P3.137: Prescription for the District: A Preventive Approach to Violence

Background: Violence of any kind influences a child’s physical, emotional, mental, and relational health. Exposure to gun violence is a significant public health issue that affects the health, safety and wellbeing of children. Since 2019, gun violence has been identified as the number one cause of death in children in the United States.1 In the District of Columbia (DC) in 2023, amongst non-fatal shootings approximately 25% of suspects and 15% of victims and suspects (combined) were under the age of 17.2 Traditionally, pediatricians have been trained to evaluate and treat the downstream drivers of gun violence exposure: housing insecurity, inadequate healthcare and access to weapons. However, a preventive, community-centered approach, which recognizes and explores its root causes, is essential to sustainably decreasing risk and harm.

Project Description: In response to a need to apply a trauma informed, multi-sectoral approach to gun violence prevention, the DC Chapter of the American Academy of Pediatrics (DCAAP) embarked on a longitudinal advocacy initiative to advance equitable and trauma informed systems. Our goal was to develop universal strategies to address community stressors to improve safety and support. The result was DCAAP’s Prescription for the District (Rx4DC), a strength-based, preventive approach to addressing violence in communities, built in collaboration with adolescents, families and community organizations. Rx4DC now serves as a framework for our chapter’s advocacy priorities and as a Call to Action for local decision makers.

Discussion: The development of Rx4DC was framed using the Building Community Resilience Process3, which facilitates collaboration across sectors to drive measurable change. This systematic approach includes four components: Assessment, Readiness, Implementation & Sustainability. Our Assessment included developing a shared understanding of the problem, using the Pair of Aces4 as a framework. During our 2023 Symposium, participants were guided through an interactive workshop using the Pair of Aces tree to co-create goals and strategies for systems change. Next, chapter leadership met with community partners5 to assess our collective state of Readiness and prioritize components of Rx4DC. Activities during this stage included collaborative strategic planning sessions, key informant interviews with local nonprofit and governmental agencies and the development of our advocacy priorities.The Implementation began in May 2024, with the launch 6 of Rx4DC. Currently, in our Sustainability phase, we are using a continuous improvement approach that allows our partners to join in this movement, which includes supporting public funding for primary prevention programs centered on early childhood development and family support to advance community resilience.

Conclusion: In order to effectively address and ultimately prevent violence in communities, pediatricians must lead work across systems to develop collaborative approaches to create healthy communities for children to thrive. This innovative approach shifts the paradigm on youth violence to a preventive approach that is scalable and adaptable to other communities.