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Social Process Theory and Juvenile Violence
Those who have come in conflict with the law cannot be said to be contributing to a sustainable future for their generation's young people or the population at large. If, on the other hand, punishment resulted in lower reoffending rates, did not increase the likelihood of offenders becoming more violent, did not exacerbate physical and emotional trauma often suffered by offenders, among other harmful results that punishment can produce, then many of us might have few objections to expanding its already widespread use. But this is not the case at all. Studies abound on the iatrogenic effects of incarceration and there remains little empirical evidence or professional consensus on the ability of prisons to substantially reduce reoffending rates and improves public safety. In the American juvenile justice system these circumstances are magnified, because secure confinement (or prison) is to be a measure of last resort. All other available measures, such as diversion, probation, or court-ordered treatment, are to be exhausted prior to consideration of a sentence of secure confinement. Yet, juvenile incarceration rates in the U.S. tell a very different story.
Faced with any type of social ill, society often has numerous approaches or strategies at its disposal to try to ameliorate or eliminate the problem at hand. Aside from doing nothing, which is hardly a viable alternative, approaches can range from the humane to the draconian. But not all approaches can be considered sustainable. The world is ripe with examples of unsustainable approaches to social, economic, health, and other problems that have in many cases exacerbated the very problems that they were set out to remedy. In the case of criminal violence perpetrated by young people, a serious problem that faces all societies (Siegel, 2002) and one that poses an immediate and long-lasting threat to the sustainability of communities, cities, and regions through the victimization, fear, urban decay, and other negative impacts that it engenders, the approach that is taken has important implications for a sustainable society.
A society that relies solely on punishing in the form of incarceration its young people who have come in conflict with the law cannot be said to be contributing to a sustainable future for its young people or the population at large (Siegel, 2002). If, on the other hand, punishment resulted in lower reoffending rates, did not increase the likelihood of offenders becoming more violent, did not exacerbate physical and emotional trauma often suffered by offenders, among other harmful results that punishment can produce, then many of us might have few objections to expanding its already widespread use (Siegel, 2002). But this is not the case at all. Studies abound on the iatrogenic effects of incarceration and there remains little empirical evidence or professional consensus on the ability of prisons to substantially reduce reoffending rates and improves public safety. It is a reality that the juvenile justice system in the U.S., as it presently functions, represents an unsustainable approach to the prevention of juvenile violence (and juvenile crime in general). This is not to suggest that the juvenile justice system is wholly ineffective and is a complete waste of taxpayer dollars and thus should be disbanded. Rather, its increasingly punitive nature in recent years, in dealing with juvenile violence that are at the heart of the problem. The justice system stands as a reactive system, one that is waiting to deal with young people who violate the law and to try to prevent the reoccurrence of law violating behavior, largely through the control and management of the offender population (Siegel, 2002). These are necessary and important functions, but they are far from enough to turn the tide on juvenile crime in the U.S., let alone the more acute problem of juvenile violence. One approach to addressing the problem of juvenile violence that has garnered much attention and support over the last two decades, mostly in the U.S., is a public health approach (Siegel, 2002). This approach is seen not so much as a challenger to law and order, but rather as a complement to it -- part of an effort to create a more balanced and comprehensive strategy in reducing juvenile violence.
Public health brings a focus on primary prevention; that is, prevention in the first instance, well before a young person has committed a violent act. The juvenile justice system is comprised of three main components: law enforcement, the courts, and corrections, which can also include probation and parole or aftercare. This is the same for the criminal justice system, which deals with adult offenders and youthful offenders who have been transferred from juvenile court (Siegel, 2002). The juvenile justice system provides young people with a further set of legal and social protections that are not available in the adult justice system, such as not being allowed to be identified in the press and a higher level of parental involvement throughout the proceedings. At the heart of these extra safeguards is the belief that the primary purpose of the juvenile system is protection and treatment, while in the adult system it is punishment of the guilty (Siegel et al., 2003, p. 379).
The prevention of criminal violence by young people is one of the chief concerns of the juvenile system. From a public health perspective a justice system response is considered largely a form of tertiary prevention. This response is neither about preventing violence in the first instance (before the onset of violent offending), for example, through early childhood programs (primary prevention) nor intervening with young people who are at higher levels of risk for involvement in violence because of, for example, their association with antisocial peers or the use of illicit substances (secondary prevention). Rather, a justice response to violence involves dealing with the young person after the fact; that is, once an offense has been committed, once someone has been victimized (Gabor, 1996). The one exception to the justice system being solely a form of tertiary prevention is when the police intervene with high risk young people by way of giving them a warning or participating in various violence prevention programs in schools, public housing communities, and other settings. But, when violent offending is the subject, as it is here, a justice response has come to be known as interventions on the part of courts and corrections: interventions of the last resort.
Some smaller-scale, experimental studies designed to text the efficacy of juvenile correctional treatment programs in prisons compared to usual services provided to juveniles in these settings (e.g., drug counseling), demonstrate that a focus on treatment can produce modest to substantial reductions in recidivism rates (Gabor, 1996).
In a meta-analysis involving 83 evaluation studies of these types of programs and focused on serious and violent juvenile offenders, it was found that treatment for institutionalized juveniles, compared to the usual services, reduced recidivism rates by about nine percent (Gabor, 1996). The most effective of treatment programs for institutionalized juveniles, compared to the usual services, reduced recidivism rates by as much as 40 percent. Just locking up violent juvenile offenders seemingly pays few dividends to society. When incarceration is required, treatment programs, some types more than others, can improve the life chances of juveniles upon return to the community (Gabor, 1996). Correctional facilities with a special focus on treatment may also be creating a safer and healthier environment for juvenile offenders. Still, however, incarceration is an after-the-fact response, the last resort to dealing with juvenile violence. Is there a more effective, humane, and sustainable approach? In the next two sections the role of public health in preventing juvenile criminal violence is explored. Why has the health community shown an interest in criminal violence and, specifically, juvenile criminal violence? One of the first reasons for this interest is that the "study of mortality and injury is an obvious concern of public health specialists, even where injuries are inflicted deliberately" (Gabor et al., 1996, p. 318).
Also, public health perceives intentional criminal violence as more of a "social" rather than "criminal justice" problem. This is because the majority of criminal violence and resulting deaths and injuries take place among family members or acquaintances (e.g., domestic violence, dating violence, school fights). These are problems that are in many ways beyond the reach of the criminal justice system working alone. In the U.S., where the interest of public health in criminal violence has been the strongest (see below for a comparison with other industrialized countries), public health's interest has also been marked by homicide becoming a leading cause of death in the last two decades. In 1999, homicide was the second leading cause of death among young people between the ages of 15 and 24; for African Americans in this age group and in the 25 to 34 age group, it was the leading cause of death.
In a recent article titled "Murder and Medicine", Harris and his colleagues (2002) found that advances in emergency medical technology and care (e.g., development of 911 call system and trauma units at hospitals, improved training for medical technicians) over the last four decades in the U.S. have played an important role in increasing the chances that a victim of a violent criminal assault will not end up dying. They estimated that the lethality of violent assaults (i.e., assaults resulting in homicides) decreased over this time period by 2.5 to 4.5 percent per year (Harris, 2002).
This is just one example of the many contributions that the health community has made to a safer, more sustainable society. What follows are a number of primary and secondary prevention measures that public health providers are engaged in to reduce juvenile criminal violence. Primary prevention involves efforts to prevent violent behavior before it occurs; that is, before any signs of it become evident. It aims positively to influence the early risk factors or "root causes" of later delinquency or violent behavior. Some of the major risk factors that health care providers can help to address include: early childhood behavior problems (e.g., aggressiveness towards parents, acting out in school), poor child rearing methods (e.g. poor parental supervision, harsh or inconsistent discipline), low socioeconomic status, and poor school performance or school failure (Rivara & Farrington, 1995). Pediatricians, family physicians, and health nurses, are among the many health care providers that are involved in primary prevention.
According to Rivara and Farrington (1995), pediatricians can play a particularly important role in primary prevention approaches, because they "are likely to be the professionals who have the most contact with the greatest number of young children and their families. Few children and their parents at that stage have contact with helpful social service agencies and many of those at greatest risk have few effective advocates other than their physician." Much of the pediatrician's role in helping to address some of the above risk factors involves: first, gauging the level of risk through a detailed family history and regular screening for specific problems; and, second, through the provision of advice and educational information, such as parenting tips and links to community resources (Rivara & Farrington, 1995). Health nurses can also play a key role in primary prevention approaches. One way is through the provision of family support for new mothers and their children in the form of home visits. The only home visitation program with a long-term follow-up of juvenile offending is the Prenatal/Early Infancy Project (PEIP), which was started in Elmira, New York, in the early 1980s (Rivara & Farrington, 1995).
The program targeted first-time mothers-to-be who had at least one of the following high risk characteristics prone to health and developmental problems in infancy: under 19 years of age, unmarried, or low socioeconomic status. In all, 400 women were enrolled in the program. The mothers-to-be received home visits from health nurses during pregnancy and during the first two years of the child's life. Each home visit lasted about one and one-quarter hours and the mothers were visited on average every two weeks. The nurses gave advice to the mothers about care of the child, infant development, and the importance of proper nutrition and avoiding smoking and drinking during pregnancy. A randomized-experimental design was used to evaluate the program's impact on a number of outcomes. Fifteen years after the program started, children of the mothers who received home visits had half as many arrests as their control counterparts who did not receive home visits (Rivara & Farrington, 1995). It was also found that the experimental children, compared to the controls, had fewer convictions and violations of probation, were less likely to run away from home, and were less likely to drink alcohol Secondary prevention is distinguished from primary prevention by its targeted interventions at older children and adolescents who show signs of involvement in antisocial behavior or possess related risk factors (e.g., use of illicit substances, carrying firearms, associating with delinquent peers).
The above example of advances in emergency medical care that helped to improve the life chances of victims of violent assaults is a form of secondary prevention. Emergency room workers must resort to secondary intervention strategies because they are faced with a person at considerable risk for future morbidity or mortality resulting from violence. But this is not limited to dealing with the physical and emotional trauma suffered by victims of violence. Schools are a particularly important setting in which health care providers are often directly involved in secondary prevention efforts to reduce juvenile criminal violence (Larson, 1994). These efforts almost always involve collaborations with teachers or school counselors and focus on, but are not limited to, students who have been involved in fights or bullying at school or suspended from school. Violence prevention curriculum as part of health education classes is one type of program that has received much attention in recent years in the U.S. In one program that was implemented in a number of urban high schools across the country, the curriculum was designed to do five main things over the course of ten sessions: (1) provide statistical information on adolescent violence and homicide; (2) present anger as a normal, potentially constructive emotion; (3) create a need in the students for alternatives to fighting by discussing the potential gains and losses from fighting; (4) have students analyze the precursors to a fight and practice avoiding fights using role-play and videotape; and (5) create a classroom ethos that is nonviolent and values violence prevention behavior. An evaluation of the program showed that fighting had been significantly reduced among the young people who attended the sessions compared to a control group that did not receive the curriculum (Larson, 1994)