A Hospital-based Approach to Stopping Youth Violence

In this podcast, Anne Marks, executive director of the Youth ALIVE! hospital-based anti-violence program in Oakland, discusses the history and mission of Youth ALIVE!, its partnerships with local public health and law enforcement agencies, and how funding under the Minority Youth Violence Prevention Initiative is increasing the organization’s capacity to serve high-risk minority youth. The following is a transcript RAPHAEL POPE-SUSSMAN: Hi, this is Raphael Pope-Sussman with the Center for Court Innovation. Today we’re speaking with Anne Marks, executive director of Youth ALIVE!, and training director for the National Network of Hospital-based Violence Intervention Programs. Anne, thank you for speaking with us today, and welcome. ANNE MARKS: Thanks. POPE-SUSSMAN: Tell me a bit about Youth Alive. MARKS: Youth ALIVE! is an almost 25-year-old violence prevention intervention and youth leadership organization. We are a home-grown organization. We began with a group of students 25 years ago in East Oakland who were dealing with violence in and around their school, and in their community who wanted to do something about it, and they developed a series of workshops, which they peer lead to this day, to talk to young people about gang, gun, family, and dating violence and what people can do to make themselves safer and to make choices that are healthier. Starting with those young people is how we began. We incorporated it to support their vision and their work. They also do a number of community engagement and organizing and advocacy activities, and from there, we actually had a staff person working in that program, who founded our Caught in the Crossfire program. Sherman Spears was, as a young man, a victim of violence. He was a gunshot victim and found that that moment was pivotal in his life, and he wanted to make sure that he was there for people who dealt with that in the future. Whereas his options at the time were to retaliate or to just die, he wanted to find another way out, and so he found a way to start working in violence prevention, so he started the Caught in the Crossfire program to help respond immediately after a young person has experienced trauma, gunshot, stabbing, assault, to help them get on a different path with a peer who can relate to them to support them. That program then later incorporated not just people who had been recently assaulted, but also people who had recently experienced the trauma of incarceration, so we’ve been working with youth and young adults for some time through that program. That program has actually been replicated in dozens of communities, and we support those programs through our National Network of Hospital-based Violence Intervention Programs. The last thing that we do at Youth ALIVE! is, we work not just with young people who have been injured, but we work with the families and friends left behind when someone has been killed by violence. We respond to every single homicide in the city of Oakland to provide the family and friends with support. We do that work in the memory of Khadafy Washington, who was the murdered son of the founder of that project, the Khadafy Washington project. POPE-SUSSMAN: A lot of your work really focuses on trauma and responding to trauma. MARKS: Absolutely. POPE-SUSSMAN: Can you tell me a bit about the Screening Tool for Awareness and Relief of Trauma, and what the origin of that is? MARKS: So START, we call it the Screening Tool for Awareness and Relief of Trauma. It’s really just that. It’s a start for addressing trauma. The metaphor that we think to look at this is that, trauma is something that hurts, and START is not a cure. START is aspirin that helps relieve the pain of trauma. It doesn’t make it go away. It’s not the same thing as engaging in long-term therapy or other support, but it’s something that can help people feel better and get some relief. How it works is we do a brief screening with someone around different symptoms of trauma, how it may actually be affecting their life. What their actual experiences of trauma are are actually irrelevant to how we do this, so we don’t need to know the details of what happened to them to be able to say, “are these things affecting your life?” For example, issues with focusing, issues with sleep, things that can really impact how you live. Then, based on how the respondent answers these questions, we give them a series of one to three different tools that are brief. We can usually get through this interview in 10-25 minutes, and give them tools they can walk away with, things they can take home. Maybe it’s a plan on how to sleep better, maybe it’s a relaxation exercise they didn’t have before, so when they leave, they’ll have something that will make their lives better. The goal with START is two things. One, give people some relief, but the other is that when they have this relief, either they will go home, and because they have some relief, they’ll be able to kick in their own resilience and their own coping skills and strategies, and turn their life into a better direction. And, the second thing is, maybe the experience of something actually being beneficial to them, that positive experience will actually make them want to continue to get care and believe that change and improvement is possible in their lives. There have been a lot of tools out there that address trauma, and trauma is something that, historically there have been three groups that have been treated for trauma: veterans of wars, refugees, and survivors of domestic violence. What is in fact true right here, in America, and particularly here in Oakland, is that the vast majority of people who are affected by violence are actually young men of color who are affected by street violence. They are overwhelmingly the victims of street violence, community violence, and yet none of these tools have ever been developed with their needs in mind, and none of them had ever been developed understanding that, given the poor treatment they had had at the hands of a lot of institutions that are set up to “care for them,” that the likelihood of someone attaching to long-term services was not necessarily something you could count on. So, how to give someone something when you, maybe this might be the only time you interact with them that can actually help them, was really important to us. POPE-SUSSMAN: What’s the strategy for evaluating the efficacy of this tool? MARKS: This tool we use internally, and then we have a couple community partners that use it as well. Because there’s a screen that is part of the tool, what we’re able to do is, 30-45 days after we’ve given them the tool, we can do follow-up phone calls where we ask them again, questions about their symptoms that they’re having and then also ask them questions about qualitatively, have they used any of the tools since then and has it helped them in any way. POPE-SUSSMAN: Are there plans to study that on a larger level? MARKS: Yes, we’re working right now with a couple of clinics. One operated by Kaiser Permanente Vallejo and another operated by the county Alameda Health System in East Oakland, as sites to do a randomized control trial to compare and show the efficacy of this, not just sort of in people’s symptoms but potentially how it affects their other health concerns. We think that will be important for the science for how this goes down. So we can really show the effectiveness of it. I will say, internally it’s been very surprisingly dramatic just the responses that we’ve gotten from individuals who have received this. We developed this over two years through a series of focus groups with young men who were gunshot victims, and then a series of 69 structured interviews with young men who we didn’t know, who came in just from all parts of Oakland to do an interview, and it was profound, the impact it had. We feel very hopeful that this is going to be something that we can publish and show the efficacy of so that other people can use it, but we have lots of partners who are involved in the development of it who are going to use it right now. POPE-SUSSMAN: So, Minority Youth Violence Prevention Initiative. Can you talk about how that is allowing you to expand the work that you do? MARKS: Yeah, absolutely. Minority Youth Violence Prevention was a way for us to do two things. One, pay for a community health advocate who can then do County Alameda Health System interviews, so use this Screening Tool for Awareness and Relief of Trauma with young people that we work with, and then it also helps pay for mental health services. For a long time, all of our services that we offered were peer-based, and all of our intervention specialists were community members that didn’t have clinical training, and we would always refer to mental health services when needed. What we found was that people didn’t stick. But when a mental health therapist was introduced as a counselor, or someone you might want to talk to, and came along with them in the car, to someone’s house, to someone’s school, spent time with them in a more casu...