'Prevention science' can improve Baltimore's future

Prevention science can attack Baltimore's problems before they reach crisis proportions.

Similar to Hurricane Katrina, when the nation's attention turned to the abject poverty in the South, the unrest following the death of Freddie Gray has unveiled the deep-seated and longstanding neglect in Baltimore. Over the past century, Baltimore has become a tinderbox, easily ignited and difficult to extinguish. The young people who looted and set fires after Gray's death were portrayed in the media as hooligans taking advantage of a chaotic situation to misbehave. But closer to the truth, the uprisings are the culmination of decades of public indifference and misguided policies.

Freddie Gray died needlessly, but there is a vital takeaway message — a call to action to effectively address the social ills that underlie the unrest. It is imperative that we all take ownership and have the courage to make bold, anticipatory decisions to implement new policies that reverse the damage from our neglect.

The task is not easy. Many Baltimore residents face formidable obstacles to breaking intergenerational cycles of poverty, academic failure, violence and drug addiction. It is difficult enough for impoverished residents to meet even the most basic needs of these children; schools try to compensate, but there is little time left for a solid education. Children raised in poverty are also exposed at alarming rates to traumatic experiences that are harmful to brain development and, in turn, diminish academic and social skills crucial for success throughout life.

It is unsettling that the Data Resource Center for Child & Adolescent Health reported that nearly 1 in 3 children growing up in Baltimore City experience multiple adverse childhood experiences (ACEs), and at significantly higher rates compared to state and national levels. The Centers for Disease Control and Prevention documented that exposure to ACEs is associated with chronic disease, drinking and drug use, mental health problems and premature death. ACEs tend to accumulate over time, creating a snowball effect of trauma, loss and hardship. Our call to action is to intervene early to alleviate the damage.

Prevention science — one of the most well-established bodies of research on how to improve lives — can provide that guidance. TheInstitute of Medicine report on preventionconcluded 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." As a civilized society we have no excuse to allow adverse conditions to prevail in poor communities in light of evidence that many if not most are preventable.

Prevention science offers proven programs and policies that help to reduce psychological problems, violence, drug abuse and even poverty, and they improve academic performance and health outcomes. They work by enhancing safe, supportive and nurturing relationships with caregivers and teachers and building social networks that allow our children to grow into healthy, responsible and productive adults.

Well-tested strategies include support for mothers before and after giving birth, strengthening parenting and family functioning, creating classroom and school conditions that promote academic and interpersonal success, improving social-emotional learning skills, providing services specifically needed by "at-risk" youth, building social supports in neighborhoods, and bolstering job training.

Prevention science demonstrates how making intelligent investments today will improve the health and wellbeing of a community. At its core, it shows us a way to address problems before they reach crisis proportions. This approach saves lives and communities, and over time it saves substantial taxpayer dollars. But it requires a long-term perspective, political will from policy makers, partnership with the community to guide decision-making, and coordination across service settings and systems. Real progress takes a sustained coordinated effort targeting all environments that should be nurturing our children — families, schools and neighborhoods.

We implore public and private sectors in Baltimore City to learn something from this crisis about critical but changeable influences on the ability of children and teens to overcome adversity. We can use prevention science as an instrument in our toolbox for change, a message and method fostered by the National Prevention Science Coalition to Improve Lives, a nonpartisan, nonprofit coalition of scientists, educators, clinicians, policy makers and community organizations.

Wide-scale adoption of evidence-based policies and practices requires federal government participation and substantial private investment. Thanks to a budding bipartisan interest, there is renewed interest in putting these policies to work. Granted, this is a significant undertaking that will require several years of concerted effort.But if we can unite around a common understanding of what works, we can build a system that gives all youth the opportunity to lead happy, healthy and successful lives. The children of Baltimore are not problems to be fixed or contained. They are our future.

Diana H. Fishbein is a professor at the University of Maryland School of Medicine, director of the Center for Translational Research on Adversity, Neurodevelopment, and Substance abuse and director of the National Prevention Science Coalition to Improve Lives. Her email is dfishbein@c-trans.org.

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