Navigating the Boundaries of Youth Violence Prevention and Reduction: Reflections on Power in Community Engaged Scholarship

Community-engaged scholars grapple with power asymmetries in community-university partnerships, generally working from the assumption that deliberate practices are required to moderate the researchers’ power vis-a-vis that of the community. In this article, we suggest that this dyadic framing masks the complexity of power dynamics within communities, of which the university is just one part, and examine how power is negotiated in the boundary zones of a partnership. We use Third Generation Cultural Historical Activity Theory (CHAT) as a conceptual framework to analyse the structural and cultural dimensions of the boundary zone in which research, learning and action in our partnership occurred (Engeström 1996). A brief story sheds light on our boundary work which uses research and data to span, broker and shake institutional boundaries for the purpose of youth violence prevention and intervention. Our analysis illuminates the potential and limitations of our power to foster transformational change. It also allows us to show that underestimating power differentials and the diversity of values and cultures within an organisation and between a university and a community partner, and certainly across multiple institutions in the case of a cross-sector partnership, can slow down and even thwart work to address societal problems.

Implementation of a youth violence prevention programme in primary care

Background and objectivesYouth violence is an alarming public health problem, yet, violence screening and interventions are not systematically offered in primary care (PC). This paper describes data from a pilot effectiveness-implementation trial of an efficacious youth violence prevention programme (SafERteens).MethodsThe study was conducted in two PC clinics: a university-affiliated satellite clinic and a community health centre. In phase 1, we obtained stakeholder feedback to customise the SafERteens package and enrolled a comparison group of adolescents (age 14–18) seeking care in two clinics. In phase 2, clinical staff delivered the SafERteens-PC intervention with adolescents, which is a single, behavioural health therapy session delivered one-on-one from clinic providers to youth patients, followed by text message (TM) reminders. In phase 3, we assessed planned maintenance. All participants reported past-year violent behaviour at intake and completed a 3-month follow-up assessment.ResultsBased on stakeholder interviews (n=13), we created a web-based SafERteens-PC programme package, including a three-item past-year violence screen, 30 min motivational interviewing-based brief intervention delivery tool, training videos and 2 months of TM boosters. We enrolled a comparison group (n=49) first, then an intervention group (n=61). Intervention delivery characteristics varied by clinic, including completion of intervention (75.9%; 62.5%), modality (100% delivered via telehealth; 60% via telehealth/40% in-person) and enrolment in TMs (81.8%; 55.0%); 91.8% completed the follow-up. Using an intention-to-treat approach, the intervention group showed significantly greater reductions in severe peer aggression (p<0.05), anxiety (p<0.05) and substance use consequences (p<0.05) relative to the comparison group. Participant and staff feedback were positive and identified challenges to long-term implementation, such as lack of availability of reimbursement for youth violence prevention.ConclusionsIf these challenges could be addressed, routine provision of behavioural health services for violence prevention in PC could have high impact on health outcomes for adolescents.