As we mourn those lost in the recent string of shootings, we feel intense sadness, fear and confusion. We are shocked by what some human beings are capable of and afraid what other dangerous individuals may lurk in our communities. The media dramatizes these unthinkable crimes until they take on fictional proportions, making them seem foreign, distant and unreal.

Violence is an everyday reality

However, violence in the lives of our young people is a daily reality that does not always make the nightly national news.

  • According to 2009 data, an average of 16 people between the ages of 10 and 24 are murdered daily in the United States.
  • In a national survey of teenagers, six percent skipped school in the previous month because of fears of violence.
  • Just under 700,000 youths receive emergency medical care yearly for injuries from violent assaults.[i]

The extreme mass violence perpetrated by a small number of youth and young adults, branded on our psyches by dramatic news reports, can create the false impression that violence occurs with out any warning, at the hands of mysterious monsters with inaccessible motives.
–Dr. Michael Kisicki

Reducing risk factors leading to violence

The goal for care providers and protectors of children is to prevent this violence. Although the problem seems overwhelmingly complex, the basic formula for successful treatment is quite simple: “reduce factors that place youth at risk for perpetrating violence, and promote factors that protect youth at risk for violence.”[ii] The challenges are detecting those young people at risk because of personal or social challenges and connecting those at-risk individuals with appropriate support and services. Research shows a host of risk factors that are associated with violence include the following:

Individual risk factors

  • A history of victimization, learning disorders, hyperactivity, attention deficits, early aggressive behavior, drug and alcohol use, information processing deficits, as well as emotional disorders.
  • Harsh or inconsistent parenting, limited parental involvement, parental substance abuse and family criminality are family level risk factors.

Peer group risk factors

  • Delinquent friends and contacts, social rejection, lack of conventional activity, and poor peer academic performance.

Community level risks factors

  • Economic instability, poverty, prevalent disrupted families and access to firearms.[iii][iv][v]

It is important to appreciate that no single or group of risk factors condemns one to violence. Rather each factor adds further risk and vulnerability for aggression, but there are plenty of individuals that overcome tremendous risk and lead successful lives.
Dr. Michael Kisicki

Prevention and intervention

Primary prevention, before violence actually occurs, focuses on the reduction of those risk factors that make violence more likely. For example:

  • Parents can better supervise their children using community resources or extended family. They can also prioritize weekend family time to increase involvement in their child’s life.
  • Teachers and schools can more effectively screen for language, developmental and learning disabilities and address them at younger ages.
  • Communities can improve detection of and services for mental illness in families, provide more recreational and career opportunities, and decrease the availability of drugs and weapons.

Once a youth begins exhibiting troublesome behavior or even the beginning signs of violence, intervention involves further reduction of risk factors but also referral to effective evidence based treatment programs. The University of Colorado maintains “Blueprints for Violence Prevention” which identifies 11 “model” treatment /prevention programs that have been stringently evaluated for efficacy. The list includes programs such as: Big Brother/Big Sisters, Multisystemic Therapy, the Incredible Years programs and Functional Family Therapy, among others.[iv] These programs utilize strategies such as family work to improve family relations, parenting and expanding supervision. Some also focus on strengthening a youth’s distress tolerance, social problem solving skills and negotiation.  Mentoring programs are effective by providing a positive role model and guidance for positive social interaction. Unfortunately, inadequate funding and development for programs with proven effectiveness make it impossible for these community, mental health and school programs to achieve their maximum potential, while some programs and interventions with no supporting evidence (or even negating evidence) continue, such as Scared Straight, Boot Camps, Gun Buyback programs, peer counseling, summer jobs, home detainment and transfer of juveniles to adult court.[vii]

The extreme mass violence perpetrated by a small number of youth and young adults, branded on our psyches by dramatic news reports, can create the false impression that violence occurs without any warning, at the hands of mysterious monsters with inaccessible motives.  However, youth violence is a daily issue that occurs mostly under the radar, with the majority perpetrated by young people who have suffered potentially preventable or treatable individual, family and community hardships that paved a way to violence.

Greater screening for children at-risk prior to the development of violence and a greater stakeholder interest in developing proven effective interventions are essential in truly addressing this grave problem in a rational way.
Dr. Michael Kisicki

Furthermore, anyone who works with children and youth in any capacity can have a positive impact by minimizing the risk factors and bolstering their strengths.

[i] Centers for Disease Control and Prevention. Youth risk behavioral surveillance – United States, 2009. MMWR 2010; 59 (SS-5).


[iii] Department of Health and Human Services. Youth violence: a report of the Surgeon General [online]; 2001.

[iv] Lipsey MW, Derzon JH. Predictors of violent and serious delinquency in adolescence and early adulthood: a synthesis of longitudinal research. In: Loeber R. Farrington DP. Serious and violent juvenile offenders: risk factors and successful interventions. Thousand Oaks: Sage Publications: 1998. P. 86-105.

[v] Resnick MD, Ireland M, Borowsky I. Youth violence perpetration: what protects? What predicts? Findings from the National Longitudinal Study of Adolescent Health. Journal of Adolescent Health 2004; 35: 424. E1-e10.

[vi] Blueprints for Violence Prevention

[vii]Youth Violence, A Report of the Surgeon General. Office of the Surgeon General (US); National Center for Injury Prevention and Control; National Institute of Mental Health; Center for Mental Health Services. Rockville: Office of the Surgeon General.

Dr. Michael Kisicki is a psychiatry and behavioral  health specialist at Seattle Children’s Hospital. He is acting assistant professor at the University of Washington School of Medicine and a consulting psychiatrist for the Washington State Juvenile Rehabilitation Administration. If you’d like to interview Dr. Kisicki, please contact Seattle Children’s PR team at 206-987-4500 or