Community interventions to prevent violence: translation into public health practice.

T his supplement to the American Journal of Preventive Medicine presents evidence reviews and recommendations from the Task Force on Community Preventive Services (the Task Force) regarding three intervention areas for the prevention of violence: firearms laws, early childhood visitation, and therapeutic foster care. 1–3 Of the interventions evaluated by the Task Force, two are recommended for implementation on the basis of evidence of effectiveness: early childhood home visitation to prevent child maltreatment and program-intensive foster care for chronically delinquent juveniles. With strong evidence of effectiveness (for home visitation) and sufficient evidence (for therapeutic foster care), federal, state, and local policy-makers should consider the implementation of these interventions in their specific jurisdictions. The purpose of this commentary is to outline the considerations of translating these recommendations into practice at the state level. Colorado's experience may present an informative example of the implementation of these types of interventions , in that we have successfully implemented a statewide early childhood visitation program. Our experience may not generalize to each unique state, as there is significant variation in the states in terms of administrative structure, government revenue and tax laws, predominant political ideology, and public health and human services infrastructure. Still, many barriers to implementation are shared, as are potentially enabling factors. Barriers to creating policy for the implementation of community interventions can be grouped into fiscal, political, structural, and perceptual. Fiscal barriers lead the list, especially in view of the nation's more recent economic challenges. States have differing laws regarding debt and deficit spending, and tax limitation laws requiring voter approval for increases in revenue and spending are in place or being considered in some states. Regardless of the source of revenue, most state governments faced significant challenges with budgets in 2002 and 2003. Adding new programs when faced with continuing budget problems, or when faced with restoring funding levels for critical services, requires novel solutions to fiscal issues. It seems logical that prevention programs with proven cost benefit should be easy to create through legislation. However, when faced with significant budget reductions, legislators are forced to concede investing in the future in order to pay for the core programs in the current year and still balance the budget, even if programs will save state monies in future years. Intertwined with fiscal barriers are political barriers, which can be much more complex. In general, it seems that prevention programs are a little …