Interview with Felton Earls, MD - Children as Citizens: Engaging Adolescents in Research on Exposure to Violence

These interviews followed the presentation "Children as Citizens: Engaging Adolescents in Research on Exposure to Violence" given as part of NIJ's Research for the Real World Seminar Series.

Felton Earls, MD, Professor of Social Medicine, Harvard Medical School

• The Convention's Impact on Engaging Children in Decision-Making
• From Chicago to Tanzania: Globalizing the Young Citizens Program
• Intergenerational Closure
• The Public Health and Public Safety Connection

The Convention's Impact on Engaging Children in Decision-Making

The Convention on the Rights of the Child was a very important event ... the passage by the General Assembly was a very important event for people who work with children throughout the world.

It really sort of was an ethical framework of confronting children's problems and addressing them in a way that involved children in a more respectful way than had been done conventionally, where you do it through a parent, you do it through advocates for children, but children themselves were sort of conceived of as irresponsible, as immature, unreliable, and the Convention says that ethically this may be true, but one has to adjust one's framework to the developmental competence of a child, so all 7 year olds are not the same. Some are more ready to participate in decision-making than others are and one has to take that ethic, if you will, into consideration.

One of the things that we were really concerned about is how to involve children in a legitimate equal way in bringing them into the project. We were Harvard professors, we were scientists, established scientists, we were professionals. So here we are working with children and we want their honest opinions about things, but we don't know them and there is a sort of classic authoritarian stance where children are supposed to succumb, if you will, or agree with, or obey, or play by the rules that adults set.

So that happened. I mean, this ethical application and extension of the Convention was happening at the time that we were formulating the project on human development in Chicago neighborhoods, thinking about how would we address the problems of children in a city like Chicago when we were primarily interested in violence.

So we started to think seriously about this and it was in the Chicago project that we started this idea of consulting with children - having children become interns in the project. So during the summers we would have small groups of children come and actually learn the research techniques that we were using. And from there the idea grew to say that if we're interested in community welfare collective advocacy, which was a great discovery of the Chicago project, then what role do children play in the understanding of that, and what role should children play in building more competent neighborhoods?

From Chicago to Tanzania: Globalizing the Young Citizens Program

In the late '90s and early part of the first decade of the new century, we were confronted with a reality that HIV/AIDS was a catastrophe that could wipe Africa off the map. I mean, nobody really knew what the potential of this epidemic was, but it was devastating. It was pretty clear 20 years into the epidemic that there was not going to be a vaccine any time soon.

And so along with many other people I was called into action to say, "How would you address this epidemic? What have you learned? Have you learned anything in the Chicago project ? this massive undertaking that might be applicable to addressing the HIV/AIDS epidemic in Africa?"

And we saw this as an opportunity to apply the Young Citizens Program of engaging children in the research on what the risk factors were, what was transmission like, and I had been to Tanzania and had worked in Tanzania for a number of years and knew the society to be very well organized, democratic, peaceful, culturally coherent, where Muslims and Christians work together.

So in many ways it was an ideal climate to try this experiment of what it would mean to bring children into this solution, the decision-making about what a community should do and should know to curb the epidemic. We got funding from the NIMH to do this and for the last 10 years I've carried out a community randomized trial where we actually randomized communities into those that had the Young Citizens Program and those that were a control group with the understanding that if collective efficacy and AIDS risk, HIV risk was reduced in those experimental communities, the control communities would get it.

And so we've done both the experimental group, showing that it was effective, and now we've finished the control group and are ready to sustain this project into the government structure, the local government structure in a town called Moshi, Tanzania.

Intergenerational Closure

Intergenerational closure. That it's not about kids. That most adolescents in our society feel alone. They feel a bit deserted. They feel that people are uncomfortable and afraid of them, and that what they want and what our program is about is bringing those young people into full membership in our society and because so many risk factors - for crime, for HIV infection, for drug abuse - are clustered in exactly the time period when children feel the most disengaged, we strongly believe, and now we have evidence to back it up in our Tanzania project, that by engaging those children in society, in community, in building collective efficacy for their schools and for their communities, their risk is reduced. And we'll all benefit from that. They benefited from that, but as a society or as a community, adults benefit from it, and what's happened is this closure, this collapsing of generations.

The Public Health and Public Safety Connection

The partnership between public health and public safety is one mission, as I see it. And part of what we learned and what we prepared ourselves to learn on the Chicago project is that what we were discovering about the causes of violence was equally related to health conditions, and we've demonstrated that in many publications over the years - that collective efficacy not only explains community impact on violence, but it does so on birth weight, on asthma, on age of sexual initiation, on literacy.

And one of the things I'm going to do in my talk today, I'll give away the thunder, is that I grew up in New Orleans. And Katrina was devastation like New Orleans, in a long history of devastation, has never experienced. But New Orleans had a high homicide rate before Katrina and after Katrina, and one of the things that we've been working on for the past five years is how to bring the Young Citizens Program to New Orleans. So as it recovers and revitalizes itself as an urban center, as it does so, it must bring down the rate of violence, and to do that public health and criminal justice has to work together.