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Part II Papers and Commentary from Speakers

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II.1 VIOLENCE: CONTAGION, GROUP MARGINALIZATION, AND RESILIENCE OR PROTECTIVE FACTORS Carl C. Bell, M.D. Community Mental Health Council, Inc. Department of Psychiatry, College of Medicine, University of Illinois at Chicago The relationships among contagion, group marginalization, and resil- ience form a complex issue that does not lend itself to quantitative method- ology, but rather is best studied using qualitative methods. Thus, having a historical perspective is an important attribute to understand appropriately the phenomenon of violence as it relates to contagion, group marginaliza- tion, and resilience or protective factors. Furthermore, in order to have a coherent discussion about violence, we must first understand which type of violence we are focusing on, as violence is a very complex and multi­ determined phenomenon. In addition, we must understand the science. The Need for Good Science To understand this complex problem, we must understand the need for good science. Unfortunately, there is a fundamental scientific problem with understanding violence, whether it is directed toward others or self- directed. The reality is that these phenomena, while being the third or lead- ing cause of death for some population groups, such as teens or young black males, respectively, are actually rare events. The reality is that suicide rates tend to be 11 suicides/100,000 (IOM, 2002) and homicide rates are about 9/100,000 (Douglas and Bell, 2011). Even if you focus on non-Hispanic black people who have rates of homicide of around 33/100,000 or gun ho- micides with rates of 58/100,000, these are low base rates and developing statistical power to differentiate between an experimental intervention and control is very difficult. Accordingly, the 2002 Institute of Medicine report Reducing Suicide: A National Imperative noted that to prove a suicide pre- vention intervention is evidence-based, a study would need 5 to 10 popula- tion studies with 100,000 persons per study to get enough statistical power to show that either a suicide or homicide prevention study works (IOM, 2002). Because the homicide rates are actually lower than the suicide rates, despite many scientific claims to the contrary, apparently one would need an equally large population to prove a homicide prevention intervention is evidence-based, and neither of these two studies has been done. 53

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54 CONTAGION OF VIOLENCE Types of Violence Having formally studied the phenomenon of violence for more than 30 years, we proposed that there were many different forms of violence, which required different prevention, intervention, and postintervention strategies (Bell, 1997). As identified by Baker and Bell (1999), such types of violence include • group or mob violence; • individual violence; • systemic violence, such as war, racism, and sexism; • institutional violence, such as preventing inmates from getting the benefit of prophylactic medications to prevent hepatitis; • hate-crime violence, such as terrorism; • multicide (e.g., mass murder, murder sprees, and serial killing); • psychopathic violence; • predatory violence, also known as instrumental or secondary violence; • interpersonal altercation violence, also known as expressive or primary violence (e.g., domestic violence, child abuse, elder abuse, and peer violence); • drug-related violence, such as systemic drug-related violence (whereby drug dealers kill to sell drugs), pharmacological (whereby an individual perpetrates violence because of drug intoxication), economic-compulsive (whereby a drug addict uses violence to obtain drugs), and negligent (e.g., a drunk driver who kills a pedestrian); • gang-related violence; • violence by mentally ill individuals; • lethal violence directed toward others (homicide); • lethal violence directed toward self (suicide); • violence by organically brain-damaged individuals; • legitimate/illegitimate violence; and • non lethal violence. Observations About Types of Violence Regarding Issues of Contagion, Group Marginalization, and Resilience Culture Destroys and Culture Protects Culture destroys  Black communities in Chicago experience discrimina- tion, stigma, and injustice at higher rates than their white counterparts. Consider the science that illustrates white males perpetrate similar levels of

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PAPERS AND COMMENTARY FROM SPEAKERS 55 violence as black males (HHS, 2001) and engage in more illegal drug use; however, the majority of children and young adults who are incarcerated for these offenses are people of color. There also have been well-known allegations that Chicago police forced confessions of murder from inno- cent black men, several of whom were on death row until DNA evidence proved their innocence. For example, police officer Jon Burge, fired after the Police Board determined he had used torture, was convicted on counts of obstruction of justice and perjury arising out of a civil suit in which Burge was named a participant in the abuse or torture of people in custody (Stein, 1993). Structurally, we understand that most mid- and large-size cities have more absolute numbers of low-income whites than low-income blacks, but there are few low-income white neighborhoods because low-income whites have scattered-site housing. Police have a more difficult time finding and incarcerating illegal drug users when they live in scattered-site housing. Therefore, blacks who use illegal drugs are incarcerated more often than whites who use illegal drugs; this is one of the reasons for the dispropor- tionate percentage of incarcerated black people. In Canada, children from First Nations communities were removed from their families and told their culture was not acceptable, resulting in individuals within First Nations communities losing their cultural protec- tive factors, which ultimately led to many of them engaging in the risky behaviors of suicide and intragroup homicide. Within these communities, alcoholism is common. For every one child in Canadian juvenile detention centers without fetal alcohol syndrome, 19 children have fetal alcohol spec- trum disorders (Popova et al., 2011). Bell (2012) has proposed that many disruptive behaviors leading to incarceration results from fetal alcohol exposure (FAE). It is well known that FAE is a leading cause of speech and language disorders, attention deficit hyperactivity disorder, and other devel- opmental or cognitive disorders (IOM, 1996). These are often responsible for affect dysregulation, which leads to disruptive behaviors, which in turn leads to incarceration. These phenomena increase marginalization, thus facilitating fertile ground for promoting the contagion of violence. A perfect example is the victimization of Rodney King by police that spread into the African Ameri- can community and resulted in mob violence. Thus, when we talk about violence and the contagion of violence, we must also discuss the systemic violence of racism and imperialism that historically spread across the world. Culture protects  While doing HIV prevention work in Durban, South Af- rica, it was striking that 40 percent of the Zulu people were HIV positive, 6 percent of the white South Africans were HIV positive, but only 1 percent of the Indian South Africans were HIV positive. The conclusion was that the Indian South African culture protected them, while the Zulu culture and

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56 CONTAGION OF VIOLENCE its protective influence had been stripped from them, making them vulner- able to risky activities, such as risky sexual behavior, substance abuse, and violence. The white South African culture also is eroding, resulting in higher levels of HIV-positive individuals (Murray, 2012). Contagion of Suicide and Mass Murder In discussing self-directed violence, we understand the phenomena of contagion of suicide (Phillips et al., 1992) and how the mass media can cause what is referred to as cluster suicide, copycat suicide, and suicide con- tagion. Accordingly, in an effort to reduce this phenomenon of contagion, this recognition resulted in the “Reporting on Suicide: Recommendations for the Media.”1 Given that certain types of mass murders often lead to sui- cide (Petee et al., 1997), it is proposed that these mass murders are actually suicides preceded by mass murder (Bell and McBride, 2010a). One could hypothesize that when the media publicizes events such as the ones that occurred in Columbine High School; Platte Canyon High School; an Amish school in Nickel Mines, Pennsylvania; Virginia Tech; and Northern Illinois University, such “suicides preceded by mass murder” are inadvertently promoted. We understand the high level of public interest in sensational news stories; nevertheless, unless we understand that an individual suicide is the dynamic driving the mass murder behavior, we will continue to inad- vertently encourage this behavior. The difficulty is that electronic media is so ubiquitous; it would be difficult to design a study as Phillips (1974) did when we only had to contend with local print media. We need a consensus meeting to discuss these issues and figure out how to responsibly report on “suicides preceded by mass murders,” or the hypothesized contagion will likely continue. Interpersonal Violence Regarding the type of violence known as interpersonal violence, we understand this type is responsible for most violence. Furthermore, al- though different cultural, racial, and ethnic groups have different rates of different types of violence (e.g., Latinos have more gang-related violence), we understand that interpersonal violence is more common in the African American community; however, from the mid-1970s to the mid-1990s, Af- rican American domestic violence decreased from 16/100,000 to 3/100,000 (Greenfield et al., 1998). Why? Because the number of domestic violence shelters increased dramatically, reducing the number of battered African 1  See http://www.sprc.org/sites/sprc.org/files/library/sreporting.pdf.

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PAPERS AND COMMENTARY FROM SPEAKERS 57 American women who turned to committing violence against their partner as a means to stop being battered. Other Forms of Violence One form of violence that has not been studied adequately is violence by organically brain-damaged individuals (Bell et al., 1985; Bell, 1986, 1987; Bell and Kelly, 1987). Although there is no evidence for the reason for this lack of study, it can be hypothesized that the major reason for this oversight is the marginalization of those afflicted with head injury that ulti- mately results in their explosive behavior. It is hoped the recent “discovery” of this problem in football players will reduce the marginalization of this population resulting in appropriate study of the issue yielding more pre- vention and treatment strategies. The issue of legitimate versus illegitimate violence is another issue we must explore. Protective Factors That Cultivate Resilience Against Various Types of Violence Social Fabric Prevents Contagion of Violence As director of the Institute of Juvenile Research, where child psychiatry began and where the issue of family and community violence was addressed more than 100 years ago, I am aware of a great deal of relevant history that pertains to contagion, group marginalization, and resilience or protec- tive factors as they relate to violence. The lessons learned from this history are quite instructive to this discussion. In Chicago in 1871, the Great Fire created a lot of instability in a city with a population that was 70 percent either foreign-born or first-generation. The results were families who, due to being disrupted by poverty and unfamiliar community circumstances as result of immigration, were unable to provide stable family environments and to flourish. Evidence of this problem was the extraordinarily high rate of European immigrant domestic violence in Chicago from 1875 to 1920 (Adler, 2003). Seeing the problem, Jane Addams made efforts to found Hull House “to aid in the solution of the social and industrial problems which are engendered by the modern conditions of life in a great city.” In 1889, Addams and her colleagues established a Juvenile Court in Illinois to dis- tinguish between delinquency and criminality. The procedures of this new institution were not to be adversarial; rather it was “primarily protective and educational rather than punitive, and the commission of a child to a correctional institution is deemed to be for his welfare and not for the sole purpose of inflicting penalty.” Ten years later, in 1909, these foresighted women convinced the state of Illinois to discover the cause of delinquency;

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58 CONTAGION OF VIOLENCE the Juvenile Psychopathic Institute (later called the Institute for Juvenile Research, or IJR) was created, and neurologist William Healy was hired to be the first director. Later, IJR researchers Shaw and McKay (1942) noted delinquency was less due to biological, ethnic, or cultural factors and more due to social disruption eroding formal and informal social control in spe- cific transitional neighborhoods (delinquency areas) in a city. Fifty years ago, the science was not as advanced as it is now. The re- search designs were empirical and qualitative instead of being quantitative, and much of the IJR’s research was mostly biographical. Thus, the statisti- cal methodology was very primitive by today’s standards and multivariate influences could not be studied well enough statistically. However, despite this lack of scientific methodology, it is interesting that the IJR’s observa- tions were correct. Their observations were that children’s biology was not causing delinquency, but rather it was the lack of social fabric in the new immigrant communities. Of course, this finding predated by 50 years the seminal research of Sampson et al. (1997) that coined the term “collective efficacy.” Another example of how protective factors cultivate resiliency, which in turn is protective against contagion of violence, specifically cluster or copycat suicide, is found in building protective factors around vulnerable populations of potentially suicidal individuals. Because 20,000/100,000 people in the United States suffer from depression, 5,000/100,000 attempt suicide, and 11/100,000 actually complete suicide, something must be protecting people (Health Care Innovations Exchange Team, 2012). Ac- cordingly, because youth engage in multiple risky behaviors due to their immature brain development, we have likened adolescents to be like cars with just gasoline, but no brakes and steering wheels, that is, community or social fabric (Bell and McBride, 2010b). These protective factors can be cultivated (Bell, 2001) and have been proposed as a strategy of suicide prevention. A specific example of infusing protective factors to prevent sui- cide occurs when, in an effort to prevent copycat or cluster suicide after a successful suicide, the victim’s friends are screened for suicidality and then provided with preventive services (Brent et al., 1989). Research has indicated that children who are sexually and physically abused are more likely to engage in suicidal behavior compared to chil- dren who are not abused (IOM, 2002). However, children with protective factors in their lives have fewer traumatic stress drivers of suicidal and other-directed violent behavior than children without these protective fac- tors (Griffin et al., 2011). Thus, it is possible to cultivate resiliency in these populations as well. Finally, based on years of public health research and work, the Seven Field Principles for Health Behavior Change are appropriate universal guiding principles to infuse protective factors in populations at risk for

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PAPERS AND COMMENTARY FROM SPEAKERS 59 various types of violence: (1) rebuilding the village; (2) access to modern and ancient technology; (3) connectedness; (4) building self-esteem (a sense of power, uniqueness, connectedness, and models); (5) cultivating social and emotional skills; (6) reestablishing the adult protective shield; and (7) minimizing trauma. These efforts have led to the maxim that “risk factors are not predictive factors due to protective factors” (Bell et al., 2008). II.2 SCHOOL-BASED VIOLENCE AND INTERRUPTION Patrick Burton, Ph.D. Center for Justice and Crime Prevention, South Africa Introduction Crime is one of the most significant challenges facing democratic South Africa, and young people between the ages of 12 and 21 are often at the receiving end of this escalating violence. Figures show that young people experience violence at rates that are exponentially higher than their adult counterparts (Leoschut and Burton, 2006). Given that this age cohort con- stitutes a significant proportion of the general population of South Africa, any efforts to reduce and prevent violence should incorporate components addressing child and youth violence. Furthermore, substantial evidence shows that violence and victimization against young people is closely cor- related to later violence; any attempt to adequately address violence at a community or societal level must therefore take into account the levels and nature of violence experienced by young people and children.2 Schools in South Africa are consistently shown to be one of the most common sites of violence perpetrated against children and youth. This is not surprising because children spend most of their time away from home in the school environment. In 2005, the first National Youth Victimization Study in South Africa revealed that 11.5 percent of youth between ages 12 and 22 feel anxious and fearful while at school. These feelings of apprehen- sion were most frequently attributed to the fear of criminals (52.5 percent), of being harmed (21.4 percent), of classmates (18.3 percent), and of educa- tors (4.8 percent). Fear was not limited to the school environment, but was 2  See, for example, Farrington, D., and P. Welsh. 2007. Saving children from a life of crime. Oxford University Press, Oxford; Haggerty, R., et al. 1996. Stress, risk, and resilience in children and adolescents: Processes, mechanisms and interventions. Cambridge: Cambridge University Press; and Cornell, D. G., and M. J. Mayer. 2010. Why do school order and safety matter? Educational Researcher (39)1:7-15.

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60 CONTAGION OF VIOLENCE also often associated with the journey to and from school, as reported by 16.8 percent of the more than 4,000 young persons surveyed. Being raised in violent social contexts influences children’s understand- ing of how the social world works (CIET Africa, 2004). In addition to undermining their sense of safety and security, creating feelings of fear and anxiety, disrupting eating and sleeping patterns, and leading to difficulties concentrating at school, direct and indirect exposure to violence can result in the adoption of violence as a legitimate means of resolving conflicts and as a way of protecting oneself from harm (Boxford, 2006). All of these factors make it extremely difficult, if not impossible, for quality learning to occur and have thus been found to contribute to grade repetition and the non-completion of schooling. This suggests that the vast majority of children and youth in South Africa are deprived of their right to live and learn in a safe environment that is free of violence or its threat. This paper will provide insights into just one approach to addressing school violence in South Africa, and into some of the lessons learned as the program has evolved and adapted based on several evaluations. The program is the Hlayiseka School Safety Toolkit, and forms the basis for the National Department of Basic Education’s developing school safety framework. The Approach The departure point for the toolkit recognizes that violence has physi- cal, social, psychological, and environmental roots, and that, to end it, we need to address it at multiple levels and from different sectors of society. The complex and dynamic interactions of all the environments (e.g., com- munities, homes) in which young people live out their life are what impact the experience and nature of violence, within the school environment in particular. Another point needs to be emphasized at the outset. While the most common reaction to the phrase “school-based violence” may lead the mind to jump to high-profile incidents of school shootings, or increasingly maybe highly reported cases of cyberbullying, for example, these are not the mani- festation of violence within the learning environment that we should be most concerned. Rather, these are isolated, high-profile, and sensationalized incidents, and while tragic, are not where the problem lies. Rather, the real problem lies in the apparently minor, but repetitive, acts of violence. These acts lead to the most frequent negative consequences of violence in schools: dropping out, truancy, school (and often social) phobia, depression, and lack of self-confidence in students. These acts can also negatively affect educational outcomes and attachment to schools and learning, which we

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PAPERS AND COMMENTARY FROM SPEAKERS 61 know are among some of the most significant protective factors for young people (Debarbiaux, 2003). The Hlayiseka Toolkit uses a training methodology built on the prin- ciple of a “whole school approach” to school safety. This approach posits that the responsibility for and successful approach to school safety requires the commitment of all those who constitute the schooling environment: learners, educators, principals, parents, and the school governance struc- tures. It also advocates that a safe school needs to be first and foremost a functional school. In short, the more effectively and democratically a school is managed, generally, the higher the likelihood of a positive impact on safety outcomes (Gottfredson, 2001). The approach provides the basis for the South African School Safety Policy that is being developed; details the implementation of standardized school policies regarding learner and educator conduct, rights, responsibilities, and expectations; and requires buy-in from principals, learners, educators, school safety teams, and school governing bodies. The toolkit acknowledges that each school is at a different point in its journey toward school safety and that available resources and capacity dif- fer from school to school. The toolkit thus allows for the least resourced school to find an appropriate entry point into the system as well as the most-resourced school. The toolkit is built on a foundation composed of four building blocks: Be prepared to prevent and manage problems and violence; be aware of what is happening at school; take action when something happens; and finally, take steps to build a caring school. Each building block assists the school to work systematically toward achieving school safety. The broad objectives of the toolkit are to help the school to understand and identify security issues and threats; guide schools to re- spond effectively to security issues and threats; establish reporting systems and manage reported incidents appropriately; monitor the school’s progress over time; and integrate existing departmental policy and legislation to ensure that school safety is not an “add on.” On a purely programmatic level, the whole-school approach provides each school with the tools to themselves understand and identify threats to safety; respond effectively to violence and threats of violence (including early identification of threats); and prevent, report, and manage threats and incidents effectively. These effectively constitute a process of diagnosing, planning, acting, and moni- toring. Most importantly, such an approach is designed to improve school management rather than the range of additional activities and interventions that may be offered. It does not serve to replace, for example, life skills, conflict mediation, positive discipline, or after-school care activities that may be implemented at the school level.

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