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Book Review   |    
Youth Violence: Prevention, Intervention, and Social Policy
Carl C. Bell, M.D.
Psychiatric Services 1999; doi:
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edited by Daniel J. Flannery, Ph.D., and C. Ronald Huff, Ph.D.; Washington, D.C., American Psychiatric Press, 1999, 332 pages, $48.50

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The books in the publisher's clinical practice series are designed to "give the mental health clinician a practical, clinical approach to psychiatric problems"—in this case, youth violence—and to provide up-to-date literature reviews and highlight current treatment strategies. Unfortunately, since the topic is a social problem rather than a clinical phenomenon, the reader has to extrapolate the information contained in the text to make it useful for clinical practice.

A major strength of the book is that the chapter authors uniformly assert that multicomponent prevention programs focusing on the social ecology of at-risk children and families are the best bets for prevention and intervention rather than society's current criminal justice response, which is an inadequate control strategy. In addition, psychotherapy and intensive casework programs are found to be ineffective for youth violence, and biomedical approaches have not produced effectiveness.

The chapters also reveal the complex interdependence between aggression, victimization, exposure to violence, perpetration, and the development of other psychiatric disorders. There appears to be a consensus that integrated, systematic, long-term approaches that include multiple disciplines and intervene at multiple levels are the core strategies necessary to create change.

Useful correlations are made between combat veterans' and children's exposure to violence. Army principles of prevention and treatment of "battle fatigue" are outlined, with applications for children exposed to violence. One chapter condemns the "gendered habits" of researchers that have caused girls' involvement with gangs to be neglected, sexualized, or oversimplified and concludes that traditional models of law enforcement, which guide policy for boys, are inappropriate for girls.

Differences in philosophy between advocates of gun control from a public health perspective and those who cite criminological studies supporting the protective value of firearms are presented with the caveat that even gun control opponents agree that firearms should not be available to children and adolescents. Parental criminality, maltreatment, parenting practices, and family relationship characteristics are adequately explored as causes of youth violence.

The editors appropriately note that even though neurobiology plays a role in causing violence, violence is also a form of learned behavior, and, accordingly, families have a role in preventing youth violence. Thus youths taught social competence and problem-solving skills will obtain the expertise necessary to resolve conflicts and avoid violence. The editors suggest that clinicians need to know the potential impact of exposure to violence and victimization on neurodevelopmental pathways that affect children's behavior. Further, by recognizing warning signs of risk factors, clinicians can reduce future victimization or reduce the chance that victimized children will perpetrate violence.

Clinicians are admonished that just focusing on reducing risk or managing aggressive behavior will not be as effective as an intervention strategy that enhances social competence. Further, though we may not be able to change violent neighborhoods, by involving families we can change home environments and social networks. Social policy to reduce violence should strengthen support for families, neighborhoods, and communities and prevent youth from joining gangs. Finally, investment in rigorous evaluation of policy and program initiatives must be enhanced.

All of the authors are experts in the field. What makes their contributions valuable is that they have all done basic empirical research on violence among youth and are able to merge scientific thought with the practical realities of working with violent youth.

Dr. Bell is president and chief executive officer of the Community Mental Health Council in Chicago and professor of psychiatry and public health at the University of Illinois.




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