My Brother’s Keeper: The Vital Role of Prevention Science

We were pleased to hear about the “My Brother’s Keeper” Initiative. It addresses a very significant need in society.  As President Obama indicated, young men of color are particularly at risk for a wide variety of problems. There are many factors that influence the statistics, primary of which is their high rate of poverty, harsher living conditions, institutional racism, stressful family dynamics and lack of opportunities.  The consequences for the nation are substantial.  Economist Ted Miller estimated the cost of the most common problems for all youth, such as violence, drug abuse, high-risk sexual behavior, poor academic achievement, high school dropouts and suicide attempts, total about $462 billion annually.

The success of this Initiative would significantly increase the proportion of young people who arrive at adulthood with the skills, interests, and values they need to be successful.  And in turn, we can expect to achieve a substantial reduction in both the human and financial burden to the nation.

However, many initiatives of this sort have failed because they did not make use of tested and effective strategies or the empirical tools for evaluating and improving those strategies.  A successful effort will require the systematic application of well-established, evidence-based principles and practices generated by the prevention sciences.  These lessons learned are applicable to all populations at risk for poor outcomes; however, given the focus of this initiative, we attest they should be followed for this effort as well to improve chances for success in young men of color.

It is important first to understand that these diverse problems are inter-related and stem from the same set of adverse conditions, all of which are more prevalent in high poverty neighborhoods.  More than 20% of children are being raised in poverty in this country and the rates for African American children are higher (38.2%), as are those for Hispanic children (32.3%).  Caregivers and their children in these communities experience a lack of resources ranging from low household wages and unemployment, to poorly equipped schools, to inaccessible health care services.  Research indicates that poverty – and for people of color, also racism – increases stress, which contributes to increased risk of cardiovascular disease, diabetes and many other diseases.  For families, the high levels of stress among caregivers often leads to increased experiences of conflict, threat, dysfunction and deprivation for their children, and less reserve to foster healthy childhood development. Indeed chronic exposure to stress rewires people’s physiology in ways that make them hyper-vigilant to threat, more likely to perceive hostile intent in others, and more likely to react aggressively or to become depressed.

The result of experiencing these conditions early in life is that children are less likely to develop adequate self-regulation skills.  The aggressive and off-task behavior that often emerges in these children as they enter adolescence is associated with academic failure, peer rejection, affiliation with other troubled kids and family problems.  By adulthood, the skills for success are not in place.

While all of this is true for every child experiencing adversity, youth of color often also face daily incidents in which they are subtly and not-so subtly treated in demeaning, hostile, and even lethal ways.  President Obama has spoken eloquently about this in his remarks about the Trayvon Martin murder. And the long history of racist acts that Isabel Wilkerson describes in The Warmth of Other Suns makes it clear the African American community, in particular, lives with a legacy of oppression.

As said above, a successful effort will require the application of evidence-based principles.  Indeed, the 2009 Institute of Medicine report on prevention concluded that we know enough “to begin to create a society in which young people arrive at adulthood with the skills, interests, assets, and health habits needed to live healthy, happy, and productive lives in caring relationships with others.”  These programs work by rallying caregivers and teachers around their values and goals for their children and helping them to hone their skills to nurture their children’s development. They learn to richly reinforce their children’s developing skills, interests, and values.

There are a host of policies that can contribute directly to reducing poverty and we hope and expect that the Brother’s Keeper Initiative will work to get them implemented. However, even given the current realities of poverty and racism, there is a wide range of programs that have proven beneficial in helping families ensure that their children develop successfully.

A few examples of evidence-based programs that have been provided to children and families of color include the Nurse Family Partnership, the Family Check Up, and the Good Behavior Game, a universal school-based program.  There is strong documentation of their beneficial effects and cost-savings; they and others have promise to increase children’s chances for success in school, their communities, and in life.

In the interest of young men of color and, in fact, all children and adolescents, we need to build a world class national prevention system.  The IOM’s report on prevention identified science-based interventions and policies that are capable of preventing the development of virtually the entire range of psychological problems that hamper the development of children and adolescents who are at risk due to poverty and other adverse social and environmental conditions. Some of these programs have been implemented already across the country, but only on a piecemeal basis; they need to be scaled up and systematically sustained.

A comprehensive and effective prevention system, which is described in a related blog post, would have five facets: (a) An effective and nurturing system of family supports; (b) Effective positive behavioral supports in all schools; (c) A set of well-tested and proven prevention programs and policies; (d) Ongoing public education about prevention and accurate information about mental and behavioral health, including violence and drug abuse; and (e) A system for monitoring the wellbeing of children and adolescents. Such a system should be built in stages with careful attention to the effective implementation of evidence-based interventions.  It might begin by concentrating resources in a small number of high poverty communities, such as the Harlem Children’s Zone and “Promise Neighborhoods” which are currently being supported by another Presidential initiative. The impact of the effort should be carefully evaluated—not because “more research is needed” (though it is) —but because rigorous evaluation should routinely be built into every social program for continuous improvement, to amass evidence of the program’s effects, and for citizens to judge the benefits of these efforts.

The U.S. can significantly improve the success of young men of color through coordination between all child-serving and health agencies and organizations to make use of the strong science-base that decades of prevention research has produced.  It is a significant undertaking that requires several years of concerted effort.  But if we can unite everyone around a common understanding of what is needed, we can build a system that equalizes the playing field for all children to have the opportunity to lead happy, healthy and successful lives to a degree never before seen in human history.

The newly formed  ​Prevention Coalition for Promoting Healthy Child and Adolescent Developmentstrives to improve the health and wellbeing of children, adolescents, families and communities by (1) promoting a science-driven approach to preventing risks and disadvantages; (2) building links among researchers, child/adolescent-serving organizations, advocacy groups, policy makers, and the media; and (3) working with government to adopt a “prevention model” that would reduce costs while benefitting society. We stand with and are ready to work with My Brother’s Keeper Task Force and partnering philanthropic and business sectors.

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Anthony Biglan, Ph.D., Oregon Research Institute, Coauthor of the IOM Report on Prevention and Former President of the Society for Prevention Research

Diana Fishbein, Ph.D., Director of the Center for Translational Research on Adversity, Neurodevelopment and Substance abuse, University of Maryland School of Medicine

Neil Wollman, Ph.D., Chair of the “Prevention Project” and Organized Two Congressional Briefings on this topic, from Bentley University

 

Address correspondence to Neil Wollman; Senior Fellow, Bentley Alliance for Ethics and Social Responsibility; Bentley University; Waltham, MA, 02452; NWollman@Bentley.eduPrevention Project Web Site  http://www.preventionproject.us/

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