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Release: Dec. 14, 2000

UI psychologist sees need to address inner-city youths' exposure to homicide

IOWA CITY, Iowa -- A service project led by a psychologist now with University of Iowa Health Care is providing insight into how counseling helps inner-city youth better deal with bereavement associated with violence and how other interventions might help reduce the violence altogether. The project was conducted in conjunction with an anti-crime group in Kansas City, Mo.

Scott D. Temple, Ph.D., UI associate professor (clinical) of psychiatry since 1999, led the service project from 1994 to 1997 while he was on the faculty of the University of Kansas Medical Center. Temple published a paper on the community and policy implications of his clinical experience in the November issue of the Journal of Community Psychology.

Temple said there is not enough focus on the dangers faced by young people in inner cities and the often "toxic" environment that results from the mix of easy access to guns, crime, compromised school systems, economic deprivation and lack of health care resources.

"We've habituated to the presence of violence in our culture in certain areas," Temple said. "I think we assume that the inner city is inevitably going to have a certain amount of murder, and so we react with more surprise and horror when it occurs in the suburbs like Littleton."

Temple said he decided to embark on the counseling effort when he began getting more and more treatment referrals for inner-city children, the majority of them African-American, who were struggling to adjust to the murder of a family member -- often a parent or a sibling.

"I was interested in developing a treatment model for these kids that would help them and their families," Temple said. "I developed an individual and family therapy model that uses an approach called contextual therapy. It's a model of understanding relationships that is well suited to the problems of people who are dealing not only with bereavement but also with issues of social injustice."

One of the main goals was to prevent surviving siblings or children from turning to retaliation as a way of dealing with their anger and grief. Retaliation was a danger because people often knew who the assailant was, and many people often believed that the criminal justice system would hand out weak sentences, if any at all.

To reach more people in the inner city, Temple contacted the Ad Hoc Group Against Crime, which had been set up in 1977 and retained its original name even after becoming permanent. The AHGAC, along with the Kansas City Police Department, is the "first line" of contact for most people whose family members have been murdered, Temple said. He and others ended up working directly with more than 100 families, including parents whose children had been murdered.

Temple said the counseling was based on the assumption that the majority of the inner-city clients did not have psychological disorders but were people in extraordinary situations and experiencing an overload of traumatic events.

"I don't think it's fair to regard people as being disordered or having a psychological-psychiatric disorder when they are responding to a situation in their community that ought to be troubling to anyone growing up in it," Temple said.

Many of the individuals lived in economically deprived areas where, compared to other Americans, they had less access to health care resources, greater financial problems and perceived problems with the justice system.

"Any intervention has to take into account not only the psychological needs of the individual but also medical needs," Temple said. "The first order of business might be to ensure that a mother who has inadequate health insurance can purchase cardiac medication and be encouraged to take care of herself so she can be there for her surviving children."

It was cases such as those that made Temple think of policy implications of the bereavement counseling.

"In these situations, I think psychotherapy is weak medicine," Temple said. "It is the most tertiary intervention you can provide to kids living in violent communities. You need to prevent the violence from happening in the first place."

Temple's work also brought him into contact with people in health and human welfare agencies in Northern Ireland. Through e-mail consults and visits to Belfast, he helped a Belfast trauma unit develop a family therapy model to treat war victims.

During the years known as the "Troubles," Northern Ireland's annual murder rate averaged 100. Kansas City, with a nearly equal population of 1.5 million, has averaged at least 100 murders annually for the past 20 years, with up to 150 in some years.

"One thing that was very striking about my contact with Northern Ireland was the recognition that although that was a war zone for 30 years, the amount of violence was the same as what occurs in many medium and large cities in the United States," Temple said.

He added, "Most of the murders in Northern Ireland were political killings, so they were somewhat different in their causes and in some of their solutions. Murder in Northern Ireland is relatively rare except in that context of political killings."

Temple is involved in writing projects based on his work in Kansas City and Northern Ireland, and he continues to work with bereavement and depression, particularly in young people.

"When you see that level of violence, when you see murder that is not randomly distributed in a society, you need to look at the kind of social and environmental factors that may help account for it," Temple said.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.