Since violence is so insidious in our culture,
it is difficult to examine the topic, particularly how to
prevent violence, in a manner that is systematic and productive.
There has been much in the literature about violence prevention;
however there is limited research in the area. Multiple perspectives
exist, including violence prevention models. In the models
there is significant overlap in approach. Covered in this
course are: The Public Health Model for Violence Prevention,
The Ecological Model and the New York State SAVE Legislation
The Public Health
Model for Violence Prevention
The focus of public health is on the health, safety and well-being of entire populations. A unique aspect of the field is that it strives to provide the maximum benefit for the largest number of people (CDC, 2015a).
Public health draws on a science base that is multi-disciplinary. It relies on knowledge from a broad range of disciplines including medicine, epidemiology, sociology, psychology, criminology, education, and economics. This broad knowledge base has allowed the field of public health to respond successfully to a range of health conditions across the globe (CDC, 2015a).
The field also emphasizes input from diverse sectors including health, education, social services, justice, policy and the private sector. Collective action on the part of these stakeholders can help in addressing problems like violence (CDC, 2015a).
The public health perspective asks the foundational questions: Where does the problem begin? How could we prevent it from occurring in the first place? To answer these questions, public health uses a systematic, scientific approach for understanding and preventing violence.
The public health approach is a four-step process that is rooted in the scientific method. It can be applied to violence and other health problems that affect populations (CDC, 2015a; CDC, 2016). Many people, organizations, and systems are involved at each step along the way.
Figure 1. The Public Health
STEP 1: Define the
The first step in preventing violence is
to understand it. Grasping the magnitude of the problem involves
analyzing data such as the number of violence-related behaviors,
injuries, and deaths. Data can demonstrate how frequently
violence occurs, where it occurs, trends, and who the victims
and perpetrators are. These data can be obtained from a variety
of sources. In the community, police reports, medical examiner
files, vital records, hospital charts, registries, population-based
surveys, and other sources can be used to obtain data.
It is important that data be collected in
a systematic and unbiased manner with uniform definitions
and uniform reporting methods. Without such standardization,
it is difficult to make use of the data. One teacher, with
a higher tolerance for activity and noise from students, may
not identify bullying behavior and may see it as a playful
interaction among peers. Another teacher may have a lower
tolerance for noise and activity, or a greater awareness of
what constitutes bullying. Obtaining information from these
two teachers would yield significantly different information.
What one agency defines as "violent behavior", another may
define as an "assault". Clearly without uniform definitions
and reporting methods, it is difficult to utilize the data
and even more difficult to generalize any information from
The federal government requires that states establish
a uniform management and reporting system to collect information
on school safety and drug use among young people. The states
must include incident reports by school officials and anonymous
student and teacher surveys in the data they collect. This
information is to be publicly reported so that parents, school
officials and others who are interested have information about
any violence and drug use at their schools. They can then
assess the problems at their schools and work toward finding
solutions. Continual monitoring and reports will track progress
New York State has uniform reporting procedures
as well. These will be covered during the specifics related
to the SAVE legislation.
STEP 2: Identify
Risk and Protective Factors
It is not enough to know the magnitude of
a public health problem. It is important to understand what
factors protect people or put them at risk for experiencing
or perpetrating violence. Why are risk and protective factors
useful? They help identify where prevention efforts need to
that increases the likelihood of a person becoming a
victim or perpetrator of violence.
that decreases the likelihood of a person becoming a
victim or perpetrator of violence because it provides
a buffer against risk.
There is a growing understanding of how trauma and adverse childhood experiences (ACEs) not only affect the brain and learning, but can lead to numerous behavior challenges, including aggression and impulse control (Felitti, et al., 1998). The ACE study relates to the 1998 CDC-Kaiser Adverse Childhood Experiences Study, a groundbreaking public health study that discovered that childhood trauma impacts children’s developing brains profoundly and leads to the later or adult onset of chronic diseases, depression and other mental illness, violence and being a victim of violence. The ACE Study has published about 70 research papers since 1998. Hundreds of additional research papers based on the ACE Study have also been published.
In the landmark Adverse Childhood Experiences (ACE) Study (1998) and successive research since then, it was identified that childhood experiences, both positive and negative, have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. As such, early experiences are an important public health issue. Much of the foundational research in this area has been referred to as Adverse Childhood Experiences (ACEs). Some examples of these adverse experiences include emotional, physical, sexual abuse, emotional and physical neglect, mother treated violently, household substance abuse, household mental illness, parental separation/divorce, incarcerated household member.
The Adverse Childhood Experiences (ACE) Study referred to previously also determined that these adverse experiences have been linked to:
- risky health behaviors (for example, tobacco smoking, drug use, alcohol use, unsafe sexual behavior, etc.),
- chronic health conditions (for example, obesity, diabetes, depression, suicide, sexually transmitted diseases, heart disease, cancer, stroke, chronic obstructive pulmonary disease, broken bones, etc.),
- low life potential (for example, impact on high school graduation rates, academic performance and achievement, poor occupational options, unemployment, lost time from work, etc.) , and
- early death.
As the number of ACEs increases, so does the risk for these outcomes.
Not all children who witness violence or who are victims of abusive or neglectful behavior will experience long-term consequences. Outcomes of individual cases vary widely and are affected by a combination of factors, including (CDC, 2016):
- The child's age and developmental status when witnessing or experiencing the abuse or neglect;
- The type of abuse (physical abuse, neglect, sexual abuse, etc.) witnessed or experienced;
- Frequency, duration, and severity of abuse;
- Relationship between the child, victim, and the abuser.
It is not always possible to predict behavior that will lead
to violence. However, educators and parents, and sometimes
students, can recognize certain early warning signs. In some
situations and for some youth, different combinations of events,
behaviors, and emotions may lead to aggressive rage or violent
behavior toward self or others. A good rule of thumb is to
assume that these warning signs, especially when they are
presented in combination, indicate a need for further analysis
to determine an appropriate intervention (CDC, 2016; NYSCSS,
We know from research that most children
who become violent toward self or others feel rejected and
psychologically victimized. In most cases, children exhibit
aggressive behavior early in life and, if not provided support,
will continue a progressive developmental pattern toward severe
aggression or violence. However, research also shows that
when children have a positive, meaningful connection to an
adult, whether it be at home, in school, or in the community,
the potential for violence is reduced significantly (CDC,
2016; NYSCSS, 2001).
The following early warning signs are risk
factors. They are presented with the following qualifications:
They are not equally significant and they are not presented
in order of seriousness (CDC, 2016b).
- Social withdrawal. In some situations, gradual
and eventually complete withdrawal from social contacts
can be an important indicator of a troubled child. The withdrawal
often stems from feelings of depression, rejection, persecution,
unworthiness, and lack of confidence.
- Excessive feelings of isolation and being alone.
Research has shown that the majority of children who are
isolated and appear to be friendless are not violent. In
fact, these feelings are sometimes characteristic of children
and youth who may be troubled, withdrawn, or have internal
issues that hinder development of social affiliations. However,
research also has shown that in some cases feelings of isolation
and not having friends are associated with children who
behave aggressively and violently.
- Excessive feelings of rejection. In the
process of growing up, and in the course of adolescent development,
many young people experience emotionally painful rejection.
Children who are troubled often are isolated from their
mentally healthy peers. Their responses to rejection will
depend on many background factors. Without support, they
may be at risk of expressing their emotional distress in
negative ways, including violence. Some aggressive children
who are rejected by non-aggressive peers seek out aggressive
friends who, in turn, reinforce their violent tendencies.
- Being a victim of violence. Children who
are victims of violence including physical or sexual abuse
in the community, at school, or at home are sometimes at
risk themselves of becoming violent toward themselves or
- Feelings of being picked on and persecuted.
The youth who feels constantly picked on, teased, bullied,
singled out for ridicule, and humiliated at home or at school
may initially withdraw socially. If not given adequate support
in addressing these feelings, some children may vent them
in inappropriate ways including possible aggression or violence.
- Low school interest and poor academic performance.
Poor school achievement can be the result of many factors.
It is important to consider whether there is a drastic change
in performance and/or poor performance becomes a chronic
condition that limits the child's capacity to learn. In
some situations.such as when the low achiever feels frustrated,
unworthy, chastised, and/or denigrated, acting out and aggressive
behaviors may occur. It is important to assess the emotional
and cognitive reasons for the academic performance change
to determine the true nature of the problem.
- Expression of violence in writings and drawings.
Children and youth often express their thoughts, feelings,
desires, and intentions in their drawings and in stories,
poetry, and other written expressive forms. Many children
produce work about violent themes that for the most part
is harmless when taken in context. However, an overrepresentation
of violence in writings and drawings that is directed at
specific individuals (family members, peers, other adults)
consistently over time, may signal emotional problems and
the potential for violence. Because there is a real danger
in misdiagnosing such a sign, it is important to seek the
guidance of a qualified professional such as a school psychologist,
counselor, or other mental health specialist.
- Uncontrolled anger. Everyone gets angry;
anger is a natural emotion. However, anger that is expressed
frequently and intensely in response to minor irritants
may signal potential violent behavior toward self or others.
- Patterns of impulsive and chronic hitting, intimidating,
and bullying behaviors. Children often engage in
acts of shoving and mild aggression. However, some mildly
aggressive behaviors such as constant hitting and bullying
of others that occur early in children's lives, if left
unattended, might later escalate into more serious behaviors.
- History of discipline problems. Chronic
behavior and disciplinary problems both in school and at
home may suggest that underlying emotional needs are not
being met. These unmet needs may be manifested in acting
out and aggressive behaviors. These problems may set the
stage for the child to violate norms and rules, defy authority,
disengage from school, and engage in aggressive behaviors
with other children and adults.
- Past history of violent and aggressive behavior.
Unless provided with support and counseling, a youth who
has a history of aggressive or violent behavior is likely
to repeat those behaviors. Aggressive and violent acts may
be directed toward other individuals, be expressed in cruelty
to animals, or include fire setting. Youth who show an early
pattern of antisocial behavior frequently and across multiple
settings are particularly at risk for future aggressive
and antisocial behavior. Similarly, youth who engage in
overt behaviors such as bullying, generalized aggression
and defiance, and covert behaviors such as stealing, vandalism,
lying, cheating, and fire setting also are at risk for more
serious aggressive behavior. Research suggests that age
of onset may be a key factor in interpreting early warning
signs. For example, children who engage in aggression and
drug abuse at an early age (before age 12) are more likely
to show violence later on than are children who begin such
behavior at an older age. In the presence of such signs
it is important to review the child's history with behavioral
experts and seek parents' observations and insights.
- Intolerance for differences and prejudicial attitudes.
All children have likes and dislikes. However, an intense
prejudice toward others based on racial, ethnic, religious,
language, gender, sexual orientation, ability, and physical
appearance, when coupled with other factors, may lead to
violent assaults against those who are perceived to be different.
Membership in hate groups or the willingness to victimize
individuals with disabilities or health problems also should
be treated as early warning signs.
- Drug use and alcohol use. Apart from being
unhealthy behaviors, drug use and alcohol use reduces self-control
and exposes children and youth to violence, either as perpetrators,
as victims, or both.
- Affiliation with gangs. Gangs that support
anti-social values and behaviors, including extortion, intimidation,
and acts of violence toward other students, cause fear and
stress among other students. Youth who are influenced by
these groups, those who emulate and copy their behavior,
as well as those who become affiliated with them may adopt
these values and act in violent or aggressive ways in certain
situations. Gang-related violence and turf battles are common
occurrences tied to the use of drugs that often result in
injury and/or death.
- Inappropriate access to, possession of, and use
of firearms. Children and youth who inappropriately
possess or have access to firearms can have an increased
risk for violence. Research shows that such youngsters also
have a higher probability of becoming victims. Families
can reduce inappropriate access and use by restricting,
monitoring, and supervising children's access to firearms
and other weapons. Children who have a history of aggression,
impulsiveness, or other emotional problems should not have
access to firearms and other weapons.
- Serious threats of violence. Idle threats
are a common response to frustration. Alternatively, one
of the most reliable indicators that a youth is likely to
commit a dangerous act toward self or others is a detailed
and specific threat to use violence. Recent incidents across
the country clearly indicate that threats to commit violence
against oneself or others should be taken very seriously.
Steps must be taken to understand the nature of these threats
and to prevent them from being carried out.
Research on youth violence has increased our understanding of factors that make some populations more vulnerable to victimization and perpetration. Risk factors increase the likelihood that a young person will become violent. However, risk factors are not direct causes of youth violence; instead, risk factors contribute to youth violence. Risk factors as well as protective factors (described below) can be conceptualized as pertaining to the individual, to the family, to social and peer groups and the broader community (CDC, 2016b).
Individual Risk Factors
- History of violent victimization;
- Attention deficits, hyperactivity, or learning disorders;
- History of early aggressive behavior;
- Involvement with drugs, alcohol, or tobacco;
- Low IQ;
- Poor behavioral control;
- Deficits in social cognitive or information-processing
- High emotional distress;
- History of treatment for emotional problems;
- Antisocial beliefs and attitudes;
- Exposure to violence and conflict in the family.
Family Risk Factors
- Authoritarian childrearing attitudes;
- Harsh, lax, or inconsistent disciplinary practices;
- Low parental involvement;
- Low emotional attachment of parents or caregivers;
- Low parental education and income;
- Parental substance abuse or criminality;
- Poor family functioning;
- Poor monitoring and supervision of children.
Peer/School Risk Factors
- Association with delinquent peers;
- Involvement in gangs;
- Social rejection by peers;
- Lack of involvement in conventional activities;
- Poor academic performance;
- Low commitment to school and school failure.
Community Risk Factors
- Diminished economic opportunities;
- High concentrations of poor residents;
- High level of transiency;
- High level of family disruption;
- Low levels of community participation;
- Socially disorganized neighborhoods.
Protective Factors buffer young people from risks
of becoming violent. These factors exist at various levels.
Protective factors serve to mediate the negative impact of
risk factors that are associated with violence. To date, protective
factors have not been studied as extensively or rigorously
as risk factors. However, identifying and understanding protective
factors are equally as important as researching risk factors (CDC, 2016b).
Individual Protective Factors
- Intolerant attitude toward deviance;
- High IQ
- High grade point average (as indicator of high academic achievement);
- Positive social orientation;
- Highly developed social skills/competencies;
- Highly developed skills for realistic planning;
Family Protective Factors
- Connectedness to family or adults outside of the family;
- Ability to discuss problems with parents;
- Perceived parental expectations about school performance
- Frequent shared activities with parents;
- Consistent presence of parent during at least one of
the following: when awakening, when arriving home from
school, at evening mealtime, and when going to bed;"
- Involvement in social activities.
- Parental/family use of constructive strategies for coping with problems (provision of models of constructive coping).
Peer/School Protective Factors
- Possession of effective relationships with those at school that are strong, close, and prosocially oriented;
- Commitment to school (an investment in school and in doing well at school);
- Close relationships with non-deviant peers;
- Membership in peer groups that do not condone antisocial behavior;
- Involvement in prosocial activities;
- Exposure to school climates that characterized by:
- Intensive supervision
- Clear behavior rules
- Consistent negative reinforcement of aggression
- Engagement of parents and teachers.
Characteristics of Youth Who Have Caused School-Associated
The National Safe School Center studied school-associated
violent deaths in the United States during the 1990s. They
identified common characteristics of youth who have caused
such deaths. The following list identifies behaviors, which
could indicate a youth's potential for harming him/herself
or others. While there is no guarantee that these characteristics
and behaviors identifying potentially dangerous students who
may harm themselves and/or others, they are clearly red flags
that should be further considered (NSSC, 1998).
In the review of such violent incidents, in most cases, a troubled youth has demonstrated these behaviors or has talked to others about problems with bullying and feelings of isolation, anger, depression and frustration. These characteristics should serve to alert school administrators, teachers and support staff to address needs of troubled students through meetings with parents, provision of school counseling, guidance and mentoring services, as well as referrals to appropriate community health/social services and law enforcement personnel. Further, such behavior should also provide an early warning signal that safe school plans and crisis prevention/intervention procedures must be in place to protect the health and safety of all school students and staff members so that schools remain safe havens for learning (NSSC, 1998).
- Has a history of tantrums and uncontrollable angry outbursts.
- Characteristically resorts to name calling, cursing or
- Habitually makes violent threats when angry.
- Has previously brought a weapon to school.
- Has a background of serious disciplinary problems at school
and in the community.
- Has a background of drug, alcohol or other substance abuse
- Is on the fringe of his/her peer group with few or no
- Is preoccupied with weapons, explosives or other incendiary
- Has previously been truant, suspended or expelled from
- Displays cruelty to animals.
- Has little or no supervision and support from parents
or a caring adult.
- Has witnessed or been a victim of abuse or neglect in
- Has been bullied and/or bullies or intimidates peers
or younger children.
- Tends to blame others for difficulties and problems s/he
- Consistently prefers TV shows, movies or music expressing
violent themes and acts.
- Prefers reading materials dealing with violent themes,
rituals and abuse.
- Reflects anger, frustration and the dark side of life
in school essays or writing projects.
- Is involved with a gang or an antisocial group on the
fringe of peer acceptance.
- Is often depressed and/or has significant mood swings.
- Has threatened or attempted suicide.
STEP 3: Develop and Test Prevention
Research data and findings from needs assessments, community
surveys, stakeholder interviews, and focus groups are useful
for designing prevention programs. Using these data and findings
is known as an evidence-based approach to program planning.
Once programs are implemented, they are evaluated rigorously
to determine their effectiveness.
The Centers for Disease Control and Prevention, Center for
Injury Prevention and Control (CDC-NCIP) developed Best
Practices of Youth Violence Prevention: A Sourcebook for Community
Action (2002). The goal of this document, which expanded
on the earlier 1993 version, was to share the experience of
those who have successfully intervened in preventing youth
violence. It serves as a blueprint for communities, and the
various agencies and organizations serving the community,
including schools. The strategies outlined in this document
Parent and family based strategies. These are designed
to improve family relationships. There is growing evidence
that these interventions, especially those that start early
and recognize all the factors that influence a family, can
have substantial, longterm effects in reducing violent behavior
by children. Parent and family-based interventions combine
training in parenting skills, education about child development
and the factors that predispose children to violent behavior,
and exercises to help parents develop skills for communicating
with their children and for resolving conflict in nonviolent
ways. This type of intervention is ideal for families with
very young children and for at-risk parents with a child
on the way.
Home visiting strategy. Many European countries
provide home visits to all families, regardless of risk
status. Some advocates have argued that this service should
be made available to all families in the United States,
as well. But home-visiting interventions are resource intensive,
and few communities have the financial and human resources
needed to carry out an effective program on such a large
scale. Therefore, targeting select groups for home-visiting
services is typically most appropriate. A needs assessment
conducted with input from the community will help identify
families who could benefit most from a home-visiting intervention.
Community leaders should play a key role in this decision,
as they are often in a position to direct the allocation
Social Cognitive strategy. Researchers have linked
a lack of social problem-solving skills to youth violence.
When children and adolescents are faced with social situations
for which they are unprepared emotionally and cognitively,
they may respond with aggression or violence. Many assert
that we can improve children's ability to avoid violent
situations and solve problems nonviolently by enhancing
their social relationships with peers, teaching them how
to interpret behavioral cues, and improving their conflict-resolution
skills. Social-cognitive interventions strive to equip children
with the skills they need to deal effectively with difficult
social situations, such as being teased or being the last
one picked to join a team. They build on Albert Bandura's
Social-Cognitive Theory, which posits that children learn
social skills by observing and interacting with parents,
adult relatives and friends, teachers, peers, and others
in the environment, including media role models (Bandura,
1986). Social-cognitive interventions incorporate didactic
teaching, modeling, and role-playing to enhance positive
social interactions, teach nonviolent methods for resolving
conflict, and establish or strengthen nonviolent beliefs
in young people.
Mentoring Strategy. Research has shown that the
presence of a positive adult role model to supervise and
guide a child's behavior is a key protective factor against
violence. The absence of such a role model-whether a parent
or other individual-has been linked to a child's risk for
drug and alcohol use, sexual promiscuity, aggressive or
violent behavior, and inability to maintain stable employment
later in life. Mentoring is the pairing of a young person
with a volunteer who acts as a supportive, nonjudgmental
role model. It has been touted by many as an excellent means
of providing a child or adolescent with a positive adult
influence when such an influence does not otherwise exist.
Evidence has shown that mentoring can significantly improve
school attendance and performance, reduce violent behavior,
decrease the likelihood of drug use, and improve relationships
with friends and parents.
In 2007, the CDC published the Task Force on Community Preventative
Services' systematic review of universal school-based violence
prevention programs. Programs were identified as "universal"
because they were administered to all children in classrooms
regardless of individual risk, not only to those who already
manifested violent or aggressive behavior or those who had
risk factors for these behaviors. The Task force concluded
(CDC, 2007, p. 1):
"The results of this review provided strong evidence
that universal school-based programs decrease rates of violence
and aggressive behavior among school-aged children. Program
effects were demonstrated at all grade levels. An independent
meta-analysis of school-based programs confirmed and supplemented
these findings. On the basis of strong evidence of effectiveness,
the Task Force recommends the use of universal school-based
programs to prevent or reduce violent behavior."
No plan will make a school immune to violence. However, schools
can plan for, and execute, violence prevention strategies
as well as effective responses when prevention efforts are
not effective. A violence prevention and response plan in
place reduces the likelihood of violence and helps schools
respond quickly and effectively to violent incidents that
may occur. Just as the causes of violence in our society,
as well as in our schools, are multi-dimensional, so are the
interventions to reduce or eliminate violence.
Additionally, school violence occurs in a unique context
in every school, making a one-size-fits-all approach ineffective.
No one particular plan for school safety will address the
issues in all schools or for every child. The issues related
to safety in schools is addressed through multiple levels,
including the federal and state governments, the school district,
the specific school, the classroom and individual teachers
The Task Force (CDC, 2007) found additional benefits of such
violence prevention programs:
- Reduced truancy;
- Improvements in school achievement;
- Reduction in "problem behavior";
- Reduced activity levels;
- decreased attention problems;
- Improved social skills;
- Decreased internalization of problems (e.g., anxiety
According to the New York State Center for School Safety
(2001), educational strategies that are promising in reducing
or preventing violence include:
- Social skills development;
- Conflict resolution skills;
- Peer mediation;
- Parental involvement.
STEP 4: Assure Widespread Adoption
Once prevention programs have proven effective, they must
be disseminated. Communities are encouraged to adapt programs
to meet their own needs and to evaluate the program's success.
Dissemination techniques to promote widespread adoption include
training (such as this course you are now completing), technical
assistance, and process evaluation.
A critical method for insuring adoption is to enact laws
governing dissemination of information. The 2000 New York
State SAVE legislation is one such method for insuring adoption
of violence prevention strategies. The SAVE legislation mandated
this course as well as the specific violence prevention strategies
that will be covered later in this course.
Continue on to