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Community-Oriented Policing and Problem-Oriented Policing

In 1979, Hermon Goldstein observed from several studies conducted at the time on standard policing practices that law enforcement agencies seemed to be more concerned about the means rather than the goals of policing. He argued that law enforcement agencies should shift away from the traditional, standard model of policing and that police become more proactive, rather than reactive, in their approaches to crime and disorder (Hinkle et al., 2020; Weisburd et al., 2010). Goldstein’s work set the stage for the development of two new models of policing: community-oriented policing (COP) and problem-oriented policing (POP).

COP is a broad policing strategy that relies heavily on community involvement and partnerships, and on police presence in the community, to address local crime and disorder. POP provides law enforcement agencies with an analytic method to develop strategies to prevent and reduce crime and disorder, which involves problem identification, analysis, response, and assessment (National Research Council, 2018).

Although COP and POP differ in many ways, including the intensity of focus and diversity of approaches (National Research Council, 2004), there are several important similarities between them. For example, COP and POP both represent forms of proactive policing, meaning they focus on preventing crime before it happens rather than just reacting to it after it happens. Further, both COP and POP require cooperation among multiple agencies and partners, including community members (National Research Council, 2018). In addition, POP and COP overlap in that each involves the community in defining the problems and identifying interventions (Greene, 2000).

Although few studies focus on youth involvement in COP and POP, youths can play an important role in both strategies. In COP, youths often are part of the community with whom police work to identify and address problems. Youths can be formally involved in the process (i.e., engaging in local community meetings) or informally involved in efforts to strengthen the relationship between the police and members of the community. For example, a police officer on foot patrol may decide to engage with youths in the community through casual conversation, as part of a COP approach (Cowell and Kringen, 2016). Or police might encourage youth to participate in activities, such as police athletic leagues, which were designed to prevent and reduce the occurrence of juvenile crime and delinquency, while also seeking to improve police and youth attitudes toward each other (Rabois and Haaga, 2002). Using POP, law enforcement agencies may specifically focus on juvenile-related problems of crime and disorder. For example, the Operation Ceasefire intervention, implemented in Boston, MA, is a POP strategy that concentrated on reducing homicide victimization among young people in the city (Braga and Pierce, 2005).

This literature review discusses COP and POP in two separate sections. In each section, definitions of the approaches are provided, along with discussions on theory, examples of specific types of programs, overlaps with other policing strategies, and outcome evidence.

Specific research on how police and youth interact with each other in the community will not be discussed in this review but can be found in the Interactions Between Youth and Law Enforcement literature review on the Model Programs Guide.  

Community-Oriented Policing Definition

Community-oriented policing (COP), also called community policing, is defined by the federal Office of Community-Oriented Policing Services as “a philosophy that promotes organizational strategies that support the systemic use of partnerships and problem-solving techniques to proactively address the immediate conditions that give rise to public safety issues such as crime, social disorder, and fear of crime” (Office of Community-Oriented Policing Services, 2012:3). This policing strategy focuses on developing relationships with members of the community to address community problems, by building social resilience and collective efficacy, and by strengthening infrastructure for crime prevention. COP also emphasizes preventive, proactive policing; the approach calls for police to concentrate on solving the problems of crime and disorder in neighborhoods rather than simply responding to calls for service. This model considerably expands the scope of policing activities, because the targets of interest are not only crimes but also sources of physical and social disorder (Weisburd et al., 2008).

After gaining acceptance as an alternative to traditional policing models in the 1980s, COP has received greater attention and been used more frequently throughout the 21st century (Greene, 2000; National Research Council, 2018; Paez and Dierenfeldt, 2020). The Violent Crime Control and Law Enforcement Act of 1994 articulated the goal of putting 100,000 additional community police officers on the streets and established the federal Office of Community-Oriented Policing Services. Research from 2013 suggests that 9 out of 10 law enforcement agencies in the United States that serve a population of 25,000 or more had adopted some type of community policing strategy (Reaves, 2015).

COP comprises three key components (Office of Community-Oriented Policing Services, 2012):

  • Community Partnerships. COP encourages partnerships with stakeholders in the community, including other government agencies (prosecutors, health and human services, child support services and schools); community members/groups (volunteers, activists, residents, and other individuals who have an interest in the community); nonprofits/service providers (advocacy groups, victim groups, and community development corporations); and private businesses. The media also are an important mechanism that police use to communicate with the community.
  • Organizational Transformation. COP emphasizes the alignment of management, structure, personnel, and information systems within police departments to support the philosophy. These changes may include increased transparency, leadership that reinforces COP values, strategic geographic deployment, training, and access to data.
  • Problem-Solving. Proactive, systematic, routine problem-solving is the final key component of COP. COP encourages police to develop solutions to underlying conditions that contribute to public safety problems, rather than responding to crime only after it occurs. The SARA model (which stands for Scanning, Analysis, Response, and Assessment) is one major conceptual model of problem-solving that can be used by officers (for a full description of the SARA model, see Problem-Oriented Policing below).

At the heart of COP is a redefinition of the relationship between the police and the community, so that the two collaborate to identify and solve community problems. Through this relationship, the community becomes a “co-producer” of public safety in that the problem-solving process draws on citizen expertise in identifying and understanding social issues that create crime, disorder, and fear in the community (Skolnick and Bayley, 1988; Gill et al., 2014; National Research Council, 2018).

COP is not a single coherent program; rather, it encompasses a variety of programs or strategies that rest on the assumption that policing must involve the community. Elements typically associated with COP programs include the empowerment of the community; a belief in a broad police function; the reliance of police on citizens for authority, information, and collaboration; specific tactics (or tactics that are targeted at particular problems, such as focused deterrence strategies) rather than general tactics (or tactics that are targeted at the general population, such as preventive patrol); and decentralized authority to respond to local needs (Zhao, He, and Lovrich, 2003). One Major Cities Chiefs Association (MCCA) survey of MCCA members found that some of the most common COP activities were officer representation at community meetings, bicycle patrols, citizen volunteers, foot patrols, police “mini-stations” (see description below), and neighborhood storefront offices (Scrivner and Stephens, 2015; National Research Council, 2018).

Community members who engage in COP programs generally report positive experiences. For example, residents who received home visits by police officers as part of a COP intervention reported high confidence in police and warmth toward officers, compared with residents who did not receive visits (Peyton et al., 2019). Notably, however, those who participate in COP–related activities, such as community meetings, may not be representative of the whole community (Somerville, 2008). Many individuals in communities remain unaware of COP activities, and those who are aware may choose not to participate (Adams, Rohe, and Arcury, 2005; Eve et al., 2003). Additionally, it can be difficult to sustain community participation. While police officers are paid for their participation, community members are not, and involvement could take time away from family and work (Coquilhat, 2008).

Specific Types of COP Programs

Because COP is such a broad approach, programs that involve the community may take on many different forms. For example, some COP programs may take place in a single setting such as a community center, a school, or a police mini-station. Other COP–based programs, such as police foot patrol programs, can encompass the entire neighborhood. The following are different examples of specific types of COP programs and how they can affect youth in a community.

School Resource Officers (SROs) are an example of a commonly implemented COP program in schools. SROs are trained police officers who are uniformed, carry firearms and a police department badge, and have arrest powers. They are tasked with maintaining a presence at schools to promote safety and security (Stern and Petrosino, 2018). The use of SROs is not new; SRO programs first appeared in the 1950s but increased significantly in the 1990s as a response to high-profile incidents of extreme school violence and the subsequent policy reforms (Broll and Howells, 2019; Lindberg, 2015). SROs can fulfill a variety of roles. They are intended to prevent and respond to school-based crime; promote positive relationships among law enforcement, educators, and youth; and foster a positive school climate (Thomas et al., 2013).

The National Association of School Resource Officers (NASRO), the largest professional organization of SROs, formally defines the SRO roles using a “triad model,” which aligns with community policing models (May et al., 2004), and includes the three primary functions of SROs: 1) enforcing the law; 2) educating students, school staff, and the community; and 3) acting as an informal counselor or mentor (Broll and Howells, 2019; Fisher and Hennessy, 2016; Javdani, 2019; Thomas et al., 2013). There may be significant variability in how these roles and responsibilities are balanced, as they are usually defined through a memorandum of understanding between the local law enforcement agency and the school district (Fisher and Hennessy, 2016). Even with the SRO responsibilities formally spelled out, there may still be tensions and ambiguities inherent to the SRO position based on their positioning at the intersection of the education system and the juvenile justice system, which often have competing cultures and authority structures (Fisher and Hennessy, 2016). As members of the police force, the SROs may view problematic behaviors as crimes, whereas educators view them as obstacles to learning. Another ambiguity is that as an informal counselor/mentor, the SRO is expected to assist students with behavioral and legal issues, which may result in a conflict of interest if the adolescent shares information about engaging in illegal activities (Fisher and Hennessy, 2016).

Evaluation findings with regard to the effectiveness of the presence of SROs in schools have been inconsistent. In terms of school-related violence and other behaviors, some studies have found that SROs in schools are related to decreases in serious violence (Sorensen, Shen, and Bushway, 2021; Zhang, 2019), and decreases in incidents of disorder (Zhang, 2019). Others have found increases in drug-related crimes (Gottfredson et al., 2020; Zhang, 2019) associated with the presence of SROs in schools, and other studies have shown no effects on bullying (Broll and Lafferty, 2018; Devlin, Santos, and Gottfredson, 2018). In terms of school discipline, one meta-analysis (Fisher and Hennessy, 2016) examined the relationship between the presence of SROs and exclusionary discipline in U.S. high schools. Analysis of the seven eligible pretest–posttest design studies showed that the presence of SROs was associated with rates of school-based disciplinary incidents that were 21 percent higher than incident rates before implementing an SRO program. However, in another study, of elementary schools, there was no association found between SRO presence and school-related disciplinary outcomes, which ranged from minor consequences, such as a warning or timeout, to more serious consequences such as suspension from school (Curran et al., 2021).

Further, several studies have been conducted on the effects of SROs on students’ attitudes and feelings. One example is a survey of middle and high school students (Theriot and Orme, 2016), which found that experiencing more SRO interactions increased students’ positive attitudes about SROs but decreased school connectedness and was unrelated to feelings of safety. Conversely, findings from a student survey, on the relationship between awareness and perceptions of SROs on school safety and disciplinary experiences, indicated that students’ awareness of the presence of SROs and their perceptions of SROs were associated with increased feelings of safety and a small decrease in disciplinary actions. However, students belonging to racial and ethnic minority groups reported smaller benefits related to SROs, compared with white students (Pentek and Eisenberg, 2018).

Foot Patrol is another example of a program that uses COP elements. Foot patrol involves police officers making neighborhood rounds on foot. It is a policing tactic that involves movement in a set area for the purpose of observation and security (Ratcliffe et al., 2011). The primary goals of foot patrol are to increase the visibility of police officers in a community and to make greater contact and increase rapport with residents. Officers sometimes visit businesses on their beat, respond to calls for service within their assigned areas, and develop an intimate knowledge of the neighborhood. Additionally, police officers on foot patrols may offer a level of “citizen reassurance” to community members and may decrease a resident’s fear of crime by bringing a feeling of safety to the neighborhood (Wakefield, 2006; Ratcliffe et al., 2011; Walker and Katz, 2017). Another duty of foot patrol officers is to engage youth in the community, and some are instructed to go out of their way to engage vulnerable youth. For example, if an officer sees a group of youths hanging out on a street corner, the officer may stop and initiate casual conversation in an effort to build a relationship (Cowell and Kringen, 2016).

Though foot patrols limit the speed at which an officer can respond to a call (compared with patrol in a vehicle), research has found that community members are more comfortable with police being in the neighborhood on foot. Residents are more likely to consider an officer as “being there for the neighborhood” if they are seen on foot (Cordner, 2010; Piza and O’Hara, 2012).

While there are mixed findings regarding the effectiveness of foot patrols on crime (Piza and O’Hara, 2012), improved community relationships are one of the strongest benefits. Research has shown that foot patrol improves the relationships between community members and police officers through increasing approachability, familiarity, and trust Ratcliffe et al. 2011; Kringen, Sedelmaier, and Dlugolenski, 2018). Foot patrols can also have a positive effect on officers. Research demonstrates that officers who participate in foot patrol strategies have higher job satisfaction and a higher sense of achievement (Wakefield, 2006; Walker and Katz, 2017).

Mini-Stations are community-forward stations that allow police to be more accessible to members of a community. Mini-stations (also known as substations, community storefronts, and other names) can be based in many places—such as local businesses, restaurants, or community centers—and can be staffed by police officers, civilian employees, volunteers, or a combination of these groups, and have fewer officers stationed in them (Maguire et al., 2003). These stations allow officers to build on existing relationships with businesses in the area and give citizens easier access to file reports and share community concerns. Additionally, they are a means to achieving greater spatial differentiation, or a way for a police agency to cover a wider area, without the cost of adding a new district station (Maguire et al., 2003). Residents can also go to mini-stations to receive information and handouts about new policing initiatives and programs in the community. Police mini-stations also increase the overall amount of time officers spend in their assigned patrol areas. The concept of mini-stations stems from Japanese kobans , which gained prominence in the late 1980s. Officers who worked in kobans became intimately familiar with the neighborhood they served and were highly accessible to citizens (usually within a 10-minute walk of residential homes) [Young, 2022].

Mini-stations can also be helpful to youth in the community. For example, Youth Safe Haven mini-stations are mini-stations that are deployed in 10 cities by the Eisenhower Foundation. These mini-stations were first developed in the 1980s and are located in numerous youth-related areas, including community centers and schools (Eisenhower Foundation, 2011). In addition to crime outcomes (such as reduced crime and fear of crime), goals of youth-oriented mini-stations include homework help, recreational activities, and providing snacks and social skills training. Older youths can be trained to be volunteers to assist younger youths with mentoring and advocacy. There are mixed findings regarding mini-stations and their effect on crime rates, but research has shown that adults and older youths who participate in mini-station community programs (or have children who participate) are more likely to report crime, and younger youths are more comfortable speaking with police (Eisenhower Foundation, 1999; Eisenhower Foundation, 2011).

Theoretical Foundation

COP approaches are usually rooted in two different theories of crime: broken windows theory and social disorganization theory (Reisig, 2010; National Research Council, 2018). Both focus on community conditions to explain the occurrence of crime and disorder.

Broken Windows Theory asserts that minor forms of physical and social disorder, if left unattended, may lead to more serious crime and urban decay (Wilson and Kelling, 1982). Visual signs of disorder (such as broken windows in abandoned buildings, graffiti, and garbage on the street) may cause fear and withdrawal among community members. This in turn communicates the lack of or substantial decrease in social control in the community, and thus can invite increased levels of disorder and crime (Hinkle and Weisburd, 2008). In response, to protect the community and establish control, the police engage in order maintenance (managing minor offenses and disorders). Four elements of the broken windows strategy explain how interventions based on this approach may lead to crime reduction (Kelling and Coles, 1996). First, dealing with disorder puts police in contact with those who commit more serious crimes. Second, the high visibility of police causes a deterrent effect for potential perpetrators of crime. Third, citizens assert control over neighborhoods, thereby preventing crime. And finally, as problems of disorder and crime become the responsibility of both the community and the police, crime is addressed in an integrated fashion. COP programs rooted in broken windows theory often use residents and local business owners to help identify disorder problems and engage in the development and implementation of a response (Braga, Welsh, and Schnell, 2015).

Social Disorganization Theory focuses on the relationship between crime and neighborhood structure; that is, how places can create conditions that are favorable or unfavorable to crime and delinquency (Kubrin and Weitzer, 2003). Social disorganization refers to the inability of a community to realize common goals and solve chronic problems. According to the social disorganization theory, community factors such as poverty, residential mobility, lack of shared values, and weak social networks decrease a neighborhood’s capacity to control people’s behavior in public, which increases the likelihood of crime (Kornhauser, 1978; Shaw and McKay, 1969 [1942]). Researchers have used various forms of the social disorganization theory to conceptualize community policing, including the systemic model and collective efficacy (Reisig, 2010). The systemic model focuses on how relational and social networks can exert social controls to mediate the adverse effects of structural constraints, such as concentrated poverty and residential instability. The model identifies three social order controls with decreasing levels of influence: 1) private, which includes close friends and family; 2) parochial , which includes neighbors and civic organizations; and 3) public, which includes police (Bursik and Grasmick, 1993; Hunter, 1985). Community policing efforts based on the systemic model can increase informal social controls by working with residents to develop stronger regulatory mechanisms at the parochial and public levels (Kubrin and Weitzer, 2003; Resig, 2010). Collective efficacy, which refers to social cohesion and informal social controls, can mitigate social disorganization. Community policing can promote collective efficacy by employing strategies that enhance police legitimacy in the community and promote procedurally just partnerships, to encourage residents to take responsibility for public spaces and activate local social controls (Resig, 2010).

Outcome Evidence

Although there are numerous programs that incorporate COP, there are limited examples of COP programs that directly target youth, and fewer that have been rigorously evaluated (Forman, 2004; Paez and Dierenfeldt, 2020). The following programs, which are featured on CrimeSolutions , are examples of how COP has been implemented and evaluated in different cities.

The Chicago Alternative Policing Strategy (CAPS , developed in 1993, incorporates aspects of both community and problem-oriented policing (see Problem-Oriented Policing, below). The CAPS approach has been implemented by dividing patrol officers into beat teams and rapid response teams in each of the districts. Beat teams spend most of their time working their beats with community organizations, while rapid response teams concentrate their efforts on excess or low-priority 911 calls. Meetings occur monthly for both teams, and they receive extensive training. This structure enables officers to respond quickly and effectively to problems that they have not been traditionally trained to handle but have learned how to do by receiving training, along with residents, in problem-solving techniques. Civic education, media ads, billboards, brochures, and rallies have been used to promote awareness of the program in the community (Skogan, 1996; Kim and Skogan, 2003).

To evaluate the effects of the CAPS program, one study (Kim and Skogan, 2003) examined the impact on crime rates and 911 calls. Data were collected from January 1996 to June 2002, using a time-series analysis. The study authors found statistically significant reductions in crime rates and 911 calls in police beats that implemented the CAPS program, compared with police beats that did not implement the program.

Some studies have found that foot-patrol interventions make varying impacts on different types of street violence. Operation Impact , a saturation foot-patrol initiative in the Fourth Precinct of Newark, NJ, was selected as the target area based on an in-depth analysis of the spatial distribution of street violence. The initiative primarily involved a nightly patrol of 12 officers in a square-quarter-mile area of the city, which represented an increase in police presence in the target area. Officers also engaged in proactive enforcement actions that were expected to disrupt street-level disorder and narcotics activity in violence-prone areas. One study (Piza and O’Hara, 2012) found that the target area that implemented Operation Impact experienced statistically significant reductions in overall violence, aggravated assaults, and shootings, compared with the control area that implemented standard policing responses. However, there were no statistically significant differences between the target and control areas in incidents of murder or robbery.

With regard to community-based outcomes, other studies have shown that COP programs have demonstrated positive results. A COP intervention implemented in New Haven, CT , consisted of a single unannounced community home visit conducted by uniformed patrol officers from the New Haven Police Department. During the visits, the patrol officers articulated their commitment to building a cooperative relationship with residents and the importance of police and residents working together to keep the community safe. One evaluation found that residents in intervention households who received the COP intervention reported more positive overall attitudes toward police, a greater willingness to cooperate with police, had more positive perceptions of police performance and legitimacy, had higher confidence in police, reported higher scores on perceived warmth toward police, and reported fewer negative beliefs about police, compared with residents who did not receive home visits. These were all statistically significant findings. However, there was no statistically significant difference in willingness to comply with the police between residents in households that received home visits, compared with those who did not (Peyton et al., 2019).

Problem-Oriented Policing Definition

Problem-oriented policing (POP) is a framework that provides law enforcement agencies with an iterative approach to identify, analyze, and respond to the underlying circumstances that lead to crime and disorder in the community and then evaluate and adjust the response as needed (Braga et al., 2001; Hinkle et al., 2020; National Research Council, 2004). The POP approach requires police to focus their attention on problems rather than incidents (Cordner and Biebel, 2005). Problems, in this model, are defined “as chronic conditions or clusters of events that have become the responsibility of the police, either because they have been reported to them, or they have been discovered by proactive police investigation, or because the problems have been found in an investigation of police records” (National Research Council, 2004:92).

The POP strategy contrasts with incident-driven crime prevention approaches, in which police focus on individual occurrences of crime. Instead, POP provides police with an adaptable method to examine the complicated factors that contribute and lead to crime and disorder, and develop customized interventions to address those factors (National Research Council, 2018).

As noted previously, the idea behind the POP approach emanated several decades ago (Goldstein, 1979) from observations that law enforcement agencies seemed to be more concerned about the means rather than the goals of policing, or “means-over-ends syndrome” (Goldstein, 1979; Eck, 2006; MacDonald, 2002). In 1990, this work was expanded to systematically define and describe what it meant to use POP approaches in policing. During the 1990s, law enforcement agencies in the United States and other countries (such as Australia, Canada, and the United Kingdom) began to implement POP strategies (Scott, 2000).

The traditional conceptual model of problem-solving in POP, known as the SARA model, consists of the following four steps (Weisburd et al., 2010; Hinkle et al., 2020; National Research Council, 2004):

  • Scanning. Police identify problems that may be leading to incidents of crime and disorder. They may prioritize these problems based on various factors, such as the size of the problem or input from the community.
  • Analysis. Police study information about the identified problem or problems, using a variety of data sources, such as crime databases or surveys of community members. They examine information on who is committing crimes, victims, and crime locations, among other factors. Police then use the information on responses to incidents — together with information obtained from other sources — to get a clearer picture of the problem (or problems).
  • Response. Police develop and implement tailored strategies to address the identified problems by thinking “outside the box” of traditional police enforcement tactics and creating partnerships with other agencies, community organizations, or members of the community, depending on the problem. Examples of responses in POP interventions include target hardening, area cleanup, increased patrol, crime prevention through environmental design measures, multiagency cooperation, and nuisance abatement.
  • Assessment. Police evaluate the impact of the response through self-assessments and other methods (such as process or outcome evaluations) to determine how well the response has been carried out and what has been accomplished (or not accomplished). This step may also involve adjustment of the response, depending on the results of the assessment.

The SARA model was first defined by a POP project conducted in Newport News, VA, during the 1980s. The Newport News Task Force designed a four-stage problem-solving process . A case study of the project revealed that officers and their supervisors identified problems, analyzed, and responded to these problems through this process, thus leading to the SARA model (Eck and Spelman, 1987).

Since the creation and development of SARA, other models have been established, in part to overcome some noted weaknesses of the original model, such as an oversimplification of complex processes or a process in which problem-solving is nonlinear. These other models include the following 1) PROCTOR (which stands for PROblem, Cause, Tactic or Treatment, Output, and Result); 2) the 5I’s (Intelligence, Intervention, Implementation, Involvement, and Impact); and 3) the ID PARTNERS (which stands for I dentify the demand; D rivers; P roblem; A im, R esearch and analysis; T hink creatively; N egotiate and initiate responses; E valuate; R eview; and S uccess) [Sidebottom and Tilley, 2010]. However, compared with these models, the SARA model appears to be used more often by agencies that apply a POP approach to law enforcement (Sidebottom and Tilley, 2010; Borrion et al., 2020).

A POP approach can be used by law enforcement agencies to address youth-related issues, including offenses committed by youths (such as gun violence, vandalism, graffiti, and other youth-specific behaviors such as running away from home or underage drinking.

For example, in the 2019–20 school year, about one third of public schools experienced vandalism (Wang et al., 2022). If a police agency wanted to tackle the problem of school vandalism , often committed by youth, they could apply the SARA model to determine the scope of the problem, develop an appropriate response, and conduct an overall assessment of efforts. A problem-oriented guide, put together by the Problem-Oriented Policing Center at Arizona State University, outlines the steps that law enforcement agencies can take to use the SARA model and address the issues of vandalism committed specifically at schools (Johnson, 2005).

Thus, during the scanning step of the SARA model, to identify the problem police would focus on the specific problem of school vandalism by examining multiple sources of data, including information gathered from both police departments and school districts. During the analysis step, police would ask about the specific school vandalism problems they are targeting, such as 1) how many and which schools reported vandalism to the police, 2) which schools were vandalized, 3) what are the characteristics (such as the age, gender, school attendance rate) of any youth identified as committing the vandalism, and 4) on what days and times the vandalism occurred. The analysis step also should include information from various data sources, including official reports to the police of school vandalism incidents, interviews with SROs, and information from students at the school (Johnson, 2005).

Once police have analyzed the school vandalism problem and have a clear picture of the issue, they would then move on to the response step. The response depends on what police learn about the vandalism problem at schools. For example, if police find that vandalism occurs because youths have easy access to school grounds, especially after school hours, they might suggest a response that improves building security. Finally, during the assessment stage, police would determine the degree of effectiveness of their response to school vandalism through various measures of success, such as the reduction in the number of incidents of vandalism, the decrease in the costs for repair of damaged property, and the increase of incidents (when they do occur) in which the person or persons who engaged in vandalism are identified and apprehended (Johnson, 2005).

Overlap of POP With Other Policing Strategies

POP shares several similarities and overlapping features with other policing models, such as focused deterrence strategies and hot-spots policing. Hot-spots policing involves focusing police resources on crime “hot spots,” which are specific areas in the community where crime tends to cluster. Hot-spots policing interventions tend to rely mostly on traditional law enforcement approaches (National Research Council, 2004; Braga et al., 2019). Focused deterrence strategies (also referred to as “pulling levers” policing) follow the core principles of deterrence theory. These strategies target specific criminal behavior committed by a small number of individuals who repeatedly offend and who are vulnerable to sanctions and punishment (Braga, Weisburd, and Turchan, 2018).

While POP, focused deterrence, and hot spots policing are three distinct policing strategies, there can be an overlap in techniques. For example, a POP approach can involve the identification and targeting of crime hot spots, if the scanning and analysis of the crime problems in a community reveal that crime is clustering in specific areas. Further, a hot-spots policing intervention may use a problem-oriented approach to determine appropriate responses to address the crime in identified hot spots. However, POP can go beyond examination of place-based crime problems, and hot-spots policing does not require the detailed analytic approach used in POP to discern which strategy is appropriate to prevent or reduce crime (Hinkle et al., 2020; National Research Council, 2018; Gill et al., 2018). Similarly, POP involves targeting resources to specific, identified problems, in a similar way that focused deterrence strategies target specific crimes committed by known high-risk offenders. However, focused deterrence strategies tend to rely primarily on police officers to implement programs, whereas POP may involve a variety of agencies and community members (National Research Council, 2004).

Although POP, focused deterrence, and hot-spots policing differ in some distinct ways (such as intensity of focus and involvement of other agencies), these strategies may often overlap (National Research Council, 2004).

POP draws on theories of criminal opportunity to explain why crime occurs and to identify ways of addressing crime, often by altering environmental conditions (Reisig, 2010). While much criminological research and theory are concerned with why some individuals offend in general, POP strategies often concentrate on why individuals commit crimes at particular places, at particular times, and against certain targets (Braga, 2008; Goldstein, 1979; Eck and Spelman, 1987; Eck and Madensen, 2012). Thus, POP draws on several theoretical perspectives that focus on how likely individuals (including those who may commit a crime and those who may be victimized) make decisions based on perceived opportunities. These include rational choice theory, routine activities theory , and situational crime prevention (Braga, 2008; Braga et al., 1999; Eck and Madensen, 2012; Hinkle et al., 2020; McGarrell, Freilich, and Chermak, 2007). These three theories are considered complements to one another (Tillyer and Eck, 2011).

Rational Choice Theory focuses on how incentives and constraints affect behavior (Cornish and Clark 1986; Gull, 2009). In criminology, rational choice theory draws on the concepts of free will and rational thinking to examine an individual’s specific decision-making processes and choices of crime settings by emphasizing their motives in different situations. The starting point for rational choice theory is that crime is chosen for its benefits. Thus, rational choice theory informs POP by helping to examine and eliminate opportunities for crime within certain settings. Eliminating these opportunities should help to intervene with a potential offender’s motives to commit a crime (Karğın, 2010).

Routine Activity Theory , formulated by Cohen and Felson (1979), is the study of crime as an event, highlighting its relation to space and time and emphasizing its ecological nature (Mir ó–Llinares , 2014). It was originally developed to explain macro-level crime trends through the interaction of targets, offenders, and guardians (Eck, 2003). The theory explains that problems are created when offenders and targets repeatedly come together, and guardians fail to act. Since its formulation, routine activity theory has expanded. In terms of POP, routine activity theory implies that crime can be prevented if the chances of the three elements of crime (suitable target, motivated offender, and accessible place) intersecting at the same place and at the same time are minimized (Karğın, 2010). The SARA problem-solving methodology allows law enforcement agencies to examine and identify the features of places and potential targets that might generate crime opportunities for a motivated offender and develop solutions to eliminate these opportunities, thereby preventing future crime (Hinkle et al., 2020).

Situational Crime Prevention was designed to address specific forms of crime by systematically manipulating or managing the immediate environment with the purpose of reducing opportunities for crime. The goal is to change an individual’s decisionmaking processes by altering the perceived costs and benefits of crime by identifying specific settings (Clarke, 1995; Tillyer and Eck, 2011). Situational crime prevention has identified a number of ways to reduce opportunity to commit crime, such as: 1) increase the effort required to carry out the crime, 2) increase the risks faced in completing the crime, 3) reduce the rewards or benefits expected from the crime, 4) remove excuses to rationalize or justify engaging in criminal action, and 5) avoid provocations that may tempt or incite individuals into criminal acts (Clarke 2009). Certain POP strategies make use of situation crime prevention tactics during the response phase, such as physical improvements to identified problem locations. These may include fixing or installing street lighting, securing vacant lots, and getting rid of trash from the streets (Braga et al., 1999).

Although the POP approach is a well-known and popular approach in law enforcement, there have been a limited number of rigorous program evaluations, such as randomized controlled trials (National Research Council 2018; Gill et al. 2018), and even fewer evaluations specifically centered on youth. 

One meta-analysis (Weisburd et al., 2008) reviewed 10 studies, which examined the effects of problem-oriented policing on crime and disorder. These included various POP interventions and took place in eight cities across the United States (Atlanta, GA; Jersey City, NJ; Knoxville, TN; Oakland, CA; Minneapolis, MN; Philadelphia, PA; San Diego, CA; and one suburban Pennsylvania area.) and six wards in the United Kingdom. The studies evaluated interventions focused on reducing recidivism for individuals on probation or parole; interventions on specific place-based problems (such as drug markets, vandalism and drinking in a park, and crime in hot spots of violence); and interventions that targeted specific problems such as school victimization. Findings across these studies indicated that, on average, the POP strategies led to a statistically significant decline in measures of crime and disorder.

The following programs, which are featured on CrimeSolutions, provide a brief overview of how POP has been implemented and evaluated in the United States. Programs with examined youth-related outcomes or a specific focus on youth are noted; however, most of the research on POP interventions does not focus on youth.

Operation Ceasefire in Boston (first implemented in 1995) is a problem-oriented policing strategy that was developed to reduce gang violence, illegal gun possession, and gun violence in communities. Specifically, the program focused on reducing homicide victimization among young people in Boston (Braga and Pierce, 2005). The program involved carrying out a comprehensive strategy to apprehend and prosecute individuals who carry firearms, to put others on notice that carrying illegal firearms faces certain and serious punishment, and to prevent youth from following in the same criminal path. The program followed the steps of the SARA model, which included bringing together an interagency working group of criminal justice and other practitioners to identify the problem (scanning); using different research techniques (both qualitative and quantitative) to assess the nature of youth violence in Boston ( analysis ); designing and developing an intervention to reduce youth violence and homicide in the city, implementing the intervention, and adapting it as needed ( response ); and evaluating the intervention’s impact ( assessment ). An evaluation of the program found a statistically significant reduction (63 percent) in the average number of youth homicide victims in the city following the implementation of the program. There were also statistically significant decreases in citywide gun assaults and calls for service (Braga et al., 2001). Similarly, another study found a statistically significant reduction (24.3 percent) in new handguns recovered from youth (Braga and Pierce, 2005).

Another program implemented in the same city, the Boston Police Department’s Safe Street Teams (SSTs) , is an example of a place-based, problem-oriented policing strategy to reduce violent crime and includes some components targeting youth. Using mapping technology and violent index crime data, the Boston Police Department identified 13 violent crime hot spots in the city where SST officers could employ community- and problem-oriented policing techniques such as the SARA model. SST officers implemented almost 400 distinct POP strategies in the crime hot spots, which fell into three broad categories: 1) situational/environment interventions, such as removing graffiti and trash or adding or fixing lighting, designed to change the underlying characteristics and dynamics of the places that are linked to violence; 2 ) enforcement interventions, including focused enforcement efforts on drug-selling crews and street gangs, designed to arrest and deter individuals committing violent crimes or contributing to the disorder of the targeted areas; and 3) community outreach/social service interventions, designed to involve the community in crime prevention efforts. Examples of these activities included providing new recreational opportunities for youth (i.e., basketball leagues), partnering with local agencies to provide needed social services to youth, and planning community events. One evaluation (Braga, Hureau, and Papachristos, 2011) found that over a 10-year observation period areas that implemented the SSTs interventions experienced statistically significant reductions in the number of total violent index crime incidents (17.3 percent), in the number of robbery incidents (19.2 percent), and in the number of aggravated assault incidents (15.4 percent), compared with the comparison areas that did not implement the interventions. However, there were no statistically significant effects on the number of homicides or rape/sexual assault incidents. The study also did not examine the impact on youth-specific outcomes.

The Problem-Oriented Policing in Violent Crime Places (Jersey City, N.J.) intervention used techniques from hot spots policing and POP to reduce violent crime in the city. The program and evaluation design followed the steps of the SARA model. During the scanning phase, the Jersey City Police Department and university researchers used computerized mapping technologies to identify violent crime hot spots. During the analysis phase, officers selected 12 pairs of places for random assignment to the treatment group, which received the POP strategies, or to the control group. During the response phase, the 11 officers in the department’s Violent Crime Unit were responsible for developing appropriate POP strategies at the hot spots. For example, to reduce social disorder, aggressive order maintenance techniques were applied, including the use of foot and radio patrols and the dispersing of groups of loiterers. During the assessment phase, the police department evaluated the officers’ responses to the problems, and either adjusted the strategies or closed down the program to indicate that the problem was alleviated. An evaluation found statistically significant reductions in social and physical incivilities (i.e., disorder), the total numbers of calls for service, and criminal incidents at the treatment locations that implemented POP techniques, compared with the control locations (Braga et al., 1999).

COP and POP are two broad policing approaches that, while sharing many characteristics, are still distinct—owing to the focus of their respective approaches. COP’s focus is on community outreach and engagement and does not necessarily rely on analysis methods such as the SARA model. For POP, the primary goal is to find effective solutions to problems that may or may not involve the participation of the community (Gill et al., 2014).

Though COP and POP may differ in their approaches, the end goal is the same in both models. Both are types of proactive policing that seek to prevent crime before it happens. COP and POP also both rely on cooperation from numerous different parties and agencies, including community members (National Research Council, 2018). The two models are similar enough that they often overlap in implementation. For example, the Chicago Alternative Policing Strategy (CAPS) incorporates elements from both models. Using aspects of COP, police officers divide into beat teams and spend most of their time working with community organizations. With regard to POP, CAPS trains officers and residents to use problem-solving techniques that stem from its theoretical basis (Skogan, 1996; Kim and Skogan, 2003).

There are, however, limitations in the research examining the effectiveness of these models. For example, evaluation studies on COP and POP tend to focus on results related to crime and disorder; other outcomes, such as collective efficacy, police legitimacy, fear of crime, and other community-related outcomes are often overlooked or not properly defined (Hinkle et al., 2020; Gill et al., 2014). Exploring other community-related outcomes would be useful, as community involvement is an important component to both models. Further, some researchers have noted specific limitations to the implementation of COP and POP interventions. With regard to COP programs, for example, the definition of “community” is sometimes lacking. This can be an important factor to define, as community may mean something different across law enforcement agencies (Gill et al., 2014). Regarding POP programs, it has been noted that the rigor of the SARA process is limited and that law enforcement agencies may take a “shallow” approach to problem-solving (National Research Council, 2018:193; Borrion et al., 2020). To date, the research on both models has lacked focus on youth; only a few evaluations have focused on youth in either in the implementation process or in examined outcomes (Braga et al., 2001; Gill et al., 2018). Despite these limitations, however, the outcome evidence supports the effectiveness of COP and POP interventions to reduce crime and disorder outcomes.

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About this Literature Review

Suggested Reference: Development Services Group, Inc. January  2023. “Community-Oriented Policing and Problem-Oriented Policing.” Literature review. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.  https://ojjdp.ojp.gov/model-programs-guide/literature-reviews/community-oriented-problem-oriented-policing

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Problem-Oriented Policing

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problem solving policing definition

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Problem Solving Policing

Problem-oriented policing is an alternative approach to crime reduction that challenges police officers to understand the underlying situations and dynamics that give rise to recurring crime problems and to develop appropriate responses to address these underlying conditions. Problem-oriented policing is often given operational structure through the well-known SARA model that includes a series of iterative steps: Scanning, Analysis, Response, and Assessment. Police officers often find it difficult to implement problem oriented policing properly with deficiencies existing in all stages of the process. The existing evaluation evidence shows that problem-oriented policing generates noteworthy crime and disorder reduction impacts. These crime reduction impacts are generated even when problem-oriented policing is not fully implemented; this confirms the robustness of the problem-oriented approach in addressing crime and disorder problems.


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David Weisburd

Faculty of Law, The Hebrew University, Mt. Scopus, Jerusalem, Israel

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Braga, A.A. (2014). Problem-Oriented Policing. In: Bruinsma, G., Weisburd, D. (eds) Encyclopedia of Criminology and Criminal Justice. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5690-2_266

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Center for Problem oriented policing

Identifying and Defining Policing Problems

Tool guide no. 13 (2015).

by Michael S. Scott

PDF Guide   Order Bound Copy

Translations:   Identificación y Definición de Problemas Policiales


This Problem-Solving Tools guidebook deals with the process of identifying and defining policing problems. Under the most widely adopted police problem-solving model—the SARA (Scanning, Analysis, Response, Assessment) model—the process of identifying and defining policing problems is referred to as the Scanning phase. The Scanning phase is distinct from the Analysis phase, which principally is about explaining the problem’s causes and contributing factors; the Response phase, which is about developing, selecting, and implementing new responses to the problem; and the Assessment phase, which principally is about measuring the impact that new responses had on the problem. 

The advice provided in this guidebook is based primarily upon theory and practice: there is no evaluative research into what methods most accurately and efficiently identify and define policing problems.

Figure 1. The SARA model of problem solving

Related problem-solving tools guides.

This guidebook complements others in the Problem-Solving Tools series. The following other Problem-Solving Tools guidebooks address various aspects of these other three phases.*

* Some guidebooks address aspects of more than one phase of the problem-solving model.

Analysis Phase

  • Researching a Problem (Guide No. 2)
  • Using Offender Interviews to Inform Police Problem Solving (Guide No. 3)
  • Analyzing Repeat Victimization (Guide No. 4)
  • Partnering With Businesses to Address Public Safety Problems (Guide No. 5)
  • Understanding Risky Facilities (Guide No. 6)
  • Using Crime Prevention Through Environmental Design in Problem Solving (Guide No. 8)
  • Enhancing the Problem-Solving Capacity of Crime Analysis Units (Guide No. 9)
  • Analyzing and Responding to Repeat Offending (Guide No. 11)
  • Understanding Theft of ‘Hot Products’ (Guide No. 12)

Response Phase

  • Understanding Risky Facilities  (Guide No. 6)
  • Implementing Responses to Problems (Guide No. 7)
  • Using Crime Prevention Through Environmental Design in Problem Solving  (Guide No. 8)
  • Analyzing and Responding to Repeat Offending  (Guide No. 11)
  • Understanding Theft of ‘Hot Products’  (Guide No. 12)  

Assessment Phase

  • Assessing Responses to Problems: An Introduction for for Police Problem Solvers, 2nd Ed. (Guide No. 1)
  • Analyzing Repeat Victimization  (Guide No. 4)
  • Using Crime Prevention Through Environmental Design in Problem Solving   (Guide No. 8)
  • Analyzing Crime Displacement and Diffusion (Guide No. 10)
  • Understanding Theft of ‘Hot Products’  (Guide No. 12)

Contents & Links

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Official websites use .gov A .gov website belongs to an official government organization in the United States.

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Problem-Oriented Policing

Strategic planning tool.

Strategic Planning Tool Home

Planning & Implementation

Risk Factors

Risk Factor Matrix

Program Matrix

Community Resource Inventory

  • Program Type: Suppression
  • Ages: 15-24
  • Effectiveness: Promising gang structure; Promising delinquency structure; Effective adult program  (Read the criteria for this rating)

Several gang suppression measures have shown limited success, including forming cul-de-sacs with concrete barriers to alter the flow of gang-driven vehicles, anti-loitering statutes, civil injunctions, traffic checkpoints, curfew and truancy enforcement, and crackdowns on gun violations. However, law enforcement suppression in the form of  problem-oriented policing  (Goldstein, 1979, 1990; also called problem-solving policing) shows much more promise.

Problem-oriented policing involves two distinctive features: (1) analyzing crime data and using that information in designing strategies and tactics and (2) engaging community representatives and others in the analysis and planning process. For example, problem-oriented strategies that identify gun crime hot spots and incorporate increased patrol and street searches of suspicious individuals show the most promise (Braga, 2004). The short-term success of “offender-oriented” or “pulling levers” deterrence strategies used to target high-rate, violent offenders has been demonstrated in several sites. Pioneered in the Boston Gun Project (also called Operation Ceasefire; see separate description in this compendium), this strategy specifically and effectively targeted gang members in Boston and in Stockton, California (Braga, 2004). Problem-oriented policing has been used widely in targeting group-involved violence generally in addition to gangs themselves (Braga, Kennedy, and Tita, 2002).

Exposure to firearm violence

General delinquency involvement, high alcohol/drug use, high drug dealing, illegal gun ownership/carrying, physical violence/aggression, violent victimization, availability and use of drugs in the neighborhood, availability of firearms, feeling unsafe in the neighborhood, high-crime neighborhood, neighborhood youth in trouble, association with antisocial/aggressive/delinquent peers; high peer delinquency, association with gang-involved peers/relatives, peer alcohol/drug use, endorsements.

Office of Community Oriented Policing Services: Effective strategy

U.S. Department of Justice Office of Community Oriented Policing Services 1100 Vermont Avenue, NW Washington, DC 20530 Phone: (800) 421-6770 or (202) 307-1480 E-mail:  [email protected] Web site:  http://www.cops.usdoj.gov/

Braga. A. A. (2004).  Gun Violence Among Serious Young Offenders. Problem-Oriented Guides for Police. Problem-Specific Guides Series. Guide No. 23 . Washington, DC: Office of Community Oriented Policing Services.

Braga, A. A.; Kennedy, D. M.; and Tita, G. E. (2002). “New Approaches to the Strategic Prevention of Gang and Group-Involved Violence.” In C. R. Huff (ed.),  Gangs in America III . Thousand Oaks, CA: Sage Publications, pp. 271–285.

Goldstein, H. (1979). “Improving Policing: A Problem-Oriented Approach.”  Crime and Delinquency , 25:236–258.

Goldstein, H. (1990).  Problem-Oriented Policing . New York: McGraw-Hill.

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Problem-solving: problem-oriented policing in newport news, additional details.

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Uncategorized | August 6th, 2020

Community policing vs. traditional policing.

problem solving policing definition

Community policing has been defined as a “philosophy, management style and organizational strategy” with the end goal of building community relationships and not only solving crime but addressing the causes of crime within a community. Community policing involves any body of people (whether that be schools, businesses, residents, community organizations, churches or anyone in the community) collaborating with the police to identify problems within the areas they live and how to solve them. Whereas, traditional policing tends to draw from police officers and law enforcement agencies working solely at identifying problems in the community and tackling how to solve them on their own.

Traditional policing can separate police departments from the communities they serve. Departments that use more traditional policing also tend to be more reactive and can create a disconnect with the community. Little time is taken to look beyond to strategies that will potentially mediate a situation they are placed in without the necessary use of force. In the 1950’s, during the Reform Era, police were seen as “enforcers” who were called to deal with large riots and social disorder. Usually, when things went wrong, whether large or small, this continued identity and behaviour was used to handle any situation presented.

Community Policing challenges this approach by creating a dynamic within law enforcement officials to build trust and relationships with their communities, dismantling this in and out “enforcer” approach. More understanding is needed to establish this philosophy within police departments to create it as an overall staple in police response tactics. Although, this can’t only rest on the shoulders of local law enforcement to create this change within departments, but community policing must also be embraced by the communities, governments responsible for policies/law and the elected officials serving nationwide. 

Editorial Disclaimer: All blog posts are contributed by a member of the MovementForward, Inc. team in their personal capacity. The opinions expressed in the posts are the author’s own and do not reflect the views of MovementForward, Inc. or any other partnership associated with the organization.

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problem solving policing definition

Gaps in pediatric obesity treatment make access inequitable, says Stanford Medicine expert

This week, the U.S. Preventive Services Task Force updated its recommendations for treatment of pediatric obesity. The task force reviews scientific research and makes evidence-based recommendations for all areas of primary care.

Since their last update to pediatric obesity recommendations in 2017, the landscape of obesity treatment has changed dramatically, particularly with the introduction of weight loss drugs such as semaglutide (Wegovy) and liraglutide (Saxenda), which the FDA has approved to treat obesity in adolescents 12 and older. Obesity rates have also risen, with nearly 20 percent of children and teens now meeting the threshold for the medical definition of obesity.

Thomas Robinson , MD, the Irving Schulman, MD, Endowed Professor of Child Health and professor of pediatrics and of medicine, developed the Pediatric Weight Control Program at Stanford Medicine Children's Health in the 1990s, has conducted decades of research on childhood and adolescent obesity and was following the updated recommendations closely.

He was invited to write an editorial for the Journal of the American Medical Association to accompany the new guidelines, outlining what treatments got the top recommendation, and how gaps in the healthcare system make access to the best treatments inequitable. Robinson took the time to go over those key points and emphasize what needs to be done next. This interview has been edited for clarity and length.

What are the best evidence-based approaches for treating pediatric obesity, according to the US Preventive Services Task Force?

From their review of behavioral treatment of obesity, the only treatments that consistently showed benefits are what they call comprehensive, intensive behavioral interventions. Our Pediatric Weight Control Program at Stanford Medicine Children's Health is an example and has had a great success rate for the last 25 years. They recommend these types of programs as the mainstay of pediatric obesity treatment.

problem solving policing definition

The Task Force looked at programs aimed at kids age 6 to 19, and gave a "B" grade to the scientific evidence for these programs, which is the same level of recommendation they issued in 2010 and 2017. (The task force uses letter grades for the strength of scientific evidence, similar to grades used in school. A "B" grade indicates there is at least a moderate certainty that the net benefit is moderate to substantial, and the USPSTF recommends that the service is offered in practice.)

These types of programs are typically structured as regular visits to help kids learn new skills. The programs include specific behavioral elements such as self-monitoring, goal-setting and problem-solving. They address behaviors related to obesity, including physical activity, nutrition and screen time.

The evidence is strongest for programs that have 26 hours or more of contact and include physical activity. That amount, 26 hours, may seem arbitrary, but it's often structured as at least an hour a week for six months, long enough to support and reinforce new behaviors over time. The Stanford program is designed as 90-minute sessions each week for six months and includes both children and their parents or other caregivers. Generally, the more effective programs target both parents and kids.

Why is it important to include both parents and children in pediatric weight management programs, and what is the best way to do so?

You need parents to be supportive of changes the kids are making, even if, as in our program, you focus on the children as their own change agents. Children live in the context of families, and their parents have so much control over what resources they have: nutritious foods, physical activity opportunities, screen time.

But children need to be motivated to make changes themselves. Otherwise it's them versus the parents. We believe it works better when the parents are supportive of goals that the child is making, as opposed to the parent coming up with the goals themselves and then "policing" the child's behavior or choices.

Children need to be motivated to make changes themselves. Otherwise it's them versus the parents. Thomas Robinson

In our program, we encourage kids and parents to meet every night to review their journals (of their eating, physical activity and screen behaviors) and goals, but we don't want the parent to fill out the journal; we want them to help the child succeed in doing that for themselves. We want the children and parents to set appropriate goals together: How much should I try to reduce my "red-light" foods, how much should I try to increase my physical activity this week, knowing that, OK, how many birthday parties are there this week? How many school events? Are we going to have time to do that?

We also encourage kids and parents to explain the importance of the program to everyone in the family, "We're doing this as a family, to get healthier as a family" so that one child does not feel singled out and others don't feel punished, and to help deal with challenges like grandparents who might want to "spoil" their grandkids with treats.

Comprehensive, intensive behavioral programs have been recommended by the US Preventive Services task force for pediatric weight loss since 2010, but these programs can be difficult to find. Why is that?

Partly because these programs don't fit the standard doctor-patient, single-visit or periodic-visit, acute-care medical model. But even more important, because there is almost no reimbursement for them. Reimbursement and funding of these programs tend to be local, and patchy. Our program is primarily supported by Stanford Medicine Children's Health, through the community benefits program, through our children's hospital's financial aid system for people who can't afford it, and out-of-pocket for families who can afford it. We've also had several grants from local foundations in the past. But that type of support doesn't exist in every community.

We have done a lot of work to try to make our Pediatric Weight Control Program model more widely available. Over the years, we've gone to plenty of medical plans and talked to their decision makers, and there has been a lot of resistance to paying for a program that fits this intensive behavioral model. Part of the problem is that, from a health insurer's perspective, the costs of obesity accumulate over a lifetime. While they won't necessarily admit it, they prefer not to pay now to help a child prevent a problem that is mostly going to cause medical expenses years from now when they might be covered by a different insurer. We've also talked to employers' benefit plans, but we've not found much appetite among employers for adding services for employees' dependents, even though they offer dependent health insurance.

Because reimbursement isn't consistently available, comprehensive, intensive pediatric weight management programs exist in only a handful of communities in the entire U.S.  There is real inequity in families' ability to access this treatment that has been recommended for nearly 15 years.

Because reimbursement isn't consistently available, comprehensive, intensive pediatric weight management programs exist in only a handful of communities in the entire U.S. Thomas Robinson

What did the task force say about other treatments, such as new drugs or bariatric surgery?

The U.S. Preventive Services Task Force reviewed the data on new obesity medications. Because the number of studies for all drugs were small, particularly for the two drugs that are most effective (semaglutide and liraglutide), they concluded that the data are inadequate to make a recommendation. The drugs have FDA approval for treating obesity for those over 12, but the task force requires more studies to recommend something for all primary care. Weight loss surgery was not included in the USPSTF evidence review.

It's worth noting that the American Academy of Pediatrics recently took a different recommendation approach. After their own evidence reviews, the AAP said that because comprehensive, intensive lifestyle programs don't exist in many places, and are hard to get reimbursed for even where they do exist, pediatricians can consider using medications and bariatric surgery for adolescents with severe obesity.

There's a lot of excitement about the newer weight loss drugs because we've been hoping for effective obesity medications for many years. One can make a pretty good case for using these medications in children and adolescents who are experiencing negative effects from their obesity, with the caveat that there is a lot we don't know about them. The U.S. Preventive Services Task Force listed gaps in the scientific evidence that need to be filled, such as risks and benefits of longer-term use and how they should be integrated with other treatments like diet and physical activity changes.

The main mechanism of these drugs is to dramatically reduce food intake, but they don't all of a sudden make you want to eat more fruits and vegetables and become more physically active - behaviors that have their own benefits beyond weight. If you're eating less and it's mostly unhealthy food, what does that do to your nutritional health?

We also don't know the long-term impacts of these drugs on teens who are continuing to develop their brains and bodies; teens are not the same as adults. When you lose weight, you lose muscle mass, too. How does that affect your bone and muscle development while you're growing? In addition, we don't know the effects of the drugs themselves long-term. Will people be able to go off the drugs for a while and then go back on, or will they need to keep taking them for the rest of their lives? I am also concerned that the success of these medications will distract attention away from changing the social and physical environments that are the causes of the obesity epidemic.

How do we address pediatric obesity without shaming kids or worsening their body image?

We know there's a tremendous amount of stigma and discrimination associated with obesity - from individuals and from society as a whole. Many children with obesity are teased and harassed, and sometimes blame themselves. Parents can also feel blamed or judged and blame themselves if they have a child with obesity. Because of the stigma, it takes a lot for patients and families to seek medical care. All health professionals need to be very sensitive to that.

At the very least, we try to use thoughtful language. This includes using people-first language: saying "a child with overweight" not "an overweight child," for example, because we don't want to define a person by their disease. When we're working with families, we try to let them come up with the language they want to use. It is not the same for every family. Some families are comfortable using the word "fat" and others would never use that word, for instance. Some might say "big boned" or "heavy for their age." 

We also try to focus blame on the environments we live in that make it very difficult to control one's weight. There is so much we need to do at a societal level to address the factors driving obesity. Obesity is not due to a lack of willpower. We saw very low rates of obesity in children and adults before the 1980's - the world didn't experience a sudden loss of willpower in 1980.

We want people to feel they have power to make changes and help themselves get healthier. But we also need to say that even if your genes make you more susceptible to our environment, this is not your fault. Thomas Robinson

We want people to feel they have power to make changes and help themselves get healthier. But we also need to say that even if your genes make you more susceptible to our environment -- a broken food system which provides cheap, high-calorie, super-tasty, heavily marketed food everywhere, and transportation, media, technology and community design that make so much of our lives sedentary -- this is not your fault. We need to use public health policy to address the true causes. But there are also things you can do to fight back by adopting the more healthful strategies we help you learn.

It is important to note that participants in our Pediatric Weight Control Program report significant reductions in depressive symptoms and increases in self-esteem. We also systematically measure risk for eating disorders and have not found increases. This has also been found in meta-analyses of behavioral weight control programs for children and was highlighted in both the USPSTF report and the AAP guidelines.

Some of your research has focused on how to make obesity treatment more equitable. How should we be doing that?

Obesity among kids and teens isn't equally distributed across the U.S. It's more of a problem among low-income and racial and ethnic minority populations, who are more likely to live in environments that are more obesity-promoting. Like we say, "Your Zip code matters more than your genetic code."

Since 2010, the US Preventive Services Task Force has recommended comprehensive, intensive behavioral interventions for pediatric obesity. The American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention also recommend these programs. But because they're not widely covered by health insurance, access to these recommended obesity treatment programs is very inequitable. There is a great need for medical care organizations and insurers to finally catch up with the recommendations and make these programs widely available.

More on pediatric health

  • More kids are being hospitalized for eating disorders -- researchers learned why
  • Healthy eating and activity reverse aging marker in kids with obesity, Stanford Medicine-led study finds
  • Ask Me Anything: Diets, cooking and healthy eating
  • Biomarkers predict weight loss, suggest personalized diets
  • Screen time: The good, the healthy and the mind-numbing
  • What one youth mental health expert wants you to know about suicide

We studied taking many of the components of our program from the clinic setting to community settings for low-income Latino families - right into their homes and neighborhood community centers - and have shown this can work. We need more ways to deliver effective interventions in settings where children and families already live, learn and play.

Also, with funding from the CDC, we have almost completed developing a first-of-its-kind, online, comprehensive platform to provide everything needed for any health care practice, hospital, public health agency, medical insurer, employer, or youth-serving community organization to deliver our comprehensive, intensive Pediatric Weight Control Program for their own patients and community Our goal is to make safe and effective weight control more feasible, cost-effective and equitably available for all children with obesity in every community in the US.

But the most important way to address the inequity is with better public policy, to change our toxic environment that preys unequally on different population groups.

Image: Thanakorn.P / Shutterstock

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  1. Problem-solving policing

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  7. Problem‐oriented policing for reducing crime and disorder: An updated

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    What Is Problem-Oriented Policing? PROBLEM-ORIENTED POLICING (POP) is an approach to policing in which (1) DISCRETE PIECES OF POLICE BUSINESS (each consisting of a cluster of similar incidents, whether crimes or acts of disorder, that the police are expected to handle) are subject to (2) MICROSCOPIC EXAMINATION (drawing on the especially honed skills of crime analysts and the accumulated ...

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