Firearm‑related injuries have been the leading cause of death for young people since 2020, surpassing motor vehicle crashes, cancer, drug overdoses, and poisoning. In 2022, more than 48,000 people died from firearm‑related injuries, including suicides, homicides, and unintentional deaths.
In a limited number of jurisdictions, cognitive behavioral interventions (CBIs) have emerged as an evidence-informed strategy for stopping violence and saving lives. But despite strong evidence supporting the efficacy of CBIs, capacity to implement these strategies remains limited, and only a small number of providers are effectively engaging with those most likely to be involved in community violence as either victims or perpetrators.
A new white paper from the Violence Reduction Center — based on a symposium held last year that brought together on the-ground practitioners, leading academics, government officials, and interested funders — looks at the science and practice of CBIs, and how CBIs can be scaled across the country.
These interventions use cognitive behavioral therapy-inspired methods to change the way recipients “think about their thinking” in an effort to change the behaviors that lead to violent conflicts. Originating in the field of psychology in the second half of the 20th century, Cognitive Behavior Therapy (CBT) addresses the ways that dysfunctional thinking, negative emotions, and learned patterns of maladaptive behavior contribute to common psychological problems such as depression, anxiety, and anger. A core principle of CBT is that psychological problems are partially caused by (1) faulty or unhelpful ways of thinking and (2) learned patterns of unhelpful behavior.
CBIs that address community violence specifically tend to focus on decision making in heat-of-the-moment, volatile situations, and encourage participants to be reflective rather than reflexive, to think before acting. This is because such violence often occurs when people react impulsively to real or perceived provocations, disputes, arguments or fights.
“We’re doing deep breathing meditation, we’re doing role plays - having people assess a situation and figure out which pathway to go forward, and we’re also modeling - leading with our adults and our vulnerability,” said A.J. Watson with the organization Becoming a Man.
Research has provided convincing support for the effectiveness of CBIs in reducing recidivism for both adult and juvenile offenders, and in general, evidence suggests that CBIs can make a significant difference in reducing crime and violence across multiple settings.
To implement CBI strategies effectively, however, several practices are essential. First, successful CBIs employ practical tools and strategies that are proven to work. Second, they utilize street outreach workers with a high degree of cultural responsivity. Third, these organizations employ “relentless engagement” to connect high risk individuals to treatment and services. Fourth, they offer extensive training to their employees, both so they may utilize CBI tools and teach them to others. Fifth, they are flexible, adapting models to real world conditions. Sixth and finally, successful CBIs support and invest in their workers - their most valuable asset.
To successfully scale CBIs, CBIs must be cost-effective, although even the most expensive approaches more than justify themselves in terms of social return on investment. CBIs must also secure consistent funding, increasing their capacity to access governmental and nongovernmental resources. Medicaid is an emerging possibility for CBI funding,
Increased professionalization is also necessary for sustainable and scalable CBI interventions, and investments must be made in order to effectively implement the evidence-based programming, Medicaid billing expertise, and staff wellness protocols that a successful program requires.
“The team is the most precious asset we have,” said Jackie Santiago Nazario with the Compass Youth Collaborative. “It’s important to know your team well and what they need to deliver CBI effectively.”
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