In the last century, the United States addressed the nation’s high incidence of tooth decay by adding fluoride to the water supply, encouraging families to brush and floss daily and to see their dentists regularly. Oral health improved dramatically — and the success of this program indicates a similar multi-pronged approach could work to end another pervasive social ill: chronic violence, according to Kenneth A. Dodge, PhD, director of the Center for Child and Family Policy at Duke University.

“Can we envision a fluoride-in-the-water policy for preventing chronic violence?” Dodge asked attendees during a plenary session at the National Summit on Interpersonal Violence and Abuse Across the Lifespan, Feb. 24–26, in Dallas.

Nearly 350 researchers, clinicians, advocates and students from the fields of psychology, social work, sociology, criminal justice, medicine and public health attended the summit, sponsored by the National Partnership to End Interpersonal Violence Across the Lifespan (NPEIV), a group of more than 150 state, regional and national organizations — including APA. The group was formed two years ago in response to an APA presidential initiative addressing violence against women and children, launched by APA’s 2008 president, Alan Kazdin, PhD. The initiative, and a 2008 APA Summit on violence and abuse in relationships, identified the need for a multidisciplinary think tank to lead public awareness initiatives around the issue, said Robert Geffner, PhD, and Jacquelyn White, PhD, NPEIV’s co-chairs.

At this latest summit, speakers explored the gaps in research on interpersonal violence and its effect on minorities and other vulnerable populations, as well as the role of substance abuse in violence. They also discussed successful interventions to help people exposed to violence. They unveiled a series of books examining research and emerging priorities in the field of violence against women and children, due out this fall, and a new APA journal, Psychology of Violence, which will debut next year. They also proposed solutions to help the country address violence in a systematic way, including through the development of a federally funded national institute on interpersonal violence. The National Institutes of Health, for example, includes more than 25 institutes and centers on a variety of public health issues, and almost every one has programs that touch on violence, said summit co-chair Kazdin, who directs the Yale Parenting Center and Child Conduct Clinic. It’s time to bring that work together, he said.

“We need a clearinghouse of all of this information and a place to set priorities,” Kazdin said, urging attendees to join him in advocating for a more streamlined focus on violence in the United States. “It’s time do something together that has a national impact.”

Melba J.T. Vasquez, PhD, president-elect of APA, agreed, adding that approximately 2 million people are victims of interpersonal violence each year.

“Interpersonal violence leaves a devastating impact on women, men and children of every background and social class,” said Vasquez, an independent practitioner in Austin, Texas. “As psychologists, mental health providers and researchers, we have the ability to influence research, policy and treatment.”

A multi-level approach

School systems will be a key route to addressing interpersonal violence, Dodge said, and such programs are especially effective if children receive instruction in goal-setting and impulse management throughout their school years. Parental support and community collaboration on these character education goals are also key to programs’ success. Students’ progress would be rigorously measured and educators held accountable through tests similar to those used to gauge math and reading abilities.

“We wouldn’t take an 18-year-old child in this country who couldn’t read and say, ‘You must belong in prison,’ as we do with chronically violent adolescents,” Dodge said.

A pilot intervention Dodge and his colleagues began testing 20 years ago provides an example of how this public education model might work. The researchers randomly assigned kindergartners at risk for chronic violence to a 10-year program that helped the kids learn how to manage impulses and negotiate disputes and taught parents how to manage anger and model self-control. They followed the participants into young adulthood and found that those who were assigned to the intervention reported fewer visits to the emergency room and a 48 percent reduction in arrests for severe violence such as murder and rape compared with those who were not given the training. The intervention also reduced the prevalence of conduct disorder among this group by 52 percent, Dodge said.

The results, he said, also show the danger of governmental efforts that define aggressive children and teens as “super predators” or “permanently broken” and point to the need to use science to inform the development of youth violence interventions.

“The metaphors used to characterize adolescent offenders have been ‘incite-ful’ but not insightful,” Dodge said. “We have an ethical responsibility as scientists, professionals and leaders to understand the words we use and to become as accurate as possible.”

Interventions that work

If at-risk youth are often labeled as hoodlums by our legal system, it’s no surprise that we often consider violent criminals as essentially untreatable, said David Kennedy, an anthropology professor at John Jay College of Criminal Justice. Kennedy has helped more than a dozen cities, including Baltimore, Cincinnati and Washington, D.C., implement a radical approach to reducing gang violence. In addition to arresting the person responsible for a shooting or other crime, Kennedy encourages police to instill a sense of group responsibility for every violent incident. He teaches police forces to abandon their heavy-handed ways and meet with these gang members to talk about the needs of the community and provide information on job training and mentorship. He also encourages community members — particularly well-known and respected local figures such as ministers, mothers and even ex-offenders — to speak out against the violence and remind gang members of their role as valuable members of society.

When Kennedy implemented his program in Boston in 1996, within a year, the city saw a 63 percent decline in youth homicides in the Roxbury neighborhood, the city’s highest-risk police district.

“All of this works because we’re talking to them,” Kennedy said. “We’re learning that, although we can’t necessarily see it, no one likes the violence.”

Summit speakers also proposed solutions to aid the most innocent victims of interpersonal violence — children. Nearly 30 percent of children witness intimate-partner violence in the home each year, and while some of them prove to be resilient and go on to lead healthy lives, many remain at-risk for developing emotional and social problems, said University of Michigan psychology professor Sandra Graham-Bermann, PhD. They may blame themselves for fighting with adults in their lives or view violence as an acceptable way to solve problems, she said.

To help kids learn new strategies for problem-solving and coping with violence exposure, Graham-Bermann developed the Kids’ Club program, a community-based intervention for children and moms exposed to domestic violence. The club helps the children address family violence through stories, films, drawings and puppet plays, Graham-Bermann said. The mothers meet in a separate group to share concerns and learn parenting skills to help their children improve their attitudes and beliefs around violence. Research on the intervention, which has spread to 26 states, shows that it reduces aggression, anxiety and trauma in children exposed to violence, she said.

“The bottom line is, if you really want to help kids, help their moms,” Graham-Bermann said. “If you can improve parenting and, with that, a child’s coping skills, that kind of change will last.”

Interpersonal violence is also a key topic at the NPEIV-sponsored 15th Annual Conference on Violence, Abuse and Trauma, Sept. 12–15, in San Diego. For more information, visit the IVAT Web site.

Amy Novotney is a writer in Chicago.