Learning to do violence prevention well.

The worth of violence-prevention programs has been clearly demonstrated. We’ve learned through careful scientific demonstrations that participation in certain types of violence-prevention programs can reduce the likelihood of involvement in violent behavior and, for those already involved, reduce the rate and seriousness of offending.1 We have also learned that some violence-prevention programs can be more cost effective than incarceration for preventing serious criminal violence.2 Moreover, we have come to recognize that intervening early in the course of human development offers the best opportunity to protect our children from being perpetrators and victims of violence.3,4 One of our biggest challenges in the field, now that we know that violence prevention is worth doing, is how to do violence prevention well. The challenge of doing violence prevention well cannot be underestimated. Clearly the effectiveness of an intervention in a particular setting depends not just on whether it’s been demonstrated in the past to be efficacious, but on the quality of implementation. Systematic documentation of the best practices and procedures for implementing violence-prevention programs, however, is quite limited. Communities and neighborhoods across the country are highly motivated to implement programs that work, but they often lack the knowledge, resources, and skills that are needed to ensure that the implementation of programs found to be effective elsewhere will have the desired effect in their communities. Moreover, because of the great diversity in the make-up and nature of communities, they may face obstacles to violence prevention that were not evident or anticipated in the communities where programs were demonstrated to be effective. While we have learned a great deal about what programs are effective and which ones are not, we still have much to learn about how to improve the quality of the broader implementation of violence-prevention programs and practices. This supplement to the American Journal of Preventive Medicine highlights some of the challenges encountered in implementing interventions in the context of prevention research targeted at very young children and their families. It provides information that can help to improve both the quality of programmatic implementation and prevention research in the area of violence prevention. Among the issues discussed are strategies for building and maintaining successful collaborations between academia and community agencies.5 Such collaborations can be fruitful for both parties by, for example, facilitating the transfer of technical knowledge about violence prevention to communities while simultaneously enabling scientists to better understand the information needs of agencies on the front lines. Also discussed are recommendations for recruiting and retaining study participants in prevention trials.6 The practical strategies identified in this paper have broad applicability to programs that seek to involve and maintain the participation of families. The next issue addressed is the challenge of maintaining the fidelity of an intervention,7 which is ensuring that the intervention is being delivered in the manner it is supposed to be and in the same way to all participants. As the authors point out, ensuring a satisfactory level of fidelity is critical for all prevention interventions, even if such efforts must be limited in scope due to financial considerations. The quality of program implementation is also frequently challenged by the nature of the populations toward which the intervention is targeted. For example, strategies for successful program implementation and prevention research with incarcerated parents, a population whose children are at high risk for involvement in violence, are discussed.8 The need to gain the support of staff in correctional facilities and develop training materials in basic language are among the factors thought to be critical to successful implementation in this population. Many community violenceprevention programs are challenged by the complexities of addressing ethnically diverse populations. These challenges and the opportunities for creative approaches to addressing diverse populations are explored in a child care setting.9 As we look toward the future in the field of violence prevention, three types of investments will be particuFrom the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia Address reprint requests to: James A. Mercy, PhD, Associate Director for Science, Division of Violence Prevention, National Center for Injury Prevention and Control, Mailstop K60, 4770 Buford Highway, NE, Atlanta, GA 30341-3724. E-mail: JAM2@cdc.gov.