Fostering Resilience Among Urban Youth Exposed to Violence

Abstract

Most studies to date have examined negative effects of exposure to community violence, in line with the deficit-based perspective. However, given that most youth exposed to community violence demonstrate positive adaptation or resilience over time, we suggest a shift in perspective, practices, and policies across systems toward identifying and building individual, family, and community assets and strengths that may more effectively support youth who have been exposed to community violence and related risks into competent, caring, and thriving adults. In this article, we review how resilience has been conceptualized and operationalized within the context of community violence, highlight gaps in literature, and offer directions for future public health research and practice. We illustrate this review with practice-based examples from public health work in the San Francisco Bay Area. Future multidisciplinary longitudinal studies that identify protective processes and successful trajectories and rigorous evaluations of strength-based policies, programs, and protective processes are needed.

Keywords

adolescent development protective factors resilience urban health violence

Interpersonal violence continues to plague of lives of children and youth throughout the United States and worldwide. Striking disparities in youths’ exposure to community violence by race/ethnicity, gender, and geography persist: urban males of color (Buka, Stichick, Birdthistle, & Earls, 2001) and low-income urban youth (Cooley-Quille, Boyd, Frantz, & Walsh, 2001) are most likely to be exposed. Exposure to community violence means witnessing and/or being a victim of interpersonal violence such as shootings, stabbings, physical fights, or hitting (Schwab-Stone et al., 1999); exposure to community violence can also be measured on a gradient from being a direct victim of such violence, to indirectly witnessing (or observing/seeing), to hearing about community violence, to being entirely unexposed (Fowler, Tompsett, Braciszewski, Jacques-Tiura, & Baltes, 2009). Many youth are exposed to multiple types of violence over time, but the frequency, severity (witness vs. victim), duration (chronic vs. acute), and timing (early childhood vs. adolescence) of exposure to community violence are important aspects to decipher when understanding risk exposure, which researchers often lack the data to specify (Schwartz & Gorman, 2003).

Children exposed to community violence are more likely to drop out of school, have lower academic attainment, become pregnant, abuse substances, and experience long-term adverse psychological and behavioral difficulties (DuRant, Cadenhead, Pendergast, Slavens, & Linder, 1994; Kliewer et al., 2004; Osofsky, 2003; Sampson, Raudenbush, & Earls, 1997). Many children and youth exposed to violence become violent or display deviant behavior (DuRant et al., 1994) or have atypical mental health or trauma (Fowler et al., 2009), but many others may develop typically over time. Although many have documented detrimental outcomes among youth exposed to violence, few have examined variations in resilience (Jain & Cohen, 2013; Ozer & Weinstein, 2004). Resilience is when individuals or groups adapt positively within the context of risk(s) and/or adversity (Luthar, 2003). Implicit within this notion are two critical conditions: (a) exposure to significant threat or severe adversity and (b) the achievement of positive adaptation despite major assaults on the developmental process (Masten, Best, & Garmezy, 1990; Werner & Smith, 1992).

Historically, researchers and practitioners have considered violence using the traditional deficit-focused model of psychopathology and risks (Ginwright & Cammarota, 2007). For instance, despite traditional risk factor prevention approaches, violence and social determinants of violence remain prevalent in urban communities (Allison, Edmonds, Wilson, Pope, & Farrell, 2011). Primary prevention of violence in urban neighborhoods would require eliminating underlying social and economic inequalities, which is unlikely (Aisenberg & Herrenkohl, 2008). In comparison, resilience research considers individual and community strengths plus risk prevention. By building human and community capacity for healthy development under adversity, resilience frameworks can inform psychopathology prevention and treatment (Cicchetti & Hinshaw, 2002; Masten & Curtis, 2000). Therefore, in conjunction, researchers and practitioners could enhance strengths-based approaches that facilitate and sustain effective conditions for positive youth development and resilience (Fergus & Zimmerman, 2005; Windle, Bennett, & Noyes, 2011).

In this article, we review the literature conceptualizing resilience within the context of community violence (and in general as relevant), discuss the theoretical basis for resilience in the context of community violence, describe how resilience can be operationalized, and review individual and community-level protective factors that can promote resilience among youth exposed to violence. Then, we describe how the resilience perspective can be applied to public health practice and conclude with recommendations for future research and practice. We focus on resilience among adolescents and young adults exposed to violence because of the high prevalence of community violence during this stage and the relative dearth of focused research, but the concept indeed is relevant to other risk exposures though recognizing that specific protective factors and interactive processes may differ by developmental stage across the life course.

Conceptualizing Resilience Within the Context of Community Violence

Resilience is a dynamic developmental process of positive adaptation that occurs in the context of risk(s) (Garmezy, Masten, & Tellegen, 1984; Luthar, 2003; Masten et al., 1999; Table 1). Resilience is not only the absence of psychopathology but also the presence of competence or stage-salient positive youth developmental outcomes that are deemed fundamental to achieve (Rutter, 1985). Resilience is observed when protective factors buffer or modify the effects of risks over time, including through dynamic developmental processes that may only be apparent under high-risk circumstances (Rutter, 2012). Resilience researchers have conceptualized resilience as a predictor, process, and/or outcome and operationalized the construct of resilience in many different ways (Luthar, Cicchetti, & Becker, 2000). We posit a nested conceptualization of resilience, in which protective factors interact with risks within the historical, ecological, and cultural context to influence individual and community positive development over time. Note, resilience is related to, though distinct from, positive youth development (Lee, Cheung, & Kwong, 2012). Although positive youth development applies to all youth who may or may not have been exposed to risk, resilience necessarily occurs within the context of risk.

Table 1.

Definitions of Key Terms Used in This Review.

Key Term	Definition	Citations
Resilience	Positive adaptation in the presence of risks or stressors	Garmezy et al. (1984), Luthar (2003), Masten et al. (1999)
Positive youth development	Positive adaptation through acquisition of stage-salient skills and abilities in multiple domains (risk may or may not be present)	Catalano, Berglund, Ryan, Lonczak, and Hawkins (2004), Lee et al. (2012)
Protective factors	Characteristics or assets that buffer the effects of risks, thereby supporting positive adaptation	Rutter (2012)
Developmental assets	Protective factors at any level (e.g., individual, family, school, neighborhood) that are promote positive developmental tasks at stages across adolescence and young adulthood	Scales (1999), Scales and Leffert (1999), Scales, Benson, Leffert, and Blyth (2000)

Resilience is necessarily dynamic: It is constantly changing by developmental stage, domain, and evolving risk and protective contexts. For example, younger children may be more prone to greater longer-term effects than adolescents to same exposures, as adolescent cognitive and emotional coping skills are more advanced. Additionally, risk and/or protective factors present at certain key developmental stages may be more important than the general presence of such factors over the life course (Rutter, 1985), suggesting one can strategically intervene to favorably alter life trajectories.

Although often observed at the individual level, albeit embedded within the social ecology, resilience can also be observed at a group or community level (Ungar, 2011) and combines psychosocial and environmental factors (Table 2). Though the study of resilience is becoming more multidisciplinary (Luthar & Brown, 2007), public health, psychology, education, and social welfare often focus on the psychosocial environmental forces, whereas environmental systems, biology, ecology, and urban planning emphasize physical environmental factors.

Table 2.

Comparison of How Resilience Is Conceptualized and Observed at Different Levels.

Level	How Resilience Is Conceptualized	Domains in Which Resilience Can Be Observed
Community	System or group adaptation to adversity	Ecological
		Environmental
		Urban planning
Family	Interpersonal adaptation to adversity	Household
Individual	Personal adaptation to adversity	Behavioral
		Cognitive
		Emotional
		Social

At the individual level, resilience refers to how people respond to stress (Connor, 2006). We note that these stressors can come from multiple sources or exposures to risk such as community violence, including participation in the foster care system (Leve, Fisher, & Chamberlain, 2009), parental death (Rutter, 1985), sexual identity (Saewyc, 2011), attention-deficit/hyperactivity disorder (Modesto-Lowe, Yelunina, & Hanjan, 2011), and more. Resilience can be conceptualized in four domains: behavioral, emotional, social, and cognitive/educational (Walsh, Dawson, & Mattingly, 2010). A resilient child thrives and develops “normally” despite adversity (Fonagy, Steele, Steele, Higgitt, & Target, 1994; Werner & Smith, 2001). Resilience can also be defined at the family level by how family members relate to each other or recover together from adversity (Walsh, 1996), which may affect individual resilience (Hawley & DeHaan, 1996).

A community or environment could demonstrate resilience by adapting well to change or recovering constructively from significant threat, for instance, natural or man-made disasters/war (Davis, Cook, & Cohen, 2005; Godschalk, 2003; Pickett, Cadenasso, & Grove, 2004). Similarly, an organization or system may demonstrate resilience by overcoming challenges and gaps successfully through capitalizing on system strengths, balancing and achieving inherently oxymoronic characteristics, underscoring the inherent challenges (redundant and efficient, independent and interdependent), and being able to both plan ahead and act spontaneous (Godschalk, 2003).

Theoretical Basis for Resilience in the Context of Community Violence

Although numerous longitudinal prospective studies have sought to better understand resilient trajectories of children exposed to chronic poverty (Garmezy, 1985), parental psychopathology (Rutter, 1985; Werner & Smith, 1992), and child abuse and neglect (Garbarino, Dubrow, Kostelny, & Pardo, 1992), little research has documented resilience in the face of community violence, despite its high prevalence, persistence, and consequences, which often co-occur with myriad other risk exposures.

Ecological-Transactional Framework

There are limited consolidated models of positive adolescent development in the face of community violence (e.g., McDonald, Deatrick, Kassam-Adams, & Richmond, 2011), although overall resilience research is moving toward more integrated, multidisciplinary, and multilevel models of human development. Many concur that to fully understand the problem of community violence, an ecological-transaction framework (Dawes & Donald, 2000) is required, which places the developing individual within the dynamic distal context of their families, communities, and societies. The ecological-transaction framework considers the reciprocal interaction between the multilevel ecological context and the developing individual, acknowledging exposures and experiences at multiple points across the developmental trajectory, and considers how these factors may change and interact over the life course at each developmental stage. Similarly, developmental psychopathologists recognize that the child is an active agent and “niche-seeking” participant, and the child and evolving social system mutually influence each other (Gottfredson, 2002). Gottfredson (2002) posits that there are multilevel social determinants of community violence, including lack of social organization and support structures at the ecological level and violence-seeking and violence-perpetuating and/or positive behavior at the individual level.

Developmental Assets Framework

The developmental assets framework shifts this perspective by going beyond preventing high-risk behaviors and toward enhancing resilience, with the assets reflecting core developmental processes at multiple levels (Scales, 1999; Scales et al., 2000) with a focus on adolescents (Scales & Leffert, 1999). The developmental assets framework pulls from the ecology of human development (Bronfenbrenner, 1979), sociocultural influences on adolescent development (Jessor, 1993), and developmental contextualism (Lerner & Kauffman, 1985). The framework highlights four external assets (i.e., support/caring relationship, empowerment, boundaries and expectations, and constructive use of time/meaningful opportunities) and four internal assets (i.e., commitment to learning, positive values, social competencies, and positive identity; Scales & Leffert, 1999). External assets are positive developmental experiences offered by means of opportunities and relationships with adults and communities, reinforced by institutions, whereas internal assets develop gradually over time, reflecting individual competencies, skills, and self-perceptions (Scales et al., 2000).

Phenomenological Variant of Ecological Systems Theory

In addition, the phenomenological variant of ecological systems theory posits that all youth have individual and contextual assets that can help ensure positive healthy adolescent development (Taylor et al., 2002). Given America’s increasingly diverse population of adolescents, risk exposures, strengths, and competencies of youth of color within their specific environments and experiences are important to consider, given the ecological-developmental framework (García Coll et al., 1996).

In sum, the developmental assets approach, within the ecological-transactional framework and the phenomenological variant of ecological systems theory have tremendous potential to effectively complement, strengthen, and expand existing violence prevention efforts. For example, instead of focusing on confinement and treatment as a solution to violent behavior, if juvenile justice systems, as they move toward incorporating principles and practices of youth development, partner with other systems of education, mental health and community-based organizations to systematically identify and build on youth and community strengths to create healthy conditions during and postrelease, recidivism rates are more likely to drop as well as increase in academic performance, school engagement, and having caring relationships with parents (Chew, Osseck, Raygor, Eldridge-Houser, & Cox, 2010). In turn, these “resilient” youth will give back and strengthen their communities and families, subsequently resulting in reduction in community violence and related risk factors (Gaylord-Harden, Burrow, & Cunningham, 2012; Ginwright & Cammarota, 2007; Ginwright & James, 2002). Building protective factors and strengths thus has burgeoning effects on multiple outcomes for individuals, families, and communities. The promising area of using developmental assets to promote domain-specific resilience within the context of community violence has been unduly unexplored and merits considerable future attention, since developmental assets could help identify opportunities for intervention that could be key to promoting resilience.

Operationalizing Resilience

Resilience can be attained in three ways: (a) positive adaptation under high-risk environment, (b) recovery from trauma, and/or (c) competent functioning in the face of chronic or acute life stressors (Masten et al., 1990). Depending on the type and length of violence exposure, the mechanisms hypothesized, and the outcomes of interest, all three may occur. For instance, youth exposed to high rates of community violence since childhood, and who may have posttraumatic stress disorder and behavioral problems by adolescence, may still recover from trauma by young adulthood, or attainment of age-appropriate developmental tasks would be considered resilience. Resilience is often indirectly inferred via measurement of time-specific outcomes, so the outcomes selected and at which time points they are assessed matter when defining resilience.

By definition, resilient youth display normal or better than expected functioning within the context of risk. Overall, most youth exposed to violence do not display problems (Lynch, 2003). Given the intensity and chronic nature of exposure to community violence, near-average functioning of mental health may be an appropriate measure of resilience (Jain, Buka, Subramanian, & Molnar, 2012). Resilience has been operationalized in a variety of psychopathology diagnoses and psychometric instruments, but there is no consensus in measurement strategy (Waaktaar & Torgersen, 2010; Windle et al., 2011). For youth exposed to community violence, it may be appropriate to use more lenient criteria to assess resilience, such as achieving average or above-average functioning in the child behavior checklist, because violence is expected to affect youth outcomes, and resilience researchers are interested in thriving beyond what is expected (Jain & Cohen, 2013). Additionally, domain-specific measures, such as emotional resilience and behavioral resilience (Jain & Cohen, 2013), may inform a more nuanced understanding of resilience among youth exposed to violence. For example, youth may be competent socially but not emotionally (Jain, Buka, Subramanian, & Molnar, 2010).

Resilience is not just the absence of psychopathology or behavioral problems but also manifestation of competence and positive behaviors (Luthar, Doernberger, & Zigler, 1993). To this end, a growing number of researchers (Jain et al., 2012; Molnar, Cerda, Roberts, & Buka, 2008; Taylor et al., 2002) consider positive youth development and positive psychology indicators (e.g., self-esteem, thriving) among children exposed to violence.

Resilience, if inferred by measuring outcomes over time within context of significant risk, can be measured both proximally and distally, that is, using short- or long-term outcomes; Luthar (2003) encourages measuring at least three time points when studying resilience. For example, academic resilience could be measured as attending school the day after witnessing a violent event, maintaining school attendance over a period of time, completing a grade on time despite chronic exposure to community violence, or graduating in a high-violence neighborhood. There are therefore many ways to describe to what extent a particular individual or group is resilient, and also how levels of resilience may change over time—for example, an individual may be absent from school immediately after an event, but still complete a grade on time.

Predictors of Resilience Among Youth Exposed to Violence: Individual and Contextual-Level Protective Factors

Negotiating multiple neighborhood-level adversities including violence is challenging for any youth undergoing major cognitive, emotional, and behavioral development. More than 40% of youth nationwide experienced more than one type of violence within the past year and 20% experienced at least four (Finkelhor, Ormrod, & Turner, 2007), illustrating how exposures to violence may accumulate and interact over time. Furthermore, youth exposed to multiple forms of violence are often also disadvantaged economically and socially (Crouch, Hanson, Saunders, Kilpatrick, & Resnick, 2000; Sanchez, Lambert, & Cooley-Strickland, 2012). Any youth able to meet stage-salient tasks and expectations and exhibit positive youth development must have had some protective factors along the way to help the youth cope effectively. Protective factors interact with risks to affect adaptation and resilience (Cicchetti & Rogosch, 1994); they do not guarantee resilience, but help tip the balance away from vulnerability toward successful coping (Stoiber & Good, 1998). For example, children exposed to greater number of risks may require more intense and diverse protective factors, and resilience may manifest differently (Doll, Jones, Osborn, Dooley, & Turner, 2011). It may also take longer to manifest resilience as the chain of positive events unfolds. Protective factors can be identified by main (protective in the presence or absence of risk) and/or interactive (more protective for at-risk youth) effects (Masten & Coatsworth, 1998). The salience of protective factors for exposure to violence toward positive outcomes, however, deserves greater attention.

Protective factors that promote resilience exist at the individual, family, and community levels (Luthar, 2003). Protective factors are typically identified as characteristics that are associated with resilience; one of the challenges of the literature is that resilience is operationalized in many different ways. For the purposes of this review, we specify both the protective factor and the measure of resilience with which it is associated. We encourage researchers to identify factors that are consistently protective across measures of resilience.

First, at the individual level, personal attributes may differentiate resilient children from nonresilient ones. These range from being female to having easy temperament and internal locus of control or self-efficacy, to high intelligence, and to increased flexibility and responsiveness toward peers (Mandleco & Peery, 2000). Domain-specific resilience may change over time as the home and community environments change. For example, if family problems increase during late adolescence, emotional resilience displayed earlier may be compromised. Second, differences in individual’s exposure to violence and sensitivity to risk may also explain differences in resilience. For instance, youth witnesses to violence may be more similar to those not exposed to violence than to victims (O’Donnell, Schwab-Stone, & Muyeed, 2002), suggesting that risks may need to accumulate to a certain threshold before nonadaptive behavior is displayed (Rutter, 2012; Sameroff & Seifer, 1995). Additionally, we posit that perceived (as opposed to actual) risks and perceived safety may contribute to resilience among youth exposed to violence.

Family is a proximal and enduring force in most children’s lives and robustly predicts adaptation among youth exposed to violence. Much of the community violence literature focuses on the mitigating potential of family structure and functioning (Gorman-Smith & Tolan, 1998; Kliewer et al., 2004; Lynch & Cicchetti, 1998) during childhood. In historically disadvantaged neighborhoods, many youth rely on single mothers for support and guidance, who, with strict and directive yet affectionate parenting, manage to protect their children against street violence or negative peer groups (Brody & Flor, 1997; Resnick, 2000a). Large family size, also common among minorities, is also protective against mental health problems (Overstreet, Dempsey, Graham, & Moely, 1999), suggesting that, in the African American culture, large and extended families provide a primary network of support (Boyd-Franklin, 1989). In terms of family functioning, measures of ties, cohesion, and relationships have shown to be protective against negative symptoms of violence (Kliewer et al., 2004; Ozer & Weinstein, 2004; Plybon & Kliewer, 2001). At high violence exposures or cumulative risks, family support helps promote positive mental health (Kennedy, Bybee, Sullivan, & Greeson, 2009). Since family relations and attachment are also affected by community violence (Lynch & Cicchetti, 2002)—for example—parents may become more strict or violent when living in violent communities (Krenichyn, Saegert, & Evans, 2001; Osofsky, 1995)—researchers must further study how family mediates and/or modifies the effects of community violence on adolescent development. Furthermore, social support through different relationships (e.g., family, peer) may have different protective effects (Kaynak, Lepore, & Kliewer, 2012; Salzinger, Feldman, Rosario, & Ng-Mak, 2010).

We focus on protective factors at the community level, especially because much of the literature on community violence and resilience has focused on mitigating effects of family structure and functioning (Gorman-Smith & Tolan, 1998; Lynch & Cicchetti, 1998), but others have identified neighborhood context to be important (Kliewer et al., 2004). Aspects of the community, school and the larger, more distal social, political, and economic systems may provide a harmonious and organized environment within which urban youth exposed to violence may still successfully negotiate healthy development (Dill, 2011; Gaylord-Harden et al., 2012). Violent communities are typically also disadvantaged and disorganized (Sampson et al., 1997); poverty, violence, social disorder, and other risk factors often affect the same neighborhoods (McBride Murry, Berkel, Gaylord-Harden, Copeland-Linder, & Nation, 2011). Nevertheless, protective factors exist: for example, collective efficacy increases altruistic behaviors (Lenzi et al., 2011) and decreases negative psychopathology (Ahern & Galea, 2011; McKenzie, Whitley, & Weich, 2002), which can help break the cycle of violence (Molnar, Miller, Azrael, & Buka, 2004; Sampson et al., 1997). And school connectedness buffers the effects of exposure to violence on subsequent violent behavior among youth (Brookmeyer, Fanti, & Henrich, 2006). Additionally, neighborhood advantage/disadvantage interacts with exposure to violence to affect youth’s survival expectations (Swisher & Warner, 2013). However, it is difficult to identify the most efficacious points for intervention, given simultaneous challenges in positive development at the individual level and ecological adversities. For example, having hope is protective (Stoddard, Henly, Sieving, & Bolland, 2011) but hope-driven interventions could occur at multiple levels. We acknowledge that building community resilience amidst violence and deprivation is a particular challenge; we posit that it therefore requires particularly creative and community-driven solutions. One such solution is Oakland’s (CA) Measure Y, a voter-passed initiative to promote community safety, including through funding violence prevention programs. The programs funded range from school-based programs for all youth to targeting youth already involved in the Juvenile Justice Center.

Resilience research, with great variation in scope and methods used, has evolved from identifying protective factors to examining interactive protective processes. With the expansion of studies in the last two decades on positive human development, positive psychology, social and psychiatric epidemiology, and developmental psychopathology, it is timely to merge the multidisciplinary concepts and methods toward better understanding the positive developmental process of resilience within the context of violence (Resnick, 2000b).

Although researchers have identified some protective factors for exposure to community violence, less is known about how these factors buffer exposure to risk, indirectly moderate its effects, or promote domain-specific adaptation. Protective factors may lead to resilience by reducing sensitivity to subsequent risk, impact of risk, and/or negative chain reactions; and/or increasing positive chain reactions, self-esteem, positive opportunities, and/or positive attitude (Rutter, 1985).

Applying Resilience Concepts to Public Health Practice

Resilience indicates an ability to recover from negative events and is not necessarily mutually exclusive of invulnerability to stress; most resilient youth continue to stay emotionally distressed (Luthar et al., 1993). Therefore, violence prevention and youth development programs must screen for youth who, despite appearing asymptomatic, may be emotionally distressed and require additional services and supports. On the other hand, even youth displaying posttraumatic stress disorder, anxiety, or depression may still attain adaptation per stage-salient tasks over time; the presence of protective factors could ensue a positive chain of reaction leading to favorable outcomes (Wu, 2011). Thus, researchers and practitioners must consider the complex multidimensional nature of both risk and resilience. For example, practitioners from different domains and disciplines could collaborate to most effectively promote resilience among youth.

Both risks and assets are often socially patterned, further accentuating disparities. At the neighborhood level, violence tends to constellate in densely populated urban areas characterized by poverty, low economic opportunity, high residential mobility, physical deterioration, and social disorganization (Hawdon & Ryan, 2009). As risks accumulate at the individual, family, and neighborhood levels, likelihood of successful adaptation decreases (Jaffee, Caspi, Moffitt, Polo-Tomas, & Taylor, 2007). Advantages and assets can also accumulate (DiPrete & Eirich, 2006).

Community assets (like educational, faith, and service institutions) affect resilience (Anderson, Sabatelli, & Kosutic, 2007; Molnar et al., 2008) and mental health (Fitzpatrick, Piko, Wright, & LaGory, 2005). Communities can build resilience and promote health at school, through connectedness with teachers and other adults (Benard, 2004; Luthar, 2003; Resnick, 2000b), peer supports (Morrison & Allen, 2007), opportunities for participation in after-school programs (Eccles & Barber, 1999), and school-based services (Doll & Lyon, 1998). For example, many Alameda County schools have school-based health centers, which help schools better support and nurture the whole child. An increasing number of Oakland schools conduct whole school restorative justice, which seeks to promote a healthy, safe school environment and broader community. The foster care system offers another entry point to promote resilience among youth exposed to violence and other adversities; multidimensional treatment foster care is one effective approach for such youth (Leve et al., 2009). Increased civic participation may prevent violence (Zeldin, 2004), build resilience (Vieno, Nation, Perkins, & Santinello, 2007), and promote health (Kim & Kawachi, 2006). Additionally, youth themselves may serve as agents of change, if empowered and recognized as assets (Checkoway, 2011; Ozer, Ritterman, & Wanis, 2010). Hence, building community and youth capacity through relationships may help prevent violence and promote resilience (David-Ferdon & Hammond, 2008; Zimmerman, Stewart, Morrel-Samuels, Franzen, & Reischl, 2011). How these people and resources lead to community-level change, given barriers posed by violence in the neighborhood, needs to be better understood. Understanding these community-level processes is one area where research may be able to learn from practice.

Conclusion

Future Research Directions

Overall, researchers and practitioners must have a more nuanced understanding of the lives of youth exposed to community violence across the life course to understand what potential community assets could help promote resilience. Identifying such assets requires characterizing in greater detail the risks that typically occur along with exposure to community violence, including neighborhood-level (e.g., public safety) and family-level (e.g., family violence) adversities. An index of neighborhood adversity could help measure the cumulative risk these youth experience. When examining a particular potential protective factor, researchers should analyze whether the factor has the same association with positive outcomes across groups with different levels of risk (such as exposure to violence; i.e., main effects) or if the protective factor is particularly protective among only certain risk-level groups (i.e., interaction occurs). In addition to assessing interaction, researchers could attempt to elucidate why these interactive processes occurred, including through mixed-methods research. Researchers should also examine if the same factors are protective across multiple, diverse communities, given how people and places interrelate in complex ways (Cummins, Curtis, Diez-Roux, & Macintyre, 2007).

Explicitly focusing on vulnerable populations is essential; this can not only include analyzing race- and gender-specific trajectories but also age-specific trajectories, since children, adolescents, and young adults may have different experiences, as well as using local knowledge about the neighborhood to better inform the full set of co-occurring vulnerabilities. Protective factors may have different impacts at different developmental stages, and resilience may not be stable from childhood to adulthood, especially within the context of community violence beyond individual control (Jain et al., 2012). Since access to assets, outcomes, definitions of success, and risk exposures vary by race (García Coll et al., 1996; Sesma, Mannes, & Scales, 2005), instead of controlling for race, we encourage using race-specific models. We also identify youth exposed to violence as a more general vulnerable population meriting specific subgroup analyses, especially since we found few studies of youth exposed to violence that identified neighborhood-level protective factors for resilience or effective interventions to promote resilience.

Then, one must understand how adaptation unfolds over the life course. Prospective longitudinal studies of youth exposed to violence are one way to more comprehensively examine positive development trajectories and how resilience can be maintained over time among individuals and communities. These analyses usually require multilevel data to identify protective processes at multiple nested levels (individual, family, neighborhood) and at multiple developmental stages longitudinally; these analyses may also require multiple measures of resilience (e.g., domain-specific measures and global measures and positive measures in addition to lack of psychopathologies). Such studies could also help identify effective time-varying community-level protective factors. In characterizing community-level protective factors, researchers must document what context-specific barriers exist to attaining and maintaining resilience, as well as how different levels of the social ecology, from family to school to community, interact to build resilience. Studying how indicators already identified to be important for healthy cities (e.g., Corburn & Cohen, 2012) relate to resilience is one place to start. Since urban neighborhoods present one of the most challenging environments for positive development, research must measure diverse, culturally appropriate “positive” processes and outcomes experienced by youth living in urban neighborhoods over time; the Project on Human Development in Chicago Neighborhoods was one such example, but additional studies in other regions should be funded as well. Nuances of protective factors include understanding to what extent quality or quantity of protective factors matter, and if there are factors that are globally protective or if local context matters. The protective effect of these factors could be modified by both exposure to community violence and developmental stage, as well.

Implications for Practice

Public health practitioners and policy makers must acknowledge the successes and achievements of at-risk urban youth and build on the age-appropriate assets in their environments. More after-school programs (Durlak, Weissberg, & Pachan, 2010; Fredricks & Simpkins, 2011), scaffolded job opportunities for youth (Ross, Buglione, & Safford-Farquharson, 2011), and community capacity building efforts (Allison et al., 2011; Nissen, 2011; Vivolo, Matjasko, & Massetti, 2011) could help ensure success among at-risk youth.

This is all within reach, and is already occurring in some places, including the San Francisco Bay Area. The Alameda County Public Health Department started Project New Start in partnership with the Alameda County Probation Department and other health care service providers to support formerly gang-affiliated youth with tattoo removal, case management, and youth development services to help them transition back into positive roles in their communities (Jain, Alvarado, Cohen, & Eldridge, in press). Based on this example, we recommend increased collaboration between public health, juvenile justice, nonprofits, including mentoring centers and community-based organizations, and schools to better serve the multiple needs of high-risk youth and build on youths’ strengths and skills. Elsewhere in the region, within Alameda County’s Second Chance Initiative, the Human Services, Health Care Services, and Probation departments collaborate with each other and with community-based organizations to more systematically reduce juvenile recidivism (Jain, Cohen, & Bassey, 2013). Systematic data collection of positive indicators at the community and individual levels, as done there, could also help promote the resilience perspective.

The Benefits of the Resilience Lens for Public Health Research and Practice

The concept of resilience, although largely developed within the fields of psychology and education, can advance our knowledge to combat health disparities and social inequalities by helping explain how vulnerable populations achieve and sustain positive adaptation.

First, resilience encourages a multidisciplinary approach to violence prevention by acknowledging the dynamic nature of the life course within the ecological context and the variety of factors that affect human development, including co-occurring risks. Second, it promotes an assets-based approach by highlighting the importance of protective factors in mitigating risks and promoting positive development. Third, it applies this multidisciplinary, assets-based approach to health promotion and multiple positive outcomes, paralleling the World Health Organization’s definition of health. An assets-based approach also allows practitioners and policy makers to see vulnerable populations locally and globally for their internal strengths in addition to their needs.

Resilience-oriented researchers and practitioners recognize that, despite adversities and stressful contexts imposed on youth, there are events, characteristics, and experiences that can help protect young people from harm and toward positive “normal” development. Researchers and practitioners must acknowledge and measure the achievements and successes youth attain despite overwhelming risks they experience, as they develop into caring, confident, and contributing adults. Recognizing ordinary children and communities as assets holds great promise for combating major public health inequalities and transforming lives.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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