As discussed in the last chapter, many of the contemporary approaches to curtail violent extremism lack evidence of success, which can undermine their efforts. Many programs have resulted in profiling, discrimination, and resentment in the individuals they were meant to help, and, sometimes, programs have been shown to increase an individual’s sense of isolation and inspire violent behavior. A public health approach could address and mitigate many of these issues, but because of past behavior key stakeholders are often reluctant to participate in activities that are sponsored by counterterrorism organizations. This chapter explores (1) how the complicated objectives of CVE and unintended consequences of earlier practices have hindered efforts to address violent extremism, and (2) the opportunities presented by approaching violent extremism as a public health issue.
Given that violent extremism is a relatively low-base-rate issue in terms of number of deaths, Runnels asked the workshop participants what else CVE was intended to prevent and to preserve. David Reddick, chief strategy officer and co-founder of the Bio-Defense Network, suggested focusing on preventing future potential deaths by looking at what steps can be taken to meet and resolve the concerns of people who are vulnerable to violent extremism. Muhammad Babar, physician with the Muslim Americans for Compassion, remarked that CVE approaches should aim not only to prevent future incidents, but to build a society to preserve American values for the entire nation, including Muslim Americans. In that vein, Downing commented that the key question is how to create an environment that is hostile to prejudice, bigotry, and racism:
not an inoculation to prevent violent extremism, but rather a prescription to build healthy resilient communities where people feel like they’re part of the process, they have a voice, they’re American, and this is their home. I think that’s what we’re trying to preserve.
Stewart argued for the need to broaden the focus beyond religion, ideology, or motivation and to embed the CVE effort into violence prevention more generally. German concurred that the task at hand should be countering violence irrespective of extremism and the ideology. Turk warned that given the high-profile nature of violent extremism, and the political will and consequent funding it attracts, a shift in focus from violent extremism to violence more broadly construed will be a complicated path to navigate. He suggested that it would require strategies for placing attention on issues of violent extremism and positive outcomes of the program (e.g., benefiting
the society as whole with a focus on mental health in resilient communities and finding ways to prevent factors that lead people to violence).
Saeed outlined the U.S. Department of State’s joint strategy with the U.S. Agency for International Development (USAID) for approaching CVE on the international level, which focuses on adapting to the constantly evolving threat of violent extremism (see Box 4-1). He emphasized that the concepts of prevention and intervention are crucial to the U.S. Department of State’s adaptive approach to countering and preventing violent extremism. USAID’s strength of good governance enables them to play a larger role in the prevention space, albeit not necessarily directly targeting violent extremism, but rather by aiming to leverage USAID’s capacity for good governance to help prevent people from embarking on the pathway to violent extremism. Broadly, the strategy is designed to address the entire life cycle of violent extremism. To better disrupt and intervene in that cycle, the strategy focuses not only on the reactive side (investigation, arrest, and prosecution), but also on understanding how a person becomes motivated to commit violent extremism.
One of the differences between CVE and traditional counterterrorism efforts is that CVE is designed to work in the “precriminal space,” according to Romaniuk. Susan Szmania, senior advisor for the Office for Community Partnerships, Science and Technology Directorate, DHS, warned that our thoughts are not good predictors of our actions, calling the “precrimi-nality” concept critically important in understanding violent extremism in the CVE space. German contended that an important problem is situated in the premise of CVE programming: the notion that bad ideas are a precursor state to committing violence, which empirical studies discount.
German cautioned about the consequences of adopting language that is used in a different sphere and has a very different meaning. For example, if CVE programming determines vulnerability in terms of racial background, ethnicity, national origin, or ideology, then “suspect” communities are identified as precriminal, which he suggested is tantamount to criminalizing them. If discrimination is one of the drivers of violence, then declaring someone or some communities to be precriminal could have the counterintuitive effect of increasing their risk of committing criminal acts. As a result, he argued, no such program should disproportionately target any particular community, since that would be both counterintuitive and counterproductive.
Rajeev Ramchand, senior behavioral scientist at RAND Corporation, contributed that in the realm of suicide prevention work, there are no interventions in place to screen people for (or prevent) thoughts of killing oneself, because of the difficulty in distinguishing between those who are thinking about killing themselves and those who go on to kill themselves. He noted parallel issues in the CVE space—whether individuals should be screened for extremist thoughts, and how to distinguish between those who have extremist thoughts and those who act violently on them—and suggested that there are lessons to be gleaned from public health in considering these ethically challenging issues.
Wynia posed a hypothetical scenario to illustrate the potential moral, policy, and programmatic hazards at play after a person is identified as precriminal. If a law enforcement or FBI officer is investigating a person and genuinely believes that person will commit violence, but has not done so yet, then what is the next step? He suggested that the officer faces a moral dilemma: either let the person go and see what happens, or create an environment to entrap the person in a situation that warrants arrest. Furthermore, if it is simply not possible to predict who will go from holding extremist beliefs to acting violently on those extremist beliefs, then he questioned where that leaves the policy community in terms of options.
With respect to the “diagnostics” for radicalization, German noted that when a person receives a mental health evaluation, there is a strict and scientifically established diagnostic procedure. However, this is not the case when it comes to determining whether a person has become radicalized in a dangerous way. The mixture of those approaches is a cause for concern, he warned, because it entails pathologizing characteristics that are not scientifically validated and extend into the realm of political beliefs. He cautioned that the early warning signs and indicators used by CVE programs for this purpose may also be problematic. For example, he challenged the argument that an individual who professed belief that the United States is at war with Islam was unreasonable, because, as he put it, “It is certainly true that the U.S. is at war with Muslims and with multiple Muslim countries.” German worried about civil liberty violations if such a belief is taken to be an indicator of mental illness and potential dangerousness within a CVE approach. He argued that at its core, CVE is really about suppressing dissent, particularly within the Muslim community, and specifically about suppressing dissent against U.S. foreign policy. He argued that there is an existing body of good research that challenges the conventional premises underlying CVE approaches and how they affect impacted communities that should be reviewed. He expressed dissatisfaction that neither the people conducting that research nor anyone from the impacted communities were present on the workshop panels. He suggested that meaningful engagement with critics is crucial in the CVE space moving forward.
Violent Extremism, Political Violence, and Civil Liberties
German remarked that for the past 30 years the field of counterterrorism research has been struggling with many of the issues raised in the workshop. He emphasized that the body of relevant research has been ignored because it does not provide the answers that CVE practitioners are seeking: How to establish the profile of a violent extremist; how to predict violent extremism, and how to define the preterrorist state. Instead, he observed, this research suggests that there are no simple answers to those questions. This narrow focus on ideology, he contended, comes at the expense of exploring the other critical dimensions. He argued that a narrow focus ultimately pathologizes the political viewpoint of people who align themselves with political ideologies that are deemed inappropriate, when in fact, there is no mental illness underpinning their views and that young men going to conflict (for example, when there is an invasion from a hated enemy on the border, as is the case in Somalia) is a part of human life. He emphasized that focusing on people who watch the “wrong” video or read the “wrong” book blinds the CVE enterprise to the enormity of the political situation and impedes said politics from entering the discussion. He noted that this
is not a new development, because governments have historically labelled their opponents or anyone who challenges the status quo as “radicals” and have sought to suppress them through police practices.
German explained that existing research looks at political violence in context. He reported that in empirical studies seeking to understand terrorists’ motivations, there are references to drones, Guantanamo, and torture policies—none of which are included on lists of risk factors for violent extremism or addressed by CVE programs. He posited that this is because the government wants to construe such violence as a problem of a bad ideology rather than conceding its political nature. Furthermore, he suggested that the political nature of so-called extremist violence is the only reason that it is distinguished from the other types of violence that are far more prevalent, such as police violence and state violence, saying “You are allowed to be very violent in this society. You just have to be with the right club.” He clarified that he is not calling for violent extremism to be reframed as political violence. He argued that the objective should be to counter violence irrespective of extremism and ideology, by looking at it in context and trying to resolve violence writ large, whether it is state violence, police violence, or criminal violence.
Griss cautioned against using the public health framework to address violence.1 He characterized it as a type of subterfuge aimed at diverting resources from the public health sector where it can be used to address real public health concerns and shifting it to the military and to law enforcement. He suggested that many people are comfortable with the public health approach in part because it is easy to ignore such concerns, and to focus instead on the individual predictors of violent behavior and how soft power can be wielded to achieve objectives. He contended that the hidden agenda in this CVE framework is to ignore the politics around antiterrorism.
Reflecting on the differences between CVE in the United States and other countries, Skellett observed that unlike the national-level programs implemented in other countries, the U.S. governance structures are completely different in that each state has a large degree of autonomy, which in itself creates a host of challenges in the CVE space. Civil liberties and the balance of beliefs are also critical differentiating components that need to be carefully considered, she argued. In Europe, for example, she noted that there are more restrictions on freedoms of expression, particularly with respect to language that incites hate and violence. Skellett reported feeling like she could not talk about all violent extremism ideologies in the United
1 Griss noted that public health approaches to violence prevention have a well-established and successful history. More information about this history can be found at https://www.cdc.gov/violenceprevention/pub/history0fviolence.html (accessed January 17, 2017).
States in the same way that she can across Europe. She cast as hypocritical the fact that the list of foreign terrorist organizations in the United States does not feature domestic white supremacists or extreme right-wing groups. She explained that this causes her to refrain from speaking openly about ongoing neo-Nazi movements because she fears that it has been accepted as a right of freedom of speech in the United States in a way that has not been condoned elsewhere in the world. Paul Turner, senior conflict advisor at Creative Associates International, commented that there are separate and distinct strands of CVE approaches in place around the world; assuming that there are commonalities among different types of violent extremism, he suggested that there should be platforms for networking where practitioners can share lessons learned and best practices on the ground while also embracing differences in approaches.
Based on her experience, Skellett disagreed with the contention that the public sector is discriminatory in the sense of encouraging stereotypes and discrimination; rather, she suggested, the public-sector spirit is to safeguard strategies that stretch the mark and speak up against injustices. She called for a distinction between using the term radicalization to describe normal social movements used as a force of the good, as opposed to violent radicalization. She suggested that people are often recruited and encouraged to use violent means to achieve aims on behalf of leaders who are hiding their true intentions; thus, policies should be put into place to protect those people. She urged all areas of public service to maintain their focus on the individuals affected by violent extremism and how to make a positive impact on their lives.
Griss suggested that a neglected issue has been the role of radicalized social movements in driving social change, in strengthening democracy, and in changing the power structure for the better. He argued that it is a mistake to construe radicalization itself as the problem, when in fact it is an essential ingredient in rethinking the assumptions of power and legitimacy. He expressed concern about CVE programming because of how similar approaches have been used in the past against public health advocates like Martin Luther King, Jr., against the Black Panthers, and against the Native Americans in North Dakota challenging the Dakota Access Pipeline:
Unless we recognize that pathologizing radicalization is itself part of the propagandistic role that we are seeing supported by the government and the police and the military, this is a very dangerous movement that has undermined democracy in the United States in the past and probably even more so now.
Social Injustices and Earned Mistrust
In many diaspora (and particularly Muslim) communities, there are widespread and deeply held concerns that CVE policies are a mechanism for profiling and discrimination, according to John Hick, Medical Director for Emergency Preparedness and Deputy Chief EMS Medical Director, Hennepin County Medical Center, and other participants. Rondon argued that CVE must address the problem of people feeling alienated because they are being targeted and victimized, not in a sense, but in actuality. She called for law enforcement accountability and oversight with hate crime enforcement policies, as well as investment into education and infrastructure. Jensen also suggested that counternarratives and programs should be put in place to address such feelings of community victimization, but warned that because of common biasing mechanisms, certain audiences may not be responsive to the message.
Turk noted that violent extremism is much less of a concern for most Muslim families and community leaders than other issues, such as gangs, but that the Muslim community often feels victimized by certain targeted CVE strategies. He observed that this has created a sense of mistrust among Muslim communities toward law enforcement: “Whether it is counterterrorism or the securitization of the relationship between the Muslim community and government, it has stigmatized the Muslim community.”
W. Craig Vanderwagen, retired rear admiral, U.S. Public Health Service, and co-founder and director of East West Protection, LLC, commented that the complex issue of violence in society commonly revolves around issues of social injustice that engender anger within communities. Whether that anger takes an ideological or some other form, he suggested, violence is a product of many of these social inequities and social injustices. He argued that criminalizing or “medicalizing” violence is inevitably reductive; while it may be useful in constructing specific interventions and dealing with certain individuals, it does not contribute to resolving the problem’s complexities at the macrolevel or mesolevel. He urged practitioners to devise a paradigm for approaching CVE more holistically, and to validate such a holistic approach.
Griss suggested exploring the potential for applying the restorative justice model, which has programs at the school level and at the prison level but has wider implications for society as social movements are trying to address real dysfunctions at the national and global level.2 He suggested that this would improve the effectiveness of CVE work, and mitigate the tendency to pathologize so-called terrorist behavior. Griss argued that it
is counterproductive to use the counterterrorism framework to try to create healthier and more just communities. He suggested that applying a restorative justice model to CVE may be more appropriate than the antiterrorism frameworks, because it recognizes the legitimacy of individuals’ and groups’ respective and overlapping grievances. He explained that the restorative justice approach involves providing a platform for dialogue—not only within small groups (such as a school anti-bullying program), but within neighborhoods, within the broader criminal justice program, and nationwide. For a given problem, the strategy creates opportunities to address and legitimatize different grievances, to validate the contribution of different perspectives, and through that process, to resolve it by restoring justice.3 He argued that the participants in the workshop had ignored the primary sources of violence: the military and the police, both of whom he suggested have been given carte blanche in many contexts. He contended that this underlies much of the behavior that has been labeled as terrorism, and urged CVE practitioners to inspect this critical blind spot.
Wynia suggested that if there are injustices driving the belief systems that cause people to become violent, some may argue that instead of addressing the injustices, CVE efforts are only focused on trying to prevent people from getting violent about them. He asked how it may be possible to ensure protection of speech and continue to value radicalization and radical speech, while also discouraging violent extremism. Brette Steele, acting deputy director of the Countering Violent Extremism Task Force at the U.S. Department of Justice (DOJ), emphasized that maintaining a clear distinction between extremism and violent extremism needs to remain at the core of CVE work, though she noted that no single program will ever be able to address every grievance. The root causes of these grievances should be addressed through a range of efforts and different programs.
Wynia suggested that a broader approach would also focus on the reasons for mistrust and how to address it. He considered restorative justice to be a tool for achieving improved trust or, as an example, for proving the trustworthiness of the prior offending organization. He characterized community mistrust as beyond mere political polarization, but as arising out of earned mistrust of a variety of different entities. He noted that this has been an issue that the medical system has dealt with over the past decade in investigating the drivers of health and health care disparities, many of which have been related to policy decisions that created adverse health outcomes and mistrust within minority communities. He described how the medical profession has struggled to find ways to address the legitimate
3 He noted that using the term restoring when justice did not exist before is somewhat of a misnomer, but it is at least providing an opportunity to collectively create conditions for justice.
mistrust that has gained momentum over decades: “not mistrust that comes from misunderstandings, but mistrust that comes from understanding.” He suggested that the CVE arena will have to struggle similarly to prove its trustworthiness, after having deservedly lost that trust.
Saeed observed that partner governments around the world have contributed to the senses of grievance and anger that are potential drivers of violent extremism; for example, the International Covenant on Civil and Political Rights (ICCPR) has been signed by multiple countries that do not necessarily abide by it.4 He reported that to address this, the U.S. Department of State has sought to increase diplomatic engagement with governments that have been too overzealous in their CVE efforts by encouraging them to adopt CVE programming that builds in a rights-respecting component as its driving mechanism in law enforcement and government responses. The U.S. Department of State and USAID, he argued, should push partner governments around the world to adhere to the ICCPR and to consider whether their rule-of-law initiatives are essential to their CVE programs.
Ellis suggested that the field of CVE is at a unique juncture where it can be shaped to fit the needs of the country and its communities. Ellis echoed Selim’s point about the importance of empowering local partners and strengthening communities from within. She related a procedural lesson learned from her experience in working with refugee youth as a clinical psychologist:
You don’t do this research on a community and to a community and then decide what to do with the answers. You have to partner in a really genuine fashion with the communities that you’re trying to serve. If you don’t have an equal partnership where they have voice, where they can shape the questions, where they can interpret the answers with you, and where they can use the information to build a program that’s relevant to them, then don’t do the work.
Shifting the Bell Curve: Addressing Social Determinants and Engaging Communities
Brett Kubicek, manager, Research and Academic Relations at Public Safety Canada, observed that the shift to the second wave of CVE programming ushered in an expanded focus on context, unintended consequences, and stigma. He suggested that potentially instructive lessons could be drawn from the literature on social determinants of health to contextualize violence and its link to community resilience, as well as to inform CVE
4 Available at http://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx (accessed November 8, 2016).
programming, implementation, outreach, measurement, evaluation, and accountability.
In the context of social determinants, Leesa Lin, senior program manager with the Emergency Preparedness Research, Evaluation, and Practice (EPREP) Program, Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, emphasized that people are the products of their environments. She observed that violence should be construed as a symptom to be addressed, rather than a driving cause, because progress will depend on addressing the root causes of violence. She suggested investing at the community level in building trust, education, and improving environmental circumstances to help to shift the bell curve, but she expressed concern that currently those areas do not get enough attention or sufficient funding to warrant investing in the programs that produce the greatest outcomes. In that vein, Benjamin commented that from a societal perspective, more attention needs to be paid and resources devoted to factors that put individuals at high risk for a range of violent activities: improving early childhood education, broadening access to mental health services, preventing domestic violence, limiting access to firearms, and strengthening economic empowerment.
Leana Wen, health commissioner of Baltimore, Maryland, noted that there may be a disconnection between people working outside the public health sphere and the understanding of root causes that may lead to radicalization and eventual violence. To explain, she remarked that frontline practitioners treating a patient for gunshot wounds do not have time to investigate root causes and determine whether the person was a victim of trauma earlier in life. Even if that were established, she said, at that point it would be too late to intervene. Furthermore, she noted that the disparities present in the communities in Baltimore City, for example, make it difficult (and even disingenuous) to address root causes such as healthy nutrition, for example, with parents who live in a food desert. She highlighted the need to call out and address the disparities that are in and of themselves the root causes of so many problems.
Rondon agreed that CVE does not address the root factors that drive violent behavior; she suggested that people are feeling alienated because they are actually being targeted and victimized by CVE programming. She emphasized that law enforcement accountability and oversight must be addressed with hate crime enforcement policies, coupled with investments in education and infrastructure. She also suggested improving access, particularly for Arab and Muslim communities, to mental health resources that are not linked to CVE and do not require a person to profess to being a criminal or at risk of criminality.
Multiple participants highlighted the need to bring more community stakeholders and credible voices to the table. Rondon suggested that CVE
programs are developed and implemented without input from key stakeholders and credible voices who are only asked for input after the fact, when they should have been involved in the planning stages. Farooq also commented that the CVE space should bring more stakeholders to the table, particularly people who have been involved in developing and implementing evidence-based CVE programs. Farooq suggested that this is one reason the conversation constantly circles back to semantic concerns about what to call CVE, rather than focusing on actions to take. She contended that people who have implemented CVE programs would be able to describe the practical challenges that they and their communities have faced. Based on her experience, she observed that the communities being served do not need to be convinced of the need for action; they already recognize it and should be allowed to play a driving role defining what that specific threat is and how to address it. To that end, she cautioned against generalizing and recommended allowing communities to define what the threat of violent extremism means to them, because it will always differ based on geography and demography. She pointed out that community building is not rocket science; rather, it is about drawing on basic principles of community mobilization and development from the international development field, and applying them to the challenge of violent extremism. Hick commented that the polarization that surrounds these types of discussions in the CVE space is difficult to surmount:
Even efforts to promote community equity wind up being tainted with optics from different perspectives, and make it hard to accomplish anything in the value of the common good, regardless of whether that applies to the whole population or not.
Ellis characterized individual resilience as a process that can be built within an individual, rather than a binary attribute that a person has or does not have. Identifying factors that interfere with that process (e.g., mental illness, trauma, or a sense of disconnection) and addressing them can promote more resilient trajectories at the individual level. She suggested widening the lens of the prevention component of CVE to encompass early-stage interventions to prevent future negative outcomes. According to Ellis, resilient communities are those in which everyone feels like they belong and feels they have a meaningful voice, with communal social bonds among and within different subsets of the community and at different levels of government. Annie Miller, associate professor at University of Denver/Metropolitan State University of Denver, suggested that public health can
lend a useful lens for examining community-level perceptions of safety, and offer ways to enhance them with effective mechanisms.
Multiple participants emphasized the importance of educating communities about the warning signs that an individual may be at risk of radicalization that may lead to violent extremism. They suggested that to effectively intervene with individuals who are vulnerable to radicalization and may be on the pathway to violence, recognizing the warning signs must be coupled with a network of appropriate referral channels for seeking help and accessing services for remediation. Key challenges highlighted were the stigmatization that can surround seeking help and some community members’ reluctance and apprehension about engaging with traditional avenues of referral through law enforcement or government agencies.
Selim reported that over the previous 24 months, there had been roughly 100 cases inspired by ISIL, in which the U.S. government or federal law enforcement agencies interdicted in some way—either in attempted attacks in the United States or in attempts to travel abroad. He pointed to a single predictor as a common theme: in the overwhelming majority of those cases, someone in the person’s social or family sphere realized that something was amiss but did not know what to do or where to go (anecdotally, this may be attributable to trepidation in contacting law enforcement for a range of different reasons). According to Selim, this bolsters the need for integrating a public health approach in developing CVE-related programs to help destigmatize the issue of wanting or needing to seek help, as well as having the resources and ability to access advice and services.
Wynia noted that in recent years, public health has moved away from negative framing (i.e., preventing bad outcomes) and toward encouraging better outcomes like health and well-being. He questioned whether there has been an analogous shift in the CVE space. Ellis located a similar shift surrounding the issue of preventing violence. There is a gray area surrounding the best way to intervene with a youth who has not actually committed violence, but his or her family, teachers, and peers recognize intuitively that something is wrong. It can be problematic if turning to law enforcement to help prevent violence is the only option in such cases, because law enforcement have a different mandate than other disciplines that operate in the constructive space of helping the youth to reconnect with the community and foster a sense of belonging. She suggested that prevention approaches should shift in focus from the prevention of violent acts to exploring options for reengaging youth who are embarking on a trajectory that could lead to violence.
Wynia remarked that while the discipline of CVE is still young, it is far from stagnant, with multiple innovative approaches already being implemented in the field. He argued, however, that a novel public health approach is urgently needed. He drew parallels between the origin stories of public health and CVE: both are fields that arose out of eras in which heroic interventions for very challenging problems became common. Although these aggressive interventions made intuitive sense, he explained, people began to question their efficacy and began to recognize them as counterproductive, giving rise to retrospective examination about how to prevent those bad outcomes from occurring. He remarked that in both CVE and public health, this triggered the emergence of new fields focusing on different types of approaches (e.g., those that focus on root causes, on prevention, population-based approaches, or environmental and restorative justice approaches). However, he noted, both CVE and public health have faced similar difficulties in distinguishing themselves from existing approaches, in defining the appropriate language, and in implementing approaches that do not alienate the very people they are designed to help—these challenges may be new to CVE, but they have been perennial challenges in public health for more than 100 years, he observed. He continued, suggesting there is much these sectors can learn from each other, emphasizing that this avenue for reciprocal learning and spreading of ideas represents a crucial opportunity to strengthen both fields. Selim remarked that the director of the FBI, the Secretary of Homeland Security, and the attorney general have all stated that the current threat of radicalization, recruitment, and the influence of foreign terrorist organizations to inspire an act of domestic terrorism is not a problem that “we are going to arrest our way out of.” Similarly, he reported, law enforcement professionals have acknowledged the new state of threat from both foreign and domestic influence on communities in the United States and are calling for the integration of more holistic, adaptive approaches.
Selim continued, noting that conversations around the country are seeking to refine the concept and reshape the scope of prevention, how various sectors should be involved, and what prevention should look like on a community-based level. He suggested that the federal government has an important role to play in promoting and facilitating these conversations and catalyzing continued engagement toward a multidisciplinary comprehensive approach to CVE. Selim remarked that given the potentially negative perceptions related to the prevention of radicalization toward extreme violence, the overall spirit of the U.S. government’s national CVE strategy is not just to prevent or intervene, but to build and strengthen communities from the ground up. He reported that many U.S. cities have cultivated
and invested in their own CVE strategies, shaped by local perspectives and contexts, to enhance community resilience and empower local partners. He said,
The intent and spirit of our [CVE] policy and all our programs is to invest, is to build, is to engage, and not to have some type of coercive measure, but really to provide solutions in a way that is constructive.
Legal and Ethical Responsibilities of the Nonmedical Practitioners
Hick reflected on the legal and ethical obligations of parents who have children that may be venturing into risky or threatening territory, given that once the parents broach the legal boundary they risk losing their children to the criminal justice system. He noted that similar concerns apply to the ethical obligations of religious or community leaders and community members who may be intimidated into not speaking up about activities within their community that they consider potentially dangerous because of concerns they have about garnering unwanted attention and the risk of legal action. However, he was optimistic that there is the space and opportunity to develop applicable ethical frameworks to establish expectations and counterbalance some of the legal obligations.
Role of the Media
Dan Hanfling, contributing scholar from the Johns Hopkins University Center for Health Security, raised the issue of media ethics and the role media can play in perpetuating stereotypes and exposing risks in vulnerable communities, especially in the age of the 24-hour news cycle and pervasive social media networks. David Eisenman, professor of medicine and public health at the David Geffen School of Medicine, University of California, Los Angeles (UCLA), UCLA Fielding School of Public Health; and director of the UCLA Center for Public Health and Disasters, expressed similar concerns about how the media can incite problems, but he suggested there could be opportunities to leverage the media in advantageous ways and to reinforce positive behaviors. He proposed that storytelling might be a way to inject characters with new traits and new behaviors into television programs and other types of media. Having stigmatized groups shown playing less stigmatized and more respectable roles, he suggested, could counter stereotypes and provide those groups with a voice.
Funding and Resources
Harlan Dolgin, president and cofounder of the Bio-Defense Network, pointed to the challenge of how to convince funders to support CVE programming, given that the payoff will be at least 15 to 20 years in the future. Lin suggested that to better quantify the return on investment, research should be marketed in a better way to get the right people to pay attention. Neil Rainford, public health advisor with the Prevention Practice and Translation Branch, Division of Violence Prevention, within the National Center for Injury Prevention and Control at CDC, commented that the source of resources matters not only to communities, in terms of trusting the outcomes or intentions of those resources, but in the sense that resources can come in many different nonfinancial forms, such as people and capabilities. He suggested framing all resource conversations in the context of building sustainable programs, noting that resources provide an opportunity to develop solutions and strategies that can potentially solve multiple problems or issues. He also highlighted the need to diversify resources so programs and strategies are supported by multiple funding streams. With respect to government resources he suggested that communities can feel exploited when researchers supported by the government appear to take data and depart after 3- to 5-year project cycles are completed, but the issues that plague the community do not get resolved.
German warned that with the funding currently available for CVE, people may be tempted to shoehorn other types of programming into the CVE space, when in fact they are programs for law enforcement, the FBI, or DHS. Anderson also remarked on the need for caution in using science as part of an effort to prevent dissent versus using it to help to prevent violence, a distinction that can sometimes be lost because of groupthink and the availability of funding.
Performance Assessment and Measurement
Wynia asked about how to measure the success of CVE programs in terms of the types of outcomes, measurements, or proximal measures that should be used. Steele noted that assessing outcomes will require better understanding of risk and protective factors, assessment strategies, and identifying opportunities for prevention programs by evaluating preventive efforts at the primary, secondary, and tertiary levels.5
Wynia suggested that teaching people how to measure performance is
5 Here, the terms primary, secondary, and tertiary refer to the timing of prevention efforts. More information can be found on page 15 of the World Health Organization’s World Report on Violence and Health, available here: http://www.who.int/violence_injury_prevention/violence/world_report/en (accessed February 10, 2017).
critical, and that there are many pitfalls in performance assessment. For instance, the best outcomes might not be the easiest to measure, leading to a false sense of security because measured outcomes are looking good, while unmeasured (but more important) outcomes might be poor. A related issue he highlighted is the propensity to “game” the system. In situations where resources and other meaningful impacts are contingent on better or worse performance, he cautioned that people will inevitably finesse that measure. He suggested that there is an entire panoply of issues related to evaluation, and especially high-stakes evaluation, that warrant careful attention. Anderson raised the similar issue of how monitoring, evaluation, and measures of effectiveness can be subject to manipulation. He noted that because of those concerns, USAID switched to a policy of using independent agencies to perform their measures of effectiveness. He suggested that CVE policy makers should budget to include an independent evaluation, rather than the agency evaluating itself. Miller suggested that the element of protection may be missing in discussions about measuring and evaluating community resilience and other work carried on in the CVE environment.
Wynia commented that despite the challenges facing evaluators (such as publication bias and the lack of a shared measure set), there are positive developments afoot. For example, DOJ now requires many of its funded projects to share data in a common database, and the DHS is thought to be moving in that direction; the use of independent evaluators has gained positive momentum as well. He explained that the public health concept of community-based participatory research could be a useful model for working with communities to determine which outcomes matter to them and which measures would be appropriate, meaningful, and salient for both communities and policy makers. He asked whether any such efforts were under way in CVE. Steele reported that similar efforts are under way in the CVE realm, with several researchers employing those methods. She observed that because CVE is built around the concept of collaborative problem solving, community-based participatory research can serve as an excellent vehicle for implementing that strategy.
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