Building Violence Prevention into the Curriculum.

A Physician-Administrator Applies a Public Health Model to Schools

Our problem of violence in America is unlike that of any other developed country. Our homicide rate for young men is four times higher than the next most violent industrialized country in the world, Scotland, and a rate 70 times that of Austria.

The FBI estimates 1.8 million Americans are victims of violence each year (that number excludes most family violence). Each month about 420 children die from gunshot injuries. Each year we spend about $64 billion paying for the costs associated with violence. Each day violence makes us more fearful and resigned.

Many of our public schools, once considered safe, are devastated and destroyed by violence. According to the U.S. Department of Justice, almost 3 million crimes occur on or near school property each year. An estimated 400,000 students were victims of violence at schools in a recent six-month period. Violence is the second leading cause of death for America's students.

The causes of violence in our culture are complicated and deeply embedded. The complex interaction between poverty, racism, drugs and alcohol, the loss of jobs with decent wages in our inner cities, gangs, inadequate handgun regulation, lack of personal opportunity and responsibility, disinvestment in schools and after-school activities, and family violence plays a critical role in our culture of violence.

Our problem with violence does not lend itself to easy solutions. There is no one-shot curriculum that will cure the pervasive violence. What is needed is a commitment from politicians, educators, parents, community leaders, public health professionals, and business leaders to work in their communities to develop a comprehensive, longterm plan to prevent violence.

My frustration with the inadequate response the medical profession gives to treating people with violence-related injuries led me to develop the Violence Prevention Curriculum for Adolescents in 1987 (which I intend to revise in 1994).

As a medical intern, early one morning in one of Boston's teaching hospitals, I stitched up a victim of violence who had been in a party brawl. He warned me I shouldn't go to sleep because the guy who did this to him would be in the emergency department very soon.

If someone had just attempted suicide and threatened to try again, the medical profession would have required me to take action to protect that person. No such protocol existed for a person who threatened to commit another violent act. That experience and the subsequent encounters with victims of violence provided the impetus for me to do something to prevent violence.

Site-Based Plans

The Safe Schools Project of the Pittsburgh Public Schools is an excellent

Model for a multi-disciplinary violence-prevention coalition. Members of the school district, the Jewish Healthcare Foundation, the Western Psychiatric Institute and Clinic, the Center for Injury Research and Control at the University of Pittsburgh, and the Boys and Girls Club of Western Pennsylvania formed a working group that produced a "Blueprint for Violence Reduction" for the district. It is an action plan based on a sound theoretical framework, data collection and analysis, a commitment to understanding the causes of violence, and an analysis of state-of-the-art school violence-prevention programs.

The blueprint contains a review of the project's components and discusses each step thoroughly so it can be replicated in other school districts. The blueprint also includes a set of guiding principles for school-based program implementation:

* Violence prevention must be a long-term priority for the school district;

* Resources should be focused on young children, particularly those at risk of developing aggressive lifestyles;

* Developmentally appropriate programs should be integrated in a comprehensive approach for all grade levels;

* Students, teachers, and parents should participate in planning and assessing violence-prevention activities;

* Activities should be culturally and racially appropriate;

* Prevention efforts should include home, school, and community coordination;

* Program evaluation measures should be integrated into the program design; and

* New programs should be built upon successful existing programs.

Many school-based strategies designed to reduce violence are developed and implemented using a public health model. Public health practitioners and school personnel have a longstanding alliance in working to protect the health of students.

Together, they have designed and implemented proactive prevention programs like vision, hearing, and tuberculosis screening and disease vaccination. Prevention is also a focus in health education classes, where students are taught about fitness, human reproduction, nutrition, and substance abuse.

In this setting we can use public health strategies to prevent violence, drawing on our country's experience with anti-smoking campaigns. Typically, public health efforts follow a three-pronged approach. First, they look at changing attitudes toward the problem, then they help people modify unhealthy behaviors, and finally they reach out with treatment options for those afflicted with a disease. The following analogy between anti-smoking and violence-prevention efforts clarify these common goals.

Early Intervention 

Anti-smoking campaigns are designed and implemented to counter the glamorous view of smoking by focusing on the dangers of smoking (cancer and even death). The idea is to generate a negative view of smoking to keep people from starting to smoke or to prompt them to quit. Violence-prevention programs similarly deglamorize and redefine the violent "hero" and introduce an alternative notion of power, namely, non-violent problem solving. These programs may examine mass media messages that realistically portray the effects of violence and reinforce the concept that it is not a smart way to solve problems.

For anti-smoking campaigns, the next step is to get people to quit through behavior modification programs or therapy, which teach people alternatives to try whenever they feel the urge to "light up." In violence-prevention efforts, the next step is to employ behavioral programs for children at risk of violence, such as those who were fighting at school or suspended from school.

Public health campaigns also address the health needs of the sick population. As part of any extensive antismoking campaign, some effort is directed toward smokers who contract cancer and require surgery or chemotherapy. Likewise, for violence-prevention efforts, part of the campaign also should address the needs of violent offenders by offering rehabilitation programs to incarcerated violent offenders.

In violence prevention as in lung-cancer prevention, early intervention is safer, preferable, and more cost-effective. It is better to teach students conflict-resolution skills and non-violent methods of dealing with anger or not to smoke than to run programs in treatment facilities or perform surgery to remove a lung. In general, the later the intervention, the costlier the treatment Options.

Prevention Efforts

Public schools offer communities the most logical and accessible intervention point to reach our most at-risk student populations. Many curriculums are marketed and used within our public schools with varying success. Most are highly dependent on the devotion of a small group of teachers or parents who spend a great deal of time and energy in promoting a prevention curriculum to school administrators, other teachers, and students. Other efforts, like the Resolving Conflict Creatively program in New York City, require a programmatic buy-in from the entire school system.

Many public health and education academics have criticized stand-alone prevention curriculums as ineffective in preventing violence. These critics are right. A 10-module curriculum taught in 10th grade is not enough to provide long-term measurable change in youth attitudes and behavior.

These efforts should not be demeaned, however, as they are often a school's first step in acknowledging and treating violence as a preventable problem.

One Purpose

The Violence Prevention Curriculum for Adolescents is designed to raise adolescents' threshold for violence by creating a non-violent ethos within the classroom. It focuses on extending a student's repertoire of responses to anger. While it acknowledges the existence of societal and institutional violence and institutional racism, students are encouraged not to react passively, but to accept their anger and become intentional and creative about their responses to it.

In the curriculum, anger is presented as a normal, essential, and potentially constructive emotion. Creative alternatives to fighting are stressed. The classroom discussion during one session focuses on good and bad results of fighting. The students list the results of each. The list of bad results is invariably longer than the good list, thus students begin to see the need for alternatives.

The exercise emphasizes that fighting or not fighting is a choice and that the potential consequences are important to consider when making the choice.

Central Challenge

The school administrator plays a crucial role in developing an effective school-based violence-prevention program. Ideally, the administrator is the lead agent coalescing the various community groups necessary to build a successful program.

A comprehensive program requires the buy-in from diverse groups of people including political funding authorities, school boards or commissions, students, teachers, academics, business leaders, the news media, and foundation representatives. Once a program is designed and approved, the administrator must seek additional funds to ensure adequate training and implementation.

An ideal school systemwide violence-prevention program may include:

* teaching social skills including problem solving (including a companion course for parents);

* a peer-mentoring program;

* conflict-resolution programs;

* after-school activities;

* parenting courses;

* early intervention programs for Head Start children and for victims and witnesses of violence;

* dating-violence intervention program;

* parenting courses for teens;

* extended school hours to offer a community safe-haven;

* gang-and drug-prevention programs;

* mentoring and job training programs; and

* peer-leadership and peer-mediation programs.

General Improvement

We must develop violence-prevention strategies, but we should not overlook the most logical violence-prevention strategy for schools: to improve the learning environment and the academic achievement of students. Extra attention must be given to the needs of the African-American male student who is at greatest risk for becoming another homicide statistic in America.

That extra attention should translate into academic help for at-risk students in learning cognitive skills for reasoning, weighing consequences, and making considered choices, the very skills that can help resolve problems and conflict. Children generally develop these cognitive skills while studying English, social studies, math, and science. These skills help them reason their way through the stressful and conflict-laden situations that life presents.

Research and personal experience confirms that students with superior language skills and analytic abilities are less likely to use force to persuade and more likely to use creative and intellectual exercises to imagine and respect differing viewpoints. They also are able to envision the consequences of certain actions and to have developed more concrete options for dealing with conflict. All adolescents from poor urban areas are at risk for violence, but those who have been taught to think decisions through clearly are less at risk than others.

We must ensure that every child is given the support and encouragement to meet with success. Research shows that smaller schools with strong principals, where discipline is fair but firm, where teachers are imbued with high expectations for every child, and where parents are drawn into the educational orbit are schools where learning takes place.

Many adults blame children personally for their failure to learn. Most teachers agree that every child begins first grade excited and hungry to learn. This is as true for black children as for white, as true for boys as for girls. All children want to learn, but poor black children, especially black males, too often encounter circumstances that dampen and then kill their excitement.

Renewed Faith

Teachers and teen-agers using peermediation and violence-prevention classroom materials tell numerous success stories. One peer educator involved in the Boston Violence Prevention Program told about using his violence-prevention training in a potentially life-threatening confrontation.

A young man insulted him on a street in Boston. The peer educator's typical response would have required him to fight. Instead, he turned and walked away--realizing he may be shot or knifed. He described how later that day, the other young man and he met, talked, and ended up playing basketball together.

Stories like this give me renewed hope and commitment to my violence-prevention efforts. It took us 30 years to reduce smoking in America and 10 to 15 years to reduce drunk driving. It may take even longer to prevent violence, but I urge you as school administrators to join in this effort. We must get started.

Deborah Prothrow-Stith, author of Deadly Consequences, directs violence-prevention programs at the Harvard injury Control Center. She acknowledges the help of Sher Quaday, assistant director of violence-prevention programs at the Harvard School of Public Health, in preparing this article.