficacy (e.g., shared trust among residents and 

willingness to intervene).56-58 Examples of this work include increasing lighting, managing accessibility to buildings 

and public spaces, street cleaning, increasing security, abandoned building and vacant lot remediation, creating 

green space, and sponsoring community events that bring residents together. These approaches can also be applied 

in school and other settings where young people frequently interact.184-187 These approaches are often led by 

governmental and nongovernmental community partners (e.g., city planners, parks and recreation, business) and may 

include youth and adult residents.

Reduce exposure to community-level risks. Youth violence is associated with a number of community-level risks, 

such as concentrated poverty, residential instability, and density of alcohol outlets.33,37,61,63 Reducing exposure to 

these community-level risks can potentially yield population-level impacts on youth violence outcomes.188 Prevention 

approaches to reduce these risks include changing, enacting, or enforcing laws, city ordinances and local regulations, 

and policies to improve household financial security, safe and affordable housing, and the social and economic 

sustainability of neighborhoods. Public-private partnerships and community-driven needs and services are important 

elements of these approaches. 

Street outreach and community norm change approaches connect trained outreach staff with residents to mediate 

conflicts, promote norms of nonviolence, and connect youth to community supports to reduce risks and build buffers 

against violence.183 The ways in which these connections occur can vary depending on the model used, outreach 

staff training and expertise, and available community resources. Outreach staff typically connect with residents 

with known histories of engaging in criminal and violence-related activities or who are at heighten risk to engage in 

violence (e.g., had a recent argument, family member or friend recently harmed by violence). This approach also uses 

public education and neighborhood events to change norms about the acceptability of violence and willingness of 

community members to act in ways to reduce the likelihood of violence. 
 30 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

Potential Outcomes 

• Reductions in nonfatal physical assault, firearm assaults, nonfatal shootings, and homicide

• Reductions in violence-related injuries among youth

• Reductions in nonviolent and violent crime and arrests

• Reductions in gang-related violence

• Reductions in community risk factors for youth violence (e.g., alcohol use by minors)

• Reductions in acceptability of using guns to resolve disputes

• Increases in normative beliefs that violence is unacceptable

Evidence

The evidence supporting these approaches is growing and shows significant impacts on neighborhood crime and 

youth violence.77,189

Modify the physical and social environment. Evaluations of physical and social environment approaches 

demonstrate significant decreases in crime and violence in neighborhood settings. For example, Business Improvement 

Districts (BIDs) are public-private partnerships that collect and invest resources from local merchants and property 

owners into local services and activities, such as efforts to improve commercial activity, street cleaning and 

beautification, and public safety, in order to increase appeal and use by residents and the prosperity of the businesses 

and community. An evaluation of BIDs in Los Angeles found a 12% reduction in robberies and 8% reduction in overall 

violent crime in BID neighborhoods compared to the non-exposed neighborhoods as well as significant economic 

benefits due to reduced crime rates, reduced arrests, and lower prosecution-related expenditures.78,190 Environmental 

design activities, such as Crime Prevention Through Environmental Design (CPTED), promote positive interpersonal 

interactions and the safe use of spaces through enhanced visibility, access management, and proper maintenance 

and design.56 A systematic review of CPTED principles applied to business settings found significant reductions in 

robberies.191 Evaluations and a systematic review also show communities applying some CPTED principles, such as 

abandoned building and vacant lot remediation and cleaning and maintenance of neighborhood green spaces and 

housing, experience decreases in gun assaults, youth homicide, disorderly conduct, and violent crime as well as 

beneficial impacts on residents’ perception of crime, stress, community pride, and physical health.192-197

Reduce exposure to community-level risks. Strengthening household financial security through tax credits, such as 

the Earned Income Tax Credit (EITC), can help families increase their income while incentivizing work or offsetting the 

costs of child-rearing and help create home environments that promote healthy development.198 While the EITC has 

not been evaluated for its direct impact on rates of youth violence, the evidence suggests that the EITC can lift families 

out of poverty.199,200 Simulations show that a Child Tax Credit of a $1000 allowance per child, paid to each household 

regardless of income or tax status, would reduce child poverty in the United States from 26.3% to 23.2%; a $2000 

allowance per child would reduce child poverty to 20.4%; a $3000 allowance per child would reduce child poverty to 

17.6%; and a $4000 allowance per child would reduce child poverty to 14.8%.201 The Low-Income Housing Tax Credit 

(LIHTC), which is designed to improve the availability of safe and affordable rental housing in highly distressed urban 

neighborhoods, can help revitalize the poorest neighborhoods and offset a number of negative outcomes in these 

communities.59 There is evidence suggesting that the LIHTC can reduce the concentration of poverty and is also 

associated with reductions in violent crime and aggravated assault without evidence of spatial displacement.59,202

Evaluations of other strategies to reduce exposure to community-level risks are emerging, with policies related to 

alcohol receiving substantial attention. Systematic reviews and meta-analyses show alcohol policies (e.g., location and 

concentration of outlets, licensing regulations, pricing, hours and days of sale) can influence risk factors associated 

with youth violence and other health conditions.203-205 An evaluation of a Richmond, Virginia policy restricting licenses 

for the sale of single-serve alcoholic beverages by convenience stores found significant declines in ambulance 

pickups of youth for violent injuries (19.6 to 0 per 1,000) as compared to a control community (7.4 to 3.3 per 1,000).206

International studies also demonstrate policies related to alcohol sales are associated with significant reductions in 

homicide, physical assaults, and violent crime.207-209
Street outreach and community norm change. Several types of street outreach and community norm change 

programs exist, and some have evidence to support their effectiveness in preventing violence. Cure Violence

(formerly known as Ceasefire), and similar programs, such as Baltimore’s Safe Streets, have been implemented and 

evaluated in several communities. These programs are associated with reductions in gun violence, homicides, gangrelated violence, and nonfatal assault-related injuries in some but not all implementation areas where studied.183 An 

evaluation of Chicago’s Cure Violence implemented in seven communities found significant reductions in aggravated 

batteries and assaults and shootings in half of the implementation communities while the other implementation 

communities either had no significant declines or no differences in the rate of decline relative to the comparison 

communities.210 An evaluation of Baltimore’s Safe Streets program in four neighborhoods found significant reductions 

in nonfatal shootings in the four implementation areas, significant reductions in homicide in two implementation 

areas, and either no reduction or an increase in homicides in two implementation areas relative to comparison 

communities. The impacts on homicide and nonfatal injuries also extended to the neighborhoods surrounding the 

implementation sites. Across all the implementation sites and bordering areas, the combined prevention effects were 

at least 5 fewer homicides and approximately 35 fewer nonfatal shootings.182 Across the implemented programs and 

evaluations, investigators suggest mixed effects may be related to variations in the outreach workers, how well the 

program is managed and implemented, and other community contextual factors, such as shifts in gang violence and 

support from neighborhood organizations.182,183

An additional goal of these programs is to change community norms about the acceptability of violence. The 

evaluation of Safe Streets on youth’s attitudes found youth in one intervention community were 4 times less likely than 

youth in a nonintervention comparison neighborhood to support the use of a gun to resolve disputes.211 Another 

evaluation shows one year after the implementation of Safe Streets, youth in the intervention community relative to 

the control community had significant changes in their attitudes about the use of gun violence to resolve conflicts, 

with intervention youth viewing violence to solve conflicts less favorably.60

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 31

Evaluations of physical 

and social environment 

approaches demonstrate 

significant decreases in 

crime and violence in 

neighborhood settings.

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 33

Intervene to Lessen Harms 

and Prevent Future Risk

Rationale

Many youth who engage in violence as teens and young adults have histories of childhood conduct problems, 

aggression, violence perpetration and victimization, delinquency, and criminal behavior.20,33,212-214 These youth often 

have other known risk factors for violence, including substance use, academic problems, associations with deviant 

peers, and home environments characterized by disruption, conflict, violence, and other family problems.20,33,215 Many 

have experienced traumatic events and show signs of behavioral and mental health problems from experiencing, 

witnessing, and living with chronic exposures to violence and in unhealthy environments.15,216,217 Justice responses, 

such as incarceration alone, have limited effect on youths’ future criminal behavior, and some policies, such as 

the transfer of juvenile offenders to adult criminal courts, can result in worse outcomes for youth.15,28-30,218 Other 

approaches designed to address these youths’ many risk factors have the potential to interrupt the continuation and 

escalation of violence.2,49,219,220 These interventions can also create resiliency and strengthen familial protective factors, 

such as parental monitoring, parent-child communication, and behavioral management.

Approaches

Several approaches have been identified to lessen the harms of violence exposure and prevent the continuation 

and escalation of violence and its associated risk factors, including therapeutic treatments and hospital-community 

partnerships that provide brief intervention and community prevention services.

Treatment to lessen the harms of violence exposures. Therapeutic treatment can mitigate the behavioral and 

health consequences of witnessing or experiencing violence in the home and community and other adverse child 

experiences.221-224 Improvements can occur in youth’s maladaptive and acting out behaviors, irritability, difficulty 

sleeping or concentrating, and symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD). 

Treatments are designed to help youth process traumatic exposures, manage trauma-related distress, and develop 

effective coping strategies and skills. These treatments are typically delivered by trained professionals in a one-on-one 

or group setting and over the course of 12 or more sessions. Referrals may come from social services, schools, or other 

local community organizations. Treatment is often provided to children at varying ages and stages of development, 

and as such, may engage both the child and caregiver in the treatment process.

Treatment to prevent problem behavior and further involvement in violence simultaneously addresses multiple 

risk factors and builds supports at home and in the community. These approaches develop youth’s social and 

problem-solving skills, provide youth with therapeutic services to address behavioral and emotional issues, offer 

families therapeutic services to reduce conflict, improve communication, and enhance parents’ management and 

supervision of youth.49,219,220 The goal of these supports is to assist youth and families in making significant changes 

in their behavior in order to prevent youth from engaging in future acts of violence. Referrals may come from the 

juvenile justice system, schools, or other community organizations working with young people and families who have 

many risk factors for youth violence. Programs are often delivered by trained clinicians in the home or a clinic setting 

and can be administered to individual families or groups of families. Programs typically include multiple components, 

such as individual counseling of youth, family counseling, parent training, and school consultation.
 34 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

Hospital-community partnerships are intended to strengthen connections between the acute treatment of 

violence-related injuries and community assistance in order to prevent future injuries and health risk behaviors.225

These approaches provide support to youth shortly after receiving care in emergency departments for acute issues. 

The youth served by these approaches and the length and content of the program vary based on the model used. 

Typically these programs involve brief interventions to develop skills and risk awareness, needs assessments, and 

connection to case-management services. Motivational interviewing to engage youth and encourage behavior 

change, components to address peer norms about risk behaviors, and ways to manage life stressors and situations 

post-injury are elements of these interventions.226

Potential Outcomes

• Reductions in victimization and perpetration of violence

• Reductions in nonviolent and violent crime

• Reductions in arrests and recidivism

• Reductions in gang involvement

• Reductions in out-of-home placements

• Reductions in siblings’ criminal behavior

• Reductions in teen dating violence

• Reductions in child abuse

• Reductions in substance use

• Reductions in symptoms of PTSD, depression, and behavioral problems

• Increases in school attendance and homework completion

• Increases in positive parenting and family management practices (e.g., monitoring and supervision)

• Improvements in family relationships and communication

Evidence

A large body of evidence highlights the importance and benefits of intervening with youth who have histories of 

violence, crime, and delinquency exposures.

Treatment to lessen the harms of violence exposures, such as Trauma-Focused Cognitive Behavioral Therapy® 

(TF-CBT), is effective in reducing symptoms of PTSD, depression, and behavioral problems as well as strengthening 

positive parenting practices.221,227 TF-CBT was originally designed to address symptoms associated with sexual abuse 

and has been adapted to treat other traumas including witnessing community or domestic violence, which are 

important risk factors for youth violence.228 Another example, Cognitive Behavioral Intervention for Trauma in Schools 

(CBITS), is designed for youth ages 10–15.229 This program addresses treatment barriers, such as stigma and access 

to services, by offering the treatment in school settings but has also been implemented in community settings with 

a range of populations (e.g., ethnic minority, immigrant, low and middle-income). The treatment is associated with 

improvements in symptoms of PTSD and depression and parent-reported behavioral problems.230

Treatment to prevent problem behavior and further involvement in violence. The benefits of therapeutic 

interventions for young people with histories of violence, crime and delinquency have been documented in 

numerous reviews.49,219,220 One meta-analysis of interventions for youth with a history of criminal offenses found that 

relative to controls juveniles who received treatment had an average 12% decrease in future violence and crime.220

Across studies, larger effects were found for more serious offenders (e.g., history of both person and property 

offenses) than less serious offenders and when the treatments were longer. However, the effects of individual 

programs varied with some programs having more substantial impacts (e.g., 40% reduction in recidivism) and 

others associated with no effects or an increase in recidivism. Examples of programs demonstrating benefits for 

participating youth and families include Functional Family Therapy (FFT), Multidimensional Treatment Foster Care 

(MTFC), and Multisystemic Therapy® (MST). 
A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 35

FFT is a short-term, family-focused program that strengthens parentchild communication and relationships and helps families set clear 

expectations and use consequences to improve youth’s behavior. 

Evaluations of FFT have shown significantly lower recidivism in 

misdemeanor and felony offenses among participating youth relative to 

youth receiving only probation during adolescence (11% versus 67%) and 

young adulthood (9% versus 41%).231,232 Other evaluations have replicated 

the impact on recidivism in domestic and international samples 

and also demonstrated other positive outcomes, including stronger 

family communication, improved family mental health, reduced court 

involvement of siblings, and lower substance use by youth.233-235

MTFC includes short-term placements of chronically delinquent youth 

with extensively trained foster parents, family therapy for biological 

parents, and behavioral and academic supports to youth. A systematic 

review of therapeutic foster care approaches, such as MTFC, demonstrates 

an approximate 72% reduction in violent crimes among participants.236

Relative to youth in usual care services, MTFC participants also had 

significantly lower self-reported violence and fewer referrals for violent 

crime (5% versus 24%) two years post intervention.237 Other benefits include 

lower substance use, improvement in family management practices, and 

stronger school attendance and homework completion.238,239

MST is an intensive multi-component program for chronically delinquent and violent youth that engages the 

youth’s entire social network (e.g., family, school and teachers, neighborhood, friends) in order to reduce risks 

and improve protective factors. MST has been evaluated in numerous trials with samples of chronic and violent 

juveniles.240 These studies demonstrate significant long-term reductions in re-arrests (reduced by a median 

of 42%) and out-of-home placements (reduced by a median of 54%), as well as beneficial impacts on family 

functioning and positive parenting practices, youth’s substance use, youth’s behavioral and mental health, youth’s 

gang involvement, and sibling’s criminal behavior.240,241 For example, MST participants relative to youth receiving 

individual therapy had fewer violent felony arrests approximately 22 years later (4.3% versus 15.5%), and the 

siblings of these participants had fewer arrests for any crime (43.3% versus 72%) and felonies (15% versus 34%) 

approximately 25 years later.242,243 Other benefits include improvements in positive parenting practices, reductions 

in child abuse, lower substance use, and community cost savings.240

Hospital-community partnerships. The implementation of brief emergency department interventions is growing 

across the United States.244 Some of these interventions have also been rigorously evaluated to assess their effects 

on revictimization, substance use, further involvement in crime and violence, and rates of entry or re-entry into 

the criminal justice system.245-247 For instance, SafERteens is an emergency department intervention for youth who 

present with violence or alcohol use problems that uses motivating interviewing techniques to increase problem 

recognition and skills, including conflict resolution, alcohol refusal, and anger management. Evaluations of SafERteens

demonstrate that participating youth relative to controls had significant reductions in perpetration and victimization 

of peer violence that were maintained one-year following the intervention.248 Additional program benefits include 

reductions in alcohol use and dating violence victimization.246,249 SafERteens has been adapted to include content 

applicable to youth regardless of their history of violence or alcohol use, and an evaluation of the adapted model 

(Project SYNC) also demonstrated a significant decrease in the frequency of perpetrating violence and an increase 

in self-efficacy to avoid fighting among participating youth relative to controls.250 An evaluation of the Caught in the 

Crossfire program in Oakland, California yielded positive outcomes on youths’ involvement in crime. During the sixmonth post-injury evaluation period, the intervention youth were 70% less likely to be arrested for any offense and 

60% less likely to have had any involvement in the criminal justice system compared with controls.245

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 37

Benefits Relative to Costs

A robust evidence base of effective prevention approaches has enabled researchers to systematically assess the 

benefits relative to costs of many youth violence prevention activities. Many prevention programs and policies 

presented in this technical package have been shown in one or more studies to have significant preventive effects 

on youth violence or risk and protective factors for youth violence as well as have economic benefits that exceed 

implementation costs.76,78-80 Published cost-benefit estimates can vary as researchers and states calculating the 

economic benefits of programs can differ in their methods, such as focusing on a single program versus multiple 

programs, the rigor of included research, and costs and outcomes considered.251,252 The table below includes 

examples of benefit-cost information for some of the programs in this technical package based on Washington 

State’s methodology of estimating cost-benefits. Washington State’s approach considers program impacts on 

factors and systems, including future labor market earnings, criminal justice costs, education system costs, and 

health care expenses. 

 Estimates of Benefits Relative to Costs*

Evidence-based Approach/Program Benefits per $1 of cost

Nurse Family Partnership® $1.61

The Incredible Years® – Parent $1.65

Strengthening Families 10–14 $5.00

Early Childhood Education Programs (state and district) $5.05

Good Behavior Game $64.18

Life Skills® Training $17.25

Mentoring (school-based) $14.85 (with volunteer cost)

$23.86 (taxpayer only)

Functional Family Therapy $6.51

Multidimensional Treatment Foster Care $1.70

Multisystemic Therapy® $1.74

*

Dollar estimates by Washington State Institute for Public Policy are in 2015 dollars and are specific to the state of Washington. Estimates 

are likely to vary across states and communities. The benefit-cost estimates are continually updated, and cost estimates presented are 

based on information published by Washington State Institute for Public Policy as of September 2016. The latest information is available 

online at: http://www.wsipp.wa.gov.

A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 39

Sector Involvement

Public health can play an important and unique role in preventing youth violence. Public health agencies, which 

typically place prevention at the forefront of efforts and work to create broad population-level impact, can bring 

critical leadership and resources to bear on this problem.1,253 For example, these agencies can serve as a convener, 

bringing together partners and stakeholders to plan, prioritize, and coordinate youth violence prevention activities. 

Public health agencies are also well positioned to collect and disseminate data, implement preventive measures, 

evaluate programs and policies, and track progress. Although public health can play a leadership role in preventing 

youth violence, the strategies and approaches outlined in this technical package cannot be accomplished by the 

public health sector alone. 

Other sectors vital to implementing this package include, but are not limited to, education, health care (mental, 

behavioral, medical), justice, government (local, state, and federal), social services, business, housing, media, and 

organizations that comprise the civil society sector, such as faith-based organizations, youth-serving organizations, 

foundations, and other non-governmental organizations. Collectively, these sectors can make a difference by 

collaborating to prevent youth violence by impacting the various contexts and underlying risks that contribute to 

youth violence.254,255 The selection and implementation of prevention strategies and approaches by these sectors can 

also be informed and strengthened by youth, families, and other community adults all of whom have important roles 

in preventing youth violence.1,15

The strategies and approaches described in this technical package are summarized in the Appendix along with the 

relevant sectors that are well positioned to lead implementation efforts. For instance, the social services, education, 

and public health sectors are vital for the implementation and continued provision of Quality Education Early in Life. As 

the lead sector in implementing programs, such as Child-Parent Centers and Early Head Start throughout the country, 

the social services sector is helping to ensure that families and communities receive the skills and services necessary 

to promote the physical, cognitive, social, and emotional development of children, thereby preparing youth for 

long-term academic success and positive behavioral and health outcomes. Some of these programs extend into the 

elementary school years making the education sector an important partner in prevention. The public health sector 

can play a vital role by educating communities and other sectors about the importance of ensuring early childhood 

education and continuing research that documents the benefits of early childhood education on health and 

development, family well-being, and youth violence prevention, as this evidence is important in making the case for 

continued support of these programs for children and families in need.

The approaches and programs that Strengthen Youth’s Skills are often implemented in the education setting, making 

education an important sector for implementation. Public health departments across the country often work in 

partnership with school districts to implement and evaluate prevention programs in school settings. Some of these 

programs may also be suitable for delivery in community settings, and local and state public health departments can 

also play a leadership role in implementing and evaluating these programs in other settings. Programs to Promote 

Family Environments that Support Healthy Development are implemented in a variety of settings and involve the 

collaborative work of public health, community organizations, and education. As with other prevention programs, 

local and state public health departments can bring partners together to plan, prioritize, and coordinate prevention 

efforts and play a leadership role in evaluating these programs and tracking their impact on health, behavioral, and 

other outcomes.
Community organizations and education are well positioned to lead and implement approaches and programs that 

Connect Youth to Caring Adults and Activities. These sectors can help identify youth with known risk factors, such as 

academic, behavior, or family problems, and tailor programming to best meet the needs of these youth and their 

families. Business, housing, and government entities, on the other hand, are in the best position to implement policies 

and programs that Create Protective Community Environments. These are the sectors that can more directly address 

some of the community-level risks and environmental contexts that make youth violence more likely to occur. Public 

health can play an important role by gathering and synthesizing information, working with other agencies within their 

state or local governments in supporting policy and other approaches, and evaluating the effectiveness of measures 

taken.

This technical package includes a number of therapeutic programs as well as interventions delivered in hospital 

settings designed to Intervene to Lessen Harms and Prevent Future Risk. The health care, social services, and justice 

sectors can work collaboratively to support young people and their families to prevent and address the harms of 

violence exposures, decrease recidivism, and reduce the potential for the escalation in crime and violence and serious 

violence-related injury or death. The intensity and multiple activities of these interventions benefit from the expertise 

of licensed and trained professionals. Coordination of supports across various service providers and community 

organizations is also critical.

Regardless of the strategy, action by many sectors will be necessary for the successful implementation of this technical 

package. In this regard, all sectors can play an important and influential role in helping to prevent youth violence.

 40 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

Monitoring and 

evaluation are 

necessary components 

of the public health 

approach to 

prevention.
A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 41

Monitoring and Evaluation

Monitoring and evaluation are necessary components of the public health approach to prevention. Timely and reliable 

data are necessary to monitor youth violence and its related risk and protective factors and to evaluate the impact of 

prevention efforts. Data are also necessary for prevention planning and implementation.

Surveillance data help researchers and practitioners track changes in the burden of youth violence. Surveillance 

systems exist at the national, state, and local levels. It is important to assess the availability of surveillance data and 

data systems across these levels to identify and address gaps in the systems and to utilize this information when 

implementing and evaluating prevention activities. The National Violent Death Reporting System (NVDRS), National 

Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), and the Youth Risk Behavior Surveillance System 

(YRBSS) are examples of surveillance systems that include data on youth violence. The NVDRS is a state-based 

surveillance system that combines data from death certificates, law enforcement reports, and coroner or medical 

examiner reports to provide detailed information on the circumstances of violent deaths, including youth homicides, 

which can assist communities in guiding prevention approaches.256 The NEISS-AIP provides nationally representative 

data about all types and causes of nonfatal injuries treated in U.S. hospital emergency departments, including those 

related to youth violence, and can be used to characterize and monitor trends in nonfatal injuries involving youth and 

inform program and policy decisions.6

 The YRBSS collects information from a nationally representative sample of 9–12 

grade students and is a key resource in monitoring health-risk behaviors among youth, including physical fighting on 

and off school property, bullying, and weapon carrying.257 The YRBSS data are obtained from a national school-based 

survey conducted by CDC as well as state, territorial, tribal, and large urban school district surveys conducted by 

education and health agencies. 

National, state, and local data about juvenile’s violent offenses, victimization, and involvement with the justice system are 

also available from the Department of Justice’s Bureau of Justice Statistics, the Federal Bureau of Investigation Uniform 

Crime Reports, and the Office of Juvenile Justice and Delinquency Statistical Briefing Book.9,258,259 State and local data 

from police incident reports, 911 calls, ambulance and medical services, and school disciplinary reports may also be 

available. Many communities and schools also conduct surveys about youth’s behavior and the strengths and needs of 

organizations serving youth to monitor youth violence and to inform ongoing and future prevention activities.

It is important at all levels (national, state, and local) to track progress of prevention efforts and evaluate the impact 

of those efforts, including the impact of this technical package. Evaluation data, produced through program and 

policy implementation and monitoring, are essential to knowing what does and does not work to affect rates of 

youth violence and associated risk and protective factors. Theories of change and logic models that identify short, 

intermediate, and long-term outcomes are an important part of program and policy evaluation. Understanding how 

approaches are being implemented and what implementation conditions result in the best outcomes can inform the 

refinement of a community’s prevention activities over time.

The evidence base for youth violence prevention has advanced greatly over the last few decades, resulting in strong 

evidence for strategies that address many individual and relationship risk and protective factors. More research is 

needed to strengthen the evidence for strategies that address community risk and protective factors for violence, reduce 

minors’ inappropriate access to and use of weapons, and youth’s risk for lethal violence.88,90 Most existing evaluations 

focus on approaches implemented in isolation. However, research is growing about the likely synergistic effects of 

using a combination of the strategies and approaches, many of which are included in this package, and results are 

encouraging.82,260 Continued research is needed to understand the extent to which combinations of strategies and 

approaches result in greater reductions in youth violence than individual programs, practices, or policies. As evidence 

related to a strategy or approach or combination continues to grow and research gaps are filled, this technical package 

can be refined to reflect the latest knowledge and understanding of what works to prevent youth violence.
Conclusion

Youth violence is a significant public health problem that results in the premature death of thousands of young 

people each year. An additional half a million youth experience injuries that are treated in emergency departments, 

which can leave them with serious short- and long-term physical and psychological challenges that require 

rehabilitation supports. Violence directly or indirectly harms everyone in a community by contributing to fear of 

engaging in neighborhood activities, impairing the ability of businesses to grow and prosper, and creating financial 

strain on education, justice, and medical systems that leave communities with limited resources to achieve other 

community goals. 

The good news is that youth violence is preventable. The knowledge, experience, and scientifically supported 

strategies described in this technical package can help communities prevent youth violence perpetration and 

victimization and achieve substantial cost benefits.76,80 Implementing one strategy will have benefits but may not 

result in long-term and wide-spread changes in an entire community’s level of violence. A comprehensive prevention 

approach is more likely to result in significant, broad, and lasting effects. The strategies and approaches in this 

technical package are intended to be used in combination in a multi-level, multi-sector way to prevent youth violence. 

The package includes strategies that are in keeping with CDC’s emphasis on primary prevention, or preventing youth 

violence from happening in the first place, as well as those to lessen the short- and long-term harms of youth violence. 

The hope is that multiple sectors, such as public health, health care, education, justice, social services, and business, 

will use this technical package as a guide and join CDC in efforts to prevent youth violence and its consequences.

 42 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

The good 

news is that 

youth violence 

is preventable.
A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 43

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Journal of Primary Prevention, 37(2), 141-163.
 60 A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors

Appendix: Summary of Strategies and 

Approaches to Prevent Youth Violence

Strategy Approach/Program,

Practice or Policy

Best Available Evidence

Lead Sectors Youth 1

Violence

Perpetration

Youth 

Violence 

Victimization

Risk/Protective 

Factors for 

Youth Violence

Promote Family 

Environments 

that Support 

Healthy 

Development

Early childhood home visitation Public health

Health care

Social services Nurse Family Partnership®  

Parenting skill and family relationship programs

Public health

Education

The Incredible Years®  

Parent Management Training—

Oregon ModelTM  

Strengthening Families 10–14  

Coping Power  

Familias UnidasTM  

Provide Quality 

Education Early 

in Life

Preschool enrichment with family engagement Public health

Social services

Education

Child Parent Centers  

Early Head Start  

Strengthen 

Youth’s Skills

Universal school-based programs

Public health

Education

Good Behavior Game  

Promoting Alternative THinking 

Strategies®  

Life Skills® Training  

Steps to Respect   

Connect Youth to 

Caring Adults and 

Activities

Mentoring programs Community 

organizations

Education

Big Brothers Big Sisters 

of America  

After-school programs Community 

organizations

Education

Los Angeles’ Better Educated 

Students for Tomorrow  

After School Matters 
A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors 61

Strategy Approach/Program,

Practice or Policy

Best Available Evidence

Lead Sectors Youth 1

Violence

Perpetration

Youth 

Violence 

Victimization

Risk/Protective 

Factors for 

Youth Violence

Create Protective 

Community 

Environments

Modify the physical and social environment Business

Government

(local, state)

Business Improvement Districts  

Crime Prevention through 

Environmental Design   

Reduce exposure to community-level risks Business

Housing

Government

(local, state)

Tax credits  

Alcohol policies 

(outlet density, pricing)   

Street outreach and community norm change Public health

Community 

organzations

Cure Violence   

Safe Streets   

Intervene to 

Lessen Harms 

and Prevent 

Future Risk

Treatment to lessen the harms of violence exposures Health care

Social services

Community 

organizations

Trauma-Focused Cognitive 

Behavioral Therapy® N/A2 N/A2 

Cognitive Behavioral Intervention 

for Trauma in Schools N/A2 N/A2 

Treatment to prevent problem behavior and future involvement in violence

Health care

Social services

Justice

Functional Family Therapy  

Multidimensional Treatment 

Foster Care  

Multisystemic Therapy®  

Hospital-community partnerships Health care

Community 

organizations

SafERteens   

Caught in the Crossfire  

1

This column refers to the lead sectors well positioned to bring leadership and resources to implementation efforts. For each strategy, there 

are many other sectors, such as non-governmental organizations, that are instrumental to prevention planning and implementing the specific 

programmatic activities.

2

The program is designed to lessen the harms of violence exposures (e.g., post-traumatic stress disorder, depression, behavioral problems)
For more information

To learn more about preventing youth violence, 

call 1-800-CDC-INFO or visit CDC’s violence prevention 

pages at www.cdc.gov/violenceprevention.

AK2016

TM

National Center for Injury Prevention and Control

Division of Violence Prevention