Changing service systems for high-risk youth using state-level strategies

ALTHOUGH FRANKFORD HAS identified important problems in prevention and positive youth development, there are at least 2 concerns about the type of positive youth development framework proposed. First, a broad analysis of youth development provides only a starting point for understanding the etiology and course of adolescent problem behaviors and the development of effective interventions. Second, a focus on positive youth development may not provide the basis for a truly public health approach because it may be tied to strategies that “fix” or “inoculate” individuals through participation in inter-and intrapersonal prevention programs, rather than promote strategies to strengthen the broader social environment. The positive youth development model proposed by Frankford is grounded in 2 sets of ideas that have influenced much of the contemporary research and practice in health education, namely risk and protective factor theory and the tripartite classification of intervention programs (i.e., universal, selective, and indicated). As Frankford notes, the basic premise of risk and protective factor theory is that the greater the number of risk factors experienced by a young person, the greater the probability that he or she will experience 1 or more of an array of behavioral, emotional, and mental health problems such as drug use, violence, and school failure. It is further argued that this risk can be off-set or mitigated by the presence of protective factors such as attachment to prosocial others and personal competency. At a very general level, the basic premise of the youth development model is almost certainly true—the backgrounds of children and adolescents who develop behavioral, emotional, and mental health problems are probably more similar to one another than they are to those who reach adulthood unscathed. They are also individuals with more negative experiences that threaten social and emotional competence, self-efficacy, and other personal traits. Thus, from one perspective, child and adolescent problem behaviors can be considered the result of some broad common developmental pathway. However, when one focuses attention on the experiences that place youth at risk, the picture becomes more complex. For example, research suggests that adolescent problem behaviors cluster into more than a single factor, that the associations between problems and behaviors are unstable over time, and that the predictors of problem behaviors differ according to socio-demographic characteristics, such as gender, and from one point in time to another.1–3 Indeed, even if one focuses on a single health or behavioral problem (e.g., substance use and abuse or delinquency), the evidence shows that there are different risk factors associated with different types of the problem.4–6 Such research suggests the existence of a number of at-risk subtypes within any one of the adolescent health and behavioral problems of concern to public health, based on factors such as etiology, duration, and co-occurrence with other types of problems. This has important implications for the development of preventive interventions. Specifically, if there are distinct subtypes within the broad category of adolescent problem behaviors with distinct developmental paths, one would expect generic interventions such as those delivered through school-based curricula to work with some individuals but not others and with some problem behaviors but not others. Indeed, one might expect some interventions to have a detrimental effect with some subgroups of individuals, as indeed seems to be the case with high-risk youth in poorly structured group settings.7,8 Beyond the issue of adolescent subgroups is the idea that there exists a number of empirically supported positive youth development programs grounded in risk and protective factor models. This big picture of effectiveness is presented in the recent review of positive youth development programs by Catalano et al.9 cited by Frankford. This work describes 15 broad objectives considered relevant to the issue of positive youth development, such as promoting bonding and social competence and fostering self-efficacy and resilience. It then goes on to identify programs that target 1 or more of these objectives and purport to have had a positive effect in the form of reduction or prevention of some type of problem behavior. For example, evaluations of Catalano and colleagues’ Seattle Social Development Project revealed some positive outcomes (e.g., increased attachment to school) attributed to the objectives of positive youth development (e.g., bonding). These limited positive outcomes are used to affirm the benefits of a positive youth development approach. The difficulty with using scattered positive effects from a wide range of prevention program evaluations to support a general theory of positive youth development is that it gives the appearance that these interventions have a potentially broad reach. However, when one focuses on the specific evidence presented in the evaluations of these programs one finds that they often do not show effects on the behaviors that they were designed to influence. This weakens the argument for some generalized effect of these programs upon a successful transition to adulthood.10–12 Although the use of isolated statistically significant results to designate programs as “best practice” in relation to a specific outcome (e.g., drug use) is in itself a problem,11 it is even more questionable to use such evidence to argue that they provide some form of generalized developmental panacea. Finally, although Frankford notes the importance of changing the broader social environment, the model she presents is grounded in the delivery of services and intervention programs through schools and primary health care settings. The major reviews of positive youth development interventions cited9,13 also focused on inter- and intrapersonal intervention programs typically delivered in schools. Thus, there is little focus at the population level, and one might question the extent to which positive youth development models provide a basis for a genuine public health approach. Indeed, with a focus on individual-level risk and protective factors and interpersonal interventions, it is not clear how this model moves beyond much previous public health practice that has ultimately yielded disappointing results.14 As a recent description of the tobacco industry’s promotion of a well-known school-based positive youth development program illustrates, such a focus may actually draw attention and resources away from environmental and community-based strategies.15