Public health model brings new tools for violence prevention in the Caribbean

By Jillian Slutzker

April 26, 2017

Q&A with Debra Wahlberg, Chief of Party for the USAID-funded Community, Family and Youth Resilience Program

Debra Wahlberg (center), Chief of Party for the Community, Family and Youth Resilience program speaks with Christopher Cushing, USAID Mission Director for the Eastern and Southern Caribbean, and USAID Development Outreach and Communications Specialist Carol Gaskin at a program launch event. Photo by Jillian Slutzker

When it comes to preventing violence and building resilience, a one-size approach does not fit all.

Working in three Eastern and Southern Caribbean states, the Community, Family and Youth Resilience program is using evidence-based diagnostic tools to assess youth risk levels for crime and violence and develop targeted interventions to support prevention, intervention or reintegration.

Known as the public health model, this approach matches appropriate “treatment” to an individual’s level of risk or vulnerability. It focuses on targeting intervention activities across three risk-differentiated groups—including the general population of youth in at-risk area, youth at the highest risk for violence, and youth offenders— and serves as a complement to criminal justice interventions.

Funded by the U.S. Agency for International Development, the program also seeks to improve the ability of national and local government, community-based family support networks and local service providers to deliver violence prevention services to at-risk youth.

Debra Wahlberg, Chief of Party for the program, explains what this approach looks like in action and just how critical data can be to ensuring youth at risk receive the support they need. Wahlberg will also share insights from the program’s work in St. Lucia, St. Kitts and Nevis and Guyana at the Los Angeles Gang Prevention & Intervention Conference 2017 on May 1 and 2.

How is the public health approach applied in the program?

Wahlberg: The Community, Family and Youth Resilience program’s current practices and future approaches incorporate each of the four elements of the public health approach—— defining the problem, identifying risk and protective factors, developing prevention strategies and assuring widespread adoption.

We are now conducting baseline surveys of the perceptions, experiences and behaviors of residents in our beneficiary communities to better understand the problems faced by adult and youth residents of these communities. We are also preparing a community asset mapping exercise that will allow the resources within each community, be they physical, cultural or environmental, to be identified and integrated into the violence prevention plans designed for each community.

We identify risk and protective factors using a diagnostic protocol entailing structured interviews that assess nine risk factors within a developmental psychology framework. These interviews provide the basis for dialogue with families and the wider support network to develop and support customized prevention strategies for the youths most at-risk.

Finally, the fourth step of promoting widespread adoption of winning strategies will be undertaken by community residents themselves. The program will support local leadership bodies to implement evidence-based activities and assess the value of these activities to address crime and violence. These local leadership bodies will also receive appropriate support from the program to build their capacity as conduits for sharing lessons learned on violence prevention with other residents of their communities and to residents of other communities that face similar challenges with crime and violence.

What would you say are some of the biggest challenges for youth in these communities that the program seeks to address?

Wahlberg: In crafting our intervention strategies, we have initiated ongoing conversations with youth living in our focus countries on what they believe they need for their personal development.

These youths have not mentioned the need for hand-outs or favors. They simply want the chance to uplift themselves and their communities through jobs, education and emotional support. But in order to do that, they expressed how they must contend with fear from potential victimization, political exploitation and stigmas and labels from members of the mainstream society.

The Community, Family and Youth Resilience program is also aware that there remain groups of underserved and unattached youth from our communities whom we are yet to hear from – those currently in institutional settings and those engaged in crime and violence and have no interest engaging with us or any other change agent.

Our approach is that everyone can be reached, and we are well into the process of implementing specialized interventions to locate and engage the most troubled youth living in our communities and over a sustained length of time to convince them that there are worthwhile alternatives to crime and violence they can still pursue.

What does the program mean by “resilience”?

Wahlberg: When we engage our community members in a conversation of resilience, we ask them to move beyond identifying the threats to their safety and deficits in local services and resources to consider what features of their community exist that offer the potential to mobilize them to collectively address community crime and violence and sustain positive outcomes in their neighborhood. These can be informal supports that the community can tap into such as a shared culture or concern for others or formal elements such as resilience development projects in schools or religious organizations.

We also like to stress that resilience does not only involve reducing or removing risks for residents at the individual and group level, but also includes the fostering of coping strategies at the individual and group level to withstand future onsets of threats to and within the community.

To be sure, these conversations are not easy. We find that persons living in stressful situations can feel overwhelmed by the enormity of the challenges they face and can sometimes find it difficult to identify new solutions or articulate the approaches they are currently employing to manage.

But for the Community, Family and Youth Resilience program, we see it as critical in our support to community members to encourage the awareness of personal agency with our community partners so that they can lead in addressing community problems from a place of confidence and hope.

How does the program differentiate youth risk levels?

Wahlberg: The program distinguishes youth risk levels as low, moderate and high based on the Youth Service Eligibility Tool, or YSET. The YSET is constructed on a framework comprised of nine risk factors at an individual, peer, and family level domain. The nine risk factors are:

  • Anti-Social Tendencies
  • Weak Parental Supervision
  • Critical Life Events
  • Impulsive Risk Tendencies
  • Guilt Neutralization
  • Negative Peer Influence
  • Peer Delinquency
  • Delinquency Associated with Substance Abuse
  • Family Gang Influence

The tool measures the intensity, and the accumulation, of risk factors, and based on this configuration a youth is categorized into either one of three risk levels, which will then determine which level of intervention – primary, secondary, or tertiary – is the appropriate approach to treat the risk factors.

For example, the accumulation of 0-3 risk factors might determine that a youth is at a primarily level of risk. Likewise, those with 4 or more risk factors may be categorized at the secondary level of risk. It is important to note that it is the accumulation of any four of the nine risk factors that places a youth at a higher level of risk. The tertiary level category is identified by a series of self-reported behaviors associated with delinquency in the service of a group, such as a gang.

The program is currently working with the developers of the YSET to adapt the tool for use in the Eastern and Southern Caribbean. We look forward to piloting new phrasings and establishing the right cut-off thresholds for categorizing the level of support needed for our youth beneficiaries.

How does the program gather and apply evidence and data?

Wahlberg: The Community, Family and Youth Resilience program’s approach to gathering and applying data to policies and practice align with our partner-driven framework. Whereas existing good practices and research literature are called upon as points of reference and a basis for discussion, we depend upon our partners within and serving our communities to identify key questions for our learning agenda, collaborate in conducting studies and establish the relevance of findings for practice.

A great example of this practice was our first research exercise- developing and employing a mixed-methods approach to selecting our fifteen target communities.

First, the program research team identified the 50 most vulnerable communities within each of our three target countries by compiling data on the incidence of crime and violence as well as socio-demographic predictors of community-level social disorder and resilience.

Once compiled, these data produced an initial ranking of communities in order of priority for intervention. These community rankings were then vetted by two rounds of qualitative examination involving focus group discussions with community stakeholders within the higher ranked communities and nongovernmental organizations and validation workshops with key national stakeholders in the public sector.

The qualitative component allowed local partners, and youth in particular, to openly and transparently discuss issues related to police/citizen relations, fear of victimization and local informal social controls, all of which contributed to a more robust selection process both scientifically and politically.

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