adapted from an article by Bill Du Bois in Utopian Thinking in Sociology: Creating the Good Society, edited by Art Shostak, American Sociological Association, 2001: pp. 123-143.

 


 

The Prevention Game

 

Thinking Creatively About Reducing Crime

 

William Du Bois, Ph.D.

 

 

Picture a game.  Players are given identical neighborhoods or small towns.  Each has a budget of $2.5 million which can be spent in any way over a ten year period of time.  The winner is the one with the lowest crime rate over the ten year period.  What would be the best strategy to win the game?  How should players invest their resources to maximize their return? 

 

                        Two and a half million dollars over ten years may seem like a sizable sum.  However, we should remember how that money is spent today.  At $25,000 per year, $2.5 million is the cost of keeping 10 people in prison for ten years.  Prisons are already filled to capacity.  The cost of building and housing inmates in new cells is $39,000 so that is only enough able to house 6.4 inmates a year.  Or it is the cost of 7.5 juvenile beds in group homes for the same period, or 2 beds in intensive psychiatric group homes.  We can spend all our money on removing a few criminals from the neighborhood, but that does not guarantee that the neighborhood will not breed new ones to take their place.  The same sum will fund a typical at risk program to identify and track juveniles in one school.  Or the money could be spent on boot camps or counselors or conflict resolution or positive recreation programs. 

 

                        What would be the winning strategy?  How might we proceed?  Most of our thinking about preventing crime is not very sophisticated.  Most social policy does not advance much beyond political knee jerks.  Rather than just responding routinely, we need to become more creative in imagining new solutions.

 

A Similar Prevention Game -- Prevention in Health Care

"The significant problems we face cannot be solved at the same level of thinking

we were at when we created them." -- Albert Einstein

 

                         Sometimes it makes sense to move to a different metaphor for a moment to gain perspective on a problem.   As a way of stretching our thinking, we might simultaneously imagine a similar prevention game as it might be applied to health care.  Although prevention in health care is still in its infancy, it is not in nearly as primitive a state as our thinking about crime.  Particularly in the area of risk assessment, a few insurance companies have begun thinking about the cost effectiveness of preventing rather just treating diseases.  Some factors have been found to relate to low sickness/disease.  Exercise, healthy diet, quitting smoking, early detection, and wellness programs all reduce the risk of disease, hospitalization, and expensive treatment.  Today some insurance companies offer reduced rates for customers who lead healthier lifestyles.  They also substantially reduce rates for corporations willing to invest in employee wellness programs and early prevention. 

 

                        We are beginning to realize we can safe money by investing in preventive health care.  If we wait for a catastrophe to see a doctor, we purchase our medical care through the emergency room where it is most expensive.   If we choose not to spend dollars on prevention, inoculations, and early detection, we also pay more in later health care costs.  Playing a simultaneous Prevention Game as it relates to health care might help us discover insights about preventing crime that we otherwise would never have imagined.

 

Reacting to Crime and Delinquency

                        We are not accustomed  to thinking about preventing crime.  We wait for an emergency.  We are used to simply reacting  to the crisis de jour.  We focus on the latest Susan Smith, Jeffrey Dohmers, Ted Bundy, Charlie Manson, Timothy McVeigh in Oklahoma City, or Eric Harris and Dylan Klebold at Columbine High School in Littleton.  We don't think about problems until they hit the front page of the newspaper.  Each monopolizes our attention for a time and then is gone:  once again out of sight and out of mind.  With each new crisis comes public outrage and societal condemnation.  Lawmakers are likely to draft hurried legislation.  Talk show hosts flaunt easy answers.  A few experts get their fifteen minutes of fame.  In depth analysis is hurried, if at all.  When it exists, it is sandwiched between the agendas of politicians and the ready-made solutions of talk radio.  Many times, we throw a collective temper tantrum of vengeance.  We eliminate the problem.  We execute people or throw them away in a prison where we don't have to think about them.  We then wait for the next crisis de jour.

 

                       With such a strategy, it is small wonder that we don't get ahead of problems or implement comprehensive strategies.  If we never address the roots of a problem, we are left simply to react.  We move from one crisis to the next.

 

From Reaction to True Prevention

                        We might imagine a continuum from reaction to prevention.  There are at least three components involved along this continuum.  First of all, reaction takes place after the fact.  It is how we respond to an act once it has occurred.  Prevention takes place before something happens.   

 

Reaction

Prevention
After
Before

 

                        Today, most of our crime strategy focuses on reaction.  With such a strategy, we are forever driving while looking in the rear view mirror.  However, prevention strategies focus on the road ahead: potential problems, alternative routes, better ways of traveling and new destinations.

 

                        Much of our reluctance to spend money on prevention is because we think we can avoid problems.  We only spend money when we have to.  Prevention on the other hand requires an investment  up front.  We refuse to be realistic.  We are much like an auto owner who only services the car by the side of the road when it breaks down.

 

                        As a society, we don't understand the concept of investment.  Most Americans seem to think a penny saved is a penny earned.  However, that is not always true with health care.  Skimping on services now, can mean huge medical bills later.  And it is not true for most social problems.  "Penny wise and pound foolish" is a more appropriate aphorism.  The liberals haven't been able to get this concept across to the American people for the last thirty years.  While there are certainly pork barrel, wasteful, ineffective programs, and pie in the sky extravagances, there are also some very good programs which give us a substantial return on our investment. 

 

                        However, even the most simple investments in prevention seem to elude us.  For example, the last figures I saw showed that for every $1 we spend on childhood vaccinations, we will save $8 in health care costs.  And yet many diseases thought eradicated are making a comeback today because so many children are not getting their shots.  It is one of those areas where we have sought savings by cutting back government services.  

 

                        When we only are willing to invest money after  the fact, expenditures are usually expensive, problems harder to remedy, and potential solutions more likely to prove ineffective.  The person who waits to get their medical care at the emergency room not only pays more, but runs the risk that it is too late. 

 

                        However, we put it off hoping we won't have to spend money on a problem at all.  This is even more true when it comes to societal and psychological health.  Psychologist Arthur Warmoth warns that the only time mental health has a market value is when somebody become such a pain in the ass that their friends and neighbors are willing to pay to have something done with them.  The rest of the time we expect to get good mental health for free.  We feel that we will get it by contagion if we only hang out with the right people.  We certainly see no need to invest in good community mental health.

 

                        Crime is also one of those places we feel we can save money.  Most don't do anything until there is a breakdown by the side of the road.  And even when we are willing to throw money at the problem, we're not willing to invest our time thinking about it.  We want easy answers and ready made solutions.  That's why we hire experts.  We certainly don't want to have to re-think a problem.  However, we need to understand that our thinking is often part of the problem.  If we just pour more and more money into the wrong solutions, it won't help and might even make things worse. 

 

                        Prevention is a matter of paying a little now rather than a lot later.  Ironically, so many still believe that we can skimp on education, job opportunities, and other aspects of the good society and not have to pay for it later with higher prison costs.  Prevention focuses on investing effectively in the future.  Early investment works.  For instance, research on youth who attended the Perry Preschool showed they were less likely to be later arrested both as juveniles and as adults (Mendel, 1995).  The old saying "an ounce of prevention is worth a pound of cure" maybe even underestimate the benefits.

 

                        Secondly, prevention focuses on health while traditional approaches respond only when something is wrong.  Reaction does not focus on what is healthy.  It seeks to avoid sickness.

 

Reaction

Prevention
Sickness
Health

 

                        This is a stimulus-response dynamic.  All action is in reaction to being sick.  Reaction seeks to move away from sickness.  Prevention, on the other hand, seeks to move towards health.  What type of lifestyle makes it less likely a person will get sick in the first place?   Are there factors that insulate one from sickness?  What would a healthy lifestyle look like?

 

                        Psychologist Erich Fromm (1947; 1956) noted modern medicine spends most of its time focusing on sickness, and knows very little about the healthy person.  The only people who show up in the doctor's office are sick people.  Fromm notes that even medical students spend much more time studying dead people (cadavers) than living healthy people.  Similarly, psychiatrists spend all day seeing people with problems.  Before Maslow and Fromm, we knew very little about psychologically healthy people.  The healthy personality was hypothesized but not explored.  Health was just the absence of sickness.  Freud's healthy individual would be one who had had made it successfully through all the phases without getting fixated and stuck in any phase.  There was never any exploration of what the healthy personality was like. 

 

                        We must realize that health is more than just not being sick.  Only recently has attention in criminology been given to studying people who are not criminals.  Resiliency theory asks why some people even in high crime neighborhoods don't become criminals.  However, here again the focus has been on what makes people resilient to crime rather than on creating the healthy people and fully functioning communities where people flourish.  A healthy life style focuses on more than just not doing crime.  The healthy, happy community isn't tacitly trying to be anti-crime.  The productive community just happens to produce bonus side effects which include lower alcoholism, fewer drug problems, and less crime.  The path "towards a healthy community" may be a quite different journey than the path "away from crime."

 

                        Finally, reaction is a negative approach.  The emphasis is on not  being sick;  on not  being a criminal.  The dynamic of reaction is to escape and repel away from the negative.  We seek to push  the problem away.  Prevention, on the other hand, is positive.  It is the force of attraction:  a pull  rather than a push.  People are repelled away  from the negative.  They are drawn towards  the positive.

 

Reaction

Prevention
Negative
Positive

 

                        Perhaps, much of our confusion and ineptitude concerning crime has to do with our focus on the negative.  If we only focus on what is broken, how will we know when something is right?

 

                        By dwelling on the extreme cases which are too acute for easy remedy, we miss insights about the seeds we could have planted and tended which would have prevented problems in the first place.  By obsessing about stopping negative acts, we miss opportunities to cultivate positive environments.

 

                        Prevention is effective, while reaction is often too little too late.  Once the cat is out of the bag, it becomes a very expensive proposition to get it back in.  And sometimes, it becomes impossible.

 

                              Once Susan Smith drives that car into the water, there is only so much we can do.  After Ted Bundy has gone on a rampage, there are only so many alternative.  Before the act, there is a whole range of possibilities.  After a crime has been committed there are certainly some creative options, but they are more limited.  But what about the conditions that breed crime?  We must understand that crime comes out of a struggle.  People in desperate circumstances do desperate things.  What available resources might have made a difference?  What would have changed lives and prevented crime from occurring in the first place?  How can we create healthy conditions where people thrive and are less likely to turn to crime?

 

                        Reaction follows  the problem:  forever chasing but never catching it, and with no hope of ever stopping it.  It is an absurd chase.  Prevention gets out in front of the problem.  It offers real hope. 

 

Types of Prevention Strategies

                        With $2.5 million to spend in the Prevention Game, where should we invest our money?  Along the continuum of prevention, there are several types of strategies players might employ.  These range from traditional reactive responses to true prevention. 

 

Continuum of Prevention
Reaction

Prevention
   
|
     

Traditional
Responses

Early
Diagnosis
At-Risk
Identify
& Treat
Reactive
Prevention
Positive
Prevention
Minimum
Daily
Needs
Provention
Healthy
Community

 

Strategy #1:  Traditional Responses

                        In a health care Prevention Game, some players may take the obvious solution:  more doctors and hospitals.  We could spend the $2.5 million improving hospital facilities or adding hospital beds.  Another traditional tactic would be physician recruitment.  A recruiter could be hired to visit medical schools, new doctors' offices could be built, the neighborhood could offer income guarantees to new physicians, or the community might finance medical education in return for later service.  Other traditional approaches might be to purchase better equipment or hire more nurses.  More creative reactive approaches would include expanding the role of nurses and physician's assistants so we could get more health care for the same amount of money.

 

                        The traditional response to crime is to hire more police or build more prisons.  $2.5 million over ten years will buy 5 more police officers including benefits.  Or it will house 10 prisoners in current facilities.   If we want to expand the number of prison beds, then it is enough to could build and operate facilities for an additional 8 inmates (Irwin, 1997). 

 

                        Another traditional approach to crime is to provide more judges and courts so that judicial processes can be made more swift and efficient.  This would mean more money for lawyers, judges, and court house staff.  It also might mean finding more court rooms.  $2.5 million over ten years might purchase enough personnel to run two courtrooms. [1]    However, if judges are merely going to dispose of cases with prison or jail sentences then our budget for jail cells is going to have to be increased and we're out of money.  If only one new courtroom is staffed, then perhaps other half of the money could be used for more creative sentencing options. 

 

                        House arrest is considerably cheaper than prison confinement.  Approximately 15 people can be electronically monitored for the price of a prison cell.  Unfortunately, electronic monitoring has not led to less confinement.  Indeed, studies show that it is being used for people who in the past would have received probation, community service or other non-custodial options.  Critics refer to this as "net-widening."  People who previously would have received only probation come into the clutches of the new system.  Intensive supervision is another sentencing option which would theoretically lower our costs.  In practice, such close scrutiny leads to more parole violations and a much higher rate of parole revocations.  These higher rates of re-confinement are due largely to minor rule infractions rather than actual crimes.  Intensive probation saves money but does not lower recidivism.

 

                        For awhile, boot camps were politically popular because they fit a get tough mentality.  For the money, they are cheaper than prison.  This is particularly true if people are confined to the bootcamp for a few months as opposed to a more lengthy prison stay.  However, although they are cost efficient, studies have consistently demonstrated that boot camps are as ineffective as prisons in decreasing future criminal behavior.  The only boot camps which have been shown to be successful have been entirely because of particularly effective aftercare programs.  Successful aftercare programs all have substantial job placement and job training components. 

 

                        Reactive approaches that show success empower people for the future.  Interestingly, those who earn college degrees while in prison have over a 90% rate of success of not returning to prison.  However, such programs are controversial and have been discontinued in most states. In a society that doesn't have universal access to a college education, taxpayers do not want to "reward" people in prison.  Certainly we do need to make college affordable to all citizens.  We also need to understand that investing in the education of prisoners now will insure that we don't have to pay the cost of imprisoning them on an ongoing basis.  It is a new way of thinking but it is hard for most people to accept the realities.  If we put a calculator on the proposition, [2]   the person who returns to prison will cost us $25,000 a year plus the costs of prosecution, apprehension, and the damage of their crimes. [3] The person who makes a successful life following prison, becomes a taxpayer contributing to society and a role model that one can turn their life around.  However, turning your life around requires skills and opportunities.

 

                        Prisons do not work.  People learn criminal skills, become more violent, gain better drug connections and gun connections, develop worse attitudes towards authority, and become more likely to commit future crimes.  Furthermore, prison cuts people off from viable connections on the outside that they might use to develop a new life.  Most people sent to prison will be back on the streets.  Somehow we need to heal broken people.  If we just concentrate on punishment, the people we release will be even more broken and incapacitated.

 

                        Providing resources is an important component to helping someone successfully change.  Psychological treatment and psychotherapy where we try to fix the person have not proven to be successful.  The counseling approaches which do show positive results focus on the problem, not the person.  They concentrate on problem solving skills and conflict resolution.  Another significant component of successful counseling is a close bond forming between the therapist and the client.  Without this bonding, no real healing can take place. 

 

                        Treatment is expensive.  However, it is not nearly as expensive as other alternatives.  Careful cost-benefit analysis by the Rand Corporation (Greenwood, 1994 Everingham, 1994; Rydell, 1994;  Caulkins ,1997) shows drug treatment and prevention is seven times more effective than law enforcement to reducing the supply of drugs.  For every dollar not spent on drug prevention and treatment, we would have had to spend $7 on reducing the supply to get the same effect.  Treatment is also more cost effective than warehousing people in prisons.  Per million dollars of taxpayer money spent, treatment reduces serious crimes 15 times as much as incarceration (Caulkins, 1997). 

 

 

Creative Reactive Programs

 

                        Winning the Prevention Game requires smart investment and creative programming.  The most successful reactive approaches don't dwell on punishment but use the occasion as an opportunity to equip the person with skills and resources to navigate future circumstances.  Rather than rendering people impotent from a pound of punishment, effective programs recycle people into new lives.  The truth about changing from a criminal path is the same as for getting off drugs or alcohol:  You get a life transplant.  To use the A.A. party lingo, "You get new play pens and new play pals."  The same is true for those leaving prison.  The most effective aftercare programs feature a heavy job component including training and job placement, and a support group that is there to hold your hand and understand what you are experiencing.  Restorative justice is also a creative idea that shows real promise.  Victim Offender Mediation empowers the victim and allows the offender to experience the results in a tangible way and be able to make amends directly to the victim (Zehr, 1990; Umbreit, 1994).  Navaho peacemaker courts, community peacemaking circles in the Canadian Yukon, and restorative justice circles in South St. Paul, Minnesota use the crime as an opportunity to deal with the problem incident at hand, but understand why similar problems keep happening, and develop new solutions and programs (Galaway and Hudson, 1997; Stuart, 1997; Bussler, 2001).  Conferencing involvement the victim, offender, and their support groups have become the law of the land in New Zealand and has been exported internationally.  Police have convened this conferencing from Australia to Anoka, Minnesota.

 

                        Having frequent visits from family or friends is one of the best predictors of post-prison success.  Louis Farrakan's suggestion that church groups ÒadoptÓ a prisoner is also great idea.  Half of all prisoners get no visitors.  No one cares enough to maintain a relationship.  When they try to reenter society, they will have no buffer.  In truth, most prison officials discourage visitors.  It diminishes their sense of control and disrupts the routine.  Visitors are not made to feel welcome but instead often experience harassment.  Increasingly, prisons are being built in isolated locations where it is expensive and difficult for visitors to come.  This is crazy.  Anything we could do to encourage connections on the outside would make the transition to life outside of prison easier. 

 

                        Most people who go to prison will be out someday.  They are going to be somebody's neighbor.  If don't end up living on your block, they'll end up living on mine.  We need to use the time we have them in custody to make them better.  For example, it is the common wisdom that we can't do anything to rehabilitate sex offenders.  So we do nothing.  We may keep them in prison for a long time but eventually they will be somebody's neighbor.

 

                        We need to invent better treatment options.  When diseases are diagnosed as incurable many families don't give up.  Although it doesn't happen often, every once in awhile someone who had been diagnosed as incurable is able to beat the odds.  If science would have given up every time someone said it couldn't be done, we would still be in the Dark Ages.  Most of what today passes for sex offender treatment is simply a political agenda.  It happens to be a political agenda I often agree with, but as a treatment strategy, it is not very effective.  We need to be inventing new programs to treat sex offenders.  We certainly don't want to turn the public into guinea pigs.  However, it is shameful that we accept cynicism and resignation from our social science.   

 

Strategy #2:  Early Diagnosis

                        Reaction is always after the fact and a day too late.  A more effective strategy would be early detection, diagnosis, and treatment.  In the health care arena, this involves testing and  screenings to identify and treat diseases at an early stage.  Early diagnosis is not only more cost effective, it produces better results.  Waiting for more acute symptoms often means a disease has progressed to a state where it is untreatable or only radical approaches might work. 

 

                        In France, pregnant mothers are paid $1,000 if they will keep five prenatal appointments with a doctor.  The society calculates it will save considerable money by investing early in health care.   The reason the United States leads the modern, industrial world in both infant mortality and mothers who die in childbirth, is that the first time many poor pregnant women see a doctor is when their water breaks.  Not getting good prenatal care has other serious health consequences including low birth weights.  Low birth weights are associated with poor development, mental retardation, infant mortality, and physical disabilities.  The United States chooses to skimp on prenatal care.  These children will be more likely to need special schooling or even institutionalization.  It is only then that Uncle Sam takes out the checkbook.

 

                        Early diagnosis looks for early warning signs.  Prevention Game money might be invested in professionals, better diagnostic equipment, and more extensive testing.  Health care clinics could be made more widely accessible and early treatment more affordable to the public.  Investment could also be made in advertising to promote public awareness about early detection.

 

                          In criminology, people who are anti-social at an early age may also have problems later.  Violence at age eight is a good predictor of violence later in life.  If we can address problems early, we can prevent them from growing into larger problems.  People resort to violence when they can't get their needs met and have no other repertoire to address problems.  Psychologist Carl Rogers says, "Violence is the last resort of a powerless person."  In many families, people learn violence as a way of coping with problems.  Their only repertoire of conflict resolution skills to deal with frustration is to hit.  People need to learn problem solving skills and alternative ways of getting their needs met.  Teaching conflict resolution is a promising solution. 

 

                        Counseling is the most effective around a particular problem at the point of crisis.  School children can be trained to assist others in dealing with situations.  Playground patrols trained in conflict resolution can be available on the spot when conflicts arise to address problems.  This also serves to educate the people involved how they might handle similar situations themselves in the future.  People always learn best on the spot at the point of crisis.  Prevention game money invested in creating such a program will pay dividends.

 

                        Other programs can address early signs of violence.  Some youth attribute violent intentions to others when in fact there is none.  Research shows teaching people to correctly read and interpret situations lowers violence (Mendel, 1995).

 

                        Healthy Families America is another effective early intervention program.  It begins by identifying pregnant mothers who are likely to later physically abuse their child.  It is not hard to accurately predict who they are.  They are "resource poor."  They tend to be young, poor, isolated, uneducated, and without help or support from their families or the child's father.  When the frustration gets too great, they have few places to turn.  Healthy Start gives these mothers a menu of potential services:  job training, day care, conflict resolution skills, parenting training, anger management, job search skills, etc.  The program is innovative because the "case worker" who decides which services are appropriate is the mother herself.  We thus avoid a tug of war trying to get a person into parenting training or anger management when they don't want to go.  The program works by providing resources and alternatives in a self directed program.

 

                        The Healthy Families America program lasts the first five years of a child's life.  It isn't cheap.  It costs $1,000 a year for a total of $5,000.  It pays for itself in the long run.  Playing our Prevention Game, we have $2.5 million for 10 Years.  If we do the math: 

 

Prisons

10 Prisoners in existing facilities

(two and half year average stay)

40 people

over 10 years

Bootcamps

25 people each year in Bootcamps

(six month average stay)

250 people

over 10 years

Healthy Families America
250 in program for five years

500 people

over 10 years

 

                        In ten years, we can treat twice as many people with Healthy Families America as with bootcamps and 12.5 times as many people in Healthy Families as in prison cells.  If we are really interested in having lower crime rates, we need to also look at indirect effects.  Children whose parents are imprisoned are much more likely themselves to then get in trouble.

 

                        To figure the benefits, let's make the very conservative assumption that without the program 40% of these kids would have went on to a life of crime.  Let's assume that Healthy Families children have the crime rate of normal cohorts of 6%:  The average stay in prison is 2.2 years.  Thus the comparison of cost for Healthy Families Americas and prison would look like this

 

 

40% of 500 =   200 kids @ $25,000 / year x 2.2 years
$11,000,000
6% of 500 = 30 kids @ $25,000 / year x 2.2 years
    $1,650,000
Savings for Healthy Families America
 $9,350,000

 

 

                       These figures are just for their the first stay in prison.  Additional offenses will cost us even more and these are the very people most likely to be back.  It also does not include costs of $35,000 for juvenile institutions which these kids are likely to experience before they graduate to adult prison.  By focusing on early warning signs, Healthy Families America is able to provide a series of resources and opportunities to help people successfully navigate their circumstances. 

 

                        A word a caution is needed here.  Early warning signs should be used to identify people in need of help with their problems.  We must then provide help and invent resources they can use in their struggles.  If we use early warning signs to simply stigmatize people, we may make the situation worse.  As any good counselor knows, we must separate the person from the behavior.

 

                        James Wilson's "Broken Windows" theory received quite a bit of attention nationally especially in New York City.  He argued that if small crimes like breaking windows are ignored, they accelerate into larger crime.  Broken windows in neighborhoods gives the sign that    People may just give up in a deteriorating neighborhood where no one cares and anything goes.    His strategy was to spend money cracking down on small crime as a way of reducing major crime.  Such a strategy may be effective to the extent that it is informational: you are over the line and it will not be tolerated.  The value of punishment is feedback. 

 

                        However, we must be careful not to turn people into criminals for small offenses.  Labeling can destroy self esteem, incapacitate selves, and turn into a self-fulfilling prophecy where authority figures on the lookout for crime may turn typical deviance into a sanctioned offense.  For juveniles in particular, exploring the boundaries is a normal part of breaking away.  Most adolescents "age out" of illegal activities.  It is important that labeling doesn't turn them into criminals. 

 

                        How do we avoid creating a negative self-fulfilling prophecy and still get the person help when they need it?  Healing must begin early or wounds grow.  Early signs of problems need to be dealt with before they become larger problems.  However, if we magnify something too much under the microscope, all of our lives can look pretty distorted.  The answer is that we should focus on fixing the problem rather than fixing the person.  Creative solutions manage to deal with the problem without stigmatizing the person. 

 

 

Strategy #3:  At Risk Identification and Treatment

 

                        Traditional responses and early diagnosis both react after a problem has already occurred.  At Risk programs are an attempt to get out in front before a the problem happens.  The strategy is to identify people particularly susceptible and provide early detection, treatment and prevention. 

 

                        For health care this translates into careful monitoring of people with a family history of certain diseases.  Another strategy is community wide screenings to identify people with the preconditions which might turn into a problem.

 

                        Criminals are more likely to come from homes of childhood domestic violence.  Poor reading ability is one of the best predictors of future delinquency.  Children of teen moms are also more likely to become criminals -- a teen mom has fewer resources to make ends meet and has to cope with all the problems of growing up herself.   Criminals are also likely to have been victims themselves.  We must invent effect programs to deal with their needs.  

 

                        We know that those with a parent in prison are much more likely to become delinquent themselves.  One creative program called "Girl Scouts Beyond Bars" allows girls spend a weekend a month in prison with their moms doing activities.  This not only bonding for the children but motivation and connection for the mothers.  It is good crime prevention.

 

                        We have chosen to make war on crime.  We concentrate on punishing the offender and neglect victims.  Instead we need a peacemaking approach that heals broken lives.  Ironically, one of the things we know about criminals is that most of them have themselves been victims.  They have been victims of child abuse and many other crimes.  The child abused at home then terrorizes younger children on the playground.  The person whose possessions are stolen by later steal from someone else.  There is an endless cycle of victimization where crime gets passed on.  As Hal Pepinsky notes, "While not every victim becomes an offender, every offender has been a victim."   We need to take the opportunity to heal our victims.  They themselves are at risk of turning their anger and pain on others.  One of the ways we could decrease crime is by concentrating on healing victims and breaking the cycle.  Restorative Justice and Victim Offender Mediation offers particular opportunities here.  One restorative justice advocate can be funded for a rather modest salary. 

 

                        One of crazes in delinquency prevention has been school at-risk programs.  One model program which has been copied in schools throughout the country consists of hiring staff whose primary purpose is to identify and track potentially at risk children.  In theory, these kids are then referred to already existing social services.  In practice, existing programs are already overcrowded.                        A typical school at risk program that I am familiar with costs in the neighborhood of our $250,000 a year.  Generally, $10,000-$15,000 goes towards developing new programs.  About the same amount might be spent on program evaluation.  The rest of the money is spent on identifying who is "at risk" and record keeping to track their progress.  This means the vast proportion of the budget goes to professional staff, secretaries, and computers equipment for record keeping. 

 

                        Precious resources are exhausted on identifying individuals  when actually the problems stem from the lack of opportunities and resources for a whole range of people caught in difficult circumstances.  Individualistic approaches which assume that the roots of the problems reside inside individuals will be of limited effect.   If most of the money is spent on identification and tracking of at risk kids, few funds are left over for actual treatment and resources. 

 

                        People need skills and resources they can use in their situations.  Head Start is one of those great examples of focusing on the needs rather than the labeling the person.   We do not need to pinpoint which particular individuals will become sick in order to improve community health.  

 

                        "At Risk Programs" make sense to the extent they identify needs and provide resources to meet those needs.   It is not cost effective to spend so much time, energy, and money on identifying and tracking who should be included and who should be excluded from programs.  Instead, it would be wiser to develop resources to address unmet needs and allow all people access them. 

 

Reaction

Prevention
The Act
The Struggle

 

Reaction

Prevention
Individual
Situation

Strategy #4:  Reactive Prevention Programs

                        Today most wellness programs are really anti-sickness programs rather than full fledged positive prevention programs.  They are what I call "reactive prevention."  Traditional wellness programs fit this category.  They focus on stopping an unhealthy behavior or activity:  not gaining weight, not smoking, not drinking, not doing drugs, not having a heart attack, or in not having stress that causes diseases.  They are not true prevention programs, but "anti-sickness" programs.

 

                        Reactive prevention has a foot in both worlds.   It teeters at the fulcrum between Reaction and true Prevention.  The focus and the motivation is clearly negative:  it is a reaction against sickness.  Yet there are also components of true prevention.  There is a genuine investment in creating a healthy lifestyle even though the focus remains on reducing or eliminating elements that are unhealthy.  It aims towards the positive moving away from sickness and towards health.

 

                        Many of today's crime prevention programs are of this type:   alcohol and drug treatment, anger management, conflict resolution, parenting classes.  We try to eliminate negative behaviors.  At their best, reactive prevention programs can provide power skills and provide new opportunities. 

 

                        We know most juvenile crime takes place after school.  ÒGrandma PleaseÓ in Chicago is a program where latchkey kids can phone retired homework between 3 p.m. and 6 p.m. to talk and get help with homework or problems.  It uses the excuse of a problem to create bonding and a pseudo baby sitter. 

 

                        Parent management training decreases delinquency.  In Des Moines, a hospital gets parents to attend parenting classes by giving them $500 if they attend all ten sessions.  Students get "paid" for taking college class -- they get 3 hours of credit.  Rather than trying to force people into parenting classes, it makes more sense to attract them.   

 

                        Poor reading ability is one of the best predictors of future delinquency.  We could invent creative delivery systems including peer tutors.  Perhaps we also could even switch roles with the older students who are poor readers being called up to read to much younger children.

 

                        Being the child of a teen mom dramatically increases your chances of being a criminal.  Anything we can do to decrease teen pregnancy will decrease future crime rates.  Research on lowering teen pregnancy is fairly clear:  empower the girls and give them realistic hope and opportunities for the future.  United States has highest teenage pregnancy rate among modern industrial nations.  Despite our considerable investment in a "just say no" strategy, most girls are sexually active by the time they graduate from high school.  Ironically, Scandinavian countries with their more open approach to sexuality actually have the lowest rates of teen pregnancy and the highest average age for commencing sexual activity.  Our methods of repression seem foredoomed to creating more not less teen pregnancy.  The truth is teen pregnancy is reduced by contraceptive knowledge and availability; healthy and realistic attitudes about sexuality and relationships; and opportunities for a meaningful life.

 

                        Most prisoners were high school dropouts.  Again, anything we can do to encourage people to stay in school will lower crime.  However, we need to get more creative than we have been.  Schools need to become exciting places.  As Charles Silberman (1970) noted so long ago in Crisis in the Classroom, most schools are boring authoritarian places than do more to contribute to increasing delinquency than to decreasing it.  It doesn't have to be that way.  Schools could become places than energize and enthuse.  Moving beyond reactive prevention, we need to create programs that are attractive in their own right. 

 


Strategy #5:  Positive Prevention Programs

                        Positive prevention programs are a destination in their own right.  The emphasis is on the program rather than just a movement away from sickness. They are pulls ra