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Community Programs to Promote Youth Development

Simon, Peter M.D.

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Journal of Developmental & Behavioral Pediatrics: October 2005 - Volume 26 - Issue 5 - p 390
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Community Programs to Promote Youth Development, National Research Council Institute of Medicine, Landover, MD, National Academy Press, 2002, 441 pp., $49.95.

Aaron Wildavsky once wrote a paper called "Doing Better and Feeling Worse" recommending that when we consider aspects of the health care system, we first must define our perspective. In telling you what I think about this report on "Community Based Programs for Youth" from the NRC/IOM, I will be in large part revealing my perspective as a Community Pediatrician (for precise definition see AAP web site; http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/6/1304).

As is usually the case with reports from the National Research Council and the Institute of Medicine, the Committee on Community-Level Programs for Youth is largely recruited from academic research based institutions and large non-profit policy and research organizations. Chaired by Jacquelynne Eccles and staffed by Jennifer Gootman, they accomplished in a bit over two years what they set out to do: to evaluate and integrate the current science of adolescent health and development with research and findings related to program design, implementation and evaluation for community programs for youth. If you are a student or student-to-be of this topic, you will find this document to be a well-organized summary of much of the existing research and theory about the value of community based youth development programs. If you are starting to think about making investments in youth as a Community Pediatrician applying for an American Academy of Pediatrics CATCH or Healthy Tomorrow Grant, this is an essential read.

On the other hand, if you are staffing a policy or planning effort at the community level in local, state or the federal government, some of the questions that you will want to have asked remain unanswered. For example, we are told about our country's proclivity to lock up young people in juvenile detention facilities. We are told that poor neighborhoods lack opportunity for youth. We are shown the health consequences, impacts on education, law enforcement, social spending, etc. What we are not told is what difference increasing expenditures on community youth programs would have on the health of these communities. They don't discuss this much because they do not have any data.

An even more important limitation of this report is the unstated research biases of the committee. I know that the NRC/IOM has a process to document conflicts of interest, but it falls short of making explicit what I think subtly impacts on what shows up in the reports findings and conclusions. When research is overly focused, biased towards individual risk or resilience, and largely observational, huge areas of the explanatory model are ignored. When there are social and contextual factors that might explain or predict large proportions of the outcomes of concern and they are not adequately addressed in research, we are left with an incomplete conceptualization of what is going on and worse, we are given only "hammers" as tools to address problems that might not be "nails."

The committee demonstrates its collective bias by calling for more investment and research into programs that expose youth to certain professionals (who should possess qualities that are "intangible") offering quality services as the best (only?) way to mitigate the effects of overall social policy that is anti-family and anti-youth. As long as national, state and local policies continue to lead to more and more concentration of non-white minority groups, disabled adults, newly resettled refugees and immigrants with limited English proficiency into fewer and fewer places, should we be surprised when we see the youth who live in these neighborhoods faring poorly?

If it truly "takes a village" to raise a child, when will we research efforts to improve the quality of neighborhoods that are disenfranchised, disempowered, and hazardous to the health and safety of its residents? When living in these places, isolation, fear of neighbors, objectively observed evidence of environmental degradation leads most parents to believe that they are the problem and not the solution to any and all the challenges facing them in raising healthy children. Where is the recommendation for a new NIH study group charged to address these questions?

Peter Simon, M.D.

Rhode Island Department of Health

Providence, Rhode Island

© 2005 Lippincott Williams & Wilkins, Inc.