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|  | ******Chapter 6**A Vision for the Future

Continue to Build the Science Base

Accelerate the Decline in Gun Use by Youths in Violent Encounters

Facilitate the Entry of Youths into Effective Intervention Programs Rather Than Incarcerating Them

Disseminate Model Programs with Incentives That Will Ensure Fidelity to Original Program Design When Taken to Scale

Provide Training and Certification Programs for Intervention Personnel

Improve Public Awareness of Effective Interventions

Convene Youths and Families, Researchers, and Private and Public Organizations for a Periodic Youth Violence Summit

Improve Federal, State, and Local Strategies for Reporting Crime Information and Violent Deaths

Conclusion

Reference | Chapter 6A Vision for the Future
In the late 1990s, people in the United States were stunned by a seriesof tragic shootings at schools that were planned and carried out by youths. Theseshocking, widely reported events prompted the preparation of this Surgeon General’sreport on youth violence. Yet these shootings were not characteristic of youth violencenationally. Moreover, at the time of the shootings, youth violence in the United Statesappeared to be on a downward trend. 

Serious youth violence—that is, physical assault by a child oradolescent that carries a significant risk of injuring or killing anotherperson—began to emerge as a social and public health problem of sizable proportionsin the 1980s. Arrests of youths for index crimes (robbery, aggravated assault, rape, andhomicide) peaked in 1993 after a decade of climbing rapidly, leading some observers toexpress doubt that anything could be done to halt the epidemic of youth violence. By 1999,after 6 years of sustained decline nationwide, arrests of youths for robbery, rape, andhomicide began to resemble the pre-epidemic arrest rates of 1983. A striking exception tothis trend was arrests for aggravated assault, which remained 70 percent above 1983 rates.

While arrest records and victimization reports indicated that youth violence was generally declining, other sources of information presented a different picture. In approaching youth violence as a public health problem, this report has looked beyond arrest and other criminal justice records to several national surveys in which high school–age youths report in confidence on their violent behavior. These self-reports reveal that the propensity for and actual involvement of youths in serious violence have not declined with arrest rates. Rather, they have remained at the peak rates of 1993, a troublesome finding. In January 2001, as this report goes to press, the first indications of a long-awaited downturn in self-reported violent behavior are being countered by signs from the FBI’s Uniform Crime Reports database that the decline in arrests of youths for violent crimes has bottomed out and, for some index crimes, has begun to climb again.

Clearly, the dynamics and magnitude of youth violence remain fluid andcomplex. Nevertheless, research in the past several decades has developed a wealth ofinformation about the causes of youth violence and how to prevent it. Numerous studieshave identified and examined specific risk factors for violence—the personal andenvironmental features of young people’s lives that increase the statisticalprobability of their engaging in violent behaviors. Research also has begun to identifyprotective factors that appear to buffer the effects of risk factors. While thisinformation has been accumulating, researchers, youth service practitioners, and othershave been designing, implementing, and evaluating a variety of programs and strategies toreduce or prevent the occurrence of youth violence. The best of these interventions targetpopulations of young people identified as being particularly at risk of becoming involvedin a violent lifestyle.

Many effective intervention programs exist to reduce and prevent youthviolence. The United States is well past the point where anyone can claim that"nothing works" to prevent youth violence or to modify the destructive lifecourses of youths who are either engaged in or appear to be headed for lifestylescharacterized by violence. At the same time, however, many purported youth violenceprevention programs used today are untested, and some are known to be ineffective or evendeleterious to a child or adolescent’s healthy, safe development. 

The courses of action highlighted below are potential next steps. Theseare not formal policy recommendations. Instead, they represent a vision for the futurebuilt on information we possess today. They are intended for policy makers, service andtreatment providers, people affiliated with the juvenile justice system, researchers, andmost important, the people of the United States. This vision for the future is presentedwith the hope that it will engage an expanding number of citizens in the challenge ofredressing the problem of youth violence.
CONTINUE TO BUILD THE SCIENCE BASE
Scientific research is an essential underpinning of the public healthapproach to the problem of youth violence. Years of extensive research have revealed thescope of the problem, and we are beginning to understand how to intervene effectively toreduce and prevent violence. Yet most violence prevention programs used in schools,communities, and the justice system today have not been subjected to systematic scientificevaluation, so their effectiveness—or lack of effectiveness—is unknown. Givenevidence that some well-intentioned prevention and intervention programs have proved to beharmful, it is imperative that all programs be scientifically evaluated. Research mustalso be prepared to address areas of emerging concern. One that has become increasinglyclear is the need for studies to investigate intimate violence, or dating violence, amongyouths to identify patterns that predict continuation of such behaviors into adulthood andto design new types of interventions targeting this form of violent behavior. Another areaof concern requiring research is the impact of violent interactive media, such as computergames, on serious violent behavior.

This Surgeon General’s report is issued at a time of unprecedentedscientific opportunity in numerous disciplines—developmental psychology, sociology,criminology, epidemiology, neuroscience, and many other fields. No single researchspecialty holds the key to understanding, treating, and preventing violence. Rather, theymust work together. One of the greatest challenges to researchers today is finding newways to use the tools, strategies, and insights from these diverse fields of research toreveal the many factors that may lead a young person toward—or protect a young personfrom—involvement in violence. A related need is to invest in cross-level researchdesigns that will enable researchers to examine individual, family, and community factorssimultaneously.

Research frequently examines questions and issues that crop up in thedaily lives of millions of people—the relationship of media depictions of violence toviolent behavior is a key example; the impact of strategies to discourage firearm use isanother. Such familiarity often increases the likelihood that a person will hold strongopinions regarding the effect of television or popular music, or the presence and use ofweapons, on violent behavior. Appropriately designed and conducted research offers afactual basis, rather than opinion, for proposing and debating social policy. It istherefore critical to devise ways of giving people with diverse interests (includingparents, teachers, and others) a voice in identifying urgent research questions and toinform them about the conclusions drawn from research. 
ACCELERATE THE DECLINE IN GUN USE BY YOUTHS IN VIOLENT ENCOUNTERS
The carrying and use of guns by youths in violent encounters havedeclined dramatically since 1993, the peak of the violence epidemic. To accelerate thatdecline, we must seek to understand more completely the reasons for it. Are youths’decisions not to carry or use guns in violent encounters related to any specificstrategies put in place to discourage firearm use, or did the drop in firearm use resultfrom other factors or conditions? Clearly, important questions remain about precisely whathas happened in communities nationwide to reduce the frequency with which adolescentscarry guns. While some research has addressed these questions (Blumstein & Wallman,2000), further studies are imperative—data documenting the continuing magnitude ofviolent behaviors suggest that a return to lethal violence is likely if adolescents onceagain carry and use guns in violent encounters.
FACILITATE THE ENTRY OF YOUTHS INTO EFFECTIVE INTERVENTIONPROGRAMS RATHER THAN INCARCERATING THEM
In the 1990s, faced with the epidemic of violence and largely unawarethat research had found some violence prevention programs to be effective—as well asoften buying into the "just desserts" philosophy—the only option somelegislators saw was to lock up violent youths to protect society. New evidence makes acompelling case that intervention programs can be cost-effective and can reduce thelikelihood that youths will become repeat offenders. Given this evidence, it is in thecountry’s interest to place as many violent youths as possible in these programs,thus correcting the imbalance that now favors use of the criminal justice system overeffective intervention programs. Reclaiming youths from a violent lifestyle has clearadvantages over warehousing them in prisons and training schools. 

Effective programs are not available in many communities. Specialefforts must be undertaken to increase awareness of these programs, provide technicalassistance and information about them, and devise incentives for states and communities toinvest in tested programs. At present, states and communities are squandering substantialamounts of money on untested programs or programs known to be ineffective. Policy makersmust be encouraged to focus existing resources on programs that work; evidence ofeffectiveness might be required, for example, as a condition of receiving Federal or localfunding. An informed public is also critical in building support for effectivealternatives to incarceration.
DISSEMINATE MODEL PROGRAMS WITH INCENTIVES THAT WILL ENSURE FIDELITY TO ORIGINAL PROGRAM DESIGN WHEN TAKEN TO SCALE
Experience has shown repeatedly that intervention programs shown to beeffective in their original sites do not yield uniform outcomes when replicated elsewhere.Upon examination, program evaluators often find that subtle modifications have beenintroduced into the model program. Lack of a particular category of personnel in a givenlocation, for example, may prompt a program director to substitute professionals orparaprofessionals without proper credentials. Face-to-face training sessions that initiallyencouraged interaction between a program originator and new staff may be supplanted byvideotaped tutorials. The frequency of participants’ contacts with a program may belessened or program duration abbreviated.

Legislators, agency administrators, and program directors should beencouraged to identify incentives for ensuring that the integrity of a model program isnot compromised when it is replicated. 
PROVIDE TRAINING AND CERTIFICATION PROGRAMS FOR INTERVENTION PERSONNEL
The major challenge in implementing effective intervention programs ona national scale is guaranteeing a well-trained staff that understands the interventionand its limitations. Staff must be adequately trained to deliver a particular interventionin the specific settings for which it was designed. Yet because the supply ofappropriately trained individuals who are available to work in the variety of settings inwhich violence prevention programs operate is limited, operational entropy often sets in.Establishing formal training programs and university certification programs will helpensure the quality of interventions. 
IMPROVE PUBLIC AWARENESS OF EFFECTIVE INTERVENTIONS
Identifying specific youth violence interventions as effective in thisreport will probably stimulate demand for these programs. Youth advocacy organizationshave an opportunity to educate citizens on how to interact effectively with their localeducational and juvenile justice systems, with appropriate sectors of the electedgovernment, and with private organizations involved in youth violence prevention. 

Media campaigns and public service announcements offer a means ofincreasing public awareness. News or documentary television programs featuring modelprograms have had a measurable impact both on the funding of the programs and on thevolume of requests from sites throughout the country for information about the programs.The 1938 film *Boys Town,* with Spencer Tracy and Mickey Rooney, proved highlybeneficial to the reputation and funding opportunities available to Boys Town.Conceivably, featuring model youth violence prevention programs in popular films todaycould have an equivalent effect. 
CONVENE YOUTHS AND FAMILIES, RESEARCHERS, AND PRIVATE AND PUBLIC ORGANIZATIONS FOR A PERIODIC YOUTH VIOLENCE SUMMIT
The move to a public health focus on violence involves new players andnew collaborative partnerships among criminologists, psychologists, psychiatrists,sociologists, neuroscientists, and others. Physicians and other general medical serviceproviders have important roles to play, but they are not yet sufficiently involved.Preparation of the Surgeon General’s report underscored the risks of disciplinarycompartmentalization in the study of youth violence.

There is no common place where information needed by all partiesinterested in the problem of youth violence can be exchanged. A rich literature onresearch and services appears in the specialty journals of various disciplines, inprofessional newsletters, in the mass media, and increasingly on the World Wide Web. Lackof interaction between academic research centers and the community-based agenciesresponsible for implementing youth violence prevention programs or providing medicalservices to victims (many of whom are also perpetrators) can result in significant costs. 

A periodic, highly visible national summit that receives wide popularas well as specialized media coverage would offer a way of disseminating information onnew research findings, effective programs and strategies, best practices, and relatedinformation for diverse audiences. 
IMPROVE FEDERAL, STATE, AND LOCAL STRATEGIES FOR REPORTING CRIMEINFORMATION AND VIOLENT DEATHS
The proportion of law enforcement agencies nationwide that reportarrests to the FBI’s Uniform Crime Reports (UCR) program has been declining. In 1999,participating agencies represented only 63 percent of the U.S. population. The accuracy ofnational estimates would be enhanced if this reporting rate were improved. In addition toexpanding the participation rate, opportunities for improvement might entail: 
- Including arrest rates for  all  racial and ethnic groups. Hispanics in particular    are not represented in systematic data collection systems.
- Encouraging law enforcement agencies to participate in the National Incident-Based    Reporting System. Developed by the UCR, the incident-based reporting system provides a    much richer data set for tracking violent crime than the aggregated data available in the    current UCR. Another potentially useful, innovative data set is the National Violent Death    Reporting System proposed by the Centers for Disease Control and Prevention. This data set    would help in monitoring the magnitude and characteristics of youth violence on a timely    basis so that programmatic and policy responses can be more effectively planned and    evaluated.
- Develop a standard set of questions for national self-report surveys (such as Monitoring    the Future) that include serious violent offenses. Annual data from these surveys should    be obtained from all adolescents age 11 through 17, not just high school seniors. At    present, variation among surveys in the age of respondents, data obtained, and frequency    of data collection severely limit any composite picture that might result. Data collection    efforts must make use of the best methodology available and include follow-up questions on    each reported violent event to determine weapon use, drug or alcohol involvement at the    time of the event, seriousness of injury, victim’s relationship to offender, number    of youths involved in the attack, and other details. Such data enable researchers to    correct for the overreporting in the simple checklist used in most surveys. 
CONCLUSION
*Youth Violence: A Report of the Surgeon General*offers compelling testimony that the safety and well-being of children and adolescents are issues of the utmost importance and urgency to individuals and organizations throughout the United States. The report has drawn on the expertise of countless persons in diverse private organizations in local, state, and Federal government agencies; in schools; and most important, in families—all of whom are dedicating immense energy and caring to countering the most common threat to the lives of young Americans. Thanks to these efforts and to the insights and actions of young people themselves, it is clear today that youth violence is not an intractable problem; rather, it is a behavior that we can understand, treat, and prevent. This final chapter has offered courses of action intended to help inform the decisions that we must make as we strive to ensure that every child has the opportunity to grow and mature safely, healthily, and happily.
REFERENCE
Blumstein, A., & Wallman, J. (2000). *The crime drop in America.* Cambridge, United Kingdom: Cambridge University Press. 

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