Although we are reminded regularly of the violence-prone nature of our society, the details and pervasiveness of assaults, robberies, child abuse, and senseless, vicious acts are shocking. Political and social debates about gun control, eradication of gang and drug-related crimes, and censorship of television violence often have the effect of increasing anxiety and reinforcing a sense of helplessness.
Professor Mark Singer of the Mandel School of Applied Social Sciences in Cleveland recently received wide press coverage for his study documenting the pervasiveness of exposure to violence among high school students. Young people are widely implicated as victims and perpetrators; the National Center for Health Statistics (1993) now rates violence as the third leading cause of death of children ages five to 14. But violence does not always end in death. Gunshots, beatings, or stabbings frequently result in spinal cord and head injuries. Child abuse may cause complex neurological and functional sequelae, disfigurement, learning problems, and social and emotional dysfunction.
Social workers in the health field are familiar with violence and its outcomes. People who experience violence meet social workers in emergency departments, trauma and rehabilitation units, burn centers, and obstetric and pediatric services. Often social workers assess and report to authorities. alleged cases of abuse and maltreatment. Despite our efforts, the problems of adjustment and recovery from the physical, social, and emotional consequences of violence are often insurmountable.
Violence as a Public Health
The effects of violence on health are far reaching, and the costs to individuals, institutions, and society are staggering. Former Surgeon General C. Everett Koop and current Surgeon General Jocelyn Elders have suggested that violence must be viewed as a public health issue. As with other public health problems, we must attend to those who are currently affected by violence, and we must invest ourselves and our resources to prevent its continued spread. Identifying violence as a public health problem will pave the way for new initiatives in settings where health and mental health care services are provided.
School-Based Clinics and
Access to Children
It is imperative that we reach as many children as possible as soon as possible. Schools are the obvious places to interact with children and to study, identify, treat, and prevent youth violence and its causes. School-based and school-linked clinics present important opportunities for social workers to connect with a vital initiative and to help children and their families cope with a vast array of social and emotional problems that contribute to violent acting-out behavior.
Comprehensive school-based health care clinics were conceived in the early 1970s as an innovative model of delivering health care services to adolescents (Harold & Harold, 1993). Early projects focused on reproductive health; improvements in birth outcomes were documented. These programs have increased from 61 in 1985 to more than 500 in 1993 (Center for Adolescent Health, 1993). Programs will continue to proliferate, because they can effectively deliver health care services to children and are compatible with the movement toward community health care services delivery.
Funding of school-based and school-linked clinics has traditionally been dependent on state health and human services departments, federal Medicaid and early intervention and screening programs, maternal child health block grants, local governments, foundations, and school districts (Waszak & Neidell, 1991). …