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Testimony on Youth Violence Initiative by Donna E. Shalala
U.S. Department of Health and Human Services

Before the Senate Appropriations Subcommittee on Labor, HHS, Education and Related Agencies
September 14, 1999

Mr. Chairman and Members of the Subcommittee, thank you for the opportunity to appear with my colleagues from the Departments of Education, Labor and Justice to discuss the complex problem of youth violence in the United States . I am pleased to discuss our efforts at HHS to address youth violence as a public health and youth development issue and how we have coordinated our activities throughout the Administration.

Before I discuss the Administration's efforts, I would like to congratulate you, Mr. Chairman, Senator Harkin, and the members of the Subcommittee, for the leadership and dedication that you have shown on this issue. Your initiative to prevent youth violence has much in common with the Administration's efforts, including an emphasis on involving a broad array of sectors in reducing youth risk behaviors and promoting positive youth development. I believe that we can work together to make the nation's children safer and more secure, as well as prepared for the future.

Adolescent violence is reflective of a larger, persistent problem. While it is truly a tragedy that 15 lives were lost at Columbine High School, the fact is that violence takes a heavy toll on children every day in communities throughout the country, claiming the lives of far too many and affecting the lives of children and families in important and enduring ways.

Violence is one of many youth risk behaviors that are preventable, but there are no easy answers, shortcuts or panaceas. It is an extremely complex, multi-faceted issue which will depend significantly on our society's ability to promote the positive development of children, before problems arise and become entrenched. While we can and must continue to learn more, we now know enough to take some important steps.

In the 1996 Carnegie Report, entitled Great Transitions: Preparing Adolescents for a New Century, the authors wrote: "Current interventions on behalf of young adolescents ... often do not take into adequate account two findings from research: that more than one problem behavior is likely to occur in the same individual; and that these problems are likely to have common roots in childhood and educational experience." Subsequently, this June, the Department published a report entitled, Positive Youth Development in the United States , which revealed that an increasing number of studies show that the same individual, family, school and community factors often predict both positive and negative outcomes for youth.

These research findings are leading us to what Karin Pittman calls a significant "conceptual shift" - from thinking that youth problems are merely the principal barrier to youth development to thinking that youth development serves as the most effective strategy for the prevention of youth problems. She has defined youth development as "an ongoing process in which all young people are engaged and invested, and through which young people seek ways to meet their basic physical and social needs and to build competencies and connections they perceive as necessary for survival and success."

The Positive Youth Development report defines the types of characteristics that are embodied in effective positive youth development programs. These programs do more than prevent risky behavior. They promote such things as the social, emotional, cognitive and moral competence of young people.

Having said this, we must also make two things clear. First, simply adding funds to federal programs, while an important first step, cannot do the whole job. Federal agencies must coordinate their services, using models like the Safe Schools/Healthy Students program. We must include state and local governments and community organizations as partners. An effective, long-term strategy requires that communities themselves develop a coordinated and integrated framework of services that promotes healthy development beginning at birth and continuing throughout childhood and adolescence into adulthood.

We also must understand that services alone will not achieve the goal of healthy development. A 1999 report written by James Hyman and published by the Casey Foundation, entitled Spheres of Influence, points out that in addition to the broad array of services, a comprehensive strategy must include "opportunities for constructive use of time, meaningful experiences, and the support of caring adults (family members and mentors, as well as others)." Most importantly, it must include adolescents themselves and make them active participants in the strategies that we develop for their successful futures.

The Scope of the Youth Violence Problem

Mr. Chairman, allow me to take a moment to describe some of the consequences of youth violence for our society. Rates of homicide among youths 15-19 years of age reached record-high levels in the latter half of the 1980s and continue to be among the highest ever recorded for this age group. Between 1985 and 1991, annual homicide rates among males 15-19 years old increased 154 percent (from 13 to 33 per 100,000). Homicide rates for young males began to decline in 1994 and dropped 25 percent between 1993 and 1996 (from 34.7 to 26.1 per 100,000). In 1997, the latest year for which we have data available, the rate of homicide among males 15-19 years of age was 22.6 per 100,000 - a continuing decline. Despite this encouraging trend, rates are still unacceptably high.

In 1997, 6,083 young people 15-24 years old were victims of homicide. This amounts to an average of 17 youth homicide victims per day. - Homicide is the second leading cause of death for persons 15-24 years of age, and is the leading cause of death for African-American youths in this age group.

In each year since 1988, more than 80 percent of homicide victims 15-19 years of age were killed with a firearm. In 1996, 85 percent of homicide victims 15-19 years of age were killed with a firearm.

Between July 1992 and June 1994, 105 violent deaths occurred on or near school grounds or at school-associated events. The majority (81 percent) were homicides and firearms were used in most (77 percent) of the deaths. The violent deaths occurred in communities of all sizes in 25 states.

Public health research tells us that deaths are only the tip of the iceberg of youth violence. There is an underlying layer of non-fatal violent behavior that should alarm us, both for its own sake and for its role as a precursor to lethal violence. We do not have all of the information we need to quantify the impact of non-fatal violence. Nonetheless, according to the CDC's 1997 Youth Risk Behavior Survey (YRBS) - a national survey of high school students - 37 percent of high school students reported being in at least one physical fight in the past 12 months, 18 percent reported carrying a weapon at least once in the previous 30 days, and 6 percent had carried a gun. More than 7 percent of the students reported being threatened or injured with a weapon on school property during the previous 12 months. And one out of 25 students was afraid to go to school at least once in the previous 30 days because of the threat of violence.

These statistics indicate that there are "early warning signs" of potentially lethal violence. Awareness of the overall national incidence of bullying behavior, threats, weapon carrying, and other clues to potentially violent behavior is helpful. Responding effectively to these early warning signs is crucial.

In addition to being victims and perpetrators of violence, young people also are harmed by being witnesses to violence. The National Longitudinal Study of Adolescent Health found that over one in ten middle- and high-school youths witness a shooting or stabbing each year. Among African-American youth, nearly one in four young people have this experience.

We should also recognize that not all youth violence is directed at others. Youth suicide is an inseparable component of the problem of youth violence. Suicide is the third leading cause of death for young people, ages 15-24, in the United States . The rates have nearly tripled since 1950 but over the past decade have declined by about 10 percent. In 1997, according to the YRBS, about 21 percent of students in grades 9 through 12 - more than one in five - reported that they seriously considered taking their own lives during the previous year. And almost 8 percent reported actually attempting suicide. Suicide among American Indian/Alaskan Native youth is especially high, with rates three to four times those of the general population.

The Administration's Commitment to Prevent Youth Violence

President Clinton has a deep and longstanding commitment to positive youth development and prevention of youth risk behaviors. Last May, the President directed Surgeon General David Satcher to conduct a landmark study of the potential causes of youth violence and to identify successful prevention and intervention strategies. The process Dr. Satcher will follow in preparing this report will be unique. The report will look carefully at what the science tells us about the effect of environmental influences - including exposure to violence in real life and in contemporary media - in normalizing violent behavior. Additionally, we intend to engage the American people in a broad dialogue about the causes of youth violence, and the solutions. Unlike traditional Surgeon General publications, the youth violence report also will involve a series of regional conversations with parents, students, educators, business and community leaders. We expect to involve other federal departments - like Justice, Education, and Labor - as active partners in this effort, as well.

As you know, we also are working to establish a White House Council on Youth Violence, which will be an interagency coordinating body for federal youth violence services. We would welcome your input as we shape the Council's structure and responsibilities.

Mr. Chairman, in discussing youth development as a significant prevention strategy, we understand the importance of starting early in our approach to healthy child and adolescent development.

For example, we can help to prevent violence if we ensure that every child has a healthy start and if our policies support parents as they strive to nurture and protect their children from infancy through adolescence. Such a strategy includes a commitment to invest in quality child care and early childhood education services that can help to lay the foundation for positive child development. Current research on brain development from birth to age three shows the importance of children's earliest experiences in shaping their future development. The connections in the brain that are formed during this time provide the foundation for intellectual development and the capacity to form social bonds and empathize with others, which are key factors in promoting healthy, non-violent development.

In addition, research shows that the quality of child care and other early childhood programs is integrally linked to the healthy development of children, preparing them for success in school, and helping them to establish positive social relationships with adults and peers. Furthermore, quality early childhood programs can help parents to strengthen their relationships with their children, improve their parenting skills and become more actively involved in their children's ongoing education and development.

The President's FY 2000 budget would expand the Child Care and Development Block Grant to make child care more affordable for low- and moderate-income working parents. Our budget includes additional funds to create an Early Learning Fund to enhance the quality of child care, with a focus on school readiness. The President's budget requests $5.3 billion for the Head Start program, a $607 million increase over the amount appropriated in FY 1999. This funding increase will continue our bipartisan commitment to expand Head Start, America's premier early childhood development program, while assuring that increased investments are made in the quality of Head Start services. The request will support the expansion of Early Head Start for infants and toddlers and their parents.

These investments reflect what Surgeon General Satcher described when he said: "A crucial part of having a healthy start in life is communicating a message of hope. Without hope, a mother will not seek prenatal care. Without hope, a violent young person sees little purpose in treating their peers with respect and caring." That means parents, families, students, teachers, government officials, public health experts, nurses, doctors, researchers, and corporate, community and religious leaders must work together if we are to build a community foundation that instills hope, provides security and fosters optimism - all essential conditions for a healthy and safe childhood.

What Does A Public Health approach Have to Offer?

Mr. Chairman, I would like to discuss in more detail the contribution that we believe public health can make in preventing youth violence. Because the problem is so complex, the response needs to draw on the best that all fields of research have to offer: education, psychology, psychiatry, social work, criminology, public health, medicine, research, sociology, and others. This Administration is providing leadership in mobilizing these diverse disciplines to seek creative solutions to the problem of violence, and to translate what we know from science into sound prevention programs. This new approach begins with the coming together of the fields of youth development and public health.

For example, one of the priorities for the Surgeon General is to promote healthy lifestyles. He focuses on physical activity, nutrition, responsible sexual behavior and avoidance of toxins, because together, they promote wellness and help us prevent a whole array of negative health outcomes. Similarly, in youth development, we focus on building assets - the physical, emotional and cognitive strengths young people need for survival and success.

But the Surgeon General is also the first to acknowledge that healthy lifestyles are not just a matter for individuals, but that families and communities must support them, at every step of the way. For example, it is one thing to tell people about the value of exercise, but it is equally important to support them through after school sports programs, building safe walking paths in communities, or having workplaces develop exercise programs. Likewise, positive youth development will require not only the actions of young people themselves, but also a collaborative, coordinated approach by families and all segments of our society. And they have to occur in every community.

Applying a public health approach to the problem of youth violence, we begin by asking four questions:

  1. What is the problem? (Surveillance). We collect useful data on the problem to better understand it and to do something about it. We ask: to whom, what, where, when, and how did it happen?"

    As an example, consider how CDC, in order to improve our monitoring of school-associated nonfatal injuries as well as violent deaths, is exploring the use of sentinel schools to report nonfatal injuries from violence on a routine basis. We hope to provide this kind of information to communities and schools throughout the country to alert them to emerging problems and to help them monitor the success of their responses.

  2. What are the causes? (Risk Factor Research). We seek to discover what puts people at risk and what protects them from that risk.

    CDC and the National Institute for Mental Health (NIMH) are working together to conduct risk and protective factor research. We hope to learn more about the risk factors and the protective factors for youth violence and to disseminate this information to parents, teachers and public health officials. As we achieve a greater understanding of these circumstances, we can better assist parents, schools and health care providers to identify children at risk and help them before another tragedy occurs. We must also collect information about the existing individual and community assets that can be brought to bear on a violence problem.

  3. What works to help prevent the problem? (Intervention). We use the knowledge we have of the pattern of the problem to develop interventions that might work to prevent it.

President Clinton announced Saturday the award of the Safe Schools/Healthy Students grants, which are a good example of an effective intervention in the problem of youth violence.

The Department of Education, the Department of Justice and the Department of Health and Human Services collaborate to provide students, schools and communities with enhanced comprehensive educational, mental health, social service, law enforcement, and, as appropriate, juvenile justice system services that can promote healthy childhood development and prevent violence and alcohol and drug abuse. In the future, we hope to work more closely with Department of Labor as an additional partner in this initiative.

An important function of this interdepartmental grant program is to require local communities to coordinate various youth services in order to access funds from three federal agencies concerned with promoting healthy child development and preventing violence in schools. Local education agencies consult with community leaders in law enforcement, mental health and social services and apply for grants from the Departments of Health and Human Services, Education, and Justice using a single application. The Substance Abuse and Mental Health Services Administration (SAMHSA) component of this initiative will provide support to 54 local education agencies to implement the mental health intervention services and early childhood psychological and emotional development portions of their comprehensive Safe Schools/Healthy Students Strategic Plan.

How does intervention work? (Evaluation and Implementation). We test those interventions to understand if they succeed better than current practices and how they actually accomplish their results. And we look at how we can accelerate the dissemination of research findings more quickly and effectively. We also explore how we apply the proven effective interventions broadly in the community. We seek to learn how to transfer successful interventions from one community to the other.

To help state and local education agencies and schools promote safety and teach students the skills needed to prevent future injuries and violence, CDC, in collaboration with other federal and national non-governmental organizations, has recently begun to develop evidence-based injury and violence prevention guidelines. The guidelines development process has been successfully employed to prevent tobacco use and HIV infection prevention, and to promote good nutrition and physical activity. It includes an extensive review and synthesis of the literature on effective program components and the creation of an expert panel to guide the process.

Partners in Violence Prevention

For many young people, violence begins at home. Research has shown that over two-thirds (68 percent) of youths who are arrested have a prior history of abuse and neglect. Moreover, abuse and neglect can cause significant neurological damage and frequently lead to learning and emotional problems. The Administration believes that our communities should invest in child abuse and neglect prevention efforts, and child welfare programs that protect children, while helping families address problems that place children at risk.

We should underscore the critical role that parents play in preventing adolescent violence - and that parents could use some help. We know from research that violence prevention programs that include parent training and family intervention have a better chance of success. It's not hard to understand why.

Last year, the National Longitudinal Study on Adolescent Health - a large study of 90,000 students in grades 7 through 12 - found that adolescents who reported a close connection with their parents were the least likely to engage in risky behaviors. This is consistent with a National Institute of Mental Health study indicating that the adolescents most likely to engage in delinquency and violence are those who spend the most time with peers doing the same thing.

But parents are under enormous stress. They're working longer hours with less job security. They have less time to spend with their children. Many cannot afford the child care they need to ensure that their children are safe while they are at work. And there are fewer families that feel connected to strong, supportive communities and extended families.

In this regard, we see great promise in parenting services that help parents to learn appropriate developmental expectations for their children at different ages, establish positive relationships with their children and learn non-violent forms of discipline. Programs such as Head Start, the Community-Based Family Resource and Support Grant, and the Promoting Safe and Stable Families program, all support community-based efforts to help adults strengthen their parenting skills.


Mr. Chairman, we know that integrated, positive youth development is far more effective than a focus on preventing a single problem behavior when working with young people. Any successful strategy needs to include the long-term commitment of concerned adults beginning at the birth of the child and lasting throughout the child's development to adulthood. Programs in schools, communities, religious institutions, or health-based organizations that foster the presence of caring, committed adults in the lives of children have been shown to be of critical value. All sectors of society must work together to build a caring community. Our children deserve this.

The concern that you and Senator Harkin and the members of this Subcommittee have demonstrated will help us to develop more effective strategies for promoting peaceful communities and communicating a powerful message of hope and good health. Thank you for the opportunity to share with you the public health perspective on Youth Violence and to highlight some of the initiatives underway in the U.S. Department of Health and Human Services to promote positive development and prevent violence in the lives of our nation's young people . We look forward to working with you and your colleagues on a bipartisan basis to build on these efforts.

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