The last days have been marked by a process of collective mourning. We were all shocked by the tragic death of a seemingly uneventful 16-year-old.
Faced with the surge in firearms-related events on the island of Montreal, the local community, Montreal society and the nation of Quebec are turning to the federal government to regulate the trafficking of weapons on the territory. Should our collective action rethink access to firearms? Should we reconsider how violence fits into our society and the individuals who make it up? We take the floor to summarize what recent research on the development of violent behavior suggests.
The gestation of violence
Numerous studies of the development of violent behavior have shown that violent acts committed during adolescence and adulthood have their roots early in the development of individuals. We can identify family and individual risk factors early in life. The family history of violence, a criminal past with one of the parents, the socio-economic status of the family, the age and education of the parents (especially young mothers) and exposure to certain substances during the period of pregnancy are risk factors associated with violent behavior.
Since we know these risk factors well, how can we identify them and, above all, how to intervene? In obstetrics medicine, risk pregnancy clinics for diabetes and gestational hypertension exist throughout Quebec. Why is it any different for high-risk pregnancy programs that target risk factors related to behavioral disorders in children? A national program implemented throughout the territory would make it possible to identify families at risk from the first weeks of pregnancy and to mobilize specific interventions to these problems.
The development of violence
In diagnostic classifications, the early onset of violence is a marker of recidivism and chronicity of delinquent behavior. It is well known that difficulties in childhood are the precursors of difficulties in adulthood. Biological (impulsivity, temperament, ADHD) and psychosocial (psychosocial adversity, supervision at home, at the early childhood center, at school) data have been well documented in longitudinal follow-up studies carried out in Quebec for nearly 40 years. years.
These studies have inspired regulators around the world. However, in many preschool and school education settings in Quebec, screening for behavioral problems is often limited to expulsion from educational settings instead of adding resources.
A structured service offer, with universal screening criteria and guidelines for psychosocial (behavioral, psychoeducational intervention) and pharmacological interventions, is available. A national policy would coordinate the deployment of manual approaches in all CLSCs with the support of the Youth in Difficulty (JED) and Youth Mental Health (SMJ) programs.
The deployment of violence
Adolescence is a hormonal ferment, a tangle of neurological connections that comes to fruition around the age of 25. It is during this period that personality traits are consolidated. Peers have a major influence at this age. Substance use is a significant precipitator of violent acts. Academic success, a protective factor. We have unique expertise in Quebec. Research groups have generated scientific data on which we can rely in order to intervene in a “multisystemic” approach. However, in the field, we see that the service offer still operates in silos despite the creation of the CISSS and CIUSSS which were to help eliminate barriers between psychosocial, medical and rehabilitation services. Currently, each CLSC, youth center, drug addiction rehabilitation center or child psychiatry service has its own referral process.
Young people often arrive disillusioned, having to tell their story again. We deplore the absence of care navigators who accompany young people from their first contact with the “system”.
We deplore the administrative burden in the transmission of psychosocial and medical files. However, the literature is clear, it is necessary to integrate the approaches, to increase the interfaces of collaboration, to make the trajectories of care and intervention fluid and especially to start at the beginning of the life and to maintain the support throughout the development of the children coming from. high-risk families, that is, children of young adults who themselves have been in difficulty since childhood.
Finally, we cannot ignore the limits of certain interventions. In community settings, youth centers represent recruitment sites for street gangs. As for institutional settings, through placements in youth centers, there is an iatrogenic impact, namely an effect of contamination. We must ensure adequate supervision in these settings and increase their numbers. But all long-term studies of the development of troubled youth show that problems start early in life. It is therefore clear that it is necessary to target families at risk from the first pregnancy, to give them the support and the tools to better supervise their children and to accompany them from pregnancy to adolescence by an offer of services in line with the needs. that change during the development of their children.
* Co-signers: Emmett Francoeur, Associate Professor at McGill University, Developmental Pediatrician at the Montreal Children’s Hospital, McGill University Health Center, and Richard E. Tremblay, professor emeritus in the departments of psychology and pediatrics at the University of Montreal, professor emeritus of public health at University College Dublin (Ireland), researcher of the Research Group on Psychosocial Maladjustment in Children and the Center for research at Sainte-Justine Hospital in Montreal.