Opinions or points of view expressed are those of the author(s)/presenter(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.
An NIJ Research for the Real World Seminar
Felton Earls, M.D.
Professor of Social Medicine
Harvard Medical School
January 25, 2011
John Laub: Good morning, and welcome to today's seminar in NIJ's Research for the Real World seminar series. My name is John Laub, and I'm the director for the National Institute of Justice, and I want to thank you for taking time out of your busy schedules to join us this morning.
Today's presentation is entitled "Children as Citizens: Engaging Adolescents in Research on Exposure to Violence" and will feature Dr. Felton Earls of Harvard University. Dr. Earls will discuss the importance of engaging children, particularly adolescents, as legitimate and competent citizens when devising ways to combat violence in local communities. He'll present research on child participation, child citizenship and the relationship to exposure to violence.
As many of you know, the issue of children exposed to violence is extremely important to our work here in the Department of Justice. Attorney General Holder recently unveiled his Defending Childhood Initiative, which strives to harness Department of Justice resources to prevent children's exposure to violence, mitigate the negative impact of children's exposure to violence when it does occur and develop knowledge and spread awareness of this issue. We want to emphasize what Dr. Earls and other notable scholars have done in helping us address this issue.
Now it's my pleasure to introduce Dr. Felton Earls. Dr. Felton Earls is the Professor of Social Medicine at Harvard Medical School and Professor of Human Behavior and Development at Harvard School of Public Health. His research interests include child and youth development and health, the psychosocial impact of the HIV/AIDS pandemic on children and the causes and consequences of children's exposure to violence.
From 1990 to 2005, he was the principal investigator for the Project on Human Development in Chicago Neighborhoods, a multilevel, longitudinal study on the causes and consequences of children's exposure to violence. This was one of the largest studies ever funded to date by the National Institute of Justice. Note the emphasis on "to date."
Dr. Earls has published widely, and I think his 2005 Science piece on children's exposure to violence is one of the best pieces out there.
Most recently, Dr. Earl's served as special editor of the January 2011 edition of the Annals of the American Academy of Political and Social Science. The theme of this volume is "Child as Citizen," and there are copies of the volume available at the sign-in sheet.
And Dr. Earls has a connection to Washington, D.C. He's received his Bachelor's degree and his M.D. degree from Howard University. Now, I first met Tony, as he's known to friends and family I was trying to place the exact date — I think it was in the late 80s, early 90s, in Cambridge, Mass when I was at the Murray Research Center. And I met Tony at the beginning of what was soon to be known as the Project on Human Development in Chicago Neighborhoods. At the time I remember Tony talking very passionately about how the site for the project should be New Orleans, his home town. And I think it was down to three cities — New Orleans, Chicago and Los Angeles — that were being kicked around.
Dr. Felton Earls: I had to give it up. [Laughter.]
Laub: I understand.
And upon meeting Tony and getting to know him, I was struck by Tony's commitment to science and his genuine concern to use science to better the lives of children, adolescents, families and communities. And there are many, many amazing stories that I could tell about Tony Earls. I just want to share one with you — and Tony, don't worry, this is published, so it's not revealing any secrets.
Tony did a post-doc fellowship in neurophysiology at the University of Wisconsin, and that's where he met his wife and research partner, Dr. Mary Carlson, who is also a neurophysiologist. When they met, they were both aiming for what was referred to as a "white jacket career" in the laboratory. And in April 1968, Tony spent 36 straight hours alone in a soundproof room mapping responses of a cat's brain to various high- or low-frequency sounds.
When Tony emerged from the laboratory 36 hours later on the evening of April 5th, the Wisconsin campus was in an uproar. Only then did he learn that Martin Luther King had been killed the day before. Having participated in rallies led by Dr. King, Tony said he reacted instantly. And I quote, "I realized that I couldn't have a career in neurophysiology. I couldn't remain in the laboratory. King's death made me see that I had to work for society. My laboratory had to be the community, and I had to work with children because they represent our best hope." End of quote.
Tony Earls is a scientist, a doctor and an activist. Please join me in welcoming my friend, colleague and mentor, Dr. Felton Earls.
Dr. Felton Earls: I think I should wrap it up and go home. [Laughter.]
My talk is intended to be like an excursion, a voyage that, as John was saying to you all, started here at NIJ 23 years ago. It's been a journey to — as John better than I could say it — has been one to connect the dots of science with the dots of human rights and not to make a distinction between the two — that good science is good human rights, and good human rights has to have the knowledge and understanding that comes from science.
And so I'm very pleased that Sage Publisher is offering the "Child as Citizen" book because, before I get into the details of my own work and my work with many other colleagues — and a few who are here today, starting with my wife, Mary Carlson — I wanted to make a few comments about the Annals because it's a very important historical document, journal, in American society as far as children go. I mean, it's important generally speaking in terms of political and social science and connecting science and policy. It's always had that reputation. But it's particularly important around children's education and children's work because in the 1900s the Annals published a number of special volumes on child labor, and it was trying to characterize and grasp what it meant for children to work and to be excluded by that work from education — from the right to education, if you will.
And those volumes of 1908, 1910, 1912 actually formed the intellectual foundation for legislation that fortunately set the limit on how children could work — the age limits as well as the conditions under which they could work.
The volume that you hopefully have from the most recent edition of the Annals is really celebrating, in many ways, the 20th anniversary of the signing — the ratification of the Convention on the Rights of the Child by the General Assembly in the current 1989, 1990. But 20 years is not a long time, so we weren't sure if we should use the word celebration or not when we gathered in Cambridge a year ago to have this conference that led up to the volume.
And there were many people who said, "You know, the Convention on the Rights of the Child is just hand-washing. It hasn't really done anything except give international lawyers something to shout about."
But my thought is that 20 years after the Emancipation Proclamation wasn't a long time, either; not much had happened. Democratization is a very slow process and a very painful process.
But that volume, the volume that you have (The Annals of the American Academy of Political and Social Science), is meant to be a statement of what is needed in terms of thinking and action to advance children as citizens and part of the world citizenry and democracies. And there's no expectation that it's going to happen in 20 years or 40 years or 60 years, but it's an irreversible process at the same time.
And so I think we're very proud — the contributors of that volume are very proud — of the achievement of having brought developmental psychology, philosophy, law, public health, public safety together in one volume to create this statement — if you will, intellectual scholarly statement — about the rights of children. And I would forecast that it's going to be an important historical document.
Now one of the chapters in that volume is really the text of what I want to tell you about — the text of this excursion that I'm going to take you on. It's called "Adolescents as Deliberative Citizens in Their Local Communities: Promoting Health in Their Local Communities." And the project, as I said before, starts out actually in Chicago, with the realization that, during the 1980s and beginning of the 1990s, as a society we confronted levels of violence that is, levels of community violence that had never been experienced before, that the homicide rate in cities like Chicago was such that one could legitimately call it a war zone in terms of the number of people who were being killed.
That map shows about 5,000 homicides that occurred over a six-year period. And the distribution of the homicides makes it such that some communities at the epicenter were worse than war zones — I mean, some war zones — could be. But at the same time, the distribution — this is one of the first geo-coded maps of homicide, I think , and Jeff Warnoff did this as part of his dissertation at the University of Chicago and did it with our project, and it took him about a year to confer the geo-codes because he was working with several sources of records. So we're pretty confident that that map is a pretty good depiction — public health, public safety depiction — of what homicide looks like.
It turns out people don't die of homicide very far from where they live, unlike robbery, so a geo-coded map of robbery would look much more diffuse and would have different epicenters than one of homicide. But that one for homicide is one that we have a lot of confidence in. And I can't go into the details of the map but — if Chicago census maps, that's the blocks you see inside — so there are 863 census tracts. A census tract has about 4,000 people on average, making up a city of 3.1 or 3.2 million people.
And there were about three homicides a month on average for six years in the city of Chicago, and that represents — and the Lake Michigan — do I have a pointer? I'm not sure. I can point with this, I guess. Lake Michigan is here, and O'Hare Airport is up here. Evanston and Gary, Indiana, are at the bottom.
What you see is a map that has maybe two definite large epicenters and a third one, surprisingly to us, in the upper northeast corner of Chicago — Uptown, Edgewater communities. We were a little surprised with that because that community is considered a relatively affluent community, unlike the West Side and the South Side that, since the death of Martin Luther King, has been in a tailspin.
One of the things we weren't prepared for is that a map of homicide distribution correlated spatially with a map of other things that had nothing to do with homicide but were very important health problems. Now, low birth weight is a marker in public health for a general condition of children, if you will, so if you had to make a statement about how well children are doing in a particular society, that the birth weight would be one indicator of how well that health system was working for children.
So the distribution of — I want to go back to the map. Can you take me back to the map? So this map, these two maps, essentially framed the Chicago project. Yes, we were interested in violence. Yes, we were funded by the National Institute of Justice. But we were also funded by NIMH and by the Macarthur Foundation, so it was a partnership.
So we wanted to make sure we understood multilevel influences on violence, but at the same time we're studying violence, we had this opportunity to study other health conditions. And this mapping exercise was a very important sort of scientific justification, if you will. But it raised a question: How was the environment working to be able to be a risk factor for violence that is mostly adult males between the ages of 16 and 30? How could that environment control or regulate a woman's pregnancy such that there was a distribution of low birth weight that correlated spatially with homicide?
And one of the thoughts that kept passing through our minds is that it could be exposure to violence. It could be that the distress and disorganization that is caused by eruptions in the violence could interfere sufficiently with a woman's pregnancy to produce low birth weight. That's a rational kind of thing, but we didn't know that at this point.
And so the Chicago project, with its handsome funding, created a design that was to put crime and health on the moon. It was like a moon shot. If you had one shot at understanding this complex problem that we're in — this epidemic of violence, but an epidemic of violence that has these offshoots into all the other problems — how would you design that project?
And so for three years after John met me, before collecting a shred of data, we organized workshops and committees and had all kinds of scientific consultation, asked people around the world to help us organize the study in a way that would really advance knowledge such that you wouldn't have to repeat the study. If you're going to spend millions of dollars on a study, you don't want to repeat it. You don't want to have to replicate it at the end. You can replicate parts of it, but you want that study to be such that it brings sociology, psychology, physiology together in a way that truly advances things.
So it was important to do community surveys that were independent of the kind of data you would collect longitudinally on children. So the first two lines indicate that we did these cross-sectional community surveys of every community in Chicago, and the longitudinal study was an accelerated longitudinal design, and I have a cartoon I'll show you about that studied multiple age groups of children in each community over time.
We didn't want to rely — and this I think was probably the smartest decision we made — we didn't want to rely exclusively on what people told us in interviews and surveys, and so we videotaped the city of Chicago in 95 and 96, we equipped vans with cameras and we just rolled down the street saying, "Harvard University at work," five miles an hour, filming, taping, videotaping the public landscape, if you will. We weren't aiming at people's front doors, but the public landscape.
And we saw everything. And Rob Sampson, my colleague in the project, also designed a study of asking experts in neighborhoods — business people, religious leaders, police, public health officials — how they viewed neighborhoods so that we didn't have a point of view of neighborhoods that came exclusively from residents. They were also interested in how business sectors and religious sectors viewed those same neighborhoods, so you had a richer, if you will
So I'm telling you all this to say that this study collected a lot of data, and it did it, I think, in a very good way.
This is the schematic of the longitudinal study. So there were seven age cohorts that were sampled randomly from 80 different neighborhoods representing all of the race and ethnic composition of the city of Chicago. And what that design is called — it's an "accelerated longitudinal design," such that there's overlap between adjacent cohorts, which means that at the end of this study, if you've studied children being born up to the age of 7 and you've studied 7-year-olds 5-year-olds up to the age of 12, then it's like an accordion. Then in 7 years, if you can splice together the intervening cohorts, you have a 25-year study.
And what it tries to map out — what are the risk conditions and the individual and family level that characterize children in the different ages. We know that reading and verbal intelligence are very important predictors, just like impulse control is — temperamental qualities — of future crime at the individual level. So we wanted to capture that at the same time we captured the age crime curve, which is part of the mainstay of criminology forever and ever.
Now we wanted to subject this massive amount of data that we had to a multilevel model, and we were able to do that. I don't have time to go into great detail about that. But what it meant is that we could measure community-level factors with the same degree of reliability and precision that we're measuring reading scores or IQ or family conflict.
And it took us a while to get to that point because the measures of family characteristics and individual characteristics were much better established than were measures of the community. So we actually had to stop the study and develop better measures of community characteristics, because what we were depending on without such measures was demography — demographic characteristics.
I mean we could say If somebody asked you, "What was Pilsen?", they would say, "It's a Mexican community." Who lives on the South Side? They would say, "African Americans live on the South Side," as if that was telling you something about the community. And people would impute problems of the community with demography, with demographic characteristics, and we didn't want to be in that position. We didn't want to say that a neighborhood was black or white or Hispanic or whatever. We wanted to say a community functions or it doesn't function, and what are the mentions of that function that are important?
That's where the notion of collective efficacy comes out. Theory is very important — that I had to be convinced by people that it was really important to concentrate on the theory before collecting data because in public health training you're not necessarily forced to learn theory on par with measurement characteristics.
But my wife and various other people convinced me that it was important to slow down, get your theoretical head together and then create a measure that tests whether or not your theoretical concept is right or not.
So this notion of collective efficacy is one that I worked on with Al Reese and with Rob Sampson and a variety of other people who've continued that work — not Al, of course. But the important thing about collective efficacy is that we wanted to distinguish it from social capital. And one of the more important papers we've written is actually called "Beyond Social Capital" because while it captures trust and cohesion at the community level as community characteristics, it puts emphasis on agency — that is, the willingness of residents in the neighborhood to act on common goals.
So the kinds of questions that we asked in the community survey were questions like this.
And it was important to emphasize that these are questions not about what you would do, but your perception and beliefs about what your community advocates or your community companions or your neighbors would do.
So, would neighbors in this community take action if they saw these things happening, and how confident are you? So it was a graded ordinal scale to "completely unlikely" to "maybe, maybe not" and then "very likely." And what we're able to do is create a scale now, a score on this notion of collective efficacy that was a score that had a lot of reliability and validity associated with it, so it was a precise score.
So we created a new map of Chicago that was unlike any other map. It wasn't a map of race or social class; it was a map of how communities function. The blue areas represent areas of Chicago that were functioning well — had high collective efficacy levels. And the neutral tone, the gray tones, were those that were in the middle of the scale. And the red zones are the areas that were not functioning very well at all.
And what we went out to show in, I think, a very convincing way, is that collective efficacy had a direct effect — so in that model I showed you before, the multilevel analytical model, there are all kinds of interactions going on — that a community influence could act through family supervision and through individual characteristics on children to affect an outcome like violence or low birth weight.
Or you could have models in which the community influences were direct — they didn't depend on how much supervision you got or what your IQ was — that if you lived in the community, you were at risk. And what we're beginning to show is that community characteristics have direct effects on these outcomes that were statistically significant and of great public health and public safety significance, because what it meant is that if you can change that level of collective efficacy just a little bit, if you could tweak it, you could have a massive impact on the individual outcome.
So what we were learning in the process of all of this is that collective efficacy and exposure to violence were key characteristics of communities that were important.
Now I'm just going to show you these slides quickly because it represents one way — I think a novel way — in which we dealt with this longitudinal study — that in most cases, when you have a longitudinal study, what you do is you study the same individuals unfolding or developing over time, so you do repeated measures.
We took advantage of the longitudinal study to actually carry out a pseudo-experiment, a false experiment, that you could not carry out in real life because we were interested in the age-old question of what happens if children are exposed to serious violent behavior, serious violent events, over a fairly narrow window of time.
So we had collected data, and the slide here shows over a 60-month period of time, so what we were able to do is carry on a false experiment in which we matched children who were exposed to violence with children who were not exposed to violence but had 153 other characteristics that were common. So it approximated a randomized experiment.
So these are the matching variables that we had. So we had this huge data set, so we were able to draw two kinds of kids out of this data set, one who had all these characteristics and was exposed to violence, and one who wasn't.
And what we showed is that it's what we had known from the ages is true in Chicago and it's true in adolescence, and that is that if you're exposed to violence over a two-year period of time, there's a two- to threefold increase in the likelihood that you will be involved in serious, firearm-related violent behavior.
Now all of that's background because as we were carrying out this massive study, doing these sophisticated propensity stratification and analyses and multilevel analyses, we're also troubled by the fact that we weren't aligning ourselves sufficiently with the Convention on the Rights of the Child, that much of this work that I just told you about, that we were becoming famous for, was without the consultation and advice of children. It was all about them, but it wasn't engaging them in a process of saying that, "Yes, we think you're doing a good job, Dr. Earls and Dr. Sampson. Keep it up! We'll write a supporting letter to the National Institute of Justice for you."
So that's the kind of attitude that we want. We wanted to work with a group of children who had that attitude that you're doing a good job, you're doing a lousy job, and we will write a supporting letter for you.
It's not easy to set up that, because here we are, Harvard professors, professionals, criminologists, public health people. We want to work with 13- and 14-year-old kids who are accustomed to an authoritarian structure where adults call the shots.
So this is where this book that you have in your hand (The Annals of the American Academy of Political and Social Science) becomes important — that we wanted to create the conditions on which we could level the playing field, that a group of Chicago teenagers could become respected, self-respected and other-respected, in a way in which they genuinely gave us their point of view about what we were doing and what we were trying to understand.
So one of the things they did was to take our exposure-to-violence measure that we were very proud of — it's called MyETV, My Exposure To Violence — and we'd done these reliability and validity studies and had all kinds of inter-scale correlations and predictions from it, and we said to this first group of five to six adolescents, "Would you take a look at our exposure-to-violence scale and tell us whether or not you think we're doing a good job? Have we missed something or not?"
But we didn't just give it to them. We worked with them for weeks establishing a base of respect and mutuality, such that when they did get the questionnaire and started to scan it and react to it, they were doing it with some sense that they were real partners — they were established partners with us. So this is not focus groups, folks — this is working with the same five to 10 Young Citizens for eight to 10 hours a day for a whole summer, in which we would introduce the Convention on the Rights of the Child and say, "Read these articles; read this document and interpret it for us, with us, in terms of your life. Is this of any relevance to you? And if it is, then how does that go?"
Now people were looking over our shoulders and laughing, saying, "You've got to be joking. These kids are not interested in some international Convention on the Rights of the Child. These kids are reading at a third-grade level, and they're thinking about gangs, and they're thinking about being dissed and drugs and sex and so forth and so on, and you mean you're going to keep them there for eight hours a day for the whole summer?"
But as I was telling Tom Feucht, that at some point in this first two or three weeks, we lost control of the group. The group was saying, "We don't want to go to lunch right now, we're in the middle of Article 27, Standard of Living, and we haven't finished our deliberation, so we want to continue, please." And I'd miss lunch.
But we established a proof of concept, and that's what that slide at the bottom kind of says — that children as young as 12 and 13 and 14 are prepared to deliberate seriously about standard of living, about the quality of life that they're living, and to come up with a point of view and a perspective that is genuinely their point of view.
For example, one of the questions that we had not thought about — I mean, an event that we hadn't thought about — is that every high school in Chicago, and in many big cities in the United States, have security check points, have metal detectors, that you have to walk through to go to school. And the Young Citizens in Chicago said, "Why didn't you ask about that? Because every morning there's some set of events to take place at the security checkpoint that essentially represents a violation of our human right."
And they'd give us an example of a girl who walked through the metal detector, and it went off, and they searched her and they couldn't figure it out, and they made her open her blouse, and it turns out that she had metal rings in her bra, and that was very embarrassing to this girl to have to open her shirt in front of a policeman.
"Dr. Earls, why didn't you include metal detectors, security checkpoints?"
They told another story about how kids would bring in razor blades and make them horizontal and carry them under their tongue or in their mouth and how every couple of days or every week or so somebody would come in actually having a cut either because somebody had hit them or they'd fallen — so the stories went on and on and on about what we had missed in our questionnaire that were important to them. But the most important thing we had missed was asking about caring and attachment.
So they did their own surveys. They were enough — they learned social science pretty quickly and were able to design their own surveys and go out into the community, their community, and collect the kind of data that they wanted to collect, and the data they wanted to collect was about parents, teachers and police, the three sets of authority figures that regulate their lives.
Now, by using a term "authority figure," they didn't imply that there was anything wrong with that. That's good. We need guidance and we are children and so forth, but what they wanted to map out was how age related to the degree to which those three classes of adults were attached to them. And their hypothesis was that as they got older, from 13 to 18, that there would be a decline in attachment of the caring that came from these three classes of people. And they were right. They proved it with their own data.
So in working with small groups of young people, we established the fact that children could be deliberative and they could be serious and they could come up with opinions and ideas that were truly their own ideas.
So this caused us to go back to our theoretical position and think more deeply about what we were doing and what we wanted to do with children — that we had been very much impressed and guided by the theory of human ecology by Urie Bronfenbrenner, and by the great work of Albert Bandura, the psychologist who introduced social cognitive theory and has done so much with self-efficacy. He hasn't done that much with collective efficacy, even though we use that term, but Bandura never really tested collective efficacy. He never really designed a measure of collective efficacy to approximate his self-efficacy measures.
But we were interested in human capability and communicative action. Now these are theories that come from Amartya Sen, the welfare economist who's at Harvard, and Jόrgen Habermas, who's the author of Communicative Action, or discourse ethics theory. That's a German philosopher, probably the most important philosopher of our age.
Sen's philosophy tries to move beyond income as an indicator of well-being. Basically, economists have used income and socioeconomic markers as a status quo. What Sen argues is that well-being is established by the kind of life that you choose to have. You may want to be a painter. That doesn't generate much income, but it generates a lot of satisfaction.
And so he has created a theoretical, philosophical platform on which one judges success or well-being or quality of life based on the capacity to choose, the capability to choose, and then having an environment and resources that allow you to approximate that choice that you've made. So, if you want to ride a bicycle, and that's something that you value as a capability, that there are bicycles around and teachers and adults around to guide you in riding a bicycle. It's just the kind of metaphor he uses a lot.
So this is very compatible with positive youth development. It's very compatible with thinking about children as having assets and the environment of having resources that allow those developmental assets to mature and to express themselves in ways that satisfy the individual but also satisfy the society as well.
Communicative action is a theory that approximates what we were trying to do with these eight-hour sessions with adolescents — that communicative action is the basis of deliberative democracy, basically, and argues that rational decision-making depends on leveling the playing field among all citizens. In Germany it might be between Jews and non-Jews, which is one of the things that motivated Habermas. How could a great society like Germany fall apart around ethnicity? It had all the music, art and science in the world, but it failed.
So his philosophy is one that is intended to bring people of different persuasions and backgrounds together in a medium where there is what he calls an "ideal speech situation," where if you speak, you know you're going to be respected — that you have an honest chance to voice your opinion.
So that theory was a theory that allowed us to bring age — to collapse the age barrier — and to bring children into an arena, into a space that was as protected as a space could be to allow them to participate in this meaningful way. So that philosophy was a very important kind of weigh station to make sure we understood it and we knew how to apply it and we knew how to test it.
And so the excursion then moves from Chicago to Moshi. Now I don't know how many people have been to Moshi — I know Micah has been to Moshi. But Moshi is a very important city in the world, because it's on the slopes of Mount Kilimanjaro, and that alone would make it a very important place, the highest point in Africa — on the slopes of the highest point in Africa.
But during the Chicago project, we had created this evidence base that collective efficacy was related, as I said before, to this variety of outcomes. And so in the late 90s and early part of the last decade, 2000, it was becoming very clear that the HIV catastrophe would remain out of control for a long time because there's no vaccine that was going to be developed any time soon and that the treatments — the drugs used for treatment — were very complicated where people were really concerned about drug resistance. So social behavioral approaches to HIV became very important.
So Steve Hyman, who was then the director of NIMH, said to me after he'd been to a meeting in Durban of the World AIDS Meeting, "Tony, have you ever thought about applying collective efficacy theory and engaging adolescents in the way that you did in Chicago to the HIV/AIDS epidemic? Because you were showing evidence that collective efficacy was predictive of age of onset of sexual initiation. Age of onset of sexual initiation is a risk factor for HIV in a society that has the virus in epidemic proportions."
It didn't take much to persuade my family to engage themselves in Tanzania because we had been impressed with the revolution — I call it "revolution" — the liberation of Tanzania from the very beginning and the great president they had in Julius Nyerere — that here was a society that was peaceful, cohesive, that Muslim and Christians lived together, and it had become the base for deliberation movements all over Central and Southern Africa. Very well respected country. Strong democracy that was evolving there. But an HIV rate that was about 10 percent, so a hyper-endemic area.
We took this as an opportunity to take a big leap in engaging adolescents. I'm going to make this brief because it's elaborated in the text, and I want to leave enough time for questions. So I'm going to go over a very complicated experience quickly just to give you a gist of what happened in this project.
We took a big leap. We had never worked with more than 10 or 15 adolescents in this sort of intensive dialogue way before. So in this case, we felt we had proven the concept. We'd worked in Chicago. We'd worked in Costa Rica. We'd worked in Cambridge, where we come from, and we were ready to formalize the Young Citizens program into a scripted intervention that would be prepared to give to hundreds of kids. But we wanted to do it experimentally, being cautious scientists, and we wanted to set it up such that if it didn't work, we would prove ourselves wrong. That's what you're supposed to do when you design an experiment, the null hypothesis.
Moshi, Tanzania, gave us an opportunity to do this because — so that's Moshi in northern central to east Tanzania.
So that's the city of Moshi with 150,000 people. It's now 200,000 people. Those are like census tracts except they're called [indistinguishable], called street communities or neighborhoods. And each of those units has a population of two to 3,000 people, and each of the units has a democratic structure, such that there's an elected leader, called a street leader, and a committee structure under that leader or with that leader that regulates the health and education and safety and sanitation of that community. So it's like you have 61 democracies.
So what we did was that we matched 30 of those, 15 and 15 of those democracies, those mini-democracies, and randomly assigned 15 to the Young Citizens Project and 15 to the control group. We worked with the city administration to make sure that they understood what we wanted to do, that we wanted to educate young people about HIV, we wanted to engage them as citizens in understanding the impact and the direction that that epidemic was taking place, and that, if it worked, we wanted them to feel like they were owning this kind of project, that we weren't dropping in from the stars to do something that they didn't want to have done.
So this takes years of work to establish.
At the end of the project, two years into it, these young people, who were 10 to 14 — that's the age group we were working in, so it's actually before sexual initiation — that these young people understood the intricacies of the microbiology of HIV/AIDS.
So this is a community performance, where they're teaching the community about drug resistance. What they're showing is that a virus which is on its knees has been conquered or inhibited by the drug on the right — Dawa is a medication. And he's done that by putting a rope around the T4 cell. So if you know the mechanics, the biology of HIV, it's a virus that attacks the captain of the immune system, kills the captain of the immune system, the immune system falls apart, and that's why it's an immune- insufficiency disease.
So they're explaining this to people in a way that the audience of children and old people and whatever can say, "Stop, please. I didn't understand what just happened. Could you rewind?" Or that if you had a better way to depict a virus than I did, that you could take my place in it. So the wall between — this is community theater — the barrier between audience and performance is dissolved, essentially. And at the end of the performance, people can ask questions about this.
They did this kind of micro-world — what's happening inside your body — at the same time they did macro-world depictions, skits, where they're showing what happens to a 14- or 15-year old girl who is approached by a sugar daddy who has enough money to buy sex in return for some school books or a new dress or something like that.
What happens to an orphan when both parents die? So they were carrying out micro-world and macro-world.
And what we were able to do is to do pre- and post- carefully done community surveys and surveys of the participating adolescents and show that this project created intergenerational closure — it created collective efficacy as reflected in intergenerational closure.
And it not only says that children can teach adults scientific facts about AIDS, but this last line is a stumper, that children can help decrease stigma and discrimination. And it was, at the time that we did this, most people felt that stigma and discrimination were the biggest social behavioral challenges, that if you didn't have people tested, if people weren't willing to admit that they were at risk, then there was no controlling the epidemic, and people were justifiably holding back their identity because of the stigma and the discrimination that existed in the community.
And so the project established this about four or five years ago and has gone on to hold testing fairs where, in public spaces, the VCT consulates, the voluntary consulates and testers, come into the community settings, set up their testing apparatus confidentially but in public space and have successfully tested — done HIV testing on — hundreds of people.
So the Young Citizens' action actually opened the gateway to not only decrease stigma but, very importantly in the epidemic, to get people tested because it's only if you're tested and know your status that you can do something about AIDS.
Now the individual participating adolescents who carried out the intervention also benefited from being able to demonstrate high levels of deliberative and communicative self-efficacy. And we had these scales that said, "Can you exercise your opinion without losing friends?" for example. They had no effect on other kinds of self-efficacy. We measured everything. We measured peer resistance, we measured mathematic skills, reading skills, and none of that was different between treatment of the control communities and treatment of the control adolescents.
What was significant was what the intervention intended to do, and that is to create the confidence and the self-respect of adolescents to be dignified, knowledgeable people.
So I could make a long story about sustainability, but I really want to close the talk with where I go next on this excursion.
Home sweet home. Home sweet home for me is New Orleans, and since 2006 we have worked with the Louisiana Public Health Institute, the mayor's office, the office of public health, the chief of police, the changing chiefs of police, the changing mayors, the changing structures in New Orleans, to incorporate the Young Citizens program in the redeployment and rebuilding and revitalization of New Orleans.
There's an economic recovery plan that's on a neighborhood basis, and what this shows — I don't know how many of you remember a guy named Ed Blakely who was called a recovery czar working under Ray Nagin. And because New Orleans post-Katrina was so much in the media that finally having a world-class urban planner take over the redevelopment process was a very important event, and Ed Blakely was without a doubt one of the world's great urban planners.
He came to live in New Orleans and created this plan where there were recovery zones and revitalization zones. Recovery zones were zones that had been devastated, and you really had to build up the infrastructure. And revitalization zones were areas that still had some infrastructure but needed housing redevelopment, or something like that.
And the idea we mapped out was to do a randomized cluster trial in which the Young Citizens program would embrace and partner with the police, who were using CompStat — I think that's what it's called — community policing, and with economic recovery, such that Young Citizens would be engaged in understanding and making decisions about economic recovery — what that meant for their neighborhoods — and engage with the police who were studying community patterns of, pretty much, homicide. In New Orleans, you don't get past homicide because it's such — it was a pre-Katrina problem, and did not get any better post-Katrina.
So we're making — I'm showing these maps without going into detail about it because I don't have time, but this is just now like our Moshi experiment. This is a district. The problem that we're dealing with in New Orleans is that there are no local democracies. So I want that to have a resounding effect on you. Because you can't be a young citizen in a school district. You have to be a young citizen in a democracy.
And New Orleans has 400,000 people, maybe 450,000 people now with the recovery back, and six city counselors, and a mayor's office. That's it.
So in Moshi, we had — every 2,000 people were part of a democratic unit. So when we said to the health department, "We want the Young Citizens Project to be integrated into local government," there's a very clear pathway of locality that made that partnership possible and exciting to work with.
So here I go back to home sweet home, and without there being a local unit of integrity, there can't be a Young Citizens Project. We're not going to do this project just because there's a police district or a school district. We can only do the project if it can be sustained in a democratic structure that respects the dignity and self-respect that we think, we hypothesize, children will gain in the process of it.
So after two big successes — success in Chicago, success in Moshi, Tanzania — so far we have failed in New Orleans. But the Young Citizens Project is ready to engage itself in a city that I think has the first, second — it's up there in the top three in terms of danger and lack of safety in the United States. It remains that after Katrina. There was a small period of quiescence after Katrina when everybody left, and the minute the city started to be repopulated by different people — by the way, not all the same people came back; my family never came back — in its repopulated, new infrastructure development characteristics, it's got the same imprint of violence.
That's a sad statement about American society that we're not able to do more about that, and I'm hoping that one day the Justice Department and the Public Health Department can put their heads together about New Orleans and do something about it. And that's where I want to end my talk.
But I wanted to remind you of the Young Citizens — that if anybody thinks kids can't change the world, then there are lots of examples of it: Christina Green may be one, but Ruby Nell Bridges is certainly somebody who is extremely important in terms of changing the world that we live in. Thank you very much.
John Laub: Thank you, Tony. We have time for questions, and I ask that you use the microphones and identify yourself if you're going to
Akiva Liberman: Hello. I'm Akiva Liberman with Urban Institute. And Tony, you've told me about the different parts of this over the years, but I never really understood how they came together as well as I do right now, so that was terrific.
My question is about the notion of child citizens and the examples you've given — you've brought together children, adolescents, with a couple of adults as facilitators and guides — and I'm wondering how you think about that in contrast to a different model that's sometimes tried, where a few adolescents are put into an adult body, and whether or not you think that has not as strong a chance.
Earls: Yeah. I think critical mass is an important issue and I know examples many examples of children being a minority in a larger adult-dominated structure. I think there's a chapter in the book written by James Bohman, who's a philosopher at St. Louis University, about "non-domination." This is a word that philosophers use to characterize the ideal of democracy that a group has to have a non-authoritarian structure and that has to be implemented in a way that remains non-authoritarian and non-dominating in order for people to rise up, if you will, to the level that they have confidence and are persuasive in their voice and their opinions.
So I think, Akiva, that at this stage of development, that we need to have groups that are not dominated by adults.
Now, I say that with the reality that in Cambridge, where I come from, and Cambridge is sometimes called the Republic of Cambridge — adolescents largely working on their own were able to reduce the voting age — this is local elections — from 18 to 17. They miscalculated. The city council was actually ready to reduce it to age 16, even though they thought they would overshoot if they tried to go for 16, so they stopped at age 17.
But they're now voting members — children are now voting members on the city council. And there are two seats for people under the age of 18. And it's very effective, I might say, so it can happen.
Winnie Reed: My name is Winnie Reed, with the National Institute of Justice, and I wondered if you could perhaps talk a little bit about applying this model of engaging youth in the gang problem, which is such an intractable issue in our country, certainly.
Earls: Well, I've been interested in two things, and I actually asked John at one point — or Yolanda, I'm not sure — to help me with this — that my general take on it is that youth have — there have not been very systematic studies done on youth participation in gang resolution, that is resolving conflicts between gangs, or what is sometimes called youth courts, where children are engaged in helping to make decisions about outcomes of conflicts and infringements that go on in their communities.
Now these courts exist around in various places — they're very scattered — but I can't find any systematic work done in those kinds of organizations. I first became aware of youth courts and youth involvement in decision-making in the criminal justice system in Brazil.
But even in Brazil, where it's pretty well established, there're still not very systematic studies done. So my reservation about this body of work — this body of practice, if you will, because it's really a legitimate practice — but the legitimate practice is not backed up as far as I can tell by any evidence.
Now, I don't know if I'm wrong about that. Maybe I should have a student work with me, and we really do a thorough evaluation of the literature, but I asked you, John, to help me find programs that had been carefully evaluated where there were control groups, that there was statistical power in the analysis. Couldn't come up with anything. So I think this is a very important area for NIJ to encourage scientific development.
Jose Viertiaga: My name is Jose Viertiaga. I work here in the District of Columbia for the Juvenile Justice Agency, DYRS, although my question isn't related to my position there.
Besides some of the superpower reasons the United States often doesn't sign the landmine treaty, the cluster bomb, the CRC, a whole host of them, we're sometimes in bad company in terms of non-signator status, but do you think that in part in addition to those superpower reasons that the United States proclaims, it's because we want to incarcerate juveniles in adult facilities — we want to charge juveniles as an adult in the way the rest of civilized societies don't? Do you think that we'll never sign the CRC, or do you think that we somehow might be able to?
Earls: No, I think we will sign the CRC. Who knows? But it may come before we think because there is this momentum — it's not flashy, but Bill Clinton signed the Convention in 1995 and has referred to it a few times just as he was leaving office — that President Bush actually tried to introduce the Convention, ratification of the Convention, to the Senate in 2005 or 2006, and they weren't quite ready to take it.
And so, there's a queuing up of these conventions — it's women's rights and indigenous people and so forth and so on. But there is a groundswell of activity around the Convention on the Rights of the Child that could make it advance more quickly than we expect, so let's not close the book on it.
But I just wanted to say one thing: that I belong to an organization called Physicians for Human Rights, and one of the things that we help to do is to write an opinion, an amicus brief, on the importance of eliminating the death penalty, extension of the death penalty for minors, for children, that successfully did pass the Supreme Court.
We thought that that would be — that was a big stumbling block to advancing the Convention's platform, and we may or may not have been correct about that. But a scientific error was made in the process of that, and I want to tell you because this is really important about how science and policy work together, or they don't work together. We thought, or somebody at Physicians for Human Rights thought, that it was very important to use this new brain science data to suggest that children weren't mature and weren't capable of making good decisions, and it was this incapability or immaturity that was the justification, if you will — the sort of scientific brain neurobiology justification — for not extending the death penalty to these largely irresponsible people.
The citizenship argument, and the cognitive maturity data actually suggest that, if anything, children are maturing faster than they did 20 years or 100 years ago, and so there's this sort of conflict between the neurobiology, which is data based on samples of 10 and 20 people having brain scans — highly selected, skewed population.
What we know about the brain now is that it never finishes growing. If you're in a stimulating environment, you sprout new neurons for the rest of your life. Maybe not as old as I am, but for a long time. I don't think I'm sprouting new neurons now.
So, and it turns out that Sandra Day O'Connor became really impressed with this part of the argument, the brain immaturity part of the argument, and I think, I mean Jay and I may be wrong about this, but I think it was Sandra Day O'Connor's vote that was the swing vote in the decision, that made it a 5-4 decision.
So it's just one of those instances where science can get it wrong, or policy people can get it wrong, and do something that actually contradicts the bigger issue — the bigger issue being that children are mature enough. All 13-year-olds are not the same, that some 13-year-olds are ready to vote, and Daniel Hart's article in that journal makes a pretty convincing argument that 14- and 15- and 16-year-olds — there's a transition in cognitive development in that period that makes them as good a decision-maker as older people are.
Jean O'Neal: Thank you. This is wonderful, and it's a great gift to many of us, I know. I've had a fairly long background in — my name's Jean O'Neal, by the way — I was working with the National Crime Prevention Council. I'm out on my own now.
The recurrent issue as we've worked with young people in several programs where they were given opportunities to take civic responsibility is that they wind up being dependent on adult leadership, and that's typically a personality issue. Have you thought about diving into the question of the kind of adult base that needs to be there to sustain these things?
Earls: Well, in the Tanzania project we were very careful to — we did a national search for our staff, basically. And we wanted young people who were close enough to the children, to the experiences of being a child, to understand the sort of contemporary children's issues in language and so forth. But we wanted them to have the capacity to be people who were equalizers, who were non-dominant in their own personalities and their own style of working with people, and that they were patient. Because, as I sort of say throughout all of this, democratization of children or for adults is a very slow process. It feels like a waste of time a lot, you know that you're just going back over something you already went over before, so you really need that patience to stay with this kind of slow grinding process.
I don't know how many of you know what Zhou Enlai said about the French Revolution. Zhou Enlai was Mao Tse-tung's right-hand guy and in '78, when he was asked by some foreign journalist what he thought about the French Revolution. He says, "It's too soon to tell." Well, that's the way I feel about the Young Citizens program.
So we have data from the cluster randomized trial, but it's way too soon to know what kind of adults to choose and how to choose them and so forth. So we're kind of going on what is our best judgment about this and being very careful to evaluate it, to be in a position to prove ourselves wrong. It's a mixed age group.
Nancy Ritter: I'm Nancy Ritter from the National Institute of Justice. Picking up on the "It's too soon to tell" and the idea of getting policymakers involved in any research, how do you bridge that gap?
Earls: Yeah, that's a good question. How do you bridge the policy-science-policy gap? On bad days, I say, "It's enough trouble to be a good scientist." It's really a headache to get funding and to get your papers published and to gain respect from your peers and that sort of thing — that you've done a good job.
And so I'm so consumed with being a good scientist that I really don't have the time or I don't have the patience to deal with policy. On the other hand, I'm a human rights activist. And if the policymakers don't get it right, then my principles and my values are denied.
So what I think is important is that scientists engage as I'm engaging you in what we do and what we think about in a way that provides thoughtful, penetrating analysis of complex ideas. So I think that this book — so to me the most important thing that has happened with the book so far is that the publisher, Sage Publishing Company, sees enough value in the book to give out 100 copies at an event like this.
Not only that, but Emily Wood, who's a managing editor of the Annals, is here. So the American Academy of Political and Social Science has a stake in bridging that gap between science and policy. So by publishing in that journal, it increases the reach and the likelihood that that reach will make a difference because I have this apparatus, or we have this apparatus, that's helping us to disseminate, and to disseminate in a high-quality way. It's a very high-quality journal.
Carrie Mulford: Hi. I'm Carrie Mulford, also at the National Institute of Justice. What kind of selection process goes into picking the kids that participate with you? Is it leaders or average kids?
Earls: Ah. The best question yet, because my scientific colleagues would say you cherry picked. When you see — I mean, we have videotapes of the performances that the children do — their capacity to answer questions that adults ask them about HIV or about transmission or what have you. And when you see these videotapes or you listen, read the transcripts, or what have you, you'll believe that something special is happening. That this is not an ordinary kid. That Dr. Earls and his group went through the schools of Moshi and got the highest-performing kids and randomized them into the Young Citizens group and the control group was everybody else.
So we went to great lengths to do probability sampling so that it was the average child who was in the groups and that we could show that.
So we had, and I could talk all day about this, we had aerial photographs of Moshi, Tanzania, that we digitized. So we produced some of the first digitized maps. Every chicken coop, every house was digitized, and we created a sampling frame from these digital maps using University of Michigan survey researcher technique for randomly choosing households I'm blocking on his name Kish. Kish methods. So it's a random sample of each neighborhood that makes up the Young Citizen's project, and it's only there that we can confidently say that this program can work for everybody.
Laub: Please join me in thanking Felton Earls for a wonderful presentation.
Earls: Thank you.