Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. In this Idea Gallery, Bryan Samuels, Commissioner of the Administration on Children, Youth and Families, provides his perspective on how communities and organizations and families can work together to keep children safe, in honor of Child Abuse Prevention Month.

Nancy Barrand, Senior Adviser for Program Development at the Robert Wood Johnson Foundation (RWJF), also weighed in to provide some context for Commissioner Samuels' post:

Few events are more traumatic for children than being removed from their families and entered into the foster care system. In 2010, the Robert Wood Johnson Foundation funded the Corporation for Supportive Housing to develop and implement a pilot program in New York City that uses supportive housing to offer stability to families with children who are at risk of recurring involvement in the child welfare system. The New York pilot initiative, called Keeping Families Together (KFT), showed positive results in keeping and reuniting children with their families in a safe, stable environment. A 2011 evaluation indicates that the KFT pilot generated a 91 percent housing retention rate among participating families. By the end of the evaluation, 61 percent of the child welfare cases open at the time of placement in supportive housing had been closed, and there were fewer repeat incidents of child maltreatment.

Now, RWJF has partnered with the U.S. Department of Health and Human Services, Administration on Children Youth and Families and three private foundations – the Annie E. Casey Foundation, Casey Family Programs, and the Edna McConnell Clark Foundation – to jointly fund a $35.5 million initiative to further test how supportive housing can help stabilize highly vulnerable families. The national replication effort will be evaluated and we’re anxious to see whether, again, secure and affordable housing, when paired with the right services for struggling families, can reduce instances of child abuse and neglect.  The long-term gains in health and well-being, and costs saved, could be tremendous.

Commissioner Bryan Samuels on Child Abuse Prevention

Throughout the month of April, we turn our attention to the prevention of child abuse and neglect, celebrating those efforts in neighborhoods, faith communities, and schools that keep children safe and help families thrive. Whether formal or informal, these efforts involve wrapping caregivers and children in supports that reduce risk factors for maltreatment and promote protective factors, by decreasing stress, boosting parenting skills, and helping parents manage substance abuse or mental health issues.

Last year, more than 675,000 U.S. children were victims of maltreatment. These children are more likely than their peers to have emotional and behavioral problems, struggles in school, and difficulty forming and maintaining relationships. The effects of abuse and neglect can be pernicious and lifelong.

In recent years, we’ve come a long way in learning what it takes to help children who have experienced abuse and neglect heal and recover. We have interventions that help put families back together after maltreatment has occurred. But preventing abuse and neglect in the first place by giving families the support they need, when they need it, yields the best outcomes.

Shortly after the shooting of 20 children and six adults in Newtown, Ct., a large group of Hollywood stars released a video  asking viewers to “demand a plan” on action to be taken to prevent future mass shootings.  Since then several videos have popped up on YouTube that show almost all of the actors in the video wielding weapons in films and television shows.

Another video also demands a plan on gun violence, with a compelling set of spokespeople. This one stars and was developed with minority teens in California and produced by the California Endowment, a private health foundation. At last check, the teens’ video had gotten close to 750,000 hits on YouTube.

NewPublicHealth spoke with Barbara Raymond, director of youth opportunity at the California Endowment about how the video came to be and what the next steps are for taking action on gun violence.

NewPublicHealth: How did this video come to be?

Barbara Raymond: The Endowment looks at health very broadly, including things that happen in our schools and happen in our neighborhoods. We started work a couple of years ago in 14 communities across California, and through the process we’ve worked with  over 20,000 residents and they came back so strongly saying safety and my own health prevention are our number one issues. And they drilled down further to issues including school safety and school climate and the epidemic of suspensions and extreme school discipline policies.  

We have been able to engage a whole set of young people and they have really identified these issues as well. It’s especially the young people saying that working on these issues is urgent, including violence in the community and on the streets of our neighborhoods, fixing issues in our schools and what the kids call the school-to-prison pipeline. These issues have just come up so strongly so when the Newtown tragedy happened, young people wanted to say something and react to that.  

As staff, we talked about how the tragedy would open up a whole public conversation around mental health and school safety practices and staff members suggested we reach out to the kids with the video idea.  

NPH: How were the kids involved in the development of the video?

Mental health has become a more prominent topic since the recent shooting in Newtown, Conn., that claimed 26 lives, 20 of them children. The Alliance for Health Reform, a non-profit group based in Washington, D.C., that provides information to journalists and Congressional staff on health reform issues, released some key numbers on mental health issues recently that can be useful in moving the discussion forward:

• An estimated 45.9 million adults in the United States age 18 or older had any mental illness in 2010 (one out of five people in this age group).
• In 2010, an estimated 31.3 million adults received any kind of mental health service during the past year.
• Among adults with severe mental illness, 60.8 percent received mental health services during the past year.
• An estimated 11.1 million adults reported an unmet need for mental health care in the past year. Of those, 5.2 million had not received any mental health care at all in the past year. 
• People who are out of work are four times as likely as those with jobs to report symptoms consistent with severe mental illness.
• The cost of care is the reason most often given by people who recognize that they need mental health treatment but don’t get it. 

According to research by the Alliance, mental illnesses range from occasionally troubling to life-consuming. To cope with temporary problems, such as depression following illness or a traumatic event, many people need only a short-term intervention. But others experience more debilitating and long-lasting conditions that interfere with routine activities such as work, school and family, and can require lifelong treatment.

Effective, well-documented treatments for mental illness and substance abuse have been developed and widely disseminated, including psychotherapy,  psychosocial treatment and prescription medications. But a significant number of Americans do not have adequate access to mental health treatment or do not take advantage of available help.

Last week at the American Public Health Association (APHA) annual meeting, a number of presenters took on an important, but often overlooked topic in the public health world: violence. Violence is often primarily considered a criminal justice or public safety issue, but there is a growing movement of public health practitioners that recognize that the health of vulnerable communities cannot be improved without first stopping shootings and killings.

When violence is present in a community, it impacts the physical, mental and emotional health of all residents. Violence also often prevents other positive changes from taking place. According to Greta Massetti from the Centers for Disease Control and Prevention, the current economic impact of youth violence is an estimated $14.1 billion in combined costs from medical care and work loss.

During the APHA meeting, speakers from organizations such as Cure Violence, UNITY and the Centers for Disease Control and Prevention discussed the latest research and strategies to prevent disease.

Treating violence as a disease

For many vulnerable communities, violence is the most pressing health issue. For children growing up in violent communities, the health impact is more than just the physical threat. As Benita Tsao from Urban Networks to Increase Thriving Youth (UNITY) pointed out, growing up in a community plagued by violence can often feel like being in a war zone.  That constant fear results in real health consequences, as evidenced by the increasing number of children who have grown up surrounded by violence and are now showing signs of chronic traumatic stress disorder. Experiencing ongoing trauma impacts young people’s physical, mental and emotional development, and has the ripple effect of making it harder to focus and succeed in school. 

In the wake of yet one more high-profile shooting this week, at Texas A&M University, the Associated Press profiled the Violence Prevention Research Program at the University of California, Davis, which is calling for a public health approach to reducing gun violence, in the same way that public health has tackled such issues as motor vehicle deaths, tobacco and alcohol.  "The greater toll is not from these clusters but from endemic violence, the stuff that occurs every day and doesn't make the headlines," says Garen J. Wintemute, MD, MPH, the program’s director.

According to information in the article from the Centers for Disease Control and Prevention, there were more than 73,000 emergency room visits in 2010 for firearm-related injuries.

Critical factors being addressed by the Violence Prevention Research Program include:

• What makes someone more likely to shoot?
• Which firearms are most dangerous and why?
• What conditions allow or contribute to shootings?

>>Read the article.

 >>Bonus Link: Public Health Law Research, a program of the Robert Wood Johnson Foundation and Temple University Beasley School of Law are co-sponsoring LEPH 2012: The First International Conference on Law Enforcement and Public Health to be held in Melbourne, Australia, November 11-13, 2012.

Among the sessions will be case studies of successful collaborations between police and public health across a wide range of issues.

Several mental health organizations and government agencies have announced online or telephone resources to help citizens and professionals  cope with worry, fear, anxiety and stress in the aftermath of the Colorado shooting at a movie theater early this morning that has taken at least 12 lives and injured dozens more:

• The Centers for Disease Control and Prevention has a web portal dedicated to disaster response with resources for direct victims and the larger community.
• Mental Health America, a national advocacy and education group on mental health issues, has developed guidelines and a fact sheet  to help facilitate discussions about the tragedy.
• The Disaster Distress Helpline (800-985-5990) of the Substance Abuse and Mental Health Administration provides immediate crisis counseling and help to people in the US coping with the shooting incident in Colorado, or any other disaster. The helpline operates 24/7 and connects callers with trained professionals from the closest crisis counseling center in the nationwide network of centers. The helpline can also be accessed by text (Text: TalkWithUs to 66746).
• The Department of Veterans Affairs has a helpful fact sheet on post traumatic stress disorder after a disaster.
• UPDATE: One of our commenters shared resources from the National Child Traumatic Stress Network, which is funded by SAMHSA. See the comment below for more details.

>>Weigh In: Do you have a response system ready for local and national disasters? 

Stricter Seat Belt Laws Push Teens to Buckle Up

Teen drivers and passengers are more likely to use seat belts in states with "click it or ticket" laws, according to a new study in the American Journal of Public Health. These laws, also known as primary enforcement laws, allow police to stop and ticket drivers for not wearing a seat belt. Under a secondary law, police can only ticket drivers not buckled up if they are stopped for some other reason, such as speeding.

The study found that in states with secondary laws teens were 12 percent less likely to wear a seat belt when driving and 15 percent less likely to do so as a passenger than teens in states with primary laws. Read more on public health law.

Current Bullying Prevention Programs may not Thwart Cyberbullying

A new study by researchers at the University of British Columbia found that a survey of 17,000 Canadian students in grades 8 to 12 showed that 25 to 30 percent admitted to cyberbullying, while only twelve percent said they had participated in schoolyard bullying. The researchers say that indicates that current prevention programs may not be sufficient to protect kids from online bullying. Read more on violence prevention.

Killing in Wartime Linked to Later Suicidal Thoughts

Researchers analyzing data from a survey of Vietnam War veterans have found that those with more killing experiences were twice as likely to have suicidal thoughts as those with fewer or no experiences of killing.

The researchers, who published their findings in the journal Depression and Anxiety, say the association between killing and suicidal thoughts remained even after adjusting for variables such as post-traumatic stress disorder, depression, substance use disorders and combat exposure.

"We want clinicians and suicide prevention coordinators to be aware that in analyzing a veteran's risk of suicide, killing in combat is an additional factor that they may or may not be aware of,” says Shira Maguen, PhD, the study’s lead researcher. Read more on military health.

“They said he was a geek, he was worthless and that he should go and just hang hisself, and I think he just got to the point where enough was enough” – spoken by Kirk Smalley, father of Ty, in the forthcoming documentary, Bully. Ty, 11, hanged himself in 2010.

An astonishing thirteen million kids face bullying each year according to government surveys, making it the most common form of violence experienced by young people in the United States. Bullying’s effects can impact every aspect of a child’s life from grades to self-esteem and, as Ty’s story shows, even the desire to live. The new documentary Bully, set to hit theaters across the U.S. on March 30, offers an intimate look at how bullying has affected five children and their families.

Parents and schools have been invited to sign on to a Twitter Town Hall on bullying to be hosted TODAY by the Centers for Disease Control and Prevention (CDC) between 3 p.m. and 4 p.m. EST. Follow the conversation using the hashtag #vetoviolence, or by following the CDC Injury Center on Twitter. The Town Hall will feature experts from the CDC, the Anti-Defamation League, the Health Resources and Services Administration, and the Department of Education.

>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.

Earlier this week on The Colbert Report, Stephen Colbert likened Ameena Matthews, a violence “interrupter” at CeaseFire, a Chicago-based organization that employs a public health approach to stop the epidemic of gun violence in cities around the country, to an antibody. Matthews works in tough neighborhoods to stop the transmission of violence from person to person in much the same way that disease control professionals contain and prevent the spread of infectious illnesses.

Matthews can be seen in “The Interrupters," a documentary about CeaseFire that will be aired on PBS Frontline on February 14, 2012.

Recommended Readings:

• Read NewPublicHealth interviews with CeaseFire founder Gary Slutkin and Tio Hardiman, director of CeaseFire Illinois, first posted when “The Interrupters” was released last year.
• Also check out the first rigorous evaluation of the CeaseFire model outside of Chicago. In Baltimore, researchers found the Safe Streets program cut homicides by more than half in the Cherry Hill neighborhood.
• Watch The Colbert Report video and read more over at APHA's Public Health Newswire.

The Public Health Law Research Program as well as the American Society of Law Medicine and Ethics, the Network for Public Health Law and the Public Health Law Association and will be hosting a webinar on Thursday, January 26 at one p.m., looking at laws related to mental illness and firearms. The webinar will focus on what is known about the contribution of mental illness to violence and will consider the implications of research literature for law and policy that seek to limit firearms access for people with mental disorders who may pose a danger to themselves or others. The presentation will discuss research findings on whether current federal and state firearms restrictions reduce gun violence, and will lay out an agenda for needed future research.

>>UPDATE: Check out the recording of Thursday's webinar on the Network for Public Health Law website, here.

NewPublicHealth spoke with Jeffrey Swanson, PhD, Professor of Psychiatry and Behavioral Sciences at Duke University School of Medicine, and a presenter for the webinar.

NewPublicHealth: What’s the scope of the problem?

Jeffrey Swanson: Firearm violence is a major public health problem in the U.S. More than 300,000 people died from gunshot injuries from 1998 to 2007—a death toll five times greater than the number of U.S. military casualties in the Vietnam War. Very public acts of gun violence by persons with mental illness—such as the mass shootings at Virginia Tech in 2007 and in Tucson in 2011—suggest that the current patchwork of state and federal firearms laws may be ineffective at protecting the public from dangerous individuals. But, in fact, research shows that the large majority of people with mental illness are not violent, and that most violent acts are not caused by mental illness.

Two consequences can result from the varying state laws—mentally ill people can be kept from their constitutional right to own a firearm, and some laws can put firearms into the hands of mentally ill people who may use them not to kill others, but to commit suicide.

NPH: What’s the status of your research on the topic?