How Prevention Research Can Short-Circuit Urban Problems
VOLUME 24 | ISSUE 3 | FALL 2017
Since its inception, faculty at SSA have focused on understanding the underlying causes of some of society's most pressing social problems. This knowledge often has been used to develop and test strategies to address those causes—to get ahead of or eliminate such problems.
Detouring youth from urban violence, protecting children from potential abuse, or keeping students in school is far better than trying to rebuild lives scarred by violence, maltreatment, or a failed education.
That’s how prevention research can offer proof, new hope, and innovative strategies in tackling the evolving challenges facing urban residents. And while nearly every community must cope, to some extent, with such problems as violence, drug use, educational inequality, and family stress, these issues are often exacerbated in urban contexts.
Prevention research at SSA focuses not only on testing programs, but also on conducting research to understand the underlying causes, risk, and protective factors for a range of problems. Collaboration also is key. Associate Professor Alida M. Bouris co-directs a team of social work and medical colleagues to address equity imbalances in HIV-AIDS prevention and treatment. Not only is the team cross-disciplinary, it also is embedded within the community so it connects directly with affected individuals and organizations. With a local community center, Associate Professor Waldo E. Johnson, Jr. is testing interventions that seek to improve father-son relationships among Black men and boys—adapting a successful program used in Flint, Michigan. Professor Dexter R. Voisin’s background as a clinical social worker provided him ample opportunities to observe how poverty and economic disinvestment trigger community violence. His subsequent research uncovered the behavioral health repercussions on youths exposed to violence. Violence prevention research conducted in high-risk communities by Interim Dean and Emily Klein Gidwitz Professor Deborah Gorman-Smith’s Center for Youth Violence Prevention led to early intervention programs focused on developing parenting skills and improving family interaction among children and their families—resulting in a drastic reduction in violent behavior among youths and improved graduation rates among participating students.
These are just some examples of how scholars at SSA are applying advanced scientific methodologies to build solid evidence, evaluate interventions, and form new partnerships across disciplines, communities, and practice levels. Their work amplifies how prevention research can help shape enhanced public health policies, launch new community programs, and spur investments that can create generational—and cost-effective—change.
PREVENTING HIV/AIDS AMONG LGBTQ+ YOUTH
In the fourth decade of the HIV/AIDS pandemic, the impact on vulnerable populations remains one of the most pressing social welfare concerns of our time. As in the earliest days of the epidemic, gay and bisexual men and people of color continue to be disproportionately impacted. Nationwide, young Black gay and bisexual men ages 16 to 29 carry the highest burden of HIV, with many youth becoming infected across the transition from adolescence to adulthood.
In this context, Alida M. Bouris’ research is focused on understanding how parents, families, and other supportive adults can help prevent HIV/AIDS among young gay and bisexual men of color. Her work will generate new insights into how parents and families can help to prevent HIV and improve outcomes for young men living with HIV. For example, Bouris’ research shows that many young men are close and connected to their families and openly discuss their sexuality with their parents, siblings, and extended family members. She also is finding that family relationships can greatly impact young men’s health—promoting routine HIV testing, helping young men to cope with an HIV diagnosis, and supporting young men living with HIV to stay engaged in their HIV care.
Bouris collaborates with UChicago colleagues in social work and medicine who are equally committed to addressing racial/ethnic inequities in HIV/AIDS prevention and treatment. She co-directs the Chicago Center for HIV Elimination (CCHE), a research and social service organization working to prevent HIV/AIDS among Black gay and bisexual men and transgender women. In addition to serving as a major research center, CCHE employs a team of social workers, case managers, and outreach workers to deliver services to LGBTQ+ youth at risk for and living with HIV/AIDS. For example, CCHE offers free HIV and STI testing, as well as a weekly drop-in program for LGBTQ+ youth. Other programs include resource counseling and the citywide PrEPLine, a free telephone line that connects individuals to PrEP (the daily HIV-prevention medicine) providers throughout the city. These kinds of partnerships blending research and practice and working directly with affected communities—are necessary if we are to make a difference in one of the most complex health conditions today.
RE-IMAGING URBAN BLACK FATHER-SON RELATIONSHIPS
Father-son relationships provide unique developmental resources to boys. Too often, however, connections between many Black fathers and their sons are undermined by the conditions of urban neighborhoods where these fathers and sons live. Exposure to concentrated poverty, racial bias and discrimination in education and employment, hyper-surveillance by authority figures and structures, and vanishing physical and mental health services especially disadvantage Black boys and men. These conditions also threaten the ability of Black fathers to share their life experiences with their sons, provide them with options for the positive social construction of masculinity, and maintain their own and their sons’ personal safety.
Waldo E. Johnson, Jr. examines how these social and institutional practices—which particularly affect Black fathers and sons—impact how Black fathers and sons communicate about safety, healthy masculinity performance, and avoiding involvement in violence and other risky behaviors. This topic has received scant attention in existing research. But it is particularly important for Black fathers and sons, whose health and safety are routinely compromised by the workings of urban institutions such as schools, declining access to public health care, and interactions with law enforcement.
Johnson is developing new kinds of research questions to reframe how we think about the health and safety of Black men and boys, and to re-imagine how to build an evidence base for interventions that will improve their lives. His approach is rooted in the social work tradition of using research to inform social change.
In the “Chicago Fathers and Sons Study,” Johnson and colleagues will test whether a 15-year intervention with nonresident fathers and their pre-adolescent sons found to be effective in reducing boys’ risk for violence in Flint, Michigan can be replicated with similar positive outcomes in the larger urban setting of Chicago. Building from this work and in collaboration with the K.L.E.O. Center in Chicago’s Washington Park neighborhood, Johnson’s team will examine the relationships and communication among 400 Black father-son pairs over a five-year period. Results from the study will be used to promote and enhance father-son interventions and programs and create curriculum for boys who do not have a father figure in their lives. In the long term, the study will examine whether father-son communication of different types can reduce sons’ likelihood of adverse health behaviors such as early sexual activity and substance use.
COMMUNITY VIOLENCE EXPOSURE THREATENS YOUTH FUTURES
Before becoming an academic, Dexter R. Voisin worked as a clinical social worker providing mental health counseling to youth and families. Many youth and families in his practice reported witnessing or being victims of violence, and many reported the use of guns in these acts of violence. Over his academic career, Voisin’s research has built on his practice observations. He has found a relation between concentrated disadvantage in communities, high rates of poverty, community disinvestment, and community violence. Structural inequalities and racial segregation have resulted in African American youth, especially males, bearing the highest burden of witnessing violence and violent victimization.
Voisin finds that urban youth who have been exposed to violence are at increased risk for a range of mental health problems, including depression, anxiety, and symptoms of PTSD. Following youth over time, he finds them failing to complete high school, which other research has shown can lead to increased involvement with juvenile justice systems. The impact of exposure to violence, Voisin shows, is far-reaching, adversely affecting youth mental health, school completion, drug use, and sexual health, and increasing the risk for violence perpetration.
Voisin’s research implies that violence prevention efforts must include addressing and treating the impact of violence on young people. Violence begets violence; hurting people hurts people. Schools and other youth-serving organizations must receive trauma-informed education so adults in those systems can recognize the symptoms of trauma and refer young people to intervention and mental health services. More youth-friendly mental health services need to exist inside schools and within at-risk communities. Addressing the mental health of young people exposed to violence is a means to prevent violence before it starts.
Voisin currently is completing a book that explores how American policies and practices have led to enclaves of violence in cities; how youth and families cope with such exposures; and how community restorative justice approaches can help curtail the negative effects and cycles of violence in high risk communities.
PREVENTING URBAN VIOLENCE THROUGH EARLY INTERVENTION
Violence remains one of the leading causes of death in the U.S. and a significant public health problem, creating lasting scars among victims and communities. While violence afflicts all communities, it is disproportionately an urban problem.
A recent study of high-risk Chicago neighborhoods by SSA’s Chicago Center for Youth Violence Prevention (CCYVP) led by Deborah Gorman-Smith uncovered sobering facts: among 15- to 17-year-olds, nearly all had been exposed to some form of violence. Thirty-two percent had a close friend or family member murdered. Eighteen percent had witnessed a shooting that resulted in death. Children and youth in poor, urban neighborhoods are exposed to high rates of community violence, as well as an assortment of environmental stressors simply because of where they live. These stressors include concentrated poverty, substandard housing, residential instability, racial segregation, and structural and other forms of racism.
Imagine growing up in a poor, segregated, high-crime neighborhood. What skills would you need to navigate such precarious daily living? To find answers, Gorman-Smith’s research team has focused on identifying the aspects within these high-risk communities that may help protect against stress conditions. One central finding was the role of parenting and family. And while all children and youth benefit from supportive, consistent, and secure parenting and family functioning, the need is greatest for youth living in the most stressed communities.
That finding led to the development of the SAFE Children program for firstgraders and their families. SAFE Children focuses on parents, teaching them how to get more involved in their children’s school, how to develop consistent discipline and monitoring practices, and how to use other parents and families for information and support.
Learning these parenting skills makes a decisive impact. By the time participating first graders entered high school, they were 50 percent more likely to be “on track” for graduation and half as likely to have had a violent incident in school, compared to a control group of non-participating students. A similar program for families of at-risk middle school students, GREAT Families, found a reduction in aggressive and violent behavior among young people. And the research found that the GREAT families program also reduces violence among other children in the same school.
While early intervention programs can prevent youth violence involvement, large scale change requires a coordinated and comprehensive effort, combining interventions at multiple levels and across systems. Because of the complexity of the issue, Gorman-Smith and the Center team are collaborating with community partners to create expanded violence prevention strategies that are informed by data, measure impact, and respond to resident needs.