Prevention—not more prisons and school detentions—is the answer to solving the growing problem of youth violence. Building on that theme, members of the Commission for the Prevention of Youth Violence, which represents 10 prominent health care groups including APA, called on their colleagues last month to advocate for measures that can protect youth in their communities from violence.

"Violence in America can and must be prevented. We are calling on the health care professionals who repair the bodies and lives of victims of violence to play an active role in this crusade," said Howard Spivak, M.D., chair of the Task Force on Violence of the American Academy of Pediatrics, at a press briefing last month.

Commission members representing medicine, public health, and nursing (see box below) signed a four-part pledge on behalf of their organizations to become involved in the community, put youth violence prevention strategies into practice, become educated about youth violence prevention and intervention, and advocate for youth violence prevention programs.

U.S. Surgeon General David Satcher, M.D., who has made this area a crucial element of his agenda, also pledged his support of the four principles.

The commissioners identified seven critical goals to combat youth violence successfully:

• To support the development of healthy families.

• To promote healthy communities.

• To enhance services to identify children, youth, and families at risk and provide intervention.

• To increase access to health and mental health services.

• To reduce youth access to and risk from firearms.

• To reduce exposure to media violence.

• To ensure national support and advocacy for solutions to violence through research, public policy, legislation, and funding.

To achieve these objectives, the commissioners recommended several strategies. To increase access to health and mental health services, they suggested that all children and adolescents in the United States have health insurance and parity for mental health services.

David Fassler, M.D., chair of the APA Council on Children, Adolescents, and Their Families and APA’s representative on the commission, told Psychiatric News that he is "pleased with the report’s emphasis on early intervention and access to comprehensive mental health evaluation and treatment services. The report also clearly states that parity is essential to reducing barriers to mental health services."

The commissioners urge health and mental health professionals to work closely with the juvenile justice and school systems, community groups, and others to prevent problem behaviors and identify and treat at-risk populations.

Fassler added, "I am also pleased that among the recommendations to promote healthy communities is increased funding for comprehensive and coordinated school health and mental health services."

Marilyn Benoit, M.D., president of the American Academy of Child and Adolescent Psychiatry (AACAP), said at the briefing that early intervention is critical for children and families involved in or at risk for violence.

"We have learned that violence begets violence. We recommend funding for long-term prevention, education, screening, and treatment programs in the community for children and adolescents at risk for psychiatric illness, abuse, neglect, alcohol and other drug abuse, violence, and other potentially dangerous behaviors," Benoit said.

She suggested that prevention would result in considerable cost savings to the health care system. The estimated medical cost of treating injuries from domestic violence is $44 million annually, the report points out, while the cost of treating firearm injuries is between $1 billion and $4 billion annually, and the cost of treating child abuse and neglect is more than $500 million annually.

Fassler said the report is a useful tool for collaborating with other organizations and implementing the recommendations and initiatives. The commissioners emphasize that meaningful social change will be accomplished only if there is a concerted multidisciplinary effort at the community and national level.

The commission was established in October 1999 with funding from the Robert Wood Johnson Foundation. Its report is based on the commissioners’ understanding of the causes of violence, the scientific literature, and selected testimony from community advocates, concerned citizens, and youth representatives, according to the commissioners.

The report of the Commission for Prevention of Youth Violence is available on the Web at www.ama-assn.org/ama/upload/mm/386/fullreport.pdf. ▪