Prevention is the act or process of reducing or eliminating a problem. The development, evaluation, and dissemination of effective prevention programs are critical to ongoing efforts to address the causes and correlates of interpersonal violence, particularly those with origins in childhood and adolescence. Prevention programs or strategies to prevent or reduce interpersonal violence include those targeting intimate partner violence, child maltreatment, bullying, gang violence, the impact of witnessing violence on children, and violence-related problems (e.g., drug and alcohol use, delinquency).
Universal prevention (also known as primary prevention) refers to population-directed activities or strategies to address a problem that has been defined as a concern to an entire population (e.g., a public health problem). Universal prevention efforts to address interpersonal violence have included public service advertisements, general violence prevention, and ant bullying programs in schools. Selective, or secondary, prevention refers to programs or efforts directed at preventing or ameliorating difficulties among a subgroup of the population that is defined as high-risk on a selected characteristic. Programs to prevent child maltreatment have often focused on the selective level of intervention by targeting parents identified as at risk for child abuse and neglect (e.g., teen parents, parents aging out of foster placement, or those who had formerly been victims or witnesses to abuse). Indicated, or tertiary, prevention, sometimes referred to as early intervention, encompasses programs or strategies that aim to ameliorate difficulties or prevent the growth of problems among those already defined as exhibiting the target problem. Examples of indicated prevention programs include advocacy interventions for battered women, programs or strategies to prevent further escalation of aggressive behavior among children identified as aggressive by teachers or parents, or family preservation programs to improve caregiving and parent–child relationships in families with histories of child maltreatment and foster placement.
The Context Of Prevention
Attention to prevention dates back thousands of years to Hippocrates, who asserted that “the function of protecting and developing health must rank even above that of restoring it when it is impaired.” The field of prevention, and violence prevention in particular, has been informed by developmental research revealing the childhood or adolescent roots of later problem behavior. For this reason, many prevention efforts are directed at children and youth and are implemented in school or afterschool contexts. Workplace prevention programs for adults have also increasingly been used to address issues related to interpersonal violence, such as sexual harassment and intimate partner violence.
There is increasing interest, partially created through interdisciplinary dialog among those engaging in prevention (e.g., social work, psychology, public health, and medicine), in the weaving of health promotion, resilience, strengths-based, and empowerment concepts into prevention programming. This interest has resulted in a shift away from deficit or disease-based models of prevention and toward positive goals (e.g., promoting healthy development), outcomes (e.g., measurement of adaptive behaviors to supplement symptom-based measurement), and methods (e.g., focusing on nurturing positive skills in addition to reducing negative behaviors).
Characteristics Of Effective Prevention Programs
Research has enabled the delineation of core characteristics of program content, structure, and delivery in effective prevention programs. Such programs have a theory of etiology and/or change (i.e., a theoretical perspective on the causes of the problem and how the intervention is expected to change participants’ behavior, attitudes, and/or norms). They specify clear goals, and target problems for change (e.g., behaviors, attitudes, and norms related to dating violence) but use multicomponent interventions that cross contexts (e.g., school, home) and implement different intervention strategies or teaching methods (e.g., role-play, media, mentoring) to build skills to address the target behavior or problem. Successful prevention programs are of sufficient duration and intensity to produce change and may include booster or follow-up session(s) to maintain and consolidate change. These programs meet the developmental and sociocultural needs of participants by their appropriate developmental timing and their tailoring to the cultural and contextual needs of the target community. An emerging literature documents the ways in which programs can effectively be adapted to meet the needs of different cultural groups, although many research-based prevention programs remain to be validated with diverse, particularly immigrant, populations. Program participants and representatives of the community are involved in the program planning and implementation of effective interventions. Prevention program staffs are appropriately trained, supported, and supervised so that the intervention can be delivered as intended. Finally, effective prevention programs build on developmental assets (factors that promote competence in all individuals) by promoting self-regulation (e.g., managing emotions, behavior) and healthy, supportive relationships within and among program participants and facilitators.
Prevention programs are considered evidence-based when there is clear empirical evidence for their effectiveness in reducing or eliminating the target problem behavior or risk factor (e.g., incidents of bullying or episodes of intimate partner violence) or in strengthening the target positive behavior or protective factor (e.g., nonviolent conflict resolution, positive parenting). There is an increasing literature on the effectiveness of prevention programs, and several national databases operate to evaluate and provide information on those prevention programs considered effective, model, or promising with regard to reducing interpersonal violence and related risk behaviors. Databases include the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, and the University of Colorado’s Center for the Study and Prevention of Violence, Blueprints for Violence Prevention project. The Centers for Disease Control and Prevention provides information on prevention strategies with regard to intimate partner violence specifically.
Prevention Research Concepts
In recent years, applications of prevention within the social sciences have resulted in the emerging field of prevention science, which studies the development, evaluation, implementation, and widespread dissemination of research-based prevention programs to address psychosocial problems. There is increasing consensus within and beyond the field of prevention science that the gold standard for proof of the efficacy or effectiveness of a program is the randomized controlled trial (RCT). In RCTs, participants in the program or “treatment condition” are randomly assigned to either the prevention program or a control group (usually an existing standard of care and sometimes a delayed intervention group). However, some interventions may not be amenable to a randomized control trial for either ethical or practical considerations. In these cases, quasiexperimental evaluations of the intervention’s effectiveness (comparing participants in a prevention program with a comparable, nonrandom sample not receiving the intervention) may be implemented. The stringent criteria for proof of effectiveness have resulted in a relatively small number of prevention programs deemed effective or model programs, but the process of evaluation has proven to be extremely important in understanding what prevention strategies are key to changing behaviors such as interpersonal violence and to understanding the mechanisms of change.
Longitudinal research on prevention is necessary to understand factors that may mediate or moderate the effectiveness of an intervention (e.g., age, gender, context) and to understand how the effects of a prevention program may wax or wane over time. In some cases, prevention programs have been shown to have cascade effects over time, that is, the reduction in the target problem behavior subsequently improves related positive outcomes and/or reduces the occurrence of other negative outcomes. For example, in the Nurse–Family Partnership program—an effective home-visiting program developed by David Olds and colleagues, aimed at reducing child abuse among young mothers—those who participated in the intervention during their pregnancy and first 2 years of motherhood were significantly less likely to abuse their children. In addition, over the 15 to 20 years following the families’ involvement in the program, their children were more likely to complete high school and were engaged in fewer risk behaviors, including interpersonal violence, drugs, and risky sexual behaviors. Interestingly, however, in a 2002 article in the Journal of the American Medical Association, Olds and his colleagues reported that domestic violence was a negative moderator of the intervention effects (i.e., that the intervention was less effective in families with ongoing domestic violence).
Challenges And Emerging Issues
Although an increasing number of effective universal violence prevention programs are available and utilized in school and community settings, there is a dearth of evidence-based selective or indicated prevention programs for victims and witnesses of interpersonal violence. Various federal initiatives, such as the U.S. Department of Justice’s Safe Start and the Substance Abuse and Mental Health Services Administration’s National Child Traumatic Stress Network, aim to raise the standard of care for children exposed to violence and related traumatic stressors by developing and disseminating such programs.
A key set of challenges for evidence-based prevention programs is their implementation and widespread dissemination in community settings (particularly in nontraditional care systems serving those exposed to interpersonal violence, such as shelters). Taking an efficacious program from the controlled research environment in which it has been developed to a broader scale requires an adequate infrastructure for its delivery (i.e., interested stakeholder organizations, rigorous staff training and supervision, implementation of the prevention program with fidelity to the model, and the ability of program staff to engage and retain participants and to attract sustainable funding). Prevention researchers are increasingly attempting to answer questions about the factors involved in taking programs to statewide and nationwide scale. Other emerging questions in prevention relate to increasing client engagement in prevention programming and tailoring programs to meet the unique needs and preferences of participants of diverse groups of participants.
- Aos, S., Lieb, R., Mayfield, J., Miller, M., & Pennucci, A. (2004, July). Benefits and costs of prevention and early intervention programs for youth (Document ID: 04-07- 3901). Available at http://www.wsipp.wa.gov/ReportFile/881/Wsipp_Benefits-and-Costs-of-Prevention-and-Early-Intervention-Programs-for-Youth_Summary-Report.pdf
- Flay, B., Biglan, A., Boruch, R. F., Castro, F. G., Gottfredson, D., Kellam, S., et al. (2005). Standards of evidence: Criteria for efficacy, effectiveness, and dissemination. Prevention Science, 6(3), 151–172.
- Mihalic, S., Fagan, A., Irwin, K., Ballard, D., & Elliott, D. (2004, July). Blueprints for violence prevention (No. NCJ 204274). Washington, DC: Office of Juvenile Justice and Delinquency Prevention. Retrieved from https://www.ncjrs.gov/pdffiles1/ojjdp/204274.pdf
- National Center for Injury Prevention and Control, Division of Violence Prevention. (2007). Intimate Partner Violence: Prevention Strategies. Available at https://www.cdc.gov/violenceprevention/intimatepartnerviolence/prevention.html
- Perry, C. L. (1999). Creating health behavior change: How to develop community-wide programs for youth. Thousand Oaks, CA: Sage.
- National Institute of Drug Abuse. Preventing Drug Use among Children and Adolescents. https://www.drugabuse.gov/publications/preventing-drug-abuse-among-children-adolescents/acknowledgments
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