Public health approach to violence: Focus on children and adolescents

Dr Asha Pemberton

teenhealth.tt@gmail.com

AS WE begin the New Year, we find ourselves immersed in dialogue surrounding our current societal state and a focus on the public health approach to violence interventions and prevention.

Public health approaches to violence prevention have foundations in exploring root causes, risk factors, mitigating factors and the triggers that precipitate such behaviours in susceptible populations. These must all be grounded in the culture of the society so that strategies are relevant and effective to those affected.

A comprehensive discourse on the public health approach to violence must include exploration into the risk factors which involve children and adolescents. Indeed, the continuation of violent behaviour and recruitment of participants into organisations entrenched in violence largely involves young people.

The public health approach aims to prevent violence before it occurs and promote healthy development across the lifespan and includes a strong emphasis on children and adolescents.

When we consider the paediatric population there are several risk factors which increase the risk of violent behaviour, even in early childhood. These include experiences of child abuse or maltreatment, bullying, peer-related violence and exposure to domestic or interpersonal violence.

The lived experiences of children, particularly if steeped in trauma and violence, increase the risk of these behaviours being repeated in their lives – in childhood and beyond. This principle is the basis of the concept of the inter-generational transmission of violence.

Without specific interventions targeted to this population, strategies directed only toward adults are not likely to lead to sustained changes and improvement in levels of violence in any society.

In addition to exposure-related risk factors, there are intrinsic risk factors in childhood and adolescence which increase the likelihood of violent behaviour. These include mental and emotional health concerns that worsen impulsivity, aggression, substance misuse, and oppositional behaviours.

Several diagnosable mental illnesses involve violent behaviour as direct symptoms or complications. A large percentage of mental health conditions arise during adolescence. This underscores the need to invest in this population, when dialogue surrounding the intersection between mental health and violence arises.

In societies where stigma surrounding mental health, or access to appropriate services, remains a significant challenge, there is again difficulty in effectively tackling this complex issue.

If parents or educators have hesitations in identifying or accepting emerging oppositional or antisocial behaviours, then affected children and adolescents will continue to act these out. First in their homes and schools and then later into wider society.

In addition, if children and youth are identified but for any reason are unable to access consistent, evidence-based and appropriate treatment, they remain under-managed and continue to display these behaviours. Public health interventions to address the symptom of violence must be broad-ranged, accessible and inclusive.

The risk factor of exposure cannot be forgotten. The actions of children and adolescents are largely, but not always, directly related to their environments of origin. Experiences of violence, particularly early in childhood, contribute to adverse childhood experiences (ACEs).

Years of research have consistently demonstrated that ACEs lead to structural and emotional neurobiological changes. These render those affected at a higher risk for not only repeated behaviours, but a host of emotional and physical health concerns. These in turn add to vulnerabilities which, unaddressed, add to their risk.

It is also to be noted that exposure occurs in many ways. Violence found in music and song lyrics, video games, social media and “entertainment” content can have similar effects on the developing minds of children and adolescents. Effective strategies must be holistic and relevant to the current time.

As dire as this all sounds, there is certainly hope all around. There are many protective and mitigating factors which, if identified and enhanced, can reduce the risks of continued violence and prevent vulnerable youth from such engagement.

Emotional well-being lies at the core of many protective factors. Children and adolescents should be taught to develop emotional resilience, which includes positive coping skills, conflict resolution, and strong self-esteem.

A positive self-concept is a strong buffer against the lure of seemingly attractive but negative behaviours. Young people require the confidence to make good and right decisions, despite peer influence.

In addition, children and teens who arise from stable family structures, where parenting practices are fair, consistent and attuned to child development, generally fare much better.

On the family level, there is much parents can do to prevent violence or address it when it emerges. The first step is understanding this complex plague and its many manifestations. Public health approaches must include family and child health approaches which, if consistently applied, offer more hope for the future.