Speaker David Hawkins of the University of Washington gave an example of the State of Washington deciding to cut funding for a new prison from its budget upon reviewing cost-benefit analysis for prevention and instead putting additional funds toward violence and crime prevention.

Speakers addressed the importance of interventions that emphasized prosocial behavior and resiliency as a means of providing coping mechanisms in the face of everyday stress, adversity, or violence. Speaker Theresa Betancourt of Harvard University discussed her ongoing work with war-affected youth in Sierra Leone (further information can be found in Chapter 7), noting that children formerly associated with armed groups who underwent formal reintegration adapted better to post-conflict community life. She stressed the importance of a “safe place,” a sentiment that speaker Mindy Fullilove of Columbia University also expressed. The formal demilitarization process in Sierra Leone provided such a space via interim care centers, before youth were reunited with their families. This process was intended to help facilitate healthy reconnection with family and community members. Dr. Betancourt emphasized that one of the most critical findings of the study was that the long-term mental health of war-involved youth was influenced not only by past war experiences, but also by ongoing stressors in the post-conflict environment, again underscoring the importance of “place” and the larger social ecology. For instance, exposure to toxic violence (such as rape or being forced to injure/kill others) was associated with increased hostility over time and deficits in interpersonal functioning, but these deficits were further compounded by community stigma. Furthermore, loss of a caregiver during war was associated with increases in internalizing problems (e.g., depression and anxiety) over time, but further exacerbated by family abuse and neglect and daily hardships such as food and housing insecurity. The research also identified several malleable protective factors, such as access to school, community acceptance, and adequate social support all of which have the potential to serve as key leverage points for intervention. Again, underscoring the importance of “place,” community acceptance was observed to have beneficial effects on all mental health outcomes investigated (see Box 5-1).

Speaker and Forum member Elizabeth Ward of the Violence Prevention Alliance in Jamaica also spoke to the importance of enforcing prosocial behavior and messaging. Unattached youth in Jamaica—those who are not employed, are not in school or training, and face high rates of violence— fare better and are more empowered if they have received prosocial messaging at home or at school than those who did not. Dr. Ward pointed out that keeping youth in school prevents them from joining gangs, and learning to read reduces aggression. The cost of after-school programs in Jamaica is approximately 45,000 Jamaican dollars per year, while a specific literacy program costs about 3,000 Jamaican dollars. On the other hand, caring for a

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