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Thinking globally but acting locally: the case of SC's children by Phillippe Cunningham, Ph.D. Department of Psychiatry and Behavioral Sciences, Family Services Research Center During his 2005 State of the Union address, President Bush asked first lady Laura Bush to lead a nationwide initiative called “Helping America’s Youth.” This initiative is designed to help at-risk children and teens reach their full potential by connecting them with family, school and community.   This initiative originated out of an overarching concern that many of America’s youth are at high risk of not making a successful transition into adulthood. They are living in unsafe neighborhoods, lacking nurturance, structure and support, and engaging in risky behaviors (e.g., cigarette smoking, drug use, early sexual activity, dropping out of school). Many of America’s youth are staring at a lifetime of poverty and failure.   But, it is not just high-risk youth that are in trouble. America’s youth are academically lagging behind children from other industrialized nations. In 2003, U.S. students’ average score in science literacy was lower than 18 other countries; our students scored lower than their counterparts in 25 other countries in problem solving; and in mathematics literacy, U.S. students scored lower than their counterparts in 20 other countries. If America’s youth are to successfully compete in a global economy, we must remove impediments to their development such as poverty, inadequate health care, ineffective and inadequate schools, and risky behavior. Sadly, South Carolina’s children are no exception.   As part of the Helping America’s Youth Initiative, Mrs. Bush held a conference in October on the grounds of Howard University that brought together more than 500 parents, civic leaders, faith-based community service providers, researchers, child advocates and child development experts. The conference was designed to review problems facing our youth, and to discuss and recommend possible solutions.   My colleagues and I at the MUSC Family Services Research Center, (directed by Scott W. Henggeler, Ph.D.) have devoted our scientific careers to developing, validating and disseminating clinically-effective mental health and substance abuse services for youth with serious clinical problems and their families.   Our faculty was honored to participate in the first lady’s conference, not because it would validate our work, but because the conference held promise to serve as a catalyst for putting the health and welfare of America’s youth on the national agenda. Such promise has yet to be realized either nationally or locally. With coverage of the war in Iraq and the political scene, the first lady’s conference regrettably failed to garner much attention. This is ironic considering that the future health, vitality, and safety of our nation depend on the well-being of our children.   Unfortunately, key indicators of child well-being would suggest that South Carolina’s children may have a particularly hard time becoming successful adults.   According to South Carolina Kids Count, in 2000 an incredible 37.8 percent of our youth lived 200 percent below the poverty level. But this statistic tells only part of the story.   According to South Carolina Kids Count: Twenty-six percent of South Carolina mothers get less than adequate prenatal care Forty percent of babies born in S.C. are born to single mothers Fourteen percent of students are not academically ready for the first grade Thirteen percent repeat one of the first three grades Thirty-three percent of tenth graders fail one or more parts of the exit exam on their first attempt Thirty-two percent fail to graduate from high school S.C. ranks 34th in children living in poverty; 49th in teen births; 48th in low birthweight babies; and 48th in single-parent households with children.   These indicators suggest that South Carolina’s children are at high risk of being ill-prepared to compete in America’s economy and no hope of competing in a global economy.   As I mentioned in my brief comments at the first lady's Helping America’s Youth Conference, public policy must be informed by the realization that helping children means helping their families. This will require three actions: (1) Be brave enough to stop doing what does not work. Many programs that may have curb appeal have no empirical evidence and are unlikely to work because they fail to address the known causes of the problem. These programs may include removing youth to special schools or other institutional placements and using tactics touted as “silver bullets,” and strategies that are politically popular, such as character education, or Scared Straight. The single best predictor of youth engaging in antisocial behavior (e.g., drug use, violence) is association with deviant peers. (2) Do what is proven to work in helping youth. For example, successful violence prevention programs share several important characteristics. They have targeted the known causes and correlates of the behavior; they have demonstrated a significant deterrent effect; they have demonstrated effectiveness via rigorous experimental designs (e.g., random assignment); and they have sustained effects over time. Some of the more successful programs that target antisocial behavior include Multisystemic Therapy, Prenatal and Infancy Home Visitation by Nurses, Behavioral Parent Training, Multidimensional Treatment Foster Care, and Functional Family Therapy. (3) Let researchers who are good stewards of taxpayer dollars (National Institute of Drug Abuse, National Institute of Mental Health, National Institute of Alcohol Abuse and Alcoholism) produce scientific evidence to help influence policies related to the prevention and reduction of serious behavior problems in youth.   In my opinion, it is only through these steps that South Carolina can overcome some of the obstacles facing our children and help them fulfill the promise of successful, productive lives. We owe it to our children to recognize when there are problems that need to be addressed, to identify solutions that work (based on scientific evidence), and to support them along the way.   The future of our country and the state of South Carolina depends on it. Together with Mrs. Bush, my colleague and I are committed to this cause. We invite you to educate yourself about the subject and to do your part.   More information about this subject is available at http://www.helpingamericasyouth.gov. Visit the Family Services Research Center Web site at http://www.musc.edu/psychiatry/research/fsrc/abt_fsrc.htm Friday, Jan. 20, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778, ext. 201.