Editor’s Note: In this article, the lead author and former DHS Center for Prevention Programs and Partnerships (CP3) researcher, Theo Warner, summarizes CP3’s Approach to Prevention. While CP3 is no longer a viable organization, the office helped to create prevention doctrine that remains essential for the multidisciplinary prevention community of practice going forward. Doctrine helps individuals and organizations with different capabilities, responsibilities and cultures to share a common vocabulary and set of organizing principles. This allows them to work towards shared goals, such as reducing risk factors for violence and bolstering protective factors against violence, in complementary ways in direct collaboration or indirect coordination. Doctrine allows prevention providers and initiatives, working at different levels of prevention and in different contextual settings, to have a collective impact greater than the sum of their parts. It also allows for more efficient measurement and evaluation, information sharing and knowledge management by helping to organize the field conceptually and in accordance with established violence prevention theory and practice developed over the past four decades by the public health community.
From grievance-based school and workplace shootings, to hate crimes, to ideologically-motivated terrorist attacks, incidents of targeted violence and terrorism continue to devastate communities across the country. Preventing acts of targeted violence before they occur is one of the most urgent and complex challenges facing the United States. While traditional security and law enforcement efforts play an essential role in responding to these threats, their authority to intervene is restricted unless actions rise to the level of criminal activity or constitute a legally defined threat to public safety. What our traditional efforts lack are proactive strategies that don’t just react to violence but work to prevent it before it happens.
A public health-informed approach to targeted violence and terrorism prevention fills this gap. Rather than waiting for warning signs to escalate into criminal acts, a public health-informed approach focuses on early intervention and draws on decades of research in public health, behavioral health, psychology, and criminology to address the complex factors that contribute to violence.
Until recently, the Department of Homeland Security’s Center for Prevention Programs and Partnerships (CP3) led the national prevention mission. Guided by principles of public health, CP3 advanced targeted violence and terrorism prevention efforts through funding, capacity-building, curating research, and building a national coalition for targeted violence prevention. Although CP3 has been slashed in recent months, research and recent experiences indicate that advancing a public health-informed approach is a winning strategy to prevent targeted violence and terrorism.
At the heart of a public health-informed approach is identifying the factors that increase or reduce the likelihood of violence. Risk factors are characteristics or conditions that may increase an individual’s susceptibility to engaging in violence. These can include factors like social isolation, lack of access to mental health and wellness resources, or having a history of trauma. Protective factors mitigate risk factors, and can include factors like strong social connection and trust in institutions. Just as a health risk factor like high blood pressure is not predictive of specific health outcomes but increases the likelihood of heart disease, strokes and kidney damage, violence risk factors are not predictive. However, awareness of risk factors and the protective factors that mitigate against them can help communities develop targeted violence prevention efforts in the same way that medical professionals can help develop pragmatic strategies to improve cardio-vascular health.
Risk and protective factors exist across all layers of society. The Social-Ecological Model frames the public health-informed approach by considering factors at the individual, relationship, community, and societal levels. This framework allows us to understand and address not only the individual, person-centered factors, but to consider and take preventative action within the environment where an individual lives and acts.
Prevention efforts are organized by four levels of intervention:
- Primordial Prevention targets broad societal influences, such as political polarization, that can create environments conducive to violence. Efforts at this level may aim to strengthen protective factors like social inclusion and civic engagement, and may take the form of strategies, policies or cultural norms.
- Primary Prevention takes place at the community level, often supporting institutions like schools or work places to strengthen protective factors and build resilience to risk factors.. Primary prevention programs can include improving awareness of and access to helpful resources, fostering inclusion to reduce the prevalence of bullying, and media literacy to reduce exposure to online harms.
- Secondary Prevention applies when individuals show behavioral warning signs associated with violence, such as fixating on previous instances of mass violence or making generalized threats of violence. Prevention programs at this stage include multidisciplinary intervention teams providing mental health, social, or behavioral support services and case management.
- Tertiary Prevention helps rehabilitate and reintegrate individuals who have already engaged in or advocated for violence to reduce the risk of reoffending.
The benefits of integrating a public health-informed approach into targeted violence prevention are substantial, spanning from cost-benefits to long-term community health and well-being.
The Benefits of Adopting a Public Health Informed Approach
- Holistic
Rather than focusing narrowly on individual behavior or ideology, a public health model looks across the entire social ecology, from individuals to families, peer groups, schools, and communities. It examines the social, emotional, and environmental factors that influence violence. This holistic approach drastically increases the number of individuals, organizations, initiatives and policies that can contribute to positively affecting risk and protective factors associated with violence.
- Proactive
Traditional law enforcement interventions engage after someone is already mobilizing toward violence. By contrast, a public health-informed approach focuses on early, upstream intervention. It allows communities to identify and address the conditions that make violence more likely, such as social isolation, untreated mental health needs, or exposure to hate-fueled ideologies. This proactive approach therefore decreases the number of people who ever mobilize to violence in the first-place.
- Empowering
One of the most powerful components of a public health-informed approach is its focus on building strengths. By investing in the protective factors that help communities thrive while also mitigating the risk of violence, communities can foster environments where violence becomes less attractive.
This approach also reduces stigma. Rather than targeting or securitizing communities based on ideology, it focuses instead on empowering and providing communities with the resources to overcome challenges. This encourages communities to engage in prevention efforts and avoids reinforcing “us versus them” narratives that violent extremists often exploit.
- Multidisciplinary
The root causes of violence are complex, and can emerge from psychological, social, cultural, or economic conditions. To effectively address this multifaceted problem, a public health informed approach relies on collaboration across sectors, including educators, mental health professionals, social workers, community leaders, and law enforcement. This approach benefits from an understanding of shared risk and protective factors that link and can therefore help prevent different forms of violence, like suicide, domestic abuse, and violent extremism.
- Cost-Effective
Research shows that early intervention in targeted violence prevention can lead to significant public savings by reducing the need for costly investigations, prosecutions, and incarceration. Programs that invest in protective factors, like behavioral health, social services, and youth engagement, are far less expensive than responding to a mass casualty event or its aftermath. The CDC previously highlighted several youth and school-based violence prevention programs whose economic benefits outweigh their implementation costs. In both the short and long term, preventing violence is far less expensive, and far more effective, than addressing its consequences after harm has occurred.
- Continually Improving Evidence Base
Public health-informed prevention efforts are grounded in publicly available research and undergo regular evaluation, allowing for continuous improvement and ensuring that programs are effective and protective of civil rights and liberties.
- Pragmatic
Research shows that many perpetrators exhibit clear warning signs before acting, often leaking their intentions as a cry for help. 83% of school attackers and nearly half of mass casualty gun violence perpetrators showed concerning behaviors ahead of the attack. These warning signs offer a critical window for early, non-punitive intervention. Recognizing and responding to these signs allows communities to take meaningful action before violence occurs.
- Long-Term
Targeted violence and terrorism are enduring challenges that demand sustained, long-term strategies. A public health-informed approach recognizes that addressing the societal, community, and relationship-level factors that contribute to hate and violence is key to prevention. By investing in prevention, communities can reduce the overall incidence of violence over time while building a culture committed to targeted violence prevention.